MR Imaging Characteristics Associate with Tumor-Associated Macrophages in Glioblastoma and Provide an Improved Signature for Survival Prognostication

BACKGROUND AND PURPOSE

In glioblastoma, tumor-associated macrophages have tumor-promoting properties. This study determined whether routine MR imaging features could predict molecular subtypes of glioblastoma that differ in the content of tumor-associated macrophages.

MATERIALS AND METHODS

Seven internally derived MR imaging features were assessed in 180 patients, and 25 features from the Visually AcceSAble Rembrandt Images feature set were assessed in 164 patients. Glioblastomas were divided into subtypes based on the telomere maintenance mechanism: alternative lengthening of telomeres positive (ALT+) and negative (ALT-) and the content of tumor-associated macrophages (with [M+] or without [M-] a high content of macrophages). The 3 most frequent subtypes (ALT+/M-, ALT-/M+, and ALT-/M-) were correlated with MR imaging features and clinical parameters. The fourth group (ALT+/M+) did not have enough cases for correlation with MR imaging features.

RESULTS

Tumors with a regular margin and those lacking a fungating margin, an expansive T1/FLAIR ratio, and reduced ependymal extension were more frequent in the subgroup of ALT+/M- (P < .05). Radiologic necrosis, lack of cystic component (by both criteria), and extensive peritumoral edema were more frequent in ALT-/M+ tumors (P < .05). Multivariate testing with a Cox regression analysis found the cystic imaging feature was additive to tumor subtype, and O6-methylguanine methyltransferase (MGMT) status to predict improved patient survival (P < .05).

CONCLUSIONS

Glioblastomas with tumor-associated macrophages are associated with routine MR imaging features consistent with these tumors being more aggressive. Inclusion of cystic change with molecular subtypes and MGMT status provided a better estimate of survival.

Peripheral vascular effects of bretylium tosylate in man

After intra-arterial infusion of bretylium tosylate (12.5 mg.), the reflex changes in vasoconstrictor tone which normally occur in the forearm with body cooling, positive pressure breathing, the Valsalva manoeuvre and postural change were greatly reduced or abolished. Reflex vasodilatation mediated by cholinergic fibres in response to body heating or to emotional stress was little affected. It was concluded that bretylium can selectively block the activity of sympathetic noradrenergic fibres without causing a similar block of sympathetic cholinergic fibres. As the responses to intravenous or intra-arterial infusions of adrenaline or noradrenaline were not reduced after bretylium, it was concluded that bretylium interferes with the activity of noradrenergic fibres rather than with the activity of the noradrenaline released at the nerve ending. After bretylium infusion, forearm and hand blood flow did not often rise to levels characteristic of full release of vasoconstrictor tone. As infusion of bretylium into a nerve-blocked forearm resulted in a pronounced reduction in flow, it is concluded that bretylium also has a constrictor effect on blood vessels. The state of the vessels following an infusion of bretylium appears to depend on the balance between this constrictor action and the longer-acting sympathetic blocking effect.

CD4 T cells inhibit the CD8 T cell response during low-dose virus infection

CD4 T cells are not thought to play a significant role in generating an effective primary CD8 T cell response to most viral infections. We have challenged this view by demonstrating that antigen-specific CD4 T cells can indeed suppress the proliferation of antigen-specific naive CD8 T cells in response to low doses of vesicular stomatitis virus. This finding is in contrast to the established observations that at high antigen loads CD4 T cells play little role in generating CD8 T cell responses, and that in non-infectious model systems CD4 T cells actually help the CD8 T cell response. Our results suggest that at low infectious doses, CD4 T cells play a much larger role in controlling infections than previously appreciated.

The "knowingly and willfully" continuum of the anti-kickback statute's scienter requirement: its origins, complexities, and most recent judicial developments

Mr. Blair analyzes the evolution of the Anti-Kickback Statute's scienter requirement. The article includes a historical review of the Anti-Kickback Statute and an in-depth discussion of three notable cases in this area, United States v. Greber, Hanlester Network v. Shalala, and United States v. Davis. The author concludes that without further guidance from either Congress or the Department of Health and Human Services, the split among circuits as to the proper definition of the Statute's scienter requirement makes the matter ripe for Supreme Court review.

Human x human hybridomas from patients with myasthenia gravis: possible tools for idiotypic therapy for myasthenia

Hybridomas secreting monoclonal antibodies directed against the nicotinic acetylcholine receptor have been developed from rats with experimental autoimmune myasthenia gravis and from a patient with myasthenia gravis. Rat monoclonal antibodies were characterized by their ability to bind to electroblotted acetylcholine receptor subunits. Of 34 tested, 22 bound to the alpha subunit. Three bound to other subunits, and the remainder appeared to bind only to the native molecule. The human monoclonal antibodies were analyzed with respect to their binding to membrane-bound and solubilized acetylcholine receptor. Many bound with greater affinity to the membrane-bound form of the antigen. Two rat monoclonal antibodies capable of passively transferring experimental autoimmune myasthenia gravis, and with reactivities to the alpha subunit of the acetylcholine receptor, were employed to produce isogeneic monoclonal antiidiotypic antibodies. When they were injected prior to immunization with acetylcholine receptor, two of the antiidiotypic antibodies directed against framework determinants prevented the development of experimental autoimmune myasthenia gravis. This observation raises the possibility that the human monoclonal antibodies will be useful in the development of idiotypic treatment of the human disease.

Monoclonal antibodies to acetylcholine receptor secreted by human x human hybridomas derived from lymphocytes of a patient with myasthenia gravis

Peripheral blood lymphocytes of a patient with myasthenia gravis (MG) were fused to the non-secreting human lymphoblastoid line HuNSI to produce human x human hybridomas that secrete monoclonal antibodies (mAb) to acetylcholine receptor (AChR). Screening of hybridomas for antibody production involved an enzyme-linked immunosorbent (ELISA) assay with AChR from Torpedo californica (TAChR). 25 of 302 wells tested (8.3%) were positive for anti-AChR antibody production and have been stable in their secretion of mAb for eleven months. Nine lines have been studied in detail. All produced IgM mAb, and most had greater activity against membrane-bound TAChR, than against solubilized TAChR. For anti-AChR clones, the mAb concentration in culture supernatants ranged from 2 to 33 micrograms/ml. Saturation curves of binding to TAChR performed on 4 lines demonstrated dissociation constants (Kds) estimated to range from 0.1-1.0 nM. The patient whose lymphocytes were used in this study had a serum anti-AChR antibody concentration of 243nM against human AChR and 15nM against AChR from T. californica. The results demonstrate the feasibility of producing stable human x human hybridomas secreting mAb to the autoantigen from the peripheral blood of patients with organ-specific autoimmune diseases. The mAb produced here may prove to be useful in analyzing, and possibly treating, the autoimmune phenomena in MG.

Cutaneous vasomotor nerves to the head and trunk

Simultaneous measurements of skin temperature of various skin areas of the body were made during indirect cooling and heating of the body. Cooling the body caused a much larger fall in the nose and finger temperature than in mouth temperature, indicating active vasoconstriction in these areas. In the ear, cheek, chest and forehead there was no evidence for vasoconstriction. Evidence of vasodilatation in all the skin areas studied was obtained when the body was indirectly heated. Blocking the vasomotor nerves to the ear resulted in a large increase in skin temperature and, during body heating, the skin temperature of the normal ear did not exceed that of the nerve-blocked ear. It was concluded that the changes in ear blood flow subserving temperature regulation are mainly due to alterations in vasoconstrictor tone. In the chest and cheek, cutaneous nerve block did not alter skin temperature, yet it reduced the rise in skin temperature normally seen during body heating. It was concluded that the vasodilatation normally seen in these areas is not due to release of vasoconstrictor tone, but rather to an active vasodilator mechanism, mediated through fibers running with the cutaneous nerves.

Submitted on May 27, 1960