Biodiversity patterns of the benthic macrofaunal communities across the intertidal sedimentary shores of two Antarctic islands

Antarctic benthic ecosystems support a unique fauna characterized by high levels of diversity and endemism. However, our knowledge of the macrofauna communities across the Antarctic intertidal sedimentary shore is limited, and their fundamental ecological features, including spatial variability, remain poorly understood. This study aimed to investigate the abundance, community structure (i.e. taxa-specific abundance), and biodiversity patterns (α-, β-, and λ-diversity) of benthic macrofauna communities on intertidal sedimentary shores of two Antarctic islands (South Shetland archipelago, N of Antarctic Peninsula): Livingston and Deception. We conducted a quantitative sampling during two Austral summer campaigns (2004 and 2005), studying eleven intertidal sites, with five sites located on Livingston and six on Deception. Our results demonstrated a significantly higher abundance of intertidal benthic macrofauna communities on Livingston than on Deception. Furthermore, significant differences in community structure were observed between the two islands. In terms of biodiversity patterns, there were no significant differences in the number of taxa within communities (α-diversity) between the two islands. However, significant differences in the variation of community composition (determined by the number and identity of taxa) between intertidal sites (β-diversity) were observed, shedding light on the higher total taxa count (λ-diversity) on Livingston compared to Deception. We suggest that the island-specific characteristics (e.g., granulometric characteristics, ice disturbance, sedimentation rates, and geothermal activity) determine the differences observed in macrofauna communities. However, other ecological processes and factors are operating on different spatial and temporal scales (e.g., population dynamics, biotic interactions, oceanographic conditions, and climate change) that influence the occurrence and abundance of macrofaunal taxa. Our findings contribute to the fundamental understanding of the spatial variability of these communities and provide essential information for better management decisions and conservation practices in Antarctic coastal ecosystems.

Radiation-Associated Lymphopenia in Advanced Prostate Cancer Treated with Contemporary Radiation Techniques

PURPOSE/OBJECTIVE(S)

Lymphocytes play a critical role in the immune system as primary effector cells for cancer control, often depleted by external beam radiation therapy (EBRT). Radiation-associated lymphopenia (RAL) has been shown to be a poor prognostic factor in the management of multiple solid tumors. We hypothesize RAL is similarly observed in advanced prostate cancer (PC) RT with contemporary techniques.

MATERIALS/METHODS

We identified patients with advanced PC (high-risk or clinical/pathologic node-positive) receiving EBRT including lymph node/prostatic lesion boost on a prospective collection protocol for whom 1 baseline and ≥2 subsequent complete blood count (CBC) with differential samples were available, collected at RT end, 3-, 6-, and 12-months post-RT. Clinicopathological characteristics were retrieved from chart review. Common Terminology Criteria for Adverse Events (CTCAE)v5 was used to grade absolute lymphocyte count (ALC); RAL was defined as CTCAEv5 grade ≥2. As these patients received pelvic nodal irradiation, they were pooled with low/intermediate-risk PC cohort treated with high dose-rate (HDR) brachytherapy or prostate alone EBRT with similar CBC timepoints for univariable analysis to understand RT field size effect on RAL.

RESULTS

Between 2019 and 2022, among 17 patients in the low/intermediate-risk PC cohort, 6 patients had grade ≥2 lymphopenia. Among 25 patients in the advanced PC cohort, all received androgen deprivation therapy (ADT), 6 received lymph node boost, and 5 received prostatic lesion boost. At RT end, leukopenia was prominently observed (median nadir count 75.1% of baseline), with ALC as major driver (median nadir count 27.3% of baseline). Grade ≥2 lymphopenia was observed in 76% of patients (n = 19) Of 19 advanced PC patients who reached 6 months post-RT follow-up, median ALC was 53.0% of baseline, and Grade ≥2 lymphopenia remained in 37% (n = 7) of patients. Of 8 advanced PC patients who reached 12 months post-RT follow-up, median ALC was 55.6% of baseline. When evaluating whether RT dose or field size contributed to lower nadir ALC counts, combining the low/intermediate-risk and advanced PC cohorts (n = 42), univariable analysis demonstrated Gleason grade group (p = 0.009), RT field size (p = 0.020), ADT use (p = 0.020), baseline ALC (p = 0.037), and baseline hemoglobin (p = 0.009) were independent predictors of Grade ≥2 lymphopenia. Age, prostatic lesion/lymph node boost, and equivalent dose in 2 Gy/fraction (EQD2) were nonsignificant.

CONCLUSION

Grade ≥2 RAL was observed in patients with advanced PC at end of RT, irrespective of age, RT boost, or EQD2. Lymphocyte recovery from baseline can be prolonged even at 12 months post-RT. Ongoing analyses include expanding data with additional serial CBC, increasing cohort size, and integrating effect of additional systemic therapies. RAL has downstream implications for future chemotherapy/radiopharmaceuticals.

A U.S. Cancer Center's Interactive Cancer Education Program for Spanish-Speaking Latinos during COVID-19 Pandemic

PURPOSE/OBJECTIVE(S)

Cancer is a leading cause of mortality in U.S. Latino adults, a group with limited access to screening, higher rates of advanced disease, and prone to online misinformation. Our project created a Facebook Live social media video campaign on general cancer prevention, screening, risk, information, and resources, targeting Spanish-monolingual Latinos during the COVID-19 pandemic.

MATERIALS/METHODS

Our project consisted of a hybrid video campaign model released to Facebook social media platform between October and December 2021, where pre-recorded videos or livestream interviews were delivered in Spanish with auto-generated, language-concordant subtitles to increase accessibility for the hearing-impaired. The videos featured fluent and ethnically concordant cancer topic experts. The content of these videos included introductions to the local academic cancer center as a resource, general cancer risk factors, screening, early detection and lifestyle modifications. The livestream interview format consisted of structured questions followed by time allocation for community members to ask questions in real time through Facebook Live comments. At interview conclusion, the recording was promptly uploaded within minutes for future replay. Performance metrics as reported by Facebook media analytics were collected, including total views, people reached, impressions, engagements, and shares.

RESULTS

A total of 7 videos (4 pre-recorded, 3 livestream interviews) were released onto Facebook social media platform generating 2 hours, 55 minutes, and 32 seconds of playtime, 161 shares, 1000 engagements, 12,000 views, 19,000 people reached, and 34,000 impressions from October 2021 to January 2022. The video with the most views (4,400), people reached (7,100), and impressions (10,000) was the pre-recorded "The importance of a healthy diet in the prevention of cancer." The video with the least views (355), people reached (747), and impressions (904) was the livestream interview, "Cancer and nutrition." The pre-recorded videos accumulated more views (9,607) than the livestream interviews (2,707). The highest performing livestream interview by views, people reached, impressions, shares, and engagements were, "Cancer in the Latino community."

CONCLUSION

Our project bidirectionally engaged Spanish-monolingual Latino community members and culturally/linguistically concordant cancer experts during the COVID-19 pandemic. Strengths included developing community partnerships and collaborations, providing evidence-based cancer information in a culturally responsive manner to a marginalized group, and presenting an academic cancer center as an accessible resource to its community. Programmatic efforts to improve our project include formalizing evaluation strategies to capture medical engagement via cancer screening and detection rates, delivering focused cancer discussions by disease sites, and further expanding audience base through mixed media formats.

Humoral and cellular response induced by a second booster of an inactivated SARS-CoV-2 vaccine in adults

BACKGROUND

The Omicron variant has challenged the control of the COVID-19 pandemic due to its immuno-evasive properties. The administration of a booster dose of a SARS-CoV-2 vaccine showed positive effects in the immunogenicity against SARS-CoV-2, effect that is even enhanced after the administration of a second booster.

METHODS

During a phase-3 clinical trial, we evaluated the effect of a second booster of CoronaVac®, an inactivated vaccine administered 6 months after the first booster, in the neutralization of SARS-CoV-2 (n = 87). In parallel, cellular immunity (n = 45) was analyzed in stimulated peripheral mononuclear cells by flow cytometry and ELISPOT.

FINDINGS

Although a 2.5-fold increase in neutralization of the ancestral SARS-CoV-2 was observed after the second booster when compared with prior its administration (Geometric mean units p < 0.0001; Geometric mean titer p = 0.0002), a poor neutralization against the Omicron variant was detected. Additionally, the activation of specific CD4⁺ T lymphocytes remained stable after the second booster and, importantly, equivalent activation of CD4⁺ T lymphocytes against the Omicron variant and the ancestral SARS-CoV-2 were found.

INTERPRETATION

Although the neutralizing response against the Omicron variant after the second booster of CoronaVac® was slightly increased, these levels are far from those observed against the ancestral SARS-CoV-2 and could most likely fail to neutralize the virus. In contrast, a robust CD4⁺T cell response may confer protection against the Omicron variant.

FUNDING

The Ministry of Health, Government of Chile, the Confederation of Production and Commerce, Chile and SINOVAC Biotech.NIHNIAID. The Millennium Institute on Immunology and Immunotherapy.

Differences in the immune response elicited by two immunization schedules with an inactivated SARS-CoV-2 vaccine in a randomized phase 3 clinical trial

Background:

The development of vaccines to control the coronavirus disease 2019 (COVID-19) pandemic progression is a worldwide priority. CoronaVac is an inactivated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine approved for emergency use with robust efficacy and immunogenicity data reported in trials in China, Brazil, Indonesia, Turkey, and Chile.

Methods:

This study is a randomized, multicenter, and controlled phase 3 trial in healthy Chilean adults aged ≥18 years. Volunteers received two doses of CoronaVac separated by 2 (0–14 schedule) or 4 weeks (0–28 schedule); 2302 volunteers were enrolled, 440 were part of the immunogenicity arm, and blood samples were obtained at different times. Samples from a single center are reported. Humoral immune responses were evaluated by measuring the neutralizing capacities of circulating antibodies. Cellular immune responses were assessed by ELISPOT and flow cytometry. Correlation matrixes were performed to evaluate correlations in the data measured.

Results:

Both schedules exhibited robust neutralizing capacities with the response induced by the 0–28 schedule being better. No differences were found in the concentration of antibodies against the virus and different variants of concern (VOCs) between schedules. Stimulation of peripheral blood mononuclear cells (PBMCs) with Mega pools of Peptides (MPs) induced the secretion of interferon (IFN)-γ and the expression of activation induced markers in CD4⁺ T cells for both schedules. Correlation matrixes showed strong correlations between neutralizing antibodies and IFN-γ secretion.

Conclusions:

Immunization with CoronaVac in Chilean adults promotes robust cellular and humoral immune responses. The 0–28 schedule induced a stronger humoral immune response than the 0–14 schedule.

Funding:

Ministry of Health, Government of Chile, Confederation of Production and Commerce & Millennium Institute on Immunology and Immunotherapy, Chile.

Clinical trial number:

NCT04651790

POS0805 GLUCOCORTICOID-RELATED ADVERSE EVENTS IN GIANT CELL ARTERITIS: APPLICATION OF THE GLUCOCORTICOID TOXICITY INDEX IN A MONOCENTRIC COHORT OF 140 PATIENTS

Background

Oral glucocorticoids (GC) are the mainstay of treatment for giant cell arteritis (GCA) but chronic exposure to GC is associated with serious comorbidities.

Objectives

The objective of this study was to determine the GC exposure and risk of GC-related adverse events (AEs) in GCA, validating the Glucocorticoid Toxicity Index (GTI) (1,2) in a cohort of real-world patients.

Methods

140 consecutive patients with GCA were enrolled in this retrospective monocentric study. All patients were older than 50 years of age, met the 1990 ACR criteria for GCA and/or had the evidence of a large vessel vasculitis at FDG-PET/CT scan. Patients’ clinical data were collected from clinical charts, calculating GC cumulative dose and GTI at baseline and in the following 5 years.

Results

140 patients were enrolled in the study: median (IQR) age at diagnosis 74 (67-79), Female: 97 (69%), Male: 43 (31%). According to vascular involvement patients were classified in cranial-GCA (C-GCA, n:91), large vessel-GCA (LV-GCA, n:21) and cranial and large vessel-GCA (LV-C-GCA, n:28). Furthermore, 50 (36%) patients were treated with only GC, 44 (31%) with GC+methotrexate (MTX), 46 (33%) with GC+tocilizumab (in 20 cases TCZ was started in the first 3 months after diagnosis: early-TCZ, in 26 cases after 3 months for relapses or AEs: late-TCZ).

During the follow up, 57 (41%) patients presented at least one relapse. In the GC group 22 relapses in 18 patients were reported, in MTX group 33 relapses in 25 patients (with 15 relapses before and 18 after MTX start), in early-TCZ group no relapses were reported, in late-TCZ group 21 relapses in 14 patients (with 17 relapses before and 4 after TCZ start) were reported.

Median cumulative GC doses after 1 and 5 years were respectively 7.9 (6.3-9.8) gr and 16.5 (13.8-18.9) gr in GC group, 8.7 (5.9-10.0) gr and 16.5 (13.2-20.7) gr in MTX group, 7.1 (5.5-8.0) gr and 13.3 (12.8-13.7) gr in early-TCZ and 7.7 (6.2-11.1) gr and 19.7 (12.2-23.8) gr in late-TCZ.

Eighty-eight percent of patients developed at least one GC-AE, with infections and hypertension being the most common reported AEs (42% e 44%, respectively). Median GTI-CWS (Cumulative Worsening Score) after 1 year was 65 (20-137) in GC, 63 (10-95) in MTX, 51 (33-116) in TCZ-early, 44 (0-91) in TCZ-late. Median GTI-CWS after 5 years was 219 (118-240) in GC, 137 (65-206) in MTX, 147 (146-147) in TCZ-early, 200 (121-231) in TCZ-late. A correlation between GTI-CWS and the GC cumulative dose was found (after 5 years r: 0.295, p: 0.026).

Conclusion

Chronic GC treatment is associated with a high risk of developing comorbidities. GTI score demonstrated to be an effective tool to assess GC-related AEs and proved to correlate with GC cumulative dose.

TCZ confirmed its efficacy in reducing relapse rate, both in early and late-TCZ groups (3). TCZ showed for the first time in a real-life cohort a GC sparing effect, with a 19% reduction in GC cumulative dose and a 33% reduction in GTI-CWS in 5 years (comparing GC group vs early-TCZ group).

References

[1]Glucocorticoid Toxicity Index (Copyright © 2016, 2018. Massachusetts General Hospital. All rights reserved.)

[2]Miloslavsky EM et al. Ann Rheum Dis. 2017 doi: 10.1136/annrheumdis-2016-210002.

[3]Stone JH et al. N Engl J Med. 2017 doi: 10.1056/NEJMoa1613849.

Disclosure of Interests

None declared

How we approach the treatment of patients with high-risk neuroblastoma with naxitamab: experience from the Hospital Sant Joan de Déu in Barcelona, Spain

Naxitamab [humanized 3f8 (hu3F8)] is a humanized monoclonal antibody (mAb) targeting the disialoganglioside GD2. It was approved in 2020 by the United States Food and Drug Administration (FDA) in combination with granulocyte–macrophage colony-stimulating factor (GM-CSF) for treatment of pediatric and adult patients with relapsed/refractory high-risk neuroblastoma, limited to the bone or bone marrow (BM). The team at Sant Joan de Déu Children’s Hospital in Barcelona, Spain, have been using naxitamab to treat neuroblastoma under clinical trial protocols [e.g. Trial 201, and hu3F8, irinotecan, temozolomide, and sargramostim (GM-CSF) (HITS) study] and compassionate use since 2017. The team has experience with two primary regimens: naxitamab with GM-CSF only, or naxitamab in combination with irinotecan, temozolomide, and GM-CSF (chemoimmunotherapy). This article aims to provide a practical overview of the team’s experience with naxitamab to date, including preparing the treatment room and selecting the team. Adverse event management, including the use of ketamine to manage pain during anti-GD2 mAb infusions, is also discussed. We hope this will provide practical information for other health care providers considering offering this treatment.

•

Immunotherapy with anti-GD2 antibodies has revolutionized the treatment of patients with high-risk neuroblastoma.

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In 2020, FDA approved naxitamab + GM-CSF for treatment of patients with R/R neuroblastoma in the bone and/or BM.

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Outpatient treatment with naxitamab-based immunotherapy may improve health-related quality of life.

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Naxitamab infusions require specific training and teamwork to prevent and efficiently manage most frequent adverse events.

Predictive factors of six-week mortality in critically ill patients with SARS-CoV-2: A multicenter prospective study

Objective

The objective of the study is to identify the risk factors associated with mortality at six weeks, especially by analyzing the role of antivirals and munomodulators.

Design

Prospective descriptive multicenter cohort study.

Setting

26 Intensive care units (ICU) from Andalusian region in Spain.

Patients or participants

Consecutive critically ill patients with confirmed SARS-CoV-2 infection were included from March 8 to May 30.

Interventions

None.

Variables

Variables analyzed were demographic, severity scores and clinical condition. Support therapy, drug and mortality were analyzed. An univariate followed by multivariate Cox regression with propensity score analysis was applied.

Results

495 patients were enrolled, but 73 of them were excluded for incomplete data. Thus, 422 patients were included in the final analysis. Median age was 63 years and 305 (72.3%) were men. ICU mortality: 144/422 34%; 14 days mortality: 81/422 (19.2%); 28 days mortality: 121/422 (28.7%); 6-week mortality 152/422 36.5%. By multivariable Cox proportional analysis, factors independently associated with 42-day mortality were age, APACHE II score, SOFA score at ICU admission >6, Lactate dehydrogenase at ICU admission >470 U/L, Use of vasopressors, extrarenal depuration, %lymphocytes 72 h post-ICU admission <6.5%, and thrombocytopenia whereas the use of lopinavir/ritonavir was a protective factor.

Conclusion

Age, APACHE II, SOFA > value of 6 points, along with vasopressor requirements or renal replacement therapy have been identified as predictor factors of mortality at six weeks.

Administration of corticosteroids showed no benefits in mortality, as did treatment with tocilizumab.

Lopinavir/ritonavir administration is identified as a protective factor.

A booster dose of an inactivated SARS-CoV-2 vaccine increases neutralizing antibodies and T cells that recognize Delta and Omicron variants of concern

Background

CoronaVac ^® is an inactivated SARS-CoV-2 vaccine approved by the World Health Organization. Previous studies reported increased levels of neutralizing antibodies and specific T cells two- and four-weeks after two doses of CoronaVac ^® , but the levels of neutralizing antibodies are reduced at six to eight months after two doses. Here we report the effect of a booster dose of CoronaVac ^® on the anti-SARS-CoV-2 immune response generated against variants of concern (VOC) Delta and Omicron in adults participating in a phase 3 clinical trial in Chile.

Methods

Volunteers immunized with two doses of CoronaVac ^® in a four-week interval received a booster dose of the same vaccine between twenty-four and thirty weeks after the 2nd dose. Four weeks after the booster dose, neutralizing antibodies and T cell responses were measured. Neutralization capacities and T cell activation against VOC Delta and Omicron were detected at four weeks after the booster dose.

Findings

We observed a significant increase in neutralizing antibodies at four weeks after the booster dose. We also observed an increase in CD4 ⁺ T cells numbers over time, reaching a peak at four weeks after the booster dose. Furthermore, neutralizing antibodies and SARS-CoV-2 specific T cells induced by the booster showed activity against VOC Delta and Omicron.

Interpretation

Our results show that a booster dose of CoronaVac ^® increases the anti-SARS-CoV-2 humoral and cellular immune responses in adults. Immunity induced by a booster dose of CoronaVac ^® is active against VOC, suggesting an effective protection.

Recognition of Variants of Concern by Antibodies and T Cells Induced by a SARS-CoV-2 Inactivated Vaccine

Background

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the virus responsible of the current pandemic ongoing all around the world. Since its discovery in 2019, several circulating variants have emerged and some of them are associated with increased infections and death rate. Despite the genetic differences among these variants, vaccines approved for human use have shown a good immunogenic and protective response against them. In Chile, over 70% of the vaccinated population is immunized with CoronaVac, an inactivated SARS-CoV-2 vaccine. The immune response elicited by this vaccine has been described against the first SARS-CoV-2 strain isolated from Wuhan, China and the D614G strain (lineage B). To date, four SARS-CoV-2 variants of concern described have circulated worldwide. Here, we describe the neutralizing capacities of antibodies secreted by volunteers in the Chilean population immunized with CoronaVac against variants of concern Alpha (B.1.1.7), Beta (B.1.351) Gamma (P.1) and Delta (B.617.2).

Methods

Volunteers enrolled in a phase 3 clinical trial were vaccinated with two doses of CoronaVac in 0-14 or 0-28 immunization schedules. Sera samples were used to evaluate the capacity of antibodies induced by the vaccine to block the binding between Receptor Binding Domain (RBD) from variants of concern and the human ACE2 receptor by an in-house ELISA. Further, conventional microneutralization assays were used to test neutralization of SARS-CoV-2 infection. Moreover, interferon-γ-secreting T cells against Spike from variants of concern were evaluated in PBMCs from vaccinated subjects using ELISPOT.

Results

CoronaVac promotes the secretion of antibodies able to block the RBD of all the SARS-CoV-2 variants studied. Seropositivity rates of neutralizing antibodies in the population evaluated were over 97% for the lineage B strain, over 80% for Alpha and Gamma variants, over 75% for Delta variant and over 60% for the Beta variant. Geometric means titers of blocking antibodies were reduced when tested against SARS-CoV-2 variants as compared to ancestral strain. We also observed that antibodies from vaccinated subjects were able to neutralize the infection of variants D614G, Alpha, Gamma and Delta in a conventional microneutralization assay. Importantly, after SARS-CoV-2 infection, we observed that the blocking capacity of antibodies from vaccinated volunteers increased up to ten times for all the variants tested. We compared the number of interferon-γ-secreting T cells specific for SARS-CoV-2 Spike WT and variants of concern from vaccinated subjects and we did not detect significant differences.

Conclusion

Immunization with CoronaVac in either immunization schedule promotes the secretion of antibodies able to block SARS-CoV-2 variants of concern and partially neutralizes SARS-CoV-2 infection. In addition, it stimulates cellular responses against all variants of concern.

Gallbladder disease and pancreatic cancer risk: a multicentric case-control European study

BACKGROUND AND AIMS

The overall evidence on the association between gallbladder conditions (GBC: gallstones and cholecystectomy) and pancreatic cancer (PC) is inconsistent. To our knowledge, no previous investigations considered the role of tumour characteristics on this association. Thus, we aimed to assess the association between self-reported GBC and PC risk, by focussing on timing to PC diagnosis and tumour features (stage, location, and resection).

METHODS

Data derived from a European case-control study conducted between 2009 and 2014 including 1431 PC cases and 1090 controls. We used unconditional logistic regression models to estimate odds ratios (ORs) and corresponding 95% confidence intervals (CIs) adjusted for recognized confounders.

RESULTS

Overall, 298 (20.8%) cases and 127 (11.6%) controls reported to have had GBC, corresponding to an OR of 1.70 (95% CI 1.33-2.16). The ORs were 4.84 (95% CI 2.96-7.89) for GBC diagnosed <3 years before PC and 1.06 (95% CI 0.79-1.41) for ≥3 years. The risk was slightly higher for stage I/II (OR = 1.71, 95% CI 1.15-2.55) vs. stage III/IV tumours (OR = 1.23, 95% CI 0.87-1.76); for tumours sited in the head of the pancreas (OR = 1.59, 95% CI 1.13-2.24) vs. tumours located at the body/tail (OR = 1.02, 95% CI 0.62-1.68); and for tumours surgically resected (OR = 1.69, 95% CI 1.14-2.51) vs. non-resected tumours (OR = 1.25, 95% CI 0.88-1.78). The corresponding ORs for GBC diagnosed ≥3 years prior PC were close to unity.

CONCLUSION

Our study supports the association between GBC and PC. Given the time-risk pattern observed, however, this relationship may be non-causal and, partly or largely, due to diagnostic attention and/or reverse causation.

Immune Profile and Clinical Outcome of Breakthrough Cases After Vaccination With an Inactivated SARS-CoV-2 Vaccine

Constant efforts to prevent infections by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are actively carried out around the world. Several vaccines are currently approved for emergency use in the population, while ongoing studies continue to provide information on their safety and effectiveness. CoronaVac is an inactivated SARS-CoV-2 vaccine with a good safety and immunogenicity profile as seen in phase 1, 2, and 3 clinical trials around the world, with an effectiveness of 65.9% for symptomatic cases. Although vaccination reduces the risk of disease, infections can still occur during or after completion of the vaccination schedule (breakthrough cases). This report describes the clinical and immunological profile of vaccine breakthrough cases reported in a clinical trial in progress in Chile that is evaluating the safety, immunogenicity, and efficacy of two vaccination schedules of CoronaVac (clinicaltrials.gov NCT04651790). Out of the 2,263 fully vaccinated subjects, at end of June 2021, 45 have reported symptomatic SARS-CoV-2 infection 14 or more days after the second dose (1.99% of fully vaccinated subjects). Of the 45 breakthrough cases, 96% developed mild disease; one case developed a moderate disease; and one developed a severe disease and required mechanical ventilation. Both cases that developed moderate and severe disease were adults over 60 years old and presented comorbidities. The immune response before and after SARS-CoV-2 infection was analyzed in nine vaccine breakthrough cases, revealing that six of them exhibited circulating anti-S1-RBD IgG antibodies with neutralizing capacities after immunization, which showed a significant increase 2 and 4 weeks after symptoms onset. Two cases exhibited low circulating anti-S1-RBD IgG and almost non-existing neutralizing capacity after either vaccination or infection, although they developed a mild disease. An increase in the number of interferon-γ-secreting T cells specific for SARS-CoV-2 was detected 2 weeks after the second dose in seven cases and after symptoms onset. In conclusion, breakthrough cases were mostly mild and did not necessarily correlate with a lack of vaccine-induced immunity, suggesting that other factors, to be defined in future studies, could lead to symptomatic infection after vaccination with CoronaVac.

Safety and Immunogenicity of an Inactivated Severe Acute Respiratory Syndrome Coronavirus 2 Vaccine in a Subgroup of Healthy Adults in Chile

BACKGROUND

The development of effective vaccines against coronavirus disease 2019 is a global priority. CoronaVac is an inactivated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine with promising safety and immunogenicity profiles. This article reports safety and immunogenicity results obtained for healthy Chilean adults aged ≥18 years in a phase 3 clinical trial.

METHODS

Volunteers randomly received 2 doses of CoronaVac or placebo, separated by 2 weeks. A total of 434 volunteers were enrolled, 397 aged 18-59 years and 37 aged ≥60 years. Solicited and unsolicited adverse reactions were registered from all volunteers. Blood samples were obtained from a subset of volunteers and analyzed for humoral and cellular measures of immunogenicity.

RESULTS

The primary adverse reaction in the 434 volunteers was pain at the injection site, with a higher incidence in the vaccine than in the placebo arm. Adverse reactions observed were mostly mild and local. No severe adverse events were reported. The humoral evaluation was performed on 81 volunteers. Seroconversion rates for specific anti-S1-receptor binding domain (RBD) immunoglobulin G (IgG) were 82.22% and 84.44% in the 18-59 year age group and 62.69% and 70.37% in the ≥60 year age group, 2 and 4 weeks after the second dose, respectively. A significant increase in circulating neutralizing antibodies was detected 2 and 4 weeks after the second dose. The cellular evaluation was performed on 47 volunteers. We detected a significant induction of T-cell responses characterized by the secretion of interferon-γ (IFN-γ) upon stimulation with Mega Pools of peptides from SARS-CoV-2.

CONCLUSIONS

Immunization with CoronaVac in a 0-14 schedule in Chilean adults aged ≥18 years is safe, induces anti-S1-RBD IgG with neutralizing capacity, activates T cells, and promotes the secretion of IFN-γ upon stimulation with SARS-CoV-2 antigens.

Neutralization of alpha, gamma, and D614G SARS-CoV-2 variants by CoronaVac vaccine-induced antibodies

Vaccination generates a neutralizing immune response against SARS‐CoV‐2. The genomic surveillance is showing the emergence of variants with mutations in spike, the main target of neutralizing antibodies. To understand the impact of these variants, we report the neutralization potency against alpha, gamma, and D614G SARS‐CoV‐2 variants in 44 individuals that received two doses of CoronaVac vaccine, an inactivated SARS‐CoV‐2 vaccine. Plasma samples collected at 60 days after the second dose of CoronaVac were analyzed by the reduction of cytopathic effect in Vero E6 cells with the three infectious variants of SARS‐CoV‐2. Plasma showed lower neutralization with alpha (geometric mean titer [GMT] = 18.5) and gamma (GMT = 10.0) variants than with D614G (GMT = 75.1) variant. Efficient neutralization against the alpha and gamma variants was not detected in 31.8% and 59.1% of plasma, respectively. These findings suggest the alpha and gamma variants could escape from neutralization by antibodies elicited by vaccination. Robust genomic and biological surveillance of viral variants could help to develop effective strategies for the control of SARS‐CoV‐2.

The paediatric cancer clinical research landscape in Spain: a 13-year multicentre experience of the new agents group of the Spanish Society of Paediatric Haematology and Oncology (SEHOP)

PURPOSE

Early phase trials are crucial in developing innovative effective agents for childhood malignancies. We report the activity in early phase paediatric oncology trials in Spain from its beginning to the present time and incorporate longitudinal data to evaluate the trends in trial characteristics and recruitment rates.

METHODS

Members of SEHOP were contacted to obtain information about the open trials at their institutions. The study period was split into two equal periods for analysis: 2007-2013 and 2014-2020.

RESULTS

Eighty-one trials and two molecular platforms have been initiated. The number of trials has increased over the time of the study for all tumour types, with a predominance of trials available for solid tumours (66%). The number of trials addressed to tumours harbouring specific molecular alterations has doubled during the second period. The proportion of industry-sponsored compared to academic trials has increased over the same years. A total of 565 children and adolescents were included, with an increasing trend over the study period. For international trials, the median time between the first country study approval and the Spanish competent authority approval was 2 months (IQR 0-6.5). Fourteen out of 81 trials were sponsored by Spanish academic institutions.

CONCLUSIONS

The number of available trials, and the number of participating patients, has increased in Spain from 2007. Studies focused on molecular-specific targets are now being implemented. Barriers to accessing new drugs for all ranges of age and cancer diseases remain. Additionally, opportunities to improve academic research are still required in Spain.

Interim report: Safety and immunogenicity of an inactivated vaccine against SARS-CoV-2 in healthy chilean adults in a phase 3 clinical trial

BACKGROUND

The ongoing COVID-19 pandemic has had a significant impact worldwide, with an incommensurable social and economic burden. The rapid development of safe and protective vaccines against this disease is a global priority. CoronaVac is a vaccine prototype based on inactivated SARS-CoV-2, which has shown promising safety and immunogenicity profiles in pre-clinical studies and phase 1/2 trials in China. To this day, four phase 3 clinical trials are ongoing with CoronaVac in Brazil, Indonesia, Turkey, and Chile. This article reports the safety and immunogenicity results obtained in a subgroup of participants aged 18 years and older enrolled in the phase 3 Clinical Trial held in Chile.

METHODS

This is a multicenter phase 3 clinical trial. Healthcare workers aged 18 years and older were randomly assigned to receive two doses of CoronaVac or placebo separated by two weeks (0-14). We report preliminary safety results obtained for a subset of 434 participants, and antibody and cell-mediated immunity results obtained in a subset of participants assigned to the immunogenicity arm. The primary and secondary aims of the study include the evaluation of safety parameters and immunogenicity against SARS-CoV-2 after immunization, respectively. This trial is registered at clinicaltrials.gov ( NCT04651790 ).

FINDINGS

The recruitment of participants occurred between November 27 ^th , 2020, until January 9 ^th , 2021. 434 participants were enrolled, 397 were 18-59 years old, and 37 were ≥60 years old. Of these, 270 were immunized with CoronaVac, and the remaining 164 participants were inoculated with the corresponding placebo. The primary adverse reaction was pain at the injection site, with a higher incidence in the vaccine arm (55.6%) than in the placebo arm (40.0%). Moreover, the incidence of pain at the injection site in the 18-59 years old group was 58.4% as compared to 32.0% in the ≥60 years old group. The seroconversion rate for specific anti-S1-RBD IgG was 47.8% for the 18-59 years old group 14 days post immunization (p.i.) and 95.6% 28 and 42 days p.i. For the ≥60 years old group, the seroconversion rate was 18.1%, 100%, and 87.5% at 14, 28, and 42 days p.i., respectively. Importantly, we observed a 95.7% seroconversion rate in neutralizing antibodies for the 18-59 years old group 28 and 42 days p.i. The ≥60 years old group exhibited seroconversion rates of 90.0% and 100% at 28 and 42 days p.i. Interestingly, we did not observe a significant seroconversion rate of anti-N-SARS-CoV-2 IgG for the 18-59 years old group. For the participants ≥60 years old, a modest rate of seroconversion at 42 days p.i. was observed (37.5%). We observed a significant induction of a T cell response characterized by the secretion of IFN-γ upon stimulation with Mega Pools of peptides derived from SARS-CoV-2 proteins. No significant differences between the two age groups were observed for cell-mediated immunity.

INTERPRETATION

Immunization with CoronaVac in a 0-14 schedule in adults of 18 years and older in the Chilean population is safe and induces specific IgG production against the S1-RBD with neutralizing capacity, as well as the activation of T cells secreting IFN-γ, upon recognition of SARS-CoV-2 antigens.

FUNDING

Ministry of Health of the Chilean Government; Confederation of Production and Commerce, Chile; Consortium of Universities for Vaccines and Therapies against COVID-19, Chile; Millennium Institute on Immunology and Immunotherapy.

Predictive factors of six-week mortality in critically ill patients with SARS-CoV-2: A multicenter prospective study

OBJECTIVE

The objective of the study is to identify the risk factors associated with mortality at six weeks, especially by analyzing the role of antivirals and munomodulators.

DESIGN

Prospective descriptive multicenter cohort study.

SETTING

26 Intensive care units (ICU) from Andalusian region in Spain.

PATIENTS OR PARTICIPANTS

Consecutive critically ill patients with confirmed SARS-CoV-2 infection were included from March 8 to May 30.

INTERVENTIONS

None.

VARIABLES

Variables analyzed were demographic, severity scores and clinical condition. Support therapy, drug and mortality were analyzed. An univariate followed by multivariate Cox regression with propensity score analysis was applied.

RESULTS

495 patients were enrolled, but 73 of them were excluded for incomplete data. Thus, 422 patients were included in the final analysis. Median age was 63 years and 305 (72.3%) were men. ICU mortality: 144/422 34%; 14 days mortality: 81/422 (19.2%); 28 days mortality: 121/422 (28.7%); 6-week mortality 152/422 36.5%. By multivariable Cox proportional analysis, factors independently associated with 42-day mortality were age, APACHE II score, SOFA score at ICU admission >6, Lactate dehydrogenase at ICU admission >470U/L, Use of vasopressors, extrarenal depuration, %lymphocytes 72h post-ICU admission <6.5%, and thrombocytopenia whereas the use of lopinavir/ritonavir was a protective factor.

CONCLUSION

Age, APACHE II, SOFA>value of 6 points, along with vasopressor requirements or renal replacement therapy have been identified as predictor factors of mortality at six weeks. Administration of corticosteroids showed no benefits in mortality, as did treatment with tocilizumab. Lopinavir/ritonavir administration is identified as a protective factor.

AAPS Perspective on the EURL Recommendation on the use of Non-Animal-Derived Antibodies

In May 2020, the EU Reference Laboratory for alternatives to animal testing (EURL ECVAM) published a recommendation report entitled "Recommendation on nonanimal-derived antibodies". In this report, the EURL ECVAM specifically states: "Therefore, taking into consideration the ESAC Opinion on the scientific validity of replacements for animal-derived antibodies, EURL ECVAM recommends that animals should no longer be used for the development and production of antibodies for research, regulatory, diagnostic and therapeutic applications. The provisions of Directive 2010/63/EU should be respected, and EU countries should no longer authorise the development and production of antibodies through animal immunisation, where robust, legitimate scientific justification is lacking." (1). Here, we are providing the American Association of Pharmaceutical Scientists (AAPS) opinion on the EURL ECVAM recommendation report. In brief, there has been a clear and strong progress in reduction of animal use in the drug discovery and development process, including significant reduction of animal use in production of antibody reagents. Yet, it is proposed that more data need to be generated, shared and discussed within the scientific community before a decision to implement the change to non-animal derived antibodies is made.

How relevant is the ISCHEMIA trial to a rapid access chest pain clinic cohort of patients?

Background

The ISCHEMIA trial demonstrated that optimal medical therapy (OMT) is not inferior to an early interventional approach for stable angina. This could significantly impact on clinical practice. This study aimed to check the relevance of the ISCHEMIA trial in a real-world population of patients referred to a tertiary centre with recent onset chest pain (CP).

Methods

In this registry study, electronic notes of all patients assessed in a Rapid Access Chest Pain Clinic (RACPC) within a 12-month period (2018–19) were reviewed. Patients were selected if they met key ISCHEMIA trial inclusion criteria.

Results

2416 patients were assessed, 378 (15.6%) presented with typical anginal CP, 1357 (56.2%) had atypical CP and 681 (28.2%) had non anginal CP.

Of the typical CP group, 158 patients were excluded (91 known CAD, 62 ACS, 2 eGFR &lt;30mL/min, 3 severe LVSD). This resulted in 220 patients, representing 58.2% of the typical chest pain population and 9.1% of all patients seen in RACPC. These patients had a median age of 60 years, 96 (44%) female, 119 (54.1%) had high cholesterol, 44 (20%) had diabetes, 115 (52.3%) had hypertension, 104 (47.3%) had a family history of ischaemic heart disease, and 32 (14.5%) were current smokers.

Of these 220 patients, 48 (21.8%) had a CT coronary angiogram (CTCA) requested as their first line investigation (42 completed) with 1 (2.4%) patients result suggestive of significant left main stem (LMS) disease. 15 (6.8%) patients had stress echocardiography requested as their first line investigation (13 completed), 4 (31%) were positive for inducible ischaemia. 3 (1.4%) patients had stress CMR requested as their first line investigation (2 completed), both were negative. 143 (65%) patients had an invasive coronary angiogram (ICA) requested as their first line investigation (112 completed). 8 patients had severe LMS disease and were referred for surgical opinion. A further 11 patients were referred for surgical opinion due to multivessel disease or aberrant coronary anatomy. In total 24 (21.4%) patients were treated with PCI following ICA as their first line investigation.

All patients were started on medical therapy for presumed CAD with up-titration while awaiting investigations. The median wait time for a CTCA was 55 days compared to 165.5 days for ICA.

Two patients (0.9%) from the cohort of 220 patients died during the follow up period, compared to 2.5% of patients admitted from RACPC with an ACS diagnosis.

Conclusion

Patients present with undifferentiated chest pain, consequently the outcomes of the ISCHEMIA trial must be considered cautiously. Within our cohort of 2416 patients, only 9% of patients met key inclusion criteria of the trial. Ultimately, only 19.5% patients with typical chest pain were revascularised, unlike 80% of patients in the invasive arm of ISCHEMIA. It is unclear how the results of the ISCHEMIA trial will impact on UK practice, but it is clear that OMT plays a central role.

Funding Acknowledgement

Type of funding source: None

In vivo CRISPR/Cas9 targeting of fusion oncogenes for selective elimination of cancer cells

Fusion oncogenes (FOs) are common in many cancer types and are powerful drivers of tumor development. Because their expression is exclusive to cancer cells and their elimination induces cell apoptosis in FO-driven cancers, FOs are attractive therapeutic targets. However, specifically targeting the resulting chimeric products is challenging. Based on CRISPR/Cas9 technology, here we devise a simple, efficient and non-patient-specific gene-editing strategy through targeting of two introns of the genes involved in the rearrangement, allowing for robust disruption of the FO specifically in cancer cells. As a proof-of-concept of its potential, we demonstrate the efficacy of intron-based targeting of transcription factors or tyrosine kinase FOs in reducing tumor burden/mortality in in vivo models. The FO targeting approach presented here might open new horizons for the selective elimination of cancer cells.

In vivo CRISPR/Cas9 targeting of fusion oncogenes for selective elimination of cancer cells

Fusion oncogenes (FOs) are common in many cancer types and are powerful drivers of tumor development. Because their expression is exclusive to cancer cells and their elimination induces cell apoptosis in FO-driven cancers, FOs are attractive therapeutic targets. However, specifically targeting the resulting chimeric products is challenging. Based on CRISPR/Cas9 technology, here we devise a simple, efficient and non-patient-specific gene-editing strategy through targeting of two introns of the genes involved in the rearrangement, allowing for robust disruption of the FO specifically in cancer cells. As a proof-of-concept of its potential, we demonstrate the efficacy of intron-based targeting of transcription factors or tyrosine kinase FOs in reducing tumor burden/mortality in in vivo models. The FO targeting approach presented here might open new horizons for the selective elimination of cancer cells.

Optimizing the storage of chemotherapeutics for ophthalmic oncology: stability of topotecan solution for intravitreal injection

BACKGROUND

. Intravitreal administration of topotecan shows activity against tumor vitreous seeding in the conservative treatment of retinoblastoma, a malignant tumor originated in the retina of small children. Adequate storage of the intravitreal topotecan solution would allow immediate availability for patients at health care institutions. The goal of the work was to address the stability of the intravitreal topotecan formulation upon reconstitution.

MATERIALS AND METHODS

. Intravitreal topotecan solutions were reconstituted (at a concentration of 0.2 mg topotecan in 1 mL saline solution vehicle, aliquoted in 1 mL plastic syringes) and stored either frozen or at room temperature for different times. Topotecan content was analyzed at time zero and at different conditions using a high performance liquid chromatography method to quantify topotecan lactone (active) and to detect its pH-dependent hydrolysis product, the open carboxylate.

RESULTS

. We found that intravitreal topotecan syringes remained stable at room temperature at least for 24 h, at least for 167 days upon stored frozen at -20°C, and up to 8 h after thawing at day 6. The degradation carboxylate product did not appear in the analyzed thawed samples during the whole study.

CONCLUSIONS

. This study confirms the stability of frozen intravitreal topotecan syringes and will help optimize the use of this chemotherapy modality at institutions with low resources. Storage of aliquots will also help reduce personnel exposure to chemotherapy at hospital pharmacies.

2502. Host Susceptibility to Andes Hantavirus Infection Associates to a Single Nucleotide Polymorphism at the αVβ3 Integrin

Background

Methods

Results

Conclusion

Disclosures

One-day protocol versus two-day protocol in acquisition of scintigraphy with "in vitro" labelled white blood cells for diagnosis of osteoarticular infection

INTRODUCTION

It is difficult to determine osteoarticular infection and differentiate inflammation from infection with laboratory and imaging procedures (CT, MRI, US). Labelled white-blood-cell scintigraphy (WBCS) is the nuclear medicine test of choice but it takes two days, sometimes finds it difficult to differentiate soft tissue from bone infection and therefore causes interobserver variability, which decreases its specificity.

OBJECTIVE

To demonstrate the usefulness of the one-day protocol with time decay-corrected acquisition in WBCS to diagnose osteoarticular infection and to reduce interobserver variability. The role of SPECT/CT in WBCS in locating the infected focus was also evaluated.

METHODS

110 patients with suspected osteoarticular infection were studied prospectively. Planar images were obtained with time decay-corrected acquisition at 30min, 4h, 8h and 24h. WBCS planar images were grouped in two protocols: One-day protocol: experts evaluated 30min, 4h and 8h images. Two-day protocol: experts evaluated 30min, 4h and 24h images. Both protocols were classified as: SPECT/CT was performed in 72 patients. Kappa index was calculated to evaluate interobserver variability.

RESULTS

Infection was confirmed in 34 cases. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were 97.1%, 97.4%, 94.3%, 98.7%, and 97.3% for the one-day protocol and 94.1%, 97.4%, 94.1%, 97.4%, and 96.4% for two-days-protocol. SPECT/CT contributed to diagnosis in 45/50 patients with planar WBCS positive. Kappa index: 0.8 for one-day protocol and 0.79 for two-day protocol, respectively.

CONCLUSION

One-day protocol with time decay-corrected acquisition WBCS and SPECT/CT enables early and accurate diagnosis of osteoarticular infection.

Risk of pancreatic cancer associated with family history of cancer and other medical conditions by accounting for smoking among relatives

Background

Family history (FH) of pancreatic cancer (PC) has been associated with an increased risk of PC, but little is known regarding the role of inherited/environmental factors or that of FH of other comorbidities in PC risk. We aimed to address these issues using multiple methodological approaches.

Methods

Case-control study including 1431 PC cases and 1090 controls and a reconstructed-cohort study (N = 16 747) made up of their first-degree relatives (FDR). Logistic regression was used to evaluate PC risk associated with FH of cancer, diabetes, allergies, asthma, cystic fibrosis and chronic pancreatitis by relative type and number of affected relatives, by smoking status and other potential effect modifiers, and by tumour stage and location. Familial aggregation of cancer was assessed within the cohort using Cox proportional hazard regression.

Results

FH of PC was associated with an increased PC risk [odds ratio (OR) = 2.68; 95% confidence interval (CI): 2.27-4.06] when compared with cancer-free FH, the risk being greater when ≥ 2 FDRs suffered PC (OR = 3.88; 95% CI: 2.96-9.73) and among current smokers (OR = 3.16; 95% CI: 2.56-5.78, interaction FHPC*smoking P-value = 0.04). PC cumulative risk by age 75 was 2.2% among FDRs of cases and 0.7% in those of controls [hazard ratio (HR) = 2.42; 95% CI: 2.16-2.71]. PC risk was significantly associated with FH of cancer (OR = 1.30; 95% CI: 1.13-1.54) and diabetes (OR = 1.24; 95% CI: 1.01-1.52), but not with FH of other diseases.

Conclusions

The concordant findings using both approaches strengthen the notion that FH of cancer, PC or diabetes confers a higher PC risk. Smoking notably increases PC risk associated with FH of PC. Further evaluation of these associations should be undertaken to guide PC prevention strategies.

Temporal reprogramming of calcium signalling via crosstalk of gonadotrophin receptors that associate as functionally asymmetric heteromers

Signal crosstalk between distinct G protein-coupled receptors (GPCRs) is one mechanism that underlies pleiotropic signalling. Such crosstalk is also pertinent for GPCRs activated by gonadotrophic hormones; follicle-stimulating hormone (FSH) and luteinising hormone (LH), with specific relevance to female reproduction. Here, we demonstrate that gonadotrophin receptor crosstalk alters LH-induced Gαq/11-calcium profiles. LH-induced calcium signals in both heterologous and primary human granulosa cells were prolonged by FSHR coexpression via influx of extracellular calcium in a receptor specific manner. LHR/FSHR crosstalk involves Gαq/11 activation as a Gαq/11 inhibitor abolished calcium responses. Interestingly, the enhanced LH-mediated calcium signalling induced by FSHR co-expression was dependent on intracellular calcium store release and involved Gβγ. Biophysical analysis of receptor and Gαq interactions indicated that ligand-dependent association between LHR and Gαq was rearranged in the presence of FSHR, enabling FSHR to closely associate with Gαq following LHR activation. This suggests that crosstalk may occur via close associations as heteromers. Super-resolution imaging revealed that LHR and FSHR formed constitutive heteromers at the plasma membrane. Intriguingly, the ratio of LHR:FSHR in heterotetramers was specifically altered following LH treatment. We propose that functionally significant FSHR/LHR crosstalk reprograms LH-mediated calcium signalling at the interface of receptor-G protein via formation of asymmetric complexes.

Musicogenic reflex seizures in epilepsy with glutamic acid decarbocylase antibodies

BACKGROUND

Musicogenic reflex seizures (MRS) are a rare form of seizures described in patients with temporal lobe epilepsy (TLE), mainly of unknown etiology. Epilepsy with antibodies against glutamic acid decarboxylase (GAD-ab) is a form of autoimmune epilepsy for which no specific semiology has been described.

AIM OF THE STUDY

To retrospectively review the incidence of MRS in the general epileptic population and in the series of patients with epilepsy and GAD-ab and to describe its clinical and paraclinical characteristics.

METHODS

Patients recorded between January 2010 and January 2016 in the Database of Bellvitge Hospital Epilepsy Unit were reviewed.

RESULTS

From a group of 1510 epileptic patients, three reported MRS (0.0019%) (two patients with epilepsy and GAD-ab and one patient with cryptogenic TLE). The incidence of MRS in patients with epilepsy and GAD-ab was 2 of 22 (9%). Both patients had a normal magnetic resonance Imaging (MRI), but FDG-PET showed medial temporal lobe hypometabolism (unilateral or bilateral) in both and also in the insula in one of them. MRS (recorded via video-EEG[electroencephalography] in one patient) arose from the right temporal lobe.

CONCLUSIONS

MRS may be a distinctive seizure type in patients with epilepsy and antiGADab. Determination of GAD-ab should be carried out in all cases of MRS, even those with normal structural MRI.

NG2 antigen is involved in leukemia invasiveness and central nervous system infiltration in MLL-rearranged infant B-ALL

Mixed-lineage leukemia (MLL)-rearranged (MLLr) infant B-cell acute lymphoblastic leukemia (iMLLr-B-ALL) has a dismal prognosis and is associated with a pro-B/mixed phenotype, therapy refractoriness and frequent central nervous system (CNS) disease/relapse. Neuron-glial antigen 2 (NG2) is specifically expressed in MLLr leukemias and is used in leukemia immunophenotyping because of its predictive value for MLLr acute leukemias. NG2 is involved in melanoma metastasis and brain development; however, its role in MLL-mediated leukemogenesis remains elusive. Here we evaluated whether NG2 distinguishes leukemia-initiating/propagating cells (L-ICs) and/or CNS-infiltrating cells (CNS-ICs) in iMLLr-B-ALL. Clinical data from the Interfant cohort of iMLLr-B-ALL demonstrated that high NG2 expression associates with lower event-free survival, higher number of circulating blasts and more frequent CNS disease/relapse. Serial xenotransplantation of primary MLL-AF4⁺ leukemias indicated that NG2 is a malleable marker that does not enrich for L-IC or CNS-IC in iMLLr-B-All. However, NG2 expression was highly upregulated in blasts infiltrating extramedullar hematopoietic sites and CNS, and specific blockage of NG2 resulted in almost complete loss of engraftment. Indeed, gene expression profiling of primary blasts and primografts revealed a migratory signature of NG2⁺ blasts. This study provides new insights on the biology of NG2 in iMLLr-B-ALL and suggests NG2 as a potential therapeutic target to reduce the risk of CNS disease/relapse and to provide safer CNS-directed therapies for iMLLr-B-ALL.

GEIS-21: a multicentric phase II study of intensive chemotherapy including gemcitabine and docetaxel for the treatment of Ewing sarcoma of children and adults: a report from the Spanish sarcoma group (GEIS)

BACKGROUND

First Spanish trial of Ewing sarcoma (ES) including adults and children with the aim to test the efficacy of Gemcitabine and Docetaxel (G/D) in newly diagnosed high-risk (HR) patients.

METHODS

This was a prospective, multicentric, non-randomised, open study for patients ⩽40 years with newly diagnosed ES. HR patients (metastatic, axial-pelvic primaries or bone marrow micrometastasis) received 2 window cycles of G/D. Patients with an objective response (OR) to G/D received 12 monthly cycles of G/D after completion of mP6. The primary end point was the OR rate to the G/D window phase and the event-free survival (EFS) and overall survival (OS) for all patients. The study is registered at ClinicalTrials.gov (identifier: NCT00006734).

RESULTS

Forty-three patients were enroled, median age 17 years (range, 3-40). After a median follow-up of 43.4 months, the 5-year OS rate is 55.0% (95% CI, 41-74%) with an EFS of 50.0% (95% CI, 36-68%). The 5-year OS and EFS rates for standard risk (SR) patients was 76.0% (95% CI, 57-100%) and 71.0% (CI, 54-94%); for HR 36.0% (CI, 20-65%) and 29.0% (CI, 15-56%). Twelve of 17 (70.6%) high-risk (HR) patients showed an OR (7 PR and 5 SD) to G/D window therapy. The 5-year OS rate for patients ⩽18 years of age was 74.0% (CI, 56-97%) and 31.0% for >18 years (95% CI, 15-66%), P<0.001. Grade 4 adverse events during mP6 occurred in 28/39 of patients (72%) and did not correlate with age. Multivariate survival analyses with <18 vs ⩾18 and risk groups significant differences, P<0.00001. Using a Cox model for OS, both age and risk group were statistically significant (P=0.0011 and P=0.0065, respectively).

CONCLUSIONS

Age at diagnosis is an independent prognostic factor superior to the presence of metastases with 18 years as the strongest cut-off. The mP6 regimen provided survival curves that plateau at 3 years and G/D produced significant responses in HR-ES that is worth further exploring.

Serum levels of interleukin-6 are linked to the severity of the disease caused by Andes Virus

Andes virus (ANDV) is the etiological agent of hantavirus cardiopulmonary syndrome in Chile. In this study, we evaluated the profile of the pro-inflammatory cytokines IL-1β, IL-12p70, IL-21, TNF-α, IFN-γ, IL-10 and IL-6 in serum samples of ANDV-infected patients at the time of hospitalization. The mean levels of circulating cytokines were determined by a Bead-Based Multiplex assay coupled with Luminex detection technology, in order to compare 43 serum samples of healthy controls and 43 samples of ANDV-infected patients that had been categorized according to the severity of disease. When compared to the controls, no significant differences in IL-1β concentration were observed in ANDV-infected patients (p = 0.9672), whereas levels of IL-12p70 and IL-21 were significantly lower in infected cases (p = <0.0001). Significantly elevated levels of TNF-α, IFN-γ, IL-10, and IL-6 were detected in ANDV-infected individuals (p = <0.0001, 0.0036, <0.0001, <0.0001, respectively). Notably, IL-6 levels were significantly higher (40-fold) in the 22 patients with severe symptoms compared to the 21 individuals with mild symptoms (p = <0.0001). Using multivariate regression models, we show that IL-6 levels has a crude OR of 14.4 (CI: 3.3–63.1). In conclusion, the serum level of IL-6 is a significant predictor of the severity of the clinical outcome of ANDV-induced disease.

Andes virus (ANDV) causes hantavirus cardiopulmonary syndrome (HCPS) that is characterized by the development of vascular leakage syndrome, eventually leading to massive pulmonary edema, shock and, in many cases, death. To date, no FDA-approved immunotherapeutics, specific antivirals, or vaccines are available for use against HCPS. Patient survival rates hinge largely on early virus diagnosis, hospital admission and aggressive pulmonary and hemodynamic support in an intensive care unit. Individual host factors associated with the outcome of an ANDV infection are poorly known, and such knowledge could allow the disease progression of hospitalized patients to be predicted, resulting in individualized treatment. In this study, we show that serum levels of IL-6 at the time of hospitalization in ANDV-infected patients are associated with the severity of the clinical outcome of ANDV-induced disease. Therefore, these finding suggest that determining IL-6 levels at the time of admission to the hospital could be useful to predict the progression of ANDV-induced disease.

A systems approach identifies time-dependent associations of multimorbidities with pancreatic cancer risk

BACKGROUND

Pancreatic ductal adenocarcinoma (PDAC) is usually diagnosed in late adulthood; therefore, many patients suffer or have suffered from other diseases. Identifying disease patterns associated with PDAC risk may enable a better characterization of high-risk patients.

METHODS

Multimorbidity patterns (MPs) were assessed from 17 self-reported conditions using hierarchical clustering, principal component, and factor analyses in 1705 PDAC cases and 1084 controls from a European population. Their association with PDAC was evaluated using adjusted logistic regression models. Time since diagnosis of morbidities to PDAC diagnosis/recruitment was stratified into recent (<3 years) and long term (≥3 years). The MPs and PDAC genetic networks were explored with DisGeNET bioinformatics-tool which focuses on gene-diseases associations available in curated databases.

RESULTS

Three MPs were observed: gastric (heartburn, acid regurgitation, Helicobacter pylori infection, and ulcer), metabolic syndrome (obesity, type-2 diabetes, hypercholesterolemia, and hypertension), and atopic (nasal allergies, skin allergies, and asthma). Strong associations with PDAC were observed for ≥2 recently diagnosed gastric conditions [odds ratio (OR), 6.13; 95% confidence interval CI 3.01-12.5)] and for ≥3 recently diagnosed metabolic syndrome conditions (OR, 1.61; 95% CI 1.11-2.35). Atopic conditions were negatively associated with PDAC (high adherence score OR for tertile III, 0.45; 95% CI, 0.36-0.55). Combining type-2 diabetes with gastric MP resulted in higher PDAC risk for recent (OR, 7.89; 95% CI 3.9-16.1) and long-term diagnosed conditions (OR, 1.86; 95% CI 1.29-2.67). A common genetic basis between MPs and PDAC was observed in the bioinformatics analysis.

CONCLUSIONS

Specific multimorbidities aggregate and associate with PDAC in a time-dependent manner. A better characterization of a high-risk population for PDAC may help in the early diagnosis of this cancer. The common genetic basis between MP and PDAC points to a mechanistic link between these conditions.