Subclonal landscape of cancer drives resistance to immune therapy.

Tumor mutation burden (TMB) is often used as a biomarker for immunogenicity and prerequisite for immune checkpoint inhibitor (ICI) therapy. However, it is becoming increasingly evident that not all tumors with high TMB respond to ICIs as expected. It has been shown that the ability of T-cells to infiltrate the tumor microenvironment and elicit a specific immune response is dependent not only on the TMB, but also on intra-tumor heterogeneity and the fraction of low-frequency subclonal mutations that make up the tumor. High intra-tumor heterogeneity leads to inefficient recognition of tumor neoantigens by T-cells due to their diluted frequency and spatial heterogeneity. Clinical studies have shown that tumors with a high degree of intra-tumor heterogeneity respond poorly to ICI therapy, and previous cytotoxic treatment may increase the intra-tumor heterogeneity and render second-line ICI therapy less effective. This paper reviews the role of ICI therapy when following chemotherapy or radiation to determine if they may be better suited as first-line therapy in patients with high TMB, low intra-tumor heterogeneity, and high PD-1, PD-L1, or CTLA-4 expression.

I(f) current and spontaneous activity in mouse embryonic ventricular myocytes.

Knowledge of the initiation of electrical and contractile activity in the embryonic heart relies to a large extent on data obtained in chicken. In recent years, molecular biological techniques have raised an interest in mouse physiology, including early embryonic development. We studied action potentials and the occurrence of one of the pacemaker currents, I(f), by the whole-cell voltage and current-clamp technique at the earliest stage at which a regular heartbeat is established (9.5 days postcoitum) and at 1 day before birth. We show, first, that at the early stage there is a prominent I(f) in mouse embryonic ventricles, which decreases by 82% before birth in concert with the loss of regular spontaneous activity of ventricular cells. Second, the decrease in I(f) current is associated with a slight change in channel gating kinetics and a decrease in total mRNA expression of the genes encoding for I(f) current. Third, the most prevalent mRNA subtype is switched from HCN4 to HCN2 during the second half of embryonic development. Fourth, the I(f) current may be modulated by the beta-adrenergic cascade, although the coupling to the beta-adrenoceptor in the sarcolemma itself is not yet mature. We conclude that I(f) current of the sinus node type is present in early embryonic mouse ventricular cells. In association with a loss of I(f) current, the ventricle tends to lose pacemaker potency during the second half of embryonic development.

Cell-to-cell interaction prevents cell death in cultured neonatal rat ventricular myocytes.

OBJECTIVES: Loss of cardiac cells and the anatomical or functional remodeling of intercellular coupling occur under several pathological conditions. We have assessed the significance of intercellular coupling for cell death. METHODS AND RESULTS: Ventricular cells obtained from 1 day old Wistar rats were cultured. Apoptosis was detected by nick-end labeling. Cells were plated at low and high cell density (3x10(4)/ml and 12x10(4)/ml, respectively). Cultured myocytes died spontaneously by apoptosis in a time dependent manner. The increase of the apoptotic cell population in a culture with high cell density on day 4 (1+/-1.2%, n=4) was significantly lower than that in a culture with low cell density (20+/-5.5%, n=4). The progression of apoptosis in the culture of low cell density was prevented in part after application of the medium extract from the culture of high cell density; the apoptotic cell population on day 6 decreased from 57+/-8.0% (n=4) to 36+/-3.8% (n=4). Treatment of the cultured myocytes at high cell density with antisense oligonucleotide for connexin43 (Cx43) for 24 h on day 2 resulted in a significant decrease in Cx43 expression as judged by Western blot, dye transfer and immunocytochemistry using mouse monoclonal antibody for Cx43. In association with the down-regulation of Cx43, the progress of apoptosis was accelerated; the apoptotic cell population on day 5 in the antisense-treated cultures (27+/-5.7%, n=4) was significantly higher than the sense-treated cultures (5+/-1.1%, n=4). The effect of Cx43 antisense treatment to promote apoptosis was not reversed by application of high cell-density culture medium. CONCLUSIONS: These findings suggest that cell-cell communication through gap junction formation and some humoral factors play important roles in the survival of cultured myocytes.

IGF-I regulates K(+)-channel expression of cultured neonatal rat ventricular myocytes.

Insulin-like growth factor (IGF) I has been known as an important peptide during heart development and myocardial hypertrophy. In the present study, the effects of IGF-I on cardiac K(+)-channel expression were investigated in cultured neonatal rat ventricular myocytes. Two distinct 4-aminopyridine (AP)-sensitive and rapidly activating outward K+ currents (IK) were observed. The predominant K(+)-channel current in cultured cells was a fast inactivating current similar to a 4-AP-sensitive transient outward current [I(to) half-maximal inhibitory concentration (IC60) = 0.87 mM]. Some cells lacking I(to) expressed an IK with little or no slow inactivation. IK exhibited higher sensitivity to inhibition by 4-AP (IC50 = 66.5 microM) and could be enhanced by isoproterenol but unaffected by tetraethylammonium. These characteristics indicate that IK might be the rat isoform of ultrarapid delayed rectifier K+ current IKur previously described in human atrial myocytes. Seventy-two-hour exposure to 60 ng/ml IGF-I induced myocyte hypertrophy and increased the percentage of cells expressing only IKur and the cells expressing both Ito and IKur. In some cultured myocytes, immunofluorescent staining with a polyclonal antibody specific to the COOH terminus of Kv1.5 K(+)-channel protein was performed in the same single cells after voltage-clamp recordings. The IGF-I-pretreated cells expressing larger IKur revealed a significantly intense antibody labeling. These observations indicate that the long-term administration of IGF-I can regulate the K(+)-channel expression of cultured neonatal rat ventricular myocytes. This is important for understanding the role of IGF-I in the modulation of cardiac excitability.

Orientation change of cardiocytes induced by cyclic stretch stimulation: time dependency and involvement of protein kinases.

UNLABELLED: Mechanical stress has been implicated as one of the growth regulators in the heart. We investigated the effect of cyclic stretch stimulation on morphology and orientation of cultured cardiocytes. Embryonic rat (17 days postcoital) cardiomyocytes cultured on silicone dishes were cyclically stretched to 120% in length at a frequency of 30 cycles/min. After 12 h, in the initial stage of cultivation, cardiocytes and intracellular myofibrils oriented parallel to the stretch direction. When the stretch stimulus was prolonged to 24-48 h, myofibrils that oriented perpendicular to the stretch direction emerged. Furthermore, when the cells were stretched only in the later stage (after 24 h of cultivation), both cells and myofibrils tended to orient perpendicular to the stretch direction. Next we examined the effects of chemical compounds on these phase-related changes in myofibril orientation. None of the drugs tested (H-7, HA-1004, staurosporine, herbimycin A, genistein, GdCl3, and EGTA) blocked the parallel orientation of myofibrils induced by the initial-stage stretch. By contrast, H-7, staurosporine, herbimycin A, and genistein did inhibit almost completely the perpendicular orientation of the myofibrils induced by the late-stage stretch, but HA-1004, GdCl3, or EGTA did not. Immunoblotting study using anti-phsophotyrosine antibody indicated that tyrosine phosphorylation of a protein of about 125 kDa was enhanced in a time-dependent manner by the late-stage stretch, but not by the initial-stage stretch. IN CONCLUSION: the alignment change induced by cyclic stretch depends on the stage of cultivation: with stretch in the initial stage (within 12 h), cells and myofibrils orient parallel to the stretch; with stretch in the later stage (after 24 h), they orient perpendicular to the stretch. The effect of stretch in the later stage is likely mediated by protein kinase C and tyrosine kinase pathways.

Regulation of cardiac Kv1.5 K+ channel expression by cardiac fibroblasts and mechanical load in cultured newborn rat ventricular myocytes.

Of the six voltage-gated K+ channel alpha subunits detected in rat heart, the Kv1.5 channel is abundantly expressed, and its gene transcription and protein expression are reduced during cardiac remodeling. Since cardiac fibroblasts and mechanical load have been known to play important roles in myocardial hypertrophy, we studied the regulation of Kv1.5 K+ channel protein expression by these factors in cultured newborn rat ventricular myocytes, using immunofluorescent cytochemistry and Western blot analysis. Ventricular cells were isolated from 1-day-old Wistar rats and cultured for a period of 5 days. The effect of cardiac fibroblasts was examined by co-culturing myocytes with fibroblasts or incubating pure myocytes in fibroblast-conditioned growth medium (FCGM) for 72 h. In addition, a 48-h cyclic stretch at 0.5 Hz with 20% elongation in length was applied to pure myocyte cultures to mimic mechanical load. With a polyclonal antibody against rat Kv1.5 K+ channel protein, single cultured myocytes showed a weak and uniform antibody labeling. Co-culturing with fibroblasts or incubating pure myocytes in FCGM both induced a significant increase in myocyte size implying cell hypertrophy, but neither allowed normal expression of the Kv1.5 K+ channel as indicated by almost negative anti-Kv1.5 labeling. Western blots of cell proteins prepared from ventricular myocyte cultures revealed a single protein band at 75 kD recognized by the anti-Kv1.5 antibody and a 45% decrease in Kv1.5 immunoreactive protein level in the FCGM-treated preparations. Application of 1 microM losartan, an angiotensin II type I receptor blocker, significantly attenuated the FCGM-induced myocyte hypertrophy and reduction of Kv1.5 K+ channel expression. On the other hand, although no cell hypertrophy was stimulated by mechanical stretch, intense punctate antibody labeling with a 48% increase in Kv1.5 protein level was observed in the stretched myocytes. These results suggest that the protein expression of cardiac Kv1.5 K+ channel is differentially regulated by cardiac fibroblasts and mechanical load. Some soluble factors produced from cardiac fibroblasts contribute to the depressed Kv1.5 K+ channel expression in myocardial hypertrophy. This channel regulation may be mediated by angiotensin II type I receptor.

Effects of near-infrared irradiation to stellate ganglion in glossodynia.

OBJECTIVE: This study was designed to assess the effect of stellate ganglion near-infrared irradiation (SGR) on glossodynia and the mechanism of action. STUDY DESIGN: Thirty-seven patients with glossodynia received SGR once weekly for 4 weeks. The response to treatment was evaluated on the basis of the change in pain intensity, assessed with a visual analogue scale (VAS) before and after 4 weeks of treatment. The temperature and blood flow of the tongue were also measured before and after first SGR. As control, eight healthy subjects were studied. RESULTS: Tongue pain as assessed by the VAS decreased in 28 of the 37 patients (75.7%). Mean pain intensity decreased significantly from 5.1 +/- 2.2 to 1.9 +/- 2.1 (P < 0.05). Tongue blood flow at rest in the patients with glossodynia [7.2 +/- 1.6 ml min(-1) (100 g)(-1)] was significantly lower than that in the healthy subjects [7.8 +/- 0.23 ml min(-1) (100 g)(-1)]. Five minutes after SGR, the temperature of the tongue rose 1.5 +/- 0.21 degrees C, and blood flow increased to 8.5 +/- 1.2 ml min(-1) (100 g)(-1). Tongue blood flow (at rest) after 4 weeks of SGR had increased to 7.7 +/- 1.1 ml min(-1) (100 g)(-1). CONCLUSION: SGR is an effective treatment for glossodynia. The mechanism by which SGR improves symptoms associated with glossodynia is thought to be as follows: SGR inhibits abnormally increased sympathetic activity associated with glossodynia. This is followed by normalization of decreased tongue blood flow, thereby alleviating pain.