Impact of steroid premedication on atezolizumab (atezo)-induced immune cell activation: A comparative analysis of IMpassion130 and IMpassion131 peripheral blood mononuclear cells (PBMCs)

1083

Background: The immune checkpoint inhibitor (ICI) atezo showed disparate outcomes as first-line therapy for metastatic TNBC when combined with nab-paclitaxel (nPac) in IMpassion130 [Schmid 2018] vs solvent-based paclitaxel (Pac) in IMpassion131 [Miles 2021]. A key difference between the trials was use of steroid premedication for Pac in IMpassion131 but not for nPac in IMpassion130. In patients (pts) receiving ICIs, prior steroid exposure has been linked to worse outcome [Drakaki 2020]. Further, IMpassion130 and IMpassion131 subgroup analyses suggested reduced atezo treatment effect in taxane-pretreated pts. This post hoc biomarker study explored the impact of: 1) steroids on systemic immune cell activation with atezo+taxane; 2) prior taxane exposure on atezo-induced immune cell activation. Methods: PBMCs collected at baseline and at day 1, cycle 2 (wk 4) were selected from matched pts (RECIST responders, PD-L1+, no liver metastases) from IMpassion130 and IMpassion131. Single-cell RNAseq was performed and the transcriptomic profile of immune cells was analyzed using GSEA pathway analyses, cell proportion and TCR clonality. Results: CITEseq from 695,851 single cells was generated from 39 IMpassion130 PBMC pairs (29 atezo+nPac; 10 placebo [Pla]+nPac) and 35 IMpassion131 pairs (26 atezo+Pac; 9 Pla+Pac). At wk 4, atezo+nPac resulted in increased IFNα and IFNγ responses across multiple cell types (CD4+ and CD8+ T cells, B cells, NK cells and monocytes) and proliferation in NK cells, but reduced TNF signaling across multiple cell types. In contrast, 4 wks of Pla+nPac increased TNF signaling but decreased IFNα and IFNγ responses. In the presence of steroids, 4 wks of atezo+Pac also increased IFNα and IFNγ responses mainly in NK cells and monocytes, but not T cells, and reduced proliferative pathways across B and T cells and TNF signaling. Pla+Pac increased TNF signaling only in NK cells, but reduced proliferative signatures across cell types. The only on-treatment change differing significantly between atezo+nPac vs atezo+Pac was the increase in proliferation pathways in NK, T and B cells with atezo+nPac. There were no significant changes in proportions of cell subsets or TCR clonality. PBMCs from taxane-pretreated pts had higher RNA-based metabolic profile (OxPhos, DNA repair and IFNα). Taxane-naive but not taxane-pretreated immune cells had increased IFNγ and IFNα response after atezo+taxane. Conclusions: Our results suggest that atezo+taxane promotes IFNα and IFNγ responses and that steroid co-administration reduces proliferation pathways across immune cells. Prior taxane exposure was associated with an increased metabolic status, possibly rendering immune cells less sensitive to atezo-induced activation. The immune context of taxane-naive TNBC may result in more potent immune activation with atezo. Clinical trial information: NCT02425891 and NCT03125902.

Long reads capture simultaneous enhancer-promoter methylation status for cell-type deconvolution

MOTIVATION

While promoter methylation is associated with reinforcing fundamental tissue identities, the methylation status of distant enhancers was shown by genome-wide association studies to be a powerful determinant of cell-state and cancer. With recent availability of long reads that report on the methylation status of enhancer-promoter pairs on the same molecule, we hypothesized that probing these pairs on the single-molecule level may serve the basis for detection of rare cancerous transformations in a given cell population. We explore various analysis approaches for deconvolving cell-type mixtures based on their genome-wide enhancer-promoter methylation profiles.

RESULTS

To evaluate our hypothesis we examine long-read optical methylome data for the GM12878 cell line and myoblast cell lines from two donors. We identified over 100 000 enhancer-promoter pairs that co-exist on at least 30 individual DNA molecules. We developed a detailed methodology for mixture deconvolution and applied it to estimate the proportional cell compositions in synthetic mixtures. Analysis of promoter methylation, as well as enhancer-promoter pairwise methylation, resulted in very accurate estimates. In addition, we show that pairwise methylation analysis can be generalized from deconvolving different cell types to subtle scenarios where one wishes to resolve different cell populations of the same cell-type.

AVAILABILITY AND IMPLEMENTATION

The code used in this work to analyze single-molecule Bionano Genomics optical maps is available via the GitHub repository https://github.com/ebensteinLab/Single_molecule_methylation_in_EP.

Multi-clonal SARS-CoV-2 neutralization by antibodies isolated from severe COVID-19 convalescent donors

The interactions between antibodies, SARS-CoV-2 and immune cells contribute to the pathogenesis of COVID-19 and protective immunity. To understand the differences between antibody responses in mild versus severe cases of COVID-19, we analyzed the B cell responses in patients 1.5 months post SARS-CoV-2 infection. Severe, and not mild, infection correlated with high titers of IgG against Spike receptor binding domain (RBD) that were capable of ACE2:RBD inhibition. B cell receptor (BCR) sequencing revealed that VH3-53 was enriched during severe infection. Of the 22 antibodies cloned from two severe donors, six exhibited potent neutralization against authentic SARS-CoV-2, and inhibited syncytia formation. Using peptide libraries, competition ELISA and mutagenesis of RBD, we mapped the epitopes of the neutralizing antibodies (nAbs) to three different sites on the Spike. Finally, we used combinations of nAbs targeting different immune-sites to efficiently block SARS-CoV-2 infection. Analysis of 49 healthy BCR repertoires revealed that the nAbs germline VHJH precursors comprise up to 2.7% of all VHJHs. We demonstrate that severe COVID-19 is associated with unique BCR signatures and multi-clonal neutralizing responses that are relatively frequent in the population. Moreover, our data support the use of combination antibody therapy to prevent and treat COVID-19.

Multi-Clonal Live SARS-CoV-2 In Vitro Neutralization by Antibodies Isolated from Severe COVID-19 Convalescent Donors

The interactions between antibodies, SARS-CoV-2 and immune cells contribute to the pathogenesis of COVID-19 and protective immunity. To understand the differences between antibody responses in mild versus severe cases of COVID-19, we analyzed the B cell responses in patients 1.5 months post SARS-CoV-2 infection. Severe and not mild infection correlated with high titers of IgG against Spike receptor binding domain (RBD) that were capable of viral inhibition. B cell receptor (BCR) sequencing revealed two VH genes, VH3-38 and VH3-53, that were enriched during severe infection. Of the 22 antibodies cloned from two severe donors, six exhibited potent neutralization against live SARS-CoV-2, and inhibited syncytia formation. Using peptide libraries, competition ELISA and RBD mutagenesis, we mapped the epitopes of the neutralizing antibodies (nAbs) to three different sites on the Spike. Finally, we used combinations of nAbs targeting different immune-sites to efficiently block SARS-CoV-2 infection. Analysis of 49 healthy BCR repertoires revealed that the nAbs germline VHJH precursors comprise up to 2.7% of all VHJHs. We demonstrate that severe COVID-19 is associated with unique BCR signatures and multi-clonal neutralizing responses that are relatively frequent in the population. Moreover, our data support the use of combination antibody therapy to prevent and treat COVID-19.

Rapid Quantification of Oxidation and UV Induced DNA Damage by Repair Assisted Damage Detection-(Rapid RADD)

Knowing the amount and type of DNA damage is of great significance for a broad range of clinical and research applications. However, existing methods are either lacking in their ability to distinguish between types of DNA damage or limited in their sensitivity and reproducibility. The method described herein enables rapid and robust quantification of type-specific single-strand DNA damage. The method is based on repair-assisted damage detection (RADD) by which fluorescent nucleotides are incorporated into DNA damage sites using type-specific repair enzymes. Up to 90 DNA samples are then deposited on a multiwell glass slide, and analyzed by a conventional slide scanner for quantification of DNA damage levels. Accurate and sensitive measurements of oxidative or UV-induced DNA damage levels and repair kinetics are presented for both in vitro and in vivo models.

Curated, multi-omic, ML-driven single-cell atlas for characterizing the human immune system across disease states

The immune system plays a key role in various diseases such as cancer, autoimmune disorders and infections. It has been recently shown that cell surface protein markers on peripheral blood mononuclear cells (PBMCs) can be predictive of response to therapies1, but measurements of such markers is technically limited in the number of cells and markers that can be assessed. Single-cell RNA technology allows the measurement of the entire transcriptome in tens of thousands of cells, and therefore has the potential to survey the immune system in more depth and reveal rare cell states. However, no large single-cell datasets for immune cell states exist. Moreover, attempts to combine smaller distinct datasets are often hindered by batch effects stemming from differences in sample handling, single-cell technologies and computational analyses. We created a large curated multi-omic single-cell human PBMC atlas with clinical annotations from dozens of patients with several conditions across hundreds of thousands of cells. Our standardized end-to-end protocols and quality control processes provide a platform that allows production of large datasets with minimal batch effects. By combining single-cell RNA-seq (scRNA-seq) with surface marker identification by CITE-seq, we generate curated immune gene signatures and train a classifier to robustly identify many cell types and states across patients and different diseases, including rare cell populations. This curated, multi-omic clinically-annotated atlas is particularly suited for use by machine learning algorithms, and we are confident that as this data accumulates, it will be instrumental for inferring disease states and predict responses to various therapies.

Selective nanopore sequencing of human BRCA1 by Cas9-assisted targeting of chromosome segments (CATCH)

Next generation sequencing (NGS) is challenged by structural and copy number variations larger than the typical read length of several hundred bases. Third-generation sequencing platforms such as single-molecule real-time (SMRT) and nanopore sequencing provide longer reads and are able to characterize variations that are undetected in NGS data. Nevertheless, these technologies suffer from inherent low throughput which prohibits deep sequencing at reasonable cost without target enrichment. Here, we optimized Cas9-Assisted Targeting of CHromosome segments (CATCH) for nanopore sequencing of the breast cancer gene BRCA1. A 200 kb target containing the 80 kb BRCA1 gene body and its flanking regions was isolated intact from primary human peripheral blood cells, allowing long-range amplification and long-read nanopore sequencing. The target was enriched 237-fold and sequenced at up to 70× coverage on a single flow-cell. Overall performance and single-nucleotide polymorphism (SNP) calling were directly compared to Illumina sequencing of the same enriched sample, highlighting the benefits of CATCH for targeted sequencing. The CATCH enrichment scheme only requires knowledge of the target flanking sequence for Cas9 cleavage while providing contiguous data across both coding and non-coding sequence and holds promise for characterization of complex disease-related or highly variable genomic regions.

Long-read single-molecule maps of the functional methylome

We report on the development of a methylation analysis workflow for optical detection of fluorescent methylation profiles along chromosomal DNA molecules. In combination with Bionano Genomics genome mapping technology, these profiles provide a hybrid genetic/epigenetic genome-wide map composed of DNA molecules spanning hundreds of kilobase pairs. The method provides kilobase pair–scale genomic methylation patterns comparable to whole-genome bisulfite sequencing (WGBS) along genes and regulatory elements. These long single-molecule reads allow for methylation variation calling and analysis of large structural aberrations such as pathogenic macrosatellite arrays not accessible to single-cell second-generation sequencing. The method is applied here to study facioscapulohumeral muscular dystrophy (FSHD), simultaneously recording the haplotype, copy number, and methylation status of the disease-associated, highly repetitive locus on Chromosome 4q.

Microfluidic DNA combing for parallel single-molecule analysis

DNA combing is a widely used method for stretching and immobilising DNA molecules on a surface. Fluorescent labelling of genomic information enables high-resolution optical analysis of DNA at the single-molecule level. Despite its simplicity, the application of DNA combing in diagnostic workflows is still limited, mainly due to difficulties in analysing multiple small-volume DNA samples in parallel. Here, we report a simple and versatile microfluidic DNA combing technology (μDC), which allows manipulating, stretching and imaging of multiple, microliter scale DNA samples by employing a manifold of parallel microfluidic channels. Using DNA molecules with repetitive units as molecular rulers, we demonstrate that the μDC technology allows uniform stretching of DNA molecules. The stretching ratio remains consistent along individual molecules as well as between different molecules in the various channels, allowing simultaneous quantitative analysis of different samples loaded into parallel channels. Furthermore, we demonstrate the application of μDC to characterise UVB-induced DNA damage levels in human embryonic kidney cells and the spatial correlation between DNA damage sites. Our results point out the potential application of μDC for quantitative and comparative single-molecule studies of genomic features. The extremely simple design of μDC makes it suitable for integration into other microfluidic platforms to facilitate high-throughput DNA analysis in biological research and medical point-of-care applications.

Epigenetic Optical Mapping of 5-Hydroxymethylcytosine in Nanochannel Arrays

The epigenetic mark 5-hydroxymethylcytosine (5-hmC) is a distinct product of active DNA demethylation that is linked to gene regulation, development, and disease. In particular, 5-hmC levels dramatically decline in many cancers, potentially serving as an epigenetic biomarker. The noise associated with next-generation 5-hmC sequencing hinders reliable analysis of low 5-hmC containing tissues such as blood and malignant tumors. Additionally, genome-wide 5-hmC profiles generated by short-read sequencing are limited in providing long-range epigenetic information relevant to highly variable genomic regions, such as the 3.7 Mbp disease-related Human Leukocyte Antigen (HLA) region. We present a long-read, highly sensitive single-molecule mapping technology that generates hybrid genetic/epigenetic profiles of native chromosomal DNA. The genome-wide distribution of 5-hmC in human peripheral blood cells correlates well with 5-hmC DNA immunoprecipitation (hMeDIP) sequencing. However, the long single-molecule read-length of 100 kbp to 1 Mbp produces 5-hmC profiles across variable genomic regions that failed to show up in the sequencing data. In addition, optical 5-hmC mapping shows a strong correlation between the 5-hmC density in gene bodies and the corresponding level of gene expression. The single-molecule concept provides information on the distribution and coexistence of 5-hmC signals at multiple genomic loci on the same genomic DNA molecule, revealing long-range correlations and cell-to-cell epigenetic variation.

Lighting up individual DNA damage sites by in vitro repair synthesis

DNA damage and repair are linked to fundamental biological processes such as metabolism, disease, and aging. Single-strand lesions are the most abundant form of DNA damage; however, methods for characterizing these damage lesions are lacking. To avoid double-strand breaks and genomic instability, DNA damage is constantly repaired by efficient enzymatic machinery. We take advantage of this natural process and harness the repair capacity of a bacterial enzymatic cocktail to repair damaged DNA in vitro and incorporate fluorescent nucleotides into damage sites as part of the repair process. We use single-molecule imaging to detect individual damage sites in genomic DNA samples. When the labeled DNA is extended on a microscope slide, damage sites are visualized as fluorescent spots along the DNA contour, and the extent of damage is easily quantified. We demonstrate the ability to quantitatively follow the damage dose response to different damaging agents as well as repair dynamics in response to UV irradiation in several cell types. Finally, we show the modularity of this single-molecule approach by labeling DNA damage in conjunction with 5-hydroxymethylcytosine in genomic DNA extracted from mouse brain tissue.