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Munoz Pinto MF, Campbell SJ, Simoglou Karali C, Johanssen VA, Bristow C, Cheng VWT, Zarghami N, Larkin JR, Pannell M, Hearn A, Chui C, Brinquis Nunez B, Bokma E, Holgate R, Anthony DC, Sibson NR. Selective blood-brain barrier permeabilization of brain metastases by a type 1 receptor-selective tumor necrosis factor mutein. Neuro Oncol 2022; 24:52-63. [PMID: 34297105 PMCID: PMC8730757 DOI: 10.1093/neuonc/noab177] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Metastasis to the brain is a major challenge with poor prognosis. The blood-brain barrier (BBB) is a significant impediment to effective treatment, being intact during the early stages of tumor development and heterogeneously permeable at later stages. Intravenous injection of tumor necrosis factor (TNF) selectively induces BBB permeabilization at sites of brain micrometastasis, in a TNF type 1 receptor (TNFR1)-dependent manner. Here, to enable clinical translation, we have developed a TNFR1-selective agonist variant of human TNF that induces BBB permeabilization, while minimizing potential toxicity. METHODS A library of human TNF muteins (mutTNF) was generated and assessed for binding specificity to mouse and human TNFR1/2, endothelial permeabilizing activity in vitro, potential immunogenicity, and circulatory half-life. The permeabilizing ability of the most promising variant was assessed in vivo in a model of brain metastasis. RESULTS The primary mutTNF variant showed similar affinity for human TNFR1 than wild-type human TNF, similar affinity for mouse TNFR1 as wild-type mouse TNF, undetectable binding to human/mouse TNFR2, low potential immunogenicity, and permeabilization of an endothelial monolayer. Circulatory half-life was similar to mouse/human TNF and BBB permeabilization was induced selectively at sites of micrometastases in vivo, with a time window of ≥24 hours and enabling delivery of agents within a therapeutically relevant range (0.5-150 kDa), including the clinically approved therapy, trastuzumab. CONCLUSIONS We have developed a clinically translatable mutTNF that selectively opens the BBB at micrometastatic sites, while leaving the rest of the cerebrovasculature intact. This approach will open a window for brain metastasis treatment that currently does not exist.
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Affiliation(s)
- Mario F Munoz Pinto
- Medical Research Council Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, UK
- Center for Neuroscience and Cell Biology (CNC), University of Coimbra, Coimbra, Portugal
| | - Sandra J Campbell
- Medical Research Council Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, UK
| | - Christina Simoglou Karali
- Medical Research Council Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, UK
- MRC Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Vanessa A Johanssen
- Medical Research Council Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, UK
| | - Claire Bristow
- Medical Research Council Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, UK
| | - Vinton W T Cheng
- Medical Research Council Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, UK
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - Niloufar Zarghami
- Medical Research Council Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, UK
| | - James R Larkin
- Medical Research Council Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, UK
| | - Maria Pannell
- Medical Research Council Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, UK
- OxSonics Ltd., The Magdalen Centre, Oxford Science Park, Oxford, UK
| | - Arron Hearn
- Abzena Ltd., Babraham Research Campus, Babraham, Cambridge, UK
| | - Cherry Chui
- Abzena Ltd., Babraham Research Campus, Babraham, Cambridge, UK
| | | | - Evert Bokma
- Abzena Ltd., Babraham Research Campus, Babraham, Cambridge, UK
| | - Robert Holgate
- Abzena Ltd., Babraham Research Campus, Babraham, Cambridge, UK
| | | | - Nicola R Sibson
- Medical Research Council Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, UK
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Thomas X. Acute Promyelocytic Leukemia: A History over 60 Years-From the Most Malignant to the most Curable Form of Acute Leukemia. Oncol Ther 2019; 7:33-65. [PMID: 32700196 PMCID: PMC7360001 DOI: 10.1007/s40487-018-0091-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Indexed: 02/07/2023] Open
Abstract
Acute promyelocytic leukemia (APL) is a distinct subtype of acute myeloid leukemia (AML) that is cytogenetically characterized by a balanced reciprocal translocation between chromosomes 15 and 17, which results in the fusion of the promyelocytic leukemia (PML) and retinoic acid receptor alpha (RARα) genes. Because patients with APL present a tendency for severe bleeding, often resulting in an early fatal course, APL was historically considered to be one of the most fatal forms of acute leukemia. However, therapeutic advances, including anthracycline- and cytarabine-based chemotherapy, have significantly improved the outcomes of APL patients. Due to the further introduction of all-trans retinoic acid (ATRA) and-more recently-the development of arsenic trioxide (ATO)-containing regimens, APL is currently the most curable form of AML in adults. Treatment with these new agents has introduced the concept of cure through targeted therapy. With the advent of revolutionary ATRA-ATO combination therapies, chemotherapy can now be safely omitted from the treatment of low-risk APL patients. In this article, we review the six-decade history of APL, from its initial characterization to the era of chemotherapy-free ATRA-ATO, a model of cancer-targeted therapy.
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Affiliation(s)
- Xavier Thomas
- Hospices Civils de Lyon, Hematology Department, Lyon-Sud University Hospital, Pierre Bénite, France.
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Zhang X, Zhang H, Chen L, Wang M, Xi J, Liu X, Xie M, Li D, Gulati ES, Gong S, Wang H. Arsenic trioxide and all-trans retinoic acid (ATRA) treatment for acute promyelocytic leukemia in all risk groups: study protocol for a randomized controlled trial. Trials 2018; 19:476. [PMID: 30185214 PMCID: PMC6126003 DOI: 10.1186/s13063-018-2812-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 07/17/2018] [Indexed: 12/16/2022] Open
Abstract
Background The treatment of acute promyelocytic leukemia (APL) has been revolutionized in the past two decades by the advent of all-trans retinoic acid (ATRA) and arsenic trioxide (ATO). It suggests that non-high-risk APL patients can be cured without chemotherapy. However, ATRA plus chemotherapy is still the standard therapy for the high-risk patients. Central nervous system (CNS) relapse remains a significant cause of treatment failure in high-risk patients. However, increasing the ATO concentration in cerebrospinal fluid (CSF) may reduce CNS relapse in high-risk patients. Mannitol can allow ATO to penetrate the blood-brain barrier (BBB) and reach therapeutically effective levels in the CSF. It is used for the treatment of CNS relapse in patients APL. We compare ATRA-ATO with ATRA-ATO plus chemotherapy in both high-risk and non-high-risk patients with APL. Methods This study was designed as a multicenter randomized controlled trial. Patients with APL were randomly assigned into two groups: the ATRA-ATO group (experimental group) and the ATRA-ATO plus chemotherapy group (control group). The experimental group receives therapy with ATRA-ATO for induction, consolidation and maintenance therapy. In the high-risk patients, mannitol will be used with ATO in the consolidation and maintenance therapy. Hydroxyurea will be used in patients who developed leukocytosis in the induction therapy. The control group receives therapy with ATRA-ATO plus chemotherapy for induction and consolidation therapy. Discussion In this study, a randomized clinical trial design is described. It aims to compare the efficacy of ATRA-ATO versus ATRA-ATO plus chemotherapy in all-risk patients with APL. Trial registration Chinese Clinical Trials Registry, ID: ChiCTR-IPR-15006821. Registered on 27 July 2015. Electronic supplementary material The online version of this article (10.1186/s13063-018-2812-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Xinxin Zhang
- Department of Hematology, First affiliated hospital of Xi'an Jiaotong University, Yanta West Road, Xi'an, 710061, Shaanxi, China
| | - Huiyun Zhang
- Department of Hematology, First affiliated hospital of Xi'an Jiaotong University, Yanta West Road, Xi'an, 710061, Shaanxi, China
| | - Limei Chen
- Department of Hematology, First affiliated hospital of Xi'an Jiaotong University, Yanta West Road, Xi'an, 710061, Shaanxi, China
| | - Mengchang Wang
- Department of Hematology, First affiliated hospital of Xi'an Jiaotong University, Yanta West Road, Xi'an, 710061, Shaanxi, China
| | - Jieying Xi
- Department of Hematology, First affiliated hospital of Xi'an Jiaotong University, Yanta West Road, Xi'an, 710061, Shaanxi, China
| | - Xin Liu
- Department of Hematology, First affiliated hospital of Xi'an Jiaotong University, Yanta West Road, Xi'an, 710061, Shaanxi, China
| | - Ming Xie
- Department of Hematology, First affiliated hospital of Xi'an Jiaotong University, Yanta West Road, Xi'an, 710061, Shaanxi, China
| | - Dengzhe Li
- Department of Hematology, First affiliated hospital of Xi'an Jiaotong University, Yanta West Road, Xi'an, 710061, Shaanxi, China
| | - Ekamjyot Singh Gulati
- Department of Hematology, First affiliated hospital of Xi'an Jiaotong University, Yanta West Road, Xi'an, 710061, Shaanxi, China
| | - Sha Gong
- Department of Hematology, First affiliated hospital of Xi'an Jiaotong University, Yanta West Road, Xi'an, 710061, Shaanxi, China
| | - Huaiyu Wang
- Department of Hematology, First affiliated hospital of Xi'an Jiaotong University, Yanta West Road, Xi'an, 710061, Shaanxi, China.
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Pianovich NA, Dean M, Lassak A, Reiss K, Jursic BS. Anticancer potential of aminomethylidene-diazinanes I. Synthesis of arylaminomethylidene of diazinetriones and its cytotoxic effects tested in glioblastoma cells. Bioorg Med Chem 2017; 25:5068-5076. [PMID: 28864149 DOI: 10.1016/j.bmc.2017.08.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 08/09/2017] [Accepted: 08/10/2017] [Indexed: 10/19/2022]
Abstract
Diazinane and aryl moieties with vinylamine linkers were synthesized to investigate the importance of their structural variations as potential anti-glioblastoma agents. Structural variations incorporated on to the diazinane moiety included oxa and thio derivatives, each with a variety of nitrogen-bound substituents. The size and shape of the aromatic moiety was varied, with the final variation introducing two carbonyl groups, yielding a substituted anthraquinone. Readily available diazinanes and aryl amines were used asan advantageous foundation. Several parameters were calculated whilst engineering these compounds, including: ClogP, molecular polarizability, polar surface area, minimal molecular projected area, and pKa. In addition, a simple and efficient procedure was developed to synthesize these compounds. It was demonstrated that a vinylamine with 1,3-diazinane-2,4,6-trione and 1-anthraquinone moiety is the most promising drug candidate causing almost 70% of LN229 tumor cell death at 1µg/ml. In addition, its molecular polarizability, polar surface area and minimal molecular projected area indicate a possible potential of this molecule for crossing BBB.
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Affiliation(s)
- Nichole A Pianovich
- Department of Chemistry, University of New Orleans, New Orleans, LA 70148, USA
| | - Mathew Dean
- Neurological Cancer Research, Stanley S. Scott Cancer Center, Department of Medicine, LSU Health Sciences Center, New Orleans, LA 70119 USA
| | - Adam Lassak
- Neurological Cancer Research, Stanley S. Scott Cancer Center, Department of Medicine, LSU Health Sciences Center, New Orleans, LA 70119 USA
| | - Krzysztof Reiss
- Neurological Cancer Research, Stanley S. Scott Cancer Center, Department of Medicine, LSU Health Sciences Center, New Orleans, LA 70119 USA
| | - Branko S Jursic
- Department of Chemistry, University of New Orleans, New Orleans, LA 70148, USA; STEPHARM, LLC., PO Box 24220, New Orleans, LA 70184, USA.
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Hersh DS, Wadajkar AS, Roberts NB, Perez JG, Connolly NP, Frenkel V, Winkles JA, Woodworth GF, Kim AJ. Evolving Drug Delivery Strategies to Overcome the Blood Brain Barrier. Curr Pharm Des 2016; 22:1177-1193. [PMID: 26685681 PMCID: PMC4900538 DOI: 10.2174/1381612822666151221150733] [Citation(s) in RCA: 192] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 12/18/2015] [Indexed: 01/10/2023]
Abstract
The blood-brain barrier (BBB) poses a unique challenge for drug delivery to the central nervous system (CNS). The BBB consists of a continuous layer of specialized endothelial cells linked together by tight junctions, pericytes, nonfenestrated basal lamina, and astrocytic foot processes. This complex barrier controls and limits the systemic delivery of therapeutics to the CNS. Several innovative strategies have been explored to enhance the transport of therapeutics across the BBB, each with individual advantages and disadvantages. Ongoing advances in delivery approaches that overcome the BBB are enabling more effective therapies for CNS diseases. In this review, we discuss: (1) the physiological properties of the BBB, (2) conventional strategies to enhance paracellular and transcellular transport through the BBB, (3) emerging concepts to overcome the BBB, and (4) alternative CNS drug delivery strategies that bypass the BBB entirely. Based on these exciting advances, we anticipate that in the near future, drug delivery research efforts will lead to more effective therapeutic interventions for diseases of the CNS.
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Affiliation(s)
| | | | | | | | | | | | | | - Graeme F. Woodworth
- Address correspondence to these authors at the Department of Neurosurgery, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD 21201; E-mail: , Departments of Neurosurgery and Pharmaceutical Sciences, University of Maryland, Baltimore, 655 W. Baltimore Street, Baltimore, MD 21201;, E-mail:
| | - Anthony J. Kim
- Address correspondence to these authors at the Department of Neurosurgery, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD 21201; E-mail: , Departments of Neurosurgery and Pharmaceutical Sciences, University of Maryland, Baltimore, 655 W. Baltimore Street, Baltimore, MD 21201;, E-mail:
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