Enhanced SLAMF7 Homotypic Interactions by Elotuzumab Improves NK Cell Killing of Multiple Myeloma

Elotuzumab (Elo) is an IgG₁ monoclonal antibody targeting SLAMF7 (CS1, CRACC, and CD319), which is highly expressed on multiple myeloma (MM) cells, natural killer (NK) cells, and subsets of other leukocytes. By engaging with FcγRIIIA (CD16), Elo promotes potent NK cell-mediated antibody-dependent cellular cytotoxicity (ADCC) and macrophage-mediated antibody-dependent cellular phagocytosis (ADCP) toward SLAMF7⁺ MM tumor cells. Relapsed/refractory MM patients treated with the combination of Elo, lenalidomide, and dexamethasone have improved progression-free survival. We previously showed that Elo enhances NK cell activity via a costimulation mechanism, independent of CD16 binding. Here, we further studied the effect of Elo on cytotoxicity of CD16-negative NK-92 cells. Elo, but not other SLAMF7 antibodies, uniquely enhanced cytotoxicity mediated by CD16-negative NK-92 cells toward SLAMF7⁺ target cells. Furthermore, this CD16-independent enhancement of cytotoxicity required expression of SLAMF7 containing the full cytoplasmic domain in the NK cells, implicating costimulatory signaling. The CD16-independent costimulation by Elo was associated with increased expression of NKG2D, ICAM-1, and activated LFA-1 on NK cells, and enhanced cytotoxicity was partially reduced by NKG2D blocking antibodies. In addition, an Fc mutant form of Elo that cannot bind CD16 promoted cytotoxicity of SLAMF7⁺ target cells by NK cells from most healthy donors, especially if previously cultured in IL2. We conclude that in addition to promoting NK cell-mediated ADCC (CD16-dependent) responses, Elo promoted SLAMF7-SLAMF7 interactions in a CD16-independent manner to enhance NK cytotoxicity toward MM cells.

Three-dimensional Model of Coagulation Factor Va Bound to Activated Protein C

A complete molecular model of blood coagulation factor Va (FVa) bound to anticoagulant activated protein C (APC) and to a phospholipid membrane was constructed. The three homologous A domains and the two homologous C domains of FVA were modeled based on the X-ray crystallographic structures of ceruloplasmin and C2 domain of factor V, respectively. The final arrangement of the five domains in the complete FVa model bound to a membrane incorporated extensive published experimental data. FVa binds the phospholipid membrane through its C2 domain while the A-domain trimer is located from 40 through 100 Å above the membrane plane. From our model we infer a probable role for metal ions at the interface between FVa light and heavy chains, provide an explanation for the slower APC cleavage at Arg306 relative to Arg506, and predict specific interactions between positively and negatively charged exosites in APC and FVa, respectively.

Structural Basis for Hemophilia A Caused by Mutations in the C Domains of Blood Coagulation Factor VIII

Three dimensional homology models for the C1 and C2 domains of factor VIII (FVIII) were generated. Each C domain formed a β-sandwich, and C1 was covalently connected to C2 in a head-to-head orientation. Of the >250 missense mutations that cause FVIII deficiency and hemophilia A, 34 are in the C domains. We used the FVIII C1-C2 model to infer the structural basis for the pathologic effects of these mutations. The mutated residues were divided into four categories: 15 conserved buried residues that affect normal packing of the hydrophobic side chains, 2 non-conserved buried residues that affect structure, 11 conserved exposed residues and 6 non-conserved exposed residues. The effects of all 34 missense mutations can be rationalized by predictable disruptions of FVIII structure while at most four mutations (S2069F, T2154I, R2209Q/G/L and E2181D) may affect residues directly involved in intermolecular interactions of FVIII/VIIIa with other coagulation factors or vWF.

Towards a framework for analysis of eye-tracking studies in the three dimensional environment: a study of visual search by experienced readers of endoluminal CT colonography

OBJECTIVE

Eye tracking in three dimensions is novel, but established descriptors derived from two-dimensional (2D) studies are not transferable. We aimed to develop metrics suitable for statistical comparison of eye-tracking data obtained from readers of three-dimensional (3D) "virtual" medical imaging, using CT colonography (CTC) as a typical example.

METHODS

Ten experienced radiologists were eye tracked while observing eight 3D endoluminal CTC videos. Subsequently, we developed metrics that described their visual search patterns based on concepts derived from 2D gaze studies. Statistical methods were developed to allow analysis of the metrics.

RESULTS

Eye tracking was possible for all readers. Visual dwell on the moving region of interest (ROI) was defined as pursuit of the moving object across multiple frames. Using this concept of pursuit, five categories of metrics were defined that allowed characterization of reader gaze behaviour. These were time to first pursuit, identification and assessment time, pursuit duration, ROI size and pursuit frequency. Additional subcategories allowed us to further characterize visual search between readers in the test population.

CONCLUSION

We propose metrics for the characterization of visual search of 3D moving medical images. These metrics can be used to compare readers' visual search patterns and provide a reproducible framework for the analysis of gaze tracking in the 3D environment.

ADVANCES IN KNOWLEDGE

This article describes a novel set of metrics that can be used to describe gaze behaviour when eye tracking readers during interpretation of 3D medical images. These metrics build on those established for 2D eye tracking and are applicable to increasingly common 3D medical image displays.

Experiences of women referred for urgent assessment of postmenopausal bleeding (PMB)

Women with postmenopausal bleeding (PMB) are referred for specialist assessment within 2 weeks of presentation to their GP. No research has previously examined women's experiences of expedited referral. This was investigated in the present study using questionnaires (6-item State Anxiety Inventory (6-STAI)) and focus groups. A total of 55 women completed questionnaires. Results showed high levels of anxiety at first hospital visit (mean 47.0 (SD 14.27); 95% CI 43.14-50.93). Scores declined by 90 days, but were higher in those not undergoing hysteroscopy. Fifteen women who underwent hysteroscopy attended focus groups. Women recalled fear of cancer from symptom onset until receipt of results. Anxiety was exacerbated by poor knowledge of PMB and lack of awareness of expedited referral. Post-discharge, those with unexplained or recurrent symptoms expressed frustration and upset. Effective strategies to raise awareness of PMB and its causes are needed, including reasons for expedited referral. Women without cancer may also need more support.

Stratigraphy of the Anthropocene

The Anthropocene, an informal term used to signal the impact of collective human activity on biological, physical and chemical processes on the Earth system, is assessed using stratigraphic criteria. It is complex in time, space and process, and may be considered in terms of the scale, relative timing, duration and novelty of its various phenomena. The lithostratigraphic signal includes both direct components, such as urban constructions and man-made deposits, and indirect ones, such as sediment flux changes. Already widespread, these are producing a significant 'event layer', locally with considerable long-term preservation potential. Chemostratigraphic signals include new organic compounds, but are likely to be dominated by the effects of CO(2) release, particularly via acidification in the marine realm, and man-made radionuclides. The sequence stratigraphic signal is negligible to date, but may become geologically significant over centennial/millennial time scales. The rapidly growing biostratigraphic signal includes geologically novel aspects (the scale of globally transferred species) and geologically will have permanent effects.

The aerobiology of the environment around mechanically ventilated broiler sheds

AIM

To investigate the aerobiology of the environment around mechanically ventilated broiler sheds with the aim of understanding dispersion in the surrounding environment.

METHODS AND RESULTS

Aerosol samples were collected weekly on four different commercial broiler farms through the cycle of 55 days from 2005 to 2007. Samples were collected inside the shed and at varying distances from the sheds. Litter and dust from within the shed were also examined. Members of the genera Staphylococcus (and to a lesser extent Corynebacterium) dominated (10(6) CFU m(-3)) in the outside air at 20 m from the fan and were shown to decrease with distance. At distances of around 400 m, the levels of staphylococci/coryneforms returned to levels typical of those present before the placement of chickens. Escherichia coli levels were low (maximum 100 CFU m(-3)) at 20 m. Fungi were present at uniform levels across the broiler cycle.

CONCLUSIONS

Staphylococci are the dominant organisms present in the air around mechanically ventilated broiler sheds and have the potential to act as an airborne 'marker organism'. SIGNIFICANT IMPACT OF THE STUDY: The outcomes of this study suggest that the impact of aerosols emitted from broiler sheds could be monitored and managed by examining the levels of staphylococci/coryneforms.

Hyoid bone position after surgical mandibular advancement

A cephalometric evaluation of the changes in the horizontal and vertical placement of the hyoid bone and of those in the position of the head over the cervical spine after surgical mandibular advancement was undertaken. Seven linear and one angular measurement were investigated in 60 patients, 17 males and 43 females, before and one year after surgical mandibular advancement. The hyoid bone moved forwards horizontally in 78 per cent of the subjects, backwards in 17 per cent, and in 5 per cent of patients it retained its pre-operative position. It moved vertically downwards in 32 per cent of subjects, and in 63 per cent it moved upwards and closer to the body of mandible. The amount of horizontal and vertical change of the hyoid bone was associated with the corresponding change of the mandible after surgery. The vertical change was more distinct in females compared with males. There was variation in the position of the head over the cervical spine; it showed extension in 26.7 per cent of the sample, flexion in 71.7 per cent, and remained the same in only 1.6 per cent after surgery. The results show that with surgical mandibular advancement the hyoid bone follows mainly the advancement of the mandible and moves closer to the body of the mandible. However, there are variations in the changes of hyoid bone and head position that are difficult to predict.

Factors influencing nurses' inferences about patient pain

This study examined the factors that influence nurses' perception of patient pain. Sixteen vignettes were constructed on the basis of interviews with nurses about factors affecting their perception of patient pain and previous published literature. Four variables were systematically varied within a factorial design: diagnosis (surgery vs oncology), level of patient mobility, presence or absence of physical and behavioural signs, and patient gender. Twenty-seven nurses rated each vignette for degree of inferred patient pain and degree of patient psychological distress. Mobility and positive signs of pain had statistically significant effects on nurses' judgments of inferred pain (P < 0.001), but diagnosis had no main effect. Significant interactions showed that: inferred pain in male patients was seen to be greater when immobile while mobility had no effect on the inferred pain of female patients (P < 0.003); oncology patients (compared with surgical patients) had greater inferred pain when displaying positive signs (P < 0.024); and positive signs yielded higher ratings where patients were immobile (P < 0.001). Female patients were perceived to experience higher psychological distress than men (P < 0.037) and oncology patients were perceived to experience higher distress than surgical patients (P < 0.005). Ratings of perceived pain and distress were significantly correlated but did not differ in magnitude. Offered a choice of analgesics to relieve pain for each of the patients depicted, nurses typically chose those with the lowest strength.

Developing the role of the generic healthcare support worker: phase 1 of an action research study

This paper reports on the first phase of an action research practice development project to explore, develop and evaluate the role of the generic healthcare support worker in a high dependency rehabilitation service. The project is being jointly conducted by staff from the University of Southampton, the University of Portsmouth and the Isle of Wight Healthcare NHS Trust and phase 1 is supported by a grant from the NHS Executive (South and West). The aim of phase 1 of the project is to explore the attitudes of staff towards the implementation of the role of the generic healthcare support worker, particularly regarding the practical, professional and ethico-legal problems of the role. Professional and support staff from different parts of the service were interviewed in groups and the interviews were tape recorded, transcribed and subjected to a simple thematic analysis. Four themes emerged from the data relating to the challenge to professional boundaries, being a generic worker, outcomes for service and patients and implementing the role. As an action research project, the aim was not to produce findings that are generalizable beyond the practice areas in which they were generated, but it is nevertheless hoped that the reader might be able to apply some of the conclusions to his or her own setting.

Electrophysiological measures of cognition in biological psychiatry: some cautionary notes

Research into the electrophysiological correlates of mental illness is currently expanding, largely because of the availability of relatively inexpensive and powerful computers. However, improvements in technology do not always lead to enhanced methodological procedures; thus, there are concerns over the proper interpretation of the results of these investigations. Our argument is that electroencephalographic (EEG) research into psychopathology of psychiatric diseases should adopt a cognitivist model of mental dysfunction rather than a neurologist model of brain disease. Cognitive science has significant potential as an integrative framework for theorizing and researching psychiatric disorders and their treatment. Models of human cognitive functioning have rather special and unique features; these will make their impact upon the nature of both the analysis and interpretation of EEG data. The adoption of a sound model of brain function has implications for the methods to be used at different successive stages of the research process. We address a number of methodological requirements pertaining to: the recording and analysis of EEG signals, the laboratory context, the nature of the tasks, and the attribution of obtained effects. However, there are grounds for great caution. Even if the mapping of electrical changes in brain activity leads to a good approximation of the temporal and spatial dynamics of higher brain function, exploitation of such information presupposes a deeper understanding of both human cognition and the physiological basis of the EEG than is often displayed in the literature. To demonstrate this fundamental point, we draw a number of comparisons between traditional neurological approaches to brain assessment and contemporary cognitive psychophysiology.

Will managed care collapse at the hands of the civil justice system? ERISA protection may end

For the first time, instances where HMO strategies to save money collide with the patient's right to receive quality of care have come under the scrutiny of the law.

A psychophysiological inquiry into the nature of the Sokolovian orienting response comparator model: skin conductance and EEG data

The mechanisms which trigger the orienting response (OR) are still the subject of lively debate. Sokolov (1990) proposes the development of a multidimensional model of the physical parameters of stimulation. Recent OR research has shown that the skin conductance OR (SCOR) is related to task demands and controlled processing, although this is not so clear for central physiological indexes of orienting. Seventy-three subjects performed visual discriminations of stimuli within a warning-stimulus paradigm. The physical complexity of stimuli and their task relevance were manipulated within subjects, while the nonspecific effects of workload were controlled with a group factor. SCORs were measured concurrently with 1-s epochs of EEG alpha and theta power from Fz, Cz, Pz, and Oz. Neither index was reliably affected by the physical complexity of stimulation alone. However, both higher task relevance and higher workload significantly increased the magnitude of EEGORs and SCORs. Task averages of central and autonomic activity showed an overall pattern of covariation, but a second-by-second breakdown of EEG spectra suggests that the SCOR may be an aggregate of the activation of diverse brain mechanisms responsible for physiological orienting. The results are consistent with a model of orienting as a continuous dimension of resource allocation to anticipated and current task demands, rather than with the abrupt dichotomy between voluntary and involuntary orienting. Implications for the classical OR Sokolovian model are discussed.

Is sham smoking an adequate control condition for the motoric component of smoking?

This is a study of the similarities and differences between real and sham smoking; 15 participants, all of whom had a smoking history of more than two years, attended on two occasions within a balanced design. They were instructed to either smoke or sham smoke their own brand of cigarette as normally as possible. Real and sham smoking were highly correlated for various measures: frequency of puffs, puff duration, interpuff interval, puff volume, and puff pressure. This showed that the pattern of smoking was common across the two conditions. At the same time, there were differences between the two conditions in the intensity of smoking, such that sham smoking led to significant increases in puff duration, volume, frequency, and decreases in the length of interpuff interval. Sham smoking is often used in smoking experimentation as a control for various aspects of smoking. This is the first study to examine the commonalities between real and sham smoking in a detailed and systematic fashion.

U937 cells can utilize plasminogen activator to regulate human interferon-gamma

Urokinase-type plasminogen activator (uPA) converts the proenzyme plasminogen to plasmin and thereby contributes to processes like cell migration, tissue remodeling, and cytokine processing. We report here that uPA produced by the human U937 promonocytic cell line also initiated the inactivation of recombinant interferon-gamma (rIFN-gamma) by plasmin-mediated proteolysis. When cultured serum-free with plasminogen, U937 promonocytic cells generated measurable levels of plasmin activity and destroyed the antiviral activity of exogenously added rIFN-gamma. This effect was not seen in the absence of plasminogen, was prevented by inhibitors of uPA and plasmin, and was accompanied by changes in the electrophoretic mobility of rIFN-gamma on polyacrylamide gels, consistent with limited proteolysis of the lymphokine. Culturing U937 cells or blood monocytes for 48 h led to an elevated expression of their surface uPA and an increase in their capacity to produce plasmin and inactivate rIFN-gamma. The ability of rIFN-gamma to induce Fc receptors on U937 cells could also be prevented by providing the cells with a source of exogenous plasminogen, indicating that U937 cells could control their own activation in vitro through the action of uPA. The results of these studies support the conclusion that mononuclear phagocytes have the capacity to use uPA to regulate cytokine activity in vitro.

Effects of situational demands on the direction of electrodermal activation during smoking

Task demands (normal smoking; sham smoking; smoking or non-smoking during complex cognitive performance; and, smoking or non-smoking during monotonous vigilance performance) were manipulated in three experiments. Smoking increased electrodermal activity (EDA) arousal from pre-smoking baseline. Sham smoking (as a control for motoric aspects) also increased EDA arousal but to a lesser degree. In contrast the demands of complex cognitive performance were associated with lower EDA arousal during smoking than during non-smoking. Finally, during vigilance performance smoking maintained EDA arousal which during non-smoking decreased. Smoking did not improve performance during complex cognitive processing or vigilance above deprivation performance levels. It was concluded that smoking did have bidirectional effects as a function of task demand. However, there was no evidence that these physiological changes were functional and the smoking behavior data gave no indication as to the cause of these changes.

Motor nerve biopsy in severe Guillain-Barré syndrome

We undertook a biopsy of a terminal branch of the musculocutaneous nerve in a man with severe Guillain-Barré syndrome and very small distally evoked action potentials. The biopsy showed pronounced subperineurial edema, macrophage infiltration, and many axons that had been completely demyelinated, some associated with intratubal macrophages. The biopsy unequivocally identified the pathological process as primary demyelination, not axonal degeneration, and was more informative than previous reports of sural nerve biopsies in patients with Guillain-Barré syndrome.