Phase I/II trial of a peptide-based COVID-19 T-cell activator in patients with B-cell deficiency

T-cell immunity is central for control of COVID-19, particularly in patients incapable of mounting antibody responses. CoVac-1 is a peptide-based T-cell activator composed of SARS-CoV-2 epitopes with documented favorable safety profile and efficacy in terms of SARS-CoV-2-specific T-cell response. We here report a Phase I/II open-label trial (NCT04954469) in 54 patients with congenital or acquired B-cell deficiency receiving one subcutaneous CoVac-1 dose. Immunogenicity in terms of CoVac-1-induced T-cell responses and safety are the primary and secondary endpoints, respectively. No serious or grade 4 CoVac-1-related adverse events have been observed. Expected local granuloma formation has been observed in 94% of study subjects, whereas systemic reactogenicity has been mild or absent. SARS-CoV-2-specific T-cell responses have been induced in 86% of patients and are directed to multiple CoVac-1 peptides, not affected by any current Omicron variants and mediated by multifunctional T-helper 1 CD4+ T cells. CoVac-1-induced T-cell responses have exceeded those directed to the spike protein after mRNA-based vaccination of B-cell deficient patients and immunocompetent COVID-19 convalescents with and without seroconversion. Overall, our data show that CoVac-1 induces broad and potent T-cell responses in patients with B-cell/antibody deficiency with a favorable safety profile, which warrants advancement to pivotal Phase III safety and efficacy evaluation. ClinicalTrials.gov identifier NCT04954469.

An optimized IgG-based B7-H3xCD3 bispecific antibody for treatment of gastrointestinal cancers

T cell-based immunotherapy has revolutionized oncological treatment. However, many patients do not respond to treatment, and long-term remissions remain rare, particularly in gastrointestinal cancers like colorectal cancer (CRC). B7-H3 is overexpressed in multiple cancer entities including CRC on both tumor cells and tumor vasculature, the latter facilitating influx of effector cells into the tumor site upon therapeutic targeting. We generated a panel of T cell-recruiting B7-H3xCD3 bispecific antibodies (bsAbs) and show that targeting a membrane-proximal B7-H3 epitope allows for a 100-fold reduction of CD3 affinity. In vitro, our lead compound CC-3 showed superior tumor cell killing, T cell activation, proliferation, and memory formation, whereas undesired cytokine release was reduced. In vivo, CC-3 mediated potent antitumor activity in three independent models using immunocompromised mice adoptively transferred with human effector cells with regard to prevention of lung metastasis and flank tumor growth as well as elimination of large established tumors. Thus, fine-tuning of both target and CD3 affinities as well as binding epitopes allowed for the generation of a B7-H3xCD3 bsAbs with promising therapeutic activity. CC-3 is presently undergoing good manufacturing practice (GMP) production to enable evaluation in a clinical "first-in-human" study in CRC.

Study of "ALS reversals": LifeTime environmental exposures (StARLiTE)

We previously reported on a series of patients diagnosed with ALS whom had an extraordinary course defined by substantial and sustained improvement in weakness and function. For this study, twenty-five of these "ALS Reversals" completed extensive environmental exposure questionnaires. These responses were then compared to a large database of prior responses from patients with typically progressive ALS (n = 6187). The results demonstrated that the "Reversal" participants have had a diverse number of exposures with substantial heterogeneity. In general, this was similar to the control group; however, there were a few specific differences that could be further explored in future research.

Two new species in a new genus and a critical revision of Brachybasidiaceae (Exobasidiales, Basidiomycota) in honor of Franz Oberwinkler

The Brachybasidiaceae are a family of 22 known species of plant-parasitic microfungi belonging to Exobasidiales, Basidiomycota. Within this family, species of the largest genus Kordyana develop balls of basidia on top of stomatal openings. Basidial cells originate from fungal stroma filling substomatal chambers. Species of Kordyana typically infect species of Commelinaceae. During fieldwork in the neotropics, fungi morphologically similar to Kordyana spp. were found on Goeppertia spp. (syn. Calathea spp., Marantaceae), namely on G. panamensis in Panama and on G. propinqua in Bolivia. These specimens are proposed as representatives of a genus new to science, Marantokordyana, based on the distinct host family and molecular sequence data of ITS and LSU rDNA regions. The specimens on the two host species represent two species new to science, M. oberwinkleriana on G. panamensis and M. boliviana on G. propinqua. They differ by the size and shape of their basidia, molecular sequence data of ITS and LSU rDNA regions, and host plant species. In the past, the understanding of Brachybasidiaceae at order and family level was significantly improved by investigation realized by Franz Oberwinkler and his collaborators at the University of Tübingen, Germany. On species level, however, our knowledge is still very poor due to incomplete species descriptions of several existing names in literature, scarceness of specimens, as well as sequence data lacking for many taxa and for further barcode regions. Especially species of Kordyana and species of Dicellomyces are in need of revision.

Temperature responses of photosynthetic capacity parameters were not affected by foliar nitrogen content in mature Pinus sylvestris

A key weakness in current Earth System Models is the representation of thermal acclimation of photosynthesis in response to changes in growth temperatures. Previous studies in boreal and temperate ecosystems have shown leaf-scale photosynthetic capacity parameters, the maximum rates of carboxylation (V_cmax ) and electron transport (J_max ), to be positively correlated with foliar nitrogen (N) content at a given reference temperature. It is also known that V_cmax and J_max exhibit temperature optima that are affected by various environmental factors and, further, that N partitioning among the foliar photosynthetic pools is affected by N availability. However, despite the strong recent anthropogenic influence on atmospheric temperatures and N deposition to forests, little is known about the role of foliar N contents in controlling the photosynthetic temperature responses. In this study, we investigated the temperature dependencies of V_cmax and J_max in 1-year-old needles of mature boreal Pinus sylvestris (Scots pine) trees growing under low and high N availabilities in northern Sweden. We found that needle N status did not significantly affect the temperature responses of V_cmax or J_max when the responses were fitted to a peaked function. If such N insensitivity is a common tree trait it will simplify the interpretation of the results from gradient and multi-species studies, which commonly use sites with differing N availabilities, on temperature acclimation of photosynthetic capacity. Moreover, it will simplify modeling efforts aimed at understanding future carbon uptake by precluding the need to adjust the shape of the temperature response curves to variation in N availability.

Formation of exceptionally weak C-C bonds by metal-templated pinacol coupling

The ability of the bis(imidazolyl)ketone ligand BM^diPhIK (bis(1-methyl-4,5-diphenylimidazolyl)ketone) to function as a redox active ligand has been investigated. The reduction of [M(BM^diPhIK)Cl₂] (M = Fe and Zn) complexes resulted in a pinacol-type coupling to form dinuclear complexes featuring very weak and abnormally elongated C-C bonds (1.729(5) and 1.708(3) Å for Fe and Zn, respectively). Oxidation of these complexes using ferrocenium in the presence of Cl^- ions regenerated the original [M(BM^diPhIK)Cl₂] complexes, showing the reversibility of the coupling process. This makes it a potentially interesting approach for the storage of electrons and application of the BM^diPhIK ligand as a redox active ligand.

Influence of hyperoxia on diastolic myocardial and arterial endothelial function

OBJECTIVE

Hyperoxia is known to influence cardiovascular and endothelial function, but it is unknown if there are differences between younger and older persons. The aim of this study was to monitor changes in myocardial diastolic function and flow-mediated dilatation (FMD) in younger and elderly volunteers, before and after exposure to relevant hyperbaric hyperoxia.

METHODS

51 male patients were separated into two groups for this study. Volunteers in Group 1 (n=28, mean age 26 ±6, "juniors") and Group 2 (n=23, mean age 53 ±9, "seniors") received standard HBO₂ protocol (240kPa oxygen). Directly before and after hyperoxic exposure in a hyperbaric chamber we took blood samples (BNP, hs-troponin-t), assessed the FMD and echocardiographic parameters with focus on diastolic function.

RESULTS

After hyperoxia we observed a high significant decrease in heart rate and systolic/diastolic FMD. Diastolic function varied in both groups: E/A ratio showed a statistically significant increase in Group 1 and remained unchanged in Group 2. E/e' ratio showed a slight but significant increase in Group 1, whereas e'/a' ratio increased in both groups. Deceleration time increased significantly in all volunteers. Isovolumetric relaxation time remained unchanged and ejection fraction showed a decrease only in Group 2. There were no changes in levels of BNP and hs-troponin-t in either group.

CONCLUSION

Hyperoxia seems to influence endothelial function differently in juniors and seniors: FMD decreases more in seniors, possibly attributable to pre-existing reduced vascular compliance. Hyperoxia-induced bradycardia induced a more pronounced improvement in diastolic function in juniors. The ability of Group 1 to cope with hyperoxia-induced effects did not work in the same manner as with Group 2.

Sagittal Wrist Motion of Carpal Bones Following Intraarticular Fractures of the Distal Radius

Forty patients (mean age, 37 years) with intraarticular C2 and C3 Colles fractures were treated by open reduction, internal fixation and bone grafting. At a mean follow-up of 8 years radiocarpal and midcarpal motion was evaluated, the depth of the articular surface of the distal radius in the sagittal plane was measured and the presence of arthritis was noted. The fractures healed with a mean palmar tilt of 6°, a mean ulnar tilt of 18° and ulna variance within 1 mm of the contralateral side. The depth of the articular surface of the distal radius was 1.3 mm greater than the uninvolved side. Measurement of carpal bone angles relative to the radius in maximum flexion and extension revealed lunate extension of 23°, lunate flexion of 15°, capitate extension of 62°, capitate flexion of 40°. There was a significant correlation between articular surface depth and radiocarpal motion.

Delayed Single Kirschner Wire Compression Technique for Mallet Fracture

Twenty-four mallet fractures which involved at least one third % of the articular surface of the distal interphalangeal joint were treated by open reduction and internal fixation using a single double-ended Kirschner wire at a mean of 9 days after injury (range 4–15). At a mean follow-up of 43 (range 12–18) months the active range of motion, pain and the Warren and Norris criteria were evaluated. The mean active range of motion was from −2° extension (range 0–10°) to 72° flexion (range 50–90°). Nineteen patients were pain free and five suffered from mild pain during strenuous work. The Warren and Norris results were successful in 22 and improved in two cases. Radiographs showed, that all the fractures united in a near-anatomic position but with joint narrowing in six digits.

[German translation of the performance-oriented mobility assessment according to Tinetti]

BACKGROUND

In clinical research as well as good clinical practice increasing importance is placed on standardized and evaluated procedures. They provide information which is important for the prognosis, determination of the need for interventions, determination of treatment goals and evaluation of treatment approaches and outcomes. Furthermore, they serve as justification of the reimbursement for presentation to official bodies. Until now no officially authorized German version of the performance-oriented mobility assessment (POMA) according to Tinetti was available.

OBJECTIVES

This article presents a methodically translated German version of the POMA that also includes so far partially unpublished instructions for the examiner and the examined person.

MATERIAL AND METHODS

The internationally recognized recommendations for the cross-cultural adaptation of health status measures served as the foundation of the translation process. By means of three translations from the original language into the target language a preliminary consensus version was developed, which was then translated back into the original language by two native speakers.

RESULTS AND CONCLUSION

With this new and for the first time authorized German translation of the POMA a version of this assessment is available that achieves unification and standardization in German speaking countries and guarantees an improved comparability with international studies.

How to tackle the molecular species inventory for an industrialized nation-lessons from the first phase of the German Barcode of Life initiative GBOL (2012-2015)

Biodiversity loss is mainly driven by human activity. While concern grows over the fate of hot spots of biodiversity, contemporary species losses still prevail in industrialized nations. Therefore, strategies were formulated to halt or reverse the loss, driven by evidence for its value for ecosystem services. Maintenance of the latter through conservation depends on correctly identified species. To this aim, the German Federal Ministry of Education and Research is funding the GBOL project, a consortium of natural history collections, botanic gardens, and universities working on a barcode reference database for the country's fauna and flora. Several noticeable findings could be useful for future campaigns: (i) validating taxon lists to serve as a taxonomic backbone is time-consuming, but without alternative; (ii) offering financial incentives to taxonomic experts, often citizen scientists, is indispensable; (iii) completion of the libraries for widespread species enables analyses of environmental samples, but the process may not hold pace with technological advancements; (iv) discoveries of new species are among the best stories for the media; (v) a commitment to common data standards and repositories is needed, as well as transboundary cooperation between nations; (vi) after validation, all data should be published online via the BOLD to make them searchable for external users and to allow cross-checking with data from other countries.

Increased Needle Nitrogen Contents Did Not Improve Shoot Photosynthetic Performance of Mature Nitrogen-Poor Scots Pine Trees

Numerous studies have shown that temperate and boreal forests are limited by nitrogen (N) availability. However, few studies have provided a detailed account of how carbon (C) acquisition of such forests reacts to increasing N supply. We combined measurements of needle-scale biochemical photosynthetic capacities and continuous observations of shoot-scale photosynthetic performance from several canopy positions with simple mechanistic modeling to evaluate the photosynthetic responses of mature N-poor boreal Pinus sylvestris to N fertilization. The measurements were carried out in August 2013 on 90-year-old pine trees growing at Rosinedalsheden research site in northern Sweden. In spite of a nearly doubling of needle N content in response to the fertilization, no effect on the long-term shoot-scale C uptake was recorded. This lack of N-effect was due to strong light limitation of photosynthesis in all investigated canopy positions. The effect of greater N availability on needle photosynthetic capacities was also constrained by development of foliar phosphorus (P) deficiency following N addition. Thus, P deficiency and accumulation of N in arginine appeared to contribute toward lower shoot-scale nitrogen-use efficiency in the fertilized trees, thereby additionally constraining tree-scale responses to increasing N availability. On the whole our study suggests that the C uptake response of the studied N-poor boreal P. sylvestris stand to enhanced N availability is constrained by the efficiency with which the additional N is utilized. This efficiency, in turn, depends on the ability of the trees to use the greater N availability for additional light capture. For stands that have not reached canopy closure, increase in leaf area following N fertilization would be the most effective way for improving light capture and C uptake while for mature stands an increased leaf area may have a rather limited effect on light capture owing to increased self-shading. This raises the question if N limitation in boreal forests acts primarily by constraining growth of young stands while the commonly recorded increase in stem growth of mature stands following N addition is primarily the result of altered allocation and only to a limited extent the result of increased stand C-capture.

Transpiration of urban trees and its cooling effect in a high latitude city

An important ecosystem service provided by urban trees is the cooling effect caused by their transpiration. The aim of this study was to quantify the magnitude of daytime and night-time transpiration of common urban tree species in a high latitude city (Gothenburg, Sweden), to analyse the influence of weather conditions and surface permeability on the tree transpiration, and to find out whether tree transpiration contributed to daytime or nocturnal cooling. Stomatal conductance and leaf transpiration at day and night were measured on mature street and park trees of seven common tree species in Gothenburg: Tilia europaea, Quercus robur, Betula pendula, Acer platanoides, Aesculus hippocastanum, Fagus sylvatica and Prunus serrulata. Transpiration increased with vapour pressure deficit and photosynthetically active radiation. Midday rates of sunlit leaves ranged from less than 1 mmol m(-2) s(-1) (B. pendula) to over 3 mmol m(-2) s(-1) (Q. robur). Daytime stomatal conductance was positively related to the fraction of permeable surfaces within the vertically projected crown area. A simple estimate of available rainwater, comprising of precipitation sum and fractional surface permeability within the crown area, was found to explain 68% of variation in midday stomatal conductance. Night-time transpiration was observed in all studied species and amounted to 7 and 20% of midday transpiration of sunlit and shaded leaves, respectively. With an estimated night-time latent heat flux of 24 W m(-2), tree transpiration significantly increased the cooling rate around and shortly after sunset, but not later in the night. Despite a strong midday latent heat flux of 206 W m(-2), a cooling effect of tree transpiration was not observed during the day.

Reversible cyclometalation at RhI as a motif for metal–ligand bifunctional bond activation and base-free formic acid dehydrogenation

The first example of base-free catalytic dehydrogenation of formic acid using reversible cyclometalation at Rh(i) is discussed, using a combination of experimental and computational methods.

Does MIPO of fractures of the distal femur result in more rotational malalignment than ORIF? A retrospective study

PURPOSE

Intraoperative control of rotational malalignment poses a big challenge for surgeons when using modern MIPO (minimally invasive plate osteosynthesis) techniques. We hypothesized that distal femoral fractures treated with MIPO technique are more often fixed in malrotation than those treated with open reduction internal fixation (ORIF).

METHODS

In this retrospective study, we identified 20 patients who met the inclusion criteria and agreed to take part in the study. In ten patients MIPO was applied, in the other ten ORIF was used. Mean age was 44.8 (19-71 years). Functional status was assessed using clinical scores (Harris Hip Score, WOMAC Hip, KS Score, WOMAC Knee, Kujala Score). Rotational alignment was assessed with magnetic resonance imaging and compared to the opposite leg.

RESULTS

We discovered a significant difference in the mean rotational difference between the MIPO group (14.3°) and the ORIF group (5.2°). Functionally, patients in the ORIF group outperformed patients in the MIPO group in all clinical scoring systems although no one proved to be statistically significant. MIPO technique was associated with significantly more rotational malalignment compared to ORIF in distal femur fracture fixation. However, implant failure and nonunion was more common in the ORIF group, with a revision rate of 3 versus 1 in the ORIF group. Clinical scoring did not significantly different between both groups.

CONCLUSION

Taking into account the undisputable advantages of minimally invasive surgery, improved teaching of methods to avoid malrotation as well as regular postoperative investigations to detect any malrotation should be advocated.

Rhodium catalysed conversion of carbenes into ketenes and ketene imines using PNN pincer complexes

PNN pincer-type rhodium complexes catalyze ketene and ketene imine synthesis, using CO or an isocyanide and a carbene precursor.

Intermolecular C–H activation with an Ir-METAMORPhos piano-stool complex – multiple reaction steps at a reactive ligand

Reaction of phenylacetylene with an Ir^III(METAMORPhos) complex generates a unique four-membered IrPNC metallacyclic species with an exocyclic CC fragment.

Late enhanced computed tomography in Hypertrophic Cardiomyopathy enables accurate left-ventricular volumetry

OBJECTIVES

Late enhancement (LE) multi-slice computed tomography (leMDCT) was introduced for the visualization of (intra-) myocardial fibrosis in Hypertrophic Cardiomyopathy (HCM). LE is associated with adverse cardiac events. This analysis focuses on leMDCT derived LV muscle mass (LV-MM) which may be related to LE resulting in LE proportion for potential risk stratification in HCM.

METHODS

N=26 HCM-patients underwent leMDCT (64-slice-CT) and cardiovascular magnetic resonance (CMR). In leMDCT iodine contrast (Iopromid, 350 mg/mL; 150mL) was injected 7 minutes before imaging. Reconstructed short cardiac axis views served for planimetry. The study group was divided into three groups of varying LV-contrast. LeMDCT was correlated with CMR.

RESULTS

The mean age was 64.2 ± 14 years. The groups of varying contrast differed in weight and body mass index (p < 0.05). In the group with good LV-contrast assessment of LV-MM resulted in 147.4 ± 64.8 g in leMDCT vs. 147.1 ± 65.9 in CMR (p > 0.05). In the group with sufficient contrast LV-MM appeared with 172 ± 30.8 g in leMDCT vs. 165.9 ± 37.8 in CMR (p > 0.05). Overall intra-/inter-observer variability of semiautomatic assessment of LV-MM showed an accuracy of 0.9 ± 8.6 g and 0.8 ± 9.2 g in leMDCT. All leMDCT-measures correlated well with CMR (r > 0.9).

CONCLUSIONS

LeMDCT primarily performed for LE-visualization in HCM allows for accurate LV-volumetry including LV-MM in > 90% of the cases.

KEY POINTS

• LeMDCT of relatively low contrast allows for LV planimetry in HCM. • The correlation of leMDCT-based LV volumetry with gold-standard CMR was excellent (r > 0.9). • LeMDCT requires approximately 2.0mL/kgBW of dye to achieve acceptable contrast.

Pressure distribution in carpometacarpal joint, due to step-off in operatively treated Bennett's fractures

INTRODUCTION

The purpose of the current study was to investigate the effects of residual articular incongruity after Bennett's fracture on load distribution of the joint surface. Our aim was to investigate whether a residual joint step and the altered load distribution led to negative clinical outcomes or symptomatic degenerative osteoarthritis of the trapeziometacarpal joint.

PATIENTS AND METHODS

Twenty-four patients were available for long-term follow-up examination and were contacted by phone, and they returned for follow-up examination. Computed tomography (CT) scans of both carpometacarpal (CMC) joints were performed. CT scans were taken in the sagittal plane of the forearms with a slice thickness of 0.625 mm for three-dimensional reconstruction. The CMC joints were analysed due to a residual step in the joint. Only patients with a residual step-off were included in this study. To determine the areas of maximum density in the joint, CT-osteoabsorptiometry was performed.

RESULTS

Ten patients had the maximum loading area radial and two patients central. The second major position of mineralization was detected central in four patients, volar-ulnar in two patients, radial in one patient, dorso-radial in one patient, volar in one patient and volar-radial in two patients.

CONCLUSION

Finally, no higher loading in the area of the beak fragment could be found. The Wagner technique, even if it results in a persistent 1-2-mm intra-articular step-off of the beak fragment, is still the favourable method for the treatment of Bennett's luxation fractures.

A new radiological method to detect dorsally penetrating screws when using volar locking plates in distal radial fractures. The dorsal horizon view

Penetration of the dorsal screw when treating distal radius fractures with volar locking plates is an avoidable complication that causes lesions of the extensor tendon in between 2% and 6% of patients. We examined axial fluoroscopic views of the distal end of the radius to observe small amounts of dorsal screw penetration, and determined the ideal angle of inclination of the x-ray beam to the forearm when making this radiological view. Six volar locking plates were inserted at the wrists of cadavers. The actual screw length was measured under direct vision through a dorsal approach to the distal radius. Axial radiographs were performed for different angles of inclination of the forearm at the elbow. Comparing axial radiological measurements and real screw length, a statistically significant correlation could be demonstrated at an angle of inclination between 5° and 20°. The ideal angle of inclination required to minimise the risk of implanting over-long screws in a dorsal horizon radiological view is 15°.

Clinical and biomechanical investigation of an increased articular cavity depth after distal radius fractures: effect on range of motion, osteoarthrosis and loading patterns

INTRODUCTION

After fracture, distal radius malunion with dissociation of the volar and dorsal ulnar fracture fragments can lead to an increased articular cavity.

PATIENTS AND METHODS

To investigate its clinical impact we retrospectively analyzed the outcome of 81 patients and simulated this form of malunion in a biomechanical experiment with six cadaver specimens in a dynamic loading set-up.

RESULTS

In clinics, a higher arthritis stage was significantly correlated with an increased articular cavity depth and an increased anterioposterior distance. In cadaver specimens, a significantly decreased range of motion and significantly altered intraarticular contact characteristics were recognized for an increased cavity.

CONCLUSION

Alterations in contact biomechanics could be one reason for the higher incidence of posttraumatic osteoarthritis when a deeper central impaction of the distal radius is present. From a clinical and experimental point of view, restoration of the normal shape of the distal radius is considered to minimize the risk for posttraumatic radiocarpal osteoarthritis.