Citations

Abstract T cell cytokine production has been shown to be dependent not only on T cell antigen receptor (TCR), but also the chemokine receptor CXCR4. Evidence in the literature suggests that, in addition to stimulating migration, CXCR4 might also more directly regulate T cell immune activation. Recent studies from our lab have revealed that TCR stimulation in the absence of SDF-1 induces association of TCR and CXCR4, and that this is inhibited by pretreating cells with the specific CXCR4 antagonist AMD3100. Cytokine production, particularly cytokines IL-2, IL-4, and IL-10, by TCR-stimulated cells was inhibited by using either AMD3100 or CXCR4 siRNA to prevent TCR-CXCR4 formation. Interestingly, TCR-CXCR4 was not required for activation of many TCR-stimulated signaling pathways or for cytokine gene transcription. Instead, TCR-CXCR4 formation during TCR-mediated T cell immune activation was required for the post-transcriptional stabilization of cytokine mRNAs through a Rac-1 mediated pathway. Our results suggest that targeting the TCR-CXCR4 complex formation or downstream signaling pathways may provide therapeutic targets to regulate cytokine production.

Abstract The PD-1:PD-L1 axis is a major immune regulatory pathway that blunts T cell activation in the tumor microenvironment. We recently identified that PD-1 is also upregulated on ovarian mouse tumor-infiltrating myeloid dendritic cells (TIDCs) that exhibit an immune suppressive phenotype. Extending those observations in this study, we now report that PD-1 is also expressed on human myeloid TIDCs of ovarian cancer patients, on which it suppresses the expression of co-stimulatory molecules (CD40 and CD80) as well as production of inflammatory cytokines. Mechanistic studies revealed that PD-1 on TIDCs is associated with Src homology domain-containing phosphatase-2 (SHP-2) and that PD-1-mediated blockade of NFkB-dependent cytokine release is SHP-2 dependent. PD-1 also inhibits NFkB-mediated antigen presentation which appears, however, to be independent of SHP-2. Thus, suppression of NFkB is critical in mediating PD-1-induced paralysis of ovarian tumor-associated immune TIDCs and is mediated through multiple signaling circuits that are both SHP-2 dependent and independent.

Abstract IQGAP1 is a ubiquitous, cytoskeletal-interacting scaffold protein frequently overexpressed in cancer. CXCR4 is a chemokine receptor that signals upon binding stromal cell-derived factor 1 (SDF-1, CXCL12). CXCR4 regulates lymphocyte migration and development and cancer cell proliferation and metastasis. Here, we show that IQGAP1 potently enhances CXCR4’s expression, trafficking, and function in the Jurkat T cell line and epithelial cancer cells. The SDF-1-induced cell migration and activation of ERK MAPK were impaired in IQGAP1-deficient cells, even after forced CXCR4 overexpression. Exploring the mechanism, we found that SDF-1 treatment induced CXCR4 endocytosis and caused IQGAP1 to bind a-tubulin and localize to EEA-1 endosomes containing endocytosed CXCR4. In IQGAP1-deficient cells, CXCR4-containing EEA-1 endosomes accumulated at the distal ends of microtubules instead of moving towards the centrosome. This inhibited CXCR4’s signaling and cell-surface expression by preventing CXCR4 from trafficking into the Rab11 endosomes previously shown to be a critical site of CXCR4 signaling and recycling to the cell-surface. In contrast, IQGAP1 depletion had no effect on TCR trafficking, which does not require EEA-1 endosomes. Together, these results characterize a novel function of IQGAP1 as a regulator of EEA-1 endosomes, and in addition identify IQGAP1 as a critical enhancer of CXCR4 cell-surface expression and signaling in lymphocytes and epithelial cancer cells.

Abstract Osteoblasts are known to protect acute myeloid leukemia (AML) cells in the bone marrow microenvironment, however, the identity of these protective signals is not known. Because disrupting this protection could help prevent the relapse of AML patients following chemotherapy, we characterized the molecular mechanisms. We previously showed that SDF-1 (CXCL12), a chemokine abundant in the bone marrow, induces apoptosis of AML cells in cocultures unless the leukemic cells are protected via proximity to differentiating osteoblasts. Treating differentiating osteoblasts with either suberoylanilide hydroxamic acid (SAHA) or LBH-589 histone deacetylase (HDAC) inhibitor drugs inhibited their protection of AML cells. RNAseq revealed that SAHA globally inhibits osteoblast differentiation while inducing expression of the scaffold protein, Nherf-1. Remarkably, expressing Nherf-1 in differentiating osteoblasts was both required and sufficient to block osteoblast-mediated protection of AML cells. Together, these results indicate that disrupting the differentiation of osteoprogenitors in the bone marrow inhibits their ability to protect AML cells from apoptosis, and that this can be achieved via either inhibiting HDACs or overexpressing Nherf-1 in osteoblast-lineage cells. HDAC inhibitors or treatments specifically designed to induce Nherf-1 expression either during or immediately prior to chemotherapy may therefore be a useful strategy for reducing the risk of disease relapse in AML patients.

Abstract We study mechanisms of tumor escape from adoptive therapy in the mouse melanoma model B16ova. In this model, transfer of OT-I T cells can significantly prolong the survival of mice. However, intense OT-I pressure promotes tumor cell genomic instability, and most mice eventually develop recurrent ova gene-loss tumors. We hypothesized that simultaneous transfer of two CTL clones would limit tumor recurrence by preventing the selection of single gene-loss cells. To accomplish this, we co-transferred OT-I T cells and Pmel T cells. Co-transfer three days following tumor challenge prevented tumor growth, while neither clone alone could. And in mice with established tumors, co-transfer provided significantly better therapy than either clone alone. This improvement was due to both fewer tumors recurring and the delayed appearance of those that did recur. Additionally, we found that recurrent tumors from mice treated with co-transfer continued to express both target antigens, and the mice maintained both T cell populations. We therefore hypothesized that it should be possible to exploit those cells to further prolong the survival of mice. We used cyclophosphamide to stimulate reactivation of the immune system in mice with recurrent tumors and found that this supplemental therapy significantly prolonged the lives of only those mice which had previously received co-transfer. Overall, our results reveal several benefits of targeting multiple tumor antigens.

Background: Prescription opioids are a major cause of the opioid epidemic. Despite the minimally invasive nature of medical thoracoscopy (MT), data on the efficacy of non-opioid-based pain control after MT is lacking. The purpose of this study is to assess the feasibility and efficacy of a non-opioid-based pain management strategy in patients who underwent MT. Methods: We performed a retrospective analysis of all patients who underwent MT in the Mayo Clinic (Minnesota and Arizona) outpatient setting. We assessed their pain level and the need for analgesia post-MT from August 1, 2019, to May 24, 2021. Results: Forty patients were included. In the first 24 hours, 5/40 (12.5%) reported no pain. Twenty-eight patients out of 40 (70%) reported minor pain (pain scale 1-3), and 7/40 (17.5%) reported moderate pain (pain scale 4-6). No patients reported severe pain. Twenty-two out of 35 patients who experienced discomfort (63%) required acetaminophen, 6/35 patients (17%) required nonsteroidal anti-inflammatory drug, and 7/35 patients (20%) did not require analgesia. Of the 7 patients who had moderate pain, 5 (71%) reported that the moderate pain improved to mild at 72 hours post-MT. Zero patients required opioids, and none reported contacting any provider to manage the pain post-MT. Fourteen patients (78%) who had both parietal pleural biopsies and tunneled pleural catheter placed reported minor pain, 3 patients (17%) reported moderate pain, and 1 patient (6%) experienced no discomfort. Conclusion: MT is well-tolerated by patients with non-opioid-based pain management strategy as needed if there is no absolute contraindication.

Abstract Coronavirus disease 2019 (COVID-19) infection is associated with risk of persistent neurocognitive and neuropsychiatric complications, termed “long COVID”. It is unclear whether the neuropsychological manifestations of COVID-19 present as a uniform syndrome or as distinct neurophenotypes with differing risk factors and recovery trajectories. We examined post-acute outcomes following SARS-CoV-2 infection in 205 patients recruited from inpatient and outpatient populations, using an unsupervised machine learning cluster analysis, with objective and subjective neuropsychological measures as input features. This resulted in three distinct post-COVID clusters. In the largest cluster (69%), cognitive functions were within normal limits (“normal cognition” neurophenotype), although mild subjective attention and memory complaints were reported. Cognitive impairment was present in the remaining 31% of the sample but clustered into two differentially impaired groups. In 16% of participants, memory deficits, slowed processed speed, and fatigue were predominant. Risk factors for membership in the “memory-speed impaired” neurophenotype included anosmia and more severe COVID-19 infection. In the remaining 15% of participants, executive dysfunction was predominant. Risk factors for membership in this milder “dysexecutive” neurophenotype included disease-nonspecific factors such as neighborhood deprivation and obesity. Recovery trajectories at 6-month follow-up differed across neurophenotypes, with the normal cognition group showing stability, the dysexecutive group showing improvement, and the memory-speed impaired group showing persistent processing speed deficits and fatigue, as well as worse functional outcomes. These results indicate that there are multiple post-acute neurophenotypes of long COVID, with different etiological pathways and recovery trajectories. This information may inform phenotype-specific approaches to treatment.

Abstract Objectives People with dementia often have high care needs at end of life. We compared care delivery in the last year of life for people living with dementia in the community (home/assisted living facilities, ALF) to those in skilled nursing facilities (SNF). Methods This was a retrospective study of people who died with a diagnosis of dementia in the community compared with SNF between 2013 and 2018. Primary outcomes of hospitalizations/ED visits in the last year of life were measured. Secondary outcomes included advance care planning (ACP) completion, hospice enrollment, provider visits and ICU admissions. Results Of 1203 people with dementia, 581 (48.3%) were living in a SNF and 622 (51.7%) in the home/ALF. At least one hospitalization was recorded for 70.7% in the home/ALF compared with 50.8% in the SNF (p< 0.01), similar to ED visits (80.2% versus 58% in home/ALF and SNF groups, respectively, p< 0.01). People in the SNF had more provider visits (median 9 (IQR 6, 12) compared with 5 (IQR 3,9) in the home/ALF group (p< 0.01). There was no ACP for 12% of those in the home/ALF, compared with 4.6% in the SNF(p< 0.01). Approximately half (56.5%) in the SNF were enrolled in hospice compared with 68.3% in the home/ALF group (p< 0.01), Median time in hospice was 26.5 days in the SNF versus 30 days in the home/ALF (p=0.67). Conclusions People living with dementia have frequent acute care utilization in the last year of life. Hospice care was more common in the home/ALF. Time in hospice was short.