An NKG2A biased immune response confers protection for infection, autoimmune disease, and cancer

Infection, autoimmunity, and cancer are the principal human health challenges of the 21st century and major contributors to human death and disease. Often regarded as distinct ends of the immunological spectrum, recent studies have hinted there may be more overlap between these diseases than appears. For example, pathogenic inflammation has been demonstrated as conserved between infection and autoimmune settings. T resident memory (TRM) cells have been highlighted as beneficial for infection and cancer. However, these findings are limited by patient number and disease scope; exact immunological factors shared across disease remain elusive. Here, we integrate large-scale deeply clinically and biologically phenotyped human cohorts of 526 patients with infection, 162 with lupus, and 11,180 with cancer. We identify an NKG2A+ immune bias as associative with protection against disease severity, mortality, and autoimmune and post-acute chronic disease. We reveal that NKG2A+ CD8+ T cells correlate with reduced inflammation, increased humoral immunity, and resemble TRM cells. Our results suggest that an NKG2A+ bias is a pan-disease immunological factor of protection and thus supports recent suggestions that there is immunological overlap between infection, autoimmunity, and cancer. Our findings underscore the promotion of an NKG2A+ biased response as a putative therapeutic strategy.

Development of a Definition of Postacute Sequelae of SARS-CoV-2 Infection

Importance

SARS-CoV-2 infection is associated with persistent, relapsing, or new symptoms or other health effects occurring after acute infection, termed postacute sequelae of SARS-CoV-2 infection (PASC), also known as long COVID. Characterizing PASC requires analysis of prospectively and uniformly collected data from diverse uninfected and infected individuals.

Objective

To develop a definition of PASC using self-reported symptoms and describe PASC frequencies across cohorts, vaccination status, and number of infections.

Design, Setting, and Participants

Prospective observational cohort study of adults with and without SARS-CoV-2 infection at 85 enrolling sites (hospitals, health centers, community organizations) located in 33 states plus Washington, DC, and Puerto Rico. Participants who were enrolled in the RECOVER adult cohort before April 10, 2023, completed a symptom survey 6 months or more after acute symptom onset or test date. Selection included population-based, volunteer, and convenience sampling.

Exposure

SARS-CoV-2 infection.

Main Outcomes and Measures

PASC and 44 participant-reported symptoms (with severity thresholds).

Results

A total of 9764 participants (89% SARS-CoV-2 infected; 71% female; 16% Hispanic/Latino; 15% non-Hispanic Black; median age, 47 years [IQR, 35-60]) met selection criteria. Adjusted odds ratios were 1.5 or greater (infected vs uninfected participants) for 37 symptoms. Symptoms contributing to PASC score included postexertional malaise, fatigue, brain fog, dizziness, gastrointestinal symptoms, palpitations, changes in sexual desire or capacity, loss of or change in smell or taste, thirst, chronic cough, chest pain, and abnormal movements. Among 2231 participants first infected on or after December 1, 2021, and enrolled within 30 days of infection, 224 (10% [95% CI, 8.8%-11%]) were PASC positive at 6 months.

Conclusions and Relevance

A definition of PASC was developed based on symptoms in a prospective cohort study. As a first step to providing a framework for other investigations, iterative refinement that further incorporates other clinical features is needed to support actionable definitions of PASC.

The impact of flash glucose monitoring on adults with type 1 Diabetes' eating habits and relationship with food

AIM

To gain a better understanding of how the FreeStyle Libre (FSL) flash glucose monitor influences the eating habits and relationship with food of adults with type 1 diabetes (T1D).

METHODS

Reflexive thematic analysis was conducted on fifteen semi-structured interviews conducted with adults with T1D, exploring their experiences of at least one year of FSL use.

RESULTS

Four themes were constructed from the qualitative data: (1) Personal Food Story (what food represented before and after diabetes diagnosis), (2) New Opportunities (the FSL offered novel discoveries and increased self-confidence regarding food choices), (3) Body as a Machine (participants viewed their bodies as a collection of complex processes requiring continuous maintenance), and (4) re-evaluating Diabetes (participants expressed a shift in their expectations of themselves and their diabetes management). Although the FSL offered participants more freedom and flexibility with their eating, this was constrained by feeling forever under scrutiny from the data.

CONCLUSIONS

Findings suggest the FSL influences users' eating habits, including when, why, what and how much they eat. Participants described both the positive and negative impact of these changes on their emotional wellbeing and relationship with diabetes, arguing for a need to address patients' relationship with food in routine clinic care.

Large libraries of single-chain trimer peptide-MHCs enable rapid antigen-specific CD8+ T cell discovery and analysis

CD8 + cytotoxic T cell responses against viral infection represent a major element of the adaptive immune response. We describe the development of a peptide antigen - major histompatibility complex (pMHC) library representing the full SARS-CoV-2 viral proteome, and comprised of 634 pMHC multimers representing the A*02.01, A*24.02, and B*07.02 HLA alleles, as well as specific antigens associated with the cytomegalovirus (CMV). These libraries were used to capture non-expanded CD8 + T cells from blood samples collected from 64 infected individuals, and then analyzed using single cell RNA-seq. The discovery and characterization of antigen-specific CD8 ⁺ T cell clonotypes typically involves the labor-intensive synthesis and construction of peptide-MHC tetramers. We adapted single-chain trimer (SCT) technologies into a high throughput platform for pMHC library generation, showing that hundreds can be rapidly prepared across multiple Class I HLA alleles. We used this platform to explore the impact of peptide and SCT template mutations on protein expression yield, thermal stability, and functionality. SCT libraries were an efficient tool for identifying T cells recognizing commonly reported viral epitopes. We then constructed SCT libraries designed to capture SARS-CoV-2 specific CD8 ⁺ T cells from COVID-19 participants and healthy donors. The immunogenicity of these epitopes was validated by functional assays of T cells with cloned TCRs captured using SCT libraries. These technologies should enable the rapid analyses of peptide-based T cell responses across several contexts, including autoimmunity, cancer, or infectious disease.

Abstract 2757: Correlates of peptide-HLA manufacturing success, TCR capture and neoTCR trafficking from patients using the PACTImmune࣪ Database

PACT Pharma uses a state-of-the-art approach to predict and validate neoepitopes (neoEs) and their cognate T cell receptors (neoTCRs) by capturing neoE-specific T cells from peripheral blood. This neoTCR discovery and validation process is being applied in a clinical trial (NCT03970382) evaluating personalized neoTCR-T cell therapy in solid tumors. The PACTImmune Database (PIDB) accumulates extensive pre-, on- and post-treatment data related to this trial. Here we present PIDB data on the prediction of peptide-HLA manufacturing success, as well as correlates of success of neoTCR capture and neoTCR T cell tumor trafficking, all of which have direct applications for prospective patient enrollment and treatment.

The PIDB contains distinct data sets on our neoTCR platform that we examined for predictive capabilities for three distinct applications. The first application was predicting manufacturing success rates of our single chain trimer (comPACT) which consists of the predicted neoE peptide together with B2M and the HLA heavy chain. Using multiple linear regression (MLR), we built a model predicting success rates of comPACT protein manufacturing (defined as comPACT protein yields >detection threshold) and compared it to prediction based solely on expressed tumor mutation burden (eTMB). Using univariate analysis, we compared variables between patients with 3 neoTCRs selected versus those with 0 neoTCRs. Finally, using principal component analysis (PCA) we evaluated if the PIDB neoantigen and TCR characteristics correlate with neoTCR T cell trafficking in patients (n=4) dosed with neoTCR T cells. Trafficking was determined by sequencing (neoTCR specific reads) and in some cases, IHC/RNAScope imaging of post-dosing biopsies.

MLR analysis of comPACT protein expression data resulted in significant improvement in comPACT manufacturing success rate predictions (R2=0.66, P<<0.001). These predictions were better than using eTMB alone (R2=0.33, P<<0.001). Patients with 3 neoTCRs selected had a significantly higher number of comPACTs and mutations covered by those comPACTs as compared to 0 neoTCR patients (P=0.004 and 0.002, respectively). All four patients demonstrated trafficking of neoTCR products into the tumor in post-dosing biopsies. Based on TCR characteristics PCA showed separation between tumor trafficking and non-trafficking TCRs (data pending).

Application of PIDB data improves predictions of peptide-HLA manufacturing success, identifies differences between patients with 3 and no neoTCR products and provides insights into trafficking TCR characteristics, which in turn enables us to optimize our neoTCR selection strategy for patients with solid cancers. PIDB thus represents a significant & maturing dataset for patient-specific tumor immunogenicity in solid cancers and provides opportunities to optimize personalized neoTCR T cell treatment.

Citation Format: Eric W. Stawiski, Vinnu Bhardwaj, Jyoti Mathur, Eva Huang, Olivier Dalmas, Zheng Pan, Cliff Wang, James Heath, Barbara Sennino, Mark Frohlich, Arati Rao, Stefanie Mandl. Correlates of peptide-HLA manufacturing success, TCR capture and neoTCR trafficking from patients using the PACTImmune࣪ Database [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 2757.

Human KIR+ CD8+ T cells target pathogenic T cells in Celiac disease and are active in autoimmune diseases and COVID-19

Previous reports show a small subset of CD8+ T cells expressing Ly49 proteins in mice can suppress autoimmunity in a model of demyelinating disease. Here we find a markedly increased frequency of CD8+ T cells expressing inhibitory Killer cell Immunoglobulin like Receptors (KIR), the human equivalent of the Ly49 family, in the blood and inflamed tissues of various human autoimmune diseases. Increased KIR+ CD8+ T cells in the gut also correlate with disease activity in Celiac disease (CeD) patients. Moreover, KIR+ CD8+ T cells can efficiently eliminate pathogenic gliadin-specific CD4+ T cells from CeD patients’ leukocytes in vitro. Together with gene expression data, this shows that these cells are the likely equivalent of the mouse Ly49+ CD8+ T cells. Furthermore, we observe elevated levels of KIR+ CD8+ T cells, but not CD4+ regulatory T cells, in COVID-19 and influenza-infected patients, and this correlates with disease severity and vasculitis in COVID-19. Single-cell RNA and parallelized TCR sequencing reveals that expanded KIR+ CD8+ T cells from these different diseases and healthy subjects display shared phenotypes and similar T cell receptor sequences. Selective ablation of the murine counterpart in virus-infected mice leads to exacerbated autoimmunity developed after infection. These results characterize a regulatory CD8+ T cell subset in humans which we hypothesize functions to control pathogenic cells in autoimmune and infectious diseases, with important implications for the cellular dynamics and possible therapeutic approaches to suppress unwanted autoimmunity.

Supported by National Institutes of Health U19-AI057229 Howard Hughes Medical Institute Stanford Diabetes Research Center (P30DK116074)

The risk of COVID-19 death is much greater and age-dependent with type I IFN autoantibodies

SARS-CoV-2 infection fatality rate (IFR) doubles with every five years of age from childhood onward. Circulating autoantibodies neutralizing IFN-α, IFN-ω, and/or IFN-β are found in ~20% of deceased patients across age groups. In the general population, they are found in ~1% of individuals aged 20-70 years and in >4% of those >70 years old. With a sample of 1,261 deceased patients and 34,159 uninfected individuals, we estimated both IFR and relative risk of death (RRD) across age groups for individuals carrying autoantibodies neutralizing type I IFNs, relative to non-carriers. For autoantibodies neutralizing IFN-α2 or IFN-ω, the RRD was 17.0[95% CI:11.7-24.7] for individuals under 70 years old and 5.8[4.5-7.4] for individuals aged 70 and over, whereas, for autoantibodies neutralizing both molecules, the RRD was 188.3[44.8-774.4] and 7.2[5.0-10.3], respectively. IFRs increased with age, from 0.17%[0.12-0.31] for individuals <40 years old to 26.7%[20.3-35.2] for those ≥80 years old for autoantibodies neutralizing IFN-α2 or IFN-ω, and from 0.84%[0.31-8.28] to 40.5%[27.82-61.20] for the same two age groups, for autoantibodies neutralizing both molecules. Autoantibodies against type I IFNs increase IFRs, and are associated with high RRDs, particularly those neutralizing both IFN-α2 and -ω. Remarkably, IFR increases with age, whereas RRD decreases with age. Autoimmunity to type I IFNs appears to be second only to age among common predictors of COVID-19 death.

Falling through the gap: Dental treatment experiences of patients affected by cleft lip and/or palate

Introduction

In the UK, one in 600–700 infants is born with a cleft lip and/or palate (CL/P). Previous research has identified patients with CL/P to be at high risk of long-term oral health issues. Yet, few of these patients are currently accessing community dental care.

Aims

To assess patients' dental treatment experiences and their suggestions for improving services.

Materials and methods

Five focus groups were conducted with 24 adults with CL/P. Thematic analysis was performed on the data.

Results

Participants perceived local dental practitioners to lack knowledge about CL/P and its treatment. Consequently, some participants had stopped visiting a dental practice altogether. Participants were also largely unaware of the specialist CL/P services they are entitled to.

Discussion

Suggestions are made for the integration of improved training and resources for local dental practitioners. Closer communication between specialist cleft teams and local dental practitioners could also help to bridge the gap in knowledge and improve patients' engagement with dental services. The tertiary sector has a crucial role to play in empowering patients to take more control of their oral health and dental treatment.

Single-cell multiplexed cytokine profiling of CD19 CAR-T cells reveals a diverse landscape of polyfunctional antigen-specific response

Background

It remains challenging to characterize the functional attributes of chimeric antigen receptor (CAR)-engineered T cell product targeting CD19 related to potency and immunotoxicity ex vivo, despite promising in vivo efficacy in patients with B cell malignancies.

Methods

We employed a single-cell, 16-plex cytokine microfluidics device and new analysis techniques to evaluate the functional profile of CD19 CAR-T cells upon antigen-specific stimulation. CAR-T cells were manufactured from human PBMCs transfected with the lentivirus encoding the CD19-BB-z transgene and expanded with anti-CD3/anti-CD28 coated beads. The enriched CAR-T cells were stimulated with anti-CAR or control IgG beads, stained with anti-CD4 RPE and anti-CD8 Alexa Fluor 647 antibodies, and incubated for 16 h in a single-cell barcode chip (SCBC). Each SCBC contains ~12,000 microchambers, covered with a glass slide that was pre-patterned with a complete copy of a 16-plex antibody array. Protein secretions from single CAR-T cells were captured and subsequently analyzed using proprietary software and new visualization methods.

Results

We demonstrate a new method for single-cell profiling of CD19 CAR-T pre-infusion products prepared from 4 healthy donors. CAR-T single cells exhibited a marked heterogeneity of cytokine secretions and polyfunctional (2+ cytokine) subsets specific to anti-CAR bead stimulation. The breadth of responses includes anti-tumor effector (Granzyme B, IFN-γ, MIP-1α, TNF-α), stimulatory (GM-CSF, IL-2, IL-8), regulatory (IL-4, IL-13, IL-22), and inflammatory (IL-6, IL-17A) functions. Furthermore, we developed two new bioinformatics tools for more effective polyfunctional subset visualization and comparison between donors.

Conclusions

Single-cell, multiplexed, proteomic profiling of CD19 CAR-T product reveals a diverse landscape of immune effector response of CD19 CAR-T cells to antigen-specific challenge, providing a new platform for capturing CAR-T product data for correlative analysis. Additionally, such high dimensional data requires new visualization methods to further define precise polyfunctional response differences in these products. The presented biomarker capture and analysis system provides a more sensitive and comprehensive functional assessment of CAR-T pre-infusion products and may provide insights into the safety and efficacy of CAR-T cell therapy.

Electronic supplementary material

The online version of this article (10.1186/s40425-017-0293-7) contains supplementary material, which is available to authorized users.

Future cancer research priorities in the USA: a Lancet Oncology Commission

We are in the midst of a technological revolution that is providing new insights into human biology and cancer. In this era of big data, we are amassing large amounts of information that is transforming how we approach cancer treatment and prevention. Enactment of the Cancer Moonshot within the 21st Century Cures Act in the USA arrived at a propitious moment in the advancement of knowledge, providing nearly US$2 billion of funding for cancer research and precision medicine. In 2016, the Blue Ribbon Panel (BRP) set out a roadmap of recommendations designed to exploit new advances in cancer diagnosis, prevention, and treatment. Those recommendations provided a high-level view of how to accelerate the conversion of new scientific discoveries into effective treatments and prevention for cancer. The US National Cancer Institute is already implementing some of those recommendations. As experts in the priority areas identified by the BRP, we bolster those recommendations to implement this important scientific roadmap. In this Commission, we examine the BRP recommendations in greater detail and expand the discussion to include additional priority areas, including surgical oncology, radiation oncology, imaging, health systems and health disparities, regulation and financing, population science, and oncopolicy. We prioritise areas of research in the USA that we believe would accelerate efforts to benefit patients with cancer. Finally, we hope the recommendations in this report will facilitate new international collaborations to further enhance global efforts in cancer control.

Faster turnover of new soil carbon inputs under increased atmospheric CO2

Rising levels of atmospheric CO₂ frequently stimulate plant inputs to soil, but the consequences of these changes for soil carbon (C) dynamics are poorly understood. Plant-derived inputs can accumulate in the soil and become part of the soil C pool ("new soil C"), or accelerate losses of pre-existing ("old") soil C. The dynamics of the new and old pools will likely differ and alter the long-term fate of soil C, but these separate pools, which can be distinguished through isotopic labeling, have not been considered in past syntheses. Using meta-analysis, we found that while elevated CO₂ (ranging from 550 to 800 parts per million by volume) stimulates the accumulation of new soil C in the short term (<1 year), these effects do not persist in the longer term (1-4 years). Elevated CO₂ does not affect the decomposition or the size of the old soil C pool over either temporal scale. Our results are inconsistent with predictions of conventional soil C models and suggest that elevated CO₂ might increase turnover rates of new soil C. Because increased turnover rates of new soil C limit the potential for additional soil C sequestration, the capacity of land ecosystems to slow the rise in atmospheric CO₂ concentrations may be smaller than previously assumed.

Abstract 2144: A novel method for high-throughput discovery of neo-antigens and corresponding T-cell receptors

Immunotherapies that boost the ability of endogenous T cells to destroy cancer cells have demonstrated therapeutic efficacy in several human malignancies. Cytotoxic T cells actively recognize peptide antigens, which are displayed on major histocompatibility complexes (MHCs) on the surface of the malignant cells, to play a central role in cancer immunotherapy. However, efficient methods for identifying the tumor antigens and the corresponding T cell receptors are still limited. We report here a DNA-barcode nanoparticle and microfluidics-based method to sort and enumerate neoantigen-specific T cells, at an unprecedented level of sensitivity. The method also permits the matching of a single neoantigen to a specific CD8+ T cell with the TCR a/b gene sequence. The resultant information informs an immunotherapy regimen that is specific for that patient, which can be used to custom-design effective ACT therapies.

Citation Format: Songming Peng, Jesse Zaretsky, Michael T. Bethune, Alice Hsu, David Baltimore, Antoni Ribas, James Heath. A novel method for high-throughput discovery of neo-antigens and corresponding T-cell receptors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 2144. doi:10.1158/1538-7445.AM2017-2144

Abstract 2069: Overcoming drug resistance by targeting melanoma dedifferentiation through information-theoretic analysis and single cell proteomics

Despite impressive initial response of BRAF targeted therapy in mestastic melanoma patients, acquired drug resistance, often times derived from tumor heterogeneity, always limit its clinical outcome. A dedifferentiation process named melanocyte to neural crest transition (MNT) has shown to be critical in the early stage resistance development. The dedifferentiation could induce a whole cell state change resulting a drug tolerant state of melanoma cells, which will lead to initial drug resistance. Mathematic modeling indicates the nature of the transition as results of both stochastic phenotypic transition and non-genetic drug selection, which indicates and further proved that the whole cell state transition should be reversible during drug removal. Information theoretic analysis reduced the dimensional of thousands of gene expression level changes as results of only two unbalanced processes onto a cellular steady state. Reversible transition trajectory defined through two processes indicates it to resemble a critical transition in physical systems. Refined single cell proteomic analysis of those proteins that associate with major unbalanced processes identify the critical points of the transition as early as day6, which cannot be resolved from bulk proteomic measurement. By co-targeting the drivers at the critical points in combination with original brafi targeted drug successfully arrested the transition and induced a sustained tumor growth inhibition in multiple patient-derived melanoma cell lines. This study provides us a noval methodology of mining whole transcriptomic transition with information theoretic analysis to reduce the dimensionality and then using single cell proteomic analysis for refining critical points and driver proteins which eventually rationalized a effective combination therapy to stop the drug resistance development early on.

Citation Format: Yapeng SU, Wei Wei, Lidia Robert, Jennifer Tsoi, Min Xue, Jungwoo Kim, Thomas Graeber, Raphael Levine, Antoni Ribas, James Heath. Overcoming drug resistance by targeting melanoma dedifferentiation through information-theoretic analysis and single cell proteomics [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 2069. doi:10.1158/1538-7445.AM2017-2069

Population-based cohort study of variation in the use of emergency cholecystectomy for benign gallbladder diseases

Background

The aims of this prospective population-based cohort study were to identify the patient and hospital characteristics associated with emergency cholecystectomy, and the influences of these in determining variations between hospitals.

Methods

Data were collected for consecutive patients undergoing cholecystectomy in acute UK and Irish hospitals between 1 March and 1 May 2014. Potential explanatory variables influencing the performance of emergency cholecystectomy were analysed by means of multilevel, multivariable logistic regression modelling using a two-level hierarchical structure with patients (level 1) nested within hospitals (level 2).

Results

Data were collected on 4744 cholecystectomies from 165 hospitals. Increasing age, lower ASA fitness grade, biliary colic, the need for further imaging (magnetic retrograde cholangiopancreatography), endoscopic interventions (endoscopic retrograde cholangiopancreatography) and admission to a non-biliary centre significantly reduced the likelihood of an emergency cholecystectomy being performed. The multilevel model was used to calculate the probability of receiving an emergency cholecystectomy for a woman aged 40 years or over with an ASA grade of I or II and a BMI of at least 25·0 kg/m2, who presented with acute cholecystitis with an ultrasound scan showing a thick-walled gallbladder and a normal common bile duct. The mean predicted probability of receiving an emergency cholecystectomy was 0·52 (95 per cent c.i. 0·45 to 0·57). The predicted probabilities ranged from 0·02 to 0·95 across the 165 hospitals, demonstrating significant variation between hospitals.

Conclusion

Patients with similar characteristics presenting to different hospitals with acute gallbladder pathology do not receive comparable care.

Abstract 879: Single cell analysis resolves combinatory targeted therapy for arresting the BRAFi-induced cellular dedifferentiation of metastatic melanomas

Targeted therapy that inhibits the BRAF (V600E) protein has shown impressive initial responses in metastatic melanoma patients. However, acquired drug resistance, derived from tumor heterogeneity, always limits its efficacy and compromises its treatment outcomes. Melanocyte to neural crest transition (MNT) has been observed to play crucial role in early stage adaptive drug tolerance, and the mathematic modeling indicates the transition is contributed from both stochastic phenotypic transition and non-genetic selection. Whole transcriptomic analysis enriched important signaling proteins that are involved in the resistance development process. Single cell proteomic analysis of those proteins was performed on patient-derived melanoma models to further study the early stage drug tolerance. This resolves how protein signaling network coordination rewires in the process, which cannot be resolved from proteomic analysis of bulk tumor tissue. Signaling network coordination analysis indicates that co-inhibiting the hubs of the network (MEK, NFKB-p65) could keep cells in the drug-susceptible stages. The combination therapy that co-inhibits mutant BRAF, MEK and NFKB-p65 together successfully arrested the MNT transition and induced a sustained tumor growth suppression in multiple patient-derived melanoma cell lines. This study provides us a brand-new way of using single cell proteomic analysis to infer effective combinations by resolving protein signaling network coordination that is inaccessible through traditional bulk-level proteomic measurement.

Citation Format: Yapeng Su, Wei Wei, Min Xue, Lidia Robert, Jennifer Tsoi, Thomas Graeber, Antoni Ribas, James Heath. Single cell analysis resolves combinatory targeted therapy for arresting the BRAFi-induced cellular dedifferentiation of metastatic melanomas. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 879.

An inpatient observation and comparison of the bennett's I.p.p.R. And aerosol methods of administering salbutamol

Compared with aerosol administration the Bennett's Intermittent Positive Pressure Respirator (I.P.P.R.) has been the most favoured method of Salbutamol administration in hospitals for the treatment of asthma or Chronic Obstructive Airways Disease (C.O.A.D.).

The effects of short wave diathermy, microwave and ultra sonics on demand pacemakers and ventrical inhibited pacemakers

In 1971 tests were performed by Mrs. D. Bieri, Mrs. J. Heath of the School of Physio-therapy, New South Wales, and Dr. S. Hunyor of the Pacemaker Clinic, Royal Prince Alfred Hospital. Until this time there was no theory regarding diathermy on patients with implanted pacemakers.

Living with a pituitary tumour: a narrative analysis

This study aimed to synthesise the illness narratives of individuals living with a pituitary tumour. Eight adults with a pituitary tumour were recruited from an endocrinology service in the north-west of England. A narrative methodology was adopted which investigated elements of the individual narratives such as metaphor and structure but which also aimed to produce a joint account of experience in this particular illness context by extracting themes across the stories; these are presented as part of a chronological narrative. However, the resulting group story was also analysed in terms of different types of narrative plots. The group narrative started from the recognition of symptoms and then diagnosis though treatment to post-treatment and future plans. In terms of narrative plots, one notable element of the joint narrative was the flow between the culturally dominant restitution narrative, where participants focused on treatment and recovery and the chaos narrative when recovery did not seem possible. The findings contain many elements consistent with previous research; however, the use of a celebrity figure to communicate about the illness experience and a perception that objects or individuals should not be taken at face value emerged as more novel findings.

Abstract LB-4: Use of iterative in situ click chemistry to develop a capture agent specific for a transforming point mutation in the pleckstrin homology domain of Akt1

We present an iterative in situ click chemistry approach to sequentially assemble peptide ligands that can selectively bind to and inhibit a transforming point mutation (E17K) found in the Pleckstrin Homology Domain (PHD) of the Akt1 kinase. The Akt1 kinase plays a critical role in the PI3K signaling pathway - the activation of which is closely linked to tumor development and cancer cell survival. It has recently been shown that the E17K mutation in the PHD of Akt1 results in an increased affinity of the PHD for the PIP3 substrate. Consequently, deregulated recruitment of Akt1 to the cell membrane causes constitutive activation of the PI3K pathway, which has been shown to induce leukemia in mice.

We previously showed that peptide affinity agents that mimic the performance of antibodies can be created through the use of iterative in situ click chemistry. These affinity agents have more recently been shown to penetrate cells and function as enzyme inhibitors or activators. Because the selective inhibition of this E17K mutant would be a potentially powerful therapeutic agent, herein a similar in situ click technique was used to create a capture agent targeting the mutant PHD.

To selectively target this E17K point mutation, we employed an epitope targeting strategy that began with a 33mer peptide “epitope” fragment from Akt1-PHD containing the mutation (residues 1-32). An alkyne-containing amino acid was substituted into the sequence near the site of the mutation to facilitate an in situ click reaction near that point. An azide-equipped comprehensive One-Bead-One-Compound (OBOC) peptide library was screened for the positive in situ click product with the epitope fragment. The resulting hit “anchors” were sequenced and their affinity and selectivity to the E17K mutant target were validated. Those anchor peptides were further expanded into biligands by repeating the in situ click screening steps, but this time against the full length PHD. Early results with the identified biligand show that the affinity and selectivity for the mutant protein is significantly enhanced compared to the anchor peptide. Preliminary inhibition studies also show that the biligand can partially inhibit the binding of the mutant PHD to the PIP3 substrate.

Further studies are currently being conducted to characterize the identified ligands and to evaluate their efficacy as a potential therapeutic. The epitope targeting approach combined with the iterative in situ click screening represents a unique methodology to develop capture agents targeting protein mutations. The resultant selective ligands hold highly anticipated potential value in the field of cancer treatment and/or diagnosis.

Citation Format: Kaycie M. Deyle, Ying Qiao Hee, Steven Millward, James Heath. Use of iterative in situ click chemistry to develop a capture agent specific for a transforming point mutation in the pleckstrin homology domain of Akt1. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr LB-4. doi:10.1158/1538-7445.AM2013-LB-4

An exploratory randomized controlled trial comparing telephone and hospital follow-up after treatment for colorectal cancer

AIM

Following treatment for colorectal cancer it is common practice for patients to attend hospital clinics at regular intervals for routine monitoring, although debate persists on the benefits of this approach. Nurse-led telephone follow-up is effective in meeting information and psycho-social needs in other patient groups. We explored the potential benefits of nurse-led telephone follow-up for colorectal cancer patients.

METHOD

Sixty-five patients were randomized to either telephone or hospital follow-up in an exploratory randomized trial.

RESULTS

The telephone intervention was deliverable in clinical practice and acceptable to patients and health professionals. Seventy-five per cent of eligible patients agreed to randomization. High levels of satisfaction were evident in both study groups. Appointments in the hospital group were shorter (median 14.0 min, range 2.3-58.0) than appointments in the telephone group (median 28.9 min, range 6.1-48.3). Patients in the telephone arm were more likely to raise concerns during consultations.

CONCLUSION

Historical approaches to follow-up unsupported by evidence of effectiveness and efficiency are not sustainable. Telephone follow-up by specialist nurses may be a feasible option. A main trial comparing hospital and telephone follow-up is justified, although consideration needs to be given to trial design and practical issues related to the availability of specialist nurses at study locations.

Comprehensive, longitudinal T cell functional analyses correlated with clinical outcome of a melanoma immunotherapy trial (53.18)

Adoptive cell transfer (ACT) of transgenic T lymphocytes expressing tumor antigen specific T cell receptor (TCR) can mediate objective responses. However, little is known about the functional activity of the transferred cells and the dynamics of host immunity. We monitored the transgenic and endogenous immunity of 8 metastatic melanoma patients over 8-10 time points in a MART-1 TCR ACT therapy. Using 3 highly multiplex clinical immune diagnostics methods (Ma, C. et al. Nature Medicine 17, 738-743 (2011)), the abundance of 35 melanoma antigen specific cytotoxic T lymphocyte (CTL) populations, 19 functional proteins from 6 types of phenotypically defined single T cells, and 37 blood tumor and immune markers was quantified, yielding millions of readouts. In all patients there was an initial clinical antitumor response followed by disease progression, which correlated with T cell changes observed. The transgenic MART-1 T cells expanded rapidly after infusion, producing multiple cytotoxic and antitumor cytokines. However, their abundance and polyfunctionality diminished within 2-3 weeks. Around 30 days post infusion, a multi-clonal expansion of melanoma specific CTLs emerged only in patients with regressing metastatic lesions. These cells exhibited antitumor functions initially, but gained inhibitory and non-specific functions and diminished in number when tumor progressed. This study points to the need of maintaining T cell functionality to improve ACT therapy effectiveness.

Abstract 4839: Adoptive cell transfer of transgenic T cells elicited a two-wave antitumor cellular immune response consisted of engineered and endogenous T lymphocytes with different sets of functions

Background: Adoptive cell transfer (ACT) of transgenic T lymphocytes expressing tumor antigen specific T cell receptor (TCR) can mediate an objective response in 30%-50% of the metastatic melanoma patients and result in long term tumor regression in certain subjects. However, little is known about the fate of engineered T cells once transferred and the dynamics of host immunity, important for understanding the biological mechanism of the therapy and differing long term efficacy between patients. Methods: We designed a comprehensive study that monitored the transgenic and endogenous immune response in 8 metastatic melanoma patients over 8-10 time points in an ACT therapy of transgenic F5 MART-1 TCR T cells, using newly developed, highly multiplexed clinical immune diagnostics methods (Ma, C. et al. Nature Medicine 17, 738-743 (2011)): (1) The abundance of 35 melanoma antigen specific T cell subsets was enumerated by peptide/MHC tetramer microarrays. (2) The functional performance of 6 phenotypically defined T cell subsets was evaluated via the quantitation of 19 functional proteins secreted from single cells, utilizing a clinical single cell barcode microchip coupled with florescent activated cell sorting. (3) A panel of 37 blood proteins incorporating melanoma associated markers, cytokines and chemokines were measured by an ELISA-like assay. Results: The change of blood marker abundance reflected the general course of the therapy, from pre-conditioning, immune system recovery, immune response, to tumor remission. Furthermore, we found that the TCR engineered T cells sustained a 2-3 week duration anti-tumor response in all patients and secreted large quantities of granzyme B, MIP-1α and MIP-1α. However, this first wave infused immune response vanished rapidly in terms of the number of polyfunctional cells and the amount of cytokines secreted. After day 30 a second wave anti-tumor immunity emerged, incorporating a rebound of the MART-1 TCR engineered population and a new endogenous multi-clonal melanoma specific T cell response. Both groups of cells secreted IFN-γ and TNF-α; however, later they shifted to inhibitory and non-specific functions, such as TGF-β, IL-10 and IL-13. The patient with the most endogenous melanoma specific T cell populations emerged and the strongest functions in the second wave response showed the most effective long term tumor control; weaker second wave response was associated with weaker therapeutic efficacy. Conclusions: The melanoma-specific T cells within the ACT went through a process of in vivo functional changes that correlated with clinical antitumor activity. The appearance and the persistence of the second wave immune response featured by engineered and newly appeared endogenous anti-tumor cellular immunity provided indications of long term therapeutic efficacy.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 4839. doi:1538-7445.AM2012-4839

Eosinophilic infiltration of the esophagus following endoscopic ablation of Barrett's neoplasia

To assess the incidence of esophageal intra-epithelial eosinophilic infiltration following endoscopic ablation of Barrett's esophagus (BE), a retrospective study of consecutive cases of endoscopic ablation of BE with dysplasia or cancer using radiofrequency ablation (RFA) and spray cryotherapy at two centers in the United States was performed. Post-ablation eosinophilia was defined as ≥ 5 eosinophils per high power field during post-treatment surveillance. Twenty of 122 patients (16%) undergoing ablation developed esophageal eosinophilia after ablation, including 8/77 (10%) treated with RFA and 12/44 (27%) treated with cryotherapy. No patient had clinical or endoscopic findings of or risk factors for eosinophilic esophagitis. Esophageal eosinophilia persisted in 30% over a median of 20.2 months. On multivariate analysis, post-ablation eosinophilia was independently associated with increasing BE segment length (adjusted odds ratio 1.46 for every 2-cm increase, 95% confidence interval 1.24-1.71) and cryotherapy as the ablation modality (adjusted odds ratio 5.23, 95% confidence interval 1.67-16.39). Esophageal eosinophilic infiltration after endoscopic ablation with RFA and cryotherapy is common and is associated with the BE segment length and treatment modality. The clinical significance of post-ablation eosinophilia is unclear.

The role of vocabulary, working memory and inference making ability in reading comprehension in Down syndrome

Thirteen children and young adults with Down syndrome (DS) completed tests of language and reading and their performance was compared to that of three control groups. Reading comprehension was confirmed to be a specific deficit in DS and found to be strongly correlated with underlying language skills. Although reading comprehension was more strongly related to language ability in the DS group, this was shown to be a function of more advanced word recognition rather than a characteristic of DS per se. Individuals with DS were found to have greater difficulty with inferential comprehension questions than expected given their overall comprehension ability and the reading profile associated with DS was found to be similar to that of children known as poor comprehenders. It is recommended that oral language training programs, similar to those that have been shown to improve reading comprehension in poor comprehenders, be trialed with children who have DS.

A self-powered, one-step chip for rapid, quantitative and multiplexed detection of proteins from pinpricks of whole blood

We describe an automated, self-powered chip based on lateral flow immunoassay for rapid, quantitative, and multiplex protein detection from pinpricks of whole blood. The device incorporates on-chip purification of blood plasma by employing inertial forces to focus blood cells away from the assay surface, where plasma proteins are captured and detected on antibody "barcode" arrays. Power is supplied from the capillary action of a piece of adsorbent paper, and sequentially drives, over a 40 minute period, the four steps required to capture serum proteins and then develop a multiplex immunoassay. An 11 protein panel is assayed from whole blood, with high sensitivity and high reproducibility. This inexpensive, self-contained, and easy to operate chip provides a useful platform for point-of-care diagnoses, particularly in resource-limited settings.

Differences in the response sensitivity of stomatal index to atmospheric CO2 among four genera of Cupressaceae conifers

BACKGROUND AND AIMS

The inverse relationship between stomatal density (SD: number of stomata per mm(2) leaf area) and atmospheric concentration of CO2 ([CO2]) permits the use of plants as proxies of palaeo-atmospheric CO2. Many stomatal reconstructions of palaeo-[CO2] are based upon multiple fossil species. However, it is unclear how plants respond to [CO2] across genus, family or ecotype in terms of SD or stomatal index (SI: ratio of stomata to epidermal cells). This study analysed the stomatal numbers of conifers from the ancient family Cupressaceae, in order to examine the nature of the SI-[CO2] relationship, and potential implications for stomatal reconstructions of palaeo-[CO2]. Methods Stomatal frequency measurements were taken from historical herbarium specimens of Athrotaxis cupressoides, Tetraclinis articulata and four Callitris species, and live A. cupressoides grown under CO2-enrichment (370, 470, 570 and 670 p.p.m. CO2).

KEY RESULTS

T. articulata, C. columnaris and C. rhomboidea displayed significant reductions in SI with rising [CO2]; by contrast, A. cupressoides, C. preissii and C. oblonga show no response in SI. However, A. cupressoides does reduce SI to increases in [CO2] above current ambient (approx. 380 p.p.m. CO2). This dataset suggests that a shared consistent SI-[CO2] relationship is not apparent across the genus Callitris. Conclusions The present findings suggest that it is not possible to generalize how conifer species respond to fluctuations in [CO2] based upon taxonomic relatedness or habitat. This apparent lack of a consistent response, in conjunction with high variability in SI, indicates that reconstructions of absolute palaeo-[CO2] based at the genus level, or upon multiple species for discrete intervals of time are not as reliable as those based on a single or multiple temporally overlapping species.

Vision screening in children by Plusoptix Vision Screener compared with gold-standard orthoptic assessment

BACKGROUND/AIMS

To evaluate a new autorefractor, the Plusoptix Vision Screener (PVS), as a screening tool to detect risk factors for amblyopia by comparing it with gold-standard orthoptic vision screening in children.

METHODS

Community-based screening study including 288 children age 4-7 years who were screened with the PVS and by orthoptic assessment (distance acuity, cover test, extraocular movements, 20 PD prism test, Lang stereotest). Follow-up comprehensive eye examination of screening-positive children included manual cycloplegic retinoscopy.

RESULTS

Testability was high for both methods. Orthoptic screening identified 36 children with reduced vision and/or factors associated with amblyopia (referral rate 12.5%). The PVS identified 16 children with potential vision problems (referral rate 5.6%), indicating only moderate sensitivity (44%; 95% CI 27.9 to 61.9%), but high specificity (100%; 95% CI 98.5 to 100%) to detect factors associated with amblyopia. The PVS underestimated visually significant refractive errors.

CONCLUSIONS

Use of the PVS as single screening test in young children may miss a significant number of children with amblyopia or amblyogenic risk factors.

Plusoptix Vision Screener: the accuracy and repeatability of refractive measurements using a new autorefractor

BACKGROUND

The Plusoptix Vision Screener (PVS) is a new non-cycloplegic videoretinoscopy autorefractor. Refractive accuracy may affect its performance as a screening tool.

AIMS

Study 1: To determine the intra- and interobserver variability of PVS measurements. Study 2: To compare PVS measurements with gold-standard manual cycloplegic retinoscopy (MCR).

METHODS

Study 1: PVS refraction of 103 children with mean (SD) age 5.5 (0.6) years by two observers. Study 2: PVS and MCR refraction of 126 children with mean (SD) age 5.5 (1.5) years, including 43 children with manifest strabismus >/=5 PD, comparing mean spherical equivalent (MSE) and Jackson cross cylinders J(0) and J(45).

RESULTS

Study 1: Repeatability coefficients (observer 1): MSE: 0.63 D, J(0): 0.24 D, J(45): 0.18 D; those of observer 2 were nearly identical. The mean difference (95% limits of agreement) between the two observers for MSE, J(0) and J(45) were, respectively, 0.03 (-0.62 to 0.68 D), -0.008 (-0.25 to 0.23 D) and 0.013 (-0.18 to 0.20) D. Study 2: MSE tended to be lower on PVS than MCR, with differences of up to 8.00 D. Less than 20% of values were within +/-0.50 D of each other. Agreement was better for J(0) and J(45). Strabismus was associated with an odds ratio of 3.7 (95% CI 1.3 to 10.5) of the PVS failing to obtain a reading.

CONCLUSIONS

The PVS may underestimate children's refractive error.

Abstract ED02-03: The integration of new in vivo and in vitro diagnostic technologies with new therapeutics to accelerate the development and approval of new cancer therapeutics

ED02-03

The Nanosystems Biology Cancer Center (NSBCC) was founded three years ago by the NCI to accelerate the translation of systems biology models of cancer into clinical tool for cancer diagnosis and treatment. Over the past three years we have demonstrated that we can go, within a period of 1 to 1.5 years, from a concept on paper to Phase I trials or demonstrations in humans for three major cancer technologies: in vivo PET molecular imaging probes of cancer, siRNA-based cancer therapeutics, and highly multiplexed in vitro diagnostic assays. These advances represent major cost reductions and efficiency increases in three major aspects of cancer clinical care. However, the goal of achieving the same level of cost reductions and efficiency improvements in pushing a new therapeutic from a Phase I trial to an FDA-approved drug remains a daunting challenge. In this talk, I will discuss how the integration of in vivo and in vitro diagnostic tools with drug trials can be done to achieve this goal, and I will give examples of how we are beginning to push in this direction.

Citation Information: Cancer Prev Res 2008;1(7 Suppl):ED02-03.

Pre-operative DTI and probabilisitic tractography in four patients with deep brain stimulation for chronic pain

This study aimed to examine, using diffusion tensor imaging (DTI), differences in electrode placement in four patients undergoing deep brain stimulation for chronic neuropathic pain of varying aetiology. A pre-operative DTI was obtained for each patient, who was then implanted with deep brain stimulation electrodes in the periventricular/periaqueductal grey area with good pain relief. Using seeds from the postoperative MRI scan, probabilistic tractography was performed from the pre-operative DTI.

Preoperative DTI and probabilistic tractography in an amputee with deep brain stimulation for lower limb stump pain

This study aimed to find out whether preoperative diffusion tensor imaging (DTI) and probabilistic tractography could help with surgical planning for deep brain stimulation in the periaqueductal/periventricular grey area (PAG/PVG) in a patient with lower leg stump pain. A preoperative DTI was obtained from the patient, who then received DBS surgery in the PAG/PVG area with good pain relief. The postoperative MRI scan showing electrode placement was used to calculate four seed areas to represent the contacts on the Medtronic 3387 electrode. Probabilistic tractography was then performed from the pre-operative DTI image. Tracts were seen to connect to many areas within the pain network from the four different contacts. These initial findings suggest that preoperative DTI scanning and probabilistic tractography may be able to assist surgical planning in the future.

Providing a community-based cancer risk assessment service for a socially and ethnically diverse population

BACKGROUND

Patients from ethnic minorities are under-represented in referrals to cancer genetics services. In a regional genetics centre that serves two London boroughs, the existing service attracts 3% of its referrals from Black and Minority Ethnic (BME) and other ethnic groups, despite the fact that these groups make up 34% of the population.

OBJECTIVES

To improve access to familial cancer risk assessment in a socially and ethnically diverse population.

SETTING

The London boroughs of Lambeth and Southwark.

DESIGN

Community-based, nurse-led clinics were established for people who were concerned about their familial cancer risk. Patients were asked to triage themselves by answering three questions. Self-referral was encouraged.

MAIN OUTCOME MEASURES

Data were gathered on ethnicity of clients, cancer risk, source of referral and patient and health professional satisfaction with the service.

RESULTS

Of the 415 people who have accessed the service, 46% were from not White British groups and 67% referred themselves to the service, demonstrating the success of this model in reaching 'hard to reach' groups. Thirty-seven percent of patients were assessed as being at population risk and 63% were assessed as being at moderate risk or higher, showing that the clinics were meeting an unmet need in the community.

Nicotine improves memory for delayed intentions

RATIONALE

The present paper asked first whether the cholinergic agonist nicotine improves memory for delayed intentions (prospective memory, ProM) and second whether pharmacological dissociation would support the psychological distinction that is made between strategic (effortful) and automatic (non-effortful) intention activation in prospective memory.

OBJECTIVES

To use nicotine as a pharmacological tool with which to examine the neurochemical bases of prospective memory and to dissociate strategic from automatic components of ProM retrieval.

METHODS

In three experiments, minimally deprived (2 h) smokers either smoked or abstained prior to completing a standard prospective memory study. This involved participants in the simultaneous processing of a ProM task and a cover task (ongoing between the setting and the recall of the intention). Here, the ongoing task involved lexical decision (LDT), while the ProM task required a response to pre-specified target items occurring within the LDT stimuli. Variations in task instructions were used to manipulate the processing requirements of the ProM task, the attention allocated to the ProM task and the balance of importance assigned to the ongoing and ProM tasks.

RESULTS

In experiment 1, where the ProM processing was automatic, nicotine did not improve ProM accuracy. In experiment 2, where the ProM task involved strategic processing, positive effects of nicotine were observed. In experiment 3, we covaried ProM task instructions, assigned task importance and nicotine conditions. We observed a main effect of nicotine on ProM accuracy, a main effect of task on ProM accuracy and a main effect of assigned task importance on ProM accuracy. There were no interactions between the factors.

CONCLUSIONS

Employing both direct and indirect manipulations of strategic engagement, we demonstrated nicotine-induced enhancement of performance on the ProM task. The results are consistent with the view that relatively small changes in instruction and in task variables engage strategic processing in a ProM task and that when these conditions stretch cognitive resources, nicotine may significantly improve performance.

Rising atmospheric CO2 reduces sequestration of root-derived soil carbon

Forests have a key role as carbon sinks, which could potentially mitigate the continuing increase in atmospheric carbon dioxide concentration and associated climate change. We show that carbon dioxide enrichment, although causing short-term growth stimulation in a range of European tree species, also leads to an increase in soil microbial respiration and a marked decline in sequestration of root-derived carbon in the soil. These findings indicate that, should similar processes operate in forest ecosystems, the size of the annual terrestrial carbon sink may be substantially reduced, resulting in a positive feedback on the rate of increase in atmospheric carbon dioxide concentration.

Women and the global tobacco epidemic: nurses call to action

BACKGROUND

Tobacco consumption is increasing among women across the globe at alarming rates. Without effective intervention, the smoking prevalence among women will nearly triple over the next generation. These trends are potentially more threatening when considering how tobacco intersects women's lives, regardless if they use tobacco products or not.

AIM

A review and analysis of the literature is conducted to examine the scope of tobacco's global effect on the multiple dimensions of women's health.

METHOD

Medline (1990-2003), Cumulative Index to Nursing and Allied Health Literature (1990-2003) and World Health Organization databases were searched for related topics. Keywords for searches included global health, tobacco, women and nursing.

FINDINGS

The epidemiology and prevalence of tobacco use among women are presented and its impact on women globally. Using an ecological perspective, the consequences of tobacco are analysed within the contexts of health, social, environment, economic and policy as it relates to women, their families and their communities.

IMPLICATIONS

Nurses are in prime positions to empower individuals, families, communities and nations in the prevention and treatment of tobacco use. Health for all women continues to be a call for equity and social justice. Recommendations are provided for nursing practice, education, theory, research and policy to address this global health concern.

Analysis of CO2 leakage through ‘low-permeability’ faults from natural reservoirs in the Colorado Plateau, east-central Utah

The numerous CO2 reservoirs in the Colorado Plateau region of the United States are natural analogues for potential geological CO2 sequestration repositories. To understand better the risk of leakage from reservoirs used for long-term underground CO2 storage, we examine evidence for CO2 migration along two normal faults that cut a reservoir in east-central Utah. CO2-charged springs, geysers, and a hydrocarbon seep are localized along these faults. These include natural springs that have been active for long periods of time, and springs that were induced by recent drilling. The CO2-charged spring waters have deposited travertine mounds and carbonate veins. The faults cut siltstones, shales, and sandstones and the fault rocks are fine-grained, clay-rich gouge, generally thought to be barriers to fluid flow. The geological and geochemical data are consistent with these faults being conduits for CO2 moving to the surface. Consequently, the injection of CO2 into faulted geological reservoirs, including faults with clay gouge, must be carefully designed and monitored to avoid slow seepage or fast rupture to the biosphere.

Are changes in MAPK/ERK necessary or sufficient for entrainment in chick pineal cells?

Chick pineal cells in culture display a circadian rhythm of melatonin release. Light pulses can entrain (phase shift) the rhythm. One candidate for the photoentrainment pathway uses a mitogen-activated protein kinase (MAPK), also known as extracellular signal-regulated kinase (ERK). We tested the hypothesis that activation of ERK (by phosphorylation to p-ERK) is necessary and/or sufficient for entrainment by measuring the ability of several drugs, light, and other perturbations to change levels of p-ERK and to induce phase shifts in the melatonin rhythm. If changes in the levels of p-ERK are sufficient for photoentrainment, then all perturbations that reduce its level must induce light-like phase shifts, and all those that increase its level must induce dark-like phase shifts. If such changes are necessary for photoentrainment, then light pulses must reduce p-ERK levels, and the duration of the light pulse, the magnitude and duration of the change in p-ERK, and the size of the phase shift must correlate. We found five perturbations that reduced p-ERK levels. Of these, two induced light-like phase shifts (PD 98059 and caffeine), one induced dark-like phase shifts (SB203580), and two did not induce phase shifts at all (U0126 and omitting a medium change). Serum increased p-ERK levels without inducing any phase shifts. Finally, light pulses did not elicit changes in p-ERK, nor was there a diurnal rhythm in p-ERK levels, nor could rapid changes in p-ERK levels have accounted for duration effects of light pulses on phase shifts. Taken together, these results argue strongly against the hypothesis that reduction (or increases) in MAPK/ERK activation is necessary or sufficient for entrainment in chick pineal cells.

Activation of human matrix metalloproteinase 2 by gingival crevicular fluid and Porphyromonas gingivalis

AIM

To assess the potential of gingival crevicular fluid (GCF) from adult periodontitis patients and Porphyromonas gingivalis proteases to activate matrix metalloproteinase 2 (MMP-2) in vitro.

MATERIAL AND METHODS

GCF samples were collected from each of 15 adult periodontitis patients, from a clinically healthy site, a deep (>6 mm) bleeding site, and a deep nonbleeding site. The GCF samples were examined for general proteolytic activity, gelatinolytic activity and ability to activate pro-MMP-2 by zymography. Ultrasonic extracts of a range of clinical isolates of P. gingivalis cells and purified arg- and lys-gingipains were also assessed for their ability to activate pro-MMP-2.

RESULTS

GCF from deep nonbleeding sites showed higher general proteolytic activity than samples from deep bleeding and healthy sites but this did not reach statistical significance. Pefabloc, a general serine protease inhibitor, inhibited the majority (92%) of the proteolytic activity. GCF samples contained neutrophil MMP-9 in its latent form in 93% of the samples, and in its activated form in 40% of the samples. In contrast, MMP-2 was present in only trace amounts in 9% of the samples. When latent MMP-2 was added to these GCF samples, it was converted to the activated form (59 kDa) in 68% of the samples. Lower molecular weight (55 and 45 kDa) activated forms also appeared in 53% of the samples, particularly those from deep sites. Activation to the 55 and 45 kDa forms was inhibited by MSAAPket (a neutrophil elastase inhibitor), whereas Pefabloc completely inhibited the activation of latent MMP-2. All ultrasonic extracts of P. gingivalis activated latent MMP-2 in a concentration- and time-dependent manner. Also, latent MMP-2 was activated by purified arg-gingipain but less efficiently by lys-gingipain.

CONCLUSION

These findings suggest that P. gingivalis arg-gingipain and neutrophil elastase present in GCF can activate latent MMP-2, which may contribute in vivo to local periodontal tissue destruction.