A course in medical device design & commercialization for medical students pursuing surgical fields

BACKGROUND

The modern surgeon faces an ever-changing landscape of procedural innovation. The demands of present-day healthcare highlight the importance of successfully developing new medical devices and technologies. This effort requires multidisciplinary collaborations of professionals ranging from manufacturers and engineers to researchers and healthcare providers. Surgeons regularly interact with complex equipment and user interfaces without substantial formal education on their design and development. The objective of this study was to ascertain the impact of a 10-week BME course into a medical school curriculum on surgery-bound students' knowledge of product design and gauge their ability to develop an actual product to meet a real need in a surgical field.

METHODS

A Medical Device Design and Commercialization co-enrolled elective course was offered to medical students at a single institution. Five students with an expressed surgical and procedural interest were enrolled. At the beginning of the course, they were tasked with developing a product to meet a clinical need they observed. At the conclusion of the course, students filled out a questionnaire about their level of comfort and knowledge of the material using a 5-point Likert scale. This survey was administered to a control group of medical students who did not take the course.

RESULTS

The BME student cohort was able to successfully identify a post-operative need, develop a prototype of a novel device, and present their product to attending surgeons. A total of 35 survey entries were received: five from the experimental group and 30 from the comparison group. The experimental group scored higher than the comparison group for all survey questions and reached the level of statistical significance in 13 of the 15 questions (p < 0.05). Survey respondents reported similar degrees of knowledge and comfort in recognizing unmet needs in a hospital setting and formulating a comprehensive statement describing them.

CONCLUSION

The principles of biomedical engineering are integral to advancing the field of surgery. Presently, a small cohort of medical students/residents successfully acquired and applied basic BME concepts in a relatively short period of time relative to other training paradigms. Our findings also suggest medical students recognize unmet needs in the hospital setting, and those who completed a BME course felt more able to take steps to meet those needs. Early integration of biomedical engineering principles in medical training may help produce more innovative and well-rounded surgeons.

YAP/TAZ Transcriptional Coactivators Create Therapeutic Vulnerability to Verteporfin in EGFR-mutant Glioblastoma

PURPOSE

Glioblastomas (GBMs), neoplasms derived from glia and neuroglial progenitor cells, are the most common and lethal malignant primary brain tumors diagnosed in adults, with a median survival of 14 months. GBM tumorigenicity is often driven by genetic aberrations in receptor tyrosine kinases, such as amplification and mutation of EGFR.

EXPERIMENTAL DESIGN

Using a Drosophila glioma model and human patient-derived GBM stem cells and xenograft models, we genetically and pharmacologically tested whether the YAP and TAZ transcription coactivators, effectors of the Hippo pathway that promote gene expression via TEA domain (TEAD) cofactors, are key drivers of GBM tumorigenicity downstream of oncogenic EGFR signaling.

RESULTS

YAP and TAZ are highly expressed in EGFR-amplified/mutant human GBMs, and their knockdown in EGFR-amplified/mutant GBM cells inhibited proliferation and elicited apoptosis. Our results indicate that YAP/TAZ-TEAD directly regulates transcription of SOX2, C-MYC, and EGFR itself to create a feedforward loop to drive survival and proliferation of human GBM cells. Moreover, the benzoporphyrin derivative verteporfin, a disruptor of YAP/TAZ-TEAD-mediated transcription, preferentially induced apoptosis of cultured patient-derived EGFR-amplified/mutant GBM cells, suppressed expression of YAP/TAZ transcriptional targets, including EGFR, and conferred significant survival benefit in an orthotopic xenograft GBM model. Our efforts led us to design and initiate a phase 0 clinical trial of Visudyne, an FDA-approved liposomal formulation of verteporfin, where we used intraoperative fluorescence to observe verteporfin uptake into tumor cells in GBM tumors in human patients.

CONCLUSIONS

Together, our data suggest that verteporfin is a promising therapeutic agent for EGFR-amplified and -mutant GBM.

Abstract 3789: Therapeutic targeting of the YAP/TAZ pathway in glioblastoma with verteporfin

Glioblastoma (GBM) is a particularly lethal brain neoplasm accounting for half of malignant primary brain tumors diagnosed in adults and maintains a devastating diagnosis, with a median survival of 14 months despite standard clinical interventions of surgical, chemotherapeutic, and radiation treatments. GBM tumorigenicity is often driven by aberrations in receptor tyrosine kinases (RTKs) such as EGFR, and the Pi-3 kinase (PI3K) signaling pathway. Using a Drosophila glioma model and human patient-derived glioma cells, we identified YAP/TAZ, effectors of the Hippo pathway that promote expression of stemness factors and oncogenes via activation of the TEAD transcription factors, as drivers of glioma tumorigenicity. This led to the discovery that YAP/TAZ are highly expressed in human patient-derived glioma stem cells and that knockdown of these inhibits cell growth. We hypothesized that Verteporfin, a benzoporphyrin derivative approved by the FDA for the treatment of macular degeneration, may have therapeutic benefit for glioblastoma due to its published ability to inhibit interaction between YAP and TEAD transcription factors. Using in vitro culture-based assays and in vivo in GBM xenograft models, we observed Verteporfin specifically induces apoptosis in GBM cells, slows tumor growth, and durably suppressesexpression of known and novel TEAD transcriptional targets in tumor tissue. We validated several direct targets using chromatin immunoprecipitation, and are seeking to further identify the full transcriptional program controlled by YAP/TAZ-TEAD in GBM. Our efforts have led to a phase 0 clinical trial where we were able to observe Verteporfin uptake in GBM tumors in human patients. These data indicate that Verteporfin is a promising therapeutic target for GBM.

Citation Format: Nathaniel H. Boyd, Krish Vigneswaran, Shoeb Lallani, Se-Yeong Oh, Andrew Boucher, Jeffrey Olson, Renee Read. Therapeutic targeting of the YAP/TAZ pathway in glioblastoma with verteporfin [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 3789.

Upregulation of the chromatin remodeler HELLS is mediated by YAP1 in Sonic Hedgehog Medulloblastoma

Medulloblastoma is a malignant pediatric tumor that arises from neural progenitors in the cerebellum. Despite a five-year survival rate of ~70%, nearly all patients incur adverse side effects from current treatment strategies that drastically impact quality of life. Roughly one-third of medulloblastoma are driven by aberrant activation of the Sonic Hedgehog (SHH) signaling pathway. However, the scarcity of genetic mutations in medulloblastoma has led to investigation of other mechanisms contributing to cancer pathogenicity including epigenetic regulation of gene expression. Here, we show that Helicase, Lymphoid Specific (HELLS), a chromatin remodeler with epigenetic functions including DNA methylation and histone modification, is induced by Sonic Hedgehog (SHH) in SHH-dependent cerebellar progenitor cells and the developing murine cerebella. HELLS is also up-regulated in mouse and human SHH medulloblastoma. Others have shown that HELLS activity generally results in a repressive chromatin state. Our results demonstrate that increased expression of HELLS in our experimental systems is regulated by the oncogenic transcriptional regulator YAP1 downstream of Smoothened, the positive transducer of SHH signaling. Elucidation of HELLS as one of the downstream effectors of the SHH pathway may lead to novel targets for precision therapeutics with the promise of better outcomes for SHH medulloblastoma patients.