Viscoelastic testing in oncology patients (including for the diagnosis of fibrinolysis): Review of existing evidence, technology comparison, and clinical utility.

The quantification of the coagulopathic state associated with oncologic and hematologic diseases is imperfectly assessed by common coagulation tests such as prothrombin time, activated partial thromboplastin time, fibrinogen levels, and platelet count. These tests provide a static representation of a component of hemostatic integrity, presenting an incomplete picture of coagulation in these patients. Viscoelastic tests (VETs), such as rotational thromboelastometry (ROTEM) and thromboelastography (TEG), as whole blood analyses, provide data related to the cumulative effects of blood components and all stages of the coagulation and fibrinolytic processes. The utility of VETs has been demonstrated since the late 1960s in guiding blood component therapy for patients undergoing liver transplantation. Since then, the scope of viscoelastic testing has expanded to become routinely used for cardiac surgery, obstetrics, and trauma. In the past decade, VETs' expanded usage has been most significant in trauma resuscitation. However, use of VETs for patients with malignancy-associated coagulopathy (MAC) and hematologic malignancies is increasing. For the purposes of this narrative review, we discuss the similarities between trauma-induced coagulopathy (TIC) and MAC. These similarities center on the thrombomodulin-thrombin complex as it switches between the thrombin-activatable fibrinolysis inhibitor coagulation pathway and activating the protein C anticoagulation pathway. This produces a spectrum of coagulopathy and fibrinolytic alterations ranging from shutdown to hyperfibrinolysis that are common to TIC, MAC, and hematologic malignancies. There is expanding literature regarding the utility of TEG and ROTEM to describe the hemostatic integrity of patients with oncologic and hematologic conditions, which we review here.

MAPK pathway inhibition induces MET and GAB1 levels, priming BRAF mutant melanoma for rescue by hepatocyte growth factor.

Therapeutic resistance is a major obstacle to achieving durable clinical responses with targeted therapies, highlighting a need to elucidate the underlying mechanisms responsible for resistance and identify strategies to overcome this challenge. An emerging body of data implicates the tyrosine kinase MET in mediating resistance to BRAF inhibitors in BRAFV600E mutant melanoma. In this study we observed a dominant role for the HGF/MET axis in mediating resistance to BRAF and MEK inhibitors in models of BRAFV600E and NRAS mutant melanoma. In addition, we showed that MAPK pathway inhibition induced rapid increases in MET and GAB1 levels, providing novel mechanistic insight into how BRAFV600E mutant melanoma is primed for HGF-mediated rescue. We also determined that tumor-derived HGF, not systemic HGF, may be required to convey resistance to BRAF inhibition in vivo and that resistance could be reversed following treatment with AMG 337, a selective MET inhibitor. In summary, these findings support the clinical evaluation of MET-directed targeted therapy to circumvent resistance to BRAF and MEK inhibitors in BRAFV600E mutant melanoma. In addition, the induction of MET following treatment with BRAF and MEK inhibitors has the potential to serve as a predictive biomarker for identifying patients best suited for MET inhibitor combination therapy.

Viability of Listeria monocytogenes on uncured turkey breast commercially prepared with and without buffered vinegar during extended storage at 4 and 10°C.

We determined the viability of Listeria monocytogenes on uncured turkey breast containing buffered vinegar (BV) and surface treated with a stabilized solution of sodium chlorite in vinegar (VSC). Commercially produced, uncured, deli-style turkey breast was formulated with BV (0.0, 2.0, 2.5, or 3.0%), sliced (ca. 100 g and ca. 1.25 cm thick), and subsequently surface inoculated (ca. 4.3 log CFU per slice) in each of two trials with a five-strain cocktail of L. monocytogenes. Next, 1 ml per side of a 2 or 10% solution of VSC was added to each package before vacuum sealing and storing at 4 or 10°C. Without antimicrobials, L. monocytogenes numbers increased by ca. 6.2 log CFU per slice after 90 and 48 days of storage at 4 or 10°C, respectively. At 4°C, L. monocytogenes numbers increased by ca. 0.4 to 1.9 log CFU per slice on turkey breast formulated with 2.0 or 2.5% BV and treated or not with 2% VSC, whereas when treated with 10% VSC, L. monocytogenes levels remained relatively unchanged over 90 days. However, when turkey breast was formulated with 3.0% BV and treated or not with VSC, pathogen numbers decreased by ca. 0.7 to 1.3 log CFU per slice. At 10°C, L. monocytogenes numbers increased by ca. 1.5 to 5.6 log CFU per slice after 48 days when formulated with 2.0 to 3.0% BV and treated or not with 2% VSC. When formulated with 2.0% BV and treated with 10% VSC, L. monocytogenes numbers increased by ca. 3.3 log CFU per slice, whereas when formulated with 2.5 or 3.0% BV and treated with 10% VSC, L. monocytogenes decreased by ca. 0.3 log CFU per slice. Inclusion of BV as an ingredient in uncured turkey breast, alone or in combination with VSC added to the package, appreciably suppressed outgrowth of L. monocytogenes during an extended refrigerated shelf life.

Selective regulation of lymphopoiesis and leukemogenesis by individual zinc fingers of Ikaros.

C2H2 zinc fingers are found in several key transcriptional regulators in the immune system. However, these proteins usually contain more fingers than are needed for sequence-specific DNA binding, which suggests that different fingers regulate different genes and functions. Here we found that mice lacking finger 1 or finger 4 of Ikaros exhibited distinct subsets of the hematological defects of Ikaros-null mice. Most notably, the two fingers controlled different stages of lymphopoiesis, and finger 4 was selectively required for tumor suppression. The distinct defects support the hypothesis that only a small number of genes that are targets of Ikaros are critical for each of its biological functions. The subcategorization of functions and target genes by mutagenesis of individual zinc fingers will facilitate efforts to understand how zinc-finger transcription factors regulate development, immunity and disease.