Abstract OT2-07-06: Antibody-coupled T cell receptor (ACTR) engineered autologous T cells in combination with trastuzumab for the treatment of HER2-positive malignancies

Antibody-Coupled T cell Receptor (ACTR) is an autologous engineered T cell therapy developed to combine with tumor-targeting antibodies to exert potent anti-tumor immune responses and tumor cell killing. The ACTR construct is composed of the extracellular domain of CD16 fused to CD3ζ signaling and T cell co-stimulatory domains. ACTR-expressing T cells are universal in that they can be paired with a therapeutic antibody to target specific antigens on tumors. Unum has two ACTR constructs, ACTR087 and ACTR707, currently in clinical testing. ACTR087 and ACTR707 are being tested in combination with rituximab in subjects with CD20+ B cell lymphoma in two separate trials (NCT02776813 and NCT03189836, respectively). Preliminary data with ACTR087 + rituximab has demonstrated clinical proof-of-concept and a dose-response relationship in subjects with relapsed/refractory B cell lymphoma. ACTR087 is also being tested in combination with a novel BCMA-targeting antibody in subjects with multiple myeloma (NCT03266692).

While T cell therapies, such as chimeric antigen receptor (CAR) T cells, have demonstrated clinical activity in hematological cancers, the therapeutic potential of this approach has yet to be established in solid tumors. Challenges associated with targeting solid tumors with CAR-T cells include tumor antigen heterogeneity and antigen expression on normal tissues. HER2 is a well-established therapeutic target that is over-expressed in a number of cancer indications. HER2 is also expressed at low levels on normal epithelial cells, creating a risk for on-target/off-tumor toxicities of HER2-targeted CAR-T cells. Here we present nonclinical studies demonstrating that ACTR T cells in combination with trastuzumab have antigen density-dependent activity on HER2-expressing tumor cell lines, while trastuzumab-based CAR-T cells do not. We observed that ACTR + trastuzumab had robust activity against HER2-amplified tumor cells and more modest activity against non-amplified tumor cells, whereas HER2-targeting CAR-T cells had comparable activity against HER2-amplified and non-amplified tumor cells. On normal human primary cells, ACTR + trastuzumab had minimal activity in comparison to HER2 CAR-T cells, suggesting that ACTR + trastuzumab may exhibit a superior clinical therapeutic index. Furthermore, the activity of ACTR T cells against HER2-amplified tumor cells was titratable with antibody concentration, allowing for control of ACTR activity by modulation of trastuzumab concentration. Together, these data demonstrate the specificity of the ACTR T cell therapeutic approach to target HER2-amplified tumors and support clinical testing in combination with trastuzumab.

A phase 1, multicenter, single-arm, open-label dose escalation study, ATTCK-34-01, is proposed to evaluate ACTR T cells in combination with trastuzumab in subjects with advanced HER2-positive malignancies. The primary study objectives are to assess the safety and tolerability of the combination, and to define the recommended phase 2 dose combination for further study. Additional objectives include assessment of anti-tumor activity, ACTR T cell persistence and trastuzumab pharmacokinetics. Enrollment is expected to commence in early 2019.

Citation Format: O'Callaghan KM, Shin J, Cheung AS, Cheema T, Judge C, Ranger A, Huet HA, Ettenberg SA, Sachs J, Vasconcelles M, Motz G. Antibody-coupled T cell receptor (ACTR) engineered autologous T cells in combination with trastuzumab for the treatment of HER2-positive malignancies [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr OT2-07-06.

Preliminary investigations of magnetic modulated nanoparticles for microwave breast cancer detection

This paper investigates the potential of magnetic modulated iron oxide nanoparticles in terms of a contrast enhancement for Ultra-wideband (UWB) breast imaging. The work is motivated by the low dielectric contrast between tumor and normal glandular/fibroconnective tissue. The influence of an external polarizing magnetic field on pure and coated magnetite nanoparticles is investigated in this contribution. Measurements were conducted using M-sequence UWB technology and an oil-gelatin phantom. It is shown that a coating, which is necessary for clinical use, results in a lower signal response, and thus leads to a lower detectability of magnetic modulated nanoparticles.

Assessing "dangerous climate change": required reduction of carbon emissions to protect young people, future generations and nature

We assess climate impacts of global warming using ongoing observations and paleoclimate data. We use Earth's measured energy imbalance, paleoclimate data, and simple representations of the global carbon cycle and temperature to define emission reductions needed to stabilize climate and avoid potentially disastrous impacts on today's young people, future generations, and nature. A cumulative industrial-era limit of ∼500 GtC fossil fuel emissions and 100 GtC storage in the biosphere and soil would keep climate close to the Holocene range to which humanity and other species are adapted. Cumulative emissions of ∼1000 GtC, sometimes associated with 2°C global warming, would spur "slow" feedbacks and eventual warming of 3-4°C with disastrous consequences. Rapid emissions reduction is required to restore Earth's energy balance and avoid ocean heat uptake that would practically guarantee irreversible effects. Continuation of high fossil fuel emissions, given current knowledge of the consequences, would be an act of extraordinary witting intergenerational injustice. Responsible policymaking requires a rising price on carbon emissions that would preclude emissions from most remaining coal and unconventional fossil fuels and phase down emissions from conventional fossil fuels.

Abstract A71: Expression of Sushi Domain Containing 2 (SUSD2) in high-grade ovarian serous carcinoma correlated with increased longevity of patients

Despite research in therapeutic strategies, ovarian cancer (OvCa) remains the most lethal gynecologic malignancy. The anatomical location of the ovaries within the peritoneal cavity facilitates metastasis by allowing tumor cells sloughed from the main tumor on the ovary to bind to the peritoneum or organs within the peritoneal cavity. These tumor cells are released from the main tumor either as single cells or as spheroids, the latter of which have been shown to be more effective at metastasizing and invading into the mesothelial lining. To identify novel tumor markers and therapeutic targets for epithelial cancers, a cDNA library enriched for cancer genes that encode membrane and secreted proteins was generated. The 18th most abundant gene represented in this library was Sushi Domain Containing 2 (SUSD2), which encodes an 822 amino acid membrane surface protein. To begin defining the role of SUSD2 in OvCa, stable SUSD2-expressing and vector control A2780 cell lines were generated. To examine whether SUSD2 affects the growth of OvCa cells, cellular proliferation assays were performed. There was no significant difference in growth rates with SUSD2 over-expression compared to the vector control cell lines. A Boyden chamber assay was performed to analyze the effect of SUSD2 on cell migration. A2780-SUSD2 cell lines and vector-only controls were plated on membranes and allowed to migrate toward a chemoattractant in a lower chamber. SUSD2 over-expression significantly increased migration by greater than 2-fold. In addition, a scratch wound-healing assay was performed, and after 24 hours the A2780-SUSD2 cell line had 2-fold more cells within the wound compared to the A2780-vector control cells (P<0.05). Consistently, agarose beads containing either A2780-SUSD2 or vector cells were grown in chemoattractant containing media. The distance the escaped cells traveled from the bead was measured. A2780-SUSD2 cells traveled farther away from the bead compared to the vector control (717 μm compared to 125 μm, respectively, P<0.05). Spheroid-forming ability was analyzed, and A2780-SUSD2 cells formed smaller and looser spheroids (length and width average of 933 μm) compared to A2780-vector control cells (length and width average of 1237 μm, P=0.025). To correlate OvCa patient outcome with the presence of SUSD2 in the corresponding tumor, a tissue microarray containing high-grade ovarian serous carcinoma core samples from 128 patients was stained with an anti-SUSD2 antibody. The intensity of SUSD2 staining was scored by a pathologist, and results were correlated with patient outcome. A Kaplan-Meier curve indicated a significant separation for patients with low SUSD2 levels, median survival 31.7 months, versus patients with strong SUSD2 staining, median survival 49.1 months (P=0.0083). This data suggests that low SUSD2 levels in OvCa tumors are associated with a poorer prognosis for the patient. Our in vitro assays indicate that expression of SUSD2 in A2780 cells increased the ability of the cells to migrate and caused the formation of smaller spheroids. Because spheroids are better able to resist chemotherapy and invade the mesothelium, the decreased spheroid size of SUSD2-expressing cells may allow for a better patient prognosis.

Citation Format: Jennifer A. A. Gubbels, Elizabeth M. Hultgren, Jessica Johnson, Emily Johnson, Jeffrey Sachs, Michelle S. Hirsch, Joyce Liu, Ronny Drapkin, Kristi A. Egland. Expression of Sushi Domain Containing 2 (SUSD2) in high-grade ovarian serous carcinoma correlated with increased longevity of patients. [abstract]. In: Proceedings of the AACR Special Conference on Advances in Ovarian Cancer Research: From Concept to Clinic; Sep 18-21, 2013; Miami, FL. Philadelphia (PA): AACR; Clin Cancer Res 2013;19(19 Suppl):Abstract nr A71.

Combining magnetic resonance imaging and ultrawideband radar: a new concept for multimodal biomedical imaging

Due to the recent advances in ultrawideband (UWB) radar technologies, there has been widespread interest in the medical applications of this technology. We propose the multimodal combination of magnetic resonance (MR) and UWB radar for improved functional diagnosis and imaging. A demonstrator was established to prove the feasibility of the simultaneous acquisition of physiological events by magnetic resonance imaging and UWB radar. Furthermore, first in vivo experiments have been carried out, utilizing this new approach. Correlating the reconstructed UWB signals with physiological signatures acquired by simultaneous MR measurements, representing respiratory and myocardial displacements, gave encouraging results which can be improved by optimization of the MR data acquisition technique or the use of UWB antenna arrays to localize the motion in a focused area.

The malaria gap

Although the correlation between malaria and poverty is apparent, the nature of the linkages in terms of directions and mechanisms of causation is less so, and different methodologic approaches provide widely divergent perspectives concerning the impact of the disease. Certain macroeconomic studies find that in highly endemic countries, malaria may be responsible for reducing economic growth by more than one percentage point a year. Microeconomic studies, which aggregate the cost per case, find a considerably smaller impact, generally less than one percent of annual per capita gross domestic product. The large gap between these estimates suggests economic externalities associated with malaria that make the burden much greater than the sum of the costs of individual cases. Both the magnitude of the burden and the channels through which malaria affects reduces income are important for policymakers. We explore this gap, examining diverse mechanisms through which malaria can affect long-term economic development.

A global index representing the stability of malaria transmission

To relate stability of malaria transmission to biologic characteristics of vector mosquitoes throughout the world, we derived an index representing the contribution of regionally dominant vector mosquitoes to the force of transmission. This construct incorporated published estimates describing the proportion of blood meals taken from human hosts, daily survival of the vector, and duration of the transmission season and of extrinsic incubation. The result of the calculation was displayed globally on a 0.5 degrees grid. We found that these biologic characteristics of diverse vector mosquitoes interact with climate to explain much of the regional variation in the intensity of transmission. Due to the superior capacity of many tropical mosquitoes as vectors of malaria, particularly those in sub-Saharan Africa, antimalaria interventions conducted in the tropics face greater challenges than were faced by formerly endemic nations in more temperate climes.

The economic and social burden of malaria

Where malaria prospers most, human societies have prospered least. The global distribution of per-capita gross domestic product shows a striking correlation between malaria and poverty, and malaria-endemic countries also have lower rates of economic growth. There are multiple channels by which malaria impedes development, including effects on fertility, population growth, saving and investment, worker productivity, absenteeism, premature mortality and medical costs.

The fusion of anatomic and physiologic imaging in the management of patients with cancer

Imaging is of major clinical importance in the noninvasive evaluation and management of patients with cancer. Computed tomography (CT) and other anatomic imaging modalities, such as magnetic resonance imaging (MRI) or ultrasound, have a high diagnostic ability by visualizing lesion morphology and by providing the exact localization of malignant sites. Nuclear medicine provides information on the function and metabolism of cancer. Over the last decade, there have been numerous attempts to combine data obtained from different imaging techniques. Fused images of nuclear medicine and CT (or to a lesser extent, MRI) overcome the inherent limitations of both modalities. Valuable physiologic information benefits from a precise topographic localization. Coregistered data have been shown to be useful in the evaluation of patients with cancer at diagnosis and staging, in monitoring the response to treatment, and during follow up, for early detection of recurrence. Time-consuming and difficult realignment and computation for fusion of independent studies have, until now, limited the use of registration techniques to pilot studies performed in a small number of patients. The development of the new technology of single photon emission computed tomography/CT and positron emission tomography/CT that allows for combined functional and anatomic data acquisition has the potential to make fusion an everyday clinical tool.

The new technology of combined transmission and emission tomography in evaluation of endocrine neoplasms

The clinical value of a novel technology of combined transmission and emission tomography (TET) was assessed in patients with endocrine tumors.

METHODS

TET technology, which combines simultaneous acquisition of SPECT and CT images, using the same imaging device, allows correct fusion of images of both modalities. TET was performed on 27 patients with known or suspected endocrine tumors. The radiopharmaceuticals used for the emission part of the study were chosen according to the tumor type: (111)In-octreotide for patients with neuroendocrine tumors (n = 10), (99m)Tc-sestamibi for patients with primary hyperparathyroidism (n = 8), (131)I for patients with thyroid cancer (n = 4), and (123)I-metaiodobenzylguanidine and (75)Se-cholesterol for patients with adrenal masses (n = 3 and n = 2, respectively). The additional information provided by TET compared with scintigraphy was assessed for both image interpretation and clinical utility.

RESULTS

TET did not provide any additional data in 16 patients (59%), including 5 patients with normal scintigraphy. In 11 patients (41%) with abnormal SPECT findings, TET improved image interpretation by providing a better anatomic localization of SPECT-detected lesions. It showed unsuspected bone involvement in 4 patients, it identified the organs involved and the relationship of the lesions to neighboring structures in 5 patients, and it differentiated physiologic uptake from tumor uptake in 2 patients. TET provided additional information of clinical value in 9 patients (33%). It assisted in better planning of surgery in 2 patients with neuroendocrine tumors and in 2 patients with ectopic parathyroid adenomas. It changed the treatment approach in 2 patients with neuroendocrine tumors and 1 patient with thyroid carcinoma, and it altered prognosis in 2 patients with thyroid malignancy.

CONCLUSION

TET enhances the already unique role of nuclear medicine procedures in the assessment and management of patients with endocrine neoplasms.

Defining and refining international donor support for combating the AIDS pandemic

The international aid effort against AIDS is greatly incommensurate with the severity of the epidemic. Drawing on the data that international aid donors self-reported to the Organization for Economic Cooperation and Development (OECD), we find that, between 1996 and 1998, finance from all rich countries to sub-Saharan Africa for projects designated as AIDS control averaged US $69 million annually, and, assuming a safe margin for under-reporting and misreporting, we estimate that total donor spending on HIV/AIDS control was perhaps twice that at most. Since the late 1980s, aid levels have dropped relative to the prevalence of HIV infection, and stood recently at about $3 per HIV-infected person. Lack of finance is now the primary constraint on progress against AIDS, notwithstanding the widespread belief that a lack of interest from the goveements of poor countries is limiting. We argue that to produce a meaningful response to the pandemic, international assistance must be based on grants, not loans, for the poorest countries; be increased within the next 3 years to a minimum of $7.5 billion or more; be directed toward funding projects which are proposed and desired by the affected countries themselves, and which are judged as having epidemiological merit against the pandemic by a panel of independent scientific experts; and fund concurrent needs, including prevention, drug treatment (such as highly active antiretroviral therapy), and blocking mother-to-child HIV transmission. An effort of this scope and scale will both radically alter the prospects for intervention against AIDS in poor countries, and together with comparable efforts to control other infectious diseases, is easily afforded by the OECD donor economies, whose aggregate national income recently surpassed $21 trillion annually.

Dipole lattice membrane model for protein calculations

A dipole lattice model for lipid membranes and their interactions with peptides is presented. It uses the Langevin dipole method to calculate electrostatic interactions in the heterogeneous membrane environment. A series of test cases are presented, including spherical charges, dipoles, side chain analogs, and helical peptides. The model consistently produces qualitatively correct results.

Item-level and subscale-level factoring of Biggs' Learning Process Questionnaire (LPQ) in a mainland Chinese sample

BACKGROUND

The learning process questionnaire (LPQ) has been the source of intensive cross-cultural study. However, an item-level factor analysis of all the LPQ items simultaneously has never been reported. Rather, items within each subscale have been factor analysed to establish subscale unidimensionality and justify the use of composite subscale scores.

AIMS

It was of major interest to see if the six logically constructed items groups of the LPQ would be supported by empirical evidence. Additionally, it was of interest to compare the consistency of the reliability and correlational structure of the LPQ subscales in our study with those of previous cross-cultural studies.

METHODS

Confirmatory factor analysis was used to fit the six-factor item level model and to fit five representative subscale level factor models.

SAMPLE

A total of 1070 students between the ages of 15 to 18 years was drawn from a representative selection of 29 classes from within 15 secondary schools in Guangzhou, China. Males and females were almost equally represented.

RESULTS

The six-factor item level model of the LPQ seemed to fit reasonably well, thus supporting the six dimensional structure of the LPQ and justifying the use of composite subscale scores for each LPQ dimension. However, the reliability of many of these subscales was low. Furthermore, only two subscale-level factor models showed marginally acceptable fit. Substantive considerations supported an oblique three-factor model.

CONCLUSIONS

Because the LPQ subscales often show low internal consistency reliability, experimental and correlational studies that have used these subscales as dependent measures have been disappointing. It is suggested that some LPQ items should be revised and other items added to improve the inventory's overall psychometric properties.

Motivational Beliefs, Study Strategies, and Mathematics Attainment in High- and Low-Achieving Chinese Secondary School Students

In order to examine the relationship between cognitive and motivational variables and their relationship to mathematics attainment, Hong Kong-Chinese students enrolled in schools for high-, average-, and low-achievers completed questionnaires in Year 10 and in Year 11. Low-achievers perceived academic learning as being less useful over time and reported spending less time studying in Year 10 than in Year 11 but high- and low-achievers did not differ on their use of self-regulated learning strategies. Performance on the public examination in mathematics was predicted by prior achievement and Self-Concept of Mathematics Ability. Results underscore the importance of considering cultural beliefs systems and educational systems in models of academic motivation. Copyright 2000 Academic Press.

Using a small sample Q sort to identify item groups

A small sample of 40 second-year university students in Hong Kong were asked to perform a Q sort on the 36 items of a questionnaire used to assess six dimensions of student approaches to learning, the Learning Process Questionnaire. Participants were instructed to sort the items into as many groups as they liked with the only conditions being that all items within a group be as similar as possible in perceived meaning and that no item be placed into more than one group. By treating participants' responses as a form of multiple-choice data and by applying optimal scaling, three solutions were obtained. A two-dimensional plot of the optimal item scores for the first two solutions yielded 10 clearly defined item clusters suggesting a possible ten-factor model as opposed to the six-factor model found in studies of this questionnaire. The implications of using this approach to identify potential competing factor models, especially within a cross-cultural context, are discussed.

Lymphohematopoietic graft-vs.-host reactions can be induced without graft-vs.-host disease in murine mixed chimeras established with a cyclophosphamide-based nonmyeloablative conditioning regimen

Mixed hematopoietic chimerism can be induced in mice receiving allogeneic bone marrow transplantation (BMT) after nonmyeloablative host conditioning with depletion T cells with of anti-T cell monoclonal antibodies (mAbs), low-dose (3 Gy) total-body irradiation (TBI), and local thymic irradiation (7 Gy). These mice are specifically tolerant to donor and host antigens. When nontolerant donor T cells are given to chimeras several months after BMT, full donor-type chimerism develops, but graft-vs.-host disease (GVHD) does not occur. The induction of such lymphohematopoietic GVH reactions without GVHD could provide an approach to separating graft-vs.-leukemia (GVL) from GVHD in patients with hematologic malignancies. To make the nonmyeloablative conditioning regimen described above more cytoreductive for such malignancies, we have now modified it by replacing TBI with cyclophosphamide (CP). Treatment with anti-CD4 and anti-CD8 mAbs on day -5, 200 mg/kg CP on day -1, and 7 Gy thymic irradiation on day 0 was only slightly myelosuppressive and allowed fully major histocompatibility complex (MHC)-mismatched (with or without multiple minor antigen disparities) allogeneic bone marrow to engraft and establish long-term mixed chimerism in 40 to 82% of recipients in three different strain combinations. The administration of nontolerant donor spleen cells at 5 weeks or at 5, 8, and 11 weeks posttransplant was capable of eliminating host hematopoietic cells, leading to full or nearly full donor chimerism in six of six and two of four chimeric animals in two different strain combinations. No clinical evidence of GVHD was observed in any recipients of these donor leukocyte infusions (DLI). These studies demonstrate that induction of mixed chimerism with nonmyeloablative conditioning followed at appropriate times by DLI might allow lymphohematopoietic GVH reactions, and hence GVL effects, to eliminate chronic hematologic malignancies without causing clinically significant GVHD.

Efficient transfer of a tumor antigen-reactive TCR to human peripheral blood lymphocytes confers anti-tumor reactivity

The tumor-associated-Ag MART-1 is expressed by most human melanomas. The genes encoding an alphabeta TCR from a MART-1-specific, HLA-A2-restricted, human T cell clone have been efficiently transferred and expressed in human PBL. These retrovirally transduced PBL cultures were MART-1 peptide reactive, and most cultures recognized HLA-A2+ melanoma lines. Limiting dilution clones were generated from three bulk transduced PBL cultures to investigate the function of individual clones within the transduced cultures. Twenty-nine of 29 CD8+ clones specifically secreted IFN-gamma in response to T2 cells pulsed with MART-1(27-35) peptide, and 23 of 29 specifically secreted IFN-gamma in response to HLA-A2+ melanoma lines. Additionally, 23 of 29 CD8+ clones lysed T2 cells pulsed with the MART-1(27-35) peptide and 15 of 29 lysed the HLA-A2+ melanoma line 888. CD4+ clones specifically secreted IFN-gamma in response to T2 cells pulsed with the MART-1(27-35) peptide. TCR gene transfer to patient PBL can produce CTL with anti-tumor reactivity in vitro and could potentially offer a treatment for patients with metastatic melanoma. This approach could also be applied to the treatment of other tumors and viral infections. Additionally, TCR gene transfer offers unique opportunities to study the fate of adoptively transferred T cells in vivo.

[Digital storage phosphor mammography in a magnification technic: experimental studies for spatial resolution and for detection of microcalcifications]

PURPOSE

Since the routine use of storage phosphor systems for mammography has been limited by its inadequate spatial resolution of 5 linepairs/mm, a combination of a magnification mammography technique with storage phosphor plates was investigated to detect microcalcifications.

MATERIAL AND METHODS

A new mammography system with a microfocus tube using an anode of 0.05-0.12 mm allowed to obtain survey views of the breast with 1.7x magnification (m), and spot views with 4x magnification. The digital image receptor comprised a high resolution storage phosphor plate. To determine spatial resolution, contrast transfer curves were obtained, and the detection of microcalcifications was investigated by ROC (receiver operating characteristic) analysis.

RESULTS

Spatial resolution for digital survey views (m = 1.7) was 8 linepairs/mm and for spot views (m = 4) was 18 linepairs/mm. ROC analysis demonstrated a significantly higher performance of the digital magnification technique compared to the conventional screen-film mammography technique.

CONCLUSIONS

The limitations of digital mammography with respect to spatial resolution can be overcome by using a high magnification technique.

Substance P as an immune modulator of anxiety

Peripheral blood concentrations of the proinflammatory peptide substance P (SP) have been shown to increase in response to psychological anxiety in human subjects. In this study, we examined changes in SP levels in peripheral blood in response to the anxiety of a diagnostic medical procedure. The levels of SP were found to he higher in subjects with high initial anxiety as compared to subjects with low initial anxiety as measured on the Multiple Affect Adjective Checklist. Changes in the percentages of CD-8-expressing T lymphocytes were found to correlate with alterations in measures of anxiety as well as SP. These changes persisted for 3 days following the diagnostic procedure. The results of the study seem to indicate that SP may serve as a mediator in stress-induced immune reactions.

The pharmacological effect of sodium phosphate after absorption from the peritoneal cavity

Hyperosmolar solutions are frequently used in clinical practice for enemas. In a review of the literature we found 43 published cases of severe complications connected with the use of hyperosmolar enemas. The absorption of sodium phosphate led to a raise of the temperature up to 41.1 degrees C, massive acidosis and electrolyte disturbances with hypocalcemia and hypernatremia. The clinical picture was dominated in most of the cases by somnolence or coma. In our experiment the absorption of sodium phosphate from the peritoneal cavity of rats led to similar clinical symptoms and--depending on the amount of sodium phosphate absorbed--to the death of the animals. Hypovolemia, hypernatremia, hypocalcemia and a direct toxic effect of phosphate on the kidneys is responsible for the complex mode of intoxication. Sodium phosphate solutions should not be used in patients with inflammatory bowel disease with a high risk of laceration of the mucosa or perforation of the bowel.

Autoimmunity--towards the year 2001

The interactive roles of T cells, major histocompatibility complex (MHC) class I and II molecules and antigen-presenting cells in the generation of autoimmunity is the subject of much discussion. A recent symposium contributed to the debate by inviting experts in several fields of immunology to answer specific questions relating to the mechanisms that trigger autoimmunity.

A ligand-epitope in vitro analysis of major histocompatibility determinants expressed on B and T lymphocytes

Human histocompatibility leucocyte antigen (HLA)-specific monoclonal antibody probes were used to determine the affinity constant, and cell-surface density of HLA class I and class II determinants. The measurements were estimated for single-cell units of B-lymphoblastoid cell line (B-LCL) and cloned activated T cells in different functional states. Each HLA subset showed unimodal affinity constant values for the interaction with the corresponding HLA-specific antibodies. Such values ranged between 2.2 x 10(7) M-1 (class I) and 4.0 x 10(7) M-1 (class II) for different histocompatibility epitopes. In both B and T cells there was a rank order of epitope expression, class I being highly expressed (5 x 10(6) epitopes/cell) followed by DR, DQ and DP, (1.1-3.0 x 10(6) epitopes/cell). Suppressive clones carrying functionally defined stimulating determinants previously designated 'DY' carried similar numbers of DR, DQ and DP binding sites to DY- non-suppressive clones, but showed selective increases of class II determinants reactive with broad class II-specific antibodies. The results are discussed in the context of the functional consequences of different patterns of HLA epitope expression in immune responses.