Abstract: Pancreatic ductal adenocarcinoma (PDAC) is one of the most aggressive cancers with a low response to treatment and a five-year survival rate below 5%. The ineffectiveness of treatment is partly because of an immunosuppressive tumor microenvironment, which comprises tumor-supportive pancreatic stellate cells (PSCs). Therefore, new therapeutic strategies are needed to tackle both the immunosuppressive PSC and pancreatic cancer cells (PCCs). Recently, physical cold atmospheric plasma consisting of reactive oxygen and nitrogen species has emerged as a novel treatment option for cancer. In this study, we investigated the cytotoxicity of plasma-treated phosphate-buffered saline (pPBS) using three PSC lines and four PCC lines and examined the immunogenicity of the induced cell death. We observed a decrease in the viability of PSC and PCC after pPBS treatment, with a higher efficacy in the latter. Two PCC lines expressed and released damage-associated molecular patterns characteristic of the induction of immunogenic cell death (ICD). In addition, pPBS-treated PCC were highly phagocytosed by dendritic cells (DCs), resulting in the maturation of DC. This indicates the high potential of pPBS to trigger ICD. In contrast, pPBS induced no ICD in PSC. In general, pPBS treatment of PCCs and PSCs created a more immunostimulatory secretion profile (higher TNF-α and IFN-γ, lower TGF-β) in coculture with DC. Altogether, these data show that plasma treatment via pPBS has the potential to induce ICD in PCCs and to reduce the immunosuppressive tumor microenvironment created by PSCs. Therefore, these data provide a strong experimental basis for further in vivo validation, which might potentially open the way for more successful combination strategies with immunotherapy for PDAC.

Abstract: Targeting the redox balance of malignant cells via the delivery of high oxidative stress unlocks a potential therapeutic strategy against glioblastoma (GBM). We investigated a novel reactive oxygen species (ROS)-inducing combination treatment strategy, by increasing exogenous ROS via cold atmospheric plasma and inhibiting the endogenous protective antioxidant system via auranofin (AF), a thioredoxin reductase 1 (TrxR) inhibitor. The sequential combination treatment of AF and cold atmospheric plasma-treated PBS (pPBS), or AF and direct plasma application, resulted in a synergistic response in 2D and 3D GBM cell cultures, respectively. Differences in the baseline protein levels related to the antioxidant systems explained the cell-line-dependent sensitivity towards the combination treatment. The highest decrease of TrxR activity and GSH levels was observed after combination treatment of AF and pPBS when compared to AF and pPBS monotherapies. This combination also led to the highest accumulation of intracellular ROS. We confirmed a ROS-mediated response to the combination of AF and pPBS, which was able to induce distinct cell death mechanisms. On the one hand, an increase in caspase-3/7 activity, with an increase in the proportion of annexin V positive cells, indicates the induction of apoptosis in the GBM cells. On the other hand, lipid peroxidation and inhibition of cell death through an iron chelator suggest the involvement of ferroptosis in the GBM cell lines. Both cell death mechanisms induced by the combination of AF and pPBS resulted in a significant increase in danger signals (ecto-calreticulin, ATP and HMGB1) and dendritic cell maturation, indicating a potential increase in immunogenicity, although the phagocytotic capacity of dendritic cells was inhibited by AF. In vivo, sequential combination treatment of AF and cold atmospheric plasma both reduced tumor growth kinetics and prolonged survival in GBM-bearing mice. Thus, our study provides a novel therapeutic strategy for GBM to enhance the efficacy of oxidative stress-inducing therapy through a combination of AF and cold atmospheric plasma.

Abstract: The data generated in buildings are used for all types of purposes. The quality of information used in assisting people to escape an emergency situation is of importance. In practice today, none of the data-generating systems that aid in the escape from emergency situations is validated on a regular basis. This study is based on the smart building concept. The rationale behind this concept is to provide information about a building and the usage of that building at each moment in time. An experiment was conducted to measure the impact of different types of information on participants' choice of exit, exit time and distance travelled. Seven identical floors of one building were used with different setups to see if the choice of exit is influenced by the type of information provided at the moment of an alarm. It was found that the information does have a significant impact on the choice of exit, escape speed and distance travelled. Furthermore, it was shown that false information can increase the time it takes to leave the building and the distance travelled, impacting the survival rate. The more imperative information is visualised, the stronger its influence is on the choices made.

Abstract: Socially responsible investments can be defined as an investment process that integrates ethical values and environmental protection, improving social conditions, and good governance into a traditional investment decision. This integration is mainly a consequence of the growing importance that investors give to environmental, social, and governance (ESG) criteria, resulting in more sustainable development. Also, in the real estate sector, increased attention is being paid to the contributions made to integrate economic, environmental, and social factors into decisions. The ESG framework looks closely at how companies are managed, and the impact related to their market value. The factors for investors’ focus are summarized as environmental, social, and governance. The term ESG was coined in a 2004 United Nations (UN) report titled “Who Cares Wins,” aimed at raising awareness regarding the importance of environmental, social, and corporate governance issues in financial markets. The ESG criteria’s specific purpose is to guide investors in recognizing sustainable investments without evaluating how sustainable the asset is or the investment value represented by sustainability. It is essential to underline that ESG does not take specific economic interests into account. The rationale behind this apparent gap is that investors investigate the economic aspects before investing. However, by not explicitly linking ESG and economic criteria, attractive investments are often misjudged and not implemented. For example, investments that only show their value in the longer term or indirectly influence value by achieving a higher retention rate among incumbent tenants, reducing or eliminating friction costs. A product–service system (PSS) refers to a market proposition (business model) that builds on a product’s traditional functionality by incorporating additional services. Although services are already offered, the PSS function is to link the service to a product. The service thereby supports the operation of the product and generates additional benefits. It encompasses the integrated solutions of products and services to satisfy customers' needs and generate maximum value. According to Sutanto et al., a PSS is designed to focus on sustainability characterized in three dimensions. 1. The economic dimension 2. The environmental dimension 3. The social dimension When discussing sustainability in this thesis, we use the criteria listed above related to socially responsible investments. The link between PSS and ESG is that a PSS focuses on creating a sustainable system, and ESG makes sustainability more visible to investors. Therefore, when PSS are recognized and implemented in buildings, they must be evaluated using ESG analysis methods. Product-Service Systems (PSS) try to find a way to offer services on top of a product. The product is essentially secondary to the result that is delivered from the services. For example, the modem (product) that a cable company provides will be of secondary importance to the connectivity (service). Alternatively, it will be less critical how heat is made (product) than the intended set point is achieved in the building. PSSs transform the supply of products into services. In doing so, the responsibility shifts from delivering a product (once only) to continuous service delivery. Therefore, it is in the best interest of the service provider to deliver the outcome of the service as efficiently (read: lowest cost) as possible. A direct consequence of this is that the service provider will want to use the product as efficiently as possible and as long as possible to reduce his costs. Therefore, the supplier will also want to recover and maximize the reuse of his product based on the same rationale. A positive impact on the environment and the used raw materials is thus to be expected. The whole process of servitization (transforming products into services) in real estate will positively impact the Economic, Environmental and Social factors. Therefore, demonstrating this proposition is the main objective of this thesis. Smart PSS is the same idea as Product-Service systems but in which the digitization of the services plays a key role. It will be shown that by digitizing services, a broader range can be offered. It will be demonstrated that products that provide services at the building level can, through their interconnectedness, also provide services to external systems (e.g. electricity grid, urban planning, mobility, ...). At the same time, digitizing the products and services will also underpin trust in the systems and allow for proper remuneration. In this PhD, different standard systems in a building, such as the reservation system, the water heater, or the fire detection system, are equipped with additional services. A PSS is often specifically designed to focus on economic, social, and environmental dimensions. These dimensions correspond to the investor’s examination as part of the ESG analysis before investing. As the PSS is often specifically designed to integrate sustainability, there is a close link between the sustainability performance of the PSS and the ESG criteria evaluated by the investor. Throughout the work, the owner is considered to be the user of the building. It is not the case that only an owner-user can generate cash flow. In essence, if they have sufficient rights to the underlying product, any building user can activate services that generate cash flow. In today's market, it is logical that this is viewed in the owner-user context as they will usually choose the products to be installed in larger technical installations. They may have previously used a PSS or choose to move to one. However, a building’s tenant could choose to lease out their meeting rooms if they are not contractually prohibited from doing so since, in practice, contracts have begun to prohibit certain services. For example, rental contracts that actively prohibit renting out a property through platforms such as Airbnb. Thus, the user’s function could potentially impact how the PSS is designed. This work does not explicitly explore the impact of this aspect. The owner-user is assumed throughout this manuscript. The second chapter describes the state of affairs concerning PSSs in a broad framework evolving towards focusing on the real estate sector. After which, in the second chapter, ESG and the link to real estate and how smart real estate (smart buildings) is missing from this evaluation are discussed in more detail. Chapter 3 shows from a fire alarm system, which was extended with an evacuation support system, the usefulness, and the risk of data. Further work was done to demonstrate the added value in terms of Economic, Environmental and Social factors of standard installations in buildings. In Chapter 4, a simple sanitary hot water boiler is extended with a service that allows controlling this boiler according to the status of the electricity grid (surplus or shortage of energy). The supply and demand of energy on the power grid must be equal at all times. By equipping a classic water heater (product) with additional intelligence (service), it becomes possible to adjust the energy use to the grid's needs. The grid operators are prepared to pay for this. This payment can be linked to different energy markets (long term market, spot market, ...). This study looked at the fee that would have to be paid when the adjustment of the energy use can be made instantaneously so that the fee must be settled according to the prices on the imbalance market. In chapter 5, we look at the impact of the service to rent out free spaces as co-working places on a broad market (external to the building), compared to a regular reservation system. By renting out unused workplaces on a broad market, the utilization of the existing patrimony will be higher. The demand for new square meters with the same function will decrease as the supply-demand curve changes, and so will the price. This makes it less interesting to build new buildings. Less construction of new buildings will result in fewer resources being used, which will positively affect the environment. In addition, fewer new buildings with an office function will leave more space for buildings with another function. Also, the city's infrastructure will be less burdened (roads, sewerage, electricity grid,...). In The Hague, the decreasing need for new square meters of office buildings can lead to more space for affordable housing, for which the city has a great need. Chapter 6 will frame the valuation of service as a real options method that gives an impetus to a general valuation methodology to value the flexibility that Smart PSS inherently has. Finally, this thesis demonstrates that (smart) PSSs impact real estate profitability, while positively influencing environmental and social factors. Further research and the limitations of the studies conducted are documented. This PhD concludes that Product-Service systems should break the silos between different stakeholders, resulting in a lower total cost of ownership of buildings in the longer term. This can only be achieved if the valuation of Product-Service systems is done correctly and is recognized by every stakeholder in the real estate process.

Abstract: Patient-derived tumor organoids (PDTOs) hold great promise for preclinical and translational research and predicting the patient therapy response from ex vivo drug screenings. However, current adenosine triphosphate (ATP)-based drug screening assays do not capture the complexity of a drug response (cytostatic or cytotoxic) and intratumor heterogeneity that has been shown to be retained in PDTOs due to a bulk readout. Live-cell imaging is a powerful tool to overcome this issue and visualize drug responses more in-depth. However, image analysis software is often not adapted to the three-dimensionality of PDTOs, requires fluorescent viability dyes, or is not compatible with a 384-well microplate format. This paper describes a semi-automated methodology to seed, treat, and image PDTOs in a high-throughput, 384-well format using conventional, widefield, live-cell imaging systems. In addition, we developed viability marker-free image analysis software to quantify growth rate-based drug response metrics that improve reproducibility and correct growth rate variations between different PDTO lines. Using the normalized drug response metric, which scores drug response based on the growth rate normalized to a positive and negative control condition, and a fluorescent cell death dye, cytotoxic and cytostatic drug responses can be easily distinguished, profoundly improving the classification of responders and non-responders. In addition, drug-response heterogeneity can by quantified from single-organoid drug response analysis to identify potential, resistant clones. Ultimately, this method aims to improve the prediction of clinical therapy response by capturing a multiparametric drug response signature, which includes kinetic growth arrest and cell death quantification. ,

Abstract: Pancreatic ductal adenocarcinoma (PDAC) is one of the most lethal diseases, characterized by a treatment-resistant and invasive nature. In line with these inherent aggressive characteristics, only a subset of patients shows a clinical response to the standard of care therapies, thereby highlighting the need for a more personalized treatment approach. In this study, we comprehensively unraveled the intra-patient response heterogeneity and intrinsic aggressive nature of PDAC on bulk and single-organoid resolution. We leveraged a fully characterized PDAC organoid panel ( N  = 8) and matched our artificial intelligence-driven, live-cell organoid image analysis with retrospective clinical patient response. In line with the clinical outcomes, we identified patient-specific sensitivities to the standard of care therapies (gemcitabine-paclitaxel and FOLFIRINOX) using a growth rate-based and normalized drug response metric. Moreover, the single-organoid analysis was able to detect resistant as well as invasive PDAC organoid clones, which was orchestrates on a patient, therapy, drug, concentration and time-specific level. Furthermore, our in vitro organoid analysis indicated a correlation with the matched patient progression-free survival (PFS) compared to the current, conventional drug response readouts. This work not only provides valuable insights on the response complexity in PDAC, but it also highlights the potential applications (extendable to other tumor types) and clinical translatability of our approach in drug discovery and the emerging era of personalized medicine.

Abstract: Background This study explores the repurposing of Auranofin (AF), an anti-rheumatic drug, for treating non-small cell lung cancer (NSCLC) adenocarcinoma and pancreatic ductal adenocarcinoma (PDAC). Drug repurposing in oncology offers a cost-effective and time-efficient approach to developing new cancer therapies. Our research focuses on evaluating AF's selective cytotoxicity against cancer cells, identifying RNAseq-based biomarkers to predict AF response, and finding the most effective co-therapeutic agents for combination with AF. Methods Our investigation employed a comprehensive drug screening of AF in combination with eleven anticancer agents in cancerous PDAC and NSCLC patient-derived organoids (n = 7), and non-cancerous pulmonary organoids (n = 2). Additionally, we conducted RNA sequencing to identify potential biomarkers for AF sensitivity and experimented with various drug combinations to optimize AF's therapeutic efficacy. Results The results revealed that AF demonstrates a preferential cytotoxic effect on NSCLC and PDAC cancer cells at clinically relevant concentrations below 1 µM, sparing normal epithelial cells. We identified Carbonic Anhydrase 12 (CA12) as a significant RNAseq-based biomarker, closely associated with the NF-κB survival signaling pathway, which is crucial in cancer cell response to oxidative stress. Our findings suggest that cancer cells with low CA12 expression are more susceptible to AF treatment. Furthermore, the combination of AF with the AKT inhibitor MK2206 was found to be particularly effective, exhibiting potent and selective cytotoxic synergy, especially in tumor organoid models classified as intermediate responders to AF, without adverse effects on healthy organoids. Conclusion Our research offers valuable insights into the use of AF for treating NSCLC and PDAC. It highlights AF's cancer cell selectivity, establishes CA12 as a predictive biomarker for AF sensitivity, and underscores the enhanced efficacy of AF when combined with MK2206 and other therapeutics. These findings pave the way for further exploration of AF in cancer treatment, particularly in identifying patient populations most likely to benefit from its use and in optimizing combination therapies for improved patient outcomes.