NCI Resources for Cancer Immunoprevention Research

Cancer prevention and early detection, the first two of the eight primary goals of the National Cancer Plan released in April 2023, are at the forefront of the nation's strategic efforts to reduce cancer incidence and mortality. The Division of Cancer Prevention (DCP) of the NCI is the federal government's principal component devoted to promoting and supporting innovative cancer prevention research. Recent advances in tumor immunology, cancer immunotherapy, and vaccinology strongly suggest that the host immune system can be effectively harnessed to elicit protective immunity against the development of cancer, that is, cancer immunoprevention. Cancer immunoprevention may be most effective if the intervention is given before or early in the carcinogenic process while the immune system remains relatively uncompromised. DCP has increased the emphasis on immunoprevention research in recent years and continues to expand program resources and interagency collaborations designed to facilitate research in the immunoprevention field. These resources support a wide array of basic, translational, and clinical research activities, including discovery, development, and validation of biomarkers for cancer risk assessment and early detection (Early Detection Research Network), elucidation of biological and pathophysiological mechanistic determinants of precancer growth and its control (Translational and Basic Science Research in Early Lesions), spatiotemporal multiomics characterization of precancerous lesions (Human Tumor Atlas Network/Pre-Cancer Atlas), discovery of immunoprevention pathways and immune targets (Cancer Immunoprevention Network), and preclinical and clinical development of novel agents for immunoprevention and interception (Cancer Prevention-Interception Targeted Agent Discovery Program, PREVENT Cancer Preclinical Drug Development Program, and Cancer Prevention Clinical Trials Network).

Comprehensive immunoprofiling and systematic adjuvant comparisons for identifying suitable vaccine: Adjuvant pairings

Adjuvants are critical components of vaccines that enhance the host immune response to the vaccine antigen, however, only a small number of adjuvants are used in vaccines approved for human use. This is in part due to the slow process of novel adjuvants advancing from preclinical models to human studies, and modest mechanistic insights obtained using standard immunological methods to justify selection of a particular adjuvant for clinical evaluation. Here, we discuss several aspects of current adjuvant research and strategies to better assess the complex pathways triggered by adjuvant candidates that can increase adjuvanticity and vaccine efficacy while minimizing reactogenicity. We propose a more systematic use of broad immunoprofiling, coupled with data integration using computational and mathematical modeling. This comprehensive evaluation of the host immune response will facilitate the selection of the most appropriate adjuvant for a vaccine, ultimately leading to the expeditious evaluation of novel adjuvants for vaccines against emerging infectious diseases, which will prove especially valuable during a pandemic where speed is of the essence when developing vaccines.

Prolapse of Orbital Fat through the Inferior Orbital Fissure: Description, Prevalence, and Assessment of Possible Pathologic Associations

BACKGROUND AND PURPOSE

A few patterns of orbital fat prolapse have been described. Some are associated with disease, and others may mimic a neoplasm. We have observed prolapse of orbital fat into the infratemporal fossa via the inferior orbital fissure on MR imaging. The clinical relevance of this finding, if any, is unknown. The purposes of this study were to describe the MR imaging appearance of orbital fat prolapse through the inferior orbital fissure, to estimate the prevalence of this finding, and to assess possible pathologic associations.

MATERIALS AND METHODS

For this retrospective study of 228 orbital MR imaging examinations, 3 neuroradiologists independently assessed the presence of prolapse on high-resolution T1-weighted images. Discrepancies were resolved by consensus, and interobserver agreement was calculated. Patient demographics, indications for imaging, and pertinent clinical history were recorded. One-way analysis of variance and the Fisher exact test were used to assess possible associations between prolapse and specific patient characteristics.

RESULTS

Orbital fat prolapse through the inferior orbital fissure was observed in 20/228 patients (9%). This finding was unilateral in 11 patients (55%) and bilateral in 9 patients (45%). There was no significant association with age, sex, obesity, Graves disease, hypercortisolism, prior orbital trauma, proptosis, or enophthalmos. Interobserver agreement was 90%.

CONCLUSIONS

Prolapse of orbital fat into the infratemporal fossa via the inferior orbital fissure is a relatively common finding on orbital MR imaging that has no identified pathologic association. Neuroradiologists should recognize this finding so as not to report it as pathologic.

Trochlear Groove and Trochlear Cistern: Useful Anatomic Landmarks for Identifying the Tentorial Segment of Cranial Nerve IV on MRI

BACKGROUND AND PURPOSE

The trochlear groove and trochlear cistern are anatomic landmarks closely associated with the tentorial segment of cranial nerve IV. The purposes of this study were to describe the MR imaging appearances of the trochlear groove and trochlear cistern and to test our hypothesis that knowledge of these anatomic landmarks facilitates identification of cranial nerve IV in routine clinical practice.

MATERIALS AND METHODS

For this retrospective study, consecutive MR imaging examinations of the sinuses performed in 25 patients (50 sides) at our institution were reviewed. Patient characteristics and study indications were recorded. Three readers performed independent assessments of trochlear groove, cistern, and nerve visibility on coronal images obtained by using a T2-weighted driven equilibrium radiofrequency reset pulse sequence.

RESULTS

Interobserver agreement was 78% for visibility of the trochlear groove, 56% for the trochlear cistern, and 68% for cranial nerve IV. Following consensus review, the trochlear groove was present in 44/50 sides (88%), the trochlear cistern was present in 25/50 sides (50%), and cranial nerve IV was identified in 36/50 sides (72%). When the trochlear groove was present, cranial nerve IV was identified in 35/44 sides (80%), in contrast to 1/6 sides (17%) with no groove (P = .0013). When the trochlear cistern was present, cranial nerve IV was identified in 23/25 sides (92%), in contrast to 13/25 sides (52%) with no cistern (P = .0016).

CONCLUSIONS

The trochlear groove and trochlear cistern are anatomic landmarks that facilitate identification of cranial nerve IV in routine clinical practice.

CT Findings in the External Auditory Canal after Transcanal Surgery

BACKGROUND AND PURPOSE

Middle ear surgery is often performed through the external auditory canal, and the CT appearance of the external auditory canal after transcanal middle ear surgery can mimic erosive pathology such as carcinoma, external auditory canal cholesteatoma, or necrotizing external otitis. We reviewed the CT findings in a group of patients following transcanal surgery to highlight this potential pitfall in interpretation.

MATERIALS AND METHODS

Twenty-seven temporal bones in 25 patients with a history of a transcanal approach to the middle ear and available postoperative CT imaging were identified. Images were assessed for changes along or involving the walls of the external auditory canal, including widening, irregularity, bony defects, and soft tissue opacification.

RESULTS

Osseous changes along the floor of the external auditory canal were demonstrated in 25 of 27 (92.6%) temporal bone CT scans. Similar changes were present in the superior and anterior walls of the external auditory canal in 21 and 18 temporal bones, respectively. The anterior wall was the most common site for complete bony defects (10 of 27 temporal bones). The posterior wall was the least often involved, with osseous changes in 15 of 27 temporal bones and bony defects in 3 cases. Soft tissue thickening was seen most commonly along the floor. No patient was found to have a superimposed pathologic process of the external auditory canal.

CONCLUSIONS

CT findings in the external auditory canal after transcanal surgery include thinning, irregularity and/or flattening of the bone, soft tissue thickening, and bony wall defects. Although these changes may be subtle, they may mimic pathology and should be included in the differential diagnosis of osseous abnormality of the external auditory canal.

4D-CT for preoperative localization of abnormal parathyroid glands in patients with hyperparathyroidism: accuracy and ability to stratify patients by unilateral versus bilateral disease in surgery-naive and re-exploration patients

BACKGROUND AND PURPOSE

4D-CT is an emerging technique that uses high-resolution images, multiplanar reformats, and perfusion characteristics to identify abnormal parathyroid glands in patients with hyperparathyroidism. This study evaluates the accuracy of 4D-CT for localization and lateralization of abnormal parathyroid glands in preoperative planning for minimally invasive parathyroidectomy vs bilateral neck exploration at a tertiary referral center.

MATERIALS AND METHODS

Radiology, pathology, and operative reports were retrospectively reviewed for 208 patients with hyperparathyroidism who underwent 4D-CT and parathyroid surgery between May 2008 and January 2012. 4D-CT performance in localizing side and site was determined by use of surgical and pathologic findings as a reference.

RESULTS

Of 208 patients, 155 underwent initial surgery and 53 underwent re-exploration parathyroid surgery. No lesions were found in 8 patients (3.8%). A total of 284 lesions were found in 200 patients; 233 were correctly localized by 4D-CT (82.0%). Of the 200 patients with parathyroid lesions, 146 underwent unilateral and 54 bilateral neck exploration. 4D-CT correctly identified unilateral vs bilateral disease in 179 (89.5%) of 200. 4D-CT correctly localized parathyroid lesions in 126 of the unilateral cases (86.3%). In the re-exploration cohort, 4D-CT correctly identified unilateral vs bilateral disease in 46 (95.8%) of 48. There was no statistically significant difference in subgroups stratified by surgery type (primary or subsequent) and number of scan phases (3 or 4) (P > .56).

CONCLUSIONS

4D-CT leverages modern high-resolution CT scanning and dynamic contrast enhancement to localize abnormal parathyroid glands in patients with hyperparathyroidism of any cause and can be used for planning minimally invasive parathyroidectomy vs bilateral neck exploration.

Contrast extravasation on CT angiography predicts hematoma expansion and mortality in acute traumatic subdural hemorrhage

BACKGROUND AND PURPOSE

The presence of active contrast extravasation at CTA predicts hematoma expansion and in-hospital mortality in patients with nontraumatic intracerebral hemorrhage. This study aims to determine the frequency and predictive value of the contrast extravasation in patients with aSDH.

MATERIALS AND METHODS

We retrospectively reviewed 157 consecutive patients who presented to our emergency department over a 9-year period with aSDH and underwent CTA at admission and a follow-up NCCT within 48 hours. Two experienced readers, blinded to clinical data, reviewed the CTAs to assess for the presence of contrast extravasation. Medical records were reviewed for baseline clinical characteristics and in-hospital mortality. aSDH maximum width in the axial plane was measured on both baseline and follow-up NCCTs, with hematoma expansion defined as >20% increase from baseline.

RESULTS

Active contrast extravasation was identified in 30 of 199 discrete aSDHs (15.1%), with excellent interobserver agreement (κ = 0.80; 95% CI, 0.7-0.9). The presence of contrast extravasation indicated a significantly increased risk of hematoma expansion (odds ratio, 4.5; 95% CI, 2.0-10.1; P = .0001) and in-hospital mortality (odds ratio, 7.6; 95% CI, 2.6-22.3; P = 0.0004). In a multivariate analysis controlled for standard risk factors, the presence of contrast extravasation was an independent predictor of aSDH expansion (P = .001) and in-hospital mortality (P = .0003).

CONCLUSIONS

Contrast extravasation stratifies patients with aSDH into those at high risk and those at low risk of hematoma expansion and in-hospital mortality. This distinction could affect patient treatment, clinical trial selection, and possible surgical intervention.

Neutralizing antibody patterns and viral escape in HIV-1 non-B subtype chronically infected treatment-naive individuals

Here we studied the patterns of generation of neutralizing antibodies (NAbs) and virus escape during non-B subtype HIV-1 chronic infection among asymptomatic patients, and established whether a correlation exists between the generation of NAbs and the kinetics of CD4 T-cell decline. Therefore, sequential viruses and plasma obtained at 6 months to one year intervals over a three years period from ten HIV-1 group M subtype A, CRF02_AG, G, and H infected treatment-naïve individuals were tested in neutralization assays. Overall, NAbs were present in all ten individuals, and had the capacity to neutralize autologous virus obtained six months earlier. Eight of the ten subjects showed an increasing capacity to neutralize early viruses and a low capacity to neutralize contemporaneous and later time-point viruses. The neutralizing activities within these individuals resulted in emergence of neutralization resistant viruses, and with the subsequent generation of more NAbs to the emerging resistant viruses. In the remaining two individuals, the capacity to neutralize early, contemporaneous, and later time-point viruses remained conserved. While the kinetics of CD4 T-cell decline varied among all ten individuals, there was no correlation with the capacity to generate NAbs in that, sequential plasmas from individuals with moderately or rapidly declining CD4 T-cells were capable of neutralizing early sequential viruses. We conclude from this study that in non-B subtype chronically infected asymptomatic patients with moderately and rapidly declining CD4 T-cells, potent NAbs are readily generated as the virus evolves to escape the effect of these antibodies.

Behaviour of 3-week weaned pigs in Straw-Flow(R), deep straw and flatdeck housing systems

The behaviour of 3-week weaned pigs in different housing systems was examined as part of an assessment of the suitability of the Straw-Flow(R) system for pigs of this age. Three replicate pens of 20 pigs were weaned at 6.4 kg liveweight into each of: (a) deep-straw; (b) Straw-Flow(R); (c) large flatdeck; (d) small flatdeck. A kenneled lying area was provided in (a) and (b). The floor in (c) and (d) was expanded metal. Stocking densities were 0.23 m(2)/pig in (a), (b) and (c), and 0.17 m(2)/pig in (d). After 4-5 weeks (at 19.6 kg liveweight), 16 pigs from each pen were moved into Straw-Flow(R) grower pens (0.68 m(2)/pig) and observed until slaughter at 90.6 kg. Pigs in systems incorporating straw showed behaviour patterns associated with increased welfare (greater straw-directed behaviour and less pig-directed and pen-directed behaviour) relative to those in barren pens. Behavioural differences between (a) and (b) related to differences in available straw; there were few differences between (c) and (d). Pigs from (c) and (d) showed increased rooting relative to those from (a) after transfer to the grower pens, but other behavioural differences between weaner treatments did not persist. It is concluded that the Straw-Flow(R) system can provide suitable accommodation for weaned pigs.