Citations

e21030 Background: Docetaxel +/- ramucirumab remains the standard of care therapy after progression on platinum doublet and immune checkpoint blockade (ICB) in patients with metastatic non-small cell lung cancer (NSCLC). However, the clinical benefit from docetaxel is short-lived with substantial toxicity. Additionally, whether cancer gene mutation status impacts the benefit from docetaxel has not been systemically studied. In this real-world study, we aim to investigate whether cancer gene mutation status is associated with benefit from docetaxel. We also explored whether IMPOWER150-based regimens (ABCP-atezolizumab + bevacizumab + carboplatin + paclitaxel; ACP-atezolizumab + carboplatin + paclitaxel; BCP-bevacizumab + carboplatin+paclitaxel) may serve as alternative options with better efficacy in this patient population. Methods: We retrospectively queried MD Anderson Cancer Center GEMINI database for patients with metastatic NSCLC who received docetaxel, docetaxel+ramucirumab, or one of the above-mentioned IMPOWER150-based regimens after progression on concomitant or sequential platinum-doublet and ICI. Primary endpoints include progression-free survival (PFS) and overall survival (OS). Results: 274 patients were analyzed (docetaxel n = 99; docetaxel +ramucirumab n = 142; ABCP n = 28; BCP n = 4, ACP n = 1). No significant difference was observed in mPFS (3.00m versus 3.93m, P = 0.156) or mOS (8.40m vs.8.67m, P = 0.737) between patients from docetaxel monotherapy group and docetaxel+ ramucirumab group. Cancer gene mutations in EGFR, KRAS, TP53 or PD-L1 expression (0-1%; 1-49%; ≥50%) were not associated with PFS or OS in the 241 patients treated with docetaxel +/- ramucirumab. Furthermore, there was no difference in mPFS (5.50m versus 3.47m, P = 0.516) or mOS (10.40m versus 8.83m, P = 0.737) in patients who received IMPOWER 150-based regimens compared to those who were treated with docetaxel+/- ramucirumab. The median treatment duration was 1.60m (0.70m-20.23m), 1.90m (0.70m-32.90m), 4.80m(0.70m-33.47m) and 11 patients (11.11%), 20 patients (14.08%), and 3 patients (9.09%) discontinued treatment due to adverse events in the patients treated with docetaxel monotherapy, docetaxel+ramucirumab combined therapy, and the IMPOWER150 regimens, respectively. Conclusions: These results from this real-world study suggested that unlike for ICI therapy, where onco-driver mutations have profound impact on the clinical benefit, the cancer gene mutation status does not impact the benefit from docetaxel +/- ramucirumab in NSCLC patients who progressed on platinum doublets and ICI. Furthermore, the clinical benefit from docetaxel +/- ramucirumab is short-lived. Novel treatment regimens are urgently needed in this clinical setting.

Abstract IBD affects roughly 1.6 million US adults, with its prevalence increasing since the late 1990s. Characterized by unchecked intestinal inflammation, multiple proinflammatory cytokines including IL6 have been implicated as critical factors in this pathology. It has been established that EZH2 is a gene involved in the production of specific histone methyltransferase enzymes, as well as in the differentiation of Treg cells. The association between the Treg master transcription factor, Foxp3 and EZH2 results in the suppressive function of Tregs, with our previous work revealing impairment of this interaction under the influence of IL6 signaling in an inflamed intestinal setting. We investigated this further in a murine preventative T cell transfer model of colitis that involved injecting donor Treg cells that lacked IL6Ra, into immunocompromised mice. Histological scoring of the mice receiving the IL6Rko Tregs revealed a resolved inflammatory milieu and flow cytometric analysis of cells isolated from the spleens and MLNs showed increased Foxp3+ expression when compared to mice that received WT Tregs. Foxp3IL6Rako mice were subjected to a DSS model of colitis to further characterize the absence of the IL6R on Treg function in the intestinal milieu. Exacerbated signs of colitis were observed through histology and colon shortening of the conditional knockout mice when compared to their WT counterparts. We postulate that Tregs could be acting as a donor of sILR to promote intestinal integrity and healing. Further experiments will be conducted to define a role for the IL6R in the development of Foxp3+ cells, along with outlining the instrumental process of sIL6R donation in the intestinal milieu. Supported by Mayo Clinic Graduate School for Biomedical Sciences

Abstract A promising strategy in tumor immunotherapy is the use of activated dendritic cells as vehicles for tumor vaccines. Clinical trials of dendritic cell-based immunotherapies have proven successful, resulting in recent FDA approval for their use in the treatment of late-stage prostate cancer. Current formulations for dendritic cell-based immunotherapies are capable of prolonging patient survival by only four months, providing motivation for further investigation of ways to enhance dendritic cell priming of anti-tumor T cell responses. Since the discovery of B7-H1 by our laboratory, we have been investigating the regulatory function of B7-H1 expressed by immune cells. In preliminary studies investigating the use of B7-H1 knockout dendritic cells as tumor vaccines, we found that B7-H1 knockout dendritic cells prime enhanced anti-tumor CD8 T cell responses. Further investigations revealed that the enhanced CD8 T cell response raised by B7-H1 knockout dendritic cells is not due to a lack of signaling through the receptors for B7-H1 on CD8 T cells. We observed that B7-H1 knockout dendritic cells produced increased levels of IL-12, a key cytokine that is centrally involved in both innate and adaptive immunity. Our results suggest that B7-H1 expressed by dendritic cells has a role in negatively regulating IL-12 production, and as a result B7-H1 deficient dendritic cells are able to prime enhanced anti-tumor CD8 T cell responses.

Abstract We utilized CD11a, an integrin up-regulated on effector and memory CD8+ T cells, as a biomarker to identify, measure, and monitor endogenous tumor-reactive cytotoxic lymphocytes (CTLs) in two mouse tumor models and in melanoma patients. CD11ahigh CD8+ T cells were detected in primary and metastatic tumor sites after tumor cell injection, as well as in spontaneous murine breast cancer tissues. In the peripheral blood of melanoma patients, tumor antigen-specific T cells were detected within the population of CD11ahigh CD8+ T cells that express high levels of PD-1. Infusion of lethally irradiated tumor cells failed to stimulate the expansion of CD11ahigh CD8+ T cells, suggesting that the access of tumor cells to target tissues is required to induce CD11ahigh CD8+ T cell responses. Phenotypic analysis revealed that the CD11ahigh CD8+ T cells detected in our studies were proliferating (Ki67+) activated T cells (CD62L-, CD69+). Although CD11ahigh CD8+ T cells were differentiated effector cells with CTL effector functions, they were typically unable to control tumor growth in our mouse models, possibly due to high expression of PD-1. Our results demonstrate that CD11a can be used as a biomarker to identify and track endogenous tumor-reactive CTLs.

Abstract Studies from cancer and chronic infections show that B7-H1 (PD-L1) engagement with its receptor PD-1 enhances apoptosis of effector T cells. It is not clear how B7-H1 regulates T cell apoptosis and the subsequent impact of B7-H1 on T cell memory generation. In immunized B7-H1 deficient mice we observed increased expansion of effector CD8 T cells and delayed T cell contraction followed by protective CD8 T cell memory capable of completely rejecting tumor metastases in lung tissue. Intracellular staining revealed that antigen-primed CD8 T cells in B7-H1 deficient mice express lower levels of the pro-apoptotic molecule Bim. Injection of B7-H1 or PD-1 blocking antibody into immunized mice reduced Bim levels in effector CD8 T cells. In vitro studies show that engagement of activated CD8 T cells by plate-bound B7-H1 fusion protein led to increased cell death and higher levels of Bim expression. Our results suggest that B7-H1 may negatively regulate CD8 T cell memory by enhancing the depletion of effector CD8 T cells through up-regulation of Bim. Our findings would provide a new strategy to target B7-H1 signaling in effector CD8 T cells to achieve protective immunity in the treatment of cancer and infectious diseases.

Abstract Spontaneous antitumor immunity remains challenging to detect and monitor largely due to the absence of established biomarkers. We selected the integrin CD11a as a biomarker to define antitumor T cell responses. CD11a is up-regulated on effector and memory T cells and is involved in the killing of tumor cells by cytotoxic T lymphocytes. In primary (subcutaneously inoculated) and metastatic (intravenously injected) tumors, CD11a high CD8 T cells were detected in the primary (skin) or metastatic (lung) tumor sites, but not in secondary lymphoid organs. Once tumors were established, CD11a high CD8 T cells were identified in tumor draining lymph nodes and peripheral blood. Phenotype analysis revealed that CD11a high CD8 T cells were proliferating (Ki67+) activated T cells (CD62L low, CD69 high, PD-1 high). CD11a high CD8 T cells expressed the transcription factor T-bet but not Foxp3. Live, but not dead, tumor cells, induced expansion of CD11a high CD8 T cells in the lung, suggesting that the access of tumor cells to target tissues is required to induce CD11a high CD8 T cell responses. Our results suggest that CD11a may provide a new T cell biomarker to measure ongoing natural tumor-reactive T cell responses and to predicate the efficacy of tumor immunotherapy.

Sinus tachycardia (ST) is ubiquitous, but its presence outside of normal physiological triggers in otherwise healthy individuals remains a commonly encountered phenomenon in medical practice. In many cases, ST can be readily explained by a current medical condition that precipitates an increase in the sinus rate, but ST at rest without physiological triggers may also represent a spectrum of normal. In other cases, ST may not have an easily explainable cause but may represent serious underlying pathology and can be associated with intolerable symptoms. The classification of ST, consideration of possible etiologies, as well as the decisions of when and how to intervene can be difficult. ST can be classified as secondary to a specific, usually treatable, medical condition (eg, pulmonary embolism, anemia, infection, or hyperthyroidism) or be related to several incompletely defined conditions (eg, inappropriate ST, postural tachycardia syndrome, mast cell disorder, or post-COVID syndrome). While cardiologists and cardiac electrophysiologists often evaluate patients with symptoms associated with persistent or paroxysmal ST, an optimal approach remains uncertain. Due to the many possible conditions associated with ST, and an overlap in medical specialists who see these patients, the inclusion of experts in different fields is essential for a more comprehensive understanding. This article is unique in that it was composed by international experts in Neurology, Psychology, Autonomic Medicine, Allergy and Immunology, Exercise Physiology, Pulmonology and Critical Care Medicine, Endocrinology, Cardiology, and Cardiac Electrophysiology in the hope that it will facilitate a more complete understanding and thereby result in the better care of patients with ST.

Based on the rapid increase in incidence of inflammatory bowel disease (IBD), the identification of susceptibility genes and cell populations contributing to this condition is essential. Previous studies suggested multiple genes associated with the susceptibility of IBD; however, due to the analysis of whole-tissue samples, the contribution of individual cell populations remains widely unresolved. Single-cell RNA sequencing (scRNA-seq) provides the opportunity to identify underlying cellular populations. We determined the enrichment of Crohn’s disease (CD)-induced genes in a publicly available Crohn’s disease scRNA-seq dataset and detected the strongest induction of these genes in innate lymphoid cells (ILC1), highly activated T cells and dendritic cells, pericytes and activated fibroblasts, as well as epithelial cells. Notably, these genes were highly enriched in IBD-associated neoplasia, as well as sporadic colorectal cancer (CRC). Indeed, the same six cell populations displayed an upregulation of CD-induced genes in a CRC scRNA-seq dataset. Finally, after integrating and harmonizing the CD and CRC scRNA-seq data, we demonstrated that these six cell types display a gradual increase in gene expression levels from a healthy state to an inflammatory and tumorous state. Together, we identified cell populations that specifically upregulate CD-induced genes in CD and CRC patients and could, therefore, contribute to inflammation-associated tumor development.