Vaccine-derived poliomyelitis 12 years after infection in Minnesota

A 44-year-old woman with long-standing common variable immunodeficiency who was receiving intravenous immune globulin suddenly had paralysis of all four limbs and the respiratory muscles, resulting in death. Type 2 vaccine-derived poliovirus was isolated from stool. The viral capsid protein VP1 region had diverged from the vaccine strain at 12.3% of nucleotide positions, and the two attenuating substitutions had reverted to the wild-type sequence. Infection probably occurred 11.9 years earlier (95% confidence interval [CI], 10.9 to 13.2), when her child received the oral poliovirus vaccine. No secondary cases were identified among close contacts or 2038 screened health care workers. Patients with common variable immunodeficiency can be chronically infected with poliovirus, and poliomyelitis can develop despite treatment with intravenous immune globulin.

Abstract 1787: ImmTACs: Bi-functional reagents for redirected tumour cell killing

The human immune system can theoretically identify malignant cells by inspecting cell surface Class I HLA -peptide complexes for the presence of disease-associated epitopes. Indeed, many cancer patients generate CD8 cyto-toxic T cell responses to tumour-associated antigens; the majority of patients, however, fail to clear tumours since T cell avidity for self-antigens tends to be weak, and cancer cells employ escape mechanisms for avoiding destruction by T cells. To overcome these issues, we have engineered novel, bi-functional protein therapeutics termed ImmTACs (Immune Mobilising mTCR Against Cancer) which re-direct the immune system to target and destroy tumour cells with a high degree of potency and specificity. An ImmTAC comprises a high affinity ‘monoclonal’ T cell Receptor (mTCR) targeting a cancer-associated HLA-peptide complex, fused to an anti-CD3 scFv domain which activates an anti-tumour T cell response.

We demonstrate that ImmTACs against a number of different cancer-associated antigens can target and kill tumour cells expressing as few as 10-20 epitopes per cell with pico-Molar potency. ImmTACs preferentially activate effector memory CD8 T cells, resulting in secretion of multiple cytokines and tumour cell killing; a single activated T cell can kill multiple antigen positive tumour cells. Furthermore, we demonstrate that the reagents are able to inhibit tumour growth in mouse xenograft models. In vitro ImmTAC potency translates to a dose of less than 1mg in humans, representing a significant advance over existing targeted anti-cancer therapies. Currently we are conducting a phase I dose-escalation trial and Phase 0 exploratory trial using ImmTAC-gp100 in late stage melanoma patients. In summary, ImmTACs offers a novel therapeutic approach for the treatment of various cancers with the potential to provide major benefits over current treatments including reduction in dose to sub-mg quantities and an improved safety profile.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 1787. doi:10.1158/1538-7445.AM2011-1787

Report of the NAP4 Airway Project

Major complications related to airway management over a 12-month period were reported and examined by an expert panel in the Royal College of Anaesthetists' fourth National Audit Project. Thirty-six reports originated in the intensive care unit, just under 20% of all reports, but resulted in 60% of deaths or significant neurological injury of all cases examined. Cases could be broadly divided into: failed or unrecognised oesophageal intubation; airway displacement; haemorrhage; airway problems during patient transfer; and other. Capnography was not used routinely and contributed to delayed recognition of airway problems. Staff managing complex airways did not always have advanced airway skills. Equipment and back-up planning was frequently deficient. The panel have made recommendations to attempt to improve airway management in the intensive care environment.

This article is a précis of two chapters (chapter 9, Intensive care; and chapter 15, Major airway events in patients with a tracheostomy) in the NAP4 audit report. The complete report is available as referenced below.1 The British Journal of Anaesthesia has also published a report of airway events in intensive care and emergency departments from NAP4.2

Bi-specific TCR anti-CD3 fusion for the immunotherapy of malignant melanoma (156.16)

The human immune system can theoretically identify malignant cells by ‘scanning’ peptide antigens presented on the cell surface by Class I HLA molecules, and indeed many cancer patients generate CD8 cyto-toxic T cell responses to tumour-specific antigens. However, the majority of patients fail to clear tumours, since T cell avidity for self-antigens tends to be weak, and cancer cells employ escape mechanisms for avoiding destruction by T cells. We have engineered novel, bi-functional protein therapeutics termed ImmTACs which re-direct the immune system to target and destroy tumour cells with a high degree of potency and specificity. IMCgp100 comprises a soluble, high affinity T cell Receptor specific for the HLA-A2 presented melanoma-associated epitope gp100 280-288, fused to an anti-CD3 scFv domain. The anti-CD3 moiety activates a polyclonal T cell response when targeted to melanoma cells presenting as few as twenty gp100 epitopes, predominantly through activation of effector memory CD8 lymphocytes, leading to killing of the tumour cells. Extensive in vitro testing of IMCgp100 with a panel of tumour cells and normal human tissue cells demonstrates pico-Molar potency against cancer cells and specificity for HLA-A2 gp100 positive cells. The agent is able to inhibit tumour growth in mouse xenograft models. A phase I dose-escalation trial in late stage melanoma patients was initiated in October 2010 and interim results will be presented at this meeting.

Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 2: intensive care and emergency departments

BACKGROUND

The Fourth National Audit Project of the Royal College of Anaesthetists and Difficult Airway Society (NAP4) was designed to identify and study serious airway complications occurring during anaesthesia, in intensive care unit (ICU) and the emergency department (ED).

METHODS

Reports of major complications of airway management (death, brain damage, emergency surgical airway, unanticipated ICU admission, prolonged ICU stay) were collected from all National Health Service hospitals over a period of 1 yr. An expert panel reviewed inclusion criteria, outcome, and airway management.

RESULTS

A total of 184 events met inclusion criteria: 36 in ICU and 15 in the ED. In ICU, 61% of events led to death or persistent neurological injury, and 31% in the ED. Airway events in ICU and the ED were more likely than those during anaesthesia to occur out-of-hours, be managed by doctors with less anaesthetic experience and lead to permanent harm. Failure to use capnography contributed to 74% of cases of death or persistent neurological injury.

CONCLUSIONS

At least one in four major airway events in a hospital are likely to occur in ICU or the ED. The outcome of these events is particularly adverse. Analysis of the cases has identified repeated gaps in care that include: poor identification of at-risk patients, poor or incomplete planning, inadequate provision of skilled staff and equipment to manage these events successfully, delayed recognition of events, and failed rescue due to lack of or failure of interpretation of capnography. The project findings suggest avoidable deaths due to airway complications occur in ICU and the ED.

Effect of Fast Electron Irradiation on Electrical and Optical Properties of CdGeAs2 and ZnGep2

We report on the effects of fast electron irradiation on the optical absorption (α) of CdGeAs2and ZnGeP2 and on the electrical properties of CdGeAs2. In p-CdGeAs2 irradiation led to the reduction in α and an increase in the electrical resistivity. The lowest values of α (about 0.1 cm' at 5µm<λ<10µm) were obtained on irradiated crystals of p-type with the highest degree of compensation. Further accumulation of the electron dose caused conversion to n-type and deterioration of the optical transmission. In ZnGeP2 irradiation caused a decrease in a at λ>0.85 λm and increase in α at λ<0.85 μm. At λ=2.05 μm, α for the o-ray could be reduced to less than 0.08 cm−1. At higher doses, saturation in α was observed. The effects of irradiation are discussed in connection with possible mechanisms of optical absorption in CdGeAs2 and ZnGeP2.