On integrity in immunity during ontogeny or how thymic regulatory T cells work

The effect of Time-Acupoints-Space Acupuncture on fatigue in postoperative chemotherapy patients with breast cancer: a randomized controlled trial

Background

Breast cancer (BC) is a common malignant tumor in women, and cancer-related fatigue (CRF) is prevalent among breast cancer patients. Time-Acupoints-Space Acupuncture (ATAS) is an acupuncture method different from traditional acupuncture. It combines time acupoints with space acupoints, proposing a new treatment approach. This randomized controlled trial aims to evaluate whether ATAS can improve fatigue in postoperative chemotherapy patients with breast cancer.

Objective

This randomized controlled trial focuses on survivors of postoperative chemotherapy for breast cancer, primarily assessing whether ATAS can reduce fatigue in these patients. Additionally, it reports on the effects of ATAS on sleep, anxiety, depression, and inflammatory factors.

Methods

The researchers randomly assigned 90 postoperative breast cancer patients to the ATAS group (n=30), the sham acupuncture group (n=30), and the waitlist control group (n=30). The primary outcome was the Piper Fatigue Scale (PFS), and the secondary outcomes were the Insomnia Severity Index (ISI), Hospital Anxiety and Depression Scale (HADS), Interleukin-2 (IL-2), Interleukin-6 (IL-6), CD3+T, and CD4+T. Data analysis was performed using the statistical software SPSS, utilizing descriptive statistics and analytic statistics. The significance level was set at less than 0.05.

Results

The baseline differences in PFS scores among the three groups were not statistically significant (P > 0.05). ATAS treatment is superior to sham acupuncture and the waitlist control in improving fatigue (mean difference 4.98, 95% CI 3.96 to 6.00, P<0.05). Additionally, secondary outcome analysis shows that the ATAS group has positive effects on ISI, HADS, and inflammatory factors. After the treatment ended, ISI (mean difference 15.17, 95% CI 12.28 to 18.06, P<0.05), HADS-A (mean difference 8.63, 95% CI 5.18 to 12.08, P<0.05), HADS-D (mean difference 7.80, 95% CI 4.73 to 10.87, P<0.05). IL-2(mean difference 20.18, 95% CI 11.51 to 28.85, P<0.05), IL-6(mean difference 24.56, 95% CI 7.57 to 41.55, P<0.05), CD3+T(mean difference 79.03, 95% CI 68.56 to 89.50, P<0.05), CD4+T(mean difference 42.89, 95% CI 35.14 to 50.64, P<0.05).

Conclusions

Our preliminary findings indicate that ATAS effectively improves fatigue in postoperative chemotherapy patients with breast cancer. It also has positive effects on sleep, anxiety, depression, and inflammatory factors. These results suggest that ATAS intervention may be an effective method for alleviating fatigue in breast cancer patients.

Clinical Trial Registration

https://www.chictr.org.cn/showproj.html?proj=21999, identifier ChiCTR17013652.

Low Expression of Lipoic Acid Synthase Aggravates Silica-Induced Pulmonary Fibrosis by Inhibiting the Differentiation of Tregs in Mice

Aims: In addition to reducing the respiratory function, crystalline silica (SiO2) disturbs the immune response by affecting immune cells during the progression of silicosis. Regulatory T cell (Treg) differentiation may play a key role in the abnormal polarization of T helper cell (Th)1 and Th2 cells in the development of silicosis-induced fibrosis. Alpha-lipoic acid (ALA) has immunomodulatory effects by promoting Tregs differentiation. Thus, ALA may have a therapeutic potential for treating autoimmune disorders in patients with silicosis. However, little is known regarding whether ALA regulates the immune system during silicosis development. Results: We found that the expression levels of collagen increased, and the antioxidant capacity was lower in the Lias-/-+SiO2 group than in the Lias+/++SiO2 group. The proportion of Tregs decreased in the peripheral blood and spleen tissue in mice exposed to SiO2. The proportion of Tregs in the Lias-/-+SiO2 group was significantly lower than that in the Lias+/++SiO2 group. Supplementary exogenous ALA attenuates the accumulation of inflammatory cells and extracellular matrix in lung tissues. ALA promotes the immunological balance between Th17 and Treg responses during the development of silicosis-induced fibrosis. Innovation and Conclusion: Our findings confirmed that low expression of lipoic acid synthase aggravates SiO2-induced silicosis, and that supplementary exogenous ALA has therapeutic potential by improving Tregs in silicosis fibrosis.

Defending and Integrating an Organism by the Immune System

The Integrity model proposes that the adaptive immune response defends, protects and keeps vigilance over the unity of an organism. These functions conceptually rely on three signals that can explain them. All signals have a dual character. The signal‐1 is the recognition of antigen or peptide/MHC ligand. The signal‐2 comprises either help and costimulation or suppression and coinhibition. Lastly, the signal‐3 signals tissues' condition, state or integrity. A part overlaps with the Danger‐associated molecular patterns, and the other part should be detected by putative cell‐surface molecules, intracellular factors or epigenetic events. They are called the Integrity‐associated molecular patterns (IAMPs). The IAMPs originate from damaged (positive signal‐3) or undamaged (negative signal‐3) tissues. The positive signal‐3 would induce costimulatory signal‐2, whereas the negative signal‐3 would induce coinhibitory signal‐2 in APCs. However, in analogue reality, we might more likely encounter a range of signals supposedly sensed by a group of responder cells and integrated overtime (quorum sensing). The predominant option would sway the decision of the immune system to perform either defence or protection (active tolerance). Thus, the quorum sensing supposedly delivers two qualitative thresholds for T (and B) cells' decisions to defend or suppress. If these were not attained, the vigilance (anergy) of adaptive immunocytes for T‐dependent antigens would ensue. These functions provide defence against pathogens and preservation of unity/integrity of an organism, which in turn permits protection of commensals.

Antitumor Drugs and Their Targets

Through novel methodologies, including both basic and clinical research, progress has been made in the therapy of solid cancer. Recent innovations in anticancer therapies, including immune checkpoint inhibitor biologics, therapeutic vaccines, small drugs, and CAR-T cell injections, mark a new epoch in cancer research, already known for faster (epi-)genomics, transcriptomics, and proteomics. As the long-sought after personalization of cancer therapies comes to fruition, the need to evaluate all current therapeutic possibilities and select the best for each patient is of paramount importance. This is a novel task for medical care that deserves prominence in therapeutic considerations in the future. This is because cancer is a complex genetic disease. In its deadly form, metastatic cancer, it includes altered genes (and their regulators) that encode ten hallmarks of cancer-independent growth, dodging apoptosis, immortalization, multidrug resistance, neovascularization, invasiveness, genome instability, inflammation, deregulation of metabolism, and avoidance of destruction by the immune system. These factors have been known targets for many anticancer drugs and treatments, and their modulation is a therapeutic goal, with the hope of rendering solid cancer a chronic rather than deadly disease. In this article, the current therapeutic arsenal against cancers is reviewed with a focus on immunotherapies.

MHC-II alleles shape the CDR3 repertoires of conventional and regulatory naïve CD4+ T cells

T cell maturation and activation depend upon T cell receptor (TCR) interactions with a wide variety of antigenic peptides displayed in a given major histocompatibility complex (MHC) context. Complementarity-determining region 3 (CDR3) is the most variable part of the TCRα and -β chains, which govern interactions with peptide-MHC complexes. However, it remains unclear how the CDR3 landscape is shaped by individual MHC context during thymic selection of naïve T cells. We established two mouse strains carrying distinct allelic variants of H2-A and analyzed thymic and peripheral production and TCR repertoires of naïve conventional CD4⁺ T (T_conv) and naïve regulatory CD4⁺ T (T_reg) cells. Compared with tuberculosis-resistant C57BL/6 (H2-A^b) mice, the tuberculosis-susceptible H2-A^j mice had fewer CD4⁺ T cells of both subsets in the thymus. In the periphery, this deficiency was only apparent for T_conv and was compensated for by peripheral reconstitution for T_reg We show that H2-A^j favors selection of a narrower and more convergent repertoire with more hydrophobic and strongly interacting amino acid residues in the middle of CDR3α and CDR3β, suggesting more stringent selection against a narrower peptide-MHC-II context. H2-A^j and H2-A^b mice have prominent reciprocal differences in CDR3α and CDR3β features, probably reflecting distinct modes of TCR fitting to MHC-II variants. These data reveal the mechanics and extent of how MHC-II shapes the naïve CD4⁺ T cell CDR3 landscape, which essentially defines adaptive response to infections and self-antigens.

Regulatory T cells and co-evolution of allele-specific MHC recognition by the TCR

What is the evolutionary mechanism for the TCR-MHC-conserved interaction? We extend Dembic's model (Dembic Z. In, Scand J Immunol e12806, 2019) of thymus positive selection for high-avidity anti-self-MHC Tregs among double (CD4 + CD8+)-positive (DP) developing thymocytes. This model is based on competition for self-MHC (+ Pep) complexes presented on cortical epithelium. Such T cells exit as CD4 + CD25+FoxP3 + thymic-derived Tregs (tTregs). The other positively selected DP T cells are then negatively selected on medulla epithelium removing high-avidity anti-self-MHC + Pep as T cells commit to CD4 + or CD8 + lineages. The process is likened to the competitive selection and affinity maturation in Germinal Centre for the somatic hypermutation (SHM) of rearranged immunoglobulin (Ig) variable region (V[D]Js) of centrocytes bearing antigen-specific B cell receptors (BCR). We now argue that the same direct SHM processes for TCRs occur in post-antigenic Germinal Centres, but now occurring in peripheral pTregs. This model provides a potential solution to a long-standing problem previously recognized by Cohn and others (Cohn M, Anderson CC, Dembic Z. In, Scand J Immunol e12790, 2019) of how co-evolution occurs of species-specific MHC alleles with the repertoire of their germline TCR V counterparts. We suggest this is not by 'blind', slow, and random Darwinian natural selection events, but a rapid structured somatic selection vertical transmission process. The pTregs bearing somatic TCR V mutant genes then, on arrival in reproductive tissues, can donate their TCR V sequences via soma-to-germline feedback as discussed in this journal earlier. (Steele EJ, Lindley RA. In, Scand J Immunol e12670, 2018) The high-avidity tTregs also participate in the same process to maintain a biased, high-avidity anti-self-MHC germline V repertoire.