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Marasco M, Kirkpatrick J, Carlomagno T, Hub JS, Anselmi M. Phosphopeptide binding to the N-SH2 domain of tyrosine phosphatase SHP2 correlates with the unzipping of its central β-sheet. Comput Struct Biotechnol J 2024; 23:1169-1180. [PMID: 38510972 PMCID: PMC10951427 DOI: 10.1016/j.csbj.2024.02.023] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/26/2024] [Accepted: 02/26/2024] [Indexed: 03/22/2024] Open
Abstract
SHP2 is a tyrosine phosphatase that plays a regulatory role in multiple intracellular signaling cascades and is known to be oncogenic in certain contexts. In the absence of effectors, SHP2 adopts an autoinhibited conformation with its N-SH2 domain blocking the active site. Given the key role of N-SH2 in regulating SHP2, this domain has been extensively studied, often by X-ray crystallography. Using a combination of structural analyses and molecular dynamics (MD) simulations we show that the crystallographic environment can significantly influence the structure of the isolated N-SH2 domain, resulting in misleading interpretations. As an orthogonal method to X-ray crystallography, we use a combination of NMR spectroscopy and MD simulations to accurately determine the conformation of apo N-SH2 in solution. In contrast to earlier reports based on crystallographic data, our results indicate that apo N-SH2 in solution primarily adopts a conformation with a fully zipped central β-sheet, and that partial unzipping of this β-sheet is promoted by binding of either phosphopeptides or even phosphate/sulfate ions.
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Affiliation(s)
- Michelangelo Marasco
- Molecular Pharmacology Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - John Kirkpatrick
- School of Biosciences, University of Birmingham, Edgbaston, B15 2TT Birmingham, UK
| | - Teresa Carlomagno
- School of Biosciences, University of Birmingham, Edgbaston, B15 2TT Birmingham, UK
- Institute of Cancer and Genomic Sciences, University of Birmingham, Edgbaston, B15 2TT Birmingham, UK
| | - Jochen S. Hub
- Theoretical Physics and Center for Biophysics, Saarland University, 66123 Saarbrücken, Germany
| | - Massimiliano Anselmi
- Theoretical Physics and Center for Biophysics, Saarland University, 66123 Saarbrücken, Germany
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LaBella D, Khanna O, McBurney-Lin S, Mclean R, Nedelec P, Rashid AS, Tahon NH, Altes T, Baid U, Bhalerao R, Dhemesh Y, Floyd S, Godfrey D, Hilal F, Janas A, Kazerooni A, Kent C, Kirkpatrick J, Kofler F, Leu K, Maleki N, Menze B, Pajot M, Reitman ZJ, Rudie JD, Saluja R, Velichko Y, Wang C, Warman PI, Sollmann N, Diffley D, Nandolia KK, Warren DI, Hussain A, Fehringer JP, Bronstein Y, Deptula L, Stein EG, Taherzadeh M, Portela de Oliveira E, Haughey A, Kontzialis M, Saba L, Turner B, Brüßeler MMT, Ansari S, Gkampenis A, Weiss DM, Mansour A, Shawali IH, Yordanov N, Stein JM, Hourani R, Moshebah MY, Abouelatta AM, Rizvi T, Willms K, Martin DC, Okar A, D'Anna G, Taha A, Sharifi Y, Faghani S, Kite D, Pinho M, Haider MA, Alonso-Basanta M, Villanueva-Meyer J, Rauschecker AM, Nada A, Aboian M, Flanders A, Bakas S, Calabrese E. A multi-institutional meningioma MRI dataset for automated multi-sequence image segmentation. Sci Data 2024; 11:496. [PMID: 38750041 PMCID: PMC11096318 DOI: 10.1038/s41597-024-03350-9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 05/07/2024] [Indexed: 05/18/2024] Open
Abstract
Meningiomas are the most common primary intracranial tumors and can be associated with significant morbidity and mortality. Radiologists, neurosurgeons, neuro-oncologists, and radiation oncologists rely on brain MRI for diagnosis, treatment planning, and longitudinal treatment monitoring. However, automated, objective, and quantitative tools for non-invasive assessment of meningiomas on multi-sequence MR images are not available. Here we present the BraTS Pre-operative Meningioma Dataset, as the largest multi-institutional expert annotated multilabel meningioma multi-sequence MR image dataset to date. This dataset includes 1,141 multi-sequence MR images from six sites, each with four structural MRI sequences (T2-, T2/FLAIR-, pre-contrast T1-, and post-contrast T1-weighted) accompanied by expert manually refined segmentations of three distinct meningioma sub-compartments: enhancing tumor, non-enhancing tumor, and surrounding non-enhancing T2/FLAIR hyperintensity. Basic demographic data are provided including age at time of initial imaging, sex, and CNS WHO grade. The goal of releasing this dataset is to facilitate the development of automated computational methods for meningioma segmentation and expedite their incorporation into clinical practice, ultimately targeting improvement in the care of meningioma patients.
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Affiliation(s)
- Dominic LaBella
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA
| | - Omaditya Khanna
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Shan McBurney-Lin
- Center for Intelligent Imaging (ci2), Department of Radiology & Biomedical Imaging, University of California San Francisco (UCSF), San Francisco, CA, USA
| | | | - Pierre Nedelec
- Center for Intelligent Imaging (ci2), Department of Radiology & Biomedical Imaging, University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Arif S Rashid
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Ujjwal Baid
- Division of Computational Pathology, Department of Pathology and Laboratory Medicine, School of Medicine, Indiana University, Indianapolis, IN, USA
| | - Radhika Bhalerao
- Center for Intelligent Imaging (ci2), Department of Radiology & Biomedical Imaging, University of California San Francisco (UCSF), San Francisco, CA, USA
| | | | - Scott Floyd
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA
| | - Devon Godfrey
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA
| | | | | | - Anahita Kazerooni
- Center for Data-Driven Discovery in Biomedicine (D3b), The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Neurosurgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Collin Kent
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA
| | - John Kirkpatrick
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA
| | - Florian Kofler
- Helmholtz AI, Helmholtz Munich, Neuherberg, Germany
- Department of Computer Science, TUM School of Computation, Information and Technology, Technical University of Munich, Munich, Germany
- TranslaTUM - Central Institute for Translational Cancer Research, Tech nical University of Munich, Munich, Germany
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Kevin Leu
- Center for Intelligent Imaging (ci2), Department of Radiology & Biomedical Imaging, University of California San Francisco (UCSF), San Francisco, CA, USA
| | | | | | - Maxence Pajot
- Center for Intelligent Imaging (ci2), Department of Radiology & Biomedical Imaging, University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Zachary J Reitman
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA
| | - Jeffrey D Rudie
- Department of Radiology, University of California San Diego, San Diego, CA, USA
| | - Rachit Saluja
- Department of Radiology, Cornell University, Ithaca, NY, USA
| | - Yury Velichko
- Department of Radiology, Northwestern University, Evanston, IL, USA
| | - Chunhao Wang
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA
| | - Pranav I Warman
- Duke University Medical Center, School of Medicine, Durham, NC, USA
| | - Nico Sollmann
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | | | - Khanak K Nandolia
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Rishikesh, India
| | - Daniel I Warren
- Department of Neuroradiology, Washington University, St. Louis, MO, USA
| | - Ali Hussain
- University of Rochester Medical Center, Rochester, NY, USA
| | - John Pascal Fehringer
- Faculty of Medicine, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
| | | | - Lisa Deptula
- Ross University School of Medicine, Bridgetown, Barbados
| | - Evan G Stein
- Department of Radiology, New York University Grossman School of Medicine, New York, NY, USA
| | | | | | - Aoife Haughey
- Department of Neuroradiology, JDMI, University of Toronto, Toronto, TO, Canada
| | | | - Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria of Cagliari-Polo di Monserrato, Cagliari, Italy
| | | | | | | | | | - David Maximilian Weiss
- Department of Neuroradiology, University Hospital Essen, Essen, North Rhine-Westphalia, Germany
| | | | - Islam H Shawali
- Department of Radiology, Kasr Alainy, Cairo University, Cairo, Egypt
| | - Nikolay Yordanov
- Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria
| | - Joel M Stein
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Roula Hourani
- Department of Radiology, American University of Beirut Medical center, Beirut, Lebanon
| | | | | | - Tanvir Rizvi
- Department of Radiology and Medical Imaging, University of Virginia Health, Charlottesville, VA, USA
| | | | - Dann C Martin
- Department of Radiology and Radiologic Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Abdullah Okar
- Faculty of Medicine, Hamburg University, Hamburg, Germany
| | - Gennaro D'Anna
- Neuroimaging Unit, ASST Ovest Milanese, Legnano, Milan, Italy
| | - Ahmed Taha
- University of Manitoba, Winnipeg, Manitoba, Canada
| | - Yasaman Sharifi
- Department of Radiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Shahriar Faghani
- Radiology Informatics Lab, Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Dominic Kite
- Department of Radiology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
| | - Marco Pinho
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Michelle Alonso-Basanta
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Javier Villanueva-Meyer
- Center for Intelligent Imaging (ci2), Department of Radiology & Biomedical Imaging, University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Andreas M Rauschecker
- Center for Intelligent Imaging (ci2), Department of Radiology & Biomedical Imaging, University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Ayman Nada
- University of Missouri, Columbia, MO, USA
| | - Mariam Aboian
- Department of Radiology, Children's Hospital of Philadelphia (CHOP), Philadelphia, PA, USA
| | - Adam Flanders
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Spyridon Bakas
- Division of Computational Pathology, Department of Pathology and Laboratory Medicine, School of Medicine, Indiana University, Indianapolis, IN, USA
- Department of Neurological Surgery, School of Medicine, Indiana University, Indianapolis, IN, USA
- Department of Radiology and Imaging Sciences, School of Medicine, Indiana University, Indianapolis, IN, USA
| | - Evan Calabrese
- Department of Radiology, Duke University Medical Center, Durham, NC, USA.
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Zhao J, Vaios E, Wang Y, Yang Z, Cui Y, Reitman ZJ, Lafata KJ, Fecci P, Kirkpatrick J, Fang Yin F, Floyd S, Wang C. Dose-Incorporated Deep Ensemble Learning for Improving Brain Metastasis Stereotactic Radiosurgery Outcome Prediction. Int J Radiat Oncol Biol Phys 2024:S0360-3016(24)00505-4. [PMID: 38615888 DOI: 10.1016/j.ijrobp.2024.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 03/19/2024] [Accepted: 04/02/2024] [Indexed: 04/16/2024]
Abstract
PURPOSE To develop a novel deep ensemble learning model for accurate prediction of brain metastasis (BM) local control outcomes after stereotactic radiosurgery (SRS). METHODS AND MATERIALS A total of 114 brain metastases (BMs) from 82 patients were evaluated, including 26 BMs that developed biopsy-confirmed local failure post-SRS. The SRS spatial dose distribution (Dmap) of each BM was registered to the planning contrast-enhanced T1 (T1-CE) magnetic resonance imaging (MRI). Axial slices of the Dmap, T1-CE, and planning target volume (PTV) segmentation (PTVseg) intersecting the BM center were extracted within a fixed field of view determined by the 60% isodose volume in Dmap. A spherical projection was implemented to transform planar image content onto a spherical surface using multiple projection centers, and the resultant T1-CE/Dmap/PTVseg projections were stacked as a 3-channel variable. Four Visual Geometry Group (VGG-19) deep encoders were used in an ensemble design, with each submodel using a different spherical projection formula as input for BM outcome prediction. In each submodel, clinical features after positional encoding were fused with VGG-19 deep features to generate logit results. The ensemble's outcome was synthesized from the 4 submodel results via logistic regression. In total, 10 model versions with random validation sample assignments were trained to study model robustness. Performance was compared with (1) a single VGG-19 encoder, (2) an ensemble with a T1-CE MRI as the sole image input after projections, and (3) an ensemble with the same image input design without clinical feature inclusion. RESULTS The ensemble model achieved an excellent area under the receiver operating characteristic curve (AUCROC: 0.89 ± 0.02) with high sensitivity (0.82 ± 0.05), specificity (0.84 ± 0.11), and accuracy (0.84 ± 0.08) results. This outperformed the MRI-only VGG-19 encoder (sensitivity: 0.35 ± 0.01, AUCROC: 0.64 ± 0.08), the MRI-only deep ensemble (sensitivity: 0.60 ± 0.09, AUCROC: 0.68 ± 0.06), and the 3-channel ensemble without clinical feature fusion (sensitivity: 0.78 ± 0.08, AUCROC: 0.84 ± 0.03). CONCLUSIONS Facilitated by the spherical image projection method, a deep ensemble model incorporating Dmap and clinical variables demonstrated excellent performance in predicting BM post-SRS local failure. Our novel approach could improve other radiation therapy outcome models and warrants further evaluation.
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Affiliation(s)
- Jingtong Zhao
- Duke University Medical Center, Durham, North Carolina
| | - Eugene Vaios
- Duke University Medical Center, Durham, North Carolina
| | - Yuqi Wang
- Duke University Medical Center, Durham, North Carolina
| | - Zhenyu Yang
- Duke University Medical Center, Durham, North Carolina
| | - Yunfeng Cui
- Duke University Medical Center, Durham, North Carolina
| | | | - Kyle J Lafata
- Duke University Medical Center, Durham, North Carolina
| | - Peter Fecci
- Duke University Medical Center, Durham, North Carolina
| | | | | | - Scott Floyd
- Duke University Medical Center, Durham, North Carolina
| | - Chunhao Wang
- Duke University Medical Center, Durham, North Carolina.
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Romero A, Lynch D, Johnson E, Zhu X, Kirkpatrick J. MRI order appropriateness for chronic neck pain: Comparison of ordering practices and treatment outcomes for primary care physicians and specialists. J Orthop Res 2024; 42:425-433. [PMID: 37525551 DOI: 10.1002/jor.25669] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 07/06/2023] [Accepted: 07/26/2023] [Indexed: 08/02/2023]
Abstract
Chronic neck pain is a common reason for doctor visits in the United States. This diagnosis can be evaluated through patient history, physical examination, and judicious use of radiographs. However, possible inappropriate magnetic resonance imaging (MRI) ordering persists. We hypothesized that no difference in ordering practices, ordering appropriateness, and subsequent intervention would be appreciated regarding physician specialty, location, patient characteristics, and history and physical exam findings. A multisite retrospective review of cervical spine MRI between 2014 and 2018 was performed. A total of 332 patients were included. Statistical analysis was used to assess MRI order appropriateness, detail of history and physical exam findings, and intervention decision-making among different specialties. If significant differences were found, multiple linear regression was performed to evaluate the association of MRI order appropriateness regarding physician specialty, location, patient characteristics and history, and physical exam findings. The significance level for all tests was set at <0.05 Orthopedic surgeons ordered MRIs most appropriately with an average American College of Radiology (ACR) score of 8.4 (p < 0.005). Orthopedic surgeons had more comprehensive physical exams as compared to the remaining specialties. The decision for intervention did not vary by physician specialty or ACR score, except for patients of pain medicine physicians who received pain management (p = 0.000). Orthopedic surgeons utilize MRI most appropriately and have more comprehensive physical exams. These findings suggest a need for increased physician education on what indicates an appropriate MRI order to improve the use of resources and further protect patient risk-benefit profiles. Further research elucidating factors to minimize negative findings in "appropriate" MRIs is indicated. Clinical significance: More detailed physical exams may lead to more appropriately ordered MRIs, subsequently resulting in surgery or procedures being performed when appropriately indicated. This suggests the need for increased physician education on when MRI ordering is appropriate for chronic neck pain to improve the use of resources and further protect patient risk-benefit profiles.
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Affiliation(s)
- Andrew Romero
- Department of Orthopaedic Surgery, University of Central Florida/HCA Healthcare GME Consortium, Ocala, Florida, USA
| | - Daniel Lynch
- Department of Orthopaedic Surgery, University of Central Florida/HCA Healthcare GME Consortium, Ocala, Florida, USA
| | - Evan Johnson
- Department of Orthopaedic Surgery, University of Tennessee-Campbell Clinic, Memphis, Tennessee, USA
| | - Xiang Zhu
- Department of Orthopaedic Surgery, University of Central Florida College of Medicine, Orlando, Florida, USA
| | - John Kirkpatrick
- Department of Orthopaedic Surgery, Orlando VA Healthcare System, Orlando, Florida, USA
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Erickson B, Cui Y, Alber M, Wang C, Fang Yin F, Kirkpatrick J, Adamson J. Independent Monte Carlo dose calculation identifies single isocenter multi-target radiosurgery targets most likely to fail pre-treatment measurement. J Appl Clin Med Phys 2024:e14290. [PMID: 38289874 DOI: 10.1002/acm2.14290] [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: 09/19/2023] [Revised: 01/04/2024] [Accepted: 01/08/2024] [Indexed: 02/01/2024] Open
Abstract
PURPOSE For individual targets of single isocenter multi-target (SIMT) Stereotactic radiosurgery (SRS), we assess dose difference between the treatment planning system (TPS) and independent Monte Carlo (MC), and demonstrate persistence into the pre-treatment Quality Assurance (QA) measurement. METHODS Treatment plans from 31 SIMT SRS patients were recalculated in a series of scenarios designed to investigate sources of discrepancy between TPS and independent MC. Targets with > 5% discrepancy in DMean[Gy] after progressing through all scenarios were measured with SRS MapCHECK. A matched pair analysis was performed comparing SRS MapCHECK results for these targets with matched targets having similar characteristics (volume & distance from isocenter) but no such MC dose discrepancy. RESULTS Of 217 targets analyzed, individual target mean dose (DMean[Gy]) fell outside a 5% threshold for 28 and 24 targets before and after removing tissue heterogeneity effects, respectively, while only 5 exceeded the threshold after removing effect of patient geometry (via calculation on StereoPHAN geometry). Significant factors affecting agreement between the TPS and MC included target distance from isocenter (0.83% decrease in DMean[Gy] per 2 cm), volume (0.15% increase per cc), and degree of plan modulation (0.37% increase per 0.01 increase in modulation complexity score). SRS MapCHECK measurement had better agreement with MC than with TPS (2%/1 mm / 10% threshold gamma pass rate (GPR) = 99.4 ± 1.9% vs. 93.1 ± 13.9%, respectively). In the matched pair analysis, targets exceeding 5% for MC versus TPS also had larger discrepancies between TPS and measurement with no GPR (2%/1 mm / 10% threshold) exceeding 90% (71.5% ± 16.1%); whereas GPR was high for matched targets with no such MC versus TPS difference (96.5% ± 3.3%, p = 0.01). CONCLUSIONS Independent MC complements pre-treatment QA measurement for SIMT SRS by identifying problematic individual targets prior to pre-treatment measurement, thus enabling plan modifications earlier in the planning process and guiding selection of targets for pre-treatment QA measurement.
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Affiliation(s)
- Brett Erickson
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina, USA
| | - Yunfeng Cui
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina, USA
| | | | - Chunhao Wang
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina, USA
| | - Fang Fang Yin
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina, USA
| | - John Kirkpatrick
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina, USA
| | - Justus Adamson
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina, USA
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Adamson J, Erickson BG, Wang C, Cui Y, Alber M, Kirkpatrick J, Yin FF. Generation, validation, and benchmarking of a commercial independent Monte Carlo calculation beam model for multi-target SRS. Z Med Phys 2023:S0939-3889(23)00093-4. [PMID: 37689499 DOI: 10.1016/j.zemedi.2023.08.004] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 07/27/2023] [Accepted: 08/11/2023] [Indexed: 09/11/2023]
Abstract
BACKGROUND Dosimetric validation of single isocenter multi-target radiosurgery plans is difficult due to conditions of electronic disequilibrium and the simultaneous irradiation of multiple off-axis lesions dispersed throughout the volume. Here we report the benchmarking of a customizable Monte Carlo secondary dose calculation algorithm specific for multi-target radiosurgery which future users may use to guide their commissioning and clinical implementation. PURPOSE To report the generation, validation, and clinical benchmarking of a volumetric Monte Carlo (MC) dose calculation beam model for single isocenter radiosurgery of intracranial multi-focal disease. METHODS The beam model was prepared within SciMoCa (ScientificRT, Munich Germany), a commercial independent dose calculation software, with the aim of broad availability via the commercial software for use with single isocenter radiosurgery. The process included (1) definition & acquisition of measurement data required for beam modeling, (2) tuning model parameters to match measurements, (3) validation of the beam model via independent measurements and end-to-end testing, and finally, (4) clinical benchmarking and validation of beam model utility in a patient specific QA setting. We utilized a 6X Flattening-Filter-Free photon beam from a TrueBeam STX linear accelerator (Siemens Healthineers, Munich Germany). RESULTS In addition to the measured data required for standard IMRT/VMAT (depth dose, central axis profiles & output factors, leaf gap), beam modeling and validation for single-isocenter SRS required central axis and off axis (5 cm & 9 cm) small field output factors and comparison between measurement and simulation of backscatter with aperture for jaw much greater than MLCs. Validation end-to-end measurements included SRS MapCHECK in StereoPHAN geometry (2%/1 mm Gamma = 99.2% ± 2.2%), and OSL & scintillator measurements in anthropomorphic STEEV phantom (6 targets, volume = 0.1-4.1cc, distance from isocenter = 1.2-7.9 cm) for which mean difference was -1.9% ± 2.2%. For 10 patient cases, MC for individual PTVs was -0.8% ± 1.5%, -1.3% ± 1.7%, and -0.5% ± 1.8% for mean dose, D95%, and D1%, respectively. This corresponded to custom passing rates action limits per AAPM TG-218 guidelines of ±5.2%, ±6.4%, and ±6.3%, respectively. CONCLUSIONS The beam modeling, validation, and clinical action criteria outlined here serves as a benchmark for future users of the customized beam model within SciMoCa for single isocenter radiosurgery of multi-focal disease.
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Affiliation(s)
- Justus Adamson
- Duke University Medical Center, Department of Radiation Oncology, Durham, NC.
| | - Brett G Erickson
- Duke University Medical Center, Department of Radiation Oncology, Durham, NC
| | - Chunhao Wang
- Duke University Medical Center, Department of Radiation Oncology, Durham, NC
| | - Yunfeng Cui
- Duke University Medical Center, Department of Radiation Oncology, Durham, NC
| | | | - John Kirkpatrick
- Duke University Medical Center, Department of Radiation Oncology, Durham, NC
| | - Fang-Fang Yin
- Duke University Medical Center, Department of Radiation Oncology, Durham, NC
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7
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Solovyeva O, Dimairo M, Weir CJ, Hee SW, Espinasse A, Ursino M, Patel D, Kightley A, Hughes S, Jaki T, Mander A, Evans TRJ, Lee S, Hopewell S, Rantell KR, Chan AW, Bedding A, Stephens R, Richards D, Roberts L, Kirkpatrick J, de Bono J, Yap C. Development of consensus-driven SPIRIT and CONSORT extensions for early phase dose-finding trials: the DEFINE study. BMC Med 2023; 21:246. [PMID: 37408015 PMCID: PMC10324137 DOI: 10.1186/s12916-023-02937-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/12/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Early phase dose-finding (EPDF) trials are crucial for the development of a new intervention and influence whether it should be investigated in further trials. Guidance exists for clinical trial protocols and completed trial reports in the SPIRIT and CONSORT guidelines, respectively. However, both guidelines and their extensions do not adequately address the characteristics of EPDF trials. Building on the SPIRIT and CONSORT checklists, the DEFINE study aims to develop international consensus-driven guidelines for EPDF trial protocols (SPIRIT-DEFINE) and reports (CONSORT-DEFINE). METHODS The initial generation of candidate items was informed by reviewing published EPDF trial reports. The early draft items were refined further through a review of the published and grey literature, analysis of real-world examples, citation and reference searches, and expert recommendations, followed by a two-round modified Delphi process. Patient and public involvement and engagement (PPIE) was pursued concurrently with the quantitative and thematic analysis of Delphi participants' feedback. RESULTS The Delphi survey included 79 new or modified SPIRIT-DEFINE (n = 36) and CONSORT-DEFINE (n = 43) extension candidate items. In Round One, 206 interdisciplinary stakeholders from 24 countries voted and 151 stakeholders voted in Round Two. Following Round One feedback, one item for CONSORT-DEFINE was added in Round Two. Of the 80 items, 60 met the threshold for inclusion (≥ 70% of respondents voted critical: 26 SPIRIT-DEFINE, 34 CONSORT-DEFINE), with the remaining 20 items to be further discussed at the consensus meeting. The parallel PPIE work resulted in the development of an EPDF lay summary toolkit consisting of a template with guidance notes and an exemplar. CONCLUSIONS By detailing the development journey of the DEFINE study and the decisions undertaken, we envision that this will enhance understanding and help researchers in the development of future guidelines. The SPIRIT-DEFINE and CONSORT-DEFINE guidelines will allow investigators to effectively address essential items that should be present in EPDF trial protocols and reports, thereby promoting transparency, comprehensiveness, and reproducibility. TRIAL REGISTRATION SPIRIT-DEFINE and CONSORT-DEFINE are registered with the EQUATOR Network ( https://www.equator-network.org/ ).
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Affiliation(s)
| | - Munyaradzi Dimairo
- Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Christopher J Weir
- Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Siew Wan Hee
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
- University of Warwick, Coventry, UK
| | | | - Moreno Ursino
- Inserm, Centre de Recherche Des Cordeliers, Sorbonne UniversitéUniversité Paris Cité, 75006, Paris, France
- HeKA, Inria Paris, 75015, Paris, France
- Unit of Clinical Epidemiology, AP-HP, CHU Robert Debré, CIC-EC 1426, Paris, France
- RECaP/F-CRIN, Inserm, 5400, Nancy, France
| | | | - Andrew Kightley
- Patient and Public Involvement and Engagement (PPIE) Lead, Lichfield, UK
| | | | - Thomas Jaki
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
- University of Regensburg, Regensburg, Germany
| | | | | | - Shing Lee
- Columbia University, Mailman School of Public Health, New York, USA
| | - Sally Hopewell
- Oxford Clinical Trials Research Unit, University of Oxford, Oxford, UK
| | | | - An-Wen Chan
- Department of Medicine, Women's College Research Institute, University of Toronto, Toronto, Canada
| | | | | | | | | | | | - Johann de Bono
- The Institute of Cancer Research, London, UK
- The Royal Marsden NHS Foundation Trust, London, UK
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8
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Krüger G, Kirkpatrick J, Mahieu E, Franzetti B, Gabel F, Carlomagno T. An NMR Study of a 300-kDa AAA+ Unfoldase. J Mol Biol 2023; 435:167997. [PMID: 37330287 DOI: 10.1016/j.jmb.2023.167997] [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: 11/07/2022] [Revised: 01/20/2023] [Accepted: 01/30/2023] [Indexed: 06/19/2023]
Abstract
AAA+ ATPases are ubiquitous hexameric unfoldases acting in cellular protein quality control. In complex with proteases, they form protein degradation machinery (the proteasome) in both archaea and eukaryotes. Here, we use solution-state NMR spectroscopy to determine the symmetry properties of the archaeal PAN AAA+ unfoldase and gain insights into its functional mechanism. PAN consists of three folded domains: the coiled-coil (CC), OB and ATPase domains. We find that full-length PAN assembles into a hexamer with C2 symmetry, and that this symmetry extends over the CC, OB and ATPase domains. The NMR data, collected in the absence of substrate, are incompatible with the spiral staircase structure observed in electron-microscopy studies of archaeal PAN in the presence of substrate and in electron-microscopy studies of eukaryotic unfoldases both in the presence and in the absence of substrate. Based on the C2 symmetry revealed by NMR spectroscopy in solution, we propose that archaeal ATPases are flexible enzymes, which can adopt distinct conformations in different conditions. This study reaffirms the importance of studying dynamic systems in solution.
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Affiliation(s)
- Georg Krüger
- Centre of Biomolecular Drug Research and Institute of Organic Chemistry, Leibniz University Hannover, Schneiderberg 38, 30167 Hannover, Germany
| | - John Kirkpatrick
- School of Biosciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Emilie Mahieu
- Univ. Grenoble Alpes, CEA, CNRS, IBS, 71 avenue des Martyrs, F-38000 Grenoble, France
| | - Bruno Franzetti
- Univ. Grenoble Alpes, CEA, CNRS, IBS, 71 avenue des Martyrs, F-38000 Grenoble, France
| | - Frank Gabel
- Univ. Grenoble Alpes, CEA, CNRS, IBS, 71 avenue des Martyrs, F-38000 Grenoble, France
| | - Teresa Carlomagno
- Centre of Biomolecular Drug Research and Institute of Organic Chemistry, Leibniz University Hannover, Schneiderberg 38, 30167 Hannover, Germany; School of Biosciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK; Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
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9
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Marasco M, Kirkpatrick J, Carlomagno T, Hub JS, Anselmi M. Experiment-guided molecular simulations define a heterogeneous structural ensemble for the PTPN11 tandem SH2 domains. Chem Sci 2023; 14:5743-5755. [PMID: 37265738 PMCID: PMC10231330 DOI: 10.1039/d3sc00746d] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 05/04/2023] [Indexed: 06/03/2023] Open
Abstract
SHP2 plays an important role in regulating cellular processes, and its pathogenic mutations cause developmental disorders and are linked to cancer. SHP2 is a multidomain protein, comprising two SH2 domains arranged in tandem, a catalytic PTP domain, and a disordered C-terminal tail. SHP2 is activated upon binding two linked phosphopeptides to its SH2 domains, and the peptide orientation and spacing between binding sites are critical for enzymatic activation. For decades, the tandem SH2 has been extensively studied to identify the relative orientation of the two SH2 domains that most effectively binds effectors. So far, neither crystallography nor experiments in solution have provided conclusive results. Using experiment-guided molecular simulations, we determine the heterogeneous structural ensemble of the tandem SH2 in solution in agreement with experimental data from small-angle X-ray scattering and NMR residual dipolar couplings. In the solution ensemble, N-SH2 adopts different orientations and positions relative to C-SH2. We suggest that the intrinsic structural plasticity of the tandem SH2 allows SHP2 to respond to external stimuli and is essential for its functional activity.
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Affiliation(s)
- Michelangelo Marasco
- Molecular Pharmacology Program, Memorial Sloan Kettering Cancer Center New York NY USA
| | - John Kirkpatrick
- School of Biosciences, University of Birmingham Edgbaston B15 2TT Birmingham UK
| | - Teresa Carlomagno
- School of Biosciences, University of Birmingham Edgbaston B15 2TT Birmingham UK
- Institute of Cancer and Genomic Sciences, University of Birmingham Edgbaston B15 2TT Birmingham UK
| | - Jochen S Hub
- Theoretical Physics and Center for Biophysics, Saarland University 66123 Saarbrücken Germany
| | - Massimiliano Anselmi
- Theoretical Physics and Center for Biophysics, Saarland University 66123 Saarbrücken Germany
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10
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LaBella D, Adewole M, Alonso-Basanta M, Altes T, Anwar SM, Baid U, Bergquist T, Bhalerao R, Chen S, Chung V, Conte GM, Dako F, Eddy J, Ezhov I, Godfrey D, Hilal F, Familiar A, Farahani K, Iglesias JE, Jiang Z, Johanson E, Kazerooni AF, Kent C, Kirkpatrick J, Kofler F, Leemput KV, Li HB, Liu X, Mahtabfar A, McBurney-Lin S, McLean R, Meier Z, Moawad AW, Mongan J, Nedelec P, Pajot M, Piraud M, Rashid A, Reitman Z, Shinohara RT, Velichko Y, Wang C, Warman P, Wiggins W, Aboian M, Albrecht J, Anazodo U, Bakas S, Flanders A, Janas A, Khanna G, Linguraru MG, Menze B, Nada A, Rauschecker AM, Rudie J, Tahon NH, Villanueva-Meyer J, Wiestler B, Calabrese E. The ASNR-MICCAI Brain Tumor Segmentation (BraTS) Challenge 2023: Intracranial Meningioma. ArXiv 2023:arXiv:2305.07642v1. [PMID: 37608937 PMCID: PMC10441446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
Meningiomas are the most common primary intracranial tumor in adults and can be associated with significant morbidity and mortality. Radiologists, neurosurgeons, neuro-oncologists, and radiation oncologists rely on multiparametric MRI (mpMRI) for diagnosis, treatment planning, and longitudinal treatment monitoring; yet automated, objective, and quantitative tools for non-invasive assessment of meningiomas on mpMRI are lacking. The BraTS meningioma 2023 challenge will provide a community standard and benchmark for state-of-the-art automated intracranial meningioma segmentation models based on the largest expert annotated multilabel meningioma mpMRI dataset to date. Challenge competitors will develop automated segmentation models to predict three distinct meningioma sub-regions on MRI including enhancing tumor, non-enhancing tumor core, and surrounding nonenhancing T2/FLAIR hyperintensity. Models will be evaluated on separate validation and held-out test datasets using standardized metrics utilized across the BraTS 2023 series of challenges including the Dice similarity coefficient and Hausdorff distance. The models developed during the course of this challenge will aid in incorporation of automated meningioma MRI segmentation into clinical practice, which will ultimately improve care of patients with meningioma.
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11
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Krüger G, Kirkpatrick J, Mahieu E, Franzetti B, Gabel F, Carlomagno T. A real-time analysis of GFP unfolding by the AAA+ unfoldase PAN. J Magn Reson 2023; 350:107431. [PMID: 37058954 DOI: 10.1016/j.jmr.2023.107431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/27/2023] [Accepted: 03/30/2023] [Indexed: 05/10/2023]
Abstract
Protein quality control systems are essential to maintain a healthy proteome. They often consist of an unfoldase unit, typically an AAA+ ATPase, coupled with a protease unit. In all kingdoms of life, they function to eliminate misfolded proteins, and thus prevent that their aggregates do harm to the cell, and to rapidly regulate protein levels in the presence of environmental changes. Despite the huge progress made in the past two decades in understanding the mechanism of function of protein degradation systems, the fate of the substrate during the unfolding and proteolytic processes remains poorly understood. Here we exploit an NMR-based approach to monitor GFP processing by the archaeal PAN unfoldase and the PAN-20S degradation system in real time. We find that PAN-dependent unfolding of GFP does not involve the release of partially-folded GFP molecules resulting from futile unfolding attempts. In contrast, once stably engaged with PAN, GFP molecules are efficiently transferred to the proteolytic chamber of the 20S subunit, despite the only weak affinity of PAN for the 20S subunit in the absence of substrate. This is essential to guarantee that unfolded but not proteolyzed proteins are not released into solution, where they would form toxic aggregates. The results of our studies are in good agreement with previous results derived from real-time small-angle-neutron-scattering experiments and have the advantage of allowing the investigation of substrates and products at amino-acid resolution.
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Affiliation(s)
- Georg Krüger
- Institute of Organic Chemistry and Centre of Biomolecular Drug Design, Leibniz University Hannover, Schneiderberg 38, D-30167 Hannover, Germany
| | - John Kirkpatrick
- School of Biosciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, B15 2TT Birmingham, United Kingdom
| | - Emilie Mahieu
- Univ. Grenoble Alpes, CEA, CNRS, IBS, 71 avenue des Martyrs, F-38000 Grenoble, France
| | - Bruno Franzetti
- Univ. Grenoble Alpes, CEA, CNRS, IBS, 71 avenue des Martyrs, F-38000 Grenoble, France
| | - Frank Gabel
- Univ. Grenoble Alpes, CEA, CNRS, IBS, 71 avenue des Martyrs, F-38000 Grenoble, France
| | - Teresa Carlomagno
- School of Biosciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, B15 2TT Birmingham, United Kingdom.
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12
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Verma D, Hegde V, Kirkpatrick J, Carlomagno T. The EJC disassembly factor PYM is an intrinsically disordered protein and forms a fuzzy complex with RNA. Front Mol Biosci 2023; 10:1148653. [PMID: 37065448 PMCID: PMC10098021 DOI: 10.3389/fmolb.2023.1148653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 03/17/2023] [Indexed: 04/03/2023] Open
Abstract
The discovery of several functional interactions where one or even both partners remain disordered has demonstrated that specific interactions do not necessarily require well-defined intermolecular interfaces. Here we describe a fuzzy protein–RNA complex formed by the intrinsically unfolded protein PYM and RNA. PYM is a cytosolic protein, which has been reported to bind the exon junction complex (EJC). In the process of oskar mRNA localization in Drosophila melanogaster, removal of the first intron and deposition of the EJC are essential, while PYM is required to recycle the EJC components after localization has been accomplished. Here we demonstrate that the first 160 amino acids of PYM (PYM1–160) are intrinsically disordered. PYM1–160 binds RNA independently of its nucleotide sequence, forming a fuzzy protein–RNA complex that is incompatible with PYM’s function as an EJC recycling factor. We propose that the role of RNA binding consists in down-regulating PYM activity by blocking the EJC interaction surface of PYM until localization has been accomplished. We suggest that the largely unstructured character of PYM may act to enable binding to a variety of diverse interaction partners, such as multiple RNA sequences and the EJC proteins Y14 and Mago.
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Affiliation(s)
- Deepshikha Verma
- Laboratory of NMR-based Integrative Structural Biology, Centre for Biomolecular Drug Research (BMWZ) and Institute of Organic Chemistry, Leibniz University Hannover, Hanover, Germany
| | - Veena Hegde
- Laboratory of NMR-based Integrative Structural Biology, Centre for Biomolecular Drug Research (BMWZ) and Institute of Organic Chemistry, Leibniz University Hannover, Hanover, Germany
| | - John Kirkpatrick
- Laboratory of Integrative Structural Biology, School of Biosciences, College of LES, University of Birmingham, Birmingham, United Kingdom
| | - Teresa Carlomagno
- Laboratory of Integrative Structural Biology, School of Biosciences, College of LES, University of Birmingham, Birmingham, United Kingdom
- *Correspondence: Teresa Carlomagno,
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13
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Chan M, Tatter S, Chiang V, Fecci P, Strowd R, Prabhu S, Hadjipanayis C, Kirkpatrick J, Sun D, Sinicrope K, Mohammadi AM, Sevak P, Abram S, Kim AH, Leuthardt E, Chao S, Phillips J, Lacroix M, Williams B, Placantonakis D, Silverman J, Baumgartner J, Piccioni D, Laxton A. Efficacy of Laser Interstitial Thermal Therapy (LITT) for Biopsy-Proven Radiation Necrosis in Radiographically Recurrent Brain Metastases. Neurooncol Adv 2023; 5:vdad031. [PMID: 37114245 PMCID: PMC10129388 DOI: 10.1093/noajnl/vdad031] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Abstract
Abstract
Background
LITT (laser interstitial thermal therapy) in the setting of post-SRS radiation necrosis (RN) for patients with brain metastases has growing evidence for efficacy. However, questions remain regarding hospitalization, local control, symptom control, and concurrent use of therapies.
Methods
Demographics, intraprocedural data, safety, Karnofsky performance status (KPS) and survival data were prospectively collected then analyzed on patients consented between 2016-2020 and who were undergoing LITT for biopsy-proven RN at one of 14 U.S. centers. Data was monitored for accuracy. Statistical analysis included individual variable summaries, multivariable Fine and Gray analysis, and Kaplan Meier estimated survival.
Results
Ninety patients met the inclusion criteria. Four patients underwent two ablations on the same day. Median hospitalization time was 32.5hrs. The median time to corticosteroid cessation after LITT was 13.0 days (0.0, 1229.0) and cumulative incidence of lesional progression was 19% at 1-year. Median post-procedure overall survival was 2.55 years [1.66, infinity] and 77.1% at one year as estimated by Kaplan Meier. Median KPS remained at 80 through 2-year follow-up. Seizure prevalence was 12% within 1-month post-LITT and 7.9% at three months; down from 34.4% within 60-days prior to procedure.
Conclusions
LITT for RN was not only again found to be safe with low patient morbidity but was also a highly effective treatment for RN for both local control and symptom management (including seizures). In addition to averting expected neurological death, LITT facilitates ongoing systemic therapy (in particular immunotherapy) by enabling the rapid cessation of steroids, thereby facilitating maximal possible survival for these patients.
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Affiliation(s)
- Michael Chan
- Corresponding Author: Michael Chan, Wake Forest Baptist Health, Winston-Salem, NC 27157, USA ()
| | - Steven Tatter
- Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | | | - Peter Fecci
- Duke University Medical Center, Durham, North Carolina, USA
| | - Roy Strowd
- Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Sujit Prabhu
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | | | - David Sun
- Norton Neuroscience Institute, Louisville, Kentucky, USA
| | | | | | - Parag Sevak
- Norton Neuroscience Institute, Louisville, Kentucky, USA
| | - Steven Abram
- Ascension St. Thomas Hospital West, Nashville, Tennessee, USA
| | - Albert H Kim
- Washington University School of Medicine, St. Louis, Missouri, USA
| | - Eric Leuthardt
- Washington University School of Medicine, St. Louis, Missouri, USA
| | - Samuel Chao
- Cleveland Clinic Lerner College of Medicine at CWRU, Cleveland, Ohio, USA
| | - John Phillips
- Ascension St. Thomas Hospital West, Nashville, Tennessee, USA
| | | | - Brian Williams
- University of Louisville Health, Louisville, Kentucky, USA
| | | | | | | | - David Piccioni
- University of California San Diego Health, La Jolla, California, USA
| | - Adrian Laxton
- Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
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14
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Dhar R, Kirkpatrick J, Gilbert L, Khanna A, Modi MM, Chawla RK, Dalal S, Maturu VN, Stern M, Keppler OT, Djukanovic R, Gadola SD. Doxycycline for the prevention of progression of COVID-19 to severe disease requiring intensive care unit (ICU) admission: A randomized, controlled, open-label, parallel group trial (DOXPREVENT.ICU). PLoS One 2023; 18:e0280745. [PMID: 36689456 PMCID: PMC9870104 DOI: 10.1371/journal.pone.0280745] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 12/19/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND After admission to hospital, COVID-19 progresses in a substantial proportion of patients to critical disease that requires intensive care unit (ICU) admission. METHODS In a pragmatic, non-blinded trial, 387 patients aged 40-90 years were randomised to receive treatment with SoC plus doxycycline (n = 192) or SoC only (n = 195). The primary outcome was the need for ICU admission as judged by the attending physicians. Three types of analyses were carried out for the primary outcome: "Intention to treat" (ITT) based on randomisation; "Per protocol" (PP), excluding patients not treated according to randomisation; and "As treated" (AT), based on actual treatment received. The trial was undertaken in six hospitals in India with high-quality ICU facilities. An online application serving as the electronic case report form was developed to enable screening, randomisation and collection of outcomes data. RESULTS Adherence to treatment per protocol was 95.1%. Among all 387 participants, 77 (19.9%) developed critical disease needing ICU admission. In all three primary outcome analyses, doxycycline was associated with a relative risk reduction (RRR) and absolute risk reduction (ARR): ITT 31.6% RRR, 7.4% ARR (P = 0.063); PP 40.7% RRR, 9.6% ARR (P = 0.017); AT 43.2% RRR, 10.8% ARR (P = 0.007), with numbers needed to treat (NTT) of 13.4 (ITT), 10.4 (PP), and 9.3 (AT), respectively. Doxycycline was well tolerated with not a single patient stopping treatment due to adverse events. CONCLUSIONS In hospitalized COVID-19 patients, doxycycline, a safe, inexpensive, and widely available antibiotic with anti-inflammatory properties, reduces the need for ICU admission when added to SoC.
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Affiliation(s)
- Raja Dhar
- Department of Pulmonology, CMRI Hospital, Kolkata, India
| | - John Kirkpatrick
- John Kirkpatrick, MSc, Independent Researcher, Cambridgeshire, United Kingdom
| | - Laura Gilbert
- Laura Gilbert, Rutherford Research, Hampshire, United Kingdom
| | - Arjun Khanna
- Pulmonary and Critical care medicine, Yashoda Superspeciality Hospital, Kaushambi, Ghaziabad, UP, India
| | | | - Rakesh K. Chawla
- Saroj Super Speciality Hospital and Jaipur Golden Hospital, Dept of Respiratory Medicine, Critical Care and Sleep Disorders, New Delhi, India
| | - Sonia Dalal
- Sterling Hospital and Kalyan Hospital, Vadodara, India
| | | | - Marcel Stern
- Max von Pettenkofer Institute and Gene Center, Virology, National Reference Center for Retroviruses, Faculty of Medicine, LMU München, Munich, Germany
| | - Oliver T. Keppler
- Max von Pettenkofer Institute and Gene Center, Virology, National Reference Center for Retroviruses, Faculty of Medicine, LMU München, Munich, Germany
| | - Ratko Djukanovic
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- NIHR Southampton Biomedical Research Centre, Southampton, United Kingdom
| | - Stephan D. Gadola
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- NIHR Southampton Biomedical Research Centre, Southampton, United Kingdom
- Rheumatology and Pain Medicine, Bethesda Hospital, Basel, Switzerland
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15
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Zioupos L, Kirkpatrick J, Anand A. 1272 A PILOT ROUTINE ELECTRONIC HEALTH RECORD FUNCTIONAL TRACKING SCORE FOR OLDER PATIENTS IN HOSPITAL. Age Ageing 2023. [DOI: 10.1093/ageing/afac322.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Abstract
Introduction
Approximately one-third of older patients leave hospital with a new functional impairment. Tracking rehabilitation progress following acute illness could improve recognition and understanding of hospital-acquired disability. However, traditional mobility and functional scores include measures that are not part of routine rehabilitation therapy, adding a time burden for staff to report. Capturing data already recorded in routine electronic records could provide an efficient patient tracking measure of rehabilitation success.
Methods
A scoping literature review appraised existing scores of mobility and functional status. Analysis of 15 admissions through the Royal Infirmary of Edinburgh identified mobility and functional domains which were reliably recorded in free text electronic health records. A pilot score was drafted, comprising admission and discharge scores (0-30 points), medical progress (0-10), physiotherapy and occupational therapy tracking (0-30). Higher scores indicate greater functional independence. Expert feedback was obtained through focus group discussion with physiotherapists and occupational therapists. The approach was tested in a fresh set of six case studies. Two independent scorers applied the scoring schema and agreement was assessed using Cohen’s weighted-kappa coefficient.
Results
The selected electronic health records contained 438 medical, 352 nursing and 183 therapist entries. Existing measures such as the Barthel Index were not recorded for any patient. Focus group discussion identified value in the overall approach and informed item-weighting. The pilot functional score allowed visualisation of rehabilitation trajectories over the course of each admission. Excellent inter-rater reliability was demonstrated for the medical (Cohen’s Kappa 0.99, 95% confidence interval [CI] 0.96–1.00) and physiotherapy (Kappa 0.96, 95% CI 0.93–0.99) components.
Conclusions
A functional tracking score generated from routine health records proved feasible and reproducible in this pilot. Future development should assess validity, reliability and prognostic power in larger populations, exploring automation using natural language processing. Development of graphic visualisations may aid communication within multidisciplinary teams.
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Affiliation(s)
- L Zioupos
- University of Edinburgh Medical School
| | | | - A Anand
- University of Edinburgh Centre for Cardiovascular Science,
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16
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Vaios E, Shenker R, Hendrickson P, D'Anna R, Niedzwiecki D, Carpenter D, Floyd W, Winter S, Dietrich J, Salama A, Clarke J, Allen K, Mullikin T, Floyd S, Kirkpatrick J, Reitman Z. RADT-02. IMPACT OF SINGLE AND DUAL IMMUNE CHECKPOINT BLOCKADE ON RISK OF RADIATION NECROSIS AND LOCAL CONTROL AMONG PATIENTS WITH BRAIN METASTASES TREATED WITH STEREOTACTIC RADIOSURGERY. Neuro Oncol 2022. [PMCID: PMC9660913 DOI: 10.1093/neuonc/noac209.192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
PURPOSE
Single and dual immune checkpoint inhibition (ICPI) are common treatment options for patients, particularly with melanoma and non-small cell lung cancer (NSCLC). While data suggest a cancer control benefit of combining stereotactic radiosurgery (SRS) and ICPI, we hypothesized that concurrent dual ICPI and SRS increases risk for radiation necrosis (RN).
METHODS
We retrospectively reviewed patients with metastatic melanoma or NSCLC treated with SRS for intact brain metastases from 2014-2020. Patients were stratified by receipt of dual ICPI, single ICPI, and SRS alone. Concurrent ICPI was defined as treatment within 30 days of SRS. RN and local control (LC) were biopsy confirmed or determined radiographically and longitudinally, in combination with clinical assessment and steroid use. Kaplan-Meier estimates were used to compare rates of RN and LC between cohorts.
RESULTS
673 brain lesions from 93 patients met inclusion criteria [median (Q1, Q3): 5.0 (2.0-10.0) lesions per patient]. Median follow-up was 8.1 months (95% CI: 7.3-8.7). Histologies included melanoma (53.5%), adenocarcinoma NSCLC (27.3%), squamous cell NSCLC (6.1%), and NSCLC NOS (6.1%). 88 lesions from 25 patients (27%) developed RN and 11 (13%) were biopsy-proven. ICPI use was enriched among lesions that developed RN (85.2%) versus those that did not (19.8%). RN was associated with concurrent ICPI (p< 0.001). Freedom from RN at 6 months was 80% for dual ICPI, 82% for single ICPI, and 97% for SRS alone; 12-month rates were 78% in each ICPI cohort and 95% with SRS alone (p=0.0002). LC differed among dual (97.5%), single (88.7%), and no ICPI (79.7%, p < 0.001). There was a trend toward improved LC with RN (96.6% vs 91.8%; p=0.087).
CONCLUSIONS
In a large cohort of brain metastases, we observed increased risk of RN and improved LC with SRS plus concurrent dual or single ICPI. Awareness of these associations is critical for patient management.
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Affiliation(s)
| | | | | | - Rachel D'Anna
- Department of Biostatistics and Bioinformatics, Duke University Medical Center , Durham, NC , USA
| | - Donna Niedzwiecki
- Duke Cancer Institute Biostatistics, Duke University Medical Center , Durham, NC , USA
| | | | | | - Sebastian Winter
- Division of Neuro-Oncology, Department of Neurology, Massachusetts General Hospital , Boston, MA , USA
| | - Jorg Dietrich
- Division of Neuro-Oncology, MGH Cancer Center, Massachusetts General Hospital and Harvard Medical School , Boston, MA , USA
| | - April Salama
- Department of Medicine, Division of Medical Oncology, Duke University Medical Center , Durham, NC , USA
| | - Jeffrey Clarke
- Department of Medicine, Division of Medical Oncology, Duke University Medical Center , Durham, NC , USA
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17
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Sperduto PW, De B, Li J, Carpenter D, Kirkpatrick J, Milligan M, Shih HA, Kutuk T, Kotecha R, Higaki H, Otsuka M, Aoyama H, Bourgoin M, Roberge D, Dajani S, Sachdev S, Gainey J, Buatti JM, Breen W, Brown PD, Ni L, Braunstein S, Gallitto M, Wang TJC, Shanley R, Lou E, Shiao J, Gaspar LE, Tanabe S, Nakano T, An Y, Chiang V, Zeng L, Soliman H, Elhalawani H, Cagney D, Thomas E, Boggs DH, Ahluwalia MS, Mehta MP. Graded Prognostic Assessment (GPA) for Patients With Lung Cancer and Brain Metastases: Initial Report of the Small Cell Lung Cancer GPA and Update of the Non-Small Cell Lung Cancer GPA Including the Effect of Programmed Death Ligand 1 and Other Prognostic Factors. Int J Radiat Oncol Biol Phys 2022; 114:60-74. [PMID: 35331827 PMCID: PMC9378572 DOI: 10.1016/j.ijrobp.2022.03.020] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/02/2022] [Accepted: 03/14/2022] [Indexed: 11/23/2022]
Abstract
PURPOSE Patients with lung cancer and brain metastases represent a markedly heterogeneous population. Accurate prognosis is essential to optimally individualize care. In prior publications, we described the graded prognostic assessment (GPA), but a GPA for patients with small cell lung cancer (SCLC) has never been reported, and in non-small cell lung cancer (NSCLC), the effect of programmed death ligand 1 (PD-L1) was unknown. The 3-fold purpose of this work is to provide the initial report of an SCLC GPA, to evaluate the effect of PD-L1 on survival in patients with NSCLC, and to update the Lung GPA accordingly. METHODS AND MATERIALS A multivariable analysis of prognostic factors and treatments associated with survival was performed on 4183 patients with lung cancer (3002 adenocarcinoma, 611 nonadenocarcinoma, 570 SCLC) with newly diagnosed brain metastases between January 1, 2015, and December 31, 2020, using a multi-institutional retrospective database. Significant variables were used to update the Lung GPA. RESULTS Overall median survival for lung adenocarcinoma, SCLC, and nonadenocarcinoma was 17, 10, and 8 months, respectively, but varied widely by GPA from 2 to 52 months. In SCLC, the significant prognostic factors were age, performance status, extracranial metastases, and number of brain metastases. In NSCLC, the distribution of molecular markers among patients with lung adenocarcinoma and known primary tumor molecular status revealed alterations/expression in PD-L1 50% to 100%, PD-L1 1% to 49%, epidermal growth factor receptor, and anaplastic lymphoma kinase in 32%, 31%, 30%, and 7%, respectively. Median survival of patients with lung adenocarcinoma and brain metastases with 0, 1% to 49%, and ≥50% PD-L1 expression was 17, 19, and 24 months, respectively (P < .01), confirming PD-L1 is a prognostic factor. Previously identified prognostic factors for NSCLC (epidermal growth factor receptor and anaplastic lymphoma kinase status, performance status, age, number of brain metastases, and extracranial metastases) were reaffirmed. These factors were incorporated into the updated Lung GPA with robust separation between subgroups for all histologies. CONCLUSIONS Survival for patients with lung cancer and brain metastases has improved but varies widely. The initial report of a GPA for SCLC is presented. For patients with NSCLC-adenocarcinoma and brain metastases, PD-L1 is a newly identified significant prognostic factor, and the previously identified factors were reaffirmed. The updated indices establish unique criteria for SCLC, NSCLC-nonadenocarcinoma, and NSCLC-adenocarcinoma (incorporating PD-L1). The updated Lung GPA, available for free at brainmetgpa.com, provides an accurate tool to estimate survival, individualize treatment, and stratify clinical trials.
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Affiliation(s)
| | - Brian De
- MD Anderson Cancer Center, Houston, Texas
| | - Jing Li
- MD Anderson Cancer Center, Houston, Texas
| | | | | | | | - Helen A Shih
- Massachusetts General Hospital, Boston, Massachusetts
| | - Tugce Kutuk
- Miami Cancer Institute, Baptist Health South Florida, Miami, Florida
| | - Rupesh Kotecha
- Miami Cancer Institute, Baptist Health South Florida, Miami, Florida
| | | | | | - Hidefumi Aoyama
- Hokkaido Cancer Center, Hokkaido, Japan; Hokkaido University, Sapporo, Japan
| | - Malie Bourgoin
- Centre Hospitalier de l' Université de Montreal, Montreal, Quebec, Canada
| | - David Roberge
- Centre Hospitalier de l' Université de Montreal, Montreal, Quebec, Canada
| | | | | | | | | | | | | | - Lisa Ni
- University of California, San Francisco, California
| | | | | | | | | | - Emil Lou
- University of Minnesota, Minneapolis, Minnesota
| | - Jay Shiao
- University of Colorado Denver, Denver, Colorado
| | - Laurie E Gaspar
- University of Colorado Denver, Denver, Colorado; Banner MD Anderson Cancer Center, Loveland, Colorado
| | | | | | - Yi An
- Yale University, New Haven, Connecticut
| | | | - Liang Zeng
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Hany Soliman
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Evan Thomas
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | - Minesh P Mehta
- Miami Cancer Institute, Baptist Health South Florida, Miami, Florida
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18
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Vaios E, Shenker R, Hendrickson P, D’Anna R, Niedzwiecki D, Carpenter D, Floyd W, Winter S, Dietrich J, Floyd S, Kirkpatrick J, Mullikin T, Allen K, Salama A, Clarke J, Reitman Z. MMAP-07 IMPACT OF SINGLE AND DUAL IMMUNE CHECKPOINT BLOCKADE ON RISK OF RADIATION NECROSIS AMONG PATIENTS WITH BRAIN METASTASES TREATED WITH STEREOTACTIC RADIOSURGERY. Neurooncol Adv 2022. [PMCID: PMC9354147 DOI: 10.1093/noajnl/vdac078.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
PURPOSE While stereotactic radiosurgery (SRS) is often an efficacious treatment for brain metastases, it carries a significant risk of radionecrosis (RN). Single and dual immune checkpoint inhibition (ICPI) have emerged as common treatment options for many patients, particularly those with melanoma and non-small cell lung cancer (NSCLC). While data suggest a cancer control benefit of combining SRS and ICPI, we hypothesized that concurrent receipt of dual ICPI with SRS increases the risk for RN. METHODS We performed a retrospective review of serial patients with metastatic melanoma or NSCLC treated with SRS for intact brain metastases from 2014-2020 at our single institution. Patients were stratified by receipt of dual vs. single ICPI vs. SRS alone. RN was biopsy confirmed or determined radiographically, in combination with clinical assessment and steroid use. Kaplan-Meier estimates were used to compare rates of RN between cohorts. RESULTS 673 brain lesions from 93 patients met inclusion criteria [median (Q1, Q3): 5.0 (2.0-10.0) lesions per patient]. Median follow-up of lesions was 8.1 months (95% CI: 7.3, 8.7). Most (82.8%) lesions were supratentorial and histologies included melanoma (53.5%), adenocarcinoma NSCLC (27.3%), squamous cell NSCLC (6.1%), and NSCLC NOS (6.1%). In the entire cohort, 88 lesions from 25 patients (27%) developed RN. 77 (87%) lesions were diagnosed clinico-radiographically and 11 (13%) were biopsy-proven. ICPI use was highly enriched among lesions that developed RN (85.2%) versus those that did not (19.8%). Freedom from RN at 6 months was 80% for dual ICPI, 82% for single ICPI, and 97% for SRS alone; 12 month rates were 78% in each of the ICPI cohorts and 95% with SRS alone (P=0.0002). CONCLUSIONS In a large cohort of SRS-treated brain metastases, we observed an increased risk of RN among patients who received either dual or single ICPI concurrently with SRS.
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Affiliation(s)
- Eugene Vaios
- Department of Radiation Oncology, Duke University Medical Center , Durham, NC , USA
| | - Rachel Shenker
- Department of Radiation Oncology, Duke University Medical Center , Durham, NC , USA
| | - Peter Hendrickson
- Department of Radiation Oncology, Duke University Medical Center , Durham, NC , USA
| | - Rachel D’Anna
- Department of Biostatistics and Bioinformatics , Durham, NC , USA
| | | | - David Carpenter
- Department of Radiation Oncology, Duke University Medical Center , Durham, NC , USA
| | | | - Sebastian Winter
- Division of Neuro-Oncology, Massachusetts General Hospital , Boston, MA , USA
| | - Jorg Dietrich
- Division of Neuro-Oncology, Massachusetts General Hospital , Boston, MA , USA
| | - Scott Floyd
- Department of Radiation Oncology, Duke University Medical Center , Durham, NC , USA
| | - John Kirkpatrick
- Department of Radiation Oncology, Duke University Medical Center , Durham, NC , USA
- Department of Neurosurgery, Duke University Medical Center , Durham, NC , USA
| | - Trey Mullikin
- Department of Radiation Oncology, Duke University Medical Center , Durham, NC , USA
| | - Karen Allen
- Department of Radiation Oncology, Duke University Medical Center , Durham, NC , USA
| | - April Salama
- Department of Medicine, Division of Medical Oncology, Duke University Medical Center , Durham, NC , USA
| | - Jeffrey Clarke
- Department of Medicine, Division of Medical Oncology, Duke University Medical Center , Durham, NC , USA
| | - Zachary Reitman
- Department of Radiation Oncology, Duke University Medical Center , Durham, NC , USA
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19
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Peters K, Kirkpatrick J, Batinic-Haberle I, Affronti ML, Woodring S, Lipp E, Herndon J, Boyd K, Spasojevic I, Penchev S, Gad S, Silberstein D, Johnson M, Desjardins A, Friedman H, Ashley D, Crapo J. SPCR-03 NEUROCOGNITIVE OUTCOMES FROM PHASE 1 TRIAL OF BMX-001 IN COMBINATION WITH CONCURRENT RADIATION THERAPY AND TEMOZOLOMIDE IN NEWLY DIAGNOSED HIGH-GRADE GLIOMA PATIENTS. Neurooncol Adv 2022. [PMCID: PMC9354202 DOI: 10.1093/noajnl/vdac078.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Neurocognitive dysfunction can result from radiation therapy which is the mainstay of treatment for high-grade glioma, particularly glioblastoma. Preclinical observations found that BMX-001, a novel metalloporphyrin, acts as a radioprotectant for normal CNS cells yet as a radiosensitizer to cancer cells in human GBM xenograft experiments. In a phase 1 study evaluating the safety of BMX-001 in combination with concurrent radiation therapy and temozolomide, we further studied neurocognitive function before and after concurrent radiation therapy and temozolomide in newly diagnosed high-grade glioma patients. METHODS We performed a phase 1 study of BMX-001 combined with radiation therapy (6-week total of 59.4-60 Gy) and temozolomide (75 mg/m2/day for 42 days). We administered BMX-001 as a subcutaneous injection at a loading dose before radiation therapy and temozolomide and then subsequent doses twice weekly for eight weeks. A key secondary endpoint was the evaluation of neurocognition. We performed neurocognitive testing with the computerized program CNS Vital Signsâ. This battery consists of seven tests: verbal memory, visual memory, finger tapping, symbol digit coding, the Stroop Test, a test of shifting attention, and a continuous performance test. We defined neurocognitive impairment at baseline as a z-score ≥ 1.5 SDs below the normative mean. We described improvements or declines in neurocognition at 2 and 6 months from baseline. RESULTS Fifteen patients (age 19-80 years) enrolled and underwent neurocognitive testing before and after RT. All patients had WHO grade 4 glioblastoma. Most subjects had neurocognitive impairment ranging from 46.7-to 80% on specific neurocognitive tests. At two months (N=15) and six months (N=9), most testing demonstrated improved neurocognitive performance. CONCLUSIONS Neurocognitive function is maintained and can improve after concurrent radiation therapy and temozolomide in this high-grade glioma cohort treated with BMX-001 during concurrent radiation therapy and temozolomide.
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Affiliation(s)
| | | | | | | | | | - Eric Lipp
- Duke University Medical Center , Durham, NC , USA
| | | | - Kendra Boyd
- Duke University Medical Center , Durham, NC , USA
| | | | - Sara Penchev
- BioMimetix JV, LLC , Greenwood Village, CO , USA
| | | | | | | | | | | | - David Ashley
- Duke University Medical Center , Durham, NC , USA
| | - James Crapo
- BioMimetix JV, LLC , Greenwood Village, CO , USA
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20
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Homer V, Yap C, Bond S, Holmes J, Stocken D, Walker K, Robinson EJ, Wheeler G, Brown S, Hinsley S, Schipper M, Weir CJ, Rantell K, Prior T, Yu LM, Kirkpatrick J, Bedding A, Gamble C, Gaunt P. Early phase clinical trials extension to guidelines for the content of statistical analysis plans. BMJ 2022; 376:e068177. [PMID: 35131744 PMCID: PMC8819597 DOI: 10.1136/bmj-2021-068177] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/10/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Victoria Homer
- Cancer Research Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Christina Yap
- Clinical Trials and Statistics Unit, Institute for Cancer Research, London, UK
| | - Simon Bond
- Cambridge Clinical Trials Unit, Cambridge, UK
| | - Jane Holmes
- Oxford Clinical Trials Research Unit, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Deborah Stocken
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Katrina Walker
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Emily J Robinson
- Royal Marsden Clinical Trials Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - Graham Wheeler
- Imperial Clinical Trials Unit, Imperial College London, London, UK
| | - Sarah Brown
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Samantha Hinsley
- Cancer Research UK Glasgow Clinical Trials Unit, University of Glasgow, Glasgow, UK
| | - Matthew Schipper
- Departments of Radiation Oncology and Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Christopher J Weir
- Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Khadija Rantell
- Medicines and Healthcare products Regulatory Agency, London, UK
| | - Thomas Prior
- Early Development Oncology Statistics Department, Janssen Research and Development, Spring House, PA, USA
| | - Ly-Mee Yu
- Primary Care Clinical Trials Unit, University of Oxford, Oxford, UK
| | | | | | - Carrol Gamble
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Piers Gaunt
- Cancer Research Clinical Trials Unit, University of Birmingham, Birmingham, UK
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21
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Batich K, Mitchell D, Healy P, Herndon J, Broadwater G, Michael G, Huang MN, Hotchkiss K, Sanchez-Perez L, Nair S, Congdon K, Norberg P, Weinhold K, Archer G, Reap E, Xie W, Shipes S, Albrecht E, Peters K, Randazzo D, Johnson M, Landi D, Desjardins A, Friedman H, Vlahovic G, Reardon D, Vredenburgh J, Bigner D, Khasraw M, McLendon R, Thompson E, Cook S, Fecci P, Codd P, Floyd S, Reitman Z, Kirkpatrick J, Friedman A, Ashley DM, Sampson J. CTIM-10. REPRODUCIBILITY OF CLINICAL TRIALS USING CMV-TARGETED DENDRITIC CELL VACCINES IN PATIENTS WITH GLIOBLASTOMA. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab196.202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
INTRODUCTION
Vaccination with dendritic cells (DCs) fares poorly in primary and recurrent glioblastoma (GBM). Moreover, GBM vaccine trials are often underpowered due to limited sample size.
METHODS
To address these limitations, we conducted three sequential clinical trials utilizing Cytomegalovirus (CMV)-specific DC vaccines in patients with primary GBM. Autologous DCs were generated and electroporated with mRNA encoding for the CMV protein pp65. Serial vaccination was given throughout adjuvant temozolomide cycles, and 111Indium radiolabeling was implemented to assess migration efficiency of DC vaccines. Patients were followed for median overall survival (mOS) and OS.
RESULTS
Our initial study was the phase II ATTAC study (NCT00639639; total n=12) with 6 patients randomized to vaccine site preconditioning with tetanus-diphtheria (Td) toxoid. This led to an expanded cohort trial (ATTAC-GM; NCT00639639) of 11 patients receiving CMV DC vaccines containing granulocyte-macrophage colony-stimulating factor (GM-CSF). Follow-up data from ATTAC and ATTAC-GM revealed 5-year OS rates of 33.3% (mOS 38.3 months; CI95 17.5-undefined) and 36.4% (mOS 37.7 months; CI95 18.2-109.1), respectively. ATTAC additionally revealed a significant increase in DC migration to draining lymph nodes following Td preconditioning (P=0.049). Increased DC migration was associated with OS (Cox proportional hazards model, HR=0.820, P=0.023). Td-mediated increased migration has been recapitulated in our larger confirmatory trial ELEVATE (NCT02366728) of 43 patients randomized to preconditioning (Wilcoxon rank sum, Td n=24, unpulsed DC n=19; 24h, P=0.031 and 48h, P=0.0195). In ELEVATE, median follow-up of 42.2 months revealed significantly longer OS in patients randomized to Td (P=0.026). The 3-year OS for Td-treated patients in ELEVATE was 34% (CI95 19-63%) compared to 6% given unpulsed DCs (CI95 1-42%).
CONCLUSION
We report reproducibility of our findings across three sequential clinical trials using CMV pp65 DCs. Despite their small numbers, these successive trials demonstrate consistent survival outcomes, thus supporting the efficacy of CMV DC vaccine therapy in GBM.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Daniel Landi
- Preston Robert Tisch Brain Tumor Center at Duke, Durham, NC, USA
| | | | | | | | - David Reardon
- Dana-Farber Cancer Institute, Boston, MA, USA, Boston, MA, USA
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22
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Aguion PI, Kirkpatrick J, Carlomagno T, Marchanka A. Identifizierung von RNA‐Basenpaaren und vollständige Zuordnung von Nukleobasen‐Resonanzen durch Protonen‐detektierte Festkörper‐NMR‐Spektroskopie bei MAS Geschwindigkeiten von 100 kHz. Angew Chem Int Ed Engl 2021. [DOI: 10.1002/ange.202107263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Philipp Innig Aguion
- Institut für organische Chemie und Biomolekulares Wirkstoffzentrum (BMWZ) Leibniz Universität Hannover Schneiderberg 38 30167 Hannover Deutschland
| | - John Kirkpatrick
- Institut für organische Chemie und Biomolekulares Wirkstoffzentrum (BMWZ) Leibniz Universität Hannover Schneiderberg 38 30167 Hannover Deutschland
- NMR-basierte strukturelle Chemie Helmholtz-Zentrum für Infektionsforschung Inhoffenstrasse 7 38124 Braunschweig Deutschland
| | - Teresa Carlomagno
- Institut für organische Chemie und Biomolekulares Wirkstoffzentrum (BMWZ) Leibniz Universität Hannover Schneiderberg 38 30167 Hannover Deutschland
- NMR-basierte strukturelle Chemie Helmholtz-Zentrum für Infektionsforschung Inhoffenstrasse 7 38124 Braunschweig Deutschland
| | - Alexander Marchanka
- Institut für organische Chemie und Biomolekulares Wirkstoffzentrum (BMWZ) Leibniz Universität Hannover Schneiderberg 38 30167 Hannover Deutschland
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23
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Wang Y, Kirkpatrick J, Zur Lage S, Korn SM, Neißner K, Schwalbe H, Schlundt A, Carlomagno T. 1H, 13C, and 15N backbone chemical-shift assignments of SARS-CoV-2 non-structural protein 1 (leader protein). Biomol NMR Assign 2021; 15:287-295. [PMID: 33770349 PMCID: PMC7996116 DOI: 10.1007/s12104-021-10019-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 03/13/2021] [Indexed: 05/30/2023]
Abstract
The current COVID-19 pandemic caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has become a worldwide health crisis, necessitating coordinated scientific research and urgent identification of new drug targets for treatment of COVID-19 lung disease. The covid19-nmr consortium seeks to support drug development by providing publicly accessible NMR data on the viral RNA elements and proteins. The SARS-CoV-2 genome comprises a single RNA of about 30 kb in length, in which 14 open reading frames (ORFs) have been annotated, and encodes approximately 30 proteins. The first two-thirds of the SARS-CoV-2 genome is made up of two large overlapping open-reading-frames (ORF1a and ORF1b) encoding a replicase polyprotein, which is subsequently cleaved to yield 16 so-called non-structural proteins. The non-structural protein 1 (Nsp1), which is considered to be a major virulence factor, suppresses host immune functions by associating with host ribosomal complexes at the very end of its C-terminus. Furthermore, Nsp1 facilitates initiation of viral RNA translation via an interaction of its N-terminal domain with the 5' untranslated region (UTR) of the viral RNA. Here, we report the near-complete backbone chemical-shift assignments of full-length SARS-CoV-2 Nsp1 (19.8 kDa), which reveal the domain organization, secondary structure and backbone dynamics of Nsp1, and which will be of value to further NMR-based investigations of both the biochemical and physiological functions of Nsp1.
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Affiliation(s)
- Ying Wang
- Centre of Biomolecular Drug Research (BMWZ), Leibniz University Hannover, Schneiderberg 38, 30167, Hannover, Germany
| | - John Kirkpatrick
- Centre of Biomolecular Drug Research (BMWZ), Leibniz University Hannover, Schneiderberg 38, 30167, Hannover, Germany
- Group of NMR-Based Structural Chemistry, Helmholtz Centre for Infection Research, Inhoffenstrasse 7, 38124, Braunschweig, Germany
| | - Susanne Zur Lage
- Group of NMR-Based Structural Chemistry, Helmholtz Centre for Infection Research, Inhoffenstrasse 7, 38124, Braunschweig, Germany
| | - Sophie M Korn
- Institute for Molecular Biosciences, St Lucia, QLD, 4072, Australia
- Center for Biomolecular Magnetic Resonance (BMRZ), Johann Wolfgang Goethe-University Frankfurt, Max-von-Laue-Str. 7, 60438, Frankfurt, Germany
| | - Konstantin Neißner
- Institute for Molecular Biosciences, St Lucia, QLD, 4072, Australia
- Center for Biomolecular Magnetic Resonance (BMRZ), Johann Wolfgang Goethe-University Frankfurt, Max-von-Laue-Str. 7, 60438, Frankfurt, Germany
| | - Harald Schwalbe
- Institute for Organic Chemistry and Chemical Biology, 60438, Frankfurt, Germany
- Center for Biomolecular Magnetic Resonance (BMRZ), Johann Wolfgang Goethe-University Frankfurt, Max-von-Laue-Str. 7, 60438, Frankfurt, Germany
| | - Andreas Schlundt
- Institute for Molecular Biosciences, St Lucia, QLD, 4072, Australia
- Center for Biomolecular Magnetic Resonance (BMRZ), Johann Wolfgang Goethe-University Frankfurt, Max-von-Laue-Str. 7, 60438, Frankfurt, Germany
| | - Teresa Carlomagno
- Centre of Biomolecular Drug Research (BMWZ), Leibniz University Hannover, Schneiderberg 38, 30167, Hannover, Germany.
- Group of NMR-Based Structural Chemistry, Helmholtz Centre for Infection Research, Inhoffenstrasse 7, 38124, Braunschweig, Germany.
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24
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Carlomagno T, Aguion P, Kirkpatrick J, Marchanka A. Identification of RNA base pairs and complete assignment of nucleobase resonances by 1H-detected solid-state NMR spectroscopy at 100 kHz MAS. Angew Chem Int Ed Engl 2021; 60:23903-23910. [PMID: 34379871 PMCID: PMC8597087 DOI: 10.1002/anie.202107263] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Indexed: 12/02/2022]
Abstract
Knowledge of RNA structure, either in isolation or in complex, is fundamental to understand the mechanism of cellular processes. Solid‐state NMR (ssNMR) is applicable to high molecular‐weight complexes and does not require crystallization; thus, it is well‐suited to study RNA as part of large multicomponent assemblies. Recently, we solved the first structures of both RNA and an RNA‐protein complex by ssNMR using conventional 13C‐ and 15N‐detection. This approach is limited by the severe overlap of the RNA peaks together with the low sensitivity of multidimensional experiments. Here, we overcome the limitations in sensitivity and resolution by using 1H‐detection at fast MAS rates. We develop experiments that allow the identification of complete nucleobase spin‐systems together with their site‐specific base pair pattern using sub‐milligram quantities of one uniformly labelled RNA sample. These experiments provide rapid access to RNA secondary structure by ssNMR in protein‐RNA complexes of any size.
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Affiliation(s)
- Teresa Carlomagno
- Leibniz Universität Hannover, BMWZ Institute of Organic Chemistry, Schneiderberg 38, 30167, Hannover, GERMANY
| | - Philipp Aguion
- Leibniz Universität Hannover: Leibniz Universitat Hannover, Institute of Organic Chemistry, Hannover, GERMANY
| | - John Kirkpatrick
- Leibniz Universität Hannover: Leibniz Universitat Hannover, Institute of Organic Chemistry, GERMANY
| | - Alexander Marchanka
- Leibniz Universität Hannover: Leibniz Universitat Hannover, Institute of Organic Chemistry, GERMANY
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25
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Natesan D, Carpenter D, Giles W, Oyekunle T, Niedzwiecki D, Reitman Z, Kirkpatrick J, Floyd S. RADI-09. Clinical factors associated with death after radiotherapy for brain metastases. Neurooncol Adv 2021. [PMCID: PMC8351293 DOI: 10.1093/noajnl/vdab071.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Introduction It can be challenging to accurately identify patients with brain metastases who have very poor prognosis and are unlikely to benefit from radiation (RT). We characterized factors of patients who died within 30 days of receiving RT for brain metastases. Methods Patients who received whole brain RT (WBRT) or stereotactic radiosurgery (SRS) for brain metastases between 1/1/2017–9/30/2020 at a single institution were identified. Patient, tumor, treatment, and death variables were collected. Characteristics between those who did and did not die within 30 days were compared using the Wilcoxon Rank-Sum or Chi-Square test. Survival was estimated with Kaplan-Meier method. Results 636 patients received WBRT (n=117) or SRS (n=519). Median age was 61. Median survival was 6 months (95% CI 5–7 months). 75 (12%) died within 30 days of RT. Patients who died within 30 days had worse median KPS (50 vs 80, p<0.001). A higher proportion who died within 30 days had innumerable intracranial metastases (45% vs 11%, p<0.001), leptomeningeal disease (16% vs 5%, p<0.001), and higher burden of neurologic symptoms at presentation (seizures (12% vs 4%, p=0.003); cranial neuropathies (32% vs 9%, p<0.001); motor/sensory deficits (51% vs 29%, p<0.001); altered mentation (60% vs 26%, p<0.001); headaches (48% vs 30%, p<0.001); steroid use (68% vs 48%, p<0.001)). Patients who died within 30 days had progressive extracranial disease (intrathoracic: 87% vs 50%; spinal: 57% vs 18%; liver/adrenal: 60% vs 24%), p<0.001. More patients who died within 30 days received inpatient RT (39% vs 4%, <0.001) and did not complete RT (24% vs 1%, p<0.001). Discussion Patients who died within 30 days of RT had worse KPS, intracranial/extracranial disease burden, and neurologic symptoms. Future analyses will assess whether these factors can inform a prognostic model to identify patients with poor prognosis who may be appropriate for supportive care alone.
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Affiliation(s)
| | | | | | | | | | | | | | - Scott Floyd
- Duke University Medical Center, Durham, NC, USA
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Altincekic N, Korn SM, Qureshi NS, Dujardin M, Ninot-Pedrosa M, Abele R, Abi Saad MJ, Alfano C, Almeida FCL, Alshamleh I, de Amorim GC, Anderson TK, Anobom CD, Anorma C, Bains JK, Bax A, Blackledge M, Blechar J, Böckmann A, Brigandat L, Bula A, Bütikofer M, Camacho-Zarco AR, Carlomagno T, Caruso IP, Ceylan B, Chaikuad A, Chu F, Cole L, Crosby MG, de Jesus V, Dhamotharan K, Felli IC, Ferner J, Fleischmann Y, Fogeron ML, Fourkiotis NK, Fuks C, Fürtig B, Gallo A, Gande SL, Gerez JA, Ghosh D, Gomes-Neto F, Gorbatyuk O, Guseva S, Hacker C, Häfner S, Hao B, Hargittay B, Henzler-Wildman K, Hoch JC, Hohmann KF, Hutchison MT, Jaudzems K, Jović K, Kaderli J, Kalniņš G, Kaņepe I, Kirchdoerfer RN, Kirkpatrick J, Knapp S, Krishnathas R, Kutz F, zur Lage S, Lambertz R, Lang A, Laurents D, Lecoq L, Linhard V, Löhr F, Malki A, Bessa LM, Martin RW, Matzel T, Maurin D, McNutt SW, Mebus-Antunes NC, Meier BH, Meiser N, Mompeán M, Monaca E, Montserret R, Mariño Perez L, Moser C, Muhle-Goll C, Neves-Martins TC, Ni X, Norton-Baker B, Pierattelli R, Pontoriero L, Pustovalova Y, Ohlenschläger O, Orts J, Da Poian AT, Pyper DJ, Richter C, Riek R, Rienstra CM, Robertson A, Pinheiro AS, Sabbatella R, Salvi N, Saxena K, Schulte L, Schiavina M, Schwalbe H, Silber M, Almeida MDS, Sprague-Piercy MA, Spyroulias GA, Sreeramulu S, Tants JN, Tārs K, Torres F, Töws S, Treviño MÁ, Trucks S, Tsika AC, Varga K, Wang Y, Weber ME, Weigand JE, Wiedemann C, Wirmer-Bartoschek J, Wirtz Martin MA, Zehnder J, Hengesbach M, Schlundt A. Large-Scale Recombinant Production of the SARS-CoV-2 Proteome for High-Throughput and Structural Biology Applications. Front Mol Biosci 2021; 8:653148. [PMID: 34041264 PMCID: PMC8141814 DOI: 10.3389/fmolb.2021.653148] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 02/04/2021] [Indexed: 01/18/2023] Open
Abstract
The highly infectious disease COVID-19 caused by the Betacoronavirus SARS-CoV-2 poses a severe threat to humanity and demands the redirection of scientific efforts and criteria to organized research projects. The international COVID19-NMR consortium seeks to provide such new approaches by gathering scientific expertise worldwide. In particular, making available viral proteins and RNAs will pave the way to understanding the SARS-CoV-2 molecular components in detail. The research in COVID19-NMR and the resources provided through the consortium are fully disclosed to accelerate access and exploitation. NMR investigations of the viral molecular components are designated to provide the essential basis for further work, including macromolecular interaction studies and high-throughput drug screening. Here, we present the extensive catalog of a holistic SARS-CoV-2 protein preparation approach based on the consortium's collective efforts. We provide protocols for the large-scale production of more than 80% of all SARS-CoV-2 proteins or essential parts of them. Several of the proteins were produced in more than one laboratory, demonstrating the high interoperability between NMR groups worldwide. For the majority of proteins, we can produce isotope-labeled samples of HSQC-grade. Together with several NMR chemical shift assignments made publicly available on covid19-nmr.com, we here provide highly valuable resources for the production of SARS-CoV-2 proteins in isotope-labeled form.
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Affiliation(s)
- Nadide Altincekic
- Institute for Organic Chemistry and Chemical Biology, Goethe University Frankfurt, Frankfurt am Main, Germany
- Center of Biomolecular Magnetic Resonance (BMRZ), Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Sophie Marianne Korn
- Center of Biomolecular Magnetic Resonance (BMRZ), Goethe University Frankfurt, Frankfurt am Main, Germany
- Institute for Molecular Biosciences, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Nusrat Shahin Qureshi
- Institute for Organic Chemistry and Chemical Biology, Goethe University Frankfurt, Frankfurt am Main, Germany
- Center of Biomolecular Magnetic Resonance (BMRZ), Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Marie Dujardin
- Molecular Microbiology and Structural Biochemistry, UMR 5086, CNRS/Lyon University, Lyon, France
| | - Martí Ninot-Pedrosa
- Molecular Microbiology and Structural Biochemistry, UMR 5086, CNRS/Lyon University, Lyon, France
| | - Rupert Abele
- Institute for Biochemistry, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Marie Jose Abi Saad
- Swiss Federal Institute of Technology, Laboratory of Physical Chemistry, ETH Zurich, Zurich, Switzerland
| | - Caterina Alfano
- Structural Biology and Biophysics Unit, Fondazione Ri.MED, Palermo, Italy
| | - Fabio C. L. Almeida
- National Center of Nuclear Magnetic Resonance (CNRMN, CENABIO), Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Institute of Medical Biochemistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Islam Alshamleh
- Institute for Organic Chemistry and Chemical Biology, Goethe University Frankfurt, Frankfurt am Main, Germany
- Center of Biomolecular Magnetic Resonance (BMRZ), Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Gisele Cardoso de Amorim
- National Center of Nuclear Magnetic Resonance (CNRMN, CENABIO), Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Multidisciplinary Center for Research in Biology (NUMPEX), Campus Duque de Caxias Federal University of Rio de Janeiro, Duque de Caxias, Brazil
| | - Thomas K. Anderson
- Institute for Molecular Virology, University of Wisconsin-Madison, Madison, WI, United States
| | - Cristiane D. Anobom
- National Center of Nuclear Magnetic Resonance (CNRMN, CENABIO), Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Institute of Chemistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Chelsea Anorma
- Department of Chemistry, University of California, Irvine, CA, United States
| | - Jasleen Kaur Bains
- Institute for Organic Chemistry and Chemical Biology, Goethe University Frankfurt, Frankfurt am Main, Germany
- Center of Biomolecular Magnetic Resonance (BMRZ), Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Adriaan Bax
- LCP, NIDDK, NIH, Bethesda, MD, United States
| | | | - Julius Blechar
- Institute for Organic Chemistry and Chemical Biology, Goethe University Frankfurt, Frankfurt am Main, Germany
- Center of Biomolecular Magnetic Resonance (BMRZ), Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Anja Böckmann
- Molecular Microbiology and Structural Biochemistry, UMR 5086, CNRS/Lyon University, Lyon, France
| | - Louis Brigandat
- Molecular Microbiology and Structural Biochemistry, UMR 5086, CNRS/Lyon University, Lyon, France
| | - Anna Bula
- Latvian Institute of Organic Synthesis, Riga, Latvia
| | - Matthias Bütikofer
- Swiss Federal Institute of Technology, Laboratory of Physical Chemistry, ETH Zurich, Zurich, Switzerland
| | | | - Teresa Carlomagno
- BMWZ and Institute of Organic Chemistry, Leibniz University Hannover, Hannover, Germany
- Group of NMR-Based Structural Chemistry, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Icaro Putinhon Caruso
- National Center of Nuclear Magnetic Resonance (CNRMN, CENABIO), Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Institute of Medical Biochemistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Multiuser Center for Biomolecular Innovation (CMIB), Department of Physics, São Paulo State University (UNESP), São José do Rio Preto, Brazil
| | - Betül Ceylan
- Institute for Organic Chemistry and Chemical Biology, Goethe University Frankfurt, Frankfurt am Main, Germany
- Center of Biomolecular Magnetic Resonance (BMRZ), Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Apirat Chaikuad
- Institute of Pharmaceutical Chemistry, Goethe University Frankfurt, Frankfurt am Main, Germany
- Structural Genomics Consortium, Buchmann Institute for Molecular Life Sciences, Frankfurt am Main, Germany
| | - Feixia Chu
- Department of Molecular, Cellular, and Biomedical Sciences, University of New Hampshire, Durham, NH, United States
| | - Laura Cole
- Molecular Microbiology and Structural Biochemistry, UMR 5086, CNRS/Lyon University, Lyon, France
| | - Marquise G. Crosby
- Department of Molecular Biology and Biochemistry, University of California, Irvine, CA, United States
| | - Vanessa de Jesus
- Institute for Organic Chemistry and Chemical Biology, Goethe University Frankfurt, Frankfurt am Main, Germany
- Center of Biomolecular Magnetic Resonance (BMRZ), Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Karthikeyan Dhamotharan
- Center of Biomolecular Magnetic Resonance (BMRZ), Goethe University Frankfurt, Frankfurt am Main, Germany
- Institute for Molecular Biosciences, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Isabella C. Felli
- Magnetic Resonance Centre (CERM), University of Florence, Sesto Fiorentino, Italy
- Department of Chemistry “Ugo Schiff”, University of Florence, Sesto Fiorentino, Italy
| | - Jan Ferner
- Institute for Organic Chemistry and Chemical Biology, Goethe University Frankfurt, Frankfurt am Main, Germany
- Center of Biomolecular Magnetic Resonance (BMRZ), Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Yanick Fleischmann
- Swiss Federal Institute of Technology, Laboratory of Physical Chemistry, ETH Zurich, Zurich, Switzerland
| | - Marie-Laure Fogeron
- Molecular Microbiology and Structural Biochemistry, UMR 5086, CNRS/Lyon University, Lyon, France
| | | | - Christin Fuks
- Institute for Organic Chemistry and Chemical Biology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Boris Fürtig
- Institute for Organic Chemistry and Chemical Biology, Goethe University Frankfurt, Frankfurt am Main, Germany
- Center of Biomolecular Magnetic Resonance (BMRZ), Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Angelo Gallo
- Department of Pharmacy, University of Patras, Patras, Greece
| | - Santosh L. Gande
- Institute for Organic Chemistry and Chemical Biology, Goethe University Frankfurt, Frankfurt am Main, Germany
- Center of Biomolecular Magnetic Resonance (BMRZ), Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Juan Atilio Gerez
- Swiss Federal Institute of Technology, Laboratory of Physical Chemistry, ETH Zurich, Zurich, Switzerland
| | - Dhiman Ghosh
- Swiss Federal Institute of Technology, Laboratory of Physical Chemistry, ETH Zurich, Zurich, Switzerland
| | - Francisco Gomes-Neto
- National Center of Nuclear Magnetic Resonance (CNRMN, CENABIO), Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Laboratory of Toxinology, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - Oksana Gorbatyuk
- Department of Molecular Biology and Biophysics, UConn Health, Farmington, CT, United States
| | | | | | - Sabine Häfner
- Leibniz Institute on Aging—Fritz Lipmann Institute (FLI), Jena, Germany
| | - Bing Hao
- Department of Molecular Biology and Biophysics, UConn Health, Farmington, CT, United States
| | - Bruno Hargittay
- Institute for Organic Chemistry and Chemical Biology, Goethe University Frankfurt, Frankfurt am Main, Germany
- Center of Biomolecular Magnetic Resonance (BMRZ), Goethe University Frankfurt, Frankfurt am Main, Germany
| | - K. Henzler-Wildman
- Institute for Molecular Virology, University of Wisconsin-Madison, Madison, WI, United States
| | - Jeffrey C. Hoch
- Department of Molecular Biology and Biophysics, UConn Health, Farmington, CT, United States
| | - Katharina F. Hohmann
- Institute for Organic Chemistry and Chemical Biology, Goethe University Frankfurt, Frankfurt am Main, Germany
- Center of Biomolecular Magnetic Resonance (BMRZ), Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Marie T. Hutchison
- Institute for Organic Chemistry and Chemical Biology, Goethe University Frankfurt, Frankfurt am Main, Germany
- Center of Biomolecular Magnetic Resonance (BMRZ), Goethe University Frankfurt, Frankfurt am Main, Germany
| | | | - Katarina Jović
- Department of Molecular, Cellular, and Biomedical Sciences, University of New Hampshire, Durham, NH, United States
| | - Janina Kaderli
- Swiss Federal Institute of Technology, Laboratory of Physical Chemistry, ETH Zurich, Zurich, Switzerland
| | - Gints Kalniņš
- Latvian Biomedical Research and Study Centre, Riga, Latvia
| | - Iveta Kaņepe
- Latvian Institute of Organic Synthesis, Riga, Latvia
| | - Robert N. Kirchdoerfer
- Institute for Molecular Virology, University of Wisconsin-Madison, Madison, WI, United States
| | - John Kirkpatrick
- BMWZ and Institute of Organic Chemistry, Leibniz University Hannover, Hannover, Germany
- Group of NMR-Based Structural Chemistry, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Stefan Knapp
- Institute of Pharmaceutical Chemistry, Goethe University Frankfurt, Frankfurt am Main, Germany
- Structural Genomics Consortium, Buchmann Institute for Molecular Life Sciences, Frankfurt am Main, Germany
| | - Robin Krishnathas
- Institute for Organic Chemistry and Chemical Biology, Goethe University Frankfurt, Frankfurt am Main, Germany
- Center of Biomolecular Magnetic Resonance (BMRZ), Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Felicitas Kutz
- Institute for Organic Chemistry and Chemical Biology, Goethe University Frankfurt, Frankfurt am Main, Germany
- Center of Biomolecular Magnetic Resonance (BMRZ), Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Susanne zur Lage
- Group of NMR-Based Structural Chemistry, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Roderick Lambertz
- Institute for Molecular Biosciences, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Andras Lang
- Leibniz Institute on Aging—Fritz Lipmann Institute (FLI), Jena, Germany
| | - Douglas Laurents
- “Rocasolano” Institute for Physical Chemistry (IQFR), Spanish National Research Council (CSIC), Madrid, Spain
| | - Lauriane Lecoq
- Molecular Microbiology and Structural Biochemistry, UMR 5086, CNRS/Lyon University, Lyon, France
| | - Verena Linhard
- Institute for Organic Chemistry and Chemical Biology, Goethe University Frankfurt, Frankfurt am Main, Germany
- Center of Biomolecular Magnetic Resonance (BMRZ), Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Frank Löhr
- Center of Biomolecular Magnetic Resonance (BMRZ), Goethe University Frankfurt, Frankfurt am Main, Germany
- Institute of Biophysical Chemistry, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Anas Malki
- Univ. Grenoble Alpes, CNRS, CEA, IBS, Grenoble, France
| | | | - Rachel W. Martin
- Department of Chemistry, University of California, Irvine, CA, United States
- Department of Molecular Biology and Biochemistry, University of California, Irvine, CA, United States
| | - Tobias Matzel
- Institute for Organic Chemistry and Chemical Biology, Goethe University Frankfurt, Frankfurt am Main, Germany
- Center of Biomolecular Magnetic Resonance (BMRZ), Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Damien Maurin
- Univ. Grenoble Alpes, CNRS, CEA, IBS, Grenoble, France
| | - Seth W. McNutt
- Department of Molecular, Cellular, and Biomedical Sciences, University of New Hampshire, Durham, NH, United States
| | - Nathane Cunha Mebus-Antunes
- National Center of Nuclear Magnetic Resonance (CNRMN, CENABIO), Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Institute of Medical Biochemistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Beat H. Meier
- Swiss Federal Institute of Technology, Laboratory of Physical Chemistry, ETH Zurich, Zurich, Switzerland
| | - Nathalie Meiser
- Institute for Organic Chemistry and Chemical Biology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Miguel Mompeán
- “Rocasolano” Institute for Physical Chemistry (IQFR), Spanish National Research Council (CSIC), Madrid, Spain
| | - Elisa Monaca
- Structural Biology and Biophysics Unit, Fondazione Ri.MED, Palermo, Italy
| | - Roland Montserret
- Molecular Microbiology and Structural Biochemistry, UMR 5086, CNRS/Lyon University, Lyon, France
| | | | - Celine Moser
- IBG-4, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | | | - Thais Cristtina Neves-Martins
- National Center of Nuclear Magnetic Resonance (CNRMN, CENABIO), Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Institute of Medical Biochemistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Xiamonin Ni
- Institute of Pharmaceutical Chemistry, Goethe University Frankfurt, Frankfurt am Main, Germany
- Structural Genomics Consortium, Buchmann Institute for Molecular Life Sciences, Frankfurt am Main, Germany
| | - Brenna Norton-Baker
- Department of Chemistry, University of California, Irvine, CA, United States
| | - Roberta Pierattelli
- Magnetic Resonance Centre (CERM), University of Florence, Sesto Fiorentino, Italy
- Department of Chemistry “Ugo Schiff”, University of Florence, Sesto Fiorentino, Italy
| | - Letizia Pontoriero
- Magnetic Resonance Centre (CERM), University of Florence, Sesto Fiorentino, Italy
- Department of Chemistry “Ugo Schiff”, University of Florence, Sesto Fiorentino, Italy
| | - Yulia Pustovalova
- Department of Molecular Biology and Biophysics, UConn Health, Farmington, CT, United States
| | | | - Julien Orts
- Swiss Federal Institute of Technology, Laboratory of Physical Chemistry, ETH Zurich, Zurich, Switzerland
| | - Andrea T. Da Poian
- Institute of Medical Biochemistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Dennis J. Pyper
- Institute for Organic Chemistry and Chemical Biology, Goethe University Frankfurt, Frankfurt am Main, Germany
- Center of Biomolecular Magnetic Resonance (BMRZ), Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Christian Richter
- Institute for Organic Chemistry and Chemical Biology, Goethe University Frankfurt, Frankfurt am Main, Germany
- Center of Biomolecular Magnetic Resonance (BMRZ), Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Roland Riek
- Swiss Federal Institute of Technology, Laboratory of Physical Chemistry, ETH Zurich, Zurich, Switzerland
| | - Chad M. Rienstra
- Department of Biochemistry and National Magnetic Resonance Facility at Madison, University of Wisconsin-Madison, Madison, WI, United States
| | | | - Anderson S. Pinheiro
- National Center of Nuclear Magnetic Resonance (CNRMN, CENABIO), Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Institute of Chemistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Nicola Salvi
- Univ. Grenoble Alpes, CNRS, CEA, IBS, Grenoble, France
| | - Krishna Saxena
- Institute for Organic Chemistry and Chemical Biology, Goethe University Frankfurt, Frankfurt am Main, Germany
- Center of Biomolecular Magnetic Resonance (BMRZ), Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Linda Schulte
- Institute for Organic Chemistry and Chemical Biology, Goethe University Frankfurt, Frankfurt am Main, Germany
- Center of Biomolecular Magnetic Resonance (BMRZ), Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Marco Schiavina
- Magnetic Resonance Centre (CERM), University of Florence, Sesto Fiorentino, Italy
- Department of Chemistry “Ugo Schiff”, University of Florence, Sesto Fiorentino, Italy
| | - Harald Schwalbe
- Institute for Organic Chemistry and Chemical Biology, Goethe University Frankfurt, Frankfurt am Main, Germany
- Center of Biomolecular Magnetic Resonance (BMRZ), Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Mara Silber
- IBG-4, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Marcius da Silva Almeida
- National Center of Nuclear Magnetic Resonance (CNRMN, CENABIO), Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Institute of Medical Biochemistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marc A. Sprague-Piercy
- Department of Molecular Biology and Biochemistry, University of California, Irvine, CA, United States
| | | | - Sridhar Sreeramulu
- Institute for Organic Chemistry and Chemical Biology, Goethe University Frankfurt, Frankfurt am Main, Germany
- Center of Biomolecular Magnetic Resonance (BMRZ), Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Jan-Niklas Tants
- Center of Biomolecular Magnetic Resonance (BMRZ), Goethe University Frankfurt, Frankfurt am Main, Germany
- Institute for Molecular Biosciences, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Kaspars Tārs
- Latvian Biomedical Research and Study Centre, Riga, Latvia
| | - Felix Torres
- Swiss Federal Institute of Technology, Laboratory of Physical Chemistry, ETH Zurich, Zurich, Switzerland
| | - Sabrina Töws
- Institute for Molecular Biosciences, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Miguel Á. Treviño
- “Rocasolano” Institute for Physical Chemistry (IQFR), Spanish National Research Council (CSIC), Madrid, Spain
| | - Sven Trucks
- Institute for Organic Chemistry and Chemical Biology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | | | - Krisztina Varga
- Department of Molecular, Cellular, and Biomedical Sciences, University of New Hampshire, Durham, NH, United States
| | - Ying Wang
- BMWZ and Institute of Organic Chemistry, Leibniz University Hannover, Hannover, Germany
| | - Marco E. Weber
- Swiss Federal Institute of Technology, Laboratory of Physical Chemistry, ETH Zurich, Zurich, Switzerland
| | - Julia E. Weigand
- Department of Biology, Technical University of Darmstadt, Darmstadt, Germany
| | - Christoph Wiedemann
- Institute of Biochemistry and Biotechnology, Charles Tanford Protein Centre, Martin Luther University Halle-Wittenberg, Halle/Saale, Germany
| | - Julia Wirmer-Bartoschek
- Institute for Organic Chemistry and Chemical Biology, Goethe University Frankfurt, Frankfurt am Main, Germany
- Center of Biomolecular Magnetic Resonance (BMRZ), Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Maria Alexandra Wirtz Martin
- Institute for Organic Chemistry and Chemical Biology, Goethe University Frankfurt, Frankfurt am Main, Germany
- Center of Biomolecular Magnetic Resonance (BMRZ), Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Johannes Zehnder
- Swiss Federal Institute of Technology, Laboratory of Physical Chemistry, ETH Zurich, Zurich, Switzerland
| | - Martin Hengesbach
- Institute for Organic Chemistry and Chemical Biology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Andreas Schlundt
- Center of Biomolecular Magnetic Resonance (BMRZ), Goethe University Frankfurt, Frankfurt am Main, Germany
- Institute for Molecular Biosciences, Goethe University Frankfurt, Frankfurt am Main, Germany
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Marasco M, Kirkpatrick J, Nanna V, Sikorska J, Carlomagno T. Phosphotyrosine couples peptide binding and SHP2 activation via a dynamic allosteric network. Comput Struct Biotechnol J 2021; 19:2398-2415. [PMID: 34025932 PMCID: PMC8113834 DOI: 10.1016/j.csbj.2021.04.040] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/14/2021] [Accepted: 04/16/2021] [Indexed: 11/18/2022] Open
Abstract
SHP2 is a ubiquitous protein tyrosine phosphatase, whose activity is regulated by phosphotyrosine (pY)-containing peptides generated in response to extracellular stimuli. Its crystal structure reveals a closed, auto-inhibited conformation in which the N-terminal Src homology 2 (N-SH2) domain occludes the catalytic site of the phosphatase (PTP) domain. High-affinity mono-phosphorylated peptides promote catalytic activity by binding to N-SH2 and disrupting the interaction with the PTP. The mechanism behind this process is not entirely clear, especially because N-SH2 is incapable of accommodating complete peptide binding when SHP2 is in the auto-inhibited state. Here, we show that pY performs an essential role in this process; in addition to its contribution to overall peptide-binding energy, pY-recognition leads to enhanced dynamics of the N-SH2 EF and BG loops via an allosteric communication network, which destabilizes the N-SH2-PTP interaction surface and simultaneously generates a fully accessible binding pocket for the C-terminal half of the phosphopeptide. Subsequently, full binding of the phosphopeptide is associated with the stabilization of activated SHP2. We demonstrate that this allosteric network exists only in N-SH2, which is directly involved in the regulation of SHP2 activity, while the C-terminal SH2 domain (C-SH2) functions primarily to recruit high-affinity bidentate phosphopeptides.
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Affiliation(s)
- Michelangelo Marasco
- Leibniz University Hannover, Center of Biomolecular Drug Research and Institute of Organic Chemistry, Schneiderberg 38, 30167 Hannover, Germany
| | - John Kirkpatrick
- Leibniz University Hannover, Center of Biomolecular Drug Research and Institute of Organic Chemistry, Schneiderberg 38, 30167 Hannover, Germany
- Helmholtz Center for Infection Research, Group of NMR-based Structural Chemistry, Inhoffenstrasse 7, 38124 Braunschweig, Germany
| | - Vittoria Nanna
- Leibniz University Hannover, Center of Biomolecular Drug Research and Institute of Organic Chemistry, Schneiderberg 38, 30167 Hannover, Germany
| | - Justyna Sikorska
- Helmholtz Center for Infection Research, Group of NMR-based Structural Chemistry, Inhoffenstrasse 7, 38124 Braunschweig, Germany
| | - Teresa Carlomagno
- Leibniz University Hannover, Center of Biomolecular Drug Research and Institute of Organic Chemistry, Schneiderberg 38, 30167 Hannover, Germany
- Helmholtz Center for Infection Research, Group of NMR-based Structural Chemistry, Inhoffenstrasse 7, 38124 Braunschweig, Germany
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28
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Moon H, Lennon DT, Kirkpatrick J, van Esbroeck NM, Camenzind LC, Yu L, Vigneau F, Zumbühl DM, Briggs GAD, Osborne MA, Sejdinovic D, Laird EA, Ares N. Machine learning enables completely automatic tuning of a quantum device faster than human experts. Nat Commun 2020; 11:4161. [PMID: 32814777 PMCID: PMC7438325 DOI: 10.1038/s41467-020-17835-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 07/16/2020] [Indexed: 11/28/2022] Open
Abstract
Variability is a problem for the scalability of semiconductor quantum devices. The parameter space is large, and the operating range is small. Our statistical tuning algorithm searches for specific electron transport features in gate-defined quantum dot devices with a gate voltage space of up to eight dimensions. Starting from the full range of each gate voltage, our machine learning algorithm can tune each device to optimal performance in a median time of under 70 minutes. This performance surpassed our best human benchmark (although both human and machine performance can be improved). The algorithm is approximately 180 times faster than an automated random search of the parameter space, and is suitable for different material systems and device architectures. Our results yield a quantitative measurement of device variability, from one device to another and after thermal cycling. Our machine learning algorithm can be extended to higher dimensions and other technologies.
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Affiliation(s)
- H Moon
- Department of Materials, University of Oxford, Parks Road, Oxford, OX1 3PH, UK
| | - D T Lennon
- Department of Materials, University of Oxford, Parks Road, Oxford, OX1 3PH, UK
| | | | - N M van Esbroeck
- Department of Materials, University of Oxford, Parks Road, Oxford, OX1 3PH, UK
- Department of Applied Physics, Eindhoven University of Technology, Eindhoven, MB, 5600, The Netherlands
| | - L C Camenzind
- Department of Physics, University of Basel, Basel, 4056, Switzerland
| | - Liuqi Yu
- Department of Physics, University of Basel, Basel, 4056, Switzerland
| | - F Vigneau
- Department of Materials, University of Oxford, Parks Road, Oxford, OX1 3PH, UK
| | - D M Zumbühl
- Department of Physics, University of Basel, Basel, 4056, Switzerland
| | - G A D Briggs
- Department of Materials, University of Oxford, Parks Road, Oxford, OX1 3PH, UK
| | - M A Osborne
- Department of Engineering, University of Oxford, Walton Well Road, Oxford, OX2 6ED, UK
| | - D Sejdinovic
- Department of Statistics, University of Oxford, 24-29 St Giles, Oxford, OX1 3LB, UK
| | - E A Laird
- Department of Physics, Lancaster University, Lancaster, LA1 4YB, UK
| | - N Ares
- Department of Materials, University of Oxford, Parks Road, Oxford, OX1 3PH, UK.
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29
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Werbeck ND, Shukla VK, Kunze MBA, Yalinca H, Pritchard RB, Siemons L, Mondal S, Greenwood SOR, Kirkpatrick J, Marson CM, Hansen DF. A distal regulatory region of a class I human histone deacetylase. Nat Commun 2020; 11:3841. [PMID: 32737323 PMCID: PMC7395746 DOI: 10.1038/s41467-020-17610-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 07/09/2020] [Indexed: 01/05/2023] Open
Abstract
Histone deacetylases (HDACs) are key enzymes in epigenetics and important drug targets in cancer biology. Whilst it has been established that HDACs regulate many cellular processes, far less is known about the regulation of these enzymes themselves. Here, we show that HDAC8 is allosterically regulated by shifts in populations between exchanging states. An inactive state is identified, which is stabilised by a range of mutations and resembles a sparsely-populated state in equilibrium with active HDAC8. Computational models show that the inactive and active states differ by small changes in a regulatory region that extends up to 28 Å from the active site. The regulatory allosteric region identified here in HDAC8 corresponds to regions in other class I HDACs known to bind regulators, thus suggesting a general mechanism. The presented results pave the way for the development of allosteric HDAC inhibitors and regulators to improve the therapy for several disease states.
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Affiliation(s)
- Nicolas D Werbeck
- Institute of Structural and Molecular Biology, Division of Biosciences, University College London, London, WC1E 6BT, UK
- Nuvisan ICB GmbH, Innovation Campus Berlin, Müllerstraße 178, 13353, Berlin, Germany
| | - Vaibhav Kumar Shukla
- Institute of Structural and Molecular Biology, Division of Biosciences, University College London, London, WC1E 6BT, UK
| | - Micha B A Kunze
- Institute of Structural and Molecular Biology, Division of Biosciences, University College London, London, WC1E 6BT, UK
| | - Havva Yalinca
- Institute of Structural and Molecular Biology, Division of Biosciences, University College London, London, WC1E 6BT, UK
| | - Ruth B Pritchard
- Institute of Structural and Molecular Biology, Division of Biosciences, University College London, London, WC1E 6BT, UK
| | - Lucas Siemons
- Institute of Structural and Molecular Biology, Division of Biosciences, University College London, London, WC1E 6BT, UK
| | - Somnath Mondal
- Institute of Structural and Molecular Biology, Division of Biosciences, University College London, London, WC1E 6BT, UK
| | - Simon O R Greenwood
- Institute of Structural and Molecular Biology, Division of Biosciences, University College London, London, WC1E 6BT, UK
- Department of Chemistry, University College London, London, WC1E 6BT, UK
| | - John Kirkpatrick
- Institute of Structural and Molecular Biology, Division of Biosciences, University College London, London, WC1E 6BT, UK
| | - Charles M Marson
- Department of Chemistry, University College London, London, WC1E 6BT, UK
| | - D Flemming Hansen
- Institute of Structural and Molecular Biology, Division of Biosciences, University College London, London, WC1E 6BT, UK.
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30
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Abstract
2'-O-rRNA methylation, which is essential in eukaryotes and archaea, is catalysed by the Box C/D RNP complex in an RNA-guided manner. Despite the conservation of the methylation sites, the abundance of site-specific modifications shows variability across species and tissues, suggesting that rRNA methylation may provide a means of controlling gene expression. As all Box C/D RNPs are thought to adopt a similar structure, it remains unclear how the methylation efficiency is regulated. Here, we provide the first structural evidence that, in the context of the Box C/D RNP, the affinity of the catalytic module fibrillarin for the substrate-guide helix is dependent on the RNA sequence outside the methylation site, thus providing a mechanism by which both the substrate and guide RNA sequences determine the degree of methylation. To reach this result, we develop an iterative structure-calculation protocol that exploits the power of integrative structural biology to characterize conformational ensembles.
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Affiliation(s)
- Andrea Graziadei
- European Molecular Biology Laboratory, Structural and Computational BiologyHeidelbergGermany
- Leibniz University Hannover, Centre for Biomolecular Drug ResearchHannoverGermany
| | - Frank Gabel
- University Grenoble Alpes, CEA, CNRS IBSGrenobleFrance
- Institut Laue-LangevinGrenobleFrance
| | - John Kirkpatrick
- Leibniz University Hannover, Centre for Biomolecular Drug ResearchHannoverGermany
- Helmholtz Centre for Infection Research, Group of Structural ChemistryBraunschweigGermany
| | - Teresa Carlomagno
- Leibniz University Hannover, Centre for Biomolecular Drug ResearchHannoverGermany
- Helmholtz Centre for Infection Research, Group of Structural ChemistryBraunschweigGermany
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31
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Marasco M, Berteotti A, Weyershaeuser J, Thorausch N, Sikorska J, Krausze J, Brandt HJ, Kirkpatrick J, Rios P, Schamel WW, Köhn M, Carlomagno T. Molecular mechanism of SHP2 activation by PD-1 stimulation. Sci Adv 2020; 6:eaay4458. [PMID: 32064351 PMCID: PMC6994217 DOI: 10.1126/sciadv.aay4458] [Citation(s) in RCA: 128] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 11/22/2019] [Indexed: 05/02/2023]
Abstract
In cancer, the programmed death-1 (PD-1) pathway suppresses T cell stimulation and mediates immune escape. Upon stimulation, PD-1 becomes phosphorylated at its immune receptor tyrosine-based inhibitory motif (ITIM) and immune receptor tyrosine-based switch motif (ITSM), which then bind the Src homology 2 (SH2) domains of SH2-containing phosphatase 2 (SHP2), initiating T cell inactivation. The SHP2-PD-1 complex structure and the exact functions of the two SH2 domains and phosphorylated motifs remain unknown. Here, we explain the structural basis and provide functional evidence for the mechanism of PD-1-mediated SHP2 activation. We demonstrate that full activation is obtained only upon phosphorylation of both ITIM and ITSM: ITSM binds C-SH2 with strong affinity, recruiting SHP2 to PD-1, while ITIM binds N-SH2, displacing it from the catalytic pocket and activating SHP2. This binding event requires the formation of a new inter-domain interface, offering opportunities for the development of novel immunotherapeutic approaches.
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Affiliation(s)
- M. Marasco
- Leibniz University Hannover, Institute of Organic Chemistry and Center for Biomolecular Drug Research, Schneiderberg 38, 30167 Hannover, Germany
| | - A. Berteotti
- European Molecular Biology Laboratory, Structural and Computational Biology Unit, Meyerhofstrasse 1, 69117 Heidelberg, Germany
- European Molecular Biology Laboratory, Genome Biology Unit, Meyerhofstrasse 1, 69117 Heidelberg, Germany
| | - J. Weyershaeuser
- Faculty of Biology, Institute of Biology III, University of Freiburg, Schänzlestrasse 18, 79104 Freiburg, Germany
- Signalling Research Centers BIOSS and CIBSS, University of Freiburg, Freiburg, Germany
| | - N. Thorausch
- Faculty of Biology, Institute of Biology III, University of Freiburg, Schänzlestrasse 18, 79104 Freiburg, Germany
- Signalling Research Centers BIOSS and CIBSS, University of Freiburg, Freiburg, Germany
| | - J. Sikorska
- Helmholtz Centre for Infection Research, Group of Structural Chemistry, Inhoffenstrasse 7, 38124 Braunschweig, Germany
| | - J. Krausze
- Leibniz University Hannover, Institute of Organic Chemistry and Center for Biomolecular Drug Research, Schneiderberg 38, 30167 Hannover, Germany
| | - H. J. Brandt
- Faculty of Biology, Institute of Biology III, University of Freiburg, Schänzlestrasse 18, 79104 Freiburg, Germany
- Signalling Research Centers BIOSS and CIBSS, University of Freiburg, Freiburg, Germany
| | - J. Kirkpatrick
- Leibniz University Hannover, Institute of Organic Chemistry and Center for Biomolecular Drug Research, Schneiderberg 38, 30167 Hannover, Germany
- Helmholtz Centre for Infection Research, Group of Structural Chemistry, Inhoffenstrasse 7, 38124 Braunschweig, Germany
| | - P. Rios
- European Molecular Biology Laboratory, Genome Biology Unit, Meyerhofstrasse 1, 69117 Heidelberg, Germany
- Faculty of Biology, Institute of Biology III, University of Freiburg, Schänzlestrasse 18, 79104 Freiburg, Germany
- Signalling Research Centers BIOSS and CIBSS, University of Freiburg, Freiburg, Germany
| | - W. W. Schamel
- Faculty of Biology, Institute of Biology III, University of Freiburg, Schänzlestrasse 18, 79104 Freiburg, Germany
- Signalling Research Centers BIOSS and CIBSS, University of Freiburg, Freiburg, Germany
- Center of Chronic Immunodeficiency CCI, University Clinics and Medical Faculty, Freiburg, Germany
| | - M. Köhn
- European Molecular Biology Laboratory, Genome Biology Unit, Meyerhofstrasse 1, 69117 Heidelberg, Germany
- Faculty of Biology, Institute of Biology III, University of Freiburg, Schänzlestrasse 18, 79104 Freiburg, Germany
- Signalling Research Centers BIOSS and CIBSS, University of Freiburg, Freiburg, Germany
- Corresponding author. (T.C.); (M.K.)
| | - T. Carlomagno
- Leibniz University Hannover, Institute of Organic Chemistry and Center for Biomolecular Drug Research, Schneiderberg 38, 30167 Hannover, Germany
- European Molecular Biology Laboratory, Structural and Computational Biology Unit, Meyerhofstrasse 1, 69117 Heidelberg, Germany
- Helmholtz Centre for Infection Research, Group of Structural Chemistry, Inhoffenstrasse 7, 38124 Braunschweig, Germany
- Corresponding author. (T.C.); (M.K.)
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32
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Barbour A, Healy P, Lipp E, Herndon J, Thomas L, Johnson M, Ashley D, Desjardins A, Randazzo D, Friedman H, Kirkpatrick J, Peters K. HOUT-21. CHARACTERISTICS OF SHORT-TERM SURVIVAL IN PATIENTS WITH GLIOBLASTOMA: A RETROSPECTIVE ANALYSIS. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz175.486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
We sought to identify characteristics of glioblastoma (GBM) patients with short survival (< 10 months) in order to identify prognostic factors useful for guiding treatment management. This is an IRB-approved retrospective analysis of adult newly diagnosed GBM patients from 2008–2016 who survived < 10 months from diagnosis. We extracted demographics, tumor characteristics, and treatment details. We calculated survival from surgical diagnosis to date of death. The cohort includes 197 subjects (61% male) with a median age of 68 years (range 19–94). The majority (93%) are non-Hispanic white. The cohort has a median survival of 144 days (95% CI: 130–160). We focused on traditional prognostic indicators, including extent of surgical resection and KPS. A majority had biopsy only (n=92, 46.7%) rather than gross total (n=59, 29.9%) or subtotal (n=46, 23.4%) resection. Moreover, 160 out of 197 patients had a documented KPS with a majority being below 90 (KPS=70–80 (n=96); KPS < 70 (n=31)). Of 179 patients with data on RT course, 18% (n=32) received no RT or opted for hospice after diagnosis, 3% (n=6) received only RT, 54% (n=97) received RT+temozolomide (TMZ), and 24% (n=43) received RT+TMZ+bevacizumab. Of the 147 subjects receiving RT, 79% completed their RT course as prescribed. Most commonly, RT was prescribed as a 6- to 6-1/2-week course (85%), typically 59.4 Gy (45Gy primary, 14.4Gy boost) over 33 fractions or 60 Gy over 30 fractions. In contrast, 15% received a 3-week RT course, typically scheduled as 15 fractions of 2.667 Gy. We concluded that GBM patients with survival < 10 months were more likely to have biopsy only and a KPS < 90, notably associated with poorer prognosis. We continue to explore this dataset for further prognostic factors, particularly inability to complete planned RT course, and are comparing these traits to a larger cohort.
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Affiliation(s)
| | | | - Eric Lipp
- Duke University Medical Center, Durham, NC, USA
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33
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Kirkpatrick J, Franklin H, Torok J, Floyd S, Anders C, Fecci P, Salama A, Clarke J, George D, Crapo J, Peters K. TRLS-10. MITIGATING NEUROCOGNITIVE DEFICITS FROM WHOLE-BRAIN RADIOTHERAPY IN PATIENTS WITH NUMEROUS BRAIN METASTASES VIA A NOVEL SUPEROXIDE DISMUTASE MIMETIC: RATIONALE & DESIGN OF A CLINICAL TRIAL. Neurooncol Adv 2019. [PMCID: PMC7213399 DOI: 10.1093/noajnl/vdz014.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND: Patients with a large number of brain metastases (BM) and/or micrometastatic disease in the brain present a clinical challenge. While technical innovations in stereotactic radiosurgery (SRS) have extended the number of BM that can be effectively treated, SRS does not treat occult disease and distant brain failure (DBF) post-SRS remains high. Immuno- and targeted therapies show promise in treating metastatic disease to the brain, though response rates are variable. In contrast, whole-brain radiotherapy (WBRT) provides high rates of local control and, compared to SRS, reduces the risk of distant brain failure. Unfortunately, WBRT is also associated with substantial neurocognitive deficits and neither altered fractionation nor the use of available neuroprotectants has adequately addressed this issue. An agent that safely minimizes the adverse effects of WBRT while preserving or enhancing tumor control would provide meaningful clinical benefit. TRIAL DESIGN: BMX-001, a novel Mn-porphyrin superoxide dismutase mimetic, has been shown to protect normal tissues from ionizing radiation in preclinical trials, reducing neurocognitive adverse effects as well as enhancing tumor response. Based on the first-in-human trial of this agent in patients with high-grade gliomas, we have instituted a clinical trial of WBRT +/- BMX-001 in adult patients with more than 10 BM from melanoma, non-small-cell lung, breast and renal cancer. Following a safety lead-in of 5 patients, all of whom will receive WBRT and BMX-001, 69 patients will be randomized to WBRT (3Gy/fraction x 10 fractions) with or without BMX-001 administered subcutaneously before, twice weekly during and once after WBRT (6 injections total.) The primary endpoint is cognition, as measured by the Hopkins Verbal Learning, Trailmaking A/B and Controlled Oral Word Association tests. Secondary endpoints include health-related quality-of-life, overall and progression-free survival, rates of radiation necrosis, DBF and neurologic death. Enrollment began January 2019. (ClinicalTrials.gov Identifier: NCT03608020.)
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Affiliation(s)
| | | | | | - Scott Floyd
- Duke University Medical Center, Durham, NC, USA
| | | | - Peter Fecci
- Duke University Medical Center, Durham, NC, USA
| | | | | | | | - James Crapo
- BioMimetix Pharmaceutical, Inc., Greenwood Village, CO, USA
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34
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Jacobs C, Woldemichael K, Williamson H, Abisheva Z, Howell E, Abdelgadir J, Dechant C, Floyd S, Fecci P, Kirkpatrick J, Adamson J, Torok J. RADI-06. SINGLE- VERSUS MULTI-FRACTION STEREOTACTIC RADIOSURGERY FOR BRAINSTEM METASTASES. Neurooncol Adv 2019. [PMCID: PMC7213304 DOI: 10.1093/noajnl/vdz014.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND: For intracranial metastases with planning target volume (PTV) overlap of the brainstem (BSmet), the radiosurgical dose-fractionation that optimizes the therapeutic window is unknown. MATERIALS/METHODS: A retrospective review of brain metastases (BM) with/without BSmets treated with single-fraction stereotactic radiosurgery (SRS) or hypofractionated (2–5 fractions) radiosurgery (HF-SRS) between 2012–2016 was performed. Brainstem biologically effective doses (BED) and single-fraction equivalents of brainstem V10/V12 were calculated using α/β=3. Characteristics were compared between patients with/without BSmet and between SRS/HF-SRS cohorts using Wilcoxon rank sum, chi-square, or Fisher’s exact tests. Radiographic progression (RP) was assessed in patients with post-treatment contrasted MRI and defined as BSmet enlargement regardless of etiology (progression, radionecrosis, indeterminate). Kaplan-Meier estimates were compared between cohorts using log-rank test. RESULTS: 634 SRS/HF-SRS courses were identified, of which 59 (9.3%) treated ≥1 BSmet in 55 patients. BSmets occurred more commonly in patients with >4 BM (31% vs 10%, p< 0.001) and intracranial recurrence (39% vs 20%, p=0.003). BSmets were treated in 1 (22/59; 37%), 2 (1/59; 2%), or 5 (36/59; 61%) fractions. Age, KPS, and primary tumor site were balanced between SRS/HF-SRS cohorts. The HF-SRS cohort had significantly larger BSmet PTV (median 1.39cc vs 0.39cc, p=0.021), marginal dose (median 25Gy vs 15Gy, p< 0.001), brainstem V10 (median 1.60cc vs 0.47cc, p< 0.001), brainstem V12 (median 0.78cc vs 0.06cc, p< 0.001), and mean brainstem BED (median 9.27Gy3 vs 6.55Gy3, p=0.019). The SRS cohort was more likely to have prior whole brain radiotherapy (50% vs 14%, p=0.005) and restart steroids post-treatment (78% vs 41%, p=0.019). RP occurred in 6/17 vs 2/25 patients in the SRS vs HF-SRS cohorts, respectively (p=0.045). HF-SRS trended to higher freedom from RP (93% vs 74% @12mo; p=0.072). There was no overall survival difference (p=0.36). CONCLUSIONS: HF-SRS was associated with decreased RP and decreased likelihood of restarting steroids despite treating larger BSmets.
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Affiliation(s)
| | | | | | | | | | | | | | - Scott Floyd
- Duke University Medical Center, Durham, NC, USA
| | - Peter Fecci
- Duke University Medical Center, Durham, NC, USA
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35
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Danilenko N, Lercher L, Kirkpatrick J, Gabel F, Codutti L, Carlomagno T. Histone chaperone exploits intrinsic disorder to switch acetylation specificity. Nat Commun 2019; 10:3435. [PMID: 31387991 PMCID: PMC6684614 DOI: 10.1038/s41467-019-11410-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 07/14/2019] [Indexed: 12/13/2022] Open
Abstract
Histones, the principal protein components of chromatin, contain long disordered sequences, which are extensively post-translationally modified. Although histone chaperones are known to control both the activity and specificity of histone-modifying enzymes, the mechanisms promoting modification of highly disordered substrates, such as lysine-acetylation within the N-terminal tail of histone H3, are not understood. Here, to understand how histone chaperones Asf1 and Vps75 together promote H3 K9-acetylation, we establish the solution structural model of the acetyltransferase Rtt109 in complex with Asf1 and Vps75 and the histone dimer H3:H4. We show that Vps75 promotes K9-acetylation by engaging the H3 N-terminal tail in fuzzy electrostatic interactions with its disordered C-terminal domain, thereby confining the H3 tail to a wide central cavity faced by the Rtt109 active site. These fuzzy interactions between disordered domains achieve localization of lysine residues in the H3 tail to the catalytic site with minimal loss of entropy, and may represent a common mechanism of enzymatic reactions involving highly disordered substrates.
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Affiliation(s)
- Nataliya Danilenko
- Leibniz University Hannover, Centre for Biomolecular Drug Research, Schneiderberg 38, D-30167, Hannover, Germany
| | - Lukas Lercher
- Leibniz University Hannover, Centre for Biomolecular Drug Research, Schneiderberg 38, D-30167, Hannover, Germany
| | - John Kirkpatrick
- Leibniz University Hannover, Centre for Biomolecular Drug Research, Schneiderberg 38, D-30167, Hannover, Germany.,Helmholtz Centre for Infection Research, Group of Structural Chemistry, Inhoffenstrasse 7, D-38124, Braunschweig, Germany
| | - Frank Gabel
- University Grenoble Alpes, CEA, CNRS IBS, 71 avenue des Martyrs, F-38044, Grenoble, France.,Institut Laue-Langevin, 71 avenue des Martyrs, F-38042, Grenoble, France
| | - Luca Codutti
- Leibniz University Hannover, Centre for Biomolecular Drug Research, Schneiderberg 38, D-30167, Hannover, Germany
| | - Teresa Carlomagno
- Leibniz University Hannover, Centre for Biomolecular Drug Research, Schneiderberg 38, D-30167, Hannover, Germany. .,Helmholtz Centre for Infection Research, Group of Structural Chemistry, Inhoffenstrasse 7, D-38124, Braunschweig, Germany.
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36
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Lercher L, Danilenko N, Kirkpatrick J, Carlomagno T. Structural characterization of the Asf1-Rtt109 interaction and its role in histone acetylation. Nucleic Acids Res 2019; 46:2279-2289. [PMID: 29300933 PMCID: PMC5861439 DOI: 10.1093/nar/gkx1283] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 12/18/2017] [Indexed: 02/03/2023] Open
Abstract
Acetylation of histone H3 at lysine-56 by the histone acetyltransferase Rtt109 in lower eukaryotes is important for maintaining genomic integrity and is required for C. albicans pathogenicity. Rtt109 is activated by association with two different histone chaperones, Vps75 and Asf1, through an unknown mechanism. Here, we reveal that the Rtt109 C-terminus interacts directly with Asf1 and elucidate the structural basis of this interaction. In addition, we find that the H3 N-terminus can interact via the same interface on Asf1, leading to a competition between the two interaction partners. This, together with the recruitment and position of the substrate, provides an explanation of the role of the Rtt109 C-terminus in Asf1-dependent Rtt109 activation.
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Affiliation(s)
- Lukas Lercher
- BMWZ and Institute of Organic Chemistry, Leibniz Universität Hannover, Hannover, Germany
| | - Nataliya Danilenko
- BMWZ and Institute of Organic Chemistry, Leibniz Universität Hannover, Hannover, Germany
| | - John Kirkpatrick
- BMWZ and Institute of Organic Chemistry, Leibniz Universität Hannover, Hannover, Germany
| | - Teresa Carlomagno
- BMWZ and Institute of Organic Chemistry, Leibniz Universität Hannover, Hannover, Germany.,Research Group of NMR-based Structural Chemistry, Helmholtz Centre for Infection Research, Braunschweig, Germany
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37
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Devi GR, Hough H, Barrett N, Cristofanilli M, Overmoyer B, Spector N, Ueno NT, Woodward W, Kirkpatrick J, Vincent B, Williams KP, Finley C, Duff B, Worthy V, McCall S, Hollister BA, Palmer G, Force J, Westbrook K, Fayanju O, Suneja G, Dent SF, Hwang ES, Patierno SR, Marcom PK. Perspectives on Inflammatory Breast Cancer (IBC) Research, Clinical Management and Community Engagement from the Duke IBC Consortium. J Cancer 2019; 10:3344-3351. [PMID: 31293637 PMCID: PMC6603420 DOI: 10.7150/jca.31176] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 04/12/2019] [Indexed: 12/26/2022] Open
Abstract
Inflammatory breast cancer (IBC) is an understudied and aggressive form of breast cancer with a poor prognosis, accounting for 2-6% of new breast cancer diagnoses but 10% of all breast cancer-related deaths in the United States. Currently there are no therapeutic regimens developed specifically for IBC, and it is critical to recognize that all aspects of treating IBC - including staging, diagnosis, and therapy - are vastly different than other breast cancers. In December 2014, under the umbrella of an interdisciplinary initiative supported by the Duke School of Medicine, researchers, clinicians, research administrators, and patient advocates formed the Duke Consortium for IBC to address the needs of patients in North Carolina (an ethnically and economically diverse state with 100 counties) and across the Southeastern United States. The primary goal of this group is to translate research into action and improve both awareness and patient care through collaborations with local, national and international IBC programs. The consortium held its inaugural meeting on Feb 28, 2018, which also marked Rare Disease Day and convened national research experts, clinicians, patients, advocates, government representatives, foundation leaders, staff, and trainees. The meeting focused on new developments and challenges in the clinical management of IBC, research challenges and opportunities, and an interactive session to garner input from patients, advocates, and community partners that would inform a strategic plan toward continuing improvements in IBC patient care, research, and education.
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Affiliation(s)
- Gayathri R Devi
- Duke Cancer Institute, Duke University.,Department of Surgery, Duke University.,Department of Pathology, Duke University
| | - Holly Hough
- Duke Office of Clinical Research, Duke University
| | | | | | - Beth Overmoyer
- Department of Medical Oncology, Dana-Farber Cancer Institute
| | - Neil Spector
- Duke Cancer Institute, Duke University.,Department of Medicine, Duke University
| | - Naoto T Ueno
- Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center
| | - Wendy Woodward
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center
| | - John Kirkpatrick
- Duke Cancer Institute, Duke University.,Department of Radiation Oncology, Duke University
| | - Benjamin Vincent
- Division of Hematology/Oncology, University of North Carolina at Chapel Hill
| | - Kevin P Williams
- Department of Pharmaceutical Sciences, North Carolina Central University
| | | | | | | | - Shannon McCall
- Duke Cancer Institute, Duke University.,Department of Pathology, Duke University
| | | | - Greg Palmer
- Duke Cancer Institute, Duke University.,Department of Radiation Oncology, Duke University
| | - Jeremy Force
- Duke Cancer Institute, Duke University.,Department of Medicine, Duke University
| | - Kelly Westbrook
- Duke Cancer Institute, Duke University.,Department of Medicine, Duke University
| | | | - Gita Suneja
- Duke Cancer Institute, Duke University.,Department of Radiation Oncology, Duke University
| | | | - E Shelley Hwang
- Duke Cancer Institute, Duke University.,Department of Surgery, Duke University
| | - Steven R Patierno
- Duke Cancer Institute, Duke University.,Department of Medicine, Duke University
| | - P Kelly Marcom
- Duke Cancer Institute, Duke University.,Department of Medicine, Duke University
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38
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Peters K, Kirkpatrick J, Batinic-Haberle I, Affronti M, Woodring S, Iden D, Panta S, Lipp E, Healy P, Herndon J, Spasojevic I, Penchev S, Gad S, Siberstein D, Johnson M, Randazzo D, Desjardins A, Friedman H, Ashley D, Crapo J. ACTR-28. PHASE 1 DOSE ESCALATION TRIAL OF THE SAFETY OF BMX-001 CONCURRENT WITH RADIATION THERAPY AND TEMOZOLOMIDE IN NEWLY DIAGNOSED PATIENTS WITH HIGH-GRADE GLIOMAS. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy148.061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Katherine Peters
- Duke University Medical Center, Durham, North Carolina, Durham, NC, USA
| | - John Kirkpatrick
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA
| | - Ines Batinic-Haberle
- Department of Radiation Oncology-Cancer Biology, Duke University Medical Center, Durham, NC, USA
| | - Mary Affronti
- The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC, USA
| | - Sarah Woodring
- The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC, USA
| | - Deborah Iden
- The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC, USA
| | - Sujata Panta
- The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC, USA
| | - Eric Lipp
- The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC, USA
| | - Patrick Healy
- Duke Cancer Institute Biostatistics, Duke University Medical Center, Durham, NC, USA
| | - James Herndon
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA
| | - Ivan Spasojevic
- Department of Medicine - Oncology, Duke University Medical Center, Durham, NC, USA
| | - Sara Penchev
- BioMimetix Pharmaceutical, Inc., Greenwood Village, CO, USA
| | - Shayne Gad
- Gad Consulting Services, Raleigh, NC, USA
| | - David Siberstein
- Duke University Medical Center, Durham, North Carolina, Durham, NC, USA
- BioMimetix, Jefferson, MD, USA
| | - Margaret Johnson
- The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC, USA
| | - Dina Randazzo
- The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC, USA
| | - Annick Desjardins
- The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC, USA
| | - Henry Friedman
- The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC, USA
| | - David Ashley
- The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC, USA
| | - James Crapo
- BioMimetix Pharmaceutical, Inc., Greenwood Village, CO, USA
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Vaslow Z, Kirkpatrick J, Affronti M, Healy P, Herndon J, Lipp E, Thomas L, Johnson M, Randazzo D, Desjardins A, Friedman H, Ashley D, Peters K. RARE-16. CLINICAL AND HISTOPATHOLOGICAL CHARACTERISTICS OF YOUNG ADULTS WITH GLIOBLASTOMA AT DIAGNOSIS. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy148.990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Zachary Vaslow
- The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC, USA
| | - John Kirkpatrick
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA
| | - Mary Affronti
- The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC, USA
| | - Patrick Healy
- Duke Cancer Institute Biostatistics, Duke University Medical Center, Durham, NC, USA
| | - James Herndon
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA
| | - Eric Lipp
- The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC, USA
| | - Leslie Thomas
- The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC, USA
| | - Margaret Johnson
- The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC, USA
| | - Dina Randazzo
- The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC, USA
| | - Annick Desjardins
- The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC, USA
| | - Henry Friedman
- The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC, USA
| | - David Ashley
- The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC, USA
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Johnson M, Kirkpatrick J, Weant M, Vaslow Z, Lipp E, Herndon J, McSherry F, Desjardins A, Randazzo D, Friedman H, Ashley D, Peters K. HOUT-19. TREATMENT PATTERNS, OUTCOMES, AND PROGNOSTIC INDICATORS IN ELDERLY PATIENTS WITH GLIOBLASTOMA: A RETROSPECTIVE SINGLE INSTITUTION ANALYSIS. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy148.487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Margaret Johnson
- The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC, USA
| | - John Kirkpatrick
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA
| | - Mallika Weant
- The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC, USA
| | - Zachary Vaslow
- The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC, USA
| | - Eric Lipp
- The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC, USA
| | - James Herndon
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA
| | - Frances McSherry
- Duke Cancer Institute Biostatistics, Duke University Medical Center, Durham, NC, USA
| | - Annick Desjardins
- The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC, USA
| | - Dina Randazzo
- The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC, USA
| | - Henry Friedman
- The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC, USA
| | - David Ashley
- The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC, USA
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Randazzo D, Kirkpatrick J, McSherry F, Herndon J, Affronti M, Johnson M, Vaslow Z, Lipp E, Desjardins A, Friedman H, Peters K. QOLP-13. PSYCHOSOCIAL DISTRESS IN PATIENTS WITH RECURRENT MENINGIOMAS. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy148.899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Dina Randazzo
- The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC, USA
| | - John Kirkpatrick
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA
| | - Frances McSherry
- Duke Cancer Institute Biostatistics, Duke University Medical Center, Durham, NC, USA
| | - James Herndon
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA
| | - Mary Affronti
- The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC, USA
| | - Margaret Johnson
- The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC, USA
| | - Zachary Vaslow
- The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC, USA
| | - Eric Lipp
- The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC, USA
| | - Annick Desjardins
- The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC, USA
| | - Henry Friedman
- The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC, USA
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Wang C, Sun W, Kirkpatrick J, Chang Z, Yin FF. Assessment of concurrent stereotactic radiosurgery and bevacizumab treatment of recurrent malignant gliomas using multi-modality MRI imaging and radiomics analysis. J Radiosurg SBRT 2018; 5:171-181. [PMID: 29988289 PMCID: PMC6018043] [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] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 03/16/2018] [Indexed: 06/08/2023]
Abstract
PURPOSE To assess the response and predict the overall survival (OS) of recurrent malignant gliomas (MG) patients treated with concurrent BVZ/SRS using multi-modality MRI imaging and radiomics analysis.Methods and materials: SRS was delivered in a single fraction (18/24Gy) or 25Gy in 5 fractions. BVZ was administered immediately before SRS and 2 weeks after. MRI scans were performed before SRS, 1 week and 2 months after SRS. The MR protocol included 2 anatomical (T1w and T2w) and 2 functional (dynamic contrast-enhanced DCE-MRI and diffusion weighted DW-MRI) modalities. Functional biomarkers including apparent diffusion coefficient (ADC), micro-vascular transfer constant Ktrans, brain blood flow FB, and blood volume VB were analyzed. Radiomics analysis was performed to extract imaging features from anatomical MRI images and functional biomarker maps. Wicoxon signed rank tests were performed to evaluate treatment-induced changes, and Mann-Whitney U tests were performed to compare the differences of treatment-induced changes between different patient groups. Selected biomarkers and radiomics features were used to predict the OS after treatment using Support Vector Regression (SVR) with leave-one-out cross validation (LOOCV). RESULTS Twelve patients with recurrent MG were studied. The median OS was 13.8 months post SRS. DCE results showed that Ktrans (p=0.035) and VB (p=0.035) showed significant decrease 2 months after SRS, and FB showed significant decrease as early as 1 week (p=0.017) after SRS. No functional parameters reflected statistically significant treatment response 1 week after SRS. A total of 888 radiomics features were extracted. 31/126 features demonstrated significant changes 1 week/2 months after SRS, respectively. 9 features' changes were significantly different between WHO Grade III vs IV patient groups, and 6 features' changes were found to be linearly correlated with OS. Using 5 selected features, 9 patients' survival time could be accurately predicted (Mean absolute error = 1.47 months, RMSE = 2.10 months). CONCLUSION The results of this work demonstrate the potential of combined radiomics analysis and functional MR imaging in quantitatively identifying early treatment response of concurrent SRS/BVZ.
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Affiliation(s)
- Chunhao Wang
- Department of Radiation Oncology, Duke University, Durham, NC 27710, USA
| | - Wenzheng Sun
- Department of Radiation Oncology, Duke University, Durham, NC 27710, USA
| | - John Kirkpatrick
- Department of Radiation Oncology, Duke University, Durham, NC 27710, USA
| | - Zheng Chang
- Department of Radiation Oncology, Duke University, Durham, NC 27710, USA
| | - Fang-Fang Yin
- Department of Radiation Oncology, Duke University, Durham, NC 27710, USA
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Weant MP, Kirkpatrick J, Johnson M, Dunn-Pirio A, Healy P, Herndon JE, Lipp ES, Fountain E, Desjardins A, Randazzo D, Friedman HS, Peters KB. RARE-36. PATTERNS OF RELAPSE AFTER SUCCESSFUL COMPLETION OF INITIAL THERAPY IN PRIMARY CENTRAL NERVOUS SYSTEM LYMPHOMA. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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44
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Wilkinson A, Robertson B, Kirkpatrick J. Three-Year Experience of Flexor Tendon Injuries in a Tertiary Referral Centre. Int J Surg 2017. [DOI: 10.1016/j.ijsu.2017.08.343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Adamson JD, Cooney T, Demehri F, Stalnecker A, Georgas D, Yin FF, Kirkpatrick J. Characterization of Water-Clear Polymeric Gels for Use as Radiotherapy Bolus. Technol Cancer Res Treat 2017; 16:923-929. [PMID: 28554255 PMCID: PMC5762050 DOI: 10.1177/1533034617710579] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Our purpose was to investigate polymeric gels for use as a highly transparent radiotherapy bolus and determine the relevant physical and dosimetric properties. We first quantified tensile properties (maximum stress, strain, and Young modulus) for various polymeric gels, along with a commercial bolus product in order to illustrate the wide variety of potential materials. For a select polymeric gel with tensile properties similar to currently used radiotherapy bolus, we also evaluated mass and electron density, effective atomic number, optical transparency, and percent depth dose in clinical megavoltage photon and electron beams. For this polymeric gel, mass density was 872 ± 12 and 896 ± 13 g/cm3 when measured via weight/volume and computed tomography Hounsfield units, respectively. Electron density was 2.95 ± 0.04 ×1023 electrons/cm3. Adding fused silica (9% by weight) increases density to that of water. The ratio of the effective atomic number to that of water without and with added silica was 0.780 and 0.835 at 1 MeV, 0.767 and 0.826 at 6 MeV, and 0.746 and 0.809 at 20 MeV. Percent depth dose for 6 MV photons was within 2% of water within the first 2.5 cm and after scaling by the density coincided within 1% out to >7 cm. For 6 and 20 MeV electrons, after scaling for density D80% was within 1.3 and 1.5 mm of water, respectively. The high transparency and mechanical flexibility of polymeric gels indicate potential for use as a radiotherapy bolus; differences in density from water may be managed via either using “water equivalent thickness” or by incorporating fused silica into the material.
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Affiliation(s)
- Justus D Adamson
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA
| | - Tabitha Cooney
- Department of Neurology and Neurological Sciences, Division of Child Neurology, Stanford University, Stanford, CA, USA
| | | | | | - Debra Georgas
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA
| | - Fang-Fang Yin
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA
| | - John Kirkpatrick
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA
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46
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Faught AM, Trager M, Yin FF, Kirkpatrick J, Adamson J. Re-examining TG-142 recommendations in light of modern techniques for linear accelerator based radiosurgery. Med Phys 2017; 43:5437. [PMID: 27782700 DOI: 10.1118/1.4962471] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE The recent development of multifocal stereotactic radiosurgery (SRS) using a single isocenter volumetric modulated arc theory (VMAT) technique warrants a re-examination of the quality assurance (QA) tolerances for routine mechanical QA recommended by the American Association of Physicists in Medicine Task Group Report Number 142. Multifocal SRS can result in targets with small volumes being at a large off-axis distance from the treatment isocenter. Consequently, angular errors in the collimator, patient support assembly (PSA), or gantry could have an increased impact on target coverage. METHODS The authors performed a retrospective analysis of dose deviations caused by systematic errors in PSA, collimator, and gantry angle at the tolerance level for routine linear accelerator QA as recommended by TG-142. Dosimetric deviations from multifocal SRS plans (N = 10) were compared to traditional single target SRS using dynamic conformal arcs (N = 10). The chief dosimetric quantities used in determining clinical impact were V100% and D99% of the individual planning target volumes and V12Gy of the healthy brain. RESULTS Induced errors at tolerance levels showed the greatest change in multifocal SRS target coverage for collimator rotations (±1.0°) with the average changes to V100% and D99% being 5% and 6%, respectively, with maximum changes of 33% and 20%. A reduction in the induced error to half the TG-142 tolerance (±0.5°) demonstrated similar changes in coverage loss to traditional single target SRS assessed at the recommended tolerance level. The observed change in coverage for multifocal SRS was reduced for gantry errors (±1.0°) at 2% and 4.5% for V100% and D99%, respectively, with maximum changes of 18% and 12%. Minimal change in coverage was noted for errors in PSA rotation. CONCLUSIONS This study indicates that institutions utilizing a single isocenter VMAT technique for multifocal disease should pay careful attention to the angular mechanical tolerances in designing a robust and complete QA program.
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Affiliation(s)
- Austin M Faught
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina 27710
| | - Michael Trager
- Medical Physics Graduate Program, Duke University, Durham, North Carolina 27710
| | - Fang-Fang Yin
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina 27710
| | - John Kirkpatrick
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina 27710
| | - Justus Adamson
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina 27710
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Narloch JL, Harnden K, Broadwater G, Peterson B, Hyslop T, Kirkpatrick J, Fecci P, Kim G, Blackwell KL. Abstract P5-08-12: HER2 status remains the primary predictor of improved survival in patients with BCBM over the past 2 decades (1996-2015). Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p5-08-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
BACKGROUND: Brain metastasis is a complication in advanced breast cancer (ABC) and is associated with poor prognosis. Incidence of breast cancer brain metastasis (BCBM) is increasing with advances in therapy, allowing patients to survive long enough to develop CNS metastasis. Improved outcomes have been documented in ABC over the past decades, largely related to the use of trastuzumab in HER2+ ABC. However, it remains unclear whether survival has improved in HER2- ABC in patients with BCBM. This study asks: has the improvement in systemic and radiotherapies for HER2- breast cancer impacted survival in patients with breast cancer brain metastasis.
OBJECTIVES: 1) To estimate whether date of BCBM diagnosis is associated with overall survival (OS) in patients diagnosed between 1996-2015. 2) To estimate whether OS of this patient population depends upon other demographic and clinical factors.
METHODS: This is a retrospective chart review of patients with diagnosis of BCBM between 1996-2015. Data collection includes: age at BCBM diagnosis, ethnicity, ER/PR/HER2 status, date of BCBM diagnosis, date of primary breast cancer diagnosis, date of death/last clinical follow-up, and treatment. Kaplan-Meier analysis and the log-rank test compared OS (time from diagnosis of BCBM until death or last clinical FU) between groups diagnosed in 5-year cohorts (1996-2000, 2001-2005, 2006-2010, 2011-2015). A univariate proportional hazards model was used to regress OS on date of diagnosis. A multivariate proportional hazards model was used which included the subset of patients diagnosed with BCBM in 2001 and later. This model adjusted for additional factors: race, time to development of BCBM diagnosis, age at the time of BCBM diagnosis, year of diagnosis as a continuous factor, ER, PR, while testing the significance of HER2 status. A p-value < 0.05 was significant.
RESULTS: A total of 165 patients with BCBM were included in this analysis, with a median age of 53.8 (SD 13.0) at time of BCBM diagnosis. Most patients were Caucasian (66%; 109/165) or African-American (29%; 48/165). Although statistical significance was not attained, greater median overall survival was seen for patients diagnosed with BCBM in more recent 5-year cohorts (2011-2016, 9.5 months; 2006-2010, 8 months) than patients in older cohorts (2001-2006, 3.6 months; 1996-2000, 5.3 months), p=0.3. Date of diagnosis of BCBM as a continuous variable is predictive of overall survival (HR 0.83 [95% CI: 0.71-0.97] comparing 5-year intervals, p=0.016). After adjusting for the covariates listed above, HER2 positive status is predictive of overall survival (HR 0.34 [95% CI: 0.34-0.56]; p<0.0001).
CONCLUSIONS: While survival has improved by 5.9 months over the past two decades, it remains highly dependent on HER2 status. Novel therapies for BCBM are greatly needed for ER+ and triple negative subtypes. Final results will include an expanded analysis to incorporate additional cases and three other categorical covariates measured during follow-up: whether the patient received radiotherapy, surgery, and/or medical therapy after diagnosis of brain metastases.
GRANT FUNDING: TL-1 CTSA Pre-Doctoral Training Grant (5TL1TR001116-03).
Citation Format: Narloch JL, Harnden K, Broadwater G, Peterson B, Hyslop T, Kirkpatrick J, Fecci P, Kim G, Blackwell KL. HER2 status remains the primary predictor of improved survival in patients with BCBM over the past 2 decades (1996-2015) [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 P5-08-12.
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Affiliation(s)
- JL Narloch
- Clinical Research Training Program, Duke University Medical Center, Durham, NC; Duke University Medical Center, Durham, NC; Duke Cancer Institute, Durham, NC
| | - K Harnden
- Clinical Research Training Program, Duke University Medical Center, Durham, NC; Duke University Medical Center, Durham, NC; Duke Cancer Institute, Durham, NC
| | - G Broadwater
- Clinical Research Training Program, Duke University Medical Center, Durham, NC; Duke University Medical Center, Durham, NC; Duke Cancer Institute, Durham, NC
| | - B Peterson
- Clinical Research Training Program, Duke University Medical Center, Durham, NC; Duke University Medical Center, Durham, NC; Duke Cancer Institute, Durham, NC
| | - T Hyslop
- Clinical Research Training Program, Duke University Medical Center, Durham, NC; Duke University Medical Center, Durham, NC; Duke Cancer Institute, Durham, NC
| | - J Kirkpatrick
- Clinical Research Training Program, Duke University Medical Center, Durham, NC; Duke University Medical Center, Durham, NC; Duke Cancer Institute, Durham, NC
| | - P Fecci
- Clinical Research Training Program, Duke University Medical Center, Durham, NC; Duke University Medical Center, Durham, NC; Duke Cancer Institute, Durham, NC
| | - G Kim
- Clinical Research Training Program, Duke University Medical Center, Durham, NC; Duke University Medical Center, Durham, NC; Duke Cancer Institute, Durham, NC
| | - KL Blackwell
- Clinical Research Training Program, Duke University Medical Center, Durham, NC; Duke University Medical Center, Durham, NC; Duke Cancer Institute, Durham, NC
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Sperduto P, Yang TJ, Beal K, Pan H, Brown P, Bangdiwala A, Shanley R, Yeh N, Gaspar LE, Braunstein S, Sneed P, Boyle JM, Kirkpatrick J, Mak K, Shih H, Engelman A, Roberge D, Arvold N, Alexander B, Awad M, Contessa J, Chiang V, Hardie J, Ma D, Lou E, Sperduto W, Mehta M. BMET-06. IMPROVED SURVIVAL AND PROGNOSTIC ABILITY IN LUNG CANCER PATIENTS WITH BRAIN METASTASES: AN UPDATE OF THE GRADED PROGNOSTIC ASSESSMENT FOR LUNG CANCER USING MOLECULAR MARKERS (LUNG-molGPA). Neuro Oncol 2016. [DOI: 10.1093/neuonc/now212.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
Horseshoe kidneys are a common, yet enigmatic, renal malformation. This review critically appraised the literature surrounding the embryology, etiology and clinical anatomy of horseshoe kidneys. The systematic literature search produced 104 articles, and 56 primary and further secondary references. There were several etiological theories regarding horseshoe kidneys. The established view was that during ascent, the kidneys come into close apposition as they pass through an arterial fork. Another possible mechanism related to lateral flexion of the trunk or rotation of the caudal embryo; the association of asymmetrical horseshoe kidneys with a number of vertebral conditions supported this hypothesis. More recent animal models implicated the notochord and sonic hedgehog signaling. Furthermore, it has been suggested that the isthmus may be the result of ectopic mesenchymal tissue. Surgical anatomy of the horseshoe kidney is complex, due to variability in location, orientation and blood supply. Both arterial and venous anatomy is highly variable. This raised the question of whether anomalous blood supply is the cause or result of abnormal renal position. In the majority of cases, the isthmus contained functional renal parenchyma. In over 90% of cases, fusion between the kidneys occurred at the lower pole. Despite commonly being quoted as 'held back by the inferior mesenteric artery' at L3, in reality the isthmus was only found immediately inferior to this in 40% of cases.
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Affiliation(s)
- K Taghavi
- Department of Paediatric Surgery, Wellington Children's Hospital, Wellington, New Zealand; Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand
| | - J Kirkpatrick
- School of Medicine, University of Auckland, Auckland, New Zealand
| | - S A Mirjalili
- Department of Anatomy, University of Auckland, Auckland, New Zealand.
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50
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Olson AC, Thomas S, Qin R, Singh B, Salama JK, Kirkpatrick J, Salama AK. Outcomes and toxicity of stereotactic radiosurgery for melanoma brain metastases in patients receiving ipilimumab. Melanoma Manag 2016; 3:177-186. [PMID: 30190887 DOI: 10.2217/mmt-2016-0004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 03/17/2016] [Indexed: 02/07/2023] Open
Abstract
Purpose Patients with melanoma treated with ipilimumab and radiosurgery (stereotactic radiosurgery [SRS]) were reviewed for efficacy/safety. Methods Patients who received ipilimumab and SRS for brain metastases were analyzed for control of SRS-treated metastasis and overall survival. Results We identified 27 patients, 26 were assessable for outcomes. Median time-to-treated metastasis progression was 6.3 months (95% CI: 3.1-12.2). Overall survival was 23.4 months (95% CI: 5.7-not estimable) for SRS prior to/during ipilimumab (n = 14), and 10.4 months (95% CI: 1.9-not estimable) for SRS after ipilimumab (n = 12). Overall, no unexpected toxicities were seen: 11% of patients experienced grade 3 CNS toxicity and 7% developed radionecrosis. Conclusion SRS for melanoma brain metastases with ipilimumab was well-tolerated. There may be improved survival for patients receiving SRS prior to/during ipilimumab.
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Affiliation(s)
- Adam C Olson
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA.,Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA
| | - Samantha Thomas
- Department of Biostatistics, Duke Cancer Institute, Durham, NC, USA.,Department of Biostatistics, Duke Cancer Institute, Durham, NC, USA
| | - Rosie Qin
- Duke University School of Medicine, Durham, NC, USA.,Duke University School of Medicine, Durham, NC, USA
| | - Bhavana Singh
- Department of Medicine, Duke University Medical Center, Durham, NC, USA.,Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Joseph K Salama
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA.,Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA
| | - John Kirkpatrick
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA.,Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA
| | - April Ks Salama
- Department of Medicine, Division of Medical Oncology, Duke University Medical Center, Durham, NC, USA.,Department of Medicine, Division of Medical Oncology, Duke University Medical Center, Durham, NC, USA
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