Autosomal-dominant polycystic kidney disease (ADPKD) is a common genetic disorder that frequently leads to renal failure. Mutations in polycystin-1 (PC1) underlie most cases of ADPKD, but the ...function of PC1 has remained poorly understood. No preventive treatment for this disease is available. Here, we show that the cytoplasmic tail of PC1 interacts with tuberin, and the mTOR pathway is inappropriately activated in cyst-lining epithelial cells in human ADPKD patients and mouse models. Rapamycin, an inhibitor of mTOR, is highly effective in reducing renal cystogenesis in two independent mouse models of PKD. Treatment of human ADPKD transplant-recipient patients with rapamycin results in a significant reduction in native polycystic kidney size. These results indicate that PC1 has an important function in the regulation of the mTOR pathway and that this pathway provides a target for medical therapy of ADPKD.
Here we present the results from an intercomparison of multiple global gridded crop models (GGCMs) within the framework of the Agricultural Model Intercomparison and Improvement Project and the ...Inter-Sectoral Impacts Model Intercomparison Project. Results indicate strong negative effects of climate change, especially at higher levels of warming and at low latitudes; models that include explicit nitrogen stress project more severe impacts. Across seven GGCMs, five global climate models, and four representative concentration pathways, model agreement on direction of yield changes is found in many major agricultural regions at both low and high latitudes; however, reducing uncertainty in sign of response in mid-latitude regions remains a challenge. Uncertainties related to the representation of carbon dioxide, nitrogen, and high temperature effects demonstrated here show that further research is urgently needed to better understand effects of climate change on agricultural production and to devise targeted adaptation strategies.
Water scarcity severely impairs food security and economic prosperity in many countries today. Expected future population changes will, in many countries as well as globally, increase the pressure on ...available water resources. On the supply side, renewable water resources will be affected by projected changes in precipitation patterns, temperature, and other climate variables. Here we use a large ensemble of global hydrological models (GHMs) forced by five global climate models and the latest greenhouse-gas concentration scenarios (Representative Concentration Pathways) to synthesize the current knowledge about climate change impacts on water resources. We show that climate change is likely to exacerbate regional and global water scarcity considerably. In particular, the ensemble average projects that a global warming of 2 °C above present (approximately 2.7 °C above preindustrial) will confront an additional approximate 15% of the global population with a severe decrease in water resources and will increase the number of people living under absolute water scarcity (<500 m3 per capita per year) by another 40% (according to some models, more than 100%) compared with the effect of population growth alone. For some indicators of moderate impacts, the steepest increase is seen between the present day and 2 °C, whereas indicators of very severe impacts increase unabated beyond 2 °C. At the same time, the study highlights large uncertainties associated with these estimates, with both global climate models and GHMs contributing to the spread. GHM uncertainty is particularly dominant in many regions affected by declining water resources, suggesting a high potential for improved water resource projections through hydrological model development.
A seasonal forecast system is presented, based on the global coupled climate model MPI-ESM as used for CMIP5 simulations. We describe the initialisation of the system and analyse its predictive skill ...for surface temperature. The presented system is initialised in the atmospheric, oceanic, and sea ice component of the model from reanalysis/observations with full field nudging in all three components. For the initialisation of the ensemble, bred vectors with a vertically varying norm are implemented in the ocean component to generate initial perturbations. In a set of ensemble hindcast simulations, starting each May and November between 1982 and 2010, we analyse the predictive skill. Bias-corrected ensemble forecasts for each start date reproduce the observed surface temperature anomalies at 2–4 months lead time, particularly in the tropics. Niño3.4 sea surface temperature anomalies show a small root-mean-square error and predictive skill up to 6 months. Away from the tropics, predictive skill is mostly limited to the ocean, and to regions which are strongly influenced by ENSO teleconnections. In summary, the presented seasonal prediction system based on a coupled climate model shows predictive skill for surface temperature at seasonal time scales comparable to other seasonal prediction systems using different underlying models and initialisation strategies. As the same model underlying our seasonal prediction system—with a different initialisation—is presently also used for decadal predictions, this is an important step towards seamless seasonal-to-decadal climate predictions.
Context. Simulations of astrophysical turbulence have reached such a level of sophistication that quantitative results are now starting to emerge. However, contradicting results have been reported in ...the literature with respect to the performance of the numerical techniques employed for its study and their relevance to the physical systems modelled. Aims. We aim at characterising the performance of a variety of hydrodynamics codes including different particle-based and grid-based techniques on the modelling of decaying supersonic turbulence. This is the first such large-scale comparison ever conducted. Methods. We modelled driven, compressible, supersonic, isothermal turbulence with an rms Mach number of $M_\mathrm{rms} \sim 4$, and then let it decay in the absence of gravity, using runs performed with four different grid codes (ENZO, FLASH, TVD, ZEUS) and three different SPH codes (GADGET, PHANTOM, VINE). We additionally analysed two calculations denoted as PHANTOM A and PHANTOM B using two different implementations of artificial viscosity in PHANTOM. We analysed the results of our numerical experiments using volume-averaged quantities like the rms Mach number, volume- and density-weighted velocity Fourier spectrum functions, and probability distribution functions of density, velocity, and velocity derivatives. Results. Our analysis indicates that grid codes tend to be less dissipative than SPH codes, though details of the techniques used can make large differences in both cases. For example, the Morris & Monaghan viscosity implementation for SPH results in less dissipation (PHANTOM B and VINE versus GADGET and PHANTOM A). For grid codes, using a smaller diffusion parameter leads to less dissipation, but results in a larger bottleneck effect (our ENZO versus FLASH runs). As a general result, we find that by using a similar number of resolution elements N for each spatial direction means that all codes (both grid-based and particle-based) show encouraging similarity of all statistical quantities for isotropic supersonic turbulence on spatial scales $k\lesssim N/32$ (all scales resolved by more than 32 grid cells), while scales smaller than that are significantly affected by the specific implementation of the algorithm for solving the equations of hydrodynamics. At comparable numerical resolution ($N_\mathrm{particles}\approx N_\mathrm{cells}$), the SPH runs were on average about ten times more computationally intensive than the grid runs, although with variations of up to a factor of ten between the different SPH runs and between the different grid runs. Conclusions. At the resolutions employed here, the ability to model supersonic to transonic flows is comparable across the various codes used in this study.
During neural tube closure, regulated changes at the level of individual cells are translated into large-scale morphogenetic movements to facilitate conversion of the flat neural plate into a closed ...tube. Throughout this process, the integrity of the neural epithelium is maintained via cell interactions through intercellular junctions, including apical tight junctions. Members of the claudin family of tight junction proteins regulate paracellular permeability, apical-basal cell polarity and link the tight junction to the actin cytoskeleton. Here, we show that claudins are essential for neural tube closure: the simultaneous removal of Cldn3, −4 and −8 from tight junctions caused folate-resistant open neural tube defects. Their removal did not affect cell type differentiation, neural ectoderm patterning nor overall apical-basal polarity. However, apical accumulation of Vangl2, RhoA, and pMLC were reduced, and Par3 and Cdc42 were mislocalized at the apical cell surface. Our data showed that claudins act upstream of planar cell polarity and RhoA/ROCK signaling to regulate cell intercalation and actin-myosin contraction, which are required for convergent extension and apical constriction during neural tube closure, respectively.
Display omitted
•Simultaneous removal of Cldn3, −4 and −8 causes open neural tube defects.•Folic acid cannot rescue open NTDs caused by depletion of Cldn3, −4 and −8.•Removal of Cldn3, −4 and −8 prevents convergent extension.•Apical constriction to form the median hinge point requires Cldn3, −4 and −8.•Claudins localize polarity complex components to the apical surface.
Belantamab mafodotin (GSK2857916), an immunoconjugate targeting B-cell maturation antigen, showed single-agent activity in the phase 1 DREAMM-1 study in heavily pre-treated patients with relapsed or ...refractory multiple myeloma. We further investigated the safety and activity of belantamab mafodotin in the DREAMM-2 study.
DREAMM-2 is an open-label, two-arm, phase 2 study done at 58 multiple myeloma specialty centres in eight countries. Patients (aged ≥18 years) with relapsed or refractory multiple myeloma with disease progression after three or more lines of therapy and who were refractory to immunomodulatory drugs and proteasome inhibitors, and refractory or intolerant (or both) to an anti-CD38 monoclonal antibody with an Eastern Cooperative Oncology Group performance status of 0–2 were recruited, centrally randomly assigned (1:1) with permuted blocks (block size 4), and stratified by previous lines of therapy (≤4 vs >4) and cytogenetic features to receive 2·5 mg/kg or 3·4 mg/kg belantamab mafodotin via intravenous infusion every 3 weeks on day 1 of each cycle until disease progression or unacceptable toxicity. The intention-to-treat population comprised all randomised patients, regardless of treatment administration. The safety population comprised all patients who received at least one dose of belantamab mafodotin. The primary outcome was the proportion of randomly assigned patients in the intention-to-treat population who achieved an overall response, as assessed by an independent review committee. This study is registered with ClinicalTrials.gov, NCT03525678, and is ongoing.
Between June 18, 2018, and Jan 2, 2019, 293 patients were screened and 196 were included in the intention-to-treat population (97 in the 2·5 mg/kg cohort and 99 in the 3·4 mg/kg cohort). As of June 21, 2019 (the primary analysis data cutoff date), 30 (31%; 97·5% CI 20·8–42·6) of 97 patients in the 2·5 mg/kg cohort and 34 (34%; 23·9–46·0) of 99 patients in the 3·4 mg/kg cohort achieved an overall response. The most common grade 3–4 adverse events in the safety population were keratopathy (in 26 27% of 95 patients in the 2·5 mg/kg cohort and 21 21% of 99 patients in the 3·4 mg/kg cohort), thrombocytopenia (19 20% and 33 33%), and anaemia (19 20% and 25 25%); 38 (40%) of 95 patients in the 2·5 mg/kg cohort and 47 (47%) of 99 in the 3·4 mg/kg cohort reported serious adverse events. Two deaths were potentially treatment related (one case of sepsis in the 2·5 mg/kg cohort and one case of haemophagocytic lymphohistiocytosis in the 3·4 mg/kg cohort).
Single-agent belantamab mafodotin shows anti-myeloma activity with a manageable safety profile in patients with relapsed or refractory multiple myeloma.
GlaxoSmithKline.
Background
On the basis of the DREAMM‐2 study (ClinicalTrials.gov identifier NCT03525678), single‐agent belantamab mafodotin (belamaf) was approved for patients with relapsed or refractory multiple ...myeloma (RRMM) who received ≥4 prior therapies, including anti‐CD38 therapy. The authors investigated longer term efficacy and safety outcomes in DREAMM‐2 after 13 months of follow‐up among patients who received belamaf 2.5 mg/kg.
Methods
DREAMM‐2 is an ongoing, phase 2, open‐label, 2‐arm study investigating belamaf (2.5 or 3.4 mg/kg) in patients with RRMM who had disease progression after ≥3 lines of therapy and were refractory to immunomodulatory drugs and proteasome inhibitors and refractory and/or intolerant to an anti‐CD38 therapy. The primary outcome was the proportion of patients that achieved an overall response, assessed by an independent review committee.
Results
As of January 31, 2020, 10% of patients still received belamaf 2.5 mg/kg. Thirty‐one of 97 patients (32%; 97.5% confidence interval CI, 21.7%‐43.6%) achieved an overall response, and 18 responders achieved a very good partial response or better. Median estimated duration of response, overall survival, and progression‐free survival were 11.0 months (95% CI, 4.2 months to not reached), 13.7 months (95% CI, 9.9 months to not reached), and 2.8 months (95% CI, 1.6‐3.6 months), respectively. Response and survival outcomes in patients who had high‐risk cytogenetics or renal impairment were consistent with outcomes in the overall population. Outcomes were poorer in patients with extramedullary disease. In patients who had a clinical response and prolonged dose delays (>63 days; mainly because of corneal events), 88% maintained or deepened responses during their first prolonged dose delay. Overall, there were no new safety signals during this follow‐up.
Conclusions
Extended follow‐up confirms sustained clinical activity without new safety signals with belamaf in this heavily pretreated patient population with RRMM.
Extended follow‐up of patients enrolled in the ongoing phase 2 DREAMM‐2 study confirms sustained clinical activity without new safety signals in patients with relapsed or refractory multiple myeloma who receive belantamab mafodotin 2.5 mg/kg every 3 weeks. These data show that belantamab mafodotin has the potential to shift the treatment paradigm in this heavily pretreated, anti‐CD38 monoclonal antibody–exposed patient population, which has a poor prognosis and few alternative treatment options.
PDF
