A high LDH to absolute lymphocyte count ratio in patients with DLBCL predicts for a poor intratumoral immune response and inferior survival

Purpose: To test the utility of the circulating Lactate Dehydrogenase (LDH) to absolute lymphocyte count (ALC) ratio (LAR) to predict outcome to conventional first-line chemo-immunotherapy in Diffuse Large B-cell Lymphoma (DLBCL), and investigate its correlation to the tumour immune microenvironment (TME). Experimental Design: A population based cohort of 210 patients (median age: 64, range 18-90 years) with median follow up 3.8 years was analysed. All patients were treated with R-CHOP, and no immunosuppression related cases were included. Tissue for nanoString gene expression was available in 141. Results: High (i.e. adverse) LAR was associated with inferior progression free and overall survival (PFS 45% vs. 78%; OS 56% vs 86%, both p < 0.001) at 5-years. Patients with a high LAR had a strikingly different TME compared to patients with a low ratio. Low LAR was associated with a good-risk TME immune gene signature (p < 0.0001), including high CD8 and lower M2 macrophage infiltration. COO classification was not significantly different between high and low LAR patients. LAR was predictive of outcome independent of cell of origin and the international prognostic index (IPI). In particular, LAR discriminated patients with high IPI (3- 5), showing 5-year PFS and OS of 32% vs. 74% (p=0.0006), and 43% vs. 81% (p=0.0003). A combined nanoString based immune score and the LAR allowed better prediction of outcome than either prognosticator alone (p < 0.0001). Conclusions: The LAR reflects the TME within DLBCL, and is a strong predictor of outcome in DLBCL treated with conventional first-line therapy that is independent of and additive to the IPI. Further studies are required to determine if this easily applicable blood assay can determine patients that might benefit from immune checkpoint blockade

A high LDH to absolute lymphocyte count ratio in patients with DLBCL predicts for a poor intratumoral immune response and inferior survival

Purpose: To test the utility of the circulating Lactate Dehydrogenase (LDH) to absolute lymphocyte count (ALC) ratio (LAR) to predict outcome to conventional first-line chemo-immunotherapy in Diffuse Large B-cell Lymphoma (DLBCL), and investigate its correlation to the tumour immune microenvironment (TME). Experimental Design: A population based cohort of 210 patients (median age: 64, range 18-90 years) with median follow up 3.8 years was analysed. All patients were treated with R-CHOP, and no immunosuppression related cases were included. Tissue for nanoString gene expression was available in 141. Results: High (i.e. adverse) LAR was associated with inferior progression free and overall survival (PFS 45% vs. 78%; OS 56% vs 86%, both p < 0.001) at 5-years. Patients with a high LAR had a strikingly different TME compared to patients with a low ratio. Low LAR was associated with a good-risk TME immune gene signature (p < 0.0001), including high CD8 and lower M2 macrophage infiltration. COO classification was not significantly different between high and low LAR patients. LAR was predictive of outcome independent of cell of origin and the international prognostic index (IPI). In particular, LAR discriminated patients with high IPI (3- 5), showing 5-year PFS and OS of 32% vs. 74% (p=0.0006), and 43% vs. 81% (p=0.0003). A combined nanoString based immune score and the LAR allowed better prediction of outcome than either prognosticator alone (p < 0.0001). Conclusions: The LAR reflects the TME within DLBCL, and is a strong predictor of outcome in DLBCL treated with conventional first-line therapy that is independent of and additive to the IPI. Further studies are required to determine if this easily applicable blood assay can determine patients that might benefit from immune checkpoint blockade

Autologous adoptive T-cell therapy for recurrent or drug-resistant cytomegalovirus complications in solid organ transplant patients: a single-arm open-label phase I clinical trial

BACKGROUND: Opportunistic infections including cytomegalovirus (CMV) are a major cause of morbidity and mortality in solid organ transplant (SOT) recipients. The recurrent and protracted use of anti-viral drugs with eventual emergence of drug resistance represents a significant constraint to therapy. While adoptive T-cell therapy has been successfully used in haematopoietic stem cell transplant recipients, its extension to the SOT setting poses a considerable challenge because of the inhibitory effects of immunosuppressive drugs on the virus-specific T-cell response in vivo, and the perceived risk of graft rejection. METHODS: In this prospective study, 22 SOT recipients (13 renal, 8 lung and 1 heart) with recurrent or ganciclovir-resistant CMV infection were recruited and of these, 13 patients were treated with in vitro-expanded autologous CMV-specific T cells. These patients were monitored for safety, clinical symptoms and immune reconstitution. RESULTS: Autologous CMV-specific T-cell manufacture was attempted for 21 patients, and was successful in 20 cases. The use of this adoptive immunotherapy was associated with no therapy-related serious adverse events. Eleven (84%) of the thirteen treated patients showed improvement in symptoms, including complete resolution or reduction in DNAemia, CMV-associated end organ disease and/or the cessation or reduced use of anti-viral drugs. Furthermore, many of these patients showed co-incident increased frequency of CMV-specific T cells in peripheral blood following completion of T-cell therapy. CONCLUSIONS: The data presented here demonstrate for the first time the clinical safety of CMV-specific adoptive T-cell therapy and its potential therapeutic benefit for SOT patients with recurrent and/or drug-resistant CMV infection or disease

The Vehicle, 1962, Vol. 4

Vol. 4 Table of Contents The SearchLarry Pricepage 7 If We Should MeetPauline B. Smithpage 16 Sonnet No. 1Linda Campbellpage 17 SnowflakesPauline B. Smithpage 17 Encounter in the VoidEric Crookspage 18 symbolBen Polkpage 24 The Sound of SilenceJames Wilhelmpage 24 ColoursJean Ellen Danenbargerpage 26 vegetableBen Polkpage 27 The GiftJan Holstlawpage 29 The Tiled OvenRichard Glassonpage 30 This Lover Ever WeepsBen Polkpage 31 El DoradoPauline B. Smithpage 32 I\u27m SorryMary Jean Pitratpage 32 The WalkDavid Schwarzpage 33 The Twenty-Third ChannelBen Polkpage 34 After the PicnicLinda Campbellpage 35 SoliloquyJanice Brookspage 35 JulieMyra Edmanpage 36 Poems (1) (2)Gale Crousepage 40 Boardwalk at NightSheran Broadwaypage 41 SunsetPauline B. Smithpage 42 SummerC.E.M.page 42 It\u27s Spring AgainJanice Brookspage 43 Chinese SymbolsJean Ellen Danenbargerpage 43 Why Do You Wait?Gale Crousepage 44 seekerBen Polkpage 46 Poems (3) (4) (5)Gale Crousepage 47 Opposite AttractionsC.E.M.page 48 Illustrations for the winning short story and poemDouglas Koertgehttps://thekeep.eiu.edu/vehicle/1010/thumbnail.jp

The Vehicle, 1963, Vol. 5

Vol. 5 Table of Contents Milepostspage 3 Rhyme Conceived At DawnDaun Alan Leggpage 4 NightRoss Kokospage 4 UncrownedOra Blanche T. Kingpage 4 SunfishingL.J.G.page 5 The Man Who Went To New YorkEric Crookspage 7 The DreamPauline B. Smithpage 18 Open WindowsDavid Helmpage 19 SalvationChristine McCollpage 19 The Chess GamePierre Hooverpage 20 CataclysmRaymond Kapraunpage 20 A Microscopic ViewKenneth L. Vadovskypage 21 See How Love ComesLiz Puckettpage 21 A Can Of Beer For AndyKenneth L. Vadovskypage 22 A MonsterDixie Lee Motleypage 28 InconstancyJanice Brookspage 29 DreamerDaun Alan Leggpage 29 The Third WishGlenda Vursellpage 30 The MiracleJanice Brookspage 32 What Lives Where Love Once Dwelt?Vernell Vyvialpage 33 The Most Unforgettable Person I Have Ever KnownJames Flingpage 34 Winter ThoughtsPauline B. Smithpage 35 A Winter NightPeggy Lambertpage 35 The Silver WhaleL.J.G.page 36 RaindropsDixie Lee Motleypage 40 Conflict Of Soul IJean Konzelmanpage 40 JudyChristine McCollpage 41 Sadness No. 3 (Vergessen)Sherry Sue Frypage 41 Lost GoldLarry Pricepage 42 EchoesCharles Cooleypage 48 TruthDaun Alan Leggpage 48 SunsetCarol Bennettpage 48 Cover designTom Windsor Illustration for winning storyJoel E. Hendrickshttps://thekeep.eiu.edu/vehicle/1011/thumbnail.jp

BHPR research: qualitative1. Complex reasoning determines patients' perception of outcome following foot surgery in rheumatoid arhtritis

Background: Foot surgery is common in patients with RA but research into surgical outcomes is limited and conceptually flawed as current outcome measures lack face validity: to date no one has asked patients what is important to them. This study aimed to determine which factors are important to patients when evaluating the success of foot surgery in RA Methods: Semi structured interviews of RA patients who had undergone foot surgery were conducted and transcribed verbatim. Thematic analysis of interviews was conducted to explore issues that were important to patients. Results: 11 RA patients (9 ♂, mean age 59, dis dur = 22yrs, mean of 3 yrs post op) with mixed experiences of foot surgery were interviewed. Patients interpreted outcome in respect to a multitude of factors, frequently positive change in one aspect contrasted with negative opinions about another. Overall, four major themes emerged. Function: Functional ability & participation in valued activities were very important to patients. Walking ability was a key concern but patients interpreted levels of activity in light of other aspects of their disease, reflecting on change in functional ability more than overall level. Positive feelings of improved mobility were often moderated by negative self perception ("I mean, I still walk like a waddling duck”). Appearance: Appearance was important to almost all patients but perhaps the most complex theme of all. Physical appearance, foot shape, and footwear were closely interlinked, yet patients saw these as distinct separate concepts. Patients need to legitimize these feelings was clear and they frequently entered into a defensive repertoire ("it's not cosmetic surgery; it's something that's more important than that, you know?”). Clinician opinion: Surgeons' post operative evaluation of the procedure was very influential. The impact of this appraisal continued to affect patients' lasting impression irrespective of how the outcome compared to their initial goals ("when he'd done it ... he said that hasn't worked as good as he'd wanted to ... but the pain has gone”). Pain: Whilst pain was important to almost all patients, it appeared to be less important than the other themes. Pain was predominately raised when it influenced other themes, such as function; many still felt the need to legitimize their foot pain in order for health professionals to take it seriously ("in the end I went to my GP because it had happened a few times and I went to an orthopaedic surgeon who was quite dismissive of it, it was like what are you complaining about”). Conclusions: Patients interpret the outcome of foot surgery using a multitude of interrelated factors, particularly functional ability, appearance and surgeons' appraisal of the procedure. While pain was often noted, this appeared less important than other factors in the overall outcome of the surgery. Future research into foot surgery should incorporate the complexity of how patients determine their outcome Disclosure statement: All authors have declared no conflicts of interes

SARS-CoV-2 susceptibility and COVID-19 disease severity are associated with genetic variants affecting gene expression in a variety of tissues

Variability in SARS-CoV-2 susceptibility and COVID-19 disease severity between individuals is partly due to genetic factors. Here, we identify 4 genomic loci with suggestive associations for SARS-CoV-2 susceptibility and 19 for COVID-19 disease severity. Four of these 23 loci likely have an ethnicity-specific component. Genome-wide association study (GWAS) signals in 11 loci colocalize with expression quantitative trait loci (eQTLs) associated with the expression of 20 genes in 62 tissues/cell types (range: 1:43 tissues/gene), including lung, brain, heart, muscle, and skin as well as the digestive system and immune system. We perform genetic fine mapping to compute 99% credible SNP sets, which identify 10 GWAS loci that have eight or fewer SNPs in the credible set, including three loci with one single likely causal SNP. Our study suggests that the diverse symptoms and disease severity of COVID-19 observed between individuals is associated with variants across the genome, affecting gene expression levels in a wide variety of tissue types

Identification of genetic variants associated with Huntington's disease progression: a genome-wide association study

Background Huntington's disease is caused by a CAG repeat expansion in the huntingtin gene, HTT. Age at onset has been used as a quantitative phenotype in genetic analysis looking for Huntington's disease modifiers, but is hard to define and not always available. Therefore, we aimed to generate a novel measure of disease progression and to identify genetic markers associated with this progression measure. Methods We generated a progression score on the basis of principal component analysis of prospectively acquired longitudinal changes in motor, cognitive, and imaging measures in the 218 indivduals in the TRACK-HD cohort of Huntington's disease gene mutation carriers (data collected 2008–11). We generated a parallel progression score using data from 1773 previously genotyped participants from the European Huntington's Disease Network REGISTRY study of Huntington's disease mutation carriers (data collected 2003–13). We did a genome-wide association analyses in terms of progression for 216 TRACK-HD participants and 1773 REGISTRY participants, then a meta-analysis of these results was undertaken. Findings Longitudinal motor, cognitive, and imaging scores were correlated with each other in TRACK-HD participants, justifying use of a single, cross-domain measure of disease progression in both studies. The TRACK-HD and REGISTRY progression measures were correlated with each other (r=0·674), and with age at onset (TRACK-HD, r=0·315; REGISTRY, r=0·234). The meta-analysis of progression in TRACK-HD and REGISTRY gave a genome-wide significant signal (p=1·12 × 10−10) on chromosome 5 spanning three genes: MSH3, DHFR, and MTRNR2L2. The genes in this locus were associated with progression in TRACK-HD (MSH3 p=2·94 × 10−8 DHFR p=8·37 × 10−7 MTRNR2L2 p=2·15 × 10−9) and to a lesser extent in REGISTRY (MSH3 p=9·36 × 10−4 DHFR p=8·45 × 10−4 MTRNR2L2 p=1·20 × 10−3). The lead single nucleotide polymorphism (SNP) in TRACK-HD (rs557874766) was genome-wide significant in the meta-analysis (p=1·58 × 10−8), and encodes an aminoacid change (Pro67Ala) in MSH3. In TRACK-HD, each copy of the minor allele at this SNP was associated with a 0·4 units per year (95% CI 0·16–0·66) reduction in the rate of change of the Unified Huntington's Disease Rating Scale (UHDRS) Total Motor Score, and a reduction of 0·12 units per year (95% CI 0·06–0·18) in the rate of change of UHDRS Total Functional Capacity score. These associations remained significant after adjusting for age of onset. Interpretation The multidomain progression measure in TRACK-HD was associated with a functional variant that was genome-wide significant in our meta-analysis. The association in only 216 participants implies that the progression measure is a sensitive reflection of disease burden, that the effect size at this locus is large, or both. Knockout of Msh3 reduces somatic expansion in Huntington's disease mouse models, suggesting this mechanism as an area for future therapeutic investigation

A first update on mapping the human genetic architecture of COVID-19

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