Evaluation of the safety and pharmacokinetics of the multi-targeted receptor tyrosine kinase inhibitor sunitinib during embryo-fetal development in rats and rabbits

BACKGROUND

Angiogenesis plays a key role in embryo-fetal development and, based on nonclinical safety data, the majority of vascular endothelial growth factor (VEGF)-targeted antiangiogenic agents used in cancer therapy are not recommended during pregnancy. We investigated the effects of sunitinib (an oral inhibitor of multiple receptor tyrosine kinases [RTKs] including VEGF-receptors) on embryo-fetal development.

METHODS

Presumed-pregnant Sprague-Dawley rats and New Zealand White rabbits received repeated daily oral doses of sunitinib (0-30 mg/kg/day), during the major period of organogenesis. Clinical/physical examinations were performed throughout the gestation phase, and blood samples were collected to determine systemic exposure. Necropsy (including uterine examination) was performed on all animals and fetal morphology was examined.

RESULTS

The no-observed-adverse-effect level was 1-5 mg/kg/day for maternal toxicity and 3 mg/kg/day for developmental toxicity in rats; 1 and 0.5 mg/kg/day, respectively, in rabbits. Embryo-fetal toxicity included decreases in the number of live fetuses and increases in the numbers of resorptions and post-implantation/complete litter losses; these were observed at doses of > or =5 mg/kg/day in rats and 5 mg/kg/day in rabbits. Malformations included fetal skeletal malformations (generally thoracic/lumbar vertebral alterations) in rats and cleft lip/palate in rabbits. These developmental effects were observed at approximately 5.5- (rats) and approximately 0.3-times (rabbits) the human systemic exposure at the approved sunitinib dose (50 mg/day).

CONCLUSIONS

Similar effects have been reported with the prototype monoclonal antibody bevacizumab. As is typically observed for potent inhibitors of RTKs involved in angiogenesis, sunitinib was associated with embryo-fetal developmental toxicity in rats and rabbits at clinically relevant dose levels.

Analysis of repertory grids in clinical practice

OBJECTIVES

This paper illustrates the use of several different forms of analysis of repertory grid data, using a case study of a client who completed repertory grids at various stages of therapy.

METHOD

Participants in a survivors' group completed grids before and after therapy and at 3- and 6-month follow-up. Grids from one of the participants, who had been sexually abused as a child, are presented using different levels of analysis: visual inspection of the raw grid; analysis of dissimilarities between pairs of elements or constructs; hierarchical cluster analysis of elements and constructs both separately and combined; principal components analysis; biplot representation of elements and constructs combined; multidimensional scaling analysis and unfolding analysis. The latter two methods also provide ways of presenting a combined analysis of a number of grids. Computer packages are reviewed, and SYSTAT commands are presented to perform the analyses.

RESULTS

The review of methods illustrates how different levels of analysis can usefully back up clients' own accounts of progress through therapy, from detailed analysis of individual ratings in the raw grid, through analyses that pull out structural patterns at the expense of detail, to the broad sweep provided by methods that combine data from a number of grids.

CONCLUSIONS

Analysis of repertory grids completed at various stages of therapy can provide useful qualitative information on progress, but can also provide some simple quantitative measures (such as Self-Ideal Self discrepancy as a measure of self esteem) to track progress. Different forms of analysis can be informative, highlighting different aspects of progress, but also allowing checks on adequacy and goodness-of-fit of particular analyses.

Cohort profile: the ESC EURObservational Research Programme Non-ST-segment elevation myocardial infraction (NSTEMI) Registry

AIMS

The European Society of Cardiology (ESC) EURObservational Research Programme (EORP) Non-ST-segment elevation myocardial infarction (NSTEMI) Registry aims to identify international patterns in NSTEMI management in clinical practice and outcomes against the 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without ST-segment-elevation.

METHODS AND RESULTS

Consecutively hospitalised adult NSTEMI patients (n = 3620) were enrolled between 11 March 2019 and 6 March 2021, and individual patient data prospectively collected at 287 centres in 59 participating countries during a two-week enrolment period per centre. The registry collected data relating to baseline characteristics, major outcomes (in-hospital death, acute heart failure, cardiogenic shock, bleeding, stroke/transient ischaemic attack, and 30-day mortality) and guideline-recommended NSTEMI care interventions: electrocardiogram pre- or in-hospital, pre-hospitalization receipt of aspirin, echocardiography, coronary angiography, referral to cardiac rehabilitation, smoking cessation advice, dietary advice, and prescription on discharge of aspirin, P2Y12 inhibition, angiotensin converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB), beta-blocker, and statin.

CONCLUSION

The EORP NSTEMI Registry is an international, prospective registry of care and outcomes of patients treated for NSTEMI, which will provide unique insights into the contemporary management of hospitalised NSTEMI patients, compliance with ESC 2015 NSTEMI Guidelines, and identify potential barriers to optimal management of this common clinical presentation associated with significant morbidity and mortality.

PEGylation of Metal Oxide Nanoparticles Modulates Neutrophil Extracellular Trap Formation

Novel metal oxide nanoparticle (NP) contrast agents may offer safety and functionality advantages over conventional gadolinium-based contrast agents (GBCAs) for cancer diagnosis by magnetic resonance imaging. However, little is known about the behavior of metal oxide NPs, or of their effect, upon coming into contact with the innate immune system. As neutrophils are the body's first line of defense, we sought to understand how manganese oxide and iron oxide NPs impact leukocyte functionality. Specifically, we evaluated whether contrast agents caused neutrophils to release web-like fibers of DNA known as neutrophil extracellular traps (NETs), which are known to enhance metastasis and thrombosis in cancer patients. Murine neutrophils were treated with GBCA, bare manganese oxide or iron oxide NPs, or poly(lactic-co-glycolic acid) (PLGA)-coated metal oxide NPs with different incorporated levels of poly(ethylene glycol) (PEG). Manganese oxide NPs elicited the highest NETosis rates and had enhanced neutrophil uptake properties compared to iron oxide NPs. Interestingly, NPs with low levels of PEGylation produced more NETs than those with higher PEGylation. Despite generating a low rate of NETosis, GBCA altered neutrophil cytokine expression more than NP treatments. This study is the first to investigate whether manganese oxide NPs and GBCAs modulate NETosis and reveals that contrast agents may have unintended off-target effects which warrant further investigation.

Short-term exposure of female BALB/cJ mice to e-cigarette aerosol promotes neutrophil recruitment and enhances neutrophil-platelet aggregation in pulmonary microvasculature

Despite the perception that e-cigarettes are safer than conventional cigarettes, numerous findings demonstrated that e-cigarette aerosol (EC) exposure induced compromised immune functionality, vascular changes even after acute exposure, and lung injury. Notably, altered neutrophil functionality and platelet hemodynamics have been observed post-EC exposure. It was hypothesized that EC exposure initiates an inflammatory response resulting in altered neutrophil behavior and increased neutrophil-platelet interaction in the pulmonary microvasculature. Neutrophil and platelet responses were examined up to 48 hrs following whole-body, short-term EC exposure without flavorants or nicotine in a murine model, which most closely modeled secondhand exposure. This study is the first to investigate the impact of EC exposure through lung intravital imaging. Compared to room air-exposed mice, EC-exposed mice displayed significantly increased 1.7‒1.9-fold number of neutrophils in the pulmonary microvasculature associated with no marked change in neutrophils within whole blood or bronchoalveolar lavage fluid (BALF). Neutrophil-platelet interactions were also significantly elevated 1.9‒2.5-fold in exposed mice. Plasma concentration of myeloperoxidase was markedly reduced 1.5-fold 48 hr following exposure cessation, suggesting suppressed neutrophil antimicrobial activity. Cytokine expression exhibited changes indicating vascular damage. Effects persisted for 48 hr post-EC exposure. Data demonstrated that EC exposure repeated for 3 consecutive days in 2.5 hr intervals in the absence of flavorants or nicotine resulted in modified pulmonary vasculature hemodynamics, altered immune functionality, and a pro-inflammatory state in female BALB/cJ mice.

Personal constructs, childhood sexual abuse and revictimization

Within the theoretical framework of Ryle's Procedural Sequence Object Relations Model and Kelly's Personal Construct Theory, this study investigates sex-role polarization of incest survivors and the centrality of abuse within survivors' constructs of men that may contribute to revictimization. Repertory grid methodology was used with 40 female survivors of childhood sexual abuse and 28 non-abused women. Grid measures and psychometric measures were compared between groups of women who had and had not experienced childhood sexual abuse, revictimized and non-revictimized survivors, and survivors who had and had not experienced incestuous abuse. Results showed significant differences between survivors and non-abused women, with survivors having higher levels of depression and perceived distress, lower self-esteem and higher self/ ideal self discrepancy. Hypothesized differences in sex-role polarization were not found. There were few differences between revictimized and non-revictimized survivors, although revictimized survivors rated 'self now' as more powerful than non-revictimized survivors. No differences were found between survivors who had and had not experienced incestuous abuse. In addition to the value of exploring personal constructs, a range of models need to be considered in understanding revictimization and women's construal of men. The implications of using repertory grid methodology for research and clinical work are discussed.

Caveat Emptor: Commercialized Manganese Oxide Nanoparticles Exhibit Unintended Properties

Nano-encapsulated manganese oxide (NEMO) particles are noteworthy contrast agents for magnetic resonance imaging (MRI) due to their bright, pH-switchable signal ("OFF" to "ON" at low pH), high metal loading, and targeting capability for increased specificity. For the first time, we performed a head-to-head comparison of NEMO particles from In-house and commercialized sources (US Nano vs Nanoshel) to assess their potential as bright T₁ MRI contrast agents. Manganese oxide nanocrystals (MnO, Mn₂O₃, and Mn₃O₄) were systematically evaluated for size, chemistry, release of manganese ions, and MRI signal pre- and post-encapsulation within poly(lactic-co-glycolic acid) (PLGA). Suprisingly, a majority of the commercialized formulations were not as advertised by displaying unintended sizes, morphologies, chemistry, dissolution profiles, and/or MRI signal that precludes in vivo use. US Nano's Mn₃O₄ and Mn₂O₃ nanocrystals contained impurities that impacted Mn ion release as well as micron-sized rodlike structures. Nanoshel's MnO and Mn₂O₃ nanoparticles had very large hydrodynamic sizes (>600 nm). In-house MnO and Nanoshel's Mn₃O₄ nanoparticles demonstrated the best characteristics with brighter T₁ MRI signals, small hydrodynamic sizes, and high encapsulation efficiencies. Our findings highlight that researchers must confirm the properties of purchased nanomaterials before utilizing them in desired applications, as their experimental success may be impacted.

Development and validation of a controlled heating apparatus for long-term MRI of 3D microfluidic tumor models

Conventional testing of novel contrast agents for magnetic resonance imaging (MRI) involves cell and animal studies. However, 2D cultures lack dynamic flow and in vivo MRI is limited by regulatory approval of long-term anesthesia use. Microfluidic tumor models (MTMs) offer a cost-effective, reproducible, and high throughput platform for bridging cell and animal models. Yet, MRI of microfluidic devices is challenging, due to small fluid volumes generating low sensitivity. For the first time, an MRI of MTMs was performed at low field strength (1 T) using conventional imaging equipment without microcoils. To enable longitudinal MRI, we developed (1) CHAMP-3 (controlled heating apparatus for microfluidics and portability) which heats MTMs during MRI scans and (2) an MRI-compatible temperature monitoring system. CHAMP-3 maintained chip surface temperature at ~37°C and the media inside at ~35.5°C. Enhanced T1-weighted MRI contrast was achieved in 3D MTMs with free manganese (Mn2+) solutions and Mn2+ labeled tumor cells.