Abstract CT108: A phase I dose escalation study of intra-tumoral LTX-315 as monotherapy or in combination with either ipilimumab or pembrolizumab in patients with transdermally accessible tumors (NCT01986426)

This Phase I clinical study is evaluating the safety and tolerability of intra-tumoral doses of LTX-315 in patients with advanced/metastatic solid tumors. Intratumoral administration results in growth inhibition, complete regression and long lasting tumor specific immune responses in multiple pre-clinical tumor models. LTX-315 treatment results in increased CD8+ T cell infiltration, increased CD8+ T cell/Treg ratio and enhanced T cell clonality.

The oncolytic effect of LTX-315 involves immunogenic cell death as shown by disintegration of cytosolic organelles with subsequent release of DAMPs (Damage-Associated Molecular Pattern molecules) such as ATP, cytochrome C and HMGB1. Multi-domain proteins from the BCL-2 family seem to be partially involved in LTX-315 mediated killing. The membranolytic effect of LTX-315 also facilitates effective release of tumor antigens. In preclinical tumor models, combination of LTX-315 and immune checkpoint inhibitors demonstrates significant synergy.

In this phase I study a recommended Phase II dose as monotherapy and in combination with immune checkpoint inhibitors will be determined. Post-treatment biopsies are also being collected to assess changes in the tumor microenvironment resulting from LTX-315 treatment.

Patients are being recruited to one of 4 arms. Arm A: LTX-315 monotherapy single tumor lesion treatment; Arm B: LTX-315 monotherapy single or multiple lesion treatment; Arm C: LTX-315 and ipilimumab in patients with unresectable/metastatic malignant melanoma previously treated with an anti-PD-1 antibody; Arm D: LTX-315 and pembrolizumab in patients with triple negative breast cancer. Patients are receiving LTX-315 in transdermally accessible lesions on days 1, 2, 8, 9, 15 and 16. Ipilimumab and pembrolizumab are administered at standard dose and schedule. As of January 2017, 28 of 60 planned patients have been recruited. Immune responses are assessed by analysis of T lymphocyte subsets in (peripheral blood) and in tumor tissue. In Arm B PD-L1 expression is assessed in bystander (non-injected) tumor biopsies. Anti-tumor activity is assessed by the immune-related response criteria (irRC) for measureable lesions (irCR, irPR, overall response duration, progression free survival (PFS), time to response and disease control rate (irPR, irCR and stable disease (irSD)).

Citation Format: Jean-Francois Baurain, Ahmad Awada, Paal F. Brunsvig, Rebecca Kristeleit, Delphine Loirat, Dag Eirik Jøssang, Laurence Zitvogel, Guido Kroemer, Aurilièn Marabelle, Øystein Rekdal, Baldur Sveinbjørnsson, Hedda Wold, Berit Nicolaisen, Andrew Saunders, James Spicer. A phase I dose escalation study of intra-tumoral LTX-315 as monotherapy or in combination with either ipilimumab or pembrolizumab in patients with transdermally accessible tumors (NCT01986426) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr CT108. doi:10.1158/1538-7445.AM2017-CT108

LTX-315, an oncolytic peptide, to convert immunogenically ‘cold' tumors to ‘hot' in patients with advanced or metastatic tumours: Results from an ongoing phase I study

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Background: Intratumoral LTX-315 disintegrates cytoplasmic organelles with release of tumor antigens in preclinical models accompanied by increase in tumor-infiltrating lymphocytes (TILs). LTX-315 induced complete regression in several rodent models, with systemic immune responses. LTX-315 is strongly synergistic preclinically with immune checkpoint inhibitors (ICI). We are conducting a phase 1 trial to evaluate LTX-315 in combination therapy. Methods: Patients with advanced metastatic solid tumours received injections of LTX-315 into a single accessible tumour over 6 weeks. Additional injections could be administered thereafter every 2 weeks. Biopsies of injected lesions were taken at baseline, and on treatment. Results: 28 have been enrolled to date, median age is 58 (range 32-80) and median prior treatments 2 (range 1-14). LTX-315 monotherapy was administered at doses of 2-7mg to a median of 1.8 tumour lesions (range 1-6) for a median of 9 weeks (range 1-33). In 24 patients all LTX-315-related adverse events were CTC grade 1 or 2, most commonly local erythema, flushing, pruritis and hypotension, most resolving within minutes of injection. Related grade 3 (3 patients) or 4 (1) allergic/anaphylaxis adverse event occurred and resolved without sequelae. Best response in 44 injected lesions in 20 evaluable patients included 2 complete responses, > 50% reduction in 5 tumours, and 20 stable (injected ). Significant increases in TILs occurred in 67% (14 of 21) patients with biopsies of injected tumours available. Regression of distant non-injected tumour has been observed clinically on biopsy (abscopal effect). No irRC response in non-injected tumours has been observed in 16 evaluable patients. Stable disease (median duration 14 weeks) occurred in 50% of patients as best response (melanoma (4), sarcoma (3), breast (1)). Conclusions: This phase 1 study demonstrates that intratumoural LTX-315 has a manageable safety profile and induces increases in TILs in pre-treated patients. Partial and complete regression was seen in some injected tumours. Evaluation of LTX-315 in combination with ICIs in breast and melanoma is ongoing. Clinical trial information: NCT01986426.

A new method for measuring the neutron lifetime using an in situ neutron detector

In this paper, we describe a new method for measuring surviving neutrons in neutron lifetime measurements using bottled ultracold neutrons (UCN), which provides better characterization of systematic uncertainties and enables higher precision than previous measurement techniques. An active detector that can be lowered into the trap has been used to measure the neutron distribution as a function of height and measure the influence of marginally trapped UCN on the neutron lifetime measurement. In addition, measurements have demonstrated phase-space evolution and its effect on the lifetime measurement.

A Comparison of Prenatal Exposures in Children with and Without A Diagnosis of Autism Spectrum Disorder in an Atlantic Canadian City

BACKGROUND: Autism spectrum disorder (ASD) is a multifactorial disorder characterized by varying deficits in social interactions, disordered communication and repetitive behaviour patterns. Signs that a child has autism are present in the early developmental stages and the symptoms cause significant impairment in many areas of functioning, including social, educational/occupational, and performance of everyday activities. There have been established genetic correlates and noticeable heredity with ASD diagnoses, but so far chromosomal genetic changes have only been found in approximately 25% of children with autism who were studied and there was no single variance that predominated. This signifies that there may be other external factors at play for autism to develop from preexisting genetic risk. Current studies suggest that prenatal exposures are more important to future autism diagnoses than those that happen after birth; there appears to be disruption of neuron gene networks in the cell cycle, protein folding, DNA damage repair and cell apoptosis. Potential prenatal triggers are the focus of this study, with interest to one geographical area in Atlantic Canada.

OBJECTIVES: The study focused on the presence of environmental exposures during pregnancy in children who developed autism spectrum disorder and those who did not, with a specific focus on a specific Atlantic Canadian city. Exposures inquired about included: acetaminophen/ paracetamol use, air pollution, fever, parental age, maternal diabetes, prenatal vitamin use, workplace exposures, recreational drug use, seafood consumption, obesity, and maternal thyroid issues.

DESIGN/METHODS: Mothers of children aged 0-10 years were asked to participate in a telephone interview regarding environmental exposures during their pregnancy. This was followed up by a prenatal chart review. There were two groups of participants: 107 from the autism group and 108 from the non-autism group. The data was analyzed with univariate tests and a logistic regression.

RESULTS: Univariate analysis revealed significant differences between groups for presence of siblings with ASD, presence of family members with ASD, presence of fever, use of medications, use of cigarettes, and gesta-tional age at the start of prenatal vitamins. Logistic regression analysis found significance with use of medications, use of cigarettes, and gesta-tional age at the start of prenatal vitamins.

CONCLUSION: The use of medications and cigarettes during pregnancy are associated with an increased rate of autism diagnosis. As well, a later starting date for use of prenatal vitamins was associated wth autism. Working towards an understanding of factors that come together to create a diagnosis of autism will be helpful for families, physicians, and allocating government resources.

Engaging Consumer Voices in Health Care Policy: Lessons for Social Work Practice

Community health centers provide comprehensive public health care in some of the most disadvantaged communities in the United States. To ensure that health centers meet the needs of their consumers, they uniquely engage them in their organizational decision-making and policy-development processes by requiring that their boards of directors encompass a 51 percent consumer majority. To understand the quality of board members' experiences, a critical ethnography was conducted using Arnstein's ladder of citizen participation and the socioecological model as a framework. The analysis identified multiple influences on the quality of participation among consumer members. Findings also confirm other research that has found that knowledge of the economic, political, and cultural factors surrounding the context of the individual health center is important to understanding meaningful participation. The experience is important to understand given the shift driven by the Patient Protection and Affordable Care Act of 2010 in health care, which emphasizes a patient-entered model of care. Social work practitioners and others in the public health arena interested in empowering consumers to have a role in the provision of services need to understand the impact of each of these areas'and the experience of this unique sample of health center board members.

High order magnetic optics for high dynamic range proton radiography at a kinetic energy of 800 MeV

Flash radiography with 800 MeV kinetic energy protons at Los Alamos National Laboratory is an important experimental tool for investigations of dynamic material behavior driven by high explosives or pulsed power. The extraction of quantitative information about density fields in a dynamic experiment from proton generated images requires a high fidelity model of the proton imaging process. It is shown that accurate calculations of the transmission through the magnetic lens system require terms beyond second order for protons far from the tune energy. The approach used integrates the correlated multiple Coulomb scattering distribution simultaneously over the collimator and the image plane. Comparison with a series of static calibration images demonstrates the model's accurate reproduction of both the transmission and blur over a wide range of tune energies in an inverse identity lens that consists of four quadrupole electromagnets.

Benefits of an expanded use of plasma exchange for anti-neutrophil cytoplasmic antibody-associated vasculitis within a dedicated clinical service

Background

Current recommendations for ANCA-associated vasculitis (AAV) support its management within a dedicated clinical service. Therapies for AAV are imperfect with many patients failing to achieve disease control and others experiencing disease relapse. Plasma exchange (PEX) may be beneficial especially when the kidney is involved.

Methods

Within a new, dedicated service we retrospectively assessed, over a 6-year period, the benefits of PEX in two patient cohorts, discriminated by PEX treatment alone. Patients received PEX alongside standard of care if they fulfilled any of the following criteria: 1. serum creatinine >500 μmol/l or dialysis-requiring renal failure, 2. alveolar haemorrhage, 3. renal biopsy showing ≥30 % focal and necrotising lesions ± cellular crescents. Outcome measures included disease remission and relapse, cumulative immunosuppression, and morbidity and mortality.

Results

Of 104 new patients, 58 patients received PEX at presentation, 46 did not. Cyclophosphamide and/or rituximab dosing was similar for both groups. Although patients receiving PEX had poorer renal function, a higher C-reactive protein and disease activity score at presentation disease remission rate was similar in both groups (no PEX vs. PEX: 96 % vs. 98 %). The PEX group entered remission quicker (no PEX vs. PEX: 3.9 ± 4.0 vs. 2.8 ± 1.3 months, p < 0.05), with a lower 3-month cumulative glucocorticoid dose (no PEX vs. PEX: 2.5 ± 0.4 vs. 2.3 ± 0.2 g, p < 0.001). Relapse was similar between groups but adverse events lower in the PEX group.

Conclusions

PEX may be of benefit in AAV. Larger, longer randomised controlled trials are now needed.

Electronic supplementary material

The online version of this article (doi:10.1186/s12891-015-0796-7) contains supplementary material, which is available to authorized users.

iCarer: AAL for the Informal Carers of the Elderly

In the context of the long-term care for older adults, informal carers play a key role. Daily competing priorities or a care-skills deficit may lead them to stress, anxiety and/or depression. The iCarer project (AAL-2012-5-239) proposes the design and implementation of a cloud-inspired personalised and adaptive platform which will offer support to informal carers of older adults with cognitive impairment. By means of a holistic approach comprising technologies and services addressing the intelligent and interactive monitoring of activities, knowledge management for personalised guidance and orientation, virtual interaction, e-learning, care coordination facilities and social network services, iCarer aims to reduce the informal carer stress and to enhance the quality of care they provide, thus improving their quality of life. The iCarer platform will be evaluated through a multi-centre non-controlled study (4 months; 48 homes located in England and in Slovenia). Currently the iCarer project is completing the development work. The evaluation trial is expected to start in August 2015.

Charged particle radiography

New applications of charged particle radiography have been developed over the past two decades that extend the range of radiographic techniques providing high-speed sequences of radiographs of thicker objects with higher effective dose than can be obtained with conventional radiographic techniques. In this paper, we review the motivation and the development of flash radiography and in particular, charged particle radiography.

Qualitative comparison of bremsstrahlung X-rays and 800 MeV protons for tomography of urania fuel pellets

We present an assessment of x-rays and proton tomography as tools for studying the time dependence of the development of damage in fuel rods. We also show data taken with existing facilities at Los Alamos National Laboratory that support this assessment. Data on surrogate fuel rods have been taken using the 800 MeV proton radiography (pRad) facility at the Los Alamos Neutron Science Center (LANSCE), and with a 450 keV bremsstrahlung X-ray tomography facility. The proton radiography pRad facility at LANSCE can provide good position resolution (<70 μm has been demonstrate, 20 μm seems feasible with minor changes) for tomography on activated fuel rods. Bremsstrahlung x-rays may be able to provide better than 100 μm resolution but further development of sources, collimation, and detectors is necessary for x-rays to deal with the background radiation for tomography of activated fuel rods.

Performance of the Los Alamos National Laboratory spallation-driven solid-deuterium ultra-cold neutron source

In this paper, we describe the performance of the Los Alamos spallation-driven solid-deuterium ultra-cold neutron (UCN) source. Measurements of the cold neutron flux, the very low energy neutron production rate, and the UCN rates and density at the exit from the biological shield are presented and compared to Monte Carlo predictions. The cold neutron rates compare well with predictions from the Monte Carlo code MCNPX and the UCN rates agree with our custom UCN Monte Carlo code. The source is shown to perform as modeled. The maximum delivered UCN density at the exit from the biological shield is 52(9) UCN/cc with a solid deuterium volume of ~1500 cm(3).

A high-field adiabatic fast passage ultracold neutron spin flipper for the UCNA experiment

The UCNA collaboration is making a precision measurement of the β asymmetry (A) in free neutron decay using polarized ultracold neutrons (UCN). A critical component of this experiment is an adiabatic fast passage neutron spin flipper capable of efficient operation in ambient magnetic fields on the order of 1 T. The requirement that it operate in a high field necessitated the construction of a free neutron spin flipper based, for the first time, on a birdcage resonator. The design, construction, and initial testing of this spin flipper prior to its use in the first measurement of A with UCN during the 2007 run cycle of the Los Alamos Neutron Science Center's 800 MeV proton accelerator is detailed. These studies determined the flipping efficiency of the device, averaged over the UCN spectrum present at the location of the spin flipper, to be ̅ε=0.9985(4).

Magnifying lens for 800 MeV proton radiography

This article describes the design and performance of a magnifying magnetic-lens system designed, built, and commissioned at the Los Alamos National Laboratory (LANL) for 800 MeV flash proton radiography. The technique of flash proton radiography has been developed at LANL to study material properties under dynamic loading conditions through the analysis of time sequences of proton radiographs. The requirements of this growing experimental program have resulted in the need for improvements in spatial radiographic resolution. To meet these needs, a new magnetic lens system, consisting of four permanent magnet quadrupoles, has been developed. This new lens system was designed to reduce the second order chromatic aberrations, the dominant source of image blur in 800 MeV proton radiography, as well as magnifying the image to reduce the blur contribution from the detector and camera systems. The recently commissioned lens system performed as designed, providing nearly a factor of three improvement in radiographic resolution.

Determination of the axial-vector weak coupling constant with ultracold neutrons

A precise measurement of the neutron decay β asymmetry A₀ has been carried out using polarized ultracold neutrons from the pulsed spallation ultracold neutron source at the Los Alamos Neutron Science Center. Combining data obtained in 2008 and 2009, we report A₀ = -0.119 66±0.000 89{-0.001 40}{+0.001 23}, from which we determine the ratio of the axial-vector to vector weak coupling of the nucleon g{A}/g{V}=-1.275 90{-0.004 45}{+0.004 09}.

First measurement of the neutron beta asymmetry with ultracold neutrons

We report the first measurement of an angular correlation parameter in neutron beta decay using polarized ultracold neutrons (UCN). We utilize UCN with energies below about 200 neV, which we guide and store for approximately 30 s in a Cu decay volume. The interaction of the neutron magnetic dipole moment with a static 7 T field external to the decay volume provides a 420 neV potential energy barrier to the spin state parallel to the field, polarizing the UCN before they pass through an adiabatic fast passage spin flipper and enter a decay volume, situated within a 1 T field in a 2x2pi solenoidal spectrometer. We determine a value for the beta-asymmetry parameter A_{0}=-0.1138+/-0.0046+/-0.0021.

Functionally relevant microorganisms to enhanced biological phosphorus removal performance at full-scale wastewater treatment plants in the United States

The abundance and relevance ofAccumulibacter phosphatis (presumed to be polyphosphate-accumulating organisms [PAOs]), Competibacter phosphatis (presumed to be glycogen-accumulating organisms [GAOs]), and tetrad-forming organisms (TFOs) to phosphorus removal performance at six full-scale enhanced biological phosphorus removal (EBPR) wastewater treatment plants were investigated. Coexistence of various levels of candidate PAOs and GAOs were found at these facilities. Accumulibacter were found to be 5 to 20% of the total bacterial population, and Competibacter were 0 to 20% of the total bacteria population. The TFO abundance varied from nondetectable to dominant. Anaerobic phosphorus (P) release to acetate uptake ratios (P(rel)/HAc(up)) obtained from bench tests were correlated positively with the abundance ratio of Accumulibacter/(Competibacter +TFOs) and negatively with the abundance of (Competibacter +TFOs) for all plants except one, suggesting the relevance of these candidate organisms to EBPR processes. However, effluent phosphorus concentration, amount of phosphorus removed, and process stability in an EBPR system were not directly related to high PAO abundance or mutually exclusive with a high GAO fraction. The plant that had the lowest average effluent phosphorus and highest stability rating had the lowest P(rel)/HAc(up) and the most TFOs. Evaluation of full-scale EBPR performance data indicated that low effluent phosphorus concentration and high process stability are positively correlated with the influent readily biodegradable chemical oxygen demand-to-phosphorus ratio. A system-level carbon-distribution-based conceptual model is proposed for capturing the dynamic competition between PAOs and GAOs and their effect on an EBPR process, and the results from this study seem to support the model hypothesis.

Direct observation of the phenomenology of a solid thermal explosion using time-resolved proton radiography

We present a new phenomenology for burn propagation inside a thermal explosion based on dynamic radiography. Radiographic images were obtained of an aluminum cased solid cylindrical sample of a plastic bonded formulation of octahydro-1,3,5,7-tetranitro-1,3,5,7-tetrazocine. The phenomenology observed is ignition followed by cracking in the solid accompanied by the propagation of a radially symmetric front of increasing proton transmission. This is followed by a further increase in transmission through the sample, ending after approximately 100 micros. We show that these processes are consistent with the propagation of a convective burn front followed by consumption of the remaining solid by conductive particle burning.