Vascular endothelial profilin-1 drives a protumorigenic tumor microenvironment and tumor progression in renal cancer

Overexpression of actin-binding protein profilin-1 (Pfn1) correlates with advanced disease features and adverse clinical outcome of patients with clear cell renal carcinoma, the most prevalent form of renal cancer. We previously reported that Pfn1 is predominantly overexpressed in tumor-associated vascular endothelial cells in human clear cell renal carcinoma. In this study, we combined in vivo strategies involving endothelial cell-specific depletion and overexpression of Pfn1 to demonstrate a role of vascular endothelial Pfn1 in promoting tumorigenicity and enabling progressive growth and metastasis of renal carcinoma cells in a syngeneic orthotopic mouse model of kidney cancer. We established an important role of endothelial Pfn1 in tumor angiogenesis and further identified endothelial Pfn1-dependent regulation of several pro- (VEGF, SERPINE1, CCL2) and anti-angiogenic factors (platelet factor 4) in vivo. Endothelial Pfn1 overexpression increases tumor infiltration by macrophages and concomitantly diminishes tumor infiltration by T cells including CD8+ T cells in vivo, correlating with the pattern of endothelial Pfn1-dependent changes in tumor abundance of several prominent immunomodulatory cytokines. These data were also corroborated by multiplexed quantitative immunohistochemistry and immune deconvolution analyses of RNA-seq data of clinical samples. Guided by Upstream Regulator Analysis of tumor transcriptome data, we further established endothelial Pfn1-induced Hif1α elevation and suppression of STAT1 activation. In conclusion, this study demonstrates for the first time a direct causal relationship between vascular endothelial Pfn1 dysregulation, immunosuppressive tumor microenvironment, and disease progression with mechanistic insights in kidney cancer. Our study also provides a conceptual basis for targeting Pfn1 for therapeutic benefit in kidney cancer.

Immune landscape in invasive ductal and lobular breast cancer reveals a divergent macrophage-driven microenvironment

T cell-centric immunotherapies have shown modest clinical benefit thus far for estrogen receptor-positive (ER+) breast cancer. Despite accounting for 70% of all breast cancers, relatively little is known about the immunobiology of ER+ breast cancer in women with invasive ductal carcinoma (IDC) and invasive lobular carcinoma (ILC). To investigate this, we performed phenotypic, transcriptional and functional analyses for a cohort of treatment-naive IDC (n = 94) and ILC (n = 87) tumors. We show that macrophages, and not T cells, are the predominant immune cells infiltrating the tumor bed and the most transcriptionally diverse cell subset between IDC and ILC. Analysis of cellular neighborhoods revealed an interplay between macrophages and T cells associated with longer disease-free survival in IDC but not ILC. Our datasets provide a rich resource for further interrogation into immune cell dynamics in ER+ IDC and ILC and highlight macrophages as a potential target for ER+ breast cancer.

Linking Expression of Cell-Surface Receptors with Transcription Factors by Computational Analysis of Paired Single-Cell Proteomes and Transcriptomes

Complex signaling and transcriptional programs control the development and physiology of specialized cell types. Genetic perturbations in these programs cause human cancers to arise from a diverse set of specialized cell types and developmental states. Understanding these complex systems and their potential to drive cancer is critical for the development of immunotherapies and druggable targets. Pioneering single-cell multi-omics technologies that analyze transcriptional states have been coupled with the expression of cell-surface receptors. This chapter describes SPaRTAN (Single-cell Proteomic and RNA-based Transcription factor Activity Network), a computational framework, to link transcription factors with cell-surface protein expression. SPaRTAN uses CITE-seq (cellular indexing of transcriptomes and epitopes by sequencing) data and cis-regulatory sites to model the effect of interactions between transcription factors and cell-surface receptors on gene expression. We demonstrate the pipeline for SPaRTAN using CITE-seq data from peripheral blood mononuclear cells.

Primary health care reforms in Poland: ambitions versus reality

Poland, like many other former eastern bloc countries, inherited a health system dominated by narrow medical specialties, a large number of hospital beds and relatively weak primary health care (PHC). Since early 1990s, efforts have been made to strengthen the role of PHC, starting with the introduction of specialization training in family medicine. With privatization of PHC practices the standard of PHC care has improved. However, national audits have repeatedly found PHC to still be inadequate, with the key weaknesses including shortages of family medicine specialists, insufficient provision of preventive services, and limited use of diagnostics, which led to inappropriate referrals and long waiting times for specialist consultations. Between mid-2018 and the end of 2021, a new model of PHC organization was piloted in around 40 PHC practices across Poland that met the model's requirements. The pilot, supported by the World Bank, put much emphasis on health promotion and disease prevention by including health educators and dieticians in PHC teams and by introducing periodic check-ups. It also aimed to reduce referrals to specialist care by allowing PHC doctors to order extensive diagnostic and laboratory tests and, if needed, consult with a range of cooperating specialists. It also sought to increase the role of PHC doctors in the management of chronic conditions by introducing disease management programmes (DMPs) for 11 most prevalent conditions. PHC teams were made responsible for coordinating patients’ care pathways, including post-hospital treatment, and a new role of care coordinator was introduced to that end. After the pilot was concluded, all PHC practices were mandated to hire care coordinators. Implementation of other solutions tested in the pilot remains uncertain, mainly due to the lack of financial and human resources, and the dominance of small PHC practices that struggle to meet the ambitious requirements set out in the new model.

Governing the COVID-19 response

The COVID-19 pandemic has demonstrated that effective leadership and strong governance are essential for resilience in the face of a shock to the health system. Even though adequate financing of health systems, and ensuring that they have an adequate workforce, physical infrastructure and material supplies can bolster health system resilience, resilience is not merely a function of hard resources but also of soft factors, including capacities of leaders, strengths of institutions, and societal values and culture. Indeed, countries that topped the Global Health Security Index (GHSI), an index that focuses on measuring technical preparedness for epidemics and pandemics, in 2019 were among those that performed the worst during the COVID-19 crisis, as measured in deaths or damage to the economy. A country's initial governance capacity, at the onset of the pandemic, shaped its ability to respond. For example, countries with effective leaders, strong institutions and higher levels of societal trust were often better positioned to respond adequately. But government capacity and trust could change over the course of the response. For example, deliberative decision making that is inclusive, transparent, and accountable, coupled with effective public engagement, can build legitimacy and support for difficult decisions. In the longer term, it can contribute to building trust and improving policy making. This presentation will provide an overview of the strategies that countries-mainly in Europe but also with examples from other regions-have implemented to achieve effective leadership and decision making, coordination, generation and use of information in COVID-19 response decisions. A brief overview of key metrics to assess resilience in the area of governance will also be provided.

Olfactory hallucinations during migraine in an adolescent with an MRI temporal lobe lesion

OBJECTIVE

To report the first example of an abnormal magnetic resonance imaging (MRI) test in a patient with migraine and olfactory hallucinations and to provide additional evidence for a possible role of the temporal lobe in migraine.

BACKGROUND

The relationship between the temporal lobe and migraine with or without hallucinations is unclear and continues to evolve. Clinical and functional neuroimaging studies (positron emission tomography/single photon emission computed tomography) have lent support to the possibility of a relationship. Anatomical neuroimaging with computed tomography has previously been normal.

METHODS

The history and findings of an adolescent with migraine and olfactory hallucinations is reported.

RESULTS

Brain MRI demonstrated a mass in the temporal lobe.

CONCLUSIONS

Magnetic resonance imaging should be considered in patients with olfactory hallucinations and migraine. In addition, the role of the temporal lobe in migraine warrants further study.

Jovian Atmosphere: Structure and Composition between the Turbopause and the Mesopause

The occultation of the star Beta Scorpii by Jupiter was observed at high time resolution in three wavelength channels. The results imply a temperature of 220 degrees K at an altitude in the Jovian atmosphere corresponding to 10(14) molecules per cubic centimeter, and temperature fluctuations of 2 degrees to 10 degrees K over vertical scales of 2 to 10 kilometers. They suggest that the vertical eddy diffusion coefficient near the turbopause has a lower limit of 7 x 10(5)K square centimeters per second, and that the turbopause lies above the altitude where the density is 5 x 10(13) molecules per cubic centimeter. Below the turbopause, the ratio of hydrogen to helium is consistent with cosmic abundances.