Circulating pre-treatment T-cell receptor repertoire as a predictive biomarker in advanced or metastatic non-small-cell lung cancer patients treated with pembrolizumab alone or in combination with chemotherapy

BACKGROUND

The circulating T-cell receptor (TCR) repertoire is a dynamic representation of overall immune responses in an individual.

MATERIALS AND METHODS

We prospectively collected baseline blood from patients treated with first-line pembrolizumab monotherapy or in combination with chemotherapy. TCR repertoire metrics were correlated with clinical benefit rate (CBR), progression-free survival (PFS), overall survival (OS) and immune-related adverse events (irAEs). We built a logistic regression classifier by fitting all four TCR-β repertoire metrics to the immune checkpoint inhibitor (ICI) CBR data. In the subsequent receiver operating characteristic (ROC) analysis of the resulting logistic regression model probabilities, the best cut-off value was selected to maximise sensitivity to predict CBR to ICI.

RESULTS

We observed an association between reduced number of unique clones and CBR among patients treated with pembrolizumab monotherapy (cohort 1) [risk ratio = 2.86, 95% confidence interval (CI) 1.04-8.73, P = 0.039]. For patients treated with pembrolizumab plus chemotherapy (cohort 2), increased number of unique clones [hazard ratio (HR) = 2.96, 95% CI 1.28-6.88, P = 0.012] and Shannon diversity (HR = 2.73, 95% CI 1.08-6.87, P = 0.033), and reduced evenness (HR = 0.43, 95% CI 0.21-0.90, P = 0.025) and convergence (HR = 0.41, 95% CI 0.19-0.90, P = 0.027) were associated with improved PFS, while only an increased number of unique clones (HR = 4.62, 95% CI 1.52-14.02, P = 0.007) were associated with improved OS. Logistic regression models combining the TCR repertoire metrics improved the prediction of CBR (cohorts 1 and 2) and were strongly associated with PFS (cohort 1, HR = 0.38, 95% CI 0.19-0.78, P = 0.009) and OS (cohort 2, HR = 0.20, 95% CI 0.05-0.76, P < 0.0001). Reduced TCR conversion was associated with increased frequency of irAEs needing systemic steroid treatment.

CONCLUSION

Combined pre-treatment circulating TCR metrics might serve as a predictive biomarker for clinical outcomes among patients with advanced non-small-cell lung cancer treated with pembrolizumab alone or in combination with chemotherapy.

Anti-diabetic effect of cotreatment with resveratrol and pioglitazone in diabetic rats

OBJECTIVE

Limitations and side effects associated with current anti-diabetic treatments have necessitated the search for new therapeutic alternatives. This study aimed to explore the combined use of resveratrol (RVT) and established anti-diabetic drug pioglitazone (PGZ) against streptozotocin (STZ)-induced diabetes mellitus (DM).

MATERIALS AND METHODS

 STZ was supplemented daily to Sprague-Dawley rats to induce DM. The synergistic effect of the RVT (20 mg/kg) and PGZ (0.65 mg/kg) on DM complications was evaluated after 8 weeks of treatment. Biochemical analyses were performed to evaluate the effectiveness of our treatment on glucose level, insulin sensitivity, lipid disturbances, oxidative mediators and inflammatory markers.

RESULTS

STZ induced DM onset that is accompanied with elevated diabetic markers, lipid disturbances, remarkable oxidative damage and hyper-inflammation. The PGZ+RVT combination has the best effect as illustrated by significant (p < 0.05) decreases in fasting blood glucose, insulin, HbA1c and HOMA-IR levels. This combination attenuated (p < 0.05) lipid disturbances and their associated elevated atherogenic biomarkers. At the same time, treatments with PGZ+RVT exhibited an anti-inflammatory effect as it attenuated the increase in inflammatory parameters (CRP, TNF-α, IL-6). Also, it restored total antioxidant capacity and peroxisome proliferator-activated receptor (PPARg) levels that decreased by STZ-DM induction.

CONCLUSIONS

This study provides PGZ+RVT as promising DM therapeutic alternative. This synergistic combination alleviates most of DM-related complications and insulin resistance.

Immune signature of CCR7+ central memory T cells associates with disease severity and Immunoglobulin E in bronchial asthma

Summary

Objective. CD4⁺T cell subtypes are the central orchestrators of airway inflammation in bronchialasthma (BA); however, the mechanisms that regulate their accumulation in asthmatic airways are still a challenging subject. In addition, neutrophils play a significant role in the development of airway remodeling and their presence may influence clinical presentation of BA being linked to the development of severe BA. Neutrophils have also been found to acquireantigen presenting functions, enabling them to directly activate T cells. The study aimed to evaluate the possible association of chemokine receptor 7 (CCR7)⁺ memory CD4⁺T cells andCCR4⁺ effector T cells with disease severity and immunoglobulin E (IgE) production as well as to explore the relationship between these cells and neutrophil function in both allergic andnon-allergic asthmatic patients. Methods. Flow cytometry was used to determine the expression of different T cell subset phenotypes (CCR7 memory CD4⁺ and CCR4⁺T cells using anti-human CD3, CD4, CD45RO, CCR4 and CCR7 monoclonal antibodies) utilizing peripheral blood mononuclear cells (PBMCs) isolated from 78 allergic asthmatic patients, 41 non-allergic asthmatic patients, and 40 healthy individuals. Moreover, neutrophils' phagocytic activity was assessed by ingestion of candida particles. Results. We demonstrated increased percentages of CCR7⁺ memory CD4⁺T cells and CCR4⁺CD4⁺T cells in patients compared to control, where this up regulation was significantly higher in allergic than non-allergic asthmatic patients. Additionally, these cells were negatively correlated with improved pulmonary tests and significantly associated with disease severity scores and IgE levels. The neutrophil phagocytic activity was markedly increased in patients compared to control, showing a significant positive correlation with disease severity. Conclusions. These findings suggest that increased CCR4⁺ CD4⁺ T cells and CCR7⁺ memory CD4⁺ T cells (Tcm) may be associated with BA severity, especially in allergic BA patients and can potentially contribute to the rational design of new therapeutic approaches for asthma in the future.

The WD40-domain containing protein CORO2B is specifically enriched in glomerular podocytes and regulates the ventral actin cytoskeleton

Podocytes are highly specialized epithelial cells essentially required to establish and maintain the kidney filtration barrier. Due to their complex cellular architecture these cells rely on an elaborated cytoskeletal apparatus providing plasticity as well as adaptive adhesion properties to withstand significant physical filtration forces. However, our knowledge about podocyte specific components of the cytoskeletal machinery is still incomplete. Employing cross-analysis of various quantitative omics-data sets we identify the WD40-domain containing protein CORO2B as a podocyte enriched protein. Furthermore, we demonstrate the distinct localization pattern of CORO2B to the ventral actin cytoskeleton serving as a physical linkage module to cell-matrix adhesion sites. Analysis of a novel Coro2b knockout mouse revealed that CORO2B modulates stress response of podocytes in an experimental nephropathy model. Using quantitative focal adhesome proteomics we identify the recruitment of CFL1 via CORO2B to focal adhesions as an underlying mechanism. Thus, we describe CORO2B as a novel podocyte enriched protein influencing cytoskeletal plasticity and stress adaptation.

Gender differences in a mouse model of chemotherapy-induced neuropathic pain

Chemotherapy-induced neuropathic pain is one of the major problems for cancer patients. Although paclitaxel and cisplatin are widely used in women, most laboratory studies of chemotherapy-induced neuropathic pain have been conducted on male animals. The current study examined the gender differences in chemotherapy-induced neuropathic pain in mice. Neuropathic pain was induced by intraperitoneal injection of paclitaxel (2 mg/kg) for five consecutive days and cisplatin (1 mg/kg) for seven consecutive days. Cold allodynia was evaluated by measuring the paw withdrawal frequency and duration of paw licking in mice; however, mechanical allodynia was assessed by von Frey filaments. Neuropathic pain began to manifest after a few days ( P < 0.001). Cold allodynia was more robust in female mice ( P < 0.001) treated with paclitaxel, while no differences were observed between the two genders in the manifestation of paclitaxel-induced mechanical allodynia. Interestingly, no gender differences were observed in cisplatin-induced cold and mechanical allodynia tests. In conclusion, gender differences play a major role in neuropathic pain induced by paclitaxel. The differences between male and female animals should be considered in future studies and the findings should be generalized to humans with caution.

A low-power, high-speed, 9-channel germanium-silicon electro-absorption modulator array integrated with digital CMOS driver and wavelength multiplexer

We demonstrate the first germanium-silicon C-band electro-absorption based waveguide modulator array and echelle-grating-based silicon wavelength multiplexer integrated with a digital CMOS driver circuit. A 9-channel, 10Gbps SiGe electro-absorption wavelength-multiplexed modulator array consumed a power of 5.8mW per channel while being modulated at 10.25Gbps by 40nm CMOS drivers delivering peak-to-peak voltage swings of 2V, achieving a modulation energy-efficiency of ~570fJ/bit including drivers. Performance up to 25Gbps on a single-channel SiGe modulator and CMOS driver is also reported.

Possible beneficial effects of lithium chloride on cerulein-induced acute pancreatitis in mice

One of the most important and serious disorders of gastrointestinal tract is acute pancreatitis which in severe form is associated with high mortality rate particularly in the presence of systemic inflammatory response and multiple organ failure. Apoptosis linked to oxidative stress has been shown in the pancreas of the patients with acute pancreatitis. Lithium, one of the most effective drugs for the treatment of bipolar disorder, also has dramatic effects on preventing cell damage and apoptosis. Also lithium has shown anti-inflammatory effects in some animal studies. This study was designed to investigate the possible effect of lithium chloride in acute pancreatitis. Induction of acute pancreatitis was performed in male mice (25-30 g) by five intraperitoneal (i.p.) injection of cerulein (50 μg/kg) with 1 h intervals. Lithium chloride (10, 20 and 30 mg/kg) was administered i.p. 15 min before the induction of pancreatitis. Six h after the last injection of cerulein, the animals were sacrificed and biochemical as well as histopathological analysis was performed. Pretreatment with 20 mg/kg i.p. of lithium chloride reduced significantly the inflammatory response in cerulein-induced acute pancreatitis by ameliorating pancreatic edema and leukocyte infiltration, attenuating amylase and lipase serum levels, and myeloperoxidase activity compared to control group (p<0.05). Two other administered doses namely 10 and 30 mg/kg were found ineffective. In this study our findings demonstrate that lithium can dose dependently exhibit protective effect against cerulein-induced acute pancreatitis.

[Drainage by echo-guided nephrostomy in hydronephrosis secondary to a pyelo-ureteral junction in a single kidney syndrome in a pregnant woman. Apropos of a case]

We report an exceptional case of pyeloureteral malformation which occurred on a single kidney. The malformation was discovered at 32 week of gestation when ultrasonography showed hydronephrosis. Initial treatment consisted in echoguided drainage. The patient gave birth to a live infant via normal vaginal delivery and then underwent resection of the pyeloureteral malformation with anastomotic reconstruction of the upper urinary tract.

[A rare complication of renal lithiasis: peritonitis and splenic abscess caused by rupture of pyonephrosis]

Peritonitis can result from many causes. We report a case caused by a renal abscess which contaminated the abdominal cavity. A 30-year-old patient was referred with suspected ruptured ectopic pregnancy with signs of peritoneal flooding. The culdocentesis was positive and returned frank pus. Endoscopic exploration with an open laparoscope revealed that the infection did not originate from a gynecological infection but did not identify the exact origin. Laparotomy was performed and revealed a splenic abscess and a subphrenic peritoneal breach releasing a purulent liquid. Splenectomy and abdominal lavage with draining was performed. A post-operative pyelourogram showed a silent kidney with multiple coralliform lithiases. Interventional sonography allowed drainage of a retroperitoneal collection. The post-operative period was uneventful. Left nephrectomy was later performed. Only rare cases of ruptured pyonephrosis leading to peritonitis have been reported, usually with poor prognosis.

[Uterine rupture during labor. Report of 106 cases at the Maternity Center of Tunis (Tunisia)]

This study involves 106 cases of the uterus seen at the Rabta Maternity and Neonatology Center (Tunis) over a period of 6 years. The incidence was 1.51% of labors and 75.4% of cases involved rupture of a scarred uterus. Rupture of a healthy uterus accounted for 24.6% of cases. The clinical picture was asymptomatic in 66.25% of cases involving a scarred uterus. Treatment of rupture of the uterus was essentially conservative by suture of the tear (73.6%). Maternal mortality was 2.8%. Perinatal mortality was high at 37.7%.

[Norplant contraception at the Rabta Tunis maternity hospital]

612 women had the benefit of contraceptive implants in the Maternity Hospital of La Rabta in Tunis over a period of 5 years (1988-1992). This study aimed at analysing the tolerance of this method by studying a group of 508 normal women and 104 women at risk (58 women were heart-diseased, 22 nursing, 13 diabetic, 11 hypertensive). The typical woman in this group is thirty years old, having 3 children, and weighing 61 kg. The implants were most of the cases withdrawn because of problems related to the menstrual cycle that were observed in 37% of the cases, equally distributed among both groups of the series. Contraceptive implants failed in 1.79% of the cases.