Stratification of Atherosclerosis based on Plasma Metabolic States

CONTEXT

Atherosclerosis is a dominant cause of cardiovascular disease (CVD), including myocardial infarction and stroke.

OBJECTIVE

To investigate metabolic states that are associated with the development of atherosclerosis.

METHODS

Cross-sectional cohort study at a university hospital in the Netherlands. A total of 302 adult subjects with a body mass index (BMI) ≥ 27 kg/m2 were included. We integrated plasma metabolomics with clinical metadata to quantify the "atherogenic state" of each individual, providing a continuous spectrum of atherogenic states that ranges between nonatherogenic states to highly atherogenic states.

RESULTS

Analysis of groups of individuals with different clinical conditions-such as metabolically healthy individuals with obesity, and individuals with metabolic syndrome-confirmed the generalizability of this spectrum; revealed a wide variation of atherogenic states within each condition; and allowed identification of metabolites that are associated with the atherogenic state regardless of the particular condition, such as gamma-glutamyl-glutamic acid and homovanillic acid sulfate. The analysis further highlighted metabolic pathways such as catabolism of phenylalanine and tyrosine and biosynthesis of estrogens and phenylpropanoids. Using validation cohorts, we confirmed variation in atherogenic states in healthy subjects (before atherosclerosis plaques become visible), and showed that metabolites associated with the atherogenic state were also associated with future CVD.

CONCLUSION

Our results provide a global view of atherosclerosis risk states using plasma metabolomics.

Abstract CT154: B-cell infiltration in lung cancer predicts response to neoadjuvant pembrolizumab

Background Neoadjuvant immune checkpoint inhibitor treatment is a promising approach for resectable cancer, including non-small cell lung cancer (NSCLC). The characteristics of potential responders to such treatments and the molecular underlying events are not known. Methods We have conducted a phase I, investigator-initiated single-center study (MK3457-223), to examine the safety of neoadjuvant pembrolizumab for stage I-II resectable NSCLC and to determine the recommended phase II dose/schedule (RP2D/S). FFPE biopsies and surgical specimens were subjected to correlative studies. NanoString’s GeoMx Digital Spatial Profiler (DSP) analysis was conducted on pre-treatment samples and post-treatment responder samples. Protein (72 proteins) and mRNA expression data (73 genes) analysis was conducted on regions of interest (ROIs), defined as mostly CD8 positive or mostly pan-cytokeratin positive (presumed cancer cells). Pathology assessment was done on the surgical specimen to identify major pathologic response (MPR; ≤10% remaining viable cells). Statistical analysis was done to compare responders (MPR+) to non-responders (MPR-) by Mann Whitney with false discovery rate correction. Immunohistochemistry (IHC) was conducted on post-treatment samples. Results Twenty-six patients initiated treatment on the study. Two patients (8%, 95% C.I 0-18%) had adverse events that precluded surgery, 1 patient refused surgery after treatment. 7 patients (27%, 95% C.I 10-44%) achieved a major pathologic response (MPR; responders), 3 patients (12%, 95% C.I 0-24%) achieved complete pathologic response. Responders had a longer interval from treatment to surgery (43 days vs. 36 days, univariate analysis, p-value 0.043). RP2D/S was determined as 2 treatments of 200mg pembrolizumab at 3 week interval, followed by surgery at least 2 weeks later. The expression of several proteins and genes differed between responders and non-responders. Pre-treatment, CD20 protein was the most differentially expressed protein both in in CD8+ (4.7 fold, p=0.002) and in cancer cells (4.8 fold, p=0.001) ROIs, in both cases higher in the responders compared to the non-responders. Comparing pre to post-treatment expression in responding tumors, the protein found to be upregulated to the highest extent following pembrolizumab treatment was CD20 protein (6.2-fold, p=0.001), as was its encoding gene, MS4A1 (2.4-fold, p=0.006). CD20 IHC of post-treatment samples demonstrated tertiary lymphoid structures (TLS) to be more prevalent in responders compared to non-responders (3.2-fold, p<0.05). Conclusions Longer interval from treatment to surgery was associated with higher rate of MPR. Presence of tumor-infiltrating B-cells and evolvement of TLSs was strongly correlated with pathologic response to neoadjuvant pembrolizumab in early stage NSCLC.

Citation Format: Jair Bar, Iris Kamer, Oranit Zadok, Damien Urban, Marina Perelman, Ilanit Redinsky, Aliza Ackerstein, Sameh Daher, Efrat Ofek, Amir Onn, Nona Zeitlin, Alon Ben-Nun, Ran Kremer, Inbal Daniel, Yossef Glantzspiegel, Irit Gat-Viks. B-cell infiltration in lung cancer predicts response to neoadjuvant pembrolizumab [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr CT154.