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Zhu P, Li SY, Ding J, Fei Z, Sun SN, Zheng ZH, Wei D, Jiang J, Miao JL, Li SZ, Luo X, Zhang K, Wang B, Zhang K, Pu S, Wang QT, Zhang XY, Wen GL, Liu JO, August JT, Bian H, Chen ZN, He YW. Combination immunotherapy of glioblastoma with dendritic cell cancer vaccines, anti-PD-1 and poly I:C. J Pharm Anal 2023; 13:616-624. [PMID: 37440907 PMCID: PMC10334272 DOI: 10.1016/j.jpha.2023.04.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 04/13/2023] [Accepted: 04/18/2023] [Indexed: 07/15/2023] Open
Abstract
Glioblastoma (GBM) is a lethal cancer with limited therapeutic options. Dendritic cell (DC)-based cancer vaccines provide a promising approach for GBM treatment. Clinical studies suggest that other immunotherapeutic agents may be combined with DC vaccines to further enhance antitumor activity. Here, we report a GBM case with combination immunotherapy consisting of DC vaccines, anti-programmed death-1 (anti-PD-1) and poly I:C as well as the chemotherapeutic agent cyclophosphamide that was integrated with standard chemoradiation therapy, and the patient remained disease-free for 69 months. The patient received DC vaccines loaded with multiple forms of tumor antigens, including mRNA-tumor associated antigens (TAA), mRNA-neoantigens, and hypochlorous acid (HOCl)-oxidized tumor lysates. Furthermore, mRNA-TAAs were modified with a novel TriVac technology that fuses TAAs with a destabilization domain and inserts TAAs into full-length lysosomal associated membrane protein-1 to enhance major histocompatibility complex (MHC) class I and II antigen presentation. The treatment consisted of 42 DC cancer vaccine infusions, 26 anti-PD-1 antibody nivolumab administrations and 126 poly I:C injections for DC infusions. The patient also received 28 doses of cyclophosphamide for depletion of regulatory T cells. No immunotherapy-related adverse events were observed during the treatment. Robust antitumor CD4+ and CD8+ T-cell responses were detected. The patient remains free of disease progression. This is the first case report on the combination of the above three agents to treat glioblastoma patients. Our results suggest that integrated combination immunotherapy is safe and feasible for long-term treatment in this patient. A large-scale trial to validate these findings is warranted.
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Affiliation(s)
- Ping Zhu
- Department of Clinical Immunology, Xijing Hospital, Department of Cell Biology, National Translational Science Center for Molecular Medicine, Fourth Military Medical University, Xi'an, 710032, China
| | - Shi-You Li
- Beijing Tricision Biotherapeutics Inc., Beijing, 100176, China
| | - Jin Ding
- Department of Clinical Immunology, Xijing Hospital, Department of Cell Biology, National Translational Science Center for Molecular Medicine, Fourth Military Medical University, Xi'an, 710032, China
| | - Zhou Fei
- Department of Neurosurgery, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - Sheng-Nan Sun
- Beijing Tricision Biotherapeutics Inc., Beijing, 100176, China
| | - Zhao-Hui Zheng
- Department of Clinical Immunology, Xijing Hospital, Department of Cell Biology, National Translational Science Center for Molecular Medicine, Fourth Military Medical University, Xi'an, 710032, China
| | - Ding Wei
- Department of Clinical Immunology, Xijing Hospital, Department of Cell Biology, National Translational Science Center for Molecular Medicine, Fourth Military Medical University, Xi'an, 710032, China
| | - Jun Jiang
- Zhuhai Tricision Biotherapuetics Inc., Zhuhai, Guangdong, 519040, China
| | - Jin-Lin Miao
- Department of Clinical Immunology, Xijing Hospital, Department of Cell Biology, National Translational Science Center for Molecular Medicine, Fourth Military Medical University, Xi'an, 710032, China
| | - San-Zhong Li
- Department of Neurosurgery, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - Xing Luo
- Department of Clinical Immunology, Xijing Hospital, Department of Cell Biology, National Translational Science Center for Molecular Medicine, Fourth Military Medical University, Xi'an, 710032, China
| | - Kui Zhang
- Department of Clinical Immunology, Xijing Hospital, Department of Cell Biology, National Translational Science Center for Molecular Medicine, Fourth Military Medical University, Xi'an, 710032, China
| | - Bin Wang
- Department of Clinical Immunology, Xijing Hospital, Department of Cell Biology, National Translational Science Center for Molecular Medicine, Fourth Military Medical University, Xi'an, 710032, China
| | - Kun Zhang
- Department of Clinical Immunology, Xijing Hospital, Department of Cell Biology, National Translational Science Center for Molecular Medicine, Fourth Military Medical University, Xi'an, 710032, China
| | - Su Pu
- Beijing Tricision Biotherapeutics Inc., Beijing, 100176, China
| | - Qian-Ting Wang
- Beijing Tricision Biotherapeutics Inc., Beijing, 100176, China
| | - Xin-Yue Zhang
- Zhuhai Tricision Biotherapuetics Inc., Zhuhai, Guangdong, 519040, China
| | - Gao-Liu Wen
- Zhuhai Tricision Biotherapuetics Inc., Zhuhai, Guangdong, 519040, China
| | - Jun O. Liu
- Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - John Thomas August
- Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Huijie Bian
- Department of Clinical Immunology, Xijing Hospital, Department of Cell Biology, National Translational Science Center for Molecular Medicine, Fourth Military Medical University, Xi'an, 710032, China
| | - Zhi-Nan Chen
- Department of Clinical Immunology, Xijing Hospital, Department of Cell Biology, National Translational Science Center for Molecular Medicine, Fourth Military Medical University, Xi'an, 710032, China
| | - You-Wen He
- Beijing Tricision Biotherapeutics Inc., Beijing, 100176, China
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Montemurro N, Pahwa B, Tayal A, Shukla A, De Jesus Encarnacion M, Ramirez I, Nurmukhametov R, Chavda V, De Carlo A. Macrophages in Recurrent Glioblastoma as a Prognostic Factor in the Synergistic System of the Tumor Microenvironment. Neurol Int 2023; 15:595-608. [PMID: 37218976 DOI: 10.3390/neurolint15020037] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 04/05/2023] [Accepted: 04/21/2023] [Indexed: 05/24/2023] Open
Abstract
Glioblastoma (GBM) is a common and highly malignant primary tumor of the central nervous system in adults. Ever more recent papers are focusing on understanding the role of the tumor microenvironment (TME) in affecting tumorigenesis and the subsequent prognosis. We assessed the impact of macrophages in the TME on the prognosis in patients with recurrent GBM. A PubMed, MEDLINE and Scopus review was conducted to identify all studies dealing with macrophages in the GBM microenvironment from January 2016 to December 2022. Glioma-associated macrophages (GAMs) act critically in enhancing tumor progression and can alter drug resistance, promoting resistance to radiotherapy and establishing an immunosuppressive environment. M1 macrophages are characterized by increased secretion of proinflammatory cytokines, such as IL-1ß, tumor necrosis factor (TNF), IL-27, matrix metalloproteinase (MMPs), CCL2, and VEGF (vascular endothelial growth factor), IGF1, that can lead to the destruction of the tissue. In contrast, M2 is supposed to participate in immunosuppression and tumor progression, which is formed after being exposed to the macrophage M-CSF, IL-10, IL-35 and the transforming growth factor-ß (TGF-β). Because there is currently no standard of care in recurrent GBM, novel identified targeted therapies based on the complex signaling and interactions between the glioma stem cells (GSCs) and the TME, especially resident microglia and bone-marrow-derived macrophages, may be helpful in improving the overall survival of these patients in the near future.
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Affiliation(s)
- Nicola Montemurro
- Department of Neurosurgery, Azienda Ospedaliero Universitaria Pisana (AOUP), University of Pisa, 56100 Pisa, Italy
| | - Bhavya Pahwa
- University College of Medical Sciences and GTB Hospital, New Delhi 110095, India
| | - Anish Tayal
- University College of Medical Sciences and GTB Hospital, New Delhi 110095, India
| | - Anushruti Shukla
- University College of Medical Sciences and GTB Hospital, New Delhi 110095, India
| | | | - Issael Ramirez
- Royal Melbourne Hospital, Melbourne, VIC 3000, Australia
| | - Renat Nurmukhametov
- Department of Spinal Surgery, Central Clinical Hospital of the Russian Academy of Sciences, 121359 Moscow, Russia
| | - Vishal Chavda
- Department of Pathology, Stanford of School of Medicine, Stanford University Medical Centre, Palo Alto, CA 94305, USA
| | - Antonella De Carlo
- Department of Neurosurgery, Azienda Ospedaliero Universitaria Pisana (AOUP), University of Pisa, 56100 Pisa, Italy
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Madhugiri VS, Venkatesan S, Dutt A, Moiyadi AV, Shetty P, Gupta T, Epari S, Jalali R, Sasidharan GM, Kumar VRR, Ganesh CVS, Ramesh AS, Prabhu AS, Dutt AK. An Analysis of Eosinophil- and Basophil-Based Indices in Patients with Glioblastoma and their Correlation with Survival. World Neurosurg 2023; 170:e292-e300. [PMID: 36368458 DOI: 10.1016/j.wneu.2022.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 11/01/2022] [Accepted: 11/02/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Glioblastoma (GBM) is the most frequently diagnosed malignant brain tumor in adults. GBM is usually lethal within 24 months of diagnosis, despite aggressive multimodality treatment. Although it has been established that cancer-related inflammation is associated with worse outcomes, the role of eosinophils, basophils, atopy, and allergy in glioma biology is only gradually being delineated. In this study, we aimed to examine if eosinophil-based and basophil-based indices were altered in patients with GBM compared with healthy controls. We also aimed to study if there was any correlation between these indices and patient-related and tumor-related factors and survival. METHODS This study was a retrospective analysis of prospectively maintained databases. Data pertaining to patient-related and tumor-related factors, hemograms, and survival data were obtained from the electronic medical records of selected patients. Correlations between eosinophil-based and basophil-based indices and these factors were studied, as was the association with overall survival. RESULTS All the indices were altered in patients with GBM compared with normal healthy controls. The absolute eosinophil count was higher and the neutrophils/eosinophils ratio was lower in the better prognosis groups: those with better performance status; those without features of increased intracranial pressure or altered sensorium at presentation; those with ATRX-retained tumors that did not overexpress p53; and in the long-term survivors. The total lymphocyte count/basophils ratio and the absolute eosinophil count both independently predicted survival in a multivariate analysis. CONCLUSIONS The absolute eosinophil count was consistently higher in the better prognosis groups and is likely to be incorporated into prognostic models for GBM.
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Affiliation(s)
- Venkatesh S Madhugiri
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India.
| | - Subeikshanan Venkatesan
- Department of Neurosurgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Akshat Dutt
- Department of Neurosurgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Aliasgar V Moiyadi
- Division of Neurosurgery, Neuro-Oncology Disease Management Group, Tata Memorial Centre (TMH and ACTREC), Mumbai, India
| | - Prakash Shetty
- Division of Neurosurgery, Neuro-Oncology Disease Management Group, Tata Memorial Centre (TMH and ACTREC), Mumbai, India
| | - Tejpal Gupta
- Department of Radiation Oncology, Neuro-Oncology Disease Management Group, Tata Memorial Centre (TMH and ACTREC), Mumbai, India
| | - Sridhar Epari
- Department of Pathology, Neuro-Oncology Disease Management Group, Tata Memorial Centre (TMH and ACTREC), Mumbai, India
| | - Rakesh Jalali
- Department of Radiation Oncology, Apollo Proton Cancer Centre, Chennai, India
| | - Gopalakrishnan M Sasidharan
- Department of Neurosurgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - V R Roopesh Kumar
- Department of Surgical Oncology, Apollo Proton Cancer Centre, Chennai, India
| | | | - Andi Sadayandi Ramesh
- Department of Neurosurgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - A Sathia Prabhu
- Department of Neurosurgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
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Han Y, Sun J, Wei H, Hao J, Liu W, Wang X. Ultrasound-Targeted Microbubble Destruction: Modulation in the Tumor Microenvironment and Application in Tumor Immunotherapy. Front Immunol 2022; 13:937344. [PMID: 35844515 PMCID: PMC9283646 DOI: 10.3389/fimmu.2022.937344] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 05/27/2022] [Indexed: 12/14/2022] Open
Abstract
Tumor immunotherapy has shown strong therapeutic potential for stimulating or reconstructing the immune system to control and kill tumor cells. It is a promising and effective anti-cancer treatment besides surgery, radiotherapy and chemotherapy. Presently, some immunotherapy methods have been approved for clinical application, and numerous others have demonstrated promising in vitro results and have entered clinical trial stages. Although immunotherapy has exhibited encouraging results in various cancer types, however, a large proportion of patients are limited from these benefits due to specific characteristics of the tumor microenvironment such as hypoxia, tumor vascular malformation and immune escape, and current limitations of immunotherapy such as off-target toxicity, insufficient drug penetration and accumulation and immune cell dysfunction. Ultrasound-target microbubble destruction (UTMD) treatment can help reduce immunotherapy-related adverse events. Using the ultrasonic cavitation effect of microstreaming, microjets and free radicals, UTMD can cause a series of changes in vascular endothelial cells, such as enhancing endothelial cells' permeability, increasing intracellular calcium levels, regulating gene expression, and stimulating nitric oxide synthase activities. These effects have been shown to promote drug penetration, enhance blood perfusion, increase drug delivery and induce tumor cell death. UTMD, in combination with immunotherapy, has been used to treat melanoma, non-small cell lung cancer, bladder cancer, and ovarian cancer. In this review, we summarized the effects of UTMD on tumor angiogenesis and immune microenvironment, and discussed the application and progress of UTMD in tumor immunotherapy.
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Affiliation(s)
| | | | | | | | | | - Xiaolei Wang
- In-Patient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Harbin, China
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Wang QT, Nie Y, Sun SN, Lin T, Han RJ, Jiang J, Li Z, Li JQ, Xiao YP, Fan YY, Yuan XH, Zhang H, Zhao BB, Zeng M, Li SY, Liao HX, Zhang J, He YW. Tumor-associated antigen-based personalized dendritic cell vaccine in solid tumor patients. Cancer Immunol Immunother 2020; 69:1375-1387. [PMID: 32078016 DOI: 10.1007/s00262-020-02496-w] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 01/20/2020] [Indexed: 12/14/2022]
Abstract
Tumor-associated antigens (TAAs) have been tested in various clinical trials in cancer treatment but the patterns of specific T cell response to personalized TAA immunization remains to be fully understood. We report antigen-specific T cell responses in patients immunized with dendritic cell vaccines pulsed with personalized TAA panels. Tumor samples from patients were first analyzed to identify overexpressed TAAs. Autologous DCs were then transfected with pre-manufactured mRNAs encoding the full-length TAAs, overexpressed in the patients' tumors. Patients with glioblastoma multiforme (GBM) or advanced lung cancer received DC vaccines transfected with personalized TAA panels, in combination with low-dose cyclophosphamide, poly I:C, imiquimod and anti-PD-1 antibody. Antigen-specific T cell responses were measured. Safety and efficacy were evaluated. A total of ten patients were treated with DC vaccines transfected with personalized TAA panels containing 3-13 different TAAs. Among the seven patients tested for anti-TAA T cell responses, most of the TAAs induced antigen-specific CD4+ and/or CD8+ T cell responses, regardless of their expression levels in the tumor tissues. No Grade III/IV adverse events were observed among these patients. Furthermore, the treated patients were associated with favorable overall survival when compared to patients who received standard treatment in the same institution. Personalized TAA immunization-induced-specific CD4+ and CD8+ T cell responses without obvious autoimmune adverse events and was associated with favorable overall survival. These results support further studies on DC immunization with personalized TAA panels for combined immunotherapeutic regimens in solid tumor patients.Trial registration ClinicalTrials.gov, NCT02709616 (March, 2016), NCT02808364 (June 2016), NCT02808416 (June, 2016).
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Affiliation(s)
- Qian-Ting Wang
- College of Life Science and Technology, Jinan University, Guangzhou, People's Republic of China.,Jinan University Affiliated Guangdong 999 Brain Hospital, Guangzhou, People's Republic of China
| | - Ying Nie
- Jinan University Affiliated Guangdong 999 Brain Hospital, Guangzhou, People's Republic of China
| | - Sheng-Nan Sun
- Beijing Tricision Biotherapeutics Corporation, Beijing, People's Republic of China
| | - Tao Lin
- Jinan University Affiliated Guangdong 999 Brain Hospital, Guangzhou, People's Republic of China
| | - Ru-Jin Han
- Jinan University Affiliated Guangdong 999 Brain Hospital, Guangzhou, People's Republic of China
| | - Jun Jiang
- Beijing Tricision Biotherapeutics Corporation, Beijing, People's Republic of China
| | - Zhe Li
- Jinan University Affiliated Guangdong 999 Brain Hospital, Guangzhou, People's Republic of China
| | - Jun-Qi Li
- College of Life Science and Technology, Jinan University, Guangzhou, People's Republic of China
| | - Yun-Peng Xiao
- Guangzhou Trinomab Biotechnology Corporation, Guangzhou, People's Republic of China
| | - Yu-Ying Fan
- Jinan University Affiliated Guangdong 999 Brain Hospital, Guangzhou, People's Republic of China
| | - Xiao-Hui Yuan
- College of Life Science and Technology, Jinan University, Guangzhou, People's Republic of China
| | - Hui Zhang
- First Affiliated Hospital, China Medical University, Shenyang, People's Republic of China
| | - Bin-Bin Zhao
- MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Ming Zeng
- The Cancer Center, Sichuan Provincial People's Hospital, Chengdu, People's Republic of China
| | - Shi-You Li
- Beijing Tricision Biotherapeutics Corporation, Beijing, People's Republic of China
| | - Hua-Xin Liao
- College of Life Science and Technology, Jinan University, Guangzhou, People's Republic of China.
| | - Jian Zhang
- Jinan University Affiliated Guangdong 999 Brain Hospital, Guangzhou, People's Republic of China.
| | - You-Wen He
- Department of Immunology, Duke University Medical Center, Box 3010, Durham, NC, 27710, USA.
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Zhang J, Xiao X, Zhang X, Hua W. Tumor Microenvironment Characterization in Glioblastoma Identifies Prognostic and Immunotherapeutically Relevant Gene Signatures. J Mol Neurosci 2020; 70:738-750. [PMID: 32006162 DOI: 10.1007/s12031-020-01484-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 01/17/2020] [Indexed: 12/13/2022]
Abstract
Tumor microenvironment (TME) cells are important elements in tumor tissue. There is increasing evidence that they have important clinical pathological significance in predicting tumor clinical outcomes and therapeutic effects. However, no systematic analysis of TME cell interactions in glioblastoma (GBM) has been reported. We systematically analyzed the transcriptional sequencing data of GBM to find an immune gene marker to predict the clinical results of GBM. First, we downloaded the expression profiles and clinical follow-up information of GBM from The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO). CIBERSORT was used to evaluate the infiltration mode of TME in 757 patients, systematically correlated TME phenotype with genomic characteristics and clinicopathological characteristics of GBM, defined four TME phenotypes, and TMEScore was constructed using algorithms such as random forest and principal component analysis. There is a significant correlation between TMEScore and age of onset. High TMEScore samples are characterized by immune activation, TGF pathway activation, and high expression of immune checkpoint genes, while low TMEScore samples are characterized by high-frequency IDH1 and MET mutations. Therefore, a comprehensive landscape depicting the TME characteristics of GBM may help explain GBM's response to immunotherapy and provide new strategies for cancer treatment. In this study, TMEScore can be used as a new prognostic marker to predict the survival of GBM patients, and as a potential predictor of immune checkpoint inhibitor response.
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Affiliation(s)
- Jinsen Zhang
- Department of Neurosurgery, Huashan Hospital, Fudan University, No.12 Wulumuqi Zhong Road, Shanghai, 200040, China
| | - Xing Xiao
- Department of Neurosurgery, Huashan Hospital, Fudan University, No.12 Wulumuqi Zhong Road, Shanghai, 200040, China
| | - Xin Zhang
- Department of Neurosurgery, Huashan Hospital, Fudan University, No.12 Wulumuqi Zhong Road, Shanghai, 200040, China
| | - Wei Hua
- Department of Neurosurgery, Huashan Hospital, Fudan University, No.12 Wulumuqi Zhong Road, Shanghai, 200040, China.
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