Establishing a protocol for the compatibilities of closed-system transfer devices with multiple chemotherapy drugs under simulated clinical conditions.

Closed-system drug transfer devices (CSTDs) are used to prevent occupational exposure to hazardous drugs in health care providers. They are considered Class II medical devices by the US FDA and are cleared but not approved before marketing. While compatibility tests are conducted by CSTD manufacturers, the procuring institution needs to consider performing its own studies before buying these devices. Herein we tested the compatibility of the components of the Needleless® DualGuard CSTD system (vial access clips, vial access spikes, and administration adaptors) with 10 antineoplastic drugs, under simulated clinical conditions, including compounding and administration, and examined drug potency maintenance, plasticizer migration, and device functionality. All drugs maintained potency within 5%. Diisononyl phthalate leakage was observed from the administration adaptors for paclitaxel and concentrated etoposide solution. In addition, white particles were discovered in CSTDs storing busulfan solution and small cracks were observed on devices which stored melphalan. Thus, it was concluded that even in simulated clinical conditions, instead of extreme conditions, there are still concerns regarding the efficacy and safety of CSTD components. The methodology may be used to implement and detect possible interactions between antineoplastic agents and CSTD components before procurement.

Generating a Precision Endoxifen Prediction Algorithm to Advance Personalized Tamoxifen Treatment in Patients with Breast Cancer.

Tamoxifen is an endocrine treatment for hormone receptor positive breast cancer. The effectiveness of tamoxifen may be compromised in patients with metabolic resistance, who have insufficient metabolic generation of the active metabolites endoxifen and 4-hydroxy-tamoxifen. This has been challenging to validate due to the lack of measured metabolite concentrations in tamoxifen clinical trials. CYP2D6 activity is the primary determinant of endoxifen concentration. Inconclusive results from studies investigating whether CYP2D6 genotype is associated with tamoxifen efficacy may be due to the imprecision in using CYP2D6 genotype as a surrogate of endoxifen concentration without incorporating the influence of other genetic and clinical variables. This review summarizes the evidence that active metabolite concentrations determine tamoxifen efficacy. We then introduce a novel approach to validate this relationship by generating a precision endoxifen prediction algorithm and comprehensively review the factors that must be incorporated into the algorithm, including genetics of CYP2D6 and other pharmacogenes. A precision endoxifen algorithm could be used to validate metabolic resistance in existing tamoxifen clinical trial cohorts and could then be used to select personalized tamoxifen doses to ensure all patients achieve adequate endoxifen concentrations and maximum benefit from tamoxifen treatment.

Cellular systems biology identifies dynamic trophoblast populations in early human placentas.

INTRODUCTION: The human placenta is accessible in early developmental stages and affords a unique opportunity to investigate human organogenesis and the dynamics of transitory cell populations in human placenta development. METHODS: The cell surface proteomic profile of early trophoblast cells of first trimester human placentas was quantified using a high throughput flow cytometry screen of 370 Cluster of Differentiation (CD) antigens. Targeted investigation of candidate trophoblast progenitor populations was done through immunohistochemistry, multi-color flow cytometry, and genome wide expression analysis. RESULTS: Using a novel batch correction and normalization methodology, we identified 23 increasing and 13 decreasing markers of dynamic populations between the week 6 and week 10 of placenta development. We identified and characterized two transient populations expressing either EpCAM (CD326) or CDCP1 (CD318). Immunohistochemistry revealed these CD antigens are expressed by discrete cells with EpCAM localized to the proximal villi columns and CDCP1 to distal columns. Flow analysis confirmed independence of these populations and identified EpCAM cells as positive for EGFR. Microarray analysis indicated EpCAM+/EGFR+ and EFGR + cells showed high degree of gene expression similarities to villus cytotrophoblast but loss of EpCAM expression was concomitant with exit from the cell cycle. Similarly, CDCP1 positive trophoblast are enriched in cell cycle gene sets and expressed genes with significant similarity to extravillous cytotrophoblast. DISCUSSION: Our study indicates at least two distinct subpopulations of cytotrophoblasts exist in the early first trimester within the column that likely maintains pools of actively dividing progenitor cells giving rise to the developing placenta villous tree.