The role of glioma-associated myeloid cells in tumor growth and immune evasion remains poorly understood. We performed single-cell RNA sequencing of immune and tumor cells from 33 gliomas, identifying two distinct myeloid-derived suppressor cell (MDSC) populations in isocitrate dehydrogenase–wild-type (IDT-WT) glioblastoma: an early progenitor MDSC (E-MDSC) population with up-regulation of metabolic and hypoxia pathways and a monocytic MDSC (M-MDSC) population. Spatial transcriptomics demonstrated that E-MDSCs geographically colocalize with metabolic stem-like tumor cells in the pseudopalisading region. Ligand-receptor analysis revealed cross-talk between these cells, where glioma stem-like cells produce chemokines attracting E-MDSCs, which in turn produce growth factors for the tumor cells. This interaction is absent in IDH-mutant gliomas, associated with hypermethylation and repressed gene expression of MDSC-attracting chemokines. Our study elucidates specific MDSCs that may facilitate glioblastoma progression and mediate tumor immunosuppression.

Glioblastoma (GBM) is the most common and fatal primary central nervous system malignancy in adults with a median survival of less than 15 months. Surgery, radiation, and chemotherapy are the standard of care and provide modest benefits in survival, but tumor recurrence is inevitable. The poor prognosis of GBM has made the development of novel therapies targeting GBM of paramount importance. Immunotherapy via dendritic cells (DCs) has garnered attention and research as a potential strategy to boost anti-tumor immunity in recent years. As the “professional” antigen processing and presenting cells, DCs play a key role in the initiation of anti-tumor immune responses. Pre-clinical studies in GBM have shown long-term tumor survival and immunological memory in murine models with stimulation of DC activity with various antigens and costimulatory molecules. Phase I and II clinical trials of DC vaccines in GBM have demonstrated some efficacy in improving the median overall survival with minimal to no toxicity with promising initial results from the first Phase III trial. However, there remains no standardization of vaccines in terms of which antigens are used to pulse DCs ex vivo, sites of DC injection, and optimal adjuvant therapies. Future work with DC vaccines aims to elucidate the efficacy of DC-based therapy alone or in combination with other immunotherapy adjuvants in additional Phase III trials.

According to National AIDS Control Organization of India, NACO, in 2003 there were 530,000 new HIV infections in India with women accounting for a significant number. This raises the issue of HIV prevalence among pregnant women and the transfer of HIV from mother to child (MTCT) especially in states such as Tamil Nadu where the HIV prevalence rates among pregnant women exceeds 1%1. To prevent MTCT various voluntary counseling and testing (VCT) programs have been implemented but baseline data regarding knowledge, attitude and practice towards HIV/AIDS among the pregnant women in many of the regions is lacking. The goal of this study was to determine the general baseline knowledge regarding HIV/AIDS along with attitudes and practices towards HIV/AIDS among rural women in the Namakkal district presenting for antenatal care at government health facilities. Our results show that about 50% of the women did not think or did not know that HIV transmission from person to person can be prevented and also about 60% of the women did not think or know that MTCT can be prevented. Almost 90% of the women did not know where they can get testing for HIV and 80% did not know where they can go to receive PMTCT services. The majority of the women (70%) indicated they would accept medication to reduce MTCT, however only 32% were willing to accept HIV testing if pregnant. These findings help to identify the gaps in knowledge regarding HIV/AIDS among pregnant women and the barriers they face. Future VCT sessions need to take these factors into consideration to overcome such barriers and to increase the effectiveness of VCT and to reduce MTCT.

Background and Study Aims/Objective Brain lesions in deep-seated locations can present a surgical challenge. Tissue remains the gold standard for diagnosing these lesions to guide potential adjuvant therapy. These lesions have been traditionally approached by stereotactic needle biopsy, open biopsies through craniotomies, and excisional biopsies. We provide a safe alternative method using tubular retractors under exoscopic visualization for biopsies of deep-seated brain lesions. Material and Methods All patients who underwent a biopsy with the use of a tubular retractor under exoscopic visualization of a deep-seated lesion from January 2013 to September 2016 were identified prospectively and followed. This was done for patients with lesions where extensive resection was not deemed possible because of eloquent location and/or lack of impact on the natural history of the disease. Results A total of 11 patients, with an average age (plus or minus standard deviation) of 48.7 ± 18.3 years, underwent biopsies with tubular retractors and exoscopic visualization. The locations included thalamus (n = 3), optic pathway (n = 2), deep cerebellar nuclei (n = 1), centrum semiovale/corpus callosum (n = 4), and multifocal (n = 2). Diagnosis was obtained in all patients: glioblastoma multiforme (n = 3), anaplastic astrocytoma (n = 3), demyelinating disease (n = 2), renal cell cancer (n = 1), and lymphoma (n = 2). In all cases with tumors, the molecular analyses were conducted successfully. On postoperative computed tomography, no patients had notable hematomas and no patients had new deficits. Conclusion Diagnosing brain lesions is critical for guiding potential adjuvant therapies. When surgical resection is not possible or required, we report the efficacy of a tubular retractor system with exoscopic visualization for the safe access of deep-seated lesions to provide adequate tissue for diagnosis and molecular evaluation.