Activation by sub-stoichiometric inhibition

Startling reports described the paradoxical triggering of the human mitogen-activated protein kinase pathway when a small-molecule inhibitor specifically inactivates the BRAF V600E protein kinase but not wt-BRAF. We performed a conceptual analysis of the general phenomenon "activation by inhibition" using bacterial and human HtrA proteases as models. Our data suggest a clear explanation that is based on the classic biochemical principles of allostery and cooperativity. Although substoichiometric occupancy of inhibitor binding sites results in partial inhibition, this effect is overrun by a concomitant activation of unliganded binding sites. Therefore, when an inhibitor of a cooperative enzyme does not reach saturating levels, a common scenario during drug administration, it may cause the contrary of the desired effect. The implications for drug development are discussed

SAM68 is a physiological regulator of SMN2 splicing in spinal muscular atrophy

Spinal muscular atrophy (SMA) is a neurodegenerative disease caused by loss of motor neurons in patients with null mutations in the SMN1 gene. The almost identical SMN2 gene is unable to compensate for this deficiency because of the skipping of exon 7 during pre-messenger RNA (mRNA) processing. Although several splicing factors can modulate SMN2 splicing in vitro, the physiological regulators of this disease-causing event are unknown. We found that knockout of the splicing factor SAM68 partially rescued body weight and viability of SMAΔ7 mice. Ablation of SAM68 function promoted SMN2 splicing and expression in SMAΔ7 mice, correlating with amelioration of SMA-related defects in motor neurons and skeletal muscles. Mechanistically, SAM68 binds to SMN2 pre-mRNA, favoring recruitment of the splicing repressor hnRNP A1 and interfering with that of U2AF65 at the 3' splice site of exon 7. These findings identify SAM68 as the first physiological regulator of SMN2 splicing in an SMA mouse model

Using shared goal setting to improve access and equity : a mixed methods study of the Good Goals intervention in children's occupational therapy

Peer reviewedPublisher PD

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome associated with COVID-19: An Emulated Target Trial Analysis.

RATIONALE: Whether COVID patients may benefit from extracorporeal membrane oxygenation (ECMO) compared with conventional invasive mechanical ventilation (IMV) remains unknown. OBJECTIVES: To estimate the effect of ECMO on 90-Day mortality vs IMV only Methods: Among 4,244 critically ill adult patients with COVID-19 included in a multicenter cohort study, we emulated a target trial comparing the treatment strategies of initiating ECMO vs. no ECMO within 7 days of IMV in patients with severe acute respiratory distress syndrome (PaO2/FiO2 <80 or PaCO2 ≥60 mmHg). We controlled for confounding using a multivariable Cox model based on predefined variables. MAIN RESULTS: 1,235 patients met the full eligibility criteria for the emulated trial, among whom 164 patients initiated ECMO. The ECMO strategy had a higher survival probability at Day-7 from the onset of eligibility criteria (87% vs 83%, risk difference: 4%, 95% CI 0;9%) which decreased during follow-up (survival at Day-90: 63% vs 65%, risk difference: -2%, 95% CI -10;5%). However, ECMO was associated with higher survival when performed in high-volume ECMO centers or in regions where a specific ECMO network organization was set up to handle high demand, and when initiated within the first 4 days of MV and in profoundly hypoxemic patients. CONCLUSIONS: In an emulated trial based on a nationwide COVID-19 cohort, we found differential survival over time of an ECMO compared with a no-ECMO strategy. However, ECMO was consistently associated with better outcomes when performed in high-volume centers and in regions with ECMO capacities specifically organized to handle high demand. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Classification of Wheelchair Related Shoulder Loading Activities from Wearable Sensor Data: A Machine Learning Approach

Shoulder problems (pain and pathology) are highly prevalent in manual wheelchair users with spinal cord injury. These problems lead to limitations in activities of daily life (ADL), labor- and leisure participation, and increase the health care costs. Shoulder problems are often associated with the long-term reliance on the upper limbs, and the accompanying "shoulder load". To make an estimation of daily shoulder load, it is crucial to know which ADL are performed and how these are executed in the free-living environment (in terms of magnitude, frequency, and duration). The aim of this study was to develop and validate methodology for the classification of wheelchair related shoulder loading ADL (SL-ADL) from wearable sensor data. Ten able bodied participants equipped with five Shimmer sensors on a wheelchair and upper extremity performed eight relevant SL-ADL. Deep learning networks using bidirectional long short-term memory networks were trained on sensor data (acceleration, gyroscope signals and EMG), using video annotated activities as the target. Overall, the trained algorithm performed well, with an accuracy of 98% and specificity of 99%. When reducing the input for training the network to data from only one sensor, the overall performance decreased to around 80% for all performance measures. The use of only forearm sensor data led to a better performance than the use of the upper arm sensor data. It can be concluded that a generalizable algorithm could be trained by a deep learning network to classify wheelchair related SL-ADL from the wearable sensor data.ISSN:1424-822

Electrospinning for the Modification of 3D Objects for the Potential Use in Tissue Engineering

Bauer L, Brandstäter L, Letmate M, et al. Electrospinning for the Modification of 3D Objects for the Potential Use in Tissue Engineering. Technologies. 2022;10(3): 66.Electrospinning is often investigated for biotechnological applications, such as tissue engineering and cell growth in general. In many cases, three-dimensional scaffolds would be advantageous to prepare tissues in a desired shape. Some studies thus investigated 3D-printed scaffolds decorated with electrospun nanofibers. Here, we report on the influence of 3D-printed substrates on fiber orientation and diameter of a nanofiber mat, directly electrospun on conductive and isolating 3D-printed objects, and show the effect of shadowing, taking 3D-printed ears with electrospun nanofiber mats as an example for potential and direct application in tissue engineering in general

Stabilization and Carbonization of PAN Nanofiber Mats Electrospun on Metal Substrates

Storck JL, Brockhagen B, Grothe T, et al. Stabilization and Carbonization of PAN Nanofiber Mats Electrospun on Metal Substrates. C: Journal of Carbon Research. 2021;7(1): 12.Polyacrylonitrile (PAN) nanofiber mats are typical precursors for carbon nanofibers. They can be fixed or even elongated during stabilization and subsequent carbonization to gain straight, mechanically robust carbon nanofibers. These processes necessitate additional equipment or are—if the nanofiber mats are just fixed at the edges—prone to resulting in the specimens breaking, due to an uneven force distribution. Hence, we showed in a previous study that electrospinning PAN on aluminum foils and stabilizing them fixed on these substrates, is a suitable solution to keep the desired morphology after stabilization and incipient carbonization. Here, we report on the influence of different metallic and semiconductor substrates on the physical and chemical properties of the nanofiber mats after stabilization and carbonization at temperatures up to 1200 °C. For stabilization on a metal substrate, an optimum stabilization temperature of slightly above 240 °C was found, approached with a heating rate of 0.25 K/min. Independent from the substrate material, SEM images revealed less defect fibers in the nanofiber mats stabilized and incipiently carbonized on a metal foil. Finally, high-temperature carbonization on different substrates is shown to allow for producing metal/carbon nano-composites