Cellular and Molecular Mechanisms of MEK1 Inhibitor-Induced Cardiotoxicity

Background

Trametinib is a MEK1 (mitogen-activated extracellular signal-related kinase kinase 1) inhibitor used in the treatment of BRAF (rapid accelerated fibrosarcoma B-type)-mutated metastatic melanoma. Roughly 11% of patients develop cardiomyopathy following long-term trametinib exposure. Although described clinically, the molecular landscape of trametinib cardiotoxicity has not been characterized.

Objectives

The aim of this study was to test the hypothesis that trametinib promotes widespread transcriptomic and cellular changes consistent with oxidative stress and impairs cardiac function.

Methods

Mice were treated with trametinib (1 mg/kg/d). Echocardiography was performed pre- and post-treatment. Gross, histopathologic, and biochemical assessments were performed to probe for molecular and cellular changes. Human cardiac organoids were used as an in vitro measurement of cardiotoxicity and recovery.

Results

Long-term administration of trametinib was associated with significant reductions in survival and left ventricular ejection fraction. Histologic analyses of the heart revealed myocardial vacuolization and calcification in 28% of animals. Bulk RNA sequencing identified 435 differentially expressed genes and 116 differential signaling pathways following trametinib treatment. Upstream gene analysis predicted interleukin-6 as a regulator of 17 relevant differentially expressed genes, suggestive of PI3K/AKT and JAK/STAT activation, which was subsequently validated. Trametinib hearts displayed elevated markers of oxidative stress, myofibrillar degeneration, an 11-fold down-regulation of the apelin receptor, and connexin-43 mislocalization. To confirm the direct cardiotoxic effects of trametinib, human cardiac organoids were treated for 6 days, followed by a 6-day media-only recovery. Trametinib-treated organoids exhibited reductions in diameter and contractility, followed by partial recovery with removal of treatment.

Conclusions

These data describe pathologic changes observed in trametinib cardiotoxicity, supporting the exploration of drug holidays and alternative pharmacologic strategies for disease prevention.

Application of Pharmacokinetic Prediction Platforms in the Design of Optimized Anti-Cancer Drugs

Cancer is the second most common cause of death in the United States, accounting for 602,350 deaths in 2020. Cancer-related death rates have declined by 27% over the past two decades, partially due to the identification of novel anti-cancer drugs. Despite improvements in cancer treatment, newly approved oncology drugs are associated with increased toxicity risk. These toxicities may be mitigated by pharmacokinetic optimization and reductions in off-target interactions. As such, there is a need for early-stage implementation of pharmacokinetic (PK) prediction tools. Several PK prediction platforms exist, including pkCSM, SuperCypsPred, Pred-hERG, Similarity Ensemble Approach (SEA), and SwissADME. These tools can be used in screening hits, allowing for the selection of compounds were reduced toxicity and/or risk of attrition. In this short commentary, we used PK prediction tools in the optimization of mitogen activated extracellular signal-related kinase kinase 1 (MEK1) inhibitors. In doing so, we identified MEK1 inhibitors with retained activity and optimized predictive PK properties, devoid of hERG inhibition. These data support the use of publicly available PK prediction platforms in early-stage drug discovery to design safer drugs.

DCHS1, Lix1L, and the Septin Cytoskeleton: Molecular and Developmental Etiology of Mitral Valve Prolapse

Mitral valve prolapse (MVP) is a common cardiac valve disease that often progresses to serious secondary complications requiring surgery. MVP manifests as extracellular matrix disorganization and biomechanically incompetent tissues in the adult setting. However, MVP has recently been shown to have a developmental basis, as multiple causal genes expressed during embryonic development have been identified. Disease phenotypes have been observed in mouse models with human MVP mutations as early as birth. This study focuses on the developmental function of DCHS1, one of the first genes to be shown as causal in multiple families with non-syndromic MVP. By using various biochemical techniques as well as mouse and cell culture models, we demonstrate a unique link between DCHS1-based cell adhesions and the septin-actin cytoskeleton through interactions with cytoplasmic protein Lix1-Like (LIX1L). This DCHS1-LIX1L-SEPT9 axis interacts with and promotes filamentous actin organization to direct cell-ECM alignment and valve tissue shape.

Calibration of Five Different Thromboplastins, Using Fresh and Freeze-dried Plasma

The results of this trial confirmed that the five different thromboplastin preparations could be calibrated in terms of thromboplastin 67/40 (2) in respect to their sensitivity to coumarin induced defect.

Using thromboplastin 2 (67/40) as reference and assigning to it, by definition, a TSR of 2.0, the other four thromboplastins can be assigned the following TSRs: thromboplastin 1 (69/223) 1.9: thromboplastin 3 (68/434) 2.0; thromboplastin 4 (70/115)2.0; and thromboplastin 5 (70/178) 1.5.

In view of the great amount of collaborative work which has been invested in the study of these preparations, they should be kept primarily for the purposes of calibrating other reference preparations rather than be consumed as working standards. Thromboplastin 67/40 should be preserved for calibrating future batches of an international reference material or of national reference preparations of a similar type. The other four preparations could be used to calibrate similar types of thromboplastin: human brain without added bovine factors (69/223) for calibration of similar human thromboplastins; the bovine thromboplastin (68/434) for bovine preparations, and the two different rabbit brain preparations (70/115) and (70/178) for calibration of the rabbit brain reagents. In this manner each of the preparations would be compared to a material of the same species and similar type, and the stocks of these materials conserved to last over a longer period of time.

Carefully prepared freeze-dried pooled plasma from patients on oral anticoagulants can be used instead of a large number of individual fresh plasmas to simplify the calibration procedure of selected thromboplastins.

In the present state of knowledge about the coumarin induced coagulation defect, artificially prepared abnormal plasmas appear to have little use in the calibration of thromboplastin preparations for control of anticoagulant therapy.

Marine regime shifts: drivers and impacts on ecosystems services

Marine ecosystems can experience regime shifts, in which they shift from being organized around one set of mutually reinforcing structures and processes to another. Anthropogenic global change has broadly increased a wide variety of processes that can drive regime shifts. To assess the vulnerability of marine ecosystems to such shifts and their potential consequences, we reviewed the scientific literature for 13 types of marine regime shifts and used networks to conduct an analysis of co-occurrence of drivers and ecosystem service impacts. We found that regime shifts are caused by multiple drivers and have multiple consequences that co-occur in a non-random pattern. Drivers related to food production, climate change and coastal development are the most common co-occurring causes of regime shifts, while cultural services, biodiversity and primary production are the most common cluster of ecosystem services affected. These clusters prioritize sets of drivers for management and highlight the need for coordinated actions across multiple drivers and scales to reduce the risk of marine regime shifts. Managerial strategies are likely to fail if they only address well-understood or data-rich variables, and international cooperation and polycentric institutions will be critical to implement and coordinate action across the scales at which different drivers operate. By better understanding these underlying patterns, we hope to inform the development of managerial strategies to reduce the risk of high-impact marine regime shifts, especially for areas of the world where data are not available or monitoring programmes are not in place.

Home treatment in haemophilia: clinical, social and economic advantages

Twenty-eight severely affected haemophiliacs were observed for 3 months under treatment as hospital out-patients and for the subsequent 9 months while treating themselves at home. Delay in receiving treatment and financial costs were both clearly reduced by home treatment, the patients recovered from individual bleeds more quickly and reported a greater sense of personal freedom and independence. The amount of treatment required did not materially change and no untoward effects were noted; the use of analgesics tended to be less.

Measuring conditions and trends in ecosystem services at multiple scales: the Southern African Millennium Ecosystem Assessment (SAfMA) experience

The Southern African Millennium Ecosystem Assessment (SAfMA) evaluated the relationships between ecosystem services and human well-being at multiple scales, ranging from local through to sub-continental. Trends in ecosystem services (fresh water, food, fuel-wood, cultural and biodiversity) over the period 1990-2000 were mixed across scales. Freshwater resources appear strained across the continent with large numbers of people not securing adequate supplies, especially of good quality water. This translates to high infant mortality patterns across the region. In some areas, the use of water resources for irrigated agriculture and urban-industrial expansion is taking place at considerable cost to the quality and quantity of freshwater available to ecosystems and for domestic use. Staple cereal production across the region has increased but was outstripped by population growth while protein malnutrition is on the rise. The much-anticipated wood-fuel crisis on the subcontinent has not materialized but some areas are experiencing shortages while numerous others remain vulnerable. Cultural benefits of biodiversity are considerable, though hard to quantify or track over time. Biodiversity resources remain at reasonable levels, but are declining faster than reflected in species extinction rates and appear highly sensitive to land-use decisions. The SAfMA sub-global assessment provided an opportunity to experiment with innovative ways to assess ecosystem services including the use of supply-demand surfaces, service sources and sink areas, priority areas for service provision, service 'hotspots' and trade-off assessments.

A biodiversity intactness index

The nations of the world have set themselves a target of reducing the rate of biodiversity loss by 2010. Here, we propose a biodiversity intactness index (BII) for assessing progress towards this target that is simple and practical--but sensitive to important factors that influence biodiversity status--and which satisfies the criteria for policy relevance set by the Convention on Biological Diversity. Application of the BII is demonstrated on a large region (4 x 10(6) km2) of southern Africa. The BII score in the year 2000 is about 84%: in other words, averaged across all plant and vertebrate species in the region, populations have declined to 84% of their presumed pre-modern levels. The taxonomic group with the greatest loss is mammals, at 71% of pre-modern levels, and the ecosystem type with the greatest loss is grassland, with 74% of its former populations remaining. During the 1990s, a population decline of 0.8% is estimated to have occurred.

Experimental burn plot trial in the Kruger National Park: history, experimental design and suggestions for data analysis

The experimental burn plot (EBP) trial initiated in 1954 is one of few ongoing long-termfire ecology research projects in Africa. The trial aims to assess the impacts of differentfire regimes in the Kruger National Park. Recent studies on the EBPs have raised questions as to the experimental design of the trial, and the appropriate model specificationwhen analysing data. Archival documentation reveals that the original design was modified on several occasions, related to changes in the park's fire policy. These modifications include the addition of extra plots, subdivision of plots and changes in treatmentsover time, and have resulted in a design which is only partially randomised. The representativity of the trial plots has been questioned on account of their relatively small size,the concentration of herbivores on especially the frequently burnt plots, and soil variation between plots. It is suggested that these factors be included as covariates inexplanatory models or that certain plots be excluded from data analysis based on resultsof independent studies of these factors. Suggestions are provided for the specificationof the experimental design when analysing data using Analysis of Variance. It is concluded that there is no practical alternative to treating the trial as a fully randomisedcomplete block design.

Long term effects of fire frequency and season on the woody vegetation dynamics of the Sclerocarya birrea/Acacia nigrescens savanna of the Kruger National Park

A lack of knowledge together with vacillating fire management approaches in the Kruger National Park until the mid 1950s, gave rise to a long term fire research experiment aimed at shedding light on savanna responses to various combinations of fire fre- quencies and seasons. This trial was laid out in 1954 in four of the six major vegetation zones of the park. With the future of the experiment now being reconsidered, full scale vegetation surveys have been conducted on all the plots and compared to the surveys done in 1954. This paper examines the woody vegetation responses to fourteen fire treatments in the Knobthorn/Marula savanna. Parameters of interest were woody species composition responses, together with tree & shrub density and structural changes. The results indicate that no significant changes in woody species had occurred for the peri- od 1954 vs 1998, while density decreased on biennial and increased on triennial treatments. The proportion of single stemmed plants increased over the period. Season of burn has a marked effect on structure, with April and August burns giving rise to the largest basal areas but the lowest heights. Environmental parameters such as climate, varying herbivory and differing soils, and their respective interactions on vegetation morphology, together with fire behaviour, further influenced results.

Haemophilia treatment in the United Kingdom from 1969 to 1974

A study has been made by the Haemophilia Centre Directors of the United Kingdom and Northern Ireland. From 1969 to 1974 2600 patients with haemophilia A and 388 with haemophilia B attended Haemophilia Centres for treatment. Of these patients, 71 are known to have died in the survey period. A record is presented of the amounts and types of therapeutic materials used each year during this time. The incidenceof jaundice and anti-factor VIII and anti-factor IX antibodies was recorded.

The sporadic case of haemophilia A

Plasma samples from 41 mothers of haemophilic sons in "simplex families" (families with only one affected member) have been tested for factor VIII and factor-VIII-related antigen. The results suggest that 39 of these women are likely to be carriers of haemophilia.

The estimation of the number of binding sites for antibody on antigen molecules with reference to factor VIII and its antibody

The theoretical basis for determining the number of antibody sites on antigen molecules is examined. The theoretical considerations are applied to factor VIII molecules. Examples based on data available at the Oxford Haemophilia Centre are calculated to illustrate the approach. It is concluded that there are few sites on each factor VIII molecule for human antibody. The three antibodies for which reasonable data were available suggest 1-3 sites for human antibody. The data for rabbit antibody suggest 5-6 sites per factor VIII molecule.

Post-Infectional Compounds From the French Bean Phaseolus vulgaris; Isolation and Identification of Genistein and 2',4',5,7-Tetrahydroxyisoflavone

The isolation and identification of two isoflavones from fungal- infected pods of Phaseolus vulgaris L. is described. One, genistein, is known to occur in other legumes. On the basis of ultraviolet and p.m.r. spectroscopy and of mass spectra, the second compound was tentatively identified as 2?,4?,5,7-tetrahydroxyisoflavone.