Lenalidomide enhances antitumor functions of chimeric antigen receptor modified T cells

Tumor immunotherapy based on the use of chimeric antigen receptor modified T cells (CAR T cells) is a promising approach for the treatment of refractory hematological malignancies. However, a robust response mediated by CAR T cells is observed only in a minority of patients and the expansion and persistence of CAR T cells in vivo is mostly unpredictable.Lenalidomide (LEN) is an immunomodulatory drug currently approved for the treatment of multiple myeloma (MM) and mantle cell lymphoma, while it is clinically tested in the therapy of diffuse large B-cell lymphoma of activated B cell immunophenotype. LEN was shown to increase antitumor immune responses at least partially by modulating the activity of E3 ubiquitin ligase Cereblon, which leads to increased ubiquitinylation of Ikaros and Aiolos transcription factors, which in turn results in changed expression of various receptors on the surface of tumor cells. In order to enhance the effectiveness of CAR-based immunotherapy, we assessed the anti-lymphoma efficacy of LEN in combination with CAR19 T cells or CAR20 T cells in vitro and in vivo using various murine models of aggressive B-cell non-Hodgkin lymphomas (B-NHL).Immunodeficient NSG mice were transplanted with various human B-NHL cells followed by treatment with CAR19 or CAR20 T cells with or without LEN. Next, CAR19 T cells were subjected to series of tests in vitro to evaluate their response and signaling capacity following recognition of B cell in the presence or absence of LEN.Our data shows that LEN significantly enhances antitumor functions of CAR19 and CAR20 T cells in vivo. Additionally, it enhances production of interferon gamma by CAR19 T cells and augments cell signaling via CAR19 protein in T cells in vitro. Our data further suggests that LEN works through direct effects on T cells but not on B-NHL cells. The biochemical events underlying this costimulatory effect of LEN are currently being investigated. In summary, our data supports the use of LEN for augmentation of CAR-based immunotherapy in the clinical grounds.

Clinical significance of anti-C1q antibodies in SLE

Lupus nephritis (LN) is a severe and frequent complication of systemic lupus erythematosus (SLE). Untreated cases very often lead to patients’ death; therefore, it is important to use markers sensitive and specific enough for the diagnosis and subsequent monitoring of nephritis. Autoantibodies against double-stranded DNA (anti-dsDNA) are believed to play a major role in SLE in general and so their significance in prediction and monitoring of glomerular inflammation is low. For prediction of renal flares and effective, well-timed therapy, it is required to have an appropriate marker available. In our study, we have tested sera of 85 SLE patients with or without LN. The criterion for LN determination was the degree of proteinuria (persistent proteinuria > 0.5 g/day, according to ACR criteria for LN). Disease activity was described by SLE disease index (SLEDAI) score, renal functions were stated according to British Isles Lupus Assessment Group score. There were anti-C1q, total anti-dsDNA and high-avidity anti-dsDNA detected in the patients’ sera. We did not find any significant difference in average SLEDAI value between patients with renal and non-renal organ complications. Positivity of anti-C1q was more frequent in patients with nephritis than in those without any history of renal disease (58.3 vs. 39.1%). Higher prevalence of these antibodies was evident in patients with clinically active LN than in those without renal improvement (73.1 vs. 39.1%). When comparing anti-C1q with antibodies against structures of DNA, significant differences were found in case of high avidity anti-dsDNA. Our results have confirmed the studies showing that anti-C1q antibodies could serve as a reliable serological marker of LN activity along with other laboratory tests. Detection of anti-C1q together with high avidity anti-dsDNA antibodies seems to be a good algorithm for the prediction of possible renal flares in SLE patients.

β-glucan affects mucosal immunity in children with chronic respiratory problems under physical stress: clinical trials

BACKGROUND

The role of β-glucan in children with respiratory problems is getting more and more attention. In this report we focused on the effects of 30 days oral supplementation with β-glucan on physical activity and immune status of children with respiratory problems.

METHODS

We measured the level of sIgA, eNO and physical activity [using a 6-minute walking test (6MWT)] in 77 children and evaluated the effect of 100 mg/day oral dose.

RESULTS

We found a significant difference between males and females in physical endurance. In the glucan group, the positive effects of glucan were significant in both age groups. In the glucan group, we found significant decrease of eNO levels and stabilization of the sIgA levels.

CONCLUSIONS

Short-term oral application of natural immunomodulator β-glucan stimulated physical endurance in children with respiratory problems and, via stabilization of the sIgA levels, helps their mucosal immunity.

Striking antitumor activity of a methinium system with incorporated quinoxaline unit obtained by spontaneous cyclization

A novel pentamethinium salt was synthesized with an unforeseen expanded conjugated quinoxaline unit directly incorporated into a pentamethinium chain. The compound exhibited high fluorescence intensity, selective mitochondrial localization, high cytotoxicity, and selectivity toward malignant cell lines, and resulted in remarkable in vivo suppression of tumor growth in mice.

Optimization of the crystallizability of a single-chain antibody fragment

Single-chain variable antibody fragments (scFvs) are molecules with immense therapeutic and diagnostic potential. Knowledge of their three-dimensional structure is important for understanding their antigen-binding mode as well as for protein-engineering approaches such as antibody humanization. A major obstacle to the crystallization of single-chain variable antibody fragments is their relatively poor homogeneity caused by spontaneous oligomerization. A new approach to optimization of the crystallizability of single-chain variable antibody fragments is demonstrated using a representative single-chain variable fragment derived from the anti-CD3 antibody MEM-57. A Thermofluor-based assay was utilized to screen for optimal conditions for antibody-fragment stability and homogeneity. Such an optimization of the protein storage buffer led to a significantly improved ability of the scFv MEM-57 to yield crystals.

Clinical trials of yeast-derived β-(1,3) glucan in children: effects on innate immunity

BACKGROUND

The role of glucan in the stimulation of immune reactions is well established. In our report, we focused on the effects of orally administered glucan on nonspecific immunity of children with chronic respiratory problems.

MATERIALS AND METHODS

We measured the levels of albumin, lysozyme. C-reactive protein (CRP) and calprotectin in the saliva of 60 children ages 8-12 years and evaluated the effects of 30-day treatment with 100 mg/d oral dose of glucan.

RESULTS

We found a significant increase in the production of lysozyme, CRP and calprotectin in glucan-treated children.

CONCLUSIONS

Short-term oral application of natural immunomodulator β-glucan significantly stimulated mucosal immunity of children with chronic respiratory problems.

Placebo-driven clinical trials of yeast-derived β-(1-3) glucan in children with chronic respiratory problems

BACKGROUND

The role of glucan in stimulation of immune reactions has been studied for several decades. In this report we focused on the effects of orally administered glucan in children with chronic respiratory problems.

MATERIALS AND METHODS

We measured the levels of albumin, lysozyme and CRP in saliva of 40 children aged 8-12 years and evaluate the effects of 100 mg/d oral dose of glucan.

RESULTS

We found a significant increase in production of changes in production of lysozyme and CRP in glucan-treated children. In addition, a strong improvement in general conditions was found.

CONCLUSIONS

Short-term oral application of natural immunomodulator β-glucan stimulated mucosal immunity of children with chronic respiratory problems.

Feasibility and constraints of particle targeting using the antigen-antibody interaction

This work is concerned with the surface modification of fluorescent silica nanoparticles by a monoclonal antibody (M75) and the specific bioadhesion of such particles to surfaces containing the PG domain of carbonic anhydrase IX (CA IX), which is a trans-membrane protein specifically expressed on the surfaces of several tumor cell lines. The adhesion strength of antibody-bearing silica nanoparticles to antigen-bearing surfaces was investigated under laminar flow conditions in a microfluidic cell and compared to the adhesion of unmodified silica nanoparticles and nanoparticles coupled with an unspecific antibody. Adhesion to cancer cells using flow cytometry was also investigated and in all cases the adhesion strength of M75-modified nanoparticles was significantly stronger than for the unmodified or unspecific nanoparticles, up to several orders of magnitude in some cases. The specific modification of nano- and microparticles by an antibody-like protein therefore appears to be a feasible approach for the targeting of tumor cells.

[Diagnosis of whooping cough by serology and real-time PCR]

The goal of this study is to summarize the results of the detection of Bordetella pertussis (BP) and Bordetella parapertussis (BPP) by a real-time polymerase chain reaction (RT-PCR) assay and serological methods. In 2008-2010, 73 patients of the Department of Clinical Immunology and Allergology of the Centre for Immunology and Microbiology, Public Health Institute in Ústí nad Labem were screened for pertussis. They were selected according to the WHO and ECDC criteria, i. e. they presented with a persistent cough lasting more than two weeks. Direct detection of BP and BPP DNA from nasopharyngeal wash specimens was performed using a RT PCR assay. The serological responses were evaluated by a direct agglutination test for the detection of total antibodies and by enzyme-linked immunosobent assay (ELISA) for the detection of IgG, IgA, and IgM antibodies against pertussis toxin. Forty-two patients were positive for BP and/or BPP, 19 of them by RT-PCR (group A) and 23 by serology (group B). Ten group A patients (52.6%) were also positive by serology. Our results show that pertussis needs to be a consideration in persistent cough. We believe that increased awareness of the medical community, along with improved laboratory tests will result in increased detection of pertussis that is still considered by many physicians as a childhood infection.

Avidin-conjugated polymers with monobiotinylated antibody fragments: A new strategy for the noncovalent attachment of recombinant proteins for polymer therapeutics

The high affinity and specificity between avidin and biotin were employed to bind a recombinant single-chain antibody fragment to synthetic hydrophilic polymer drug carriers. Two semitelechelic polymers, based on poly(ethylene glycol) and poly[ N-(2-hydroxypropyl)methacrylamide], each containing a single thiol end group, were conjugated to dithiopyridyl-modified avidin. The biotinylated recombinant single-chain antibody fragment of the M75 antibody was then noncovalently bound to the polymer-avidin conjugates. The recombinant protein was chosen as a targeting ligand against carbonic anhydrase IX, a marker overexpressed by tumor cells of various human carcinomas. The antigen-binding affinity of the polymer–single-chain antibody fragment complex was confirmed by enzyme-linked immuno sorbent assay (ELISA). This approach provides an original, nondestructive way of preparing supramolecular systems intended for targeted delivery of therapeutics utilizing modern chemical procedures, including reversible addition–fragmentation chain-transfer polymerization and recombinant DNA techniques.

[Esophageal replacement using large intestine--experience with 109 cases]

Use of large intestinal transplants in esophageal replacement is an uncommonly used alternative. The authors discuss its indications in benign, as well as in malignant disorders and, based on them, assign them into three groups. Based on historical data and their professional experience, they present reasons for the commonest uses of particular parts of the large intestine. They evaluate introperative, as well as long-term outcomes.

[Video-assisted esophageal resection for carcinoma--ten-year experience]

INTRODUCTION

Esophageal procedures belong to the most complicated gastrointestinal procedures. Therefore, esophageal carcinoma patients have been and still are concentrated into specialized centres, equipped with all diagnostic and therapeutic means. At the Ist Surgical Clinic of the LF UP (Medical Faculty of the Palacky University) in Olomouc, esophageal surgery has a long lasting tradition. In the management of malignant esophageal disorders, the clinic prefers the use subtotal esophageal resection, attaching the esophagus transplant to a cervical esophageal stud, to the use of more saving resection with the anastomosis site in the mediastinum. In order to substitute for the resected esophagus, the authors normally use a tubulized gastric flap. In cases, where the stomach cannot be used, the authors use transverse colon to replace the resected esophagus. Classical esophageal procedures have nearly entirely been replaced by video-assisted procedures. Most esophageal resections are performed using video-assisted laparoscopic transhiatal approach. In the management of esophageal tumors which are located at the level of tracheal bifurcation, or below it, the authors use right- sided thoracoscopic approach.

MATERIAL AND METHODS

During the past 10 years, 178 patients have undergone subtotal esophageal resection for esophageal carcinoma. In 81 patients (45.5%), the esophagus was resected using classical approach. 35 subjects underwent transhiatal "blind"extirpation according to Orringer, in 46 subjects right-sided thoracotomy was used (subjects with tumors located in the middle third of the thoracic esophagus and higher). Video-assisted approach was used in 97 patients, which included 88 subjects with laparoscopic transhiatal modification of the procedure and 9 subjects, who underwent video-thoracoscopy.

OUTCOMES

The mean procedure duration was 242 minutes. The authors recorded the following complications: pneumothorax in 29 patients (16%) and n. laryngeus recurrens palsy in 16 subjects (9%). 13 patients (7%) developed a fistule in anastomosis, which was managed by drainage of the cervical wound. Pulmonary complications were recorded in 55 patients (31%). The mean duration of hospitalization was 12 days, intraoperative death rate was 4.5%. Only 2 out of 8 deaths occurring during the early postoperative period, were surgery-related. In the both cases, mediastinitis developed, resulting from a transponate necrosis in one of the cases and from a bronchial fistule in the other subject. Five subjects exited because of ARDS, which included one case of myocardial infarction.

CONCLUSION

When esophageal carcinoma is managed at a clinic equipped with the latest modern diagnostic and therapeutical means, the procedure of esophageal resection is a fairly safe procedure with low death and morbidity rates.

[Iatrogenic bile ducts injuries]

AIM

To evaluate therapeutic options and outcomes of repair of iatrogenic bile duct injuries during cholecystectomy, which were solved in our institution over the past five years. The incidence of this injury is stated in the range of 0-0.4% for open cholecystectomy and 0-0.7% for laparoscopic cholecystectomy.

METHODS

Authors present a group of ten patients who were operated on for iatrogenic bile duct injury incurred during cholecystectomy in 2005-2009. All patiens were refered from other hospitals. Three men and seven women aged 20-71 years. The bile duct injury occured twice during open procedure and during laparoscopic procedure in eight. Incomplete lesion was idenified in one case, complete lesions with tissue loss were found in nine patients. Right hepatic artery injuries were found in four patients with tissue loss injury. Nine patients required reconstruction of the biliary tract using hepaticojejunoanastomosis with Roux-Y loop.

RESULTS

The bile leak occurred in two patients after reconstruction. In one patient was required early percutaneous transhepatic drainage. The early death occurred in a patient with a complicated course, where our reconstruction of the biliary tract was already in the field of advanced biliary peritonitis as a third operation during 7 days. All other patients are monitored postoperatively at regular intervals in our clinic. They carried out clinical examinations and monitoring of liver enzymes. In the long interval from reconstruction (6-12 months) anastomotic stenosis occurred in three patients. Postoperative radiological intervention in the form of dilation of anastomosis and prolonged transient transanastomotic drainage was necessary (the duration of drainage was 6-7 months).

CONCLUSION

Iatrogenic bile duct injury is a serious condition threatening the patient's life from the progressive failure of liver function on the basis of secondary biliary cirrhosis. Due to the nature of lesions arising from laparoscopic cholecystectomy (loss tissue injuries, thermal damage to surrounding structures, the hepatic artery injuries) reconstructions are extremely difficult. For most patients reconstructive operations are the last possible surgical procedures in this area, except for liver transplantation. Hilar reconstructions have a higher probability of stenosis of the anastomosis. If they occur, there are repeated cholangitis, which pass into the secondary sclerosing cholangitis and cause secondary biliary cirrhosis, with all the consequences of disease (portal hypertension, bleeding esophageal varices). For these reasons, it is necessary for careful long-term postoperative monitoring of liver function and good interdisciplinary cooperation, especially with the intervention radiologist in management postoperatively evolving stenosis of anastomoses. It is necessary for the early identification and indication of radiological interventions in order to prevent damage to the liver parenchyma.

Mouse to human comparative genetics reveals a novel immunoglobulin E-controlling locus on Hsa8q12

Atopy is a predisposition to hyperproduction of immunoglobulin E (IgE) against common environmental allergens. It is often associated with development of allergic diseases such as asthma, rhinitis, and dermatitis. Production of IgE is influenced by genetic and environmental factors. In spite of progress in the study of heredity of atopy, the genetic mechanisms of IgE regulation have not yet been completely elucidated. The analysis of complex traits can benefit considerably from integration of human and mouse genetics. Previously, we mapped a mouse IgE-controlling locus Lmr9 on chromosome 4 to a segment of <9 Mb. In this study, we tested levels of total IgE and 25 specific IgEs against inhalant and food allergens in 67 Czech atopic families. In the position homologous to Lmr9 on chromosome 8q12 marked by D8S285, we demonstrated a novel human IgE-controlling locus exhibiting suggestive linkage to composite inhalant allergic sensitization (limit of detection, LOD = 2.11, P = 0.0009) and to nine specific IgEs, with maximum LOD (LOD = 2.42, P = 0.0004) to plantain. We also tested 16 markers at previously reported chromosomal regions of atopy. Linkage to plant allergens exceeding the LOD > 2.0 was detected at 5q33 (D5S1507, LOD = 2.11, P = 0.0009) and 13q14 (D13S165, LOD = 2.74, P = 0.0002). The significant association with plant allergens (quantitative and discrete traits) was found at 7p14 (D7S2250, corrected P = 0.026) and 12q13 (D12S1298, corrected P = 0.043). Thus, the finding of linkage on chromosome 8q12 shows precision and predictive power of mouse models in the investigation of complex traits in humans. Our results also confirm the role of loci at 5q33, 7p14, 12q14, and 13q13 in control of IgE.

[Analytical methods at the boundary between biochemistry and immunology]

The article presents assays shared by both disciplines; i.e the specialization 801 (Clinical Biochemistry) and 813 (Laboratory of Allergology and Immunology), and it covers over 60 tests. It is intended as reference information for general practitioners, as well as for laboratory workers at the beginning of their studies. Emphasis is laid on some facts which GPs ordering laboratory determinations should be familiar with; the pre-analytical stage (specimen collection, their transport and storage), the analytical reliability of particular methods, their accessibility, frequency and total costs. Analytical techniques are only mentioned marginally as their understanding is not essential for GPs. Assuming the readers' fundamental experience of diagnostic applications of the methods discussed; we only comment some obsolete or rare tests. The shared assays cover selected analyses of proteins (incl. some enzymes and tumormarkers), ions, osmolality and quantitative microscopic urinalysis.