Identification of elongated cilia and chiral malformation in TMEM67 mutant brains

poster abstractTransmembrane protein 67 (TMEM67) is encoded by one of four syndromic encephalocele genes. In humans a mutation in TMEM67 causes Meckel Gruber Syndrome, type 3 (MKS3) which is characterized by severe encephalocele and cystic kidneys and is usually fatal in the neonatal period. MKS3 is one of a spectrum of diseases known as ciliopathies because the proteins responsible for the disease are found in cells with the primary cilia. Primary cilia are a single, hair-like organelle that is found on the apical membrane of polarized cells and is thought to be involved in formation of left-right asymmetry during development as well as mechano- and chemo-reception. Here we characterize previously unreported details of cerebral phenotype in the Wistar polycystic kidney (Wpk) rats with a TMEM67 mutation. In choroid plexus (CP) epithelia of wild type animals, TMEM67 localizes to the plasma membrane and to a region close to the basal side of CP primary cilia. In a choroid plexus cell line that forms an epithelial sheet, the TMEM67 is found intracellularly but also localizes to the junctional complexes as evidenced by β catenin co-localization. Absence of normal TMEM67 leads to elongation of primary cilia in the ependymal cells lining the cerebral ventricles of the TMEM67-/- animals indicating that this protein is involved in the regulation of cilia length. Reduced aqueduct, bilateral dilatation with fusion of lateral ventricles, swelling of the hippocampus, and altered hindbrain histoarchitecture are noted in the TMEM67-/- rats. In the heterozygous animals mild asymmetric ventriculomegaly primarily on the left side is observed during early postnatal periods and continues into adulthood. These results suggest that TMEM67 is required for cilia length control and normal development of cerebral midline that maintains the symmetry of the left and right hemispheres. The Wpk rat model, orthologous to human MKS3, provides a unique model in which to study the development of both severe (TMEM67-/-) and mild (TMEM67+/-) hydrocephalus and other developmental abnormalities that are commonly found in human patients with ciliopathies

Subcutaneous nerve stimulation for rate control in ambulatory dogs with persistent atrial fibrillation

Background Subcutaneous nerve stimulation (ScNS) damages the stellate ganglion and improves rhythm control of atrial fibrillation (AF) in ambulatory dogs. Objective The purpose of this study was to test the hypothesis that thoracic ScNS can improve rate control in persistent AF. Methods We created persistent AF in 13 dogs and randomly assigned them to ScNS (n = 6) and sham control (n = 7) groups. 18F-2-Fluoro-2-deoxyglucose positron emission tomography/magnetic resonance imaging of the brain stem was performed at baseline and at the end of the study. Results The average stellate ganglion nerve activity reduced from 4.00 ± 1.68 μV after the induction of persistent AF to 1.72 ± 0.42 μV (P = .032) after ScNS. In contrast, the average stellate ganglion nerve activity increased from 3.01 ± 1.26 μV during AF to 5.52 ± 2.69 μV after sham stimulation (P = .023). The mean ventricular rate during persistent AF reduced from 149 ± 36 to 84 ± 16 beats/min (P = .011) in the ScNS group, but no changes were observed in the sham control group. The left ventricular ejection fraction remained unchanged in the ScNS group but reduced significantly in the sham control group. Immunostaining showed damaged ganglion cells in bilateral stellate ganglia and increased brain stem glial cell reaction in the ScNS group but not in the control group. The 18F-2-fluoro-2-deoxyglucose uptake in the pons and medulla was significantly (P = .011) higher in the ScNS group than the sham control group at the end of the study. Conclusion Thoracic ScNS causes neural remodeling in the brain stem and stellate ganglia, controls the ventricular rate, and preserves the left ventricular ejection fraction in ambulatory dogs with persistent AF

18F-NaF and 18F-FDG as molecular probes in the evaluation of atherosclerosis

The early detection of atherosclerotic disease is vital to the effective prevention and management of life-threatening cardiovascular events such as myocardial infarctions and cerebrovascular accidents. Given the potential for positron emission tomography (PET) to visualize atherosclerosis earlier in the disease process than anatomic imaging modalities such as computed tomography (CT), this application of PET imaging has been the focus of intense scientific inquiry. Although 18F-FDG has historically been the most widely studied PET radiotracer in this domain, there is a growing body of evidence that 18F-NaF holds significant diagnostic and prognostic value as well. In this article, we review the existing literature on the application of 18F-FDG and 18F-NaF as PET probes in atherosclerosis and present the findings of original animal and human studies that have examined how well 18F-NaF uptake correlates with vascular calcification and cardiovascular risk

Effects of renal sympathetic denervation on the stellate ganglion and brain stem in dogs

BACKGROUND: Renal sympathetic denervation (RD) is a promising method of neuromodulation for the management of cardiac arrhythmia. OBJECTIVE: We tested the hypothesis that RD is antiarrhythmic in ambulatory dogs because it reduces the stellate ganglion nerve activity (SGNA) by remodeling the stellate ganglion (SG) and brain stem. METHODS: We implanted a radiotransmitter to record SGNA and electrocardiogram in 9 ambulatory dogs for 2 weeks, followed by a second surgery for RD and 2 months SGNA recording. Cell death was probed by terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assay. RESULTS: Integrated SGNA at baseline and 1 and 2 months after RD were 14.0 ± 4.0, 9.3 ± 2.8, and 9.6 ± 2.0 μV, respectively (P = .042). The SG from RD but not normal control dogs (n = 5) showed confluent damage. An average of 41% ± 10% and 40% ± 16% of ganglion cells in the left and right SG, respectively, were TUNEL positive in RD dogs compared with 0% in controls dogs (P = .005 for both). The left and right SG from RD dogs had more tyrosine hydroxylase-negative ganglion cells than did the left SG of control dogs (P = .028 and P = .047, respectively). Extensive TUNEL-positive neurons and glial cells were also noted in the medulla, associated with strongly positive glial fibrillary acidic protein staining. The distribution was heterogeneous, with more cell death in the medial than lateral aspects of the medulla. CONCLUSION: Bilateral RD caused significant central and peripheral sympathetic nerve remodeling and reduced SGNA in ambulatory dogs. These findings may in part explain the antiarrhythmic effects of RD

TRPV4 antagonists ameliorate ventriculomegaly in a rat model of hydrocephalus

Hydrocephalus is a serious condition that impacts patients of all ages. The standards of care are surgical options to divert, or inhibit production of, cerebrospinal fluid; to date, there are no effective pharmaceutical treatments, to our knowledge. The causes vary widely, but one commonality of this condition is aberrations in salt and fluid balance. We have used a genetic model of hydrocephalus to show that ventriculomegaly can be alleviated by inhibition of the transient receptor potential vanilloid 4, a channel that is activated by changes in osmotic balance, temperature, pressure and inflammatory mediators. The TRPV4 antagonists do not appear to have adverse effects on the overall health of the WT or hydrocephalic animals

Robotic kidney transplantation using right-versus left-sided grafts from living donors: an european multicentre experience (ERUS-RAKT working group)

Introduction: RAKT from living donors (LD) is increasingly performedin selected centers with experience in robotic surgery and kidneytransplantation (KT). Of note, KT from LD using right-sided graft (RSG)is challenging due to the brevity of the right renal vein and has beenassociated with a higher riskof perioperative complications in selectedseries. In this scenario, RAKT may facilitate the performance ofvascular anastomoses in case of short renal vessels thanks to theadvantages of the robotic platform. However, the evidence on thesafety and feasibility of RAKT using RSGs is lacking. The aim of thisstudy is to compare the surgical andearly perioperative outcomes after RAKT from LD using right- vs. left-sided grafts in a large prospectivemulticenter cohort (ERUS-RAKT working group)

Potentiation of Carboplatin-Mediated DNA Damage by the Mdm2 Modulator Nutlin-3a in a Humanized Orthotopic Breast-to-Lung Metastatic Model

Triple-negative breast cancers (TNBC) are typically resistant to treatment, and strategies that build upon frontline therapy are needed. Targeting the murine double minute 2 (Mdm2) protein is an attractive approach, as Mdm2 levels are elevated in many therapy-refractive breast cancers. The Mdm2 protein-protein interaction inhibitor Nutlin-3a blocks the binding of Mdm2 to key signaling molecules such as p53 and p73α and can result in activation of cell death signaling pathways. In the present study, the therapeutic potential of carboplatin and Nutlin-3a to treat TNBC was investigated, as carboplatin is under evaluation in clinical trials for TNBC. In mutant p53 TMD231 TNBC cells, carboplatin and Nutlin-3a led to increased Mdm2 and was strongly synergistic in promoting cell death in vitro. Furthermore, sensitivity of TNBC cells to combination treatment was dependent on p73α. Following combination treatment, γH2AX increased and Mdm2 localized to a larger degree to chromatin compared with single-agent treatment, consistent with previous observations that Mdm2 binds to the Mre11/Rad50/Nbs1 complex associated with DNA and inhibits the DNA damage response. In vivo efficacy studies were conducted in the TMD231 orthotopic mammary fat pad model in NOD.Cg-Prkdc(scid)Il2rg(tm1Wjl)/SzJ (NSG) mice. Using an intermittent dosing schedule of combined carboplatin and Nutlin-3a, there was a significant reduction in primary tumor growth and lung metastases compared with vehicle and single-agent treatments. In addition, there was minimal toxicity to the bone marrow and normal tissues. These studies demonstrate that Mdm2 holds promise as a therapeutic target in combination with conventional therapy and may lead to new clinical therapies for TNBC

[68Ga]Ga-P16-093 as a PSMA-Targeted PET Radiopharmaceutical for Detection of Cancer: Initial Evaluation and Comparison with [68Ga]Ga-PSMA-11 in Prostate Cancer Patients Presenting with Biochemical Recurrence

Purpose: This study was undertaken to evaluate radiation dosimetry for the prostate-specific membrane antigen targeted [68Ga]Ga-P16-093 radiopharmaceutical, and to initially assess agent performance in positron emission tomography (PET) detection of the site of disease in prostate cancer patients presenting with biochemical recurrence. Procedures: Under IND 133,222 and an IRB-approved research protocol, we evaluated the biodistribution and pharmacokinetics of [68Ga]Ga-P16-093 with serial PET imaging following intravenous administration to ten prostate cancer patients with biochemical recurrence. The recruited subjects were all patients in whom a recent [68Ga]Ga-PSMA-11 PET/X-ray computed tomography (CT) exam had been independently performed under IND 131,806 to assist in decision-making with regard to their clinical care. Voided urine was collected from each subject at ~ 60 min and ~ 140 min post-[68Ga]Ga-P16-093 injection and assayed for Ga-68 content. Following image segmentation to extract tissue time-activity curves and corresponding cumulated activity values, radiation dosimetry estimates were calculated using IDAC Dose 2.1. The prior [68Ga]Ga-PSMA-11 PET/CT exam (whole-body PET imaging at 60 min post-injection, performed with contrast-enhanced diagnostic CT) served as a reference scan for comparison to the [68Ga]Ga-P16-093 findings. Results: [68Ga]Ga-P16-093 PET images at 60 min post-injection provided diagnostic information that appeared equivalent to the subject's prior [68Ga]Ga-PSMA-11 scan. With both radiopharmaceuticals, sites of tumor recurrence were found in eight of the ten patients, identifying 16 lesions. The site of recurrence was not detected with either agent for the other two subjects. Bladder activity was consistently lower with [68Ga]Ga-P16-093 than [68Ga]Ga-PSMA-11. The kidneys, spleen, salivary glands, and liver receive the highest radiation exposure from [68Ga]Ga-P16-093, with estimated doses of 1.7 × 10-1, 6.7 × 10-2, 6.5 × 10-2, and 5.6 × 10-2 mGy/MBq, respectively. The corresponding effective dose from [68Ga]Ga-P16-093 is 2.3 × 10-2 mSv/MBq. Conclusions: [68Ga]Ga-P16-093 provided diagnostic information that appeared equivalent to [68Ga]Ga-PSMA-11 in this limited series of ten prostate cancer patients presenting with biochemical recurrence, with the kidneys found to be the critical organ. Diminished tracer appearance in the urine represents a potential advantage of [68Ga]Ga-P16-093 over [68Ga]Ga-PSMA-11 for detection of lesions in the pelvis

Dynamic Bioluminescence Imaging: Development of a Physiological Pharmacokinetic Model of Tumor Metabolism

poster abstractBioluminescent imaging (BLI) has proven to be a valuable tool for the study of cellular biology and therapeutic response in a wide array of tumor types. Several BLI analytical approaches have been developed to assess tumor function and growth, all with the primary assumption that substrate concentrations saturate the luciferase enzyme. Recent work suggests that when D-luciferin is administered over the range from 75-600mg/kg, target tissue concentrations of D-luciferin are well below the Km of luciferase for the reaction, and, that the pharmacokinetics of D-luciferin significantly impact observed emission rates. To address the concentration and PK concerns, we developed a three compartment physiologically based pharmacokinetic (PhPK) model for D-luciferin including oxidation by luciferase via Michaelis-Menten kinetics. The model was applied to dynamically acquired BLI in NOD/SCID mice with ectopic luciferase-transfected SF767 tumors. The current PhPK model estimates tumor volume, tumor substrate metabolism (M ̅), tumor blood flow (Vb) and substrate extraction from the blood (Er). Studies were conducted using intraperitoneal, subcutaneous and intravenous routes of administration of 150 mg/kg of D-luciferin, where dynamic BLI was conducted weekly for four weeks. The D-luciferin concentration in tumor tissue, determined immediately after the last imaging session, was found to be approximately 8-fold below the reported Km for the reaction across all routes of administration, supporting the need for a PhPK modeling approach for analyzing BLI data. The model-predicted tumor volumes increased over time and were highly correlated with caliper-measured tumor volumes (y=1.984x, R2=0.980, p<0.0001). Tumor D-luciferin metabolism was found to increase exponentially over the 4 weeks, while blood flow decreased over this same interval, a finding which is consistent with the interpretation of a Warburg effect. When tumor M ̅ was compared with the traditional measures of peak emission (Cmax) and area under the curve (AUC), it was found that metabolism increased exponentially with increases in either Cmax (y=92.7exp(8E-11x), R2= 0.997) or AUC ( y=86.4exp(5E-14x), R2= 0.989), suggesting that Cmax and AUC may substantially underestimate the magnitude of tumor metabolism. The present PhPK model of D-luciferin distribution and metabolism overcomes limitations in the Cmax and AUC approaches caused by incorrect substrate: enzyme concentration assumptions, and thus provides a more reliable estimate of tumor burden, growth, and therapeutic response