MELLODDY: Cross-pharma Federated Learning at Unprecedented Scale Unlocks Benefits in QSAR without Compromising Proprietary Information

Federated multipartner machine learning has been touted as an appealing and efficient method to increase the effective training data volume and thereby the predictivity of models, particularly when the generation of training data is resource-intensive. In the landmark MELLODDY project, indeed, each of ten pharmaceutical companies realized aggregated improvements on its own classification or regression models through federated learning. To this end, they leveraged a novel implementation extending multitask learning across partners, on a platform audited for privacy and security. The experiments involved an unprecedented cross-pharma data set of 2.6+ billion confidential experimental activity data points, documenting 21+ million physical small molecules and 40+ thousand assays in on-target and secondary pharmacodynamics and pharmacokinetics. Appropriate complementary metrics were developed to evaluate the predictive performance in the federated setting. In addition to predictive performance increases in labeled space, the results point toward an extended applicability domain in federated learning. Increases in collective training data volume, including by means of auxiliary data resulting from single concentration high-throughput and imaging assays, continued to boost predictive performance, albeit with a saturating return. Markedly higher improvements were observed for the pharmacokinetics and safety panel assay-based task subsets.

Avian architects: Technology, domestication, and animal minds in urban America

In the mid-nineteenth century, the house sparrow (Passer domesticus) was introduced to the United States, quickly spreading across the country. For a brief period in the late nineteenth and early twentieth centuries, the observation of sparrow behavior was something of an urban pastime. Traits such as intelligence, reason, persistence, and craftsmanship were conferred onto sparrows by American urbanites. This paper argues that sparrow intelligence was often conflated with domestication: the ability of the birds to adapt to living alongside humans. Praise for the ingenuity of sparrows generally revolved around their nest building, particularly when such structures overcame the challenges posed by urban infrastructure and technology. Sparrows were far less praiseworthy when they caused electricity outages or contaminated water supplies. The sparrow in the United States demonstrates how the relationship between these anecdotes and their implications for animal minds was mediated by the technology and infrastructure of cities. Admirers of sparrows were not measuring the birds' mental capacity, but rather their ability to adapt to human habitations. Sparrows were only granted intelligence once they had demonstrated their ability to become domesticated.

Exploiting the CD200-CD200R immune checkpoint axis in multiple myeloma to enhance CAR T-cell therapy

ABSTRACT

Patients with multiple myeloma (MM) treated with B-cell maturation antigen (BCMA)-specific chimeric antigen receptor (CAR) T cells usually relapse with BCMA+ disease, indicative of CAR T-cell suppression. CD200 is an immune checkpoint that is overexpressed on aberrant plasma cells (aPCs) in MM and is an independent negative prognostic factor for survival. However, CD200 is not present on MM cell lines, a potential limitation of current preclinical models. We engineered MM cell lines to express CD200 at levels equivalent to those found on aPCs in MM and show that these are sufficient to suppress clinical-stage CAR T-cells targeting BCMA or the Tn glycoform of mucin 1 (TnMUC1), costimulated by 4-1BB and CD2, respectively. To prevent CD200-mediated suppression of CAR T cells, we compared CRISPR-Cas9-mediated knockout of the CD200 receptor (CD200RKO), to coexpression of versions of the CD200 receptor that were nonsignaling, that is, dominant negative (CD200RDN), or that leveraged the CD200 signal to provide CD28 costimulation (CD200R-CD28 switch). We found that the CD200R-CD28 switch potently enhanced the polyfunctionality of CAR T cells, and improved cytotoxicity, proliferative capacity, CAR T-cell metabolism, and performance in a chronic antigen exposure assay. CD200RDN provided modest benefits, but surprisingly, the CD200RKO was detrimental to CAR T-cell activity, adversely affecting CAR T-cell metabolism. These patterns held up in murine xenograft models of plasmacytoma, and disseminated bone marrow predominant disease. Our findings underscore the importance of CD200-mediated immune suppression in CAR T-cell therapy of MM, and highlight a promising approach to enhance such therapies by leveraging CD200 expression on aPCs to provide costimulation via a CD200R-CD28 switch.

Sequential Exposure to IL21 and IL15 During Human Natural Killer Cell Expansion Optimizes Yield and Function

Natural killer (NK) cells are frequently expanded for the clinic using irradiated, engineered K562 feeder cells expressing a core transgene set of membrane-bound (mb) IL15 and/or mbIL21 together with 41BBL. Prior comparisons of mbIL15 to mbIL21 for NK expansion lack comparisons of key attributes of the resulting NK cells, including their high-dimensional phenotype, polyfunctionality, the breadth and potency of cytotoxicity, cellular metabolism, and activity in xenograft tumor models. Moreover, despite multiple rounds of K562 stimulation, studies of sequential use of mbIL15- and mbIL21-based feeder cells are absent. We addressed these gaps and found that using mbIL15- versus mbIL21-based feeder cells drove distinct phenotypic and functional profiles. Feeder cells expressing mbIL15 alone drove superior functionality by nearly all measures, whereas those expressing mbIL21 alone drove superior yield. In combination, most attributes resembled those imparted by mbIL21, whereas in sequence, NK yield approximated that imparted by the first cytokine, and the phenotype, transcriptome, and function resembled that driven by the second cytokine, highlighting the plasticity of NK cell differentiation. The sequence mbIL21 followed by mbIL15 was advantageous in achieving significant yields of highly functional NK cells that demonstrated equivalent in vivo activity to those expanded by mbIL15 alone in two of three xenograft models. Our findings define the impact of mbIL15 versus mbIL21 during NK expansion and reveal a previously underappreciated tradeoff between NK yield and function for which sequential use of mbIL21-based followed by mbIL15-based feeder cells may be the optimal approach in many settings.

The impact of COVID-19 prevention measures on surgical wound infection rates post-cardiac surgery

The COVID-19 pandemic had a huge impact on medical services. Several measures have been implemented to reduce the risk of viral transmission. In this paper, we assessed the impact of these measures on surgical wound infection rates in patients post-cardiac surgery. Hypothesis testing was used to compare post-cardiac operation infection rates between the year prior to the COVID-19 pandemic being declared and the first 13 months of the pandemic. The infection rates in 969 patients with operations between 01/03/2019 and 29/02/2020 were compared to those of 925 patients with cardiac surgery between 01/03/2020 and 31/03/2021. Infection rates for various operative urgencies and infection types were analysed. To compare infection rates, a two-tailed pooled z-test using the difference in infection proportions was performed. A 5% significance level was used and only categories with at least 10 patients in both the pre-covid and covid populations were tested. For leg infections, only operations involving coronary artery bypass grafting were included. To ensure that any differences in outcomes were not due to differences in patient demographics resulting in unequal operative risks, Euroscore II values, a measure of cardiac operative risk, were compared between the pre-covid and post-covid cohorts. The Mann-Whitney U-test was used to determine whether the distributions of Euroscore II values were likely to be drawn from the same population. A significance level of 5% was used. A total of 1901 patients (932 during the COVID-19 pandemic) were included in this study. Significant reduction in post-operative infections for all patients undergoing cardiac surgery from 4.3% of patients before COVID to 1.5% during the pandemic. During the pandemic, fewer elective and more urgent operations were performed. This study suggests a significant role of iatrogenic causes in wound infections prior to the pandemic. The implementation of COVID-19 prevention measures in healthcare providers can reduce surgical infection rates. As COVID-19-related restrictions have been eased, we suggest maintaining them in healthcare providers to reduce the incidence of surgical wound infections.

A plague of weasels and ticks: animal introduction, ecological disaster, and the balance of nature in Jamaica, 1870-1900

Towards the end of the nineteenth century, British colonists in Jamaica became increasingly exasperated by the damage caused to their sugar plantations by rats. In 1872, a British planter attempted to solve this problem by introducing the small Indian mongoose (Urva auropunctata). The animals, however, turned on Jamaica's insectivorous birds and reptiles, leading to an explosion in the tick population. This paper situates the mongoose catastrophe as a closing chapter in the history of the nineteenth-century acclimatization movement. While foreign observers saw the introduction of the mongoose as a cautionary tale, caricaturing British Jamaica as overrun by a plague of weasels and ticks, British colonists, administrators and naturalists - identifying a gradual decline of both populations - argued that the 'balance of nature' would eventually reassert itself. As this paper argues, through this dubious claim they were attempting to retrospectively rationalize or justify the introductions and their disastrous aftermath. This strategy enabled them to gloss over the lasting ecological damage caused by the mongoose, and allowed its adherents to continue their uncritical support of both the Jamaican plantation economy and animal introductions in the British Empire.

Efficacy of Coxsackievirus A21 against drug-resistant neoplastic B cells

Primary drug resistance and minimal residual disease are major challenges in the treatment of B cell neoplasms. Therefore, this study aimed to identify a novel treatment capable of eradicating malignant B cells and drug-resistant disease. Oncolytic viruses eradicate malignant cells by direct oncolysis and activation of anti-tumor immunity, have proven anti-cancer efficacy, and are safe and well tolerated in clinical use. Here, we demonstrate that the oncolytic virus coxsackievirus A21 can kill a range of B cell neoplasms, irrespective of an anti-viral interferon response. Moreover, CVA21 retained its capacity to kill drug-resistant B cell neoplasms, where drug resistance was induced by co-culture with tumor microenvironment support. In some cases, CVA21 efficacy was actually enhanced, in accordance with increased expression of the viral entry receptor ICAM-1. Importantly, the data confirmed preferential killing of malignant B cells and CVA21 dependence on oncogenic B cell signaling pathways. Significantly, CVA21 also activated natural killer (NK) cells to kill neoplastic B cells and drug-resistant B cells remained susceptible to NK cell-mediated lysis. Overall, these data reveal a dual mode of action of CVA21 against drug-resistant B cells and support the development of CVA21 for the treatment of B cell neoplasms.

HPB P62 Is it time to introduce intraoperative ultrasound into surgical training?

Background

Gallstone disease is one of the most common causes of abdominal pain and emergency hospital admissions in the UK. Those patients that have symptomatic gallstones in the gallbladder will be offered a laparoscopic cholecystectomy (LC) as treatment and therefore reduce the risk of developing further complications. Confirmation of bile duct stones before or at the time of LC is essential in order to prevent complications.

There are three main ways to identify bile duct stones intraoperatively: x-ray cholangiography, fluoroscopic cholangiography and intraoperative ultrasound (IOUS). X-ray cholangiography is the most commonly used method intraoperatively as it is effective in identifying biliary anatomy and bile duct stones, can be repeated and has good deep tissue penetration. However, it is an invasive procedure that requires the use of ionising radiation. IOUS on the other hand is non-invasive, does not involve ionising radiation, is able to detect vascular anatomy and arguably has a shorter learning curve compared to the other two methods.

Methods

IOUS is not currently taught on the surgical curriculum. In response to this, we have set up the Laparoscopic Hands-on Intra-operative Ultrasound (L-HOUS) course which takes place over a two-day period.

The first day is delivered through interactive seminars and practice on phantom models. The topics covered are: the basic principles of the technique; the relevant anatomy; the role of IOUS in gallstone disease; and the role of IOUS in biliary surgery and various other non-HPB conditions. The afternoon is dedicated to demonstrating how to set up the equipment, the step-wise approach to IOUS of the biliary system, and hands-on practice using phantom models.

The second day takes place in the operating theatre and offers delegates the opportunity to perform IOUS of the bile duct in real clinical cases. Delegates rotate around to practice their IOUS skills under the supervision of the operating surgeon, while un-scrubbed delegates are able to watch the surgery via a video link from the seminar room.

Results

The course has been run on four occasions and attracted 21 delegates since its inception in 2017. The vast majority of delegates have been senior general surgical trainees or post-CCT fellows, in addition to one consultant. The feedback received was overwhelmingly positive and the course has evolved at each iteration to reflect the comments from delegates.

Conclusions

This is the only course in Europe that offers delegates hands-on experience in developing IOUS skills under specialist guidance. Crucially, hands-on experience has been shown to have better outcomes in relation to ultrasound training when compared to simulation or classroom-based methods. This concept fits in unity with Edgar Dale's pyramid of learning whereby students are more likely to retain information that they have practiced ‘doing’ compared to other visual or auditory methods of teaching.

Given the benefits of IOUS in terms of cost, and reduction in additional procedures or investigations, we argue that the technique should be included in the surgical training curriculum. One of the main reasons for poor uptake of a one-stage approach to bile duct stones using IOUS is lack of formal training. Given there will likely be an increase in the adoption of the IOUS technique in coming years, it is vital to equip current trainees with the necessary skills within their training pathway. However, prior to this it is imperative that trainees have access to high-fidelity training opportunities to develop skills that will be used routinely in future practice.

Increased SERCA2a sub-cellular heterogeneity in right-ventricular heart failure inhibits excitation-contraction coupling and modulates arrhythmogenic dynamics

The intracellular calcium handling system of cardiomyocytes is responsible for controlling excitation-contraction coupling (ECC) and has been linked to pro-arrhythmogenic cellular phenomena in conditions such as heart failure (HF). SERCA2a, responsible for intracellular uptake, is a primary regulator of calcium homeostasis, and remodelling of its function has been proposed as a causal factor underlying cellular and tissue dysfunction in disease. Whereas adaptations to the global (i.e. whole-cell) expression of SERCA2a have been previously investigated in the context of multiple diseases, the role of its spatial profile in the sub-cellular volume has yet to be elucidated. We present an approach to characterize the sub-cellular heterogeneity of SERCA2a and apply this approach to quantify adaptations to the length-scale of heterogeneity (the distance over which expression is correlated) associated with right-ventricular (RV)-HF. These characterizations informed simulations to predict the functional implications of this heterogeneity, and its remodelling in disease, on ECC, the dynamics of calcium-transient alternans and the emergence of spontaneous triggered activity. Image analysis reveals that RV-HF is associated with an increase in length-scale and its inter-cellular variability; simulations predict that this increase in length-scale can reduce ECC and critically modulate the vulnerability to both alternans and triggered activity. This article is part of the theme issue 'The cardiomyocyte: new revelations on the interplay between architecture and function in growth, health, and disease'.

Clinical characteristics with inflammation profiling of long COVID and association with 1-year recovery following hospitalisation in the UK: a prospective observational study

BACKGROUND

No effective pharmacological or non-pharmacological interventions exist for patients with long COVID. We aimed to describe recovery 1 year after hospital discharge for COVID-19, identify factors associated with patient-perceived recovery, and identify potential therapeutic targets by describing the underlying inflammatory profiles of the previously described recovery clusters at 5 months after hospital discharge.

METHODS

The Post-hospitalisation COVID-19 study (PHOSP-COVID) is a prospective, longitudinal cohort study recruiting adults (aged ≥18 years) discharged from hospital with COVID-19 across the UK. Recovery was assessed using patient-reported outcome measures, physical performance, and organ function at 5 months and 1 year after hospital discharge, and stratified by both patient-perceived recovery and recovery cluster. Hierarchical logistic regression modelling was performed for patient-perceived recovery at 1 year. Cluster analysis was done using the clustering large applications k-medoids approach using clinical outcomes at 5 months. Inflammatory protein profiling was analysed from plasma at the 5-month visit. This study is registered on the ISRCTN Registry, ISRCTN10980107, and recruitment is ongoing.

FINDINGS

2320 participants discharged from hospital between March 7, 2020, and April 18, 2021, were assessed at 5 months after discharge and 807 (32·7%) participants completed both the 5-month and 1-year visits. 279 (35·6%) of these 807 patients were women and 505 (64·4%) were men, with a mean age of 58·7 (SD 12·5) years, and 224 (27·8%) had received invasive mechanical ventilation (WHO class 7-9). The proportion of patients reporting full recovery was unchanged between 5 months (501 [25·5%] of 1965) and 1 year (232 [28·9%] of 804). Factors associated with being less likely to report full recovery at 1 year were female sex (odds ratio 0·68 [95% CI 0·46-0·99]), obesity (0·50 [0·34-0·74]) and invasive mechanical ventilation (0·42 [0·23-0·76]). Cluster analysis (n=1636) corroborated the previously reported four clusters: very severe, severe, moderate with cognitive impairment, and mild, relating to the severity of physical health, mental health, and cognitive impairment at 5 months. We found increased inflammatory mediators of tissue damage and repair in both the very severe and the moderate with cognitive impairment clusters compared with the mild cluster, including IL-6 concentration, which was increased in both comparisons (n=626 participants). We found a substantial deficit in median EQ-5D-5L utility index from before COVID-19 (retrospective assessment; 0·88 [IQR 0·74-1·00]), at 5 months (0·74 [0·64-0·88]) to 1 year (0·75 [0·62-0·88]), with minimal improvements across all outcome measures at 1 year after discharge in the whole cohort and within each of the four clusters.

INTERPRETATION

The sequelae of a hospital admission with COVID-19 were substantial 1 year after discharge across a range of health domains, with the minority in our cohort feeling fully recovered. Patient-perceived health-related quality of life was reduced at 1 year compared with before hospital admission. Systematic inflammation and obesity are potential treatable traits that warrant further investigation in clinical trials.

FUNDING

UK Research and Innovation and National Institute for Health Research.

Adolescents' dietary behaviour: The interplay between home and school food environments

In the UK, school food standards have looked to improve the nutritional profile of school food provision and the choices made; however, adolescents' choices tend to bias towards micronutrient poor and energy dense options. This study aimed to explore how adolescents make their school food choices, along with how they engage with their environments whilst selecting food. Seven focus group interviews took place with adolescents (n = 28; 13-14 years) in a secondary school in Northern England. Discussions with participants were audio-recorded, transcribed verbatim and then analysed using an inductive thematic approach. Six themes emerged from the data: (1) parents' and adolescents' roles in the home food environment, (2) burgeoning food autonomy, (3) school food choice factors, (4) social aspects of school food, (5) home versus school, (6) food knowledge & beliefs. Adolescents identified two distinct environments during the focus group discussions: the home and school environments. Adolescents juxtaposed the two, in terms of food provision, food choices, rules and customs surrounding food choice. This juxtaposition emerged as an indirect but important influence on adolescents' school food choices. The school and home environments both (in)directly influence adolescents' school food choices, which involve an integration of multiple, often conflicting influences. Adolescents may adopt a number of unhelpful dietary rationalisations as they try to manage and reconcile these influences. Consultation, together with consideration of relevant food choice models, is required to identify opportunities to influence adolescents' food choices at school.

O108 Central adiposity influences serum calcium concentrations and increases risk of kidney stone disease

Introduction

Serum calcium (SCa) and adiposity are associated with kidney stone disease (KSD). We used conventional and genetic epidemiological approaches to further understanding of these relationships.

Methods

Waist-hip ratio (WHR), a marker of central adiposity, SCa and KSD data were analysed by adjusted linear regression using UK Biobank participants. Univariable, multivariable and mediation Mendelian randomisation (MR) were undertaken using 316 and 246 genetic instruments for WHR and SCa, respectively.

Results

Observational analyses of 3,466 KSD cases and 489,944 controls showed that participants of normal BMI (20–25kg/m2) but in the fifth quintile for WHR have greater risk of incident KSD compared to the first quintile (HR=1.39 (95%CI=1.18–1.63)). After adjustment for sex, age, serum vitamin D, and phosphate, higher WHR was positively associated with SCa (ß=0.04, 95%=CI 0.04–0.05, P<0.001). Univariable MR demonstrated that relative risk of KSD increases with increasing WHR and SCa; 1 standard deviation (SD) increases relative risk by 46% (95%CI=1.27–1.67, P=5.9e-8) and 63% (95%CI=1.37–1.93, P=2.0E-8), respectively. A 1 SD increase in WHR increases SCa by 0.11mmol/L (95%CI=0.07–0.14, P=1.8e-8). Multivariable MR revealed that SCa and WHR independently increase KSD relative risk (OR=1.71, 95%CI=1.49–1.96, P<0.001 and OR=1.41, 95%CI=1.17–1.69, P<0.001 respectively). Mediation MR established that 14% of the effect of WHR on KSD risk is mediated via alterations in SCa.

Conclusion

Central adiposity is causally linked to KSD, partly by raising SCa. Mechanisms by which central adiposity increases KSD risk, independent of and via SCa, remain to be revealed and may identify novel therapeutic methods for KSD.

Take-home message

Central adiposity and serum calcium are independent, causal risk factors for kidney stone disease. One mechanism by which central obesity increases risk of kidney stone disease is by influencing serum calcium concentrations.

Don't Overweight Weights: Evaluation of Weighting Strategies for Multi-Task Bioactivity Classification Models

Machine learning models predicting the bioactivity of chemical compounds belong nowadays to the standard tools of cheminformaticians and computational medicinal chemists. Multi-task and federated learning are promising machine learning approaches that allow privacy-preserving usage of large amounts of data from diverse sources, which is crucial for achieving good generalization and high-performance results. Using large, real world data sets from six pharmaceutical companies, here we investigate different strategies for averaging weighted task loss functions to train multi-task bioactivity classification models. The weighting strategies shall be suitable for federated learning and ensure that learning efforts are well distributed even if data are diverse. Comparing several approaches using weights that depend on the number of sub-tasks per assay, task size, and class balance, respectively, we find that a simple sub-task weighting approach leads to robust model performance for all investigated data sets and is especially suited for federated learning.

Estimated glucose disposal rate as a candidate biomarker for thrombotic biomarkers in T1D: a pooled analysis

PURPOSE

To determine the utility of estimated glucose disposal rate (eGDR) as a candidate biomarker for thrombotic biomarkers in patients with type 1 diabetes (T1D).

METHODS

We reanalysed baseline pretreatment data in a subset of patients with T1D from two previous RCTs, consisting of a panel of thrombotic markers, including fibrinogen, tissue factor (TF) activity, and plasminogen-activator inhibitor (PAI)-1, and TNFα, and clinical factors (age, T1D duration, HbA1c, insulin requirements, BMI, blood pressure, and eGDR). We employed univariate linear regression models to investigate associations between clinical parameters and eGDR with thrombotic biomarkers.

RESULTS

Thirty-two patients were included [mean ± SD age 31 ± 7 years, HbA1c of 58 ± 9 mmol/mol (7.5 ± 0.8%), eGDR 7.73 ± 2.61]. eGDR negatively associated with fibrinogen (P < 0.001), PAI-1 concentrations (P = 0.005), and TF activity (P = 0.020), but not TNFα levels (P = 0.881). We identified 2 clusters of patients displaying significantly different characteristics; 56% (n = 18) were categorised as 'higher-risk', eliciting significantly higher fibrinogen (+ 1514 ± 594 μg/mL; P < 0.001), TF activity (+ 59.23 ± 9.42 pmol/mL; P < 0.001), and PAI-1 (+ 8.48 ± 1.58 pmol/dL; P < 0.001), HbA1c concentrations (+ 14.20 ± 1.04 mmol/mol; P < 0.001), age (+ 7 ± 3 years; P < 0.001), duration of diabetes (15 ± 2 years; P < 0.001), BMI (+ 7.66 ± 2.61 kg/m²; P < 0.001), and lower mean eGDR (- 3.98 ± 1.07; P < 0.001).

CONCLUSIONS

Compared to BMI and insulin requirements, classical surrogates of insulin resistance, eGDR is a suitable and superior thrombotic risk indicator in T1D.

TRIAL REGISTRATION

ISRCTN4081115; registered 27 June 2017.

Effects of antibiotic treatment on antimicrobial resistance in pig microbiomes: a longitudinal study

 

The United Kingdom has prohibited the prophylactic use of antibiotics in agriculture but they are still critical for disease control. It is thus vital to understand the effects of antibiotic treatment on antimicrobial resistance (AMR) spread. Hi-C metagenomic sequencing can help identify AMR genes in animal microbiomes and assign plasmid-based genes to their bacterial hosts. Leveraging Hi-C, we sequence antibiotically-treated pig microbiomes through time to identify dynamic trends in AMR gene prevalence. Fecal samples were collected at time points prior to and following antibiotic treatment in 6 farms across England when pigs presented with illness. Control samples were collected from 2 of these farms at multiple time points without treatment. Samples were processed using a bioinformatic pipeline that outputs assemblies with information on taxonomic classification and presence/absence of an AMR allele. 115 AMR alleles across 11 antibiotic classes were included. The bacterial species in highest abundance/farm belonged to order Bacteroidales (45.9-53.1%). Tetracycline resistance alleles showed the highest prevalence/farm (28.4-52.8%). No significant association between bacterial species abundance and time point, and AMR allele prevalence and time point was found in all farms (χ2 p&gt;.05). The distribution of the number of AMR alleles/assembly was significantly higher between the first and last time point in 4/6 treated farms and 1/2 control farms (Wilcoxan rank sum p &lt;.01). A higher difference in the proportion of assemblies with greater than 6 AMR alleles between the first and last time point was observed in 1 treated farm (.17 95% CI .013-.21) compared to its control (.03 95% CI .023-.033). Slight acquisition of AMR alleles was observed but we see minimal temporal fluctuations in bacterial species abundance and AMR allele prevalence overall implying that the microbiome is fairly robust to antibiotic treatment. This encourages its responsible use for disease control.

Key messages

Ensuring that the responsible use of antibiotics does not drastically affect AMR mobilization is key to preserving the efficacy of therapeutics in agriculture. While acquisition of resistance genes over time is seen it cannot conclusively be tied to treatment; Minimal microbiome perturbation post treatment implies that therapeutic antibiotic use is warranted.

An economic evaluation of an intervention to increase demand for medical male circumcision among men aged 25-49 years in South Africa

BACKGROUND

Studies estimate that circumcising men between the ages of 20-30 years who have exhibited previous risky sexual behaviour could reduce overall HIV prevalence. Demand creation strategies for medical male circumcision (MMC) targeting men in this age group may significantly impact these prevalence rates.

OBJECTIVES

The objective of this study is to evaluate the cost-effectiveness and cost-benefit of an implementation science, pre-post study designed to increase the uptake of male circumcision for ages 25-49 at a fixed MMC clinic located in Gauteng Province, South Africa.

METHODS

A health care provider perspective was utilised to collect all costs. Costs were compared between the standard care scenario of routine outreach strategies and a full intervention strategy. Cost-effectiveness was measured as cost per mature man enrolled and cost per mature man circumcised. A cost-benefit analysis was employed by using the Bernoulli model to estimate the cases of HIV averted due to medical male circumcision (MMC), and subsequently translated to averted medical costs.

RESULTS

In the 2015 intervention, the cost of the intervention was $9445 for 722 men. The total HIV treatment costs averted due to the intervention were $542,491 from a public care model and $378,073 from a private care model. The benefit-cost ratio was 57.44 for the public care model and 40.03 for the private care model. The net savings of the intervention were $533,046 or $368,628 - depending on treatment in a public or private setting.

CONCLUSIONS

The intervention was cost-effective compared to similar MMC demand interventions and led to statistically significant cost savings per individual enrolled.

677 Quick, Simple and just as Effective – Comparing PM:L3 Ratio to NELA, P-POSSUM and NSQIP Scores for Emergency Laparotomy

Aim

Multiple tools (NELA, P-POSSUM, ACS-NSQIP) are available to assess mortality risks in patients requiring emergency laparotomy(1–3), but they are time-consuming to perform and have had limited uptake in routine clinical practice in many countries(4). Simpler measures, including psoas muscle:L3 vertebrae (PM:L3) ratio(5,6), may be useful alternates. This measure is quick to perform, requiring no special skills or equipment apart from basic CT viewing software.

Method

We performed an analysis on all patients in the Hunter Emergency Laparotomy Audit (HELA) database, from January 2016 to December 2017. HELA is a retrospective review of all emergency laparotomy undertaken in a discrete area in NSW, Australia. Patients with an available CT abdomen were included (N = 500/562). A single slice axial CT image at the L3 endplate level was analysed using ImageJ® software to measure the area of L3 and bilateral psoas muscles. This can be done using normal PACS software in routine practice.

Results

PM:L3 ratios in this cohort have a mean of 1.082 (95%CI 1.042-1.122; range 0.141-3.934). PM:L3 ratio is significantly lower (p &lt; 0.00001) in those patients who did not survive beyond 30 days (mean 0.865 [95% CI 0.746-0.984 ]) and 90 days (mean 0.888 [95%CI 0.768-1.008]) compared to patients that survived these periods (30 day mean 1.106 [95% vs. 1.033-1.179], 90 day mean 1.112 [95% CI 1.070-1.154]) . These associations are similar to those calculated by established risk assessment models.

Conclusions

PM:L3 ratio is a reliable, quick and easy risk assessment tool to identify high risk patients undergoing emergency laparotomy.

678 Can patients have their old life back? Using PM:L3 ratio to predict discharge destination of emergency laparotomy survivors

Aim

Psoas muscle:L3 vertebra (PM:L3) ratio is a relatively new risk assessment tool for emergency laparotomy(1,2) based upon the proven concept that sarcopenia – as diagnosed by low skeletal muscle index(3–6), psoas muscle density(7–9) or total psoas area(10–13) in a single axial slice CT image – correlates with increasing risks of bad outcomes in surgery. This study looks into the association between PM:L3 ratio of emergency laparotomy patients from home and their discharge destination.

Method

We performed an analysis on patients in the Hunter Emergency Laparotomy Audit (HELA) database, from January 2016 to December 2017. HELA is a retrospective review of all emergency laparotomy undertaken in a discrete area in NSW, Australia. All patients admitted from home, survived to be discharged from hospital and had an available CT abdomen were included (N = 433/562). A single slice axial CT image at the L3 endplate level was analysed using ImageJ® software to measure the area of L3 and bilateral psoas muscles.

Results

PM:L3 ratio is significantly lower in the group of patient discharged to a care facility than the group discharging back to their previous home residence (mean 0.951 vs. mean 1.128, p &lt; 0.001). Upon further analysis, the PM:L3s are divided into quartiles and stratified by sex. There is an association between lower PM:L3 and risk of discharging into a care facility (Q1 22.45%, Q2 19.59%, Q3 19.10%, Q4 5.71%).

Conclusions

PM:L3 ratio can predict the discharge destination of patients undergoing emergency laparotomy.

O20 Quick, simple and just as effective—comparing pm: L3 ratio to NELA, P-POSSUM and NSQIP scores in assessing mortality risk for emergency laparotomy

Introduction

Multiple tools (NELA, P-POSSUM, ACS-NSQIP) are available to assess mortality risks in patients requiring emergency laparotomy(1–3), but they are time-consuming to perform and have had limited uptake in routine clinical practice in many countries(4). Simpler measures, including psoas muscle: L3 vertebrae (PM: L3) ratio(5,6), may be useful alternates. This measure is quick to perform, requiring no special skills or equipment apart from basic CT viewing software.

Method

We performed an analysis on all patients in the Hunter Emergency Laparotomy Audit (HELA) database, from January 2016 to December 2017. HELA is a retrospective review of all emergency laparotomy undertaken in a discrete area in NSW, Australia. Patients with an available CT abdomen were included (N = 500/562). A single slice axial CT image at the L3 endplate level was analysed using ImageJ® software to measure the area of L3 and bilateral psoas muscles. This can be done using normal PACS software in routine practice.

Result

PM: L3 ratios in this cohort have a mean of 1.082 (95%CI 1.042–1.122; range 0.141–3.934). PM: L3 ratio is significantly lower (P &lt; 0.00001) in those patients who did not survive beyond 30 days (mean 0.865 [95% CI 0.746–0.984]) and 90 days (mean 0.888 [95%CI 0.768–1.008]) compared to patients that survived these periods (30 day mean 1.106 [95% vs. 1.033–1.179], 90 day mean 1.112 [95% CI 1.070–1.154]). These associations are similar to those calculated by established risk assessment models.

Conclusion

PM: L3 ratio is a reliable, quick and easy risk assessment tool to identify high risk patients undergoing emergency laparotomy.

Take-home Message

PM: L3 ratio is a reliable, quick and easy risk assessment tool to identify high risk patients undergoing emergency laparotomy. It is comparable to NELA, P-POSSUM and ACS-NSQIP.

Outcome measures for technique survival reported in peritoneal dialysis: A systematic review

BACKGROUND

Peritoneal dialysis (PD) technique survival is an important outcome for patients, caregivers and health professionals, however, the definition and measures used for technique survival vary. We aimed to assess the scope and consistency of definitions and measures used for technique survival in studies of patients receiving PD.

METHOD

MEDLINE, EMBASE and CENTRAL databases were searched for randomised controlled studies (RCTs) conducted in patients receiving PD reporting technique survival as an outcome between database inception and December 2019. The definition and measures used were extracted and independently assessed by two reviewers.

RESULTS

We included 25 RCTs with a total of 3645 participants (41-371 per trial) and follow up ranging from 6 weeks to 4 years. Terminology used included 'technique survival' (10 studies), 'transfer to haemodialysis (HD)' (8 studies) and 'technique failure' (7 studies) with 17 different definitions. In seven studies, it was unclear whether the definition included transfer to HD, death or transplantation and eight studies reported 'transfer to HD' without further definition regarding duration or other events. Of those remaining, five studies included death in their definition of a technique event, whereas death was censored in the other five. The duration of HD necessary to qualify as an event was reported in only four (16%) studies. Of the 14 studies reporting causes of an event, all used a different list of causes.

CONCLUSION

There is substantial heterogeneity in how PD technique survival is defined and measured, likely contributing to considerable variability in reported rates. Standardised measures for reporting technique survival in PD studies are required to improve comparability.

Imitating nature: Analogy and experiment in D'Arcy Thompson's Science of Form

D'Arcy Wentworth Thompson's "Science of Form" - the explanation of biological development and morphology through physical forces and mathematical laws - has traditionally been viewed as an idiosyncratic, even heretical, episode in the history of evolutionary biology. Yet recent scholarship has sought to overturn this view by demonstrating that Thompson was active in contemporary scientific networks. This paper argues that a key influence upon Thompson's seminal work, On Growth and Form (1917), may be far more practical, and lie closer to home, than previously realised: experimental demonstrations of basic concepts in physics. Harnessing previously unpublished archival sources, this paper traces Thompson's correspondence with Charles Darling, Arthur Worthington and Cecil Warburton. In these exchanges, Thompson described his own experiments, or requested that experiments be conducted on his behalf. This correspondence, and its subsequent inclusion in the first edition of On Growth and Form, revises our current picture of Thompson from that of an abstract thinker to keen experimentalist. Moreover, his contact with physicists indicates that simple experiments enabled extensive crosstalk between early twentieth century physics and biology.

Beam Energy and Centrality Dependence of Direct-Photon Emission from Ultrarelativistic Heavy-Ion Collisions

The PHENIX collaboration presents first measurements of low-momentum (0.4<p_{T}<3  GeV/c) direct-photon yields from Au+Au collisions at sqrt[s_{NN}]=39 and 62.4 GeV. For both beam energies the direct-photon yields are substantially enhanced with respect to expectations from prompt processes, similar to the yields observed in Au+Au collisions at sqrt[s_{NN}]=200. Analyzing the photon yield as a function of the experimental observable dN_{ch}/dη reveals that the low-momentum (>1  GeV/c) direct-photon yield dN_{γ}^{dir}/dη is a smooth function of dN_{ch}/dη and can be well described as proportional to (dN_{ch}/dη)^{α} with α≈1.25. This scaling behavior holds for a wide range of beam energies at the Relativistic Heavy Ion Collider and the Large Hadron Collider, for centrality selected samples, as well as for different A+A collision systems. At a given beam energy, the scaling also holds for high p_{T} (>5  GeV/c), but when results from different collision energies are compared, an additional sqrt[s_{NN}]-dependent multiplicative factor is needed to describe the integrated-direct-photon yield.

Plasmacytoid dendritic cells orchestrate innate and adaptive anti-tumor immunity induced by oncolytic coxsackievirus A21

BACKGROUND

The oncolytic virus, coxsackievirus A21 (CVA21), has shown promise as a single agent in several clinical trials and is now being tested in combination with immune checkpoint blockade. Combination therapies offer the best chance of disease control; however, the design of successful combination strategies requires a deeper understanding of the mechanisms underpinning CVA21 efficacy, in particular, the role of CVA21 anti-tumor immunity. Therefore, this study aimed to examine the ability of CVA21 to induce human anti-tumor immunity, and identify the cellular mechanism responsible.

METHODS

This study utilized peripheral blood mononuclear cells from i) healthy donors, ii) Acute Myeloid Leukemia (AML) patients, and iii) patients taking part in the STORM clinical trial, who received intravenous CVA21; patients receiving intravenous CVA21 were consented separately in accordance with local institutional ethics review and approval. Collectively, these blood samples were used to characterize the development of innate and adaptive anti-tumor immune responses following CVA21 treatment.

RESULTS

An Initial characterization of peripheral blood mononuclear cells, collected from cancer patients following intravenous infusion of CVA21, confirmed that CVA21 activated immune effector cells in patients. Next, using hematological disease models which were sensitive (Multiple Myeloma; MM) or resistant (AML) to CVA21-direct oncolysis, we demonstrated that CVA21 stimulated potent anti-tumor immune responses, including: 1) cytokine-mediated bystander killing; 2) enhanced natural killer cell-mediated cellular cytotoxicity; and 3) priming of tumor-specific cytotoxic T lymphocytes, with specificity towards known tumor-associated antigens. Importantly, immune-mediated killing of both MM and AML, despite AML cells being resistant to CVA21-direct oncolysis, was observed. Upon further examination of the cellular mechanisms responsible for CVA21-induced anti-tumor immunity we have identified the importance of type I IFN for NK cell activation, and demonstrated that both ICAM-1 and plasmacytoid dendritic cells were key mediators of this response.

CONCLUSION

This work supports the development of CVA21 as an immunotherapeutic agent for the treatment of both AML and MM. Additionally, the data presented provides an important insight into the mechanisms of CVA21-mediated immunotherapy to aid the development of clinical biomarkers to predict response and rationalize future drug combinations.

Dopamine D4 Receptor-Selective Compounds Reveal Structure-Activity Relationships that Engender Agonist Efficacy

The dopamine D4 receptor (D4R) plays important roles in cognition, attention, and decision making. Novel D4R-selective ligands have promise in medication development for neuropsychiatric conditions, including Alzheimer's disease and substance use disorders. To identify new D4R-selective ligands, and to understand the molecular determinants of agonist efficacy at D4R, we report a series of eighteen novel ligands based on the classical D4R agonist A-412997 (1, 2-(4-(pyridin-2-yl)piperidin-1-yl)- N-( m-tolyl)acetamide). Compounds were profiled using radioligand binding displacement assays, β-arrestin recruitment assays, cyclic AMP inhibition assays, and molecular dynamics computational modeling. We identified several novel D4R-selective ( Ki ≤ 4.3 nM and >100-fold vs other D2-like receptors) compounds with diverse partial agonist and antagonist profiles, falling into three structural groups. These compounds highlight receptor-ligand interactions that control efficacy at D2-like receptors and may provide insights into targeted drug discovery, leading to a better understanding of the role of D4Rs in neuropsychiatric disorders.

[Mitochondrial DNA copy number of leucocytes as ageing marker and risk factors for age-related diseases in human.]

We used quantitative real-time PCR method to analyse mtDNA copy number in a random subsample (n=996; 358 men aged 66,31±7,24 years; 468 women aged 67,62±7,1 years) selected from a population cohort (n=9 630) examined at baseline in international project HAPIEE in Novosibirsk, Russia, in 2003-2005. The participants were re-examined after 12 years in 2015-2017. The average relative number of mtDNA copies in peripheral blood leukocytes was greater in women than in men, independently of age and smoking (p=0,001). mtDNA copy number was inversely correlated with age both in men (p=0,005) and women (p<0,001). In age adjusted analysis, mtDNA copy number was inversely associated with waist, hip and heart rate in both sexes. In addition, mtDNA copy number in women was inversely associated with triglycerides and glucose, aterogenity index and positively with HDL cholesterol. In men, mtDNA copy number was positively associated with physical activity. The age-adjusted mean of mtDNA copy number among male never-smokers was greater than in smokers (p=0,003), and the mean mtDNA copy number was lower in women with diabetes than in women without diabetes (p=0,005). In both sexes, subjects with baseline history of hypertension had lower mtDNA copy number after 12-year follow-up than those without hypertension (p=0,05). This broadly supports the hypothesis that mtDNA copy number may act as biomarker of ageing.

BOS is associated with decreased HDAC2 from steroid resistant lymphocytes in the small airways

Immunosuppression therapies including corticosteroids fail to prevent bronchiolitis obliterans syndrome (BOS), primarily a disease of the small airways, following lung transplantation. We reported increases in steroid-resistant proinflammatory lymphocytes and their loss of histone deacetylase 2 (HDAC2), an important mediator of steroid action, in the blood of stable lung transplant recipients. We noted similar increases in the steroid-resistant lymphocytes in both the blood and small airways in BOS compared with the large airways. We hypothesized that these small airway cells would also exhibit a loss of HDAC2, and that these changes could be reversed by treatment with theophylline (HDAC2 activator). Blood, bronchoalveolar lavage and large and small airway brushings were collected from lung transplant patients with BOS (n = 12) or stable lung function (n = 18) and healthy aged-matched controls (n = 13). Intracellular proinflammatory cytokines [interferon (IFN-γ) and tumour necrosis factor (TNF)-α and HDAC2 were measured in CD8⁺ T, natural killer (NK) T-like and NK cells from cultured small airway brushings ± 5 mg/l theophylline ± 1 µM prednisolone using flow cytometry. Increased small airway CD8 T, NK T-like and NK cells were identified in BOS versus stable transplant and controls. In BOS, these cells exhibited increased IFN-γ/TNF-α and a loss of HDAC2. HDAC2 expression by small airway CD8⁺ T cells correlated with forced expiratory volume in 1 s (FEV₁ ) (R = 0·880, P = 0·031). Theophylline and prednisolone synergistically up-regulated HDAC2 in CD8⁺ T cells. BOS is associated with loss of HDAC2 from steroid-resistant proinflammatory CD8⁺ T, NK T-like and NK cells in the small airways. Therapeutically increasing HDAC2 in these lymphocytes may reduce steroid resistance and improve graft survival.

Bronchiolitis obliterans syndrome is associated with increased p-glycoprotein expression and loss of glucocorticoid receptor from steroid-resistant proinflammatory CD8+ T cells

Immunosuppressive therapy fails to suppress the production of proinflammatory cytokines, particularly by CD8+ T cells, in stable lung transplant recipients and those undergoing chronic rejection, suggesting that some patients may become relatively resistant to immunosuppressants such as glucocorticoids (GC). We have shown loss of GC receptor (GCR) from the CD8+ cells, and we hypothesized that the drug membrane efflux pump, p-glycoprotein-1 (Pgp), may also be involved in lymphocyte steroid resistance following lung transplant. Pgp/GCR expression and interferon (IFN)-γ/tumour necrosis factor (TNF)-α proinflammatory cytokine production was measured in blood lymphocytes from 15 stable lung transplant patients, 10 patients with bronchiolitis obliterans syndrome (BOS) and 10 healthy aged-matched controls (± prednisolone ± Pgp inhibitor, cyclosporin A ± GCR activator, Compound A) using flow cytometry. Both Pgp+ and Pgp- lymphocyte subsets from all subjects produced IFN-γ/TNF-α proinflammatory cytokines. Pgp expression was increased in CD8+ Pgp+ T cells and correlated with IFN-γ/TNF-α expression and BOS grade. Reduced GCR was observed in CD8+ Pgp- T, natural killer (NK) T-like and NK cells from stable patients compared with controls, and reduced further in CD8+ Pgp- T cells in BOS. The addition of 2·5 ng/ml cyclosporin A and 1 µM prednisolone inhibit IFN-γ/TNF-α production significantly by CD8+ Pgp+ T cells from BOS patients. The addition of 10 µM Compound A and 1 µM prednisolone inhibit IFN-γ/TNF-α production significantly by CD8+ Pgp- T cells from BOS patients. BOS is associated with increased Pgp expression and loss of GCR from steroid-resistant proinflammatory CD8+ T cells. Treatments that inhibit Pgp and up-regulate GCR in CD8+ T cells may improve graft survival.

Occurrence and spatial distribution of chemical contaminants in edible fish species collected from UK and proximate marine waters

The occurrence of a range of regulated and emerging organic environmental contaminants was investigated in 182 samples of edible marine fish sampled mainly from UK marine regions, but extending northerly to the coast of Norway and south to the Algarve. These species (sprats, mackerel, turbot, halibut, herring, grey mullet, sea bass, grey mullet, sardines, etc.) are among those considered to be at the highest risk of contamination with regulated contaminants such as polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs, dioxins), and polychlorinated biphenyls (PCBs), but the occurrence of polybrominated diphenylethers (PBDEs) and polybrominated biphenyls (PBBs) was also investigated. Sub-sets of samples (50-75) were also analysed for emerging contaminants: polychlorinated naphthalenes (PCNs), polybrominated and mixed halogenated dibenzo-p-dioxins, dibenzofurans and biphenyls (PBDD/Fs, PXDD/Fs and PXBs) and perfluoroalkyl substances (PFAS). Contaminant occurrence varied with species and location, but all measured contaminants were detected, with sprats, sea bass, sardines, mackerel, and herring showing higher tissue concentrations. The concentrations of the different contaminants in the various samples were mapped utilising the GPS coordinate data of the capture locations to visualise spatial distribution levels. In terms of catch location, fish sampled from the coasts of southern Britain, north-western France and the Irish Sea appeared to contain proportionately higher levels of some contaminants - e.g. samples from the Irish Sea tended to show higher PCN concentrations, whereas higher levels of PCBs were observed in some fish sampled off the coasts of northern France. Similarly, samples of mullet from the southeast coast of UK showed much higher concentrations of BDE-99 than the other regions. In terms of occurrence trends, PCDD/F and PCB concentrations show a modest decline over the last decade but where limited background data is available for emerging contaminants, there is no evidence of downward trends.

Biallelic Mutations in ATP5F1D, which Encodes a Subunit of ATP Synthase, Cause a Metabolic Disorder

ATP synthase, H+ transporting, mitochondrial F1 complex, δ subunit (ATP5F1D; formerly ATP5D) is a subunit of mitochondrial ATP synthase and plays an important role in coupling proton translocation and ATP production. Here, we describe two individuals, each with homozygous missense variants in ATP5F1D, who presented with episodic lethargy, metabolic acidosis, 3-methylglutaconic aciduria, and hyperammonemia. Subject 1, homozygous for c.245C>T (p.Pro82Leu), presented with recurrent metabolic decompensation starting in the neonatal period, and subject 2, homozygous for c.317T>G (p.Val106Gly), presented with acute encephalopathy in childhood. Cultured skin fibroblasts from these individuals exhibited impaired assembly of F1FO ATP synthase and subsequent reduced complex V activity. Cells from subject 1 also exhibited a significant decrease in mitochondrial cristae. Knockdown of Drosophila ATPsynδ, the ATP5F1D homolog, in developing eyes and brains caused a near complete loss of the fly head, a phenotype that was fully rescued by wild-type human ATP5F1D. In contrast, expression of the ATP5F1D c.245C>T and c.317T>G variants rescued the head-size phenotype but recapitulated the eye and antennae defects seen in other genetic models of mitochondrial oxidative phosphorylation deficiency. Our data establish c.245C>T (p.Pro82Leu) and c.317T>G (p.Val106Gly) in ATP5F1D as pathogenic variants leading to a Mendelian mitochondrial disease featuring episodic metabolic decompensation.

Abstract 18: Evaluating the contribution of anti-myeloma immunity for the efficacy of oncolytic reovirus therapy

Introduction: The aim of this study was to examine the contribution of antitumor immunity for the efficacy of oncolytic reovirus therapy against multiple myeloma (MM). Oncolytic viruses (OV) have two main mechanisms of action; direct lytic killing and potentiation of antitumor immunity. The direct oncolytic potential of reovirus in MM has previously been demonstrated both in vitro and in vivo, but the importance of an enhanced immunologic antitumor response remains underinvestigated. Reovirus-induced antitumor immunity has been demonstrated in other types of cancer such as melanoma and chronic leukemia, and is of major importance for the efficacy of OV treatment. Thus, it was hypothesized that reovirus-induced antimyeloma immunity would contribute significantly to the efficacy of reovirus treatment for MM.

Experimental Procedures: C57BL/KaLwRij mice were used in the 5TGM1 model system to establish MM in vivo. This model closely resembles human MM with induction of osteolytic bone disease and secretion of paraprotein. C57BL/KaLwRij mice have a fully functional immune system, comparable to C57BL/6 mice, and to our knowledge, this is the first immunocompetent model of MM for the study of reovirus efficacy. After establishment of MM in the bone by intravenous injection of bone-homing 5TGM1 cells, mice were treated with repeated injections of reovirus or PBS. Upon sacrifice, direct cytotoxicity and immune activation was examined using flow cytometry. All animal experiments were performed under an appropriate project license following approval by a local ethical review committee. In vivo findings were translated into human in vitro studies, using MM cell lines, healthy donor (HD) blood, and MM patient samples. Reovirus-induced Natural Killer (NK) cell activation and degranulation was examined using flow cytometry and priming of myeloma-specific T cells was performed using long-term priming cultures.

Results: Tumor burden was reduced by reovirus treatment both in the bone marrow (BM) and spleen of tumor-bearing mice. The immune cell populations, including NK cells, CD4+ T cells, and CD8+ T cells, were restored to levels of tumor-naïve mice in the BM. NK cells were activated in the BM following reovirus treatment, which indicates the onset of an innate immune response. In the spleen, an increase in CD4+ T cells, in combination with CD8+ activation, was indicative of an early adaptive immune response. These results translate into human in vitro findings, using both HD and MM patient samples, with activation of NK cells in response to reovirus treatment and subsequent enhancement of NK cell degranulation and killing of MM target cells. Encouragingly, reovirus-activated NK cells were able to kill OPM2 cells, which are resistant to direct lytic killing. Preliminary human in vitro studies suggest that reovirus treatment can prime antimyeloma CD8+ T cells for the induction of a long-term protective response.

Conclusions: Introducing a viral agent into the body requires a delicate immunologic balance to avoid neutralizing the virus by an antiviral response and simultaneously allowing the enhancement of antitumor immunity. The importance of enhanced antitumor immunity for OV therapy efficacy is becoming more widely recognized and antiviral immunity can in some circumstances contribute to tumor eradication. The findings in this study indicate that the antitumor immune response is also important in the MM setting, with activation of both innate and adaptive immune responses resulting in enhanced killing of MM cells, in particular those resistant to direct lytic killing. This suggests that both arms of OV therapy could play a role for MM eradication, including any minimal residual disease. Future work will explore whether the antimyeloma response can be further enhanced by combinatorial treatments, including current standard of care treatments.

Citation Format: Louise M. E. Müller, Christopher Parrish, Gemma Migneco, Gina B. Scott, Matthew Holmes, Alan A. Melcher, Michelle A. Lawson, Gordon Cook, Fiona Errington-Mais. Evaluating the contribution of anti-myeloma immunity for the efficacy of oncolytic reovirus therapy [abstract]. In: Proceedings of the Second AACR Conference on Hematologic Malignancies: Translating Discoveries to Novel Therapies; May 6-9, 2017; Boston, MA. Philadelphia (PA): AACR; Clin Cancer Res 2017;23(24_Suppl):Abstract nr 18.

Temperature dependence of the single photon emission from interface-fluctuation GaN quantum dots

The temperature dependent single photon emission statistics of interface-fluctuation GaN quantum dots are reported. Quantum light emission is confirmed at temperatures up to ~77 K, by which point the background emission degrades the emission purity and results in a measured g⁽²⁾ (0) in excess of 0.5. A discussion on the extent of the background contamination is also given through comparison to extensive data taken under various ambient and experimental conditions, revealing that the quantum dots themselves are emitting single photons with high purity.

The challenge of teaching undergraduates evidence-based veterinary medicine

The Royal College of Veterinary Surgeons now lists 'How to evaluate evidence' as a day one competence for newly qualified vets. In this article, representatives from each of the veterinary schools in the UK discuss how the challenge of delivering and assessing the concepts of evidence-based veterinary medicine in a crowded undergraduate curriculum can be met.

Observation of Reverse Saturable Absorption of an X-ray Laser

A nonlinear absorber in which the excited state absorption is larger than the ground state can undergo a process called reverse saturable absorption. It is a well-known phenomenon in laser physics in the optical regime, but is more difficult to generate in the x-ray regime, where fast nonradiative core electron transitions typically dominate the population kinetics during light matter interactions. Here, we report the first observation of decreasing x-ray transmission in a solid target pumped by intense x-ray free electron laser pulses. The measurement has been made below the K-absorption edge of aluminum, and the x-ray intensity ranges are 10^{16} -10^{17}  W/cm^{2}. It has been confirmed by collisional radiative population kinetic calculations, underscoring the fast spectral modulation of the x-ray pulses and charge states relevant to the absorption and transmission of x-ray photons. The processes shown through detailed simulations are consistent with reverse saturable absorption, which would be the first observation of this phenomena in the x-ray regime. These light matter interactions provide a unique opportunity to investigate optical transport properties in the extreme state of matters, as well as affording the potential to regulate ultrafast x-ray free-electron laser pulses.

The Sparrow Question: Social and Scientific Accord in Britain, 1850-1900

During the latter-half of the nineteenth century, the utility of the house sparrow (Passer domesticus) to humankind was a contentious topic. In Britain, numerous actors from various backgrounds including natural history, acclimatisation, agriculture and economic ornithology converged on the bird, as contemporaries sought to calculate its economic cost and benefit to growers. Periodicals and newspapers provided an accessible and anonymous means of expression, through which the debate raged for over 50 years. By the end of the century, sparrows had been cast as detrimental to agriculture. Yet consensus was not achieved through new scientific methods, instruments, or changes in practice. This study instead argues that the rise and fall of scientific disciplines and movements paved the way for consensus on "the sparrow question." The decline of natural history and acclimatisation stifled a raging debate, while the rising science of economic ornithology sought to align itself with agricultural interests: the latter overwhelmingly hostile to sparrows.

Changing techniques in crop plant classification: molecularization at the National Institute of Agricultural Botany during the 1980s

Modern methods of analysing biological materials, including protein and DNA sequencing, are increasingly the objects of historical study. Yet twentieth-century taxonomic techniques have been overlooked in one of their most important contexts: agricultural botany. This paper addresses this omission by harnessing unexamined archival material from the National Institute of Agricultural Botany (NIAB), a British plant science organization. During the 1980s the NIAB carried out three overlapping research programmes in crop identification and analysis: electrophoresis, near infrared spectroscopy (NIRS) and machine vision systems. For each of these three programmes, contemporary economic, statutory and scientific factors behind their uptake by the NIAB are discussed. This approach reveals significant links between taxonomic practice at the NIAB and historical questions around agricultural research, intellectual property and scientific values. Such links are of further importance given that the techniques developed by researchers at the NIAB during the 1980s remain part of crop classification guidelines issued by international bodies today.

Efficacy of a Probiotic-Prebiotic Supplement on Incidence of Diarrhea in a Dog Shelter: A Randomized, Double-Blind, Placebo-Controlled Trial

BACKGROUND

Diarrhea is the most frequent morbidity affecting kenneled dogs in animal shelters. Diarrhea impacts animal welfare and the finances of the shelter as they must treat, clean, and house affected animals until recovered.

HYPOTHESIS/OBJECTIVES

Supplementing dogs entering an animal shelter with a probiotic-prebiotic, known as a synbiotic, will decrease the incidence of diarrhea.

ANIMALS

Seven hundred and seventy-three dogs entering an animal shelter in the United Kingdom.

METHODS

A prospective double-blind, randomized, placebo-controlled trial.

RESULTS

Statistical difference was found between the groups across 3 measures of diarrhea incidence. First, the mean percentage of scored days per dog that were scored as diarrhea throughout their stay was 2.0% in the synbiotic group and 3.2% in the placebo group (P = .0022). Second, the occurrence of diarrhea within the first 14 days' stay was 18.8% in the synbiotic product group and 27.2% in the placebo group (P = .0008). Third, the occurrence of ≥2 consecutive days of diarrhea within the first 14 days' stay was 4.6% in the synbiotic product group and 8.0% in the placebo group (P = .0300).

CONCLUSIONS AND CLINICAL IMPORTANCE

Supplementing healthy dogs entering an animal shelter with a synbiotic supplement significantly decreased the incidence of diarrhea in this trial. Animal shelters can use synbiotic supplements to improve animal welfare and decrease costs involved in cleaning and housing animals as well as potentially decreasing veterinary intervention.