The immunostimulatory activity of sea spray aerosols: bacteria and endotoxins activate TLR4, TLR2/6, NF-κB and IRF in human cells

Frequent exposure to sea spray aerosols (SSA) containing marine microorganisms and bioactive compounds may influence human health. However, little is known about potential immunostimulation by SSA exposure. This study focuses on the effects of marine bacteria and endotoxins in SSA on several receptors and transcription factors known to play a key role in the human innate immune system. SSA samples were collected in the field (Ostend, Belgium) or generated in the lab using a marine aerosol reference tank (MART). Samples were characterized by their sodium contents, total bacterial counts, and endotoxin concentrations. Human reporter cells were exposed to SSA to investigate the activation of toll-like receptor 4 (TLR4) in HEK-Blue hTLR4 cells and TLR2/6 in HEK-Blue hTLR2/6 cells, as well as the activation of nuclear factor kappa B (NF-κB) and interferon regulatory factors (IRF) in THP1-Dual monocytes. These responses were then correlated to the total bacterial counts and endotoxin concentrations to explore dose-effect relationships. Field SSA contained from 3.0 × 103 to 6.0 × 105 bacteria/m3 air (averaging 2.0 ± 1.9 × 105 bacteria/m3 air) and an endotoxin concentration ranging from 7 to 1217 EU/m3 air (averaging 389 ± 434 EU/m3 air). In contrast, MART SSA exhibited elevated levels of total bacterial count (from 2.0 × 105 to 2.4 × 106, averaging 7.3 ± 5.5 × 105 cells/m3 air) and endotoxin concentration from 536 to 2191 (averaging 1310 ± 513 EU/m3 air). SSA samples differentially activated TLR4, TLR2/6, NF-κB and IRF. These immune responses correlated dose-dependently with the total bacterial counts, endotoxin levels, or both. This study sheds light on the immunostimulatory potential of SSA and its underlying mechanisms, highlighting the need for further research to deepen our understanding of the health implications of SSA exposure.

At second glance: The importance of strict quality control - A case study on microplastic in the Southern Ocean key species Antarctic krill, Euphausia superba

The stomach content of 60 krill specimens from the Southern Ocean were analyzed for the presence of microplastic (MP), by testing different sample volumes, extraction approaches, and applying hyperspectral imaging Fourier-transform infrared spectroscopy (μFTIR). Strict quality control was applied on the generated results. A high load of residual materials in pooled samples hampered the analysis and avoided a reliable determination of putative MP particles. Individual krill stomachs displayed reliable results, however, only after re-treating the samples with hydrogen peroxide. Before this treatment, lipid rich residues of krill resulted in false assignments of polymer categories and hence, false high MP particle numbers. Finally, MP was identified in 4 stomachs out of 60, with only one MP particle per stomach. Our study highlights the importance of strict quality control to verify results before coming to a final decision on MP contamination in the environment to aid the establishment of suitable internationally standardized protocols for sampling and analysis of MP in organisms including their habitats in Southern Ocean and worldwide.

Blood immune cell biomarkers in lung cancer

Characterization of host immune cell parameters prior to treatment is expected to identify biomarkers predictive of clinical outcome as well as to elucidate why some patients fail to respond to immunotherapy. We monitored blood immune cells from 58 patients with non-small- cell lung cancer (NSCLC) undergoing surgery of the primary tumor and from 50 age-matched healthy volunteers. Complete leukocyte blood count, the number of circulating dendritic cells (DC), HLA-DR^low monocytes and several lymphocytic subpopulations were determined by eight-color flow cytometry. Furthermore, the prognostic value of the immune cell parameters investigated was evaluated by patients' survival analysis. Compared to the control group, blood of NSCLC patients contained more neutrophils resulting in a higher neutrophil-to-lymphocyte ratio (NLR), but a lower number of blood DC, in particular of plasmacytoid DC (pDC), natural killer (NK) cells and naive CD4⁺ and CD8⁺ T cells. Furthermore, a higher frequency of CD4⁺ regulatory T cells (Treg) and HLA-DR^low monocytes was detected, and smoking had a significant impact on these values. HLA-DR^low monocytes were positively correlated to the number of neutrophils, monocytes and NLR, but negatively associated with the number of pDC and naive CD4⁺ T cells. The frequency of Treg, HLA-DR^low monocytes and naive CD4⁺ and CD8⁺ T cells as well as the ratios of CD4/HLA-DR^low monocytes and HLA-DR^low monocytes/pDC correlated with patient's overall survival. Next to Treg, HLA-DR^low monocytes and naive T cells represent prognostic markers for NSCLC patients and might be useful for monitoring of patients' responses to immunotherapies in future studies.

[Rebiopsy for Patients with Lung Cancer - Joint Opinion from both the Endoscopic and Thoracic Oncology Sections of the German Society of Pneumology (DGP)]

Performing rebiopsies for primary lung cancer and/or their metastases is becoming more and more prominent in daily practice, as the therapeutical spectrum increases and some newer strategies are dependent on immunohistochemical and/or molecular factors. In general, nearly all recurrent lesions or metastases can be reached. However, frequently invasive procedures are necessary with the need to carefully weigh risks and benefits of rebiopsies for the patient in each case. In this review indications for recurrent and progressive disease as well as risks are discussed and alternatives to rebiopsies are shown. This work is the joint opinion from both the endoscopic and thoracic oncology sections of the German Society of Pneumology (DGP).

[Implementation of the German guideline for the prevention, diagnosis, treatment and follow-up of non-small cell lung cancer at the Diakoniekrankenhaus Halle/Saale]

BACKGROUND

More than three years since the release of the german guideline for the prevention, diagnosis, treatment and follow-up of lung cancer the database in terms of the implementation of guideline recommendations is deficient. The aim of this article is to analyze the implementation of the recommended algorithms for first-line therapy of non-small cell lung cancer.

PATIENTS AND METHODS

On the basis of the patients records we determined all cases of newly diagnosed non-small cell lung cancer which received a first-line therapy at the Diakoniekrankenhaus Halle/Saale between January 2010 and December 2011. The demographic data, tumor stage, time of diagnosis and performed first-line therapy were documented. Each case was assigned to the groups "guideline-adherent treatment" or "deviation from guideline recommendation" in dependency of its tumor stage. For this assignment the corresponding algorithms from guideline chapter "Therapy of non-small lung cancer" were used.

RESULTS

A total of 126 from 148 cases (85%) received guideline-adherent treatment. Deviation from guideline recommendation was found in 22 cases (15%). The categories "poor performance status", "technical factors", "patient decision" and "others" were determined as the main reasons for non guideline-adherent treatment.

CONCLUSIONS

Based on the analyzed population this study determined a high grade of guideline adherence at the period of investigation. Otherwise it shows that guideline recommendations cannot include each individual factor of the complex lung cancer disease. It could be found a wide range of reasons for deviation from the guideline recommendations.

[Treatment of respiratory papillomatosis--a case report on systemic treatment with bevacizumab]

BACKGROUND

Recurrent respiratory papillomatosis (RRP) is a known but rare disease, caused by human papilloma virus and characterised by multiple exophytic lesions and uncontrolled growth of papilloma in the respiratory tract. The most common complication of RRP is stenosis of the trachea. Medical therapeutic options have so far been less effective. However, inhibition of vascular endothelial growth factor (VEGF) by bevacizumab does appear to be an effective treatment option for RRP.

CASE REPORT

The case of a 32-year-old male patient with RRP who has been treated for his symptomatic tracheal stenosis four times a year since 1996 is described. Only treatment by laser ablation showed any efficacy. Alternative treatment options did not show any effect. In May 2006 intrapulmonary lesions of RRP were also diagnosed but without any malignancy. From December 2007 to June 2008 the patient has been treated with bevacizumab. A visible regression of RRP and markedly less symptoms were observed. During this treatment no further laser ablation was necessary.

CONCLUSION

Inhibition of VEGF by bevacizumab seems to offer a new and effective option in the medical management of RRP.

Pemetrexed in combination with cisplatin or carboplatin as adjuvant chemotherapy in early-stage NSCLC

7565

Background: Platinum based chemotherapy after complete resection of stage I-IIIa non-small cell lung cancer (NSCLC) has improved 5-yr survival by 4–15%. Pemetrexed (P) in combination with cisplatin (C) or carboplatin (Carb) has shown to be effective and safe in first-line Tx of advanced NSCLC, thus being a promising option in the adjuvant setting. Methods: Multicenter, open phase 2 in pts with resected stage Ib/II NSCLC. Pts were randomized to P (500 mg/m2)+C (75mg/m2) or P (500 mg/m2)+Carb (AUC5) d1 q3 wks, for 4 cycles; adequate organ function and ECOG PS 0–1 required. Primary endpoint was feasibility of the regimen defined as compliance to 4 Tx cycles with ≥ 95% of planned dose without ≥ Grade 3 toxicities (tox) at 30 d after last infusion. A regimen was deemed feasible if the rate (feasible pts/total pts) was >60%. Results: Please see Table for results. Conclusions: According to the strict definitions in this protocol neither regimen was feasible. The reason was poor compliance with at least one of the components that defined feasibility, but dose intensity and % pts completing cycle 4 was notably high, compared to other adjuvant trials. P+C was the more favourable regimen concerning feasibility and tolerability. In terms of tolerability pemetrexed could be combined with either platinum compound.

[Table: see text]

[Table: see text]

Randomized phase II study of three doses of the integrin inhibitor cilengitide versus docetaxel as second-line treatment for patients (pts) with stage IV non-small cell lung cancer (NSCLC)

8014

Background: Cilengitide (EMD 121974) is the most advanced compound in clinical development of a new class of oncology drugs, the integrin inhibitors. Integrins (heterodimeric transmembrane receptors) play key roles in cell interactions. Cilengitide selectively inhibits the cell-surface integrins αVβ3 and αVβ5 on activated endothelial cells during angiogenesis and on tumor cells. Methods: Multicenter, open-label, randomized, phase II study in 140 pts with relapsed stage IV NSCLC. Pts received 1 of 3 cilengitide doses (240 [n=35], 400 [n=35], or 600 [n=36] mg/m2) twice weekly or docetaxel 75 mg/m2 (n=34) once every 3-week cycle for 6 months. Responding pts could continue cilengitide for up to 1 year. Primary endpoint: progression-free survival (PFS). Results: Median age (range) was 60 (33–80) years; 94 pts were male (67%); 83% of pts had KPS ≥80%. Median PFS (95% CI) was 54 (43–64), 63 (53–66), 63 (42–67), and 67 (61–123) days for cilengitide 240, 400, 600, and docetaxel 75 mg/m2, respectively. Median OS (95% CI) was 173 (81–197), 117 (92–209), 181 (90–326), and 194 (135–298) days, respectively. One-year survival rate (95% CI) was 13% (1–24%), 13% (0–26%), 29% (12–37%), and 27% (10–43%), respectively. Survival was similar with cilengitide 600 mg/m2 and docetaxel 75 mg/m2: median OS 181 versus 194 days and 1-year survival rate (95% CI) 29% (12–37%) versus 27% (10–43%). Five docetaxel pts (15%) had a partial response. Most pts (98%) had ≥1 adverse event (AE). Most common AEs were dyspnea (33%), nausea (30%), tumor progression (29%), and cough (23%). Dyspnea and tumor progression were more common with cilengitide than with docetaxel. Grade 3/4 treatment-related AEs were more common with docetaxel (n=13, 41%) than cilengitide 240 (n=2, 6%), 400 (n=4, 11%), or 600 (n=4, 11%) mg/m2. For cilengitide, these were nausea, chest pain, dyspnea, and fatigue. Conclusions: PFS in the docetaxel group was greater than that of cilengitide at all doses. However, cilengitide monotherapy at a dose of 600 mg/m2 showed similar OS to docetaxel and better tolerability. Combination studies with standard chemotherapy and cilengitide are warranted.

[Table: see text]