Evidence is growing that the gut microbiota modulates the host response to chemotherapeutic drugs, with three main clinical outcomes: facilitation of drug efficacy; abrogation and compromise of ...anticancer effects; and mediation of toxicity. The implication is that gut microbiota are critical to the development of personalized cancer treatment strategies and, therefore, a greater insight into prokaryotic co-metabolism of chemotherapeutic drugs is now required. This thinking is based on evidence from human, animal and in vitro studies that gut bacteria are intimately linked to the pharmacological effects of chemotherapies (5-fluorouracil, cyclophosphamide, irinotecan, oxaliplatin, gemcitabine, methotrexate) and novel targeted immunotherapies such as anti-PD-L1 and anti-CLTA-4 therapies. The gut microbiota modulate these agents through key mechanisms, structured as the 'TIMER' mechanistic framework: Translocation, Immunomodulation, Metabolism, Enzymatic degradation, and Reduced diversity and ecological variation. The gut microbiota can now, therefore, be targeted to improve efficacy and reduce the toxicity of current chemotherapy agents. In this Review, we outline the implications of pharmacomicrobiomics in cancer therapeutics and define how the microbiota might be modified in clinical practice to improve efficacy and reduce the toxic burden of these compounds.
A decision to withdraw life-sustaining treatment (WLST) is derived by a conclusion that further treatment will not enable a patient to survive or will not produce a functional outcome with acceptable ...quality of life that the patient and the treating team regard as beneficial. Although many hospitalized patients die under such circumstances, controlled donation after the circulatory determination of death (cDCDD) programs have been developed only in a reduced number of countries. This International Collaborative Statement aims at expanding cDCDD in the world to help countries progress towards self-sufficiency in transplantation and offer more patients the opportunity of organ donation. The Statement addresses three fundamental aspects of the cDCDD pathway. First, it describes the process of determining a prognosis that justifies the WLST, a decision that should be prior to and independent of any consideration of organ donation and in which transplant professionals must not participate. Second, the Statement establishes the permanent cessation of circulation to the brain as the standard to determine death by circulatory criteria. Death may be declared after an elapsed observation period of 5 min without circulation to the brain, which confirms that the absence of circulation to the brain is permanent. Finally, the Statement highlights the value of perfusion repair for increasing the success of cDCDD organ transplantation. cDCDD protocols may utilize either in situ or ex situ perfusion consistent with the practice of each country. Methods to accomplish the in situ normothermic reperfusion of organs must preclude the restoration of brain perfusion to not invalidate the determination of death.
Summary
Immune checkpoint inhibition with monoclonal antibodies is becoming increasingly commonplace in cancer medicine, having contributed to a widening of therapeutic options across oncological ...indications. Disruption of immune tolerance is the key mechanism of action of checkpoint inhibitors and although immune‐related adverse events are a typical class effect of these compounds, the relationship between toxicity and response is not fully understood. Awareness and vigilance are paramount in recognizing potentially life‐threatening toxicities and managing them in a timely manner. In this review article, we provide an overview of the clinical features, pathological findings and management principles of common immune‐related toxicities, attempting to provide mechanistic insight into an increasingly common complication of cancer therapy.
An overview of the clinical features and management principles of toxicities related to immune checkpoint inhibitors, with a particular focus on current understanding of pathophysiological mechanisms.
Non-invasive mutation testing using circulating tumour DNA (ctDNA) is an attractive premise. This could enable patients without available tumour sample to access more treatment options.
Peripheral ...blood and matched tumours were analysed from 45 NSCLC patients. We investigated the impact of pre-analytical variables on DNA yield and/or KRAS mutation detection: sample collection tube type, incubation time, centrifugation steps, plasma input volume and DNA extraction kits.
2 hr incubation time and double plasma centrifugation (2000 x g) reduced overall DNA yield resulting in lowered levels of contaminating genomic DNA (gDNA). Reduced "contamination" and increased KRAS mutation detection was observed using cell-free DNA Blood Collection Tubes (cfDNA BCT) (Streck), after 72 hrs following blood draw compared to EDTA tubes. Plasma input volume and use of different DNA extraction kits impacted DNA yield.
This study demonstrated that successful ctDNA recovery for mutation detection in NSCLC is dependent on pre-analytical steps. Development of standardised methods for the detection of KRAS mutations from ctDNA specimens is recommended to minimise the impact of pre-analytical steps on mutation detection rates. Where rapid sample processing is not possible the use of cfDNA BCT tubes would be advantageous.
Senescent cells exacerbate COVID-19
Cellular senescence is a state elicited in response to stress signals and is associated with a damaging secretory phenotype. The number of senescent cells ...increases with advanced age and this in turn drives age-related diseases. Camell
et al.
show that senescent cells have an amplified inflammatory response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (see the Perspective by Cox and Lord). This response is communicated to nonsenescent cells, suppressing viral defense mechanisms and increasing the expression of viral entry proteins. In old mice infected with a SARS-CoV-2–related virus, treatment with senolytics to reduce the senolytic cell burden reduced mortality and increased antiviral antibodies.
Science
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SARS-CoV-2 amplifies the damaging senescent cell secretory state, and drugs that selectively clear senescent cells reduce mortality in infected aged mice.
INTRODUCTION
The COVID-19 pandemic revealed enhanced vulnerability of the elderly and chronically ill to adverse outcomes upon severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Senescence is a cell fate elicited by cellular stress that results in changes in gene expression, morphology, metabolism, and resistance to apoptosis. Senescent cells (SnCs) secrete pro-inflammatory factors, called the senescence-associated secretory phenotype (SASP). SnCs accumulate with age and drive chronic inflammation. In human cells and tissues and using a new infection paradigm, we asked whether SnCs are a cause of adverse outcomes of infection with aging. This is relevant because SnCs can be selectively eliminated in vivo with a new class of therapeutics called senolytics, potentially affording a new approach to treat COVID-19.
RATIONALE
We hypothesized that SnCs, because of their pro-inflammatory SASP, might have a heightened response to pathogen-associated molecular pattern (PAMP) factors, resulting in increased risk of cytokine storm and multi-organ failure. To test this, we treated senescent and nonsenescent human cells with the PAMPs lipopolysaccharide (LPS) and SARS-CoV-2 spike protein (S1) and measured the SASP and its effect on non-SnCs. Similarly, old and progeroid mice were challenged with LPS, and we measured the SASP. Previously, we created a “normal microbial experience” (NME) for mice by transmitting environmental pathogens to specified-pathogen–free (SPF) mice through exposure to pet store mice or their bedding. The first pathogen transferred was mouse hepatitis virus (MHV), a β-coronavirus closely related to SARS-CoV-2. NME rapidly killed aged SPF mice known to have an increased burden of SnCs compared with young SPF mice, which survive NME. This afforded an experimental paradigm to test whether senolytics blunt adverse outcomes in β-coronavirus infection.
RESULTS
Human endothelial SnCs became hyperinflammatory in response to challenge with LPS and S1, relative to non-SnCs. The PAMP-elicited secretome of SnCs caused increased expression of viral entry proteins and reduced expression of antiviral genes in nonsenescent human endothelial and lung epithelial cells, and the proximity of these events was established in human lung biopsies. Treatment of old mice with LPS significantly increased SASP expression in several organs relative to young mice, confirming our hypothesis in vivo. Similarly, old mice exposed to NME displayed a significant multi-organ increase in SnCs and the SASP, impaired immune response to MHV, and 100% mortality, whereas inoculation with antibodies against MHV before NME afforded complete rescue of mortality. Treating old mice with the senolytic fisetin, which selectively eliminates SnCs after NME reduced mortality by 50%, reduced expression of inflammatory proteins in serum and tissue and improved the immune response. This was confirmed with a second senolytic regimen, Dasatinib plus Quercetin, as well as genetic ablation of SnCs in aged mice, establishing SnCs as a cause of adverse outcomes in aged organisms exposed to a new viral pathogen.
CONCLUSION
SnCs amplify susceptibility to COVID-19 and pathogen-induced hyperinflammation. Reducing SnC burden in aged mice reduces mortality after pathogen exposure, including a β-coronavirus. Our findings strongly support the Geroscience hypothesis that therapeutically targeting fundamental aging mechanisms improves resilience in the elderly, with alleviation of morbidity and mortality due to pathogenic stress. This suggests that senolytics might protect others vulnerable to adverse COVID-19 outcomes in whom increased SnCs occur (such as in obesity or numerous chronic diseases).
SnCs that accumulate with age or chronic disease react to PAMPs such as SARS-CoV-2 S1 by amplifying the SASP, which increases viral entry protein expression and decreases viral defense IFITMs in normal cells.
Old mice exposed to pathogens such as the β-coronavirus MHV have increased inflammation and higher mortality. Treatment with a senolytic decreased SnCs, inflammation, and mortality and increased the antiviral antibody response.
The COVID-19 pandemic has revealed the pronounced vulnerability of the elderly and chronically ill to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)–induced morbidity and mortality. Cellular senescence contributes to inflammation, multiple chronic diseases, and age-related dysfunction, but effects on responses to viral infection are unclear. Here, we demonstrate that senescent cells (SnCs) become hyper-inflammatory in response to pathogen-associated molecular patterns (PAMPs), including SARS-CoV-2 spike protein-1, increasing expression of viral entry proteins and reducing antiviral gene expression in non-SnCs through a paracrine mechanism. Old mice acutely infected with pathogens that included a SARS-CoV-2–related mouse β-coronavirus experienced increased senescence and inflammation, with nearly 100% mortality. Targeting SnCs by using senolytic drugs before or after pathogen exposure significantly reduced mortality, cellular senescence, and inflammatory markers and increased antiviral antibodies. Thus, reducing the SnC burden in diseased or aged individuals should enhance resilience and reduce mortality after viral infection, including that of SARS-CoV-2.
Attempts at depositing uniform films of nanoparticles by drop-drying have been frustrated by the “coffee-stain” effect due to convective macroscopic flow into the contact line. Here, we show that ...uniform deposition of nanoparticles in aqueous suspensions can be attained easily by drying the droplet in an ethanol vapor atmosphere. This technique allows the particle-laden water droplets to spread on a variety of surfaces such as glass, silicon, mica, PDMS, and even Teflon. Visualization of droplet shape and internal flow shows initial droplet spreading and strong recirculating flow during spreading and shrinkage. The initial spreading is due to a diminishing contact angle from the absorption of ethanol from the vapor at the contact line. During the drying phase, the vapor is saturated in ethanol, leading to preferential evaporation of water at the contact line. This generates a surface tension gradient that drives a strong recirculating flow and homogenizes the nanoparticle concentration. We show that this method can be used for depositing catalyst nanoparticles for the growth of single-walled carbon nanotubes as well as to manufacture plasmonic films of well-spaced, unaggregated gold nanoparticles.
We have proposed, designed, manufactured and tested low loss dielectric micro-lenses for infrared (IR) radiation based on a dielectric metamaterial layer. This metamaterial layer was created by ...patterning a dielectric surface and etching to sub-micron depths. For a proof-of-concept lens demonstration, we have chosen a fine patterned array of nano-pillars with variable diameters. Gradient index (GRIN) properties were achieved by engineering the nano-pattern characteristics across the lens, so that the effective optical density of the dielectric metamaterial layer peaks around the lens center, and gradually drops at the lens periphery. A set of lens designs with reduced reflection and tailorable phase gradients have been developed and tested, demonstrating focal distances of a few hundred microns, beam area contraction ratio up to three, and insertion losses as low as 11%.
DNA ligases, critical enzymes for in vivo genome maintenance and modern molecular biology, catalyze the joining of adjacent 3'-OH and 5'-phosphorylated ends in DNA. To determine whether DNA annealing ...equilibria or properties intrinsic to the DNA ligase enzyme impact end-joining ligation outcomes, we used a highly multiplexed, sequencing-based assay to profile mismatch discrimination and sequence bias for several ligases capable of efficient end-joining. Our data reveal a spectrum of fidelity and bias, influenced by both the strength of overhang annealing as well as sequence preferences and mismatch tolerances that vary both in degree and kind between ligases. For example, while T7 DNA ligase shows a strong preference for ligating high GC sequences, other ligases show little GC-dependent bias, with human DNA Ligase 3 showing almost none. Similarly, mismatch tolerance varies widely among ligases, and while all ligases tested were most permissive of G:T mismatches, some ligases also tolerated bulkier purine:purine mismatches. These comprehensive fidelity and bias profiles provide insight into the biology of end-joining reactions and highlight the importance of ligase choice in application design.
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