Evaluation and Outcomes of Hearing Loss in Temporal Bone Fractures: A Prospective Study.

Background Fractures of the skull base occur in 3-30% of head injury presentations to the emergency department. Overall, 9-40% of the cases have temporal bone fractures (TBFs). This fracture may disrupt the intervening structures causing edema, hematoma, bleeding, hearing loss, dizziness, cerebrospinal fluid otorrhea, and facial nerve paralysis. This study aims to evaluate the type of TBF, its correlation with hearing loss, and the outcomes of hearing loss. Methodology A prospective observational study was done among 50 patients who presented to the emergency department following trauma with clinical features and CT of the temporal bone suggestive of TBF. A complete evaluation of the patients was done, and patients were managed as per the departmental protocol. The patients were followed up for six months and monitored for otological symptoms. Periodic assessment of hearing loss by pure tone audiometry (PTA) was performed at the end of one week, one month, and six months. Results The most common type of fracture in our study was longitudinal TBF (72%), followed by transverse TBF (20%) and mixed TBF (8%). According to the newer classification, otic capsule-sparing fracture was more common than otic capsule-violating fracture. Most patients presented with conductive hearing loss (60%) following the TBF. On follow-up, there was a statistically significant improvement in hearing loss at the end of six months. Conclusions Our study found that in most cases hearing loss improved over time. Patients with conductive hearing loss showed maximum improvement in comparison to patients with sensorineural and mixed hearing loss.

Mesothelin-specific CAR-T cell therapy that incorporates an HLA-gated safety mechanism selectively kills tumor cells.

BACKGROUND: Mesothelin (MSLN) is a classic tumor-associated antigen that is expressed in lung cancer and many other solid tumors. However, MSLN is also expressed in normal mesothelium which creates a significant risk of serious inflammation for MSLN-directed therapeutics. We have developed a dual-receptor (Tmod™) system that exploits the difference between tumor and normal tissue in a subset of patients with defined heterozygous gene loss (LOH) in their tumors. METHODS: T cells engineered with the MSLN CAR Tmod construct described here contain (1) a novel MSLN-activated CAR and (2) an HLA-A*02-gated inhibitory receptor (blocker). A*02 binding is intended to override T-cell cytotoxicity, even in the presence of MSLN. The Tmod system is designed to treat heterozygous HLA class I patients, selected for HLA LOH. When A*02 is absent from tumors selected for LOH, the MSLN Tmod cells are predicted to mediate potent killing of the MSLN(+)A*02(-) malignant cells. RESULTS: The sensitivity of the MSLN Tmod cells is comparable with a benchmark MSLN CAR-T that was active but toxic in the clinic. Unlike MSLN CAR-T cells, the Tmod system robustly protects surrogate "normal" cells even in mixed-cell populations in vitro and in a xenograft model. The MSLN CAR can also be paired with other HLA class I blockers, supporting extension of the approach to patients beyond A*02 heterozygotes. CONCLUSIONS: The Tmod mechanism exemplified by the MSLN CAR Tmod construct provides an alternative route to leverage solid-tumor antigens such as MSLN in safer, more effective ways than previously possible.

Potent Killing of Pseudomonas aeruginosa by an Antibody-Antibiotic Conjugate.

Pseudomonas aeruginosa causes life-threatening infections that are associated with antibiotic failure. Previously, we identified the antibiotic G2637, an analog of arylomycin, targeting bacterial type I signal peptidase, which has moderate potency against P. aeruginosa. We hypothesized that an antibody-antibiotic conjugate (AAC) could increase its activity by colocalizing P. aeruginosa bacteria with high local concentrations of G2637 antibiotic in the intracellular environment of phagocytes. Using a novel technology of screening for hybridomas recognizing intact bacteria, we identified monoclonal antibody 26F8, which binds to lipopolysaccharide O antigen on the surface of P. aeruginosa bacteria. This antibody was engineered to contain 6 cysteines and was conjugated to the G2637 antibiotic via a lysosomal cathepsin-cleavable linker, yielding a drug-to-antibody ratio of approximately 6. The resulting AAC delivered a high intracellular concentration of free G2637 upon phagocytosis of AAC-bound P. aeruginosa by macrophages, and potently cleared viable P. aeruginosa bacteria intracellularly. The molar concentration of AAC-associated G2637 antibiotic that resulted in elimination of bacteria inside macrophages was approximately 2 orders of magnitude lower than the concentration of free G2637 required to eliminate extracellular bacteria. This study demonstrates that an anti-P. aeruginosa AAC can locally concentrate antibiotic and kill P. aeruginosa inside phagocytes, providing additional therapeutic options for antibiotics that are moderately active or have an unfavorable pharmacokinetics or toxicity profile. IMPORTANCE Antibiotic treatment of life-threatening P. aeruginosa infections is associated with low clinical success, despite the availability of antibiotics that are active in standard microbiological in vitro assays, affirming the need for new therapeutic approaches. Antibiotics often fail in the preclinical stage due to insufficient efficacy against P. aeruginosa. One potential strategy is to enhance the local concentration of antibiotics with limited inherent anti-P. aeruginosa activity. This study presents proof of concept for an antibody-antibiotic conjugate, which releases a high local antibiotic concentration inside macrophages upon phagocytosis, resulting in potent intracellular killing of phagocytosed P. aeruginosa bacteria. This approach may provide new therapeutic options for antibiotics that are dose limited.

Engineered T cells directed at tumors with defined allelic loss.

We describe an approach to cancer therapy based on exploitation of common losses of genetic material in tumor cells (loss of heterozygosity) (Basilion et al., 1999; Beroukhim et al., 2010). This therapeutic concept addresses the fundamental problem of discrimination between tumor and normal cells and can be applied in principle to the large majority of tumors. It utilizes modular activator/blocker elements that integrate signals related to the presence and absence of ligands displayed on the cell surface (Fedorov et al., 2013). We show that the targeting system works robustly in vitro and in a mouse cancer model where absence of the HLA-A*02 allele releases a brake on engineered T cells activated by the CD19 surface antigen. This therapeutic approach potentially opens a route toward a large, new source of cancer targets.

Functionalized nanosponges for controlled antibacterial and antihypocalcemic actions.

The aim of the present work was to develop lysozyme impregnated surface-active nanosponges to maintain its conformational stability and break bacterial cell walls by catalyzing the hydrolysis of 1,4-ß-linkages between N-acetyl-d-glucosamine and N-acetylmuramic acid residues present in peptidoglycan layer surrounding the bacterial cell membrane, and for controlling the release of calcium in hypocalcemia condition. Different carbonyl diimidazole cross-linked ß-cyclodextrin nanosponges with and without CaCO3 and CMC were prepared by polymer condensation method. The surface-active nanosponges were impregnated by lysozyme due to their ability to adsorb protein. Lysozyme impregnated nanosponges had a monomodal particle size distribution of 347.46±3.07 to 550.34±5.23nm, with a narrow distribution. The zeta potentials were sufficiently increased upon lysozyme impregnation, suggesting stable formulations by preventing aggregation. The in vitro release studies showed controlled release of lysozyme and calcium over a period of 24h. FTIR studies confirmed the impregnation of lysozyme on nanosponges and encapsulation of calcium in nanosponges. Lysozyme formulation showed promising conformational stability by DSC. It can be concluded that the stable nanosponges formulation is a promising carrier for antibacterial protein and preventing depletion of calcium in antibiotic associated hypocalcemic condition.

Biomimetic estimation of glucose using non-molecular and molecular imprinted polymer nanosponges.

The aim of the present work was to develop biomimetics for glucose estimation using molecularly and non-molecularly imprinted polymers of pyromellitic dianhydride crosslinked ß-cyclodextrin based nanosponges. The ionic association of glucose phosphate to nanosponges by polymerization reaction and removal of glucose created molecular imprinted polymer (MIP)-nanosponges with affinity for glucose binding. Particle size, zeta potential, glucose binding studies and FTIR were used to characterize molecular and non-molecular imprinted polymer (NIP) nanosponges. Particle size of the nanosponges was found in the range of 450.81±5.33 nm to 550.63±8.14 nm with low polydispersity index. MIP-nanosponges retained a relatively large population of pores in the nano-range, while NIP was related to the nonporous materials with weak interaction and had poor tendency to aggregate. Nanosponges showed the variation in binding capacities and specificities; and also exhibited a similar degree of swelling. Moreover electrostatic force of attraction and cavities specific fitting of glucose in MIP-nanosponges might be due to advance selectivity and affinity for glucose. FTIR study showed glucose molecules might be entered into the selective binding cavities, which were created by the extraction of template molecules It is concluded that nanosized MIP-nanosponges have advantages over conventional NIP due to diffusion of template in the formed cavity as of its high surface area.

Acute and repeated dose toxicity studies of different ß-cyclodextrin-based nanosponge formulations.

Nanosponges (NS) show promising results in different fields such as medicine, agriculture, water purification, fire engineering and so on. The present study was designed to evaluate toxicity of different NS formulations (namely, S1-S6) synthesized with different cross-linking agents such as carbonyl diimidazole, pyromellitic dianhydride and hexamethylene diisocynate; and preparation methods in experimental animals. Acute and repeated dose toxicity studies of formulations were carried out as per OECD guidelines 423 and 407, respectively. For acute toxicity study, formulations were administered to female rats at doses of 300 and 2000 mg/kg orally. The general behaviour of the rats was continuously monitored for 1 h after dosing, periodically during the first 24 h and daily thereafter for a total of 14 days. On day 14, animals were fasted overnight, weighed, and sacrificed. After sacrification, animals were subjected to necropsy. For repeated dose toxicity study, rats of either sex were orally administered with formulations at the dose of 300 mg/kg per day for a period of 28 days. The maximally tolerated dose of all formulations was found to be 2000 mg/kg. Repeated administration of formulations for 28 days did not show any significant changes in haematological and biochemical parameters in experimental animals. These results indicate that the formulations are safe, when tested in experimental animals.

Van der woude syndrome with short review of the literature.

Van der Woude syndrome (VWS) is a rare autosomal dominant condition with high penetrance and variable expression. Clinical manifestation of this autosomal dominant clefting syndrome includes bilateral midline lower lip pits, cleft lip, and cleft palate along with hypodontia. These congenital lip pits appear as a malformation in the vermilion border of the lip, with or without excretion. Discomfort caused by spontaneous or induced drainage of saliva/mucus when pressure is applied or during a meal as well as poor aesthetic match is one of the main complaints of patients with congenital lip fistula. The pits are treated by surgical resection. Dentists should be aware of the congenital lip pits as in Van der Woude syndrome because they have been reported to be associated with a variety of malformations or other congenital disorders. Here, the authors report a rare case of Van der Woude syndrome with short review of the literature.

Novel cyclodextrin nanosponges for delivery of calcium in hyperphosphatemia.

Cyclodextrin nanosponges are solid, porous nanoparticulate three dimensional structures, have been used as delivery system of different drugs. In this work, new cyclodextrin-based nanosponges of calcium carbonate were prepared by polymer condensation method to release the calcium in controlled manner in the treatment of hyperphosphatemia as novel carriers. SEM measurements revealed their roughly spherical shape, porous nature and mean particle size of about 400 nm. Zeta potentials of the nanosponges were sufficiently high to obtain stable formulations. The encapsulation efficiencies of calcium in nanosponge formulations were found to be 81-95%. The moisture contents of the nanosponges were in the range of 0.1-0.7%. The optimized formulation produces enteric and controlled release kinetics of calcium in the management and treatment of hyperphosphatemia. It was also observed that calcium ions bound efficiently to free phosphate in a pH-dependent fashion especially at pH 7. In accelerated stability study no significant changes occurred in physical appearance, size and nature of drug in formulation for 3 months. The results of FTIR and DSC confirmed that calcium carbonate was encapsulated in nanosponges structure.