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Cytokine Storm: Prediction, Diagnosis, and Management, April 25-26, 2016, Seaport World Trade Center, Boston, MA

Reporter: Aviva Lev-Ari, PhD, RN

SOURCE

From: Immuno-Oncology Updates <davem@pegsummit.com>

Date: Thursday, March 24, 2016 at 4:42 PM

To: Aviva Lev-Ari <AvivaLev-Ari@alum.berkeley.edu>

Subject: Cytokine Storm: Prediction, Diagnosis, and Management [Deadline Friday]

 

 

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When dosed with an immunotherapy, adaptive and innate immune systems are activated, better allowing them to recognize disease cells in the body. However, the immune system also becomes more sensitive to self, potentially causing cytokine storm, macrophage activation syndrome, or autoimmunity. On Monday, April 25, at the PEGS Summit in Boston, there will be a special session devoted to Cytokine Storm: Prediction, Diagnosis, and Management which will include the below presentations. Register for a Premium Package to maximize your savings and learning opportunities while gaining access to the entire Immunotherapy Stream.


Cytokine Storm: Prediction, Diagnosis, and Management

Cytokine Storm Following CAR-T Cell Therapy: An Interdisciplinary Approach to Diagnosis and Symptom Management

Chrystal Louis, Ph.D., Co-Director, Neuroblastoma Program, Texas Children’s Hospital; Assistant Professor, Pediatrics, Section of Hematology-Oncology, Baylor College of Medicine

Chimeric antigen receptor (CARs) positive T cells combines the specificity and anti-tumor effects of monoclonal antibodies with the direct cytotoxicity and long-term persistence of T cells. However, modifications designed to improve the affinity and anti-tumor activity of CARs increases the likelihood of on- and off-target toxicity secondary to low level antigenic expression on normal tissues. Toxicity associated with cytokine storm and macrophage activation syndrome can be life-threatening if not quickly identified and requires interdisciplinary communication and teamwork to successfully manage the symptoms.

Biomarkers Accurately Predict Cytokine Release Syndrome (CRS) after Chimeric Antigen Receptor (CAR) T Cell Therapy for Acute Lymphoblastic Leukemia (ALL)

Simon Lacey, Ph.D., Director, Translational and Correlative Studies Laboratory, Product Development and Correlative Sciences, University of Pennsylvania

CAR T cells with anti-CD19 specificity have demonstrated remission rates as high as 90% in ALL patients treated with CTL019 (Maude et al., NEJM 2014), but cytokine release syndrome (CRS) can be a complication. We studied 43 cytokines, chemokines, and soluble receptors in 51 ALL patients treated with anti-CD19 CAR T cells. Biomarkers associated with severe CRS and predictive during the first 3 days after infusion of subsequent CRS4-5 compared to CRS0-3 were identified.

Managing Receptor-Engineered T Cell Cytokine Storms: Facts, Fabulations, Future Progress

Christopher A. Klebanoff, M.D., Assistant Clinical Investigator, Center for Cancer Research, National Cancer Institute

Adoptive transfer of receptor-engineered T cells targeting tumor-associated antigens can mediate durable complete responses in patients with refractory solid and hematologic malignancies. In some cases, infusion of engineered T cells is associated with a spectrum of toxicities attributed to an exuberant release of cytokines. Dissemination of this promising treatment modality beyond specialized academic medical centers will require detailed understanding of both the pathogenesis and medical management of cell-related toxicities.

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Diabetes Mellitus: new insight into genetic role

Larry H. Bernstein, MD, FCAP, Curator

LPBI

 

New Study May Lead to Improved Type 2 Diabetes Treatment

http://www.dddmag.com/news/2016/03/new-study-may-lead-improved-type-2-diabetes-treatment

 

Genetic cause found for loss of beta cells during diabetes development.

Worldwide, 400 million people live with diabetes, with rapid increases projected. Patients with diabetes mostly fall into one of two categories, type 1 diabetics, triggered by autoimmunity at a young age, and type 2 diabetics, caused by metabolic dysfunction of the liver. Despite being labeled a “lifestyle disease”, diabetes has a strong genetic basis. New research under the direction of Adrian Liston (VIB/KU Leuven) has discovered that a common genetic defect in beta cells may underlie both forms of diabetes. This research was published in the international scientific journal Nature Genetics.

Adrian Liston (VIB/University of Leuven): “Our research finds that genetics is critical for the survival of beta cells in the pancreas – the cells that make insulin. Thanks to our genetic make-up, some of us have beta cells that are tough and robust, while others have beta cells that are fragile and can’t handle stress. It is these people who develop diabetes, either type 1 or type 2, while others with tougher beta cells will remain healthy even in if they suffer from autoimmunity or metabolic dysfunction of the liver.”

Different pathways to diabetes development

Diabetes is a hidden killer. One out of every 11 adults is suffering from the disease, yet half of them have not even been diagnosed. Diabetes is caused by the inability of the body to lower blood glucose, a process normally driven by insulin. In patients with type 1 diabetes (T1D), this is caused by the immune system killing off the beta cells that produce insulin. In patients with type 2 diabetes (T2D), a metabolic dysfunction prevents insulin from working on the liver. In both cases, left untreated, the extra glucose in the blood can cause blindness, cardiovascular disease, diabetic nephropathy, diabetic neuropathy and death.

In this study, an international team of researchers investigated how genetic variation controls the development of diabetes. While most previous work has focused on the effect of genetics in altering the immune system (in T1D) and metabolic dysfunction of the liver (in T2D), this research found that genetics also affected the beta cells that produce insulin. Mice with fragile beta cells that were poor at repairing DNA damage would rapidly develop diabetes when those beta cells were challenged by cellular stress. Other mice, with robust beta cells that were good at repairing DNA damage, were able to stay non-diabetic for life, even when those islets were placed under severe cellular stress. The same pathways for beta cell survival and DNA damage repair were also found to be altered in diabetic patient samples, indicating that a genetic predisposition for fragile beta cells may underlie who develops diabetes.

Adrian Liston (VIB/University of Leuven): “While genetics are really the most important factor for developing diabetes, our food environment can also play a deciding role. Even mice with genetically superior beta cells ended up as diabetic when we increased the fat in their diet.”

A new model for testing type 2 diabetes treatments

Current treatments for T2D rely on improving the metabolic response of the liver to insulin. These antidiabetic drugs, in conjunction with lifestyle interventions, can control the early stages of T2D by allowing insulin to function on the liver again. However during the late stages of T2D, the death of beta cells means that there is no longer any insulin being produced in the pancreas. At this stage, antidiabetic drugs and lifestyle interventions have poor efficacy, and medical complications arise.

Dr Lydia Makaroff (International Diabetes Federation, not an author of the current study): “The health cost for diabetes currently exceeds US$600 billion, 12 percent of the global health budget, and will only increase as diabetes becomes more common. Much of this health care burden is caused by late-stage type 2 diabetes, where we do not have effective treatments, so we desperately need new research into novel therapeutic approaches. This discovery dramatically improves our understanding of type 2 diabetes, which will enable the design of better strategies and medications for diabetes in the future”.

Adrian Liston (VIB/University of Leuven): “The big problem in developing drugs for late-stage T2D is that, until now, there has not been an animal model for the beta cell death stage. Previously, animal models were all based on the early stage of metabolic dysfunction in the liver, which has allowed the development of good drugs for treating early-stage T2D. This new mouse model will allow us, for the first time, to test new antidiabetic drugs that focus on preserving beta cells. There are many promising drugs under development at life sciences companies that have just been waiting for a usable animal model. Who knows, there may even be useful compounds hidden away in alternative or traditional medicines that could be found through a good testing program. If a drug is found that stops late-stage diabetes, it would really be a major medical breakthrough!”

New Method Measures Type 2 Diabetes Risk in Blood

http://www.dddmag.com/news/2016/04/new-method-measures-type-2-diabetes-risk-blood

Researchers at Lund University in Sweden have found a new type of biomarker that can predict the risk of type 2 diabetes, by detecting epigenetic changes in specific genes through a simple blood test. The results are published today in Nature Communications.

“This could motivate a person at risk to change their lifestyle”, said Karl Bacos, researcher in epigenetics at Lund University.

Predicting the onset of diabetes is already possible by measuring the blood glucose level average, HbA1C, over time. However, the predictive potential of this method is modest and new methods are needed.

The discoveries made by the research group at Lund University have now made it possible to measure the presence of so-called DNA methylations in four specific genes, and thereby predict who is at risk of developing type 2 diabetes, long before the disease occurs. Methylations are chemical changes that control gene activity, that is, whether they are active or not.

“The hope is that this will be developed into a better way to predict the disease”, said Karl Bacos, first author of the study.

The researchers started by studying insulin-producing beta cells from deceased persons. They found that the DNA methylations in the four genes in question increased, depending on the donor’s age. This in turn affected the activity of the genes.

When these changes were copied in cultured beta cells, they proved to have a positive effect on insulin secretion.

“We could then see the same DNA methylation changes in the blood which was really cool”, said Karl Bacos.

The blood samples from the participants of two separate research projects – one Danish and one Finnish – were then studied and compared with blood samples taken from the same participants ten years later. The Finnish participants, who had exhibited higher levels of DNA methylation in their first sample, had a lower risk of type 2 diabetes ten years later. In the Danish participants, higher DNA methylation in their first sample was associated with higher insulin secretion ten years later. All of the Danish participants were healthy on both occasions, whereas approximately one-third of the Finnish participants had developed type 2 diabetes.

“Increased insulin secretion actually protects against type 2 diabetes. It could be the body’s way of protecting itself when other tissue becomes resistant to insulin, which often happens as we get older”, said professor and research project manager Charlotte Ling.

The studies were based on a relatively small number of participants, and a selection of genes. The researchers therefore now want to continue with finding markers with a stronger predictive potential by implementing so-called epigenetic whole-genome sequencing when analysing a person’s entire genetic make-up and all the DNA methylations that come with it, in a larger population group.

The research group has previously shown that age, diet and exercise affect the so-called epigenetic risk of type 2 diabetes.

“You cannot change your genes and the risks that they entail, but epigenetics means that you can affect the DNA methylations, and thereby gene activity, through lifestyle choices”, said Charlotte Ling.

 

Prognostic biomarker for NSCLC and Cancer Metastasis

Larry H. Bernstein, MD, FCAP, Curator

LPBI

 

Membranous CD24 expression as detected by the monoclonal antibody SWA11 is a prognostic marker in non-small cell lung cancer patients

Michael MajoresAnne SchindlerAngela FuchsJohannes SteinLukas HeukampPeter Altevogt and Glen Kristiansen

BMC Clinical Pathology201515:19   http://dx.doi.org:/10.1186/s12907-015-0019-z

Background    Lung cancer is one of the most common malignant neoplasms worldwide and has a high mortality rate. To enable individualized therapy regimens, a better understanding of the molecular tumor biology has still to be elucidated. The expression of the cell surface protein CD24 has already been claimed to be associated with shorter patient survival in non-small cell lung cancer (NSCLC), however, the prognostic value and applicability of CD24 immunostaining in paraffin embedded tissue specimens has been questioned due to the recent acknowledgement of restricted epitope specificity of the commonly used antibody SN3b.   Methods    A cohort of 137 primary NSCLC cases was immunostained with a novel CD24 antibody (clone SWA11), which specifically recognizes the CD24 protein core and the resulting expression data were compared with expression profiles based on the monoclonal antibody SN3b. Furthermore, expression data were correlated to clinico-pathological parameters. Univariate and multivariate survival analyses were conducted with Kaplan Meier estimates and Cox regression, respectively. Results    CD24 positivity was found in 34 % resp. 21 % (SN3b) of NSCLC with a membranous and/or cytoplasmic staining pattern. Kaplan-Meier analyses revealed that membranous, but not cytoplasmic CD24 expression (clone SWA11) was associated with lympho-nodular spread and shorter overall survival times (both p < 0.05). CD24 expression established by SN3b antibodies did not reveal significant clinicopathological correlations with overall survival, neither for cytoplasmic nor membranous CD24 staining.  Conclusions    Membranous CD24 immunoreactivity, as detected with antibody clone SWA11 may serve as a prognostic factor for lymphonodular spread and poorer overall survival. Furthermore, these results corroborate the importance of a careful distinction between membranous and cytoplasmic localisation, if CD24 is to be considered as a potential prognostic biomarker.

 

Lung cancer is a major cause of carcinoma related death, being responsible for 17.8 % of all cancer deaths and accounting for more than a million deaths worldwide per year [1]. Despite intense studies to improve therapy options, its prognosis has remained poor with a 5-year overall survival rate of less than 15 % [2].

In the past decade, the largest subgroup of lung cancer, i.e. non-small cell lung cancer (NSCLC), has been subjected to exerted research for a better understanding of the underlying molecular biology of lung cancer. More than ten years ago, CD24 has already been suggested as a novel and promising biomarker for carcinoma progression in NSCLC [3] and several groups have confirmed this finding on protein and transcript level [2, 4]. CD24 is a highly glycosylated protein, that binds to the cell surface through a GPI (glycosyl-phosphatidylinositol)-anchor and functions as a cell adhesion molecule and is involved in cell-cell-interaction via its P-selectin binding site [5]. CD24 has been found to be expressed by pre-B-lymphocytes [5]. It is assumed that CD24-positive cells can attach more easily to platelets and activated endothelial cells [6, 7]. Notably, CD24 has also been observed in many human carcinomas, such as ovarian cancer, renal cell cancer, breast cancer and NSCLC [3, 812]. In epithelial ovarian cancer high scores of cytoplasmic CD24 were highly predictive of shorter patient survival times (mean 97.8 vs. 36.5 months), whereas membranous CD24 expression seemed to have no influence on survival times. Interestingly, CD24 positivity (membranous or cytoplasmic) of prostate cancer samples was significantly associated to younger patient age and higher pT stages and a higher 3-year prostate-specific antigen (PSA) relapse rate compared with CD24-negative tumours.

In patients with gallbladder carcinoma, tumors with up-regulation of CD24 revealed lymph node metastasis and lymphovascular invasion more frequently. Moreover, up-regulation of CD24 tended to show deeper invasion depth and higher TNM stage [13]. Together, these findings support CD24 as a prognostic marker for carcinoma progression and poorer survival.

Despite these intriguing findings, major concerns regarding a lack of epitope specificity of the commonly used monoclonal antibody SN3b have been raised [14]. Recent findings indicate that the mAb (monoclonal antibody) SN3b does not bind to the protein core itself, but binds to a glycan structure that decorates the CD24 molecule. On the one hand, this motif is not present on all forms of CD24 and—on the other hand—it can be present in other epitopes irrespective of CD24 [14]. These limitations underline the need for more specific CD24 antibodies, such as the mAb SWA11 antibody that has been suggested to be more specific as it binds to the protein core [14].

As CD24 is a promising biomarker for the risk assessment of disease progression, the goal of the present study was to investigate CD24 expression in NSCLC using the novel, more specific monoclonal antibody (mAb) SWA11. Special emphasis was put on the comparison of SN3b- and SWA11-mediated CD24 detection regarding a) the subcellular distribution of CD24 expression (i.e. membranous versus cytoplasmic expression) and b) its correlation with various clinicopathological features including patient survival times.

Table 1

Clinicopathological characteristics of the NSCLC cohort

  AC SCC
N (%) N (%)
Tumour stage (pT)
1 29 (21.2 %) 5 (3.6)
2 51 (37.2 %) 23 (16.8 %)
3 6 (4.4 %) 6 (4.4 %)
4 1 (0.7 %) 0 (0 %)
Nodal Status (pN) 0 37 (27.0 %) 15 (10.9 %)
1 15 (10.9 %) 9 (6.6 %)
2 14 (10.2 %) 3 (2.2 %)
3 1 (0.7 %) 0 (0.0 %)
Grading (G) 1 5 (3.6 %) 0 (0.0 %)
2 41 (29.9 %) 16 (11.6 %)
3 44 (32.1 %) 17 (12.4 %)
Mean age at surgery 64,2 64,56
(median age) (65) (67)
Sex (m:w) 68:34 30:5
Median OS (months) 52 24
(SD; 95 % CI [months]) (±23.7; 5.5– 98.5) (± 12.8;0.0– 49.0)

 

Immunohistochemical detection of CD24 expression using clone SWA11 and SN3b

Using the mAb SWA11, 47 of 137 (34.3 %) NSCLC revealed CD24 expression (either cytoplasmic or membranous) (Table 2). CD24 expression was observed more frequently in adenocarcinomas (AC) than in squamous cell carcinomas (SCC). In AC cytoplasmic expression was observed more frequently than membranous expression. In SCC, both cyptoplasmic and membranous expression was rare. Normal lung parenchyma (i.e. alveolar surface cells) showed no expression of CD24. Bronchial epithelium showed a strong membranous and cytoplasmic staining of the brush border (Fig. 1).

Table 2

Cytoplasmic and membranous expression of CD24

SWA11 (mAb clone) SN3b (mAB clone)
  AC SCC   AC SCC
Cytoplasmic N (%) N (%) Cytoplasmic N (%) N (%)
0 45 (32.6 %) 19 (13.8 %) 0 76 (55.1 %) 31 (22.5 %)
1 22 (15.9 %) 8 (5.8 %) 1 12 (8.7 %) 1 (0.7 %)
2 17 (12.3 %) 4 (2.9 %) 2 7 (5.1 %) 2 (1.4 %)
3 18 (13.0 %) 4 (2.9 %) 3 1 (0.7 %) 0 (0 %)
AC SCC AC SCC
Membranous N (%) N (%) Membranous N (%) N (%)
0 68 (49.3 %) 21 (15.2 %) 0 64 (46.4 %) 30 (21.7 %)
1 21 (15.2 %) 5 (3.6 %) 1 10 (7.2 %) 2 (1.4 %)
2 8 (5.8 %) 4 (2.9 %) 2 12 (8.7 %) 2 1.4 %)
3 5 (3.6 %) 5 (3.6 %) 3 10 (7.2 %) 0 (0 %)

Staining intensities are determined as follows:

0: negative or equivocal, 1: weak, 2: moderate and 3: strong CD24 staining

 

https://static-content.springer.com/image/art%3A10.1186%2Fs12907-015-0019-z/MediaObjects/12907_2015_19_Fig1_HTML.gif

Fig 1

The immunohistochemical characterization reveals membranous and/or cytoplasmic CD24 (mAb SWA11) expression. Strong cytoplasmic CD24 expression is found in a proportion of both AC (a) and SCC (b, d) specimens. Membranous CD24 expression can be pronounced with only scant or even absent cytoplasmic staining as shown in the AC (c). Also, both membranous and cytoplasmic CD24 detection can be found in some instances (d), the insert is showing the corresponding squamous carcinoma in-situ with membranous staining. Simultaneous membranous and cytoplasmic CD24 expression is also found in AC specimens (e, f). In normal tissue, alveolar epithelial cells do not express CD24 (g), whereas CD24 staining is found at the apical cell membrane of bronchial respiratory epithelia (h)

Using the mAb SN3b, 29 of 137 (21.2 %) NSCLC revealed CD24 expression (either cytoplasmic or membranous) (Table 2). As above, CD24 expression was observed more frequently in adenocarcinomas (AC) than in squamous cell carcinomas (SCC). However, in contrast to mAb SWA11 cytoplasmic expression was observed less frequently than membranous expression in AC. In SCC, both cytoplasmic and membranous expression was rare. Normal lung parenchyma (i.e. alveolar surface cells) showed a distinct membranous immunoreactivity. Bronchial epithelium revealed both membranous and cytoplasmic staining of CD24.

Correlation between SWA11 and SN3b: As SWA11 and SN3b detect different epitopes, we evaluated the correlation of the immunohistochemical staining patterns. Of 132 NSCLC specimens with matched expression data, only 9 specimens (6.8 %) revealed a concordant CD24 expression. Of these cases, 4 cases revealed a concordant cytoplasmic staining and another 5 cases revealed a concordant membranous CD24 expression. Statistically, no significant correlation between the two mAb could be observed (cc = −0.63, p = 0.470; Fisher’s exact test p = 0.665). The correlation of cytoplasmic and membranous expression (for each antibody) was as follows: cc = 0.475 (p < 0.05) for SWA11 (n = 108) and cc = 0.140 (p = 0.11) for SN3b (n = 103).

Survival analyses

Recent studies indicate that CD24 expression is associated with tumor progression and poorer survival rates. Therefore, we performed follow up analyses with a special emphasis on 1) the prognostic value of mAb SWA11 in dependence on subcellular staining characteristics and 2) the prognostic values of different clinicopathological parameters:

Prognostic value of CD24 in Kaplan Meier Analyses

Only membranous CD24 (SWA11) staining revealed significantly poorer survival rates (median overall survival 21 vs. 52 months; p = 0.005) as illustrated in Fig. 2. In contrast, cytoplasmic CD24 (SWA11) staining did not affect the survival rates (median OS 34 vs. 35 months; p = 0.884) (Table 3). When stratifying the cohort into SCC (n = 35) and AC (n = 102) in Kaplan Meier analyses, membranous CD24 (SWA11) expression did not affect patients’ survival, neither in SCC (p = 0.243) nor AC (p = 0.135) (Table 3), probably due to the small number of observations (Fisher exact test: p > 0.05). After stratification for AC subtypes, membranous CD24 expression (SWA11) showed a tendency towards an association with poorer survival in acinar subtype AC, but failed significance (p = 0.328).
https://static-content.springer.com/image/art%3A10.1186%2Fs12907-015-0019-z/MediaObjects/12907_2015_19_Fig2_HTML.gif

Fig 2

Survival analysis. Kaplan-Meier curves according to SWA11 expression. Cases with moderate to strong expression were bundled in a ‘high expression’ and cases with negative or weak expression in a ‘low expression’ group. Membranous expression of CD24 detected by SWA11 proved to be an independent marker for shorter survival times in NSCLC (p = 0.005)

Table 3

Univariate survival analysis

SWA11 No. of cases Mean survival time Median survival time p-value
(months +/− s.e.) (months +/− s.e.)
Mem CD24
Negative 76 84.833 +/− 10.395 52.000 +/− 27.030 0.005
Positive 16 27.925 +/− 6.379 21.000 +/− 4.000
Cyto CD24
Negative 66 75.209 +/− 10.577 35.000 +/− 12.422 0.884
Positive 26 60.540 +/− 11.551 34.000 +/− 12.196
Total CD24
Negative 64 76.972 +/− 10.841 35.000 +/− 13.726 0.633
Positive 28 57.535 +/− 10.895 34.000 +/− 9.303
SCC
Mem CD24 negative 16 52.063 +/− 14.668 16.000 +/− 16.000 0.243
Mem CD24 positive 7 21.571 +/− 7.201 24.000 +/− 23.568
AC
Mem CD24 negative 59 88.953 +/− 11.631 56.000 +/− 22.885 0.135
Mem CD24 positive 8 39.167 +/− 11.674 21.000 +/− 8.485
pN0 31 103.641 +/− 14.940 93.000 +/− 28.224 0.012
pN1+ 30 54.911 +/− 10.646 26.000 +/− 0.983

 

…..

Univariate survival analysis according to the Cox regression model (mAb SWA11)

  Beta HR (hazard ratio) 95 % CI of HR P-value
SWA11 mem all 0.856 2.353 1.268–4.364 0.007
pN 0.963 2.620 1.389–4.943 0.003
pT 0.844 2.325 1.279–4.224 0.006
Tumour type 0.975 2.651 1.999–3.517 0.000

Table 5

Multivariate survival analysis according to the Cox regression model (mAb SWA11)

  Beta HR (hazard ratio) 95 % CI of HR P-value
SWA11 mem all 0.944 2.571 1.211–5.458 0.014
pN 0.737 2.091 1.087–4.021 0.027
pT 0.587 1.799 0.755–4.283 0.185

 

…..

In the present study, we have analyzed immunohistochemical staining characteristics and the prognostic value of CD24 expression in NSCLC with a special emphasis on the comparison of the CD24 antibodies SWA11 and SN3b. The most important result of our study is that the prognostic relevance of CD24 is critically dependent on the careful consideration of sub-cellular compartments and the epitope specificity of the antibody used.

Overall, about one third of the NSCLC cohort revealed a significant CD24 expression (either cytoplasmic or membranous). These results are in line with the findings of other studies. In another NSCLC cohort, CD24 (SN3b) expression was found in 33 % of the samples (87 of 267 cases) [2]. Consistent with those results, we have found similar rates of high CD24 expression levels (35 % of the cases) for SWA11. Originally, we would have expected lower rates than those found by Lee et al, as they used the antibody SN3b, that also recognizes yet unidentified other glycoproteins next to CD24. Furthermore, they used whole mount sections instead of tissue microarrays. A possible explanation for rather equal detection rates would be the fact that it has been demonstrated that the epitope recognized by SN3b is indeed present in CD24, but is not found in all glycoforms of CD24 [14]. In contrast to the commonly used mAb SN3b, mAb SWA11 binds to the protein core of CD24 and does not depict other glycan moieties next to CD24. The protein core of CD24 is linear, consisting of the amino acid sequence leucine-proline-alanine (LAP) next to a glycosyl-phosphatidylinositol anchor [15].

CD24 expression has been associated with disease progression and cancer-related death in the majority of malignant tumors [2, 3, 16, 17], although a caveat to these data is that most of these studies are based on the supposedly less specific CD24 clone SN3b. Lee et al demonstrated a significant association between CD24-high expression (SN3b) and shorter patient survival times. Furthermore, Lee and colleagues and ourselves in former studies referred the results to cytoplasmic CD24 expression [2, 3].

Switching Off Cancers’ Ability to Spread

http://www.technologynetworks.com/rnai/news.aspx?ID=189704

A key molecule in breast and lung cancer cells can help switch off the cancers’ ability to spread around the body.

The findings by researchers at Imperial College London, published in the journal EMBO Reports, may help scientists develop treatments that prevent cancer travelling around the body – or produce some kind of test that allows doctors to gauge how likely a cancer is to spread. During tumour growth, cancer cells can break off and travel in the bloodstream or lymph system to other parts of the body, in a process called metastasis.

Patients whose cancers spread tend to have a worse prognosis, explains Professor Justin Stebbing, senior author of the study from the Department of Surgery and Cancer at Imperial: “The ability of a cancer to spread around the body has a large impact on a patient’s survival. However, at the moment we are still in the dark about why some cancers spread around the body – while others stay in one place. This study has given important insights into this process.”

The researchers were looking at breast and lung cancer cells and they found that a protein called MARK4 enables the cells to break free and move around to other parts of the body, such as the brain and liver. Although scientist are still unsure how it does this, one theory is it affects the cell’s internal scaffolding, enabling it to move more easily around the body. The team found that a molecule called miR-515-5p helps to silence, or switch off, the gene that produces MARK4.

In the study, the team used human breast cancer and lung cancer cells to show that the miR-515-5p molecule silences the gene MARK4. They then confirmed this in mouse models, which showed that increasing the amount of miR-515-5p prevents the spread of cancer cells. The findings also revealed that the silencer molecule was found in lower levels in human tumours that had spread around the body. The team then also established that patients with breast and lung cancers whose tumours had low amounts of these silencer molecules – or high amounts of MARK4 – had lower survival rates.

Researchers are now investigating whether either the MARK4 gene or the silencer molecule could be targeted with drugs. They are also investigating whether these molecules could be used to develop a test to indicate whether a patient’s cancer is likely to spread. Professor Stebbing said: “In our work we have shown that this silencer molecule is important in the spread of cancer. This is very early stage research, so we now need more studies to find out more about this molecule, and if it is present in other types of cancer.”

Dr Olivier Pardo, lead author of the paper, also from the Department of Surgery and Cancer at Imperial, added: “Our work also identified that MARK4 enables breast and lung cancer cells to both divide and invade other parts of the body. These findings could have profound implications for treating breast and lung cancers, two of the biggest cancer killers worldwide.” The study was supported by the NIHR Imperial Biomedical Research Centre, the Medical Research Council, Action Against Cancer and the Cancer Treatment and Research Trust.

 

‘Silencer molecules’ switch off cancer’s ability to spread around body

by Kate Wighton

main image

Scientists have revealed that a key molecule in breast and lung cancer cells can help switch off the cancers’ ability to spread around the body

The findings by researchers at Imperial College London, published in the journal EMBO Reports, may help scientists develop treatments that prevent cancer travelling around the body – or produce some kind of test that allows doctors to gauge how likely a cancer is to spread.

During tumour growth, cancer cells can break off and travel in the bloodstream or lymph system to other parts of the body, in a process called metastasis.

Patients whose cancers spread tend to have a worse prognosis, explains Professor Justin Stebbing, senior author of the study from the Department of Surgery and Cancer at Imperial: “The ability of a cancer to spread around the body has a large impact on a patient’s survival. However, at the moment we are still in the dark about why some cancers spread around the body – while others stay in one place. This study has given important insights into this process.”

The researchers were looking at breast and lung cancer cells and they found that a protein called MARK4 enables the cells to break free and move around to other parts of the body, such as the brain and liver. Although scientist are still unsure how it does this, one theory is it affects the cell’s internal scaffolding, enabling it to move more easily around the body.

 

miR‐515‐5p controls cancer cell migration through MARK4 regulation

Olivier E Pardo, Leandro Castellano, Catriona E Munro, Yili Hu, Francesco Mauri,Jonathan Krell, Romain Lara, Filipa G Pinho, Thameenah Choudhury, Adam EFrampton, Loredana Pellegrino, Dmitry Pshezhetskiy, Yulan Wang, JonathanWaxman, Michael J Seckl, Justin Stebbing    

EMBO reports http://embor.embopress.org/content/early/2016/02/10/embr.201540970     http://dx.doi.org:/
Here, we show that miR‐515‐5p inhibits cancer cell migration and metastasis. RNA‐seq analyses of both oestrogen receptor receptor‐positive and receptor‐negative breast cancer cells overexpressing miR‐515‐5p reveal down‐regulation of NRAS, FZD4, CDC42BPA, PIK3C2B and MARK4 mRNAs. We demonstrate that miR‐515‐5p inhibits MARK4 directly 3′ UTR interaction and that MARK4 knock‐down mimics the effect of miR‐515‐5p on breast and lung cancer cell migration. MARK4 overexpression rescues the inhibitory effects of miR‐515‐5p, suggesting miR‐515‐5p mediates this process through MARK4 down‐regulation. Furthermore, miR‐515‐5p expression is reduced in metastases compared to primary tumours derived from both in vivo xenografts and samples from patients with breast cancer. Conversely, miR‐515‐5p overexpression prevents tumour cell dissemination in a mouse metastatic model. Moreover, high miR‐515‐5p and low MARK4 expression correlate with increased breast and lung cancer patients’ survival, respectively. Taken together, these data demonstrate the importance of miR‐515‐5p/MARK4 regulation in cell migration and metastasis across two common cancers.
Embedded Image

miR‐515‐5p inhibits cancer progression, cell migration and metastasis through its direct target MARK4, a regulator of the cytoskeleton and cell motility. Moreover, reduced miR‐515‐5p and increased MARK4 levels in metastatic lung and breast cancer correlate with poor patient prognosis.

  • MARK4 down‐regulation promotes microtubule polymerisation.

  • Increased cell spreading downstream of miR‐515‐5p overexpression or MARK4 silencing hinders cell motility and invasiveness.

  • miR‐515‐5p overexpression or MARK4 silencing prevent organ colonisation by circulating tumour cells.

  • MARK4 inhibitors may represent novel therapeutic agents to control cancer dissemination.breasat cancer

 

Liquid Biopsy for NSCLC

http://www.technologynetworks.com/Diagnostics/news.aspx?ID=190276

‘Liquid biopsy’ blood test accurately detects key genetic mutations in most common form of lung cancer, study finds.

A simple blood test can rapidly and accurately detect mutations in two key genes in non-small cell lung tumors, researchers at Dana-Farber Cancer Institute and other institutions report in a new study – demonstrating the test’s potential as a clinical tool for identifying patients who can benefit from drugs targeting those mutations.

The test, known as a liquid biopsy, proved so reliable in the study that Dana-Farber/Brigham and Women’s Cancer Center (DF/BWCC) expects to offer it soon to all patients with non-small cell lung cancer (NSCLC), either at the time of first diagnosis or of relapse following previous treatment.

NSCLC is the most common form of lung cancer, diagnosed in more than 200,000 people in the United States each year, according to the American Cancer Society. An estimated 30 percent of NSCLC patients have mutations in either of the genes included in the study, and can often be treated with targeted therapies. The study is being published online today by the journal JAMA Oncology.

The liquid biopsy tested in the study – technically known as rapid plasma genotyping – involves taking a test tube-full of blood, which contains free-floating DNA from cancer cells, and analyzing that DNA for mutations or other abnormalities. (When tumor cells die, their DNA spills into the bloodstream, where it’s known as cell-free DNA.) The technique, which provides a “snapshot” of key genetic irregularities in a tumor, is a common tool in research for probing the molecular make-up of different kinds of cancers.

“We see plasma genotyping as having enormous potential as a clinical test, or assay – a rapid, noninvasive way of screening a cancer for common genetic fingerprints, while avoiding the challenges of traditional invasive biopsies,” said the senior author of the study, Geoffrey Oxnard, MD, thoracic oncologist and lung cancer researcher at Dana-Farber and Brigham and Women’s Hospital. “Our study was the first to demonstrate prospectively that a liquid biopsy technique can be a practical tool for making treatment decisions in cancer patients. The trial was such a success that we are transitioning the assay into a clinical test for lung cancer patients at DF/BWCC.”

The study involved 180 patients with NSCLC, 120 of whom were newly diagnosed, and 60 of whom had become resistant to a previous treatment, allowing the disease to recur. Participants’ cell-free DNA was tested for mutations in the EGFR and KRAS genes, and for a separate mutation in EGFR that allows tumor cells to become resistant to front-line targeted drugs. The test was performed with a technique known as droplet digital polymerase chain reaction (ddPCR), which counts the individual letters of the genetic code in cell-free DNA to determine if specific mutations are present. Each participant also underwent a conventional tissue biopsy to test for the same mutations. The results of the liquid biopsies were then compared to those of the tissue biopsies.

The data showed that liquid biopsies returned results much more quickly. The median turnaround time for liquid biopsies was three days, compared to 12 days for tissue biopsies in newly diagnosed patients and 27 days in drug-resistant patients.

Liquid biopsy was also found to be highly accurate. In newly diagnosed patients, the “predictive value” of plasma ddPCR was 100 percent for the primary EGFR mutation and the KRAS mutation – meaning that a patient who tested positive for either mutation was certain to have that mutation in his or her tumor. For patients with the EGFR resistance mutation, the predictive value of the ddPCR test was 79 percent, suggesting the blood test was able to find additional cases with the mutation that were missed using standard biopsies.

“In some patients with the EGFR resistance mutation, ddPCR detected mutations missed by standard tissue biopsy,” Oxnard remarked. “A resistant tumor is inherently made up of multiple subsets of cells, some of which carry different patterns of genetic mutations. A single biopsy is only analyzing a single part of the tumor, and may miss a mutation present elsewhere in the body. A liquid biopsy, in contrast, may better reflect the distribution of mutations in the tumor as a whole.”

When ddPCR failed to detect these mutations, the cause was less clear-cut, Oxnard says. It could indicate that the tumor cells don’t carry the mutations or, alternatively, that the tumor isn’t shedding its DNA into the bloodstream. This discrepancy between the test results and the presence of mutations was less common in patients whose cancer had metastasized to multiple sites in the body, researchers found.

The ddPCR-based test, or assay, was piloted and optimized for patients at the Translational Resarch lab of the Belfer Center for Applied Cancer Science at Dana-Farber. It was then validated for clinical use at Dana-Farber’s Lowe Center for Thoracic Oncology.

An advantage of this form of liquid biopsy is that it can help doctors quickly determine whether a patient is responding to therapy. Fifty participants in the study had repeat testing done after starting treatment for their cancer. “Those whose blood tests showed a disappearance of the mutations within two weeks were more likely to stay on the treatment than patients who didn’t see such a reduction,” said the study’s lead author, Adrian Sacher, MD, of Dana-Farber and Brigham and Women’s Hospital.

And because tumors are constantly evolving and acquiring additional mutations, repeated liquid biopsies can provide early detection of a new mutation – such as the EGFR resistance mutation – that can potentially be treated with targeted agents.

“The study data are compelling,” said DF/BWCC pathologist Lynette Sholl, MD, explaining the center’s decision to begin offering ddPCR-based liquid biopsy to all lung cancer patients. “We validated the authors’ findings by cross-comparing results from liquid and tissue biopsies in 34 NSCLC patients. To work as a real-world clinical test, liquid biopsy needs to provide reliable, accurate data and be logistically practical. That’s what we’ve seen with the ddPCR-based blood test.

“The test has great utility both for patients newly diagnosed with NSCLC and for those with a recurrence of the disease,” she continued. “It’s fast, it’s quantitative (it indicates the amount of mutant DNA in a sample), and it can be readily employed at a cancer treatment center.”

The co-authors of the study are Cloud Paweletz, PhD, Allison O’Connell, BSc, and Nora Feeney, BSc, of the Belfer Center for Applied Cancer Science at Dana-Farber; Ryan S. Alden BSc, and Stacy L. Mach BA, of Dana-Farber; Suzanne E. Dahlberg, PhD, of Dana-Farber and Harvard T.H. Chan School of Public Health; and Pasi A. Jänne, MD, PhD, of Dana-Farber, the Belfer Center, and Brigham and Women’s Hospital.

Chromatography and Mass Spectroscopy

Larry H. Bernstein, MD, FCAP, Curator

LPBI

 

Optimization of Chromatography in the Lab

Sanji Bhal & Karim Kassam; ACD/Labs

While analytical laboratories may still rely to some extent on trial-and-error approaches, there is agreement that this is increasingly less effective as systems become more complex. Regulatory bodies are putting increasing pressure on pharmaceutical companies to incorporate Quality by Design (QbD) approaches throughout the drug development process. QbD is defined in the ICH Q8 guideline as “A systematic approach to development that begins with predefined objectives and emphasizes product and process understanding and process control, based on sound science and quality risk management.”

Developing effective and robust separations methods can be a very time-consuming process. A comprehensive approach to method development would be thorough investigation of the design space for any given mixture or sample including buffer, column, solvent, time, temperature, etc. Given the time constraints and limited resources in any R&D laboratory, however, this type of broad scope investigation is unrealistic.

Modeling for the optimization of chromatographic separations of small molecules has been successfully used for approximately 30 years. A large number of articles have been published on this topic by L. Snyder, P. Janderra, P. Schoenmakers et al. Modeling of chromatographic separations continues to be of interest because as the science of chromatographic separations continues to evolve, modeling techniques must evolve with them to support the needs of the community.

New types of chromatographic techniques (UHPLC, HILIC, ion exchange chromatography, etc.) have demanded the need for new modeling tools. This also led to the need for translation of methods from one technique to newer techniques (HPLC to UHPLC, for example). Furthermore, as pharmaceutical R&D has expanded investigation of new drugs from small molecules to proteins and bio-molecules, many of the old rules no longer apply.

The ability to model the behavior of a sample in silico provides chromatographers with a number of advantages:

Greater efficiency in method development—it is difficult to estimate the number of hours required to identify a suitable method for separation of a mixture. An experienced scientist will rely on their knowledge while an inexperienced colleague may struggle with the same separation. As the number of experienced chromatographers decreases across organizations, and the existing scientists are retiring, software to assist those less experienced becomes more attractive.

With such a large number of variables (temperature, gradient, pH, salt concentration, etc.) it is advantageous to use all available knowledge and tools to ‘get ahead’. Increased efficiency can be realized not only in identifying an optimal method faster but also increasing throughput and decreasing scale-up time.

Risk mitigation through robust methods—this is the ideal result of a method development project. By applying QbD principles and understanding the analytical design space of a sample, the chromatographer can understand, reduce, and control sources of variability; and use this information to create a method that is reliable and robust. Simulation of methods provides scientists the luxury of thoroughly investigating method development space with limited consumption of resources and time, for the best result.

Economic considerations—while there is a cost in man hours and time spent on method development, there is also unrecoverable expenditure on consumables (solvents, columns, etc.). In being able to investigate chromatographic space in silico, this time and expenditure can be greatly reduced.

Green chemistry—the ability to model separations not only reduces the volume of waste, it may also help us reduce environmental impact. Consider the case of acetonitrile shortages in recent years. The ability to use alternative methods, i.e., replacing acetonitrile with methanol, not only lead to reduced cost but also has the side effect of more environmentally safe waste.

Software provided with chromatographic instruments delivers many useful capabilities to execute experimental runs and control instruments. Simulation software, however, is typically purchased separately. Several commercial software packages are available, i.e., DryLab, ACD/LC Simulator (from ACD/Labs), ChromSword, and Osiris, each of which provides different advantages and limitations (an exhaustive list is outside the scope of this article).

Commercially available method optimization software is typically built on one of three models—simulations based on molecular structure, retention based modeling, and statistical modeling. Each has its pros and cons with details in their implementation that appeal to different applications.

Data input—flexibility of data import into a system from the instrument is an important consideration when dealing with multiple experiments under varying conditions. Lack of standardization of chromatographic data formats today, however, means that unless data from separations is transferred into Excel or similar software, scientists are left to transcribe information from one system to another. Direct data import from chromatographic runs into third-party modeling software, in the instrument format, is ideal since it avoids transcription errors and saves time in data input. ACD/Labs provides the only software (ACD/LC Simulator and ACD/GC Simulator) with instrument vendor-agnostic support of analytical data at this time.

Data visualization—the ability to review and interrogate data is of utmost importance in method development and optimization, and software vendors implement various tools to meet chromatographers’ requirements. While 3D modeling, offered by DryLab, has enjoyed popularity in the community, the question of applicability still remains. A significant amount of data input (upwards of 45 injections is not unreasonable for simultaneous optimization of 3 factors) is required for effective 3D modeling, which in itself is counter-intuitive if time and resource efficiency is the ultimate goal.

Automation—ACD/AutoChrom (from ACD/Labs) and ChromSword both provide automation through instrument control. AutoChrom provides automation of the most popular Waters Empower and Agilent ChemStation systems and keeps the scientist in control by allowing user input at key stages of the method development process. This software is best suited for challenging separations such as stability indicating methods and forced degradation studies.

Custom Modeling—while third-party modeling software may cover a broad range of structure and method development space, there is nothing better than the ability for scientists to create their own models. ACD/LC Simulator was the only software known to the authors at the time of publication that offers this capability. Work published by world class chromatographers Patrik Pettersson and Mel Eureby demonstrates the use of ACD/LC Simulator in successfully modelling protein and HILIC separations.

Reverse phase HPLC, temperature/gradient optimization as modeled in ACD/LC Simulator. (Credit:  ACD/Labs )

Reverse phase HPLC, temperature/gradient optimization as modeled in ACD/LC Simulator. (Credit: ACD/Labs )

Physicochemical property predictions such as logD and pKa can also help in method development and optimization. In a general sense, being able to predict behavior with respect to pH can offer insights into method development challenges. ChromSword and ACD/Labs software both provide property predictions, and the latter have been leaders in this field for almost two decades with applications across various areas of research and industries.

As the science of separations evolves and the compounds of interest change, the software to support scientific research and development will need to develop alongside. Software vendors need to satisfy the needs of their customer organizations in releasing the time of valuable scientists for innovation thus releasing them from monotonous and tedious tasks. If your organization has yet to invest in software for modeling separations, it will likely come in the future and many of the topics raised here should be kept in mind to ensure you get the best return on investment.

 

Tissue Imaging Mass Spec Detects Early Lipid Changes in Acute Kidney Injury

University of Alabama at Birmingham researchers have made a microscopic snapshot of the early renal lipid changes in acute kidney injury, using a laser-scanning method called MALDI tissue imaging to localize the changes.
These disease-model results, recently published in American Journal of Physiology’s Renal Physiology, show an example of the power of MALDI tissue imaging. MALDI tissue imaging is now available at UAB, and it will be able to aid basic and clinical biomedical research across the campus, said corresponding author Janusz Kabarowski, Ph.D., associate professor of microbiology.
“I think the opportunity to integrate this into existing UAB research centers to facilitate grants is immense,” Kabarowski said. “It can be utilized for any tissue damage. For drugs that can be imaged with MALDI imaging mass spectrometry, you can tell where in a slice of tissue the drugs get to, with obvious implications for testing candidate therapeutic agents in cancer research too. We can capture—at the molecular level—a moment in time.”
The imaging has the power to reveal spatial distribution of complex biochemical processes in an organism, showing where changes in proteins or small molecules take place. Unlike chemical stains, immunohistochemical tags or radioactive labels, it does not require a priori knowledge of the target compounds.
Acute kidney injury is a leading cause of hospital illness or death in critically ill patients. In a mouse model of the injury used by Kabarowski and colleagues, kidneys were made ischemic for 30 minutes. Six hours after reperfusion, and before gross kidney damage was seen, the kidneys were removed and cut in half. The lipids were extracted from one of the halves; the other was flash frozen and cut into thin sections that were mounted on specially coated slides.
Extracted lipids were analyzed using SWATH mass spectrometry, and the UAB researchers found that four were significantly changed at six hours (all were increases). Three of the lipids were ether-linked phospholipids, including a plasmalogen, a type of ether phospholipid thought to have protective anti-oxidant properties. They also found that the levels of these ether-linked phospholipids correlated with levels of plasma creatinine, a marker of acute kidney injury. This suggests a causal or a protective role for them in acute kidney injury, and also suggests they may be an effective early biomarker for injury.
The researchers then used MALDI tissue imaging to find where the most abundant of the ether-linked phospholipids was concentrated. In MALDI, a powerful laser scans the thin tissue section after application of a matrix material by vacuum sublimation, knocking the lipid ions off from the surface of the tissue. The MALDI time-of-flight mass spectrometry and ion fragmentation then allowed identification of the proximal tubules of the kidney as the place where the ether-linked phospholipids were concentrated. The proximal tubules are known to be most prone to developing ischemia-related injury.
Besides Kabarowski, authors of “Early lipid changes in acute kidney injury using SWATH lipidomics coupled with MALDI tissue imaging” are co-first authors Sangeetha Rao, M.D., fellow in the UAB Pediatric Critical Care Medicine, and Kelly B. Walters, UAB departments of Chemistry and Microbiology; Landon Wilson and Stephen Barnes, Ph.D., UAB Department of Pharmacology and Toxicology, Targeted Metabolomics and Proteomics Laboratory; Bo Chen, Ph.D., Subhashini Bolisetty, Ph.D., and Anupam Agarwal, M.D., UAB Division of Nephrology and the Nephrology Research and Training Center; and David Graves, UAB Department of Chemistry.
MALDI imaging mass spectrometry stands for “matrix-assisted laser desorption ionization” imaging mass spectrometry. SWATH mass spectrometry stands for “sequential window acquisition of all theoretical spectra” mass spectrometry.

Digital PCR

Digital PCR

Larry H. Bernstein, MD, FCAP, Curator

LPBI

 

GEN Roundup: Digital PCR Advances Partition by Partition  

By Partitioning Samples Digital PCR Is Lowering Detection Limits and Enabling New Applications

GEN  Mar 1, 2016 (Vol. 36, No. 5)       http://www.genengnews.com/gen-articles/gen-roundup-digital-pcr-advances-partition-by-partition/5697

 

  • Digital PCR (dPCR) has generated intense interest because it is showing potential as a clinical diagnostics tool. It has already proven to be a useful technique for any application where extreme sensitivity or precise quantification is essential, such as identifying mutations or copy number variations in tumor cells, or examining gene expression at the single-cell level.

    GEN interviewed several dPCR experts to find out specifically why the technique is increasing in popularity. GEN also asked the experts to envision dPCR’s future capabilities.

  • GEN: What makes dPCR technology such a superior tool for discovery and diagnostic applications?

    Dr. Shelton The high levels of sensitivity, precision, and reproducibility in DNA and quantification are the major strengths of dPCR. The technology is robust where differences in primer efficiency or the presence of sample-specific PCR inhibitors are trivial to the final quantification through an end-point amplification reaction.

    This provides value to discovery as a trusted tool for validating potential biomarkers and hypotheses generated by broad profiling techniques such as microarrays or next-generation sequencing (NGS). In diagnostics applications, the reproducibility and rapid results of dPCR are critical for labs around the world to quickly compare and share data, especially for ultra-low detection of DNA where variability is high.

    Dr. Garner Digital PCR provides a precise direct counting approach for single molecule detection, thereby providing a straightforward process for the absolute quantification of nucleic acids in samples. One of the biggest advantages of using a system such as ours is its ability to do real-time reads on digital samples. When samples go through PCR, their results are recorded after each cycle.

    These results build a curve, and customers can analyze the data if something went wrong. If it isn’t a clean read—from either a contamination issue, primer-dimer issue, or off-target issue—the curve isn’t the classic PCR curve.

    Dr. Menezes Digital PCR allows absolute quantification of target concentration in samples without the need for standard curves. Obtaining consistent, precise, and absolute quantification with regular qPCR is dependent on standard curve generation and amplification efficiency calculations, which can introduce errors.

    Ms. Hibbs At MilliporeSigma Cell Design Studio, the implementation of dPCR has improved and accelerated the custom cell engineering workflow. After the application of zinc finger nuclease or CRISPR/Cas to create precise genetic modifications in mammalian cell lines, dPCR is used to characterize the expected frequency of homologous recombination and develop a screening strategy based on this expected frequency.

    In some cell lines, homologous recombination occurs at a low frequency. In such cases, dPCR is used to screen cell pools and subsequently identify rare clones having the desired mutation. Digital PCR is also used to accurately and expeditiously measure target gene copy number. It is used this way, for example, in polyploid cell lines.

    Dr. Price The ability to partition genomic samples to a level that enables robust detection of single target molecules is what sets dPCR apart as an innovative tool. Each partition (droplet in the case of the RainDrop System) operates as an individual PCR reaction, allowing for sensitive, reproducible, and precise quantification of nucleic acid molecules without the need for reference standards or endogenous controls.

    Partitioning also provides greater tolerance to PCR inhibitors compared to quantitative PCR (qPCR). In doing so, dPCR can remedy many shortcomings of qPCR by transforming the analog, exponential nature of PCR into a digital signal.

    Mr. Wakida Digital PCR is an ideal technology for detecting rare targets at concentrations of 0.1% or lower. By partitioning samples prior to PCR, exceptionally rare targets can be isolated into individual partitions and amplified.

    Digital PCR produces absolute quantitative results, so in some respects, it is easier than qPCR because it doesn’t require a standard curve, with the added advantages of being highly tolerant of inhibitors and being able to detect more minute fold changes. Absolute quantification is useful for generating reference standards, detecting viral load, and preparing NGS libraries.

  • GEN: In what field do you think dPCR will have the greatest impact in the future?

    Dr. Shelton dPCR will have a great impact on precision medicine, especially in liquid biopsy analysis. Cell-free DNA from bodily fluids such as urine or blood plasma can be analyzed quickly and cost-effectively using dPCR. For example, a rapid dPCR test can be performed to determine mutations present in a patient’s tumor and help drive treatment decisions.

    Iterative monitoring of disease states can also be achieved due to the relatively low cost of dPCR, providing faster response times when medications are failing. Gene editing will also be greatly impacted by dPCR. Digital PCR enables refinement and optimization of gene-editing tools and conditions. Digital PCR also serves as quality control of therapeutically modified cells and viral transfer vectors used in gene-therapy efforts.

    Dr. Garner The BioMark™ HD system combines dPCR with simultaneous real-time data for counting and validation. This capability is important for applications such as rare mutation detection, GMO quantitation, and aneuploidy detection—where false positives are intolerable and precision is paramount.

    Any field that requires precision and the ability to detect false positives is a likely target for Fluidigm’s dPCR. Suitable applications include detecting and quantifying cancer-causing genes in patients’ cells, viral RNA that infects bacteria, or fetal DNA in an expectant mother’s plasma.

    Dr. Menezes This technology is particularly useful for samples with low frequency sequences as, for example, those containing rare alleles, low levels of pathogen, or low levels of target gene expression. Teasing out fine differences in copy number variants is another area where this technology delivers more precise data.

    Ms. Hibbs Digital PCR overcomes limitations associated with low-abundance template material and quantification of rare mutations in a high background of wild-type DNA sequence. For this reason, dPCR is poised to have significant impacts in diverse clinical applications such as detection and quantification of rare mutations in liquid biopsies, detection of viral pathogens, and detection of copy number variation and mosaicism.

    Dr. Price Due to its high sensitivity, precision, and absolute quantification, the RainDrop dPCR has the potential to extend the range of nucleic acid analysis beyond the reach of other methods in a number of applications that could lend themselves to diagnostic, prognostic, and predictive applications. The precision of dPCR can be extremely useful in applications that require finer measures of fold change and rare variant detection.

    Digital PCR is suitable for addressing varied research and clinical challenges. These include the early detection of cancer, pathogen/viral detection and quantitation, copy number variation, rare mutation detection, fetal genetic screening, and predicting transplant rejection. Additional applications include gene expression analysis, microRNA analysis, and NGS library quantification.

    Mr. Wakida Digital PCR will have an impact on applications for detecting rare targets by enabling investigators to complement and extend their capabilities beyond traditionally employed methods. One such application is using dPCR to monitor rare targets in peripheral blood, as in liquid biopsies.

    The monitoring of peripheral blood by means of dPCR has been described in several peer-reviewed articles. In one such article, investigators considered the clinical value of Thermo’s QuantStudio™ 3D Digital PCR system for the detection of circulating DNA in metastatic colorectal cancer (Dig Liver Dis. 2015 Oct; 47(10): 884–90).

  • GEN: Is there a new technology on the horizon that will increase the speed and/or efficiency of dPCR?

    Dr. Shelton High-throughput sample analysis can be an issue with some dPCR systems. However, Bio-Rad’s Automated Droplet Generator allows labs to process 96 samples simultaneously, a capability that eliminates user-to-user variability and minimizes hands-on time.

    We also want users to get the most information from one sample. Therefore, we are focused on expanding the multiplexing capabilities of our system. In development at Bio-Rad are new technologies that increase the multiplexing capabilities without loss of specificity or accuracy in the downstream workflow.

    Dr. Garner Much of the industry direction seems to be in offering ever-higher resolution, or the ability to run more samples at the same resolution. Thus far, however, customers haven’t found commercial uses for these tools. Also, with increasing resolution and the search for even rarer mutations, the challenge of detecting false positives becomes an even bigger issue.

    Dr. Menezes Use of ZEN™ Double-Quenched Probes by IDT in digital PCR provides increased sensitivity and a lower limit of detection. Due to the second quencher, ZEN probes provide even lower background than traditional single-quenched probes. And this lower background enables increased sensitivity when analyzing samples with low copy number targets, where every droplet matters.

    Ms. Hibbs Quantification relies upon counting the number of positive partitions at the end point of the reaction. Accordingly, precision and resolution can be increased by increasing the number of partitions. We are now capable of analyzing on the order of millions of partitions per run, further extending the lower limit of detection. Additionally, the workflow is amenable to the integration of automation in order to increase throughput and standardize reaction set up.

    Dr. Price Although dPCR is still an emerging technology, there is tremendous interest in its potential clinical diagnostics applications. Enabling adoption of dPCR in the clinical lab requires addressing current gaps in workflow, cost, throughput, and turnaround time.

    Digital PCR technology has the potential for being improved significantly in two dimensions. First, one can address the problem of serially detecting positive versus negative partitions by leveraging lower-cost imaging detection technologies. Alternatively, one may capitalize on the small partition volumes to dramatically reduce the time to perform PCR. Ideally, the future will bring both capabilities to bear.

    Mr. Wakida Compared to qPCR, dPCR currently requires more hands-on time to set up experiments. We are investigating methods to address this.

 

PCR Shows Off Its Clinical Chops   

Thanks to Advances in Genomics, PCR Is Becoming More Common in Clinical Applications

  • Last May, Roche Molecular Systems announced that its cobas Liat Strep A assay received a CLIA waiver. This clinic-ready assay can detect Streptococcus pyogenes (group A ß-hemolytic streptococcus) DNA in throat swabs by targeting a segment of the S. pyogenes genome.

    Since its invention by Kary B. Mullis in 1985, the polymerase chain reaction (PCR) has become well established, even routine, in research laboratories. And now PCR is becoming more common in clinical applications, thanks to advances in genomics and the evolution of more sensitive quantitative PCR methodologies.

    Examples of clinical applications of PCR include point-of-care (POC) molecular tests for bacterial and viral detection, as well as mutation detection in liquid or tumor biopsies for patient stratification and treatment monitoring.
    Industry leaders recently participated in a CHI conference that was held in San Francisco. This conference—PCR for Molecular Medicine—encompassed research and clinical perspectives and emphasized advanced techniques and tools for effective disease diagnosis.
    To kick off the event, speakers shared their views on POC molecular tests. These tests, the speakers insisted, can provide significant value to healthcare only if they support timely decision making.
    Clinic-ready PCR platforms need to combine speed, ease of use, and accuracy. One such platform, the cobas Liat (“laboratory in a tube”), is manufactured by Roche Molecular Systems. The system employs nucleic acid purification and state-of-art PCR-based assay chemistry to enable POC sites to rapidly provide lab-quality results.
    The cobas Liat Strep A Assay detects Streptococcus pyogenes (group A β-hemolytic streptococcus) DNA by targeting a segment of the S. pyogenes genome. The operator transfers an aliquot of a throat swab sample in Amies medium into a cobas Liat Strep A Assay tube, scans the relevant tube and sample identification barcodes, and then inserts the tube into the analyzer for automated processing and result interpretation. No other operator intervention or interpretation is required. Results are ready in approximately 15 minutes.

    According to Shuqi Chen, Ph.D., vp of Point-of-Care R&D at Roche Molecular Systems, clinical studies of the cobas Liat Strep A Assay demonstrated 97.7% sensitivity when the test was used at CLIA-waived, intended-use sites, such as physicians’ offices. In comparison, rapid antigen tests and diagnostic culture have sensitivities of 70% and 81%, respectively (according to a 2009 study Tanz et al. in Pediatrics).

    The cobas Liat assay preserved the same ease-of-use and rapid turnaround as the rapid antigen tests. It addition, it provided significantly faster turnaround than the lab-based culture test, which can take 24–48 hours.

    A CLIA waiver was announced for the cobas Liat Strep A assay in May 2015. CLIA wavers have been submitted for cobas Liat flu assays, and Roche intends to extend the assay menu.

    POC tests are also moving into field applications. Coyote Bioscience has developed a novel method for one-step gene testing without nucleic acid extraction that can be as fast as 10 minutes from blood sample to result. Their portable devices for molecular diagnostics can be used as genetic biosensors to bring complex clinical testing directly to the patient.

    “Instead of sequential steps, reactions happen in parallel, significantly reducing analysis time. Buffer, enzyme, and temperature profiles are optimized to maximize sensitivity,” explained Sabrina Li, CEO, Coyote Bioscience. “Both RNA and DNA can be analyzed simultaneously from a drop of blood in the same reaction.”

    The first-generation Mini-8 system was used for Ebola detection in Africa where close to 600 samples were tested with 98.8% sensitivity. Recently in China, the Mini-8 system was applied in hospitals and small community clinics for hepatitis B and C and Bunia virus detection. The second-generation InstantGene system is currently being tested internally with clinical samples.

  • Digital PCR

    Conventional real-time PCR technology, while suited to the analysis of high-quality clinical samples, may effectively conceal amplification efficiency changes when sample quality is inconsistent. A more effective alternative, Bio-Rad suggests, is its droplet-digital PCR (ddPCR) technology, which can provide absolute quantification of target DNA or RNA, a critical advantage when samples are limited, degraded, or contain PCR inhibitors. The company says that of the half-dozen clinical trials that are using digital PCR, half rely on the Bio-Rad QX200 ddPCR system.

    Personalized cancer care requires ultra-sensitive detection and monitoring of actionable mutations from patient samples. The high sensitivity and precision of droplet-digital PCR (ddPCR) from Bio-Rad Laboratories offers critical advantages when clinical samples are limited, degraded, or contain PCR inhibitors.

    Typically, formalin-fixed and paraffin-embedded (FFPE) tissue samples are processed. FFPE samples work well for immunohistochemistry and protein analysis; however, the formalin fixation can damage nucleic acids and inhibit the PCR reaction. Samples may yield 100 ng of purified nucleic acid, but the actual amplifiable material is less than 1%, or 1 ng, in most cases.

    “Current qPCR technology depends on real-time fluorescence accumulation as the PCR is occurring, which can be an effective means of detecting and quantifying DNA targets in nondegraded samples,” commented Dawne Shelton, Ph.D., staff scientist, Digital Biology Center, Applications Development Group, Bio-Rad Laboratories. “Amplification efficiency is critical; if that amplification efficiency changes because of sample quality it is hidden in the qPCR methodology.”

    “In ddPCR, that is a big red flag,” Dr. Shelton continued. “It changes the format of how the data look immediately so you know the amount of inhibition and which samples are too inhibited to use.”

    Tissue types vary and contain different degrees of fat or other content that can also act as PCR inhibitors. In blood monitoring, the small circulating fragments of DNA are extremely degraded; in addition, food, supplements, or other compounds ingested by the patient may have an inhibitory effect.

    Clinical labs test for these variabilities and clean the blood, but remnant PCR inhibitors can remain. In ddPCR, a single template is partitioned into a droplet. If the droplet contains a good template, it produces a signal; otherwise, it does not—a simple yes or no answer.

    “Even if there is no PCR inhibition, most clinical samples yield very small amounts of nucleic acid,” Dr. Shelton added. “To make a secure decision using qPCR is difficult because you are in a gray zone at the very end of its linear range. ddPCR operates best with small sample amounts and provides good statistics for confidence in your results.”

    Currently, at least a half dozen clinical trials worldwide are using digital PCR, half of them are using the Bio-Rad QX200 Droplet Digital PCR system. Examples of studies include examining BCR-ABL monitoring in patients with chronic myelogenous leukemia (CML); identifying activating mutations in epidermal growth factor receptor (EGFR) for first-line therapy of new drugs in patients with lung cancer; and the monitoring of resistance mutations such as EFGR T790M in patients with non-small cell lung cancer (NSCLC).

    Clovis Oncology used a technology called BEAMing (Beads, Emulsions, Amplification, and Magnetics), a type of digital PCR for blood-based molecular testing, to perform EGFR testing on almost 250 patients in clinical trials. In BEAMing, individual EGFR gene copies from plasma are separated into individual water droplets in a water-in-oil emulsion. The gene copies are then amplified by PCR on magnetic beads.

    The beads are counted by flow cytometry using fluorescently labeled probes to distinguish mutant beads from wild-type. Because each bead can be traced to an individual EGFR molecule in the patient’s plasma, the method is highly quantitative.

    “BEAMing is particularly well-suited for the detection of known mutations in circulating tumor DNA. In this circumstance, the mutation of interest often occurs at low levels, perhaps only 1–2 copies per milliliter or even less, and in a high background of wild-type DNA that comes from normal tissue. BEAMing can detect one mutant molecule in a background of 5,000 wild-type molecules in clinical samples,” stated Andrew Allen, MRCP, Ph.D., chief medical officer, Clovis Oncology.

    In the studies, the EGFR-resistance mutation T790M could be identified in plasma 81% of the time that it was seen in the matched patient tumor biopsy. Additionally, about 10% of patients in the study had a T790M mutation in plasma that was not identified in tissue, presumably because of tumor heterogeneity. Another 5–10% of the patients did not provide an EGFR result, usually because the tissue biopsy had no tumor cells.

    In aggregate, these results suggest that plasma EGFR testing can be a valuable complement to tumor testing in the clinical management of NSCLC patients, and can provide an alternative when a biopsy is not available. Tumor biopsies may provide only limited tissue, if in fact any tissue is available, for molecular analysis. Also, mutations may be missed due to tumor heterogeneity. These mutations may be captured by sampling the blood, which acts as a reservoir for mutations from all parts of a patient’s tumor burden.

    In the last few years, a panoply of clinically actionable driver mutations have been identified for NSCLC, including mutations in EGFR, BRAF, and HER2, as well as ALK, ROS, and RET rearrangements. These driver mutations will migrate NSCLC molecular diagnostic testing in the next few years toward panel testing of relevant cancer genes using various digital technologies, including next-generation sequencing.

     

PCR Has a History of Amplifying Its Game

A GEN 35th Anniversary Retrospective

PCR Has a History of Amplifying Its Game

PCR is a fast and inexpensive technique used to amplify segments of DNA that continues to adapt and evolve for the demanding needs of molecular biology researchers. This diagram shows the basic principles of PCR amplification. [NHGRI]

  • The influence that the polymerase chain reaction (PCR) has had on modern molecular biology is nothing short of remarkable. This technique, which is akin to molecular photocopying, has been the centerpiece of everything from the OJ Simpson Trial to the completion of the Human Genome Project. Clinical laboratories use this DNA amplification method for infectious disease testing and tissue typing in organ transplantation. Most recently, with the explosion of the molecular diagnostics field and meteoric rise in the use of next-generation sequencing platforms, PCR has enhanced its standing as an essential pillar of genomic science.

    Let’s open the door to the past and take a look back around 35 years ago when GEN started reporting on the relatively new disciplines of genetic engineering and molecular biology. At that time, GEN was among the first to hear the buzz surrounding a new method to synthesize and amplify DNA in the laboratory. In reviewing the fascinating history of PCR, we will see how the molecular diagnostics field took shape and where it could be headed in the future.

  • Some Like It Hot

    The biological sciences rarely advance within a vacuum—rather they rely on previous discoveries to promote directly or indirectly our understanding. The contributions made by scientists in the field of molecular biology that contributed to the functional pieces of PCR were numerous and spread out over more than two decades.

    It began with H. Gobind Khorana’s advances in understanding the genetic code, leading to the use of synthetic DNA oligonucleotides, continued through Kjell Kleepe’s 1971 vision of a two-primer system for replicating DNA segments, to Fredrick Sanger’s method of DNA sequencing—a process that would win him the Nobel prize in 1980—which utilized DNA oligo primers, nucleotide precursors, and a DNA synthesis enzyme.

    All of the previous discoveries were essential to PCR’s birth, yet it would be an egregious mistake to begin a retrospective on PCR and not discuss the enzyme upon which the entire reaction hinges upon—DNA polymerase. In 1956, Nobel laureate Arthur Kornberg and his colleagues discovered DNA polymerase (Pol I), in Escherichia coli. Moreover, the researchers described the fundamental process by which the polymerase enzyme copies the base sequence of a DNA template strand. However, it would take biologists another 20 years to discover a version of DNA polymerase that was stable enough for use for any meaningful laboratory purposes.

    That discovery came in 1976 when a team of researchers from the University of Cincinnati described the activity of a DNA polymerase (Taq) they isolated from the extreme thermophile bacteria, Thermus aquaticus, which lives in hot springs and hydrothermal vents. The fact that this enzyme could withstand typical protein-denaturing temperatures and function optimally around 75–80°C fortuitously set the stage for the development of PCR.

    By 1983, all of the ingredients to bake the molecular cake were sitting in the biological cupboard waiting to be assembled in the proper order. At that time, Nobel laureate Kary Mullis was working as a scientist for the Cetus Corporation trying to perfect oligonucleotide synthesis. Mullis stumbled upon the idea of amplifying segments of DNA using multiple rounds of replication and the two primer system—essentially modifying and expanding upon Sanger’s sequencing reaction. Mullis discovered that the temperatures for each step (melting, annealing, and extension) in the reaction would need to be painstakingly controlled by hand. In addition, he realized that since the reactions were using a non-thermostable DNA polymerase, fresh enzyme would need to be “spiked in” after each successive cycle.

    Mullis’ hard work and persistence paid off as the reaction was successful at amplifying a particular segment of DNA that was flanked by two opposing nucleotide primer molecules. Two years later, the Cetus team presented their work at the annual meeting of the American Society for Human Genetics, and the first mention of the method was published in Science that same year; however, that article did not go into detail about the specifics of the newly developed PCR method—a paper that would be rejected by roughly 15 journals and would not be published until 1987.

    Although scientists were a bit slow on the uptake for the new method, the researchers at Cetus were developing ways to improve upon the original assay. In 1986, the scientists substituted the original heat-liable DNA polymerase for the temperature-resistant Taq polymerase, removing the need to spike in enzyme and dramatically reducing errors while increasing sensitivity. A year later, PerkinElmer launched their creation of a thermal cycler, allowing scientists to regulate the heating and cooling parts of the PCR reaction with greater efficiency.

    Extremely soon after the introduction of Taq and the launch of the thermal cycler, the PCR reaction exploded exponentially among research laboratories and not only vaulted molecular biology to the pinnacle of researcher interests, it also launched a molecular diagnostics revolution that continues today and shows no signs of slowing down.

  • Molecular Workhorse

    In the years since PCR first burst onto the scene, there have been a number of significant advancements to the technique that have widely improved the overall method. For example, in 1991, a new DNA polymerase from the hyperthermophilic bacteria Pyrococcus furiosus, or Pfu, was introduced as a high-fidelity alternative enzyme to Taq. Unlike Taq polymerase, Pfu has built in 3′ to 5′ exonuclease proofreading activity, which allows the enzyme to correct nucleotide incorporation errors on the fly—dramatically increasing base specificity, albeit at a reduced rate of amplification versusTaq.

    In 1995, two advancements were introduced to PCR users. The first, called antibody “hot-start” PCR, utilized an immunoglobulin molecule that is directed to the DNA polymerase and inhibits its activity until the first 95°C melt stage, denaturing the antibody and allowing the polymerase to become active. Although this process was effective in increasing the specificity of the PCR reaction, many researchers found that the technique was time consuming and often caused cross-contamination of samples.

    The second innovation introduced that year began another revolution for molecular biology and the PCR method. Real-time PCR, or quantitative PCR (qPCR), allowed researchers to quantitatively create DNA templates for PCR amplification from RNA transcripts through the use of the reverse-transcriptase enzyme and specifically incorporated fluorescent reporter dyes. The technique is still widely used by researchers to monitor gene expression extremely accurately. Over the past 20 years, many companies have spent many R&D dollars to create more accurate, higher throughput, and simple qPCR machines to meet researcher demands.

    With the advent of next-generation sequencing techniques—and the rise of techniques that started commanding the attention of more and more researchers—PCR machines and methods needed to evolve and modernize to keep pace. PCR remained the lynchpin in almost all the next-generation sequencing reactions that came along, but the traditional technique wasn’t nearly as precise as required.

    Digital PCR (dPCR) was introduced as a refinement of the conventional method, with the first real commercial system emerging around 2006. dPCR can be used to quantify directly and clonally amplify DNA or RNA.

    The apparatus carries out a single reaction within a sample. The sample, however, is separated into a large number of partitions. Moreover, the reaction is performed in each partition individually—allowing a more reliable measurement of nucleic acid content. Researchers often use this method for studying gene-sequence variations, such as copy number variants (CNV), point mutations, rare-sequence detection, and microRNA analysis, as well as for routine amplification of next-generation sequencing samples.

  • Future of PCR: Better, Faster, Stronger!

    It is almost impossible to envision a future laboratory setting that wouldn’t utilize PCR in some fashion, especially due to the heavy reliance of next-generation sequencing techniques for accurate PCR samples and at the very least using the method as a simple amplification tool for creating DNA fragments of interest.

    Yet there is at least one new next-generation sequencing technique that can identify native DNA sequences without an amplification step—nanopore sequencing. Although this technique has performed well in many preliminary trials, it is in its relative infancy. It will probably undergo additional development lasting several years before it approaches large-scale adoption by researchers. Even then, PCR has become so engrained into daily laboratory life that to try to phase out the technique would be like asking molecular biologists to give up their pipettes or restriction enzymes.

    Most PCR equipment manufacturers continue to seek ways to improve the speed and sensitivity of their thermal cyclers, while biologists continue to look toward ways to genetically engineer better DNA polymerase molecules with even greater fidelity than their naturally occurring cousins. Whatever the new advancements are, and wherever they lead the life sciences field, you can count on us at GEN to continue to provide our readers with detailed information for another 35 years … at least!

     

ER User for Heart Failure: A Different Reality for Pennsylvania’s Geisinger Health System – A Record of Care Integration and Coordination

Reporter: Aviva Lev-Ari, PhD, RN

 

3. Geisinger’s integrated approach slashes ER use for heart failure

Thursday, March 24, 2016 | By Zack Budryk

Fully-integrated care is the wave of the future in healthcare, and one health system has used it to cut emergency room visits and improve medication management for heart failure patients, according to a blog post at NEJM Catalyst.

Leaders at Danville, Pennsylvania’s Geisinger Health System sought to build on the system’s record of care integration and coordination to address emergency and inpatient care for heart failure patients, write Geisinger’s Sanjay Doddamani, M.D., Janet F. Tomcavage, R.N., and John B. Bulger. Nearly 5 million patients in the United States have heart failure and it costs the healthcare system $32 billion per year, according to the article. 

The organization began to consider every unplanned admission for acute heart failure that required only diuretic therapy for treatment as a sentinel event. From there, system leaders developed a central urgent heart failure clinic, offering onsite review of each patient’s care plan, coordination between nurse navigators and community nurse case managers, and medication management.

Each team member coordinates care according to a methodical assessment and care algorithm, communicating face-to-face, through electronic medical records, by phone and in monthly meetings. When team members communicate with this kind of regularity, it lessens the risk of care and communication gaps, according to the post. These multidisciplinary teams include nurse navigators, nurse case managers and pharmacists, all of whom operate in their distinct spheres while each serving the broader aim of integrated care.

Preliminary metrics indicate Geisinger’s approach is bearing fruit, according to the post. Last year, it saved the system $240,000 in ED visits, with 28 percent of hospitalized heart failure patients avoiding emergency care. The system is still crunching the numbers on medication management, but thus far, monitoring of renal function and potassium is up from 41 percent to 80 percent.

To learn more:

– read the post

Related Articles:

Why Geisinger’s care coordination strategies are a model for the US

4 steps to an integrated approach to population health management

Geisinger researchers share framework for putting a learning health system into practice

Geisinger’s Nicholas Marko: Early EMR adoption has propelled innovation [Q&A]

Health systems move to solve data exchange problems on their own

Lack of standard data model poses hindrance to PCORI ‘network of networks’

Why a learning health system is important for patient care

ONC unveils Interoperability Roadmap for public comment

PCORI announces $150.7 million in Phase II funding for ‘network of networks’

SOURCE

From: FierceHealthcare <editors@fiercehealthcare.com>

Reply-To: <editors@fiercehealthcare.com>

Date: Thursday, March 24, 2016 at 2:53 PM

To: Aviva Lev-Ari <AvivaLev-Ari@alum.berkeley.edu>

Subject: | 03.24.16 | Geisinger’s integrated care model slashes ER use

Photonics instruments

Photonics instruments

Larry H. Bernstein, MD, FCAP, Curator

LPBI

 

Using Photonic Components to Design and Build Life Science and Analytical Instruments  
RICHARD SIMONS, EXCELITAS TECHNOLOGIES CORP.
http://www.photonics.com/Article.aspx?AID=58323

Leading analytical and clinical diagnostics instrumentation OEMs rely on integrated light emission and detection solutions to unlock the mysteries around disease and treatment. Photonic solutions encompassing optical, illumination, sensing and optomechanical technologies provide these OEMs with not only convenience and simplicity, but also an accelerated path to market for the development of highly complex life science and analytical instruments. Even standard, off-the-shelf components, when coupled with a modular and expandable architecture design, can be used to create a fully functional flow cytometer that achieves levels of throughput and cell analysis sensitivity comparable to commercial products.

A good example of an analytical instrument is the flow cytometer, which will be used in this article to highlight the development of the optical heart of the analytical instrument system. Flow cytometers are instruments that measure features of cells in a liquid suspension, characterizing and analyzing cell populations using light scatter and fluorescence parameters. These life science instruments began as research laboratory instruments, and they still play an important role in research into immunology and cell biology. However, they are now also used in the clinical laboratory for diagnosis and monitoring of diseases such as HIV/AIDS and blood cancers. The next phase would be for them to become diagnostic tools used in the clinic or doctor’s office lab, right at the point-of-care.

 

Laser-induced fluorescence in the heart of the flow cytometer.

Laser-induced fluorescence in the heart of the flow cytometer. The laser beam is the violet beam, entering from left, inducing fluorescence in the target flow in the center of the flow channel, entering from top.

 

Life science and analytical instruments based on optical techniques have moved from university and corporate research laboratories, through central diagnostic and pathology laboratories, to local hospital laboratories. They are now becoming more and more commonplace as diagnostic tools at or close to the point-of-care delivery. Enabling this development is the evolution of optical components and subsystems used within these instruments for the emission, manipulation and detection of light. The result has been increased capability and usability, along with decreased size and cost. For any optical instrument, the beam path can be summarized as follows in Figure 1.

Block diagram of the optical beam path in a typical analytical instrument.

Figure 1. Block diagram of the optical beam path in a typical analytical instrument. Image courtesy of Excelitas Technologies Corp.

 

Movement toward smaller laser sources

Traditionally, the instrument manufacturer would have had to begin by mastering the photochemical reactions key to the instrument function. The manufacturer would also need to design the complete optical system within the instrument and then manage the sourcing of the necessary components from a large number of other manufacturers. The lasers originally used in the instrument would have been large, powerful argon or krypton ion lasers, needing water cooling and three-phase high-voltage electrical supplies. The beam would have been delivered through a free-space optical system of lenses, filters and microscope objectives to shape the beam and deliver it to the flow cell. Collecting the fluorescent or scattered signal would also have been done using free-space components, including lenses and mirrors, bandpass filters, and complex optomechanical mounts for alignment, allowing the signal to be delivered to the detectors. These detectors would typically have been a photomultiplier tube, a fragile and complex structure of electrodes sealed in glass vacuum tube, requiring over 1000 V to convert the photons entering the detector into a useful electronic output.

 

Qioptiq iRIS fiber-coupled laser module from Excelitas Technologies Corp.

Qioptiq iRIS fiber-coupled laser module from Excelitas Technologies Corp. Photo courtesy of Excelitas Technologies Corp.

Today’s instrument designer can now use significantly smaller laser sources, using diode lasers and diode-pumped, solid-state lasers. These lasers can generate the wavelengths used to excite the fluorescence and provide the illumination for the scattering measurements. Usually, each excitation laser source is dedicated to one probe on the sample per run. Running parallel processes by using multiple illumination wavelengths fired in series on the sample can speed up the analysis.

Challenges in flow cytometry

In flow cytometry the primary challenge is to focus the light onto a moving sample in the flow stream, which is usually less than 100 microns wide. To gather meaningful data from a moving target, both the detector and illumination source need to be as stable and stationary as possible; otherwise movement from either one will cause image jitter and reduce resolution. The second physical challenge is positioning the beams from multiple light sources in sufficient proximity to generate parallel illumination spots focused in the flow cell, while sufficiently separating these spots to prevent cross-talk in the detection channels, which may collect emitted and fluorescent light simultaneously.

 

LynX silicon photomultiplier modules, as used in the flow cytometer demo system.

LynX silicon photomultiplier modules, as used in the flow cytometer demo system. Photo courtesy of Excelitas Technologies Corp.

 

Flow cytometers have traditionally used an optical system of lenses, filters and microscope objectives to shape the beam and deliver it to the flow cell. The principles are well-understood, although this can often result in a long optical beam train, making it more susceptible to the effects of laser jitter. An open beam path with optics mounted at various locations is also more susceptible to thermal temperature differences that will cause beam movement on the sample. Careful alignment of the optics is necessary as small movements can cause large changes in the beam pointing on the sample. As a result, instruments that use free-space optics can be susceptible to physical knocks and changes in environmental conditions, including heat generated by the laser itself.

The single-mode optical fiber solution

One way to guarantee a stable high-quality beam delivered to the sample without the use of complex optical components is to use single-mode optical fiber. This offers several advantages in functionality, from increased laser stability and image resolution to reduced instrument size and greater ruggedness.

LynX silicon photomultiplier modules, as used in the flow cytometer demo system.

Photo courtesy of Excelitas Technologies Corp.

Coupled directly from the laser to the fiber, the beam is much less sensitive to movement and thermal temperature changes, which reduces the need for instrument alignment service visits and creates a more robust instrument design. The fiber also acts as a spatial filter and eliminates any beam astigmatism to create a near-perfect Gaussian profile. The resulting beam is much more stable over time than those in free-space systems, and it is without accumulated errors from multiple optical interfaces. That helps ensure a more reliable and more stable measurement. Additionally, the use of fiber allows the laser source, which generates heat, to be located away from the flow cell. This means more flexibility for instrument layout, including the option of mounting the laser externally to the instrument head. It also simplifies servicing. That is because the optical alignment of the instrument is fixed and is independent of the laser — so there is no need to perform a lengthy realignment process when the laser is serviced.

Collecting the fluorescent and scattering signals from the sample requires the light to be gathered and collimated prior to using filters to select the wavelength area of interest. Again, this can be done completely in free space, or with the use of fiber, to simplify the optical set-up and to provide a stable delivery route to the detectors.

The working flow cytometer as shown at several trade shows and conferences worldwide.

Photo courtesy of Excelitas Technologies Corp.

 

For detection of these signals, today’s designers can still use photomultiplier tubes (PMTs) for the ultimate in sensitivity. However, the advent of large area avalanche photodiodes (APDs) and silicon photomultipliers (SiPMs), allows a single detector type to support a wider range of scattered and fluorescent wavelengths. The result is a greater number of dyes can be used. An SiPM is a monolithic array of silicon micro-APDs offering high photon detection efficiencies from the near UV through to red and NIR wavelengths, coupled with relatively low dark counts. With low operating voltages compared to PMTs, as well as greater ruggedness and lower cost due to the solid-state nature of a silicon detector, many flow cytometer vendors are switching away from PMTs as their detection solution.

Simplifying the photonic engine design process

Many new and innovative analytical and diagnostic companies are using optical technologies such as flow cytometry to provide solutions to their customers. The goal of modern optical component suppliers is to make the manufacturer’s life easier by shouldering the burden of the complete photonic engine design, allowing the manufacturer to focus on its core competencies. To that end, demonstrating the ease and expediency of developing life science and analytical instruments from the ground up, Excelitas Technologies and its subsidiary Qioptiq decided to build a fully functional modular flow cytometry prototype. This prototype uses off-the-shelf products from Excelitas’ various divisions.

The design process began with lasers as excitation sources, incorporating two compact solid-state Qioptiq iFLEX-iRIS lasers, with one being blue and the other being violet. The violet laser took advantage of novel violet-excitable fluorescent dyes recently introduced for flow cytometry. The units were coupled with fiber optic delivery systems, allowing them to be positioned some distance from the sample for accessibility and an efficient design. They also simplified the alignment process and made for plug-and-play laser head replacements.

To capture and collimate the scattered and fluorescent light, two Optem High Resolution 20× microscope objectives were used. One was used for forward-scattered light (indicative of cell size) and the other was used for side-scattered light and fluorescence. Sets of longpass and bandpass filters ensured transmission of the appropriate light wavelengths to the detectors. Six high-performance SiPM modules were also used for photon detection, with one being used for the forward-scattered light, and a second for the side-scattered light. The other four detected the spectral emission wavelengths for fluorescence intensity, based on the lasers selected. The modules were SiPMs integrated with a power supply and amplifier, and they were simpler to integrate than conventional photomultiplier tubes or silicon components.

LINOS Microbench parts were used for organizing the optical bench. Anodized aluminum cubes with stainless steel posts, along with mounting plates, adaptors and connectors, were used with a compatible stainless steel rail system to secure small optical components and create the system layout. Microbench parts assemble and disassemble easily, yet they can be stably aligned, making impromptu adjustments to the layout practical. Cubes could be placed next to one another or stacked, simplifying the layout of components on all three axes. The system was also used to mount the fluidics and flow cell needed for a fully functional flow cytometer.

The system alignment was fine-tuned after assembly using fluorescence dyes and calibration particles. To show that the instrument met specifications, standard fluorescence reference particles were run on the completed system. This successful project clearly demonstrated the power of using standard, off-the-shelf components and of a design approach based on a modular and expandable architecture. This fully functional flow cytometer, designed and built from scratch in less than two months, achieved levels of throughput and cell analysis sensitivity comparable to commercial products.

From modularity and flexibility follows customization for reduced size and cost. That is what manufacturers must strive to achieve when striving to provide instruments — and not only cytometers — to users worldwide.

Meet the author

Richard Simons is the senior applications specialist with Excelitas Technologies Corp. in Montreal; e-mail: richard.simons@excelitas.com

see also –

http://content.yudu.com/A3yvse/March2016/resources/26.htm

http://content.yudu.com/A3yvse/March2016/resources/50.htm

 

Fluorescence imaging method visualizes nine structures in one measurement

03/23/2016       Associate Editor, BioOptics World

http://www.bioopticsworld.com/articles/2016/03/fluorescence-imaging-method-visualizes-nine-structures-in-one-measurement.html

A research collaboration involving the University of Würzburg (Würzburg, Germany), the University of Göttingen (Göttingen, Germany), and PicoQuant (Berlin, Germany) has discovered a novel strategy for fluorescence lifetime imaging (FLIM) that allows visualizing nine different target molecules at the same time.

Related: Fluorescence ‘lifetime’ moves toward clinical application

As a fundamental imaging technique in life sciences, FLIM makes it possible to visualize structures and processes in cells by exciting molecules with light and employing the lifetime information of the triggered fluorescence. The newly devised approach, named spectrally resolved FLIM (sFLIM), uses three lasers with different wavelengths pulsing in an alternating pattern for exciting the molecular labels. As these labels exhibit subtle differences in their emission spectra and fluorescence decay patterns, the collected data can be analyzed through a software algorithm, allowing distinction between them with unparalleled precision.

Part of a cell labeled for tubulin with Abberior STAR 635p (green) and giantin with Atto647N (red) utilizing a single stimulated emission depletion (STED) laser wavelength, where the two species have been separated by fast pattern matching. (Sample courtesy of Markus Sauer, University of Würzburg, Germany)

The high sensitivity of sFLIM also allows using the same fluorescent dye to label three different cell structures at once, with the ability to still clearly distinguish them because of slight fluorescence lifetime variations induced by the chemical environment.

Multi-target spectrally resolved fluorescence lifetime imaging microscopy

Thomas NiehörsterAnna LöschbergerIngo GregorBenedikt KrämerHans-Jürgen RahnMatthias PattingFelix KoberlingJörg Enderlein & Markus Sauer
Nature Methods13,257–262(2016) 
            doi:10.1038/nmeth.3740

 

We introduce a pattern-matching technique for efficient identification of fluorophore ratios in complex multidimensional fluorescence signals using reference fluorescence decay and spectral signature patterns of individual fluorescent probes. Alternating pulsed laser excitation at three different wavelengths and time-resolved detection on 32 spectrally separated detection channels ensures efficient excitation of fluorophores and a maximum gain of fluorescence information. Using spectrally resolved fluorescence lifetime imaging microscopy (sFLIM), we were able to visualize up to nine different target molecules simultaneously in mouse C2C12 cells. By exploiting the sensitivity of fluorescence emission spectra and the lifetime of organic fluorophores on environmental factors, we carried out fluorescence imaging of three different target molecules in human U2OS cells with the same fluorophore. Our results demonstrate that sFLIM can be used for super-resolution multi-target imaging by stimulated emission depletion (STED).

 

Multi-target fluorescence imaging of five similar fluorescent probes.

(a) Total fluorescence intensity image of an U2OS cell labeled with five fluorescent probes. (bg) Resulting sFLIM composite image (b) showing F-actin stained with ATTO 488 phalloidin (green; c), Golgi stained with primary rabbit antibo…

 

IR spectroscopy method is promising for clinical test that could detect Alzheimer’s early

Recognizing that current Alzheimer’s disease diagnosis methods only address symptomatic treatment, researchers at Ruhr University Bochum (RUB; Germany) and collaborators at the University of Göttingen and the German Center for Neurogenerative Diseases (DZNE; Göttingen, Germany) have developed a clinical test based on immuno-chemical analysis using infrared (IR)-induced difference spectroscopy that may lead to early detection of Alzheimer’s.

Related: Laser-based eye test for early detection of Alzheimer’s

The promising test involves an IR sensor, whose surface is coated with highly specific antibodies that extract biomarkers for Alzheimer’s from the blood or the cerebrospinal fluid taken from the lower part of the back (lumbar liquor). The IR sensor then performs spectroscopic analysis to determine if the biomarkers show already pathological changes, which can take place more than 15 years before any clinical symptoms appear.

“If we wish to have a drug at our disposal that can significantly inhibit the progress of the disease, we need blood tests that detect Alzheimer’s in its pre-dementia stages,” says Prof. Dr. Klaus Gerwert, Head of the Department of Biophysics at RUB. “By applying such drugs at an early stage, we could prevent dementia, or at the very least delay its onset,” adds Prof. Dr. med. Jens Wiltfang, Head of the Department for Psychiatry and Psychotherapy at the University of Göttingen and Clinical Research Coordinator at DZNE Göttingen.

For the test, the secondary structure of beta amyloid (Aß) peptides serves as a biomarker. This structure changes in Alzheimer’s patients. In the misfolded, pathological structure, more and more Aß peptides can accumulate, gradually forming visible plaque deposits in the brain that are typical for Alzheimer’s disease. This, as mentioned previously, happens more than 15 years before first clinical symptoms are present. The pathological Aß plaques can be temporarily detected by positron emission tomography (PET), but this procedure is comparatively expensive and is accompanied by radiation exposure.

The IR sensor developed by the research team that detects misfolding of Aß peptides involves extracting the Aß peptide from body fluids. After initially working with cerebrospinal fluid, the researchers subsequently expanded the method towards blood analysis. “We do not merely select one single possible folding arrangement of the peptide; rather, we detect how all existing Aß secondary structures are distributed, in their healthy and in their pathological forms,” says Gerwert. Precise diagnostics is not  possible until the distribution of all secondary structures is evaluated. Tests that analyze Aß peptide are already available with enzyme-linked immunosorbent assays (ELISA). They identify the total concentration, percentage of forms of different length, as well as the concentration of individual conformations in body fluids, but they do not provide information on the diagnostically relevant distribution of the secondary structures at once. “This is why ELISA tests have not been proven very effective when applied in blood sample analysis in practice,” he explains.

The research team used the new method to analyze samples from 141 patients, achieving diagnostic precision of 84% in the blood and 90% in cerebrospinal fluid. The test revealed an increase of misfolded biomarkers as spectral shift of Aß band below threshold, allowing the researchers to determine Alzheimer’s.

An infrared sensor analysing label-free the secondary structure of the Abeta peptide in presence of complex fluids

Andreas Nabers1,†, et al.   Journal of Biophotonics Volume 9, Issue 3, pages 224–234, March 2016     http://dx.doi.org:/10.1002/jbio.201400145

Thumbnail image of graphical abstract

An immunologic ATR-FTIR sensor for Abeta peptide secondary structure analysis in complex fluids is presented.

The secondary structure change of the Abeta peptide to beta-sheet was proposed as an early event in Alzheimer’s disease. The transition may be used for diagnostics of this disease in an early state. We present an Attenuated Total Reflection (ATR) sensor modified with a specific antibody to extract minute amounts of Abeta peptide out of a complex fluid. Thereby, the Abeta peptide secondary structure was determined in its physiological aqueous environment by FTIR-difference-spectroscopy. The presented results open the door for label-free Alzheimer diagnostics in cerebrospinal fluid or blood. It can be extended to further neurodegenerative diseases.

http://onlinelibrary.wiley.com/doi/10.1002/jbio.201400145/epdf

 

 

 

DNA change with seeding asbestos molecules in living cells

Author: Danut Dragoi, PhD

As a fact, it is well known that some substances are producing DNA changes in human body. One of those substances is asbestos, see link in here, in which debatable reasons are revisited with less convincing arguments. One important aspect of the interaction of asbestos with living cells is its symmetry which is reflected in its physical and chemical properties. One important feature of substances interacting with DNA structure is to have element symmetry in common. DNA macromolecule is a low symmetry molecule and is expected that DNA’s elements of symmetry to be found in asbestos group symmetry. Looking for crystal structure of asbestos we find the powder diffraction file PDF-21-543 that contains that information, see link in here.

From symmetry point of view, we can distinguish the chirality symmetry of asbestos, which requires an axis “2” of symmetry or a mirror plan “m” that both cross the center of the unit cell, see link in here.

A schematic of chemical make up of asbestos can be seen below, see link in here

Asbestos chemical make up

Image SOURCE: https://pubchem.ncbi.nlm.nih.gov/compound/Chrysotile#section=Top

At first glance we see that the chemical formula in the picture above, H4Mg3O9Si2, corresponds to that of chrysotile, one distinguished form of asbestos. We notice the ionic bond between the Silicon tetrahedrons SiO4 using Mg++ ion between two O- ions. Since the ionic bonds are not too strong, we can imagine that a SiO4 tetrahedron can replace a PO4 tetrahedron in DNA back bone with important consequences on DNA functionality in human body. As a fact, not all asbestos structures produce cancers in human body, therefore the chirality symmetry must play an important role. From this point of view we can state, with some degree of certainty, that asbestos of D-form chirality, that fits the DNA chirality, is the culprit in the asbestos induced cancers.

Looking at the rate of cancers over 50 years we can find that the rate of cancers increased, see link in here. How we explain this? Some reasons are linked with aging, see link in here. However, other factors exists such as silicosis and its role on lung cancer, see link in here.

In the studies considered by IARC (NB-International Agency for Research on Cancer), they reported that lung cancer risk tended to increase with cumulative exposure to RCS (NB- respirable crystalline silica), duration of exposure, peak intensity of exposure, the presence of silicosis and length of follow-up time from diagnosis of silicosis. However, the findings were not consistent, i.e. those that observed a relationship with cumulative exposure did not always observe one with duration of exposure and vice versa. Again, here is the symmetry play, where not all silica is in D-form chirality to produce cancers.

As we have seen before, the presence of silicon tetrahedrons in the asbestos structure suggests that Silica is a major player in producing cancers. The main source of dangerous silica is not only in asbestos, it is in any mining and silicate processing industry, in which cement industry uses large quantities of powdered quartz, sometimes in very fine grain size that could be in the nano-size range. The roads development in the last 100 years, based on cement, is suggesting a correlation with cancers development.

Source

http://www.asbestos.com/news/2013/02/01/health-risk-of-chrysotile/

https://books.google.com/books?id=jnqOAgAAQBAJ&pg=PA98&lpg=PA98&dq=asbestos+space+group&source=bl&ots=0TplLnD9Bb&sig=4qQ6LrGbwcFV1EwcIgZKFOzPEr4&hl=en&sa=X&ved=0ahUKEwiBiI3jqdjLAhVBXGMKHW6ZDg4Q6AEIHDAA#v=onepage&q=asbestos%20space%20group&f=false.

http://www.xtal.iqfr.csic.es/Cristalografia/parte_03-en.html.

https://pubchem.ncbi.nlm.nih.gov/compound/Chrysotile#section=Top

https://pubchem.ncbi.nlm.nih.gov/compound/Chrysotile#section=Top

http://www.who.int/mediacentre/news/releases/2003/pr27/en/http://www.who.int/mediacentre/news/releases/2003/pr27/en/

http://scienceblog.cancerresearchuk.org/2015/02/04/why-are-cancer-rates-increasing/

http://occmed.oxfordjournals.org/content/59/2/89.full

https://pubchem.ncbi.nlm.nih.gov/compound/Chrysotile#section=Top

Body Labs Secures Exclusive U.S. Patents And Licenses For 3D Body Modeling Technologies

Body Labs establishes leadership through proprietary technology developed from research led by world-class computer vision scientist Michael J. Black

Mar 21, 2016, 09:00 ET from Body Labs

NEW YORK, March 21, 2016 /PRNewswire/ — Body Labs (bodylabs.com), the provider of the world’s most advanced technology for analyzing the human body’s shape, pose and motion, announced today that it has secured the exclusive rights to two patents issued to Brown University and licenses to several new technologies developed at Max-Planck-Innovation GmbH.

U.S. Patents 9,189,886 B2 and 2013/0249908 A1 expand Body Labs’ exclusive ability to create accurate 3D human models learned from natural shape and pose variations captured from data inputs such as images or range maps. These patents cover intellectual property included in Body Labs’ statistical model of human shape, pose and motion. This statistical approach employs machine learning algorithms and the world’s most comprehensive training set of human shape and pose to convert shape parameters (measurements or scans) into the most statistically-accurate body geometry currently available.

Body Labs also announced exclusive licenses to several new technologies developed at Max-Planck-Innovation GmbH. These technologies enable Body Labs to further expand its technical leadership into other areas of the human body such as hands, feet, faces and heads. Additionally, the new developments streamline the adoption of Body Labs’ technology into other industry workflows such as animation pipelines, gaming, virtual reality (VR), augmented reality (AR), health, fitness and more. These technologies also provide never-before-seen detail into soft-tissue deformation trained on shape data and pose variations captured from 4D scanners.

“These exclusive patents and licenses enable us to unlock unprecedented personalization across the entire human body and ensure our technology is more accessible than ever to a growing list of industries,” said William O’Farrell, co-founder and CEO of Body Labs. “It’s been a privilege to be partnered with Brown University and the Max Planck Institute for the past three years. These patents and licenses enable us to further expand our relationship and drive rapid innovation in the 3D body modeling space.”

According to Juniper Research, 60 million users across smartphones, tablets and smart glasses will use augmented reality apps in 2016. Gartner has also projected that 25 million units of virtual reality headsets will be in the hands of consumers by 2018. This year, tech giants such as Intel (Intel Capital led Body Labs’ Series A round of financing) will be working with manufacturers to integrate depth-sensor technology into smartphones as well. This broad adoption will deliver entirely new developer platforms made for everyday consumers that can manage, process and host 3D data.

Body Labs is the only company to provide the body as a digital platform. Through Body Labs, brands and retailers can access API’s for building consumer-facing experiences such as apparel sizing recommendations, bespoke clothing, fitness tracking, personalizing VR or AR experiences and more. For more information on how to personalize goods and services around human body shape visit:http://www.bodylabs.com/solutions.

About Body Labs
Founded in 2013 and headquartered in Manhattan, Body Labs collects, digitizes and organizes all of the data and information related to human body shape, pose and motion. Its mission is to transform the human body into a digital platform upon and around which goods and services can be designed, produced, bought and sold. For more information, please visit:www.bodylabs.com.

SOURCE Body Labs

Related Links

http://www.bodylabs.com

7th Annual – CHI’s Inflammation Inhibitors  Small Molecule and Macrocyclic Approaches, April 19-20, 2016, Hilton San Diego Resort and Spa

Inflammation Inhibitors icon

 

Reporter: Aviva Lev-Ari, PhD, RN

 

April 19-20

April 20-21

April 22

Inflammation Inhibitors

Kinase Inhibitor Chemistry

Brain Penetrant Inhibitors

Protein-Protein Interactions

Macrocyclics & Constrained Peptides

Biophysical Approaches

Epigenetic Inhibitor Discovery

Fragment-Based Drug Discovery

Antivirals

For Sponsorship & Exhibit Opportunities please contact Carolyn Benton at 781-972-5412

For more information visit

DrugDiscoveryChemistry.com/Protein-Protein-Interactions

This meeting features medicinal chemistry-focused case studies of small molecule drug candidates that are being tested in preclinical and early-phase clinical trials for inflammation-related conditions. Because the most recent ‘market’ successes for oral, anti-inflammatories have been against the intracellular janus kinases (JAKs), updates on progress of new and 2nd generation intra-cellular kinase inhibitor candidates will be covered. But drug leads directed against non-kinase targets such as nuclear receptors involved in innate immunity, will also be a part of the meeting.

Final Agenda

Day 1 | Day 2 | Download Brochure

Tuesday, April 19

7:00 am Registration and Morning Coffee

 

INHIBITING PRO-INFLAMMATORY PATHWAYS: RORγ AND OTHER TARGETS

8:00 Chairperson’s Opening Remarks

Eric Schwartz, Ph.D., Executive Director, Medicinal Chemistry, Celgene

 

8:10 FEATURED PRESENTATION: Small Molecule Modulators of RORgamma

Robert HughesRobert Hughes, Ph.D., Senior Associate Director, Small Molecule Discovery Research, Boehringer-Ingelheim

RORγt is a nuclear hormone receptor expressed in Th17 cells and distinct subsets of lymphoid cells, including innate lymphoid cells (ILC), and γδ T-cells. RORγt is required for Th17 cell and innate lymphocyte differentiation and regulates the transcription of the effector cytokines genes such as IL17A. We describe our approach, including screening, structure-based design and optimization, which led to the discovery of potent, selective ROR g modulators with favorable ADME properties.

 

8:40 Quinoline Tertiary Alcohols as Modulators of Retinoic Acid Receptor-Related Orphan Receptor gamma t (RORγt)

Hari_VenkatesanHari Venkatesan, Ph.D., Principal Scientist, Discovery Chemistry, Immunology, Janssen Research & Development

Differentiation of naïve T-cells into IL-17 producing Th17 cells is regulated by the nuclear receptor transcription factor retinoic acid receptor-related orphan receptor gt (RORgt). Blocking the production of pro-inflammatory cytokines by RORgt modulation has the potential to be a first-in-class treatment of autoimmune diseases. High-throughput screening identified a promising series of quinoline tertiary alcohols. The subsequent optimization efforts that resulted in the identification of compounds for in vivo profiling will be discussed.

9:10 Sponsored Presentation (Opportunity Available)

9:40 Coffee Break

10:05 Inducing RORgamma-Specific Inverse Agonism Using a Synthetic Benzoxazinone Ligand

Doug_MarcotteDoug Marcotte, Associate Scientist, Physical Biochemistry, Biogen

RORγ regulates transcriptional genes involved in production of pro-inflammatory interleukin IL-17 which is linked to autoimmune diseases. We have discovered a series of synthetic benzoxazinone ligands having either an agonist (BIO592) or inverse agonist (BIO399) mode of action. We demonstrate that upon binding of BIO399 the AF2 helix of RORγ become destabilized. The X-ray structures of RORγ with BIO592 and BIO399 demonstrates how small modifications modulate the mode of action for achieving RORγ-specific inverse agonism.

10:35 Small Molecule Inhibitors of RORgamma and IRAK4 for the Treatment of Autoimmune Disorders

Susanta_SamajdarSusanta Samajdar, Ph.D., Director, Medicinal Chemistry, Aurigene Discovery Technologies Limited

Although biologics such as anti-TNFα antibody are fairly successful in the treatment of autoimmune disorders, there is significant unmet need due to heterogeneity in diseases and lack of response to established therapies in some patients. While biologics typically target one cytokine signaling pathway, small molecule therapeutics directed towards intracellular target(s) can interfere in the signaling from multiple cytokines potentially leading to improved response. Development of small molecule oral inhibitors of IRAK4 and RORgamma to target TLR/IL-R and Th17 pathway respectively will be discussed.

11:05 Structure-Based Design of Macrocyclic IL-17A Antagonists

Shenping_LiuShenping Liu, Ph.D., Associate Research Fellow, Structural Biology and Biophysics, Pfizer Global Research and DevelopmentI

IL-17A is a pro-inflammatory cytokine that has been implicated in many autoimmune and inflammatory diseases. Monoclonal antibodies targeting the IL-17A pathway have shown significant efficacies in treating psoriasis and Psoriatic arthritis in late stage clinical trials, and one of them was approved recently. We are interested in developing small molecule IL-17A antagonists for oral medication. We have determined several IL-17A/antagonists complex structures. These structures enabled us to design macrocyclic IL-17A antagonists with much improved potencies.

11:35 Luncheon Presentation (Sponsorship Opportunity Available) or Enjoy Lunch on Your Own

12:05 pm Session Break

 

INTRACELLULAR KINASE INHIBITORS FOR INFLAMMATION

1:15 Chairperson’s Remarks

Jennifer Venable, Ph.D., Associate Scientific Director, Medicinal Chemistry, J&J

1:20 Discovery of Potent, Selective, and Non-Covalent BTK Inhibitors for Clinical Development

Wendy_YoungWendy B. Young, Ph.D., Vice President, Discovery Chemistry, Genentech

We developed a series of highly potent, selective, non-covalent Btk inhibitors that are efficacious in several rodent models of RA and lupus. Compounds in this chemical series remain highly active against the C481S Btk mutant identified in patients that have relapsed on Imbruvica®. We describe the SAR, preclinical DMPK and toxicology investigations leading up to the discovery and selection of our lead clinical candidate, GDC-0853. Results from our Phase 1 clinical trials will be shared.

1:50 A Covalent BTK Inhibitor for Inflammation

Eric_SchwartzEric Schwartz, Ph.D., Executive Director, Medicinal Chemistry, Celgene

This presentation will discuss the identification and characterization of a covalent BTK inhibitor with in vitro, in vivo and preliminary toxicity data presented.

 

2:20 BTK and other Case Studies: Fragment Hit Prioritization and Optimization for Immunology Targets

Jason_PickensJason Pickens, Ph.D., Senior Scientist, Medicinal Chemistry, Takeda

As cutting-edge methods for fragment screening evolve into a series of best practices, the question of how to prioritize fragment hit sets to select the “best” fragments for initial chemistry follow-up elicits wide-ranging levels of analysis and opinion among FBDD practitioners. Through select case studies of immunology targets including BTK, this presentation will illuminate some specific strategies employed recently by medicinal chemistry teams at Takeda California in the pursuit of high-quality drug candidates derived from fragment starting points.

2:50 Structure-Activity-Relationships around Lead Series of Selective Jak1 Inhibitors for Inflammation

Michael_VazquezMichael L. Vazquez, Ph.D., Associate Fellow, Medicinal Chemistry, Pfizer, Inc.

Our research efforts have identified a series of potent and selective JAK1 inhibitors. Our lead, PF-04965842, is currently in clinical trials for the treatment of autoimmune diseases. This talk will discuss learnings from our clinical experience with tofacitinib a pan-JAK inhibitor with respect to potency and selectivity, SAR, the preclinical evaluation of our lead, and crystallographic data which has enabled us to build a structural hypothesis for the JAK1 selectivity.

3:20 Sponsored Presentation (Opportunity Available)

3:35 Refreshment Break in the Exhibit Hall with Poster Viewing

 

4:30 PLENARY KEYNOTE PRESENTATION

A New Model for Academic Translational Research

Peter SchultzPeter G. Schultz, Ph.D., Professor, Department of Chemistry, The Scripps Research Institute and Director, California Institute for Biomedical Research

Our research program combines the tools and principles of chemistry with the molecules and processes of living cells to synthesize new molecules and molecular assemblies with novel physical, chemical and biological functions. By studying the structure and function of the resulting molecules, new insights can be gained into the mechanisms of complex biological and chemical systems.

 

5:30 Welcome Reception in the Exhibit Hall with Poster Viewing

6:30 Close of Day

Day 1 | Day 2 | Download Brochure

Wednesday, April 20

7:30 am Continental Breakfast Breakout Discussions

In this session, attendees choose a specific roundtable discussion to join. Each group has a moderator to ensure focused conversations around key issues within the topic. The small group format allows participants to informally meet potential collaborators, share examples from their work and discuss ideas with peers. Check our website in February to see the full listing of breakout topics and moderators.

Topic: Developing Kinase Inhibitors for Chronic Indications

Moderator: Kamal Puri, Ph.D., Senior Principal Scientist, Immunology & Inflammation, Celgene Corp.

  • Utility of kinase selectivity profiling data
  • Safety assessment as an experiment rather than a progression gateway
  • Integrating PK/PD to predict safety margins

Topic: What can medicinal chemists do better to discover safe and effective anti-inflammatory therapeutics?

Moderator: Jennifer Venable, Ph.D., Associate Scientific Director, Medicinal Chemistry, J&J

  • Next generation kinase inhibitors – opportunities and challenges
  • Irreversible versus reversible inhibitors. Will irreversible inhibitors drive a boost in approvals?
  • Phenotypic screening

Topic: Targeting Innate Immunity

Moderator: Robert Hughes, Ph.D., Senior Associate Director, Small Molecule Discovery Research, Boehringer-Ingelheim

  • RORg challenges
  • Promising targets in pathway
  • Downstream development issues
  • Animal models

 

TREATING DISEASE-SPECIFIC INFLAMMATION

8:30 Chairperson’s Remarks

Kamal Puri, Ph.D., Senior Principal Scientist, Immunology & Inflammation, Celgene Corp.

8:35 PTG-100: An Oral Peptide Antagonist of α4β7 Integrin for Ulcerative Colitis

Larry_MattheakisLarry Mattheakis, Ph.D., Senior Director, Biology, Protagonist Therapeutics

PTG-100 is an oral peptide antagonist of the gut homing integrin α4β7. Its potency and selectivity are similar to that of the FDA-approved antibody vedolizumab. PTG-100 was chemically engineered to be orally stable within the harsh proteolytic and reducing environment of the human gastrointestinal tract. In preclinical animal models, PTG-100 exposure is largely restricted to GI tissues, whereby it alters the trafficking of gut homing T cells to reduce local inflammation. Together, these results provide the rational for investigating PTG-100 in human trials, specifically ulcerative colitis.

9:05 ATPase Modulators for Treating Inflammatory Bowel Disease

Alexander_HurdAlexander (Sandy) Hurd, Ph.D., Associate Director of Chemistry, Chemistry, Lycera Corp

Autoimmune diseases occur in part as a result of dysregulation of the natural immune response. Autoimmune disease is characterized by chronic activation of lymphocytes that recognize and attack naturally occurring, endogenous targets. These chronically activated lymphocytes exhibit a distinct bioenergetic profile in comparison to acutely activated immune cells, which provide a target for therapeutic intervention. Lycera is developing modulators of the mitochondrial ATPase to treat autoimmune conditions such as inflammatory bowel disease (IBD). The talk will include a description of the identification and characterization of Lycera’s current lead candidate for treating IBD.

9:35 Coffee Break in the Exhibit Hall with Poster Viewing

10:30 AKB-4924: Targeting Hypoxia Inducible Factor 1 for Therapy of Inflammatory Bowel Disease

Kevin_PetersKevin Peters, M.D., CSO and Senior Vice President, R&D, Aerpio Therapeutics, Inc.

Emerging evidence shows that hypoxia inducible factor 1 (HIF-1) is an important regulator of the immune response. AKB-4924 is a novel small molecule inhibitor of HIF prolylhydroxylases (PHDs), a family of enzymes that promotes HIF degradation. AKB-4924 preferentially stabilizes HIF-1 over HIF-2 and has profound beneficial effects in multiple models of inflammatory bowel disease by either parenteral or oral administration without concomitant increases in erythropoiesis. These data support advancement of AKB-4924 into the clinic.

11:00 CHDI-00340246: A Potent and Selective Kynurenine Monooxygenase Inhibitor as a Potential Therapeutic Agent for the Treatment of Huntington’s Disease

Leticia Toledo-Sherman, Ph.D., Director of Medicinal Chemistry, CHDI Foundation

Deregulation of the kynurenine pathway, has been implicated in the pathophysiology of Huntington’s Disease (HD). This talk will describe CHDI’s medicinal chemistry efforts that lead to the identification of CHDI-00340246, a highly potent and selective KMO inhibitor that has been nominated as clinical candidate for the treatment of HD. We will describe the pharmacokinetic/pharmacodynamics effects of CHDI-00340246 in several species, as well as its biological effects in various disease models.

11:30 Towards Third Generation Antihistamines as Potent Inflammation Inhibitors

iwan_de_EschIwan de Esch, Ph.D., Professor, Medicinal Chemistry, VU University Amsterdam & Griffin Discoveries BV

The histamine receptor consists of four subtype GPCRs. The histamine H1 receptor has been successfully targeted by two generations of blockbuster drugs. With the emerging insights into the role of the other histamine receptor subtypes in the different mechanisms of inflammatory responses, there is now a growing interest in poly-pharmacological approaches. We will disclose how fragment-based approaches and computer-aided drug design have resulted in series of compounds with well defined activity profiles for histamine receptor subtypes. These compounds proof potent anti-inflammatory compounds in various preclinical studies.

12:00 pm Close of Track

April 19-20

April 20-21

April 22

Inflammation Inhibitors

Kinase Inhibitor Chemistry

Brain Penetrant Inhibitors

Protein-Protein Interactions

Macrocyclics & Constrained Peptides

Biophysical Approaches

Epigenetic Inhibitor Discovery

Fragment-Based Drug Discovery

Antivirals

For Sponsorship & Exhibit Opportunities please contact Carolyn Benton at 781-972-5412

For more information visit

DrugDiscoveryChemistry.com/Protein-Protein-Interactions

SOURCE

From: Anjani Shah <pete@healthtech.com>

Date: Wednesday, March 23, 2016 at 10:44 AM

To: Aviva Lev-Ari <AvivaLev-Ari@alum.berkeley.edu>

Subject: A First-in-Class Validated Chemical Probe for KEAP1-NRF2 oxidative stress PPI Target