ILT2 and ILT4 Drive Myeloid Suppression via Both Overlapping and Distinct Mechanisms

Solid tumors are dense three-dimensional (3D) multicellular structures that enable efficient receptor-ligand trans interactions via close cell-cell contact. Immunoglobulin-like transcript (ILT)2 and ILT4 are related immune-suppressive receptors that play a role in the inhibition of myeloid cells within the tumor microenvironment. The relative contribution of ILT2 and ILT4 to immune inhibition in the context of solid tumor tissue has not been fully explored. We present evidence that both ILT2 and ILT4 contribute to myeloid inhibition. We found that although ILT2 inhibits myeloid cell activation in the context of trans-engagement by MHC-I, ILT4 efficiently inhibits myeloid cells in the presence of either cis- or trans-engagement. In a 3D spheroid tumor model, dual ILT2/ILT4 blockade was required for the optimal activation of myeloid cells, including the secretion of CXCL9 and CCL5, upregulation of CD86 on dendritic cells, and downregulation of CD163 on macrophages. Humanized mouse tumor models showed increased immune activation and cytolytic T-cell activity with combined ILT2 and ILT4 blockade, including evidence of the generation of immune niches, which have been shown to correlate with clinical response to immune-checkpoint blockade. In a human tumor explant histoculture system, dual ILT2/ILT4 blockade increased CXCL9 secretion, downregulated CD163 expression, and increased the expression of M1 macrophage, IFNγ, and cytolytic T-cell gene signatures. Thus, we have revealed distinct contributions of ILT2 and ILT4 to myeloid cell biology and provide proof-of-concept data supporting the combined blockade of ILT2 and ILT4 to therapeutically induce optimal myeloid cell reprogramming in the tumor microenvironment.

Abstract 2912: INBRX-130, a 5T4-targeted CONTRA-MAB, is a potent CD3 bispecific antibody engineered to have minimal off-tumor activity

Bispecific T cell engagers that target CD3 on T cells and cell-surface antigens on tumor cells have demonstrated meaningful clinical activity against hematological cancers but have yet to achieve similar efficacy for the treatment of solid tumors. A variety of factors may be contributing to this lack of success in the solid tumor setting, including insufficient exposure of tumor cells to these targeted therapeutics due to target-independent interactions with peripheral T cells. Not only can circulating cells act as a sink for CD3 bispecifics but these interactions can lead to cytokine release syndrome (CRS), a common and dose-limiting toxicity for this class of therapeutics. We have developed a CD3 bispecific platform, CONTRA-MAB® (Constrained T Cell Redirecting and Activating Multispecific Antibody), that combines high-affinity tumor-associated antigen binding single-domain antibodies (sdAbs) with a constrained CD3-targeting VH/VL pair that has been strategically positioned and affinity engineered to minimize T cell activation and cytokine production in the absence of target antigen engagement. INBRX-130 is a CONTRA-MAB® that targets trophoblast glycoprotein (TPBG; 5T4), a cell-surface protein that is upregulated across many solid tumor indications but has restricted expression on normal adult tissues. As determined by flow cytometry, INBRX-130 exhibits specific and high-affinity binding to 5T4-positive cells but shows no detectable binding to T cells, absent target, at concentrations up to one micromolar. Additionally, treatment of peripheral blood mononuclear cells (PBMCs) with high concentration INBRX-130 does not result in production of detectable levels of CRS-associated inflammatory cytokines. Upon binding to 5T4-expressing tumor cells in vitro, INBRX-130 potently induces T cell activation, proliferation, cytokine production, and cytotoxicity, resulting in target cell death. INBRX-130 has favorable pharmacokinetic properties and the capacity to effect regression of 5T4+ tumors in humanized mice, even in models that display minimal initial T-cell infiltrate. INBRX-130 is well-tolerated by cynomolgus monkeys at the maximally administered dose of 2 mg/kg without the requirement of a priming dose. Preliminary in vitro data with CONTRA-MABs® targeting other solid tumor antigens supports the broad applicability of this unique T cell engager platform. CONTRA-MABs® have the potential to have enhanced accumulation in solid tumors relative to other CD3 bispecific antibodies as a result of reduced systemic engagement of T cells and increased tolerability at high doses. These attributes, coupled with the broad tumor biased expression of 5T4 across solid tumors, may enable INBRX-130 to have a greater therapeutic index and provide a significant benefit to patients in need.

Citation Format: Katelyn M. Willis, Margaret Haerr, Marchelle Meza, Sae Jeong Ahn, Michael Kaplan, Georgina Ortiz-Barquero, Rajay Pandit, Rafael Abalos, Yao Chen, Samuel Holley, Raul Lozano, Iljin Hwang, Emily Rowell, Brendan P. Eckelman. INBRX-130, a 5T4-targeted CONTRA-MAB, is a potent CD3 bispecific antibody engineered to have minimal off-tumor activity [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 2912.

Integrating nursing diagnoses, interventions, and outcomes in public health nursing practice

TOPIC

Applying standardized nursing language in public health nursing practice.

PURPOSE

To develop a charting format to document public health nursing practice based on standardized nursing language.

SOURCES

Literature review of documentation systems for public health nursing practice.

CONCLUSIONS

A task force of public health nurses developed a charting format based on Taxonomy I of Nursing Diagnosis (NANDA), Nursing Interventions Classification (NIC), and Nursing Outcomes Classification (NOC).

[Incidence of congenital malformations in 10 Chilean maternity hospitals that participate in the ECLAMC. Comparison of 3 periods (1971-1977, 1982-1988, 1989-1994)]

BACKGROUND

The Latin American Collaborative Study of Congenital Malformations is an epidemiological surveillance system for congenital malformations that operates in 11 Latin American Countries.

AIM

To report the incidence of congenital malformations in 8 Chilean maternity hospitals participating in this study, between 1989 and 1994.

MATERIAL AND METHODS

During the study period, 133,564 newborns and 1,196 stillbirths from 8 Chilean maternity hospitals were examined. These results were compared with those of a similar survey performed in 1982-1988.

RESULTS

The proportion of stillbirths in the study period was 0.88%. There were 3,268 malformed newborns (2.42%) and 125 malformed stillbirths (10.45%). These proportion of malformations among newborns were lower and among stillbirths were higher than those reported for the rest of Latin American countries. When comparing the results with the previous survey, a reduction in the proportion of malformations among newborns was observed. However, in all Latin American countries, the prevalence of malformations in newborns and stillbirths increased in this period. In the period 1969-1995, in one Chilean hospital, maternal ages and the proportion of congenital malformation showed parallel and rising curves.

CONCLUSIONS

This survey shows some differences in the prevalence of congenital malformations, when the figures are compared with other Latin American countries and with previous surveys.

[Shortened version of the Barcelona test (III): criterion validity with the ADAS-Cog]

The aim of this study was to assess the criterion validity of a global score of an abbreviated version of the Barcelona Test (BTA), normalized for age and education, as a clinical neuropsychometric test for the assessment of cognitive impairment. This study made a correlational analysis between test scores of the BTA and scores of the cognitive part of the Alzheimer's Disease Assessment Scale (ADAS-Cog) adjusted for age and education. It was made in a University Hospital (Dementia Unit). A group of 172 subjects (74 male, 98 female) was distributed according the Global Deterioration Stages (GDS) from 1 to 6. GDS-1 (normal controls), n = 60; GDS-2 (subjective complaints), n = 27; GDS-3, n = 21, GDS-4, n = 22; GDS-5, n = 16; GDS 6, n = 26. All dementia patients fulfilled the NINCDS/ADRDA criteria. BTA global scores correlated significantly with adjusted scores on the ADAS-Cog (r = 0.872, r2 = 0.761), p < 0.0001. The BTA has a criterion validity as a clinical neuropsychometric test for the study of cognitive impairment.

[Shortened version of the Barcelona test (II): global standard score]

The aim of this study was to determine a global scoring method for a shortened and version of the Barcelona Neuropsychological test (TB) of 55 items. 341 healthy volunteers, 178 male (52.19%), and 163 female (47.1%) were studied. Age mean: 54.80, SD = 17.44. Subjects were stratified in five groups considering age and education. A scale of cut-off points was selected in order to divide the scores of each subtest into three bands (categories): 0 (lowest), 1 (intermediate), 2 (highest). Raw scores (possible range 0-110) were obtained and then were converted to a mean of 100 and SD of 15 each normative group. Tables of normative data were obtained for each group. This study shows the cognitive profiles of the TB and a global standard score related to them. This global score will provide new possibilities in the neuropsychological assessment of neurological patients.

Myocardial contrast echocardiography: reliable, safe, and efficacious myocardial perfusion assessment after intravenous injections of a new echocardiographic contrast agent

Reliable and reproducible myocardial opacification after intravenous administration of echocardiographic contrast agents has remained elusive. This study was performed to determine whether a new agent, FS069, a suspension of perfluoropropane-filled albumin microspheres (3.6 microns average microbubble size, concentration 8 x 8(8)/ml), could achieve safe and successful myocardial opacification in open-chest dogs. Seventeen dogs (group 1, n = 7, group 2, n = 10) underwent two-dimensional echocardiography before, during, and after the administration of intravenous FS069. Safety was evaluated by measuring arterial and pulmonary artery pressures, heart rate, blood gases, systolic function, myocardial blood flow, and postmortem analysis of myocardial viability by triphenyl-tetrazolium chloride staining. Efficacy to detect changes in regional myocardial perfusion was assessed by injecting FS069 at baseline, after sequential coronary occlusions and reperfusion, and during intravenous vasodilators with and without coronary occlusions. Results were compared with radiolabeled microspheres. FS069 was found to be safe and effective. In the absence of coronary occlusions, uniform myocardial opacification was observed in all dogs. A perfusion defect was observed in all dogs during coronary occlusions. Background-subtracted peak contrast intensity in the myocardium correctly identified regional myocardial blood flow changes and showed a significant correlation with radiolabeled microspheres (r = 0.65, p = 0.0001).

Dobutamine echocardiography and myocardial contrast echocardiography. Two new techniques for the assessment of myocardial viability

As investigators have discovered that cardiac regions displaying resting wall motion abnormalities are not the necessary equivalent of myocardial scar (and therefore of irreversible injury) but are potentially viable regions rendered dysfunctional by stunning or hibernation, a new field of medicine has developed to identify viable myocardium that can improve in function after revascularization. Moreover, improvements in myocardial preservation and perfusion during coronary artery bypass grafting and percutaneous transluminal coronary angioplasty have enabled patients with poor resting ejection fractions to undergo safer revascularization. In this review, we describe briefly the diagnostic techniques most commonly used in identifying dysfunctional but viable myocardium. We give specific attention to the assets and limitations of these techniques and special emphasis to 2 promising new techniques: dobutamine echocardiography and myocardial contrast echocardiography.

[Persistent microalbuminuria in insulin-dependent diabetics and cardiovascular risk factors]

A possible association of cardiovascular risk factors and early diabetic nephropathy was investigated in 32 patients. Microalbuminuria (radioimmunoassay), total and HDL cholesterol and triglycerides (enzymatic methods), glycosylated hemoglobin (colorimetric methods), Apo A1 and B (immunonephelometric) and LDL were measured. Microalbuminuria was present in 28% of patients. Compared to subjects with no microalbuminuria they had increased levels of cholesterol (200.2 +/- 13.5 (SE) vs 168.6 +/- 9.4 mg/dl, p < 0.025) and LDL cholesterol (171.9 +/- 14.1 vs 137.4 +/- 9.1 mg/dl, p < 0.025). Systolic blood pressure was also higher in patients with microalbuminuria (127.8 +/- 3.9 vs 114.5 +/- 2.8 mmHg, p < 0.01). Microalbuminuria was correlated to the level of diastolic blood pressure (r = 0.74, p < 0.025). Thus, persistent microalbuminuria in insulin dependent diabetic patients is associated to cardiovascular risk factors which may explain the increased cardiovascular morbidity and mortality in these patients.

Aberrant thymus--MR assessment

Aberrant thymic tissue, particularly when it is located posteriorly, can present a diagnostic dilemma. Once a mediastinal "lesion" is defined on the plain film, MR is the most efficient and best diagnostic test for defining the nature of the mass and showing its relationship to other mediastinal structures. Two cases of aberrant thymic tissue, one on the right side and one on the left, are presented to elucidate the unique role of MRI.

[Tuberculosis and diabetes mellitus: a longitudinal-retrospective study in a teaching hospital]

We analyzed 1529 diabetic patients seen between 1959 and 1982 at a teaching hospital in Concepción, Chile. 116 of them were insulin dependent diabetics. Gestational diabetes was excluded. The 10 year actuarial risk of acquiring tuberculosis was 24.2% for insulin-dependent diabetics and 4.8% for the rest (p less than 0.001). The risk of the diabetic population as a whole was 5.9% compared to 0.8% for the population at large. Thus, diabetics are a high risk group for tuberculosis, especially insulin-dependent patients whose risk is about 38 times higher than the general population under 40 years of age.

A study in the relationship between emotional stability, intellectual ability, academic attainment, personal contentment and vocational aspirations

This study investigated the relationship between ability, attainment and emotional stability, as measured by neuroticism, in underachieving, emotionally disturbed children. Forty children participated in four groups (mean age: 12.6, SD: 2.4; mean IQ: 103.3, SD: 13.6). Three experimental groups received different treatments in a therapeutic community, the fourth (control group) comprised children attending remedial units in mainstream education. For group 1 emphasis was on individualized education; for group 2 on psychological treatment and for group 3 on individualized education and psychological treatment combined. Pre- and post-experiment assessments were made on emotional stability, intelligence, reading, spelling and maths quotients, vocational aspirations and contentment with life. All the experimental groups showed significant improvements on all the criteria assessed. Group 3 improved most, P less than 0.001 on all criteria except contentment and vocational aspirations (P less than 0.01). The control group showed a deterioration over the experimental year on all criteria but mostly not at a significant level.

Postplacental manual insertion of the Multiload Copper 250 IUD

A Multiload (ML) Cu 250 IUD was inserted manually immediately after childbirth in 200 volunteer women. The patients were followed up at 1, 3, 6, 12, and 24 months. There were no undesirable side effects and no serious complications occurred. No noteworthy bleeding occurred either in the postpartum period or subsequently. Maternal lactation was not affected. During the 2 years, 6 devices were removed for medical reasons and the IUD was expelled spontaneously in only 2 patients. 2 pregnancies occurred among the women who were followed up. Postpartum manual insertion of the ML Cu 250 is a very good method of postpartum contraception because there are no significant complications, the rate of expulsion is minimal, and the efficacy is quite high.