Immune checkpoint inhibition improves antimyeloma activity of bortezomib and STING agonist combination in Vk*MYC preclinical model

Multiple myeloma (MM), a hematological malignancy of plasma cells, has remained incurable despite the development of novel therapies that improve patients' outcome. Recent evidence indicates that the stimulator of interferon genes (STING) pathway may represent a novel target for induction of antitumor immune response in multiple myeloma. Here, we investigated antitumor effects of STING agonist with bortezomib with or without checkpoint inhibitor in the treatment of MM.

METHODS

STING expression in bone marrow plasma cells of 58 MM patients was examined by immunohistochemical staining. The effectiveness of the proposed therapy was evaluated in vivo in a syngeneic transplantable mouse model of MM (Vĸ*MYC) in immunocompetent mice. Flow cytometry was used to assess tumor burden and investigate activation of immune response against MM. ELISA was performed to measure serum inflammatory cytokines concentrations upon treatment.

RESULTS

Combining a STING agonist [2'3'-cGAM(PS)2] with bortezomib significantly decreased tumor burden and improved the survival of treated mice compared to either of the compounds used alone. The combination treatment led to secretion of pro-inflammatory cytokines and increased the percentage of neutrophils, activated dendritic cells and T cells in the tumor microenvironment. However, it resulted also in increased expression of PD-L1 on the surface of the immune cells. Addition of anti-PD1 antibody further potentiated the therapeutic effects.

CONCLUSIONS

Our findings indicate high antimyeloma efficacy of the three-drug regimen comprising bortezomib, STING agonist, and a checkpoint inhibitor.

Arginase Inhibition Mitigates Bortezomib-Exacerbated Cardiotoxicity in Multiple Myeloma

BACKGROUND

Multiple myeloma (MM) is associated with increased cardiovascular morbidity and mortality, while MM therapies also result in adverse cardiac effects. Endothelial dysfunction and impaired nitric oxide (NO) pathway is their possible mediator.

OBJECTIVE

Since MM is associated with increased arginase expression, resulting in the consumption of ʟ-arginine, precursor for NO synthesis, our aim was to test if cardiotoxicity mediated by MM and MM therapeutic, bortezomib (a proteasome inhibitor), can be ameliorated by an arginase inhibitor through improved endothelial function.

METHODS

We used a mouse Vĸ*MYC model of non-light chain MM. Cardiac function was assessed by echocardiography.

RESULTS

MM resulted in progressive left ventricular (LV) systolic dysfunction, and bortezomib exacerbated this effect, leading to significant impairment of LV performance. An arginase inhibitor, OAT-1746, protected the heart against bortezomib- or MM-induced toxicity but did not completely prevent the effects of the MM+bortezomib combination. MM was associated with improved endothelial function (assessed as NO production) vs. healthy controls, while bortezomib did not affect it. OAT-1746 improved endothelial function only in healthy mice. NO plasma concentration was increased by OAT-1746 but was not affected by MM or bortezomib.

CONCLUSIONS

Bortezomib exacerbates MM-mediated LV systolic dysfunction in a mouse model of MM, while an arginase inhibitor partially prevents it. Endothelium does not mediate either these adverse or beneficial effects. This suggests that proteasome inhibitors should be used with caution in patients with advanced myeloma, where the summation of cardiotoxicity could be expected. Therapies aimed at the NO pathway, in particular arginase inhibitors, could offer promise in the prevention/treatment of cardiotoxicity in MM.

Potent but transient immunosuppression of T-cells is a general feature of CD71+ erythroid cells

CD71+ erythroid cells (CECs) have been recently recognized in both neonates and cancer patients as potent immunoregulatory cells. Here, we show that in mice early-stage CECs expand in anemia, have high levels of arginase 2 (ARG2) and reactive oxygen species (ROS). In the spleens of anemic mice, CECs expansion-induced L-arginine depletion suppresses T-cell responses. In humans with anemia, CECs expand and express ARG1 and ARG2 that suppress T-cells IFN-γ production. Moreover, bone marrow CECs from healthy human donors suppress T-cells proliferation. CECs differentiated from peripheral blood mononuclear cells potently suppress T-cell activation, proliferation, and IFN-γ production in an ARG- and ROS-dependent manner. These effects are the most prominent for early-stage CECs (CD71highCD235adim cells). The suppressive properties disappear during erythroid differentiation as more differentiated CECs and mature erythrocytes lack significant immunoregulatory properties. Our studies provide a novel insight into the role of CECs in the immune response regulation.

Inhibition of arginase modulates T-cell response in the tumor microenvironment of lung carcinoma

Immunotherapy has demonstrated significant activity in a broad range of cancer types, but still the majority of patients receiving it do not maintain durable therapeutic responses. Amino acid metabolism has been proposed to be involved in the regulation of immune response. Here, we investigated in detail the role of arginase 1 (Arg1) in the modulation of antitumor immune response against poorly immunogenic Lewis lung carcinoma. We observed that tumor progression is associated with an incremental increase in the number of Arg1⁺ myeloid cells that accumulate in the tumor microenvironment and cause systemic depletion of ʟ-arginine. In advanced tumors, the systemic concentrations of ʟ-arginine are decreased to levels that impair the proliferation of antigen-specific T-cells. Systemic or myeloid-specific Arg1 deletion improves antigen-induced proliferation of adoptively transferred T-cells and leads to inhibition of tumor growth. Arginase inhibitor was demonstrated to modestly inhibit tumor growth when used alone, and to potentiate antitumor effects of anti-PD-1 monoclonal antibodies and STING agonist. The effectiveness of the combination immunotherapy was insufficient to induce complete antitumor responses, but was significantly better than treatment with the checkpoint inhibitor alone. Together, these results indicate that arginase inhibition alone is of modest therapeutic benefit in poorly immunogenic tumors; however, in combination with other treatment strategies it may significantly improve survival outcomes.

MRCP as a biomarker of motor action with varying degree of central and peripheral contribution as defined by ultrasound imaging

Motor imagination is an alternative rehabilitation strategy for people who cannot execute real movements. However, it is still a matter of debate to which degree it involves activation of deeper muscle structures, which cannot be detected by surface electromyography (SEMG). Sixteen able-bodied participants performed cue based isometric ankle plantar flexion (active movement) followed by active relaxation under four conditions: executed movements with two levels of muscle contraction (fully executed and attempted movements, EM and AM) and motor imagination with and without detectable muscle twitches (IT and I). The most prominent peaks and distinctive phases of movement-related cortical potential (MRCP) were compared between conditions. Ultrasound imaging (USI) and SEMG were used to detect movements. IT showed spatially distinctive significant differences compared to both I and AM during active movement preparation and reafferentation phase; further widespread differences were found between IT and AM during active movement execution and posteriorly during preparation for active relaxation. EM and AM showed the largest differences frontally during active movement planning and posteriorly during execution of active relaxation. Movement preparation positivity P1 showed a significant difference in amplitude between IT and AM but not between IT and I. USI can detect subliminal movements (twitches) better than SEMG. MRCP is a biomarker sensitive to different levels of muscle contraction and relaxation. IT is a motor condition distinguishable from both I and AM. EEG biomarkers of movements could be used to identify pathological conditions, that manifest themselves during either active contraction or active relaxation.NEW & NOTEWORTHY Ultrasound imaging can detect subtle muscle movements (twitches) that are not detectable with electromyography. Almost a quarter of trials of imagined movements in able-bodied people are accompanied by twitches. Analysis of movement-related cortical potential showed that motor imagination with twitches is a condition distinguishable from motor imagination without twitches and from motor attempts.

Mosaic IL6ST variant inducing constitutive GP130 cytokine receptor signaling as a cause of neonatal onset immunodeficiency with autoinflammation and dysmorphy

Interleukin-6 signal transducer (IL6ST) encodes the GP130 protein which transduces the proinflammatory signaling of the IL6 cytokine family through Janus kinase signal transducers and activators of transcription pathway (JAK/STAT) activation. Biallelic loss-of-function IL6ST variants cause autosomal recessive hyper-IgE syndrome or a variant of the Stuve-Wiedemann syndrome. Somatic gain-of-function IL6ST mutations, in particular, small monoallelic in-frame deletions of which the most prevalent is the IL6ST Ser187_Tyr190del, are an established cause of inflammatory hepatocellular tumors, but so far, no disease caused by such mutations present constitutively has been described. Herein, we report a pediatric proband with a novel syndrome of neonatal onset immunodeficiency with autoinflammation and dysmorphy associated with the IL6ST Tyr186_Tyr190del variant present constitutively. Tyr186_Tyr190del was found by exome sequencing and was shown to be de novo (absent in proband's parents and siblings) and mosaic (present in approximately 15-40% of cells depending on the tissue studied-blood, urine sediment, hair bulbs and buccal swab). Functional studies were performed in the Epstein-Barr virus-immortalized patient's B cell lymphoblastoid cell line, which carried the variant in approximately 95% of the cells. Western blot showed that the patient's cells exhibited constitutive hyperphosphorylation of Tyr705 in STAT3, which is indicative of IL6-independent activation of GP130. Interestingly, the STAT3 phosphorylation could be inhibited with ruxolitinib as well as tofacitinib, which are clinically approved JAK1 and JAK3 (to lesser extent JAK2 and JAK1) inhibitors, respectively. Given our results and the recent reports of ruxolitinib and tofacitinib use for the treatment of diseases caused by direct activation of STAT3 or STAT1, we speculate that these drugs may be effective in the treatment of our patient's condition.

Tissue clearing-based method for unobstructed three-dimensional imaging of mouse penis with subcellular resolution

Although mice are widely used to elucidate factors contributing to penile disorders and develop treatment options, quantification of tissue changes upon intervention is either limited to minuscule tissue volume (histology) or acquired with limited spatial resolution (MRI/CT). Thus, imaging method suitable for expeditious acquisition of the entire mouse penis with subcellular resolution is described that relies on both aqueous- (clear, unobstructed brain imaging cocktails and computational analysis) and solvent-based (fluorescence-preserving capability imaging of solvent-cleared organs) tissue optical clearing (TOC). The combined TOC approach allows to image mouse penis innervation and vasculature with unprecedented detail and, for the first time, reveals the three-dimensional structure of murine penis fibrocartilage.

Myeloid Cell-Derived Arginase in Cancer Immune Response

Amino acid metabolism is a critical regulator of the immune response, and its modulating becomes a promising approach in various forms of immunotherapy. Insufficient concentrations of essential amino acids restrict T-cells activation and proliferation. However, only arginases, that degrade L-arginine, as well as enzymes that hydrolyze L-tryptophan are substantially increased in cancer. Two arginase isoforms, ARG1 and ARG2, have been found to be present in tumors and their increased activity usually correlates with more advanced disease and worse clinical prognosis. Nearly all types of myeloid cells were reported to produce arginases and the increased numbers of various populations of myeloid-derived suppressor cells and macrophages correlate with inferior clinical outcomes of cancer patients. Here, we describe the role of arginases produced by myeloid cells in regulating various populations of immune cells, discuss molecular mechanisms of immunoregulatory processes involving L-arginine metabolism and outline therapeutic approaches to mitigate the negative effects of arginases on antitumor immune response. Development of potent arginase inhibitors, with improved pharmacokinetic properties, may lead to the elaboration of novel therapeutic strategies based on targeting immunoregulatory pathways controlled by L-arginine degradation.

Systematic Evaluation of Chemically Distinct Tissue Optical Clearing Techniques in Murine Lymph Nodes

Activation of adaptive immunity is a complex process coordinated at multiple levels in both time and the three-dimensional context of reactive lymph nodes (LNs). Although microscopy-based visualization of its spatiotemporal dynamics unravels complexities of developing immune response, such approach is highly limited by light-obstructing nature of tissue components. Recently, tissue optical clearing (TOC) techniques were established to bypass this obstacle and now allow to image and quantify the entire murine organs with cellular resolution. However, the spectrum of TOC is represented by wide variety of chemically distinct methods, each having certain advantages and disadvantages that were unsatisfactorily compared for suitability to LNs clearing. In this study, we have systematically tested 13 typical TOC techniques and assessed their impact on a number of critical factors such as LN transparency, imaging depth, change in size, compatibility with proteinaceous fluorophores, immunostaining, H&E staining, and light-sheet fluorescence microscopy. Based on the detailed data specific to TOC process of murine LNs, we provide a reliable reference for most suitable methods in an application-dependent manner.

Extracellular vesicles released by ovarian carcinoma contain arginase 1 that mitigates antitumor immune response

Expression of arginase-1 (ARG1) is an immunosuppressive feature of tumor microenvironment that leads to depletion of ʟ-arginine, a nutrient required for T-cells expansion. Ovarian carcinoma cells release extracellular vesicles carrying enzymatically active ARG1, that contributes to local and systemic immune suppression, which can be restored by ARG inhibitor.

Cortical Functional Domains Show Distinctive Oscillatory Dynamic in Bimanual and Mirror Visual Feedback Tasks

It is believed that Mirror Visual Feedback (MVF) increases the interlimb transfer but the exact mechanism is still a matter of debate. The aim of this study was to compare between a bimanual task (BM) and a MVF task, within functionally rather than geometrically defined cortical domains. Measure Projection Analysis (MPA) approach was applied to compare the dynamic oscillatory activity (event-related synchronization/desynchronization ERS/ERD) between and within domains. EEG was recorded in 14 healthy participants performing a BM and an MVF task with the right hand. The MPA was applied on fitted equivalent current dipoles based on independent components to define domains containing functionally similar areas. The measure of intradomain similarity was a "signed mutual information," a parameter based on the coherence. Domain analysis was performed for joint tasks (BM and MVF) and for each task separately. MVF created 9 functional domains while MB task had only 4 functionally distinctive domains, two over the left hemispheres and two bilateraly. For all domains identified for BM task alone, similar domains could be identified in MVF and joint tasks analysis. In addition MVF had domains related to motor planning on the right hemisphere and to self-recognition of action. For joint tasks analysis, seven domains were identified, with similar functions for the left and the right hand with exception of a domain covering BA32 (self-recognition of action) of the left hand only. In joint task domain analysis, the ERD/ERS showed a larger difference between domains than between tasks. All domains which involved the sensory cortex had a visible beta ERS at the onset of movement, and post movement beta ERS. The frequency of ERD varied between domains. Largest difference between tasks existed in domains responsible for the awareness of action. In conclusion, functionally distinctive domains have different ERD/ERS patterns, similar for both tasks. MVF activates contralateral hemisphere in similar manner to BM movements, while at the same time also activating the ipsilateral hemisphere. Significance: Following stroke cortical activation and interhemispheric inhibition from the contralesional side is reduced. MVF creates stronger ipsilateral activity than BM, which is highly relevant of neurorehabilitation of movements.

A Method for the Measurement of Salivary Gland Function in Mice

Patients with Sjögren's syndrome, an autoimmune disease affecting the exocrine glands, develop salivary gland inflammation and have reduced saliva production. Similarly, saliva production is severely compromised in patients receiving radiation treatment for head and neck cancers. Rodent models, developed to mimic these clinical conditions, facilitate an understanding of the disease pathogenesis and allow for the development of new therapeutic strategies. Therefore, the ability to accurately, reproducibly, and repeatedly measure salivary gland function in animal models is critical. Building on procedures previously described in the literature, a method was developed that meets these criteria and was used to evaluate salivary gland function in mice. An additional advantage of this new method is that it is easily mastered, and has little inter-operator variation. Salivary gland function is evaluated as the amount (weight or volume) or rate (mL/min) of saliva produced in response to pilocarpine stimulation. The collected saliva is a good source for the analyses of protein content, immunoglobulin concentrations, and other biomolecules.

Effect of sow age on the apparent total tract digestibility of nutrients in the diet

The objective of this research was to evaluate the effect of sow age on apparent total tract digestibility of nutrients and the concentration of metabolizable energy in the diet. The experiment was carried out on 20 gestating sows, divided into two groups: Group I - 10 sows in first pregnancy (131 ± 4.5 kg) and Group II - 10 sows in fourth pregnancy (225 ± 8.2 kg). Sows in the two groups were fed identical diets for sows during early pregnancy. The total collection of faeces began on day 30 of pregnancy and lasted eight days. Sows in the fourth pregnancy had greater digestibility coefficients of dry matter (4.1 percentage units), organic matter (3.4 percentage units), crude protein (5.5 percentage units) and crude fibre (6.2 percentage units) than sows in the first pregnancy. The total tract digestibility of ether extract, starch and sugars was not affected by pig age. The metabolizable energy, determined according to the content of digestible nutrients, in the sow diet in fourth pregnancy was 0.7 MJ/kg higher than in the diet of sows in their first pregnancy. Results of this research indicate that sow age should be considered when formulating diets during early pregnancy.______________________________________________________________________________________Keywords: Digestibility, gestation, metabolizable energy, nutrients, age of sow

Immunomodulatory activity accompanying chicken egg yolk immunoglobulin Y

Immunity transfer from a mother to the newborn does not depend exclusively on immunoglobulins. Peptides, which are characterized by immunoregulatory properties that accompany IgG₂, known as proline- rich polypeptide complex (PRP), have been discovered for the first time in ovine colostrum. In this report we present new data showing that some immunoregulatory peptides associated with the main immunoglobulin class, IgY, are also present in the avian immune system. Cytokine-inducing activity of particular fractions obtained from ovine colostrum, IgG+ (IgG₂ containing PRP), IgG− (IgG₂ free of PRP), and purified PRP, was compared with that of crude egg yolk IgY (IgY+), additionally purified egg yolk IgY (IgY−), and polypeptides accompanying IgY named Yolkin (Y), using an ex vivo model of whole human blood cells. It was shown that both IgG+ fraction and PRP, but not IgG−, stimulated the whole blood cells to release tumor necrosis factor-α and interleukin-1β cytokines. Similar experiments performed with hen's egg IgY preparations showed that IgY+ and Y samples showed higher cytokine-inducing activity than samples additionally purified with the use of size exclusion chromatography (IgY−). The IgY+ at a dose of 100 μg was even more active than the positive lipopolysaccharide control. It was also found that Y is able to stimulate macrophage cell line J774.2 to release nitric oxide. The results obtained suggest that IgY, the main chicken immunoglobulin fraction, is accompanied by additional polypeptides and plays a role of a transporter of biologically active substances, which was observed in the case of colostral IgG.

[The stomatological press in Lwow in the period between the wars]

This article deals with the history of the Polish stomatological press in Lwow. It was initiated by a distinguished Polish stomatologist - Professor Antoni Cieszynski. In 1923 he founded a periodical "Dentystyka Polska" (Polish Dentistry) to publish original articles written by Polish and foreign authors, as well as review the stomatological literature and news. In 1930 the title was changed to "Polska Stomatologia" (Polish Stomatology). The articles printed there were very sophisticated; they were not limited only to the pathological dental changes and their treament, but also showed a holistic approach to the human being and demonstrated the relation between oral cavity diseases and changes of the entire body. Sometimes this publication used to be supplemented by a special edition, among others, "Slowianska Stomatologia" (Slavonic Stomatology) or jubilees' editions. The article presents the review of the issues examined in the Lwow stomatological press and describes the conditions in which these publications were created.

[Acute intermittent porphyria: actual problems of clinical and laboratory diagnosis]

On the case of 27 old woman with clinical symptoms of acute abdomen, severe electrolyte disturbances and attacks of grand mal seizures, different clinical masks and actual treatment guidelines of acute intermittent porphyria are presented. Among laboratory methods detecting precursors of hem in the urine, high-performance liquid chromatography (HPLC) as the most sensitive and specific method is recommended. Proper prophylaxis against new episodes of acute intermittent porphyria as well as long lasting ambulatory care of the patient are emphasized. Special attention should be paid to all close relatives of the patient, who need to be send to specialistic laboratories for exclusion of enzymatic defects of hem synthesis.

[Infection in the dialysis unit as a contributing factor to the problem of hospital acquired infections]

Hospital acquired infections are especially dangerous for patients with chronic renal insufficiency. An epidemic of hospital acquired infection of dramatic course in described in 13 patients (8 being on haemodialysis (HD) and 5 treated conservatively), with 15 episodes of septic syndrome (12 cases) or septic shock (3 cases). Initial cultures of blood, urine and pharyngeal swabs were positive only in 5 patients treated conservatively. Initial cultures of dialysing fluid from all 12 monitors of HD in our Dialysis Unit revealed the presence of Gram-negative bacteria (Achromobacter) in blood of 3 patients as well as in the dialysing fluid compartments from 2 monitors of Gambro AK 10/100. The possible role of Gram-negative, apparently benign water rods, in the pathogenesis of hospital acquired opportunistic infections in Dialysis Unit were discussed.

[Recurrent acute renal failure during the course of hemolytic crisis in a patient with glucose-6-phosphate dehydrogenase deficiency]

Episodes of the acute renal failure have been noted in a 36-year old female patient in the course of recurrent hemolytic crisis. Significant G-6-DP deficit in erythrocytes was the sole possible cause of hemolytic anemia. Nitrofurantoin administered to the patient for recurrent urinary infection could have a predisposing influence in development of hemolytic anemia.