Spatial Positioning and Matrix Programs of Cancer-Associated Fibroblasts Promote T-cell Exclusion in Human Lung Tumors

It is currently accepted that cancer-associated fibroblasts (CAF) participate in T-cell exclusion from tumor nests. To unbiasedly test this, we used single-cell RNA sequencing coupled with multiplex imaging on a large cohort of lung tumors. We identified four main CAF populations, two of which are associated with T-cell exclusion: (i) MYH11+αSMA+ CAF, which are present in early-stage tumors and form a single cell layer lining cancer aggregates, and (ii) FAP+αSMA+ CAF, which appear in more advanced tumors and organize in patches within the stroma or in multiple layers around tumor nests. Both populations orchestrate a particular structural tissue organization through dense and aligned fiber deposition compared with T cell-permissive CAF. Yet they produce distinct matrix molecules, including collagen IV (MYH11+αSMA+ CAF) and collagen XI/XII (FAP+αSMA+ CAF). Hereby, we uncovered unique molecular programs of CAF driving T-cell marginalization, whose targeting should increase immunotherapy efficacy in patients bearing T cell-excluded tumors.

SIGNIFICANCE

The cellular and molecular programs driving T-cell marginalization in solid tumors remain unclear. Here, we describe two CAF populations associated with T-cell exclusion in human lung tumors. We demonstrate the importance of pairing molecular and spatial analysis of the tumor microenvironment, a prerequisite to developing new strategies targeting T cell-excluding CAF. See related commentary by Sherman, p. 2501. This article is highlighted in the In This Issue feature, p. 2483.

Radiographic Study of Distal Radius Parameters in Patients Visiting Tertiary Care Hospital

Background The important morphological parameters of distal radius namely palmar tilt, radial inclination, radial height and ulnar variance are consequential in the evaluation and management of the distal radius fracture, distal radius plate design and kinesiology. Correction of these parameters in anatomical alignment is important to restore the normal biomechanics of the wrist joint. Objective To ascertain the distal radius parameters in the patients attending tertiary care hospital with regard to gender and age. Method The wrist radiographs (postero-anterior and lateral views) of 125 patients, from 16 to above 60 years of age were used to determine the four parameters of distal radius. The subjects were divided into gender and three different age groups (16-36 years, 37-57 years and > 57 years). Independent t-test and ANOVA test was used for statistical analysis with level of significance set at p ≤ 0.05. Result The mean palmar tilt was 15.69 ± 4.84° (p-value = 0.40). The mean radial inclination was 22.58 ± 2.82° (p-value = 0.88). The mean value of radial height was 10.31 ± 1.59 mm (p-value= 0.001). Positive ulnar variance were recorded in maximum of subjects (46.40%) and the least was neutral (16.80%). Conclusion The distal radius parameters of our population were similar to the Orthopedic Trauma Association standard reference value. And there was significant difference in radial height between males and females.

Author Correction: A conserved dendritic-cell regulatory program limits antitumour immunity

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

A conserved dendritic-cell regulatory program limits antitumour immunity

Checkpoint blockade therapies have improved cancer treatment, but such immunotherapy regimens fail in a large subset of patients. Conventional type 1 dendritic cells (DC1s) control the response to checkpoint blockade in preclinical models and are associated with better overall survival in patients with cancer, reflecting the specialized ability of these cells to prime the responses of CD8⁺ T cells^1-3. Paradoxically, however, DC1s can be found in tumours that resist checkpoint blockade, suggesting that the functions of these cells may be altered in some lesions. Here, using single-cell RNA sequencing in human and mouse non-small-cell lung cancers, we identify a cluster of dendritic cells (DCs) that we name 'mature DCs enriched in immunoregulatory molecules' (mregDCs), owing to their coexpression of immunoregulatory genes (Cd274, Pdcd1lg2 and Cd200) and maturation genes (Cd40, Ccr7 and Il12b). We find that the mregDC program is expressed by canonical DC1s and DC2s upon uptake of tumour antigens. We further find that upregulation of the programmed death ligand 1 protein-a key checkpoint molecule-in mregDCs is induced by the receptor tyrosine kinase AXL, while upregulation of interleukin (IL)-12 depends strictly on interferon-γ and is controlled negatively by IL-4 signalling. Blocking IL-4 enhances IL-12 production by tumour-antigen-bearing mregDC1s, expands the pool of tumour-infiltrating effector T cells and reduces tumour burden. We have therefore uncovered a regulatory module associated with tumour-antigen uptake that reduces DC1 functionality in human and mouse cancers.

Teenage Pregnancy: Doubts, Uncertainties and Psychiatric Disturbance

Fifty-two pregnant teenagers were assessed at ‘booking’ using the General Health Questionnaire (GHQ 28), a locus of control scale, and five visual analogue ‘attitude scales’. Thirty-eight were in the antenatal and 14 in the termination clinic. One quarter had probable psychiatric disorder on the GHQ. The GHQ scores correlated significantly with indecision about the planned outcome of pregnancy (whether termination or full term). Locus of control correlated with the Depression scale of the GHQ but not with attitude to pregnancy or choice of termination or delivery. Clinic staff should be alert to the psychiatric risks when seeing teenagers who have marked doubts about their plans when pregnant.

Obstetric Referrals to a Tertiary Teaching Hospital of Nepal

Aims: This study was done to review the primary reasons and pattern of obstetric cases referred to Tribhuvan University Teaching Hospital, and to identify the clinical course, mode of management, maternal and perinatal outcomes. Methods: This prospective observational study reviewed 112 obstetric cases referred from various centers. Thorough history was taken; complete physical and obstetric examination and relevant investigations were done. Management of the patient, clinical course, mode of delivery, both maternal and perinatal outcomes were documented. Results: Most common diagnosis at referral was medical disorders complicating pregnancy (38%) among which cardiac disease accounted for 20%, followed by hypertensive disorder (17%). Unavailability of perinatal facility was the most frequent reason (24%) for referral. Twenty seven percent of the patients were in serious or critical condition on arrival, 52% patients required surgical intervention, 19% received intensive care management and there were mortalities of 2 women (1.8%). Total number of live births were 70 (62.5%) among which 28 (42%) required neonatal admission and 3 (4% of live birth) had early neonatal death. Conclusions: Wide spectrum of complicated obstetric cases were referred to this hospital. Unavailability of perinatal facility was the most common reason for referral followed by unavailability of physician. Most common diagnosis at the time of referral was medical disorders complicating pregnancy.