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Schwarz E, Benner B, Yu L, Tounkara F, Carson WE. Analysis of Changes in Plasma Cytokine Levels in Response to IL12 Therapy in Three Clinical Trials. Cancer Res Commun 2024; 4:81-91. [PMID: 38108458 PMCID: PMC10777814 DOI: 10.1158/2767-9764.crc-23-0122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 10/04/2023] [Accepted: 12/06/2023] [Indexed: 12/19/2023]
Abstract
The ability of IL12 to stimulate natural killer (NK) cell and T-cell antitumor activity makes it an attractive candidate for the immune therapy of cancer. Our group has demonstrated that IL12 enhances the NK cell response to antibody-coated tumor cells and conducted three clinical trials utilizing IL12 with mAbs (OSU-9968, OSU-0167, and OSU-11010). To better characterize IL12-induced immunity, plasma cytokine levels were measured in 21 patients from these trials with favorable and unfavorable responses. t-statistics and linear modeling were used to test for differences within and between response groups by examining levels at baseline and post-IL12 administration. Patients exhibited significant increases in 11 cytokines post-IL12 administration when analyzed collectively. However, several cytokines were differentially induced by IL12 depending on response. GMCSF was significantly increased in complete/partially responding patients, while stable disease patients had significant increases in IL10 and decreases in VEGF-C. Patients who experienced progressive disease had significant increases in CCL3, CCL4, IL18, TNFα, CXCL10, CCL8, CCL2, IL6, and IFNγ. The increases in CCL3, CCL4, and IL6 in progressive disease patients were significantly higher than in clinically benefitting patients and most prominent within the first two cycles of IL12 therapy. This correlative pilot study has identified changes that occur in levels of circulating cytokines following IL12 administration to patients with cancer, but this report must be viewed as exploratory in nature. It is meant to spark further inquiry into the topic via the analysis of additional cohorts of patients with similar characteristics who have received IL12 in a uniform fashion. SIGNIFICANCE IL12 activates immune cells and is used to treat cancer. The profile of circulating cytokines was measured in an exploratory fashion in patients with cancer that received IL12 in combination with mAbs. This correlative pilot study could serve as the basis for additional studies of IL12 effects on the production of immune cytokines.
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Affiliation(s)
- Emily Schwarz
- Biomedical Sciences Graduate Program, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Brooke Benner
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
| | - Lianbo Yu
- Center for Biostatistics, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Fode Tounkara
- Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio
| | - William E. Carson
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
- Department of Surgery, Division of Surgical Oncology, The Ohio State University, Columbus, Ohio
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Sun SH, Angell CD, Savardekar H, Sundi D, Abood D, Benner B, DiVincenzo MJ, Duggan M, Choueiry F, Mace T, Trikha P, Lapurga G, Johnson C, Carlson EJ, Chung C, Peterson BR, Lianbo Yu, Zhao J, Kendra KL, Carson WE. BTK inhibition potentiates anti-PD-L1 treatment in murine melanoma: potential role for MDSC modulation in immunotherapy. Cancer Immunol Immunother 2023; 72:3461-3474. [PMID: 37528320 PMCID: PMC10592087 DOI: 10.1007/s00262-023-03497-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 07/07/2023] [Indexed: 08/03/2023]
Abstract
Myeloid-derived suppressor cells (MDSC) have been linked to loss of immune effector cell function through a variety of mechanisms such as the generation of reactive oxygen and nitrogen species and the production of inhibitory cytokines. Our group has shown that signaling through Bruton's tyrosine kinase (BTK) is important for MDSC function. Ibrutinib is an orally administered targeted agent that inhibits BTK activation and is currently used for the treatment of B cell malignancies. Using a syngeneic murine model of melanoma, the effect of BTK inhibition with ibrutinib on the therapeutic response to systemic PD-L1 blockade was studied. BTK was expressed by murine MDSC and their activation was inhibited by ibrutinib. Ibrutinib was not directly cytotoxic to cancer cells in vitro, but it inhibited BTK activation in MDSC and reduced expression of inducible nitric oxide synthase (NOS2) and production of nitric oxide. Ibrutinib treatments decreased the levels of circulating MDSC in vivo and increased the therapeutic efficacy of anti-PD-L1 antibody treatment. Gene expression profiling showed that ibrutinib decreased Cybb (NOX2) signaling, and increased IL-17 signaling (upregulating downstream targets Mmp9, Ptgs2, and S100a8). These results suggest that further exploration of MDSC inhibition could enhance the immunotherapy of advanced melanoma.PrécisInhibition of Bruton's tyrosine kinase, a key enzyme in myeloid cellular function, improves therapeutic response to an anti-PD-L1 antibody in an otherwise fairly resistant murine melanoma model.
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Affiliation(s)
- Steven H Sun
- James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Colin D Angell
- James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Himanshu Savardekar
- James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Debasish Sundi
- James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA
- Department of Urology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - David Abood
- James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Brooke Benner
- James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Mallory J DiVincenzo
- James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Megan Duggan
- James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Fouad Choueiry
- James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Thomas Mace
- James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA
- Division of Gastrointestinal Oncology, Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Prashant Trikha
- James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Gabriella Lapurga
- James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Courtney Johnson
- James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Erick J Carlson
- Division of Medicinal Chemistry and Pharmacognosy, College of Pharmacy, The Ohio State University, Columbus, OH, USA
| | - Catherine Chung
- James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Blake R Peterson
- Division of Medicinal Chemistry and Pharmacognosy, College of Pharmacy, The Ohio State University, Columbus, OH, USA
| | - Lianbo Yu
- Department of Biomedical Informatics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Jing Zhao
- Department of Biomedical Informatics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Kari L Kendra
- James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - William E Carson
- James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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3
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Owen DH, Benner B, Wei L, Sukrithan V, Goyal A, Zhou Y, Pilcher C, Suffren SA, Christenson G, Curtis N, Jukich M, Schwarz E, Savardekar H, Norman R, Ferguson S, Kleiber B, Wesolowski R, Carson WE, Otterson GA, Verschraegen CF, Shah MH, Konda B. A Phase II Clinical Trial of Nivolumab and Temozolomide for Neuroendocrine Neoplasms. Clin Cancer Res 2023; 29:731-741. [PMID: 36255391 PMCID: PMC9932582 DOI: 10.1158/1078-0432.ccr-22-1552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 08/25/2022] [Accepted: 10/13/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE Treatment options are limited in patients with metastatic neuroendocrine neoplasms (NEN). We present the results for a phase II trial of combination nivolumab and temozolomide in patients with advanced NEN along with results of immune changes in peripheral blood. PATIENTS AND METHODS NCT03728361 is a nonrandomized, phase II study of nivolumab and temozolomide in patients with NEN. The primary endpoint was response rate using RECIST 1.1. Secondary endpoints included progression-free survival (PFS), overall survival (OS), and safety. Immune profiling was performed by mass cytometry to evaluate the effect on peripheral blood immune cell subsets. RESULTS Among all 28 patients with NEN, the confirmed response rate was 9/28 [32.1%, 95% confidence interval (CI): 15.9-52.4]. Of 11 patients with lung NEN, the response rate was 64% (n = 7); there was a significant difference in responses by primary tumor location (lung vs. others, P = 0.020). The median PFS was 8.8 months (95% CI: 3.9-11.1 months), and median OS was 32.3 months (95% CI: 20.7-not reached months). Exploratory blood immune cell profiling revealed an increase in circulating CD8+ T cells (27.9% ± 13.4% vs. 31.7% ± 14.6%, P = 0.03) and a decrease in CD4+ T cells (59.6% ± 13.1% vs. 56.5% ± 13.0%, P = 0.001) after 2 weeks of treatment. LAG-3-expressing total T cells were lower in patients experiencing a partial response (0.18% ± 0.24% vs. 0.83% ± 0.55%, P = 0.028). Myeloid-derived suppressor cell levels increased during the study and did not correlate with response. CONCLUSIONS Combination nivolumab and temozolomide demonstrated promising activity in NEN. See related commentary by Velez and Garon, p. 691.
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Affiliation(s)
- Dwight H. Owen
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University - James Comprehensive Cancer Center, Columbus, Ohio.,Corresponding Author: Dwight H. Owen, The Ohio State University - James Comprehensive Cancer Center, 1800 Cannon Drive, Columbus, OH 43201. Phone: 614-685-2039; E-mail:
| | - Brooke Benner
- Division of Surgical Oncology, Department of Surgery, The Ohio State University - James Comprehensive Cancer Center, Columbus, Ohio
| | - Lai Wei
- Department of Biomedical Informatics and Center for Biostatistics, The Ohio State University - James Comprehensive Cancer Center, Columbus, Ohio
| | - Vineeth Sukrithan
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University - James Comprehensive Cancer Center, Columbus, Ohio
| | - Ashima Goyal
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University - James Comprehensive Cancer Center, Columbus, Ohio
| | - Ye Zhou
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University - James Comprehensive Cancer Center, Columbus, Ohio
| | - Carly Pilcher
- Clinical Trials Office, The Ohio State University - James Comprehensive Cancer Center, Columbus, Ohio
| | - Sheryl-Ann Suffren
- Clinical Trials Office, The Ohio State University - James Comprehensive Cancer Center, Columbus, Ohio
| | - Gwen Christenson
- Clinical Trials Office, The Ohio State University - James Comprehensive Cancer Center, Columbus, Ohio
| | - Nancy Curtis
- Clinical Trials Office, The Ohio State University - James Comprehensive Cancer Center, Columbus, Ohio
| | - Megan Jukich
- Clinical Trials Office, The Ohio State University - James Comprehensive Cancer Center, Columbus, Ohio
| | - Emily Schwarz
- Division of Surgical Oncology, Department of Surgery, The Ohio State University - James Comprehensive Cancer Center, Columbus, Ohio
| | - Himanshu Savardekar
- Division of Surgical Oncology, Department of Surgery, The Ohio State University - James Comprehensive Cancer Center, Columbus, Ohio
| | - Ruthann Norman
- Division of Surgical Oncology, Department of Surgery, The Ohio State University - James Comprehensive Cancer Center, Columbus, Ohio
| | - Sarah Ferguson
- Clinical Trials Office, The Ohio State University - James Comprehensive Cancer Center, Columbus, Ohio
| | - Barbara Kleiber
- Clinical Trials Office, The Ohio State University - James Comprehensive Cancer Center, Columbus, Ohio
| | - Robert Wesolowski
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University - James Comprehensive Cancer Center, Columbus, Ohio
| | - William E. Carson
- Division of Surgical Oncology, Department of Surgery, The Ohio State University - James Comprehensive Cancer Center, Columbus, Ohio
| | - Gregory A. Otterson
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University - James Comprehensive Cancer Center, Columbus, Ohio
| | - Claire F. Verschraegen
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University - James Comprehensive Cancer Center, Columbus, Ohio
| | - Manisha H. Shah
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University - James Comprehensive Cancer Center, Columbus, Ohio
| | - Bhavana Konda
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University - James Comprehensive Cancer Center, Columbus, Ohio
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Krämer B, Nalin AP, Ma F, Eickhoff S, Lutz P, Leonardelli S, Goeser F, Finnemann C, Hack G, Raabe J, ToVinh M, Ahmad S, Hoffmeister C, Kaiser KM, Manekeller S, Branchi V, Bald T, Hölzel M, Hüneburg R, Nischalke HD, Semaan A, Langhans B, Kaczmarek DJ, Benner B, Lordo MR, Kowalski J, Gerhardt A, Timm J, Toma M, Mohr R, Türler A, Charpentier A, van Bremen T, Feldmann G, Sattler A, Kotsch K, Abdallah AT, Strassburg CP, Spengler U, Carson WE, Mundy-Bosse BL, Pellegrini M, O'Sullivan TE, Freud AG, Nattermann J. Single-cell RNA sequencing identifies a population of human liver-type ILC1s. Cell Rep 2023; 42:111937. [PMID: 36640314 PMCID: PMC9950534 DOI: 10.1016/j.celrep.2022.111937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 09/30/2022] [Accepted: 12/15/2022] [Indexed: 01/02/2023] Open
Abstract
Group 1 innate lymphoid cells (ILCs) comprise a heterogeneous family of cytotoxic natural killer (NK) cells and ILC1s. We identify a population of "liver-type" ILC1s with transcriptional, phenotypic, and functional features distinct from those of conventional and liver-resident NK cells as well as from other previously described human ILC1 subsets. LT-ILC1s are CD49a+CD94+CD200R1+, express the transcription factor T-BET, and do not express the activating receptor NKp80 or the transcription factor EOMES. Similar to NK cells, liver-type ILC1s produce IFN-γ, TNF-α, and GM-CSF; however, liver-type ILC1s also produce IL-2 and lack perforin and granzyme-B. Liver-type ILC1s are expanded in cirrhotic liver tissues, and they can be produced from blood-derived ILC precursors in vitro in the presence of TGF-β1 and liver sinusoidal endothelial cells. Cells with similar signature and function can also be found in tonsil and intestinal tissues. Collectively, our study identifies and classifies a population of human cross-tissue ILC1s.
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Affiliation(s)
- Benjamin Krämer
- Department of Internal Medicine I, University of Bonn, 53127 Bonn, Germany; German Center for Infection Research (DZIF), 53127 Bonn, Germany.
| | - Ansel P Nalin
- Medical Scientist Training Program, The Ohio State University, Columbus, OH 43210, USA; Biomedical Sciences Graduate Program, The Ohio State University, Columbus, OH 43210, USA
| | - Feiyang Ma
- Molecular Cell and Developmental Biology, College of Life Sciences, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Sarah Eickhoff
- Institute of Experimental Oncology (IEO), Medical Faculty, University Hospital Bonn, University of Bonn, 53127 Bonn, Germany
| | - Philipp Lutz
- Department of Internal Medicine I, University of Bonn, 53127 Bonn, Germany; German Center for Infection Research (DZIF), 53127 Bonn, Germany
| | - Sonia Leonardelli
- Institute of Experimental Oncology (IEO), Medical Faculty, University Hospital Bonn, University of Bonn, 53127 Bonn, Germany
| | - Felix Goeser
- Department of Internal Medicine I, University of Bonn, 53127 Bonn, Germany; German Center for Infection Research (DZIF), 53127 Bonn, Germany
| | - Claudia Finnemann
- Department of Internal Medicine I, University of Bonn, 53127 Bonn, Germany; German Center for Infection Research (DZIF), 53127 Bonn, Germany
| | - Gudrun Hack
- Department of Internal Medicine I, University of Bonn, 53127 Bonn, Germany; German Center for Infection Research (DZIF), 53127 Bonn, Germany
| | - Jan Raabe
- Department of Internal Medicine I, University of Bonn, 53127 Bonn, Germany; German Center for Infection Research (DZIF), 53127 Bonn, Germany
| | - Michael ToVinh
- Department of Internal Medicine I, University of Bonn, 53127 Bonn, Germany; German Center for Infection Research (DZIF), 53127 Bonn, Germany
| | - Sarah Ahmad
- Department of Internal Medicine I, University of Bonn, 53127 Bonn, Germany; German Center for Infection Research (DZIF), 53127 Bonn, Germany
| | - Christoph Hoffmeister
- Department of Internal Medicine I, University of Bonn, 53127 Bonn, Germany; German Center for Infection Research (DZIF), 53127 Bonn, Germany
| | - Kim M Kaiser
- Department of Internal Medicine I, University of Bonn, 53127 Bonn, Germany; German Center for Infection Research (DZIF), 53127 Bonn, Germany
| | | | | | - Tobias Bald
- Institute of Experimental Oncology (IEO), Medical Faculty, University Hospital Bonn, University of Bonn, 53127 Bonn, Germany
| | - Michael Hölzel
- Institute of Experimental Oncology (IEO), Medical Faculty, University Hospital Bonn, University of Bonn, 53127 Bonn, Germany
| | - Robert Hüneburg
- Department of Internal Medicine I, University of Bonn, 53127 Bonn, Germany
| | | | | | - Bettina Langhans
- Department of Internal Medicine I, University of Bonn, 53127 Bonn, Germany; German Center for Infection Research (DZIF), 53127 Bonn, Germany
| | | | - Brooke Benner
- Biomedical Sciences Graduate Program, The Ohio State University, Columbus, OH 43210, USA
| | - Matthew R Lordo
- Medical Scientist Training Program, The Ohio State University, Columbus, OH 43210, USA; Biomedical Sciences Graduate Program, The Ohio State University, Columbus, OH 43210, USA
| | | | - Adam Gerhardt
- College of Medicine, University of Cincinnati, Cincinnati, OH 45221, USA
| | - Jörg Timm
- Institute of Virology, University of Duesseldorf, 40225 Düsseldorf, Germany
| | - Marieta Toma
- Department of Pathology, University of Bonn, 53127 Bonn, Germany
| | - Raphael Mohr
- Department of Internal Medicine I, University of Bonn, 53127 Bonn, Germany
| | - Andreas Türler
- General and Visceral Surgery, Johanniter Hospital, 53113 Bonn, Germany
| | - Arthur Charpentier
- Department of Otorhinolaryngology/Head and Neck Surgery, University of Bonn, 53127 Bonn, Germany; Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, 50931 Cologne, Germany
| | - Tobias van Bremen
- Department of Otorhinolaryngology/Head and Neck Surgery, University of Bonn, 53127 Bonn, Germany
| | - Georg Feldmann
- Department of Internal Medicine III, University of Bonn, 53127 Bonn, Germany
| | - Arne Sattler
- Clinic for Surgery, Transplant Immunology Lab, Charité University Hospital Berlin, 10117 Berlin, Germany
| | - Katja Kotsch
- Clinic for Surgery, Transplant Immunology Lab, Charité University Hospital Berlin, 10117 Berlin, Germany
| | - Ali T Abdallah
- Interdisciplinary Center for Clinical Research, RWTH Aachen University, 52074 Aachen, Germany
| | | | - Ulrich Spengler
- Department of Internal Medicine I, University of Bonn, 53127 Bonn, Germany; German Center for Infection Research (DZIF), 53127 Bonn, Germany
| | - William E Carson
- Division of Surgical Oncology, Department of Surgery, Comprehensive Cancer Center and The James Cancer Hospital and Solove Research Institute, Columbus, OH 43210, USA
| | - Bethany L Mundy-Bosse
- Division of Hematology, Department of Internal Medicine, Comprehensive Cancer Center, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, OH 43210, USA
| | - Matteo Pellegrini
- Molecular Cell and Developmental Biology, College of Life Sciences, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Timothy E O'Sullivan
- Department of Microbiology, Immunology, and Molecular Genetics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 900953, USA
| | - Aharon G Freud
- Department of Pathology, Comprehensive Cancer Center, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, OH 43210, USA.
| | - Jacob Nattermann
- Department of Internal Medicine I, University of Bonn, 53127 Bonn, Germany; German Center for Infection Research (DZIF), 53127 Bonn, Germany
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Owen DH, Benner B, Wei L, Sukrithan V, Goyal A, Zhou Y, Suffren SA, Pilcher C, Christenson G, Curtis N, Savardekar H, Norman R, Ferguson S, Kleiber B, Wesolowski R, Carson WE, Otterson GA, Verschraegen CF, Shah MH, Konda B. Efficacy of nivolumab and temozolomide in advanced neuroendocrine neoplasms (NENs) in a phase 2 clinical trial. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.4121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4121 Background: Treatment options are limited in patients with metastatic NEN. Temozolomide (TEM) alone and in combination with capecitabine is active in NEN and has been shown to have immunomodulatory impact. Here we present the final results for the NEN cohort of a phase 2 trial of combination nivolumab and TEM in patients with advanced NEN along with observed peripheral immune changes. Methods: NCT03728361 is a non-randomized, two-cohort, open-label phase 2 trial of nivolumab and TEM in patients with metastatic NEN and small cell lung cancer. The NEN cohort enrolled patients with tumors of any WHO grade, location, and line of therapy; all patients had evidence of progression prior to study. Prior immunotherapy was not allowed. Treatment consisted of nivolumab 480 mg IV on day 1 and TEM 150 mg/m2 on days 1-5 of a 28-day cycle. The primary objective was efficacy measured as response rate (RR) by RECIST v1.1. Secondary objectives were progression free survival (PFS) and overall survival (OS), by the method of Kaplan–Meier. The translational objective was to analyze peripheral blood mononuclear cells (PBMCs) collected at screening (baseline) and on cycle 1, day 15 (C1D15) via mass cytometry. Results: The RR was 36% (n=10/28, 95% CI: 18.6%-55.9%), including 10 patients (36%) with PR, 16 (57%) with SD, and 2 (7%) with PD (Table). The disease control rate was 93%. Responses occurred across all WHO grades; 44% of patients with tumors with Ki-67 >20% had PR. There was a significant difference in ORR by primary tumor location (bronchial vs pancreas vs other, p=0.004). There was no significant difference in response by Ki-67% (p=0.872), or in patients treated as first line (31%) or beyond (40%, p=0.706). The median PFS was 8.9 months (95% CI: 3.9 – 11.1 months), and median OS was not reached (95% CI: 20.7 – NR months). Two immune related SAE’s occurred: myocarditis and diarrhea in one patient each; gr4 toxicities included neutropenia (10%) and thrombocytopenia (7%). Profiling of PBMCs revealed no correlation of baseline MDSC levels with clinical benefit, however significant changes within the T cell landscape, including a decrease in CD4+ T cells (59.6% ±13.08 vs. 56.5% ±13.01, p=0.001) and increase in CD8+ T cells (27.9% ±13.36 vs. 31.7% ±14.57, p=0.03) were observed. Conclusions: Combination nivolumab and TEM demonstrated promising efficacy in patients with NENs; median OS has not been reached. Clinical trial information: NCT03728361. [Table: see text]
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Affiliation(s)
- Dwight Hall Owen
- Division of Medical Oncology, Department of Internal Medicine, Ohio State University, Columbus, OH
| | - Brooke Benner
- Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Lai Wei
- Center for Biostatistics, The Ohio State University, Columbus, OH
| | | | - Ashima Goyal
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Ye Zhou
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | | | | | | | | | - Ruthann Norman
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Sarah Ferguson
- Ohio State University Wexner Medical Center, Hilliard, OH
| | - Barbara Kleiber
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Robert Wesolowski
- The Ohio State University Comprehensive Cancer Center, Division of Medical Oncology, Columbus, OH
| | - William Edgar Carson
- The Ohio State University Comprehensive Cancer Center, Department of Surgery, Columbus, OH
| | | | | | - Manisha H. Shah
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Bhavana Konda
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH
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6
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Sukrithan V, Benner B, Wei L, Goyal A, Zhou Y, Suffren SA, Pilcher C, Christenson G, Curtis N, Schwarz E, Savardekar H, Norman R, Kleiber B, Wesolowski R, Otterson GA, Verschraegen CF, Carson WE, Shah MH, Konda B, Owen DH. Association of LAG-3 expression in circulating T cells and response to combination temozolomide (TMZ) and nivolumab (NIVO) in advanced neuroendocrine neoplasms (NENs): Results from an investigator-initiated phase 2 trial. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.4123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4123 Background: LAG-3 is an immune checkpoint present on NK cells, activated T cells and myeloid cells that inhibit T cell responses. Recent evidence demonstrating the safety and efficacy of LAG-3 inhibition has increased interest in this pathway for the treatment of multiple malignancies but the role in NEN is unclear. We present results from correlative peripheral blood mass cytometry (CyTOF) performed in a phase 2 trial (NCT03728361) of the combination of NIVO and TMZ in pts with advanced NEN. Methods: Patients (pts) with progressive NEN of any grade or primary location and any line of therapy were eligible. Small cell lung cancer was excluded. Clinical results from NCT03728361 will be presented in a separate abstract. Study treatment consisted of NIVO 480 mg IV every 4 weeks and TMZ 150 mg/m2 for 5 consecutive days out of a 28-day cycle. Peripheral blood mononuclear cells (PBMCs) were available from 16 out of 28 patients at screening (baseline) and cycle 1, day 15 (C1D15) and analyzed via CyTOF. Antibody labelling was performed using a 37 marker Maxpar Direct Immune Profiling Assay (Fluidigm). Immune cell populations were compared using two sample t-tests between pts with partial response (PR) and non-partial response (non-PR). Results: At screening, no differences were observed in PD-1, TIM3, or KLRG1 positive T-cell populations between pts with PR or non-PR. Patients with a PR had a significantly lower % of LAG-3 expressing T cells (p=0.029). There was a trend towards a lower % CD8+LAG-3+ T cells in pts with PR (p=0.086). At C1D15: The % of CD8+ LAG-3+ T cells were significantly higher in PRs vs. non-PR (p = 0.015). In matched samples comparing T cell populations at screening to C1D15, LAG-3+ CD8+ T cells increased significantly in PRs when compared to non-PRs (p=0.021). Conclusions: The % of LAG-3+ T cell population at baseline associates with non-response to TMZ/NIVO in NENs. Among responders, there was a significant increase in CD8+ LAG-3+ T cells by Day 15 compared to baseline indicating a potential mechanism of immune escape and eventual resistance. Clinical trial information: NCT03728361. [Table: see text]
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Affiliation(s)
| | - Brooke Benner
- Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Lai Wei
- Center for Biostatistics, The Ohio State University, Columbus, OH
| | - Ashima Goyal
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Ye Zhou
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | | | | | | | - Emily Schwarz
- Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | - Ruthann Norman
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Barbara Kleiber
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Robert Wesolowski
- The Ohio State University Comprehensive Cancer Center, Division of Medical Oncology, Columbus, OH
| | | | | | - William Edgar Carson
- The Ohio State University Comprehensive Cancer Center, Department of Surgery, Columbus, OH
| | - Manisha H. Shah
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Bhavana Konda
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Dwight Hall Owen
- Division of Medical Oncology, Department of Internal Medicine, Ohio State University, Columbus, OH
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Quiroga DM, Pinette A, Benner B, Schwarz E, Wesolowski R, Stiff A, Zelinskas S, Macrae E, Lustberg M, Mrozek E, Ramaswamy B, Carson WE. CLO22-079: A Phase II Open-Label Study of Subcutaneous CpG ODN (PF03512676) in Combination With Trastuzumab in Patients With Metastatic Breast Cancer. J Natl Compr Canc Netw 2022. [DOI: 10.6004/jnccn.2021.7196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - Ashley Pinette
- 1 The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Brooke Benner
- 1 The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Emily Schwarz
- 1 The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Robert Wesolowski
- 1 The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Andrew Stiff
- 1 The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Sara Zelinskas
- 1 The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Erin Macrae
- 1 The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Maryam Lustberg
- 1 The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Ewa Mrozek
- 1 The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | - William E Carson
- 1 The Ohio State University Comprehensive Cancer Center, Columbus, OH
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Schwarz E, Benner B, Yu L, Carson W. 371 Analysis of changes in plasma cytokine levels in response to IL-12 therapy in three clinical trials. J Immunother Cancer 2021. [DOI: 10.1136/jitc-2021-sitc2021.371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BackgroundThe ability of IL-12 to stimulate NK and T cell anti-tumor activity has made it an attractive candidate for overcoming immunosuppressive tumor microenvironments. Our group has demonstrated in pre-clinical models that IL-12 will enhance IgG receptor-mediated NK cell responses to antibody-coated tumor cells and conducted three studies where IL-12 was used in combination with an anti-tumor monoclonal antibody. These were OSU-9968, Phase 1 study of IL-12 + trastuzumab; OSU-1067, Phase 1 study of IL-12 + trastuzumab + paclitaxel in HER2-positive cancers and OSU-11010, Phase I/II study of IL-12 + cextuximab in head and neck cancer.1–3 Cytokine levels were measured in patients with varying responses in an effort to better characterize IL-12-induced immunity.MethodsPlasma cytokine levels in 21 patients across 3 studies were measured at baseline and at 4 time points after IL-12 administration. 2 patients had complete responses, 1 had a partial response, 9 patients had stable disease > 60 days and 9 had progressive disease. A combination of 7 U-PLEX, V-PLEX, and R-PLEX Human Biomarker Assays (Meso Scale Discovery) were performed to monitor levels of 23 cytokines: GM-CSF, IFN-gamma, IL-10, IL-8, IP-10, MCP-1, MDC, MIP-1alpha, MIP-1ß, TNF-alpha, IL-15, IL-18, MCP-2, MIG, IL-13, IL-17, IL-1ß, IL-4, IL-5, IL-6, IL-1alpha, TGFß, VEGF. Student’s t-test on GraphPad Prism 9.0.0 was used for statistical analyses.ResultsNine cytokines were significantly upregulated following IL-12 therapy. IFN-gamma levels increased from a mean of 27.42 pg/mL at baseline to 1764 pg/mL after IL-12 treatment (p=0.0246). GM-CSF, TNF-alpha and IL-10 also increased following IL-12 therapy (p=0.0199, 0.0004, 0.0003). Several chemotactic factors including MCP-1, MDC, MIP-1alpha, and MIP-1ß increased from means of 483.1 pg/mL to 695.7 pg/mL, 3112 pg/mL to 4305 pg/mL, 62.44 pg/mL to 130.3 pg/mL and 263.1 to 487.4 pg/mL, respectively (p-values all < 0.013). Levels of IL-18 increased from a baseline mean of 2059 pg/mL to 3952 pg/mL (p=0.0003). Several cytokines were also differentially induced across response groups with MCP-1 and GM-CSF increased in responding patients (p=0.02, p=0.04) and IL-10, MIP-1ß and IL-6 increased in progressive disease patients (p=0.02, p=0.01, p=0.03).ConclusionsThe ability to detect significant changes in cytokines as a result of IL-12 therapy across three separate clinical trials supports the broad effects of IL-12 on NK cells and other immune compartments. The additional differential effect in responders vs. progressive disease patients indicates that these cytokines likely affect patient outcome and will be further evaluated as possible markers of response.ReferencesParihar R, et al. A phase I study of interleukin 12 with trastuzumab in patients with human epidermal growth factor receptor-2-overexpressing malignancies. Clin Cancer Res 2004;10:5027 LP–5037.Bekaii-Saab TS, et al. A phase I trial of paclitaxel and trastuzumab in combination with interleukin-12 in patients with HER2/neu-expressing malignancies. Mol Cancer Ther 2009;8:2983–2991.McMichael EL, et al. A phase I/II trial of cetuximab in combination with interleukin-12 administered to patients with unresectable primary or recurrent head and neck squamous cell carcinoma. Clin Cancer Res 2019;25:4955 LP–4965.Ethics ApprovalThese studies were approved by the Human Institutional Review Board at The Ohio State University Medical Center; approval numbers 99H0185, 1999C0326 and 2011c0019, respectively.
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Sun SH, Benner B, Savardekar H, Lapurga G, Good L, Abood D, Nagle E, Duggan M, Stiff A, DiVincenzo MJ, Suarez-Kelly LP, Campbell A, Yu L, Wesolowski R, Howard H, Shah H, Kendra K, Carson WE. Effect of Immune Checkpoint Blockade on Myeloid-Derived Suppressor Cell Populations in Patients With Melanoma. Front Immunol 2021; 12:740890. [PMID: 34712230 PMCID: PMC8547308 DOI: 10.3389/fimmu.2021.740890] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 09/23/2021] [Indexed: 12/01/2022] Open
Abstract
Introduction Myeloid-derived suppressor cells (MDSC) are a subset of immature myeloid cells that inhibit anti-tumor immunity and contribute to immune therapy resistance. MDSC populations were measured in melanoma patients receiving immune checkpoint inhibitors (ICI). Methods Patients with melanoma (n=128) provided blood samples at baseline (BL), and before cycles 2 and 3 (BC2, BC3). Peripheral blood mononuclear cells (PBMC) were analyzed for MDSC (CD33+/CD11b+/HLA- DRlo/-) and MDSC subsets, monocytic (CD14+, M-MDSC), granulocytic (CD15+, PMN-MDSC), and early (CD14-/CD15-, E-MDSC) via flow cytometry. Statistical analysis employed unpaired and paired t-tests across and within patient cohorts. Results Levels of MDSC as a percentage of PBMC increased during ICI (BL: 9.2 ± 1.0% to BC3: 23.6 ± 1.9%, p<0.0001), and patients who developed progressive disease (PD) had higher baseline MDSC. In patients who had a complete or partial response (CR, PR), total MDSC levels rose dramatically and plateaued (BL: 6.4 ± 1.4%, BC2: 26.2 ± 4.2%, BC3: 27.5 ± 4.4%; p<0.0001), whereas MDSC rose less sharply in PD patients (BL: 11.7 ± 2.1%, BC2: 18.3 ± 3.1%, BC3: 19.0 ± 3.2%; p=0.1952). Subset analysis showed that within the expanding MDSC population, PMN-MDSC and E-MDSC levels decreased, while the proportion of M-MDSC remained constant during ICI. In PD patients, the proportion of PMN-MDSC (as a percentage of total MDSC) decreased (BL: 25.1 ± 4.7%, BC2: 16.1 ± 5.2%, BC3: 8.6 ± 1.8%; p=0.0105), whereas a heretofore under-characterized CD14+/CD15+ double positive MDSC subpopulation increased significantly (BL: 8.7 ± 1.4% to BC3: 26.9 ± 4.9%; p=0.0425). Conclusions MDSC levels initially increased significantly in responders. PMN-MDSC decreased and CD14+CD15+ MDSC increased significantly in PD patients. Changes in MDSC levels may have prognostic value in ICI.
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Affiliation(s)
- Steven H Sun
- Department of Surgery, Division of Surgical Oncology, The Ohio State University, Columbus, OH, United States
| | - Brooke Benner
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States
| | - Himanshu Savardekar
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States
| | - Gabriella Lapurga
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States
| | - Logan Good
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States
| | - David Abood
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States
| | - Erin Nagle
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States
| | - Megan Duggan
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States
| | - Andrew Stiff
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States
| | - Mallory J DiVincenzo
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States
| | | | - Amanda Campbell
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States
| | - Lianbo Yu
- Center for Biostatistics, Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Robert Wesolowski
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States
| | - Harrison Howard
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States
| | - Hiral Shah
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States
| | - Kari Kendra
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States
| | - William E Carson
- Department of Surgery, Division of Surgical Oncology, The Ohio State University, Columbus, OH, United States.,Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States
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Good L, Benner B, Carson WE. Bruton's tyrosine kinase: an emerging targeted therapy in myeloid cells within the tumor microenvironment. Cancer Immunol Immunother 2021; 70:2439-2451. [PMID: 33818636 PMCID: PMC8019691 DOI: 10.1007/s00262-021-02908-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 03/02/2021] [Indexed: 12/15/2022]
Abstract
Bruton’s tyrosine kinase (BTK) is a non-receptor kinase belonging to the Tec family of kinases. The role of BTK in B cell receptor signaling is well defined and is known to play a key role in the proliferation and survival of malignant B cells. Moreover, BTK has been found to be expressed in cells of the myeloid lineage. BTK has been shown to contribute to a variety of cellular pathways in myeloid cells including signaling in the NLRP3 inflammasome, receptor activation of nuclear factor-κβ and inflammation, chemokine receptor activation affecting migration, and phagocytosis. Myeloid cells are crucial components of the tumor microenvironment and suppressive myeloid cells contribute to cancer progression, highlighting a potential role for BTK inhibition in the treatment of malignancy. The increased interest in BTK inhibition in cancer has resulted in many preclinical studies that are testing the efficacy of using single-agent BTK inhibitors. Moreover, the ability of tumor cells to develop resistance to single-agent checkpoint inhibitors has resulted in clinical studies utilizing BTK inhibitors in combination with these agents to improve clinical responses. Furthermore, BTK regulates the immune response in microbial and viral infections through B cells and myeloid cells such as monocytes and macrophages. In this review, we describe the role that BTK plays in supporting suppressive myeloid cells, including myeloid-derived suppressor cells (MDSC) and tumor-associated macrophages (TAM), while also discussing the anticancer effects of BTK inhibition and briefly describe the role of BTK signaling and BTK inhibition in microbial and viral infections.
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Affiliation(s)
- Logan Good
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Brooke Benner
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - William E Carson
- Department of Surgery, Division of Surgical Oncology, Tzagournis Medical Research Facility, The Ohio State University, Columbus, OH, USA.
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Owen D, Wei L, Pilcher C, Patel S, Konda B, Shah M, Ferguson S, Benner B, Norman R, Carson W, Smith M, Vogt SM, Verschraegen C, He K, Bertino E, Presley C, Shields P, Carbone D, Otterson G. P79.04 A Phase 2 Trial of Nivolumab and Temozolomide in Extensive Stage Small Cell Lung Cancer: Interim Efficacy Analysis. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.1183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Benner B, Carson WE. Observations on the use of Bruton's tyrosine kinase inhibitors in SAR-CoV-2 and cancer. J Hematol Oncol 2021; 14:15. [PMID: 33441177 PMCID: PMC7805262 DOI: 10.1186/s13045-020-00999-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 11/12/2020] [Indexed: 01/05/2023] Open
Abstract
Bruton's tyrosine kinase (BTK) inhibitors, drugs utilized in cancer, are being repurposed for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) (COVID-19). Recently, BTK inhibitors acalabrutinib and ibrutinib have been found to protect against pulmonary injury in a small group of patients infected with SARS-CoV-2. The high levels of pro-inflammatory cytokines found in the circulation of COVID-19 patients with severe lung disease suggest the involvement of the innate immune system in this process. Understanding the potential mechanism of action of BTK inhibition in SARS-CoV-2 is clearly of importance to determine how acalabrutinib, ibrutinib and possibly other BTK inhibitors may provide protection against lung injury.
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Affiliation(s)
- Brooke Benner
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - William E Carson
- Department of Surgery, Division of Surgical Oncology, The Ohio State University, N924 Doan Hall, 410 W. 10th Ave, Columbus, OH, 43210, USA.
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Sun SH, Benner B, Savardekar H, DiVincenzo M, Abood D, Stiff A, Duggan M, Nagle E, Howard JH, Shah MH, Kendra K, Carson WE. Abstract 4481: Effect of immune checkpoint blockade on myeloid derived suppressor cell populations in patients with melanoma. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-4481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Myeloid derived suppressor cells (MDSC) are a subset of immature myeloid cells that inhibit innate anti-tumor immunity and promote an immunosuppressive tumor microenvironment. MDSC quantity has been correlated with tumor burden and survival in cancer patients. These cells have the potential to contribute to immune therapy resistance. The purpose of this study was to elucidate the ongoing changes to MDSC populations in patients with advanced melanoma as they receive immune checkpoint therapy.
Methods: Patients with melanoma (n=125) were consented to participate in an IRB-approved prospective clinical registry (OSU-13114), and provided blood samples. Samples were drawn at the time of initiation of immune checkpoint therapy (cycle 1), and prior to the beginning of cycles 2 and 3. Samples were then processed using Ficoll and analyzed for MDSC (CD33+/CD11b+/HLA-DRlo/−) and MDSC subsets, monocyte (CD14+, M-MDSC) and granulocytic (CD15+, PMN-MDSC) via flow cytometry. Patient demographics were compiled into a comprehensive database and correlated to the flow cytometry data. Statistical analysis was performed using unpaired and paired t-tests across and within patient cohorts.
Results: Total MDSC percentages increased following initiation of immune checkpoint blockade (10 to 25%, p<0.0001). MDSC levels in patients who had complete or partial response began to taper (10% to 26% to 25%), whereas MDSC levels in those who had progressive disease on immunotherapy continued to increase (11% to 16% to 19%). PMN-MDSC significantly decreased after immunotherapy (19% to 10%, p=0.0423). Specifically, patients who received Pembrolizumab had a significant decrease in PMN-MDSC proportion (11% to 2%, p=0.04). A decrease in PMN-MDSC proportion was also noted with Nivolumab (21% to 16%, p=0.097). Patients who had received immune therapy prior to this trial had less PMN-MDSC at baseline (21% vs 12%, p=0.09), and significantly less PMN-MDSC following immune checkpoint blockade (14% vs 2%, p=0.009).
Conclusions: MDSC levels initially increase following immune checkpoint blockade, but stabilize in responders and continue to rise in non-responders. The proportion of PMN-MDSC decreases with immune checkpoint blockade, most significantly seen with pembrolizumab. Patients who have been previously treated with immune therapy have a more significant decrease in PMN-MDSC.
Citation Format: Steven Hao Sun, Brooke Benner, Himanshu Savardekar, Mallory DiVincenzo, David Abood, Andrew Stiff, Megan Duggan, Erin Nagle, John H. Howard, Manisha H. Shah, Kari Kendra, William E. Carson. Effect of immune checkpoint blockade on myeloid derived suppressor cell populations in patients with melanoma [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 4481.
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Quiroga DM, Stiff A, McQuinn C, Li Z, Nitta H, Savardekar H, Benner B, Ramaswamy B, Lustberg M, Layman R, Macrae E, Kassem M, Williams N, Sardesai S, VanDeusen J, Stover D, Cherian M, Mace T, Yu L, Duggan M, Carson WE, Wesolowski R. Abstract 5514: Analysis of immune checkpoint receptor expression by circulating T cells and tumor specimens in patients pre- and post-neoadjuvant chemotherapy for operable breast cancer. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-5514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
While combinations of immune checkpoint (ICP) inhibitors and neo-adjuvant chemotherapy (NAC) have begun to be tested in patients with breast cancer (BC), chemotherapeutic effects on ICP expression in circulating T cells are still unclear. This information could help design future clinical trials including the selection of the best ICP inhibitors to be incorporated into NAC and finding predictive/prognostic biomarkers. Peripheral blood samples and/or tumor specimens before and after NAC were obtained from twenty-four women with operable BC. Using flow cytometry, the expression of CTLA4, PD-1, Lag3, OX40, and Tim3 on circulating T lymphocytes before and at the end of NAC were measured. Differences in the percentage of CD4+ and CD8+ T cells expressing various checkpoint receptors pre- and post-NAC were determined by a paired t-test. This data showed decreased ICP expression after NAC by circulating CD4+ T cells, including significant decreases in CTLA4 (p<0.001), Lag3 (p<0.001), OX40 (p<0.001), and PD-1 (p<0.001). In comparison, circulating CD8+ T cells showed a significant increase in CTLA4 (p<0.003), Lag3 (p=0.001), and OX40 (p<0.001). In comparing breast cancer subtypes, it was found there were significantly lower amounts of circulating Lag3+ CD4+ T cells from triple-negative (lacking estrogen, progesterone, and HER2 receptor expression) breast cancer patients than those from breast cancer patients with tumors expressing at least one of these receptors. Furthermore, using multi-color immunohistochemistry (IHC), the expression of stromal tumor infiltrating lymphocytes (TILs), CD8+ T cells, and PD-1/PD-L1 within the tumor were determined before and after NAC. This analysis revealed fewer tumor specimens were considered to be PD-L1/PD-1 positive post-NAC as compared to pre-NAC biopsy samples using a cutoff of 1% or greater expression. Overall, this work reveals that NAC has opposing effects on ICP expression by CD4+ and CD8+ T cells as well as provides a starting point to study the biological significance of these changes in BC patients.Trial registration: NCT04022616
Citation Format: Dionisia M. Quiroga, Andrew Stiff, Christopher McQuinn, Zaibo Li, Hiroaki Nitta, Himanshu Savardekar, Brooke Benner, Bhuvaneswari Ramaswamy, Maryam Lustberg, Rachel Layman, Erin Macrae, Mahmoud Kassem, Nicole Williams, Sagar Sardesai, Jeffrey VanDeusen, Daniel Stover, Mathew Cherian, Thomas Mace, Lianbo Yu, Megan Duggan, William E. Carson, Robert Wesolowski. Analysis of immune checkpoint receptor expression by circulating T cells and tumor specimens in patients pre- and post-neoadjuvant chemotherapy for operable breast cancer [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 5514.
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Affiliation(s)
| | | | | | - Zaibo Li
- 1The Ohio State University, Columbus, OH
| | | | | | | | | | | | - Rachel Layman
- 3University of Texas MD Anderson Cancer Center, Houston, TX
| | - Erin Macrae
- 4OhioHealth Riverside Methodist Hospital, Columbus, OH
| | | | | | | | | | | | | | | | - Lianbo Yu
- 1The Ohio State University, Columbus, OH
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Stiff A, Savardekar H, Wesolowski R, Duggan M, Scarberry L, Benner B, Wethington D, Lapurga G, Sun S, Hedberg J, Good L, Carson WE. Abstract 3414: Brd4 inhibition enhances checkpoint therapy by inducing MDSC apoptosis. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-3414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Myeloid derived suppressor cells (MDSCs) antagonize antitumor immune responses, and limit the efficacy of immune based therapies for cancer. As a result, MDSCs have garnered attention as therapeutic targets. Unfortunately, there has been limited success in translating agents targeting MDSCs to the clinic. Brd4 is an epigenetic reader and is itself a therapeutic target in oncology due to its ability to regulate the expression of oncogenes such as Myc. In addition, Brd4 is known to regulate inflammatory cytokine production and innate immune responses including myeloid cell function. As a result, it was hypothesized that inhibition of Brd4 would impact MDSC function or expansion. In multiple tumor models (EMT6, 4T1, LLC, and C26) Brd4 inhibitors, both experimental (JQ1) and those in clinical development (PLX51107 and PLX2853) significantly reduced the abundance of total, PMN, and M-MDSC subsets within the tumor and spleen as measured by flow cytometry and IHC (p< 0.05). Furthermore, Nanostring gene expression analysis of EMT6 tumors identified a significant reduction in the abundance signature of neutrophils and macrophages with PLX51107 further confirming a reduction of myeloid cells in the presence of a Brd4 inhibitor (p< 0.01). The Nanostring analysis also showed a significant reduction of IL6 mRNA in PLX51107 treated tumors, and this was confirmed at the protein level by ELISA in the serum of EMT6 and 4T1 tumor bearing mice (p< 0.05). However, exogenous IL6 could not rescue MDSC levels in vivo or in vitro suggesting Brd4 inhibition might be directly affecting MDSCs. This was confirmed by showing that PLX51107 significantly inhibited the expansion of MDSCs from mouse bone marrow cells or healthy donor PBMCs cultured in IL6 and GMCSF as measured by flow cytometry (p<0.05). Furthermore, mouse and FACS sorted MDSCs from patients with melanoma or bladder cancer were found to undergo apoptosis when treated with PLX51107 as measured by flow cytometry (annexin and caspase3, p< 0.05), IF, and western blot. In addition, a pancaspase inhibitor rescued both mouse and patient derived MDSCs from apoptosis in the presence of PLX51107. Further investigation with specific caspase inhibitors showed this effect relied mostly on activation of the intrinsic apoptosis pathway and caspase9. The importance of Brd4 to MDSC survival was further confirmed using a LysMCre Brd4 floxed mouse model. Finally, depletion of MDSCs in vivo with PLX51107 significantly enhanced the efficacy of anti-PDL1 therapy as compared to either agent alone (p< 0.05 in EMT6, 4T1, and LLC tumor models). These results identify Brd4 and the TXNIP/ASK1 apoptosis pathway as novel regulators of MDSC survival, and provide evidence to further investigate Brd4 inhibitors in combination with immune based therapies for solid tumors.
Citation Format: Andrew Stiff, Himanshu Savardekar, Robert Wesolowski, Megan Duggan, Luke Scarberry, Brooke Benner, Darren Wethington, Gabby Lapurga, Steven Sun, Jack Hedberg, Logan Good, William E. Carson. Brd4 inhibition enhances checkpoint therapy by inducing MDSC apoptosis [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 3414.
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Affiliation(s)
- Andrew Stiff
- 1Ohio State University College of Medicine, Columbus, OH
| | | | | | - Megan Duggan
- 1Ohio State University College of Medicine, Columbus, OH
| | - Luke Scarberry
- 1Ohio State University College of Medicine, Columbus, OH
| | - Brooke Benner
- 1Ohio State University College of Medicine, Columbus, OH
| | | | - Gabby Lapurga
- 1Ohio State University College of Medicine, Columbus, OH
| | - Steven Sun
- 1Ohio State University College of Medicine, Columbus, OH
| | - Jack Hedberg
- 1Ohio State University College of Medicine, Columbus, OH
| | - Logan Good
- 1Ohio State University College of Medicine, Columbus, OH
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Choueiry F, Torok M, Shakya R, Agrawal K, Deems A, Benner B, Hinton A, Shaffer J, Blaser BW, Noonan AM, Williams TM, Dillhoff M, Conwell DL, Hart PA, Cruz-Monserrate Z, Bai XF, Carson WE, Mace TA. CD200 promotes immunosuppression in the pancreatic tumor microenvironment. J Immunother Cancer 2020; 8:e000189. [PMID: 32581043 PMCID: PMC7312341 DOI: 10.1136/jitc-2019-000189] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND A significant challenge to overcome in pancreatic ductal adenocarcinoma (PDAC) is the profound systemic immunosuppression that renders this disease non-responsive to immunotherapy. Our supporting data provide evidence that CD200, a regulator of myeloid cell activity, is expressed in the PDAC microenvironment. Additionally, myeloid-derived suppressor cells (MDSC) isolated from patients with PDAC express elevated levels of the CD200 receptor (CD200R). Thus, we hypothesize that CD200 expression in the PDAC microenvironment limits responses to immunotherapy by promoting expansion and activity of MDSC. METHODS Immunofluorescent staining was used to determine expression of CD200 in murine and human PDAC tissue. Flow cytometry was utilized to test for CD200R expression by immune populations in patient blood samples. In vivo antibody blocking of CD200 was conducted in subcutaneous MT-5 tumor-bearing mice and in a genetically engineered PDAC model (KPC-Brca2 mice). Peripheral blood mononuclear cells (PBMC) from patients with PDAC were analyzed by single-cell RNA sequencing. MDSC expansion assays were completed using healthy donor PBMC stimulated with IL-6/GM-CSF in the presence of recombinant CD200 protein. RESULTS We found expression of CD200 by human pancreatic cell lines (BxPC3, MiaPaca2, and PANC-1) as well as on primary epithelial pancreatic tumor cells and smooth muscle actin+ stromal cells. CD200R expression was found to be elevated on CD11b+CD33+HLA-DRlo/- MDSC immune populations from patients with PDAC (p=0.0106). Higher expression levels of CD200R were observed in CD15+ MDSC compared with CD14+ MDSC (p<0.001). In vivo studies demonstrated that CD200 antibody blockade limited tumor progression in MT-5 subcutaneous tumor-bearing and in KPC-Brca2 mice (p<0.05). The percentage of intratumoral MDSC was significantly reduced in anti-CD200 treated mice compared with controls. Additionally, in vivo blockade of CD200 can also significantly enhance the efficacy of PD-1 checkpoint antibodies compared with single antibody therapies (p<0.05). Single-cell RNA sequencing of PBMC from patients revealed that CD200R+ MDSC expressed genes involved in cytokine signaling and MDSC expansion. Further, in vitro cytokine-driven expansion and the suppressive activity of human MDSC was enhanced when cocultured with recombinant CD200 protein. CONCLUSIONS These results indicate that CD200 expression in the PDAC microenvironment may regulate MDSC expansion and that targeting CD200 may enhance activity of checkpoint immunotherapy.
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Affiliation(s)
- Fouad Choueiry
- The James Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, United States
| | - Molly Torok
- The James Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, United States
| | - Reena Shakya
- The James Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, United States
| | - Kriti Agrawal
- The James Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, United States
- Biomedical Science Undergaduate Program, The Ohio State University, Columbus, Ohio, United States
| | - Anna Deems
- The James Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, United States
| | - Brooke Benner
- The James Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, United States
| | - Alice Hinton
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, Ohio, United States
| | - Jami Shaffer
- Division of Hematology, The Ohio State University, Columbus, Ohio, United States
| | - Bradley W Blaser
- Division of Hematology, The Ohio State University, Columbus, Ohio, United States
| | - Anne M Noonan
- Division of Medical Oncology, The Ohio State University, Columbus, Ohio, United States
| | - Terence M Williams
- Department of Radiation Oncology, The Ohio State University, Columbus, Ohio, United States
| | - Mary Dillhoff
- Division of Surgical Oncology, The Ohio State University, Columbus, Ohio, United States
| | - Darwin L Conwell
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Phil A Hart
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Zobeida Cruz-Monserrate
- The James Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, United States
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Xue-Feng Bai
- Department of Pathology, The Ohio State University, Columbus, Ohio, United States
| | - William E Carson
- Division of Surgical Oncology, The Ohio State University, Columbus, Ohio, United States
| | - Thomas A Mace
- The James Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, United States
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Shukla VC, Duarte-Sanmiguel S, Panic A, Senthilvelan A, Moore J, Bobba C, Benner B, Carson WE, Ghadiali SN, Gallego-Perez D. Reciprocal Signaling between Myeloid Derived Suppressor and Tumor Cells Enhances Cellular Motility and is Mediated by Structural Cues in the Microenvironment. Adv Biosyst 2020; 4:e2000049. [PMID: 32419350 PMCID: PMC7489303 DOI: 10.1002/adbi.202000049] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/10/2020] [Accepted: 04/28/2020] [Indexed: 12/11/2022]
Abstract
Myeloid derived suppressor cells (MDSCs) have gained significant attention for their immunosuppressive role in cancer and their ability to contribute to tumor progression and metastasis. Understanding the role of MDSCs in driving cancer cell migration, a process fundamental to metastasis, is essential to fully comprehend and target MDSC-tumor cell interactions. This study employs microfabricated platforms, which simulate the structural cues present in the tumor microenvironment (TME) to elucidate the effects of MDSCs on the migratory phenotype of cancer cells at the single cell level. The results indicate that the presence of MDSCs enhances the motility of cancer-epithelial cells when directional cues (either topographical or spatial) are present. This behavior appears to be independent of cell-cell contact and driven by soluble byproducts from heterotypic interactions between MDSCs and cancer cells. Moreover, MDSC cell-motility is also impacted by the presence of cancer cells and the cancer cell secretome in the presence of directional cues. Epithelial dedifferentiation is the likely mechanism for changes in cancer cell motility in response to MDSCs. These results highlight the biochemical and biostructural conditions under which MDSCs can support cancer cell migration, and could therefore provide new avenues of research and therapy aimed at stemming cancer progression.
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Affiliation(s)
- Vasudha C. Shukla
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH 43210 USA
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH 43210 USA
| | - Silvia Duarte-Sanmiguel
- Department of Biomedical Engineering, OSU Nutrition, The Ohio State University, Columbus, OH, 43210, USA
| | - Ana Panic
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, 43210, USA
| | - Abirami Senthilvelan
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, 43210, USA
| | - Jordan Moore
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, 43210, USA
| | - Christopher Bobba
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, 43210, USA
| | - Brooke Benner
- Biomedical Sciences Graduate Program, The Ohio State University, Columbus, 43210, USA
| | - William E. Carson
- Department of Surgery, Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
| | - Samir N. Ghadiali
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, 43210, USA
- Dorothy M. Davis Department of Biomedical Engineering, The Ohio State University, Columbus, OH, 43210, USA
| | - Daniel Gallego-Perez
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, 43210, USA
- Dorothy M. Davis Heart and lung Research Institute, Department of Surgery, The Ohio State Wexner Medical Center, Columbus, OH, 43210, USA
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18
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Benner B, Quiroga DM, Good L, Sun S, Savardekar H, Duggan MC, Konda B, Verschraegen CF, Kendra KL, Shah MH, Rupert R, Monk P, Shah HA, Noonan AM, Bixel KL, Hays JL, Behbehani G, Pietrzak M, Carson WE, Wesolowski R. A pilot study of Bruton’s tyrosine kinase inhibitor ibrutinib alone and in combination with PD-1 inhibitor nivolumab in patients with metastatic solid tumors. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.3111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3111 Background: Myeloid-derived suppressor cells (MDSC) are expanded in cancer and promote immune suppression. We have shown that ibrutinib inhibits migration and immunosuppressive function of MDSC. Moreover, the combination of ibrutinib and a PD-L1 inhibitor has been found to have synergistic anti-tumor effects in a multiple solid tumor mouse models. Therefore, we conducted a pilot study testing the combination of ibrutinib and nivolumab in patients with metastatic solid tumors. Methods: Sixteen patients with advanced solid tumors were recruited to this trial. Ibrutinib was dosed as an oral single agent, starting 7 days prior to cycle 1 of nivolumab and given until cycle 1, day 8 of nivolumab. Nivolumab was administered intravenously on days 1 and 15 on 28-day cycles. Patients had blood samples collected prior to initiation of ibrutinib, day 1 of cycle 1, day 8 of cycle 1, day 1 of cycle 2, and at the time of disease progression. From these specimens, we measured circulating MDSC levels, other circulating immune subsets, T cell proliferation, and cytokines/chemokines levels. Circulating MDSC levels were measured by mass spectrometry. T cell function was evaluated by CFSE to monitor proliferating cells by dye dilution and cytokine/chemokine levels were measured with a U-PLEX assay. Data were analyzed using two-tailed, paired Student's t-tests to assess statistical significance. Results: An increase in circulating MDSC (22% to 28%; SD 9.158) levels was observed following 7 days of single-agent ibrutinib compared to baseline. However, in combination therapy, MDSC levels decreased (19%; SD 13.17) prior to cycle 2. Despite increasing levels of circulating MDSC, T cell function improved throughout the study. Furthermore, plasma levels of chemokines associated with MDSC recruitment and migration significantly decreased with ibrutinib treatment (IL-12, CCL2, CCL3, and CCL4). Of the 16 patients, four achieved a partial response and four achieved stable disease. Median progression free survival was 3.5 months and median overall survival was 11.5 months. Conclusions: The combination of ibrutinib and nivolumab was well tolerated, demonstrated early signs of immune modulation, and showed preliminary signs of promising clinical activity in patients with metastatic solid tumors. Clinical trial information: NCT03525925 .
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Affiliation(s)
- Brooke Benner
- Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | | | - Steven Sun
- Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | | | - Bhavana Konda
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | - Kari Lynn Kendra
- The Ohio State University Comprehensive Cancer Center, Department of Internal Medicine, Columbus, OH
| | - Manisha H. Shah
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | | | | | - Anne M. Noonan
- The Ohio State University Comprehensive Cancer Center, Arthur G. James Cancer Hospital, Columbus, OH
| | | | - John L. Hays
- The Ohio State University Wexner Medical Center, Columbus, OH
| | | | | | - William Edgar Carson
- The Ohio State University Comprehensive Cancer Center, Department of Surgery, Columbus, OH
| | - Robert Wesolowski
- The Ohio State University Comprehensive Cancer Center, Arthur G. James Cancer Hospital, and Richard J. Solove Research Institute, Columbus, OH
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19
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Wesolowski R, Stiff A, Quiroga D, McQuinn C, Li Z, Nitta H, Savardekar H, Benner B, Ramaswamy B, Lustberg M, Layman RM, Macrae E, Kassem M, Williams N, Sardesai S, VanDeusen J, Stover D, Cherian M, Mace TA, Yu L, Duggan M, Carson WE. Exploratory analysis of immune checkpoint receptor expression by circulating T cells and tumor specimens in patients receiving neo-adjuvant chemotherapy for operable breast cancer. BMC Cancer 2020; 20:445. [PMID: 32429929 PMCID: PMC7236344 DOI: 10.1186/s12885-020-06949-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 05/11/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND While combinations of immune checkpoint (ICP) inhibitors and neo-adjuvant chemotherapy (NAC) have begun testing in patients with breast cancer (BC), the effects of chemotherapy on ICP expression in circulating T cells and within the tumor microenvironment are still unclear. This information could help with the design of future clinical trials by permitting the selection of the most appropriate ICP inhibitors for incorporation into NAC. METHODS Peripheral blood samples and/or tumor specimens before and after NAC were obtained from 24 women with operable BC. The expression of CTLA4, PD-1, Lag3, OX40, and Tim3 on circulating T lymphocytes before and at the end of NAC were measured using flow cytometry. Furthermore, using multi-color immunohistochemistry (IHC), the expression of immune checkpoint molecules by stromal tumor-infiltrating lymphocytes (TILs), CD8+ T cells, and tumor cells was determined before and after NAC. Differences in the percentage of CD4+ and CD8+ T cells expressing various checkpoint receptors were determined by a paired Student's t-test. RESULTS This analysis showed decreased ICP expression by circulating CD4+ T cells after NAC, including significant decreases in CTLA4, Lag3, OX40, and PD-1 (all p values < 0.01). In comparison, circulating CD8+ T cells showed a significant increase in CTLA4, Lag3, and OX40 (all p values < 0.01). Within tumor samples, TILs, CD8+ T cells, and PD-L1/PD-1 expression decreased after NAC. Additionally, fewer tumor specimens were considered to be PD-L1/PD-1 positive post-NAC as compared to pre-NAC biopsy samples using a cutoff of 1% expression. CONCLUSIONS This work revealed that NAC treatment can substantially downregulate CD4+ and upregulate CD8+ T cell ICP expression as well as deplete the amount of TILs and CD8+ T cells found in breast tumor samples. These findings provide a starting point to study the biological significance of these changes in BC patients. TRIAL REGISTRATION NCT04022616.
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Affiliation(s)
- Robert Wesolowski
- The Ohio State University Comprehensive Cancer Center, The Ohio State University, 410 W 12th Avenue, Columbus, OH, 43210, USA.
- Department of Internal Medicine, Division of Medical Oncology, The Ohio State University, Starling Loving Hall, 320 W10th Ave, Columbus, OH, 43210, USA.
- Division of Medical Oncology, James Cancer Hospital and the Ohio State University Comprehensive Cancer Center, 1800 Cannon Drive, 1250 Lincoln Tower, Columbus, OH, 43210, USA.
| | - Andrew Stiff
- The Ohio State University Comprehensive Cancer Center, The Ohio State University, 410 W 12th Avenue, Columbus, OH, 43210, USA
- Department of Internal Medicine, Division of Medical Oncology, The Ohio State University, Starling Loving Hall, 320 W10th Ave, Columbus, OH, 43210, USA
| | - Dionisia Quiroga
- The Ohio State University Comprehensive Cancer Center, The Ohio State University, 410 W 12th Avenue, Columbus, OH, 43210, USA
- Department of Internal Medicine, Division of Medical Oncology, The Ohio State University, Starling Loving Hall, 320 W10th Ave, Columbus, OH, 43210, USA
| | - Christopher McQuinn
- The Ohio State University Comprehensive Cancer Center, The Ohio State University, 410 W 12th Avenue, Columbus, OH, 43210, USA
- Department of Surgery, The Ohio State University, 410 W 10th Ave, N911 Doan Hall, Columbus, OH, 43210, USA
| | - Zaibo Li
- Department of Pathology, The Ohio State University, 410 W 10th Ave, N337B Doan Hall, Columbus, OH, 43210, USA
| | - Hiroaki Nitta
- Roche Tissue Diagnostics, 1910 E. Innovation Park Drive, Tucson, AZ, 85744, USA
| | - Himanshu Savardekar
- The Ohio State University Comprehensive Cancer Center, The Ohio State University, 410 W 12th Avenue, Columbus, OH, 43210, USA
| | - Brooke Benner
- The Ohio State University Comprehensive Cancer Center, The Ohio State University, 410 W 12th Avenue, Columbus, OH, 43210, USA
| | - Bhuvaneswari Ramaswamy
- Department of Internal Medicine, Division of Medical Oncology, The Ohio State University, Starling Loving Hall, 320 W10th Ave, Columbus, OH, 43210, USA
| | - Maryam Lustberg
- Department of Internal Medicine, Division of Medical Oncology, The Ohio State University, Starling Loving Hall, 320 W10th Ave, Columbus, OH, 43210, USA
| | - Rachel M Layman
- Department of Internal Medicine, Division of Medical Oncology, The Ohio State University, Starling Loving Hall, 320 W10th Ave, Columbus, OH, 43210, USA
| | - Erin Macrae
- Department of Internal Medicine, Division of Medical Oncology, The Ohio State University, Starling Loving Hall, 320 W10th Ave, Columbus, OH, 43210, USA
| | - Mahmoud Kassem
- The Ohio State University Comprehensive Cancer Center, The Ohio State University, 410 W 12th Avenue, Columbus, OH, 43210, USA
| | - Nicole Williams
- Department of Internal Medicine, Division of Medical Oncology, The Ohio State University, Starling Loving Hall, 320 W10th Ave, Columbus, OH, 43210, USA
| | - Sagar Sardesai
- Department of Internal Medicine, Division of Medical Oncology, The Ohio State University, Starling Loving Hall, 320 W10th Ave, Columbus, OH, 43210, USA
| | - Jeffrey VanDeusen
- Department of Internal Medicine, Division of Medical Oncology, The Ohio State University, Starling Loving Hall, 320 W10th Ave, Columbus, OH, 43210, USA
| | - Daniel Stover
- Department of Internal Medicine, Division of Medical Oncology, The Ohio State University, Starling Loving Hall, 320 W10th Ave, Columbus, OH, 43210, USA
| | - Mathew Cherian
- Department of Internal Medicine, Division of Medical Oncology, The Ohio State University, Starling Loving Hall, 320 W10th Ave, Columbus, OH, 43210, USA
| | - Thomas A Mace
- The Ohio State University Comprehensive Cancer Center, The Ohio State University, 410 W 12th Avenue, Columbus, OH, 43210, USA
| | - Lianbo Yu
- Center for Biostatistics, The Ohio State University, 2012 Kenny Rd, Columbus, OH, 43221, USA
| | - Megan Duggan
- The Ohio State University Comprehensive Cancer Center, The Ohio State University, 410 W 12th Avenue, Columbus, OH, 43210, USA
| | - William E Carson
- The Ohio State University Comprehensive Cancer Center, The Ohio State University, 410 W 12th Avenue, Columbus, OH, 43210, USA
- Department of Surgery, The Ohio State University, 410 W 10th Ave, N911 Doan Hall, Columbus, OH, 43210, USA
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20
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Benner B, Good L, Quiroga D, Schultz TE, Kassem M, Carson WE, Cherian MA, Sardesai S, Wesolowski R. Pexidartinib, a Novel Small Molecule CSF-1R Inhibitor in Use for Tenosynovial Giant Cell Tumor: A Systematic Review of Pre-Clinical and Clinical Development. Drug Des Devel Ther 2020; 14:1693-1704. [PMID: 32440095 PMCID: PMC7210448 DOI: 10.2147/dddt.s253232] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 04/15/2020] [Indexed: 12/13/2022]
Abstract
Tenosynovial giant cell tumor (TGCT) is a rare benign tumor that involves the synovium, bursa, and tendon sheath, resulting in reduced mobility of the affected joint or limb. The current standard of care for TGCT is surgical resection. However, some patients have tumor recurrence, present with unresectable tumors, or have tumors that are in locations where resection could result in amputations or significant debility. Therefore, the development of systemic agents with activity against TGCT to expand treatment options is a highly unmet medical need. Pathologically, TGCT is characterized by the overexpression of colony-stimulating factor 1 (CSF-1), which leads to the recruitment of colony-stimulating factor-1 receptor (CSF-1R) expressing macrophages that make up the primary cell type within these giant cell tumors. The binding of CSF-1 and CSF-1R controls cell survival and proliferation of monocytes and the switch from a monocytic to macrophage phenotype contributing to the growth and inflammation within these tumors. Therefore, molecules that target CSF-1/CSF-1R have emerged as potential systemic agents for the treatment of TGCT. Given the role of macrophages in regulating tumorigenesis, CSF1/CSF1R-targeting agents have emerged as attractive therapeutic targets for solid tumors. Pexidartinib is an orally bioavailable and potent inhibitor of CSF-1R which is one of the most clinically used agents. In this review, we discuss the biology of TGCT and review the pre-clinical and clinical development of pexidartinib which ultimately led to the FDA approval of this agent for the treatment of TGCT as well as ongoing clinical studies utilizing pexidartinib in the setting of cancer.
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Affiliation(s)
- Brooke Benner
- Department of Surgery, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Logan Good
- Department of Surgery, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Dionisia Quiroga
- Division of Medical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Thomas E Schultz
- Department of Pharmacy, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Mahmoud Kassem
- Division of Medical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - William E Carson
- Department of Surgery, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Mathew A Cherian
- Division of Medical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Sagar Sardesai
- Division of Medical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Robert Wesolowski
- Division of Medical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
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21
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Sundi D, Duggan MC, Savardekar H, Kwon H, Sun S, Benner B, DiVincenzo M, Lee CT, Svatek RS, Carson WE. Association of myeloid suppressor cells with resistance to checkpoint blockade immunotherapy in urothelial carcinoma. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.6_suppl.559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
559 Background: Myeloid immune cells such as myeloid derived suppressor cells (MDSC) and tumor associated macrophages (TAM) have been hypothesized to cause resistance to immune checkpoint blockade (ICB). This is a pressing clinical problem for patients with bladder cancer. Here we determined if we could identify immune cells associated with resistance to ICB in the BBN963 mouse model, and if we could identify therapeutic strategies to target those same suppressor immune cells from patients with bladder cancer. Methods: BBN963 subcutaneous allografts were established in C57BL6/J mice. Response to anti-PD-L1 ICB was classified as partial or complete response according to RECIST criteria. Immune cell subsets with the tumors was evaluated by gene expression profiling and flow cytometry. Peripheral blood from patients with bladder cancer was collected under an IRB-approved protocol. MDSC were purified by flow sorting (CD11b+ CD33+ HLA-DRlow/neg) and screened for viability (Annexin-V staining) after 24 hours of exposure to a panel potential MDSC inhibitors. Results: 16/22 (72%) subjects met criteria for partial or complete response, while 6/22 (28%) were classified as anti-PD-L1 non-responders. Mice in the control group had a 0/10 (0%) response to isotype control (IgG) treatment. Monocytic MDSC (CD11b+ Ly6C+) were much more frequent among the intratumoral CD45+ cells of non-responding subjects as compared to control mice. Nanostring immune panel gene expression profiling revealed that combination treatment of tumor bearing mice with anti-PD-L1 plus ibrutinib (a putative MDSC inhibitor) decreased mRNA biomarkers of tumor-infiltrating macrophages. In vitro screening of patient-derived peripheral blood mononuclear cells showed that an inhibitor of the bromodomain and extraterminal domain (BET) family BRD4 specifically decreased MDSC viability. Conclusions: Monocytic MDSC appear to be associated with resistance to anti-PD-L1 ICB in a new murine model. Analysis of MDSC from patients with bladder cancer suggests that these myeloid suppressor cells can be specifically targeted.
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Affiliation(s)
| | | | | | - Hyunwoo Kwon
- Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Steven Sun
- Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Brooke Benner
- Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | - Cheryl T. Lee
- Department of Urology, University of Michigan, Ann Arbor, MI
| | | | - William Edgar Carson
- The Ohio State University Comprehensive Cancer Center, Department of Surgery, Columbus, OH
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22
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Benner B, Scarberry L, Stiff A, Duggan MC, Good L, Lapurga G, Butchar JP, Tridandapani S, Carson WE. Evidence for interaction of the NLRP3 inflammasome and Bruton's tyrosine kinase in tumor-associated macrophages: implications for myeloid cell production of interleukin-1beta. Oncoimmunology 2019; 8:1659704. [PMID: 31646085 PMCID: PMC6791459 DOI: 10.1080/2162402x.2019.1659704] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 08/20/2019] [Accepted: 08/21/2019] [Indexed: 01/05/2023] Open
Abstract
An inflammatory microenvironment has been shown to play an important role in the growth and metastasis of tumors. The NLRP3 inflammasome is a multi-protein complex of the innate immune system that is responsible for the production of the potent inflammatory cytokine IL-1β. Tumor- associated macrophages (TAM) are an expanded population of immune cells found in the tumor microenvironment that can promote the initiation and metastasis of tumor cells. Their presence has been correlated with disease burden, highlighting the therapeutic potential of targeting this population. However, to date clinically relevant pharmacologic strategies to target TAM remain elusive. Here, we show that in vitro generated TAM harbor NLRP3 inflammasome components and produce IL-1β. Ibrutinib, an irreversible inhibitor of Bruton's tyrosine kinase (BTK), is in clinical use for the treatment of B- cell malignancies. We report that BTK is expressed by human in vitro generated TAM and murine macrophages and that it physically associates with the NLRP3 inflammasome. Furthermore, ibrutinib is able to inhibit BTK phosphorylation in TAM generated in vitro. Treatment of TAM with ibrutinib significantly impaired the ability of these cells to produce IL-1β. The present study provides evidence that BTK physically associates with the NLRP3 inflammasome and that inhibition of BTK with ibrutinib can impair the production of IL-1β by in vitro generated TAM. Thus, ibrutinib could potentially be of clinical use in abrogating inflammation-associated cancer progression and the immune-suppressive effects of myeloid cells within the tumor microenvironment.
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Affiliation(s)
- Brooke Benner
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA
| | - Luke Scarberry
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA
| | - Andrew Stiff
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA
| | - Megan C. Duggan
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA
| | - Logan Good
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA
| | - Gabriella Lapurga
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA
| | | | | | - William E. Carson
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA
- Division of Surgical Oncology, The Ohio State University, Columbus, Ohio, USA
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23
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Benner B, Duggan M, Stiff A, Konda B, Rupert RD, Monk P, Verschraegen C, Shah H, Noonan A, Carson WE, Wesolowski R. Abstract CT169: Pilot study testing the effects of BTK inhibitor ibrutinib and nivolumab on levels and function of myeloid-derived suppressor cells and other immune subsets in patients with metastatic solid tumors (NCT03525925). Cancer Res 2019. [DOI: 10.1158/1538-7445.am2019-ct169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Myeloid-derived suppressor cells (MDSC) are a naturally occurring population of immature myeloid cells with immune suppressive function that curtail inflammatory processes. In cancer, these cells abnormally expand and migrate to tumor/lymphoid regions where they negatively impact antigen specific and innate immune effector cells. Circulating MDSC levels have also been associated with the higher tumor burden and decreased survival of patients with solid tumors. Preclinical studies performed by our group demonstrated that ibrutinib (PCI-32765), an irreversible inhibitor of Bruton’s tyrosine kinase, is capable of inhibiting MDSC generation and their immunosuppressive function (A. Stiff, CA Res, 2016). We also found that the combination of ibrutinib and a PD-L1 inhibitor worked synergistically in a mouse model of mammary carcinoma. Based on these results, targeting MDSC with ibrutinib has the potential to enhance the efficacy of immune checkpoint inhibitors such as nivolumab in patients with advanced solid tumors.
Materials and Methods: This pilot study will assess the effect of single agent ibrutinib and ibrutinib in combination with nivolumab on levels and function of circulating myeloid-derived suppressor cells in 15 patients with advanced solid tumors. Eligible patients are required to have metastatic malignancy and be eligible for treatment with nivolumab as determined by the treating physician. Study subjects will be treated with ibrutinib at 420 mg given orally once daily. Nivolumab will be given at a standard dose of 240 mg IV over 30 minutes on days 1 and 15 on 28-day cycles. Ibrutinib dosing will be started 7 (+/-2) days prior to cycle 1 of nivolumab therapy and will be given until cycle 1, day 8 of nivolumab or total of 15 days (whichever comes first). Peripheral blood will be collected just prior to initiation of ibrutinib (at day -7), prior to day 1 of cycle 1, prior to day 8 of cycle 1, prior to day 1 of cycle 2 and at the time of disease progression. The primary objective is to evaluate the effect of the ibrutinib therapy on circulating levels of myeloid-derived suppressor cells (MDSC). The safety of the study combination, effect of ibrutinib/nivolumab on immune cell subsets and the length of progression-free survival will also be assessed.
Conclusion: The study opened to accrual on August 10, 2018 and is currently enrolling the target 15 patients. To date 9 patients are on study.
Citation Format: Brooke Benner, Megan Duggan, Andrew Stiff, Bhavana Konda, Robert D. Rupert, Paul Monk, Claire Verschraegen, Hiral Shah, Anne Noonan, William E. Carson, Robert Wesolowski. Pilot study testing the effects of BTK inhibitor ibrutinib and nivolumab on levels and function of myeloid-derived suppressor cells and other immune subsets in patients with metastatic solid tumors (NCT03525925) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr CT169.
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McMichael EL, Benner B, Atwal LS, Courtney NB, Mo X, Davis ME, Campbell AR, Duggan MC, Williams K, Martin K, Levine K, Olaverria Salavaggione GN, Noel T, Ganju A, Uppati S, Paul B, Olencki T, Teknos TN, Savvides P, Tridandapani S, Byrd JC, Caligiuri MA, Liu SV, Carson WE. A Phase I/II Trial of Cetuximab in Combination with Interleukin-12 Administered to Patients with Unresectable Primary or Recurrent Head and Neck Squamous Cell Carcinoma. Clin Cancer Res 2019; 25:4955-4965. [PMID: 31142501 DOI: 10.1158/1078-0432.ccr-18-2108] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 03/05/2019] [Accepted: 05/10/2019] [Indexed: 12/14/2022]
Abstract
PURPOSE mAbs including cetuximab can induce antibody-dependent cellular cytotoxicity (ADCC) and cytokine production mediated via innate immune cells with the ability to recognize mAb-coated tumors. Preclinical modeling has shown that costimulation of natural killer (NK) cells via the Fc receptor and the IL12 receptor promotes NK-cell-mediated ADCC and production of cytokines. PATIENTS AND METHODS This phase I/II trial evaluated the combination of cetuximab with IL12 for the treatment of EGFR-expressing head and neck cancer. Treatment consisted of cetuximab 500 mg/m2 i.v. every 2 weeks with either 0.2 mcg/kg or 0.3 mcg/kg IL12 s.c. on days 2 and 5 of the 2-week cycle, beginning with cycle 2. Correlative studies from blood draws obtained prior to treatment and during therapy included measurement of ADCC, serum cytokine, and chemokine analysis, determination of NK cell FcγRIIIa polymorphisms, and an analysis of myeloid-derived suppressor cell (MDSC) frequency in peripheral blood. RESULTS The combination of cetuximab and IL12 was well tolerated. No clinical responses were observed, however, 48% of patients exhibited prolonged progression-free survival (PFS; average of 6.5 months). Compared with patients that did not exhibit clinical benefit, patients with PFS >100 days exhibited increased ADCC as therapy continued compared with baseline, greater production of IFNγ, IP-10, and TNFα at the beginning of cycle 8 compared with baseline values and had a predominance of monocytic MDSCs versus granulocytic MDSCs prior to therapy. CONCLUSIONS Further investigation of IL12 as an immunomodulatory agent in combination with cetuximab in head and neck squamous cell carcinoma is warranted.
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Affiliation(s)
- Elizabeth L McMichael
- Biomedical Sciences Graduate Program, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Brooke Benner
- Biomedical Sciences Graduate Program, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Lakhvir S Atwal
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
| | | | - Xiaokui Mo
- Center for Biostatistics, The Ohio State University, Columbus, Ohio
| | - Melanie E Davis
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
| | - Amanda R Campbell
- Biomedical Sciences Graduate Program, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Megan C Duggan
- Biomedical Sciences Graduate Program, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Kallan Williams
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
| | - Kyle Martin
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
| | - Kala Levine
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
| | | | - Tiffany Noel
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
| | - Akaansha Ganju
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
| | - Sarvani Uppati
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
| | - Bonnie Paul
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
| | - Thomas Olencki
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | | | - Panos Savvides
- Department of Medicine, Division of Hematology/Oncology, The Ohio State University, Columbus, Ohio
| | | | - John C Byrd
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, Ohio
| | - Michael A Caligiuri
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, Ohio
| | - Stephen V Liu
- Department of Medicine, Lombardi Comprehensive Cancer Center, MedStar Georgetown University Hospital, Washington, D.C
| | - William E Carson
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, Ohio. .,Department of Molecular Virology, Immunology, and Medical Genetics, The Ohio State University, Columbus, Ohio
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Benner B, Scarberry L, Suarez-Kelly LP, Duggan MC, Campbell AR, Smith E, Lapurga G, Jiang K, Butchar JP, Tridandapani S, Howard JH, Baiocchi RA, Mace TA, Carson WE. Generation of monocyte-derived tumor-associated macrophages using tumor-conditioned media provides a novel method to study tumor-associated macrophages in vitro. J Immunother Cancer 2019; 7:140. [PMID: 31138333 PMCID: PMC6540573 DOI: 10.1186/s40425-019-0622-0] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 05/16/2019] [Indexed: 02/08/2023] Open
Abstract
Background Tumor-associated macrophages (TAM) are expanded and exhibit tumor-promoting properties within the tumor microenvironment. Current methods to study TAM have not been replicated across cancer types and often do not include exogenous growth factors from the tumor, a key factor in TAM differentiation in vivo. Methods In this study, an in vitro method to generate monocyte- derived TAM using tumor- conditioned media (TCM) and a cytokine cocktail containing IL-4, IL-10, and M-CSF was utilized to study the phenotype, morphology, and function of TAM across multiple cancer types. TCM was generated from two breast cancer cell lines and an Epstein-Barr virus-positive lymphoma cell line. The properties of in vitro generated TAM were compared to in vitro generated M1 and M2- like macrophages and TAM isolated from patients with cancer. Results TAM generated in this fashion displayed an increase in CD163/CD206 co-expression compared to M2- like macrophages (87 and 36%, respectively). TAM generated in vitro exhibited increased transcript levels of the functional markers IL-6, IL-10, CCL2, c-Myc, iNOS, and arginase compared to in vitro generated M2-like macrophages. Functionally, in vitro generated TAM inhibited the proliferation of T cells (47% decrease from M1-like macrophages) and the production of IFN-γ by natural killer cells was inhibited (44%) when co-cultured with TAM. Furthermore, in vitro generated TAM secreted soluble factors that promote the growth and survival of tumor cells. Conclusions Limited access to patient TAM highlights the need for methods to generate TAM in vitro. Our data confirm that monocyte-derived TAM can be generated reliably using TCM plus the cytokine cocktail of IL-4, IL-10, and M-CSF. Given the ability of TAM to inhibit immune cell function, continued study of methods to deplete or deactivate TAM in the setting of cancer are warranted. Electronic supplementary material The online version of this article (10.1186/s40425-019-0622-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Brooke Benner
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Luke Scarberry
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Lorena P Suarez-Kelly
- Division of Surgical Oncology, The Ohio State University, N924 Doan Hall, 410 W. 10th Avenue, Columbus, OH, 43210, USA
| | - Megan C Duggan
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Amanda R Campbell
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Emily Smith
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Gabriella Lapurga
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Kallie Jiang
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Jonathan P Butchar
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | | | - John Harrison Howard
- Division of Surgical Oncology, The Ohio State University, N924 Doan Hall, 410 W. 10th Avenue, Columbus, OH, 43210, USA
| | - Robert A Baiocchi
- Division of Hematology, Department of Medicine, The Ohio State University, Columbus, OH, USA
| | - Thomas A Mace
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - William E Carson
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA. .,Division of Surgical Oncology, The Ohio State University, N924 Doan Hall, 410 W. 10th Avenue, Columbus, OH, 43210, USA.
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26
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Stiff A, Trikha P, Mundy-Bosse B, McMichael E, Mace TA, Benner B, Kendra K, Campbell A, Gautam S, Abood D, Landi I, Hsu V, Duggan M, Wesolowski R, Old M, Howard JH, Yu L, Stasik N, Olencki T, Muthusamy N, Tridandapani S, Byrd JC, Caligiuri M, Carson WE. Nitric Oxide Production by Myeloid-Derived Suppressor Cells Plays a Role in Impairing Fc Receptor-Mediated Natural Killer Cell Function. Clin Cancer Res 2018; 24:1891-1904. [PMID: 29363526 DOI: 10.1158/1078-0432.ccr-17-0691] [Citation(s) in RCA: 157] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 11/22/2017] [Accepted: 01/19/2018] [Indexed: 12/14/2022]
Abstract
Purpose: mAbs are used to treat solid and hematologic malignancies and work in part through Fc receptors (FcRs) on natural killer cells (NK). However, FcR-mediated functions of NK cells from patients with cancer are significantly impaired. Identifying the mechanisms of this dysfunction and impaired response to mAb therapy could lead to combination therapies and enhance mAb therapy.Experimental Design: Cocultures of autologous NK cells and MDSC from patients with cancer were used to study the effect of myeloid-derived suppressor cells (MDSCs) on NK-cell FcR-mediated functions including antibody-dependent cellular cytotoxicity, cytokine production, and signal transduction in vitro Mouse breast cancer models were utilized to study the effect of MDSCs on antibody therapy in vivo and test the efficacy of combination therapies including a mAb and an MDSC-targeting agent.Results: MDSCs from patients with cancer were found to significantly inhibit NK-cell FcR-mediated functions including antibody-dependent cellular cytotoxicity, cytokine production, and signal transduction in a contact-independent manner. In addition, adoptive transfer of MDSCs abolished the efficacy of mAb therapy in a mouse model of pancreatic cancer. Inhibition of iNOS restored NK-cell functions and signal transduction. Finally, nonspecific elimination of MDSCs or inhibition of iNOS in vivo significantly improved the efficacy of mAb therapy in a mouse model of breast cancer.Conclusions: MDSCs antagonize NK-cell FcR-mediated function and signal transduction leading to impaired response to mAb therapy in part through nitric oxide production. Thus, elimination of MDSCs or inhibition of nitric oxide production offers a strategy to improve mAb therapy. Clin Cancer Res; 24(8); 1891-904. ©2018 AACR.
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Affiliation(s)
- Andrew Stiff
- Medical Scientist Training Program, Columbus, Ohio.,Biomedical Sciences Graduate Program, The Ohio State University, Columbus, Ohio
| | - Prashant Trikha
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
| | | | - Elizabeth McMichael
- Biomedical Sciences Graduate Program, The Ohio State University, Columbus, Ohio
| | - Thomas A Mace
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
| | - Brooke Benner
- Biomedical Sciences Graduate Program, The Ohio State University, Columbus, Ohio
| | - Kari Kendra
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Amanda Campbell
- Medical Scientist Training Program, Columbus, Ohio.,Biomedical Sciences Graduate Program, The Ohio State University, Columbus, Ohio
| | - Shalini Gautam
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
| | - David Abood
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
| | - Ian Landi
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
| | - Vincent Hsu
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
| | - Megan Duggan
- Biomedical Sciences Graduate Program, The Ohio State University, Columbus, Ohio
| | - Robert Wesolowski
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Matthew Old
- Department of Otolaryngology, The Ohio State University, Columbus, Ohio
| | - John Harrison Howard
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, Ohio
| | - Lianbo Yu
- Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio
| | - Nancy Stasik
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Thomas Olencki
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Natarajan Muthusamy
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio.,Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Susheela Tridandapani
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio.,Department of Internal Medicine and Dorothy M. Davis Heart and Lung Research Institute, Columbus, Ohio
| | - John C Byrd
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio.,Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Michael Caligiuri
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio.,Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - William E Carson
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio. .,Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, Ohio
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Muccigrosso MM, Ford J, Benner B, Moussa D, Burnsides C, Fenn AM, Popovich PG, Lifshitz J, Walker FR, Eiferman DS, Godbout JP. Cognitive deficits develop 1month after diffuse brain injury and are exaggerated by microglia-associated reactivity to peripheral immune challenge. Brain Behav Immun 2016; 54:95-109. [PMID: 26774527 PMCID: PMC4828283 DOI: 10.1016/j.bbi.2016.01.009] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 01/05/2016] [Accepted: 01/12/2016] [Indexed: 01/07/2023] Open
Abstract
UNLABELLED Traumatic brain injury (TBI) elicits immediate neuroinflammatory events that contribute to acute cognitive, motor, and affective disturbance. Despite resolution of these acute complications, significant neuropsychiatric and cognitive issues can develop and progress after TBI. We and others have provided novel evidence that these complications are potentiated by repeated injuries, immune challenges and stressors. A key component to this may be increased sensitization or priming of glia after TBI. Therefore, our objectives were to determine the degree to which cognitive deterioration occurred after diffuse TBI (moderate midline fluid percussion injury) and ascertain if glial reactivity induced by an acute immune challenge potentiated cognitive decline 30 days post injury (dpi). In post-recovery assessments, hippocampal-dependent learning and memory recall were normal 7 dpi, but anterograde learning was impaired by 30 dpi. Examination of mRNA and morphological profiles of glia 30 dpi indicated a low but persistent level of inflammation with elevated expression of GFAP and IL-1β in astrocytes and MHCII and IL-1β in microglia. Moreover, an acute immune challenge 30 dpi robustly interrupted memory consolidation specifically in TBI mice. These deficits were associated with exaggerated microglia-mediated inflammation with amplified (IL-1β, CCL2, TNFα) and prolonged (TNFα) cytokine/chemokine expression, and a marked reactive morphological profile of microglia in the CA3 of the hippocampus. Collectively, these data indicate that microglia remain sensitized 30 dpi after moderate TBI and a secondary inflammatory challenge elicits robust microglial reactivity that augments cognitive decline. STATEMENT OF SIGNIFICANCE Traumatic brain injury (TBI) is a major risk factor in development of neuropsychiatric problems long after injury, negatively affecting quality of life. Mounting evidence indicates that inflammatory processes worsen with time after a brain injury and are likely mediated by glia. Here, we show that primed microglia and astrocytes developed in mice 1 month following moderate diffuse TBI, coinciding with cognitive deficits that were not initially evident after injury. Additionally, TBI-induced glial priming may adversely affect the ability of glia to appropriately respond to immune challenges, which occur regularly across the lifespan. Indeed, we show that an acute immune challenge augmented microglial reactivity and cognitive deficits. This idea may provide new avenues of clinical assessments and treatments following TBI.
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Affiliation(s)
- Megan M. Muccigrosso
- Department of Neuroscience, The Ohio State University, 333 W. 10th Ave, Columbus, OH
| | - Joni Ford
- Department of Neuroscience, The Ohio State University, 333 W. 10th Ave, Columbus, OH
| | - Brooke Benner
- Department of Neuroscience, The Ohio State University, 333 W. 10th Ave, Columbus, OH
| | - Daniel Moussa
- Department of Neuroscience, The Ohio State University, 333 W. 10th Ave, Columbus, OH
| | - Christopher Burnsides
- Department of Neuroscience, The Ohio State University, 333 W. 10th Ave, Columbus, OH
| | - Ashley M. Fenn
- Department of Neuroscience, The Ohio State University, 333 W. 10th Ave, Columbus, OH
| | - Phillip G. Popovich
- Department of Neuroscience, The Ohio State University, 333 W. 10th Ave, Columbus, OH,Center for Brain and Spinal Cord Repair, The Ohio State University, 460 W. 12th Ave, Columbus, OH,Institute for Behavioral Medicine Research, The Ohio State University, 460 Medical Center Dr., Columbus, OH
| | - Jonathan Lifshitz
- Barrow Neurological Institute at Phoenix Children’s Hospital, Department of Child Health, University of Arizona, College of Medicine-Phoenix, Phoenix, AZ
| | - Fredrick Rohan Walker
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan 2308, South Wales, Australia
| | - Daniel S. Eiferman
- Department of Surgery, The Ohio State University, 395 W. 12th Avenue, Columbus, OH
| | - Jonathan P. Godbout
- Department of Neuroscience, The Ohio State University, 333 W. 10th Ave, Columbus, OH,Center for Brain and Spinal Cord Repair, The Ohio State University, 460 W. 12th Ave, Columbus, OH,Institute for Behavioral Medicine Research, The Ohio State University, 460 Medical Center Dr., Columbus, OH,To whom correspondence should be addressed: J.P. Godbout, 259 IBMR Bldg., 460 Medical Center Dr., The Ohio State University, Columbus, OH 43210, USA. Tel: (614) 293-3456 Fax: (614) 366-2097,
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Lengeler B, Benner B, Kuhlmann M, Schroer CG. Parabolic refractive X-ray lenses. Acta Crystallogr A 2005. [DOI: 10.1107/s0108767305099125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Schroer CG, Meyer J, Kuhlmann M, Benner B, Günzler TF, Lengeler B, Rau C, Weitkamp T, Snigirev A, Snigireva I. Nano-tomography based on hard X-ray microscopy with refractive lenses. ACTA ACUST UNITED AC 2003. [DOI: 10.1051/jp4:200300078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Schroer CG, Benner B, Günzler TF, Kuhlmann M, Lengeler B, Schröder WH, Kuhn AJ, Simionovici A, Snigirev A, Snigireva I. High resolution element mapping inside biological samples using fluorescence microtomography. ACTA ACUST UNITED AC 2003. [DOI: 10.1051/jp4:200300098] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Schroer CG, Benner B, Guenzler TF, Kuhlmann M, Lengeler B, Rau C, Weitkamp T, Snigirev A, Snigireva I. Magnified hard X-ray imaging and tomography in absorption and phase contrast. Acta Crystallogr A 2002. [DOI: 10.1107/s0108767302087159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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32
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Kuhlmann M, Schroer CG, Benner B, Guenzler TF, Meyer J, Lengeler B, Rau C, Weitkamp T, Simionovici AS, Snigrev A, Snigreva I. Parabolic refractive X-ray lenses for microscopy and microanalysis. Acta Crystallogr A 2002. [DOI: 10.1107/s0108767302095326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
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Willson MF, Michaels HJ, Bertin RI, Benner B, Rice S, Lee TD, Hartgerink AP. Intraspecific Variation in Seed Packaging. American Midland Naturalist 1990. [DOI: 10.2307/2425771] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Losche GM, Benner B, Roulet JF. [Self-prep-trainer--a didactic aid for student instruction]. Quintessenz 1985; 36:963-8. [PMID: 3863174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Abstract
Occipital neuralgia syndromes have been ascribed to a great many pathological alterations, some demonstrable and some hypothetical. Recently, occipital neuralgia has been attributed to developmental and posttraumatic lesions in the cervicocranial junction region, with the nerve roots at C-1 and C-2 considered to be the principal pain pathways. The authors describe a series of seven patients with an upper neck and occipital pain syndrome due to unilateral degenerative disease (arthrosis) of a C1-2 lateral articulation. Two of the cases are presented in detail. This disease is demonstrable by radiography through the open mouth by isotope bone scanning, and by computerized tomography scanning. Temporary relief may be obtained by anesthetic and steroid injection, and permanent relief achieved by C-2 dorsal rhizotomy.
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Abstract
Twenty-seven patients with acute neurosurgical injuries were compared with 23 patients with neurosurgical and multisystem injuries and 10 patients with multi-system injuries without neurosurgical injuries. Patients with isolated acute neurosurgical injuries did not demonstrate a hypermetabolic state with increased loss of nitrogen and decreased circulating levels of albumin, prealbumin, and retinol-binding protein when compared to multisystem-injured patients. Patients with demonstrated hypermetabolism on day 1 were supported with parenteral nutrition which decreased their protein losses and stabilized other metabolic variables such as calcium and phosphorus. It is concluded that patients with neurosurgical and other multisystem injuries require close metabolic monitoring. Early institution of metabolic support in hypercatabolic patients may prevent clinically significant depletion states.
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38
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Benner B, Ehni G. Spinal arachnoiditis. The postoperative variety in particular. Spine (Phila Pa 1976) 1978; 3:40-4. [PMID: 644391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The diagnostic and therapeutic courses of 68 patients with the discharge diagnosis of spinal arachnoiditis were reviewed. The combination of oil myelography and spinal surgery was the probable cause of arachnoiditis in almost all cases. The clinical presentation featured leg pain (90%), low-back pain (80%), and sphincter disturbance (25%). Motor, sensory, and reflex changes were present in two thirds of the cases, with a majority having defects attributable to bilateral or multiple root level involvement. Specific analysis of previous operative procedures cerebrospinal fluid (CSF) studies, and myelographic patterns did not disclose any consistent correlation with the clinical presentation. Results are interpreted in light of prior clinical and experimental studies on the reaction of the meninges to trauma and myelography.
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Benner B, Moiel R, Dickson J, Harrington P. Instrumentation of the spine for fracture dislocations in children. Childs Brain 1977; 3:249-55. [PMID: 891306 DOI: 10.1159/000119674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
13 children, ages 11-16 years, sustained severe compression fractures or fracture dislocations of the thoracolumbar spine. All cases were treated with Harrington instrumentation with fusion and six also had decompressive laminectomy. All injuries had significant instability and neurologic deficits (nine complete). Follow-up of 2-10 years is provided for analysis of maintenance of reduction and neurologic improvement. This technique appears to offer stability, reduction of orthopedic defects, and assumption of a more aggressive rehabilitation program without introducing significant operative morbidity or neurologic deficit.
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40
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Benner B, Ehni G. Degenerative lumbar scoliosis. Spine (Phila Pa 1976) 1979; 4:548-52. [PMID: 515844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Recent work on degenerative lumbar curves has focused on stable deformities with entrapment syndrome secondary to spondylotic compression. A review of our local experience with degenerative lumbar curves shows that approximately half of the 14 cases have had a less typical radiographic presentation of short reciprocating lumbar curves thought to be on the basis of asymmetric intervertebral osteochondrosis. In these latter cases, marked spondylotic ridging and intervertebral buttressing were absent; therefore, major decompressive surgery on the residual posterior elements may increase instability and hasten further collapse. Although most patients have had good relief of radicular leg complaints with decompressive procedures, several patients had persistent low-back pain that appeared to have a mechanical basis. In those instances of potentially increased postoperative instability or persistent mechanical back complaints, consideration should be given to augmenting decompressive procedures with Harrington instrumentation and fusion for these painful collapsing lumbar spines.
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