Ferric carboxymaltose infusion versus oral iron supplementation for preoperative iron deficiency anaemia in patients with colorectal cancer (FIT):a multicentre, open-label, randomised, controlled trial

Background: A third of patients with colorectal cancer who are eligible for surgery in high-income countries have concomitant anaemia associated with adverse outcomes. We aimed to compare the efficacy of preoperative intravenous and oral iron supplementation in patients with colorectal cancer and iron deficiency anaemia. Methods: In the FIT multicentre, open-label, randomised, controlled trial, adult patients (aged 18 years or older) with M0 stage colorectal cancer scheduled for elective curative resection and iron deficiency anaemia (defined as haemoglobin level of less than 7·5 mmol/L (12 g/dL) for women and less than 8 mmol/L (13 g/dL) for men, and a transferrin saturation of less than 20%) were randomly assigned to either 1–2 g of ferric carboxymaltose intravenously or three tablets of 200 mg of oral ferrous fumarate daily. The primary endpoint was the proportion of patients with normalised haemoglobin levels before surgery (≥12 g/dL for women and ≥13 g/dL for men). An intention-to-treat analysis was done for the primary analysis. Safety was analysed in all patients who received treatment. The trial was registered at ClincalTrials.gov, NCT02243735, and has completed recruitment. Findings: Between Oct 31, 2014, and Feb 23, 2021, 202 patients were included and assigned to intravenous (n=96) or oral (n=106) iron treatment. Treatment began a median of 14 days (IQR 11–22) before surgery for intravenous iron and 19 days (IQR 13–27) for oral iron. Normalisation of haemoglobin at day of admission was reached in 14 (17%) of 84 patients treated intravenously and 15 (16%) of 97 patients treated orally (relative risk [RR] 1·08 [95% CI 0·55–2·10]; p=0·83), but the proportion of patients with normalised haemoglobin significantly increased for the intravenous treatment group at later timepoints (49 [60%] of 82 vs 18 [21%] of 88 at 30 days; RR 2·92 [95% CI 1·87–4·58]; p&lt;0·0001). The most prevalent treatment-related adverse event was discoloured faeces (grade 1) after oral iron treatment (14 [13%] of 105), and no treatment-related serious adverse events or deaths were observed in either group. No differences in other safety outcomes were seen, and the most common serious adverse events were anastomotic leakage (11 [5%] of 202), aspiration pneumonia (5 [2%] of 202), and intra-abdominal abscess (5 [2%] 202). Interpretation: Normalisation of haemoglobin before surgery was infrequent with both treatment regimens, but significantly improved at all other timepoints following intravenous iron treatment. Restoration of iron stores was feasible only with intravenous iron. In selected patients, surgery might be delayed to augment the effect of intravenous iron on haemoglobin normalisation. Funding: Vifor Pharma.</p

No Difference in Penetrance between Truncating and Missense/Aberrant Splicing Pathogenic Variants in MLH1 and MSH2: A Prospective Lynch Syndrome Database Study

Background. Lynch syndrome is the most common genetic predisposition for hereditary cancer. Carriers of pathogenic changes in mismatch repair (MMR) genes have an increased risk of developing colorectal (CRC), endometrial, ovarian, urinary tract, prostate, and other cancers, depending on which gene is malfunctioning. In Lynch syndrome, differences in cancer incidence (penetrance) according to the gene involved have led to the stratification of cancer surveillance. By contrast, any differences in penetrance determined by the type of pathogenic variant remain unknown. Objective. To determine cumulative incidences of cancer in carriers of truncating and missense or aberrant splicing pathogenic variants of the MLH1 and MSH2 genes. Methods. Carriers of pathogenic variants of MLH1 (path_MLH1) and MSH2 (path_MSH2) genes filed in the Prospective Lynch Syndrome Database (PLSD) were categorized as truncating or missense/aberrant splicing according to the InSiGHT criteria for pathogenicity. Results. Among 5199 carriers, 1045 had missense or aberrant splicing variants, and 3930 had truncating variants. Prospective observation years for the two groups were 8205 and 34,141 years, respectively, after which there were no significant differences in incidences for cancer overall or for colorectal cancer or endometrial cancers separately. Conclusion. Truncating and missense or aberrant splicing pathogenic variants were associated with similar average cumulative incidences of cancer in carriers of path MLH1 and path_MSH2

No Difference in Penetrance between Truncating and Missense/Aberrant Splicing Pathogenic Variants in MLH1 and MSH2: A Prospective Lynch Syndrome Database Study

Background. Lynch syndrome is the most common genetic predisposition for hereditary cancer. Carriers of pathogenic changes in mismatch repair (MMR) genes have an increased risk of developing colorectal (CRC), endometrial, ovarian, urinary tract, prostate, and other cancers, depending on which gene is malfunctioning. In Lynch syndrome, differences in cancer incidence (penetrance) according to the gene involved have led to the stratification of cancer surveillance. By contrast, any differences in penetrance determined by the type of pathogenic variant remain unknown. Objective. To determine cumulative incidences of cancer in carriers of truncating and missense or aberrant splicing pathogenic variants of the MLH1 and MSH2 genes. Methods. Carriers of pathogenic variants of MLH1 (path_MLH1) and MSH2 (path_MSH2) genes filed in the Prospective Lynch Syndrome Database (PLSD) were categorized as truncating or missense/aberrant splicing according to the InSiGHT criteria for pathogenicity. Results. Among 5199 carriers, 1045 had missense or aberrant splicing variants, and 3930 had truncating variants. Prospective observation years for the two groups were 8205 and 34,141 years, respectively, after which there were no significant differences in incidences for cancer overall or for colorectal cancer or endometrial cancers separately. Conclusion. Truncating and missense or aberrant splicing pathogenic variants were associated with similar average cumulative incidences of cancer in carriers of path MLH1 and path_MSH2

No Difference in Penetrance between Truncating and Missense/Aberrant Splicing Pathogenic Variants in MLH1 and MSH2: A Prospective Lynch Syndrome Database Study

From MDPI via Jisc Publications RouterHistory: accepted 2021-06-16, pub-electronic 2021-06-28Publication status: PublishedBackground. Lynch syndrome is the most common genetic predisposition for hereditary cancer. Carriers of pathogenic changes in mismatch repair (MMR) genes have an increased risk of developing colorectal (CRC), endometrial, ovarian, urinary tract, prostate, and other cancers, depending on which gene is malfunctioning. In Lynch syndrome, differences in cancer incidence (penetrance) according to the gene involved have led to the stratification of cancer surveillance. By contrast, any differences in penetrance determined by the type of pathogenic variant remain unknown. Objective. To determine cumulative incidences of cancer in carriers of truncating and missense or aberrant splicing pathogenic variants of the MLH1 and MSH2 genes. Methods. Carriers of pathogenic variants of MLH1 (path_MLH1) and MSH2 (path_MSH2) genes filed in the Prospective Lynch Syndrome Database (PLSD) were categorized as truncating or missense/aberrant splicing according to the InSiGHT criteria for pathogenicity. Results. Among 5199 carriers, 1045 had missense or aberrant splicing variants, and 3930 had truncating variants. Prospective observation years for the two groups were 8205 and 34,141 years, respectively, after which there were no significant differences in incidences for cancer overall or for colorectal cancer or endometrial cancers separately. Conclusion. Truncating and missense or aberrant splicing pathogenic variants were associated with similar average cumulative incidences of cancer in carriers of path MLH1 and path_MSH2

Analysis of water molecules in protein-ligand complexes with the help of computer simulations using the example of a model binding site

Wassermoleküle spielen oft eine entscheidende Rolle bei der Bindung von Liganden an Proteine. Zum einen ist dies in ihrer Eigenschaft als Wasserstoffbrückendonor und -akzeptor begründet, die es ermöglicht Wechselwirkung zwischen Ligand und Rezeptor zu vermitteln. Zum anderen stellen die Desolvatisierungsenthalpie und -entropie einer Bindetasche während der Ligandbindung einen entscheidenden Anteil der Bindungsaffinität dar. Obwohl man sich dieser Einflüsse seit langem bewusst ist, sind aktuelle Methoden des computerbasierten Wirkstoffdesigns nur in sehr begrenztem Umfang in der Lage, die entsprechenden Effekte zu erfassen und vorherzusagen. Da experimentelle Daten über die Effekte von Wassermolekülen in Protein-Ligand Komplexen von Natur aus schwierig zu erhalten sind, untersucht die vorliegende Arbeit eine Modellbindetasche einer Cytochrom c Peroxidase Mutante (CCP W191G) mit Hilfe von Molecular Modeling Techniken. Diese polare und solvatisierte Kavität ist strukturell sehr gut charakterisiert und bindet kleine, kationische Heterozyklen zusammen mit unterschiedlichen Mengen an Wassermolekülen. Für die Untersuchungen wurden strukturell ähnliche Liganden mit einem unterschiedlichen Wechselwirkungsmuster ausgewählt. Davon ausgehend wurde die Möglichkeit zweier Docking-Programme, den Grad der Wasserverdrängung durch den Liganden zusammen mit dem Bindungsmodus vorherzusagen, untersucht. Die dynamischen Eigenschaften der Bindetaschenwassermoleküle wurden mittels Molekulardynamiksimulationen studiert. Schließlich wurden diese rein strukturellen Betrachtungen durch eine energetische/thermodynamische Analyse komplettiert. Die Anwendung dieser unterschiedlichen Verfahren liefert einige neue Erkenntnisse über die untersuchte Modellbindetasche. Trotz der relativen Einfachheit der kleinen Kavität der CCP W191G Mutante war die vollständige Charakterisierung und eine korrekte (retrospektive) Vorhersage des Wasser-Wechselwirkungsmuster der Ligand-Komplexe nicht trivial. Zusammenfassend kann man festhalten, dass insgesamt eine gute Übereinstimmung zwischen den durch Computersimulationen erhaltenen Ergebnissen und den kristallographischen Daten erzielt wurde. Unerwartete Befunde, die auf den ersten Blick mit den kristallographischen Beobachtungen nicht übereinstimmen, können ebenso durch Limitationen in den Kristallstrukturen bedingt sein. Darüber hinaus gaben die Ergebnisse auch eine Hilfestellung, welches Verfahren zur Beantwortung einer Fragestellung im Rahmen von Wassermolekülen im Wirkstoffdesign geeignet sind. Schließlich wurden ebenso die Begrenzungen der jeweiligen Methoden aufgezeigt.Water molecules play an important role for the binding of small molecule ligands to proteins. One of the reasons for this is their ability to act as a hydrogen bond donor and acceptor at the same time. Additionally, the enthalpy and entropy of desolvation of the pocket is one large contribution to the overall binding affinity. Although this is long known, prediction of these effects by current methods of computer-aided drug design is rather limited. Since experimental information about water effects in protein-ligand complexes are inherently difficult to obtain, in the present work a well-suited model binding site of a mutant of the cytochrome c peroxidase (CCP W191G) is studied using molecular modeling techniques. This polar and solvated cavity is structurally very well characterized and several small, cationic heterocycles bind together with a different amount of water molecules. For this study structurally similar ligands which have a different interaction pattern where chosen. First, the ability of two docking programs to predict cavity desolvation upon ligand binding was investigated. The dynamic properties of the binding site water molecules where studied by means of molecular dynamic simulations. Ultimately, the pure structural considerations addressed in this work were complemented by an energetic/thermodynamic analysis. The application of the different methods offered some new insights into the studied model binding site. Despite the relative simplicity of the small cavity of the CCP W191G mutant, a complete characterization and a correct (retrospective) prediction of the water interaction network in ligand complexes of this model binding site is not trivial. In summary, an overall good agreement between computational results and crystallographic data is obtained. Unexpected findings, which at first sight disagree with crystallographic observations, may also be due to limitations of the crystal structures. In addition, the results help to decide which method is appropriate to address a certain question in the context of water molecules in drug design. Also, the limitations of the respective methods are exposed

Molecular Dynamics Reveal Binding Mode of Glutathionylspermidine by Trypanothione Synthetase

The trypanothione synthetase (TryS) catalyses the two-step biosynthesis of trypanothione from spermidine and glutathione and is an attractive new drug target for the development of trypanocidal and antileishmanial drugs, especially since the structural information of TryS from Leishmania major has become available. Unfortunately, the TryS structure was solved without any of the substrates and lacks loop regions that are mechanistically important. This contribution describes docking and molecular dynamics simulations that led to further insights into trypanothione biosynthesis and, in particular, explains the binding modes of substrates for the second catalytic step. The structural model essentially confirm previously proposed binding sites for glutathione, ATP and two $Mg^{2+}$ ions, which appear identical for both catalytic steps. The analysis of an unsolved loop region near the proposed spermidine binding site revealed a new pocket that was demonstrated to bind glutathionylspermidine in an inverted orientation. For the second step of trypanothione synthesis glutathionylspermidine is bound in a way that preferentially allows $N^1$-glutathionylation of $N^8$-glutathionylspermidine, classifying $N^8$-glutathionylspermidine as the favoured substrate. By inhibitor docking, the binding site for $N^8$-glutathionylspermidine was characterised as druggable