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105 records · Page 6

Expanding Structural Space for Immunomodulatory Nucleic Acid Nanoparticles via Spatial Arrangement of Their Therapeutic Moieties

Different therapeutic nucleic acids (TNAs) can be unified in a single structure by their elongation with short oligonucleotides designed to self-assemble into nucleic acid nanoparticles (NANPs). With this approach, therapeutic cocktails with precisely controlled composition and stoichiometry of active ingredients can be delivered to the same diseased cells for enhancing pharmaceutical action. In this study, an additional nanotechnology-based therapeutic option that enlists a biocompatible NANP-encoded platform for their controlled patient-specific immunorecognition is explored. For this, a set of representative functional NANPs is extensively characterized in vitro, ex vivo, and in vivo and then further analyzed for immunostimulation of human peripheral blood mononuclear cells freshly collected from healthy donor volunteers. The results of the study present the advancement of the current TNA approach toward personalized medicine and offer a new strategy to potentially address top public health challenges related to drug overdose and safety through the biodegradable nature of the functional platform with immunostimulatory regulation.

60 APPLIED LIFE SCIENCES↗

Chapter 4: Aerospace Neurology

In the practice of medicine, the neurologist is called upon to answer the following questions: (1) Does the patient have neurologic disease? (2) If so, what is the localization of the lesion or lesions? (3) What is the pathophysiology of the process? (4) What is the preliminary differential diagnosis? Utilizing the tools of the neurologic and medical history, the neurologic examination, ancillary studies, and one’s education, training, and experience, the neurologist arrives at a diagnosis. The aerospace medicine physician (evaluator) has the additional challenge of relating the neurologic condition to aviation safety and achieving an appropriate aeromedical disposition. Whether it is the aviation medical examiner (AME), flight surgeon, or Federal Aviation Administration (FAA) regulator, the aerospace medicine physician shoulders the responsibility of a determination that may decide one’s career in aviation or spaceflight. Considering the individual, and yet preserving aerospace safety, is a never-ending challenge for the aerospace medicine physician. The evaluator has the dual responsibility of applying the standards and also considering exceptions to the standards in allowing waivers from standards, while assuring aerospace safety.

Joseph I Sirven↗

Human Monitoring for Medical Operator Assistance

Measurement of multiple biologic and non-biologic signals can be exploited for the task of monitoring the physiological status of individuals - either as patients during and following illness or injury or as those engaged in operational activities. Assessing physiological status is accomplished by measuring vital signs and wellness measures that support clinical decision-making for physical optimization, illness/injury prevention and treatment, recovery progression, and general delivery of care, or monitoring an operator's moment-to-moment personal "readiness" state. Physiological measures are beneficial for monitoring the medical state of vehicle operators, for example, through the detection of incapacitation in the realm of transportation safety. Measuring physiological signals or control inputs can also be beneficial for monitoring operator state to optimize human-autonomy-teaming performance for safety and efficiency. Similarly, monitoring a health care provider during the performance of medical procedures could provide valuable feedback on optimizing human-robot interactions and human teaming with autonomous systems. In this sense, the provider can be seen as a "Medical Operator" in the same way other "operators" drive, aviate, or control vehicles by performing manual, attention-demanding tasks during safety-critical activities.

Neuroergonomics↗

Optimization of TAM16, a Benzofuran That Inhibits the Thioesterase Activity of Pks13; Evaluation toward a Preclinical Candidate for a Novel Antituberculosis Clinical Target

With increasing drug resistance in tuberculosis (TB) patient populations, there is an urgent need for new drugs. Ideally, new agents should work through novel targets so that they are unencumbered by preexisting clinical resistance to current treatments. Benzofuran 1 was identified as a potential lead for TB inhibiting a novel target, the thioesterase domain of Pks13. Although, having promising activity against Mycobacterium tuberculosis, its main liability was inhibition of the hERG cardiac ion channel. This article describes the optimization of the series toward a preclinical candidate. Despite improvements in the hERG liability in vitro, when new compounds were assessed in ex vivo cardiotoxicity models, they still induced cardiac irregularities. Further series development was stopped because of concerns around an insufficient safety window. However, the demonstration of in vivo activity for multiple series members further validates Pks13 as an attractive novel target for antitubercular drugs and supports development of alternative chemotypes.

60 APPLIED LIFE SCIENCES↗

CPAP Ventilators Needed for Rapid Response to COVID-19 by Modification of CPAP Equipment

Early on in the COVID-19 pandemic, potential ventilator shortages were a critical issue identified by national health care providers. Capacity modeling at the time suggested patient demand may exceed ventilator supply. Thus, the challenge became finding an urgent interim solution to meet health care needs. Our initial hypothesis was that CPAP technology could be modified to provide similar functionality to a ventilator, relieving demand and allowing physicians to decide which patients need high end machines, ultimately saving lives. In conjunction with medical experts and pulmonologists, we were able to identify three key thrusts associated with this research problem: (1) modification of CPAP technology to allow for 02 input that would be capable of providing ventilation; (2) development of an alarming function that would provide real-time audible alarms to alert medical personnel to critical conditions, which would be used inline with CPAP technology; and (3) a method of sterilizing expiratory air from such a system in order to protect medical personnel from biohazard, since CPAPs vent to the atmosphere. We were unable to realize results for thrust 1 (CPAP modification for 02); we identified potential safety issues associated with utilizing medical grade oxygen with a common CPAP device. In order to characterize and mitigate these issues, we would need to partner closely with a device manufacturer; such a partnership could not be achieved in the timeframe needed for this rapid response work. However, we determined that some medical grade BiPAP devices do not need this modification and that the significant progress on thrusts 2 and 3 would be sufficient to buy down risk of a massive ventilator shortage. Our team built a prototype alarm system that can be utilized with any assistive respiratory device to alert on all key conditions identified by medical personnel (high pressure, low pressure, apnea, loss of power, low battery). Finally, our team made significant progress in the rapid prototyping and demonstration of an inline UV air purifier device. The device is cost efficient and can be manufactured at scale with both commercially available and additively manufactured parts. Initial tests with SARS-CoV-2 analog bacteriophage MS2 show 99% efficacy at reducing bioburden. Following a successful demonstration of the prototype device with medical personnel, we were able to obtain follow-on (non-LDRD) funding to provide additional device characterization, validation, and production in order to respond to an immediate regional need.

42 ENGINEERING↗

Management of Pulmonary Arterial Hypertension in the Pediatric Patient

Purpose of Review: Pediatric pulmonary arterial hypertension (PAH) is associated with significant morbidity and mortality. Herein we review the diagnosis and classification for pediatric PAH and detail the current therapeutic options available for use in the pediatric PAH population. Recent Findings: Classification and treatment of pediatric PAH is guided by adult criteria and treatment algorithms, yet the distribution of factors contributing to PAH in children differs significantly from that seen in adults. It is necessary to understand these differences in order to appropriately tailor therapy to the needs of the child or adolescent. An expanding array of targeted PAH drugs are now approved for use in adults, and many of these drugs are used “off-label” to treat children and adolescents with PAH. Use of these novel therapies has coincided with marked improvement in outcomes, suggesting significant benefit. However, because most of these drugs have not been studied in rigorous randomized, controlled trials in children, it is critical that physicians understand their mechanisms of action, potential benefits, and safety profiles. Summary: Pediatric PAH outcomes have improved substantially in the modern era, coinciding with the “off-label” use of targeted PAH drugs in children and adolescents. Ideally, care should be provided at centers with specialized expertise in the diagnosis and treatment of pediatric PAH by providers who understand the appropriate diagnostic algorithms, classification schemes, and treatment approaches.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Phase IB study of ziv-aflibercept plus pembrolizumab in patients with advanced solid tumors

Background The combination of antiangiogenic agents with immune checkpoint inhibitors could potentially overcome immune suppression driven by tumor angiogenesis. We report results from a phase IB study of ziv-aflibercept plus pembrolizumab in patients with advanced solid tumors. Methods This is a multicenter phase IB dose-escalation study of the combination of ziv-aflibercept (at 2–4 mg/kg) plus pembrolizumab (at 2 mg/kg) administered intravenously every 2 weeks with expansion cohorts in programmed cell death protein 1 (PD-1)/programmed death-ligand 1(PD-L1)-naïve melanoma, renal cell carcinoma (RCC), microsatellite stable colorectal cancer (CRC), and ovarian cancer. The primary objective was to determine maximum tolerated dose (MTD) and recommended dose of the combination. Secondary endpoints included overall response rate (ORR) and overall survival (OS). Exploratory objectives included correlation of clinical efficacy with tumor and peripheral immune population densities. Results Overall, 33 patients were enrolled during dose escalation (n=3) and dose expansion (n=30). No dose-limiting toxicities were reported in the initial dose level. Ziv-aflibercept 4 mg/kg plus pembrolizumab 2 mg/kg every 2 weeks was established as the MTD. Grade ≥3 adverse events occurred in 19/33 patients (58%), the most common being hypertension (36%) and proteinuria (18%). ORR in the dose-expansion cohort was 16.7% (5/30, 90% CI 7% to 32%). Complete responses occurred in melanoma (n=2); partial responses occurred in RCC (n=1), mesothelioma (n=1), and melanoma (n=1). Median OS was as follows: melanoma, not reached (NR); RCC, 15.7 months (90% CI 2.5 to 15.7); CRC, 3.3 months (90% CI 0.6 to 3.4); ovarian, 12.5 months (90% CI 3.8 to 13.6); other solid tumors, NR. Activated tumor-infiltrating CD8 T cells at baseline (CD8+PD1+), high CD40L expression, and increased peripheral memory CD8 T cells correlated with clinical response. Conclusion The combination of ziv-aflibercept and pembrolizumab demonstrated an acceptable safety profile with antitumor activity in solid tumors. The combination is currently being studied in sarcoma and anti-PD-1-resistant melanoma. Trial registration number NCT02298959 .

Rahma, Osama E.↗

Genome-scale metabolic reconstruction of 7,302 human microorganisms for personalized medicine

The human microbiome influences the efficacy and safety of a wide variety of commonly prescribed drugs. Designing precision medicine approaches that incorporate microbial metabolism would require strain- and molecule-resolved, scalable computational modeling. Here, we extend our previous resource of genome-scale metabolic reconstructions of human gut microorganisms with a greatly expanded version. AGORA2 (assembly of gut organisms through reconstruction and analysis, version 2) accounts for 7,302 strains, includes strain-resolved drug degradation and biotransformation capabilities for 98 drugs, and was extensively curated based on comparative genomics and literature searches. The microbial reconstructions performed very well against three independently assembled experimental datasets with an accuracy of 0.72 to 0.84, surpassing other reconstruction resources and predicted known microbial drug transformations with an accuracy of 0.81. We demonstrate that AGORA2 enables personalized, strain-resolved modeling by predicting the drug conversion potential of the gut microbiomes from 616 patients with colorectal cancer and controls, which greatly varied between individuals and correlated with age, sex, body mass index and disease stages. AGORA2 serves as a knowledge base for the human microbiome and paves the way to personalized, predictive analysis of host–microbiome metabolic interactions.

59 BASIC BIOLOGICAL SCIENCES↗

Agent-based Disease Surveillance and Transmission Model

The SARS-CoV-2 pandemic has driven a need for models that can predict transmission among populations and test the effectiveness of proposed interventions to control it such as testing, quarantining, vaccinations, and nonpharmaceutical interventions. Some questions of interest include:1. How rapidly will the virus spread if no action is taken? 2. How frequently should people be tested and quarantined if necessary? 3. Should unvaccinated persons be tested more frequently than the vaccinated? 4. If test results are delayed, how will that affect the spread? 5. How do test false negative rates affect the overall efficacy of testing programs? 6. How do constraints on testing resources impact the overall efficacy of testing programs? 7. How does the patient’s failure to recognize COVID symptoms and quarantine affect the spread? 8. What level of vaccination coverage is needed to suppress the epidemic? 9. What is the risk of a large outbreak (probability exceeding x infections)? 10. What is the cost effectiveness of interventions (dollars per avoided infection)? This report describes the structure of a discrete event simulation model that provides actionable information to address these questions. Parameter inputs and results of analyses have been reported in briefings provided to LLNL management and are not discussed here.

59 BASIC BIOLOGICAL SCIENCES↗

Design and fabrication of a stereoscopic rear-viewing endoscopic tool (MARVEL)

The use of minimally invasive neurosurgical techniques has experienced a growing interest among patients and surgeons alike due their the numerous advantages over more traditional operations. Current methods employ the use either rigid or articulating endoscopes, both of which are inserted through a small diameter opening in the skull near the intended surgical region. Although these devices aid the surgeon in viewing the operating site, they are severely limited by their inability to provide dimensional awareness to the user. The Multi-Angle Rear-Viewing Endoscopic TooL (MARVEL) has been designed such that the compact form of existing endoscopes is maintained while also providing the user with an enhanced 3-dimensional stereo view. The design of the alpha prototype for MARVEL was completed over the course of three months. In parallel with development, the device's optics were characterized and several software programs were generated. Once assembled, MARVEL will hold many advantages over existing endoscopic tools. It is expected that the device will greatly outperform its traditional counterparts by both increasing safety and decreasing the duration of surgical procedures. After completion, the device will be demonstrated to the project sponsors at the Skull Base Institute where it will undergo full evaluation and a feasibility analysis.

Strongrich, Andrew↗

The Efficacy and Safety of Mesalamine and Probiotics in Mild‐to‐Moderate Ulcerative Colitis: A Systematic Review and Meta‐Analysis

Objective . To evaluate the efficacy and safety of mesalamine in conjunction with probiotics for ulcerative colitis. Methods . Random controlled trials (RCTs) were searched in PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure, Wanfang, and VIP (VIP Database for Chinese Technical Periodicals) from inception to October 2019. Methodological quality was assessed by the Cochrane Collaboration tool. The quality of evidence was rated by the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). Data analysis was carried out in Review Manager 5.3. Results . A total of fifteen studies met the criteria for inclusion. Thirteen studies reported the clinical efficacy, three studies provided data on the clinical symptom scores, two trials reported disease activity index, four studies evaluated endoscopic score, and twelve studies reported adverse events. For ulcerative colitis (UC), mesalamine and probiotics had better clinical efficacy than mesalamine alone (≤8 weeks: RR = 1.12, 95% CI: 1.07–1.18, P < 0.0001; >8 weeks: RR = 1.25, 95% CI: 1.11–1.41, P = 0.0003). On the clinical symptom scores, disease activity index, and endoscopic score, UC patients receiving mesalamine and probiotics had significant difference than patients receiving mesalazine alone (MD = −2.02, 95% CI: −3.28 to −0.76, P = 0.002; MD = −1.20, 95% CI: −1.76 to −0.65, P < 0.001; and MD = −0.42, 95% CI: −0.61 to −0.23, P < 0.0001, respectively). There was no statistically significant difference in adverse events between the two groups (RR = 0.88, 95% CI: 0.54 to 1.43, P = 0.60). Conclusion . Our meta‐analysis results supported that mesalamine and probiotics were effective and safe in treating ulcerative colitis.

Tian, Chunying↗

Supporting Crew Medical Decisions on Deep Space Missions: A Real-Time Performance Monitoring

Crewed missions into deep space will require astronauts to respond autonomously to safety- and time-critical anomalies. These and other potential issues will require the continuous monitoring and recognition of potentially subtle, but complex, anomalous data patterns. NASA continues to investigate real-time metrics for Extravehicular Operations1 and for providing feedback to improve performance2. Since it is unknown how long-term exposure to deep space will affect crew health, continuous monitoring of clinical and subclinical status is warranted. NASA is characterizing crew medical decision-support needs and identifying the recommended requirements of a Clinical Decision Support System (CDSS) within the Exploration Medical Capability Element (ExMC) of the Human Research Program3. Early detection, and continuous monitoring, of performance may provide an effective prognostic capability for assessing crew health state, and the identified requirements could be provided for an in-vehicle CDSS that acts as an assistant for delivering optimal health and performance and medical care during exploration missions. There is evidence to suggest that automatic, unobtrusive collection of keystroke features, such as alphanumeric key latencies, backspaces or typing rhythm, could be a valuable performance screening tool. Keystroke features show significant differences between control subjects and patients with overt clinical illness, such as multiple sclerosis4 and Parkinson’s disease5, as well as behavioral health and performance issues, such as mild cognitive impairment6 and depression7. This work is exploring a capability for the assessment of early task performance decline in crew as they perform daily activities. Timestamped keyboard entries are continuously collected and stored. Nominal keystroke interactions are compared to those obtained after exposure to spaceflight stressors, e.g., fatigue, to determine the methods sensitivity. This work will pave the way toward an objective detection tool that may be deployed in a spaceflight setting.

clinical↗

Zero-Gravity Locomotion Simulators: New Ground-Based Analogs for Microgravity Exercise Simulation

Maintaining health and fitness in crewmembers during space missions is essential for preserving performance for mission-critical tasks. NASA's Exercise Countermeasures Project (ECP) provides space exploration exercise hardware and monitoring requirements that lead to devices that are reliable, meet medical, vehicle, and habitat constraints, and use minimal vehicle and crew resources. ECP will also develop and validate efficient exercise prescriptions that minimize daily time needed for completion of exercise yet maximize performance for mission activities. In meeting these mission goals, NASA Glenn Research Center (Cleveland, OH, USA), in collaboration with the Cleveland Clinic (Cleveland, Ohio, USA), has developed a suite of zero-gravity locomotion simulators and associated technologies to address the need for ground-based test analog capability for simulating in-flight (microgravity) and surface (partial-gravity) exercise to advance the health and safety of astronaut crews and the next generation of space explorers. Various research areas can be explored. These include improving crew comfort during exercise, and understanding joint kinematics and muscle activation pattern differences relative to external loading mechanisms. In addition, exercise protocol and hardware optimization can be investigated, along with characterizing system dynamic response and the physiological demand associated with advanced exercise device concepts and performance of critical mission tasks for Exploration class missions. Three zero-gravity locomotion simulators are currently in use and the research focus for each will be presented. All of the devices are based on a supine subject suspension system, which simulates a reduced gravity environment by completely or partially offloading the weight of the exercising test subject s body. A platform for mounting treadmill is positioned perpendicularly to the test subject. The Cleveland Clinic Zero-g Locomotion Simulator (ZLS) utilizes a pneumatic subject load device to apply a near constant gravity-replacement load to the test subject during exercise, and is currently used in conjunction with the General Clinical Research Center for evaluating exercise protocols using a bedrest analog. The enhanced ZLS (eZLS) at NASA Glenn Research Center features an offloaded treadmill that floats on a thin film of air and interfaces to a force reaction frame via variably-compliant isolators, or vibration isolation system. The isolators can be configured to simulate compliant interfaces to the vehicle, which affects mechanical loading to crewmembers during exercise, and has been used to validate system dynamic models for new countermeasures equipment designs, such as the second International Space Station treadmill slated for use in 2010. In the eZLS, the test subject and exercise device can be pitched at the appropriate angle for partial gravity simulations, such as lunar gravity (1/6th earth gravity). On both the eZLS and the NASA-Johnson Space Center standalone ZLS installed at the University of Texas Medical Branch in Galveston, Texas, USA, the subject's body weight relative to the treadmill is controlled via a linear motor subject load device (LM-SLD). The LM-SLD employs a force-feedback closed-loop control system to provide a relatively constant force to the test subject during locomotion, and is set and verified for subject safety prior to each session. Locomotion data were collected during parabolic flight and on the eZLS. The purpose was to determine the similarities and differences between locomotion in actual and simulated microgravity. Subjects attained greater amounts of hip flexion during walking and running during parabolic flight. During running, subjects had greater hip range of motion. Trunk motion was significantly less on the eZLS than during parabolic flight. Peak impact forces, loading rate, and impulse were greater on the eZLS than during parabolic while walking with a low external load (EL) and rning with a high EL. Activation timing differences existed between locations in all muscles except for the rectus femoris. The tibialis anterior and gluteus maximus were active for longer durations on the eZLS than in parabolic flight during walking. Ground reaction forces were greater with the LM-SLD than with bungees during eZLS locomotion. While the eZLS serves as a ground-based analog, researchers should be aware that subtle, but measurable, differences in kinematics and leg musculature activities exist between the environments. Aside from space applications, zero-gravity locomotion simulators may help medical researchers in the future with development of rehabilitative or therapeutic protocols for injured or ill patients. Zero-gravity locomotion simulators may be used as a ground-based test bed to support future missions for space exploration, and eventually may be used to simulate planetary locomotion in partial gravity environments, including the Moon and Mars. Figure: Zero-gravity Locomotion Simulator at the Cleveland Clinic, Cleveland, Ohio, USA

Perusek, Gail P.↗

A Quantum Dot Nanobiosensor for Rapid Detection of Botulinum Neurotoxin Serotype E

Botulinum neurotoxins (BoNTs) are potent toxins produced by Clostridium bacteria that are responsible for the illness botulism and are listed as bioterrorism agents. BoNT serotype E (BoNT/E) is one of four BoNT serotypes that cause human botulism and is the second most frequent cause of foodborne botulism. Rapid detection and discrimination of BoNT serotypes implicated in human disease are critical for ensuring timely treatment of patients and identifying sources of toxins, but there have been few reported detection methods for BoNT/E and even fewer methods usable for BoNT serotyping. We report a nanobiosensor based on Forster resonance energy transfer (FRET) between semiconductor nanocrystals (quantum dots, QDs) and dark quencher-labeled peptide probes to detect biologically active BoNT/E in aqueous media. The peptide probes contain a specific cleavage site for active BoNT/E. QD photoluminescence, which changes intensity due to FRET when the peptide probe is cleaved, was used to indicate toxin presence and quantity. The detection of a BoNT/E light chain (LcE) and holotoxin was observed within 3 h. The limits of detection were 0.02 and 2 ng/mL for LcE and holotoxin, respectively. The nanobiosensor shows good specificity toward the target in tests with nontarget BoNT serotypes. The high sensitivity, simple operation, short detection time, and ability to be used in parallel with probes developed for other BoNT serotypes indicate that the nanobiosensor will be useful for rapid BoNT/E detection and serotype discrimination in food analysis.

botulinum neurotoxin E↗

Shotgun Immunoproteomic Approach for the Discovery of Linear B-Cell Epitopes in Biothreat Agents Francisella tularensis and Burkholderia pseudomallei

Peptide-based subunit vaccines are coming to the forefront of current vaccine approaches, with safety and cost-effective production among their top advantages. Peptide vaccine formulations consist of multiple synthetic linear epitopes that together trigger desired immune responses that can result in robust immune memory. The advantages of linear compared to conformational epitopes are their simple structure, ease of synthesis, and ability to stimulate immune responses by means that do not require complex 3D conformation. Prediction of linear epitopes through use of computational tools is fast and cost-effective, but typically of low accuracy, necessitating extensive experimentation to verify results. On the other hand, identification of linear epitopes through experimental screening has been an inefficient process that requires thorough characterization of previously identified full-length protein antigens, or laborious techniques involving genetic manipulation of organisms. In this study, we apply a newly developed generalizable screening method that enables efficient identification of B-cell epitopes in the proteomes of pathogenic bacteria. As a test case, we used this method to identify epitopes in the proteome of Francisella tularensis (Ft), a Select Agent with a well-characterized immunoproteome. Our screen identified many peptides that map to known antigens, including verified and predicted outer membrane proteins and extracellular proteins, validating the utility of this approach. We then used the method to identify seroreactive peptides in the less characterized immunoproteome of Select Agent Burkholderia pseudomallei (Bp). This screen revealed known Bp antigens as well as proteins that have not been previously identified as antigens. Although B-cell epitope prediction tools Bepipred 2.0 and iBCE-EL classified many of our seroreactive peptides as epitopes, they did not score them significantly higher than the non-reactive tryptic peptides in our study, nor did they assign higher scores to seroreactive peptides from known Ft or Bp antigens, highlighting the need for experimental data instead of relying on computational epitope predictions alone. The present workflow is easily adaptable to detecting peptide targets relevant to the immune systems of other mammalian species, including humans (depending upon the availability of convalescent sera from patients), and could aid in accelerating the discovery of B-cell epitopes and development of vaccines to counter emerging biological threats.

60 APPLIED LIFE SCIENCES↗