9 research outputs found

    Obesity diminishes response to PD-1-based immunotherapies in renal cancer

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    Background Obesity is a major risk factor for renal cancer, yet our understanding of its effects on antitumor immunity and immunotherapy outcomes remains incomplete. Deciphering these associations is critical, given the growing clinical use of immune checkpoint inhibitors for metastatic disease and mounting evidence for an obesity paradox in the context of cancer immunotherapies, wherein obese patients with cancer have improved outcomes.Methods We investigated associations between host obesity and anti-programmed cell death (PD-1)-based outcomes in both renal cell carcinoma (RCC) subjects and orthotopic murine renal tumors. Overall survival (OS) and progression-free survival (PFS) were determined for advanced RCC subjects receiving standard of care anti-PD-1 who had ≥6 months of follow-up from treatment initiation (n=73). Renal tumor tissues were collected from treatment-naive subjects categorized as obese (body mass index, ‘BMI’ ≥30 kg/m2) or non-obese (BMI <30 kg/m2) undergoing partial or full nephrectomy (n=19) then used to evaluate the frequency and phenotype of intratumoral CD8+ T cells, including PD-1 status, by flow cytometry. In mice, antitumor immunity and excised renal tumor weights were evaluated ±administration of a combinatorial anti-PD-1 therapy. For a subset of murine renal tumors, immunophenotyping was performed by flow cytometry and immunogenetic profiles were evaluated via nanoString.Results With obesity, RCC patients receiving anti-PD-1 administration exhibited shorter PFS (p=0.0448) and OS (p=0.0288). Treatment-naive renal cancer subjects had decreased frequencies of tumor-infiltrating PD-1highCD8+ T cells, a finding recapitulated in our murine model. Following anti-PD-1-based immunotherapy, both lean and obese mice possessed distinct populations of treatment responders versus non-responders; however, obesity reduced the frequency of treatment responders (73% lean vs 44% obese). Tumors from lean and obese treatment responders displayed similar immunogenetic profiles, robust infiltration by PD-1int interferon (IFN)γ+CD8+ T cells and reduced myeloid-derived suppressor cells (MDSC), yielding favorable CD44+CD8+ T cell to MDSC ratios. Neutralizing interleukin (IL)-1β in obese mice improved treatment response rates to 58% and reduced MDSC accumulation in tumors.Conclusions We find that obesity is associated with diminished efficacy of anti-PD-1-based therapies in renal cancer, due in part to increased inflammatory IL-1β levels, highlighting the need for continued study of this critical issue

    The Ontological (In)security of Similarity: Wahhabism versus Islamism in Saudi Foreign Policy

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    It has long been argued that identity matters in international relations. Yet, how identity impacts enmity and conflict among states remains the subject of debate. The existing literature asserts that differences in identity can be a source of conflict, whereas convergence and similarity lead to cooperation. Nevertheless, empirical evidence from the Middle East has long defied this hypothesis. The Kingdom of Saudi Arabia, which prides itself on being an Islamic model and claims Islamic leadership, has opposed the rise to power of Islamist movements in the Middle East. To address this paradox, this article builds on the growing literature on ontological security to propose a theoretical framework explaining how similarity can generate anxiety and identity risks. This framework, I argue, moves beyond traditional regime‐security approaches to reveal that security is not only physical but also ontological. I then illustrate the argument through a comparison of Saudi identity risks in the wake of the Iranian revolution (1979) and the ascendance of the Muslim Brotherhood to power in Egypt (2012). Ultimately, these cases provide intriguing insights into foreign policy behaviour during critical situations

    Viruses

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