T-cell bispecific antibodies in node-positive breast cancer: novel therapeutic avenue for MHC class I loss variants

BACKGROUND

Tumor-infiltrating lymphocytes (TILs) represent a prognostic factor for survival in primary breast cancer (BC). Nonetheless, neoepitope load and TILs cytolytic activity are modest in BC, compromising the efficacy of immune-activating antibodies, which do not yet compete against immunogenic chemotherapy.

PATIENTS AND METHODS

We analyzed by functional flow cytometry the immune dynamics of primary and metastatic axillary nodes [metastatic lymph nodes (mLN)] in early BC (EBC) after exposure to T-cell bispecific antibodies (TCB) bridging CD3ε and human epidermal growth factor receptor 2 (HER2) or Carcinoembryonic Antigen-Related Cell Adhesion Molecule 5 (CEACAM5), before and after chemotherapy. Human leukocyte antigen (HLA) class I loss was assessed by whole exome sequencing and immunohistochemistry. One hundred primary BC, 64 surrounding 'healthy tissue' and 24 mLN-related parameters were analyzed.

RESULTS

HLA loss of heterozygosity was observed in EBC, at a clonal and subclonal level and was associated with regulatory T cells and T-cell immunoglobulin and mucin-domain-3 expression restraining the immuno-stimulatory effects of neoadjuvant chemotherapy. TCB bridging CD3ε and HER2 or CEACAM5 could bypass major histocompatibility complex (MHC) class I loss, partially rescuing T-cell functions in mLN.

CONCLUSION

TCB should be developed in BC to circumvent low MHC/peptide complexes.

Predictors of responses to immune checkpoint blockade in advanced melanoma

Immune checkpoint blockers (ICB) have become pivotal therapies in the clinical armamentarium against metastatic melanoma (MMel). Given the frequency of immune related adverse events and increasing use of ICB, predictors of response to CTLA-4 and/or PD-1 blockade represent unmet clinical needs. Using a systems biology-based approach to an assessment of 779 paired blood and tumor markers in 37 stage III MMel patients, we analyzed association between blood immune parameters and the functional immune reactivity of tumor-infiltrating cells after ex vivo exposure to ICB. Based on this assay, we retrospectively observed, in eight cohorts enrolling 190 MMel patients treated with ipilimumab, that PD-L1 expression on peripheral T cells was prognostic on overall and progression-free survival. Moreover, detectable CD137 on circulating CD8⁺ T cells was associated with the disease-free status of resected stage III MMel patients after adjuvant ipilimumab + nivolumab (but not nivolumab alone). These biomarkers should be validated in prospective trials in MMel.The clinical management of metastatic melanoma requires predictors of the response to checkpoint blockade. Here, the authors use immunological assays to identify potential prognostic/predictive biomarkers in circulating blood cells and in tumor-infiltrating lymphocytes from patients with resected stage III melanoma.

Calreticulin exposure on malignant blasts predicts a cellular anticancer immune response in patients with acute myeloid leukemia

Experiments performed in mice revealed that anthracyclines stimulate immunogenic cell death that is characterized by the pre-apoptotic exposure of calreticulin (CRT) on the surface of dying tumor cells. Here, we determined whether CRT exposure at the cell surface (ecto-CRT) occurs in human cancer in response to anthracyclines in vivo, focusing on acute myeloid leukemia (AML), which is currently treated with a combination of aracytine and anthracyclines. Most of the patients benefit from the induction chemotherapy but relapse within 1–12 months. In this study, we investigated ecto-CRT expression on malignant blasts before and after induction chemotherapy. We observed that leukemic cells from some patients exhibited ecto-CRT regardless of chemotherapy and that this parameter was not modulated by in vivo chemotherapy. Ecto-CRT correlated with the presence of phosphorylated eIF2α within the blasts, in line with the possibility that CRT exposure results from an endoplasmic reticulum stress response. Importantly, high levels of ecto-CRT on malignant myeloblasts positively correlated with the ability of autologous T cells to secrete interferon-γ on stimulation with blast-derived dendritic cell. We conclude that the presence of ecto-CRT on leukemia cells facilitates cellular anticancer immune responses in AML patients.

Tumor-derived exosomes: a new source of tumor rejection antigens

Exosomes are small vesicles released by a broad array of hematopoietic cells. Previous studies showed that exosomes released by antigen loaded dendritic cells induce immune-mediated anti-tumor response in mice. Here, we will describe the biochemical properties of tumor-derived exosomes and, their pre-clinical activity as cancer vaccines.

Tumor-derived exosomes are a source of shared tumor rejection antigens for CTL cross-priming

The initiation of T-cell-mediated antitumor immune responses requires the uptake and processing of tumor antigens by dendritic cells and their presentation on MHC-I molecules. Here we show in a human in vitro model system that exosomes, a population of small membrane vesicles secreted by living tumor cells, contain and transfer tumor antigens to dendritic cells. After mouse tumor exosome uptake, dendritic cells induce potent CD8+ T-cell-dependent antitumor effects on syngeneic and allogeneic established mouse tumors. Therefore, exosomes represent a novel source of tumor-rejection antigens for T-cell cross priming, relevant for immunointerventions.

Equilibrium states and ground state of two-dimensional fluid foams

We study the equilibrium energies of two-dimensional (2D) noncoarsening fluid foams, which consist of bubbles with fixed areas. The equilibrium states correspond to local minima of the total perimeter. We present a theoretical derivation of energy minima; experiments with ferrofluid foams, which can be either highly distorted, locally relaxed, or globally annealed; and Monte Carlo simulations using the extended large-Q Potts model. For a dry foam with small size variance we develop physical insight and an electrostatic analogy, which enables us to (i) find an approximate value of the global minimum perimeter, accounting for (small) area disorder, the topological distribution, and physical boundary conditions; (ii) conjecture the corresponding pattern and topology: small bubbles sort inward and large bubbles sort outward, topological charges of the same signs "repel" while charges of the opposite signs "attract;" (iii) define local and global markers to determine directly from an image how far a foam is from its ground state; (iv) conjecture that, in a local perimeter minimum at prescribed topology, the pressure distribution and thus the edge curvature are unique. Some results also apply to 3D foams.

Rayleigh-taylor instability with magnetic fluids: experiment and theory

We present experiments showing the Rayleigh-Taylor instability at the interface between a dense magnetic liquid and an immiscible less dense liquid. The liquids are confined in a Hele-Shaw cell and a magnetic field is applied perpendicular to the cell. We measure the wavelength and the growth rate at the onset of the instability as a function of the external magnetic field. The wavelength decreases as the field increases. The amplitude of the interface deformation grows exponentially with time in the early stage, and the growth rate is an increasing function of the field. These results are compared to theoretical predictions given in the framework of linear stability analysis.

Generation of monocyte-derived dendritic cells from patients with renal cell cancer: modulation of their functional properties after therapy with biological response modifiers (IFN-alpha plus IL-2 and IL-12)

The combination of interferon-alpha (IFN-alpha) plus interleukin (IL-2) has been accepted in the treatment of metastatic renal cell carcinoma (MRCC), whereas vaccines based on IL-12 or dendritic cells (DCs) are still being investigated. Here the authors analyzed 1) the feasibility to generate functional monocyte-derived DCs (MDDCs) from patients treated with biological response modifiers (BRMs) who have MRCC, 2) the phenotypic modulations of these MDDCs during BRM treatment. Eight and 13 MRCC patients received IL-2 plus IFN-alpha or IL-12 immunotherapy, respectively. The adherent fraction of mononuclear cells from patients' blood drawn before, during, and after immunotherapy was incubated in clinically approved culture medium supplemented with 5% autologous serum, rhu granulocyte macrophage colony-stimulating factor, and rhuIL-4 for a week. At day 7 or 8 of culture, floating cells were examined in flow cytometric and functional assays (alloreactivity, proliferation assays in the presence of tetanus toxoid or tumor peptides, IL-12 secretion). In all patients except two, MDDCs could be generated but at a lower rate compared with healthy volunteers. Morphologic and phenotypical analyses revealed immature DCs with low levels of CD1a or CD83 expression throughout therapy with BRMs. Capacities in mixed leukocyte reactions were similar to those of healthy volunteers and stable during immunotherapy, whereas presentation of major histocompatibility complex class II tetanus toxoid peptide complexes was slightly enhanced during and after IL-12 therapy. IL-12 expression levels under IFN-gamma and CD40L stimulation were significantly lower in MDDC cultures from patients with MRCC compared with healthy volunteers. Overall, peripheral blood mononuclear cells from a cohort of 21 patients with metastatic disease who were treated with BRMs maintained their ability to differentiate into functional MDDCs with no selective quantitative or qualitative advantage.

Dendritic cells directly trigger NK cell functions: cross-talk relevant in innate anti-tumor immune responses in vivo

Cytotoxic T lymphocytes and natural killer cells are essential effectors of anti-tumor immune responses in vivo. Dendritic cells (DC) 'prime' tumor antigen-specific cytotoxic T lymphocytes; thus, we investigated whether DC might also trigger the innate, NK cell-mediated anti-tumor immunity. In mice with MHC class I-negative tumors, adoptively transferred- or Flt3 ligand-expanded DC promoted NK cell-dependent anti-tumor effects. In vitro studies demonstrated a cell-to-cell contact between DC and resting NK cells that resulted in a substantial increase in both NK cell cytolytic activity and IFN-gamma production. Thus, DC are involved in the interaction between innate and adaptive immune responses.

Eradication of established murine tumors using a novel cell-free vaccine: dendritic cell-derived exosomes

Dendritic cells (DCs) are professional antigen presenting cells with the unique capacity to induce primary and secondary immune responses in vivo. Here, we show that DCs secrete antigen presenting vesicles, called exosomes, which express functional Major Histocompatibility Complex class I and class II, and T-cell costimulatory molecules. Tumor peptide-pulsed DC-derived exosomes prime specific cytotoxic T lymphocytes in vivo and eradicate or suppress growth of established murine tumors in a T cell-dependent manner. Exosome-based cell-free vaccines represent an alternative to DC adoptive therapy for suppressing tumor growth.

Diversity of the cytotoxic melanoma-specific immune response: some CTL clones recognize autologous fresh tumor cells and not tumor cell lines

In the present work, to analyze the heterogeneity of the tumor-specific cytotoxic immune response, a large number of T cell clones were generated from the infiltrate of a tumor-proximal invaded lymph node, and two kinds of melanoma-specific CD8+ CTL clones were derived. The majority of T cell clones (about a hundred) are characterized by a specific lysis of the autologous tumor cell lines. Among 34 of the latter clones, HLA-A2 molecule and MART-1(27-35) peptide have been shown to play a predominant role in tumor recognition. However, no significant amplification at the tumor site was observed for 3 of these CTL. The other kind of tumor-specific CTL (1 oligoclonal and 2 clonal cell lines) did not lyse the autologous melanoma cell lines but lysed the "fresh" autologous tumor cells in a MHC class I-dependent manner. Functional analysis of the two different CTL clones have shown that they did not lyse NK targets, autologous peripheral monocytes, activated T cells, and transformed B cells or any of the few allogeneic cultured and uncultured melanoma cells we tested. TCR repertoire analysis has shown that one of these CTL clones was significantly detectable "in situ" among tumor-infiltrating lymphocytes, while not detectable among PBMC. Such melanoma-specific lymphocytes, which could not have been picked out through conventional screening procedures using tumor cell lines, could potentially play a role in tumor rejection. These results suggest that the immune response analyzed toward melanoma cell lines does not totally reflect the in situ immune status.

Diversity of the cytotoxic melanoma-specific immune response: some CTL clones recognize autologous fresh tumor cells and not tumor cell lines

In the present work, to analyze the heterogeneity of the tumor-specific cytotoxic immune response, a large number of T cell clones were generated from the infiltrate of a tumor-proximal invaded lymph node, and two kinds of melanoma-specific CD8+ CTL clones were derived. The majority of T cell clones (about a hundred) are characterized by a specific lysis of the autologous tumor cell lines. Among 34 of the latter clones, HLA-A2 molecule and MART-1(27-35) peptide have been shown to play a predominant role in tumor recognition. However, no significant amplification at the tumor site was observed for 3 of these CTL. The other kind of tumor-specific CTL (1 oligoclonal and 2 clonal cell lines) did not lyse the autologous melanoma cell lines but lysed the "fresh" autologous tumor cells in a MHC class I-dependent manner. Functional analysis of the two different CTL clones have shown that they did not lyse NK targets, autologous peripheral monocytes, activated T cells, and transformed B cells or any of the few allogeneic cultured and uncultured melanoma cells we tested. TCR repertoire analysis has shown that one of these CTL clones was significantly detectable "in situ" among tumor-infiltrating lymphocytes, while not detectable among PBMC. Such melanoma-specific lymphocytes, which could not have been picked out through conventional screening procedures using tumor cell lines, could potentially play a role in tumor rejection. These results suggest that the immune response analyzed toward melanoma cell lines does not totally reflect the in situ immune status.

TCR alpha/beta and TCR gamma/delta CD4-/CD8- HLA-DR alloreactive CTL clones do not use Fas/Fas ligand pathway to lyse their specific target cells

The expression of Fas Ligand (FasL) on human TCRalpha/beta and TCRgamma/delta CD4-/CD8- MHC class II-alloreactive clones and Fas/FasL-mediated cytotoxicity were investigated. These clones mediated a HLA-DR2-restricted cytotoxicity toward E418 B cell line (Fas+). Northern blot analysis demonstrated that all the clones expressed FasL mRNA upon stimulation with E418 specific target. FasL surface expression was detected by immunofluorescence analysis using Fas-Fc soluble protein as well as anti-FasL polyclonal antibodies. Cytotoxicity experiments performed in the presence of anti-Fas, anti-FasL and Fas-Fc molecule indicated that these reagents were unable to inhibit T cell clone mediated lysis toward E418. In addition, when emetine, known to inhibit the induction of Fas-mediated killing, was added during the cytolysis effector phase, no inhibition was observed. These data strongly suggest that Fas/FasL pathway is not involved in this particular T-cell clone-mediated lysis. This cytotoxicity is extracellular Ca(2+)-dependent and is abolished in the presence of EGTA suggesting that it is mainly perforin/granzyme-based.

CD48 may serve as an accessory molecule for the activation of a subset of human gamma/delta T cells

To further assess the role of CD48 in the interaction of human gamma/delta T cells with their specific target, we generated two series of alloreactive clones, L and K. These clones express a V1-D-J1-C delta chain associated to V3-J2-C2 (L) or V2-J2-C2 (K) gamma chain. Functionally they were CTLs able to lyse the sensitizing B-cell line E418. The cytotoxicity of the L and K clones toward E418 was inhibited by anti-CD48 mAb. That of the L clones was also inhibited by anti-HLA class I mAbs. Variation in L and K lysis profile was observed against a panel of CD48+ targets, further strengthening the argument that they display distinct specificities and suggesting that they do not recognize CD48. Heterogeneity in TCR gene segment usage, MHC-dependent recognition of E418 by the L clones, and resistance of some CD48+ targets strongly suggest that CD48 itself does not interact with L and K TCR. Transfection of CHO cells with CD48 induced killing by the K clones. This killing was inhibited by anti-CD48 mAbs. Taking into account the recent reports on CD48 as an accessory molecule, our results suggest that by binding to CD2 (and/or an unknown ligand), CD48 may serve to strengthen E/T interaction and may contribute to the activation of a minor subset of gamma/delta T cells.

Human TCR-gamma/delta alloreactive response to HLA-DR molecules. Comparison with response of TCR-alpha/beta

We have analyzed the human gamma/delta T cell alloreactive response to class II HLA-DR molecules and attempted to compare this response with that mediated by the TCR-alpha/beta counterparts. Several gamma/delta CTL clones from a healthy individual were generated in mixed lymphocyte reactions against an EBV-transformed B cell line termed E418. Fine specificity and primary TCR structure of 10 representative clones (all CD4- CD8 +/-) were then determined. Functional studies, with the use of B cell lines homozygous for HLA-DR (DR1-10), indicated that all gamma/delta T cell clones specifically reacted with HLA-DR2 molecules. In addition, five clones were able to cross-react with subtypes of HLA-DR8. Extended panel target experiments, including lymphoblastoid cells expressing various HLA-DR2 subtypes, showed that the T cell clones displayed distinct fine specificities. Clones with broad (Dw2, Dw12, Dw21, Dw8.1, and Dw8.2) or in contrast, more restricted (DRB1*1501 or DRB1*1503) specificity were identified. Furthermore, amino acid substitutions at predicted peptide binding site position 30 and TCR-interacting position 67 of the DRB*1 beta-chain seemed to affect alloresponse of some T cell clones. With respect to TCR-gamma/delta structure, diversity in gene segment usage was observed, with the predominance of T cells using a V3-J gamma 2/V1-J delta 1+ receptor. A smaller fraction of the cells expressed TCR comprising V gamma 9 and V delta 1 regions. In contrast, the V delta 3 gene segment was used by a minority of the cells, and the V delta 2 was not expressed by any T cell clone. Together, the present data indicate that similarly to TCR-alpha/beta, human TCR-gamma/delta lymphocytes may recognize in a highly specific fashion a particular HLA-DR heterodimer. T cell clones cross-reacting with other HLA-DR molecules were also identified. Despite some degree of heterogeneity, V gene segment use by alloreactive clones seemed to be nonrandom. No obvious correlation between TCR gene use and HLA-DR alloreactivity could be identified. Moreover, our results suggest that similarly to TCR-alpha/beta cells, foreign MHC-bound peptides may contribute to TCR-gamma/delta alloreactive response.

Human TCR-gamma/delta alloreactive response to HLA-DR molecules. Comparison with response of TCR-alpha/beta

We have analyzed the human gamma/delta T cell alloreactive response to class II HLA-DR molecules and attempted to compare this response with that mediated by the TCR-alpha/beta counterparts. Several gamma/delta CTL clones from a healthy individual were generated in mixed lymphocyte reactions against an EBV-transformed B cell line termed E418. Fine specificity and primary TCR structure of 10 representative clones (all CD4- CD8 +/-) were then determined. Functional studies, with the use of B cell lines homozygous for HLA-DR (DR1-10), indicated that all gamma/delta T cell clones specifically reacted with HLA-DR2 molecules. In addition, five clones were able to cross-react with subtypes of HLA-DR8. Extended panel target experiments, including lymphoblastoid cells expressing various HLA-DR2 subtypes, showed that the T cell clones displayed distinct fine specificities. Clones with broad (Dw2, Dw12, Dw21, Dw8.1, and Dw8.2) or in contrast, more restricted (DRB1*1501 or DRB1*1503) specificity were identified. Furthermore, amino acid substitutions at predicted peptide binding site position 30 and TCR-interacting position 67 of the DRB*1 beta-chain seemed to affect alloresponse of some T cell clones. With respect to TCR-gamma/delta structure, diversity in gene segment usage was observed, with the predominance of T cells using a V3-J gamma 2/V1-J delta 1+ receptor. A smaller fraction of the cells expressed TCR comprising V gamma 9 and V delta 1 regions. In contrast, the V delta 3 gene segment was used by a minority of the cells, and the V delta 2 was not expressed by any T cell clone. Together, the present data indicate that similarly to TCR-alpha/beta, human TCR-gamma/delta lymphocytes may recognize in a highly specific fashion a particular HLA-DR heterodimer. T cell clones cross-reacting with other HLA-DR molecules were also identified. Despite some degree of heterogeneity, V gene segment use by alloreactive clones seemed to be nonrandom. No obvious correlation between TCR gene use and HLA-DR alloreactivity could be identified. Moreover, our results suggest that similarly to TCR-alpha/beta cells, foreign MHC-bound peptides may contribute to TCR-gamma/delta alloreactive response.

A physiological amount of zinc supplementation: effects on nutritional, lipid, and thymic status in an elderly population

Forty-four institutionalized elderly subjects with body mass indexes (BMI) of either > or = 24 or < or = 21 participated in a 16-wk crossover study designed to determine the effects of low-dose zinc supplementation [306 mumol (20 mg)/d] on food intake, anthropometry, and biochemical and immunological indexes. Initial serum zinc concentrations were low in both groups and increased by approximately 20% after zinc supplementation. Zinc supplementation allowed a partial but significant restoration of serum thymulin activity and improved nutritional status (food intake and serum albumin and transthyretin concentrations) but had no effect on anthropometric indexes or serum apolipoproteins, except apolipoprotein CII and apolipoprotein CIII. After zinc supplementation, serum copper concentration decreased but there was no change in the ratio of low-density-lipoprotein cholesterol to high-density-lipoprotein cholesterol. Low-dose zinc supplementation allows restoration, at least partially, of nutritional and thymic status without the known disadvantages of high doses of zinc.

Discrepancy between anthropometry and biochemistry in the assessment of the nutritional status of the elderly

Institutionalized aged subjects, considered free of evolutive disease and whose body weight was stable, were studied. They were divided into two groups depending on their body mass index: controls (BMI greater than or equal to 24) and depleted (BMI less than or equal to 21). The depleted group, as judged by anthropometric measurements, showed dramatically reduced body muscle and adipose masses. Usual blood parameters were normal in both groups. Biochemical markers of the protein and energy status, viz. albumin, transthyretin, transferrin, somatomedin-C, as well as serum levels of osteocalcin and apolipoproteins AI, AII, B, CII, CIII and E, were not affected in the depleted group. However, moderate iron deficiency and marked zinc deficiency were found in this group. It is concluded that in the elderly, biochemical markers of the protein and energy status are not related to the nutritional status assessed by anthropometry.

Changes in rat plasma apolipoproteins and lipoproteins during moderate protein deficiency: potential use in the assessment of nutritional status

To test apolipoprotein sensitivity as protein deficiency markers, concomitant evolution of plasma apolipoproteins (apo) and usual nutritional markers (transthyretin, albumin, transferrin) were followed during a 28-d protein restriction in young male Wistar rats. In addition, plasma lipids and chemical composition of lipoproteins were assayed by d 28. The control and the deficient groups were fed 18% and 6% casein diets, respectively. By d 28 the protein-deficient group exhibited hypotriglyceridemia resulting from the decrease in VLDL triacylglycerols; free cholesterol and phospholipids were increased, reflecting the increment in LDL-HLDL1. In plasma total lipoproteins, apo BH, AI and E were not different than controls in the deficient group. Apolipoprotein AIV decreased after d 14 and was significantly less than in controls at d 28. Apolipoprotein BI was considerably reduced by d 14 (43% less) and d 28 (52% less) compared with the control group. Apolipoproteins C + AII were significantly lower in the protein-deficient group by d 14 (43%). By d 28, VLDL apo C were decreased 60% by protein restriction. Transthyretin level was 20% lower in the protein-deficient group by d 7 but returned to control values by d 14. A moderately lower value was observed for albumin by d 7 and d 14 and for transferrin by d 28. These results indicate that, in this model, apo BI and C are more sensitive to protein depletion than usual nutritional markers.

T cell target 1 (TCT.1): a novel target molecule for human non-major histocompatibility complex-restricted T lymphocytes

We have studied two gamma/delta T cell clones, E102 and E117, generated in a mixed lymphocyte culture using an allogeneic Epstein-Barr virus-transformed B cell line, E418. These clones were both found to express a molecular form of T cell receptor (TCR) infrequent in human peripheral blood, associating a V1-J1-C delta chain and a V3-JP2-C2 gamma chain. Functionally, they appeared as cytotoxic T lymphocytes (CTL) with non-major histocompatibility complex (MHC) (class I and II) requiring cytotoxicity, able to kill both the immunizing (i.e., E418) and unrelated (e.g., K562, REX, F601, and KAS) target cells. A monoclonal antibody, anti-10H3, able to selectively inhibit the cytotoxic activity of the clones has been produced. This reagent defines a 43-kD molecule, designated TCT.1, with broad distribution in the hematopoietic system, that appears to be distinct from class I MHC gene products. A series of functional experiments using various effector/target cell combinations strongly suggested that TCT.1 may represent a unique TCR ligand involved in the interaction between these particular CTL clones and certain of the target cells tested, while others were likely to be recognized and killed through a TCR-independent natural killer-like pathway. Although further experimentation will be needed to strengthen our interpretation of the present data, this study provides additional evidence that some T lymphocytes, in particular of the gamma/delta type, may interact specifically with target cells in a non-MHC class I/II-requiring fashion.

Secondary prevention after myocardial infarction: effects of beta blocking agents and calcium antagonists

Therapeutic interventions in patients with myocardial infarction, whether during the first hours after coronary occlusion or several days later, aim to reduce mortality and morbidity by several mechanisms: Prevention of fatal ventricular fibrillation, limitation of infarct size, and inhibition of platelet aggregation are some examples of such mechanisms. Results from early intervention trials with beta blocking agents, particularly from ISIS-I, suggest that 1-year mortality is significantly lower in selected patients randomized to active treatment. Late intervention studies also suggest a significant reduction in coronary mortality and morbidity with beta blockade, particularly when data are pooled. Studies with the calcium channel blockers nifedipine and verapamil were unable to demonstrate any beneficial effects of these drugs on mortality or reinfarction. In this review article, attention will be directed to the most recent information about the preventive value of beta adrenergic blocking drugs and slow calcium channel inhibitors.

An epidemiologic appraisal of the associations between the fatty acids esterifying serum cholesterol and some cardiovascular risk factors in middle-aged men

The relations between the fatty acids of cholesterol esters and some cardiovascular risk factors have been investigated in a sample of 3,348 middle-aged men examined at entry into the Paris Prospective Study 2. The partial associations between the risk factors and the various fatty acids have been evaluated using a special regression method that takes into account the structural dependencies among the percentages of fatty acids. The results show that palmitoleic acid is strongly associated with alcohol consumption and blood pressure and that its association with blood pressure is absent in nondrinkers. High density lipoprotein cholesterol and apolipoprotein A1 are negatively associated with palmitic and dihomogammalinolenic acids and positively associated with oleic and linoleic acids. An inverse relation of low density lipoprotein cholesterol and apolipoprotein B to these fatty acids is also observed. Simultaneous high levels of palmitic and dihomogammalinolenic acids and low levels of oleic and linoleic acids could then be related to profiles of lipids and apolipoproteins exposing one to a high risk of coronary heart disease. These associations may be of interest in interpreting the relations observed in other studies between the fatty acid composition of cholesterol esters or other lipids and coronary heart disease.

Effect of an hypercholesterolemic diet on the level of several serum lipids and apolipoproteins in nine rat strains

To detect the response of different strains of rats to an hypercholesterolemic diet, 9 different strains of male rats were fed successively a control diet (C) containing 20% casein for 4 weeks, then a high-protein, cholesterol-rich diet (HC) containing 50% casein and 1.2% cholesterol for 12 weeks. When the rats were fed the control diet, the highest cholesterolemia was found in the LOU strain and the lowest in the WAG and Brown-Norway (BN) strains. The latter strain had the highest free to esterified cholesterol ratio and showed a marked band in beta position (LDL) on agarose gel electrophoresis. Administration of the HC diet induced an increase of cholesterolemia in all the strains except in Fisher (FIS) and LOU. This hypercholesterolemic diet decreased the free to esterified cholesterol ratio only in the BN and FIS strains. On agarose gel, all the strains showed a highly increased band in pre-beta position (VLDL). On polyacrylamide gel, a single, tight band in HDL position was revealed in the BN strain, while a large band or two bands were seen in the other strains. The percentages of some apoproteins in serum total lipoproteins were determined in rats fed the HC diet; the apoprotein E level was inversely correlated to the difference between the cholesterolemia of the rats given the HC and C diets (r = - 0.72; P less than 0.05). So, the BN rats had the lowest apo E level with the highest cholesterolemia increase due to the HC diet.

Relation between consumption of alcohol and fatty acids esterifying serum cholesterol in healthy men

The relation between consumption of alcohol (established by interview), two of its typical markers (gamma-glutamyltransferase activity and mean corpuscular volume), and the composition of fatty acids in plasma cholesterol esters was investigated in an epidemiological study of 1467 actively employed men aged 35-45. In this group of subjects mean consumption of alcohol was 34.6 (SD 25.2) g/day. Palmitoleic acid and oleic acid were positively correlated with consumption of alcohol, gamma-glutamyltransferase activity, and mean corpuscular volume, while linoleic acid was negatively correlated with these variables. When these three fatty acids, gamma-glutamyltransferase activity, mean corpuscular volume, and the fat content of the diet were introduced into a multivariate regression analysis, with consumption of alcohol as the dependent variable, only palmitoleic acid, gamma-glutamyltransferase activity, mean corpuscular volume, and the monounsaturated fat content of the diet remained significant. Palmitoleic acid seems to be an independent correlate of consumption of alcohol and could be useful in epidemiological and clinical studies as a variable of consumption.

Effects of whey protein, casein, soya-bean and sunflower proteins on the serum, tissue and faecal steroids in rats

Four groups of rats were fed for 49 d on one of four semi-purified diets, without added cholesterol and containing 230 g/kg of the following isolated proteins: casein, whey, soya-bean or sunflower. Whey, soya-bean and sunflower proteins, when compared with casein, decreased the level of serum high-density-lipoprotein (HDL)-cholesterol. These low cholesterol levels were accompanied by an increase in the daily faecal excretion of neutral sterols and bile acids in the case of soya-bean protein, and by a decrease in the liver cholesterol content, when rats were fed on whey protein. Considering the amino acid composition of the four purified proteins, we observed that serum total and HDL-cholesterol levels had a significant positive correlation with tyrosine and glutamic acid, and a negative correlation with cystine and alanine. The present study showed that the hypocholesterolaemic effect of dietary proteins was not related to their animal or vegetable origin.

Effects of soy protein and saponins on serum, tissue and feces steroids in rat

Four groups of rats were fed, for 45 days, one of the following semipurified diets containing sucrose 55% (w/w) and (a) casein 25%, (b) casein 24%, saponins (from Saponaria officinalis) 1%, (c) isolated soy protein 25%, (d) soy protein 24%, saponins 1%. The soy protein diet, compared to the casein one, produced an increase in the fecal excretion of neutral sterols on the 29th and 42nd days, without any modification in the liver, aorta and serum cholesterol concentrations. The effect of soy protein cannot be attributed to its saponin content but other substances associated to soy protein may interfere. With the casein diet, added saponins increased the fecal excretion of neutral sterols and bile acids and decreased liver and aorta cholesterol levels. Serum cholesterol was found unchanged. The effects of saponins were suppressed or greatly reduced with the soy protein diet. These results could be explained by binding of the sterols in insoluble forms.

Functional capacity of adipose tissue in human obesity and hyperlipidaemia

1. Fifteen ‘constitutionally’ obese subjects, eleven hyperlipidaemic subjects of mixed-type and fourteen normal subjects were studied.

2. With a reduction in energy intake (range 3.3–4.2 MJ) for 21 d, there was no change in the levels of plasma total cholesterol (TC) and triglyceride (TG) of obese subjects, but the free fatty acid levels increased. However, in hyperlipidaemic subjects there was a reduction in levels of TC and TG with no increase in levels of free fatty acids.

3. There was a significant increase in the serum ketone levels of obese subjects but not in those of hyperlipidaemic subjects. The reduction of the respiratory quotient to a value of 0.7 was more rapid in the obese than in hyperlipidaemic subjects.

4. After administration of a fat load (0.5 g/kg gross body-weight) there was no change in plasma TG levels in obese subjects but there was an increase in those of normal subjects.

5. After administration of a glucose load (1 g/kg ideal body-weight) there was a significant reduction in plasma TG levels in obese subjects but no change in those of hyperlipidaemic subjects.

6. Hyperlipidaemic subjects eating their normal diet were found to have a hydroxybutyrate: acetoacetate ratio three- to fivefold that of obese and normal subjects.

7. These results suggest that obese subjects have an increased ability to store fatty acids, to mobilize them quickly and to generate fatty acid metabolites in the form of ketone bodies, while these same metabolic functions are reduced in hyperlipidaemic subjects.