Signaling via a CD27-TRAF2-SHP-1 axis during naive T cell activation promotes memory-associated gene regulatory networks

The interaction of the tumor necrosis factor receptor (TNFR) family member CD27 on naive CD8+ T (Tn) cells with homotrimeric CD70 on antigen-presenting cells (APCs) is necessary for T cell memory fate determination. Here, we examined CD27 signaling during Tn cell activation and differentiation. In conjunction with T cell receptor (TCR) stimulation, ligation of CD27 by a synthetic trimeric CD70 ligand triggered CD27 internalization and degradation, suggesting active regulation of this signaling axis. Internalized CD27 recruited the signaling adaptor TRAF2 and the phosphatase SHP-1, thereby modulating TCR and CD28 signals. CD27-mediated modulation of TCR signals promoted transcription factor circuits that induced memory rather than effector associated gene programs, which are induced by CD28 costimulation. CD27-costimulated chimeric antigen receptor (CAR)-engineered T cells exhibited improved tumor control compared with CD28-costimulated CAR-T cells. Thus, CD27 signaling during Tn cell activation promotes memory properties with relevance to T cell immunotherapy.

Abstract 1043: Advances in cystine-dense peptide (CDP) screening and therapeutic applications

Cystine-dense peptides (CDPs) are a class of drug-like miniproteins that marry many of the advantages of biologics (high affinity and specificity) and small molecule therapeutics (high tissue permeability and low immunogenicity). The beneficial properties of CDPs, and miniproteins in general, have driven interest in therapeutic applications. However, CDP diversity is vast from every clade of life, and properly interrogating “CDP space” requires specialized screening and modeling tools.

With this in mind, we have created an optimized mammalian surface display platform to screen for CDPs of clinical interest using libraries of structurally-diverse native scaffolds optimized for stability. These native CDPs can be structurally modeled, which we did in determining the structures of over 4200 native CDPs. This modeling permits further selection in silico as well as targeted mutagenesis for favorable target-binding capabilities. Hits from these screens are routinely matured to sub-nM affinity. These CDPs can play numerous roles in a drug design pipeline, from an independent drug candidate to a delivery agent for tissue-targeting to a module in a polyspecific biologic. Recent novel CDP candidates have shown promise in immune-oncology space as part of a bispecific T-cell engager targeting PD-L1, where a single 2-week treatment was capable of eliminating subcutaneous PC3 prostate cancer xenograft tumors in 27/30 mice.

Besides bispecifics, future directions for the platform include exploring targeted protein degradation. Additionally, we are expanding upon our previous work on CDPs to explore CNS or tumor delivery of therapeutic cargo. The versatility of CDPs and novel screening tools to rapidly identify and mature candidates of interest can facilitate rapid advancement of CDP therapeutics to address difficult targets in oncology.

Citation Format: Zachary R. Crook, Emily J. Girard, Gregory P. Sevilla, Mi-Youn Brusniak, Peter B. Rupert, Della J. Friend, Mesfin M. Gewe, Midori Clarke, Ida Lin, Raymond Ruff, Doan Phi, Ashok Bandaranayake, Colin E. Correnti, Andrew J. Mhyre, Natalie W. Nairn, Roland K. Strong, James M. Olson. Advances in cystine-dense peptide (CDP) screening and therapeutic applications [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 1043.

Ex silico engineering of cystine-dense peptides yielding a potent bispecific T cell engager

Cystine-dense peptides (CDPs) are a miniprotein class that can drug difficult targets with high affinity and low immunogenicity. Tools for their design, however, are not as developed as those for small-molecule and antibody drugs. CDPs have diverse taxonomic origins, but structural characterization is lacking. Here, we adapted Iterative Threading ASSEmbly Refinement (I-TASSER) and Rosetta protein modeling software for structural prediction of 4298 CDP scaffolds and performed in silico prescreening for CDP binders to targets of interest. Mammalian display screening of a library of docking-enriched, methionine and tyrosine scanned (DEMYS) CDPs against PD-L1 yielded binders from four distinct CDP scaffolds. One was affinity-matured, and cocrystallography yielded a high-affinity (K_D = 202 pM) PD-L1-binding CDP that competes with PD-1 for PD-L1 binding. Its subsequent incorporation into a CD3-binding bispecific T cell engager produced a molecule with pM-range in vitro T cell killing potency and which substantially extends survival in two different xenograft tumor-bearing mouse models. Both in vitro and in vivo, the CDP-incorporating bispecific molecule outperformed a comparator antibody-based molecule. This CDP modeling and DEMYS technique can accelerate CDP therapeutic development.

A potent peptide-steroid conjugate accumulates in cartilage and reverses arthritis without evidence of systemic corticosteroid exposure

On-target, off-tissue toxicity limits the systemic use of drugs that would otherwise reduce symptoms or reverse the damage of arthritic diseases, leaving millions of patients in pain and with limited physical mobility. We identified cystine-dense peptides (CDPs) that rapidly accumulate in cartilage of the knees, ankles, hips, shoulders, and intervertebral discs after systemic administration. These CDPs could be used to concentrate arthritis drugs in joints. A cartilage-accumulating peptide, CDP-11R, reached peak concentration in cartilage within 30 min after administration and remained detectable for more than 4 days. Structural analysis of the peptides by crystallography revealed that the distribution of positive charge may be a distinguishing feature of joint-accumulating CDPs. In addition, quantitative whole-body autoradiography showed that the disulfide-bonded tertiary structure is critical for cartilage accumulation and retention. CDP-11R distributed to joints while carrying a fluorophore imaging agent or one of two different steroid payloads, dexamethasone (dex) and triamcinolone acetonide (TAA). Of the two payloads, the dex conjugate did not advance because the free drug released into circulation was sufficient to cause on-target toxicity. In contrast, the CDP-11R-TAA conjugate alleviated joint inflammation in the rat collagen-induced model of rheumatoid arthritis while avoiding toxicities that occurred with nontargeted steroid treatment at the same molar dose. This conjugate shows promise for clinical development and establishes proof of concept for multijoint targeting of disease-modifying therapeutic payloads.

Design and realization of a wireless sensor gateway for health monitoring

This paper describes the design and realization of a wireless sensor gateway (WSG) within a wireless sensor network (WSN) for health monitoring. The WSN allows recording and wireless transmission of biosignals, namely the electrocardiogram, pulse wave and body weight, which are important parameters for cardiovascular monitoring. These can be displayed, analysed, and saved on the WSG through a user interface based on a touch screen. The proposed WSG has the distinctive feature of using two different radio transceivers, exploiting the advantages of each device. Currently, most personal computers and handhelds have standardized Bluetooth interfaces (IEEE 802.15.1) but not ZigBee interfaces (IEEE 802.15.4). Hence, the proposed gateway is designed to receive data from wireless sensors through its ZigBee interface and to forward them to a personal computer via its Bluetooth interface. This feature, combined with simple touch screen menu navigation will reach increased patient compliance and consequently increased benefit for patient in terms of healthcare and safety.

Impact of spinal cord injury on self-perceived pre- and postmorbid cognitive, emotional and physical functioning

STUDY DESIGN

Cross-sectional study with repeated measurements.

OBJECTIVES

To examine the patient's perspective of the impact of spinal cord injury (SCI) on physical, cognitive, emotional function, and quality of life (QOL).

SETTING

Australia.

METHODS

A sample of 63 patients with SCI, 32 of whom had recent injuries, and 31 with established injuries were administered the Ruff Neurobehavioral Inventory to examine patients' subjective evaluation of pre- and post-injury functioning. Current happiness levels were also evaluated using the Subjective Happiness Scale. A follow up assessment was performed 6 months later to examine changes over time.

RESULTS

A significant difference was found between perception of pre- and postmorbid function on composite Cognitive (t=5.99, df=62, P<0.001), Physical (t=11.56, df=62, P<0.001), and QOL (t=7.16, df=62, P<0.001) scales and on several of the Emotional subscales including anxiety, paranoia and suspicion, and substance abuse (P<0.001). A series of hierarchical regression analyses indicate that post-SCI pain was a significant predictor of: cognitive (R(2)=0.20, P<0.001); emotional (R(2)=0.13, P<0.004); and of QOL (R(2)=0.22, P<0.001) functioning. With the exception of a decrease in happiness (P<0.01), there were no significant changes in any measures over the 6 month time period.

CONCLUSIONS

There are significant changes in patients' perceptions of physical and cognitive functioning, and of QOL before and after SCI and some aspects of emotional functioning. Pain has a significant adverse effect on functioning. Happiness decreased slightly in the 6 months between surveys.

Visuospatial learning: Ruff Light Trail Learning Test

The assessment of memory typically includes tests for both audioverbal and visuospatial processing, while measurements of learning have primarily utilized the audioverbal mode. However, there exists no compelling reason why learning should not also be assessed in the visuospatial mode. The Ruff Light Trail Learning Test (RULIT) represents such an option. Normative values utilizing 307 volunteers indicated neither significant gender nor educational differences. However, an age effect for those subjects 55 and older was demonstrated, and our data suggest that the major reason for the inferior learning in this older subgroup was their reduced memory capacities rather than their slowed visuospatial processing. Multiple components including learning curves, error analysis, and delayed recall are presented. Test-retest data also indicate an adequate reliability. The validity was compared to concurrently administered neuropsychological tests, and, finally, the potential for neuropsychological application of this new test is discussed.

Efficacy study of THINKable in the attention and memory retraining of traumatically head-injured patients

The efficacy of computer-assisted attention and memory retraining was evaluated with 15 severely head-injured patients. Training with selected exercises tailored to the individual's needs were provided from the THINKable program for up to 20 hours in both the attention and memory remediation modules. The experimental design evaluated outcome by juxtaposing multiple baseline procedures with a pre- and post-group comparison. Significant results were documented on the computerized tasks, psychometric measures and on patient and observer ratings of everyday behaviours of attention and memory.

Hemodynamic effects of a lorazepam-fentanyl anesthetic induction for coronary artery bypass surgery

Previous anesthetic induction techniques using the combination of a benzodiazepine (midazolam or diazepam) and fentanyl have been reported to produce marked hypotension. In this study, anesthesia was induced with a combination of lorazepam and fentanyl in patients undergoing coronary artery bypass graft surgery. In 10 patients, anesthesia was induced using an exponentially declining continuous infusion of lorazepam equivalent to a total infused dose of 0.1 mg/kg over 15 minutes, which was supplemented at 10 minutes by fentanyl, 75 micrograms/kg, given as an infusion over 5 minutes. In 8 additional patients, anesthesia was induced with an exponentially declining infusion of fentanyl to a total dose of 75 micrograms/kg over 15 minutes, which was supplemented at 10 minutes by lorazepam, 0.1 mg/kg, given as an infusion over 5 minutes. Hemodynamics were recorded during a 20-minute observation period. One patient in each group required treatment for bradycardia during the initial drug infusion (before the second drug was added). Four additional patients in the group receiving lorazepam followed by fentanyl required treatment for bradycardia or hypotension within 10 minutes of the beginning of the fentanyl infusion. When an infusion of lorazepam was added to the fentanyl infusion, hemodynamics remained stable; however, the reverse order produced a high level of bradycardia and hypotension.

Comparison of different methods for detecting human immune deficiency virus in human immunodeficiency virus-seropositive hemophiliacs

Since the detection of antibodies against the human immune deficiency virus (HIV) does not definitely prove HIV infection in hemophiliacs, virus detection was attempted by virus isolation from the peripheral blood monocytes (PBL), by demonstration of p24 antigen and decline of p24 antibody, and by detection of viral DNA by the polymerase chain reaction (PCR). Virus isolation was optimized by immediate coculture of PBL and by replacement of the reverse transcriptase test by the p24 antigen test, whereas the elimination of CD8+ lymphocytes proved to be unnecessary. Virus detection was dependent on the clinical stage of the illness. Virus isolation in 70 of 211 patients (33%) was more sensitive than detection of p24 antigen or decline of p24 antibody. PCR was performed in 25 patients and indicated infection in all of 15 isolation-positive cases and in 6 of 10 patients from whom virus was not isolated. Changes from negative to positive virus culture and from a weakly fusiogenic to a highly fusiogenic isolate were often accompanied by a progression of the disease. The results suggest that reactivation of HIV occurs when immune deficiency has become manifest. Apparently virus isolation detects only the virus already reactivated in vivo, whereas the PCR may also detect latent virus.

Familial 'sleep apnea plus' syndrome: report of a family

We describe a familial disorder consisting of sleep apnea, anosmia, colorblindness, partial complex seizures, and cognitive dysfunction. The phenotypic expression of the syndrome suggests an autosomal dominant inheritance with incomplete penetrance.

Experimental cerebral ischemia produced by extracranial vascular injury: protection with indomethacin and prostacyclin

To determine whether the production of brain ischemia is modified by antiplatelet agents administered at the time of extracranial endothelial injury, we modified a four-vessel occlusion rat model so that an electrogenic platelet thrombus in one carotid artery produced cerebral ischemia. DC current was passed through an anode around the left carotid artery of 11 rats with preoccluded vertebral and contralateral carotid arteries. Five of six untreated rats became unresponsive because of carotid occlusion and resultant cerebral ischemia; none of five animals pretreated with indomethacin and infused with prostacyclin (PGI2) were clinically affected. Light- and electronmicroscopic studies showed arterial platelet-fibrin thrombi and ischemic brain damage in untreated rats. All rats had received radiolabeled platelets; radioactivity was increased in the electrogenically injured left carotid arteries from treated and untreated rats, but counts were reduced by more than 80% in indomethacin/PGI2-treated rats (p less than 0.01).

Left hemisphere visual processes in a case of right hemisphere symptomatology. Implications for theories of cerebral lateralization

A patient with a visuospatial disturbance characteristic of posterior right hemisphere disease was examined under different conditions of stimulus presentation. The visuospatial defect, which was shown by the failure to perceive abnormalities concerning the left side of objects and the misperception of spatial relations, was present under conditions of unrestricted visual exposure. However, when the stimulus material was briefly exposed in the right visual field, performance improved substantially. These data suggest that the visuospatial defect seen after right hemisphere disease is atributable to factors other than the incapacity of the left hemisphere to process visuospatial information. Our observations, together with other evidence, lead us to question those theories of cerebral lateralization based on the notion that visuospatial processing is special to the right hemisphere.