Nanostructure Accelerators: Novel concept and path to its realization

TeV/m acceleration gradients using crystals as originally envisioned by R. Hofstadter, an early pioneer of HEP, have remained unrealizable. Fundamental obstacles that have hampered efforts on particle acceleration using bulk-crystals arise from collisional energy loss and emittance degradation in addition to severe beam disruption despite the favorable effect of particle channeling along interatomic planes in bulk. We aspire for the union of nanoscience with accelerator science to not only overcome these problems using nanostructured tubes to avoid direct impact of the beam on bulk ion-lattice but also to utilize the highly tunable characteristics of nanomaterials. We pioneer a novel surface wave mechanism in nanostructured materials with a strong electrostatic component which not only attains tens of TeV/m gradients but also has focusing fields. Under our initiative, the proof-of-principle demonstration of tens of TeV/m gradients and beam nanomodulation is underway. Realizable nanostructure accelerators naturally promise new horizons in HEP as well as in a wide range of areas of research that utilize beams of high-energy particles or photons.Comment: submission to Snowmass'21 Accelerator Frontie

Long-term safety and efficacy of Eculizumab in Aquaporin-4 IgG-positive NMOSD

Objective During PREVENT (NCT01892345), eculizumab significantly reduced relapse risk versus placebo in patients with aquaporin-4 immunoglobulin G-positive neuromyelitis optica spectrum disorder (AQP4-IgG+ NMOSD). We report an interim analysis of PREVENT's ongoing open-label extension (OLE; NCT02003144) evaluating eculizumab's long-term safety and efficacy. Methods Patients who completed PREVENT could enroll in the OLE to receive eculizumab (maintenance dose = 1,200 mg/2 weeks, after a blinded induction phase). Safety and efficacy data from PREVENT and its OLE (interim data cut, July 31, 2019) were combined for this analysis. Results Across PREVENT and the OLE, 137 patients received eculizumab and were monitored for a median (range) of 133.3 weeks (5.1–276.9 weeks), for a combined total of 362.3 patient-years (PY). Treatment-related adverse event (AE) and serious adverse event (SAE) rates were 183.5 in 100 PY and 8.6 in 100 PY, respectively. Serious infection rates were 10.2 in 100 PY in eculizumab-treated patients versus 15.1 in 100 PY in the PREVENT placebo group. No patient developed a meningococcal infection. At 192 weeks (3.7 years), 94.4% (95% confidence interval [CI], 88.6–97.3) of patients remained adjudicated relapse-free. The adjudicated annualized relapse rate was 0.025 (95% CI = 0.013–0.048) in all eculizumab-treated patients versus 0.350 (95% CI = 0.199–0.616) in the PREVENT placebo group. During the OLE, 37% of patients (44 of 119 patients) stopped or decreased background immunosuppressive therapy use. Interpretation This analysis demonstrates that eculizumab's long-term safety profile in NMOSD is consistent with its established profile across other indications. This analysis also demonstrated the sustained ability of long-term eculizumab treatment to reduce relapse risk in patients with AQP4-IgG+ NMOSD. ANN NEUROL 2021;89:1088–109

Nanostructure Accelerators: Novel concept and path to its realization

TeV/m acceleration gradients using crystals as originally envisioned by R. Hofstadter, an early pioneer of HEP, have remained unrealizable. Fundamental obstacles that have hampered efforts on particle acceleration using bulk-crystals arise from collisional energy loss and emittance degradation in addition to severe beam disruption despite the favorable effect of particle channeling along interatomic planes in bulk. We aspire for the union of nanoscience with accelerator science to not only overcome these problems using nanostructured tubes to avoid direct impact of the beam on bulk ion-lattice but also to utilize the highly tunable characteristics of nanomaterials. We pioneer a novel surface wave mechanism in nanostructured materials with a strong electrostatic component which not only attains tens of TeV/m gradients but also has focusing fields. Under our initiative, the proof-of-principle demonstration of tens of TeV/m gradients and beam nanomodulation is underway. Realizable nanostructure accelerators naturally promise new horizons in HEP as well as in a wide range of areas of research that utilize beams of high-energy particles or photons

Recruitment of BAG2 to DNAJ-PKAc scaffolds promotes cell survival and resistance to drug-induced apoptosis in fibrolamellar carcinoma

Summary: The DNAJ-PKAc fusion kinase is a defining feature of fibrolamellar carcinoma (FLC). FLC tumors are notoriously resistant to standard chemotherapies, with aberrant kinase activity assumed to be a contributing factor. By combining proximity proteomics, biochemical analyses, and live-cell photoactivation microscopy, we demonstrate that DNAJ-PKAc is not constrained by A-kinase anchoring proteins. Consequently, the fusion kinase phosphorylates a unique array of substrates, including proteins involved in translation and the anti-apoptotic factor Bcl-2-associated athanogene 2 (BAG2), a co-chaperone recruited to the fusion kinase through association with Hsp70. Tissue samples from patients with FLC exhibit increased levels of BAG2 in primary and metastatic tumors. Furthermore, drug studies implicate the DNAJ-PKAc/Hsp70/BAG2 axis in potentiating chemotherapeutic resistance. We find that the Bcl-2 inhibitor navitoclax enhances sensitivity to etoposide-induced apoptosis in cells expressing DNAJ-PKAc. Thus, our work indicates BAG2 as a marker for advanced FLC and a chemotherapeutic resistance factor in DNAJ-PKAc signaling scaffolds

Displacement of PKA catalytic subunit from AKAP signaling islands drives pathology in Cushing’s syndrome

Abstract Mutations in the catalytic subunit of protein kinase A (PKAc) drive the stress hormone disorder adrenal Cushing’s syndrome. Here we define mechanisms of action for the PKAc-L205R and W196R variants. Both Cushing’s mutants are excluded from A kinase anchoring protein (AKAP) signaling islands and consequently diffuse throughout the cell. Kinase-dead experiments show that PKA activity is required for cortisol hypersecretion. However, kinase activation is not sufficient, as only cAMP analog drugs that displace native PKAc from AKAPs enhance cortisol release. Rescue experiments that incorporate mutant PKAc into AKAP signaling islands abolish cortisol overproduction, indicating that kinase anchoring restores normal endocrine function. Phosphoproteomics show that PKAc-L205R and W196R engage different mitogenic signaling pathways. ERK activity is elevated in adrenal-specific PKAc-W196R knock-in mice. Conversely, PKAc-L205R attenuates Hippo signaling, thereby upregulating the YAP/TAZ transcriptional co-activators. Thus, aberrant localization of each Cushing’s variant promotes the transmission of a distinct downstream pathogenic signal

The problem of unrecognized acromegaly: surgeries patients undergo prior to diagnosis of acromegaly

Purpose To reveal the variety of symptoms experienced by patients before acromegaly diagnosis and to emphasize unneeded surgeries that patients undergo related to acromegaly prior to diagnosis of the disease

Mislocalization of protein kinase A drives pathology in Cushing's syndrome.

Mutations in the catalytic subunit of protein kinase A (PKAc) drive the stress hormone disorder adrenal Cushing's syndrome. We define mechanisms of action for the PKAc-L205R and W196R variants. Proximity proteomic techniques demonstrate that both Cushing's mutants are excluded from A kinase-anchoring protein (AKAP)-signaling islands, whereas live-cell photoactivation microscopy reveals that these kinase mutants indiscriminately diffuse throughout the cell. Only cAMP analog drugs that displace native PKAc from AKAPs enhance cortisol release. Rescue experiments that incorporate PKAc mutants into AKAP complexes abolish cortisol overproduction, indicating that kinase anchoring restores normal endocrine function. Analyses of adrenal-specific PKAc-W196R knockin mice and Cushing's syndrome patient tissue reveal defective signaling mechanisms of the disease. Surprisingly each Cushing's mutant engages a different mitogenic-signaling pathway, with upregulation of YAP/TAZ by PKAc-L205R and ERK kinase activation by PKAc-W196R. Thus, aberrant spatiotemporal regulation of each Cushing's variant promotes the transmission of distinct downstream pathogenic signals