An HPV-E6/E7 immunotherapy plus PD-1 checkpoint inhibition results in tumor regression and reduction in PD-L1 expression.

We have investigated if immunotherapy against human papilloma virus (HPV) using a viral gene delivery platform to immunize against HPV 16 genes E6 and E7 (Ad5 [E1-, E2b-]-E6/E7) combined with programmed death-ligand 1 (PD-1) blockade could increase therapeutic effect as compared to the vaccine alone. Ad5 [E1-, E2b-]-E6/E7 as a single agent induced HPV-E6/E7 cell-mediated immunity. Immunotherapy using Ad5 [E1-, E2b-]-E6/E7 resulted in clearance of small tumors and an overall survival benefit in mice with larger established tumors. When immunotherapy was combined with immune checkpoint blockade, an increased level of anti-tumor activity against large tumors was observed. Analysis of the tumor microenvironment in Ad5 [E1-, E2b-]-E6/E7 treated mice revealed elevated CD8(+) tumor infiltrating lymphocytes (TILs); however, we observed induction of suppressive mechanisms such as programmed death-ligand 1 (PD-L1) expression on tumor cells and an increase in PD-1(+) TILs. When Ad5 [E1-, E2b-]-E6/E7 immunotherapy was combined with anti-PD-1 antibody, we observed CD8(+) TILs at the same level but a reduction in tumor PD-L1 expression on tumor cells and reduced PD-1(+) TILs providing a mechanism by which combination therapy favors a tumor clearance state and a rationale for pairing antigen-specific vaccines with checkpoint inhibitors in future clinical trials.

Depressed lymphocyte transformation and the role of prostaglandins in atopic dermatitis.

We have shown that peripheral blood mononuclear cells (PBMC) from patients with atopic dermatitis have a reduced in vitro proliferative responsiveness to concanavalin A when compared with non-atopic controls. Addition of the cyclo-oxygenase inhibitor indomethacin caused a significant enhancement of the mitogen response in the patients, indicating a suppressive effect of cyclooxygenase products. We have further demonstrated increased levels of prostaglandin E2 in the supernatants of the PBMC cultures and increased levels of IgE immune complexes in the sera of the atopic dermatitis patients and therefore hypothesize that IgE immune complexes may cause increased monocyte production of prostaglandins which in turn appears to be responsible for a reduced lymphocyte proliferation.

Circulating human leucocyte elastase levels in patients with pulmonary sarcoidosis.

In a pilot study plasma elastase concentrations were measured in 28 outpatients with pulmonary sarcoidosis. These were compared with the conventional criteria used in assessment of disease activity, namely lung function abnormalities, chest radiography changes and serum angiotensin converting enzyme (ACE) levels. An elevated plasma elastase concentration was found in 21/28 patients (mean 554 micrograms/l, range 192-1678). Of these, six had evidence of active pulmonary or cutaneous sarcoidosis and the plasma elastase level fell towards normal as the disease improved; another three had evidence of a coexistent acute phase response which might explain the raised level. Six of the remaining 12 patients had longstanding, fibrotic chest radiographic abnormalities with no apparent change during the short study period. Six of the seven patients with normal plasma elastase levels also had longstanding, apparently quiescent sarcoidosis. No correlation was found between the plasma elastase concentration and either chest radiographic score, lung function abnormalities, or serum ACE level. These findings suggest that patients with active pulmonary or cutaneous sarcoidosis have evidence of in vivo neutrophil activation. The additional finding of raised plasma elastase levels in some patients with fibrotic radiological changes implies the presence of ongoing chronic neutrophil activation, perhaps in the lung interstitium, for which further treatment might be indicated.

Effect of cardiopulmonary bypass on circulating concentrations of leucocyte elastase and free radical activity.

Circulating concentrations of leucocyte elastase and free radical activity were measured in 11 adults undergoing cardiopulmonary bypass. In all patients the bypass procedure was associated with pronounced changes in plasma elastase concentrations, and peak enzyme concentrations correlated closely with the duration of bypass (r = 0.91, p less than 0.001). Serial measurement of octadeca-9, 11-dienoic acid, a non-peroxide marker of free radical activity, showed significant changes only in the plasma free fatty acid fraction, suggesting a direct relation to the action of heparin rather than to the bypass procedure as such. These studies support the hypothesis that neutrophil activation plays a central role in the organ dysfunction that may complicate cardiopulmonary bypass and suggest that elastase release rather than free radical generation may be the appropriate marker of the event.