T-cell immunoglobulin and mucin domain 3 is upregulated in rheumatoid arthritis, but insufficient in controlling inflammation

OBJECTIVES

Rheumatoid arthritis (RA) is a chronic autoimmune disease, that involves both pro- and anti-inflammatory mechanisms. The purpose of the present study is to investigate T-cell immunoglobulin and mucin domain 3 (Tim-3) in RA.

METHODS

Plasma levels of soluble (s) Tim-3 in early RA (n=98), were followed, to evaluate association with treatment and disease activity, acquired from a prospective collected biobank (clinicaltrials.gov (NCT00660647)). We also investigate the influence of Tim-3 on spontaneous cytokine production in synovial fluid mononuclear cells (SFMC) from RA patients after addition of neutralizing anti-Tim-3's antibodies, either alone or in combination with neutralizing anti-Programmed Cell death protein 1 (PD-1) antibodies.

RESULTS

Long-time stimulated CD4 T-cells expressed high levels of Tim-3, but tended to decrease their PD-1 expression. Tim-3 expression was exclusively seen co-expressed with PD-1 by CD3, CD4, CD45RO positive cells in the inflamed RA joint. Addition of neutralizing Tim-3 antibodies increased the secretion of IFNγ and MCP-1, in SFMC cultures from RA. Whereas neutralizing anti-PD-1 antibodies showed a broader impact on cytokine production. Finally, we observed that soluble Tim-3 is increased in plasma and is associated with disease activity in early RA.

CONCLUSION

Taken together, our findings indicate disease-suppressive functions of Tim-3 in RA.

Abstract P3-06-08: Plasma (p) biomarker results from the TANIA trial evaluating continued or reintroduced bevacizumab (BEV) after 1st-line BEV for HER2-negative metastatic breast cancer (mBC)

BACKGROUND: A potential predictive and prognostic effect of pretreatment pVEGF-A concentrations was suggested in exploratory analyses of phase III trials in HER2-negative mBC (AVADO), gastric cancer (AVAGAST), and pancreatic cancer (AViTA). This led to initiation of the MERiDiAN trial evaluating pVEGF-A prospectively in patients (pts) receiving 1st-line paclitaxel ± BEV in HER2-negative mBC. Potential predictive value was also noted for pVEGFR-2 in AVADO, AViTA, and in early BC in BEATRICE. We report prespecified pVEGF-A and pVEGFR-2 analyses in TANIA.

METHODS: TANIA is an open-label randomized phase III trial evaluating the addition of BEV (15 mg/kg q3w or 10 mg/kg q2w) to the investigator’s choice of chemotherapy (CT) in pts with HER2-negative mBC who experience disease progression (PD) on/after 1st-line BEV-containing therapy. Allocation to BEV or no BEV is continued with 3rd-line therapy after 2nd PD (ie no crossover permitted). The primary endpoint is PFS from randomization to 2nd-line PD/death. Pts consenting to the optional biomarker substudy provided 6 mL plasma samples in EDTA before drug administration at randomization, at wks 7 and 13, every 12 wks thereafter, and at 2nd PD. pVEGF-A and shedded pVEGFR-2 were measured using the IMPACT assay (v2.03). The median concentration for each marker before 2nd-line treatment was prespecified as the cut-off between low (≤ median) and high (> median) biomarker subgroups. 2nd-line PFS was analyzed in each subgroup.

RESULTS: The PFS benefit from BEV seen in the ITT population (N=494; stratified hazard ratio [HR] 0.75, 95% CI 0.61–0.93) was observed consistently within subgroups of the biomarker population (N=312). However, there was no differential BEV effect according to pVEGF-A or shedded pVEGFR-2 concentrations. The stratified HR for PFS was 0.69 (95% CI 0.46–1.04) in pts with low pVEGF-A (≤1010.6 pg/mL [median]) and 0.80 (95% CI 0.54–1.18) in pts with high pVEGF-A (interaction p=0.47). As all pts had received prior BEV, unlike earlier trials showing a potential predictive effect of pVEGF-A, we explored pVEGF-A concentrations according to BEV-free interval. The BEV-free interval was ≤12 wks in 117/150 pts (78%) in the CT arm and 136/162 pts (84%) in the BEV+CT arm. Median pVEGF-A was much lower in the subgroup of 59 pts with a BEV-free interval >12 wks (45.1 pg/mL) than in pts with a BEV-free interval ≤12 wks (1135.3 pg/mL). Analyses of 2nd-line PFS according to shedded pVEGFR-2 concentration showed stratified PFS HRs of 0.68 (95% CI 0.45–1.02) for low pVEGFR-2 (≤9.6 ng/mL [median]) and 0.90 (95% CI 0.60–1.34) for high pVEGFR-2 (interaction p=0.49).

CONCLUSIONS: The potential predictive effect of pVEGF-A in AVADO was not observed in TANIA, although high pVEGF-A concentrations in pts recently treated with BEV complicate interpretation. pVEGF-A is being evaluated prospectively in BEV-naïve pts in the ongoing MERiDiAN trial. Shedded pVEGFR-2 showed no predictive effect in TANIA and the suggested trend was in the opposite direction to the effect seen in AVADO and BEATRICE. Further analyses are planned to evaluate the impact of gene expression, cell-free DNA, protein expression, and DNA mutations on treatment effect in TANIA.

Citation Format: Javier Cortes, Eduard Vrdoljak, Fabio Puglisi, Norbert Marschner, Joseph Gligorov, Christoph Zielinski, Cristian Villanueva, Gilles Romieu, István Lang, Eva Ciruelos, Corinne Veyret, Andrea Fontana, Mikkel Oestergaard, Sabine de Ducla, Ulrich Freudensprung, Gunter von Minckwitz. Plasma (p) biomarker results from the TANIA trial evaluating continued or reintroduced bevacizumab (BEV) after 1st-line BEV for HER2-negative metastatic breast cancer (mBC) [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P3-06-08.

Creating policy frameworks for public health genomics to benefit developing countries

Unprecedented advances in life sciences, as exemplified by the revolution in genomics, are yet to translate into effective public health interventions to benefit the health of populations living in the developing world. The developing countries continue to bear the major burden of disease globally, both infectious and chronic diseases, and they could clearly benefit from genomics being harnessed and used to address the greatest public health problems in addition to benefits for the health of individuals. For this to happen, we need to understand what are the major challenges or bottlenecks to be overcome and, informed by these priorities, create an effective, inclusive, equitable and sustainable policy framework within which knowledge translation into improved health outcomes of underprivileged populations can take place.

Born too soon: the global epidemiology of 15 million preterm births

This second paper in the Born Too Soon supplement presents a review of the epidemiology of preterm birth, and its burden globally, including priorities for action to improve the data. Worldwide an estimated 11.1% of all livebirths in 2010 were born preterm (14.9 million babies born before 37 weeks of gestation), with preterm birth rates increasing in most countries with reliable trend data. Direct complications of preterm birth account for one million deaths each year, and preterm birth is a risk factor in over 50% of all neonatal deaths. In addition, preterm birth can result in a range of long-term complications in survivors, with the frequency and severity of adverse outcomes rising with decreasing gestational age and decreasing quality of care. The economic costs of preterm birth are large in terms of immediate neonatal intensive care, ongoing long-term complex health needs, as well as lost economic productivity. Preterm birth is a syndrome with a variety of causes and underlying factors usually divided into spontaneous and provider-initiated preterm births. Consistent recording of all pregnancy outcomes, including stillbirths, and standard application of preterm definitions is important in all settings to advance both the understanding and the monitoring of trends. Context specific innovative solutions to prevent preterm birth and hence reduce preterm birth rates all around the world are urgently needed. Strengthened data systems are required to adequately track trends in preterm birth rates and program effectiveness. These efforts must be coupled with action now to implement improved antenatal, obstetric and newborn care to increase survival and reduce disability amongst those born too soon.