Gumarontinib in patients with non-small-cell lung cancer harbouring MET exon 14 skipping mutations: a multicentre, single-arm, open-label, phase 1b/2 trial.

Background: Approximately 3-4% of patients with non-small-cell lung cancer (NSCLC) have MET exon 14 (METex14) skipping mutations. We report primary results from the phase 2 stage of a phase 1b/2 study of gumarontinib, a selective, potent, oral MET inhibitor, in patients with METex14 skipping mutation-positive (METex14-positive) NSCLC. Methods: The single-arm, multicentre, open-label, phase 2 stage of the GLORY study was conducted at 42 centres across China and Japan. Adults with locally advanced or metastatic METex14-positive NSCLC received oral gumarontinib 300 mg once daily in continuous 21-day cycles until disease progression, intolerable toxicity, or withdrawal of consent. Eligible patients had failed one or two prior lines of therapy (not including a MET inhibitor), were ineligible for/refused chemotherapy, and had no genetic alterations targetable with standard therapies. The primary endpoint was objective response rate in patients with a valid baseline tumour assessment, by blinded independent review. The study was registered at ClinicalTrials.gov (NCT04270591). Findings: Between Aug 2, 2019 and Apr 28, 2021, 84 patients were enrolled and received gumarontinib (median follow-up 13.5 months [IQR 8.7-17.1]), at data cut-off (Apr 28, 2022) five patients whose METex14 status could not be confirmed by a central laboratory were excluded from the efficacy analysis. The objective response rate was 66% (95% CI 54-76) overall (n = 79), 71% (95% CI 55-83) in treatment-naïve patients (n = 44), and 60% (95% CI 42-76) in previously-treated patients (n = 35). The most common treatment-related adverse events (any grade) were oedema (67/84 patients, 80%) and hypoalbuminuria (32/84, 38%). Grade ≥3 treatment-emergent adverse events occurred in 45 (54%) patients. Treatment-related adverse events leading to permanent discontinuation occurred in 8% (7/84) of patients. Interpretation: Gumarontinib monotherapy had durable antitumour activity with manageable toxicity in patients with locally advanced or metastatic METex14-positive NSCLC when used in first line or later. Funding: Haihe Biopharma Co., Ltd. Supported in part by grants from the National Science and Technology Major Project of China for "Clinical Research of Gumarontinib, a highly selective MET inhibitor" (2018ZX09711002-011-003); the National Natural Science Foundation of China (82030045 to S.L. and 82172633 to YF.Y); Shanghai Municipal Science & Technology Commission Research Project (19411950500 to S.L.); Shanghai Shenkang Action Plan (16CR3005A to S.L.) and Shanghai Chest Hospital Project of Collaborative Innovation (YJXT20190105 to S.L.).

Phase II, open-label, multicenter trial of crizotinib in Japanese patients with advanced non-small cell lung cancer harboring a MET gene alteration: Co-MET study.

BACKGROUND: MET-deregulated non-small cell lung cancer represents an urgent clinical need because of the lack of specific therapies. Although recent studies have suggested a potential role for crizotinib in patients harboring MET gene alterations, no conclusive data are currently available. Therefore, we designed the Co-MET study, a single-arm phase II study to assess the efficacy and safety of crizotinib in patients with advanced non-small cell lung cancers harboring MET gene alterations. METHODS: Co-MET is an open-label, multi-center, single-arm, phase II trial to assess the safety and efficacy of oral crizotinib in patients with advanced non-small cell lung cancer harboring MET exon 14 skipping mutation (cohort 1) or a high MET gene copy number of ≥ 7 (cohort 2). We will identify MET gene alterations using RT-PCR and/or next-generation sequencing. Oral crizotinib 250 mg BID will be administered until disease progression or unacceptable toxicity. A radiology committee will review tumor scans according to the RECIST criteria. The primary endpoint is the objective response rate. Assuming a null hypothesis of 20% objective response rate and an alternative hypothesis of 50% objective response rate for cohort 1, and a one-sided alpha error of 0.05 and 80% power based on the exact binomial distribution, the required number of evaluable patients is 19. We set the exploratory sample size for cohort 2 at 10 patients. DISCUSSION: The results of this study are expected to provide evidence regarding the usefulness of oral crizotinib for advanced MET exon 14 skipping mutation-positive or MET high gene copy number-positive non-small cell lung cancer. TRIAL REGISTRATION: This study was registered with the University Hospital Medical Information Network Clinical Trials Registry as UMIN000031623 on 3 March 2018.

A quasi three-dimensional visualization of unsteady wake flow in human undulatory swimming.

Human undulatory underwater swimming (UUS) is an underwater propelling technique in competitive swimming and its propulsive mechanism is poorly understood. The purpose of this study was to visualize the three-dimensional (3D) flow field in the wake region during human UUS in a water flume. A national level male swimmer performed 41 UUS trials in a water flume. A motion capture system and stereo particle image velocimetry (PIV) equipment were used to investigate the 3D coordinates of the swimmer and 3D flow fields in the wake region. After one kick cycle was divided into eight phases, we conducted coordinate transformations and phase averaging method to construct quasi 3D flow fields. At the end of the downward kick, the lower limbs external rotations of the lower limbs were observed, and the feet approached towards each other. A strong downstream flow, i.e. a jet was observed in the wake region during the downward kick, and the paired vortex structure was accompanied by a jet. In the vortex structure, a cluster of vortices and a jet were generated in the wake during the downward kick, and the vortices were subsequently shed from the feet by the rotated leg motion. This suggested that the swimmer gained a thrust by creating vortices around the foot during the downward kick, which collided to form a jet. This paper describes, illustrates, and explains the propulsive mechanism of human UUS.

Note: High-speed optical tracking of a flying insect.

We developed a video recording system with the capability of tracking moving objects and used it to track the flight of an insect. The system consists of two galvano mirrors, which redirect the light coming from the object in two orthogonal directions toward a high-speed camera to capture the image. An additional high-speed camera, which views the same object through a beam splitter placed between one of the galvano mirrors and the observation camera, detects the position of the object. The mirror angle is controlled to maintain the position of the object at the center of the view, allowing the object to be tracked. In order to validate this system, images of a live fly in flight were recorded along a flight path that was much longer than the field of view of the stationary camera. A high-resolution video image of a rapidly moving live fly was successfully captured.

Visualization of irrigation fluid flow and calculation of its velocity distribution in the anterior chamber by particle image velocimetry.

PURPOSE: To visualize irrigation fluid flow and calculate its velocity distribution in the anterior chamber during phacoemulsification by particle image velocimetry. METHODS: Porcine eyes were fixed in a glass chamber filled with balanced salt solution. An ultrasound handpiece was fixed to the glass chamber, and its tip was inserted into the anterior chamber through a corneal incision. Irrigation fluid was mixed with fluorescein-labeled liposomes as tracer particles. During phacoemulsification without ultrasound, a sheet-like Nd-YAG pulsed laser beam was emitted and moved from the iris plane to the top of the cornea continuously. Images of illuminated liposomes in the anterior chamber were captured at short intervals with a CCD camera, and the velocity distribution of irrigation fluid flow was calculated by particle image velocimetry. RESULTS: By particle image velocimetry, the flow velocity distribution could be calculated in any plane of the anterior chamber. Dynamic flow of the irrigation fluid, ejected from the tip of the ultrasound handpiece and returned to an aspiration port, was visualized clearly in the anterior chamber. The maximum flow velocity in the anterior chamber was 342 ± 131 mm/s. CONCLUSIONS: Particle image velocimetry enabled the visualization of irrigation fluid flow and quantification of its velocity distribution in different planes of the anterior chamber during cataract surgery. These data are essential for evaluating the safety and efficacy of new surgical settings and devices during phacoemulsification.

CD8+ tumor-infiltrating lymphocytes predict favorable prognosis in malignant pleural mesothelioma after resection.

Defects in human leukocyte antigen (HLA) class I expression may allow tumor cells to escape immune recognition. T cell infiltration is associated with a good prognosis in many cancers. However, the role of HLA class I expression and tumor-infiltrating lymphocytes (TILs) in malignant pleural mesothelioma (MPM) has not been fully analyzed. In the present study, we investigated the immune profiles and conducted outcome analyses of MPM patients. HLA class I expression and TILs (CD4(+), CD8(+), and NK cells) were detected by immunohistochemistry in a series of 44 MPM cases. To detect HLA class I expression, specimens were stained with the anti-pan HLA class I monoclonal antibody EMR8-5. The expression of HLA class I was positive in all patients. There was no case that showed negative HLA class I expression. The density of CD4(+) and CD8(+) TILs were strongly correlated (R = 0.76, p < 0.001). A high density of CD8(+) TILs was a significantly better prognostic factor for the survival of patients with extrapleural pneumonectomy (p < 0.05). Multivariate analysis revealed that a high density of CD8(+) TILs is an independent prognostic factor for patients who underwent extrapleural pneumonectomy. The presence of intratumoral CD8(+) T cells was correlated with an improved clinical outcome, raising the possibility that CD8(+) T cells might play a pivotal role in the antitumor immune response against MPMs. Thus, the stimulation of CD8(+) lymphocytes might be an efficacious immunotherapy for MPM patients.

Combined micro and macro additive manufacturing of a swirling flow coaxial phacoemulsifier sleeve with internal micro-vanes.

Microstereolithography (microSL) technology can fabricate complex, three-dimensional (3D) microstructures, although microSL has difficulty producing macrostructures with micro-scale features. There are potentially many applications where 3D micro-features can benefit the overall function of the macrostructure. One such application involves a medical device called a coaxial phacoemulsifier where the tip of the phacoemulsifier is inserted into the eye through a relatively small incision and used to break the lens apart while removing the lens pieces and associated fluid from the eye through a small tube. In order to maintain the eye at a constant pressure, the phacoemulsifier also includes an irrigation solution that is injected into the eye during the procedure through a coaxial sleeve. It has been reported, however, that the impinging flow from the irrigation solution on the corneal endothelial cells in the inner eye can damage these cells during the procedure. As a result, a method for reducing the impinging flow velocities and the resulting shear stresses on the endothelial cells during this procedure was explored, including the design and development of a complex, 3D micro-vane within the sleeve. The micro-vane introduces swirl into the irrigation solution, producing a flow with rapidly dissipating flow velocities. Fabrication of the sleeve and fitting could not be accomplished using microSL alone, and thus, a two-part design was accomplished where a sleeve with the micro-vane was fabricated with microSL and a threaded fitting used to attach the sleeve to the phacoemulsifier was fabricated using an Objet Eden 333 rapid prototyping machine. The new combined device was tested within a water container using particle image velocimetry, and the results showed successful swirling flow with an ejection of the irrigation fluid through the micro-vane in three different radial directions corresponding to the three micro-vanes. As expected, the sleeve produced a swirling flow with rapidly dissipating streamwise flow velocities where the maximum measured streamwise flow velocities using the micro-vane were lower than those without the micro-vane by 2 mm from the tip where they remained at approximately 70% of those produced by the conventional sleeve as the flow continued to develop. It is believed that this new device will reduce damage to endothelial cells during cataract surgery and significantly improve patient outcomes from this procedure. This unique application demonstrates the utility of combining microSL with a macro rapid prototyping technology for fabricating a real macro-scale device with functional, 3D micro-scale features that would be difficult and costly to fabricate using alternative manufacturing methods.

Effect of shear stress on attachment of corneal endothelial cells in association with corneal endothelial cell loss after laser iridotomy.

PURPOSE: Laser iridotomy often causes bullous keratopathy; however, the mechanism is unclear. We investigated whether changes in aqueous humor hydrodynamics after laser iridotomy have any role in corneal endothelial cell loss. MATERIALS AND METHODS: Porcine corneal endothelial cells were plated onto glass slides. Following 1 or 3 hours for adhesion, the endothelial cells were exposed to shear stresses (0.1-10 dyne/cm) for 15 minutes, and the number of detached cells was counted. In addition, the pressure and shear stress on corneal endothelial layer were calculated in a virtual model of laser iridotomy. RESULTS: The number of detached corneal endothelial cells increased with shear stresses in a dose-dependent manner. Significant increase of rate of detached corneal endothelial cells was observed at >0.3 dyne/cm after 1-hour attachment and at 1 dyne/cm after 3-hour attachment. The maximum pressure on corneal endothelial layer was 0.007 mm Hg, which is negligible compared with intraocular pressure. However, the maximum shear stress on the corneal endothelial layer could be> dyne/cm in some conditions of laser iridotomy. CONCLUSIONS: The resistance of corneal endothelial cell loss to shear stress is time dependent. Shear stress could be a cause of corneal endothelial cell loss in some conditions of laser iridotomy.

Photoaffinity labeling identifies the substrate-binding site of mammalian squalene epoxidase.

Squalene epoxidase (SE) catalyzes the conversion of squalene to (3S)-2,3-oxidosqualene. Photolabeling and site-directed mutagenesis were performed on recombinant rat SE (rrSE) in order to identify the location of the substrate-binding site and the roles of key residues in catalysis. Truncated 50-kDa rrSE was purified and photoaffinity labeled by competitive SE inhibitor (Ki=18.4 microM), [(3)H]TNSA-Dza. An 8-kDa CNBr/BNPS-skatole peptide was purified and the first 24 amino acids were sequenced by Edman degradation. The sequence PASFLPPSSVNKRGVLLLGDAYNL corresponded to residues 388-411 of the full-length rat SE. Three nucleophilic residues (Lys-399, Arg-400, and Asp-407) were labeled by [(3)H]TNSA-Dza. Triple mutants were prepared in which bulky groups were used to replace the labeled charged residues. Purified mutant enzymes showed lower enzymatic activity and reduced photoaffinity labeling by [(3)H]TNSA-Dza. This constitutes the first evidence as to the identity of the substrate-binding site of SE.

SREBP-2 and NF-Y are involved in the transcriptional regulation of squalene epoxidase.

The expression of squalene epoxidase (SE) is highly regulated transcriptionally by cholesterol. To elucidate these molecular mechanisms, we isolated the human and rat genomic clones. The entire human SE gene was about 24 kb long and organized into 11 exons with 10 introns. Unidirectional deletion analysis of the human 5(')-flanking region indicated that the sequence between -264 and -230 bp conferred cholesterol sensitivity on a reporter gene. This region contained a potential copy of consensus sterol regulatory element (SRE) sequence (CCACGCAAC) previously identified in the promoter of cholesterogenic and its related genes. The transcriptional activation observed under overexpression of sterol regulatory element binding protein-2 (SREBP-2) supported the functional role of the SRE sequence. Another deletion analysis showed that the sequence -207 to -192 bp was also active and it contained nuclear factor Y (NF-Y) binding site. Both sites might play critical roles in sterol mediated regulation of SE gene.