Combination Therapies Targeting ALK-aberrant Neuroblastoma in Preclinical Models

PURPOSE ALK-activating mutations are identified in approximately 10% of newly diagnosed neuroblastomas and ALK amplifications in a further 1%-2% of cases. Lorlatinib, a third-generation anaplastic lymphoma kinase (ALK) inhibitor, will soon be given alongside induction chemotherapy for children with ALK-aberrant neuroblastoma. However, resistance to single-agent treatment has been reported and therapies that improve the response duration are urgently required. We studied the preclinical combination of lorlatinib with chemotherapy, or with the MDM2 inhibitor, idasanutlin, as recent data have suggested that ALK inhibitor resistance can be overcome through activation of the p53-MDM2 pathway. EXPERIMENTAL DESIGN We compared different ALK inhibitors in preclinical models prior to evaluating lorlatinib in combination with chemotherapy or idasanutlin. We developed a triple chemotherapy (CAV: cyclophosphamide, doxorubicin, and vincristine) in vivo dosing schedule and applied this to both neuroblastoma genetically engineered mouse models (GEMM) and patient-derived xenografts (PDX). RESULTS Lorlatinib in combination with chemotherapy was synergistic in immunocompetent neuroblastoma GEMM. Significant growth inhibition in response to lorlatinib was only observed in the ALK-amplified PDX model with high ALK expression. In this PDX, lorlatinib combined with idasanutlin resulted in complete tumor regression and significantly delayed tumor regrowth. CONCLUSIONS In our preclinical neuroblastoma models, high ALK expression was associated with lorlatinib response alone or in combination with either chemotherapy or idasanutlin. The synergy between MDM2 and ALK inhibition warrants further evaluation of this combination as a potential clinical approach for children with neuroblastoma

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

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/)

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

Role of the rhodopsin and the histamine receptor in the synchronization of the circadian clock by the visual system and in Drosophila melanogaster

L’horloge circadienne permet de régler avec précision les anticipations physiologiques et comportementales face à un environnement perpétuellement oscillant entre jour et nuit. Cette capacité endogène n’est utile que si les processus biologiques restent synchronisés sur le temps solaire. La lumière représente le stimulus le plus efficace pour informer l’horloge des cycles environnementaux.\u2028Chez la drosophile (Drosophila melanogaster) la synchronisation des rythmes veille/sommeil par la lumière est assurée par la molécule photosensible CRYPTOCHROME et par le système visuel. Alors que le cryptochrome agit dans les neurones d'horloges, le système visuel renseigne ces derniers par des voies qui restent à découvrir. La drosophile possède trois organes photorécepteurs, l'oeil composé, les ocelles et l'eyelet de Hofbauer-Buchner, qui expriment chacun une ou plusieurs rhodopsines. La cascade de phototransduction activée par la lumière dépend de la phospholipase C-ß NORPA et conduit à une libération d’histamine.\u2028Dans notre étude, nous avons tenté de caractériser la contribution de chaque rhodopsine dans l’entraînement circadien, mais également de déterminer leur contribution norpA-dépendante en condition de faible lumière.\u2028L’analyse de mutants a montré que les 6 rhodopsines du système visuel constituaient les seules molécules photosensibles capables d’informer l’horloge et que la RH2 et la RH5 seules étaient capables d’entraîner l’horloge en fonction des conditions expérimentales. Nous avons également pu mettre en évidence le fait que les RH1, RH3, RH4 et RH6 utilisaient une voie NORPA-dépendante pour informer l’horloge, alors que la RH2 ne semblait pas le faire. Des doutes subsistent quant à l’existence d’une voie NORPA- dépendante de la RH5 pour informer l’horloge. Nous avons également caractérisé la contribution des récepteurs à l’histamine ORT et HISCL1 dans les processus circadiens: en l'absence de cryptochrome, chacun des deux récepteurs suffit à synchroniser l'horloge et la perte des deux rend les mouches circadiennement aveugles De plus, nous avons constaté que la connexion des photorécepteurs à l’horloge ne se faisait pas directement mais par l’intermédiaire de voies glutamatergiques ou cholinergiques. L’ensemble de ce travail a permis de faire une 1er ébauche des circuits nécessaires à la transmission de l’information lumineuse à l’horloge cérébrale et d’identifier les opsines ainsi que les interneurones impliqués.The circadian clock allowed physiologic and behavioural anticipation against the day/night oscillation. Light is the most powerful clue for living organism. In the fly Drosophila melanogaster, the rest-activity is synchronized by light and pass through the cryptochrome and the visual system. CRYPTOCHROME act directly in the clock neurons to inform the clock but little is known about the visual system. Drosophila posses tree structures: the ocelli, the compound eye and the eyelet of Hofbauer-Buchner, each structure expressed one or multiple rhodopsins. The phototransduction cascade is activated by light and depend one a phospholipase C-ß NORPA, this lead to histamine realised. Study of mutants show that the 6 rhodopsines represent the only photo-sensible molecule for the clock and the RH2 and the RH5 alone could entrain the clock. We have also find that the RH1, RH3, RH4 and RH6 use a NORPA-dependant way to inform the clock whereas the RH2 does not. Some doubt is still present regarding the RH5 NORPA-dependant way. We have determined that the two-histamines receptor ORT and HISCL1 are involved in the circadian process. Besides, we have shown that there is no direct connexion between the clock and the photoreceptors but the information is relay on a glutamatergique and a cholinegique pathway. This thesis draws the circuit by which the light informed the clock and identified the opsines and the interneurons involved

Contribution des rhodopsines et des récepteurs à l'histamine dans la synchronisation de l'horloge circadienne par la système visuel chez Drosophila melanogaster

L horloge circadienne permet de régler avec précision les anticipations physiologiques et comportementales face à un environnement perpétuellement oscillant entre jour et nuit. Cette capacité endogène n est utile que si les processus biologiques restent synchronisés sur le temps solaire. La lumière représente le stimulus le plus efficace pour informer l horloge des cycles environnementaux. Chez la drosophile (Drosophila melanogaster) la synchronisation des rythmes veille/sommeil par la lumière est assurée par la molécule photosensible CRYPTOCHROME et par le système visuel. Alors que le cryptochrome agit dans les neurones d'horloges, le système visuel renseigne ces derniers par des voies qui restent à découvrir. La drosophile possède trois organes photorécepteurs, l'oeil composé, les ocelles et l'eyelet de Hofbauer-Buchner, qui expriment chacun une ou plusieurs rhodopsines. La cascade de phototransduction activée par la lumière dépend de la phospholipase C-ß NORPA et conduit à une libération d histamine. Dans notre étude, nous avons tenté de caractériser la contribution de chaque rhodopsine dans l entraînement circadien, mais également de déterminer leur contribution norpA-dépendante en condition de faible lumière. L analyse de mutants a montré que les 6 rhodopsines du système visuel constituaient les seules molécules photosensibles capables d informer l horloge et que la RH2 et la RH5 seules étaient capables d entraîner l horloge en fonction des conditions expérimentales. Nous avons également pu mettre en évidence le fait que les RH1, RH3, RH4 et RH6 utilisaient une voie NORPA-dépendante pour informer l horloge, alors que la RH2 ne semblait pas le faire. Des doutes subsistent quant à l existence d une voie NORPA- dépendante de la RH5 pour informer l horloge. Nous avons également caractérisé la contribution des récepteurs à l histamine ORT et HISCL1 dans les processus circadiens: en l'absence de cryptochrome, chacun des deux récepteurs suffit à synchroniser l'horloge et la perte des deux rend les mouches circadiennement aveugles De plus, nous avons constaté que la connexion des photorécepteurs à l horloge ne se faisait pas directement mais par l intermédiaire de voies glutamatergiques ou cholinergiques. L ensemble de ce travail a permis de faire une 1er ébauche des circuits nécessaires à la transmission de l information lumineuse à l horloge cérébrale et d identifier les opsines ainsi que les interneurones impliqués.The circadian clock allowed physiologic and behavioural anticipation against the day/night oscillation. Light is the most powerful clue for living organism. In the fly Drosophila melanogaster, the rest-activity is synchronized by light and pass through the cryptochrome and the visual system. CRYPTOCHROME act directly in the clock neurons to inform the clock but little is known about the visual system. Drosophila posses tree structures: the ocelli, the compound eye and the eyelet of Hofbauer-Buchner, each structure expressed one or multiple rhodopsins. The phototransduction cascade is activated by light and depend one a phospholipase C-ß NORPA, this lead to histamine realised. Study of mutants show that the 6 rhodopsines represent the only photo-sensible molecule for the clock and the RH2 and the RH5 alone could entrain the clock. We have also find that the RH1, RH3, RH4 and RH6 use a NORPA-dependant way to inform the clock whereas the RH2 does not. Some doubt is still present regarding the RH5 NORPA-dependant way. We have determined that the two-histamines receptor ORT and HISCL1 are involved in the circadian process. Besides, we have shown that there is no direct connexion between the clock and the photoreceptors but the information is relay on a glutamatergique and a cholinegique pathway. This thesis draws the circuit by which the light informed the clock and identified the opsines and the interneurons involved.PARIS11-SCD-Bib. électronique (914719901) / SudocSudocFranceF

Angiomes multiples révélateurs d’un POEMS syndrome

info:eu-repo/semantics/nonPublishe

POEMS syndrome revealed by multiple glomeruloid angiomas.

POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, skin disorders) is a rare multisystemic disease associated with plasma cell dyscrasia. A 68-year-old woman with chronic renal insufficiency and arterial hypertension included in her medical history was admitted to the hospital with confusion, somnolence and asthenia. She presented ascites, hepatosplenomegaly, leg oedema, distal dysesthesias, leuconychia and multiple nodular purple red angiomas on the trunk, upper limbs and fingers. Hypothyroidism was revealed in the laboratory investigations and monoclonal IgG peak in immunoelectrophoresis. Electromyography showed both demyelinisating and axonal degenerative neuropathy. The diagnosis of POEMS syndrome was based on the dermatopathological examination of a cutaneous angioma; histology revealed features of glomeruloid angioma, a specific marker of this syndrome.Case ReportsJournal Articleinfo:eu-repo/semantics/publishe