T145 Comprehensive flow cytometry tracking of regulatory T cells and other lymphocyte subsets during HD IL-2 therapy for melanoma

High dose IL-2 (HD IL-2) has been extensively used as an immunotherapy against metastatic melanoma However, why HD IL-2 is effective only in a subset of patients and whether predictive biomarkers, before or early during the course of therapy, can be used to improve response rates remain unresolved. In addition, it has been found that IL-2 therapy potently expands CD4+CD25+Foxp3+ T-regulatory cells (Tregs) but how Treg cell levels, phenotype, and function change and whether specific subsets of Tregs are activated and expanded during HD IL-2 therapy is remain unclear. In this study, we performed comprehensive multi-parameter FACS analysis of patient blood before and two days after the last bolus of IL-2 infusion during cycle 1 of HD IL-2 therapy. Two lymphocyte subsets were found to expand the most during the first cycle of IL-2 therapy: CD4+CD25+Foxp3+ Tregs expressing an activation marker, inducible costimulator (ICOS), and CD3-CD56hiCD16loPerforin+ NK cells. ICOS+ Tregs expressed significantly higher levels of CD25, Foxp3 and had a more activated phenotype than ICOS− Tregs as indicated by lower levels of CD45RA and CD127 expression. Further phenotypic characterization revealed a more suppressive phenotype on ICOS+ Treg with higher expression levels of CD39, CD73, and TGF-β/LAP than ICOS− Treg. ICOS+ Tregs were also the predominant Treg cells that secreted IL-10 and have potent T-cell suppressor function. Majority of ICOS+ Tregs from HD IL-2-treated patients were Ki67+ and exhibited an enhanced proliferative response to IL-2 ex vivo relative to ICOS− Tregs. Functional analysis revealed that ICOS+ Tregs secreted little IFN- and IL-2 in comparison to CD4+Foxp3 – cells. Furthermore, analysis on 38 IL-2-treated patients at MD Anderson, we found that non-responders had a significantly higher degree of ICOS+ Treg expansion than responders during the first cycle of IL-2 therapy, while no significant changes in the ICOS− or bulk Treg population. In conclusion, our data suggests that tracking changes in ICOS+ Tregs early during the course of HD IL-2 therapy may be a new predictive biomarker of clinical outcome

Preliminary Evaluation of Biplane Correlation (BCI) Stereographic Imaging for Lung Nodule Detection

A biplane correlation (BCI) imaging system obtains images that can be viewed in stereo, thereby minimizing overlapping structures. This study investigated whether using stereoscopic visualization provides superior lung nodule detection compared to standard postero-anterior (PA) image display. Images were acquired at two oblique views of ±3° as well as at a standard PA position from 60 patients. Images were processed using optimal parameters and displayed on a stereoscopic display. The PA image was viewed in the standard format, while the oblique views were paired to provide a stereoscopic view of the subject. A preliminary observer study was performed with four radiologists who viewed and scored the PA image then viewed and scored the BCI stereoscopic image. The BCI stereoscopic viewing of lung nodules resulted in 71 % sensitivity and 0.31 positive predictive value (PPV) index compared to PA results of 86 % sensitivity and 0.26 PPV index. The sensitivity for lung nodule detection with the BCI stereoscopic system was reduced by 15 %; however, the total number of false positives reported was reduced by 35 % resulting in an improved PPV index of 20 %. The preliminary results indicate observer dependency in terms of relative advantage of either system in the detection of lung nodules, but overall equivalency of the two methods with promising potential for BCI as an adjunct diagnostic technique

Common Genetic Polymorphisms Influence Blood Biomarker Measurements in COPD

Implementing precision medicine for complex diseases such as chronic obstructive lung disease (COPD) will require extensive use of biomarkers and an in-depth understanding of how genetic, epigenetic, and environmental variations contribute to phenotypic diversity and disease progression. A meta-analysis from two large cohorts of current and former smokers with and without COPD [SPIROMICS (N = 750); COPDGene (N = 590)] was used to identify single nucleotide polymorphisms (SNPs) associated with measurement of 88 blood proteins (protein quantitative trait loci; pQTLs). PQTLs consistently replicated between the two cohorts. Features of pQTLs were compared to previously reported expression QTLs (eQTLs). Inference of causal relations of pQTL genotypes, biomarker measurements, and four clinical COPD phenotypes (airflow obstruction, emphysema, exacerbation history, and chronic bronchitis) were explored using conditional independence tests. We identified 527 highly significant (p 10% of measured variation in 13 protein biomarkers, with a single SNP (rs7041; p = 10−392) explaining 71%-75% of the measured variation in vitamin D binding protein (gene = GC). Some of these pQTLs [e.g., pQTLs for VDBP, sRAGE (gene = AGER), surfactant protein D (gene = SFTPD), and TNFRSF10C] have been previously associated with COPD phenotypes. Most pQTLs were local (cis), but distant (trans) pQTL SNPs in the ABO blood group locus were the top pQTL SNPs for five proteins. The inclusion of pQTL SNPs improved the clinical predictive value for the established association of sRAGE and emphysema, and the explanation of variance (R2) for emphysema improved from 0.3 to 0.4 when the pQTL SNP was included in the model along with clinical covariates. Causal modeling provided insight into specific pQTL-disease relationships for airflow obstruction and emphysema. In conclusion, given the frequency of highly significant local pQTLs, the large amount of variance potentially explained by pQTL, and the differences observed between pQTLs and eQTLs SNPs, we recommend that protein biomarker-disease association studies take into account the potential effect of common local SNPs and that pQTLs be integrated along with eQTLs to uncover disease mechanisms. Large-scale blood biomarker studies would also benefit from close attention to the ABO blood group

Effects of Anacetrapib in Patients with Atherosclerotic Vascular Disease

BACKGROUND: Patients with atherosclerotic vascular disease remain at high risk for cardiovascular events despite effective statin-based treatment of low-density lipoprotein (LDL) cholesterol levels. The inhibition of cholesteryl ester transfer protein (CETP) by anacetrapib reduces LDL cholesterol levels and increases high-density lipoprotein (HDL) cholesterol levels. However, trials of other CETP inhibitors have shown neutral or adverse effects on cardiovascular outcomes. METHODS: We conducted a randomized, double-blind, placebo-controlled trial involving 30,449 adults with atherosclerotic vascular disease who were receiving intensive atorvastatin therapy and who had a mean LDL cholesterol level of 61 mg per deciliter (1.58 mmol per liter), a mean non-HDL cholesterol level of 92 mg per deciliter (2.38 mmol per liter), and a mean HDL cholesterol level of 40 mg per deciliter (1.03 mmol per liter). The patients were assigned to receive either 100 mg of anacetrapib once daily (15,225 patients) or matching placebo (15,224 patients). The primary outcome was the first major coronary event, a composite of coronary death, myocardial infarction, or coronary revascularization. RESULTS: During the median follow-up period of 4.1 years, the primary outcome occurred in significantly fewer patients in the anacetrapib group than in the placebo group (1640 of 15,225 patients [10.8%] vs. 1803 of 15,224 patients [11.8%]; rate ratio, 0.91; 95% confidence interval, 0.85 to 0.97; P=0.004). The relative difference in risk was similar across multiple prespecified subgroups. At the trial midpoint, the mean level of HDL cholesterol was higher by 43 mg per deciliter (1.12 mmol per liter) in the anacetrapib group than in the placebo group (a relative difference of 104%), and the mean level of non-HDL cholesterol was lower by 17 mg per deciliter (0.44 mmol per liter), a relative difference of -18%. There were no significant between-group differences in the risk of death, cancer, or other serious adverse events. CONCLUSIONS: Among patients with atherosclerotic vascular disease who were receiving intensive statin therapy, the use of anacetrapib resulted in a lower incidence of major coronary events than the use of placebo. (Funded by Merck and others; Current Controlled Trials number, ISRCTN48678192 ; ClinicalTrials.gov number, NCT01252953 ; and EudraCT number, 2010-023467-18 .)

View of stairs and hallway in Hargreaves Library II

Photograph shows stairs and hallway in Hargreaves Library, Eastern Washington College of Education (now Eastern Washington University).https://dc.ewu.edu/ewu_buildings_grounds/1045/thumbnail.jp

View of stairs and hallway in Hargreaves Library

Photograph of interior stairs and hallway in Hargreaves Library, Eastern Washington College of Education (now Eastern Washington University).https://dc.ewu.edu/ewu_buildings_grounds/1044/thumbnail.jp

Hargreaves Library, main entrance

Photograph shows main entrance to Hargreaves Library, Eastern Washington State College (currently Eastern Washington University).https://dc.ewu.edu/ewu_buildings_grounds/1027/thumbnail.jp

Hargreaves Library loan desk

Photograph of library staff checking out materials to patrons at the loan desk of Hargreaves Library, Eastern Washington College of Education (currently Eastern Washington University).https://dc.ewu.edu/ewu_buildings_grounds/1037/thumbnail.jp

Students studying at Hargreaves Library II

Photograph of students studying at tables in Hargreaves Library, Eastern Washington College of Education (now Eastern Washington University).https://dc.ewu.edu/ewu_buildings_grounds/1042/thumbnail.jp