Society for Immunotherapy of Cancer (SITC) clinical practice guideline on immunotherapy for the treatment of melanoma, version 3.0.

Since the first approval for immune checkpoint inhibitors (ICIs) for the treatment of cutaneous melanoma more than a decade ago, immunotherapy has completely transformed the treatment landscape of this chemotherapy-resistant disease. Combination regimens including ICIs directed against programmed cell death protein 1 (PD-1) with anti-cytotoxic T lymphocyte antigen-4 (CTLA-4) agents or, more recently, anti-lymphocyte-activation gene 3 (LAG-3) agents, have gained regulatory approvals for the treatment of metastatic cutaneous melanoma, with long-term follow-up data suggesting the possibility of cure for some patients with advanced disease. In the resectable setting, adjuvant ICIs prolong recurrence-free survival, and neoadjuvant strategies are an active area of investigation. Other immunotherapy strategies, such as oncolytic virotherapy for injectable cutaneous melanoma and bispecific T-cell engager therapy for HLA-A*02:01 genotype-positive uveal melanoma, are also available to patients. Despite the remarkable efficacy of these regimens for many patients with cutaneous melanoma, traditional immunotherapy biomarkers (ie, programmed death-ligand 1 expression, tumor mutational burden, T-cell infiltrate and/or microsatellite stability) have failed to reliably predict response. Furthermore, ICIs are associated with unique toxicity profiles, particularly for the highly active combination of anti-PD-1 plus anti-CTLA-4 agents. The Society for Immunotherapy of Cancer (SITC) convened a panel of experts to develop this clinical practice guideline on immunotherapy for the treatment of melanoma, including rare subtypes of the disease (eg, uveal, mucosal), with the goal of improving patient care by providing guidance to the oncology community. Drawing from published data and clinical experience, the Expert Panel developed evidence- and consensus-based recommendations for healthcare professionals using immunotherapy to treat melanoma, with topics including therapy selection in the advanced and perioperative settings, intratumoral immunotherapy, when to use immunotherapy for patients with BRAFV600-mutated disease, management of patients with brain metastases, evaluation of treatment response, special patient populations, patient education, quality of life, and survivorship, among others.

"Always Events® " just another quality improvement tool or is it?

INTRODUCTION: Always Events® are defined as "those aspects of the care experience that should always occur when patients, their family members or other care partners, and service users interact with health care professionals and the health care system". It is a quality improvement methodology that starts by asking our patients the simple question "what matters to you?" and then through coproduction, works out a way to achieve this. METHODS AND RESULTS: This article tells our story and highlights the value of undertaking an Always Event® within the Radiology department at Warrington and Halton Hospitals. It will demonstrate how this approach combines research, an evaluation of findings and implementation of those findings within a very short timeframe. Embedded within the article are comments from our staff, volunteers and patients which reflect upon their experiences, our limitations, the outcomes we achieved and the impact it has had upon our patients and staff. CONCLUSION AND IMPLICATIONS FOR PRACTICE: It was important to our patients that they would be informed of how long they would wait for their examination once they booked in at x-ray reception. By undertaking an Always Event® this process is now embedded in our departments everyday activities with over 90% of our patients now being informed of their waiting time. This continued collaboration has really emphasised the value of listening to our patients, and the benefits this can lead to. It has also encouraged a positive research culture within our department (optimisation studies, working with industry, quality projects), helping to progress our profession and resulting in a quality service for our patients.

Regulation of chemoattractant receptor interaction with transducing proteins by organizational control in the plasma membrane of human neutrophils.

Isolated purified plasma membrane domains from unstimulated human neutrophils were photoaffinity labeled with F-Met-Leu-Phe-N epsilon-(2-(p-azido-[125I]salicylamido)ethyl- 1,3'-dithiopropionyl)-Lys also referred to as FMLPL-SASD[125I]. Most of the photoaffinity-labeled N-formyl peptide receptors were found in light plasma membrane fraction (PM-L) which has been previously shown to be enriched in guanyl nucleotide binding proteins and the plasma membrane marker alkaline phosphatase (Jesaitis, A. J., G. M. Bokoch, J. O. Tolley, and R. A. Allen. 1988. J. Cell Biol. 107:921-928). Furthermore, the heavy plasma membrane fraction (PM-H), which is enriched in actin and fodrin, was depleted in receptors. Solubilization of PM-L and PM-H in divalent cation-free buffer containing octylglucoside and subsequent sedimentation at 180,000 g in detergent-containing sucrose gradients revealed two receptor forms. The major population, found in PM-L sedimented as a globular protein with an apparent sedimentation coefficient of 6-7S, while a minor fraction found in the PM-H fraction sedimented as a 4S particle. In addition, the 6-7S form could be converted to the 4S form by inclusion of guanosine 5'-O-(3-thiotriphosphate) (GTP gamma S) in the extraction buffer (ED50 = 10-30 nM). ATP was not effective at doses of up to 10 microM. In contrast, isolation and solubilization of receptors from desensitized cells (photoaffinity labeled after a 15 degrees C incubation with FMLPL-SASD[125I]) revealed that the majority of receptors (greater than 60-90%), which are found in PM-H, sedimented as 4S particles. A minor fraction of receptors found in the PM-L sedimented as 6-7S species. The receptors in the PM-H fraction, however, were still capable of interacting with G-proteins, since addition of unlabeled PM-L membrane fraction as a G-protein source reconstituted a more rapidly sedimenting form showing sensitivity to GTP gamma S. These results suggest that receptors in unstimulated human neutrophils have a higher probability of interacting with G-proteins because they are in the light plasma membrane domain. The results also suggest that receptors that have been translocated to the heavy plasma membrane domain during the process of desensitization or response termination have a lower probability of interacting with G-protein. Since the latter receptors are still capable of forming G protein associations, then their lateral segregation would represent a mechanism of controlling of receptor G-protein interactions. This reorganization of the plasma membrane, therefore, may form the molecular basis for response termination or homologous desensitization in human neutrophils.

Lateral segregation of neutrophil chemotactic receptors into actin- and fodrin-rich plasma membrane microdomains depleted in guanyl nucleotide regulatory proteins.

Subcellular fractions were prepared from human neutrophils desensitized at 15 degrees C with stimulatory doses of the photoaffinity derivative F-Met-Leu-Phe-N epsilon-(2-(rho-azido[125I]salicylamido)ethyl-1,3'- dithio-propionyl)-Lys. The covalently labeled receptors were found in a membrane fraction of higher density than those from cells preexposed to ligand at 4 degrees C but not desensitized. The denser fraction (rho approximately equal to 1.155 g/cc) was the cellular locus of the membrane associated cytoskeletal proteins, actin, and fodrin, as detected immunologically on western blots. The light fraction (rho approximately equal to 1.135), cosedimented with neutrophil plasma membrane markers, plasma membrane guanyl nucleotide regulatory proteins, and several characteristic polypeptides identified by SDS-PAGE, including a major 72-kD species. The photoaffinity-labeled species in either case showed the same mobility on SDS-PAGE (Mr = 50,000-70,000) corresponding to previously reported values for N-formyl chemotactic receptors. These labeled receptors were sensitive to proteolysis after exposure of the intact photoaffinity-labeled cells to papain at 4 degrees C. We conclude that (a) the fractions isolated are probably derived from different lateral microdomains of the surface of human neutrophils; (b) the higher density fraction contains occupied N-formyl-chemotactic receptors previously shown to have been converted, to a high affinity, slowly dissociating form coisolating with neutrophil cytoskeleton and implicated in the termination of formyl peptide-induced neutrophil activation; and (c) the translocation of receptors to these microdomains may serve to compartmentalize receptors and perhaps regulate the interaction of the receptor/G-protein transduction pair.

Improved recombinant protein production in Arabidopsis thaliana.

Production and isolation of recombinant proteins are key steps in modern Molecular Biology. Expression vectors and platforms for various hosts, including both prokaryotic and eukaryotic systems, have been used. In basic plant research, Arabidopsis thaliana is the central model for which a wealth of genetic and genomic resources is available, and enormous knowledge has been accumulated over the past years - especially since elucidation of its genome in 2000. However, until recently an Arabidopsis platform had been lacking for preparative-scale production of homologous recombinant proteins. We recently established an Arabidopsis-based super-expression system, and used it for a structural pilot study of a multi-subunit integral membrane protein complex. This review summarizes the benefits and further potential of the model plant system for protein productions. ABBREVIATIONS: Nb, Nicotiana benthamiana; OT, oligosaccharyltransferase.

Preparation and properties of an improved photoaffinity ligand for the N-formyl peptide receptor.

A new superior photoaffinity ligand for the N-formyl peptide receptor was prepared by derivatization of N-formyl-Met-Leu-Phe-Lys with a commercially available heterobifunctional crosslinking agent. The product, N-formyl-Met-Leu-Phe-N epsilon-(2-(p-azidosalicylamido)ethyl-1,3'- dithiopropionyl)-Lys was readily synthesized and radiolabelled, and had increased specificity and stability as compared to previously used photoaffinity ligands. The ligand rapidly associated with the receptor with high affinity (Kd = 0.28 nM). Once bound, it was virtually non-dissociable (in the absence of photolysis) in an experimental time-frame (t1/2 (off) = 154 min). The covalent incorporation of the photoaffinity ligand into the receptor upon irradiation was complete within 5 min, minimizing cell damage, and the efficiency of covalent incorporation was approx. 40%. The derivative had enhanced biological activity, having an ED50 for superoxide anion production of 0.23 nM, 27-fold lower than its parent peptide. This derivative of the N-formyl peptide was useful for up to 3 months after radiolabelling, showing a progressive decline in specific activity during storage in the dark at 4 degrees C. The enhanced stability, reproducibility and solubility of the photoaffinity ligand is expected to aid in the purification of the N-formyl peptide receptor and will prove a useful tool for analysing receptor-mediated processes.

A high-yield, high-purity elutriation method for preparing human granulocytes demonstrating enhanced experimental lifetimes.

A counterflow centrifugal elutriation procedure for preparing human granulocytes is described. This method permits isolation of 1-2 X 10(9) granulocytes with a yield of 70% +/- 7% from a unit of whole blood in 3 h. These cells are 99% +/- 1% pure and 95-99% viable. When compared to cells prepared by a conventional procedure employing hypotonic lysis to remove red cells, the elutriated cells show enhanced oxidative responses resulting from enhanced longevity. Other responses including receptor-mediated uptake of chemoattractant were not significantly different from those of conventionally prepared cells after incubation at 37 degrees C prior to stimulation. The population of elutriated granulocytes, however, was significantly more homogeneous and pure than cells prepared conventionally.

Determination of the pharmaceutical peptide TP9201 by post-column reaction with copper(II) followed by electrochemical detection.

An electrochemical detection method was applied to the determination of the synthetic peptide TP9201 (Telios Pharmaceuticals). The method utilizes reversed-phase HPLC, followed by post-column formation of Cu(II)-peptide complexes to render peptides electrochemically active via the Cu(III/II) couple. TP9201 is cyclic and N-amidated; the lack of a free amine precludes the use of typical fluorescent labeling reagents. Neither the cyclic structure nor the N-amidation prevented the copper complexation reaction, however. The detection limit in bovine serum was 20 nM, limited by interfering sample peaks, and the detector response was linear in a range 10-400 nM.

Self-association of analgesics in aqueous solution: micellar properties of dextropropoxyphene hydrochloride and methadone hydrochloride.

The solution properties of several analgesics including dextropropoxyphene hydrochloride, methadone hydrochloride, dextromoramide acid tartrate and dipipanone hydrochloride have been examined using light scattering, conductivity, vapour pressure osmometry and surface tension techniques. A micellar pattern of association was established for dextropropoxyphene hydrochloride and methadone hydrochloride and critical micelle concentrations and aggregation numbers are reported. The hydrophobic contribution to the free energy of micellization of dextropropoxyphene was determined from measurement of the critical micelle concentration in the presence of added electrolyte.

Self-association of analgesics in aqueous solution: association models for codeine, oxycodone, ethylmorphine and pethidine.

Light scattering, vapour pressure osmometry, conductivity and surface tension techniques have been used to examine aqueous solutions of several narcotic analgesics for evidence of association. Contrary to a previous report, no significant association could be detected in solutions of morphine sulphate and codeine phosphate. Other drugs which showed no evidence of aggregation in water included morphine hydrochloride, ethylmorphine hydrochloride, oxycodone hydrochloride and dihydrocodeine tartrate. Self-association of ethylmorphine hydrochloride, oxycodone hydrochloride and codeine phosphate was observed in the presence of 0.5 mol dm-3 electrolyte, the pattern of association conforming to that of a stepwise association process with all association constants of equal value. The association of pethidine hydrochloride in 0.5 mol dm-3 sodium chloride could be represented by an association scheme in which association constant KN increased sequentially with aggregation number N according to the relation KN = K(N - 1)/N.

Use of serum biomarkers in a diagnostic test for irritable bowel syndrome.

BACKGROUND: Currently, no single serum biomarker can reliably differentiate irritable bowel syndrome (IBS) from other functional gastrointestinal disorders or organic diseases of the gastrointestinal tract. AIM: To develop and validate a diagnostic test using serum biomarkers to detect IBS. METHODS: Ten serum biomarkers were selected from a potential panel of 140 for their ability to differentiate IBS from non-IBS disease in blood samples from patients with IBS, other gastrointestinal disorders and healthy volunteers. A predictive modelling tool was developed to assess patterns and relationships among the 10 serum biomarkers that best differentiated IBS patients from healthy controls and patients with non-IBS gastrointestinal disease. This model was tested in a different cohort of patients and healthy controls (n = 516) to determine the predictive accuracy of differentiating IBS from non-IBS. RESULTS: The sensitivity and specificity of the 10-biomarker algorithm for differentiating IBS from non-IBS was 50% and 88% respectively. The positive predictive value was 81%, and the negative predictive value was 64% at 50% IBS prevalence in the validation cohort. Overall accuracy was 70%. CONCLUSIONS: Assessing serum biomarker patterns can differentiate IBS from non-IBS with reasonable sensitivity and specificity. Assessing serum biomarkers in an overall diagnostic strategy may allow earlier diagnosis and treatment for patients with IBS.

Carotid artery occlusive disease. Clinical considerations in surgical revascularization.

In clinical evaluation and analysis of 85 consecutive carotid endarterectomies in 74 consecutive patients, the operation was shown to be an effective and safe method of treating cerebral vascular insufficiency. It must be properly timed and performed, and excellent results may be expected, particularly in comparison with nonoperatively treated patients with the same disease.

Receptor-cytoskeleton interactions and membrane traffic may regulate chemoattractant-induced superoxide production in human granulocytes.

When dihydrocytochalasin (dhCB) was added either prior to or after CHO-Met-Leu-Phe (fMLP), the rate and duration of superoxide production in human granulocytes stimulated by fMLP was augmented. This effect was maximal when dhCB was added before fMLP, increasing the rate 1.5-3-fold. The effect of dhCB was progressively diminished for later additions and was undetectable after 6-10 min. The effects of dhCB could be blocked by the additional presence of 10 microM t-Boc-Phe-Leu-Phe-Leu-Phe (where t-Boc is t-butoxycarbonyl) indicating a requirement for receptor occupancy. In the presence of dhCB, the reversible binding of fML[3H]P was elevated and the formation of slowly dissociating surface complexes of occupied receptor and cytoskeleton was inhibited. Myeloperoxidase and lactoferrin release from fMLP-stimulated cells was induced by dhCB but was only partially correlated with the potentiating effects of dhCB on superoxide production and receptor expression. To circumvent the complicating effects of degranulation on the analysis of the functional consequences of receptor-cytoskeletal associations, cells were also preincubated with 100 nM fMLP at 15 degrees C. Under these conditions, the majority of the surface receptors became irreversibly occupied and coisolated with the cytoskeletal fraction of the cell. Subsequent exposure of the cells to fMLP at 37 degrees C resulted in no superoxide production. This desensitization was blocked by dhCB which also inhibited coisolation of the ligand and cytoskeletons. Conversion of receptor to a slowly dissociating state may represent its trapping in an inactive form and would provide a role for receptor-cytoskeleton interactions in the termination of the granulocyte response to chemoattractants. The inhibition of such receptor "sequestration" and the induction of new receptor expression could, therefore, partially account for dhCB-induced potentiation of the fMLP response.

Reperfusion-induced leukocyte adhesion and vascular protein leakage in normal and hypercholesterolemic rats.

The objective of this study was to define the influence of hypercholesterolemia on ischemia-reperfusion (I/R)-induced leukocyte-endothelial cell adhesion and albumin leakage in rat mesenteric venules. The microvascular alterations normally elicited by I/R (leukocyte adherence and emigration, albumin leakage, and platelet aggregation) were more pronounced in hypercholesterolemic rats (compared with control rats). Monoclonal antibodies against the adhesion glycoproteins CD11/CD18 and intercellular adhesion molecule-1 attenuated the I/R-induced leukocyte adherence and emigration and albumin leakage. Leukocyte adherence, but not albumin leakage, was diminished in animals pretreated with a P-selectin-specific antibody. Platelet aggregation was reduced by antibodies directed against either P-selectin, CD18, or intercellular adhesion molecule-1, as well as a GPIIb-IIIa antagonist. These results indicate that the enhanced reperfusion-induced albumin leakage in hypercholesterolemic rats is dependent on leukocyte-endothelial cell adhesion. Furthermore, P-selectin- and CD11/CD18-dependent heterotypic and GPIIb-IIIa-mediated homotypic platelet aggregation appear to influence the extravasation of both leukocytes and albumin in postischemic venules of hypercholesterolemic rats.