Proceedings from the Melanoma Research Foundation Mucosal Melanoma Meeting (December 16, 2022, New York, USA).

Mucosal melanoma remains a rare cancer with high mortality and a paucity of therapeutic options. This is due in significant part to its low incidence leading to limited patient access to expert care and downstream clinical/basic science data for research interrogation. Clinical challenges such as delayed and at times inaccurate diagnoses, and lack of consensus tumor staging have added to the suboptimal outcomes for these patients. Clinical trials, while promising, have been difficult to activate and accrue. While individual institutions and investigators have attempted to seek solutions to such problems, international, national, and local partnership may provide the keys to more efficient and innovative paths forward. Furthermore, a mucosal melanoma coalition would provide a potential network for patients and caregivers to seek expert opinion and advice. The Melanoma Research Foundation Mucosal Melanoma Meeting (December 16, 2022, New York, USA) highlighted the current clinical challenges faced by patients, providers, and scientists, identified current and future clinical trial investigations in this rare disease space, and aimed to increase national and international collaboration among the mucosal melanoma community in an effort to improve patient outcomes. The included proceedings highlight the clinical challenges of mucosal melanoma, global clinical trial experience, basic science advances in mucosal melanoma, and future directions, including the creation of shared rare tumor registries and enhanced collaborations.

Neuronal NADPH oxidase is required for neurite regeneration of Aplysia bag cell neurons.

NADPH oxidase (Nox), a major source of reactive oxygen species (ROS), is involved in neurodegeneration after injury and disease. Nox is expressed in both neuronal and non-neuronal cells and contributes to an elevated ROS level after injury. Contrary to the well-known damaging effect of Nox-derived ROS in neurodegeneration, recently a physiological role of Nox in nervous system development including neurogenesis, neuronal polarity, and axonal growth has been revealed. Here, we tested a role for neuronal Nox in neurite regeneration following mechanical transection in cultured Aplysia bag cell neurons. Using a novel hydrogen peroxide (H2 O2 )-sensing dye, 5'-(p-borophenyl)-2'-pyridylthiazole pinacol ester (BPPT), we found that H2 O2 levels are elevated in regenerating growth cones following injury. Redistribution of Nox2 and p40phox in the growth cone central domain suggests Nox2 activation after injury. Inhibiting Nox with the pan-Nox inhibitor celastrol reduced neurite regeneration rate. Pharmacological inhibition of Nox is correlated with reduced activation of Src2 tyrosine kinase and F-actin content in the growth cone. Taken together, these findings suggest that Nox-derived ROS regulate neurite regeneration following injury through Src2-mediated regulation of actin organization in Aplysia growth cones.

Neoadjuvant immunotherapy in resectable non-small-cell lung cancer.

The advent of immune checkpoint inhibition has pushed the treatment paradigm for resectable non-small-cell lung cancer (NSCLC) toward neoadjuvant therapy. A growing number of promising trials have examined the utility of neoadjuvant immunotherapy, both alone and in combination with other modalities such as radiation therapy (RT) and chemotherapy. The phase II LCMC3 and NEOSTAR trials demonstrated a role for neoadjuvant immunotherapy in inducing meaningful pathologic responses, and another phase II trial established the feasibility of combining neoadjuvant durvalumab with RT. Significant interest in neoadjuvant chemoimmunotherapy resulted in the conduct of multiple successful phase II trials including the Columbia trial, NADIM, SAKK 16/14, and NADIM II. Across these trials, neoadjuvant chemoimmunotherapy led to high rates of pathologic response and improved surgical outcomes without compromising surgical timing or feasibility. CheckMate-816, which was a randomized phase III trial studying neoadjuvant nivolumab in addition to chemotherapy, definitively established a benefit for neoadjuvant chemoimmunotherapy compared to chemotherapy alone for resectable NSCLC. Despite the growing literature and success of these trials, several outstanding questions remain, including the relationship between pathologic response and patient survival, the role of biomarkers such as programmed death ligand 1 and circulating tumor DNA in determining patient selection and treatment course, and the utility of additional adjuvant therapies. Longer follow-up of CheckMate-816 and other ongoing phase III trials may help address these questions. Ultimately, the complexity of managing resectable NSCLC highlights the importance of a multidisciplinary approach to patient care.

Electro- and photoactivation of silver-iron oxide particles as magnetically recyclable catalysts for cross-coupling reactions.

Colloidal Ag particles decorated with Fe3O4 islands can be electrochemically or photochemically activated as inverse catalysts for C(sp2)-H heteroarylation. The silver-iron oxide (SIO) particles are reduced into redox-active forms by cathodic charging at mild potentials or by short-term light exposure, and can be reused multiple times by magnetic cycling without further activation. A negative shift in the reduction peak is attributed to an overpotential produced by surface Fe3O4 which separates residual Ag ions or clusters from bulk silver. The catalytic efficiency of SIO is maintained even with acid degradation, which can be countered simply by adding water to the reaction medium.

A new paradigm of reliable sensing with field-deployed electrochemical sensors integrating data redundancy and source credibility.

For a continuous healthcare or environmental monitoring system, it is essential to reliably sense the analyte concentration reported by electrochemical sensors. However, environmental perturbation, sensor drift, and power-constraint make reliable sensing with wearable and implantable sensors difficult. While most studies focus on improving sensor stability and precision by increasing the system's complexity and cost, we aim to address this challenge using low-cost sensors. To obtain the desired accuracy from low-cost sensors, we borrow two fundamental concepts from communication theory and computer science. First, inspired by reliable data transmission over a noisy communication channel by incorporating redundancy, we propose to measure the same quantity (i.e., analyte concentration) with multiple sensors. Second, we estimate the true signal by aggregating the output of the sensors based on their credibility, a technique originally developed for "truth discovery" in social sensing applications. We use the Maximum Likelihood Estimation to estimate the true signal and the credibility index of the sensors over time. Using the estimated signal, we develop an on-the-fly drift-correction method to make unreliable sensors reliable by correcting any systematic drifts during operation. Our approach can determine solution pH within 0.09 pH for more than three months by detecting and correcting the gradual drift of pH sensors as a function of gamma-ray irradiation. In the field study, we validate our method by measuring nitrate levels in an agricultural field onsite over 22 days within 0.06 mM of a high-precision laboratory-based sensor. We theoretically demonstrate and numerically validate that our approach can estimate the true signal even when the majority (~ 80%) of the sensors are unreliable. Moreover, by restricting wireless transmission to high-credible sensors, we achieve near-perfect information transfer at a fraction of the energy cost. The high-precision sensing with low-cost sensors at reduced transmission cost will pave the way for pervasive in-field sensing with electrochemical sensors. The approach is general and can improve the accuracy of any field-deployed sensors undergoing drift and degradation during operation.

Radiation-Tolerant Thin-Film Electrodes for pH Monitoring in Sterile Media.

Thin-film pH electrodes on thermoplastic substrates can be subjected to γ-radiation (up to 45 kGy) without loss of stability or sensing performance, with important ramifications for monitoring analytes in sterile environments. pH-sensing membranes composed of polyvinyl chloride (PVC), trioctyl trimellitate (TOTM), and a standard hydrogen ionophore were cast onto screen-printed carbon electrodes with exfoliated graphene as a solid contact. Irradiated thin-film electrodes were conditioned in phosphate buffers and monitored for up to 3 months for changes in voltage readout and pH sensitivity, relative to untreated controls. The sensitivities of both irradiated and control electrodes were consistently Nernstian over a 100 day window, with both types exhibiting logarithmic voltage decays but in opposite directions. The γ-irradiated electrodes had excellent long-term stability with quasi-linear voltage drifts of +0.28 mV (∼0.005 pH) per day. Voltage readouts from sterilized thin-film electrodes in cell culture media could be converted by single-point calibration into pH values that fell within 0.07 units relative to a commercial pH meter (calibrated daily).

Human-level play in the game of Diplomacy by combining language models with strategic reasoning.

Despite much progress in training artificial intelligence (AI) systems to imitate human language, building agents that use language to communicate intentionally with humans in interactive environments remains a major challenge. We introduce Cicero, the first AI agent to achieve human-level performance in Diplomacy, a strategy game involving both cooperation and competition that emphasizes natural language negotiation and tactical coordination between seven players. Cicero integrates a language model with planning and reinforcement learning algorithms by inferring players' beliefs and intentions from its conversations and generating dialogue in pursuit of its plans. Across 40 games of an anonymous online Diplomacy league, Cicero achieved more than double the average score of the human players and ranked in the top 10% of participants who played more than one game.

Characterizing metastatic uveal melanoma patients who develop symptomatic brain metastases.

Metastatic uveal melanoma (mUM) is an advanced ocular malignancy characterized by a hepatotropic pattern of spread. As the incidence of brain metastases (BM) in mUM patients has been thought to be low, routine CNS surveillance has not been recommended. Notably, no formal assessment of BM incidence in mUM has to date been published to support this clinical practice. We aimed to determine the true rate of BM in mUM and to clarify the clinical and genomic risk factors associated with BM patients through a collaborative multicenter, retrospective research effort. Data collected from 1,845 mUM patients in databases across four NCI-designated comprehensive cancer centers from 2006-2021 were retrospectively analyzed to identify patients with BM. Brain imaging in most cases were performed due to onset of neurological symptoms and not for routine surveillance. An analysis of demographics, therapies, gene expression profile, tumor next generation sequencing (NGS) data, time to metastasis (brain or other), and survival in the BM cohort was completed. 116/1,845 (6.3%) mUM patients were identified with BM. The median age at time of UM diagnosis was 54 years old (range: 18-77). The median time to any metastasis was 4.2 years (range: 0-30.8). The most common initial metastatic site was the liver (75.9%). 15/116 (12.9%) BM patients presented with BM at the time of initial metastatic diagnosis. Median survival after a diagnosis of BM was 7.6 months (range: 0.4-73.9). The median number of organs involved at time of BM diagnosis was 3 (range: 1-9). DecisionDX-UM profiling was completed on 13 patients: 10-Class 2, 2-Class 1B, and 1-Class 1A. NGS and cytogenetic data were available for 34 and 21 patients, respectively. BM was identified in 6.3% of mUM cases and was associated with high disease burden and a median survival of under 8 months once diagnosed. Since most patients in this cohort were symptomatic, the incidence of asymptomatic BM remains unknown. These data suggest the use of routine brain imaging in all mUM patients at risk for developing BM for early detection.

Temperature Self-Calibration of Always-On, Field-Deployed Ion-Selective Electrodes Based on Differential Voltage Measurement.

Originally developed for use in controlled laboratory settings, potentiometric ion-selective electrode (ISE) sensors have recently been deployed for continuous, in situ measurement of analyte concentration in agricultural (e.g., nitrate), environmental (e.g., ocean acidification), industrial (e.g., wastewater), and health-care sectors (e.g., sweat sensors). However, due to uncontrolled temperature and lack of frequent calibration in these field applications, it has been difficult to achieve accuracy comparable to the laboratory setting. In this paper, we propose a novel temperature self-calibration method where the ISE sensors can serve as their own thermometer and therefore precisely measure the analyte concentration in the field condition by compensating for the temperature variations. We validate the method with controlled experiments using pH and nitrate ISEs, which use the Nernst principle for electrochemical sensing. We show that, using temperature self-calibration, pH and nitrate can be measured within 0.3% and 5% of the true concentration, respectively, under varying concentrations and temperature conditions. Moreover, we perform a field study to continuously monitor the nitrate concentration of an agricultural field over a period of 6 days. Our temperature self-calibration approach determines the nitrate concentration within 4% of the ground truth measured by laboratory-based high-precision nitrate sensors. Our approach is general and would allow battery-free temperature-corrected analyte measurement for all Nernst principle-based sensors being deployed as wearable or implantable sensors.

Clinical and genomic correlates of imatinib response in melanomas with KIT alterations.

BACKGROUND: Imatinib is an active agent for some patients with melanoma harbouring c-KIT alterations. However, the genetic and clinical features that correlate with imatinib sensitivity are not well-defined. METHODS: We retrospectively evaluated 38 KIT-altered melanoma patients from five medical centres who received imatinib, and pooled data from prospective studies of imatinib in 92 KIT-altered melanoma patients. Baseline patient and disease characteristics, and clinical outcomes were assessed. RESULTS: In the pooled analysis (N = 130), alterations in exons 11/13 had the highest response rates (38% and 33%); L576P (N = 23) and K642E (N = 12) mutations had ORR of 52% and 42%, respectively. ORR was 38% (mucosal), 25% (acral), and 8% (unknown-primary). PFS appeared longer in exon 11/13 vs. exon 17 alterations (median 4.3 and 4.5 vs. 1.1 months; p = 0.19), with similar superiority in OS (median 19.7 and 15.4 vs. 12.1 months; p = 0.20). By histology, median PFS was 4.5 months (mucosal), 2.7 (acral), and 5.0 (unknown-primary) [p = 0.36]. Median OS was 18.0 months (mucosal), 21.8 (acral), 11.5 (unknown-primary) [p = 0.26]. In multivariate analyses, mucosal melanoma was associated with higher PFS and exon 17 mutations were associated with reduced PFS. CONCLUSION: This multicenter study highlights KIT-alterations sensitive to imatinib and augments evidence for imatinib in subsets of KIT-altered melanoma.

Novel biomarkers in NSCLC: Radiomic analysis, kinetic analysis, and circulating tumor DNA.

Current radiographic methods of measuring treatment response for patients with nonsmall cell lung cancer have significant limitations. Recently, new modalities using standard of care images or minimally invasive blood-based DNA tests have gained interest as methods of evaluating treatment response. This article highlights three emerging modalities: radiomic analysis, kinetic analysis and serum-based measurement of circulating tumor DNA, with a focus on the clinical evidence supporting these methods. Additionally, we discuss the possibility of combining these modalities to develop a robust biomarker with strong correlation to clinically meaningful outcomes that could impact clinical trial design and patient care. At Last, we focus on how these methods specifically apply to a Veteran population.

Copper(I)-Pyrazolate Complexes as Solid-State Phosphors: Deep-Blue Emission through a Remote Steric Effect.

We describe a novel manifestation of rigidochromic behavior in a series of tetranuclear Cu(I)-pyrazolate (Cu4pz4) macrocycles, with implications for solid-state luminescence at deep-blue wavelengths (<460 nm). The Cu4pz4 emissions are remarkably sensitive to structural effects far from the luminescent core: when 3,5-di-tert-butylpyrazoles are used as bridging ligands, adding a C4 substituent can induce a blue shift of more than 100 nm. X-ray crystal and computational analyses reveal that C4 units influence the conformational behavior of adjacent tert-butyl groups, with a subsequent impact on the global conformation of the Cu4pz4 complex. Emissions are mediated primarily through a cluster-centered triplet (3CC) state; compression of the Cu4 cluster into a nearly close-packed geometry prevents the reorganization of its excited-state structure and preserves the 3CC energy at a high level. The remote steric effect may thus offer alternative strategies toward the design of phosphors with rigid excited-state geometries.

New targeted and epigenetic therapeutic strategies for the treatment of uveal melanoma.

Uveal melanoma (UM) is a rare, genetically bland ocular malignancy with excellent local treatment options, but no disease-specific therapies are approved for use in the metastatic setting by the Food and Drug Administration. Metastatic UM (mUM) confers a prognosis of ~15 months. Unlike cutaneous melanoma, UM is poorly responsive to checkpoint inhibitors and cytotoxic chemotherapy highlighting the importance of clarifying vulnerable disease-specific mechanisms, such as cell cycle or metabolic pathways necessary for tumor growth and survival. The elucidation of signaling pathways downstream of the frequently mutated GNA GTPase such as PKC/MAPK/ERK/MEK, PI3K/AKT, and YAP-Hippo have offered potential targets. Potentially druggable epigenetic targets due to BAP1-mutated UM have also been identified, including proteins involved with histone deacetylation and DNA splicing. This review describes the preclinical rationale for the development of targeted therapies and current strategies currently being studied in clinical trials or will be in the near future.

Chiroptical Transitions of Enantiomeric Ligand-Activated Nickel Oxides.

Ligand-induced chirality in transition-metal oxide (TMO) nanostructures have great potential for designing materials with tunable chiroptical effects. Herein, a facile strategy is reported to prepare chiroptical active nickel-oxide hybrids combined with pH adjustment, and the redox treatment results in ligand transformation, which is attributable to multiple optical transitions in the TMO nanostructures. The theoretical calculation also explains the chiral origins based on their complex models based on empirical analysis. It is also shown that enantiomeric TMO nanoparticles can be used as chiral inducers for chiroptical sensitive polymerization. These results demonstrate that TMO nanostructures can provide rational control over photochemical synthesis and chiral transfer of inorganics nanoarchitecture chirality.

Tebentafusp in advanced uveal melanoma: proof of principle for the efficacy of T-cell receptor therapeutics and bispecifics in solid tumors.

INTRODUCTION: Tebentafusp is a novel bispecific immune mobilizing T cell receptor (TCR)-based agent developed for the treatment of metastatic uveal melanoma, a highly fatal disease with no currently approved treatment options. Recent evidence suggests this drug may become the standard of care for first-line treatment of metastatic uveal melanoma. AREAS COVERED: This review focuses on the development and investigation of tebentafusp for metastatic uveal melanoma. First, we discuss preclinical studies followed by clinical evaluation, culminating in a phase III trial showing improved overall survival with tebentafusp compared to standard of care. Finally, we expand upon key toxicities of tebentafusp and highlight biomarkers that may correlate with drug efficacy. EXPERT OPINION: Tebentafusp provides a promising advancement to date for the management of metastatic uveal melanoma. Future studies should aim at identifying biomarkers that can predict treatment response or toxicity, combination therapy, application of tebentafusp in the adjuvant setting to reduce the risk of recurrence, and development of bispecifics with activity in other HLA subtypes. With its novel mechanism of action, degree of efficacy and safety profile, tebentafusp is expected to change the standard of care for treating metastatic and, potentially localized, uveal melanoma.

Steady-State and Transient Performance of Ion-Sensitive Electrodes Suitable for Wearable and Implantable Electro-Chemical Sensing.

Traditional Potentiometric Ion-selective Electrodes (ISE) are widely used in industrial and clinical settings. The simplicity and small footprint of ISE have encouraged their recent adoption as wearable/implantable sensors for personalized healthcare and precision agriculture, creating a new set of unique challenges absent in traditional ISE. In this paper, we develop a fundamental physics-based model to describe both steady-state and transient responses of ISE relevant for wearable/implantable sensors. The model is encapsulated in a "generalized Nernst formula" that explicitly accounts for the analyte density, time-dynamics of signal transduction, ion-selective membrane thickness, and other sensor parameters. The formula is validated numerically by self-consistent modeling of multispecies ion-transport and experimentally by interpreting the time dynamics and thickness dependence of thin-film solid-contact and graphene-based ISE sensors for measuring soil nitrate concentration. These fundamental results will support the accelerated development of ISE for wearable/implantable applications.

Biological and Clinical Factors Contributing to the Metabolic Heterogeneity of Hospitalized Patients with and without COVID-19.

The Corona Virus Disease 2019 (COVID-19) pandemic represents an ongoing worldwide challenge. The present large study sought to understand independent and overlapping metabolic features of samples from acutely ill patients (n = 831) that tested positive (n = 543) or negative (n = 288) for COVID-19. High-throughput metabolomics analyses were complemented with antigen and enzymatic activity assays on plasma from acutely ill patients collected while in the emergency department, at admission, or during hospitalization. Lipidomics analyses were also performed on COVID-19-positive or -negative subjects with the lowest and highest body mass index (n = 60/group). Significant changes in amino acid and fatty acid/acylcarnitine metabolism emerged as highly relevant markers of disease severity, progression, and prognosis as a function of biological and clinical variables in these patients. Further, machine learning models were trained by entering all metabolomics and clinical data from half of the COVID-19 patient cohort and then tested on the other half, yielding ~78% prediction accuracy. Finally, the extensive amount of information accumulated in this large, prospective, observational study provides a foundation for mechanistic follow-up studies and data sharing opportunities, which will advance our understanding of the characteristics of the plasma metabolism in COVID-19 and other acute critical illnesses.

Roll-to-Roll Manufactured Sensors for Nitroaromatic Organophosphorus Pesticides Detection.

A fully roll-to-roll manufactured electrochemical sensor with high sensing and manufacturing reproducibility has been developed for the detection of nitroaromatic organophosphorus pesticides (NOPPs). This sensor is based on a flexible, screen-printed silver electrode modified with a graphene nanoplatelet (GNP) coating and a zirconia (ZrO2) coating. The combination of the metal oxide and the 2-D material provided advantageous electrocatalytic activity toward NOPPs. Manufacturing, scanning electron microscopy-scanning transmission electron microscopy image analysis, electrochemical surface characterization, and detection studies illustrated high sensitivity, selectivity, and stability (∼89% current signal retention after 30 days) of the platform. The enzymeless sensor enabled rapid response time (10 min) and noncomplex detection of NOPPs through voltammetry methods. Furthermore, the proposed platform was highly group-sensitive toward NOPPs (e.g., methyl parathion (MP) and fenitrothion) with a detection limit as low as 1 µM (0.2 ppm). The sensor exhibited a linear correlation between MP concentration and current response in a range from 1 µM (0.2 ppm) to 20 µM (4.2 ppm) and from 20 to 50 µM with an R2 of 0.992 and 0.991, respectively. Broadly, this work showcases the first application of GNPs/ZrO2 complex on flexible silver screen-printed electrodes fabricated by entirely roll-to-roll manufacturing for the detection of NOPPs.

Future of immunotherapy in pancreas cancer and the trials, tribulations and successes thus far.

Pancreas ductal adenocarcinoma (PDAC) has a dismal prognosis with a 5-year survival rate of 10%. Currently, chemotherapy remains the standard of care for systemic treatment. Immunotherapy with checkpoint inhibitors unfortunately has not been found to be effective in the treatment of PDAC to date, likely due to the highly desmoplastic and immunosuppressive tumor microenvironment (TME). Treatment targeting pathways against the immunosuppressive mechanisms of PDAC are of mounting interest to improve outcomes in PDAC. In this review, we discuss prior efforts and the current state of immunotherapy in PDAC. We will also review the emerging targets and treatments with significant clinical potential for the treatment of PDAC such as: CD40 pathway, the adenosine pathway, the CXCR4/CXCL12 axis, the CCR2/CCL2 axis, IDO pathway, and others.

Biological and Clinical Factors contributing to the Metabolic Heterogeneity of Hospitalized Patients with and without COVID-19.

The Corona Virus Disease 2019 (COVID-19) pandemic represents an ongoing worldwide challenge. Exploratory studies evaluating the impact of COVID-19 infection on the plasma metabolome have been performed, often with small numbers of patients, and with or without relevant control data; however, determining the impact of biological and clinical variables remains critical to understanding potential markers of disease severity and progression. The present large study, including relevant controls, sought to understand independent and overlapping metabolic features of samples from acutely ill patients (n = 831), testing positive (n = 543) or negative (n = 288) for COVID-19. High-throughput metabolomics analyses were complemented with antigen and enzymatic activity assays on 831 plasma samples from acutely ill patients while in the emergency department, at admission, and during hospitalization. We then performed additional lipidomics analyses of the 60 subjects with the lowest and highest body mass index, either COVID-19 positive or negative. Omics data were correlated to detailed data on patient characteristics and clinical laboratory assays measuring coagulation, hematology and chemistry analytes. Significant changes in arginine/proline/citrulline, tryptophan/indole/kynurenine, fatty acid and acyl-carnitine metabolism emerged as highly relevant markers of disease severity, progression and prognosis as a function of biological and clinical variables in these patients. Further, machine learning models were trained by entering all metabolomics and clinical data from half of the COVID-19 patient cohort and then tested on the other half yielding ~ 78% prediction accuracy. Finally, the extensive amount of information accumulated in this large, prospective, observational study provides a foundation for follow-up mechanistic studies and data sharing opportunities, which will advance our understanding of the characteristics of the plasma metabolism in COVID-19 and other acute critical illnesses.