Evaluation of all-cause mortality and cardiovascular safety in patients receiving chimeric antigen receptor T cell therapy: a prospective cohort studyResearch in context

Summary: Background: Assessment of cardiovascular risk is critical for patients with cancer. Previous retrospective studies suggest potential cardiotoxicity of CAR T cell therapies. We aimed to prospectively assess cardiotoxicity and the predictive value of cardiac biomarkers and classical risk factors (age, cardiac function, diabetes, arterial hypertension, smoking) for cardiac events and all-cause mortality (ACM). Methods: In this prospective cohort study, all patients treated with CAR T cell constructs (axi-cel, tisa-cel, brexu-cel, ide-cel, or the 3rd generation CAR HD-CAR-1) from Oct 1, 2018, to Sept 30, 2022 at the University Hospital Heidelberg were included. Surveillance included cardiac assessment with biomarkers (high-sensitive Troponin T (hs-cTnT), N-terminal brain natriuretic peptide (NT-proBNP)), 12-lead-ECG, and 2D echocardiography. ACM was defined as the primary study endpoint, while cardiotoxicity, defined by clinical syndromes of heart failure or decline in ejection fraction, served as a secondary endpoint. Findings: Overall, 137 patients (median age 60, range 20–83, IQR 16), were included in the study. 46 patients died during the follow up period (median 0.75 years, range 0.02–4.33, IQR 0.89) 57 month, with a median survival of 0.57 years (range 0.03–2.38 years, IQR 0.79). A septal wall thickness above 11 mm (HR 2.48, 95%-CI = 1.10–5.67, p = 0.029) was associated with an increased risk of ACM, with a trend seen for reduced left ventricular ejection fraction prior to therapy (LVEF <40%; HR 9.17, 95%-CI = 1.30–183.11, p = 0.051). Secondary endpoint was reached by 93 patients while no baseline parameter was able to predict an elevated risk. However, hs-cTnT change from baseline of 50% or more during the first 14 days after CAR infusion predicted ACM (HR 3.81, 95%-CI = 1.58–9.45; p = 0.003). None of the baseline characteristics was able to predict the incidence of cardiac events. Interpretation: Reduced pre-lymphodepletion ejection fraction and early post-infusion biomarker kinetics may be associated with increased ACM and cardiotoxicity events. These findings may help to identify patients who could benefit from intensified cardio-oncological surveillance. Funding: The German Center for Cardiovascular Research, German Research Foundation, and the Federal Ministry of Education and Research

On the structural evolution of nanoporous optically transparent CuO photocathodes upon calcination for photoelectrochemical applications.

Copper oxides are promising photocathode materials for solar hydrogen production due to their narrow optical band gap energy allowing broad visible light absorption. However, they suffer from severe photocorrosion upon illumination, mainly due to copper reduction. Nanostructuring has been proven to enhance the photoresponse of CuO photocathodes; however, there is a lack of precise structural control on the nanoscale upon sol-gel synthesis and calcination for achieving optically transparent CuO thin film photoabsorbers. In this study, nanoporous and nanocrystalline CuO networks were prepared by a soft-templating and dip-coating method utilizing poly(ethylene oxide)-block-poly(propylene oxide)-block-poly(ethylene oxide) (Pluronic® F-127) as a structure-directing agent, resulting for the first-time in uniformly structured, crack-free, and optically transparent CuO thin films. The photoelectrochemical properties of the nanoporous CuO frameworks were investigated as a function of the calcination temperature and film thickness, revealing important information about the photocurrent, photostability, and photovoltage. Based on surface photovoltage spectroscopy (SPV), the films are p-type and generate up to 60 mV photovoltage at 2.0 eV (0.050 mW cm-2) irradiation for the film annealed at 750 °C. For these high annealing temperatures, the nanocrystalline domains in the thin film structure are more developed, resulting in improved electronic quality. In aqueous electrolytes with or without methyl viologen (as a fast electron acceptor), CuO films show cathodic photocurrents of up to -2.4 mA cm-2 at 0.32 V vs. RHE (air mass (AM) 1.5). However, the photocurrents were found to be entirely due to photocorrosion of the films and decay to near zero over the course of 20 min under AM 1.5 illumination. These fundamental results on the structural and morphological development upon calcination provide a direction and show the necessity for further (surface) treatment of sol-gel derived CuO photocathodes for photoelectrochemical applications. The study demonstrates how to control the size of nanopores starting from mesopore formation at 400 °C to the evolution of macroporous frameworks at 750 °C

Common T-Cell-Receptor Motifs and Features in Patients with Cytomegalovirus (CMV)-Seronegative End-Stage Renal Disease Receiving a Peptide Vaccination against CMV

After solid-organ transplantation, reactivation of the cytomegalovirus (CMV) is often observed in seronegative patients and associated with a high risk of disease and mortality. CMV-specific T cells can prevent CMV reactivation. In a phase 1 trial, CMV-seronegative patients with end-stage renal disease listed for kidney transplantation were subjected to CMV phosphoprotein 65 (CMVpp65) peptide vaccination and further investigated for T-cell responses. To this end, CMV-specific CD8+ T cells were characterized by bulk T-cell-receptor (TCR) repertoire sequencing and combined single-cell RNA and TCR sequencing. In patients mounting an immune response to the vaccine, a common SYE(N)E TCR motif known to bind CMVpp65 was detected. CMV-peptide-vaccination-responder patients had TCR features distinct from those of non-responders. In a non-responder patient, a monoclonal inflammatory T-cell response was detected upon CMV reactivation. The identification of vaccine-induced CMV-reactive TCRs motifs might facilitate the development of cellular therapies for patients wait-listed for kidney transplantation