Impact of Intravascular Brachytherapy on Patient-Reported Outcomes in Patients with Coronary Artery Disease

BACKGROUND

Intravascular brachytherapy (VBT) is an established treatment for the management of in-stent restenosis (ISR). However, whether VBT is associated with improved patient reported outcomes unknown.

METHODS

We evaluated 51 consecutive patients undergoing VBT in one or more coronary arteries from January 2018 to September 2019. Data on baseline characteristics, procedural outcomes and adverse events were obtained. All patients completed the Seattle Angina Questionnaire - 7 (SAQ-7) form before and after VBT at 1 month and 6 months.

RESULTS

The mean age was 69 ± 9 years and 29 (57%) of patients were males. Procedural success was 94.1%. The mean summary SAQ-7 score improved significantly (53.2 ± 21 vs. 83 ± 19, p < .001) at 30-days. The median Quality of Life (QoL) component of SAQ-7 score was 31.3 (Interquartile Range [IQR]: 18.8, 62.5) and improved to 82.5 (IQR: 62.5, 100), p < .001 at 30 days and 87.5 [IQR: 75, 100), p < .001 at last follow up. Likewise, the median angina frequency component of the SQL-7 score pre-VBT was 55 (IQR: 45, 80) and improved significantly to 90 (IQR: 60, 100) at 30-days, p < .001 and 100 [IQR: 68.8, 100], p = .02 at last follow up. Lastly, the median activity component of the SAQ-7 score improved from 83.3 (IQR: 60-100) to 100 (IQR: 83, 100), p = .01 at 30-days. Thus, results were evident as early as 1 month and sustained at median follow up of 17 months.

CONCLUSION

VBT is associated with improvement in patient reported outcome measures at short term and long term follow up.

Myocardial bridge: bridging the differential diagnosis

A 50-year-old man with a history of vasospastic angina diagnosed 3 months prior presented with recurrent episodes of substernal chest pain. His chest pain was characterised as 'squeezing', lasting 10 min and typically occurred on awakening. Medications included isosorbide, nitroglycerin and ranolazine; however, due to lack of insurance he was unable to obtain these medications. On admission, patient was given a full-dose aspirin and nitroglycerin, which acutely worsened his chest pain. ECG did not reveal ischaemic changes and initial troponin was negative. A left heart catheterisation was conducted, revealing a myocardial bridge of the mid-left anterior descending artery. Myocardial bridge, due to its rarity, is often overlooked as an aetiology for angina, myocardial ischaemia, acute coronary syndrome, syncope and cardiac death. This case highlights the importance of broadening the differential to include myocardial bridge in the work-up for chest pain, especially if nitrates worsen symptoms.

Depletion of naive T cells using clinical grade magnetic CD45RA beads: a new approach for GVHD prophylaxis

Depletion of naive T cells from donor leukapheresis products (LPs) aims at the reduction of alloreactivity, while preserving memory T-cell reactivity (for example, to pathogens). This study established the immunomagnetic depletion procedure under clean room conditions using CD45RA beads and analyzed LPs of six donors for cell composition and functional immune responses. CD45RA depletion resulted in 3.4-4.7 log (median 4.4) reduction of CD45RA(+) T cells, thereby eliminating naive and late effector T cells. B cells were also completely removed, whereas significant proportions of NK cells, monocytes and granulocytes persisted. CD45RA-depleted LPs contained effector and central memory CD4(+) and CD8(+) T cells that showed sustained IFN-γ secretion to CMV, EBV, Aspergillus and Candida Ags. Alloreactivity was measured in MLRs between donors with complete HLA-mismatch. Alloreactive CD8(+) T cells were strongly reduced (median >1-log) upon CD45RA depletion, whereas alloreactive CD4(+) T cells persisted in significant numbers. In conclusion, clinical grade depletion of CD45RA(+) naive T cells from donor LPs is feasible and highly efficient. The depleted products show sustained CD4(+) and CD8(+) T-cell reactivity to pathogens and effectively reduced CD8-mediated alloreactivity. Prophylactic and preemptive infusions after allogeneic SCT may improve T-cell reconstitution and pathogen-specific immunosurveillance, along with lower risk of inducing GVHD.

In vitro stimulation and expansion of human tumour-reactive CD8+ cytotoxic T lymphocytes by anti-CD3/CD28/CD137 magnetic beads

Adoptive immunotherapy with tumour-reactive CD8(+) cytotoxic T lymphocytes (CTLs) requires efficient in vitro approaches allowing the expansion of CTLs to large numbers prior infusion. Here, we investigated the antigen-independent activation and the expansion of human T cells in peripheral blood mononuclear cells (PBMCs) and in tumour-reactive CTLs using Dynabeads coated with monoclonal antibodies to CD3 and to the costimulatory molecules CD28 and CD137 (4-1BB). T cells in PBMCs showed an increased expansion rate of 15- to 17-fold during a 2-week culture period using antibody-conjugated beads with interleukin-2 (IL-2) added versus IL-2 alone. No significant difference between CD3/CD28 beads and CD3/CD28/CD137 beads was observed (P = 0.4). In contrast, expansion of tumour-reactive CD8(+) CTLs over 2 weeks was more efficient using CD3/CD28/CD137 beads (14.4-fold ± 1.2) compared with CD3/CD28 beads (10.6-fold ± 0.7) (P = 0.03) and matched well to the control arm using weekly stimulation with tumour cells. Although all modes of in vitro stimulation decreased the expression of central memory markers CD62L and CCR7 on CTLs, bead-activated cultures expressed consistently higher levels than tumour-stimulated cultures. CTLs analysed after bead-induced expansion versus weekly tumour stimulation showed equal IFN-γ production in ELISPOT assay. Furthermore, cytotoxicity assays demonstrated an either unchanged or slightly reduced capability of tumour cell lysis for antigen-independent stimulated CTLs versus those that maintained on weekly tumour stimulation, regardless of which type of beads was used. Our data suggest that the conjugation of anti-CD137 antibodies to conventional CD3/CD28 beads results in a minor but significant increase in the expansion capacity for tumour-reactive CD8(+) CTLs.

Preservation of dendritic cell function upon labeling with amino functionalized polymeric nanoparticles

Dendritic cells (DCs) are key players in eliciting immunity against antigens, therefore making them the focus of many investigations on immune responses in infections, cancer and autoimmune diseases. Nanosized materials have just recently been investigated for their use as carriers of antigens and as labeling agents for DCs. For this later use nanoparticles should be non-toxic and should most importantly not alter the physiological functions of DCs. Here we demonstrate that by the use of polymeric fluorescent nanoparticles as synthesized by the miniemulsion process immature DCs (iDCs) can be efficiently labeled intracellularly. Amino functionalized nanoparticles are more effective than carboxy functionalized ones. Even after 8 days 95% of DCs have retained nanoparticles with a fluorescence intensity of 67% compared to day 1. Nanoparticle labeling does not influence expression of cell surface molecules on mature DCs (mDCs) like HLA-DR, CD80/83/86, CCR7, CD11c nor does it influence the immunostimulatory capacity of mDCs. This procedure does also not impair the capability of DCs for uptake, processing and presentation of viral antigens as demonstrated by interferon-gamma ELISPOT on T cells stimulated with viral antigens presented by DCs. Therefore polymeric nanoparticles are a promising tool to study migration and homing of DCs in animal studies.

The programmed death (PD)-1/PD-ligand 1 pathway regulates graft-versus-host-reactive CD8 T cells after liver transplantation

Acute graft-versus-host disease (aGVHD) is a life-threatening complication after solid-organ transplantation, which is mediated by host-reactive donor T cells emigrating from the allograft. We report on two liver transplant recipients who developed an almost complete donor chimerism in peripheral blood and bone marrow-infiltrating T cells during aGVHD. By analyzing these T cells directly ex vivo, we found that they died by apoptosis over time without evidence of rejection by host T cells. The host-versus-donor reactivity was selectively impaired, as anti-third-party and antiviral T cells were still detectable in the host repertoire. These findings support the acquired donor-specific allotolerance concept previously established in animal transplantation studies. We also observed that the resolution of aGVHD was not accompanied by an expansion of circulating immunosuppressive CD4/CD25/FoxP3-positive T cells. In fact, graft-versus-host-reactive T cells were controlled by an alternative negative regulatory pathway, executed by the programmed death (PD)-1 receptor and its ligand PD-L1. We found high PD-1 expression on donor CD4 and CD8 T cells. In addition, blocking PD-L1 on host-derived cells significantly enhanced alloreactivity by CD8 T cells in vitro. We suggest the interference with the PD-1/PD-L1 pathway as a therapeutic strategy to control graft-versus-host-reactive T cells in allograft recipients.

Hydrogen metabolism in blue-green algae

This manuscript reviews the literature on hydrogen metabolism in blue-green algae and reports some new data from this laboratory. H2-formation by intact cells is found to be catalyzed exclusively by nitrogenase. Its rate appears to be variable from strain to strain used byt is--in our hands--very small. Therefore, blue-green algae are presumably of limited value in projects of solar energy conversion to form molecular hydrogen. These organisms are also able to consume the gas in a reaction catalysed by hydrogenase. Hydrogen is mainly consumed in an oxygen dependent reaction, as in aerobic nitrogen fixing bacteria. It can also serve as an electron donor for nitrogen fixation under certain physiological conditions. In experiments with a cell-free preparation, hydrogenase is found to be membrane-bound. The enzyme is characterized with respect to its specifity towards electron donors and acceptors.

Emulsifiers. III. Periodic Acid Analysis for 1-Monoglycerides

Two collaborative studies were conducted to compare the official AOCS method, Cd 11–57, and a revised Miner procedure. The second study used known materials to obtain accuracy information. Studies showed that the revised Miner procedure is more accurate and more precise at low monoglyceride levels such as those encountered in commercial shortenings. It is recommended that the Miner procedure be adopted as official first action. It is further recommended that the joint AOAC-AOCS methods study of these two procedures be continued so that a single common method can be made official by both societies.

Emulsifiers. II. Periodic Acid Analysis for 1-Monoglycerides

Two periodic acid analytical methods have been compared for the determination of 1-monoglycerides. A revised Miner procedure is apparently faster and more precise than the official AOCS method, Cd 11-57. The AOCS procedure is recommended for adoption as official, first action. A joint AOAC-AOCS multi-methods study should be conducted to compare the Miner and AOCS procedures.

Emulsifiers. I. Determination of Mono-, Di-, and Triglycerides in Shortenings by Column Chromatography

A method for the quantitative determination of mono-, di-, and triglycerides in shortenings was studied collaboratively. Samples were adsorbed on silica gel columns and the glycerides were separated by benzene, benzene plus 10% ethyl ether, and ethyl ether alone. Eight samples can be run simultaneously with an average standard deviation of 0.1–0.5%. This method is recommended for adoption as official, first action.

The Determination of Mono-, Di-, and Triglycerides in Monoglyceride Concentrates by Column Chromatography

A method for the quantitative determination of mono-, di-, and triglycerides was studied collaboratively. Samples are adsorbed on silica gel columns and the glycerides are separated by benzene, benzene plus 10% ethyl ether, and ethyl ether alone. Eight samples can be run simultaneously with an average standard deviation of 0.6–1.0%. Nine collaborators obtained average recoveries of 96, 100.3, and 102% for mono-, di-, and triglycerides, respectively.