Abstract 302: Loss of head and neck squamous cell carcinoma MK2 increases STING activation through increased micronuclei formation

Our previous work has shown that the phosphorylation of MK2, a downstream kinase of the p38 pathway, is a prognostic feature of head and neck cancer (HNC) where patients with higher MK2 phosphorylation had lower overall survival. Studies with a MK2 inhibitor demonstrate control of HNC growth in a mouse model that was synergistic with radiotherapy (RT) in inhibiting tumor growth. The mechanism of action that MK2 inhibition combined with RT has on modulating HNC growth is unknown. A better understanding of this mechanism might reveal how to effectively deploy MK2 inhibitors in HNC treatment. Here we describe our studies in which we suppressed MK2 expression in HNC cell lines and found increased genomic instability in response to radiotherapy.

Tu167 and Cal27 HNC cells were transfected with a stable shRNA construct that suppressed ~90% of the MK2 expression compared to a control shRNA construct (SCR) as determined by immunoblot. Loss of MK2 did not significantly affect cell growth nor did it affect cells from forming colonies. However, exposing the cells to 10 Gy radiation caused the formation of micronuclei that was increased in the shRNA cells compared to SCR at 48 hours (Cal 27 SCR + 10 Gy = 0.5 ± 0.3 Micronuclei/cell v Cal27 shRNA + 10 Gy = 1.6 ± 0.1. Micronuclei/cell P<0.01; Tu167 SCR + 10 Gy = 1.1 ± 0.2 Micronuclei/cell; Tu167 shRNA + 10 Gy = 2.3 ± .3; Micronuclei/cell p<0.001). Immunocytochemical techniques were used to image cells at 60x magnification. In conjunction with increased micronuclei formation, we saw an increase expression in both the DNA sensor cGAS, and phosphorylation of STING in the shRNA cells compared to SCR. The increase in micronuclei caused by radiation was largely inhibited by cytochalasin B which also inhibited the increase in STING phosphorylation. There was no difference in the staining of γH2AX after 2 hours following RT but after 48 hours the γH2AX staining was concentrated in the micronuclei which were more numerous in the shRNA cells.

These data provide evidence that MK2 plays a role in controlling the DNA damage response, and we show for the first time that loss of MK2 increases the number of micronuclei formed causing an enhanced activation of the cGAS-STING pathway, an innate immune DNA sensing pathway. This suggests that inhibition of MK2 may enhance RT effectiveness by activating STING and facilitating an anti-tumor immune response.

Citation Format: Colby Spiess, Grace Millington, Hannah Smith, Dakota D. Okwuone, Kiersten Berggren, Deri Morgan, Chris Lominska, Sufi M. Thomas, Jingxin Wang, Mary Markiewicz, Gregory N. Gan. Loss of head and neck squamous cell carcinoma MK2 increases STING activation through increased micronuclei formation [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 302.

Abstract 3844: COL11A1: A driver of tumor progression and immune evasion in head and neck squamous cell carcinoma (HNSCC)

We previously reported that collagen type XI alpha 1 (COL11A1) is upregulated in head and neck squamous cell carcinoma (HNSCC) and contributes to tumor progression. Here we tested the hypothesis that COL11A1 regulates the expression of immune regulatory markers in HNSCC. Xena Browser was used to analyze 520 and 42 cancer free normal head and neck tissue samples for COL11A1 expression. The Cancer Genome Atlas (TCGA) RNASeq data from 522 HNSCC samples was downloaded and sorted by clinical parameters and RNA expression for 20,000 genes. COL11A1 expression was correlated with tumor stage (T) and clinical stage (I-IV). Data was sorted by COL11A1 high and low based on the mean COL11A1 expression level and run through the CIBERSORT analysis tool for prediction of immune cell proportions in the tumor. HNSCC lines with COL11A1 knockdown were assessed for immune regulatory markers at the RNA and protein level. COL11A1 was found to be increased in HNSCC relative to normal tissue (tumor vs. normal p<0.0001). COL11A1 expression is highest in HPV negative HNSCC. Its expression correlates with increased tumor (T1 vs T4 p=0.033) and clinical stage (stage III vs. stage IV p=0.023). CIBERSORT analysis demonstrates COL11A1hi patients have significantly decreased active natural killer (NK) cells (active vs. inactive p=0.0166), CD8+ T cells (CD8 low vs. high p<0.0001) and active dendritic cells (active vs. inactive p=0.0035) suggesting immune modulation. COL11A1 targeted lines in vitro show decreased expression of hla-a, -c and cd274 (PD-L1), suggesting COL11A1 expression modulates immune activation by regulating immune suppressive ligands on the tumor cell. COL11A1 is overexpressed in HNSCC and drives tumor proliferation, migration and invasion. Expression levels correlate with tumor and clinical stage. Bioinformatics tool CIBERSORT, predicts decreased immune cell activity in patients with high COL11A1. Targeting COL11A1 in vitro decreased expression of immune suppressive ligands. These preliminary results indicate COL11A1 may drive immune evasion in HPV negative HNSCC. Targeting COL11A1 may improve patient response to immunotherapeutic targets in HNSCC.

Citation Format: Harmony Ivanna Saunders, Levi Arnold, Mary Markiewicz, Sufi M. Thomas. COL11A1: A driver of tumor progression and immune evasion in head and neck squamous cell carcinoma (HNSCC) [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 3844.

Mutual relations between jasmonic acid and acibenzolar-S-methyl in the induction of resistance to the two-spotted spider mite (Tetranychus urticae) in apple trees

The possibility of inducing resistance to the two-spotted spider mite, Tetranychus urticae Koch, in 'Gala' apple trees growing under optimal fertilization or nitrogen-deficiency conditions was investigated. The effects of jasmonic acid (JA) at 1.5 and 2.5 mM, and acibenzolar-S-methyl (benzothiadiazole, BTH) at 0.5 and 1.5 mM, applied separately or together, on the fecundity of T. urticae females in a laboratory test as well as on the population growth of the pest in a greenhouse experiment were determined. The influence of both elicitors on the induction of LOX and PAL gene expression was assessed in a parallel experiment using real-time PCR. Jasmonic acid showed significantly higher effectiveness in inducing apple tree resistance to T. urticae, as compared to BTH. This was particularly evident in the reduction in pest numbers that was observed in the greenhouse experiment and was also confirmed by increased LOX gene expression after treatment with JA. BTH induced the expression of the PAL gene more strongly than jasmonic acid; however, this was not reflected in the performance of the two-spotted spider mite in the laboratory and greenhouse experiments. It was also found that the antagonistic effect of BTH on JA might lead to decreased effectiveness of the jasmonic acid used to induce apple tree resistance to the two-spotted spider mite. Although nitrogen fertilization stimulated the development of spider mite populations, the resistance induction mechanism was more effective in N-fertilized plants, which was especially evident at the higher jasmonic acid concentration.

Abstract P5-04-20: Progesterone promotes immunosuppression in breast cancer

Why are some early neoplastic lesions identified through immunosurveillance and subsequently destroyed, whereas other tumors evade this clearance step and progress to clinically-relevant tumors? The cancer immunoediting hypothesis highlights that the innate and adaptive immune responses work together to “flag” early neoplastic lesions for immune-mediated elimination. An early mediator of this “elimination” process is activation of type I interferon signaling. Thus, suppression of type I interferon signaling may help developing tumors evade the critical early steps of immune recognition and clearance. Preliminary data from our lab suggest that progesterone, working through the progesterone receptor (PR), may be a key player in tumor immune evasion through downregulation of interferon signaling. In breast cancer cells, we have shown that presence/activation of PR can attenuate interferon-signaling at multiple steps within the signaling cascade: decreased STAT1 phosphorylation, decreased STAT1/STAT2/IRF9 transcriptional complex formation (called ISGF3, required for interferon-alpha signaling), decreased recruitment of ISGF3 to ISG promoter sequences, and decreased transcriptional activation of interferon-stimulated genes (ISG, end point of interferon signaling). These data suggest a concerted effort aimed at reducing interferon-signaling through activation of PR. These data translate to the immune microenvironment in the murine mammary gland. In mice treated with progesterone for 21 days, we see immunosuppressive changes in the mammary gland: increased T-regulatory cells (immunosuppressive), decreased frequency of antigen-presenting cells (decreased ability to present potential tumor-associated antigens to CD8 T-cells), and a decrease in MHC class I presentation in non-lymphoid cells (decreased ability for epithelial cells to present potential tumor-associated antigens). We observe similar phenotypes in mice with transgenic overexpression of PR. These changes in the immune system suggest that PR can promote immunosuppressive changes in the mammary gland. Moreover, 80% of these mice in a multiparous cohort develop mammary gland tumors. Therefore, early changes in the immune microenvironment in the mammary gland may translate to the development of mammary gland tumors in PR transgenic mice. Cumulatively, these data suggest a mechanism through which PR aids early breast cancer lesions in escaping immune surveillance. These data have significant implications for the use of progesterone-containing hormone replacement therapy, as well as underscore the importance of studying anti-progestins as novel chemo-preventative agents for breast cancer.

Citation Format: Christy Hagan, Merit Goodman, Gloria Trinca, Katherine Walter, Katelin Gibson, Prabhakar Chalise, Mary Markiewicz. Progesterone promotes immunosuppression in breast cancer [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P5-04-20.

Quantification and biodegradability assessment of meso-2,3-dimercaptosuccinic acid adsorbed on iron oxide nanoparticles

Many interesting applications of magnetic iron oxide nanoparticles (IONPs) have recently been developed based on their magnetic properties and promising catalytic activity. Depending on their intended use, such nanoparticles (NPs) are frequently functionalized with proteins, polymers, or other organic molecules such as meso-2,3-dimercaptosuccinic acid (DMSA) to improve their colloidal stability or biocompatibility. Although the coating strongly affects the colloidal properties and environmental behaviour of NPs, quantitative analysis of the coating is often neglected. To address this issue, we established an ion chromatographic method for the quantitative analysis of surface-bound sulfur-containing molecules such as DMSA. The method determines the amount of sulfate generated by complete oxidation of sulfur present in the molecule. Quantification of the DMSA content of DMSA-coated IONPs showed that reproducibly approximately 38% of the DMSA used in the synthesis was adsorbed on the IONPs. Tests for the biodegradability of free and NP-bound DMSA using a microbial community from a wastewater treatment plant showed that both free and NP-bound DMSA was degraded to negligible extent, suggesting long-term environmental stability of DMSA-coated IONPs.

Abstract 2361: Progesterone receptor promotes immunosuppressive microenvironment in the mammary gland

Why are some early neoplastic lesions identified through immunosurveillance and subsequently destroyed, whereas other tumors evade this clearance step and progress to clinically-relevant tumors? The cancer immunoediting hypothesis highlights that the innate and adaptive immune responses work together to “flag” early neoplastic lesions for immune-mediated elimination. An early mediator of this “elimination” process is activation of type I interferon signaling. Thus, suppression of type I interferon signaling may help developing tumors evade the critical early steps of immune recognition and clearance. Preliminary data from our lab suggest that progesterone, working through the progesterone receptor (PR), may be a key player in tumor immune evasion through downregulation of interferon signaling. In breast cancer cells, we have shown that presence/activation of PR can attenuate interferon-signaling at multiple steps within the signaling cascade: decreased STAT1 phosphorylation, decreased STAT1/STAT2/IRF9 transcriptional complex formation (called ISGF3, required for interferon-alpha signaling), decreased recruitment of ISGF3 to ISG promoter sequences, and decreased transcriptional activation of interferon-stimulated genes (ISG, end point of interferon signaling). These data suggest a concerted effort aimed at reducing interferon-signaling through activation of PR. These data translate to the immune microenvironment in the murine mammary gland. In mice treated with progesterone for 21 days, we see immunosuppressive changes in the mammary gland: increased T-regulatory cells (immunosuppressive), decreased frequency of antigen-presenting cells (decreased ability to present potential tumor-associated antigens to CD8 T-cells), and a decrease in MHC class I presentation in non-lymphoid cells (decreased ability for epithelial cells to present potential tumor-associated antigens). We observe similar phenotypes in mice with transgenic overexpression of PR. These changes in the immune system suggest that PR can promote immunosuppressive changes in the mammary gland. Moreover, 80% of these mice in a multiparous cohort develop mammary gland tumors. Therefore, early changes in the immune microenvironment in the mammary gland may translate to the development of mammary gland tumors in PR transgenic mice. Cumulatively, these data suggest a mechanism through which PR aids early breast cancer lesions in escaping immune surveillance. These data have significant implications for the use of progesterone-containing hormone replacement therapy, as well as underscore the importance of studying anti-progestins as novel chemo-preventative agents for breast cancer.

Citation Format: Merit Goodman, Gloria Trinca, Katherine Walter, Katelin Gibson, Prabhakar Chalise, Mary Markiewicz, Christy R. Hagan. Progesterone receptor promotes immunosuppressive microenvironment in the mammary gland [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 2361.

Trends in patient outcome over the past two decades following allogeneic stem cell transplantation for acute myeloid leukaemia: an ALWP/EBMT analysis

BACKGROUND

Outcomes for patients with acute myeloid leukaemia (AML) undergoing allogeneic stem cell transplantation (allo-SCT) have significantly improved in recent years.

OBJECTIVES

To assess the incremental improvement of transplanted AML patients in the last two decades.

METHODS

Patients included in this analysis were adult AML patients who underwent allo-SCT from an HLA-matched sibling donor (MSD) or HLA-matched unrelated donor (MUD) in first remission. Patient outcomes were assessed between three cohorts according to the year of transplant (1993-2002, 2003-2007 and 2008-2012).

RESULTS

The analysis comprised a total of 20 187 patients of whom 4763 were transplanted between 1993 and 2002, 5835 in 2003 and 2007, and 9589 in 2008 and 2012. In multivariate analysis, leukaemia-free survival (LFS) rates were significantly improved in more recently transplanted patients compared to patients transplanted in 1993-2002 [Hazard ratio (HR) = 0.84, confidence interval (CI) 95%, 0.77-0.92; P = 0.003], a benefit which also extended to improved overall survival (OS; HR = 0.8, CI 95%, 0.73-0.89; P < 0.0001), and decreased nonrelapse mortality (NRM) rates (HR = 0.65, CI 95%, 0.56-0.75; P < 0.0001). Subset analysis revealed that in MSD, the rates of LFS, NRM and OS significantly improved in patients in the more recent cohort with similar results also seen in MUD. Finally, the incidence of acute graft-versus-host disease (GVHD) was significantly reduced leading to improved GVHD-free/relapse-free survival (GRFS) rates in more recently transplanted patients.

CONCLUSION

Outcome of allo-SCT for AML patients has markedly improved in the last two decades owing to decreased nonrelapse mortality and improved rates of leukaemia-free survival resulting in significantly longer survival.

Abstract 1304: The effect of FoxM1 inhibition with thiostrepton on ovarian cancer immune response and sensitivity to chemotherapy in vitro

Background: An ideal anti-cancer agent will target a pathway that is altered in cancer, produce a selective cytotoxic response in cancer cells, induce immunogenic cell death, and enhance tumor immunity. FoxM1 inhibitor, thiostrepton, may fit this profile of an ideal anti-cancer agent. FoxM1 is activated in the majority of high-grade serous carcinomas, regulates DNA repair genes, and enhances cell proliferation, metastasis, and chemotherapy resistance. We have previously shown that loss-of-function and gain-of-function TP53 mutations contribute to FoxM1 overexpression, thus the p53-FoxM1 axis represents a novel therapeutic target. However, the therapeutic potential of FoxM1 inhibition by thiostrepton has not been fully investigated in ovarian cancer.

Hypothesis: We hypothesize that FoxM1 inhibition by thiostrepton increases cancer cell sensitivity to chemotherapy and enhances anti-tumor immunity.

Results: Thiostrepton downregulates FoxM1 expression, induces cytotoxic effects across various ovarian cancer cell lines, and shows synergistic activities with cisplatin. In congruence with the Connectivity Map data, qRT-PCR results of A2780 cells treated with thiostrepton (10 μM) show upregulation of pro-apoptotic genes DDIT3, GADD45A and DDIT4, and downregulation of DNA repair and anti-apoptotic genes FANCF, BRCA2, BRCC3, and BCL2. These results suggest that the synergism observed may be a consequence of DNA damage induction by cisplatin combined with inhibition of DNA repair by thiostrepton, making this a lethal duo to cancer cells. Comet assay results from mouse ovarian cancer cells, ID8, support this hypothesis by demonstrating an increase in DNA damage following the combined treatment of thiostrepton and carboplatin or thiostrepton and PARP inhibitor olaparib. Western blots also show increased p-H2AX levels in these combined treatments. In addition to the cytotoxic effect, thiostrepton can alter the cancer cell immune response by affecting the expression of immunomodulatory genes. This is supported by the ENCODE data, which indicates FoxM1 binds to the cis-regulatory region of PD-L1 (programmed cell death ligand 1), a target of ongoing immunotherapy clinical trials. Flow cytometry and Western blots depict increased PD-L1 expression in ID8 cells treated with thiostrepton (5 μM). In these same cells, flow cytometry showed an increase in RAE1 and 4-1BB ligands, which may lead to increased recognition by natural killer T-cells, as well as enhanced externalization of calreticulin, a hallmark of immunogenic cell death.

Conclusion: These studies demonstrate the novel effect of thiostrepton on immunogenic cancer cell death and an effect on anti-tumor immunity. These results suggest thiostrepton as an ideal anti-cancer agent with the ability to target the DNA repair response and the immune response to enhance the chemotherapeutic effects of cisplatin and olaparib.

Citation Format: Jill Madden, Pingping Fang, Bernard Herrman, Mary Markiewicz, Ryan Moulder, Laird Forrest, Jeremy Chien. The effect of FoxM1 inhibition with thiostrepton on ovarian cancer immune response and sensitivity to chemotherapy in vitro. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 1304.

Monitoring activities of daily living based on wearable wireless body sensor network

With recent advances in microprocessor chip technology, wireless communication, and biomedical engineering it is possible to develop miniaturized ubiquitous health monitoring devices that are capable of recording physiological and movement signals during daily life activities. The aim of the research is to implement and test the prototype of health monitoring system. The system consists of the body central unit with Bluetooth module and wearable sensors: the custom-designed ECG sensor, the temperature sensor, the skin humidity sensor and accelerometers placed on the human body or integrated with clothes and a network gateway to forward data to a remote medical server. The system includes custom-designed transmission protocol and remote web-based graphical user interface for remote real time data analysis. Experimental results for a group of humans who performed various activities (eg. working, running, etc.) showed maximum 5% absolute error compared to certified medical devices. The results are promising and indicate that developed wireless wearable monitoring system faces challenges of multi-sensor human health monitoring during performing daily activities and opens new opportunities in developing novel healthcare services.

Mobility and biodegradability of an imidazolium based ionic liquid in soil and soil amended with waste sewage sludge

Sorption on solids and biodegradation are main phenomena that can mitigate the pollution of soil and water by ionic liquids (ILs). ILs sorbed on soil particles become immobilized (temporarily or permanently) which prevents them from spreading into deeper layers of soil or groundwater but which also makes them less bioavailable. In this study we attempt to examine if amendment of soil with waste sludge has a potential to mitigate the transport and enhance biodegradation of ILs using 1-methyl-3-octylimidazolium chloride ([OMIM][Cl]) as an example. We present the results of adsorption test (batch and column) and ultimate biodegradation of [OMIM][Cl] using microbial communities derived from soil. Finally, we combine all of these processes together to examine the fate of [OMIM][Cl] in a continuous column flow-through system in soil amended with waste sewage sludge. Addition of sludge serves two purposes: firstly increasing soil organic matter (formerly proved to facilitate retardation), and secondly augmenting soil with versatile microbial communities previously shown to successfully degrade ILs.

NKG2D-NKG2D ligand interaction inhibits the outgrowth of low-grade B cell lymphoma (TUM9P.1019)

Transgenic mice we generated with ubiquitous expression of the NKG2D ligand RAE1ε, and therefore low surface NKG2D expression, developed natural, spontaneous B cell lymphoma at a younger age than wild-type mice. Transplantation of lymphomas from RAE1ε transgenic mice into lymphodeficient mice resulted in expression of NKG2D on immune cells transferred along with the tumor and rejection of the lymphoma cells, suggesting NKG2D is important in controlling lymphoma outgrowth in wild-type mice. In the absence of overt tumor masses, older mice developed lymphoid aggregates in non-lymphoid organs and these aggregates occurred at a younger age in RAE1ε transgenic and NKG2D-deficient mice. The increased incidence of both these lymphoid aggregates and tumor masses in RAE1ε transgenic mice suggests these lymphoid aggregates are slow growing indolent lymphomas. Although NKG2D ligands were undetectable on wild-type tumors, ligands were present on splenic B cells in a similar proportion of 10 month-old wild-type and NKG2D-deficient mice as those with lymphoid aggregates present. These results suggest that 1) induction of NKG2D ligands is an early marker of B cell transformation, 2) NKG2D-NKG2D ligand interaction suppresses B cell lymphoma growth, and 3) loss of NKG2D receptor-ligand interactions leads to the transformation of indolent B cell lymphomas into aggressive tumors in this model. We are now exploring whether these results are relevant to human follicular lymphoma progression.

The nanoparticle biomolecule corona: lessons learned – challenge accepted?

Besides the wide use of engineered nanomaterials (NMs) in technical products, their applications are not only increasing in biotechnology and biomedicine, but also in the environmental field.

IL-10 promoter polymorphisms influence susceptibility to aGvHD and are associated with proportions of CD4+FoxP3+ lymphocytes in blood after hematopoietic stem cell transplantation

Four hundred and ninety-five patients (390 and 105 grafted from unrelated and sibling (SIB) donors, respectively) and their donors were analyzed for the impact of interleukin-10 (IL-10) promoter genotype [rs18000896 (-1082 G/A), rs18000871 (-819 C/T) and rs18000872 (-592 C/A)] on the outcome of hematopoietic stem cell transplantation (HSCT). Patients having ACC haplotype were at a lower risk of acute graft versus host disease (aGvHD, grade > I) if transplanted from human leukocyte antigen (HLA) well-matched (10/10) unrelated donors (20/135 vs 39/117, P < 0.001, Pcorr = 0.002), which was not seen if patients were transplanted from either sibling (SIB) or poorly matched (<10/10) unrelated donors (MUD). In addition, GCC haplotype positive recipients of unrelated donor transplants tended to be more susceptible to aGvHD (68/199 vs 39/169, P = 0.019, Pcorr = 0.057). Multivariate logistic regression analysis in the MUD transplanted group showed that donor-recipient human leukocyte antigen (HLA) mismatch [odds ratio (OR) = 3.937, P = 0.001] and a lack of ACC haplotype in recipients (OR = 0.417, P = 0.013) played a significant role as independent risk factors of aGvHD grade > I. ACC carriers had higher proportions of FoxP3+ lymphocytes gated in CD4+ lymphocytes as compared with patients with other IL-10 haplotypes. It was seen at the time of hematological recovery (mean ± SEM: 3.80 ± 0.91% vs 2.06 ± 0.98%, P = 0.012) and 2 weeks later (5.32 ± 0.87% vs 2.50 ± 0.83%, P = 0.013); -592 C/A polymorphism was separately analyzed and it was found that AA homozygotes tended to have a higher incidence of aGvHD (8/15 vs 116/456, P = 0.034) and low proportions of FoxP3 CD4+ lymphocytes in blood (0.43 ± 0.22% vs 4.32 ± 0.71%, P = 0.051) measured 2 weeks after hematological recovery. Functional IL-10 polymorphism associated features influenced the risk of aGvHD with a positive effect of ACC on the pool of Treg in blood.

Noisy metrology beyond the standard quantum limit

Parameter estimation is of fundamental importance in areas from atomic spectroscopy and atomic clocks to gravitational wave detection. Entangled probes provide a significant precision gain over classical strategies in the absence of noise. However, recent results seem to indicate that any small amount of realistic noise restricts the advantage of quantum strategies to an improvement by at most a multiplicative constant. Here, we identify a relevant scenario in which one can overcome this restriction and attain superclassical precision scaling even in the presence of uncorrelated noise. We show that precision can be significantly enhanced when the noise is concentrated along some spatial direction, while the Hamiltonian governing the evolution which depends on the parameter to be estimated can be engineered to point along a different direction. In the case of perpendicular orientation, we find superclassical scaling and identify a state which achieves the optimum.

Allogeneic hematopoietic SCT in patients with AML following treosulfan/fludarabine conditioning

An alternative reduced-toxicity conditioning regimen for allogeneic transplantation, based on treosulfan and fludarabine, has recently been identified. The safety and efficacy of this new conditioning regimen has been investigated prospectively in patients with AML. A total number of 75 patients with AML in CR were treated with 3 × 14 g/m(2) treosulfan and 5 × 30 mg/m(2) fludarabine, followed by matched sibling or unrelated SCT. Patients were evaluated for engraftment, adverse events, GVHD, and for non-relapse mortality, relapse incidence, overall and disease-free survival (DFS). All patients showed primary engraftment of neutrophils after a median of 20 days. Non-hematological adverse events grade III-IV in severity included mainly infections (59%) and gastrointestinal symptoms (7%). Acute GVHD grade II-IV occurred in 21% and extensive chronic GVHD occurred in 16% of the patients. After a median follow-up of 715 days, the 2-year overall and DFS estimates were 61% and 55%, respectively. The 2-year incidences of relapse and non-relapse mortality reached 34% and 11%, respectively. In summary, our data confirm promising safety and efficacy of the treosulfan-based conditioning therapy in AML patients, ClinicalTrials.gov Identifier: NCT01063660.

Antigen-independent recruitment of CTL to pancreatic islets expressing an NKG2D ligand (44.38)

The mechanisms by which CTLs enter and are retained in non-lymphoid tissue are not well-characterized. Using a novel transgenic mouse expressing the NKG2D ligand RAE1ϵ in β-islet cells of the pancreas, we found RAE1 expression was sufficient to induce the recruitment of adoptively transferred CTLs to islets. This was dependent on NKG2D expression by the CTLs and independent of antigen recognition. While transgenic mice did not develop diabetes, RAE1 expression was sufficient to induce insulitis in older, unmanipulated transgenic mice that was enhanced by viral infection and pancreatic inflammation. Surprisingly, the recruitment of CTLs resulted in the subsequent recruitment of a large number of endogenous lymphocytes. These results demonstrate that the expression of NKG2D ligands in islets is sufficient to recruit CTLs and induce a significant insulitis.

Glycosidic moiety changes the spectroscopic properties of dl-alpha-tocopherol in DMSO/water solution and in organic solvents

In this study we estimated how conjugation with a sugar moiety influences the spectral properties of tocopherol and relate the spectroscopic properties of glycosides to solvent properties such as viscosity and polarity. Spectroscopic properties (absorption, fluorescence, fluorescence anisotropy and fluorescence lifetime) of three dl-alpha-tocopheryl glycosides (dl-alpha-tocopheryl orthoacetate derivative and glycosides of dl-alpha-tocopherol model compounds: 2,2,5,7,8-pentamethyl-6-chromanol and Trolox) were studied in DMSO/water solution. In all investigated compounds dissolved in DMSO/water mixture the absorption and emission maxima were blue-shifted. The fluorescence lifetimes were longer compared with those obtained for the parent compounds, except for the Trolox glucoside, in which it was shorter. The observed effect is connected with an increase in the electronic energy in the ground state due to electron rearrangement in the chromanol system caused by interaction with the sugar moiety. The extent of the spectral shift is related to the sugar moiety substituted at the phenolic oxygen rather than to substitution at the 2a position in the chromanol ring. The fluorescent properties of dl-alpha-tocopheryl glucoside in organic solvents were measured. The Stokes shift was related to the orientational polarizability of the solvents. The study of viscosity suggested two different mechanisms explaining the results observed in a low- and high-viscosity environment. The results indicated the fundamental role of interactions between the chromophore and sugar moiety in a low-viscosity environment. The results obtained at high values of viscosity are discussed in terms of a frictional boundary solvent-solute interaction model.

Immunogenic disparities of 11 minor histocompatibility antigens (mHAs) in HLA-matched unrelated allogeneic hematopoietic SCT

We determined the alleles of 11 mHAs and investigated the association of immunogenic mHA mismatches between a donor and a recipient with a course of allogeneic hematopoietic SCT (allo-HSCT) from 10/10 alleles HLA-matched unrelated donors in 92 recipients after myeloablative conditioning between 2004 and 2006. The frequency analysis of mHA alleles, genotypes and phenotypes accompanied by appropriate restriction HLA Ags allowed for an estimation of the probability of immunogenic mismatches, which was the highest for HA-1, HA-8 and HY. GVH-directed disparity of mHAs with broad tissue distribution, especially of the sex-related HY Ag, influenced the results of allo-HSCT from HLA-matched unrelated donors by not only increasing the probability of chronic GVHD (cGVHD) but also by decreasing the relapse rate.

The influence of palifermin (Kepivance) on oral mucositis and acute graft versus host disease in patients with hematological diseases undergoing hematopoietic stem cell transplant

In this multicenter study, we assessed the use of palifermin (recombinant human-keratinocyte growth factor 1) in the prevention of oral mucositis (OM) and acute GvHD (aGvHD) induced by a hematopoietic stem cell transplant (HSCT). Fifty-three patients with hematological diseases received three doses of palifermin (60 mug/kg once daily i.v.) pre- and post-conditioning regimens (total six doses). A retrospective control group of 53 transplant patients received no palifermin. There was a significant reduction in the incidence of OM of WHO (World Health Organization) grades 1-4 (58 vs 94%, P<0.001), 3-4 (13 vs 43%, P<0.001) and the median duration of OM (4 vs 9 days, P<0.001) in the palifermin group compared to the control group. The incidence of analgesics (32 vs 75.5%, P<0.001), opioid analgesics (24 vs 64%, P<0.001) and total parenteral nutrition (11 vs 45%, P<0.001) was also significantly reduced. The analysis of distribution of affected organs revealed that aGvHD was less prevalent in the palifermin group (P=0.036). There was no significant difference in the onset of any OM after HSCT, time to engraftment and length of hospitalization between groups. The drug was generally well tolerated and safe. Our results suggest that the use of palifermin reduces OM and probably aGvHD after HSCT, but a randomized trial is needed.

Vascular Complications After Pediatric Liver Transplantation From the Living Donors

Early arterial or portal vein thrombosis is a complications that can lead to graft loss and patient death or need of immediate retransplantation. The aim of the study was to assess the incidence, causes, treatment, and outcome of vascular thrombosis after living related donor liver transplantation (LRdLTx). Between 1999 and 2004 71 LRdLTx were performed in children aged from 6 months to 10 years. Vascular thrombosis was found in 12 recipients. Hepatic artery thrombosis (HAT) occurred in 4 (5.6%), portal vein thrombosis (PVT) in 8 (11.2%) cases. HAT occurred 5 to 8 days, PVT 1 to 22 days after LTx. Diagnosis of vascular thrombosis was confirmed by routine Doppler ultrasound examination. Thrombectomy was successful in one patient with HAT and in three patients with PVT. Venous conduit was performed in one patient with PVT after second thrombosis. Two children developed biliary strictures as a late complication of HAT and required additional surgical interventions. Two children with PVT developed portal hypertension with esophageal bleeding, which required surgical intervention; one another underwent endoscopic variceal ligation for grade III varices. Follow-up ranged from 7 to 60 months. One patient died as a result of HAT after retransplantation due to multiple intrahepatic abscesses 2 months after first transplant. Any risk factors of vascular thrombosis that can be controlled should be avoided after transplantation. Routine posttransplant Doppler examination should be performed at least twice a day within 7 to 14 posttransplant days. Immediate thrombectomy should be always carried out to avoid late complications and even mortality.

Impact of Activating Killer Immunoglobulin-like Receptor Genotype on Outcome of Unrelated Donor–Hematopoietic Cell Transplantation

BACKGROUND

In a previous study we demonstrated that incompatibility regarding ligands for inhibitory killer immunoglobulin-like receptors (KIRs) is associated with a survival advantage following unrelated donor-hematopoietic cell transplantation (URD-HCT). The goal of the present analysis was to evaluate whether genotype of activating KIRs of the donor may have an impact on the outcome of URD-HCT.

PATIENTS AND METHODS

Twenty-five URD-HCT recipients with hematological malignancies, mean age 27 years (range, 14-43 years), were included in the analysis. The conditioning regimen was myeloablative and based on chemotherapy alone (n = 20) or total body irradiation (n = 5). Graft-versus-host disease (GVHD) prophylaxis consisted of cyclosporine, methotrexate, and pretransplant antithymocyte globulin. Patients were grouped according to their donors' activating KIR genotype including two loci: KIR2DS1 and KIR2DS2.

RESULTS

The presence of KIR2DS1 in the donor (n = 16/25) was not demonstrated to influence outcome. In contrast, the presence of KIR2DS2 (n = 13/25 donors) was associated with decreased probability of overall survival (0% vs 92%, P = .04) and disease-free survival (0% vs 92%, P = .046). The reason for failures in the KIR2DS2-positive group was chronic GVHD (n = 4), acute GVHD (n = 2), and relapse (n = 1). The cumulative incidence of nonrelapse mortality equaled 90% for the KIR2DS2-positive group and 8% for the KIR2DS2-negative group (P = .09).

CONCLUSION

The presence of KIR2DS2 gene in the donor is associated with a high risk of mortality following URD-HCT, resulting mainly from the incidence of severe GVHD. Whether this effect is associated with the activity of natural killer cells or KIR-bearing T lymphocytes requires further investigation.

Allogeneic transplantation of selected peripheral CD34+ cells with controlled CD3+ cells add-back in high-risk patients

We evaluated the feasibility of allogeneic transplantation of CliniMACS-selected peripheral CD34+ cells from siblings (four patients: AML-M4, M2, CLL, MDS); nonoptimal related donors (two patients: AML-M4, CML); and unrelated donors (two patients: CML, ALL, both without engraftment after preceding URDBMT). All patients had high-risk of aGVHD and/or graft failure due to multiple transplantation risk factors. Conditioning treatment was myeloablative (n=7) or nonmyeloablative (n=1). Immunosuppression consisted of CsA (n=8), Mtx (n=5), ATG (n=4). Selected CD34+ cells were transplanted (average 3.91 x 10(6)/kg, range 1.29 to 7.27 x 10(6)/kg) together with 0.01 to 0.5 x 10(7) CD3+ cells/kg to assure proper engraftment. The remaining CD34-negative fraction was cryopreserved for further CD3+ cell add-back. Average recovery and purity of CD34+ cells following CliniMACS selection were 74% and 97%. No severe complications were observed in the first 100 days. Regeneration times were satisfactory in seven of eight patients (87.5%) with ANO > 0.5 g/L and Plt > 50 g/L reached on average on days +26 and +32 (range 15 to 29 and 15 to 67), respectively. In three patients (37.5%) T-lymphocytes were added-back one to three times (due to low numbers of initially transfused CD3+ cells in two patients, in one patient with PRCA caused by ABO incompatibility). One to four additional transplantations of nonselected peripheral cells were performed on days +28 to +270 in consequence of infections (CMV-two patients; parvovirus-one patient), poor regeneration and residual disease (one patient) and prolonged transfusion dependency (one patient). Severe aGVHD grade III or IV developed in three patients (37.5%) following the nonselected cells transplantation. Finally, five patients (62.5%) are alive and in remission (median follow-up 815 days). We conclude that allogeneic transplantation of selected peripheral CD34+ cells (CliniMACS) with controlled add-back of CD3+ cells is an effective, well, tolerated procedure in high-risk patients.

Peripheral survival of naïve CD8+ T cells

Maintenance of a sufficient population of naive CD8+ T cells in the peripheral lymphoid compartment is critical for immunocompetence. Peripheral T cell number is a function of T cell generation, survival, and death. Homeostasis, a critical balance between survival and death, must exist to prevent either lymphopenia or lymphocytosis. In the current review, we discuss known requirements for the survival of naive peripheral CD8+ T cells as well as mechanisms of death when survival signals are lost. We also discuss associations between survival and homeostasis-driven proliferation, and highlight the gaps in our knowledge of these critical processes.

Depletion of normal B cells with rituximab as an adjunct to IL-2 therapy for renal cell carcinoma and melanoma

BACKGROUND

We postulated that in patients with metastatic renal cell carcinoma (RCC) or melanoma, depletion of normal B cells using the anti-CD20 mAb rituximab before treatment with low-dose interleukin (IL)-2 would improve clinical outcome.

PATIENTS AND METHODS

Rituximab (375 mg/m(2)) weekly for 4 weeks. IL-2 [11 (million units) daily] s.c., 4 days a week for weeks 5-8, followed by a 2-week rest (weeks 9 and 10). Patients without disease progression continued on IL-2. Disease re-evaluation was performed after rituximab and after every course of IL-2.

RESULTS

Fifteen patients with RCC and six with melanoma were enrolled. One patient had a partial response and seven patients had stable disease. Toxicities were similar to those expected with IL-2 alone, and there were no grade 4 events. Circulating B cells were depleted in all patients. The subsequent low-dose IL-2 increased absolute numbers of natural killer cells, activated CD4(+) and activated CD8(+) T cells. Expanded T cells produced interferon-gamma, but not IL-4. Proliferation of peripheral blood lymphocytes to phytohemagglutinin was diminished following rituximab treatment, suggesting that B cells participate in this response in vitro.

CONCLUSIONS

Our results suggest that depletion of circulating B cells with rituximab does not increase the response rate, alter the toxicity profile or change the biological activity in response to low-dose IL-2 in patients with RCC or melanoma.

Absence of teratogenicity of sirolimus used during early pregnancy in a liver transplant recipient

We describe the case of successful delivery in a 21-year-old woman who became pregnant 3 years after liver transplantation and who received sirolimus during the first 6 weeks of gestation. Sirolimus was discontinued when ultrasonography revealed a pregnancy, she was switched to tacrolimus and prednisone was continued. The course of pregnancy was uneventful; there were no signs or symptoms of graft rejection. Due to fetal intrauterine threatening asphyxia the pregnancy was concluded by cesarean section in the 39th gestational week, delivering a healthy, 2950 g, Apgar 10, female infant.

Acute coagulopathy after reperfusion of the liver graft in children correction with recombinant activated factor VII

BACKGROUND

Several studies have proven that massive blood loss increases postoperative morbidity and mortality in liver graft recipients. Since we have successfully corrected coagulopathy preoperatively using an intravenous (IV) bolus of recombinant activated factor VII (rFVIIa) in 2 patients with fulminant liver failure, we observed that there was rapid reversal of preexisting advanced coagulopathy in another 40 patients with high risk for intraoperative bleeding by this treatment immediately before transplantation. Recently to control hemostasis we have administered rFVIIa also to patients presenting with acute coagulopathy and nonsurgical bleeding after graft reperfusion as described herein.

MATERIALS AND METHODS

We have used rFVIIa in 7 children presenting with severe coagulopathy and nonsurgical bleeding after liver graft reperfusion. The dosage of rFVIIa ranged between 37 and 148 mcg/kg. An antifibrinolytic agent (aprotinin, tranexamic acid) was administered simultaneously.

RESULTS

APTT before rFVIIa was 86.10 to 183 seconds, (mean, 132.1 +/- 39.88), after the bolus of rFVIIa 49.4 to 206.1 (mean, 112.7 +/- 58.53), and at the end of surgery 71.70 to 180 (mean, 110.3 +/- 40.98). INR after reperfusion was 1.82 to 3.91 (mean, 2.56 +/- 0.67), 1.03 to 1.92 (mean, 1.54 +/- 0.35) after rFVIIa, and 1.74 to 5.58 (mean, 2.64 +/- 1.35) at the end of surgery. Before rFVIIa administration intraoperative blood transfusions after graft reperfusion were 900 to 4200 mL of red blood cells (RBC) (0.82-5.4 total blood volume) and after reperfusion 0 to 1800 mL of RBC (0-2.5 TBV). No postoperative vascular complications were observed.

CONCLUSIONS

A single dose of rFVIIa effectively reverses the severe coagulopathy developing after graft reperfusion, establishing effective hemostasis in liver transplant recipients without an increased risk of thrombotic complications.

The 72-kilodalton IE-1 protein of human cytomegalovirus (HCMV) is a potent inducer of connective tissue growth factor (CTGF) in human dermal fibroblasts

Latent human cytomegalovirus (HCMV) infection has been implicated in diseases characterized by tissue remodeling. Because of recent evidence indicating the possibility of a partial HCMV reactivation, the purpose of this study was to examine the role of the HCMV immediate early (IE) genes in the regulation of extracellular matrix (ECM) related host genes. Adenoviral vector expressing IE1 was generated to allow efficient gene delivery into human fibroblasts. IE1 stimulated the prolonged expression of connective tissue growth factor (CTGF) and TIMP1. IE1-dependent stimulation of CTGF was partially mediated by TGF-beta. Moreover, whereas collagenous proteins and collagen type 1 mRNA were only transiently induced by IE1 in the majority of fibroblasts, in selected fibroblast strains IE1 induced persistent ECM upregulation for up to 120 hours. This study suggests that transient or limited HCMV reactivation may play a direct role in abnormal matrix remodeling in GVHD, scleroderma, atherosclerosis and other HCMV-linked diseases.

The Immunological Synapse Balances T Cell Receptor Signaling and Degradation

The immunological synapse is a specialized cell-cell junction between T cell and antigen-presenting cell surfaces. It is characterized by a central cluster of antigen receptors, a ring of integrin family adhesion molecules, and temporal stability over hours. The role of this specific organization in signaling for T cell activation has been controversial. We use in vitro and in silico experiments to determine that the immunological synapse acts as a type of adaptive controller that both boosts T cell receptor triggering and attenuates strong signals.

Surgical treatment of progressive familial intrahepatic cholestasis: comparison of partial external biliary diversion and ileal bypass

AIMS

Progressive familial intrahepatic cholestasis (PFIC, Byler's disease) is an autosomal recessive disorder resulting in liver fibrosis/cirrhosis and liver insufficiency. Before the 1990s, liver transplantation was the only effective therapy for these children. During the last 12 years, two alternative methods of surgical treatment have been proposed: partial external biliary diversion (PEBD) and ileal bypass procedure (IB), which allow for effective elimination of bile acids accumulated in the body. In this study, we compare the efficacy of these surgical techniques for PFIC.

METHODS

During the last 20 years, we have treated 52 children with PFIC. PEBD was done in 21 patients (since 1995), and IB in 5 patients (since 1998), transplantation was performed in 9 patients (since 1990). The efficacy of non-transplantation surgical treatment was assessed by patients' clinical outcome, liver biochemistry, and survival without transplantation during a follow-up period of 12 to 48 months.

RESULTS

In 15 out of 21 patients clinical symptoms improved after PEBD and liver function tests normalised (blood bile acids), 1 patient had to be converted to IB due to too high output biliary fistula, 2 patients were transplanted and 3 are considered for transplantation. Out of the 5 children after IB, 4 improved clinically and biochemically, but, after 12 months, symptoms recurred in 3 patients, one patient was converted successfully to PEBD. No significant influence on growth was observed, irrespective of the type of treatment in this group of patients.

CONCLUSIONS

PEBD is more effective than IB for the permanent improvement of symptoms of PFIC. Ileal bypass procedure, although initially effective, does not ensure good long-term results in more than 50 % of patients, probably due to intestinal re-absorption of bile acids increasing over time.

Rapamycin in children after liver transplantation

Experience with sirolimus (SRL) in pediatric liver transplantation (LTx) is limited. The aim of the study was to present our experience with SRL in this setting. During the last 2 years we administered SRL to 9 LTx: children in 3 due to chronic rejection and 6 due to impaired renal function. SRL was started at 2 months to 2.5 years after LTx. Target trough levels for tacrolimus for patients with chronic rejection was 8 to 10 ng/mL and SRL 10 to 12 ng/mL; for patients with impaired renal function, 4 to 6 ng/mL and 8 to 10 ng/mL respectively. For patients on only SRL and steroids the target level was 12 to 20 ng/mL. Our observation on SRL varied from 3 to 21 months, including liver function, renal function, and side effects. All patients are alive. In 3 patients with chronic rejection (ChR), follow-up biopsies showed no signs of ChR; they all normalized liver biochemistry. Independent of indication all improved their renal function. Follow-up GFR in 5 patients showed significant improvement in all. All patients showed elevated serum cholesterol values. SRL was discontinued in 3 patients due to elevation of liver enzymes in 1, persistently high serum cholesterol in 1, and repeated bouts of opportunistic infection in 1. Addition of SRL with reduced doses of tacrolimus or switching to SRL alone significantly improves renal function.

Liver retransplantation in children in Poland

An average of 15% of patients require retransplantation due to irreversible liver graft failure due to primary graft nonfunction, chronic rejection, vascular and biliary complications, or infections. The survival of patients and grafts after retransplantation is inferior to that after primary transplantation. The purpose of the present study was to examine the incidence, indications, and outcome of retransplantation in children. In our center 169 liver transplantations had been performed in 154 patients, and 14 patients (9%) required 15 retransplantations: nine in the early postoperative period, five late after primary transplantation, and one late after the second transplantation. One-year patient survival after primary transplantation was 82%, but after early retransplantation it was 55%.

Switching cyclosporine blood concentration monitoring from C0 to C2 in children late after liver transplantation

BACKGROUND

Measurement of cyclospoprine (CsA) blood levels at 2 hours after oral administration (C(2)) has been proposed as a better measurement of trough level (C(0)) due to reduced intrapatient variability, acute rejection rate and renal toxicity. The aim of the present study was to assess whether there was any advantage to conversion from C(0) to C(2) CsA blood level monitoring in children late after liver transplantation. We reviewed the data from 44 children more than 1 year after liver transplantation. We measured the daily dose of CsA and the C(0) level before switching versus the daily dose and C(2) level at 6 months after conversion, in addition to the alanine aminotransferase (ALT) activity, creatinine blood concentration, and episodes of acute rejection.

RESULTS

Conversion from C(0) to C(2) monitoring was not associated with a significant change in mean daily dose of CsA, mean concentration of creatinine, ALT activity or occurrence of rejection episodes.

CONCLUSION

Switching from C(0) to C(2) monitoring did not seem to proffer any benefits for children late after liver transplantation.