Retrospective evaluation of the use of pembrolizumab in malignant mesothelioma in a real-world Australian population

Introduction: We investigated the efficacy and toxicity of pembrolizumab in patients with mesothelioma from a real-world Australian population. We aimed to determine clinical factors and predictive biomarkers that could help select patients who are likely to benefit from pembrolizumab. Method: Patients with mesothelioma who were treated with pembrolizumab as part of the Insurance and Care New South Wales compensation scheme were included. Clinical information was collected retrospectively. Tumor biomarkers such as programmed death-ligand 1 (PD-L1), BAP1, and CD3-positive (CD3+) tumor-infiltrating lymphocytes (TILs) were examined using archival formalin-fixed paraffin-embedded tumor samples. Results: A total of 98 patients were included with a median age of 70 years (range, 46–91 y); 92% were men; 76% had epithelioid subtype; 21% had an Eastern Cooperative Oncology Group (ECOG) performance status of 0. Pembrolizumab was used as second-line or subsequent-line treatment in 94 patients and as first-line treatment in four patients. The overall response rate was 18%, and the disease control rate was 56%. The median progression-free survival (PFS) was 4.8 months (95% confidence interval: 3.6–6.2), and the median overall survival (OS) was 9.5 months (95% confidence interval: 6.6–13.7). Immune-related adverse events occurred in 27% of patients, of which nine (9%) were of grade 3 or higher. In the multivariable analysis, factors independently associated with longer PFS included baseline ECOG status of 0 (median PFS: 12 mo versus 4 mo, p < 0.01) and PD-L1 tumor proportion score of greater than or equal to 1% (median PFS: 6 mo versus 4 mo, p < 0.01). Baseline platelet count of less than or equal to 400 × 109/liter was independently associated with longer PFS and OS (median PFS: 6 mo versus 2 mo, p = 0.05; median OS: 10 mo versus 4 mo, p = 0.01), whereas lack of pretreatment dexamethasone was independently associated with OS but not PFS (median OS: 10 mo versus 3 mo, p = 0.01). The odds of response were higher for patients with baseline ECOG status of 0 (p = 0.02) and with greater than or equal to 5% CD3+ TILs in the tumor (p < 0.01). PD-L1 expression, BAP1 loss, and CD3+ TILs in the stroma were not significantly associated with the overall response rate. Conclusions: Immunotherapy is a reasonable treatment option for patients with mesothelioma. Our results are comparable to other clinical trials investigating pembrolizumab in mesothelioma in terms of response. Good performance status assessment remains the most robust predictor for patient outcomes. CD3+ TILs in the tumor may help select patients that are likely to respond to pembrolizumab, whereas factors such as PD-L1 expression, baseline platelet count, and lack of pretreatment dexamethasone may help predict survival outcomes from pembrolizumab treatment

Minimal information for studies of extracellular vesicles (MISEV2023): From basic to advanced approaches

Extracellular vesicles (EVs), through their complex cargo, can reflect the state of their cell of origin and change the functions and phenotypes of other cells. These features indicate strong biomarker and therapeutic potential and have generated broad interest, as evidenced by the steady year-on-year increase in the numbers of scientific publications about EVs. Important advances have been made in EV metrology and in understanding and applying EV biology. However, hurdles remain to realising the potential of EVs in domains ranging from basic biology to clinical applications due to challenges in EV nomenclature, separation from non-vesicular extracellular particles, characterisation and functional studies. To address the challenges and opportunities in this rapidly evolving field, the International Society for Extracellular Vesicles (ISEV) updates its 'Minimal Information for Studies of Extracellular Vesicles', which was first published in 2014 and then in 2018 as MISEV2014 and MISEV2018, respectively. The goal of the current document, MISEV2023, is to provide researchers with an updated snapshot of available approaches and their advantages and limitations for production, separation and characterisation of EVs from multiple sources, including cell culture, body fluids and solid tissues. In addition to presenting the latest state of the art in basic principles of EV research, this document also covers advanced techniques and approaches that are currently expanding the boundaries of the field. MISEV2023 also includes new sections on EV release and uptake and a brief discussion of in vivo approaches to study EVs. Compiling feedback from ISEV expert task forces and more than 1000 researchers, this document conveys the current state of EV research to facilitate robust scientific discoveries and move the field forward even more rapidly

The role and relevance of exosomes in the development and progression of prostate cancer

Prostate cancer (PCa) is the leading diagnosed cancer in men. Prompt diagnosis of the disease can substantially improve its clinical outcome. Improving capability for early detection and developing new therapeutic targets in advanced disease are research priorities that will ultimately lead to better patient survival. Eukaryotic cells secrete proteins via distinct regulated mechanisms, which are either ER/Golgi dependent or microvesicle-mediated. The release of microvesicles has been shown to provide a novel mechanism for intercellular communication. Exosomes are nanometer-sized membrane-vesicles, which are secreted from normal/cancerous cells. They are present in various biological fluids. Recent studies have demonstrated that cancerous cells secret exosomes, which may be differentiated from those, derived from normal cells based on their composition. The main hypothesis for this Ph.D. thesis is to assess exosomes as potential diagnostic biomarkers for PCa diagnosis and investigate the role of exosomes in PCa progression. In this study, exosomes were purified from the conditioned media of six different prostate cell lines and biological fluids obtained from PCa patients. Analysis using NanosightTM, western blot and transmission-electron-microscopy validated the size, purity and integrity of isolated exosomes. Uptake by different PCa cell lines, following exposure to exosomes, was confirmed using confocal microscopy. Proteomic analysis of isolated exosomes was performed using a Waters LC-QTOF/MS in conjunction with ProteinLynx and MASCOT software. In addition to possible underlying differences in protein profiles an additional part of this study investigated the lipid profiles and cholesterol levels in exosomes as further potential diagnostic markers. Our results have also confirmed the influence of PCa derived exosomes with different functional assays including apoptosis, proliferation and migration. Finally we demonstrated the effect of PCa cells derived exosomes in vivo, and their influence on tumor growth using a human xenograft animal model of PCa. The results of this study have highlighted a potential for the differential protein/lipid composition of exosomes to be a source of diagnostic biomarkers for PCa amenable via non-invasive testing. Our experimental evidence also indicates that exosomes with different androgen receptor phenotypes attribute positively in many mechanisms that contribute to PCa progression presenting additional insight into exploratory research for novel therapeutic targets.Medicine, Faculty ofMedicine, Department ofExperimental Medicine, Division ofGraduat

Characterization of antioxidant activities from fruits rich in delphinidin or malvidin anthocyanins

Anthocyanins have been shown to possess specific antioxidant capacities, which may provide an underlying protective effect against many chronic diseases . Although the antioxidant capacity of anthocyanins has been well established, less is known about the extent to which specific anthocyanin composition affects total antioxidant capacity . The aim of the present study was to compare the antioxidant capacity of two different soft fruits, blackcurrant and grape, which have distinctly different anthocyanin profiles. The anthocyanin profiles of grape and blackcurrant were characterized by HPLC/MS coupled with a diode array detector. Results showed that blackcurrant contained four predominant anthocyanins, cyanidin 3-glucoside, delphinidin 3-glucoside, cyanidin 3-rutinoside, and delphinidin 3-rutinoside . In contrast, malvidin 3-glucoside, delphinidin 3-glucoside, cyanidin 3-glucoside, petunidin 3-glucoside, and peonidin 3- glucoside were the major anthocyanins found in grape . The concentration of individual anthocyanins in all berries was quantified with HPLC/UV using cyanidin 3-glucoside as an external standard . Finally, results showed a greater (p<0.05) antioxidant capacity of blackcurrant compared to grape. The total antioxidant capacity of crude extracts from each was measured by Oxygen Radical Absorbance Capacity (ORAC) and ABTS assays. Anthocyanin antioxidant capacity index (AACI), derived from the product of antioxidant (ORAC) activity for each of major anthocyanin present in blackcurrant and grape, was also used to determine whether the antioxidant capacity of crude anthocyanin fractions represents either the sum total anthocyanin content or, alternatively, a synergy between different anthocyanins components . Our results indicated that a plausible potential synergy between anthocyanin components in regards to ORAC antioxidant capacity existed in blackcurrant and grape semi-purified anthocyanin extracts. Furthermore, it could be concluded that both total anthocyanin content as well as the composition of individual anthocyanins in soft fruits is important to assess total antioxidant capacity of different berry sources .Land and Food Systems, Faculty ofGraduat

Host- and Microbiota-Derived Extracellular Vesicles, Immune Function, and Disease Development

Extracellular vesicles (EVs) are blebs of either plasma membrane or intracellular membranes carrying a cargo of proteins, nucleic acids, and lipids. EVs are produced by eukaryotic cells both under physiological and pathological conditions. Genetic and environmental factors (diet, stress, etc.) affecting EV cargo, regulating EV release, and consequences on immunity will be covered. EVs are found in virtually all body fluids such as plasma, saliva, amniotic fluid, and breast milk, suggesting key roles in immune development and function at different life stages from in utero to aging. These will be reviewed here. Under pathological conditions, plasma EV levels are increased and exacerbate immune activation and inflammatory reaction. Sources of EV, cells targeted, and consequences on immune function and disease development will be discussed. Both pathogenic and commensal bacteria release EV, which are classified as outer membrane vesicles when released by Gram-negative bacteria or as membrane vesicles when released by Gram-positive bacteria. Bacteria derived EVs can affect host immunity with pathogenic bacteria derived EVs having pro-inflammatory effects of host immune cells while probiotic derived EVs mostly shape the immune response towards tolerance

Stem Cell-Derived Extracellular Vesicles for Treating Joint Injury and Osteoarthritis

Extracellular vesicles (EVs) are nanoscale particles secreted by almost all cell types to facilitate intercellular communication. Stem cell-derived EVs theoretically have the same biological functions as stem cells, but offer the advantages of small size, low immunogenicity, and removal of issues such as low cell survival and unpredictable long-term behaviour associated with direct cell transplantation. They have been an area of intense interest in regenerative medicine, due to the potential to harness their anti-inflammatory and pro-regenerative effects to induce healing in a wide variety of tissues. However, the potential of using stem cell-derived EVs for treating joint injury and osteoarthritis has not yet been extensively explored. The pathogenesis of osteoarthritis, with or without prior joint injury, is not well understood, and there is a longstanding unmet clinical need to develop new treatments that provide a therapeutic effect in preventing or stopping joint degeneration, rather than merely relieving the symptoms of the disease. This review summarises the current evidence relating to stem cell-derived EVs in joint injury and osteoarthritis, providing a concise discussion of their characteristics, advantages, therapeutic effects, limitations and outlook in this exciting new area

Extracellular Vesicles: Interplay with the Extracellular Matrix and Modulated Cell Responses

The discovery that cells secrete extracellular vesicles (EVs), which carry a variety of regulatory proteins, nucleic acids, and lipids, has shed light on the sophisticated manner by which cells can communicate and accordingly function. The bioactivity of EVs is not only defined by their internal content, but also through their surface associated molecules, and the linked downstream signaling effects they elicit in target cells. The extracellular matrix (ECM) contains signaling and structural molecules that are central to tissue maintenance and repair. Recently, a subset of EVs residing within the extracellular matrix has been identified. Although some roles have been proposed for matrix-bound vesicles, their role as signaling molecules within the ECM is yet to be explored. Given the close association of EVs and the ECM, it is not surprising that EVs partly mediate repair and regeneration by modulating matrix deposition and degradation through their cellular targets. This review addresses unique EV features that allow them to interact with and navigate through the ECM, describes how their release and content is influenced by the ECM, and emphasizes the emerging role of stem-cell derived EVs in tissue repair and regeneration through their matrix-modulating properties

Interplay of extracellular vesicles and other players in cerebral malaria pathogenesis

Background: Malaria is a serious parasitic infection affecting millions of people worldwide each year. Cerebral malaria is the most severe complication of Plasmodium infections, predominantly affecting children. Extracellular vesicles are essential mediators of intercellular communication and include apoptotic bodies, microvesicles and exosomes. Microvesicle numbers increase during disease pathogenesis and inhibition of their release can prevent brain pathology and mortality. Scope of review: We explore the current knowledge on microvesicles and exosomes in cerebral malaria pathogenesis. Major conclusions: Microvesicles and exosomes are implicated in cerebral malaria pathogenesis, in the modulation of host immunity to Plasmodium, and in cell-cell communication. Blocking their production is protective in models of cerebral malaria, both in vivo and in vitro. General significance: While anti-malarial treatments exist to combat Plasmodium infections, increasing drug resistance presents a major challenge. In order to improve diagnosis and treatment outcomes, further research is required to better appreciate extracellular vesicle involvement in cerebral malaria

Correction: Epidermal Growth Factor Receptor in Prostate Cancer Derived Exosomes

<p>Correction: Epidermal Growth Factor Receptor in Prostate Cancer Derived Exosomes</p