Antibody and T cell responses to COVID-19 vaccination in patients receiving anticancer therapies

BACKGROUND

Patients with cancer were excluded from phase 3 COVID-19 vaccine trials, and the immunogenicity and side effect profiles of these vaccines in this population is not well understood. Patients with cancer can be immunocompromised from chemotherapy, corticosteroids, or the cancer itself, which may affect cellular and/or humoral responses to vaccination. PD-1 is expressed on T effector cells, T follicular helper cells and B cells, leading us to hypothesize that anti-PD-1 immunotherapies may augment antibody or T cell generation after vaccination.

METHODS

Antibodies to the SARS-CoV-2 receptor binding domain (RBD) and spike protein were assessed in patients with cancer (n=118) and healthy donors (HD, n=22) after 1, 2 or 3 mRNA vaccine doses. CD4⁺ and CD8⁺ T cell reactivity to wild-type (WT) or B.1.617.2 (delta) spike peptides was measured by intracellular cytokine staining.

RESULTS

Oncology patients without prior COVID-19 infections receiving immunotherapy (n=36), chemotherapy (n=15), chemoimmunotherapy (n=6), endocrine or targeted therapies (n=6) and those not on active treatment (n=26) had similar RBD and Spike IgG antibody titers to HDs after two vaccinations. Contrary to our hypothesis, PD-1 blockade did not augment antibody titers or T cell responses. Patients receiving B-cell directed therapies (n=14) including anti-CD20 antibodies and multiple myeloma therapies had decreased antibody titers, and 9/14 of these patients were seronegative for RBD antibodies. No differences were observed in WT spike-reactive CD4⁺ and CD8⁺ T cell generation between treatment groups. 11/13 evaluable patients seronegative for RBD had a detectable WT spike-reactive CD4⁺ T cell response. T cells cross-reactive against the B.1.617.2 variant spike peptides were detected in 31/59 participants. Two patients with prior immune checkpoint inhibitor-related adrenal insufficiency had symptomatic hypoadrenalism after vaccination.

CONCLUSIONS

COVID-19 vaccinations are safe and immunogenic in patients with solid tumors, who developed similar antibody and T cell responses compared with HDs. Patients on B-cell directed therapies may fail to generate RBD antibodies after vaccination and should be considered for prophylactic antibody treatments. Many seronegative patients do develop a T cell response, which may have an anti-viral effect. Patients with pre-existing adrenal insufficiency may need to take stress dose steroids during vaccination to avoid adrenal crisis.

Giant parathyroid adenoma: a case report

BACKGROUND

Giant parathyroid adenoma is a type of parathyroid adenoma weighing > 3.5 g and having a size of more than 2 cm.

CASE PRESENTATION

This report describes giant primary parathyroid adenoma with reference to the literature. We report the case of a 48-year-old Persian man referred to the clinic with knee and lower back pain. He had a history of mitral valve replacement and several episodes of bilateral nephrolithiasis. After a thorough assessment, a neck mass with a possible thyroid origin was detected, but further assessment showed it was of parathyroid origin. The resected mass was 9 × 6× 4 cm and weighed 122 g, and histopathology showed a giant parathyroid adenoma.

CONCLUSION

Giant parathyroid adenomas that weigh more than 110 g and are larger than 8 cm can lead to significant hypercalcemia. Despite giant parathyroid adenomas and high parathyroid hormone levels, a calcium crisis may not always occur in these patients, and the masses may be initially misdiagnosed as a thyroid mass.

Severe COVID-19 infection is associated with aberrant cytokine production by infected lung epithelial cells rather than by systemic immune dysfunction

The mechanisms explaining progression to severe COVID-19 remain poorly understood. It has been proposed that immune system dysregulation/over-stimulation may be implicated, but it is not clear how such processes would lead to respiratory failure. We performed comprehensive multiparameter immune monitoring in a tightly controlled cohort of 128 COVID-19 patients, and used the ratio of oxygen saturation to fraction of inspired oxygen (SpO2 / FiO2) as a physiologic measure of disease severity. Machine learning algorithms integrating 139 parameters identified IL-6 and CCL2 as two factors predictive of severe disease, consistent with the therapeutic benefit observed with anti-IL6-R antibody treatment. However, transcripts encoding these cytokines were not detected among circulating immune cells. Rather, in situ analysis of lung specimens using RNAscope and immunofluorescent staining revealed that elevated IL-6 and CCL2 were dominantly produced by infected lung type II pneumocytes. Severe disease was not associated with higher viral load, deficient antibody responses, or dysfunctional T cell responses. These results refine our understanding of severe COVID-19 pathophysiology, indicating that aberrant cytokine production by infected lung epithelial cells is a major driver of immunopathology. We propose that these factors cause local immune regulation towards the benefit of the virus.

The EPR spectrum for CuB in cytochrome c oxidase

Incubation of cytochrome c oxidase (CcO) in its resting state in saturated ammonium sulfate, at room temperature overnight, gave EPR signals characteristic of a single Cu(II) center. From the g// and A// values it is concluded that this is a square-planar type 2 copper center, and superhyperfine splitting shows the presence of three nearly equivalent 14N nuclei in the plane. It is suggested that this center, also formed by incubating the enzyme in 10% methanol followed by direct irradiation, must be the CuB center. This type 2 copper EPR spectrum is identical to the EPR spectrum of CuB reported for the isolated cytochrome bo3 complex from Escherichia coli; and to the EPR spectrum reported for the sulfobetaine 12 heat-treated cytochrome c oxidase complex. It is argued that a small perturbation in the system causes decoupling of the magnetic coupling of the heme a3-CuB binuclear center and the appearance of the type 2 EPR signal.

Vitamin E, membrane fluidity, and blood pressure in hypertensive and normotensive rats

Vitamin E treatment was found to lower blood pressure, and increase membrane fluidity in rats. The objectives of this study were to investigate the effects of the antioxidant, vitamin E, on the blood pressure and erythrocyte membrane fluidity in spontaneously hypertensive (SHR) and normotensive (WKY) rats. Membrane fluidity was assessed using spin labeling technique and electron paramagnetic resonance (EPR) spectroscopy. Two different spin labels were used in this study, 5-doxylstrearic acid (5-SASL) and 16-doxylstearic acid (16-SASL). The rats were given vitamin E, 3 days/week for 3 weeks and blood pressure was measured once weekly, using the tail-cuff method. Subsequently, blood was taken via heart puncture and erythrocytes were prepared for spin labeling. The fluidity of the membrane in the nonpolar region of erythrocytes from hypertensive rats was found quite different from that of normal rats as judged by the spectra of 16-SASL. The values of maximum splitting parameter of the EPR spectra of the spin label 5-SASL incorporated in erythrocyte membrane from both SHR and WKY rats, and the effects of vitamin E on membrane fluidity were compared. The maximum splitting parameter calculated from EPR spectra was larger for SHR than WKY rats. Additionally, the maximum splitting parameter calculated for vitamin E treated SHR and WKY rats were lower than those of their respective controls. As expected, the blood pressure of the SHR rats was found to be higher than that of the WKY rats. Vitamin E treated SHR and WKY rats showed significantly lower blood pressure than their controls.

Partitioning and structural effects of the antitumor drug daunomycin on model membranes

The effects of the antitumor drug daunomycin on the phase transition and dynamic properties of phosphatidylcholine membranes were investigated using the electron paramagenetic resonance spin labeling method. Multilamellar liposomes made of saturated dimyristoylphosphatidylcholine and unsaturated egg yolk phosphatidylcholine were used. The main phase transition of saturated bilayer was significantly broadened in the presence of daunomycin. In the fluid phase of saturated membranes, daunomycin caused a decrease in the rotational motion of the spin probe 16-doxylstearic acid (16-SASL). This effect was strongly diminished by raising the temperature. In unsaturated membranes no influence of daunomycin on the rotational motion of 16-SASL was observed. It is proposed that the neutral form of daunomycin can partition into lipid bilayer where it can diffuse into deeper hydrophobic regions of the membrane and decrease the motion of alkyl chains.

Partitioning and localization of spin-labeled amantadine in lipid bilayers: an EPR study

EPR was used to study the distribution of the spin-labeled amantadine (AA-SL) between the bulk hydrophobic-hydrocarbon solvent, light paraffin oil, and water and between hydrophobic-hydrocarbon chain region of lipid membranes and water. The AA-SL molecules were soluble in both hydrophobic and polar regions of investigated systems. It was shown that the partition coefficient of AA-SL between the hydrocarbon region of the L-alpha-dimyristoylphosphatidylcholine fluid-phase membrane and water is much higher than between bulk hydrocarbon solvent and water. Furthermore, the partitioning of AA-SL into membranes of multilamellar liposomes made of L-alpha-dimyristoylphosphatidylcholine, L-alpha-dipalmitoylphosphatidylcholine, and L-alpha-distearoylphosphatidylcholine was studied as a function of temperature, indicating no abrupt change at the main phase transition of these membranes. It is also clear from our data that AA-SL can penetrate into the gel-phase membrane practically with the same partitioning as into the fluid-phase membrane. Furthermore, it was shown that at least part of the AA-SL molecule is deeply buried in the hydrocarbon chain region of the membrane.

Effects of probucol on phase transition and fluidity of phosphatidylcholine membranes: a spin label study

Spin labeling methods were applied to study the structure and dynamics of phosphatidylcholine membranes as a function of temperature and the mole fraction of probucol. Multilamellar liposomes made of dimyristoylphosphatidyclcholine, dipalmitoylphosphatidylcholine both saturated, and egg yolk phosphatidylcholine, an unsaturated membrane, were used. In fluid phase membranes probucol was found to increase the order and decrease the motional freedom of alkyl chains of lipids as shown with stearic acid spin labels. The effect of probucol on order and motional freedom is more pronounced in the membrane center (16-doxylstearic acid spin label position) than in the near polar headgroup region (5-doxylstearic acid spin label position). The presence of unsaturation in alkyl chains significantly decreased the ordering effect of probucol. The main phase transition temperature of saturated bilayers was lowered by 2 degrees C in the presence of 3 mol% of probucol and significantly broadened at higher concentrations as measured with 2,2,6,6-tetramethylpiperidine-1-oxyl (TEMPO) partitioning. Also, pretransition was no longer observed in the presence of probucol. In gel phase membranes, the effect of probucol was complex. Close to the main phase transition the motion of alkyl chains was increased, showing a regulatory effect of probucol on membrane fluidity. It is proposed that probucol is located in the membrane center as opposed to vitamin E, which locates its phenolic -OH group at the membrane surface; therefore, it inhibits lipid peroxidation in this region which is less accessible to vitamin E.

Transport of spin-labeled tetracycline across model and biological membranes

Electron spin resonance spectra of spin labeled tetracycline (TC-SL) do not show any recognizable partitioning into a lipid bilayer or bulk hydrocarbon solvent, paraffin oil. TC-SL, however, penetrates through the model and biological membranes. It is shown that the rate of permeation depends on membrane composition and increases with temperature. In fluid phase, the rate is greater for saturated dimyristoylphosphatidylcholine than for unsaturated egg yolk phosphatidylcholine membranes. Cholesterol significantly decreases the rate, 30 mol% cholesterol decreases the rate of TC-SL permeation across egg yolk phosphatidylcholine bilayer 8 times at 37 degrees C. The rate of permeation of TC-SL across model membranes is much smaller than the rate for TEMPONE--a compound which slightly partitions into lipid bilayer, and much greater than the rate for TEMPO--choline-a positively charged compound. After addition to the suspension of Ehrlich's ascites tumor cells, the TC-SL is reduced to a non-paramagnetic form. Reduction rate is independent of oxygen concentrations, which led us to suggest that the permeation of TC-SL across the cell plasma membrane is the limiting step of reduction reaction.

Partitional and motional properties of a spin-labeled daunomycin in lipid bilayers. An ESR study

The partition coefficient of a spin-labeled daunomycin (DAU-SL) in dimyristoylphosphatidylcholine membrane has been determined using the electron spin resonance (ESR) method. The experiment was carried out as a function of temperature between 5 degrees C and 35 degrees C, giving partition coefficients between 2 and 6 without abrupt change at the phase transition. The thermodynamic parameters on transferring the DAU-SL from the aqueous phase to the lipid bilayer were also calculated. The calculated values are: delta H = 6.11 kcal/mol and delta S = 23 cal/K mol. The partitioning of the DAU-SL and its motion in the membrane were investigated in a wide range of pH (4-10.3). The data show that pH has no effect on partitioning of the DAU-SL which suggest that the drug exists in the uncharged form in the bilayer.

Spectroscopic and biological studies of spin-labeled tetracycline

A new nitroxyl labeled tetracycline is synthesized. Proton NMR experiments of tetracycline, spin-labeled tetracycline, and the diamagnetic reduced form in DMSO-d6 are reported. The signals observed in the NMR spectra are all assigned. The NMR data revealed that the spin label is attached to the C-2 amide group on ring A of tetracycline. The spin-labeled tetracycline is also tested in vitro for antitumor activity and is found to be active against leukemia P338/ADR cell line and in melanoma LOX cell line.

Orientational and motional properties of copper (II) complexes of dibenzotetraaza [14]annulenes in lipid bilayers: an ESR study

ESR studies of two copper(II) complexes of substituted dibenzotetraaza [14]annulenes, CuL and CuLA, in dimyristoylphosphatidylcholine (DMPC) and egg yolk phosphatidylcholine (EYPC) are reported. Our data show that both complexes partition into the membranes and that the rotational motion of CuL is faster than CuLA. Analysis of the ESR spectra of these complexes in DMPC vesicles indicate that the Cu-motion parameter, which is a measure of the degree of resolution of the nitrogen hyperfine structure, changes abruptly at the main phase transition. At 1 mole %, both complexes lowered the fluid/gel phase transition temperature by 2 degrees C as measured by the Cu-motion parameter. A gradual change of the Cu-motion parameter is observed in EYPC liposomes over the same temperature range. ESR spectra of both CuL and CuLA in oriented membranes reveal that both complexes are well oriented with the plane of the complex perpendicular to the bilayer surface.

Drug-metal interactions: spectroscopic studies of copper hydantoin complexes

The preparation and spectral properties of copper(II) complexes of two hydantoins are reported. Complexes of the general formula Cu(hyd)2(py)2, where hyd = phenytoin or nirvanol; and py = pyridine were prepared and characterized by infrared and ESR. Spectral data show that the copper atom is bound to the nitrogen atom of the hydantoin anion and to the nitrogen atom of the pyridine molecule to form 2:2:1 hydantoin:pyridine:copper complexes. The ESR data indicate that both complexes have tetragonal symmetry (g11 greater than g perpendicular greater than g e) with the unpaired electron in the d x2-y2 orbital.

Drug-metal interactions: copper(II) complex of the antidiabetic drug acetohexamide and pyridine

The preparation, spectral properties, and crystal structure of a copper(II) complex of 4-acetyl-N-[(cyclohexylamino)carbonyl]benzenesulfonamide, which is known as acetohexamide, and pyridine are reported. The complex Cu(AH)2(py)2, where AH = acetohexamide and py = pyridine, was prepared and characterized by X-ray and ESR. The complex is monoclinic, space group P2(1)/a, with a = 17.412(6), b = 9.039(2), c = 26.531(10) A, beta = 102.24(2) degrees, and Z = 4. The final refinement used 3892 unique reflections and gave an R value of 0.0646. The copper atom is surrounded by four nitrogen atoms in a square-planar arrangement, two from the acetohexamide ligands (Cu-N = 2.009 A) and two from the pyridine molecules (Cu-N = 2.016 A) in a trans geometry. The ESR data support a similar coordination behavior of the copper (g parallel greater than g perpendicular greater than ge) with the unpaired electron in the dx2-y2 orbital.

Structure-activity relationships for epidermal ornithine decarboxylase induction and skin tumor promotion by anthrones

The present study was designed to compare the skin tumor promoting and epidermal ornithine decarboxylase (ODC) inducing activities of various structural analogs of anthralin (1,8-dihydroxy-9-anthrone) and chrysarobin (1,8-dihydroxy-3-methyl-9-anthrone). Groups of 30 SENCAR mice each were initiated with 7,12-dimethylbenz[a]anthracene and 2 weeks later promoted with once- or twice-weekly applications of various doses of these anthrone derivatives. Carbon-10 (C10)-acyl derivatives of anthralin were active skin tumor promoters in the range of 25-440 nmol per mouse. 10-Acetylanthralin was significantly more active than 10-myristoyl-anthralin at low doses (e.g. 25 and 50 nmol per mouse) and nearly as potent as the unsubstituted compound. Higher doses (greater than or equal to 100 nmol per mouse) of this derivative were toxic, hence, reducing the final papilloma response. On a relative activity scale where anthralin is 1.0, these derivatives had activities that were approximately 0.7 and 0.2, respectively. 10,10-Dipropylanthralin was totally inactive at the doses tested. C6-Substituted derivatives of chrysarobin demonstrated diverse tumor promoting activities when tested in the range of 25-440 nmol per mouse. On a relative activity scale where chrysarobin is 1.0, 6-methoxychrysarobin (physcion anthrone) was approximately 0.9, whereas 6-hydroxychrysarobin (emodin anthrone) had no activity. Chrysophanic acid (1,8-dihydroxy-3-methyl-9,10-anthraquinone) was also inactive as a tumor promoter at the doses tested. In general, the tumor promoting activities of these anthrone derivatives correlated very well with their ability to induce epidermal ODC after a single topical application indicating an important role for this enzyme in skin tumor promotion by anthones. The ability of C10-substituted derivatives of anthralin to undergo base catalyzed oxidation in vitro correlated with both ODC inducing and tumor promoting activities. In addition, copper(II)bis(diisopropylsalicylate) was found to inhibit both ODC induction and skin tumor promotion by chrysarobin. These latter data, when taken together, suggest a role for oxidation at C10 in skin tumor promotion by anthrone derivatives.

ESR studies of molecular interactions of copper(II) nirvanol and copper(II) diisopropylsalicylate with Ehrlich ascites tumor cells

ESR spectra have been obtained after addition of either a cupric phenylhydantoin or a cupric diisopropylsalicylate complex to Ehrlich ascites tumor cells. It is shown that some of the complex remains in the cupric state. Because the ESR parameters of these complexes in the presence of cells differ from the ESR parameters for these complexes in the absence of cells, in the presence of cells either adducts or new cupric complexes are formed. The fast motion of these complexes, as determined from room temperature ESR spectra, is characteristic of complexes with molecular weights less than 1500.

Pharmacologic activities of copper compounds in chronic diseases

Copper complexes have been shown to be effective antiinflammatory, antiulcer, anticonvulsant, anticancer, and antidiabetic agents. This seemingly diverse variety of pharmacologic effects is unified by the hypothesis that copper complexes facilitate or promote tissue repair processes involving copper-dependent enzymes and that arthritis, ulcers, seizures, neoplasia, and diabetes are diseases of specific tissues in disrepair. The corollary to this hypothesis is that the loss or reduction of copper-dependent enzyme-mediated processes leads to tissue dysfunction that may be reversed with copper complex therapy.