Prognostic Role of Tumor Immune Microenvironment in Pleural Epithelioid Mesothelioma

Background

Pleural mesothelioma (MPM) is an aggressive malignancy with an average patient survival of only 10 months. Interestingly, about 5%–10% of the patients survive remarkably longer. Prior studies have suggested that the tumor immune microenvironment (TIME) has potential prognostic value in MPM. We hypothesized that high-resolution single-cell spatial profiling of the TIME would make it possible to identify subpopulations of patients with long survival and identify immunophenotypes for the development of novel treatment strategies.

Methods

We used multiplexed fluorescence immunohistochemistry (mfIHC) and cell-based image analysis to define spatial TIME immunophenotypes in 69 patients with epithelioid MPM (20 patients surviving ≥ 36 months). Five mfIHC panels (altogether 21 antibodies) were used to classify tumor-associated stromal cells and different immune cell populations. Prognostic associations were evaluated using univariate and multivariable Cox regression, as well as combination risk models with area under receiver operating characteristic curve (AUROC) analyses.

Results

We observed that type M2 pro-tumorigenic macrophages (CD163+pSTAT1−HLA-DRA1−) were independently associated with shorter survival, whereas granzyme B+ cells and CD11c+ cells were independently associated with longer survival. CD11c+ cells were the only immunophenotype increasing the AUROC (from 0.67 to 0.84) when added to clinical factors (age, gender, clinical stage, and grade).

Conclusion

High-resolution, deep profiling of TIME in MPM defined subgroups associated with both poor (M2 macrophages) and favorable (granzyme B/CD11c positivity) patient survival. CD11c positivity stood out as the most potential prognostic cell subtype adding prediction power to the clinical factors. These findings help to understand the critical determinants of TIME for risk and therapeutic stratification purposes in MPM.

High tumor cell platelet-derived growth factor receptor beta expression is associated with shorter survival in malignant pleural epithelioid mesothelioma

Malignant pleural mesothelioma (MPM) has a rich stromal component containing mesenchymal fibroblasts. However, the properties and interplay of MPM tumor cells and their surrounding stromal fibroblasts are poorly characterized. Our objective was to spatially profile known mesenchymal markers in both tumor cells and associated fibroblasts and correlate their expression with patient survival. The primary study cohort consisted of 74 MPM patients, including 16 patients who survived at least 60 months. We analyzed location-specific tissue expression of seven fibroblast markers in clinical samples using multiplexed fluorescence immunohistochemistry (mfIHC) and digital image analysis. Effect on survival was assessed using Cox regression analyses. The outcome measurement was all-cause mortality. Univariate analysis revealed that high expression of secreted protein acidic and cysteine rich (SPARC) and fibroblast activation protein in stromal cells was associated with shorter survival. Importantly, high expression of platelet-derived growth factor receptor beta (PDGFRB) in tumor cells, but not in stromal cells, was associated with shorter survival (hazard ratio [HR] = 1.02, p < 0.001). A multivariable survival analysis adjusted for clinical parameters and stromal mfIHC markers revealed that tumor cell PDGFRB and stromal SPARC remained independently associated with survival (HR = 1.01, 95% confidence interval [CI] = 1.00-1.03 and HR = 1.05, 95% CI = 1.00-1.11, respectively). The prognostic effect of PDGFRB was validated with an artificial intelligence-based analysis method and further externally validated in another cohort of 117 MPM patients. In external validation, high tumor cell PDGFRB expression associated with shorter survival, especially in the epithelioid subtype. Our findings suggest PDGFRB and SPARC as potential markers for risk stratification and as targets for therapy.

P–157 The pregnancy potential of embryos cryopreserved and thawed twice: A case-control study

Study question

What are the pregnancy and perinatal outcomes of twice-cryopreserved embryos compared to once-cryopreserved embryos?

Summary answer

Transfers of twice-cryopreserved embryos result in similar live birth rates (LBR) and perinatal outcomes compared to transfers of once-cryopreserved embryos.

What is known already

Repeated cryopreservation of viable surplus embryos in frozen embryo transfer (FET) cycles is a potential method to increase the cumulative pregnancy rate and reduce the risks related to multiple pregnancies. Currently, evidence on the safety and success of repeated cryopreservation is limited. Existing data from a few studies indicate that the vitrification of previously slow-frozen or vitrified embryos does not negatively impact pregnancy outcome, and no long-term health consequences in neonates have been reported. However, due to the limited number of reported pregnancies and children, more studies are needed.

Study design, size, duration

This retrospective register-based case-control study included FETs (n = 2834) performed at the University Hospital of Turku and the Central Hospital of Central Finland, Finland, between January 2012 and December 2019. The case group consisted of twice-cryopreserved FETs (n = 89), and the control group consisted of once-cryopreserved FETs (n = 304). The matching criteria were embryonic age at transfer and female age category of less or over 35 years.

Participants/materials, setting, methods

All the FETs in the case group and 86% in the control group were single-embryo transfers (p = &lt;0.001). The first cryopreservation was performed by slow freezing or vitrification (cases 58% vs 42% and controls 40% vs 60%, p = 0.002, respectively). The re-cryopreservation method was vitrification. Mixed effects logistic regression was used to analyse the pregnancy outcomes, and a linear mixed model was used to analyse neonatal weight, adjusting for gestational age, neonatal sex, parity and BMI.

Main results and the role of chance

The survival rate of the twice-cryopreserved embryos was 92.2% (94/102), and 93.7% (89/95) of the planned FETs could be carried out. FET was performed with D3–4 embryos in 17 cases and 68 controls and with D5–6 embryos in 72 cases and 238 controls. The rates of live birth, clinical pregnancy and miscarriage in the case and the control groups were comparable (27.0% vs 31.9%, p = 0.35; 31.4% vs 36.8%, p = 0.35 and 4.5% vs. 3.9%, p = 0.77, respectively). No difference was seen in the preterm delivery rate (cases 4.2% vs controls 10.3%, p = 0.69). Twenty-five children were born in the case group and 100 in the control group. No differences in birth weights were detected between the groups (3730 g, upper and lower quartiles 3500 g and 4050 g, vs 3490g, upper and lower quartiles 3150 g and 3900 g, p = 0.28), and, in the case group, all the newborns’ birth weights were appropriate for gestational age. There were no congenital malformations among the newborns in the case group. In the control group, there was one pregnancy termination due to aneuploidy, one case of undescended testicles, one child with a hypoplastic aortic valve without stenosis and one child with craniosynostosis.

Limitations, reasons for caution

This study was retrospective, and the small sample size limits interpretation of the results. FET has been demonstrated to increase the risk for fetal macrosomia and gestational hypertension/pre-eclampsia. Whether repeated cryopreservation enhances these effects or influences neonatal health in the long term needs further investigation.

Wider implications of the findings: Acceptable LBR and neonatal outcomes may be expected after transfer of twice-cryopreserved embryos. Also, the survival rate is high. To avoid embryo wastage or transfer of multiple embryos, good quality surplus embryos from FET cycles may be considered for repeated cryopreservation by vitrification.

Trial registration number

Not applicable

Artificial intelligence identifies inflammation and confirms fibroblast foci as prognostic tissue biomarkers in idiopathic pulmonary fibrosis

A large number of fibroblast foci (FF) predict mortality in idiopathic pulmonary fibrosis (IPF). Other prognostic histological markers have not been identified. Artificial intelligence (AI) offers a possibility to quantitate possible prognostic histological features in IPF. We aimed to test the use of AI in IPF lung tissue samples by quantitating FF, interstitial mononuclear inflammation, and intra-alveolar macrophages with a deep convolutional neural network (CNN). Lung tissue samples of 71 patients with IPF from the FinnishIPF registry were analyzed by an AI model developed in the Aiforia® platform. The model was trained to detect tissue, air spaces, FF, interstitial mononuclear inflammation, and intra-alveolar macrophages with 20 samples. For survival analysis, cut-point values for high and low values of histological parameters were determined with maximally selected rank statistics. Survival was analyzed using the Kaplan-Meier method. A large area of FF predicted poor prognosis in IPF (p = 0.01). High numbers of interstitial mononuclear inflammatory cells and intra-alveolar macrophages were associated with prolonged survival (p = 0.01 and p = 0.01, respectively). Of lung function values, low diffusing capacity for carbon monoxide was connected to a high density of FF (p = 0.03) and a high forced vital capacity of predicted was associated with a high intra-alveolar macrophage density (p = 0.03). The deep CNN detected histological features that are difficult to quantitate manually. Interstitial mononuclear inflammation and intra-alveolar macrophages were novel prognostic histological biomarkers in IPF. Evaluating histological features with AI provides novel information on the prognostic estimation of IPF.

0026 Strong Gene-Environment Interactions of Trank1 Gene Polymorphisms with Birth Difficulties in Kleine Levin Syndrome

Introduction

Kleine-Levin Syndrome (KLS) is a rare disorder affecting adolescents and characterized by relapsing-remitting episodes of severe hypersomnia, cognitive impairment, and behavioral disturbances such as hyperphagia and sexual disinhibition. Pathophysiology is unknown, although imaging studies indicate decreased activity in hypothalamic/thalamic areas and in cortical areas during episodes. Familial occurrence is increased, and risk is associated with reports of complicated birth.

Methods

A worldwide Genome wide association (GWA) study was conducted in 673 KLS patients and ethnically matched 15,341 control individuals.

Results

We found a strong genome-wide significant association (OR=1.48 at rs150168018, p=8.6x10-9) with 24 single nucleotide polymorphisms (SNPs) encompassing a 35kb region located in the 5’ region of TRANK1 gene previously associated with bipolar disorder and schizophrenia. Strikingly, KLS cases with TRANK1 had statistically increased reports of difficult birth. As perinatal outcomes have dramatically improved over the last 40 years, we further stratified our sample by birth years, and found that recent cases had a significantly reduced TRANK1 association. These findings were confirmed in an independent replication cohort of 171 new patients where polygenic risk scores constructed on the discovery cohort replicated (r2=0.15; p&lt;2.7x10-22 at p=0.1 threshold) and the TRANK1 association was found to be dependent on reports of birth difficulties (OR=1.54, p=0.01 versus OR=1.12, p=0.4). Pathway analysis of the overall GWAS association revealed significant association (p=0.02) with 19 genes in a pathway modulating rhythmic behaviors.

Conclusion

Our results demonstrate links between hypersomnia, behavioral rhythmicity and bipolar disorder and indicate that a polymorphism in the TRANK1 region affect brain development in the presence of a perinatal injury, with pathophysiological consequences such as KLS, bipolar disorder and schizophrenia.

Support

NIH NIMH 1R01MH080957 to EM PHRC 070138 to IA

Elevated Circulating Activin A Levels in Patients With Malignant Pleural Mesothelioma Are Related to Cancer Cachexia and Reduced Response to Platinum-based Chemotherapy

BACKGROUND

Previous preclinical studies have shown that activin A is overexpressed in malignant pleural mesothelioma (MPM), associates with cancer cachexia, and is observed in in vitro resistance to platinum-based chemotherapy. We evaluated circulating activin levels and their endogenous antagonists' follistatin/follistatin-like 3 in intrathoracic tumors.

MATERIALS AND METHODS

Patients suspected of thoracic malignancy were recruited prior to surgery. Serum samples were collected from 21 patients with MPM, 59 patients with non-small-cell lung cancer (NSCLC), and 22 patients with benign lung lesions. Circulating activin/follistatin levels were measured using enzyme-linked immunosorbent assay and compared with clinicopathologic parameters.

RESULTS

Circulating activin A levels were elevated in patients with MPM when compared with patients with NSCLC or benign lung lesion samples (P < .0001). Also, follistatin and follistatin-like 3 levels were the highest in MPM, although with less difference compared with activin A. Receiver operating characteristic analysis for activin A for separating NSCLC from benign lung lesion showed an area under the curve of 0.856 (95% confidence interval, 0.77-0.94). Activin A levels were higher in patients with cachexia (P < .001). In patients with MPM, activin A levels correlated positively with computed tomography-based baseline tumor size (R = 0.549; P = .010) and the change in tumor size after chemotherapy (R = 0.743; P = .0006). Patients with partial response or stable disease had lower circulating activin A levels than the ones with progressive disease (P = .028).

CONCLUSION

Activin A serum level could be used as a biomarker in differentiating malignant and benign lung tumors. Circulating activin A levels were elevated in MPM and associates with cancer cachexia and reduced chemotherapy response.

The relation of age to the adjustment of the circadian rhythms of oral temperature and sleepiness to shift work

The relation of age to the adjustment of the circadian rhythms of oral temperature (T0) and sleepiness (S) in shift work was studied. 145 healthy female nurses underwent detailed laboratory and field measurements. Self-rated sleepiness, and oral temperature measured with a special extended-scale mercury thermometer, were recorded at 2 hr intervals during a morning (M) and 2 consecutive night (N) shifts. Sleeping times were registered during the same days. The results were analyzed separately in the age-groups of 22-29, 30-39 and 40-49-year-old subjects. From the morning shift to the second night shift day, the oral temperature and sleepiness acrophases shifted significantly (p less than 0.001) forward in all age groups. The amplitude decreased in the youngest and in the 30-39-year old age groups but not in the oldest age group. During the second night shift day, the acrophases and amplitudes of oral temperature rhythms were significantly different (P less than 0.05) between the groups, but there were no significant differences by age in the change of the circadian rhythms from morning to the second night shift days. The results thus fail to corroborate that physiological adjustment to night work would be influenced by age.