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Law S, Kassam A, Beder M, Sediqzadah S, Levy M, Maher J. Impact of the Pandemic was Minor Compared to Systemic Decrease in Fidelity of Assertive Community Treatment Services- A Provincial Study in Ontario, Canada. Adm Policy Ment Health 2024:10.1007/s10488-024-01375-1. [PMID: 38625457 DOI: 10.1007/s10488-024-01375-1] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2024] [Indexed: 04/17/2024]
Abstract
Assertive Community Treatment (ACT) model is the gold standard in community psychiatry serving people with severe mental illness. With its outreach-based design, the pandemic has profoundly affected the operations and functioning of ACT. The Dartmouth ACT Scale (DACTS) provides a standardized comprehensive and quantitative way to evaluate ACT quality. Results could inform nature of impact and identify areas for improvement. Current online survey used DACTS during the pandemic in April-May 2021. Clinical and administrative leadership of the 80 ACT teams in Ontario, Canada cross-sectionally rated ACT quality one-year pre-Covid (2018-2019) and one-year post the start of Covid (2020-2021). The overall pre-Covid Ontario ACT DACTS fidelity was 3.65. The pandemic led to decreases in all domains of DACTS (Human Resources: -4.92%, p < 0.001, 95% CI [0.08-0.27]; Organizational Boundary: -1.03%, p < 0.013,95%CI [0.01-0.07]; and Nature of Services: -6.18%, p < 0.001, 95%CI [0.16-0.26]). These changes were accounted by expected lower face-to-face encounters, time spent with clients, reduction in psychosocial services, less interactions with hospitals and diminished workforces. The magnitude of change was modest (-3.84%, p < 0.001, 95%CI [0.09-0.19]). However, the Ontario ACT pre-Covid DACTS was substantially lower (-13.5%) when compared to that from a similar survey 15 years ago (4.22), suggestive of insidious systemic level loss of fidelity. Quantitative fidelity evaluation helped to ascertain specific pandemic impact. Changes were significant and specific, but overall relatively modest when compared to the larger system level drop over the last decade. There is both evidence for model adaptability and resilience during Covid disruption, and concerns over larger downward drift in ACT fidelity and quality.
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Affiliation(s)
- Samuel Law
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
- Department of Psychiatry, St. Michael?s Hospital, Unity Health Toronto, Toronto, ON, Canada.
| | - Aly Kassam
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Michaela Beder
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, St. Michael?s Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Saadia Sediqzadah
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, St. Michael?s Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Matthew Levy
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, St. Michael?s Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - John Maher
- Canadian Mental Health Association, Barrie, ON, Canada
- Ontario Association of ACT and FACT, Toronto, ON, Canada
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Zhou R, Wu ST, Yazdanifar M, Williams C, Sanders A, Brouwer C, Maher J, Mukherjee P. Mucin-1-Targeted Chimeric Antigen Receptor T Cells Are Effective and Safe in Controlling Solid Tumors in Immunocompetent Host. J Immunother 2024; 47:77-88. [PMID: 38270462 PMCID: PMC10913860 DOI: 10.1097/cji.0000000000000505] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 12/14/2023] [Indexed: 01/26/2024]
Abstract
The chimeric antigen receptor (CAR) T-cell therapy in solid epithelial tumors has been explored, however, with limited success. As much of the preclinical work has relied on xenograft models in immunocompromised animals, the immune-related efficacies and toxicities may have been missed. In this study, we engineered syngeneic murine CAR T cells targeting the tumor form of human mucin-1 (tMUC1) and tested the MUC1 CAR T cells' efficacy and toxicity in the immunocompetent human MUC1-expressing mouse models. The MUC1 CAR T cells significantly eliminated murine pancreatic and breast cancer cell lines in vitro. In vivo, MUC1 CAR T cells significantly slowed the mammary gland tumor progression in the spontaneous PyVMT×MUC1.Tg (MMT) mice, prevented lung metastasis, and prolonged survival. Most importantly, there was minimal short or long-term toxicity with acceptable levels of transient liver toxicity but no kidney toxicity. In addition, the mice did not show any signs of weight loss or other behavioral changes with the treatment. We also report that a single dose of MUC1 CAR T-cell treatment modestly reduced the pancreatic tumor burden in a syngeneic orthotopic model of pancreatic ductal adenocarcinoma given at late stage of an established tumor. Taken together, these findings suggested the further development of tMUC1-targeted CAR T cells as an effective and relatively safe treatment modality for various tMUC1-expressing solid tumors.
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Affiliation(s)
- Ru Zhou
- Department of Biological Sciences, University of North Carolina at Charlotte, Charlotte, NC
| | - Shu-ta Wu
- Department of Biological Sciences, University of North Carolina at Charlotte, Charlotte, NC
- Medpace, Irving, TX
| | - Mahboubeh Yazdanifar
- Department of Biological Sciences, University of North Carolina at Charlotte, Charlotte, NC
- Adaptive Biotechnologies, South San Francisco, CA
| | - Chandra Williams
- Department of Biological Sciences, University of North Carolina at Charlotte, Charlotte, NC
- Pfizer, Cambridge, MA
| | - Alexa Sanders
- Department of Bioinformatics, University of North Carolina at Charlotte, Charlotte, NC
| | - Cory Brouwer
- Department of Bioinformatics, University of North Carolina at Charlotte, Charlotte, NC
| | - John Maher
- King’s College London, School of Cancer and Pharmaceutical Sciences, Guy’s Cancer Centre, London, UK
| | - Pinku Mukherjee
- Department of Biological Sciences, University of North Carolina at Charlotte, Charlotte, NC
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Mazza R, Maher J, Hull CM. Challenges and considerations in the immunotherapy of DLL3-positive small-cell lung cancer using IL-18 armoured chimeric antigen receptor T-cells. Transl Lung Cancer Res 2024; 13:678-683. [PMID: 38601439 PMCID: PMC11002502 DOI: 10.21037/tlcr-23-793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 02/19/2024] [Indexed: 04/12/2024]
Affiliation(s)
| | - John Maher
- Leucid Bio Ltd., Guy’s Hospital, London, UK
- School of Cancer and Pharmaceutical Sciences, King’s College London, Guy’s Hospital, London, UK
- Department of Immunology, Eastbourne Hospital, Eastbourne, UK
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Davies DM, Pugliese G, Parente Pereira AC, Whilding LM, Larcombe-Young D, Maher J. Engineering a Dual Specificity γδ T-Cell Receptor for Cancer Immunotherapy. Biology (Basel) 2024; 13:196. [PMID: 38534465 DOI: 10.3390/biology13030196] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 03/08/2024] [Accepted: 03/18/2024] [Indexed: 03/28/2024]
Abstract
γδ T-cells provide immune surveillance against cancer, straddling both innate and adaptive immunity. G115 is a clonal γδ T-cell receptor (TCR) of the Vγ9Vδ2 subtype which can confer responsiveness to phosphoantigens (PAgs) when genetically introduced into conventional αβ T-cells. Cancer immunotherapy using γδ TCR-engineered T-cells is currently under clinical evaluation. In this study, we sought to broaden the cancer specificity of the G115 γδ TCR by insertion of a tumour-binding peptide into the complementarity-determining region (CDR) three regions of the TCR δ2 chain. Peptides were selected from the foot and mouth disease virus A20 peptide which binds with high affinity and selectivity to αvβ6, an epithelial-selective integrin that is expressed by a range of solid tumours. Insertion of an A20-derived 12mer peptide achieved the best results, enabling the resulting G115 + A12 T-cells to kill both PAg and αvβ6-expressing tumour cells. Cytolytic activity of G115 + A12 T-cells against PAg-presenting K562 target cells was enhanced compared to G115 control cells, in keeping with the critical role of CDR3 δ2 length for optimal PAg recognition. Activation was accompanied by interferon (IFN)-γ release in the presence of either target antigen, providing a novel dual-specificity approach for cancer immunotherapy.
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Affiliation(s)
- David M Davies
- Leucid Bio Ltd., Guy's Hospital, Great Maze Pond, London SE1 9RT, UK
| | - Giuseppe Pugliese
- Leucid Bio Ltd., Guy's Hospital, Great Maze Pond, London SE1 9RT, UK
- Department of Oncology and Hematology, University Hospital of Modena, 41124 Modena, Italy
| | - Ana C Parente Pereira
- CAR Mechanics Group, Guy's Cancer Centre, School of Cancer and Pharmaceutical Sciences, King's College London, Great Maze Pond, London SE1 9RT, UK
| | - Lynsey M Whilding
- CAR Mechanics Group, Guy's Cancer Centre, School of Cancer and Pharmaceutical Sciences, King's College London, Great Maze Pond, London SE1 9RT, UK
| | - Daniel Larcombe-Young
- CAR Mechanics Group, Guy's Cancer Centre, School of Cancer and Pharmaceutical Sciences, King's College London, Great Maze Pond, London SE1 9RT, UK
| | - John Maher
- Leucid Bio Ltd., Guy's Hospital, Great Maze Pond, London SE1 9RT, UK
- CAR Mechanics Group, Guy's Cancer Centre, School of Cancer and Pharmaceutical Sciences, King's College London, Great Maze Pond, London SE1 9RT, UK
- Department of Immunology, Eastbourne Hospital, Kings Drive, Eastbourne BN21 2UD, UK
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Gabizon A, Shmeeda H, Draper B, Parente-Pereira A, Maher J, Carrascal-Miniño A, de Rosales RTM, La-Beck NM. Harnessing Nanomedicine to Potentiate the Chemo-Immunotherapeutic Effects of Doxorubicin and Alendronate Co-Encapsulated in Pegylated Liposomes. Pharmaceutics 2023; 15:2606. [PMID: 38004584 PMCID: PMC10675201 DOI: 10.3390/pharmaceutics15112606] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 10/31/2023] [Accepted: 11/03/2023] [Indexed: 11/26/2023] Open
Abstract
Encapsulation of Doxorubicin (Dox), a potent cytotoxic agent and immunogenic cell death inducer, in pegylated (Stealth) liposomes, is well known to have major pharmacologic advantages over treatment with free Dox. Reformulation of alendronate (Ald), a potent amino-bisphosphonate, by encapsulation in pegylated liposomes, results in significant immune modulatory effects through interaction with tumor-associated macrophages and activation of a subset of gamma-delta T lymphocytes. We present here recent findings of our research work with a formulation of Dox and Ald co-encapsulated in pegylated liposomes (PLAD) and discuss its pharmacological properties vis-à-vis free Dox and the current clinical formulation of pegylated liposomal Dox. PLAD is a robust formulation with high and reproducible remote loading of Dox and high stability in plasma. Results of biodistribution studies, imaging with radionuclide-labeled liposomes, and therapeutic studies as a single agent and in combination with immune checkpoint inhibitors or gamma-delta T lymphocytes suggest that PLAD is a unique product with distinct tumor microenvironmental interactions and distinct pharmacologic properties when compared with free Dox and the clinical formulation of pegylated liposomal Dox. These results underscore the potential added value of PLAD for chemo-immunotherapy of cancer and the relevance of the co-encapsulation approach in nanomedicine.
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Affiliation(s)
- Alberto Gabizon
- Nano-Oncology Research Center, Oncology Institute, Shaare Zedek Medical Center, Jerusalem 9103102, Israel;
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Hilary Shmeeda
- Nano-Oncology Research Center, Oncology Institute, Shaare Zedek Medical Center, Jerusalem 9103102, Israel;
| | - Benjamin Draper
- King’s College London, School of Cancer and Pharmaceutical Sciences, Guy’s Cancer Centre, Great Maze Pond, London SE1 9RT, UK; (B.D.); (A.P.-P.); (J.M.)
| | - Ana Parente-Pereira
- King’s College London, School of Cancer and Pharmaceutical Sciences, Guy’s Cancer Centre, Great Maze Pond, London SE1 9RT, UK; (B.D.); (A.P.-P.); (J.M.)
| | - John Maher
- King’s College London, School of Cancer and Pharmaceutical Sciences, Guy’s Cancer Centre, Great Maze Pond, London SE1 9RT, UK; (B.D.); (A.P.-P.); (J.M.)
| | - Amaia Carrascal-Miniño
- King’s College London, School of Biomedical Engineering & Imaging Sciences, St. Thomas’ Hospital, London SE1 7EH, UK; (A.C.-M.); (R.T.M.d.R.)
| | - Rafael T. M. de Rosales
- King’s College London, School of Biomedical Engineering & Imaging Sciences, St. Thomas’ Hospital, London SE1 7EH, UK; (A.C.-M.); (R.T.M.d.R.)
| | - Ninh M. La-Beck
- Department of Immunotherapeutics and Biotechnology, Jerry H. Hodge School of Pharmacy, Texas Tech University Health Sciences Center, Abilene, TX 79601, USA;
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Abstract
OBJECTIVES To examine the impact of the Canadian MAiD program and analyze its safeguards. METHODS A working group of physicians from diverse practice backgrounds and a legal expert, several with bioethics expertise, reviewed Canadian MAiD data and case reports. Grey literature was also considered, including fact-checked and reliable Canadian mainstream newspapers and parliamentary committee hearings considering the expansion of MAiD. RESULTS Several scientific studies and reviews, provincial and correctional system authorities have identified issues with MAiD practice. As well, there is a growing accumulation of narrative accounts detailing people getting MAiD due to suffering associated with a lack of access to medical, disability, and social support. SIGNIFICANCE OF RESULTS The Canadian MAiD regime is lacking the safeguards, data collection, and oversight necessary to protect Canadians against premature death. The authors have identified these policy gaps and used MAiD cases to illustrate these findings.
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Affiliation(s)
| | - John Maher
- Ontario Association for ACT & FACT, Barrie, ON, Canada
| | - K Sonu Gaind
- Temerty Faculty of Medicine, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Trudo Lemmens
- Faculty of Law and Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Coelho R, Maher J, Gaind KS, Lemmens T. The realities of Medical Assistance in Dying in Canada - CORRIGENDUM. Palliat Support Care 2023; 21:879. [PMID: 37563088 DOI: 10.1017/s1478951523001190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
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Wong B, Shiely F, Creechan P, Moore A, Dyer B, Radhakrishna A, Russell V, McDermott A, Maher J, McDonald K, Ledwidge M. The COVID-19 pandemic has negatively affected health behaviours in those with pre- heart failure. Ir Med J 2023; 116:837. [PMID: 37791717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
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Tan G, Spillane KM, Maher J. The Role and Regulation of the NKG2D/NKG2D Ligand System in Cancer. Biology (Basel) 2023; 12:1079. [PMID: 37626965 PMCID: PMC10452210 DOI: 10.3390/biology12081079] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 07/22/2023] [Accepted: 08/01/2023] [Indexed: 08/27/2023]
Abstract
The family of human NKG2D ligands (NKG2DL) consists of eight stress-induced molecules. Over 80% of human cancers express these ligands on the surface of tumour cells and/or associated stromal elements. In mice, NKG2D deficiency increases susceptibility to some types of cancer, implicating this system in immune surveillance for malignancy. However, NKG2DL can also be shed, released via exosomes and trapped intracellularly, leading to immunosuppressive effects. Moreover, NKG2D can enhance chronic inflammatory processes which themselves can increase cancer risk and progression. Indeed, tumours commonly deploy a range of countermeasures that can neutralise or even corrupt this surveillance system, tipping the balance away from immune control towards tumour progression. Consequently, the prognostic impact of NKG2DL expression in human cancer is variable. In this review, we consider the underlying biology and regulation of the NKG2D/NKG2DL system and its expression and role in a range of cancer types. We also consider the opportunities for pharmacological modulation of NKG2DL expression while cautioning that such interventions need to be carefully calibrated according to the biology of the specific cancer type.
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Affiliation(s)
- Ge Tan
- CAR Mechanics Group, Guy’s Cancer Centre, School of Cancer and Pharmaceutical Sciences, King’s College London, Great Maze Pond, London SE1 9RT, UK;
| | | | - John Maher
- CAR Mechanics Group, Guy’s Cancer Centre, School of Cancer and Pharmaceutical Sciences, King’s College London, Great Maze Pond, London SE1 9RT, UK;
- Department of Immunology, Eastbourne Hospital, Kings Drive, Eastbourne BN21 2UD, UK
- Leucid Bio Ltd., Guy’s Hospital, Great Maze Pond, London SE1 9RT, UK
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Maher J. Chimeric Antigen Receptor (CAR) T-Cell Therapy for Patients with Lung Cancer: Current Perspectives. Onco Targets Ther 2023; 16:515-532. [PMID: 37425981 PMCID: PMC10327905 DOI: 10.2147/ott.s341179] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 06/27/2023] [Indexed: 07/11/2023] Open
Abstract
Immunotherapy using chimeric antigen receptor (CAR)-engineered T-cells has achieved unprecedented efficacy in selected hematological cancers. However, solid tumors such as lung cancer impose several additional challenges to the attainment of clinical success using this emerging therapeutic modality. Lung cancer is the biggest cause of cancer-related mortality worldwide, accounting for approximately 1.8 million deaths worldwide each year. Obstacles to the development of CAR T-cell immunotherapy for lung cancer include the selection of safe tumor-selective targets, accounting for the large number of candidates that have been evaluated thus far. Tumor heterogeneity is also a key hurdle, meaning that single target-based approaches are susceptible to therapeutic failure through the emergence of antigen null cancers. There is also a need to enable CAR T-cells to traffic efficiently to sites of disease, to infiltrate tumor deposits and to operate within the hostile tumor microenvironment formed by solid tumors, resisting the onset of exhaustion. Multiple immune, metabolic, physical and chemical barriers operate at the core of malignant lesions, with potential for further heterogeneity and evolution in the face of selective therapeutic pressures. Although the extraordinarily adaptable nature of lung cancers has recently been unmasked, immunotherapy using immune checkpoint blockade can achieve long-term disease control in a small number of patients, establishing clinical proof of concept that immunotherapies can control advanced lung carcinomas. This review summarizes pre-clinical CAR T-cell research that is specifically focused on lung cancer in addition to published and ongoing clinical trial activity. A number of advanced engineering strategies are also described which are designed to bridge the gap to the attainment of meaningful efficacy using genetically engineered T-cells.
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Affiliation(s)
- John Maher
- King’s College London, School of Cancer and Pharmaceutical Sciences, CAR Mechanics Lab, Guy’s Cancer Centre, Great Maze Pond, London, SE1 9RT, UK
- Leucid Bio Ltd., Guy’s Hospital, Great Maze Pond, London, SE1 9RT, UK
- Department of Immunology, Eastbourne Hospital, Kings Drive, Eastbourne, East Sussex, BN21 2UD, UK
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Kassam A, Beder M, Sediqzadah S, Levy M, Ritts M, Maher J, Kirwan N, Law S. Impact of COVID-19 on the lives of people with severe mental illness-front-line community psychiatry workers observation from a provincial survey of assertive community treatment teams in Ontario, Canada. Int J Ment Health Syst 2023; 17:18. [PMID: 37328776 DOI: 10.1186/s13033-023-00585-8] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 05/23/2023] [Indexed: 06/18/2023] Open
Abstract
Using an online survey distributed to members of the provincial organization that represents the 88 Assertive Community Treatment (ACT) and Flexible ACT teams in Ontario, Canada, this descriptive study relied on the unique vantage points and observations of the front-line community psychiatry workers who maintained contact with patients through outreach and telecommunication during the height of COVID-19. The patients who suffer from serious mental illness (SMI) were uniquely affected by COVID-19 due to the changes, reduction or shut down of many essential clinical and community support services. Thematic and quantitative analyses of the workers' observations highlighted 6 main areas of note, including significant social isolation and loneliness, clinical course deterioration and life disruption, increased hospital and ER use, police and legal contacts, and substance abuse and related deaths. There were also encouraging signs of positive adaptations in terms of independence and resilience. Reflections of these impacts and potential ameliorating approaches are further discussed.
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Affiliation(s)
- Aly Kassam
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Michaela Beder
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, Unity Health Toronto, St. Michael's Hospital, Toronto, ON, Canada
| | - Saadia Sediqzadah
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, Unity Health Toronto, St. Michael's Hospital, Toronto, ON, Canada
| | - Matthew Levy
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, Unity Health Toronto, St. Michael's Hospital, Toronto, ON, Canada
| | - Madeleine Ritts
- Department of Psychiatry, Unity Health Toronto, St. Michael's Hospital, Toronto, ON, Canada
| | - John Maher
- Canadian Mental Health Association, Barrie and Ontario Association of ACT and FACT, Barrie, ON, Canada
| | - Nicole Kirwan
- Department of Psychiatry, Unity Health Toronto, St. Michael's Hospital, Toronto, ON, Canada
| | - Samuel Law
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
- Department of Psychiatry, Unity Health Toronto, St. Michael's Hospital, Toronto, ON, Canada.
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Papa S, Adami A, Metoudi M, Beatson R, George MS, Achkova D, Williams E, Arif S, Reid F, Elstad M, Beckley-Hoelscher N, Douri A, Delord M, Lyne M, Shivapatham D, Fisher C, Hope A, Gooljar S, Mitra A, Gomm L, Morton C, Henley-Smith R, Thavaraj S, Santambrogio A, Andoniadou C, Allen S, Gibson V, Cook GJR, Parente-Pereira AC, Davies DM, Farzaneh F, Schurich A, Guerrero-Urbano T, Jeannon JP, Spicer J, Maher J. Intratumoral pan-ErbB targeted CAR-T for head and neck squamous cell carcinoma: interim analysis of the T4 immunotherapy study. J Immunother Cancer 2023; 11:e007162. [PMID: 37321663 PMCID: PMC10277526 DOI: 10.1136/jitc-2023-007162] [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] [Accepted: 05/26/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Locally advanced/recurrent head and neck squamous cell carcinoma (HNSCC) is associated with significant morbidity and mortality. To target upregulated ErbB dimer expression in this cancer, we developed an autologous CD28-based chimeric antigen receptor T-cell (CAR-T) approach named T4 immunotherapy. Patient-derived T-cells are engineered by retroviral transduction to coexpress a panErbB-specific CAR called T1E28ζ and an IL-4-responsive chimeric cytokine receptor, 4αβ, which allows IL-4-mediated enrichment of transduced cells during manufacture. These cells elicit preclinical antitumor activity against HNSCC and other carcinomas. In this trial, we used intratumoral delivery to mitigate significant clinical risk of on-target off-tumor toxicity owing to low-level ErbB expression in healthy tissues. METHODS We undertook a phase 1 dose-escalation 3+3 trial of intratumoral T4 immunotherapy in HNSCC (NCT01818323). CAR T-cell batches were manufactured from 40 to 130 mL of whole blood using a 2-week semiclosed process. A single CAR T-cell treatment, formulated as a fresh product in 1-4 mL of medium, was injected into one or more target lesions. Dose of CAR T-cells was escalated in 5 cohorts from 1×107-1×109 T4+ T-cells, administered without prior lymphodepletion. RESULTS Despite baseline lymphopenia in most enrolled subjects, the target cell dose was successfully manufactured in all cases, yielding up to 7.5 billion T-cells (67.5±11.8% transduced), without any batch failures. Treatment-related adverse events were all grade 2 or less, with no dose-limiting toxicities (Common Terminology Criteria for Adverse Events V.4.0). Frequent treatment-related adverse events were tumor swelling, pain, pyrexias, chills, and fatigue. There was no evidence of leakage of T4+ T-cells into the circulation following intratumoral delivery, and injection of radiolabeled cells demonstrated intratumoral persistence. Despite rapid progression at trial entry, stabilization of disease (Response Evaluation Criteria in Solid Tumors V.1.1) was observed in 9 of 15 subjects (60%) at 6 weeks post-CAR T-cell administration. Subsequent treatment with pembrolizumab and T-VEC oncolytic virus achieved a rapid complete clinical response in one subject, which was durable for over 3 years. Median overall survival was greater than for historical controls. Disease stabilization was associated with the administration of an immunophenotypically fitter, less exhausted, T4 CAR T-cell product. CONCLUSIONS These data demonstrate the safe intratumoral administration of T4 immunotherapy in advanced HNSCC.
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Affiliation(s)
- Sophie Papa
- School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
- Department of Medical Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Antonella Adami
- School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
| | - Michael Metoudi
- School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
| | - Richard Beatson
- School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
| | - Molly Sarah George
- Department of Infectious Diseases, School of Immunology & Microbial Sciences, King's College London, London, UK
| | - Daniela Achkova
- School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
| | - Evangelia Williams
- Department of Immunobiology, School of Immunology & Microbial Sciences, King's College London, London, UK
| | - Sefina Arif
- Department of Immunobiology, School of Immunology & Microbial Sciences, King's College London, London, UK
| | - Fiona Reid
- School of Life Course & Population Sciences, King's College London, London, UK
| | - Maria Elstad
- School of Life Course & Population Sciences, King's College London, London, UK
| | - Nicholas Beckley-Hoelscher
- Department of Biostatistics and Health Informatics, Institute of Psychiatry Psychology & Neuroscience, King's College London, London, UK
| | - Abdel Douri
- School of Life Course & Population Sciences, King's College London, London, UK
| | - Marc Delord
- School of Life Course & Population Sciences, King's College London, London, UK
| | - Mike Lyne
- Guy's and St Thomas' Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - Dharshene Shivapatham
- Guy's and St Thomas' Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - Christopher Fisher
- Good Manufacturing Practice Unit, Guy's and St Thomas' Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Andrew Hope
- Good Manufacturing Practice Unit, Guy's and St Thomas' Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Sakina Gooljar
- Good Manufacturing Practice Unit, Guy's and St Thomas' Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Arindam Mitra
- Good Manufacturing Practice Unit, Guy's and St Thomas' Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Linda Gomm
- Guy's and St Thomas' Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - Cienne Morton
- Department of Medical Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Guy's and St Thomas' Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - Rhonda Henley-Smith
- Head and Neck Pathology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Selvam Thavaraj
- Head and Neck Pathology, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Faculty of Dentistry, Oral and Craniofacial Sciences, Guy's Hospital, King's College London, London, UK
| | - Alice Santambrogio
- Faculty of Dentistry, Oral and Craniofacial Sciences, Guy's Hospital, King's College London, London, UK
| | - Cynthia Andoniadou
- Faculty of Dentistry, Oral and Craniofacial Sciences, Guy's Hospital, King's College London, London, UK
| | - Sarah Allen
- Department of Nuclear Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Victoria Gibson
- Department of Nuclear Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Gary J R Cook
- London School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | | | - David M Davies
- School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
| | - Farzin Farzaneh
- School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
| | - Anna Schurich
- Department of Infectious Diseases, School of Immunology & Microbial Sciences, King's College London, London, UK
| | - Teresa Guerrero-Urbano
- Department of Head and Neck Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jean-Pierre Jeannon
- Department of Head and Neck Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - James Spicer
- School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
- Department of Medical Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - John Maher
- School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
- Department of Immunology, Eastbourne Hospital, Eastbourne, UK
- Leucid Bio Ltd, London, London, UK
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13
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Maher J, Davies DM. CAR-Based Immunotherapy of Solid Tumours-A Survey of the Emerging Targets. Cancers (Basel) 2023; 15:1171. [PMID: 36831514 PMCID: PMC9953954 DOI: 10.3390/cancers15041171] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 02/08/2023] [Accepted: 02/10/2023] [Indexed: 02/16/2023] Open
Abstract
Immunotherapy with CAR T-cells has revolutionised the treatment of B-cell and plasma cell-derived cancers. However, solid tumours present a much greater challenge for treatment using CAR-engineered immune cells. In a partner review, we have surveyed data generated in clinical trials in which patients with solid tumours that expressed any of 30 discrete targets were treated with CAR-based immunotherapy. That exercise confirms that efficacy of this approach falls well behind that seen in haematological malignancies, while significant toxic events have also been reported. Here, we consider approximately 60 additional candidates for which such clinical data are not available yet, but where pre-clinical data have provided support for their advancement to clinical evaluation as CAR target antigens.
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Affiliation(s)
- John Maher
- CAR Mechanics Group, Guy’s Cancer Centre, School of Cancer and Pharmaceutical Sciences, King’s College London, Great Maze Pond, London SE1 9RT, UK
- Department of Immunology, Eastbourne Hospital, Kings Drive, Eastbourne BN21 2UD, UK
- Leucid Bio Ltd., Guy’s Hospital, Great Maze Pond, London SE1 9RT, UK
| | - David M. Davies
- Leucid Bio Ltd., Guy’s Hospital, Great Maze Pond, London SE1 9RT, UK
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14
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Maher J, Davies DM. CAR Based Immunotherapy of Solid Tumours-A Clinically Based Review of Target Antigens. Biology (Basel) 2023; 12:biology12020287. [PMID: 36829563 PMCID: PMC9953298 DOI: 10.3390/biology12020287] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 02/07/2023] [Accepted: 02/08/2023] [Indexed: 02/15/2023]
Abstract
Immunotherapy with CAR-engineered immune cells has transformed the management of selected haematological cancers. However, solid tumours have proven much more difficult to control using this emerging therapeutic modality. In this review, we survey the clinical impact of solid tumour CAR-based immunotherapy, focusing on specific targets across a range of disease indications Among the many candidates which have been the subject of non-clinical CAR T-cell research, clinical data are available for studies involving 30 of these targets. Here, we map out this clinical experience, highlighting challenges such as immunogenicity and on-target off-tumour toxicity, an issue that has been both unexpected and devastating in some cases. We also summarise how regional delivery and repeated dosing have been used in an effort to enhance impact and safety. Finally, we consider how emerging armouring systems and multi-targeted CAR approaches might be used to enhance tumour access and better enable discrimination between healthy and transformed cell types.
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Affiliation(s)
- John Maher
- CAR Mechanics Group, Guy’s Cancer Centre, School of Cancer and Pharmaceutical Sciences, King’s College London, Great Maze Pond, London SE1 9RT, UK
- Department of Immunology, Eastbourne Hospital, Kings Drive, Eastbourne BN21 2UD, UK
- Leucid Bio Ltd., Guy’s Hospital, Great Maze Pond, London SE1 9RT, UK
- Correspondence: ; Tel.: +44-(0)207188-1468
| | - David M. Davies
- Leucid Bio Ltd., Guy’s Hospital, Great Maze Pond, London SE1 9RT, UK
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15
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Maher J, McKenna-Barry M, Donnellan C, Pillay I. 290 THE VARIABLE INDICATIVE OF PLACEMENT IN ACUTE HOSPITAL OUTPATIENT CLINICS IDENTIFIES OLDER ADULTS WHO BENEFIT FROM SPECIALIST GERIATRIC ASSESSMENT. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.256] [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: 11/12/2022] Open
Abstract
Abstract
Background
Opportunistic screening of older adults results in early detection of frailty. The Variable Indicative of Placement (VIP) is validated to identify those being admitted to hospital who may benefit from specialist geriatric assessment. VIP screening was gradually introduced throughout hospital-based outpatient clinics in April 2021. The aim of this study was to quantify patient benefit following VIP screening.
Methods
A positive VIP triggered referral for Comprehensive Geriatric Assessment (CGA). Exclusion criteria included prior CGA within a year, nursing home resident or patient declined assessment. Data was prospectively entered onto Excel by a trained administrator. Demographics, Clinical Frailty Score (CFS), modified Barthel Index (mBI) and patient interventions post CGA, between July 2021 and April 2022, were analysed using descriptive statistics.
Results
Of 168 referrals received, 52 were excluded, 53 completed and 63 await review. Thirty-five of those excluded had a prior CGA. Mean (SD) age of patients receiving CGA was 79 (7.6) years. Male:female ratio was 1:1.4. Median (SD) CFS was 6 (0.8) and median (SD) mBI was 16(3.9). There was a mean (SD) of 2.8 (1.6) targeted interventions per patient. Eighty three percent (n=43) required medication changes, 47% (n=25) bone health management, 28% (n=15) dietician, 26% (n=14) occupational therapy, 17% (n=9) public health nursing, 17% (n=9) speech and language therapy, 17% (n=9) memory assessment and 15% (n=8) physiotherapy.
Conclusion
Outpatient clinic VIP screening resulted in identification of frail older adults who benefited from CGA. The VIP should be validated in various outpatient settings.
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Affiliation(s)
- J Maher
- Tipperary University Hospital , Clonmel, Ireland
| | | | - C Donnellan
- Tipperary University Hospital , Clonmel, Ireland
| | - I Pillay
- Cork University Hospital , Cork, Ireland
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16
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Ryan S, Sayers K, King L, Maher J, O'Reilly A, Donnellan C, Pillay I. 233 COGNITIVE OUTCOMES AFTER A FIRST EPISODE OF DELIRIUM IN HOSPITAL – RESULTS FROM AN ADVANCED NURSE PRACTITIONER DELIRIUM CLINIC. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.203] [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: 11/14/2022] Open
Abstract
Abstract
Background
Cognitive outcomes for frail older adult inpatients with a first episode of Delirium are unknown. Aim: To determine cognitive outcomes of frail older inpatients after a first episode of Delirium.
Methods
Consecutive frail older inpatients with a 4AT score >/= 4, without a previous history of cognitive impairment, over a 12-month period (January to December 2021) were invited for formal cognitive assessment 8-12 weeks after their delirium occurred. Collateral history, medication review, Addenbrookes (ACE III), bloods and CT brain were undertaken. Data was prospectively entered onto Excel and analysed using descriptive statistics.
Results
Fifty-one patients with a mean age of 82 years (SD=6) were referred to the Advanced Nurse Practitioner (ANP) Delirium Clinic. Median Clinical Frailty Score (CFS) was 6 with a male: female ratio of 1:2. Forty- seven percent (n=24) attended; 35 % (n-18) did not attend; 18 % (n=9) died prior to assessment. The ratio of male to female attendees was 1: 2.4. There was no difference in CFS or age between attenders and non-attenders. Thirty-three percent (n=8) of patients who attended had potentially reversible causes (high anti-cholinergic burden, folate deficiency, sleep disorder) of cognitive impairment requiring intervention. Sixty-seven percent (n=16) were diagnosed with dementia at the Delirium Clinic; 16.6% (n=4) were diagnosed with Mild Cognitive Impairment; 4% (n=1) had a resolved delirium; 8% (n=2) were referred to consultant Memory Clinic and one patient remained too unwell to assess. The median ACE III score of patients diagnosed with dementia was 54/100 (SD = 18).
Conclusion
Pro-active follow up of patients with a first episode of Delirium led to early diagnosis of dementia and mild cognitive impairment with supportive interventions. Earlier ANP intervention, during the acute phase of delirium, has been introduced in order to improve clinic attendance.
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Affiliation(s)
- S Ryan
- Tipperary University Hospital , Clonmel, Ireland
| | - K Sayers
- Tipperary University Hospital , Clonmel, Ireland
| | - L King
- Tipperary University Hospital , Clonmel, Ireland
| | - J Maher
- Tipperary University Hospital , Clonmel, Ireland
| | - A O'Reilly
- Tipperary University Hospital , Clonmel, Ireland
| | - C Donnellan
- Tipperary University Hospital , Clonmel, Ireland
| | - I Pillay
- Cork University Hospital , Cork, Ireland
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17
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King L, Donnellan C, Pillay I, Sayers K, Ryan S, Maher J. 330 RISK OF MALNUTRITION AND ITS ASSOCIATION WITH FRAILTY-ASSOCIATED FACTORS IN THE OLDER PERSON. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.288] [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: 11/14/2022] Open
Abstract
Abstract
Background
The aetiology of malnutrition is multifactorial, with age a facilitating factor. It is associated with poorer physical and mental health and functional ability in frail older persons. Nutritional screening is a key domain in Comprehensive Geriatric Assessment (CGA). This study assessed the relationship between malnutrition risk and other drivers of frailty in the older person by CGA.
Methods
All patients who had a CGA completed by an Integrated Care Team for Older Persons from March 2020 to July 2021 inclusive were studied. Data was entered onto an Excel database by a trained administrator. The variables included were: age, gender, swallow screen, living alone, cognition, loneliness, Clinical Frailty Scale (CFS) score, falls history and risk of malnutrition using the Malnutrition-Screening Tool (MST). Odds ratio (OR), 95% Confidence Intervals (CI) was used to determine if there was an association between malnutrition risk and each variable in the total group.
Results
In total, 567 patients (325 female, 242 male), mean age 82yrs (SD =19), with median CFS of 6 were studied. Sixty-eight percent (n=384) reported a fall, 37.2% (n=211) had a positive swallow screen, 44% (n=251) lived alone, 35% (n=198) had positive cognitive screening, 14% (n=80) reported loneliness and 31.6% (n=179) were identified as at risk of malnutrition. A positive association was identified between risk of malnutrition and cognitive impairment (OR 1.9, 95%CI 1.2-3.1) and a reported fall (OR 2.2, 95%CI 1.4-3.5). In the population who had a fall and risk of malnutrition, the association remained in those aged ≥80yrs (OR 2.6, 95% CI 1.46 – 4.5) and female (OR 3.6, 95%CI 1.7 – 7.4).
Conclusion
The risk of malnutrition is associated with falls risk and cognitive impairment in frail older persons. Frail older persons identified by integrated care team for older persons with falls risk & cognitive impairment will be targeted for specialist dietetic intervention.
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Affiliation(s)
- L King
- Tipperary University Hospital , Tipperary, Ireland
| | - C Donnellan
- Tipperary University Hospital , Tipperary, Ireland
| | - I Pillay
- Cork University Hospital , Cork, Ireland
| | - K Sayers
- Tipperary University Hospital , Tipperary, Ireland
| | - S Ryan
- Tipperary University Hospital , Tipperary, Ireland
| | - J Maher
- Tipperary University Hospital , Tipperary, Ireland
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18
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Hovhannisyan L, Aebersold DM, Medova M, Ochsenbein AF, Maher J, Zimmer Y. P06.08.B Radiation therapy enhances anti-tumor activity of a MET CAR T-based immunotherapy for glioblastoma. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.132] [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: 11/14/2022] Open
Abstract
Abstract
Background
Glioblastoma is the most frequent primary brain tumor with dismal prognosis after standard treatment with surgery, and chemoradiation (the Stupp protocol). After a decade of failed clinical trials, tumor-treating fields have been first to show the added benefit of improved overall survival compared to the Stupp protocol (20.9 months vs 16.0 months). However, GBM remains a devastating disease, with almost inevitable recurrence, and limited options for second-line therapy. Radiation therapy (RT), is a standard therapy option for GBM, and it is used in most GBM cases affecting tumor through induction of DNA-damage. Recently, RT has been investigated as a mediator of T cell-based therapies in the context of immunosuppressive GBM microenvironment. The findings have shown promise in combination of T cell-based therapies, such as chimeric antigen receptor (CAR) T cell therapies, in improving the tumor infiltration, and penetration with immune cells. MET is a relevant oncogene in the context of GBM, being involved in stem-like properties, radiation response and resistance․ Hence, MET appeared to be a plausible target for combination with RT. In our research, we use MET-targeting CAR T cells (MET-CAR T cells) combined with radiation, and hypothesize synergistic interaction for GBM treatment.
Material and Methods
We used adherent (2D) and stem-like (3D) human GBM cell lines with different levels of MET expression. For MET-CAR T cell generation we did retrovirus-mediated transduction of activated human T cells and sorted the CAR-positive cells. We co-cultured MET-CAR T cells with GBM cells with or without RT, and assessed the killing and cytokine production in CAR T cells.
Results
Our results indicated that 5Gy radiation combined with MET-CAR T cells increases their potential in tumor cell killing. We observed increased CAR T cells effect at lower CAR T to target cells ratios when combined with radiation, even when radiation treatment did not lead to a significant decrease in viability. This phenomenon was similar across different types of cell lines (adherent, stem-like), different levels of MET expression, and different sensitivity to CAR T cells. We investigated the underlying mechanisms via intracellular cytokine measurement. We observed the most prominent response in TNF-α-expression. We also observed an increase in Granzyme B expression in co-culture with some of the GBM cell lines, especially in CD8+ subpopulation of CAR T cells. IFN-gamma expression increased in some adherent glioma cell lines but not in stem-like cell lines.
Conclusion
In conclusion, our data demonstrates the potency of MET-CAR T cells against GBM, and increased efficiency when combined with radiation. The suggested mechanism is the increased activation of T cells in TNF-α-dependent-manner. To validate these results we are testing our setup in an orthotopic mouse GBM model.
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Affiliation(s)
- L Hovhannisyan
- University of Bern , Bern , Switzerland
- University Hospital Bern , Bern , Switzerland
| | | | - M Medova
- University of Bern , Bern , Switzerland
- University Hospital Bern , Bern , Switzerland
| | | | - J Maher
- Kings College London , London , United Kingdom
| | - Y Zimmer
- University of Bern , Bern , Switzerland
- University Hospital Bern , Bern , Switzerland
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19
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Achkova DY, Beatson RE, Maher J. CAR T-Cell Targeting of Macrophage Colony-Stimulating Factor Receptor. Cells 2022; 11:cells11142190. [PMID: 35883636 PMCID: PMC9323367 DOI: 10.3390/cells11142190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 07/07/2022] [Accepted: 07/12/2022] [Indexed: 12/18/2022] Open
Abstract
Macrophage colony-stimulating factor receptor (M-CSFR) is found in cells of the mononuclear phagocyte lineage and is aberrantly expressed in a range of tumours, in addition to tumour-associated macrophages. Consequently, a variety of cancer therapies directed against M-CSFR are under development. We set out to engineer chimeric antigen receptors (CARs) that employ the natural ligands of this receptor, namely M-CSF or interleukin (IL)-34, to achieve specificity for M-CSFR-expressing target cells. Both M-CSF and IL-34 bind to overlapping regions of M-CSFR, although affinity of IL-34 is significantly greater than that of M-CSF. Matched second- and third-generation CARs targeted using M-CSF or IL-34 were expressed in human T-cells using the SFG retroviral vector. We found that both M-CSF- and IL-34-containing CARs enable T-cells to mediate selective destruction of tumour cells that express enforced or endogenous M-CSFR, accompanied by production of both IL-2 and interferon (IFN)-γ. Although they contain an additional co-stimulatory module, third-generation CARs did not outperform second-generation CARs. M-CSF-containing CARs mediated enhanced cytokine production and cytolytic activity compared to IL-34-containing CARs. These data demonstrate the feasibility of targeting M-CSFR using ligand-based CARs and raise the possibility that the low picomolar affinity of IL-34 for M-CSFR is detrimental to CAR function.
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Affiliation(s)
- Daniela Yordanova Achkova
- CAR Mechanics Group, Guy’s Cancer Centre, School of Cancer and Pharmaceutical Sciences, King’s College London, Great Maze Pond, London SE1 9RT, UK; (D.Y.A.); (R.E.B.)
| | - Richard Esmond Beatson
- CAR Mechanics Group, Guy’s Cancer Centre, School of Cancer and Pharmaceutical Sciences, King’s College London, Great Maze Pond, London SE1 9RT, UK; (D.Y.A.); (R.E.B.)
| | - John Maher
- CAR Mechanics Group, Guy’s Cancer Centre, School of Cancer and Pharmaceutical Sciences, King’s College London, Great Maze Pond, London SE1 9RT, UK; (D.Y.A.); (R.E.B.)
- Department of Immunology, Eastbourne Hospital, Kings Drive, Eastbourne BN21 2UD, UK
- Leucid Bio Ltd., Guy’s Hospital, Great Maze Pond, London SE1 9RT, UK
- Correspondence: ; Tel.: +44-(0)207188-1468
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20
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Parente-Pereira AC, Beatson RE, Davies DM, Hull C, Whilding LM, Porter JC, Maher J. Generation and application of TGFβ-educated human Vγ9Vδ2 T cells. STAR Protoc 2022; 3:101319. [PMID: 35496793 PMCID: PMC9043756 DOI: 10.1016/j.xpro.2022.101319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Clinical trials that tested the antitumor activity of γδ T cells have been mostly unsuccessful. To address this, we expanded human Vγ9Vδ2 T cells in TGFβ1, a cytokine which enhances their viability, trafficking properties, and intrinsic antitumor activity. This protocol summarizes the production and in vitro functional characterization of TGFβ1 educated human Vγ9Vδ2 cells and highlights their compatibility with chimeric antigen receptor (CAR) engineering. We also describe in vivo testing of the antitumor activity of these CAR T cells in mice. For complete details on the use and execution of this protocol, please refer to Beatson et al. (2021). TGFβ promotes viability and retards differentiation of Vγ9Vδ2 cells TGFβ-educated Vγ9Vδ2 cells achieve greater invasion and anticancer activity Specificity of these cells can be reprogrammed using chimeric antigen receptors
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21
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Larcombe-Young D, Whilding L, Davies DM, Draper B, Bechman N, Maher J. Generation of human parallel chimeric antigen receptor (pCAR) T cells to achieve synergistic T cell co-stimulation. STAR Protoc 2022; 3:101414. [PMID: 35620078 PMCID: PMC9127424 DOI: 10.1016/j.xpro.2022.101414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Dual co-stimulation may be harnessed using parallel chimeric antigen receptors (pCARs) in which two distinct co-stimulatory units are adjacently localized on the plasma membrane. This protocol summarizes construct design, human T cell isolation, retroviral transduction, tissue culture expansion, and preclinical testing of pCAR T cells, exemplified by receptors that co-target avb6 integrin and ErbB dimers. For complete details on the use and execution of this protocol, please refer to Muliaditan et al. (2021). A protocol to enable robust generation of pCAR T cells Effective dual co-stimulation is provided by this platform Sustained and enhanced antitumor activity by pCAR T cells Detailed in vitro and in vivo evaluation of pCAR technology
Publisher’s note: Undertaking any experimental protocol requires adherence to local institutional guidelines for laboratory safety and ethics.
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Affiliation(s)
- Daniel Larcombe-Young
- School of Cancer and Pharmaceutical Sciences, King’s College London, Faculty of Life Sciences and Medicine, Guy’s Campus, London SE1 9RT, UK
- Leucid Bio Ltd., Guy’s Hospital, Great Maze Pond, London SE1 9RT, UK
| | - Lynsey Whilding
- School of Cancer and Pharmaceutical Sciences, King’s College London, Faculty of Life Sciences and Medicine, Guy’s Campus, London SE1 9RT, UK
| | - David Marc Davies
- School of Cancer and Pharmaceutical Sciences, King’s College London, Faculty of Life Sciences and Medicine, Guy’s Campus, London SE1 9RT, UK
- Leucid Bio Ltd., Guy’s Hospital, Great Maze Pond, London SE1 9RT, UK
| | - Benjamin Draper
- School of Cancer and Pharmaceutical Sciences, King’s College London, Faculty of Life Sciences and Medicine, Guy’s Campus, London SE1 9RT, UK
| | - Natasha Bechman
- School of Cancer and Pharmaceutical Sciences, King’s College London, Faculty of Life Sciences and Medicine, Guy’s Campus, London SE1 9RT, UK
| | - John Maher
- School of Cancer and Pharmaceutical Sciences, King’s College London, Faculty of Life Sciences and Medicine, Guy’s Campus, London SE1 9RT, UK
- Leucid Bio Ltd., Guy’s Hospital, Great Maze Pond, London SE1 9RT, UK
- Department of Immunology, Eastbourne Hospital, Kings Drive, Eastbourne, East Sussex BN21 2UD, UK
- Corresponding author
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22
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Hull CM, Maher J. 3D modelling of γδ T-cell immunotherapy. Clin Transl Med 2022; 12:e877. [PMID: 35538922 PMCID: PMC9091998 DOI: 10.1002/ctm2.877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 04/02/2022] [Accepted: 04/28/2022] [Indexed: 11/07/2022] Open
Affiliation(s)
| | - John Maher
- Leucid Bio Ltd.Guy's HospitalGreat Maze PondLondonUK
- CAR Mechanics LabGuy's Cancer CentreSchool of Cancer and Pharmaceutical SciencesKing's College LondonGreat Maze PondLondonUK
- Department of ImmunologyEastbourne HospitalEastbourneEast SussexUK
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23
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Halim L, Das KK, Larcombe-Young D, Ajina A, Candelli A, Benjamin R, Dillon R, Davies DM, Maher J. Engineering of an Avidity-Optimized CD19-Specific Parallel Chimeric Antigen Receptor That Delivers Dual CD28 and 4-1BB Co-Stimulation. Front Immunol 2022; 13:836549. [PMID: 35222427 PMCID: PMC8863855 DOI: 10.3389/fimmu.2022.836549] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 12/15/2021] [Accepted: 01/20/2022] [Indexed: 11/13/2022] Open
Abstract
Co-stimulation is critical to the function of chimeric antigen receptor (CAR) T-cells. Previously, we demonstrated that dual co-stimulation can be effectively harnessed by a parallel (p)CAR architecture in which a CD28-containing second generation CAR is co-expressed with a 4-1BB containing chimeric co-stimulatory receptor (CCR). When compared to linear CARs, pCAR-engineered T-cells elicit superior anti-tumor activity in a range of pre-clinical models. Since CD19 is the best validated clinical target for cellular immunotherapy, we evaluated a panel of CD19-specific CAR and pCAR T-cells in this study. First, we generated a panel of single chain antibody fragments (scFvs) by alanine scanning mutagenesis of the CD19-specific FMC63 scFv (VH domain) and these were incorporated into second generation CD28+CD3ζ CARs. The resulting panel of CAR T-cells demonstrated a broad range of CD19 binding ability and avidity for CD19-expressing tumor cells. Each scFv-modified CAR was then converted into a pCAR by co-expression of an FMC63 scFv-targeted CCR with a 4-1BB endodomain. When compared to second generation CARs that contained an unmodified or mutated FMC63 scFv, each pCAR demonstrated a significant enhancement of tumor re-stimulation potential and IL-2 release, reduced exhaustion marker expression and enhanced therapeutic efficacy in mice with established Nalm-6 leukemic xenografts. These data reinforce the evidence that the pCAR platform delivers enhanced anti-tumor activity through effective provision of dual co-stimulation. Greatest anti-tumor activity was noted for intermediate avidity CAR T-cells and derived pCARs, raising the possibility that effector to target cell avidity is an important determinant of efficacy.
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Affiliation(s)
- Leena Halim
- Chimeric Antigen Receptor (CAR) Mechanics Laboratory, Guy's Cancer Centre, School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | | | - Daniel Larcombe-Young
- Chimeric Antigen Receptor (CAR) Mechanics Laboratory, Guy's Cancer Centre, School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Adam Ajina
- Chimeric Antigen Receptor (CAR) Mechanics Laboratory, Guy's Cancer Centre, School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | | | - Reuben Benjamin
- Faculty of Life Sciences and Medicine, School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom.,Department of Clinical Haematology, King's College Hospital National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Richard Dillon
- Department of Clinical Haematology, Guy's and St Thomas' National Health Service (NHS) Foundation Trust, London, United Kingdom.,Department of Medicine and Molecular Genetics, King's College London, London, United Kingdom
| | - David M Davies
- Chimeric Antigen Receptor (CAR) Mechanics Laboratory, Guy's Cancer Centre, School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - John Maher
- Chimeric Antigen Receptor (CAR) Mechanics Laboratory, Guy's Cancer Centre, School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom.,Leucid Bio, Guy's Hospital, London, United Kingdom.,Department of Clinical Immunology and Allergy, King's College Hospital National Health Service (NHS) Foundation Trust, London, United Kingdom.,Department of Immunology, Eastbourne Hospital, Eastbourne, United Kingdom
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24
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Davis C, Li C, Nie R, Guzzardi N, Dworakowska B, Sadasivam P, Maher J, Aboagye EO, Lu Z, Yan R. Highly effective liquid and solid phase extraction methods to concentrate radioiodine isotopes for radioiodination chemistry. J Labelled Comp Radiopharm 2022; 65:280-287. [PMID: 35906717 PMCID: PMC9773003 DOI: 10.1002/jlcr.3994] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/16/2022] [Accepted: 07/25/2022] [Indexed: 12/30/2022]
Abstract
Radioactive iodine isotopes play a pivotal role in radiopharmaceuticals. Large-scale production of multi-patient dose of radioiodinated nuclear medicines requires high concentration of radioiodine. We demonstrate that tetrabutylammonium chloride and methyltrioctylamonium chloride are effective phase transfer reagents to concentrate iodide-124, iodide-125 and iodide-131 from the corresponding commercial water solutions. The resulting concentrated radioiodide, in the presence of either phase transfer reagent, does not hamper the chemical reactivity of aqueous radioiodide in the copper (II)-mediated one-pot three-component click chemistry to produce radioiodinated iodotriazoles.
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Affiliation(s)
- Christopher Davis
- School of Biomedical Engineering and Imaging Sciences, St. Thomas' HospitalKing's College LondonLondonUK
| | - Chun Li
- Department of Nuclear MedicineFirst Affiliated Hospital of Dalian Medical UniversityDalianChina
| | - Ruirui Nie
- Department of Nuclear MedicineFirst Affiliated Hospital of Dalian Medical UniversityDalianChina
| | - Norman Guzzardi
- School of Biomedical Engineering and Imaging Sciences, St. Thomas' HospitalKing's College LondonLondonUK
| | - Barbara Dworakowska
- School of Biomedical Engineering and Imaging Sciences, St. Thomas' HospitalKing's College LondonLondonUK,Cancer Imaging Centre, Department of Surgery and CancerImperial CollegeLondonUK
| | - Pragalath Sadasivam
- School of Biomedical Engineering and Imaging Sciences, St. Thomas' HospitalKing's College LondonLondonUK
| | - John Maher
- School of Cancer and Pharmaceutical Studies, Guy's HospitalKing's College LondonLondonUK,Department of ImmunologyEastbourne HospitalEast SussexUK,Guy's HospitalLeucid Bio LtdLondonUK
| | - Eric O. Aboagye
- Cancer Imaging Centre, Department of Surgery and CancerImperial CollegeLondonUK
| | - Zhi Lu
- Department of Nuclear MedicineFirst Affiliated Hospital of Dalian Medical UniversityDalianChina
| | - Ran Yan
- School of Biomedical Engineering and Imaging Sciences, St. Thomas' HospitalKing's College LondonLondonUK
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25
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Muliaditan T, Halim L, Whilding LM, Draper B, Achkova DY, Kausar F, Glover M, Bechman N, Arulappu A, Sanchez J, Flaherty KR, Obajdin J, Grigoriadis K, Antoine P, Larcombe-Young D, Hull CM, Buus R, Gordon P, Grigoriadis A, Davies DM, Schurich A, Maher J. Synergistic T cell signaling by 41BB and CD28 is optimally achieved by membrane proximal positioning within parallel chimeric antigen receptors. Cell Rep Med 2021; 2:100457. [PMID: 35028604 PMCID: PMC8714859 DOI: 10.1016/j.xcrm.2021.100457] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 05/30/2020] [Revised: 09/14/2021] [Accepted: 11/05/2021] [Indexed: 12/13/2022]
Abstract
Second generation (2G) chimeric antigen receptors (CARs) contain a CD28 or 41BB co-stimulatory endodomain and elicit remarkable efficacy in hematological malignancies. Third generation (3G) CARs extend this linear blueprint by fusing both co-stimulatory units in series. However, clinical impact has been muted despite compelling evidence that co-signaling by CD28 and 41BB can powerfully amplify natural immune responses. We postulate that effective dual co-stimulation requires juxta-membrane positioning of endodomain components within separate synthetic receptors. Consequently, we designed parallel (p)CARs in which a 2G (CD28+CD3ζ) CAR is co-expressed with a 41BB-containing chimeric co-stimulatory receptor. We demonstrate that the pCAR platform optimally harnesses synergistic and tumor-dependent co-stimulation to resist T cell exhaustion and senescence, sustaining proliferation, cytokine release, cytokine signaling, and metabolic fitness upon repeated stimulation. When engineered using targeting moieties of diverse composition, affinity, and specificity, pCAR T cells consistently elicit superior anti-tumor activity compared with T cells that express traditional linear CARs.
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Affiliation(s)
- Tamara Muliaditan
- Leucid Bio Ltd., Guy’s Hospital, Great Maze Pond, London SE1 9RT, UK
| | - Leena Halim
- King’s College London, School of Cancer and Pharmaceutical Sciences, CAR Mechanics Lab, Guy’s Cancer Centre, Great Maze Pond, London SE1 9RT, UK
| | - Lynsey M. Whilding
- King’s College London, School of Cancer and Pharmaceutical Sciences, CAR Mechanics Lab, Guy’s Cancer Centre, Great Maze Pond, London SE1 9RT, UK
| | - Benjamin Draper
- King’s College London, School of Cancer and Pharmaceutical Sciences, CAR Mechanics Lab, Guy’s Cancer Centre, Great Maze Pond, London SE1 9RT, UK
| | - Daniela Y. Achkova
- King’s College London, School of Cancer and Pharmaceutical Sciences, CAR Mechanics Lab, Guy’s Cancer Centre, Great Maze Pond, London SE1 9RT, UK
| | - Fahima Kausar
- Leucid Bio Ltd., Guy’s Hospital, Great Maze Pond, London SE1 9RT, UK
| | - Maya Glover
- Leucid Bio Ltd., Guy’s Hospital, Great Maze Pond, London SE1 9RT, UK
| | - Natasha Bechman
- King’s College London, School of Cancer and Pharmaceutical Sciences, CAR Mechanics Lab, Guy’s Cancer Centre, Great Maze Pond, London SE1 9RT, UK
| | - Appitha Arulappu
- Leucid Bio Ltd., Guy’s Hospital, Great Maze Pond, London SE1 9RT, UK
| | - Jenifer Sanchez
- King’s College London, Department of Infectious Diseases, School of Immunology and Microbial Sciences, Guy’s Hospital, Great Maze Pond, London SE1 9RT, UK
| | - Katie R. Flaherty
- King’s College London, Department of Infectious Diseases, School of Immunology and Microbial Sciences, Guy’s Hospital, Great Maze Pond, London SE1 9RT, UK
| | - Jana Obajdin
- Leucid Bio Ltd., Guy’s Hospital, Great Maze Pond, London SE1 9RT, UK
| | - Kristiana Grigoriadis
- King’s College London, School of Cancer and Pharmaceutical Sciences, Cancer Bioinformatics, Guy’s Cancer Centre, Great Maze Pond, London SE1 9RT, UK
| | - Pierre Antoine
- King’s College London, School of Cancer and Pharmaceutical Sciences, CAR Mechanics Lab, Guy’s Cancer Centre, Great Maze Pond, London SE1 9RT, UK
| | - Daniel Larcombe-Young
- King’s College London, School of Cancer and Pharmaceutical Sciences, CAR Mechanics Lab, Guy’s Cancer Centre, Great Maze Pond, London SE1 9RT, UK
| | - Caroline M. Hull
- Leucid Bio Ltd., Guy’s Hospital, Great Maze Pond, London SE1 9RT, UK
- King’s College London, School of Cancer and Pharmaceutical Sciences, CAR Mechanics Lab, Guy’s Cancer Centre, Great Maze Pond, London SE1 9RT, UK
| | - Richard Buus
- The Breast Cancer Now Toby Robins Research Centre at The Institute of Cancer Research, 237 Fulham Road, London SW3 6JB, UK
- Ralph Lauren Centre for Breast Cancer Research, Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK
| | - Peter Gordon
- King’s College London, School of Cancer and Pharmaceutical Sciences, CAR Mechanics Lab, Guy’s Cancer Centre, Great Maze Pond, London SE1 9RT, UK
| | - Anita Grigoriadis
- King’s College London, School of Cancer and Pharmaceutical Sciences, Cancer Bioinformatics, Guy’s Cancer Centre, Great Maze Pond, London SE1 9RT, UK
| | - David M. Davies
- Leucid Bio Ltd., Guy’s Hospital, Great Maze Pond, London SE1 9RT, UK
- King’s College London, School of Cancer and Pharmaceutical Sciences, CAR Mechanics Lab, Guy’s Cancer Centre, Great Maze Pond, London SE1 9RT, UK
| | - Anna Schurich
- King’s College London, Department of Infectious Diseases, School of Immunology and Microbial Sciences, Guy’s Hospital, Great Maze Pond, London SE1 9RT, UK
| | - John Maher
- Leucid Bio Ltd., Guy’s Hospital, Great Maze Pond, London SE1 9RT, UK
- King’s College London, School of Cancer and Pharmaceutical Sciences, CAR Mechanics Lab, Guy’s Cancer Centre, Great Maze Pond, London SE1 9RT, UK
- Department of Clinical Immunology and Allergy, King’s College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK
- Department of Immunology, Eastbourne Hospital, Kings Drive, Eastbourne, East Sussex BN21 2UD, UK
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26
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Beatson RE, Parente-Pereira AC, Halim L, Cozzetto D, Hull C, Whilding LM, Martinez O, Taylor CA, Obajdin J, Luu Hoang KN, Draper B, Iqbal A, Hardiman T, Zabinski T, Man F, de Rosales RT, Xie J, Aswad F, Achkova D, Joseph CYR, Ciprut S, Adami A, Roider HG, Hess-Stumpp H, Győrffy B, Quist J, Grigoriadis A, Sommer A, Tutt AN, Davies DM, Maher J. TGF-β1 potentiates Vγ9Vδ2 T cell adoptive immunotherapy of cancer. Cell Rep Med 2021; 2:100473. [PMID: 35028614 PMCID: PMC8714942 DOI: 10.1016/j.xcrm.2021.100473] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 05/18/2021] [Revised: 10/16/2021] [Accepted: 11/19/2021] [Indexed: 12/14/2022]
Abstract
Despite its role in cancer surveillance, adoptive immunotherapy using γδ T cells has achieved limited efficacy. To enhance trafficking to bone marrow, circulating Vγ9Vδ2 T cells are expanded in serum-free medium containing TGF-β1 and IL-2 (γδ[T2] cells) or medium containing IL-2 alone (γδ[2] cells, as the control). Unexpectedly, the yield and viability of γδ[T2] cells are also increased by TGF-β1, when compared to γδ[2] controls. γδ[T2] cells are less differentiated and yet display increased cytolytic activity, cytokine release, and antitumor activity in several leukemic and solid tumor models. Efficacy is further enhanced by cancer cell sensitization using aminobisphosphonates or Ara-C. A number of contributory effects of TGF-β are described, including prostaglandin E2 receptor downmodulation, TGF-β insensitivity, and upregulated integrin activity. Biological relevance is supported by the identification of a favorable γδ[T2] signature in acute myeloid leukemia (AML). Given their enhanced therapeutic activity and compatibility with allogeneic use, γδ[T2] cells warrant evaluation in cancer immunotherapy.
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MESH Headings
- Animals
- Bone Marrow Cells/pathology
- Cell Line, Tumor
- Cell Movement
- Cell Proliferation
- Culture Media, Serum-Free/pharmacology
- Gene Expression Profiling
- Gene Expression Regulation, Leukemic
- Humans
- Immunophenotyping
- Immunotherapy, Adoptive
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myeloid, Acute/immunology
- Leukemia, Myeloid, Acute/pathology
- Leukemia, Myeloid, Acute/therapy
- Lymphocyte Activation
- Mice, SCID
- Prognosis
- Receptors, Antigen, T-Cell, gamma-delta/metabolism
- Transforming Growth Factor beta1/metabolism
- Mice
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Affiliation(s)
- Richard E. Beatson
- King’s College London, School of Cancer and Pharmaceutical Sciences, Guy’s Cancer Centre, Great Maze Pond, London SE1 9RT, UK
| | - Ana C. Parente-Pereira
- King’s College London, School of Cancer and Pharmaceutical Sciences, Guy’s Cancer Centre, Great Maze Pond, London SE1 9RT, UK
| | - Leena Halim
- King’s College London, School of Cancer and Pharmaceutical Sciences, Guy’s Cancer Centre, Great Maze Pond, London SE1 9RT, UK
| | - Domenico Cozzetto
- Translational Bioinformatics, NIHR Biomedical Research Centre, Guy’s and St. Thomas’s NHS Foundation Trust and King’s College London, London SE1 9RT, UK
| | - Caroline Hull
- King’s College London, School of Cancer and Pharmaceutical Sciences, Guy’s Cancer Centre, Great Maze Pond, London SE1 9RT, UK
| | - Lynsey M. Whilding
- King’s College London, School of Cancer and Pharmaceutical Sciences, Guy’s Cancer Centre, Great Maze Pond, London SE1 9RT, UK
| | - Olivier Martinez
- King’s College London, School of Cancer and Pharmaceutical Sciences, Guy’s Cancer Centre, Great Maze Pond, London SE1 9RT, UK
| | - Chelsea A. Taylor
- King’s College London, School of Cancer and Pharmaceutical Sciences, Guy’s Cancer Centre, Great Maze Pond, London SE1 9RT, UK
| | - Jana Obajdin
- King’s College London, School of Cancer and Pharmaceutical Sciences, Guy’s Cancer Centre, Great Maze Pond, London SE1 9RT, UK
| | - Kim Ngan Luu Hoang
- King’s College London, School of Cancer and Pharmaceutical Sciences, Guy’s Cancer Centre, Great Maze Pond, London SE1 9RT, UK
| | - Benjamin Draper
- King’s College London, School of Cancer and Pharmaceutical Sciences, Guy’s Cancer Centre, Great Maze Pond, London SE1 9RT, UK
| | - Ayesha Iqbal
- King’s College London, School of Cancer and Pharmaceutical Sciences, Guy’s Cancer Centre, Great Maze Pond, London SE1 9RT, UK
- Cancer Bioinformatics, King’s College London, School of Cancer and Pharmaceutical Sciences, Guy’s Cancer Centre, Great Maze Pond, London SE1 9RT, UK
| | - Tom Hardiman
- King’s College London, School of Cancer and Pharmaceutical Sciences, Guy’s Cancer Centre, Great Maze Pond, London SE1 9RT, UK
- Cancer Bioinformatics, King’s College London, School of Cancer and Pharmaceutical Sciences, Guy’s Cancer Centre, Great Maze Pond, London SE1 9RT, UK
| | - Tomasz Zabinski
- King’s College London, School of Cancer and Pharmaceutical Sciences, Guy’s Cancer Centre, Great Maze Pond, London SE1 9RT, UK
| | - Francis Man
- King’s College London, School of Biomedical Engineering and Imaging Sciences, St. Thomas’ Hospital, London SE1 7EH, UK
| | - Rafael T.M. de Rosales
- King’s College London, School of Biomedical Engineering and Imaging Sciences, St. Thomas’ Hospital, London SE1 7EH, UK
| | - Jinger Xie
- Bayer Healthcare Innovation Center, Mission Bay, 455 Mission Bay Boulevard South, San Francisco, CA 94158, USA
| | - Fred Aswad
- Bayer Healthcare Innovation Center, Mission Bay, 455 Mission Bay Boulevard South, San Francisco, CA 94158, USA
| | - Daniela Achkova
- King’s College London, School of Cancer and Pharmaceutical Sciences, Guy’s Cancer Centre, Great Maze Pond, London SE1 9RT, UK
| | - Chung-Yang Ricardo Joseph
- King’s College London, School of Cancer and Pharmaceutical Sciences, Guy’s Cancer Centre, Great Maze Pond, London SE1 9RT, UK
| | - Sara Ciprut
- King’s College London, School of Cancer and Pharmaceutical Sciences, Guy’s Cancer Centre, Great Maze Pond, London SE1 9RT, UK
| | - Antonella Adami
- King’s College London, School of Cancer and Pharmaceutical Sciences, Guy’s Cancer Centre, Great Maze Pond, London SE1 9RT, UK
| | | | | | - Balázs Győrffy
- Department of Bioinformatics, Semmelweis University, Budapest H1085, Hungary
- Cancer Biomarker Research Group, Research Center for Natural Science, Budapest H1117, Hungary
| | - Jelmar Quist
- King’s College London, School of Cancer and Pharmaceutical Sciences, Guy’s Cancer Centre, Great Maze Pond, London SE1 9RT, UK
- Cancer Bioinformatics, King’s College London, School of Cancer and Pharmaceutical Sciences, Guy’s Cancer Centre, Great Maze Pond, London SE1 9RT, UK
| | - Anita Grigoriadis
- King’s College London, School of Cancer and Pharmaceutical Sciences, Guy’s Cancer Centre, Great Maze Pond, London SE1 9RT, UK
- Cancer Bioinformatics, King’s College London, School of Cancer and Pharmaceutical Sciences, Guy’s Cancer Centre, Great Maze Pond, London SE1 9RT, UK
| | | | - Andrew N.J. Tutt
- King’s College London, Breast Cancer Now Unit, School of Cancer and Pharmaceutical Sciences, Guy’s Cancer Centre, Great Maze Pond, London SE1 9RT, UK
| | - David M. Davies
- King’s College London, School of Cancer and Pharmaceutical Sciences, Guy’s Cancer Centre, Great Maze Pond, London SE1 9RT, UK
| | - John Maher
- King’s College London, School of Cancer and Pharmaceutical Sciences, Guy’s Cancer Centre, Great Maze Pond, London SE1 9RT, UK
- Department of Immunology, Eastbourne Hospital, Kings Drive, Eastbourne, East Sussex BN21 2UD, UK
- Department of Clinical Immunology and Allergy, King’s College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK
- Leucid Bio, Guy’s Hospital, Great Maze Pond, London SE1 9RT, UK
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27
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Mazza R, Maher J. Prospects for Development of Induced Pluripotent Stem Cell-Derived CAR-Targeted Immunotherapies. Arch Immunol Ther Exp (Warsz) 2021; 70:2. [PMID: 34897554 PMCID: PMC8666432 DOI: 10.1007/s00005-021-00640-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 10/10/2021] [Accepted: 11/24/2021] [Indexed: 12/27/2022]
Abstract
Technologies required to generate induced pluripotent stem cells (iPSC) were first described 15 years ago, providing a strong impetus to the field of regenerative medicine. In parallel, immunotherapy has finally emerged as a clinically meaningful modality of cancer therapy. In particular, impressive efficacy has been achieved in patients with selected haematological malignancies using ex vivo expanded autologous T cells engineered to express chimeric antigen receptors (CARs). While solid tumours account for over 90% of human cancer, they currently are largely refractory to this therapeutic approach. Nonetheless, given the considerable innovation taking place worldwide in the CAR field, it is likely that effective solutions for common solid tumours will emerge in the near future. Such a development will create significant new challenges in the scalable delivery of these complex, costly and individualised therapies. CAR-engineered immune cell products that originate from iPSCs offer the potential to generate unlimited numbers of homogeneous, standardised cell products in which multiple defined gene modification events have been introduced to ensure safety, potency and reproducibility. Here, we review some of the emerging strategies in use to engineer CAR-expressing iPSC-derived drug products.
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Affiliation(s)
- Roberta Mazza
- Leucid Bio Ltd, Guy's Hospital, Great Maze Pond, London, SE1 9RT, UK
| | - John Maher
- Leucid Bio Ltd, Guy's Hospital, Great Maze Pond, London, SE1 9RT, UK. .,King's College London, School of Cancer and Pharmaceutical Sciences, Guy's Cancer Centre, Great Maze Pond, London, SE1 9RT, UK. .,Department of Immunology, Eastbourne Hospital, Kings Drive, Eastbourne, BN21 2UD, East Sussex, UK.
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28
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Maher J, Ryan S, King L, Sayers K, Donnellan C, Pillay I. 124 OUTCOME OF SPEECH AND LANGUAGE THERAPY CLINICAL DYSPHAGIA ASSESSMENT FOLLOWING AN INTERDISCIPLINARY SWALLOW SCREEN. Age Ageing 2021. [DOI: 10.1093/ageing/afab219.124] [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: 02/25/2023] Open
Abstract
Abstract
Background
A 7 question non-validated swallow screen (Any reported swallowing difficulties? Any coughing with food or fluids? Any choking? Does food get stuck when eating? Any recurrent chest infections? Any pain when swallowing? Any difficulty swallowing tablets?) is used by an integrated care team for older persons to prioritise referrals to the Speech and Language Therapy (SLT) service.
This study identified the proportion of patients screened who appropriately required a clinical dysphagia assessment and intervention.
Methods
This was a retrospective study from September 2020 to June 2021. Patients were assessed by the Clinical Specialist SLT who determined if swallow impairment was present and whether intervention was required. Age, gender and clinical frailty score were documented. Patients who resided out of the catchment area or who had already received an SLT service were excluded.
Results
The average age was 80 years, range 67–103. The male to female ratio was 2:1 and the average clinical frailty score (CFS) was 5. N = 42(32%) screened positive. N = 29(69%) attended for SLT assessment. N = 27(93.1%) had a swallow impairment identified. N = 20 were discharged following a single intervention and 9 required further SLT intervention.
Conclusion
Presbyphagia is generally asymptomatic and results from age related anatomical and physiological changes, reduced functional reserve and sarcopenia. Older adults compensate for these difficulties and do not seek assistance. Presbyphagia may progress to dysphagia, resulting in adverse outcomes. The high rate of SLT confirmed swallow impairment and need for SLT intervention highlights a need to prospectively refine and validate this 7 question swallow screen.
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Affiliation(s)
- J Maher
- Tipperary University Hospital , Clonmel, Ireland
| | - S Ryan
- Tipperary University Hospital , Clonmel, Ireland
| | - L King
- Tipperary University Hospital , Clonmel, Ireland
| | - K Sayers
- Tipperary University Hospital , Clonmel, Ireland
| | - C Donnellan
- Tipperary University Hospital , Clonmel, Ireland
| | - I Pillay
- Tipperary University Hospital , Clonmel, Ireland
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29
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Murphy R, Sayers K, Ryan S, Maher J, Pillay I. 179 WHAT MATTERS TO THE FRAIL OLDER PERSON CHANGES DURING COVID-19 AND SHOULD INFORM PATIENT CENTRED CHANGE. Age Ageing 2021; 50:afab219.179. [PMCID: PMC8689994 DOI: 10.1093/ageing/afab219.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Methods Results Conclusion
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Affiliation(s)
- R Murphy
- Tipperary University Hospital, Tipperary, Ireland,CHO 5, Tipperary, Ireland
| | - K Sayers
- Tipperary University Hospital, Tipperary, Ireland,Community Health Organisation 5, Tipperary, Ireland
| | - S Ryan
- Tipperary University Hospital, Tipperary, Ireland
| | - J Maher
- Tipperary University Hospital, Tipperary, Ireland,CHO 5, Tipperary, Ireland
| | - I Pillay
- Tipperary University Hospital, Tipperary, Ireland,Community Health Organisation 5, Tipperary, Ireland
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30
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Sayers K, Maher J, King L, Ryan S, Murphy R, Pillay I. 44 BONE HEALTH AND FRACTURE RISK: KNOWLEDGE, OPINION AND PRACTICE OF PHYSIOTHERAPISTS. Age Ageing 2021. [DOI: 10.1093/ageing/afab219.44] [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: 02/25/2023] Open
Abstract
Abstract
Background
Osteoporotic-related fractures are responsible for excess mortality, morbidity, chronic pain, reduction in quality of life, admission to long-term care and health and social care costs (Papaioannou et al, 2010).
Evidence for using Fracture Risk Assessment Tool (FRAX®) based community-screening in older people is increasing (Kanis et al, 2020). There is no published evidence on the use of FRAX® by Physiotherapists.
Methods
A questionnaire was sent to South Eastern Branch members of the Irish Society of Chartered Physiotherapists (ISCP).
Survey themes were: participant characteristics, knowledge and opinion in the areas of Bone Health and Fracture Risk. Responses were downloaded from Survey Monkey and analysed using descriptive statistics.
Results
The response rate was 27% (n = 56). 72% (n = 40) of those surveyed had at least 10 years clinical experience. For 65% (n = 37) of participants, older people made up more than half of their clinical caseload. 96% (n = 54) of participants treated people with frailty and other bone health risk factors; falls (93%), osteoporosis (89%), fracture or reduced mobility (87%).
On a scale of 1–10 (1 = least confident, 10 = most confident) 49% of respondents rated confidence in prescribing Bone Health Physiotherapy interventions at ≤5.
When interpreting results of a DEXA scan; 80% reported confidence to be ≤5.
Half (49%) of participants had never heard of FRAX®.
95% of respondents felt fracture risk was under addressed in clinical practice. All felt it was within their professional responsibility to discuss fracture risk with patients.
Conclusion
This is the first evaluation of bone health and fracture risk knowledge, opinion and practice of physiotherapists. The need for more knowledge of DEXA, FRAX® and bone health was highlighted. The use of FRAX® may improve fracture risk assessment in patients attending Physiotherapy. Based on these results, FRAX® has been introduced into a Rehabilitation Unit by Physiotherapists as part of Quality Improvement Project.
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Affiliation(s)
- K Sayers
- Tipperary University Hospital , Clonmel, Ireland
| | - J Maher
- Tipperary University Hospital , Clonmel, Ireland
| | - L King
- Tipperary University Hospital , Clonmel, Ireland
| | - S Ryan
- Tipperary University Hospital , Clonmel, Ireland
| | - R Murphy
- Tipperary University Hospital , Clonmel, Ireland
| | - I Pillay
- Tipperary University Hospital , Clonmel, Ireland
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31
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King L, Pillay I, Sayers K, Maher J, Ryan S, Donnellan C. 126 A QUALITY INITIATIVE TO IMPROVE THE ASSESSMENT AND RECOMMENDATION FOR TOTAL CALCIUM INTAKE. Age Ageing 2021. [DOI: 10.1093/ageing/afab219.126] [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: 02/25/2023] Open
Abstract
Abstract
Background
This study assessed factors affecting adherence to calcium supplementation, estimated total calcium intake and potential to increase dietary calcium in the frail older adult.
Methods
Frail Older Adults who completed a comprehensive geriatric assessment (CGA) between January—June 2021 were included. Those taking calcium supplements were telephoned by a Dietitian. Nursing home residents, hospital inpatients and those unable to complete a telephone questionnaire were excluded. A modified version of the Short Calcium Intake List (SCAIL) was used and potential to improve dietary calcium was assessed (1). Data was analysed using descriptive statistics.
Results
N = 50 patients were taking a calcium supplement. N = 15 were excluded. 26 women and 9 men, aged 70 -96 yrs were included. Dietary intake ranged from 250– 1904 mg. 17% (N = 6) achieved >1,000 mg/day dietary calcium requirements from diet. 66% (N = 23) had potential to increase their dietary calcium. 97% (N = 34) were prescribed a Calcium supplement, ranging from 500– 2000 mg/day. Total Calcium Intake including supplementation ranged from 850 mg—2,737 mg. 82% (N = 29) exceeded their daily requirements.40% (N = 14) reported reduced compliance due to swallowing difficulties; 25%(N = 9) gastrointestinal upset; 11% (N = 4,) taste/consistency and 8% forgetting (N = 3).Dietitian recommendations included 31% (N = 11) to stop supplementation, 34% (N = 12) to reduce, 11% (N = 4) advice on managing concerns relating to supplement and 22% (N = 8) dietary education.
Conclusion
Most older adults did not meet their nutritional requirements for dietary calcium. Over two thirds could reduce or stop supplementation following dietary calcium assessment and advice. A dietary calcium estimator for the older adult, with education can be used to correct calcium intake. This modified SCAIL will be integrated into the CGA as part of a quality improvement initiative for the frail older adult.
Reference
1. Rasch L et al. (2017), Content Validity of a Short Calcium Intake List to Estimate Daily Dietary Calcium intake of Patients with Osteoporosis, Calcified Tissue International, 100(3): 271–277.
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Affiliation(s)
- L King
- Tipperary University Hospital , Clonmel, Ireland
| | - I Pillay
- Tipperary University Hospital , Clonmel, Ireland
| | - K Sayers
- Tipperary University Hospital , Clonmel, Ireland
| | - J Maher
- Tipperary University Hospital , Clonmel, Ireland
| | - S Ryan
- Tipperary University Hospital , Clonmel, Ireland
| | - C Donnellan
- Tipperary University Hospital , Clonmel, Ireland
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32
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Hussain F, O'Reilly A, Sayers K, Maher J, Ryan S, Pillay I. Closing the Osteoporotic-Fracture Care Gap for Frail Older Persons. Ir Med J 2021; 114:434. [PMID: 35863082] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Aim To implement standardised fracture risk assessment in the frail older person. Methods Frail older patients underwent opportunistic screening for fracture risk. Roadblocks to standardised assessment were identified. An Integrated Care Team for older persons (ICT) trained in fracture risk assessment using FRAX. Clinical assessment was via a locally agreed algorithm. Data was entered onto Excel. The SQUIRE guidelines for quality improvement programmes were used to report the results. Results Of 96 patients opportunistically screened, the average age was 84 years. FRAX was completed for 19% (n=18). 89% (n=16) met the pharmacotherapy threshold. Nine were recommended pharmacotherapy. Of sixteen patients recommended for DXA, just 31% (n=5) were booked. Following implementation of a quality improvement project, 100 patients were assessed, and average age was 80 years. FRAX was completed for 62% (n=63) and 95% (n=60) required pharmacotherapy. 24% (n=14) had untreated prior fracture. All had pharmacotherapy prescribed. 59% (n=59) required DXA scanning. 70% (n=41) had DXA ordered. Conclusion ICT ownership increased FRAX assessment 3-fold and point of contact prescribing to 100%.
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Affiliation(s)
- F Hussain
- Tipperary University Hospital, Western Road, Clonmel, Co. Tipperary
- Community Health Organisation 5, Health Service Executive, Ireland
| | - A O'Reilly
- Tipperary University Hospital, Western Road, Clonmel, Co. Tipperary
- Community Health Organisation 5, Health Service Executive, Ireland
| | - K Sayers
- Tipperary University Hospital, Western Road, Clonmel, Co. Tipperary
- Community Health Organisation 5, Health Service Executive, Ireland
| | - J Maher
- Tipperary University Hospital, Western Road, Clonmel, Co. Tipperary
- Community Health Organisation 5, Health Service Executive, Ireland
| | - S Ryan
- Tipperary University Hospital, Western Road, Clonmel, Co. Tipperary
- Community Health Organisation 5, Health Service Executive, Ireland
| | - I Pillay
- Tipperary University Hospital, Western Road, Clonmel, Co. Tipperary
- Community Health Organisation 5, Health Service Executive, Ireland
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van Schalkwyk MCI, van der Stegen SJC, Bosshard-Carter L, Graves H, Papa S, Parente-Pereira AC, Farzaneh F, Fisher CD, Hope A, Adami A, Maher J. Development and Validation of a Good Manufacturing Process for IL-4-Driven Expansion of Chimeric Cytokine Receptor-Expressing CAR T-Cells. Cells 2021; 10:cells10071797. [PMID: 34359966 PMCID: PMC8307141 DOI: 10.3390/cells10071797] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 07/01/2021] [Accepted: 07/14/2021] [Indexed: 12/22/2022] Open
Abstract
Adoptive cancer immunotherapy using chimeric antigen receptor (CAR) engineered T-cells holds great promise, although several obstacles hinder the efficient generation of cell products under good manufacturing practice (GMP). Patients are often immune compromised, rendering it challenging to produce sufficient numbers of gene-modified cells. Manufacturing protocols are labour intensive and frequently involve one or more open processing steps, leading to increased risk of contamination. We set out to develop a simplified process to generate autologous gamma retrovirus-transduced T-cells for clinical evaluation in patients with head and neck cancer. T-cells were engineered to co-express a panErbB-specific CAR (T1E28z) and a chimeric cytokine receptor (4αβ) that permits their selective expansion in response to interleukin (IL)-4. Using peripheral blood as starting material, sterile culture procedures were conducted in gas-permeable bags under static conditions. Pre-aliquoted medium and cytokines, bespoke connector devices and sterile welding/sealing were used to maximise the use of closed manufacturing steps. Reproducible IL-4-dependent expansion and enrichment of CAR-engineered T-cells under GMP was achieved, both from patients and healthy donors. We also describe the development and approach taken to validate a panel of monitoring and critical release assays, which provide objective data on cell product quality.
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Affiliation(s)
- May C. I. van Schalkwyk
- Guy’s Cancer Centre, School of Cancer and Pharmaceutical Sciences, King’s College London, Great Maze Pond, London SE1 9RT, UK; (M.C.I.v.S.); (S.J.C.v.d.S.); (L.B.-C.); (S.P.); (A.C.P.-P.); (A.A.)
| | - Sjoukje J. C. van der Stegen
- Guy’s Cancer Centre, School of Cancer and Pharmaceutical Sciences, King’s College London, Great Maze Pond, London SE1 9RT, UK; (M.C.I.v.S.); (S.J.C.v.d.S.); (L.B.-C.); (S.P.); (A.C.P.-P.); (A.A.)
| | - Leticia Bosshard-Carter
- Guy’s Cancer Centre, School of Cancer and Pharmaceutical Sciences, King’s College London, Great Maze Pond, London SE1 9RT, UK; (M.C.I.v.S.); (S.J.C.v.d.S.); (L.B.-C.); (S.P.); (A.C.P.-P.); (A.A.)
| | - Helen Graves
- Immune Monitoring Laboratory, Clinical Research Facility, NIHR Biomedical Research Centre at Guy’s and St Thomas’ NHS Foundation Trust and King’s College London, Great Maze Pond, London SE1 9RT, UK;
| | - Sophie Papa
- Guy’s Cancer Centre, School of Cancer and Pharmaceutical Sciences, King’s College London, Great Maze Pond, London SE1 9RT, UK; (M.C.I.v.S.); (S.J.C.v.d.S.); (L.B.-C.); (S.P.); (A.C.P.-P.); (A.A.)
- Guy’s and St Thomas’ NHS Foundation Trust, Department of Medical Oncology, Great Maze Pond, London SE1 9RT, UK
| | - Ana C. Parente-Pereira
- Guy’s Cancer Centre, School of Cancer and Pharmaceutical Sciences, King’s College London, Great Maze Pond, London SE1 9RT, UK; (M.C.I.v.S.); (S.J.C.v.d.S.); (L.B.-C.); (S.P.); (A.C.P.-P.); (A.A.)
| | - Farzin Farzaneh
- The Rayne Institute, School of Cancer and Pharmaceutical Sciences, King’s College London, London SE5 9NU, UK;
| | - Christopher D. Fisher
- Good Manufacturing Practice Unit, Clinical Research Facility, NIHR Biomedical Research Centre at Guy’s and St Thomas’ NHS Foundation Trust and King’s College London, Great Maze Pond, London SE1 9RT, UK; (C.D.F.); (A.H.)
| | - Andrew Hope
- Good Manufacturing Practice Unit, Clinical Research Facility, NIHR Biomedical Research Centre at Guy’s and St Thomas’ NHS Foundation Trust and King’s College London, Great Maze Pond, London SE1 9RT, UK; (C.D.F.); (A.H.)
| | - Antonella Adami
- Guy’s Cancer Centre, School of Cancer and Pharmaceutical Sciences, King’s College London, Great Maze Pond, London SE1 9RT, UK; (M.C.I.v.S.); (S.J.C.v.d.S.); (L.B.-C.); (S.P.); (A.C.P.-P.); (A.A.)
| | - John Maher
- Guy’s Cancer Centre, School of Cancer and Pharmaceutical Sciences, King’s College London, Great Maze Pond, London SE1 9RT, UK; (M.C.I.v.S.); (S.J.C.v.d.S.); (L.B.-C.); (S.P.); (A.C.P.-P.); (A.A.)
- Department of Immunology, Eastbourne Hospital, Kings Drive, Eastbourne BN21 2UD, UK
- Department of Clinical Immunology and Allergy, King’s College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK
- Leucid Bio Ltd., Guy’s Hospital, Great Maze Pond, London SE1 9RT, UK
- Correspondence: ; Tel.: +44-(0)207188-1468
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Abstract
Introduction: Chimeric antigen receptor-engineered T-cells typically use the binding domains of antibodies to target cytotoxicity toward tumors. This approach has produced great efficacy against selected hematological cancers, but benefit in solid tumors has been limited. Characteristically, the microenvironment in solid tumors restricts CAR T cell function, thereby limiting success. Enhancing efficacy will depend on novel target discovery to refine specificity and reduce toxicity. Additionally, overcoming immunosuppressive mechanisms may be achieved by altering the structure of the CAR itself, together with ancillary gene expression or additional therapeutic interventions.Areas covered: Herein, the authors discuss approaches for refining and further developing CAR T cell therapies specifically for use with solid malignancies. The authors survey the existing literature and provide perspectives for the future.Expert opinion: Pronounced efficacy in solid tumors will likely require combination therapies, targeting both the tumor itself and associated immunosuppressive mechanisms. Future exploration of CAR T cell therapies for solid tumors is likely to incorporate next-generation designs that couple more precise targeting of cancer-associated targets with enhanced potency and resistance to exhaustion.
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Affiliation(s)
| | - John Maher
- King's College London, Division of Cancer Studies, Guy's Hospital, London, UK.,Department of Clinical Immunology and Allergy, King's College Hospital NHS Foundation Trust, London, UK.,Department of Immunology, Eastbourne Hospital, East Sussex, UK
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35
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Abstract
Chimeric antigen receptor (CAR) T cell therapy has achieved unrivalled success in the treatment of B cell and plasma cell malignancies, with five CAR T cell products now approved by the US Food and Drug Administration (FDA). However, CAR T cell therapies for solid tumours have not been nearly as successful, owing to several additional challenges. Here, we discuss mechanisms of tumour resistance in CAR T cell therapy and the emerging strategies that are under development to engineer CAR T cells to overcome resistance.
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Affiliation(s)
- Maya Glover
- Leucid Bio Ltd., Guy's Hospital, London, SE1 9RT, UK
| | - Stephanie Avraamides
- King's College London, School of Cancer and Pharmaceutical Sciences, Guy's Hospital, London, SE1 9RT, UK
| | - John Maher
- Leucid Bio Ltd., Guy's Hospital, London, SE1 9RT, UK.,King's College London, School of Cancer and Pharmaceutical Sciences, Guy's Hospital, London, SE1 9RT, UK.,Department of Clinical Immunology and Allergy, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK.,Department of Immunology, Eastbourne Hospital, Eastbourne, East Sussex, BN21 2UD, UK
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36
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Hovhannisyan L, Aebersold DM, Maher J, Ochsenbein AF, Riether C, Medova M, Zimmer Y. Abstract PO-039: Radiation therapy enhances anti-tumor activity of a MET CAR T-based immunotherapy approach for glioblastoma multiforme. Clin Cancer Res 2021. [DOI: 10.1158/1557-3265.radsci21-po-039] [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
Glioblastoma multiforme (GBM) is the most prevalent primary malignant brain tumor, which has an aggressive phenotype and mostly fatal recurrence after standard therapy. MET, the hepatocyte growth factor (HGF) receptor is a relevant target for GBM treatment as it is expressed in up to 50% of cases and its expression, which may be induced by radiation therapy (RT), can potentially contribute to RT-resistance of GBM stem cells, and tumor recurrence. MET-based chimeric antigen (CAR) T cell therapy is currently being evaluated in several solid tumor working settings. A combination of T cell-based therapies with RT may improve the efficacy of the CAR T cell therapy through by the RT-induced immune activation via release of cytokines and induction of antigen expression, similarly as has been observed when combining RT with immune checkpoint inhibitors. Here we investigated the combination of MET-targeting CAR T cells with RT for GBM treatment, hypothesizing enhanced anti-tumor effects. The current study used a panel of MET-proficient and MET-deficient human GBM and GBM stem-like cell lines. Cells have been irradiated with a single dose of 0, 2, 5, or 10 Gy and RT impact on MET expression has been assessed at various time points after RT administration. Results show MET increase after RT in some cell lines. To test MET-targeting CAR T effect on the GBM cell lines, CAR constructs that are based on HGF-MET binding elements have been introduced into virus-producing cells and used for human T cells transduction to generate MET-targeting CAR T cells. CAR T cells co-cultured with GBM cell lines in vitro have specifically and significantly decreased viability of MET-positive cancer cells. Data resulting from combination of RT and CAR T cells treatment suggest that radiation exhibits an enhancement of CAR T cells anti-tumor killing activity, indicating a synergism between the two modalities. In conclusion, our data are the first to indicate the efficacy of a MET-based CAR T immunotherapy approach in GBM cell lines. The results also demonstrate a basis for the combination of a MET CAR T modality together with RT. The mechanisms for understanding the interaction between RT and the MET CAR T cells are under investigation.
Citation Format: Lusine Hovhannisyan, Daniel M. Aebersold, John Maher, Adrian F. Ochsenbein, Carsten Riether, Michaela Medova, Yitzhak Zimmer. Radiation therapy enhances anti-tumor activity of a MET CAR T-based immunotherapy approach for glioblastoma multiforme [abstract]. In: Proceedings of the AACR Virtual Special Conference on Radiation Science and Medicine; 2021 Mar 2-3. Philadelphia (PA): AACR; Clin Cancer Res 2021;27(8_Suppl):Abstract nr PO-039.
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Affiliation(s)
- Lusine Hovhannisyan
- 1Department of Radiation Oncology, Inselspital, Bern University, Bern, Switzerland,
- 2Department for BioMedical Research, University of Bern, Bern, Switzerland,
| | - Daniel M. Aebersold
- 1Department of Radiation Oncology, Inselspital, Bern University, Bern, Switzerland,
| | - John Maher
- 3Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom,
| | - Adrian F. Ochsenbein
- 2Department for BioMedical Research, University of Bern, Bern, Switzerland,
- 4Department of Medical Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Carsten Riether
- 2Department for BioMedical Research, University of Bern, Bern, Switzerland,
- 4Department of Medical Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Michaela Medova
- 1Department of Radiation Oncology, Inselspital, Bern University, Bern, Switzerland,
- 2Department for BioMedical Research, University of Bern, Bern, Switzerland,
| | - Yitzhak Zimmer
- 1Department of Radiation Oncology, Inselspital, Bern University, Bern, Switzerland,
- 2Department for BioMedical Research, University of Bern, Bern, Switzerland,
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37
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Abstract
Immunotherapy of cancer using chimeric antigen receptor-engineered T-cells has transformed the management of selected haematological malignancies, triggering intense clinical trial activity in this arena. This article summarises trial activity that has been published to date across the spectrum of haematological and solid tumour types.
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Affiliation(s)
- Antonella Adami
- King's College London, School of Cancer and Pharmaceutical Sciences, CAR Mechanics Lab, Guy's Cancer Centre, London, UK
| | - John Maher
- King's College London, School of Cancer and Pharmaceutical Sciences, CAR Mechanics Lab, Guy's Cancer Centre, London, UK.,Department of Clinical Immunology and Allergy, King's College Hospital NHS Foundation Trust, London, UK.,Department of Immunology, Eastbourne Hospital, Kings Drive, East Sussex, UK.,Leucid Bio Ltd., Guy's Hospital, London, UK
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38
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Phanthaphol N, Somboonpatarakun C, Suwanchiwasiri K, Chieochansin T, Sujjitjoon J, Wongkham S, Maher J, Junking M, Yenchitsomanus PT. Chimeric Antigen Receptor T Cells Targeting Integrin αvβ6 Expressed on Cholangiocarcinoma Cells. Front Oncol 2021; 11:657868. [PMID: 33763382 PMCID: PMC7982884 DOI: 10.3389/fonc.2021.657868] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [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: 01/24/2021] [Accepted: 02/09/2021] [Indexed: 12/12/2022] Open
Abstract
Cholangiocarcinoma (CCA) is a lethal bile duct cancer that responds poorly to current standard treatments. A new therapeutic approach is, therefore, urgently needed. Adoptive T cell transfer using chimeric antigen receptor (CAR) T cells is a new therapeutic modality with demonstrated efficacy in hematologic malignancies. However, its efficacy against solid tumors is modest, and further intensive investigation continues. An important factor that influences the success of CAR T cell therapy is the selection of a target antigen that is highly expressed on cancer cells, but markedly less so in normal cells. Integrin αvβ6 is upregulated in several solid tumors, but is minimally expressed in normal epithelial cells, which suggests integrin αvβ6 as an attractive target antigen for CAR T cell immunotherapy in CCA. We investigated integrin αvβ6 expression in pathological tissue samples from patients with liver fluke-associated CCA. We then created CAR T cells targeting integrin αvβ6 and evaluated their anti-tumor activities against CCA cells. We found overexpression of the integrin αvβ6 protein in 23 of 30 (73.3%) CCA patient tissue samples. Significant association between high integrin αvβ6 expression and short survival time (p = 0.043) was also observed. Lentiviral constructs were engineered to encode CARs containing an integrin αvβ6-binding peptide (A20) derived from foot-and-mouth disease virus fused with a second-generation CD28/CD3ζ signaling domain (A20-2G CAR) or with a fourth-generation CD28/4-1BB/CD27/CD3ζ signaling domain (A20-4G CAR). The A20-2G and A20-4G CARs were highly expressed in primary human T cells transduced with the engineered lentiviruses, and they exhibited high levels of cytotoxicity against integrin αvβ6-positive CCA cells (p < 0.05). Interestingly, the A20-2G and A20-4G CAR T cells displayed anti-tumor function against integrin αvβ6-positive CCA tumor spheroids (p < 0.05). Upon specific antigen recognition, A20-4G CAR T cells produced a slightly lower level of IFN-γ, but exhibited higher proliferation than A20-2G CAR T cells. Thus, the A20-4G CAR T cells with lower level of cytokine production, but with higher proliferation represents a promising potential adoptive T cell therapy for integrin αvβ6-positive CCA.
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Affiliation(s)
- Nattaporn Phanthaphol
- Graduate Program in Immunology, Department of Immunology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.,Siriraj Center of Research Excellence for Cancer Immunotherapy (SiCORE-CIT), Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chalermchai Somboonpatarakun
- Siriraj Center of Research Excellence for Cancer Immunotherapy (SiCORE-CIT), Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.,Division of Molecular Medicine, Research Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kwanpirom Suwanchiwasiri
- Siriraj Center of Research Excellence for Cancer Immunotherapy (SiCORE-CIT), Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.,Molecular Medicine Program, Multidisciplinary Unit, Faculty of Science, Mahidol University, Bangkok, Thailand
| | - Thaweesak Chieochansin
- Siriraj Center of Research Excellence for Cancer Immunotherapy (SiCORE-CIT), Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.,Division of Molecular Medicine, Research Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Jatuporn Sujjitjoon
- Siriraj Center of Research Excellence for Cancer Immunotherapy (SiCORE-CIT), Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.,Division of Molecular Medicine, Research Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sopit Wongkham
- Department of Biochemistry, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.,Cholangiocarcinoma Research Institute, Khon Kaen University, Khon Kaen, Thailand
| | - John Maher
- King's College London, King's Health Partners Integrated Cancer Centre and Division of Cancer Studies, Guy's Hospital, London, United Kingdom
| | - Mutita Junking
- Siriraj Center of Research Excellence for Cancer Immunotherapy (SiCORE-CIT), Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.,Division of Molecular Medicine, Research Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pa-Thai Yenchitsomanus
- Siriraj Center of Research Excellence for Cancer Immunotherapy (SiCORE-CIT), Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.,Division of Molecular Medicine, Research Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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39
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Abstract
CAR-engineered T cell immunotherapy has proven transformative in selected hematological malignancies. However, solid tumors largely remain impervious to these approaches. In addressing this challenge, Srivastava et al. in this issue demonstrate that oxaliplatin-based lymphodepleting chemotherapy promotes enhanced CAR T cell recruitment to lung tumors, boosting therapeutic impact in combination with anti-PD-L1.
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Affiliation(s)
- David M Davies
- King's College London, School of Cancer and Pharmaceutical Sciences, CAR Mechanics Lab, Guy's Cancer Centre, Great Maze Pond, London SE1 9RT, UK
| | - John Maher
- King's College London, School of Cancer and Pharmaceutical Sciences, CAR Mechanics Lab, Guy's Cancer Centre, Great Maze Pond, London SE1 9RT, UK; Leucid Bio Ltd., Guy's Hospital, Great Maze Pond, London SE1 9RT, UK; Department of Clinical Immunology and Allergy, King's College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK; Department of Immunology, Eastbourne Hospital, Kings Drive, Eastbourne, East Sussex, BN21 2UD, UK.
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40
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Shrotri M, van Schalkwyk MCI, Post N, Eddy D, Huntley C, Leeman D, Rigby S, Williams SV, Bermingham WH, Kellam P, Maher J, Shields AM, Amirthalingam G, Peacock SJ, Ismail SA. T cell response to SARS-CoV-2 infection in humans: A systematic review. PLoS One 2021; 16:e0245532. [PMID: 33493185 PMCID: PMC7833159 DOI: 10.1371/journal.pone.0245532] [Citation(s) in RCA: 85] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 01/02/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Understanding the T cell response to SARS-CoV-2 is critical to vaccine development, epidemiological surveillance and disease control strategies. This systematic review critically evaluates and synthesises the relevant peer-reviewed and pre-print literature published from 01/01/2020-26/06/2020. METHODS For this systematic review, keyword-structured literature searches were carried out in MEDLINE, Embase and COVID-19 Primer. Papers were independently screened by two researchers, with arbitration of disagreements by a third researcher. Data were independently extracted into a pre-designed Excel template and studies critically appraised using a modified version of the MetaQAT tool, with resolution of disagreements by consensus. Findings were narratively synthesised. RESULTS 61 articles were included. 55 (90%) studies used observational designs, 50 (82%) involved hospitalised patients with higher acuity illness, and the majority had important limitations. Symptomatic adult COVID-19 cases consistently show peripheral T cell lymphopenia, which positively correlates with increased disease severity, duration of RNA positivity, and non-survival; while asymptomatic and paediatric cases display preserved counts. People with severe or critical disease generally develop more robust, virus-specific T cell responses. T cell memory and effector function has been demonstrated against multiple viral epitopes, and, cross-reactive T cell responses have been demonstrated in unexposed and uninfected adults, but the significance for protection and susceptibility, respectively, remains unclear. CONCLUSION A complex pattern of T cell response to SARS-CoV-2 infection has been demonstrated, but inferences regarding population level immunity are hampered by significant methodological limitations and heterogeneity between studies, as well as a striking lack of research in asymptomatic or pauci-symptomatic individuals. In contrast to antibody responses, population-level surveillance of the T cell response is unlikely to be feasible in the near term. Focused evaluation in specific sub-groups, including vaccine recipients, should be prioritised.
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Affiliation(s)
- Madhumita Shrotri
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
- National Infection Service, Public Health England, London, United Kingdom
| | - May C. I. van Schalkwyk
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Nathan Post
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Danielle Eddy
- National Infection Service, Public Health England, London, United Kingdom
| | - Catherine Huntley
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - David Leeman
- National Infection Service, Public Health England, London, United Kingdom
| | - Samuel Rigby
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sarah V. Williams
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - William H. Bermingham
- Department of Clinical Immunology, University Hospitals Birmingham, Birmingham, United Kingdom
| | - Paul Kellam
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - John Maher
- School of Cancer and Pharmaceutical Studies, King’s College London, London, United Kingdom
- Department of Immunology, Eastbourne Hospital, Eastbourne, United Kingdom
| | - Adrian M. Shields
- Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | | | - Sharon J. Peacock
- National Infection Service, Public Health England, London, United Kingdom
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Sharif A. Ismail
- National Infection Service, Public Health England, London, United Kingdom
- Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
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41
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Post N, Eddy D, Huntley C, van Schalkwyk MCI, Shrotri M, Leeman D, Rigby S, Williams SV, Bermingham WH, Kellam P, Maher J, Shields AM, Amirthalingam G, Peacock SJ, Ismail SA. Antibody response to SARS-CoV-2 infection in humans: A systematic review. PLoS One 2020; 15:e0244126. [PMID: 33382764 PMCID: PMC7775097 DOI: 10.1371/journal.pone.0244126] [Citation(s) in RCA: 224] [Impact Index Per Article: 56.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 12/03/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Progress in characterising the humoral immune response to Severe Acute Respiratory Syndrome 2 (SARS-CoV-2) has been rapid but areas of uncertainty persist. Assessment of the full range of evidence generated to date to understand the characteristics of the antibody response, its dynamics over time, its determinants and the immunity it confers will have a range of clinical and policy implications for this novel pathogen. This review comprehensively evaluated evidence describing the antibody response to SARS-CoV-2 published from 01/01/2020-26/06/2020. METHODS Systematic review. Keyword-structured searches were carried out in MEDLINE, Embase and COVID-19 Primer. Articles were independently screened on title, abstract and full text by two researchers, with arbitration of disagreements. Data were double-extracted into a pre-designed template, and studies critically appraised using a modified version of the Public Health Ontario Meta-tool for Quality Appraisal of Public Health Evidence (MetaQAT) tool, with resolution of disagreements by consensus. Findings were narratively synthesised. RESULTS 150 papers were included. Most studies (113 or 75%) were observational in design, were based wholly or primarily on data from hospitalised patients (108, 72%) and had important methodological limitations. Few considered mild or asymptomatic infection. Antibody dynamics were well described in the acute phase, up to around three months from disease onset, but the picture regarding correlates of the antibody response was inconsistent. IgM was consistently detected before IgG in included studies, peaking at weeks two to five and declining over a further three to five weeks post-symptom onset depending on the patient group; IgG peaked around weeks three to seven post-symptom onset then plateaued, generally persisting for at least eight weeks. Neutralising antibodies were detectable within seven to 15 days following disease onset, with levels increasing until days 14-22 before levelling and then decreasing, but titres were lower in those with asymptomatic or clinically mild disease. Specific and potent neutralising antibodies have been isolated from convalescent plasma. Cross-reactivity but limited cross-neutralisation with other human coronaviridae was reported. Evidence for protective immunity in vivo was limited to small, short-term animal studies, showing promising initial results in the immediate recovery phase. CONCLUSIONS Literature on antibody responses to SARS-CoV-2 is of variable quality with considerable heterogeneity of methods, study participants, outcomes measured and assays used. Although acute phase antibody dynamics are well described, longer-term patterns are much less well evidenced. Comprehensive assessment of the role of demographic characteristics and disease severity on antibody responses is needed. Initial findings of low neutralising antibody titres and possible waning of titres over time may have implications for sero-surveillance and disease control policy, although further evidence is needed. The detection of potent neutralising antibodies in convalescent plasma is important in the context of development of therapeutics and vaccines. Due to limitations with the existing evidence base, large, cross-national cohort studies using appropriate statistical analysis and standardised serological assays and clinical classifications should be prioritised.
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Affiliation(s)
- Nathan Post
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Danielle Eddy
- National Infection Service, Public Health England, London, United Kingdom
| | - Catherine Huntley
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - May C. I. van Schalkwyk
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Madhumita Shrotri
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - David Leeman
- National Infection Service, Public Health England, London, United Kingdom
| | - Samuel Rigby
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sarah V. Williams
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - William H. Bermingham
- Department of Clinical Immunology, University Hospitals Birmingham, Birmingham, United Kingdom
| | - Paul Kellam
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - John Maher
- School of Cancer and Pharmaceutical Studies, King’s College London, London, United Kingdom
- Department of Immunology, Eastbourne Hospital, Eastbourne, United Kingdom
| | - Adrian M. Shields
- Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | | | - Sharon J. Peacock
- National Infection Service, Public Health England, London, United Kingdom
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Sharif A. Ismail
- National Infection Service, Public Health England, London, United Kingdom
- Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Abstract
INTRODUCTION Adoptive immunotherapy of cancer has evolved from the use of ex vivo expanded lymphokine-activated killer cells and tumor-infiltrating lymphocytes to an increasing array of approaches involving genetically engineered T-cells. A pivotal advance in the enablement of these therapies has been the conditioning of patients with lymphodepleting chemotherapy.A broad range of lymphodepleting regimens has been employed in an effort to improve response rates, without any single consistent approach having emerged. Only a limited number of studies involving small numbers of patients has directly compared two or more regimens, making it challenging to infer which are the preferred agents and dosing schedules. This difficulty is compounded by the fact that both response rate and toxicity appear to be disease-, patient- and T-cell product specific. EXPERT OPINION This article surveys clinical experience with lymphodepleting regimens that have been used in conjunction with adoptive T-cell immunotherapy, focussing in particular on studies where different approaches have been employed. Harnessing this limited and evolving clinical experience, we set out to provide potential insights into how an optimal balance may be achieved between efficacy and safety. Intermediate dose fludarabine-based regimens are emerging as an increasingly popular option in an attempt to achieve this goal, although further studies are required to provide definitive evidence.
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Affiliation(s)
| | - John Maher
- Leucid Bio Ltd., Guy's Hospital, London UK.,King's College London, School of Cancer and Pharmaceutical Sciences, Guy's Cancer Centre, London UK.,Department of Clinical Immunology and Allergy, King's College Hospital NHS Foundation Trust, London UK.,Department of Immunology, Eastbourne Hospital, Kings Drive, East Sussex, UK
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43
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Zhou R, Yazdanifar M, Roy LD, Whilding LM, Gavrill A, Maher J, Mukherjee P. Corrigendum: CAR T Cells Targeting the Tumor MUC1 Glycoprotein Reduce Triple-Negative Breast Cancer Growth. Front Immunol 2020; 11:628776. [PMID: 33365036 PMCID: PMC7750685 DOI: 10.3389/fimmu.2020.628776] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 11/13/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ru Zhou
- Department of Biological Sciences, University of North Carolina at Charlotte, Charlotte, NC, United States
| | - Mahboubeh Yazdanifar
- Department of Biological Sciences, University of North Carolina at Charlotte, Charlotte, NC, United States
| | - Lopamudra Das Roy
- Department of Biological Sciences, University of North Carolina at Charlotte, Charlotte, NC, United States
| | - Lynsey M Whilding
- School of Cancer and Pharmaceutical Sciences, King's College London, Guy's Hospital Campus, London, United Kingdom
| | - Artemis Gavrill
- School of Cancer and Pharmaceutical Sciences, King's College London, Guy's Hospital Campus, London, United Kingdom
| | - John Maher
- School of Cancer and Pharmaceutical Sciences, King's College London, Guy's Hospital Campus, London, United Kingdom
| | - Pinku Mukherjee
- Department of Biological Sciences, University of North Carolina at Charlotte, Charlotte, NC, United States
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Maher J, Cruz G, Huang T, Van Ligten M, Lucas A, Prado L, Attiah M, Shirzai S, Chang J, Hari A, Clair K, Tewari K. Compliance with visual inspection with acetic acid (VIA) screening for cervical cancer in northern Tanzania. Gynecol Oncol 2020. [DOI: 10.1016/j.ygyno.2020.05.656] [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: 11/25/2022]
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Abstract
Current targeted therapies for breast cancer include hormone inhibitors, monoclonal antibodies and tyrosine kinase inhibitors. However, a significant unmet therapeutic need remains for refractory disease and in particular for the triple negative subtype, which lacks hormone receptors and HER2. Chimeric antigen receptors T cells are genetically engineered to deploy selective cytolytic activity against cells that express cognate native target. Durable remissions have been achieved in refractory hematological malignancies but similar success against solid tumors remains elusive. Several hurdles hinder progress, including the need to identify safe antigens, promote T-cell homing to tumor sites and to ensure the persistence of functional chimeric antigen receptors T cells within the immunosuppressive tumor microenvironment. Perspectives to enable the attainment of this goal are presented in this review.
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Affiliation(s)
- Pierre Antoine
- King's College London, School of Cancer & Pharmaceutical Sciences, Guy’s Cancer Centre, Great Maze Pond, London, SE1 9RT, UK
| | - John Maher
- King's College London, School of Cancer & Pharmaceutical Sciences, Guy’s Cancer Centre, Great Maze Pond, London, SE1 9RT, UK
- Leucid Bio Ltd., Guy’s Hospital, Great Maze Pond, London, SE1 9RT, UK
- Department of Clinical Immunology & Allergy, King’s College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK
- Department of Immunology, Eastbourne Hospital, Kings Drive, Eastbourne, East Sussex, BN21 2UD, UK
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46
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Obajdin J, Davies DM, Maher J. Engineering of chimeric natural killer cell receptors to develop precision adoptive immunotherapies for cancer. Clin Exp Immunol 2020; 202:11-27. [PMID: 32544282 PMCID: PMC7488126 DOI: 10.1111/cei.13478] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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: 04/27/2020] [Revised: 06/04/2020] [Accepted: 06/07/2020] [Indexed: 12/15/2022] Open
Abstract
Natural killer (NK) cells are innate immune effectors which play a crucial role in recognizing and eliminating virally infected and cancerous cells. They effectively distinguish between healthy and distressed self through the integration of signals delivered by germline‐encoded activating and inhibitory cell surface receptors. The frequent up‐regulation of stress markers on genetically unstable cancer cells has prompted the development of novel immunotherapies that exploit such innate receptors. One prominent example entails the development of chimeric antigen receptors (CAR) that detect cell surface ligands bound by NK receptors, coupling this engagement to the delivery of tailored immune activating signals. Here, we review strategies to engineer CARs in which specificity is conferred by natural killer group 2D (NKG2D) or other NK receptor types. Multiple preclinical studies have demonstrated the remarkable ability of chimeric NK receptor‐targeted T cells and NK cells to effectively and specifically eliminate cancer cells and to reject established tumour burdens. Importantly, such systems act not only acutely but, in some cases, they also incite immunological memory. Moreover, CARs targeted with the NKG2D ligand binding domain have also been shown to disrupt the tumour microenvironment, through the targeting of suppressive T regulatory cells, myeloid‐derived suppressor cells and tumour vasculature. Collectively, these findings have led to the initiation of early‐phase clinical trials evaluating both autologous and allogeneic NKG2D‐targeted CAR T cells in the haematological and solid tumour settings.
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Affiliation(s)
- J Obajdin
- School of Cancer and Pharmaceutical Sciences, CAR Mechanics Laboratory, Guy's Cancer Centre, King's College London, London, UK
| | - D M Davies
- School of Cancer and Pharmaceutical Sciences, CAR Mechanics Laboratory, Guy's Cancer Centre, King's College London, London, UK
| | - J Maher
- School of Cancer and Pharmaceutical Sciences, CAR Mechanics Laboratory, Guy's Cancer Centre, King's College London, London, UK.,Department of Clinical Immunology and Allergy, King's College Hospital NHS Foundation Trust, London, UK.,Department of Immunology, Eastbourne Hospital, Eastbourne, UK.,Leucid Bio Ltd, Guy's Hospital, London, UK
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Webb TE, Davies M, Maher J, Sarker D. The eIF4A inhibitor silvestrol sensitizes T-47D ductal breast carcinoma cells to external-beam radiotherapy. Clin Transl Radiat Oncol 2020; 24:123-126. [PMID: 32875125 PMCID: PMC7451755 DOI: 10.1016/j.ctro.2020.07.002] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/12/2020] [Accepted: 07/14/2020] [Indexed: 01/05/2023] Open
Abstract
Treatment of T-47D breast cancer cells with silvestrol sensitised them to radiation. 1 nM silvestrol caused a 34% reduction in cells exposed to 2 Gy. Clonogenic assays revealed silvestrol had a dose modifying factor of 1.4. Radiation was delivered to the tissue culture plate using a clinical LINAC machine.
Purpose eIF4A is an RNA helicase that forms part of the machinery of translation initiation. Proteomic analysis demonstrated eIF4A expression to be at least two-fold greater in a radioresistant derivative of T-47D breast cancer cells compared to parental cells. Inhibition of eIF4A has previously been shown to re-sensitize lymphomas to chemotherapeutic agents that cause DNA damage. The objective of this work is to investigate whether inhibition of eIF4A using silvestrol sensitizes breast cancer cells to radiotherapy in tissue culture, using T-47D as a model system. Methods and materials T-47D cells were incubated in medium containing 0 nM to 1 nM silvestrol either for 24 h prior to irradiation at 0 Gy to 10 Gy, delivered by linear accelerator (LINAC) or continually for six days post irradiation. MTT viability and clonogenic assays were used to quantify response. Results Pre-treatment of T-47D cells with 1 nM silvestrol caused a 34% reduction (p = 0.014) in viability on irradiation at 2 Gy compared to treatment with a DMSO control, as assessed by MTT assay. Maintenance of cells in 1 nM silvestrol for six days following irradiation at 2 Gy caused a 58% reduction (p = <0.001) in tumor cell viability. Clonogenic assays performed on cells maintained in 1 nM silvestrol following irradiation showed a dose modifying factor (DMF) of 1.4 (p = <0.001, one-way ANOVA). Conclusions Low concentrations of silvestrol sensitize T-47D breast cancer cells to radiation with minimal effects on unirradiated cells. This highlights the possible usefulness of eIF4A inhibition in potentiating radiation-induced damage at the tumor site without causing systemic toxicity.
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Affiliation(s)
- Thomas E Webb
- Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
| | - Marc Davies
- Research Oncology, Comprehensive Cancer Centre, 3rd Floor Bermondsey Wing, Guy's Hospital, Great Maze, Pond Road, London SE1 9RT, UK.,King's College London, School of Cancer and Pharmaceutical Sciences, Guy's Cancer Centre, Great Maze, Pond, London SE1 9RT, UK
| | - John Maher
- King's College London, School of Cancer and Pharmaceutical Sciences, Guy's Cancer Centre, Great Maze, Pond, London SE1 9RT, UK.,Department of Clinical Immunology and Allergy, King's College Hospital NHS Foundation Trust, Denmark, Hill, London SE5 9RS, UK.,Department of Immunology, Eastbourne Hospital, Kings Drive, Eastbourne, East Sussex BN21 2UD, UK
| | - Debashis Sarker
- Research Oncology, Comprehensive Cancer Centre, 3rd Floor Bermondsey Wing, Guy's Hospital, Great Maze, Pond Road, London SE1 9RT, UK.,Department of Medical Oncology, Guy's & St Thomas' NHS Trust, London SE1 9RT, UK
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Patel N, Maher J, Lie X, Gwaltney C, Morgan S, Meyers O, Workman C, Negro A, Cohen G. P-170 Understanding patient experience in hepatocellular carcinoma: A qualitative patient interview study. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.04.252] [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: 10/23/2022] Open
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Affiliation(s)
- Daniel Larcombe-Young
- King's College London , School of Cancer and Pharmaceutical Sciences, CAR Mechanics Lab, Guy's Cancer Centre, Great Maze Pond, London, UK
| | - Sophie Papa
- King's College London , School of Cancer and Pharmaceutical Sciences, ImmunoEngineering Group, Guy's Cancer Centre, Great Maze Pond, London, UK.,Depart of Medical Oncology, Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond , London, UK
| | - John Maher
- King's College London , School of Cancer and Pharmaceutical Sciences, CAR Mechanics Lab, Guy's Cancer Centre, Great Maze Pond, London, UK.,Leucid Bio Ltd., Guy's Hospital, Great Maze Pond , London, UK.,Department of Clinical Immunology and Allergy, King's College Hospital NHS Foundation Trust , London UK.,Department of Immunology, Eastbourne Hospital , Eastbourne, UK
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50
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Abstract
Chimeric antigen receptor (CAR) T-cell immunotherapy has achieved unprecedented efficacy in the treatment of chemotherapy-resistant or refractory B-cell malignancies. Promising results from pivotal anti-CD19 CAR T-cell phase II trials have led to landmark approvals of two CD19-specific CAR T-cell products by the United States Food and Drug Administration and European Medicines Agency. However, several issues associated with CAR T-cell treatment remain unresolved, such as the management of severe toxicities and the frequent occurrence of both antigen-positive and antigen-negative relapse. Nonetheless, pre-clinical research is advancing at an unprecedented pace to develop innovative solutions to address these issues. Herein, we summarise recent clinical developments and outcomes of CD19-targeted CAR T-cell immunotherapy and discuss emerging strategies that may further improve the success, safety and broadened applicability of this approach.
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Affiliation(s)
- Leena Halim
- King’s College London, School of Cancer and Pharmaceutical Sciences, Guy’s Hospital, London, UK
| | - John Maher
- King’s College London, School of Cancer and Pharmaceutical Sciences, Guy’s Hospital, London, UK
- Department of Clinical Immunology and Allergy, King’s College Hospital NHS Foundation Trust, London, UK
- Department of Immunology, Eastbourne Hospital, East Sussex, UK
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