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1.
Cancer Cell ; 41(12): 2154-2165.e5, 2023 12 11.
Article in English | MEDLINE | ID: mdl-38039963

ABSTRACT

Circulating T cells from peripheral blood (PBL) can provide a rich and noninvasive source for antitumor T cells. By single-cell transcriptomic profiling of 36 neoantigen-specific T cell clones from 6 metastatic cancer patients, we report the transcriptional and cell surface signatures of antitumor PBL-derived CD8+ T cells (NeoTCRPBL). Comparison of tumor-infiltrating lymphocyte (TIL)- and PBL-neoantigen-specific T cells revealed that NeoTCRPBL T cells are low in frequency and display less-dysfunctional memory phenotypes relative to their TIL counterparts. Analysis of 100 antitumor TCR clonotypes indicates that most NeoTCRPBL populations target the same neoantigens as TILs. However, NeoTCRPBL TCR repertoire is only partially shared with TIL. Prediction and testing of NeoTCRPBL signature-derived TCRs from PBL of 6 prospective patients demonstrate high enrichment of clonotypes targeting tumor mutations, a viral oncogene, and patient-derived tumor. Thus, the NeoTCRPBL signature provides an alternative source for identifying antitumor T cells from PBL of cancer patients, enabling immune monitoring and immunotherapies.


Subject(s)
CD8-Positive T-Lymphocytes , Neoplasms , Humans , Prospective Studies , Antigens, Neoplasm , Neoplasms/genetics , Neoplasms/therapy , Neoplasms/metabolism , Lymphocytes, Tumor-Infiltrating , Receptors, Antigen, T-Cell
2.
J Immunother Cancer ; 11(5)2023 05.
Article in English | MEDLINE | ID: mdl-37258038

ABSTRACT

BACKGROUND: Cellular immunotherapies using autologous tumor-infiltrating lymphocytes (TIL) can induce durable regression of epithelial cancers in selected patients with treatment-refractory metastatic disease. As the genetic engineering of T cells with tumor-reactive T-cell receptors (TCRs) comes to the forefront of clinical investigation, the rapid, scalable, and cost-effective detection of patient-specific neoantigen-reactive TIL remains a top priority. METHODS: We analyzed the single-cell transcriptomic states of 31 neoantigen-specific T-cell clonotypes to identify cell surface dysfunction markers that best identified the metastatic transcriptional states enriched with antitumor TIL. We developed an efficient method to capture neoantigen-reactive TCRs directly from resected human tumors based on cell surface co-expression of CD39, programmed cell death protein-1, and TIGIT dysfunction markers (CD8+ TILTP). RESULTS: TILTP TCR isolation achieved a high degree of correlation with single-cell transcriptomic signatures that identify neoantigen-reactive TCRs, making it a cost-effective strategy using widely available resources. Reconstruction of additional TILTP TCRs from tumors identified known and novel antitumor TCRs, showing that at least 39.5% of TILTP TCRs are neoantigen-reactive or tumor-reactive. Despite their substantial enrichment for neoantigen-reactive TCR clonotypes, clonal dynamics of 24 unique antitumor TILTP clonotypes from four patients indicated that most in vitro expanded TILTP populations failed to demonstrate neoantigen reactivity, either by loss of neoantigen-reactive clones during TIL expansion, or through functional impairment during cognate neoantigen recognition. CONCLUSIONS: While direct usage of in vitro-expanded CD8+ TILTP as a source for cellular therapy might be precluded by profound TIL dysfunction, isolating TILTP represents a streamlined effective approach to rapidly identify neoantigen-reactive TCRs to design engineered cellular immunotherapies against cancer.


Subject(s)
Antigens, Neoplasm , Neoplasms , Humans , CD8-Positive T-Lymphocytes , Neoplasms/metabolism , Receptors, Antigen, T-Cell , Lymphocytes, Tumor-Infiltrating
3.
Science ; 375(6583): 877-884, 2022 02 25.
Article in English | MEDLINE | ID: mdl-35113651

ABSTRACT

The accurate identification of antitumor T cell receptors (TCRs) represents a major challenge for the engineering of cell-based cancer immunotherapies. By mapping 55 neoantigen-specific TCR clonotypes (NeoTCRs) from 10 metastatic human tumors to their single-cell transcriptomes, we identified signatures of CD8+ and CD4+ neoantigen-reactive tumor-infiltrating lymphocytes (TILs). Neoantigen-specific TILs exhibited tumor-specific expansion with dysfunctional phenotypes, distinct from blood-emigrant bystanders and regulatory TILs. Prospective prediction and testing of 73 NeoTCR signature-derived clonotypes demonstrated that half of the tested TCRs recognized tumor antigens or autologous tumors. NeoTCR signatures identified TCRs that target driver neoantigens and nonmutated viral or tumor-associated antigens, suggesting a common metastatic TIL exhaustion program. NeoTCR signatures delineate the landscape of TILs across metastatic tumors, enabling successful TCR prediction based purely on TIL transcriptomic states for use in cancer immunotherapy.


Subject(s)
Antigens, Neoplasm/immunology , Lymphocytes, Tumor-Infiltrating/immunology , Neoplasm Metastasis , Neoplasms/immunology , Receptors, Antigen, T-Cell/immunology , T-Lymphocytes/immunology , Transcriptome , CD4-Positive T-Lymphocytes/immunology , CD4-Positive T-Lymphocytes/metabolism , CD8-Positive T-Lymphocytes/immunology , CD8-Positive T-Lymphocytes/metabolism , Gene Regulatory Networks , Humans , Lymphocytes, Tumor-Infiltrating/metabolism , Neoplasms/genetics , Neoplasms/metabolism , RNA-Seq , Single-Cell Analysis
4.
Am J Surg ; 222(5): 983-988, 2021 Nov.
Article in English | MEDLINE | ID: mdl-33933208

ABSTRACT

BACKGROUND: Gastrointestinal Stromal Tumors (GISTs) are rare sarcomas with 5000 new cases arising in the United States each year. Despite their low incidence, general surgeons should be familiar with GISTs since a quarter of these neoplasms are encountered incidentally. METHODS: A retrospective medical records review was conducted to create a database of all GISTs resected from January 2005 to May 2019. We isolated patients who had incidental discovery of GISTs intraoperatively or within final pathology. Characteristics of patient (Age, gender), index procedure (malignant vs. benign, elective vs. emergent) and tumor (location, size and mitotic rate) were analyzed. RESULTS: A total 48 patients were incidentally discovered to have a GIST excised during index operation. The mean age of these patients was 62 years, with 27 females and 21 males. The primary location of tumors in descending frequency was stomach (30), small bowel (15), colon/rectum (2) and esophagus (1). The average size of all tumors was 1.2 cm, with the average size of the stomach, small bowel, colon/rectum and esophagus at 0.9 cm, 1.7 cm, 0.9 cm and 0.3 cm respectively. Mitotic rate was less than 5 mitosis per 50 HPF in 96% of patients. Incidental tumors were identified during both bariatric (13) and non-bariatric stomach surgery (8), colorectal surgery (14), hernia repair (4), ampullary/pancreatic surgery (5), esophageal surgery (2) liver surgery (1) and uterine surgery (1). Most incidental-GISTs were identified during elective surgery (81%, 39). Finally, 15 of the tumors were identified during surgery for other malignancies. CONCLUSIONS: One quarter (25%) of the GISTs encountered at our academic community cancer center over a 15-year period were discovered incidentally. These tumors had less malignant characteristics overall and were likely cured with surgical resection.


Subject(s)
Gastrointestinal Neoplasms/diagnosis , Gastrointestinal Stromal Tumors/diagnosis , Incidental Findings , Stomach Neoplasms/surgery , Adult , Aged , Aged, 80 and over , Female , Gastrectomy/statistics & numerical data , Gastrointestinal Neoplasms/pathology , Gastrointestinal Stromal Tumors/pathology , Humans , Male , Middle Aged
5.
Eur J Trauma Emerg Surg ; 46(3): 621-626, 2020 Jun.
Article in English | MEDLINE | ID: mdl-30386866

ABSTRACT

OBJECTIVES: Thoracostomy tube (TT) connection to drainage device (DD) may be unintentionally disconnected, potentiating complications. Tape may strengthen this connection despite minimal data informing optimal practice. Our goal was to analyze the utility of cable ties for TT to DD connection. METHODS: On April 1, 2015, our trauma center supplanted use of tape or nothing with cable ties for securing TT to DD connection. We abstracted trauma registry patients with TTs placed from March 1, 2014 to May 31, 2016 and dichotomized as prior ("BEFORE") and subsequent ("AFTER") to the cable tie practice pattern change. We analyzed demographics, TT-specific details and outcomes. Primary outcome was TT to DD disconnection. Secondary outcomes included TT dislodgement from the chest, complications, length of stay (LOS), mortality, number of TTs placed and TT days. RESULTS: 121 (83.4% of abstracted) patients were analyzed. Demographics, indications for TT and operative rate were similar for BEFORE and AFTER cohorts. ISS was lower BEFORE (14.12 ± 2.35 vs 18.21 ± 2.71, p = 0.022); however, RTS and AIS for chest were similar (p = 0.155 and 0.409, respectively). TT to DD disconnections per TT days were significantly higher in the BEFORE cohort [6 (2.8%) vs. 1 (0.19%), p = 0.003], and dislodgements were statistically similar [0 vs 3 (0.57%), p = 0.36]. LOS, initial TTs placed and days per TT were similar, and median and mode of days per TT were the same. CONCLUSIONS: Cable ties secure connections between TT and DDs with higher fidelity compared to tape or nothing but may increase rates of TT dislodgement from the chest.


Subject(s)
Drainage/instrumentation , Thoracic Injuries/surgery , Thoracostomy/instrumentation , Adult , Aged , Equipment Design , Equipment Failure Analysis , Humans , Injury Severity Score , Length of Stay/statistics & numerical data , Middle Aged , Registries , Retrospective Studies , Tensile Strength , Thoracic Injuries/mortality , Trauma Centers
6.
Case Rep Womens Health ; 19: e00072, 2018 Jul.
Article in English | MEDLINE | ID: mdl-30167379

ABSTRACT

BACKGROUND: Gestational trophoblastic disease (GTD) is a rare developmental form of proliferative trophoblastic tissue. Sparse literature exists regarding the optimal management of patients with advanced GTD, but the definitive treatment is urgent surgical intervention. CASE: A 48-year-old woman presented advanced GTD. She was medically managed for hypertension and hyperthyroidism prior to surgical intervention in order to minimize the risk of anesthetic and surgical complications. CONCLUSION: Advanced GTD is rare. Undetected GTD can result in complications such as thyrotoxicosis, which poses substantial risks in the peri-operative period. Appropriate identification and management of this clinical problem are essential to prevent complications as well as subsequent malignant sequelae.

7.
Pathog Dis ; 76(2)2018 03 01.
Article in English | MEDLINE | ID: mdl-29365093

ABSTRACT

Ketamine is one of several clinically important drugs whose therapeutic efficacy is due in part to their ability to act upon ion channels prevalent in nearly all biological systems. In studying eukaryotic and prokaryotic organisms in vitro, we show that ketamine short-circuits the growth and spatial expansion of three microorganisms, Stachybotrys chartarum, Staphylococcus epidermidis and Borrelia burgdorferi, at doses efficient at reducing depression-like behaviors in mouse models of clinical depression. Although our findings do not reveal the mechanism(s) by which ketamine mediates its antifungal and antibacterial effects, we hypothesize that a function of L-glutamate signal transduction is associated with the ability of ketamine to limit pathogen expansion. In general, our findings illustrate the functional similarities between fungal, bacterial and human ion channels, and suggest that ketamine or its metabolites not only act in neurons, as previously thought, but also in microbial communities colonizing human body surfaces.


Subject(s)
Anti-Infective Agents/pharmacology , Borrelia burgdorferi/drug effects , Ketamine/pharmacology , Stachybotrys/drug effects , Staphylococcus epidermidis/drug effects , Borrelia burgdorferi/growth & development , Glutamic Acid/metabolism , Microbial Sensitivity Tests , Signal Transduction/drug effects , Stachybotrys/growth & development , Staphylococcus epidermidis/growth & development
8.
Anat Rec (Hoboken) ; 300(11): 1973-1980, 2017 Nov.
Article in English | MEDLINE | ID: mdl-28696502

ABSTRACT

Patients who harbor brain arteriovenous malformations are at risk for intracranial hemorrhage. These malformations are often seen in inherited vascular diseases such as hereditary hemorrhagic telangiectasia. However, malformations within the brain also sporadically occur without a hereditary-coding component. Here, we review recent insights into the pathophysiology of arteriovenous malformations, in particular, certain signaling pathways that might underlie endothelial cell pathology. To better interpret the origins, determinants and consequences of brain arteriovenous malformations, we present a clinical case to illustrate the phenotypic landscape of the disease. We also propose that brain arteriovenous malformations might share certain signaling dimensions with those of anorectal hemorrhoids. This working hypothesis provides casual anchors from which to understand vascular diseases characterized by arteriovenous lesions with a hemorrhagic- or bleeding-risk component. Anat Rec, 2017. © The Authors. The Anatomical Record published by Wiley Periodicals, Inc. on behalf of American Association of Anatomists. Anat Rec, 300:1973-1980, 2017. © 2017 The Authors. The Anatomical Record published by Wiley Periodicals, Inc. on behalf of American Association of Anatomists.


Subject(s)
Arteriovenous Fistula/pathology , Brain/blood supply , Endothelial Cells/pathology , Intracranial Arteriovenous Malformations/pathology , Signal Transduction/genetics , Telangiectasia, Hereditary Hemorrhagic/pathology , Activin Receptors, Type II/genetics , Activin Receptors, Type II/metabolism , Adult , Arteriovenous Fistula/diagnostic imaging , Arteriovenous Fistula/diet therapy , Arteriovenous Fistula/genetics , Blood Pressure , Brain/diagnostic imaging , Dietary Fiber/therapeutic use , Endoglin/genetics , Endoglin/metabolism , Humans , Intracranial Arteriovenous Malformations/diagnostic imaging , Intracranial Arteriovenous Malformations/diet therapy , Intracranial Arteriovenous Malformations/genetics , Magnetic Resonance Angiography , Male , Mutation , Telangiectasia, Hereditary Hemorrhagic/diet therapy , Telangiectasia, Hereditary Hemorrhagic/genetics , Tomography, X-Ray Computed , Transforming Growth Factor beta/metabolism
9.
Radiol Case Rep ; 12(2): 376-382, 2017 Jun.
Article in English | MEDLINE | ID: mdl-28491192

ABSTRACT

A spinal dural arteriovenous fistula is an abnormally layered connection between radicular arteries and venous plexus of the spinal cord. This vascular condition is relatively rare with an incidence of 5-10 cases per million in the general population. Diagnosis of spinal dural arteriovenous fistula is differentiated by contrast-enhanced magnetic resonance angiography or structural magnetic resonance imaging, but a definitive diagnosis requires spinal angiography methods. Here, we report a case of a 67-year-old female with a spinal dural arteriovenous fistula, provide a pertinent clinical history to the case nosology, and discuss the biology of adhesive proteins, chemotactic molecules, and transcription factors that modify the behavior of the vasculature to possibly cause sensorimotor deficits.

10.
J Am Osteopath Assoc ; 116(3): 170-7, 2016 Mar.
Article in English | MEDLINE | ID: mdl-26927910

ABSTRACT

The brain has long been thought to lack a lymphatic drainage system. Recent studies, however, show the presence of a brain-wide paravascular system appropriately named the glymphatic system based on its similarity to the lymphatic system in function and its dependence on astroglial water flux. Besides the clearance of cerebrospinal fluid and interstitial fluid, the glymphatic system also facilitates the clearance of interstitial solutes such as amyloid-ß and tau from the brain. As cerebrospinal fluid and interstitial fluid are cleared through the glymphatic system, eventually draining into the lymphatic vessels of the neck, this continuous fluid circuit offers a paradigm shift in osteopathic manipulative medicine. For instance, manipulation of the glymphatic-lymphatic continuum could be used to promote experimental initiatives for nonpharmacologic, noninvasive management of neurologic disorders. In the present review, the authors describe what is known about the glymphatic system and identify several osteopathic experimental strategies rooted in a mechanistic understanding of the glymphatic-lymphatic continuum.


Subject(s)
Brain/blood supply , Extracellular Fluid/physiology , Lymphatic System/physiology , Osteopathic Medicine , Humans
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