Immunotherapy guided precision medicine in solid tumors.

Cancer is no longer recognized as a single disease but a collection of diseases each with its defining characteristics and behavior. Even within the same cancer type, there can be substantial heterogeneity at the molecular level. Cancer cells often accumulate various genetic mutations and epigenetic alterations over time, leading to a coexistence of distinct subpopulations of cells within the tumor. This tumor heterogeneity arises not only due to clonal outgrowth of cells with genetic mutations, but also due to interactions of tumor cells with the tumor microenvironment (TME). The latter is a dynamic ecosystem that includes cancer cells, immune cells, fibroblasts, endothelial cells, stromal cells, blood vessels, and extracellular matrix components, tumor-associated macrophages and secreted molecules. The complex interplay between tumor heterogeneity and the TME makes it difficult to develop one-size-fits-all treatments and is often the cause of therapeutic failure and resistance in solid cancers. Technological advances in the post-genomic era have given us cues regarding spatial and temporal tumor heterogeneity. Armed with this knowledge, oncologists are trying to target the unique genomic, epigenetic, and molecular landscape in the tumor cell that causes its oncogenic transformation in a particular patient. This has ushered in the era of personalized precision medicine (PPM). Immunotherapy, on the other hand, involves leveraging the body's immune system to recognize and attack cancer cells and spare healthy cells from the damage induced by radiation and chemotherapy. Combining PPM and immunotherapy represents a paradigm shift in cancer treatment and has emerged as a promising treatment modality for several solid cancers. In this chapter, we summarise major types of cancer immunotherapy and discuss how they are being used for precision medicine in different solid tumors.

Effect of extrusion processing on techno-functional properties, textural properties, antioxidant activities, in vitro nutrient digestibility and glycemic index of sorghum-chickpea-based extruded snacks.

Physico-chemical, textural, functional, and nutritional properties of the twin screw extruded whole sorghum-chickpea (8:2) snacks was investigated using in vitro procedures. The extruded snacks were analyzed for the effect of variations in extruded conditions on their properties: barrel BT (BT) (130-170°C) and feed moisture (FM) (14%-18%), keeping screw speed constant (400 rpm). The results revealed that specific mechanical energy (SME) decreased (74.4-60.0) in response to rise in both BT and FM, whereas expansion ratio (ER) had shown an alternative relation as it decreased with elevated FM (2.17 at 14%, 130°C to 2.14 at 16%, 130°C) and increased with BT (1.75 at 18%, 130°C to 2.48 at 18%, 170°C). The values of WAI and WSI improved with the surge in BT, which was associated with enhanced disruption of starch granules at higher BT. Raise in FM incremented the total phenolic content (TPC) and hence the antioxidant activity (AA) (FRAP and DPPH) along with the hardness of snacks. As per in vitro starch digestibility is concerned, slowly digestible starch (SDS) content as well as glycemic index (51-53) of the extrudates depressed with increasing BT and FM. Also, lower BT and FM improved the functional properties such as expansion ratio, in-vitro protein digestibility, and overall acceptability of the snacks. A positive correlation was seen among SME and hardness of the snacks, WSI and ER, TPC and AA, SDS and Exp-GI, color and OA, texture and OA.

Closed-Loop Gastric Outlet Obstruction Secondary to Duodenal Ulcer in a Patient With Esophageal Stricture.

Closed-loop gastric outlet obstruction (GOO) is a rare complication that results from a mechanical obstruction in the pylorus or duodenum. In the early 1990s, the common cause of GOO was peptic ulcer disease, accounting for 5% to 10% of hospital admissions. Peptic ulcer disease is the disruption of the mucosal integrity in the stomach and duodenum and can be categorized into gastric ulcers and duodenal ulcers. With the treatment for Helicobacter  pylori and the increased use of proton pump inhibitors (PPI), GOO now occurs in fewer than 5% of patients with duodenal ulcer disease and even less in those with gastric ulcer disease. Although the morbidity of duodenal ulcers has been declining in recent years, the incidence of post-bulbar duodenal ulcer (PBDU) remains at a constant 9.33%, primarily due to diagnostic and therapeutic difficulties. Additionally, fewer than 5% of obstructing duodenal ulcers are caused by PBDU, and even fewer are located in the second or third portions of the duodenum. Ulcers located in the distal part of the duodenum raise concern for syndromes associated with hypersecretion of acid, including Zollinger-Ellison syndrome (ZES). The ZES is rare, accounting only for 0.1% of all duodenal ulcers. Here, we present a case where a patient with esophageal stricture developed a rare case of closed-loop GOO secondary to a duodenal ulcer. The patient, initially treated for esophageal perforation, developed an esophageal stricture. The patient was being worked up for ZES and multiple endocrine neoplasia link type 1 (MEN1) syndrome due to his concerning laboratory findings and rare clinical presentation.

The lipolytic activity of LipJ, a stress-induced enzyme, is regulated by its C-terminal adenylate cyclase domain.

Aim: The confirmation of lipolytic activity and role of Rv1900c in the Mycobacterium physiology Methods:rv1900c/N-terminus domain (rv1900NT) were cloned in pET28a/Escherichia coli, purified by affinity chromatography and characterized. Results: A zone of clearance on tributyrin-agar and activity with pNP-decanoate confirmed the lipolytic activity of Rv1900c. The Rv1900NT demonstrated higher enzyme specific activity, Vmax and kcat, but Rv1900c was more thermostable. The lipolytic activity of Rv1900c decreased in presence of ATP. Mycobacterium smegmatis expressed rv1900c/rv1900NT-altered colony morphology, growth, cell surface properties and survival under stress conditions. The effect was more prominent with Rv1900NT as compared with Rv1900c. Conclusion: The study confirmed the lipolytic activity of Rv1900c and suggested its regulation by the adenylate cyclase domain and role in the intracellular survival of bacteria.

Lay abstract Tuberculosis (TB) remains the top contagious/infectious killer in the world. It is caused by the bacteria Mycobacterium tuberculosis. The bacteria resides/replicates in the immune cell that normally has to eradicate infectious microorganisms. Though the treatment of TB is available, the emergence of drug-resistant bacteria is of major concern. The treatment of drug-resistant TB has been reported to be more difficult due to lengthy and complex treatment regimens. Therefore, there is an urgent need for new and better drugs to treat TB/drug-resistant TB. For this purpose understanding the role of each protein in the physiology of mycobacteria is required. Lipids play a critical role in the intracellular survival of this pathogen in the host. Our study demonstrated that LipJ supported the intracellular survival of bacteria. Therefore, it could be a potential drug target.

Rv0518, a nutritive stress inducible GDSL lipase of Mycobacterium tuberculosis, enhanced intracellular survival of bacteria by cell wall modulation.

Rv0518, a hypothetical protein of Mycobacterium tuberculosis, was designated as possible exported protein. In-silico analysis suggested that the protein belonged to the family of GDSL lipases. In this study, rv0518 gene was cloned and expressed in E. coli followed by purification and characterization. It possessed lipolytic activity, preferably hydrolyzed pNP-decanoate at pH 9.0 and 40 °C. The enzyme was stable till 50 °C and wider pH range (5.0-11.0). The predicted active site residues, Ser-46, Asp-205, His-208, Gly-87, Asn-120 were confirmed by site directed mutagenesis. rv0518 gene expression in M. tuberculosis H37Ra was up-regulated under nutrient starvation and the protein was detected in membrane fraction. The expression of rv0518 in M. smegmatis altered the colony morphology/growth kinetics, provided resistance to SDS, lysozyme, anti-TB drugs and enhanced in vitro survival of M. smegmatis under nutritive stress. The total lipid content and trehalose dimycolate was elevated in M. smegmatis expressing rv0518 gene. The presence of Rv0518 enhanced infection ability and intracellular survival capability of M. smegmatis. Hence, Rv0518 is a cell wall associated GDSL lipase might helped bacteria to utilize glycerol/lipids for its growth as well as provided resistance to various intracellular stresses by cell wall modulation resulting in its enhanced intracellular survival.

mbtJ: an iron stress-induced acetyl hydrolase/esterase of Mycobacterium tuberculosis helps bacteria to survive during iron stress.

AIM: mbtJ from Mycobacterium tuberculosis H37Rv is a member of mbt A-J operon required for mycobactin biogenesis. MATERIALS & METHODS: The esterase/acetyl-hydrolase activity of mbtJ was determined by pNP-esters/native-PAGE and expression under iron stress by quantitative-PCR. Effect of gene on growth/survival of Mycobacterium was studied using antisense. Its effect on morphology, growth/infection was studied in Mycobacterium smegmatis. RESULTS: It showed acetyl hydrolase/esterase activity at pH 8.0 and 50°C with pNP-butyrate. Its expression was upregulated under iron stress. The antisense inhibited the survival of bacterium during iron stress. Expression of mbtJ changed colony morphology and enhanced the growth/infection in M. smegmatis. CONCLUSION: mbtJ, an acetyl-hydrolase/esterase, enhanced the survival of M. tuberculosis under iron stress, affected the growth/infection efficiency in M. smegmatis, suggesting its pivotal role in the intracellular survival of bacterium.