The Neuropathological Basis of a Poor Outcome After Non-Missile Head Injury

The main purpose of this thesis was to identify the pathological processes underlying a poor outcome after non-missile head injury. To achieve this, comprehensive neuropathological studies were undertaken in a postmortem series of 48 fatal cases of non-missile head injury who had survived more than one month and were classified as comatose, vegetative or severely disabled. There had been a fracture of the skull in 26 cases (54%). Cerebral contusions were present in 43 cases (90%). Contusions were quantified by the "contusion index" method and their anatomical distribution and relationship to other lesions examined. Intracranial haematomas had been present in 26 cases (54%) and had been evacuated neurosurgically in 21 cases (44%). Diffuse axonal injury was present in 25 cases (52%) and was the most common finding apart from cerebral contusions. Focal lesions in the corpus callosum and rostral brain stem occurring in cases of diffuse axonal injury were analysed and formed the basis of a method for grading the severity of diffuse axonal injury. Diffuse axonal injury was shown to be associated with various lesions apparently of vascular origin, including sulcal infarcts, gliding contusions and other parenchymal lesions. It is suggested that these features are manifestations of "diffuse vascular injury". There was evidence of a previously high intracranial pressure, in the form of pressure necrosis in one or both parahippocampal gyri, in 28 cases (58%). Lesions in the brain stem due to a high intracranial pressure were considered to be present in 14 cases (29%). In 8 of these the lesions were large and took the form of a haematoma or infarcts. In the other 6 cases, however, the secondary lesions could only be detected microscopically and comprised minute infarcts or foci of gliosis. Brain damage of hypoxic or ischaemic origin was present in 27 cases (56%). This was diffuse in 2 cases, of boundary-zone distribution in 5 cases, and occurred within main arterial territories or in the region of the basal ganglia in the remaining 20 cases. Diffuse axonal injury, cerebral contusions, hypoxic/ ischaemic brain damage and secondary lesions in the brain stem were thus identified as the principal types of structural damage. There was considerable overlap since there was more than one type of lesion in 40 cases. One type of lesion only was found in 8 cases, but in no case was a secondary lesion in the brain stem the only type of lesion present. Four main categories of structural damage were identified as contributing most to the clinical outcome. These were: diffuse axonal injury in 25 cases (52%); hypoxic/ ischaemic brain damage in 11 cases (23%); a combination of a macroscopic secondary lesion in the brain stem and hypoxic/ ischaemic brain damage in 8 cases (17%); and, cerebral contusions in 4 cases (8%). There was a relationship between the grade of diffuse axonal injury and the clinical outcome. Diffuse axonal injury was the most frequent cause of a vegetative state (68% of cases). A macroscopic secondary lesion in the brain stem together with hypoxic/ischaemic brain damage was the most common finding in cases of prolonged coma (50% of cases), and hypoxic/ischaemic brain damage was the most common cause of severe disability (44% of cases). Diffuse axonal injury was the next most frequent cause of both prolonged coma (33% of cases) and severe disability (38% of cases). Diffuse axonal injury was thus found to be the most common cause of a poor outcome after non-missile head injury. Ventricular enlargement was quantified by a point-counting method. Hydrocephalus was deemed to be present in 65% of cases assessed. In general there was a relationship between the size of the ventricles and duration of survival. Apart from one patient of long survival who died as a result of a cerebellar haematoma, a definite cause of obstructive hydrocephalus or evidence of a terminally high intracranial pressure was not found in any case although one patient had been treated clinically for obstructive hydrocephalus. Cerebral atrophy appeared to be the most important factor leading to ventricular dilatation. Some complications of late onset were identified. These comprised cerebrovascular disease, central pontine myelinolysis associated with Marchiafava-Bignami disease, and pellagra

A Probabilistic Description of the Configurational Entropy of Mixing

This work presents a formalism to calculate the configurational entropy of mixing based on the identification of non-interacting atomic complexes in the mixture and the calculation of their respective probabilities, instead of computing the number of atomic configurations in a lattice. The methodology is applied in order to develop a general analytical expression for the configurational entropy of mixing of interstitial solutions. The expression is valid for any interstitial concentration, is suitable for the treatment of interstitial short-range order (SRO) and can be applied to tetrahedral or octahedral interstitial solutions in any crystal lattice. The effect of the SRO of H on the structural properties of the Nb-H and bcc Zr-H solid solutions is studied using an accurate description of the configurational entropy. The methodology can also be applied to systems with no translational symmetry, such as liquids and amorphous materials. An expression for the configurational entropy of a granular system composed by equal sized hard spheres is deduced

Human Antibodies that Slow Erythrocyte Invasion Potentiate Malaria-Neutralizing Antibodies.

The Plasmodium falciparum reticulocyte-binding protein homolog 5 (PfRH5) is the leading target for next-generation vaccines against the disease-causing blood-stage of malaria. However, little is known about how human antibodies confer functional immunity against this antigen. We isolated a panel of human monoclonal antibodies (mAbs) against PfRH5 from peripheral blood B cells from vaccinees in the first clinical trial of a PfRH5-based vaccine. We identified a subset of mAbs with neutralizing activity that bind to three distinct sites and another subset of mAbs that are non-functional, or even antagonistic to neutralizing antibodies. We also identify the epitope of a novel group of non-neutralizing antibodies that significantly reduce the speed of red blood cell invasion by the merozoite, thereby potentiating the effect of all neutralizing PfRH5 antibodies as well as synergizing with antibodies targeting other malaria invasion proteins. Our results provide a roadmap for structure-guided vaccine development to maximize antibody efficacy against blood-stage malaria. Copyright © 2019 The Author(s). Published by Elsevier Inc. All rights reserved

Hybrid immunity to SARS-CoV-2 arises from serological recall of IgG antibodies distinctly imprinted by infection or vaccination

We describe the molecular-level composition of polyclonal immunoglobulin G (IgG) anti-spike antibodies from ancestral severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, vaccination, or their combination ("hybrid immunity") at monoclonal resolution. Infection primarily triggers S2/N-terminal domain (NTD)-reactive antibodies, whereas vaccination mainly induces anti-receptor-binding domain (RBD) antibodies. This imprint persists after secondary exposures wherein >60% of ensuing hybrid immunity derives from the original IgG pool. Monoclonal constituents of the original IgG pool can increase breadth, affinity, and prevalence upon secondary exposures, as exemplified by the plasma antibody SC27. Following a breakthrough infection, vaccine-induced SC27 gained neutralization breadth and potency against SARS-CoV-2 variants and zoonotic viruses (half-maximal inhibitory concentration [IC50] ∼0.1-1.75 nM) and increased its binding affinity to the protective RBD class 1/4 epitope (dissociation constant [KD] < 5 pM). According to polyclonal escape analysis, SC27-like binding patterns are common in SARS-CoV-2 hybrid immunity. Our findings provide a detailed molecular definition of immunological imprinting and show that vaccination can produce class 1/4 (SC27-like) IgG antibodies circulating in the blood

Pan-Cancer Analysis of lncRNA Regulation Supports Their Targeting of Cancer Genes in Each Tumor Context

Long noncoding RNAs (lncRNAs) are commonly dys-regulated in tumors, but only a handful are known toplay pathophysiological roles in cancer. We inferredlncRNAs that dysregulate cancer pathways, onco-genes, and tumor suppressors (cancer genes) bymodeling their effects on the activity of transcriptionfactors, RNA-binding proteins, and microRNAs in5,185 TCGA tumors and 1,019 ENCODE assays.Our predictions included hundreds of candidateonco- and tumor-suppressor lncRNAs (cancerlncRNAs) whose somatic alterations account for thedysregulation of dozens of cancer genes and path-ways in each of 14 tumor contexts. To demonstrateproof of concept, we showed that perturbations tar-geting OIP5-AS1 (an inferred tumor suppressor) andTUG1 and WT1-AS (inferred onco-lncRNAs) dysre-gulated cancer genes and altered proliferation ofbreast and gynecologic cancer cells. Our analysis in-dicates that, although most lncRNAs are dysregu-lated in a tumor-specific manner, some, includingOIP5-AS1, TUG1, NEAT1, MEG3, and TSIX, synergis-tically dysregulate cancer pathways in multiple tumorcontexts

Pan-cancer Alterations of the MYC Oncogene and Its Proximal Network across the Cancer Genome Atlas

Although theMYConcogene has been implicated incancer, a systematic assessment of alterations ofMYC, related transcription factors, and co-regulatoryproteins, forming the proximal MYC network (PMN),across human cancers is lacking. Using computa-tional approaches, we define genomic and proteo-mic features associated with MYC and the PMNacross the 33 cancers of The Cancer Genome Atlas.Pan-cancer, 28% of all samples had at least one ofthe MYC paralogs amplified. In contrast, the MYCantagonists MGA and MNT were the most frequentlymutated or deleted members, proposing a roleas tumor suppressors.MYCalterations were mutu-ally exclusive withPIK3CA,PTEN,APC,orBRAFalterations, suggesting that MYC is a distinct onco-genic driver. Expression analysis revealed MYC-associated pathways in tumor subtypes, such asimmune response and growth factor signaling; chro-matin, translation, and DNA replication/repair wereconserved pan-cancer. This analysis reveals insightsinto MYC biology and is a reference for biomarkersand therapeutics for cancers with alterations ofMYC or the PMN

Genomic, Pathway Network, and Immunologic Features Distinguishing Squamous Carcinomas

This integrated, multiplatform PanCancer Atlas study co-mapped and identified distinguishing molecular features of squamous cell carcinomas (SCCs) from five sites associated with smokin

Spatial Organization and Molecular Correlation of Tumor-Infiltrating Lymphocytes Using Deep Learning on Pathology Images

Beyond sample curation and basic pathologic characterization, the digitized H&E-stained images of TCGA samples remain underutilized. To highlight this resource, we present mappings of tumorinfiltrating lymphocytes (TILs) based on H&E images from 13 TCGA tumor types. These TIL maps are derived through computational staining using a convolutional neural network trained to classify patches of images. Affinity propagation revealed local spatial structure in TIL patterns and correlation with overall survival. TIL map structural patterns were grouped using standard histopathological parameters. These patterns are enriched in particular T cell subpopulations derived from molecular measures. TIL densities and spatial structure were differentially enriched among tumor types, immune subtypes, and tumor molecular subtypes, implying that spatial infiltrate state could reflect particular tumor cell aberration states. Obtaining spatial lymphocytic patterns linked to the rich genomic characterization of TCGA samples demonstrates one use for the TCGA image archives with insights into the tumor-immune microenvironment

Cytochrome 450 1B1 (CYP1B1) polymorphisms associated with response to docetaxel in Castration-Resistant Prostate Cancer (CRPC) patients

BACKGROUND: The selection of patients according to key genetic characteristics may help to tailor chemotherapy and optimize the treatment in Castration-Resistant Prostate Cancer (CRPC) patients. Functional polymorphisms within the cytochrome P450 1B1 (CYP1B1) gene have been associated with alterations in enzymatic expression and activity and may change sensitivity to the widely used docetaxel regimen. METHODS: CYP1B1 genotyping was performed on blood samples of 60 CRPC patients treated with docetaxel, using TaqMan probes-based assays. Association between CYP1B1-142C>G (leading to the 48ArgGly transition), 4326C>G (432LeuVal), and 4390A>G (453AsnSer) polymorphisms and treatment response, progression-free-survival (PFS) and overall-survival (OS) was estimated using Pearson χ2 test, Kaplan-Meier curves and Log-rank test. RESULTS: Patients carrying the CYP1B1-432ValVal genotype experienced a significantly lower response-rate (P = 0.014), shorter progression-free-survival (P = 0.032) and overall-survival (P < 0.001). Multivariate analyses and correction for multiple comparisons confirmed its prognostic significance for OS. No significant associations were found among other polymorphisms and both response and clinical outcome. CONCLUSIONS: CYP1B1-4326C>G (432LeuVal) polymorphism emerged as possible predictive marker of response and clinical outcome to docetaxel in CRPC patients and may represent a potential new tool for treatment optimization. Larger prospective trials are warranted to validate these findings, which might be applied to the future practice of CRPC treatment

Mechanisms of resistance to Hsp90 inhibitor drugs: a complex mosaic emerges

The molecular chaperone Hsp90 holds great promise as a cancer drug target, despite some of the initial clinical trials of Hsp90 inhibitor drugs having not lived up to expectation. Effective use of these drugs will benefit greatly from a much more detailed understanding of the factors that contribute to resistance, whether intrinsic or acquired. We review how cell culture studies have revealed a number of different mechanisms whereby cells can be rendered less susceptible to the effects of Hsp90 inhibitor treatment. A major influence is Hsp90 inhibition causing strong induction of the heat shock response, a stress response that increases cellular levels of prosurvival chaperones such as Hsp27 and Hsp70. Another problem seems to be that these inhibitors do not always access the Hsp90 proteins of the mitochondrion, forms of Hsp90 that-in cancer cells-are operating to suppress apoptosis. It should be possible to overcome these drawbacks through the appropriate drug redesign or with the combinatorial use of an Hsp90 inhibitor with a drug that targets either heat shock factor or the chaperone Hsp70. Still though, cells will often differ in the key antiapoptotic versus proapoptotic activities that are dependent on Hsp90, in the key steps in their apoptotic pathways responsive to Hsp90 inhibition or Hsp70 level, as well as the extents to which their survival is dependent on oncogenic tyrosine kinases that are clients of Hsp90. A systems approach will therefore often be required in order to establish the most prominent effects of Hsp90 inhibition in each type of cancer cell. © 2011 by the authors; licensee MDPI, Basel, Switzerland