Abstract P4-04-12: Enhancing the immunogenicity of breast cancer cells to stimulate innate immunity and augment the effects of cellular immunotherapy

A promising strategy for treating metastatic breast cancer is engaging the immune system to destroy disseminated breast cancer cells. However, breast cancer is a challenge for immunotherapy because of its inherent genetic heterogeneity and decreased immunogenicity. There is an unmet need to develop new, targeted therapies for breast cancer that stimulate the immune system and can be used in combination with checkpoint blockade or adoptive cell transfer to fight metastatic disease. One potential approach is to generate dying breast cancer cells that operate like a vaccine to stimulate a tumor-specific immune response. This is termed immunogenic cell death (ICD) and is characterized by a unique molecular signature, involving the release of molecules that attract and stimulate phagocytes like dendritic cells (DCs) and that could sensitize tumor cells to killing by natural killer (NK) cells. With the discovery of new ICD-inducing agents, interest in this approach is increasing. However, the current doses of drugs used to induce ICD may be too high to translate into clinically relevant regimens. To address these problems, our group developed a novel cytotoxic peptide, CT20p, and a nanotechnology-based platform to deliver and concentrate CT20p in breast tumors. We found that treatment of a murine xenograft model with nanomolar amounts of CT20p, encapsulated in nanoparticles formed with a novel hyperbranched polyester polymer (HBPE-NPs), resulted in regression of breast cancer tumors, and that dying breast cancer cells expressed markers characteristic of ICD, such as the pre-mortem exposure of the "eat me" signal, calreticulin (Crt). The intracellular target of CT20p is a protein called chaperonin-containing T-complex (CCT), which is essential for the folding of actin and tubulin and other critical proteins into their native forms. Disruption of CCT could cause endoplasmic reticulum (ER) stress through the accumulation of misfolded proteins. ER stress in turn initiates intracellular pathways that generate the danger signals associate with ICD. To this end, we observed that cancer cells treated with CT20p displayed alterations in PERK, a key mediator of the unfolded protein response (UPR) and translocation of Crt. As a result, CT20p-treated cancer cells were more readily phagocytosed. More importantly, NK cells more effectively killed cancer cells pre-treated with CT20p. This suggests that CT20p may stimulate NK cell cytotoxicity by inducing activating signals on cancer cells, which would greatly augment the curative effects of adoptive transfer of NK cells. In our experiments normal breast epithelial cells, macrophages or NK cells, themselves, were unaffected by CT20p treatment due reduced CCT. These studies indicate that a single molecule, CT20p, can do both the killing of cancer cells and activation of immune cells and can be combined with cellular immunotherapy (e.g. expanded NK cells) to provide a more complete protection from breast cancer recurrence and metastasis.

Citation Format: Khaled AR, Limaye A, Bassiouni R, Showalter A, Oyer J, Pandey V, Igarashi R, Altomare DA, Copik AJ. Enhancing the immunogenicity of breast cancer cells to stimulate innate immunity and augment the effects of cellular immunotherapy. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-04-12.

Patients' and their spouses' needs after total joint arthroplasty: a pilot study

PURPOSE

To describe the experiences and needs of patients and their spouses during hospitalization and recovery from either total hip or total knee arthroplasty.

DESIGN

Descriptive.

SAMPLE

A purposive sample of 5 patients and their spouses in one health sciences center.

METHODS

Qualitative study using a videotaped focus group interview.

FINDINGS

Content analysis revealed two perspectives of one theme: patients and their spouses need "help making transitions." Situational and role transitions that were problematic for patients reflected distress over not being able to resume activities they enjoyed within an expected time frame. Incongruence between expectations and reality was the source of distress. As a consequence of role reversal, spouses experienced feelings of insecurity and being overwhelmed. Health and illness transitions that patients experienced were also related to incongruence between expectations of the recovery period and the reality that recovery is a slow process. Pain experienced during postdischarge recovery and rehabilitation, and problems encountered when applying information and skills learned in the hospital to the home setting were sources of concern.

CONCLUSION

The needs and experiences of patients and spouses after total joint arthroplasty reflect transitional change--changes in roles, relationships, abilities, and behaviors. Health care professionals can facilitate transitions by providing education that reflects "best case-worst case scenarios" so that expectations of the recovery process are realistic. By being the link between hospital and home, health care professionals can lend support to patients as they continue the recovery process. As a program evaluation strategy, focus groups provide useful information to health care professionals who are interested in the needs and expectations of health care consumers.

IMPLICATIONS FOR NURSING RESEARCH

Further exploration of the needs of patients and their spouses following joint replacement surgery is warranted. Use of focus group methodology might provide additional insight into the needs of this population and suggest ways in which health care professionals can modify existing programs to help these patients and their spouses make the transitions.

Rhabdomyolysis and acute renal failure due to combination therapy with simvastatin and warfarin

Simvastatin, an inhibitor of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase, is widely used to treat hyperlipidaemia. Although myalgias are recognized adverse effects, clinically significant elevations in serum creatine phosphokinase (CPK) levels are uncommon. We describe a case of rhabdomyolysis and acute renal failure associated with concomitant use of simvastatin and warfarin. Rhabdomyolysis and renal failure occurred 7 days after warfarin (5 mg day-1) was added to a chronic stable dose of simvastatin (20 mg day-1) and resolved abruptly after discontinuation of simvastatin. We recommend careful monitoring when warfarin is given to patients receiving simvastatin.

Effect of salinity on growth, ion content, and cell wall chemistry in Atriplex prostrata (Chenopodiaceae)

Atriplex prostrata Boucher, a facultative halophyte, exhibits significant reduction in height and biomass and in the width of the cortex and vascular tissue under saline conditions. Therefore, the goal of this investigation was to determine the effect of salinity on plant growth as well as on the patterns of lignification, peroxidase activity, and extensin deposition. Biomass, leaf area, internode length, water potential, photosynthesis, transpiration, and ion content were measured. In addition, lignin, peroxidase, and extensin were, respectively, examined via phloroglucinol staining, peroxidase staining, and immunostaining with extensin antibody on tissue prints of free-hand stem sections. Length of internodes and leaf area significantly decreased with increased salinity, and net photosynthesis declined dramatically as well. There was a significant accumulation of Na+ in organs when plants were grown in saline solutions, while the concentration of K+, Ca2+, and Mg2+ decreased. The signals in tissue prints showed that soluble peroxidase and extensin accumulated in the first three internodes of A. prostrata grown under saline conditions. In contrast, lignification was reduced under saline growth conditions in the third and fourth internodes. These results indicate that extensin may replace lignin in providing mechanical support for cells, while stems remain in a juvenile stage because of growth retardation caused by salinity.

Construction of a recombinant bacterial plasmid containing pro-alpha 1(I) collagen DNA sequences

A partially purified mRNA preparation enriched for chick collagen messenger RNA activity was used as template for the synthesis of double stranded cDNA. The cDNA was ligated into the HindIII site of the plasmid vector pBR322 and used to transform Escherichia coli x1776. One plasmid with an 800-base pair insert was shown to contain DNA sequences corresponding to Type I pro-alpha 1 collagen.