Cardiotoxicity risk factors with immune checkpoint inhibitors

Background

Checkpoint-inhibitor immunotherapies have had a profound effect in the treatment of cancer by inhibiting down-regulation of T-cell response to malignancy. The cardiotoxic potential of these agents was first described in murine models and, more recently, in numerous clinical case reports of pericarditis, myocarditis, pericardial effusion, cardiomyopathy, and new arrhythmias. The objective of our study was to determine the frequency of and associated risk factors for cardiotoxic events in patients treated with immune checkpoint inhibitors.

Methods

Medical records of patients who underwent immunotherapy with durvalumab, ipilimumab, nivolumab, and pembrolizumab at Wake Forest Baptist Health were reviewed. We collected retrospective data regarding sex, cancer type, age, and cardiovascular disease risk factors and medications. We aimed to identify new diagnoses of heart failure, atrial fibrillation, ventricular fibrillation/tachycardia, myocarditis, and pericarditis after therapy onset. To assess the relationship between CVD risk factors and the number of cardiac events, a multivariate model was applied using generalized linear regression. Incidence rate ratios were calculated for every covariate along with the adjusted P-value. We applied a multivariate model using logistic regression to assess the relationship between CVD risk factors and mortality. Odds ratios were calculated for every covariate along with the adjusted P-value. Adjusted P-values were calculated using multivariable regression adjusting for other covariates.

Results

Review of 538 medical records revealed the following events: 3 ventricular fibrillation/tachycardia, 12 pericarditis, 11 atrial fibrillation with rapid ventricular rate, 0 myocarditis, 8 heart failure. Significant risk factors included female gender, African American race, and tobacco use with IRR 3.34 (95% CI 1.421, 7.849; P = 0.006), IRR 3.39 (95% CI 1.141, 10.055; P = 0.028), and IRR 4.21 (95% CI 1.289, 13.763; P = 0.017) respectively.

Conclusions

Our study revealed 34 significant events, most frequent being pericarditis (2.2%) and atrial fibrillation (2.0%) with strongest risk factors being female gender, African American race, and tobacco use. Patients who meet this demographic, particularly those with planned pembrolizumab treatment, may benefit from early referral to a cardio-oncologist. Further investigation is warranted on the relationship between CTLA-4 and PD-L1 expression and cardiac adverse events with ICIs, particularly for these subpopulations.

Second-harmonic generation from complementary split-ring resonators

We present experiments on second-harmonic generation from arrays of magnetic split-ring resonators and arrays of complementary split-ring resonators. In both cases, the fundamental resonance is excited by the incident femtosecond laser pulses under normal incidence, leading to comparably strong second-harmonic signals. These findings are discussed in terms of Babinet's principle and in terms of a recently developed microscopic classical theory that leads to good agreement regarding the relative and the absolute nonlinear signal strengths. The hydrodynamic convective contribution is found to be the dominant source of second-harmonic generation--in contrast to a previous assignment [Science 313, 502 (2006)].

Negative beam displacements from negative-index photonic metamaterials

It is well known that refraction of light at interfaces leads to a beam displacement for oblique incidence of light onto a slab of material. In ray optics and for homogeneous isotropic materials, the sign of this beam displacement is strictly identical to the sign of the refractive index. Our numerical calculations reveal negative beam displacements from state-of-the-art double-fishnet-type photonic metamaterials. This holds true for the "main" polarization corresponding to a negative phase velocity for normal incidence as well as for the "secondary" polarization with positive phase velocity. To understand and interpret these results, we also present exact analytical calculations for thin metal films showing that, in wave optics, the sign of the beam displacement (i.e., the sign of refraction) is generally not identical to the sign of the refractive index.

Circular dichroism of planar chiral magnetic metamaterials

We propose, fabricate, and study a double-layer chiral planar metamaterial that exhibits pronounced circular dichroism at near-infrared wavelengths. The antisymmetric oscillation modes of the two coupled layers allow local magnetic-dipole moments and enhanced polarization effects compared with similar single-layer systems where only electric-dipole moments occur. Experiment and rigorous theoretical calculations are in good agreement.

Correlation effects in disordered metallic photonic crystal slabs

We analyze the influence of correlations on the optical properties of disordered metallic photonic crystal slabs experimentally and theoretically. Different disorder models with different nearest-neighbor correlations are considered. We present a theory that allows us to quantitatively calculate the optical properties of the different samples. We find that different kinds of correlations produce characteristic spectral features such as peak reduction and inhomogeneous broadening. These features are caused by reduced excitation efficiencies and the excitation of multiple resonances.

Single-slit split-ring resonators at optical frequencies: limits of size scaling

We present magnetic metamaterials composed of 35 nm minimum feature-size gold split-ring resonators with a fundamental magnetic resonance at a wavelength of 900 nm. Corresponding calculations reveal excellent agreement with the experiments and show that the limits of size scaling have been reached.

Variation of the carrier-envelope phase of few-cycle laser pulses owing to the Gouy phase: a solid-state-based measurement

The carrier-envelope phase of a laser pulse has recently become an important quantity in extreme nonlinear optics. Because of the topological Gouy phase, it changes while the pulse propagates through the focus of a lens. This variation is measured by a simple solid-state-based approach. The experimental results are analyzed by comparison with simple analytical model calculations.

Atom fiber for omnidirectional guiding of cold neutral atoms

We present an omnidirectional matter waveguide on an atom chip. The guide is based on a combination of two current-carrying wires and a bias field pointing perpendicular to the chip surface. Thermal atoms are guided for more than two complete turns along a 25-mm-long spiral path (with curve radii as short as 200 microm) at various atom-surface distances (35-450 microm). An extension of the scheme for the guiding of Bose-Einstein condensates is outlined.

Trapping and manipulating neutral atoms with electrostatic fields

We report on experiments with cold thermal (7)Li atoms confined in combined magnetic and electric potentials. A novel type of three-dimensional trap was formed by modulating a magnetic guide using electrostatic fields. We observed atoms trapped in a string of up to six individual such traps, a controlled transport of an atomic cloud over a distance of 400 microm, and a dynamic splitting of a single trap into a double well potential. Applications for quantum information processing are discussed.

Mobility-dependent charge injection into an organic semiconductor

Measurements of charge injection from indium tin oxide (ITO) into the organic semiconductor, tetraphenyl diamine doped polycarbonate (PC:TPD), were carried out. The current injected at the contact was measured as a function of the hole mobility in the organic semiconductor, which was varied from 10(-6) to 10(-3) cm (2)/V x s by adjusting the concentration of the hole transport agent, TPD, in the PC host. These experiments reveal that the current injected at the contact is proportional to the hole mobility in the bulk. As a result, the ITO/PC:TPD contact is found to limit current flow in all samples, regardless of the hole mobility in PC:TPD.

Diagnostic accuracy and tumor-targeting kinetics of complete versus fragmented 99mTc-labeled anti-carcinoembryonic antigen antibodies: an intraindividual comparison

The goal of this study was to intraindividually compare a complete versus a fragmented, directly 99mTc-labeled, monoclonal anti-carcinoembryonic antigen (CEA) antibody, with respect to their antigen-targeting kinetics, sensitivity, and diagnostic accuracy in patients with CEA-expressing tumors. Twenty-five patients were investigated with the 99mTc-labeled anti-CEA IgG1 BW 431/26 and the F(ab')2/Fab' fragment mixture F023C5 within 7 days. For quantitative analysis, the region of interest technique was applied to planar scans, whole-body scans, and single photon emission computed tomography slices 10 min to 48 h postinjection (PI). Final correlations were performed according to the histopathology after surgery or biopsy. Earliest tumor detection was possible with complete IgG1 4 h PI (52% of finally positive lesions). Twenty-four- or even 48-h scans were necessary in 48% of finally positive lesions; tumor detection with fragments was possible in 17% at 1 h PI and in 94% at 4 h PI. With both monoclonal antibodies, in 35%, single photon emission computed tomography was necessary for tumor detection. Absolute antibody uptake in tumor lesions was higher with complete monoclonal antibodies than with fragments. The sensitivity of fragments was higher in detecting primary tumors, local recurrences, and lymph node metastases. For detection of liver metastases, sensitivity was also higher for fragments than for IgG (87 versus 73%), but in scintigraphically positive lesions, tumor:background ratios were significantly lower with fragments (1.26 +/- 0.12 versus 1.70 +/- 0.32; P < 0.01). Therefore, fragments seem to be more suitable for earlier detection of lesions known for their good vascularization, vascular permeability, and antigen accessibility, such as local recurrences, lymph node metastases, and peritoneal carcinomatoses. In liver metastases (high interstitial pressure, low vascular leakage), sensitivity of fragments is higher, but their rapid serum and whole-body clearance lead to a lower absolute antibody uptake, with the consequence of significantly lower tumor:background ratios than with IgG.

Comparison of complete versus fragmented technetium-99m-labeled anti-CEA monoclonal antibodies for immunoscintigraphy in colorectal cancer

The goal of this study was to intraindividually compare complete versus fragmented directly labeled 99mTc monoclonal anti-CEA antibody with respect to antigen targeting and tumor uptake kinetics, sensitivity and diagnostic accuracy in colorectal cancer patients.

METHODS

Twenty-five patients were investigated with 99mTc-labeled anti-CEA IgG1 BW 431/26 and the F(ab')2/Fab' fragment mixture F023C5 within 7 days. For quantitative analysis, an ROI technique was applied to planar scans, whole-body scans and SPECT slices 10 min to 48 hr postinjection. Final correlations were performed according to histology after surgery or biopsy.

RESULTS

Earliest tumor detection with complete IgG1 was possible 4 hr postinjection (52% of finally positive lesions); imaging at 24 hr or even 48 hr was necessary in 48%. Tumor detection with fragments was possible in 17% at 1 hr postinjection and in 94% at 4 hr postinjection. In 35%, SPECT was necessary for tumor detection with both MAbs. Absolute antibody uptake in tumor lesions was higher with complete MAbs than with fragments.

CONCLUSIONS

Lesions known for their good vascularization, vascular permeability and antigen accessibility were detected earlier and with higher sensitivity with fragments than with complete MAbs due to faster background clearance despite lower absolute antibody uptake.

The etiology of female juvenile delinquency and gang membership: a test of psychological and social structural explanations

A large portion of the research carried out to date on juvenile delinquency and gang behavior has been concentrated on male delinquents. For example, Thrasher's study (1927) of 1,313 gangs in Chicago devoted less than a page to the question of whether or not females form gangs in the same way that males do. When females are included in delinquency studies, their behavior is almost always explained in psychological or social-psychological terms. The general reasoning is that females commit delinquent acts or join delinquent gangs because they are socially maladjusted, come from broken and unhappy homes, and do not relate well to the opposite sex. In this article, we juxtapose this theoretical perspective to a social structural explanation of both female juvenile delinquency and female gang membership, and then test these two alternative explanations for juvenile delinquency using data on black, female juveniles collected in Los Angeles during the mid-1960s.

Radioimmunoassay, enzyme immunoassay, spectrophotometry, and gas-liquid chromatography compared for determination of phenobarbital and diphenylhydantoin

Sera from epileptic patients were assayed for phenobarbital and diphenylhydantoin by four different analytical procedures. Quantitative results obtained by radioimmunoassay (I) and enzyme immunoassay (II) were compared to each other and to the results obtained on aliquots of the same sample by gas-liquid chromatography (III) and ultraviolet spectrophotometry (IV). For phenobarbital the correlation coefficients were I vs. II, 0.909; I vs. III, 0.947; II vs. III, 0.917; I vs. IV, 0.950; II vs. IV, 0.953. For diphenylhydantoin the correlation coefficients were I vs. II, 0.953; I vs. III, 0.951; II vs. III, 0.957; I vs. IV, 0.862; II vs. IV, 0.898. The immunoassays can be substituted for liquid chromatography or ultraviolet spectrophotometry without changing the resulting clinical interpretations.

Radioimmunoassay, enzyme immunoassay, spectrophotometry, and gas-liquid chromatography compared for determination of phenobarbital and diphenylhydantoin

Sera from epileptic patients were assayed for phenobarbital and diphenylhydantoin by four different analytical procedures. Quantitative results obtained by radioimmunoassay (I) and enzyme immunoassay (II) were compared to each other and to the results obtained on aliquots of the same sample by gas-liquid chromatography (III) and ultraviolet spectrophotometry (IV). For phenobarbital the correlation coefficients were I vs. II, 0.909; I vs. III, 0.947; II vs. III, 0.917; I vs. IV, 0.950; II vs. IV, 0.953. For diphenylhydantoin the correlation coefficients were I vs. II, 0.953; I vs. III, 0.951; II vs. III, 0.957; I vs. IV, 0.862; II vs. IV, 0.898. The immunoassays can be substituted for liquid chromatography or ultraviolet spectrophotometry without changing the resulting clinical interpretations.

Radioimmunoassay, enzyme immunoassay, spectrophotometry, and gas-liquid chromatography compared for determination of phenobarbital and diphenylhydantoin

Sera from epileptic patients were assayed for phenobarbital and diphenylhydantoin by four different analytical procedures. Quantitative results obtained by radioimmunoassay (I) and enzyme immunoassay (II) were compared to each other and to the results obtained on aliquots of the same sample by gas-liquid chromatography (III) and ultraviolet spectrophotometry (IV). For phenobarbital the correlation coefficients were I vs. II, 0.909; I vs. III, 0.947; II vs. III, 0.917; I vs. IV, 0.950; II vs. IV, 0.953. For diphenylhydantoin the correlation coefficients were I vs. II, 0.953; I vs. III, 0.951; II vs. III, 0.957; I vs. IV, 0.862; II vs. IV, 0.898. The immunoassays can be substituted for liquid chromatography or ultraviolet spectrophotometry without changing the resulting clinical interpretations.