Impact of gene expression profiling on diagnosis and survival after metastasis in patients with uveal melanoma

Surveillance frequency for metastasis is guided by gene expression profiling (GEP). This study evaluated the effect of GEP on time to diagnosis of metastasis, subsequent treatment and survival. A retrospective study was conducted of 110 uveal melanoma patients with GEP (DecisionDx-UM, Castle Biosciences, Friendswood, Texas, USA) and 110 American Joint Committee on Cancer-matched controls. Surveillance testing and treatment for metastasis were compared between the two groups and by GEP class. Rates of metastasis, overall survival and melanoma-related mortality were calculated using Kaplan-Meier estimates. Baseline characteristics and follow-up time were balanced in the two groups. Patients' GEP classification was 1A in 41%, 1B in 25.5% and 2 in 33.6%. Metastasis was diagnosed in 26.4% (n = 29) in the GEP group and 23.6% (n = 26) in the no GEP group (P = 0.75). Median time to metastasis was 30.5 and 22.3 months in the GEP and no GEP groups, respectively (P = 0.44). Median months to metastasis were 34.7, 75.8 and 26.1 in class 1A, 1B and 2 patients, respectively (P = 0.28). Disease-specific 5-year survival rates were 89.4% [95% confidence interval (CI): 81.0-94.2%] and 84.1% (95% CI: 74.9-90.1%) in the GEP and no GEP groups respectively (P = 0.49). Median time to death from metastasis was 10.1 months in the GEP group and 8.5 months in the no GEP group (P = 0.40). There were no significant differences in time to metastasis diagnosis and survival outcomes in patients with and without GEP. To realize the full benefit of GEP, more sensitive techniques for detection of metastasis and adjuvant therapies are required.

Plasticity-induced repression of Irf6 underlies acquired resistance to cancer immunotherapy in pancreatic ductal adenocarcinoma

Acquired resistance to immunotherapy remains a critical yet incompletely understood biological mechanism. Here, using a mouse model of pancreatic ductal adenocarcinoma (PDAC) to study tumor relapse following immunotherapy-induced responses, we find that resistance is reproducibly associated with an epithelial-to-mesenchymal transition (EMT), with EMT-transcription factors ZEB1 and SNAIL functioning as master genetic and epigenetic regulators of this effect. Acquired resistance in this model is not due to immunosuppression in the tumor immune microenvironment, disruptions in the antigen presentation machinery, or altered expression of immune checkpoints. Rather, resistance is due to a tumor cell-intrinsic defect in T-cell killing. Molecularly, EMT leads to the epigenetic and transcriptional silencing of interferon regulatory factor 6 (Irf6), rendering tumor cells less sensitive to the pro-apoptotic effects of TNF-α. These findings indicate that acquired resistance to immunotherapy may be mediated by programs distinct from those governing primary resistance, including plasticity programs that render tumor cells impervious to T-cell killing.

Perioperative outcomes of laparoscopic low anterior resection using ArtiSential® versus robotic approach in patients with rectal cancer: a propensity score matching analysis

BACKGROUND

Total mesorectal excision using conventional straight fixed devices may be technically difficult because of the narrow and concave pelvis. Several laparoscopic articulating tools have been introduced as an alternative to robotic systems. The aim of this study was to compare perioperative outcomes between laparoscopic low anterior resection using ArtiSential® and robot-assisted surgery for rectal cancer.

METHODS

This retrospective study included 682 patients who underwent laparoscopic or robotic low anterior resection  for rectal cancer from September 2018 to December 2021. Among them, 82 underwent laparoscopic surgery using ArtiSential® (group A) and 201 underwent robotic surgery (group B). A total of 73 [group A; 66.37 ± 11.62; group B 65.79 ± 11.34] patients were selected for each group using a propensity score matching analysis.

RESULTS

There was no significant difference in the baseline characteristics between group A and B. Mean operative time was longer in group B than A (163.5 ± 61.9 vs 250.1 ± 77.6 min, p < 0.001). Mean length of hospital stay was not significantly different between the two groups (6.2 ± 4.7 vs 6.7 ± 6.1 days, p = 0.617). Postoperative complications, reoperation, and readmission within 30 days after surgery were similar between the two groups. Pathological findings revealed that the circumferential resection margins were above 10 mm in both groups (11.00 ± 7.47 vs 10.17 ± 6.25 mm, p = 0.960). At least 12 lymph nodes were sufficiently harvested, with no significant difference in the number harvested between the groups (20.5 ± 9.9 vs 19.7 ± 7.3, p = 0.753).

CONCLUSIONS

Laparoscopic low anterior resection using ArtiSential® can achieve acceptable clinical and oncologic outcomes. ArtiSential®, a multi-joint and articulating device, may serve a feasible alternative approach to robotic surgery in rectal cancer.

Plasticity-induced repression of Irf6 underlies acquired resistance to cancer immunotherapy

Acquired resistance to immune checkpoint immunotherapy remains a critical yet incompletely understood biological mechanism. Here, using a mouse model of pancreatic ductal adenocarcinoma (PDAC) to study tumor relapse following immunotherapy-induced responses, we found that tumors underwent an epithelial-to-mesenchymal transition (EMT) that resulted in reduced sensitivity to T cell-mediated killing. EMT-transcription factors (EMT-TFs) ZEB1 and SNAIL function as master genetic and epigenetic regulators of this tumor-intrinsic effect. Acquired resistance was not due to immunosuppression in the tumor immune microenvironment, disruptions in the antigen presentation machinery, or altered expression of immune checkpoints. Rather, EMT was associated with epigenetic and transcriptional silencing of interferon regulatory factor 6 (Irf6), which renders tumor cells less sensitive to the pro-apoptotic effects of TNF-α. These findings show how resistance to immunotherapy in PDAC can be acquired through plasticity programs that render tumor cells impervious to T cell killing.

Efficacy of a Small-Molecule Inhibitor of KrasG12D in Immunocompetent Models of Pancreatic Cancer

Mutations in the KRAS oncogene are found in more than 90% of patients with pancreatic ductal adenocarcinoma (PDAC), with Gly-to-Asp mutations (KRASG12D) being the most common. Here, we tested the efficacy of a small-molecule KRASG12D inhibitor, MRTX1133, in implantable and autochthonous PDAC models with an intact immune system. In vitro studies validated the specificity and potency of MRTX1133. In vivo, MRTX1133 prompted deep tumor regressions in all models tested, including complete or near-complete remissions after 14 days. Concomitant with tumor cell apoptosis and proliferative arrest, drug treatment led to marked shifts in the tumor microenvironment (TME), including changes in fibroblasts, matrix, and macrophages. T cells were necessary for MRTX1133's full antitumor effect, and T-cell depletion accelerated tumor regrowth after therapy. These results validate the specificity, potency, and efficacy of MRTX1133 in immunocompetent KRASG12D-mutant PDAC models, providing a rationale for clinical testing and a platform for further investigation of combination therapies.

SIGNIFICANCE

Pharmacologic inhibition of KRASG12D in pancreatic cancer models with an intact immune system stimulates specific, potent, and durable tumor regressions. In the absence of overt toxicity, these results suggest that this and similar inhibitors should be tested as potential, high-impact novel therapies for patients with PDAC. See related commentary by Redding and Grabocka, p. 260. This article is highlighted in the In This Issue feature, p. 247.

Tetracycline degradation by nonthermal plasma: removal efficiency, degradation pathway, and toxicity evaluation

Tetracyclines (TCs) are often discussed as one of the emerging contaminants detected in water matrices and studied for their persistence towards conventional water treatment technologies. In this work, the treatment of TC in aqueous solutions with nonthermal plasma gliding arc process was investigated. The degradation efficiency of TC was studied along with the effect of initial concentration, working gas, pH, and the presence of a radical scavenger. The generation of reactive oxidative species was characterized by the quantification of radical hydroxyl, hydrogen peroxide, ozone, nitrite, and nitrate. Mineralization efficiency was examined by assessment of Total organic carbon evolution. Experimental results have shown that the gliding arc plasma is effective for the treatment of TC. At an initial concentration of 5 mg/L: degradation rates of 94.95% and 60.45% were achieved, while mineralization rates were 81.3% and 57.34% under O₂ and air plasma, respectively. O₂ plasma exhibited an immense potential for the generation of reactive oxygen species. Meanwhile, air plasma showed better degradation performance in the presence of a radical scavenger. Moreover, degradation products were identified by mass spectroscopy analysis and degradation pathway was proposed. The gliding arc process proposed in this work is promising for the removal of TC antibiotics.

Abstract C069: Using a cancer-on-a-chip approach to study the pancreatic cancer tumor microenvironment

Pancreatic ductal adenocarcinoma (PDAC) is a lethal malignancy that is overwhelmingly resistant to therapy. PDAC tumors are characterized by an immunosuppressive fibroinflammatory stroma and can be broadly classified into those with an abundance of T cells or a paucity of T cells. Our lab has previously identified several tumor cell intrinsic factors that regulate the degree of T cell infiltration and response to immunotherapy, but it remains unknown how these factors influence T cell trafficking through the vasculature to the tumor. We used in vivo models and a cancer-on-a-chip platform to examine immune-vascular crosstalk in the pancreatic tumor microenvironment (TME). We first sought to characterize the vascular landscape in PDAC. Following up from previous work in the lab, we used bulk RNA sequencing appraoches to identify a subset of hyper-vascular murine PDAC lines. Using an in vivo dextran assay, we determined that endothelial-high tumors have increased vascular perfusion. We next utilized an in vitro tube formation assay to assess if the defects seen in tumor vasculature are from tumor-cell derived factors. Endothelial cells cultured in conditioned media from endothelial-low tumors had defects in tubule formation. We further identified endothelial-low tumors have a defect in pericyte coverage of the vessel. We next utilized organ-on-a-chip devices to assess angiogenesis in PDAC. Endothelial cells and fibroblasts self-assemble into a 3D vascular network when incorporated into the microdevices. In the absence of tumor cells, mature vascular networks formed on day 4 of culture. Interestingly, vascular networks formed faster in the presence of PDAC tumor cells, suggesting a tumor derived factor enhanced angiogenesis. The cancer-on-a-chip devices are perfusable and allow for the incorporation of other TME components. Future directions, include incorporation of myeloid cells and perfusing fluorescently labeled T cells into the vascular networks and using live imaging to monitor T cell trafficking in different PDAC TME settings. Further, we will use immune checkpoint blockade and CAR T cells to identify methods to enhance tumoral T cell infiltration.

Citation Format: Samantha B. Kemp, Andrei Georgescu, Jason Pitarresi, Takeshi Katsuda, Il-Kyu Kim, Dora Racca, John Tobias, Dan Huh, Ben Stanger. Using a cancer-on-a-chip approach to study the pancreatic cancer tumor microenvironment [abstract]. In: Proceedings of the AACR Special Conference on Pancreatic Cancer; 2022 Sep 13-16; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2022;82(22 Suppl):Abstract nr C069.

Oxidative Degradation of Hazardous Benzene Derivatives by Ferrate(VI): Effect of Initial pH, Molar Ratio and Temperature

Two of the most hazardous benzene derivatives (HBD) that have polluted the aquatic environment are bromobenzene and chlorobenzene. Ferrate can degrade various pollutants quickly and efficiently without producing harmful byproducts. This study aims to determine the ability of ferrate to degrade harmful contaminants such as bromobenzene and chlorobenzene. A series of batch experiments were carried out, including for the molar ratio, initial pH solution, and temperature. The study was conducted at an initial pH of 3.6 to 9.6, a molar ratio of 2 to 8 and a temperature of 15 to 55 °C. The study will also examine the differences in functional groups in these pollutants. As a result of the experiments, the optimum conditions to oxidize HBD in a batch reactor was found to have an initial pH of 7.0, a molar ratio of 8, and a temperature of 45 °C, with a 10 min reaction time. Ferrate has a degradation ability against chlorobenzene greater than bromobenzene. The functional cluster in pollutants also significantly affects the degradation ability of ferrate. The results of the degradation experiment showed that ferrate(VI) could effectively oxidize hazardous benzene derivatives in a solution.

Word of caution on adding hemiarch replacement to a proximal aortic aneurysm repair: long-term outcome analysis of over 1,000 patients

Background

There is no consensus nor recommendation for the surgical management of a minimally dilated adjacent aortic segment, such as the proximal aortic arch, at the time of proximal aortic aneurysm repair. Consequently, clinical equipoise exists regarding whether to extend the proximal aortic aneurysm repair to include the proximal aortic arch, by performing a hemiarch replacement, to mitigate the future risk of aortic aneurysm-related events in the proximal aortic arch. We hypothesized that additional hemiarch replacement to excise a non- or minimally aneurysmal proximal aortic arch does not have clinical benefit in patients undergoing proximal aortic aneurysm repair.

Purpose

To compare the long-term survival and freedom from aortic-arch reoperation in patients undergoing proximal aortic aneurysm repair with and without additional hemiarch replacement.

Methods

A retrospective review was performed of all patients undergoing proximal aortic aneurysm repair at our Aortic Center between 2005 and 2019. Inclusion criteria included all patients with a diagnosed root or ascending aortic aneurysm undergoing root or ascending aortic replacement with or without hemiarch replacement. Exclusion criteria were Age &lt;18 years, presence of aortic arch diameter ≥4.5 cm, type A aortic dissection, previous ascending aortic replacement, aneurysm rupture, and endocarditis. A total of 1132 patients (hemiarch =307) met inclusion criteria. Propensity score matching in a 2:1 ratio (573 non-hemiarch: 288 hemiarch) on 19 baseline characteristics was performed. The median follow-up was 29.7 months (range: 0.1–153.8 months).

Results

Hemiarch patients had a significantly lower 10-year survival rate (86.7%; 95% CI, 79.2–94.8 in non-hemiarch vs 81.9%; 95% CI, 75.9–88.3 in hemiarch; P=0.005). There was no significant difference in 10- year cumulative incidence of aortic-arch reintervention (0.7%; 95% CI, 0.3–1.9 in non-hemiarch vs 0.69%; 95% CI, 0.17–2.75 in hemiarch; P=0.99). Hemiarch patients had higher rates of in-hospital mortality (1% in non-hemiarch vs 4% in hemiarch; P&lt;0.001), stroke (3% in non-hemiarch vs 6% in hemiarch; P=0.047), reoperation for bleeding (4% in non-hemiarch vs 9% in hemiarch; P=0.011), and respiratory failure (7% in non-hemiarch vs 13% in hemiarch; P=0.006). In multivariable COX analysis, hemiarch replacement was significantly associated with long-term mortality (HR, 2.19; 95% CI, 1.36–3.55; P&lt;.001) but not with aortic-arch reintervention (HR, 1.14; 95% CI, 0.63–2.10, P=0.66).

Conclusions

Proximal aortic aneurysm repair with additional hemiarch was associated with higher mortality without a decrease in aortic-arch reintervention rates compared to isolated proximal aortic aneurysm repair. Furthermore, aortic arch reintervention rate was extremely low. These data call for caution in adding hemiarch replacement at the time of proximal aortic aneurysm repair.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Institute of Heath (NIH) 5T35HL007616-40 grant Matched Cohort: KM Survival CurveMatched Cohort: Cumulative Incidence

Endogenous TLR2 ligand embedded in the catalytic region of human cysteinyl-tRNA synthetase 1

Background

The generation of antigen-specific cytotoxic T lymphocyte (CTL) responses is required for successful cancer vaccine therapy. In this regard, ligands of Toll-like receptors (TLRs) have been suggested to activate adaptive immune responses by modulating the function of antigen-presenting cells (APCs). Despite their therapeutic potential, the development of TLR ligands for immunotherapy is often hampered due to rapid systemic toxicity. Regarding the safety concerns of currently available TLR ligands, finding a new TLR agonist with potent efficacy and safety is needed.

Methods

A unique structural domain (UNE-C1) was identified as a novel TLR2/6 in the catalytic region of human cysteinyl-tRNA synthetase 1 (CARS1) using comprehensive approaches, including RNA sequencing, the human embryonic kidney (HEK)-TLR Blue system, pull-down, and ELISA. The potency of its immunoadjuvant properties was analyzed by assessing antigen-specific antibody and CTL responses. In addition, the efficacy of tumor growth inhibition and the presence of the tumor-infiltrating leukocytes were evaluated using E.G7-OVA and TC-1 mouse models. The combined effect of UNE-C1 with an immune checkpoint inhibitor, anti-CTLA-4 antibody, was also evaluated in vivo. The safety of UNE-C1 immunization was determined by monitoring splenomegaly and cytokine production in the blood.

Results

Here, we report that CARS1 can be secreted from cancer cells to activate immune responses via specific interactions with TLR2/6 of APCs. A unique domain (UNE-C1) inserted into the catalytic region of CARS1 was determined to activate dendritic cells, leading to the stimulation of robust humoral and cellular immune responses in vivo. UNE-C1 also showed synergistic efficacy with cancer antigens and checkpoint inhibitors against different cancer models in vivo. Further, the safety assessment of UNE-C1 showed lower systemic cytokine levels than other known TLR agonists.

Conclusions

We identified the endogenous TLR2/6 activating domain from human cysteinyl-tRNA synthetase CARS1. This novel TLR2/6 ligand showed potent immune-stimulating activity with little toxicity. Thus, the UNE-C1 domain can be developed as an effective immunoadjuvant with checkpoint inhibitors or cancer antigens to boost antitumor immunity.

PTHrP Drives Pancreatic Cancer Growth and Metastasis and Reveals a New Therapeutic Vulnerability

Pancreatic cancer metastasis is a leading cause of cancer-related deaths, yet very little is understood regarding the underlying biology. As a result, targeted therapies to inhibit metastasis are lacking. Here, we report that the parathyroid hormone-related protein (PTHrP encoded by PTHLH) is frequently amplified as part of the KRAS amplicon in patients with pancreatic cancer. PTHrP upregulation drives the growth of both primary and metastatic tumors in mice and is highly enriched in pancreatic ductal adenocarcinoma metastases. Loss of PTHrP-either genetically or pharmacologically-dramatically reduces tumor burden, eliminates metastasis, and enhances overall survival. These effects are mediated in part through a reduction in epithelial-to-mesenchymal transition, which reduces the ability of tumor cells to initiate metastatic cascade. Spp1, which encodes osteopontin, is revealed to be a downstream effector of PTHrP. Our results establish a new paradigm in pancreatic cancer whereby PTHrP is a driver of disease progression and emerges as a novel therapeutic vulnerability. SIGNIFICANCE: Pancreatic cancer often presents with metastases, yet no strategies exist to pharmacologically inhibit this process. Herein, we establish the oncogenic and prometastatic roles of PTHLH, a novel amplified gene in pancreatic ductal adenocarcinoma. We demonstrate that blocking PTHrP activity reduces primary tumor growth, prevents metastasis, and prolongs survival in mice.This article is highlighted in the In This Issue feature, p. 1601.

Epigenetic and Transcriptional Control of the Epidermal Growth Factor Receptor Regulates the Tumor Immune Microenvironment in Pancreatic Cancer

Although immunotherapy has revolutionized cancer care, patients with pancreatic ductal adenocarcinoma (PDA) rarely respond to these treatments, a failure that is attributed to poor infiltration and activation of T cells in the tumor microenvironment (TME). We performed an in vivo CRISPR screen and identified lysine demethylase 3A (KDM3A) as a potent epigenetic regulator of immunotherapy response in PDA. Mechanistically, KDM3A acts through Krueppel-like factor 5 (KLF5) and SMAD family member 4 (SMAD4) to regulate the expression of the epidermal growth factor receptor (EGFR). Ablation of KDM3A, KLF5, SMAD4, or EGFR in tumor cells altered the immune TME and sensitized tumors to combination immunotherapy, whereas treatment of established tumors with an EGFR inhibitor, erlotinib, prompted a dose-dependent increase in intratumoral T cells. This study defines an epigenetic-transcriptional mechanism by which tumor cells modulate their immune microenvironment and highlights the potential of EGFR inhibitors as immunotherapy sensitizers in PDA. SIGNIFICANCE: PDA remains refractory to immunotherapies. Here, we performed an in vivo CRISPR screen and identified an epigenetic-transcriptional network that regulates antitumor immunity by converging on EGFR. Pharmacologic inhibition of EGFR is sufficient to rewire the immune microenvironment. These results offer a readily accessible immunotherapy-sensitizing strategy for PDA.This article is highlighted in the In This Issue feature, p. 521.

GITR Agonism Triggers Antitumor Immune Responses through IL21-Expressing Follicular Helper T Cells

Although treatment with the glucocorticoid-induced tumor necrosis factor receptor-related protein (GITR) agonistic antibody (DTA-1) has shown antitumor activity in various tumor models, the underlying mechanism is not fully understood. Here, we demonstrate that interleukin (IL)-21-producing follicular helper T (Tfh) cells play a crucial role in DTA-1-induced tumor inhibition. The administration of DTA-1 increased IL21 expression by Tfh cells in an antigen-specific manner, and this activation led to enhanced antitumor cytotoxic T lymphocyte (CTL) activity. Mice treated with an antibody that neutralizes the IL21 receptor exhibited decreased antitumor activity when treated with DTA-1. Tumor growth inhibition by DTA-1 was abrogated in Bcl6 ^fl/fl Cd4 ^Cre mice, which are genetically deficient in Tfh cells. IL4 was required for optimal induction of IL21-expressing Tfh cells by GITR costimulation, and c-Maf mediated this pathway. Thus, our findings identify GITR costimulation as an inducer of IL21-expressing Tfh cells and provide a mechanism for the antitumor activity of GITR agonism.

Differentiation of c-Kit+ CD24+ natural killer cells into myeloid cells in a GATA-2-dependent manner

Myeloid progenitor cells have generally been considered the predominant source of myeloid cells under steady-state conditions. Here we show that NK cells contributed to a myeloid cell lineage pool in naïve and tumor-bearing mice. Using fate tracing of NKp46⁺ cells, we found that myeloid cells could be derived from NK cells. Notably, among mature CD11b⁺ CD27⁺ NK cells, c-Kit⁺ CD24⁺ NK cells were capable of differentiating into a range of myeloid lineages in vitro and produced neutrophils and monocytes in vivo. The differentiation was completely inhibited by NK-stimulating cytokines. In addition to the potential for differentiation into myeloid cells, c-Kit⁺ CD24⁺ NK cells retained NK cell phenotypes and effector functions. Mechanistically, GATA-2 was necessary for the differentiation of c-Kit⁺ CD24⁺ NK cells. Therefore, we discovered that GATA-2-dependent differentiation of c-Kit⁺ CD24⁺ NK cells contributes to myeloid cell development and identified a novel pathway for myeloid lineage commitment under physiological conditions.

Monocyte-Derived Dendritic Cells Dictate the Memory Differentiation of CD8+ T Cells During Acute Infection

Monocyte-derived dendritic cells (moDCs) have been shown to robustly expand during infection; however, their roles in anti-infectious immunity remain unclear. Here, we found that moDCs were dramatically increased in the secondary lymphoid organs during acute LCMV infection in an interferon-γ (IFN-γ)-dependent manner. We also found that priming by moDCs enhanced the differentiation of memory CD8⁺ T cells compared to differentiation primed by conventional dendritic cells (cDCs) through upregulation of Eomesodermin (Eomes) and T cell factor-1 (TCF-1) expression in CD8⁺ T cells. Consequently, impaired memory formation of CD8⁺ T cells in mice that had reduced numbers of moDCs led to defective clearance of pathogens upon rechallenge. Mechanistically, attenuated interleukin-2 (IL-2) signaling in CD8⁺ T cells primed by moDCs was responsible for the enhanced memory programming of CD8⁺ T cells. Therefore, our findings unveil a specialization of the antigen-presenting cell subsets in the fate determination of CD8⁺ T cells during infection and pave the way for the development of a novel therapeutic intervention on infection.

GITR agonism triggers antitumor immune responses through IL-21–expressing follicular helper T cells

Treatment with glucocorticoid-induced tumor necrosis factor receptor-related protein (GITR) agonistic antibody (DTA-1) elicits potent antitumor immune responses in various tumor models. In this study, we demonstrate the crucial role of interleukin (IL)-21–producing follicular helper T (Tfh) cells in DTA-1-induced tumor inhibition. Administration of DTA-1 increased IL-21 expression from CD4 T cells, which is mainly made up of Tfh cells, in an antigen specific manner. Furthermore, mice treated with a neutralizing antibody to IL-21 receptor and Bcl6fl/flCD4cre mice exhibited abrogated antitumor activity induced by DTA-1. Mechanistically, IL-4 plays critical roles for the induction of IL-21–expressing Th cells by GITR co-stimulation, which is mediated by Bcl6 and c-Maf. Thus, our findings identify GITR co-stimulation as an inducer of IL-21–expressing Tfh cells and provide a novel mechanism for its antitumor activity.

GM-CSF Promotes Antitumor Immunity by Inducing Th9 Cell Responses

GM-CSF as an adjuvant has been shown to promote antitumor immunity in mice and humans; however, the underlying mechanism of GM-CSF-induced antitumor immunity remains incompletely understood. In this study, we demonstrate that GM-CSF potentiates the efficacy of cancer vaccines through IL9-producing Th (Th9) cells. GM-CSF selectively enhanced Th9 cell differentiation by regulating the COX2-PGE₂ pathway while inhibiting the differentiation of induced regulatory T (iTreg) cells in vitro and in vivo GM-CSF-activated monocyte-derived dendritic cells converted tumor-specific naïve Th cells into Th9 cells, and delayed tumor growth by inducing antitumor CTLs in an IL9-dependent manner. Our findings reveal a mechanism for the adjuvanticity of GM-CSF and provide a rationale for the use of GM-CSF in cancer vaccines.

Activation of NKT Cells in an Anti-PD-1-Resistant Tumor Model Enhances Antitumor Immunity by Reinvigorating Exhausted CD8 T Cells

PD-1-based cancer immunotherapy is a successful example of immune checkpoint blockade that provides long-term durable therapeutic effects in patients with cancer across a wide spectrum of cancer types. Accumulating evidence suggests that anti-PD-1 therapy enhances antitumor immunity by reversing the function of exhausted T cells in the tumor environment. However, the responsiveness rate of patients with cancer to anti-PD-1 therapy remains low, providing an urgent need for optimization and improvement. In this study, we designed an anti-PD-1-resistant mouse tumor model and showed that unresponsiveness to anti-PD-1 is associated with a gradual increase in CD8 T-cell exhaustion. We also found that invariant natural killer T cell stimulation by the synthetic ligand α-galactosylceramide (αGC) can enhance the antitumor effect in anti-PD-1-resistant tumors by restoring the effector function of tumor antigen-specific exhausted CD8 T cells. IL2 and IL12 were among the cytokines produced by αGC stimulation critical for reinvigorating exhausted CD8 T cells in tumor-bearing mice and patients with cancer. Furthermore, we observed a synergistic increase in the antitumor effect between αGC-loaded antigen-presenting cells and PD-1 blockade in a therapeutic murine tumor model. Our study suggests NKT cell stimulation as a promising therapeutic strategy for the treatment of patients with anti-PD-1-resistant cancer.Significance: These findings provide mechanistic insights into the application of NKT cell stimulation as a potent adjuvant for immunotherapy against advanced cancer. Cancer Res; 78(18); 5315-26. ©2018 AACR.

Effect of herbal extracts on bone regeneration in a rat calvaria defect model and screening system

Objectives

The aim of this study was to evaluate the effects of herbal extracts on bone regeneration. Two known samples were screened.

Materials and Methods

We previously established a rat calvaria defect model using a combination of collagen scaffold and herbal extracts. An 8 mm diameter trephine bur with a low-speed dental hand piece was used to create a circular calvaria defect. The experimental group was divided into 4 classifications: control, collagen matrix, Danshen with collagen, and Ge Gan with collagen. Animals in each group were sacrificed at 4, 6, 8, and 10 weeks after surgery, and bone regeneration ability was evaluated by histological examination.

Results

Results revealed that both Danshen and Ge Gan extracts increased bone formation activity when used with collagen matrix. All groups showed almost the same histological findings until 6 weeks. However, after 6 weeks, bone formation activity proceeded differently in each group. In the experimental groups, new bone formation activity was found continuously up to 10 weeks. In the Danshen and Ge Gan groups, grafted materials were still present until 10 weeks after treatment, as evidenced by foreign body reactions showing multinucleated giant cells in chronic inflammatory vascular connective tissue.

Conclusion

Histological analyses showed that Danshen and Ge Gan extractions increased bone formation activity when used in conjunction with collagen matrix.

Intracorporeal reduction of condylar fracture using both pedicled condylar and seperated ramal fragments after vertical ramal osteotomy

The aim of this study is to introduce a surgical technique that can maintain blood supply to prevent condylar resorption in the extracorporeal reduction of condylar fracture. Neither the medial pterygoid muscle on the ramal bone nor the lateral pterygoid muscle on the condylar fragment was detached after vertical ramal osteotomy. Thus, reduction was performed in the intracorporeal state. Therefore, blood supply was expected to be maintained to the fragments of both the condylar and ramal bones. On postoperative radiographs, the anatomical outline of the fractured condyle was well restored, and the occlusion was stable. In the unilateral case, there were no signs of mandibular condylar resorption until postoperative 3 weeks. In the 2 bilateral cases, condylar displacements with plate fractures and screw loosening were observed at postoperative 1 month or 5 months, but radiodensity at the displaced fracture site increased during the follow-up period. Finally, complete remodeling of the condylar fragments with restored anatomic appearance was observed on 8-month or 2-year follow-up radiographs. All cases exhibited good healing aspects with no signs or symptoms of mandibular condylar dysfunction during the postoperative remodeling period after intracorporeal reduction of condylar fracture.

IL-21-mediated reversal of NK cell exhaustion facilitates anti-tumour immunity in MHC class I-deficient tumours

During cancer immunoediting, loss of major histocompatibility complex class I (MHC-I) in neoplasm contributes to the evasion of tumours from host immune system. Recent studies have demonstrated that most natural killer (NK) cells that are found in advanced cancers are defective, releasing the malignant MHC-I-deficient tumours from NK-cell-dependent immune control. Here, we show that a natural killer T (NKT)-cell-ligand-loaded tumour-antigen expressing antigen-presenting cell (APC)-based vaccine effectively eradicates these advanced tumours. During this process, we find that the co-expression of Tim-3 and PD-1 marks functionally exhausted NK cells in advanced tumours and that MHC-I downregulation in tumours is closely associated with the induction of NK-cell exhaustion in both tumour-bearing mice and cancer patients. Furthermore, the recovery of NK-cell function by IL-21 is critical for the anti-tumour effects of the vaccine against advanced tumours. These results reveal the process involved in the induction of NK-cell dysfunction in advanced cancers and provide a guidance for the development of strategies for cancer immunotherapy.

Loss of major histocompatibility complex MHC-I expression contributes to cancer immune evasion. Here, the authors show that, in both mice and humans, MHC-I downregulation is associated with the induction of NK-cell exhaustion and that IL-21 restores NK-cell function and inhibits tumours progression.

IFN-γ-induced MHCII+ inflammatory monocytes play a role for down-regulating CD8 T cell responses in acute LCMV infection

During viral infection, monocytes play a protective role for clearance of pathogens. However, little is known about the role of recruited monocytes after effector phase, especially as regard to their effects to T cells. Here, we have investigated the phenotypes, the origin and inducing factor, and the effects to CD8 T cells of inflammatory monocytes in virus-infected mice. During Lymphocytic choriomeningitis virus (LCMV)-Arm infection, CCR2+ inflammatory monocytes were accumulated in lymphoid organs and reached their peak at day 8 post infections. Inflammatory monocytes of infected mice expressed high levels of MHCII and low levels of CD11c, which overlap with phenotypes of DC and those of macrophage, respectively. We found that IFN-gamma (IFN-γ) is a factor that differentiates MHCII+ monocytes from BM progenitor cells. Among the BM progenitor cells, common monocyte progenitors (cMoPs) were rapidly converted to MHCII+ inflammatory monocytes in response to GM-CSF and IFN-γ in vitro. In addition, cMoPs that were adoptively transferred to infected recipients were differentiated to MHCII+ inflammatory monocytes. We also found that MHCII+ monocytes-primed CD8 T cells could not produce inflammatory cytokine and granzymeB efficiently, implicating their lowered effector functions, despite their comparable proliferative capacity to conventional DC-primed CD8 T cells. Overall, our data suggest that IFN-γ-induced MHCII+ inflammatory monocytes during acute LCMV infection would play a role in down-regulating CD8 T cell responses.

Intramuscular hemangiomas on the masseter muscle and orbicularis oris muscle: a report of two cases

Intramuscular hemangioma (IMH) is a rare vascular disease involving skeletal muscle, comprising only 0.8% of hemangiomas. About 10% to 15% of IMHs occur in the head and neck region, mostly involving the masseter muscle. IMH occurs mostly in childhood, but is often not found until unexpected enlargement, pain, or cosmetic asymmetry occurs in adulthood. Several non-surgical treatments including cryotherapy, sclerosant injection, and arterial ligature have been described, but complete surgical resection is the curative intervention. In this report, we present two rare cases of IMH. One IMH case in a 48-year-old male occurred in the masseter muscle feeding from the transverse facial artery. Embolization of the distal branch of the facial artery was first conducted, and then the buccal mass was removed surgically via the intraoral approach. A second IMH case in a 58-year-old female occurred in the orbicularis oris muscle feeding from the superior labial artery, and the mass was excised surgically without embolization.

Early Weight Gain After Transplantation Can Cause Adverse Effect on Transplant Kidney Function

BACKGROUND

The outcomes of kidney transplant recipients with increased body mass index (BMI) remain controversial. We studied the relationship between changes in BMI and kidney transplant function, especially during the first year after transplantation.

METHODS

We performed an observational cohort study of all kidney transplant recipients at our center from March 2009 to June 2014 to determine whether changes in BMI were associated with kidney transplant function, as measured by estimated glomerular filtration rate (eGFR). Recipient BMI and eGFR were calculated pre-transplant and at 1, 3, 6, 9, and 12 postoperative months (POM) after transplantation. The correlation between changes in BMI and eGFR was then evaluated.

RESULTS

Eighty-one patients were studied. There was a strong negative correlation between changes in BMI and eGFR from pre-transplant to POM 1 (correlation coefficient, -0.406; P < .0001) and from POM 1 to POM 3 (r = -0.324, P = .004).

CONCLUSIONS

We found that increased BMI caused a significant decline in renal function as measured by eGFR, especially in the initial 3 months after kidney transplantation.

Retiform hemangioendothelioma in the infratemporal fossa and buccal area: a case report and literature review

We report a case of retiform hemangioendothelioma (RH) located in the infratemporal fossa and buccal area in a 13-year-old Korean boy. The tumor originated from the sphenoid bone of the infratemporal fossa area and spread into the cavernous sinus, orbital apex, and retro-nasal area with bone destruction of the pterygoid process. Tumor resection was conducted via Le Fort I osteotomy and partial maxillectomy to approach the infratemporal fossa and retro-nasal area. The diagnosis of RH was confirmed after surgery. In the presented patient, surgical excision was incomplete, and close follow-up was performed. There was no evidence of expansion or metastasis of the residual tumor in the 8 years after surgery. In cases of residual RH with low likelihood of expansion and metastasis, even though RH is an intermediate malignancy, close follow-up can be the appropriate treatment choice over additional aggressive therapy. To date, 29 papers and 48 RH cases have been reported, including this case. This case is the second reported RH case presenting as primary bone tumor and the first case originating in the oromaxillofacial area.

Prostate adenocarcinoma mandibular metastasis associated with numb chin syndrome: a case report

The purpose of this study is to report a rare case of mandibular adenocarcinoma that was diagnosed due to metastasis from the prostate. Numb chin syndrome (NCS), which was associated with this case, is also discussed. Computed tomography (CT) and an intraoral incisional biopsy of the left mandibular area were performed. Urology consultation, hormone therapy, chemotherapy and follow-up radiographic images were administered. Histological examination of the incised specimen revealed moderately differentiated adenocarcinoma. The Gleason score was 8 (primary 4/secondary 4). Immunohistochemical features and radiographic results confirmed the diagnosis of metastasis from prostate adenocarcinoma, moderately differentiated. The patient's prostate-specific antigen (PSA) level was very high. After hormone treatment, the patient's PSA levels dropped gradually. Seventeen months later, in May 2015, the PSA level was elevated. The 18-month follow-up CT image indicated that the patient's condition was aggravated. Docetaxel chemotherapy was started in June 2015 (18 months later), and the sixth cycle of the therapy is in progress. Oral metastases that originate from prostate adenocarcinoma are rare and can induce various periosteal reactions. Hormone therapy, chemotherapy and close follow-up could be additional, appropriate treatment, and were applied in this case. Finally, NCS is a valuable indicator of metastatic disease in the mandible.

The healing effect of platelet-rich plasma on xenograft in peri-implant bone defects in rabbits

Background

The association of biomaterial combined with repair factor-like platelet-rich plasma (PRP) has prospective values. Bovine-derived xenograft has been identified as an osteoconductive and biocompatible grafting material that provides osseointegration ability. PRP has become a valuable adjunctive agent to promote healing in a lot of dental and oral surgery procedures. However, there are controversies with respect to the regenerative capacity of PRP and the real benefits of its use in bone grafts. The purpose of this study was to assess the influence of PRP combined with xenograft for the repair of peri-implant bone defects.

Methods

Twelve rabbits were used in this study, and the experimental surgery with implant installation was performed simultaneously. Autologous PRP was prepared before the surgical procedure. An intrabony defect (7.0 mm in diameter and 3.0 mm deep) was created in the tibia of each rabbit; then, 24 titanium dental implants (3.0 mm in diameter and 8.5 mm long) were inserted into these osteotomy sites. Thus, a standardized gap (4.0 mm) was established between the surrounding bony walls and the implant surface. The gaps were treated with either xenograft alone (control group) or xenograft combined with PRP (experimental group). After healing for 1, 2, 3, 4, 5, and 6 weeks, the rabbits were sacrificed with an overdose of KCl solution. Two rabbits were killed at each time, and the samples including dental implants and surrounding bone were collected and processed for histological analysis.

Results

More newly formed bone and a better bone healing process were observed in control group. The histomorphometric analysis revealed that the mean percentage of bone-to-implant contact in the control group was significantly higher than that of the experimental group (25.23 vs. 8.16 %; P < 0.05, independent-simple t test, analysis of variance [ANOVA]).

Conclusions

The results indicate that in the addition of PRP to bovine-derived xenograft in the repair of bone defects around the implant, PRP may delay peri-implant bone healing.

GITR drives TH9-mediated antitumor immunity

TH9 cells have been implicated in triggering antitumor immunity. We have identified that GITR co-stimulation inhibits iTreg cell generation but drives TH9 cell differentiation, thereby suppressing tumor growth via enhancing the function of DCs and CTLs in vivo. Our findings provide novel mechanisms by which GITR agonists exert antitumor activity.

Facelift incision and superficial musculoaponeurotic system advancement in parotidectomy: case reports

Surgical procedures for parotidectomy had been developed to gain adequate approach, prevent morbidity of nerve, and give esthetic satisfaction.

We performed two cases of parotidectomy through facelift incision. One case was reconstructed with superficial musculoaponeurotic system (SMAS) flap and sternocleidomastoid (SCM) muscle rotated flap at the parotid bed. In second case, same procedures were performed, but collagen membrane was additionally implanted for prevention of Frey’s syndrome. After surgery, two cases showed esthetic results without neck scar and hollow defect on parotid bed area.

Intravitreal aflibercept for macular oedema secondary to central retinal vein occlusion in patients with prior treatment with bevacizumab or ranibizumab

PurposeTo report the visual and anatomic outcomes in eyes with macular oedema (MO) secondary to central retinal vein occlusion (CRVO) that were switched from either intravitreal bevacizumab or ranibizumab to intravitreal aflibercept.MethodsTwo-center retrospective chart review. Eyes with MO secondary to CRVO that received a minimum of three intravitreal injections of bevacizumab or ranibizumab and were switched to intravitreal aflibercept for persistent or recurrent MO not responding to either bevacizumab and/or ranibizumab.ResultsIn all 42 eyes of 42 patients were included in the study. The median visual acuity before the switch was 20/126, 1 month after the first injection of aflibercept 20/89 (P=0.0191), and at the end of the follow-up 20/100 (P=0.2724). The median CRT before the switch was 536 μm, 1 month after the first injection of aflibercept 293.5 μm (P=0.0038), and at the end of the follow-up 279 μm (P=0.0013 compared to before the switch). The median number of weeks between injections before the switch was 5.6 and after the switch was 7.6 (P<0.0001).ConclusionConverting eyes with refractory MO due to CRVO to aflibercept can result in stabilization of the vision, improved macular anatomy, and extension of the injection interval.

Odontogenic carcinosarcoma of the mandible: a case report and review

Odontogenic carcinosarcoma is an extremely rare malignant odontogenic tumor with only a few reported cases. It is characterized by a true mixed tumor showing malignant cytology of both epithelial and mesenchymal components. It has been assumed to arise from pre-existing lesions such as ameloblastoma, ameloblastic fibroma, and ameloblastic fibrosarcoma. To date, the reported cases have exhibited considerably aggressive clinical behavior. The case of an odontogenic carcinosarcoma in the mandible of a 61-year-old male is described herein. The tumor destroyed the cortex of the mandible and invaded the adjacent tissues. Treatment was performed by surgical resection and reconstruction. The purposes of this article are to introduce odontogenic carcinosarcoma through this case study, to distinguish it from related diseases and to discuss features of the tumor in the existing literature.

Experience of advance directives in a hospice center

To protect patient autonomy when confronting death, the importance of advance directives (ADs) has recently became an issue and gradually accepted in Korea. However, in real practice, ADs were not completed by patients but their families in most cases. To analyze the current situation of performing ADs, we reviewed medical charts of 214 terminal cancer patients admitted to the hospice center from October 2012 to September 2013. Seventy-six (35.5%) patients completed ADs. All ADs were completed by patients themselves. The most common reason for not completing ADs was poor physical and/or mental condition. As a proxy, the majority of patients preferred their spouses (55.3%). Few patients wanted life sustaining treatment (1.3%), however palliative sedation was accepted in 89.5%. The median timing of ADs after admission was three (0-90) days, and duration of survival since ADs was 22 (1-340) days. In conclusion, approximately one third of terminal cancer patients completed ADs by themselves. Considering that patient's poor condition is the main reason for not completing ADs, earlier discussion regarding ADs is necessary to enhance patients' participation.

A Case of Spontaneous Bacterial Peritonitis with Bacteremia Caused by Shewanella algae

Human infection caused by Shewanella algae is rare, which usually occurred after direct contact with seawater or ingestion of raw seafood in the immunocompromised host. There have been anecdotal reports about Shewanella infections in human, but their pathogenic role and microbiologic data are limited. Here, we report a fatal case of spontaneous bacterial peritonitis with bacteremia due to S. algae in a 57-year-old male with liver cirrhosis who had no history of exposure to seawater or raw seafood. Polymicrobial infection with Streptococcus mitis and Escherichia coli was combined and the patient died in spite of early appropriate antimicrobial therapy and early goal-directed therapy for sepsis.

The burden of influenza-like illness in the US workforce

BACKGROUND

The disease burden of influenza-like illnesses (ILIs) on the working population has been documented in the literature, but statistical evidence of ILI-related work absenteeism in the USA is limited due to data availability.

AIMS

To assess work absenteeism due to ILIs among privately insured employees in the USA in 2007-8 and 2008-9.

METHODS

We used the 2007-9 MarketScan® research databases. Full-time employees aged 18-64 years, with the ability to incur work absence and continuously enrolled in the same insurance plan during each season were included. We identified ILI episodes using ICD-9 codes for influenza and pneumonia (480-487). For each season, we calculated the mean work-loss hours per ILI episode and the proportion of employees who had at least one ILI episode. Work-loss hours and ILI rates were examined by subgroups.

RESULTS

The mean number of work hours lost per ILI episode was 23.6 in 2007-8 and 23.9 in 2008-9. The proportion of employees with at least one ILI was 1.7% in 2007-8 and 1.2% in 2008-9. In both seasons, the proportion with ILI was higher among older (2.1 and 1.5%) and hourly workers (2.0 and 1.3%), workers in the southern region (1.9 and 1.3%) and those in oil, gas or mining industries (1.9 and 1.4%).

CONCLUSIONS

Our results indicate that the disease burden associated with ILIs in the working population is not trivial and deserves attention from policymakers and health care professionals to design effective strategies to reduce this burden.

Pigmented villonodular synovitis of the temporomandibular joint - computed tomography and magnetic resonance findings: a case report

Pigmented villonodular synovitis (PVNS) is a benign but locally aggressive and destructive disease originating in the synovial membranes. It is a proliferative disorder of unknown etiology. Involvement of the temporomandibular joint (TMJ) is very rare. Computed tomography clearly reveals areas of lytic bone erosion and sclerosis, and also clearly defines the extent of the tumor which is the focal areas of hyperdensity within the soft-tissue mass. Magnetic resonance images invariably show profound hypointensity on both T1- and T2-weighted sequences due to hemosiderin pigmentation. Additionally, high signal intensity on T2-weighted images may indicate cystic loculation of the joint fluid. This case study describes a rare case of PVNS of the TMJ with bone destruction of the mandibular condyle. Complete surgical excision of the lesion was performed through a preauricular approach with temporal extension. During the 10-year follow-up, two more operations were performed due to local recurrence and the fracture of the reconstruction plate. Total joint reconstruction with Biomet was finally performed, and the absence of disease was confirmed with a biopsy report showing fibrosis with hyalinization and mild inflammation of the excised soft tissue from the old lesion.

Signals through GITR program CD4+ T cells to enhance interleukin-9 production, which mediates antitumor CTL responses (LYM3P.735)

IL-9-producing T helper cells called Th9 have been a recently identified Th subset diverted from Th2 cells and proved to mediate allergic inflammation and tumor immunity. However, the regulation of Th9 development and functions in diseases remain to be elucidated. Here, we showed that GITR costimulation could induce tumor regression by promoting IL-9 expression on CD4+ T cells. GITR signaling intrinsically enhanced IL-9 expression regardless of cytokine milieu from CD4+ T cells, and furthermore in the presence of TGF-β, could induce IL-9-producing T cells independently of IL-4 in vitro. GITR activation increased the expression of Th9-related transcription factors, Irf4, Gata3 and Batf. In addtion, GITR activated the NF-κB signaling pathway and blockade of NF-κB signaling diminished the increase of IL-9 production from CD4+ T cells by GITR. In vivo GITR ligation augmented cytotoxic T cell responses in mouse tumor models and neutralization of IL-9 led to decrease the cytotoxicity of CD8+ T cells, resultingly impeded tumor regression by anti-GITR Ab. Upregulation of CTL responses was accompanied by the amplication through increasing the maturation and cross-presentaion of infiltrating DCs, regulated by IL-9. Thus, our studies reveal the link between GITR signaling and IL-9, providing a rationale for GITR-induced antitumor immune responses.

Tibial bone fractures occurring after medioproximal tibial bone grafts for oral and maxillofacial reconstruction

Objectives

Oral and maxillofacial defects often require bone grafts to restore missing tissues. Well-recognized donor sites include the anterior and posterior iliac crest, rib, and intercalvarial diploic bone. The proximal tibia has also been explored as an alternative donor site. The use of the tibia for bone graft has many benefits, such as procedural ease, adequate volume of cancellous and cortical bone, and minimal complications. Although patients rarely complain of pain, swelling, discomfort, or dysfunction, such as gait disturbance, both patients and surgeons should pay close attention to such after effects due to the possibility of tibial fracture. The purpose of this study is to analyze tibial fractures that occurring after osteotomy for a medioproximal tibial graft.

Materials and Methods

An analysis was intended for patients who underwent medioproximal tibial graft between March 2004 and December 2011 in Inha University Hospital. A total of 105 subjects, 30 females and 75 males, ranged in age from 17 to 78 years. We investigated the age, weight, circumstance, and graft timing in relation to tibial fracture.

Results

Tibial fractures occurred in four of 105 patients. There were no significant differences in graft region, shape, or scale between the fractured and non-fractured patients.

Conclusion

Patients who undergo tibial grafts must be careful of excessive external force after the operation.

Assessment of the autogenous bone graft for sinus elevation

OBJECTIVES

The posterior maxillary region often provides a limited bone volume for dental implants. Maxillary sinus elevation via inserting a bone graft through a window opened in the lateral sinus wall has become the most common surgical procedure for increasing the alveolar bone height in place of dental implants in the posterior maxillary region. The purpose of this article is to assess the change of bone volume and the clinical effects of dental implant placement in sites with maxillary sinus floor elevation and autogenous bone graft through the lateral window approach.

MATERIALS AND METHODS

In this article, the analysis data were collected from 64 dental implants that were placed in 24 patients with 29 lacks of the bone volume posterior maxillary region from June 2004 to April 2011, at the Department of Oral and Maxillofacial Surgery, Inha University Hospital. Panoramic views were taken before the surgery, after the surgery, 6 months after the surgery, and at the time of the final follow-up. The influence of the factors on the grafted bone material resorption rate was evaluated according to the patient characteristics (age and gender), graft material, implant installation stage, implant size, implant placement region, local infection, surgical complication, and residual alveolar bone height.

RESULTS

The bone graft resorption rate of male patients at the final follow-up was significantly higher than the rate of female patients. The single autogenous bone-grafted site was significantly more resorbed than the autogenous bone combined with the Bio-Oss grafted site. The implant installation stage and residual alveolar height showed a significant correlation with the resorption rate of maxillary sinus bone graft material. The success rate and survival rate of the implant were 92.2% and 100%, respectively.

CONCLUSION

Maxillary sinus elevation procedure with autogenous bone graft or autogenous bone in combination with Bio-Oss is a predictable treatment method for implant rehabilitation.

NF-κB mediated miR-21 regulation in cardiomyocytes apoptosis under oxidative stress

Oxidative stress, defined as an excess production of reactive oxygen species (ROS), is shown to play an important role in the pathophysiology of cardiac remodeling including cell death and contractile dysfunction. Therefore, the balance between ROS production and removal of excess ROS is essential in maintaining the redox state and homeostasis balance in the cell. The increased ROS further activates nuclear factor-κB (NF-κB), a redox-sensitive transcription factor and promotes cell death. Recently, microRNAs (miRNAs) have been identified as critical regulators of various pathophysiological processes of cardiac remodeling; however, NF-κB-mediated miRNA's role in cardiomyocytes under oxidative stress remains undetermined. The miR-21 has been implicated in diverse cardiac remodeling; but, NF-κB-mediated miR-21 modulation in oxidative stress is currently unknown. Neonatal cardiomyocytes were transfected with IκBα mutant, miR-21 mimetic, and inhibitors separately, and were challenged with H2O2. The target gene, programmed cell death 4 (PDCD4), ROS activity, and NF-κB translocation were analyzed. Our results indicated that NF-κB positively regulated miR-21 expression under oxidative stress, and PDCD4 was a direct target for miR-21. NF-κB further regulated the expression of PDCD4 in H2O2-induced oxidative stress. Moreover, H2O2-induced ROS activity and cardiomyocytes apoptosis were partly protected by overexpression of miR-21 and displayed an important role in ROS-mediated cardiomyocytes injury. We evaluated a critical role of NF-κB-mediated miR-21 modulation in H2O2-induced oxidative stress in cardiomyocytes by targeting PDCD4. Our data may provide a new insight of miR-21's role in cardiac diseases primarily mediated by ROS.

Protective effects of peroxiredoxin 6 overexpression on amyloid β-induced apoptosis in PC12 cells

Oxidative stress triggered by amyloid beta (Aβ) accumulation contributes substantially to the pathogenesis of Alzheimer's disease (AD). In the present study, we examined the involvement of the antioxidant activity of peroxiredoxin 6 (Prdx 6) in protecting against Aβ25-35-induced neurotoxicity in rat PC12 cells. Treatment of PC12 cells with Aβ25-35 resulted in a dose- and time-dependent cytotoxicity that was associated with increased accumulation of intracellular reactive oxygen species (ROS) and mitochondria-mediated apoptotic cell death, including activation of Caspase 3 and 9, inactivation of poly ADP-ribosyl polymerse (PARP), and dysregulation of Bcl-2 and Bax. This apoptotic signaling machinery was markedly attenuated in PC12 cells that overexpress wild-type Prdx 6, but not in cells that overexpress the C47S catalytic mutant of Prdx 6. This indicates that the peroxidase activity of Prdx 6 protects PC12 cells from Aβ25-35-induced neurotoxicity. The neuroprotective role of the antioxidant Prdx 6 suggests its therapeutic and/or prophylactic potential to slow the progression of AD and limit the extent of neuronal cell death caused by AD.

Signals through GITR program CD4+ T cells to induce interleukin-9 (163.9)

Glucocorticoid-induced TNF receptor family-related protein (GITR) is expressed on various immune cells and well known as one of the co-stimulatory molecules to promote T helper (Th) type 2 responses. In this study, we show that an agonistic anti-GITR mAb (clone DTA-1) induced IL-9 production on the committing Th2 and regulatory T (Treg) cells, as well as enhanced IL-9 production from naive CD4+ T cells under Th9 skewing condition. Whereas, DTA-1 did not induce IFN-γ or IL-17A, lineage-specific cytokines of Th1 or Th17, respectively and was resistant to produce IL-9 from naive CD4 T cells under Th1 or Th17 polarizing conditions. Furthermore, GITR stimulation promoted reprogramming of regulatory T cells to produce IL-9+Foxp3+ Treg and effector Th9 cells. We found transcription factor Interferon-regulatory factor4 (IRF4) was up-regulated by GITR ligation at the early stage of Th9 differentiation and contributed to enhance IL-9 production. Also, when GITR signaling was activated, p65, activated by NFκB signaling pathways, directly interacted with Il9 locus including promoter region at the later stage of Th9 differentiation. Consistent with in vitro study, in vivo administration of DTA-1 enhanced IL-9 at the transcript level and the roles of IL-9 induced by GITR ligation in vivo are remained to be investigated for further studies.

Influence of serum leptin levels on future overweight risk in Korean children

BACKGROUND AND AIMS

Leptin is an important regulator of energy metabolism. It is considered to be positively related to body adiposity and metabolic disorders in obese adults and children. The purpose of this study was to evaluate the relationship between baseline circulating leptin, insulin and adiponectin levels and future overweight and metabolic risks in a paediatric population-based cohort.

METHODS AND RESULTS

First-grade students, who entered elementary school at age 7 years in Gwacheon, a Korean city, were enrolled in this cohort study, and followed from 1st grade to 5th grade. Annual physical examinations from 2005 to 2009 were performed. In 2006, the levels of serum glucose, insulin, leptin and adiponectin and lipid profiles were examined. In 2008, the above parameters, except for adiponectin, were measured again in 381 children (202 boys and 179 girls) who participated. In 2006, 10.2% of the children were overweight (body mass index (BMI) ≥ 85th percentile), and after 2 years, an additional 3% became overweight. Compared with insulin and adiponectin, leptin was most highly associated with current and future BMI, and percent body fat. Boys in the highest tertile for initial leptin (T3) showed the highest prevalence of overweight and metabolic risk scores among three leptin tertile groups. Girls showed the same trends as boys. High initial leptin levels could be predictive of greater future BMI and metabolic risk score (p < 0.001).

CONCLUSION

These results suggest that elevated serum leptin concentrations among the childhood population could be a marker for future BMI and metabolic disorders.

Effect of bath temperature on the properties of nanocrystalline ZnO thin films

The nanocrystalline zinc oxide (ZnO) thin films have been prepared by chemical bath deposition (CBD) method from aqueous zinc nitrate solution at room temperature (25 degrees C) and at higher temperature (75 degrees C). The changes in structural, morphological and optical properties were studied by means of X-ray diffraction (XRD), scanning electron microscopy (SEM), and optical absorption. The structural studies revealed that the film deposited at room temperature showed mixed phases of ZnO and Zn(OH)2 with wurtzite and orthorhombic crystal structure whereas at higher temperature, the deposited film is ZnO with wurtzite crystal structure. After air annealing at 400 degrees C, all the films converted into pure ZnO with wurtzite crystal structure. The films deposited at room temperature showed fibrous surface morphology with interconnected flakes while films deposited at higher temperature shows well-developed nano-rod morphology. Optical study shows that band gap energy (E(g)) of as-deposited thin films deposited at room temperature and at higher temperature are 3.81 and 3.4 eV, decreases up to 3.20 eV, after annealing treatment.

Oltipraz inhibits TGF-{beta}-mediated Foxp3+ regulatory T cell differentiation (139.15)

Oltipraz [5-(2-pyrazinyl)-4-methyl-1,2-dithiol-3-thione] is a synthetic dithiolethione that has been widely studied for the prevention of cancer formation as well as treatment of liver cirrhosis. Although the precise mechanism by which oltipraz inhibits cancer and liver diseases remains unknown, it may be attributed to its ability to induce the expression of numerous Phase 2 detoxification enzymes and to reduce hepatic triglyceride accumulation by S6K1-dependent pathway, respectively. However, whether oltipraz also has an effect on immune cells, especially on T helper cell differentiation has to be elucidated. Here, we found that addition of oltipraz significantly inhibited Th2 differentiation under neutral and Th2-polarizing conditions while there was little, if any, effect on Th1 differentiation. In addition, TGF-{beta}-mediated Foxp3 induction in naïve CD4+ T cells was considerably reduced in the presence of oltipraz. Furthermore, Foxp3 induction was inhibited by oltipraz even in IFN-{gamma}-deficient naïve CD4+ T cells, indicating that oltipraz can inhibit TGF-{beta}-mediated Foxp3+ regulatory T cell differentiation through an IFN-{gamma}-independent manner. Therefore, these results suggest that oltipraz can act as an immune-modulating agent.

Atmospherically stable nanoscale zero-valent iron particles formed under controlled air contact: characteristics and reactivity

Atmospherically stable NZVI (nanoscale zero-valent iron) particles were produced by modifying shell layers of Fe(H2) NZVI particles (RNIP-10DS) by using a controlled air contact method. Shell-modified NZVI particles were resistant to rapid aerial oxidation and were shown to have TCE degradation rate constants that were equivalent to 78% of those of pristine NZVI particles. Fe(H2) NZVI particles that were vigorously contacted with air (rapidly oxidized) showed a substantially compromised reactivity. Aging of shell-modified particles in water for one day resulted in a rate increase of 54%, implying that depassivation of the shell would play an important role in enhancing reactivity. Aging of shell-modified particles in air led to rate decreases by 14% and 46% in cases of one week and two months of aging, respectively. A series of instrumental analyses using transmission electron microscopy, X-ray diffractography, X-ray photoelectron spectroscopy, and X-ray absorption near-edge structure showed that the shells of modified NZVI particles primarily consisted of magnetite (Fe(3)O(4)). Analyses also implied that the new magnetite layer produced during shell modification was protective against shell passivation. Aging of shell-modified particles in water yielded another major mineral phase, goethite (alpha-FeOOH), whereas aging in air produced additional shell phases such as wustite (FeO), hematite (alpha-Fe(2)O(3)), and maghemite (gamma-Fe(2)O(3)).