Radiation Conditioning Research Articles

Multifunctional Radiation Conditioning Emitter for Laser and Infrared with Adaptive Radiative Cooling.

With the development of technology, multifunctional multiband emitters have been paid much attention due to their wide range of applications, such as LIDAR detection, spectroscopic sensing, and infrared thermal management. However, the development of such emitters is impeded by incompatible structural requirements of different electromagnetic wavebands. Here, we demonstrate coupled modulation between near-infrared (NIR) laser-wavelength and long-wavelength-infrared by constructing a multifunctional emitter (MFE) with a structure of Al/HfO2/VO2, utilizing the phase transition of VO2. The MFE displays excellent thermal modulation capability within the 8-14 μm range, achieving a thermal insulation effect (ε8-14μm = 0.18) at low temperatures, and heat dissipation effect (ε8-14μm = 0.64) at high temperatures. The MFE's radiation power regulation capability is 145.06 W m-2 between a temperature of 0 to 60 °C. Moreover, the MFE possesses a large reflectivity modulation value of 0.78 at NIR laser-wavelength (1.06 μm) with a short phase transition time of 1003 ms under 3 W cm-2 laser irradiation. This study provides a guideline for the coordinated control of electromagnetic waves and intelligent collaborative thermal management through simple structural design, thus, having broad implications in energy saving and thermal information processing.

Allogeneic Hematopoietic Cell Transplant For Bone Marrow Failure or Myelodysplastic Syndrome in Dyskeratosis Congenita/Telomere Biology Disorders: Single-Center, Single-Arm, Open-Label Trial of Reduced-Intensity Conditioning Without Radiation

BackgroundDyskeratosis congenita/Telomere biology disorders (DC/TBD) often manifest as bone marrow failure (BMF) or myelodysplastic syndrome (MDS). Allogeneic hematopoietic cell transplant (alloHCT) rescues hematologic complications, but radiation and alkylator-based conditioning regimens cause diffuse whole-body toxicity and may expedite DC/TBD-specific non-hematopoietic complications. Optimization of conditioning intensity in DC/TBD to allow for donor hematopoietic cell engraftment with the least amount of toxicity remains a critical goal of the alloHCT field. Objectives/Study DesignWe report prospectively collected standard alloHCT outcomes from a single-center single-arm open-label clinical trial of bone marrow or peripheral blood stem cell alloHCT for DC/TBD-associated BMF or MDS. Conditioning was reduced intensity (RIC) including alemtuzumab 1mg/kg, fludarabine 200 mg/m2, and cyclophosphamide 50 mg/kg. A previous single-arm open-label phase II clinical trial for the same patient population conducted at the same center, differing only by inclusion of 200 centigray of total body irradiation (TBI), served as a control cohort. ResultsThe Non-TBI cohort included 10 patients (ages 1.7-65.9 years, median follow-up of 3.9 years) compared to the control TBI cohort which included 12 patients (ages 2.2-52.2 years, median follow-up of 10.5 years). Baseline characteristics differed only in total CD34+ cells received, with a median of 5.6 (Non-TBI) compared to 2.6 (TBI) x 106/kg (p=0.02; no difference in total nucleated cells). The cumulative incidence of day +100 grade II-IV acute and 4-year chronic graft-versus-host disease (GvHD) were low at 0 and 10% (Non-TBI) and 8 and 17% (TBI), respectively (acute, p=0.36; chronic, p=0.72). Primary graft failure was absent. Secondary non-neutropenic graft failure occurred in one (Non-TBI cohort). The Non-TBI cohort demonstrated delayed achievement of full donor chimerism but superior lymphocyte recovery. There was no difference in 4-year overall survival at 80% (Non-TBI) and 75% (TBI; p=0.78).MDS as an indication for alloHCT was uncommon, but overall associated with poor outcomes. There were 3 MDS patients in the Non-TBI cohort: 1 relapsed and died at day+387; 1 relapsed at day+500 and is alive 5.5 years later following salvage with a 2nd alloHCT; 1 relapsed at day+1093 and is alive at day +100 after a 2nd alloHCT. There was 1 MDS patient in the TBI cohort who achieved 100% donor myeloid engraftment without relapse but died at day+827 from a bacterial infection in the setting of immune mediated cytopenia. ConclusionElimination of TBI from the RIC regimen for DC/TBD was not associated with significant changes in rates of graft failure, GvHD, and overall survival, but was associated with delayed achievement of full donor chimerism and improved lymphocyte reconstitution. For DC/TBD-associated BMF, TBI appears to be dispensable. Optimal approaches to DC/TBD-associated MDS remain unclear. Larger cohorts are needed to better assess the unique contribution of TBI and donor CD34+ cell dose. Longer follow-up is required to assess differences in DC/TBD complications and late effects.

Dosimetric parameters and radiation tolerance of epitaxial diodes for diagnostic radiology and computed tomography beams

A custom-made EPI diode-based dosimetry system is thoroughly characterized for diagnostic radiology and computed tomography beams. The diode has a thin n-type epitaxial layer (50 μm) grown on a thick (300 μm) Czochralski silicon substrate. It operates as an online radiation dosimeter in the short-circuit current mode. In this case, the key dosimetric quantity is the dose rate, correlated with the output current from the diode exposed to radiation. The corresponding collected charge (the integral of the current signal) is proportional to the dose. Irradiations are performed with the Pantak-Seifert 160HS Isovolt X-ray generator previously standardized by Radcal RC6-RD and RC3-CT ionization chambers. The data gathered with all radiation quality beams confirm the linearity with dose and dose rate despite a slight energy dependence. Independently from the beam energy, the dosimetric parameters of repeatability (<0.3%), long-term stability (0.4%/year), angular response (<3%, ± 5°), dose rate dependence (<3%), and signal-to-noise ratio (≥4900) fully adhere to the IEC 61674 recommendations. Compliance with the accumulated dose stability requirement (1.0%/40 Gy) is almost achieved with the pristine diode and effectively accomplished through radiation conditioning with 60Co gamma rays. Under the latter condition, the lifespan of the diode can easily reach 15 kGy, assuring the high reusability of this diode for diagnostic radiology and computed tomography dosimetry before requiring recalibrations.

Gonadotropin-Releasing Hormone (GnRH) Agonists Do Not Protect Ovarian Function in Patients Undergoing Stem Cell Transplants.

Introduction Medical indications for fertility preservation include any malignancy, chronic illness, or disease that would require gonadotoxic chemotherapy or radiation (conditioning regimens), which would impede a woman's ability to conceive in the future. Thus, any patient who plans to undergo a gonadotoxic regimen is advised to cryopreserve oocytes or embryos, which can be used in the future at the patient's convenience. Attempts have been made to suppress ovarian function with gonadotropin-releasing hormone agonists (GnRH-a) to induce ovarian quiescence and, thereby, theoretically limit the gonadotoxicimpact onthe follicular pool. We explored the use of leuprolide (a type of GnRH-a) inpreventing primary ovarian insufficiency (POI) in a cohort study of patients who underwent hematopoietic stem cell transplants (HSCT) at the National Institutes of Health(NIH); since the conditioning regimens for HSCT include cyclophosphamide and other gonadotoxic therapies, we hypothesized that GnRH-a would be ineffective in preventing POI. Methods We assessedpatients who underwent fertility preservation prior to their stem cell transplant, as their follicular-stimulating hormone(FSH) levels were evaluated prior to and post-chemotherapy. Twenty-nine patients who underwent hormonal evaluation prior to and post-chemotherapy were included. The control group did not receive GnRH-a prior to chemotherapy, while the treatment group did receive GnRH-a pre-chemotherapy. Results Our data revealed that 80% of the control group had menopausal levels post-chemotherapy, while 91% of the treatment group still had menopausal levels post-chemotherapy (p=0.33). Conclusions Thus, our hypothesis that GnRH-a is ineffective in reducing the risk of POI in a cohort of patients who receive conditioning regimens for HSCT was confirmed.

Pulmonary, Hepatic, and Allogeneic Hematopoietic Stem Cell Transplantation in Patients with Telomere Biology Disorders.

This study aimed to summarize evidence and provide consensus-based guidelines for management of transplantation in patients with telomere biology disorders (TBD). Specifically, this review focuses on clinical management of lung, liver, and bone marrow transplantation in TBD patients. TBD patients have specific unique biological vulnerabilities such as T cell immunodeficiency, susceptibility to infections, hypersensitivity to chemotherapy and radiation, and cytopenias. Furthermore, multiple organ involvement at diagnosis makes clinical management especially challenging due to higher degree of organ damage, and stress-induced telomeric crisis. Sequential and combined organ transplants, development of novel radiation and alkylator-free conditioning regimen, and use of novel drugs for graft-versus-host disease prophylaxis are some of the recent updates in the field. Multidisciplinary management is essential to optimize transplant outcomes in patients with TBD. In this review, we provide consensus-based transplant management guidelines for clinical management of transplant in TBD.

Thrombopoietin mimetic therapy alleviates radiation-induced bone marrow vascular injury in a bone marrow transplant mouse model.

There is a need for therapies that can mitigate bone marrow dysfunction and organ toxicity that occur following myeloablative injury and reduced intensity conditioning regimens used in patients undergoing bone marrow transplantation (BMT). The pathogenesis of adverse effects from BMT conditioning has been linked to injury to the vascular endothelium, bone marrow (BM), and other organs. To evaluate the impact of the thrombopoietin mimetic drug JNJ-26366821 (TPOm) on BM vascular recovery in mice undergoing myeloablative radiation conditioning followed by BMT. TPOm (doses: 0 µg, 300 µg, 1000 µg per Kg body weight) was administered on Days 0 and 7 after BMT, in mice receiving a total body irradiation (TBI) conditioning regimen (5.5 Gy x 2) before congenic BMT. BM donner cell engraftment was analyzed using flow cytometry on Days 7, 14, and 30 post-BMT. The morphological and biophysical properties of the BM vasculature were evaluated by intravital multiphoton microscopy (MPM) and immunofluorescence confocal imaging. Herein, morphological properties involve microvascular density (MVD), vessel diameter, and vascular area, while biophysical properties include transfer rate (Ktrans) of contrast within the BM vascular niche, as well as the fractional volume (vec ) of extracellular extravascular tissue (EES). No significant difference in donor chimerism was observed at days 7, 14, and 30 post-BMT, between TPOm and PBS-treated mice. TPOm intervention improved BM vasculature regeneration in transplanted mice. The MVD, Ktrans, and BM vasculature as well as vascular endothelial growth factor receptor-2 (VEGFR2) in the BM, showed a dose dependent improvement in mice treated with TPOm. On day 14 post-BMT, the group receiving 1000 µg/Kg TPOm showed significant shifts (p-value < 0.05) in MVD, Ktrans, and VEGFR2 expression from their corresponding control types (TPOm dose 0 µg) towards levels comparable to healthy controls. TPOm intervention augments BM vascular structure and function, which may be important for hematopoietic recovery and bone marrow function in radiation conditioned hematopoietic stem cell transplant patients, in addition to enhancing platelet recovery.

Hematopoietic Stem Cell Transplantation (HCT) Conditioning Leads to NK Cell Cytotoxicity Limiting Endogenous Thymus Regeneration

The thymus is highly sensitive to acute injury such as the cytoreductive conditioning given pre-hematopoietic stem cell transplant (HCT). The thymus is capable of regeneration, however its reparative capacity and T cell productivity decline with age. This leaves HCT recipients vulnerable to relapse of malignancy and opportunistic infection - the leading causes of post-HCT mortality - during a prolonged period of lymphopenia. Better understanding the endogenous mechanisms by which thymus regeneration is regulated may inform therapeutic interventions to improve T cell reconstitution in these patients. Here, we report that HCT conditioning leads to rises in stimulatory cytokine IL-18, subsequent activation of NK cells and increased cytotoxicity, which aberrantly suppresses organ recovery. Our group has reported that HCT-conditioning by ionizing radiation leads to increased Caspase-1 mediated immunogenic cell death within the thymus (Kinsella 2023 BioRxiv). Consistent with the cleavage of Caspase-1, we found an increase in release of the inflammatory cytokines IL-1b and IL-18. Although mice deficient for IL-1b signaling receptor ( Il1r -/-) did not show any modulation in their ability to regenerate after TBI, we found that mice deficient for IL-18 signaling (Il18 -/-) exhibited increased thymic cellularity one week following acute damage by sublethal irradiation (SL-TBI) (Fig. 1A left). This led us to conclude that post-damage activation and release of IL-18 suppresses thymus regeneration. We found that IL-18R was not expressed on most developing thymocytes and although a minority of thymic epithelial cells expressed the receptor, mice with a deficiency in IL-18R restricted to TECs ( Il18r1fl/fl:Foxn1-Cre +) showed no difference in regenerative capacity following conditioning. To rule out an effect on hematopoietic progenitors, for which IL-18R expression has been reported ( Silberstein 2016 Cell Stem Cell 6;19), we performed a competitive transplantation of Il18r1 -/- and WT bone marrow and measured T cell production, which showed no competitive advantage of Il18r1 -/- donor cells; this demonstrated that IL-18 does not directly regulate progenitor cells themselves, but rather, more likely acts via a bystander thymus-resident population. Within the thymus, IL-18R was expressed by highly radioresistant NK1.1 + NKT and NK cells. Depletion of both populations with anti-NK1.1 monoclonal antibody improved thymus cellularity in WT mice (Fig. 1A middle). Notably, NKT deficient CD1d -/- mice showed no defective repair which suggested that the depletion upon NK1.1 + cell depletion is largely mediated by NK cells. Depletion of NK1.1 + cells in Il18 -/- mice did not improve regeneration further, suggesting that NK-mediated suppression is IL-18 dependent. Given the known role of IL-18 in NK cell activation, we hypothesized that the HCT-conditioning resultant rise in IL-18 stimulates NK cells leading to “accidental” targeting of regeneration promoting cells. NK cell production of cytotoxic factors including IFNg, GzmB and Perforin increases following radiation conditioning, although only mice deficient for Perforin and not IFNg -exhibited improved thymus cellularity 7 days post HCT-conditioning (Fig 1A right). Further supporting this hypothesis, IL-18R +CD49b + NK cells isolated from the thymus 2-days post-irradiation induced more target cell death in head-to-head cytotoxicity assays compared to NK cells isolated pre-radiation (Fig 1B). Finally, we observe TEC downregulation of NK cytotoxicity inhibitory ligand MHC-I following radiation conditioning, suggesting that critical regeneration promoting stroma may be the targets of these activated NK cells. These findings suggest that, while necessary for successful transplantation, conditioning regimens may induce cytotoxicity of bystander NK cells which suppresses thymus recovery. Furthermore, we implicate conditioning induced immunogenic cell death and increased IL-18 in the stimulation of these suppressive cytotoxic cells and suggest that therapeutically targeting IL-18 and NK cell cytotoxicity may improve T cell reconstitution post-HCT.

First Documentation of Cell-to-Cell Peroxisome Transfer in Hematopoietic Stem and Progenitor Cells: A Method to "Relieve Stress"?

Cell to cell communication is key to survival. Recently it has been demonstrated that intercellular transfer of mitochondria occurs and can aid in marrow recovery after irradiation. Peroxisomes are a single membrane bound organelle responsible for various functions including lipid metabolism and protecting the cell from oxidative damage by reactive oxygen species (ROS). We have created the first mouse model in which peroxisomes can be tracked in living tissues using GFP tagged with a peroxisome targeting signal sequence (PTS), under the control of the Rosa promoter. Such GFP-PTS animals showed widespread peroxisomal GFP expression in all organs including hematopoietic stem and progenitor cells (HSPC) such as LSK-SLAM. Marrow stroma cell lines were established from GFP-PTS animals. In vitro peroxisome transfer from stroma to HSPC showed a transfer rate of up to 0.5 %, which could be achieved only when cell-to-cell contact took place; the use of transwells inhibited transfer. When HSPCs were simulated to proliferate, peroxisome transfer dropped by 50.1% (p<0.0001). The ability of HSPC to take up peroxisomes in vivo was tested in a model of hematopoietic cell transplant (HCT). Using GFP-PTS mice as recipients with wild-type (WT) marrow donors, we found that after busulfan or radiation (9 Gy) conditioning, peroxisome transfer could occur into WT adoptively HSPC within 48 hours after HCT at a rate of 1%. At 3 months post HCT, bone marrow mononuclear cells (BMMC) and Lin-SCA1+CKIT+ (LSK) were 100% donor and maintained GFP+peroxisomes at a frequency of 0.9% which were transferred from surrounding niche/stroma cells. To test HSPC to HSPC peroxisome transfer, sublethal conditioning (4.5 Gy) of WT was used to generate mixed chimerism models with marrow from GFP-PTS mice used as donor. Total peripheral or marrow engraftment was 45-55% donor as expected at 3 months post-HCT. WT BMMC could take up peroxisomes at a 0.9% frequency, while LSK had a significantly higher peroxisome uptake of 3.9% (p=0.02) indicating greater efficiency. Results were similar if GFP-PTS+ animals were recipients in a sublethal transplant setting. Remarkably, we could also demonstrate that peroxisome transfer can occur between GFP-PTS donor hematopoietic cells and WT cells in the liver, spleen, thymus, and brain after HCT. The genetic deletion of peroxisomes (via pex1 knockout) in animals resulted in ROS levels 10.3-fold over that of wild-type in PBMC, BMMC, and LSK (p<0.0001) as assessed by CellROX assay. Such animals had a severe defect in growth, had normal hematopoiesis, and increased radiation sensitivity indicating the importance of peroxisomes in reducing oxidative stress. To test the hypothesis that peroxisome transfer is utilized in situations of increased oxidative stress, pex1 KO stroma lines were exposed to increasing doses of radiation followed by incubation with GFP-PTS+ BMMC. Radiation treatment enhanced peroxisome transfer 5.1-fold over no-irradiated control (p<0.01), and cells receiving donor peroxisomes had greater viability (84% vs 68% viable, p<0.01) and reduced levels oxidative stress 24.8% compared to cell not receiving peroxisomes (p=0.03). The entire system was reproduced in a zebrafish model expressing GFP-PTS. Sublethally irradiated WT zebrafish engrafted donor GFP-PTS+ marrow at 50% and showed a significantly high rate of peroxisome uptake of into WT HSPS of 30% at 3 months post-HCT, suggesting some species may perform peroxisome transfer at much greater rates than others. In conclusion, we have demonstrated, for the first time, that peroxisome transfer can occur between a wide variety of cell types in vitro and in vivo, and HSPC-to-HSPC peroxisome transfer seems to be the most robust. The ability of peroxisome transfer to rescue cells from radiation-induced ROS and death was demonstrated in vitro while in vivo experiments are proceeding. There may be other far-reaching effects in terms of altering cellular metabolism occurring as a result of peroxisome transfer remaining to be discovered.

Intravenous Lentiviral Gene Therapy for Hemophilia a: Endothelial-Specific Expression and Increased Glycosylation for Improved FVIII Function

Background: Hemophilia A (HA) is an X-linked monogenic coagulation disorder in the intrinsic coagulation cascade resulting from deficiency of the factor VIII (FVIII, F8) gene. The current treatment of HA is based on protein replacement therapy (PRT) with limitations of short half-life, high cost, and life-time requirement of the treatment. Gene therapy has become a promising treatment option for HA. Methods: An advanced lentiviral vector (LV) system for intravenous (iv) F8 gene therapy has been established based on a novel B domain deleted (BDD) F8 gene, which restored all N-glycosylation sites (F8-299) in the B domain with increased coagulation function (DOI:10.1016/j.jbc.2021.101397). LV-F8-299 containing a universal (EF1a) or endothelial-specific (VEC) promoter was investigated in vitro using a human endothelial cell line, EA-hy926, and biologically and immunologically characterized in vivo in F8 knockout (KO) mice and in a non-human primate. Results: We found that LV-VEC-F8-299 (VEC-299) exhibited higher virus packaging (100 folds) and transduction efficiencies than EF1a-299. The F8 protein expression was verified in EA-hy926 by RT-PCR, Western blot and ELISA. We detected F8 activities close to 4 folds above the normal plasma level from the EF1a-299 transduced cells, whereas the VEC-299 expressed only 0.1 fold of the normal plasma F8 level. In vivo studies in F8 KO mice via iv injection of LVs after non-myeloablative radiation conditioning illustrated variable phenotypic corrections as well as anti-F8 immune responses from the two LVs. The iv gene therapy of EF1a-299 and VEC-299 LVs illustrated therapeutic F8 activities over time, in the range of 90% and 40%, respectively, in 60 days. Importantly, VEC-299 steadily reached a very high level (180%) of F8 activities, whereas EF-299 dropped to 3% after 120 days (Figure A). Kinetic analyses of anti-F8 IgG and inhibitor titer showed that the VEC-299 treated mice exhibited the lowest F8 inhibitory immune response over time. We next assessed the distribution of LV F8 gene in a macaque monkey (Macaca fascicularis). The monkey was chemo-conditioned with methylprednisolone (10 mg/kg) and prednisone (2 mg/kg) and iv injected with 1x109 TU/kg LV-VEC-299. The vector copy number (VCN) in body fluids was closely monitored by qPCR. From day 1 to week 14 after injection, the VCN in the blood remained stable (~1%), while in feces and saliva was high on day 1 (~3%), and in urine reached peak (~5%) on day 7, but all of which decreased with time. The VCN in body fluids (blood, urine, faces, saliva and tear) became nearly undetectable after 14 weeks. A second LV injection of 1x109TU/kg LV-VEC-299 was performed using a modified non-myeloablative conditioning with busulfan (2 mg/kg), cyclophosphamide (40 mg/kg) and dexamethasone (3 mg/kg). The VCN in the blood reached 20% from day 1 to day 7, then reduced to 5% and remained stable to week 6 (Figure B). The blood biochemical analyses including Alanine Transaminase (ALT), Aspartate Transaminase (AST), Total Protein (TP) and Albumin (ALB) remained in the normal range before and after treatment. Conclusion: These results demonstrated that the LV-VEC-299 exhibited delivery consistency, high coagulation function and low immunogenicity. The in vivo study supported that iv LV-VEC-299 gene therapy could be a safe, convenient and effective HA gene therapy strategy. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Total marrow irradiation reduces organ damage and enhances tissue repair with the potential to increase the targeted dose of bone marrow in both young and old mice.

Total body irradiation (TBI) is a commonly used conditioning regimen for hematopoietic stem cell transplant (HCT), but dose heterogeneity and long-term organ toxicity pose significant challenges. Total marrow irradiation (TMI), an evolving radiation conditioning regimen for HCT can overcome the limitations of TBI by delivering the prescribed dose targeted to the bone marrow (BM) while sparing organs at risk. Recently, our group demonstrated that TMI up to 20 Gy in relapsed/refractory AML patients was feasible and efficacious, significantly improving 2-year overall survival compared to the standard treatment. Whether such dose escalation is feasible in elderly patients, and how the organ toxicity profile changes when switching to TMI in patients of all ages are critical questions that need to be addressed. We used our recently developed 3D image-guided preclinical TMI model and evaluated the radiation damage and its repair in key dose-limiting organs in young (~8 weeks) and old (~90 weeks) mice undergoing congenic bone marrow transplant (BMT). Engraftment was similar in both TMI and TBI-treated young and old mice. Dose escalation using TMI (12 to 16 Gy in two fractions) was well tolerated in mice of both age groups (90% survival ~12 Weeks post-BMT). In contrast, TBI at the higher dose of 16 Gy was particularly lethal in younger mice (0% survival ~2 weeks post-BMT) while old mice showed much more tolerance (75% survival ~13 weeks post-BMT) suggesting higher radio-resistance in aged organs. Histopathology confirmed worse acute and chronic organ damage in mice treated with TBI than TMI. As the damage was alleviated, the repair processes were augmented in the TMI-treated mice over TBI as measured by average villus height and a reduced ratio of relative mRNA levels of amphiregulin/epidermal growth factor (areg/egf). These findings suggest that organ sparing using TMI does not limit donor engraftment but significantly reduces normal tissue damage and preserves repair capacity with the potential for dose escalation in elderly patients.

Feasibility of a Novel Sparse Orthogonal Collimator-Based Preclinical Total Marrow Irradiation for Enhanced Dosimetric Conformality.

Total marrow irradiation (TMI) has significantly improved radiation conditioning for hematopoietic cell transplantation in hematologic diseases by reducing conditioning-induced toxicities and improving survival outcomes in relapsed/refractory patients. Recently, preclinical three-dimensional image–guided TMI has been developed to enhance mechanistic understanding of the role of TMI and to support the development of experimental therapeutics. However, a dosimetric comparison between preclinical and clinical TMI reveals that the preclinical TMI treatment lacks the ability to reduce the dose to some of the vital organs that are very close to the skeletal system and thus limits the ability to evaluate radiobiological relevance. To overcome this limit, we introduce a novel Sparse Orthogonal Collimator (SOC)–based TMI and evaluate its ability to enhance dosimetric conformality. The SOC-TMI–based dose modulation technique significantly improves TMI treatment planning by reducing radiation exposures to critical organs that are close to the skeletal system that leads to reducing the gap between clinical and preclinical TMI.

Total Marrow and Lymphoid Irradiation with Post-Transplantation Cyclophosphamide for Patients with AML in Remission

Graft-versus-host disease (GVHD) has remained the main cause of post-transplantation mortality and morbidity after allogeneic hematopoietic cell transplantation (alloHCT), adding significant economic burden and affecting quality of life. It would be desirable to reduce the rate of GVHD among patients in complete remission (CR) without increasing the risk of relapse. In this study, we have tested a novel conditioning regimen of total marrow and lymphoid irradiation (TMLI) at 2000 cGy, together with post-transplantation cyclophosphamide (PTCy) for patients with acute myeloid leukemia in first or second CR, to attenuate the risk of chronic GVHD by using PTCy, while using escalated targeted radiation conditioning before allografting to offset the possible increased risk of relapse. The primary objective was to evaluate the safety/feasibility of combining a TMLI transplantation conditioning regimen with a PTCy-based GVHD prophylaxis strategy, through the assessment of adverse events in terms of type, frequency, severity, attribution, time course, duration, and complications, including acute GVHD, infection, and delayed neutrophil/platelet engraftment. Secondary objectives included estimation of non-relapse mortality (NRM), overall survival (OS), relapse-free survival, acute and chronic GVHD, and GVHD-relapse-free survival (GRFS). A patient safety lead-in was first conducted to ensure there were no unexpected toxicities and was expanded on the basis of lack of dose-limiting toxicities. The patient safety lead-in segment followed 3 + 3 dose expansion/(de-)escalation rules based on observed toxicity through day 30; the starting dose of TMLI was 2000 cGy, and a de-escalation to 1800 cGy was considered. After the safety lead-in segment, an expansion cohort of up to 12 additional patients was to be studied. TMLI was administered on days −4 to 0, delivered in 200 cGy fractions twice daily. The radiation dose delivered to the liver and brain was kept at 1200 cGy. Cyclophosphamide was given on days 3 and 4 after alloHCT, 50 mg/kg each day for GVHD prevention; tacrolimus was given until day 90 and then tapered. Among 18 patients with a median age of 40 years (range 19-56), the highest grade toxicities were grade 2 Bearman bladder toxicity and stomatitis. No grade 3 or 4 Bearman toxicities or toxicity-related deaths were observed. The cumulative incidence of acute GVHD grade 2 to 4 and moderate-to-severe chronic GVHD were 11.1% and 11.9%, respectively. At a median follow up of 24.5 months, two-year estimates of OS and relapse-free survival were 86.7% and 83.3%, respectively. Disease relapse at 2 years was 16.7%. The estimates of NRM at 2 years was 0%. The GVHD/GRFS rate at 2 years was 59.3% (95% confidence interval, 28.8-80.3). This chemotherapy-free conditioning regimen, together with PTCy and tacrolimus, is safe, with no NRM. Preliminary results suggest an improved GRFS rate.

Исследование безуглеродной радиационной системы жизнеобеспечения в весенний и осенний периоды

Solar energy refers to renewable carbon-free energy. Experimental studies conducted in the springautumn periods of 2018–2021. In the conditions of the sharply continental climate of Western Siberia allowed us to draw a number of conclusions about the applicability of the radiation life support system for cottages, rural houses and other detached buildings. During the research, a large number of experimental temperature measurements are carried out with their recording in the memory of the logger 88598. The temperatures are recorded on the measuring cell of the experimental stand. The obtained experimental data are processed. In spring and autumn, it is more rational to replace radiation conditioning with ventilation, since at night the temperature difference between the radiation panel and the surrounding air is small.

Toward a realistic asphalt mix ageing protocol

The time-associated changes of the asphalt cement properties significantly impact the performance and durability of pavements. Different techniques have been introduced to simulate pavement ageing, most of which use elevated temperatures and neglect factors such as moisture and solar radiation. This research evaluated the coupling effect of solar radiation, heat, and moisture conditioning on the laboratory compacted plant mixes to achieve representative aged samples for performance testing. Rheological and chemical analysis were then performed on samples at various stages of the conditioning process and recovered asphalt cement. Temperature-Sensitivity of the rheological parameters were evaluated using time-temperature superposition shift factors. Carbonyl and sulfoxide indices and carbonyl to sulfoxide ratios were used to assess the kinetics of the age-related chemical changes. This study showed that coupling moisture and solar radiation could alter the chemistry and rheology of conditioned samples.

Intravenous Lentiviral Gene Therapy for Hemophilia a: In Vitro and In Vivo Assessment of Universal Versus Tissue-Specific Promoters

Background：Hemophilia A (HA) is an X-linked monogenic coagulation disorder resulting from deficiency of the factor VIII (FVIII, F8) gene in the intrinsic coagulation cascade. The current treatment of HA is based on protein replacement therapy (PRT) through plasma-derived coagulation factors or recombinant proteins with limitations of short half-life, high cost, and life-time requirement of the treatment. Gene therapy has become a promising treatment for HA.Methods and Materials: We developed an advanced lentiviral vector (LV) system for intravenous (iv) F8 gene therapy. A selective codon optimized and B-domain deleted human F8 (hF8BDD) gene was synthesized, sequenced and functionally verified. LVs carrying a universal EF1α promoter, or several modified tissue-specific promoters including endothelial- (VEC), endothelial and epithelial- (KDR), and two megakaryocyte-specific (ITGA and Gp) promoters, were biologically and immunologically characterized in vitro using human endothelial and megakaryocytic cell lines, EA-hy926 and DAMI, and in vivo using F8 knockout (KO) mice.Results: We investigated the different LV promoter constructs and found that LV-VEC-F8BDD exhibited the highest virus packaging (1.3x10 9 transduction units/ml) and transduction efficiencies compared with the other LV constructs. Tissue-specific expression of the VEC, KDR, ITGA and Gp promoters was confirmed in EA-hy926 and DAMI cells by RT-PCR, Western blot and ELISA analyses. We detected F8 activities close to 6 folds and 4.5 folds above the normal plasma level from the EF1a LV-F8BDD transduced EA-hy926 cells and DAMI cells, respectively, whereas the VEC LV in EA-hy926 cells and the ITGA-LV in DAMI cells exhibited F8 activities at 1.5 folds and 5 folds above the normal plasma level, respectively. In vivo studies in F8 KO mice via iv injection of LVs after reduced radiation conditioning illustrated preferential vector expression in different cell lineages, with high expression of EF1a vector in CD11b, F4/80 and Ly-6G positive immune cells, and preferential expression of VEC vector in CD31 positive endothelial cells, and ITGA and Gp vectors in CD41 positive megakaryocytes. In addition, we detected variable phenotypic corrections as well as anti-F8 immune responses in the F8 KO mice treated with the different LVs. The iv deliveries of VEC and Gp F8BDD vectors illustrated therapeutic F8 activities over time, around 25% and 8%, respectively, in 60 days, which increased to high levels (80% and 25%, respectively) after 120 days (Figure A). Kinetic analyses of anti-F8 IgG and inhibitor titers (Bethesda assay) of the treated mice showed that the VEC vector exhibited the lowest F8 inhibitory immune response over time (Figure B).Conclusion: Based on the in vitro and in vivo studies, our results suggest that for HA gene therapy, optimal rather than high F8 expression is critical, and tissue-specific expression but not universal expression can reduce adverse inhibitor effect. We demonstrated that the LV-VEC-F8BDD vector displayed high tissue specificity in vivo, and high transgene delivery efficiency, high coagulation function and low immunogenicity. In addition, iv LV gene therapy could be a safe, convenient and effective HA gene therapy strategy. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

The Application of ‘Drug-Reversible’ CAR-T Cells Directed Against Recipient Hematopoietic Cells As a Selective Conditioning Strategy for Stem Cell Transplantation

The transplant of autologous or allogeneic hematopoietic stem cells (HSCs) has the proven ability to treat a wide array of malignant and non-malignant hematological diseases. The preparative regimen, however, routinely entails aggressive and genotoxic treatment with total body irradiation and/or chemotherapy, which brings severe and even life-threatening complications that limit its broader application. Previous experimental studies have established that depletion of recipient HSCs is an essential requirement of these conditioning regimens in allowing successful engraftment of the composite donor HSCs. Animal and clinical studies have also indicated that alloreactive anti-HSC donor T cells additionally facilitate stem cell engraftment, but this is often accompanied by the risks of GvHD. This has prompted the consideration of alternative conditioning methods for the depletion of HSCs with less toxic side-effects, such as anti-c-kit and anti-CD45 antibody-directed treatments. In this way, more precise HSC targeting may also be achieved by the application of short-lived, genetically engineered chimeric antigen receptor (CAR)-T cells for stem cell transplantation conditioning.We developed a novel and controllable CAR-T approach for recipient HSC targeting via genetic modification using the non-viral piggyBac™ (PB) transposon system. As opposed to viral vector delivery systems, the relatively large carrying capacity of PB allows the stable introduction of at least three separate genes encoded within the same tri-cistronic transgene cassette. This includes a second-generation CAR that targets either human c-kit (CD117) or prominin-1 (CD133), markers known to be antigenically expressed on the surface of HSCs. In addition, a drug resistance element serves as a selection gene that, in combination with a non-genotoxic drug, provides an effective method of CAR-T cell purification during manufacture. Importantly, a small molecule drug-inducible safety switch gene is also included to facilitate rapid in vivo clearance of the CAR-T cells after depletion of recipient HSCs and prior to donor HSC transplant. Lastly, as a result of the manufacturing process, the majority of the CAR-T cells express chemokine receptors such as CXCR4 that can allow more selective trafficking to the bone marrow (BM) for eradication of resident HSCs.To select a lead candidate from a panel of anti-HSC CAR constructs, CD3/CD28 stimulated T cells from human peripheral blood were first electroporated with mRNA encoding each of the CAR candidates directed against either c-kit or CD133. CAR surface expression was confirmed in transfected T cells by flow cytometry. In vitro functional assays were performed by co-culturing mRNA-transfected CAR-T cells with mouse or human cell lines (EML-C1, TF-1 and K562), expressing either c-kit or CD133, as well as mouse and human primary BM cells. Lead CAR candidates were identified from their specific activation of the CAR-T cells through degranulation according to CD107a expression and secretion of IFNγ. Furthermore, those CARs were also capable of selectively depleting c-kit or CD133 positive cells. Interestingly, some mRNA-transfected CAR-T cells retained effector activity against target c-kit+ TF-1 cells even in the presence of its soluble ligand, stem cell factor. Next, lead CAR candidates were co-expressed with the selection and drug-inducible safety switch genes in the same tri-cistronic transgene and then stably delivered to T cells using PB. The manufacturing process yielded CAR-T cells that were mainly of the T memory stem cell (Tscm) phenotype, as determined by positive expression of CD62L and CD45RA, and also expressed high levels of the CXCR4 chemokine receptor. Similar to the mRNA-transfected CAR-T cells, these stably-transposed cells were capable of extensive effector capabilities including specific depletion of c-kit or CD133 expressing target cells.Future studies will evaluate PB-produced lead anti-HSC CAR-T cells in immune-deficient NSG mice with pre-established xenogeneic human hematopoietic chimerism, along with standard busulfan or radiation conditioning controls. This approach constitutes a novel targeted biological therapy that is envisaged to lead the way towards minimally toxic transplant regimens for depletion of endogenous HSCs in the BM and to procure their replacement with engrafted allogeneic or gene-corrected stem cells. DisclosuresTimberlake:Poseida Therapeutics, Inc.: Employment. Richter:Poseida Therapeutics, Inc.: Employment. Wang:Poseida Therapeutics, Inc.: Employment. Cam:Poseida Therapeutics, Inc.: Employment. Tan:Poseida Therapeutics, Inc.: Employment. Ostertag:Poseida Therapeutics, Inc.: Employment, Equity Ownership. Shedlock:Poseida Therapeutics, Inc.: Employment. Down:Poseida Therapeutics, Inc.: Employment.

First Multimodal, Three-Dimensional, Image-Guided Total Marrow Irradiation Model for Preclinical Bone Marrow Transplantation Studies

Total marrow irradiation(TMI) has significantly advanced radiation conditioning for hematopoietic cell transplantation inhematologicmalignancies by reducing conditioning-induced toxicities and improving survival outcomes in relapsed/refractory patients. However, the relapse rate remains high, and the lack of a preclinical TMI model has hindered scientific advancements. To accelerate TMI translation to the clinic, we developed a TMI delivery system in preclinical models. A Precision X-RAD SmART irradiator was used for TMI model development. Images acquired with whole-body contrast-enhanced computed tomography (CT) were used to reconstruct and delineate targets and vital organs for each mouse. Multiple beam and CT-guided Monte Carlo-based plans were performed to optimize doses to the targets and to vary doses to the vital organs. Long-term engraftment and reconstitution potential were evaluated by a congenic bone marrow transplantation (BMT) model and serial secondary BMT, respectively. Donor cell engraftment was measured using noninvasive bioluminescence imaging and flow cytometry. Multimodal imaging enabled identification of targets (skeleton and spleen) and vital organs (eg, lungs, gut, liver). In contrast to total body irradiation (TBI), TMI treatment allowed variation of radiation dose exposure to organs relative to the target dose. Dose reduction mirrored that in clinical TMI studies. Similar to TBI, mice treated with different TMI regimens showed full long-term donor engraftment in primary BMT and second serial BMT. The TBI-treated mice showed acute gut damage, which was minimized in mice treated with TMI. A novel multimodal image guided preclinical TMI model is reported here. TMI conditioning maintained long-term engraftment with reconstitution potential and reduced organ damage. Therefore, this TMI model provides a unique opportunity to study the therapeutic benefit of reduced organ damage and BM dose escalation to optimize treatment regimens in BMT and hematologic malignancies.

Prevention and treatment of radiation-induced lung injury.

Radiation-induced lung injury (RILI) is a common complication in cancer patients receiving local thoracic radiation and bone marrow transplantation conditioning. It is divided into early-stage radiation pneumonitis and advanced radiation fibrosis of thelung. This severely hampers the quality of life and survival of cancer patients. Meanwhile, RILI is a major factor limiting radiation doses in clinical practice, which affects the local control of cancer. Unfortunately, the mechanism of RILI is still not well defined, and there are no treatment options available for these patients. In this reviewwe summarizethe methods and agents used for the treatment and prevention of RILI, with theaim of increasingunderstanding ofRILI.

A novel mouse model of acute graft-versus-host disease based on chemotherapy conditioning and G-CSF mobilized graft.

Acute graft-versus-host disease (aGVHD) is an important complication of allogeneic hematopoietic cell transplantation (HCT). The majority of aGVHD mouse models are based on radiation conditioning and bone marrow as graft, despite that most allo-HCTs performed now in clinic are based on chemotherapy conditioning and G-CSF mobilized graft. Aiming for a higher translational value, we constructed an MHC major mismatched [C57BL/6 (H-2 Kb) to BALB/c (H-2Kd)] aGVHD mouse model based on busulfan/cyclophosphomide (BU-CY) conditioning and human G-CSF mobilized splenocytes as graft. Allogeneic transplanted mice showed quick and profound donor engraftment. Moreover, there were quick onset (day +7) of typical clinical and histopathological signs of aGVHD, which gradually developed to extensive aGVHD. In addition, CD8+ T cells were the main aGVHD contributing T-cell subtype. No toxicity or GVHD signs were observed in the syngeneic setting. This clinical-relevant model offers a promising platform for future studies on aGVHD.

Laboratory simulation of the impact of solar radiation and moisture on long-term age conditioning of asphalt mixes

Ageing is a renowned phenomenon for pavement engineers that can substantially affect the durability and long-term performance of flexible pavements. Several factors affect the mechanism of age-related changes, including asphalt cement’s chemical composition, mix properties, and environmental conditions. Most of the laboratory accelerated age hardening procedures are trying to simplify conditioning by considering heat as the main affecting factor and neglecting the others, such as humidity, precipitation, and solar radiation. This research aims to examine the validity of such an assumption and evaluate the effect of photo-oxidation, moisture and precipitation on the chemical and rheological properties of the asphalt cement and mix.In this research, a plant produced asphalt mix was selected and subjected to four different age conditioning procedures including Long-Term Oven Ageing procedure (AASHTO R30), Atlas® Whetherometer™, and using a bespoke chamber by applying dry and wet cycles of solar radiation and water conditioning. After running the Complex Modulus test on unconditioned and conditioned asphalt mix samples, asphalt cement was recovered and subjected to chemical and rheological analysis. The 2S2P1D model was employed to develop Complex Modulus and Phase Angle master curves. Results of this research showed that concerning chemical changes, extended heating at excessively high temperatures would result in different chemical products of oxidation as compared to solar radiation technique in terms of Carbonyl and Sulfoxide Indices. Moreover, it was observed that the extended heating procedure resulted in less stiffening at the low-temperature range in comparison with solar radiation. From the results of this research, it can also be concluded that water plays a vital role in the age conditioning procedure using solar radiation.