Small molecule drug inhibition of PD-1 transcription is as effective as anti-PD-1 biologic blockade in cancer therapy

Despite the importance of the co-receptor PD-1 in T cell immunity, the upstream signaling pathway(s) that regulate PD-1 expression has not been defined. Glycogen synthase kinase 3 (GSK-3, isoform α and β) is a serine-threonine kinase implicated in cellular processes. We have shown that GSK-3 is a key upstream kinase that regulates PD-1 expression in CD8+ T cells. GSK-3 inactivation increased Tbx21 transcription for enhanced Tbet expression, and its suppression of Pdcd1 transcription in CD8+ cytolytic T-cells (CTLs) (Taylor et al 2016 Immunity 44, 274–86). Here, we show that GSK-3 inhibitor blockade of pcdc1 (PD-1) transcription with a small molecule inhibitor (i.e. SB415286) is as effective as anti-PD-1 and PDL-1 blocking antibodies in the control of pulmonary metastasis of B16 melanoma, intra-dermally injected B16 and EL4 lymphoma solid tumors, and in the ex vivo pre-treatment of T-cells before adoptive transfer into mice carrying tumors. In an analysis of knock out mice, GSK-3α/β−/− mice, which had greatly reduced PD-1 expression on T-cells, showed the same reduction in B16 pulmonary metastasis as Pdcd1−/− mice. Further, the ex vivo treatment of T-cells with SB415286, anti-PD-1, or in combination followed by adoptive transfer, had identical effects in inhibiting EL4 lymphoma growth. In all tumor models, GSK-3 inactivation markedly inhibited Pdcd1 transcription and PD-1 expression on tumor infiltrating T-cells (TILs), while increasing Tbx21 (Tbet) transcription and the presence of CD8+ TILs expressing CD107a+ (LAMP1) and granzyme B (GZMB). Our findings define for the first time that a next generation approach using small molecule inhibition of PD-1 expression is as effective as anti-PD-1/PL1 biologics in cancer therapy.

Osseous impingement occurs early in flexion in cam-type femoroacetabular impingement

Aims

The aim of this study was to examine the real time in vivo kinematics of the hip in patients with cam-type femoroacetabular impingement (FAI).

Patients and Methods

A total of 50 patients (83 hips) underwent 4D dynamic CT scanning of the hip, producing real time osseous models of the pelvis and femur being moved through flexion, adduction, and internal rotation. The location and size of the cam deformity and its relationship to the angle of flexion of the hip and pelvic tilt, and the position of impingement were recorded.

Results

In these patients with cam-type FAI, there was significant correlation between the alpha angle and flexion to the point of impingement (mean 41.36°; 14.32° to 57.95°) (R = -0.5815 and p = < 0.001). Patients with a large cam deformity (alpha angle > 78°) had significantly less flexion to the point of impingement (mean 36.30°; 14.32° to 55.18°) than patients with a small cam deformity (alpha angle 60° to 78°) (mean 45.34°; 27.25° to 57.95°) (p = < 0.001).

Conclusion

This study has shown that cam-type impingement can occur early in flexion (40°), particularly in patients with large anterior deformities. These patients risk chondrolabral damage during routine activities such as walking, and going up stairs. These findings offer important insights into the cause of the symptoms, the mechanisms of screening and the forms of treatment available for these patients. Cite this article: Bone Joint J 2017;99-B(4 Supple B):41–8.

Decrease in mortality of adult epilepsy patients since 1980: lessons learned from a hospital-based cohort

BACKGROUND AND PURPOSE

Data on mortality in patients with epilepsy have been available since the 1800s. They consistently show a 2-3-fold increase compared to the general population. Despite major advances in diagnostic tools and treatment options, there is no evidence for a decrease in premature deaths. The temporal trend of mortality in a hospital-based epilepsy cohort over three decades was assessed.

METHODS

A hospital-based incidence cohort was recruited from a specialized epilepsy outpatient clinic at Innsbruck Medical University between 1980 and 2007, divided by decade into three cohorts and followed for 5 years after initial epilepsy diagnosis. Deaths and their primary causes were determined using probabilistic record linkage with the Austrian death registry. Age-, sex- and period-adjusted standardized mortality rates (SMRs) were computed in relation to the general population of the same area and grouped according to time of diagnosis.

RESULTS

In all, 122 deaths in 4549.9 person-years (1954.5 women, 2595.2 men) were identified. The overall SMR was 2.2 [95% confidence interval (CI) 1.8-2.6] and decreased from 3.0 (95% CI 2.1-4.3) in 1980-1989, to 2.7 (95% CI 2.0-3.5) in 1990-1999 and to 1.4 (95% CI 1.0-2.0) in 2000-2007.

CONCLUSIONS

This study indicates a decrease in mortality in newly diagnosed epilepsy patients over the last three decades. This may be due to advances in diagnosis and treatment over the past three decades, including early identification of drug resistance, introduction of new anti-epileptic drugs and establishment of a comprehensive epilepsy surgery programme in this region.

Hepatitis C virus among genitourinary clinic attenders in Scotland: unlinked anonymous testing

Our objective is to gauge the prevalence of hepatitis C virus (HCV) antibodies among a population at risk of contracting sexually transmitted infections (STIs) and, thus, the efficiency with which the virus is transmitted sexually. The investigators undertook an unlinked anonymous HCV antibody testing study of residual syphilis serology specimens taken from attenders of genitourinary clinics in Glasgow, Edinburgh and Aberdeen during 1996/97. The results were linked to non-identifying risk information. Anti-HCV prevalences among non-injecting heterosexual men and women, and non-injecting homosexual/bisexual males ranged between 0 and 1.2%; the only exception to this was a 7.7% (4/52) prevalence among homosexual/bisexual males in Aberdeen. The overall anti-HCV prevalence for homosexual/bisexual males was 0.6% (4/668), for heterosexual males 0.8% (32/4135), for heterosexual females 0.3% (10/3035) and for injecting drug users 49% (72/148). Only 3 (all female) of the 46 non-injectors who were antibody positive were non-UK nationals or had lived abroad. HCV antibody positive injectors were less likely to have an acute STI and more likely to know their HCV status than non-injectors; no differences in these parameters were found between positive and negative non-injectors on anonymous HCV antibody testing. Our findings are in keeping with the prevailing view that HCV can be acquired through sexual intercourse but, for most people, the probability of this occurring is extremely low. Interventions to prevent the spread of HCV should be targeted mainly at injecting drug user (IDU) populations.

Diagnostic performance of HbA1c for diabetes in Arab vs. European populations: a systematic review and meta-analysis

AIM

To examine differences in the performance of HbA_1c for diagnosing diabetes in Arabs compared with Europeans.

METHODS

The PubMed, Embase and Cochrane library databases were searched for records published between 1998 and 2015. Estimates of sensitivity, specificity and log diagnostic odds ratios for an HbA_1c cut-point of 48 mmol/mol (6.5%) were compared between Arabs and Europeans, using a bivariate linear mixed-model approach. For studies reporting multiple cut-points, population-specific summary receiver operating characteristic (SROC) curves were constructed. In addition, sensitivity, specificity and Youden Index were estimated for strata defined by HbA_1c cut-point and population type. Database searches yielded 1912 unique records; 618 full-text articles were reviewed. Fourteen studies met the inclusion criteria; hand-searching yielded three additional eligible studies. Three Arab (N = 2880) and 16 European populations (N = 49 127) were included in the analysis.

RESULTS

Summary sensitivity and specificity for a HbA_1c cut-point of 48 mmol/mol (6.5%) in both populations were 42% (33-51%), and 97% (95-98%). There was no difference in area under SROC curves between Arab and European populations (0.844 vs. 0.847; P = 0.867), suggesting no difference in HbA_1c diagnostic accuracy between populations. Multiple cut-point summary estimates stratified by population suggest that Arabs have lower sensitivity and higher specificity at a HbA_1c cut-point of 44 mmol/mol (6.2%) compared with European populations. Estimates also suggest similar test performance at cut-points of 44 mmol/mol (6.2%) and 48 mmol/mol (6.5%) for Arabs.

CONCLUSIONS

Given the low sensitivity of HbA_1c in the high-risk Arab American population, we recommend a combination of glucose-based and HbA_1c testing to ensure an accurate and timely diagnosis of diabetes.

Five-year outcome of proximal femoral endoprosthetic arthroplasty for non-tumour indications

OBJECTIVES

A possible solution for the management of proximal femoral bone loss is a modular femoral endoprosthesis (EPR). Although the outcome of EPRs in tumour surgery has been well described, the outcome of their use in revision hip surgery has received less attention. The aim of this study was to describe the outcome of using EPR for non-neoplastic indications.

METHODS

A retrospective review of 79 patients who underwent 80 EPRs for non-neoplastic indications was performed, including the rates of complication and survival and the mean Oxford Hip Scores (OHS), at a mean of five years post-operatively. The mean age at the time of surgery was 69 years (28 to 93) and the mean number of previous operations on the hip was 2.4 (0 to 17). The most common indications for EPR implantation were periprosthetic joint infection (PJI) (n = 40), periprosthetic fracture (n = 12) and failed osteosynthesis of a proximal femoral fracture or complex trauma (n = 11).

RESULTS

Salvage was achieved in all patients. A total of 25 patients (25 EPRs, 31.6%) had a complication, the most common being infection (n = 9) and dislocation (n = 3). Further surgery was required for 18 EPRs (22%), nine of which were revision procedures. The five year survival of the EPR was 87% (95%CI: 76% to 98%). The mean OHS was 28 (4 to 48). Inferior survival and outcomes were seen in EPRs which were performed for the treatment of infection. However, the eradication of infection was achieved in 33 of the 40 (82.5%) which were undertaken for this indication.

CONCLUSION

We recommend the continued use of proximal femoral EPRs for non-neoplastic indications, including PJI. Cite this article: Bone Joint J 2016;98-B:1463-70.

Use of Oncept melanoma vaccine in 69 canine oral malignant melanomas in the UK

OBJECTIVES

Oral malignant melanomas carry a poor-to-guarded prognosis because of their local invasiveness and high metastatic propensity. The Oncept melanoma vaccine is licensed to treat dogs with stage II or III locally-controlled oral malignant melanoma and this retrospective study aimed to assess survival of affected dogs treated with the vaccine in the UK.

MATERIAL AND METHODS

Medical records of dogs with histopathologically-confirmed oral malignant melanoma that received the vaccine as part of their treatment were evaluated. Survival analyses for potential prognostic factors were performed.

RESULTS

Sixty-nine dogs were included; 56 dogs, staged I to III, and with previous locoregional therapy, had a median survival time of 455 days (95% CI: 324 to 586 days). Based on Kaplan-Meier survival analysis with associated log-rank testing, no significant prognostic factors were identified for this population. Of the 13 patients with macroscopic disease treated with vaccine alone or in combination therapy, eight showed clinical response. Three patients with stage IV oral malignant melanoma survived 171, 178 and 288 days from diagnosis.

CLINICAL SIGNIFICANCE

Patients treated with the melanoma vaccine in our study had survival times similar to their counterparts receiving the vaccine in the USA. There were observed responses in patients with macroscopic disease and so the vaccine could be considered as palliative treatment in dogs with stage IV disease.

Fetal endoscopic telesurgery using an Internet Protocol connection: Clinical and technical challenges

Until recently, fetoscopic laser surgery to seal the placental anastomoses that cause severe twin-to-twin transfusion syndrome has been available in only a few centres worldwide. The technique typically takes a long time to learn. We have used a dedicated Internet Protocol (IP) connection for tele-education to assist the introduction of fetoscopic laser surgery to Australia. During the implementation of the international telemedicine link, there were multiple clinical and technical problems, which were eventually overcome. The quality of images and of video-sequences was comparable to that supported by an ISDN connection. Pictures of live surgery performed by an expert in Florida, USA, were transmitted and viewed by a novice team in Brisbane, Australia. The Australian team has performed 19 fetoscopic laser operations to date. Preliminary results are comparable to those from centres that have performed over 100 procedures.

The Impact of Systemic Therapy Beyond First-line Treatment for Advanced Cervical Cancer

AIMS

Despite recent advances in the primary and secondary prevention of cervical cancer, a significant number of women present with or develop metastatic disease. There is currently no consensus on the standard of care for second-line systemic treatment of recurrent/metastatic cervical cancer. The purpose of this study was to evaluate the second-line systemic therapy used and the associated outcomes in a single cancer centre.

MATERIALS AND METHODS

A retrospective review of patients with cervical cancer who received one or more lines of treatment for recurrent or metastatic cervical cancer at the Royal Marsden Hospital between 2004 and 2014 was carried out. The primary objective was to establish the types of second-line systemic treatment used. Secondary end points included objective response rate, progression-free survival and overall survival after second-line therapy.

RESULTS

In total, 75 patients were included in the study; 53 patients (70.7%) received second-line therapy for recurrent/metastatic disease. The most common second-line therapy was weekly paclitaxel (28.3%). Carboplatin-based chemotherapy (24.5%), targeted agent monotherapy within clinical trials (22.6%), docetaxel-based chemotherapy (13.2%), topotecan (9.4%) and gemcitabine (1.9%) were also used. The objective response rate to second-line therapy was 13.2%, which included three partial responses to carboplatin and paclitaxel, two partial responses to docetaxel-based chemotherapy, one partial response to weekly paclitaxel and one partial response to cediranib. Twenty-two patients (41.5%) achieved stable disease at 4 months. The median progression-free survival for women treated with second-line therapy was 3.2 months (95% confidence interval 2.1-4.3) and median overall survival was 9.3 months (95% confidence interval 6.4-12.5). Thirty-nine per cent of patients received third-line therapy.

CONCLUSION

Seventy per cent of patients treated with first-line systemic therapy for recurrent/metastatic cervical cancer subsequently received second-line treatment but response rates were poor. There remains no standard of care for second-line systemic therapy for advanced cervical cancer. Patients should be considered for clinical trials whenever feasible, including novel targeted agents and immunotherapy.

Complex precipitation phenomena in strip cast steels with high sulfur and copper contents

A series of three steel alloys with increasing Cu and S concentrations has been prepared by simulated direct strip casting. It was found that the rapid solidification that occurs during direct strip casting results in the formation of a high number density of fine MnS precipitates, while Cu was retained in solid solution above equilibrium concentration. Upon ageing the MnS particles were found to coarsen and increase in volume fraction, indicating that some S was retained in solid solution in the as-cast condition. Ageing also resulted in the precipitation of Cu-rich precipitates. A new method to determine precipitate composition from small-angle neutron scattering is presented. This methodology, in conjunction with atom-probe tomography, has been used to show that the composition of the Cu-rich precipitates depends on the alloy's bulk Cu content.

Evaluation of Serum Aspergillus-Specific Immunoglobulin A by Indirect ELISA for Diagnosis of Feline Upper Respiratory Tract Aspergillosis

Background

Serological tests for diagnosis of aspergillosis in immunocompetent humans and animals are based on Aspergillus‐specific IgG (As‐IgG). In humans with chronic pulmonary aspergillosis, As‐IgA may be detectable even if IgG titers are negative. Cats with upper respiratory tract aspergillosis (URTA) have detectable As‐IgG, but their ability to mount an IgA response and its diagnostic utility are unknown.

Objectives

To determine whether serum As‐IgA can be detected in cats with URTA and evaluate its diagnostic utility alone or combined with As‐IgG.

Animals

Twenty‐three cats with URTA (Group 1), 32 cats with other respiratory diseases (Group 2), and 84 nonrespiratory controls (Group 3).

Methods

Serum As‐IgA and As‐IgG was measured by indirect ELISA. Optimal cutoff values were determined by receiver‐operating curve analysis. Sensitivity (Se) and specificity (Sp) for URTA diagnosis were determined.

Results

Serum IgA was detected in 91.3% of Group 1 cats. The Se of IgA detection was 78.3% and Sp was 96.9% for Group 2, 85.7% for Group 3 and 88.8% for Group 2 and 3 combined. Assay Se for IgG was 100% and Sp was 92.2%. Using combined IgA and IgG results at cutoffs optimized for Sp for IgA and Se for IgG and combined controls (Groups 2 and 3), Se for diagnosis was 100% and Sp was 91.4%.

Conclusion and Clinical Importance

Most cats with URTA have serum As‐IgA antibodies that can be detected by ELISA. Paired measurement of serum As‐IgA and IgG shows no benefit for diagnosis of feline URTA over IgG alone.

Observed bodies generate object-based spatial codes

Contemporary studies of spatial and social cognition frequently use human figures as stimuli. The interpretation of such studies may be complicated by spatial compatibility effects that emerge when researchers employ spatial responses, and participants spontaneously code spatial relationships about an observed body. Yet, the nature of these spatial codes - whether they are location- or object-based, and coded from the perspective of the observer or the figure - has not been determined. Here, we investigated this issue by exploring spatial compatibility effects arising for objects held by a visually presented whole-bodied schematic human figure. In three experiments, participants responded to the colour of the object held in the figure's left or right hand, using left or right key presses. Left-right compatibility effects were found relative to the participant's egocentric perspective, rather than the figure's. These effects occurred even when the figure was rotated by 90° to the left or to the right, and the coloured objects were aligned with the participant's midline. These findings are consistent with spontaneous spatial coding from the participant's perspective and relative to the normal upright orientation of the body. This evidence for object-based spatial coding implies that the domain general cognitive mechanisms that result in spatial compatibility effects may contribute to certain spatial perspective-taking and social cognition phenomena.

Iatrogenic copper deficiency following information and drugs obtained over the internet

We report the case of a 56-year-old woman with a 7-year history of metastatic cancer who presented with severe copper deficiency following self-treatment with the copper-chelating agent tetrathiomolybdate. This compound was used with the aim of inhibiting tumour angiogenesis and was obtained from the USA by placing an order on the internet. The patient exhibited severe neutropenia as her serum copper concentration fell from 19.8 μmol/L to 3.3 μmol/L and her caeruloplasmin concentration from 35 mg/dL to 4 mg/dL.

Contamination from Syringes and Blood Container Pots in Trace Element Analysis

Syringes, blood container pots and test tubes have been investigated to determine whether they act as sources of contaminants during trace element analyses. Urine containers were investigated to decide which materials do not absorb mercury from dilute solutions.

No copper and little magnesium contamination was found. Zinc contamination was unpredictable. Very large amounts of zinc leached from the rubber end cap of the piston of disposable, plastic sterile syringes.

The B.S.I. Standards for disposable syringes were shown to be unacceptable for heavy metals.

Determinants of serum copper, zinc and selenium in healthy subjects

Background: We have investigated the association between serum copper, zinc and selenium concentrations, dietary intake, and demographic characteristics, including individual coronary risk factors, in healthy subjects.

Methods: Serum copper, zinc and selenium were measured by atomic absorption spectrometry in 189 healthy subjects. Serum glutathione peroxidase and caeruloplasmin were also determined for each subject. A previously validated food frequency questionnaire was used to estimate the dietary trace element intake.

Results: Male subjects had significantly lower serum copper ( P<0.001) and caeruloplasmin ( P<0.001), and higher serum zinc ( P<0.05) and zinc:copper ratio ( P<0.001) than female subjects. Significant differences were observed in serum copper and caeruloplasmin concentrations ( P<0.01) with age. Weak but significant associations between dietary trace elements and their serum concentrations were observed for zinc ( r=0.18, P=0.02), copper ( r=0.17, P=0.03) and selenium ( r=0.19, P=0.02). Obese subjects had significantly lower serum concentrations of zinc ( P<0.05). In multifactorial analysis, dietary zinc ( P<0.05), serum high-density lipoprotein-cholesterol (HDL-C) ( P<0.05), diastolic blood pressure ( P<0.05) and age ( P=0.05) emerged as major predictors of serum zinc concentrations. The corresponding predictors for serum copper were C-reactive protein (CRP) ( P<0.001), serum HDL-C ( P<0.001), gender ( P=0.01), physical activity levels ( P<0.05) and dietary copper ( P<0.05). Serum selenium concentrations were predicted by serum total cholesterol ( P<0.01), serum CRP concentrations ( P<0.05) and dietary selenium ( P<0.03).

Conclusion: Serum copper, zinc and selenium concentrations are influenced by physiological conditions such as age, diet and gender. Their serum concentrations are also associated with coronary risk factors, including body mass index, levels of physical activity, serum HDL-C and CRP.

Temporal variability of beryllium-7 fallout in southwest UK

Cosmogenic beryllium-7 has been widely employed as a sediment tracing tool and continued development of its use as a soil erosion tracer requires knowledge of fallout temporal dynamics. Data regarding beryllium-7 fallout in the UK are scarce and here the authors provide a record of beryllium-7 fallout in southwest England spanning a two-year period. A monthly fallout record was developed for Plymouth, UK using regular rainfall sampling to determine beryllium-7 rainfall activity concentration (Bq L(-1)) and deposition flux (Bq m(-2)). Data showed a general tendency for higher activity during the spring/summer months and lower activity in the autumn/winter months. Comparison with data for other UK sites (Chilton and Aberporth) for the same period found significant differences in (7)Be activity in rainwater and lower variability in Plymouth than Chilton and Aberporth. Total deposition was largely controlled by rainfall in Plymouth although regression coefficients suggested greater importance of other atmospheric controls at the Chilton and Aberporth sites. Use of a deposition proportion to rainfall proportion ratio identified periods when deposition was influenced by varying (7)Be activity in rainfall. Broad ranges in ratios were found for Chilton and Aberporth and this has implications for sediment tracer studies requiring estimates of (7)Be deposition flux across months or seasons.