Serum iron element: A novel biomarker for predicting PD-1 immunotherapy efficacy

This study aims to explore the relationship between serum iron by inductively coupled plasma-mass spectrometry (ICP-MS) and the efficacy of immune checkpoint inhibitors (ICIs) and potential mechanism. Totally 113 patients from 233 patients with advanced metastatic lung cancer, esophageal cancer, gastric cancer and colorectal cancer who treated with immunotherapy in Shandong Provincial Hospital were divided into training group (n=68) and validation group (n=45), whose patients were divided into clinical benefit response (CBR) and non-clinical benefit (NCB) by RECIST (v1.1) respectively. We found for the first time that high serum iron level (>1036 μg/L) was a novel biomarker of better PFS (10.13 months vs 7.37 months; p = 0.0015) and OS(16.00 months vs 11.00 months; p = 0.0235) by ROC curve (sensitivity: 78.13 %; Specificity: 80.56 %; p < 0.0001) of CBR (n=32) and NCB (n=36) patients in training group. Interestingly, consistently stable and high serum iron level predicted better efficacy during immunotherapy. Noteworthy, the predictive efficacy of PD-L1 expression was significantly inferior than serum iron (accuracy:63.49% vs 79.41%, p=0.0432), while serum iron detected by spectrophotometry did not predict the efficacy of immunotherapy (p=0.0671) indicating higher sensitivity of ICP-MS. Bioinformatics analysis showed that serum iron could enhance innate immunity and cytokine release and was verified by proteomics that KEGG and GO analysis enriched innate immune and cytokine signaling pathways. Flow cytometry showed that IL-17 (p=0.0002) increased and IL-6 (p=0.0112) decreased after immunotherapy. Based on this, Nomogram with better prediction was constructed by multiple clinical and independent factors. Our results revealed that serum iron is positively associated with ICIs efficacy by enhancing innate immunity and cytokine release in advanced metastatic cancers, and can be a biomarker for predicting ICIs response.

Clinical applications of radiomics in non-small cell lung cancer patients with immune checkpoint inhibitor-related pneumonitis

Immune checkpoint inhibitors (ICIs) modulate the body's immune function to treat tumors but may also induce pneumonitis. Immune checkpoint inhibitor-related pneumonitis (ICIP) is a serious immune-related adverse event (irAE). Immunotherapy is currently approved as a first-line treatment for non-small cell lung cancer (NSCLC), and the incidence of ICIP in NSCLC patients can be as high as 5%-19% in clinical practice. ICIP can be severe enough to lead to the death of NSCLC patients, but there is a lack of a gold standard for the diagnosis of ICIP. Radiomics is a method that uses computational techniques to analyze medical images (e.g., CT, MRI, PET) and extract important features from them, which can be used to solve classification and regression problems in the clinic. Radiomics has been applied to predict and identify ICIP in NSCLC patients in the hope of transforming clinical qualitative problems into quantitative ones, thus improving the diagnosis and treatment of ICIP. In this review, we summarize the pathogenesis of ICIP and the process of radiomics feature extraction, review the clinical application of radiomics in ICIP of NSCLC patients, and discuss its future application prospects.

Association of pectoralis muscle area on computed tomography with airflow limitation severity and respiratory outcomes in COPD: A population-based prospective cohort study

BACKGROUND

Previous studies have shown that patients with chronic obstructive pulmonary disease (COPD) of severe or very severe airflow limitation have a reduced pectoralis muscle area (PMA), which is associated with mortality. However, whether patients with COPD of mild or moderate airflow limitation also have a reduced PMA remains unclear. Additionally, limited evidence is available regarding the associations between PMA and respiratory symptoms, lung function, computed tomography (CT) imaging, lung function decline, and exacerbations. Therefore, we conducted this study to evaluate the presence of PMA reduction in COPD and to clarify its associations with the referred variables.

METHODS

This study was based on the subjects enrolled from July 2019 to December 2020 in the Early Chronic Obstructive Pulmonary Disease (ECOPD) study. Data including questionnaire, lung function, and CT imaging were collected. The PMA was quantified on full-inspiratory CT at the aortic arch level using predefined -50 and 90 Hounsfield unit attenuation ranges. Multivariate linear regression analyses were performed to assess the association between the PMA and airflow limitation severity, respiratory symptoms, lung function, emphysema, air trapping, and the annual decline in lung function. Cox proportional hazards analysis and Poisson regression analysis were used to evaluate the PMA and exacerbations after adjustment.

RESULTS

We included 1352 subjects at baseline (667 with normal spirometry, 685 with spirometry-defined COPD). The PMA was monotonically lower with progressive airflow limitation severity of COPD after adjusting for confounders (vs. normal spirometry; Global Initiative for Chronic Obstructive Lung Disease [GOLD] 1: β=-1.27, P=0.028; GOLD 2: β=-2.29, P<0.001; GOLD 3: β=-4.88, P<0.001; GOLD 4: β=-6.47, P=0.014). The PMA was negatively associated with the modified British Medical Research Council dyspnea scale (β=-0.005, P=0.026), COPD Assessment Test score (β=-0.06, P=0.001), emphysema (β=-0.07, P<0.001), and air trapping (β=-0.24, P<0.001) after adjustment. The PMA was positively associated with lung function (all P<0.05). Similar associations were discovered for the pectoralis major muscle area and pectoralis minor muscle area. After the 1-year follow-up, the PMA was associated with the annual decline in the post-bronchodilator forced expiratory volume in 1 s percent of predicted value (β=0.022, P=0.002) but not with the annual rate of exacerbations or the time to first exacerbation.

CONCLUSION

Patients with mild or moderate airflow limitation exhibit a reduced PMA. The PMA is associated with airflow limitation severity, respiratory symptoms, lung function, emphysema, and air trapping, suggesting that PMA measurement can assist with COPD assessment.

Dust mite-derived Enterobacterial fimbriae H protein enforces the allergen specific immunotherapy in asthma mice

BACKGROUND

The mite alimentary canal contains plenty of microbiota. It is accepted that some of the microbial products function as adjuvants to speed up immune responses.

OBJECTIVES

We identified five bacterial proteins from dust mite, and Enterobacterial fimbriae H (FimH) was one of them. This study aims to test a hypothesis that the FimH protein enforces immunotherapy in asthmatic mice.

METHODS

Asthmatic mice were treated by allergen specific immunotherapy (ASIT) with rDer f1/f2 or rDer f1/f2 plus FimH. Changes in inflammatory cell infiltration, airway hyperreactivity, frequency of Tregs, splenic CD4⁺IFN-γ⁺ cells, and serum levels of TGF-β, IL-10, IL-13 and IL-17A of asthmatic mice were checked.

RESULTS

ASIT with rDer f1/f2 plus FimH reduced inflammatory cell infiltration, airway hyperreactivity (AHR), and levels of IgE and IgG1 compared to ASIT with rDer f1/f2 alone, but the levels of IgG2a increased. Asthmatic mice that underwent ASIT with rDer f1/f2 plus FimH showed increased frequency of Tregs, splenic CD4⁺IFN-γ⁺ cells, serum levels of TGF-β and IL-10; and deceased splenic CD4⁺IL-4⁺ cells, and serum levels of IL-13 and IL-17A. In vitro study showed FimH triggered IL-10 expression in a concentration dependent manner and facilitated the differentiation of Tregs.

CONCLUSION

Used as an adjuvant, FimH enforces the effect of ASIT in asthmatic mice via augmenting Tregs.

P1633Age, creatinine, and ejection fraction (ACEF) score continues to predictive prognosis in patients with ischemic cardiomyopathy

Purpose

ACEF (Age, Creatinine, and Ejection Fraction) andACEFMDRD (Modification of Diet in Renal Disease) score have been validated as effective predictors for prognosis in patients undergoing elective cardiac surgery or PCI. However, the predictive value for ICM (Ischemic Cardiomyopathy)was not clear. This study sought to investigate their predictive value in patients with ICM.

Methods

862 ICM patients hospitalized in the Department of Cardiology were prospectively enrolled during November 2014 and December 2017.Inclusion criteria: previous definite diagnosis of myocardial infarction, previous PCI, CABG, or coronary angiographic findings of one or more vessel stenosis >70%; Simpson echocardiography showed LVEF <45%. Exclusion criteria: malignant tumors of any organ or once had a history of malignancies; and other serious diseases with estimated survival time less than one year.The ACEF score was calculated by the formula: age/ejection fraction + 1 (if creatinine >176 μmol/L). As for ACEFMDRD score, estimated glomerular filtration rate (eGFR) was calculated using the MDRD formula. Then using the formula: age/EF +1 point for every 10 mL/min reduction in eGFRMDRD below 60 ml/min per 1.73 m2 (up to a maximum of 6 points). Patients were divided into low, middle and high ACEF, ACEFMDRD tertiles. The median duration of follow-up was 13 months (IQR: 7–23 months). The clinical endpoints were all-cause mortality, cardiac mortality, major adverse cardiovascular and cerebrovascular events (MACCEs) and re-hospitalization for heart failure (HF).

Results

The mean original ACEF and ACEFMDRD score were 1.99±0.63 and 2.53±1.42. Patients in high ACEF and ACEFMDRD tertile were associated with significantly higher all-cause and cardiac mortality, MACCEs and re-hospitalization for HF. Compared with ACEFMDRD score, original ACEF exhibited similar discrimination and predictive ability on all-cause mortality (AUC: 0.739 vs. 0.724, P=0.567), cardiac mortality (AUC: 0.733 vs. 0.717, P=0.525), MACCEs (AUC: 0.635 vs. 0.624, P=0.587) and rehospitalizaiotn (AUC: 0.642 vs. 0.632, P=0.757). In multivariate Cox analysis, the original ACEF or ACEFMDRD score were related with increasing risks of all-cause mortality (HR: 2.00 vs. 1.32, 95% CI: 1.46–2.73 vs. 1.13–1.53, P<0.001), cardiac mortality (HR: 1.97 vs. 1.28, 95% CI: 1.43–2.70 vs. 1.10–1.50, P<0.001 vs. P=0.002), MACCEs and re-hospitalization for HF, respectively.

ROC curves of cardiac mortality

Conclusions

In patients with ICM, the original ACEF and ACEFMDRD score are independent predictors of adverse outcomes during 13-month follow-up, respectively.

Acknowledgement/Funding

None

Peak expiratory flow as a screening tool to detect airflow obstruction in a primary health care setting

BACKGROUND

Peak expiratory flow (PEF) measurement is less expensive and requires fewer skills than spirometry testing. It is thus expected to be a reasonable substitute for spirometry in airflow obstruction screening when spirometry is unavailable.

OBJECTIVES

To evaluate the validation of PEF measurement in the detection of airflow obstruction using newly established regression equations.

METHODS

The PEFs of 553 'normal' participants aged 40-85 years were measured using mechanical devices. Based on these data, regression equations were generated to predict normal PEF values. Data were then collected from 3379 subjects. The specificity and sensitivity of the different predicted PEF cut-off points for detecting airflow obstruction were evaluated by spirometry, based on previously generated regression equations.

RESULTS

Using newly established reference values for PEF, PEF had higher sensitivity and specificity than the questionnaire in detection of airflow obstruction. That PEF < 80% of predicted was more effective in the detection of airflow obstruction was confirmed by the lower limit of normal of forced expiratory volume in 1 second/forced vital capacity, Global Initiative for Chronic Obstructive Lung Disease (GOLD), and GOLD plus symptom, with a sensitivity of 78.7%, 76.8%, 85.3% and a specificity of 81.9%, 83.8%, 81.4%, respectively.

CONCLUSIONS

Mechanical PEF may be a reasonable method of screening for airflow obstruction in settings where spirometry is unavailable.

COPD in Chinese nonsmokers

Little is known about chronic obstructive pulmonary disease (COPD) in Chinese nonsmokers. The present study aimed to investigate the profiles of COPD among nonsmokers based on the Chinese Epidemiological Survey of COPD (CESCOPD). In the CESCOPD, 20,245 subjects aged 40 yrs or older were interviewed with questionnaires and spirometry tests. Subjects with a post-bronchodilator forced expiratory volume in one second (FEV(1))/forced vital capacity (FVC) ratio of <0.70 were identified as having COPD. Data of 12,471 nonsmokers and 1,024 smoking COPD patients were analysed in the current study. The overall prevalence of COPD among nonsmokers was 5.2% (95% confidence interval 4.8-5.6). Being male, of advanced age, lower body mass index (BMI) and lower educational level, having exposure to environmental tobacco smoke, coal and/or biomass smoke, poor ventilation in the kitchen, a family history of respiratory disease and recurrent childhood cough were all independently associated with a higher risk of having COPD among nonsmokers. Nonsmokers with respiratory symptoms without airflow limitation showed a somewhat different pattern of risk factors. Nonsmokers with COPD were less likely to present with chronic productive coughs and lower BMI, while more likely to have received a physician diagnosis of asthma and respiratory diseases in childhood, than smokers with COPD. Chronic obstructive pulmonary disease is prevalent among Chinese nonsmokers, and nonsmoking chronic obstructive pulmonary disease may have different profiles from smoking chronic obstructive pulmonary disease.

Meta- and pooled analyses of the effect of glutathione S-transferase M1 and T1 deficiency on chronic obstructive pulmonary disease

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is a complex polygenic disease in which gene-environment interactions are very important. A number of studies have investigated the genotypes of glutathione S-transferase M1 and T1 (GSTM1 and GSTT1) in relation to COPD susceptibility in different populations. However, the results of individual studies have been inconsistent.

METHODS

To address the inconsistent findings in studies of the association of the polymorphism of the GSTM1 and GSTT1 genes with susceptibility to COPD, we performed a meta-analysis of the published data. We searched the Medline database for case-control studies published from 1966 to July 2008. Data were extracted and pooled, and ORs were calculated with their 95%CIs.

RESULTS

Twelve eligible studies comprising 1697 patients with COPD and 1867 controls were included in the meta-analysis. The pooled result showed that the GSTM1 deficiency was associated with risk of COPD (OR 1.46, 95%CI 1.16-1.83). Subgroup analysis supported the results in smoking and non-Asian populations, but not in Asian populations. The GSTT1 deficiency was not associated with risk of COPD.

CONCLUSIONS

The GSTM1 gene is a genetic contributor to overall COPD susceptibility in non-Asian populations, and the GSTT1 gene is not associated with COPD.

Chitosan microparticles loaded with mite group 2 allergen Der f 2 alleviate asthma in mice

BACKGROUND

In recent years, nanoparticle materials have found wide applications in drug transport and release systems. Chitosan is a good carrier for proteins, peptides, and nucleic acids because of its favorable release properties and ability to increase membrane permeability.

OBJECTIVE

To investigate the effect of chitosan microparticles loaded with the major epitope peptide of mite group 2 allergen Der f 2 from Dermatophagoides farinae (Der f 2-47-67) in alleviating asthma in mice.

METHODS

Derf 2-47-67 was entrapped in chitosan to obtain Derf 2-47-67-loaded chitosan microparticles, which were injected intraperitoneally into BALB/c mice prior to an intranasal challenge with a Der f extract allergen. Airway hyperreactivity was measured via whole-body plethysmography, and bronchoalveolar lavage (BAL) fluid was collected to calculate total cell and eosinophil counts. Changes in lung histology were assessed after hematoxylin-eosin staining, and serum levels of Der f-specific immunoglobulin (Ig) G2a and IgE were determined by enzyme-linked immunoabsorbent assay.

RESULTS

Mice immunized with Der f 2-47-67-loaded chitosan microparticles displayed decreased airway hyperreactivity, reduced numbers of eosinophils in BAL fluid, alleviated lung inflammation and mucus production, a reduced serum level of Der f-specific IgE and an increased serum level of Der f-specific IgG2a.

CONCLUSION

Our data showed that Der f 2-47-67-loaded chitosan microparticles inhibited airway allergic inflammation.

[Bcl-2 antisense oligodeoxyribonucleotide increases apoptosis of lung carcinoma cells induced by cisplatin]

OBJECTIVE

To study the effect of antisense oligodeoxyribonucleotide (ODN) to apoptotic suppress gene bcl-2 on apoptosis of lung carcinoma cells induced by cisplatin.

METHODS

The lung carcinoma cells expressing bcl-2 were chosen to participate in this experiment. Cultured cells were divided into 7 groups: ODN, nonsense, ODN + cisplatin, nonsense + cisplatin, cisplatin, lipofectin and control. Bcl-2 antisense or nonsense mixed with lipofectin was added into above corresponding cultured cells. After cultured for 6 hours, cisplatin was added into corresponding groups. The cells were cultured again for 16 hours. And then, the cells were smeared on slides. Apoptotic cells were labeled with TdT-mediated dUTP nick end labeling (TUNEL) method on cell smears. Apoptotic index (AI) was counted to show the percentage of apoptotic cancer cells. The immunocytochemistry was used to detect the expression of bcl-2 in carcinoma cells.

RESULTS

The bcl-2 expression of cancer cell in ODN group was significantly decreased compared to the control and nonsense groups. The AI of ODN + cisplatin group was 16.4 +/- 1.7, cisplatin group 4.1 +/- 0.8, antisense group 5.9 +/- 0.2, nonsense group 3.3 +/- 0.7, nonsense + cisplatin 7.6 +/- 1.1, lipofectin 5.1 +/- 0.9, control group 3.6 +/- 0.6. The AI of antisense + cisplatin group was significantly higher than that of other groups.

CONCLUSION

Antisense oligodeoxyribonucleotide to bcl-2 can inhibit significantly the expression of bcl-2 of lung cancer cells and increase apoptosis of cancer cells induced by cisplatin.

[Mite-induced interleukin-5 and interleukin-4 expressions in peripheral blood mononuclear cells from asthmatic children with respiratory syncytial virus infection]

OBJECTIVE

To investigate the effects of respiratory syncytial virus(RSV) infection on mite-induced interleukin-5 and interleukin-4 expressions in cultures of PBMC from asthmatic children and their correlation with asthmatic symptoms.

METHODS

IL-5 and IL-4 expressions in mite (D. Pteronyssinus)-stimulated PBMC were assessed ex vivo by ELISA and reverse transcription-polymerase chain reaction (RT-PCR) in 16 allergic asthmatic children with RSV infection(A) and 14 patients without RSV infection(B), as well as 10 normal controls(C) (5.1 +/- 2.4 yrs). Meanwhile their correlation with serum ECP or current wheezing was analysed in patients after RSV infection.

RESULTS

(1) Stimulation of PBMC with mite antigens induced significantly higher IL-4 (34 +/- 24) ng/L vs (8 +/- 5) ng/L, (P < 0.01) and IL-5 (26 +/- 15) ng/L vs (6 +/- 5) ng/L release in allergic patients(B) as compared with healthy controls(C). The release was in a mite dose-dependent manner. Meanwhile, IL-5 level in group A (A) was the highest (73 +/- 47) ng/L, P < 0.05 compared with (B)). Similar results were obtained with IL-5 mRNA expressions. (2) Serum ECP level was significantly higher in group A (73 +/- 47) micrograms/L than in group C (18 +/- 12) micrograms/L, P < 0.01. There was a significant correlation between IL-5 release and ECP levels (r = 0.49, P < 0.05). (3) Mite-induced IL-5 release in PBMC was significantly increased in the group with wheezing symptom (71 +/- 40) ng/L compared with the asymptomatic group (34 +/- 29) ng/L, (P < 0.05).

CONCLUSIONS

Our findings indicated that during RSV infection, mite-induced IL-5 expression in PBMC of asthmatic children was up-regulated, which may enhance activation of eosinophils and precipitate or exacerbate asthma symptoms.

[Expression of FGF-b and C-myc in rats lung tissue affected by hypoxia]

OBJECTIVE

To study FGF's roles in the reconstruction of vascular walls owing to chronic hypoxia.

METHOD

40 SD rats [corrected] were divided into different hypoxia groups and proceeded with various hypoxic intervals. Expression of FGF-b and transcription of c-myc mRNA of the rats [corrected] lung tissues were detected by immunohistochemical method and in situ hybridization.

RESULTS

FGF-b increased obviously in the smooth muscle and advential tissue of pulmonary arteries after 14 days of hypoxia, whereas C-myc mRNA showed overexpression in rats [corrected] lung tissue from 7th to 21st day of hypoxia.

CONCLUSION

(1) Hypoxia may lead to activation of C-myc oncogene and increase of FGF-b expression in lung tissue. (2) FGF-b and C-myc oncogene takes part in reconstruction of pulmonary arterial wall affected by chronic hypoxia.

[Effects of chronic hypoxia on the expression of oncogene jun fos and myb mRNA in rat lung]

This paper is to investigate the expression of oncogene jun fos and myb mRNA in the lung of rats exposed to chronic hypoxia. 15 SD rats were put in low oxygen chamber (FiO2 = 0.1), 8 hrs daily for 1, 2 and 3 weeks. Five rats breathing room air served as control. Oncogene expression in lung tissue assessed by the use of in situ hybridization. The results showed that (1) there was a slight expression of jun mRNA but not fos and myb mRNA in the control normoxic rats' lung; (2) it was found that a less expression of jun mRNA in lung after 1 week hypoxia, but after 2 week hypoxia jun mRNA elevated again and significantly increased after 3 week hypoxia as compared with that in normoxia; (3) the oncogene myb mRNA expression showed significant increase in 1 and 2 week hypoxia and returned to normal status in 3 week hypoxia; (4) after 1 to 3 week hypoxia, a significant increased expression of fos mRNA was found as compared with that in normoxia. It is suggested hypoxia may induce increased expression of proto-oncogene jun myb and fos, which may be related to proliferation of pulmonary arterial smooth muscle cells and fibroblasts.

[Expression of endothelin-1 mRNA, endothelin receptor-A and nitric oxide synthase mRNA in pulmonary artery and right ventriculus cordis of rats exposed to hypoxia]

Endothelins (ETs) are a family of novel regulatory peptides which can constrict the vascular and promote the proliferation of vascular smooth muscle cells. Serum ET-1 was elevated, and nitric oxide (NO) levels were reduced in hypoxic pulmonary hypertension. However, the exact mechanism remains unclear, and no study has elucidated if hypoxia could stimulate directly overgrowth of right ventricle in patients with chronic cor pulmonale. To investigate the role of ET-1 and NO in hypoxia-induced pulmonary hypertension and right ventricular hypertrophy, we measured the levels of ET-1 mRNA, ET receptor-A (ETR-A) mRNA and nitric oxide synthase (NOS) mRNA in the pulmonary artery and right ventricle of rats exposed to hypoxia (FiO = 0.1, 8 hours daily for 1, 2 and 3 weeks) by reverse transcription-polymerase chain reaction (RT-PCR). ET-1 mRNA level of pulmonary artery raised after 1 week's hypoxia (P < 0.05), and after 2 weeks' hypoxia, it returned to near normal, but elevated significantly again after 3 weeks' hypoxia. Pulmonary artery ETR-A mRNA in 1 and 2 weeks hypoxic groups showed no significant change, but it raised significantly in 3 weeks' hypoxic group. After exposure to hypoxia for 1, 2 and 3 weeks, NOS mRNA in the pulmonary artery all reduced significantly (P < 0.05). The right ventriculus cordis showed a significant increase in weight after 3 and 2 weeks' hypoxia. ET-1 mRNA showed no significant change but ETR-A mRNA increased significantly after 2 weeks' hypoxia; both ET-1 mRNA and ETR-A mRNA showed significant increase in weight after 3 and 2 weeks' hypoxia. In the ventriculus cordis of rats exposed to hypoxia for 2 and 3 weeks, NOS mRNA had no significant change.