Deletion of the inhibitory co-receptor CTLA-4 enhances and invigorates chimeric antigen receptor T cells.

Chimeric antigen receptor (CAR) T cell therapy targeting CD19 has achieved tremendous success treating B cell malignancies; however, some patients fail to respond due to poor autologous T cell fitness. To improve response rates, we investigated whether disruption of the co-inhibitory receptors CTLA4 or PD-1 could restore CART function. CRISPR-Cas9-mediated deletion of CTLA4 in preclinical models of leukemia and myeloma improved CAR T cell proliferation and anti-tumor efficacy. Importantly, this effect was specific to CTLA4 and not seen upon deletion of CTLA4 and/or PDCD1 in CAR T cells. Mechanistically, CTLA4 deficiency permitted unopposed CD28 signaling and maintenance of CAR expression on the T cell surface under conditions of high antigen load. In clinical studies, deletion of CTLA4 rescued the function of T cells from patients with leukemia that previously failed CAR T cell treatment. Thus, selective deletion of CTLA4 reinvigorates dysfunctional chronic lymphocytic leukemia (CLL) patient T cells, providing a strategy for increasing patient responses to CAR T cell therapy.

Buprenorphine-Naloxone in the Setting of Kratom Withdrawal, Opioid Use Disorder, and Stage IV Lung Adenocarcinoma.

Management of cancer-associated pain warrants consideration of many factors, including characterization and etiology of the pain, socioeconomic factors, medication tolerance, and substance use history. Kratom (Mitragyna speciosa) is an herbal substance with stimulant and analgesic properties that is becoming a popular drug in the United States. In this report, we present a patient with a history of opioid use disorder (OUD) who had been using high doses of kratom to alleviate progressive chest pain and dyspnea secondary to newly diagnosed stage IV lung adenocarcinoma. He underwent kratom withdrawal shortly after his index admission and was reluctant to continue full opioid agonists given his history of OUD and complex living situation. His kratom withdrawal and cancer-associated symptoms were successfully managed with buprenorphine-naloxone. Providers should obtain a careful history of novel substance use such as kratom. Furthermore, buprenorphine-naloxone is a safe and effective option to simultaneously manage kratom withdrawal and cancer-associated pain.

Structural and Chemical Compatibilities of Li1- x Ni0.5 Co0.2 Mn0.3 O2 Cathode Material with Garnet-Type Solid Electrolyte for All-Solid-State Batteries.

All-solid-state batteries (ASSBs) based on ceramic materials are considered a key technology for automobiles and energy storage systems owing to their high safety and stability. However, contact issues between the electrode and solid-electrolyte materials and undesired chemical reaction occurring at interfaces have hindered their development. Herein, the chemical compatibility and structural stability of composite mixtures of the layered cathode materials Li1- x Ni0.5 Co0.2 Mn0.3 O2 (NCM523) with the garnet-type solid electrolyte Li6.25 Ga0.25 La3 Zr2 O12 (LLZO-Ga) during high-temperature co-sintering under various gas flowing conditions are investigated. In situ high-temperature X-ray diffraction analysis of the composite materials reveals that Li diffusion from LLZO-Ga to NCM523 occurs at high temperature under synthetic air atmosphere, resulting in the decomposition of LLZO-Ga into La2 Zr2 O7 and the recovery of charged NCM523 to the as-prepared state. The structural stability of the composite mixture at high temperature is further investigated under N2 atmosphere, revealing that Li diffuses toward the opposite direction and involves the phase transition of LLZO-Ga from a cubic to tetragonal structure and the reduction of the NCM523 cathode to Ni metal. These findings provide insight into the structural stability of layered cathode and garnet-type solid-electrolyte composite materials and the design of stable interfaces between them via co-sintering for ASSBs.

Critical Role of Ti4+ in Stabilizing High-Voltage Redox Reactions in Li-Rich Layered Material.

Li-rich layered oxide materials are considered promising candidates for high-capacity cathodes for battery applications and improving the reversibility of the anionic redox reaction is the key to exploiting the full capacity of these materials. However, permanent structural change of the electrode occurring upon electrochemical cycling results in capacity and voltage decay. In view of these factors, Ti4+ -substituted Li2 IrO3 (Li2 Ir0.75 Ti0.25 O3 ) is synthesized, which undergoes an oxygen redox reaction with suppressed voltage decay, yielding improved electrochemical performance and good capacity retention. It is shown that the increased bond covalency upon Ti4+ substitution results in structural stability, tuning the phase stability from O3 to O1' upon de-lithiation during charging compared with O3 to T3 and O1 for pristine Li2 IrO3 , thereby facilitating the oxidation of oxygen. This work unravels the role of Ti4+ in stabilizing the cathode framework, providing insight for a fundamental design approach for advanced Li-rich layered oxide battery materials.