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Jain MD, Jacobs MT, Gao F, Nastoupil LJ, Spiegel JY, Lin Y, Dahiya S, Lunning M, Lekakis L, Reagan P, Oluwole O, McGuirk J, Deol A, Sehgal AR, Goy A, Hill BT, Andreadis C, Munoz J, Chavez JC, Bennani NN, Rapoport AP, Vose JM, Miklos D, Neelapu SS, Locke FL, Ghobadi A. Bridging therapy with axicabtagene ciloleucel for large B-cell lymphoma: results from the US Lymphoma CAR-T Consortium. Blood Adv 2024; 8:1042-1050. [PMID: 38051550 PMCID: PMC10920102 DOI: 10.1182/bloodadvances.2023011489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 10/13/2023] [Accepted: 10/31/2023] [Indexed: 12/07/2023] Open
Abstract
ABSTRACT During the manufacturing period of autologous chimeric antigen receptor (CAR) T-cell therapy, patients may experience a decline in their condition due to cancer progression. In this study, we investigated the impact of bridging therapy (BT) on the outcome of patients with relapsed/refractory large B-cell lymphoma who received antilymphoma treatment between leukapheresis and axicabtagene ciloleucel (axi-cel) infusion. We conducted our analysis using data from the multicenter US Lymphoma CAR-T Consortium, with a median follow-up of 33 months (range, 4.3-42.1). Out of the 298 patients who underwent leukapheresis, 275 patients received axi-cel. A total 52% of patients (n = 143) who received BT had a higher baseline risk profile than patients who did not receive BT, and these patients, as a group, had inferior outcomes compared with those who did not receive BT. However, after propensity score matching between the 2 groups, there were no statistically significant differences in overall response rate (77% vs 87%; P = .13), complete response rate (58% vs 70%; P = .1), progression-free survival (hazard ratio [HR], 1.25; P = .23), and overall survival (HR, 1.39; P=.09) between the BT group and the no-BT group, respectively. Analyzing the effects of BT in the whole cohort that underwent leukapheresis regardless of receiving axi-cel (intention-to-treat analysis) showed similar results. Radiation BT resulted in outcomes similar to those observed with nonradiation BT. Our findings suggest that BT may be safe without a significant impact on long-term survival for patients who require disease stabilization during the manufacturing period. Moreover, our results suggest that there is no clear advantage to using radiation-based BT over nonradiation-based BT.
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Affiliation(s)
- Michael D. Jain
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, FL
| | - Miriam T. Jacobs
- Division of Medical Oncology, Washington University School of Medicine and Siteman Cancer Center, St Louis, MO
| | - Feng Gao
- Division of Medical Oncology, Washington University School of Medicine and Siteman Cancer Center, St Louis, MO
| | - Loretta J. Nastoupil
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jay Y. Spiegel
- Division of Blood and Marrow Transplantation & Cellular Therapy, Stanford University Medical Center, Stanford, CA
| | - Yi Lin
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - Saurabh Dahiya
- Department of Medicine, University of Maryland School of Medicine and Greenebaum Comprehensive Cancer Center, Baltimore, MD
| | - Matthew Lunning
- Division of Hematology and Oncology, University of Nebraska Medical Center, Omaha, NE
| | - Lazaros Lekakis
- Division of Transplant and Cellular Therapy, University of Miami Miller School of Medicine, Miami, FL
| | - Patrick Reagan
- Department of Medicine, Hematology/Oncology, University of Rochester Medical Center, Rochester, NY
| | - Olalekan Oluwole
- Division of Hematology/Oncology, Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Joseph McGuirk
- Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS
| | - Abhinav Deol
- Department of Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | - Alison R. Sehgal
- Division of Hematology/Oncology, UPMC Hillman Cancer Center, Pittsburgh, PA
| | - Andre Goy
- Lymphoma Division, John Theurer Cancer Center, Hackensack Meridian Health, Hackensack, NJ
| | - Brian T. Hill
- Department of Hematology and Medical Oncology, Cleveland Clinic, Cleveland, OH
| | | | - Javier Munoz
- Division of Oncology, Banner MD Anderson Cancer Center, Gilbert, AZ
| | - Julio C Chavez
- Department of Malignant Hematology, Moffitt Cancer Center, Tampa, FL
| | | | - Aaron P. Rapoport
- Department of Medicine, University of Maryland School of Medicine and Greenebaum Comprehensive Cancer Center, Baltimore, MD
| | - Julie M. Vose
- Division of Hematology and Oncology, University of Nebraska Medical Center, Omaha, NE
| | - David Miklos
- Division of Blood and Marrow Transplantation & Cellular Therapy, Stanford University Medical Center, Stanford, CA
| | - Sattva S. Neelapu
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Frederick L. Locke
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, FL
| | - Armin Ghobadi
- Division of Medical Oncology, Washington University School of Medicine and Siteman Cancer Center, St Louis, MO
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Jacobs MT, Wong P, Zhou AY, Becker-Hapak M, Marin ND, Marsala L, Foster M, Foltz JA, Cubitt CC, Tran J, Russler-Germain DA, Neal C, Kersting-Schadek S, Chang L, Schappe T, Pence P, McClain E, Zevallos JP, Rich JT, Paniello RC, Jackson c RS, Pipkorn P, Adkins DR, DeSelm CJ, Berrien-Elliott MM, Puram SV, Fehniger TA. Memory-like Differentiation, Tumor-Targeting mAbs, and Chimeric Antigen Receptors Enhance Natural Killer Cell Responses to Head and Neck Cancer. Clin Cancer Res 2023; 29:4196-4208. [PMID: 37556118 PMCID: PMC10796148 DOI: 10.1158/1078-0432.ccr-23-0156] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 07/03/2023] [Accepted: 08/07/2023] [Indexed: 08/10/2023]
Abstract
PURPOSE Head and neck squamous cell carcinoma (HNSCC) is an aggressive tumor with low response rates to frontline PD-1 blockade. Natural killer (NK) cells are a promising cellular therapy for T cell therapy-refractory cancers, but are frequently dysfunctional in patients with HNSCC. Strategies are needed to enhance NK cell responses against HNSCC. We hypothesized that memory-like (ML) NK cell differentiation, tumor targeting with cetuximab, and engineering with an anti-EphA2 (Erythropoietin-producing hepatocellular receptor A2) chimeric antigen receptor (CAR) enhance NK cell responses against HNSCC. EXPERIMENTAL DESIGN We generated ML NK and conventional (c)NK cells from healthy donors, then evaluated their ability to produce IFNγ, TNF, degranulate, and kill HNSCC cell lines and primary HNSCC cells, alone or in combination with cetuximab, in vitro and in vivo using xenograft models. ML and cNK cells were engineered to express anti-EphA2 CAR-CD8A-41BB-CD3z, and functional responses were assessed in vitro against HNSCC cell lines and primary HNSCC tumor cells. RESULTS Human ML NK cells displayed enhanced IFNγ and TNF production and both short- and long-term killing of HNSCC cell lines and primary targets, compared with cNK cells. These enhanced responses were further improved by cetuximab. Compared with controls, ML NK cells expressing anti-EphA2 CAR had increased IFNγ and cytotoxicity in response to EphA2+ cell lines and primary HNSCC targets. CONCLUSIONS These preclinical findings demonstrate that ML differentiation alone or coupled with either cetuximab-directed targeting or EphA2 CAR engineering were effective against HNSCCs and provide the rationale for investigating these combination approaches in early phase clinical trials for patients with HNSCC.
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Affiliation(s)
- Miriam T. Jacobs
- Division of Oncology, Department of Medicine, Washington University School of Medicine
- Alvin J. Siteman Cancer Center, St. Louis, MO, USA
| | - Pamela Wong
- Division of Oncology, Department of Medicine, Washington University School of Medicine
| | - Alice Y. Zhou
- Division of Oncology, Department of Medicine, Washington University School of Medicine
- Alvin J. Siteman Cancer Center, St. Louis, MO, USA
| | - Michelle Becker-Hapak
- Division of Oncology, Department of Medicine, Washington University School of Medicine
| | - Nancy D. Marin
- Division of Oncology, Department of Medicine, Washington University School of Medicine
| | - Lynne Marsala
- Division of Oncology, Department of Medicine, Washington University School of Medicine
| | - Mark Foster
- Division of Oncology, Department of Medicine, Washington University School of Medicine
| | - Jennifer A. Foltz
- Division of Oncology, Department of Medicine, Washington University School of Medicine
| | - Celia C. Cubitt
- Division of Oncology, Department of Medicine, Washington University School of Medicine
| | - Jennifer Tran
- Division of Oncology, Department of Medicine, Washington University School of Medicine
| | - David A. Russler-Germain
- Division of Oncology, Department of Medicine, Washington University School of Medicine
- Alvin J. Siteman Cancer Center, St. Louis, MO, USA
| | - Carly Neal
- Division of Oncology, Department of Medicine, Washington University School of Medicine
| | | | - Lily Chang
- Division of Oncology, Department of Medicine, Washington University School of Medicine
| | - Timfothy Schappe
- Division of Oncology, Department of Medicine, Washington University School of Medicine
| | - Patrick Pence
- Division of Oncology, Department of Medicine, Washington University School of Medicine
| | - Ethan McClain
- Division of Oncology, Department of Medicine, Washington University School of Medicine
| | - Jose P. Zevallos
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jason T Rich
- Alvin J. Siteman Cancer Center, St. Louis, MO, USA
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Randal C. Paniello
- Alvin J. Siteman Cancer Center, St. Louis, MO, USA
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Ryan S. Jackson c
- Alvin J. Siteman Cancer Center, St. Louis, MO, USA
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Patrik Pipkorn
- Alvin J. Siteman Cancer Center, St. Louis, MO, USA
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Douglas R. Adkins
- Division of Oncology, Department of Medicine, Washington University School of Medicine
- Alvin J. Siteman Cancer Center, St. Louis, MO, USA
| | - Carl J. DeSelm
- Alvin J. Siteman Cancer Center, St. Louis, MO, USA
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Melissa M. Berrien-Elliott
- Division of Oncology, Department of Medicine, Washington University School of Medicine
- Alvin J. Siteman Cancer Center, St. Louis, MO, USA
| | - Sidharth V. Puram
- Alvin J. Siteman Cancer Center, St. Louis, MO, USA
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
- Department of Genetics, Washington University School of Medicine, St. Louis, MO, USA
| | - Todd A. Fehniger
- Division of Oncology, Department of Medicine, Washington University School of Medicine
- Alvin J. Siteman Cancer Center, St. Louis, MO, USA
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Wong P, Foltz JA, Chang L, Neal CC, Yao T, Cubitt CC, Tran J, Kersting-Schadek S, Palakurty S, Jaeger N, Russler-Germain DA, Marin ND, Gang M, Wagner JA, Zhou AY, Jacobs MT, Foster M, Schappe T, Marsala L, McClain E, Pence P, Becker-Hapak M, Fisk B, Petti AA, Griffith OL, Griffith M, Berrien-Elliott MM, Fehniger TA. T-BET and EOMES sustain mature human NK cell identity and antitumor function. J Clin Invest 2023; 133:e162530. [PMID: 37279078 PMCID: PMC10313375 DOI: 10.1172/jci162530] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 05/19/2023] [Indexed: 06/07/2023] Open
Abstract
Since the T-box transcription factors (TFs) T-BET and EOMES are necessary for initiation of NK cell development, their ongoing requirement for mature NK cell homeostasis, function, and molecular programming remains unclear. To address this, T-BET and EOMES were deleted in unexpanded primary human NK cells using CRISPR/Cas9. Deleting these TFs compromised in vivo antitumor response of human NK cells. Mechanistically, T-BET and EOMES were required for normal NK cell proliferation and persistence in vivo. NK cells lacking T-BET and EOMES also exhibited defective responses to cytokine stimulation. Single-cell RNA-Seq revealed a specific T-box transcriptional program in human NK cells, which was rapidly lost following T-BET and EOMES deletion. Further, T-BET- and EOMES-deleted CD56bright NK cells acquired an innate lymphoid cell precursor-like (ILCP-like) profile with increased expression of the ILC-3-associated TFs RORC and AHR, revealing a role for T-box TFs in maintaining mature NK cell phenotypes and an unexpected role of suppressing alternative ILC lineages. Our study reveals the critical importance of sustained EOMES and T-BET expression to orchestrate mature NK cell function and identity.
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Affiliation(s)
- Pamela Wong
- Department of Medicine, Division of Oncology
| | | | - Lily Chang
- Department of Medicine, Division of Oncology
| | | | - Tony Yao
- Department of Medicine, Division of Oncology
| | | | | | | | | | | | | | | | | | | | | | | | - Mark Foster
- Department of Medicine, Division of Oncology
| | | | | | | | | | | | - Bryan Fisk
- Department of Medicine, Division of Oncology
| | | | | | | | | | - Todd A. Fehniger
- Department of Medicine, Division of Oncology
- Siteman Cancer Center, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
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Wang Y, Jain P, Locke FL, Maurer MJ, Frank MJ, Munoz JL, Dahiya S, Beitinjaneh AM, Jacobs MT, Mcguirk JP, Vose JM, Goy A, Andreadis C, Hill BT, Dorritie KA, Oluwole OO, Deol A, Paludo J, Shah B, Wang T, Banerjee R, Miklos DB, Rapoport AP, Lekakis L, Ghobadi A, Neelapu SS, Lin Y, Wang ML, Jain MD. Brexucabtagene Autoleucel for Relapsed or Refractory Mantle Cell Lymphoma in Standard-of-Care Practice: Results From the US Lymphoma CAR T Consortium. J Clin Oncol 2023; 41:2594-2606. [PMID: 36753699 PMCID: PMC10489553 DOI: 10.1200/jco.22.01797] [Citation(s) in RCA: 37] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 12/02/2022] [Accepted: 12/15/2022] [Indexed: 02/10/2023] Open
Abstract
PURPOSE Brexucabtagene autoleucel (brexu-cel) is an autologous CD19-directed chimeric antigen receptor (CAR) T-cell therapy approved for relapsed/refractory mantle cell lymphoma (MCL). This therapy was approved on the basis of the single-arm phase II ZUMA-2 trial, which showed best overall and complete response rates of 91% and 68%, respectively. We report clinical outcomes with brexu-cel in the standard-of-care setting for the approved indication. PATIENTS AND METHODS Patients who underwent leukapheresis between August 1, 2020 and December 31, 2021, at 16 US institutions, with an intent to manufacture commercial brexu-cel for relapsed/refractory MCL, were included. Patient data were collected for analyses of responses, outcomes, and toxicities as per standard guidelines. RESULTS Of 189 patients who underwent leukapheresis, 168 (89%) received brexu-cel infusion. Of leukapheresed patients, 79% would not have met ZUMA-2 eligibility criteria. Best overall and complete response rates were 90% and 82%, respectively. At a median follow-up of 14.3 months after infusion, the estimates for 6- and 12-month progression-free survival (PFS) were 69% (95% CI, 61 to 75) and 59% (95% CI, 51 to 66), respectively. The nonrelapse mortality was 9.1% at 1 year, primarily because of infections. Grade 3 or higher cytokine release syndrome and neurotoxicity occurred in 8% and 32%, respectively. In univariable analysis, high-risk simplified MCL international prognostic index, high Ki-67, TP53 aberration, complex karyotype, and blastoid/pleomorphic variant were associated with shorter PFS after brexu-cel infusion. Patients with recent bendamustine exposure (within 24 months before leukapheresis) had shorter PFS and overall survival after leukapheresis in intention-to-treat univariable analysis. CONCLUSION In the standard-of-care setting, the efficacy and toxicity of brexu-cel were consistent with those reported in the ZUMA-2 trial. Tumor-intrinsic features of MCL, and possibly recent bendamustine exposure, may be associated with inferior efficacy outcomes.
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Affiliation(s)
| | - Preetesh Jain
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | | | - Saurabh Dahiya
- University of Maryland School of Medicine, Greenebaum Comprehensive Cancer Center, Baltimore, MD
| | - Amer M. Beitinjaneh
- University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, FL
| | - Miriam T. Jacobs
- Washington University School of Medicine, Siteman Cancer Center, St Louis, MO
| | | | - Julie M. Vose
- University of Nebraska Medical Center, Buffett Cancer Center, Omaha, NE
| | - Andre Goy
- John Theurer Cancer Center, Hackensack Meridian Health, Hackensack, NJ
| | | | | | | | | | - Abhinav Deol
- Wayne State University, Karmanos Cancer Institute, Detroit, MI
| | | | | | - Trent Wang
- University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, FL
| | - Rahul Banerjee
- University of California San Francisco, San Francisco, CA
| | | | - Aaron P. Rapoport
- University of Maryland School of Medicine, Greenebaum Comprehensive Cancer Center, Baltimore, MD
| | - Lazaros Lekakis
- University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, FL
| | - Armin Ghobadi
- Washington University School of Medicine, Siteman Cancer Center, St Louis, MO
| | | | - Yi Lin
- Mayo Clinic, Rochester, MN
| | - Michael L. Wang
- The University of Texas MD Anderson Cancer Center, Houston, TX
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McKenna M, Epperla N, Ghobadi A, Liu J, Lazaryan A, Ibrahim U, Jacobson CA, Naik SG, Nastoupil L, Chowdhury SM, Voorhees TJ, Jacobs MT, Farooq U, Osman K, Olszewski AJ, Ahmed S, Evens AM. Real-world evidence of the safety and survival with CD19 CAR-T cell therapy for relapsed/refractory solid organ transplant-related PTLD. Br J Haematol 2023. [PMID: 37129856 DOI: 10.1111/bjh.18828] [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: 03/15/2023] [Revised: 04/11/2023] [Accepted: 04/12/2023] [Indexed: 05/03/2023]
Abstract
The use of CD19 chimeric antigen receptor T-cell (CAR-T) therapy for relapsed/refractory solid organ transplantation (SOT)-related post-transplant lymphoproliferative disorder (PTLD) is not well studied. We conducted a multicentre, retrospective analysis of adults with relapsed/refractory SOT-associated PTLD. Among 22 relapsed/refractory SOT-PTLD patients, the pathology was monomorphic B cell. Prior SOTs included 14 kidney (64%), three liver (14%), two heart (9%), one intestinal (5%), one lung (5%), and one pancreas after kidney transplant (5%). The median time from SOT to PTLD diagnosis was 107 months. Pre-CAR-T bridging therapy was used in 55% of patients, and immunosuppression was stopped completely before CAR-T infusion in 64%. Eighteen (82%) patients experienced cytokine release syndrome: one (5%) each grade (G) 3 and G4. The immune effector cell-associated neurotoxicity syndrome was observed in 16 (73%) patients: six (27%) G3 and two (9%) G4. The overall response rate was 64% (55% complete response). Three patients (14%) experienced allograft rejection after CAR-T. The two-year progression-free survival and overall survival rates were 35% and 58%, respectively. Additionally, the achievement of CR post-CAR-T was strongly associated with survival. Collectively, the safety and efficacy of CD19 CAR-T therapy in relapsed/refractory SOT-related PTLD appeared similar to pivotal CAR-T data, including approximately one-third of patients achieving sustained remission.
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Affiliation(s)
- Marshall McKenna
- Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Narendranath Epperla
- Division of Hematology, Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Armin Ghobadi
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jieqi Liu
- Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Aleksandr Lazaryan
- Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, Florida, USA
| | - Uroosa Ibrahim
- Department of Hematology and Oncology, Bone Marrow Transplantation and Cellular Therapy Program, Mount Sinai Hospital, New York, New York, USA
| | - Caron A Jacobson
- Division of Hematologic Malignancies, Harvard Medical School, Dana Faber Cancer Institute, Boston, Massachusetts, USA
| | - Seema G Naik
- Penn State Cancer Institute, Penn State Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Loretta Nastoupil
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sayan Mullick Chowdhury
- Division of Hematology, Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Timothy J Voorhees
- Division of Hematology, Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Miriam T Jacobs
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Umar Farooq
- Division of Hematology, Oncology and Blood & Marrow Transplantation, University of Iowa Hospital and Clinics, Iowa City, Iowa, USA
| | - Keren Osman
- Department of Hematology and Oncology, Bone Marrow Transplantation and Cellular Therapy Program, Mount Sinai Hospital, New York, New York, USA
| | - Adam J Olszewski
- Lifespan Cancer Institute, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Sairah Ahmed
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Andrew M Evens
- Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
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Marin ND, Becker-Hapak M, Alayo QA, Berrien-Elliot M, Marsala L, Sonnek N, Jacobs MT, Foltz JA, Zhou A, Tran J, Wong P, Cubit C, Hwang K, Schappe T, Fields RC, Ciorba MA, Fehniger TA. Abstract 893: Memory like differentiation enhances in vitro and in vivo NK cell responses against colorectal cancer. Cancer Res 2023. [DOI: 10.1158/1538-7445.am2023-893] [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: 04/07/2023]
Abstract
Abstract
Metastatic (m) colorectal cancer (CRC) is an incurable, frequently lethal disease present in approximately 25% of newly diagnosed CRC patients, and almost 50% of the patients with CRC will develop metastatic disease. For mCRC, while systemic therapies (cytotoxic therapy, targeted therapy, immunotherapy or their combinations) have extended patient’s life expectancy, not all patients are candidates for these treatments. Immunotherapy has achieved significant curative effects in patients with solid tumors; however, a considerable proportion of mCRC patients (~90%) are not responsive to immune checkpoint blockade (ICB) leaving a gap in the CRC immunotherapy options.
Natural killer (NK) cells are cytotoxic innate lymphoid cells that display potent effector responses against a wide variety of tumor cells; however, they are frequently dysfunctional in cancer patients. NK cells from CRC patients exhibit decreased expression of activating receptors and reduced cytokine production after stimulation with CRC cells with a more accentuated phenotype in advanced stages of the disease. Memory-like (ML) NK cells differentiated after IL-12, IL-15, and IL-18 activation have been shown to overcome limitations associated with deficient tumor recognition and poor anti-tumor activity. In clinical trials, ML NK cells were safe and active against acute myeloid leukemia (Romee R et al, Sci Transl Med, 2016). Preclinically, ML NK cells exhibited improved responses against melanoma (Marin ND et al, Clin Cancer Res, 2021) and ovarian cancers, compared to conventional NK cells. Here, we hypothesized that memory-like differentiation will enhance multiple aspects of the NK cell response against CRC cells.
Allogeneic ML NK cells displayed enhanced IFN-γ production against four CRC cell lines DLD-1 (p=0.015), SW480 (p=0.0005), HT-29 (p=0.0005) and HCT116 (p=0.001), as well as primary patient derived CRC tumoroids (p=0.0156), compared to conventional (c) NK cells. ML NK cells also exhibited superior and sustained killing of CRC cell lines over time compared to cNK cells, as measured by Incucyte assays and using CRC tumoroids. Furthermore, IFN-γ production was significantly reduced after blockade of NKG2D, DNAM-1 and NKp46 (p<0.01) revealing mechanistic insights into how ML NK cells recognize CRC targets. Finally, using a xenograft model of CRC in NSG mice, we demonstrated that ML NK cells exhibited superior control of Luciferase expressing HCT116 cells compared to cNK cells (p=0.01) as measured by bioluminescent imaging (BLI).
Collectively, these findings demonstrate that ML NK cells exhibit enhanced responses against CRC cells, and thus warrants further investigation in clinical trials for CRC patients, especially those who are not candidates for standard of care therapy or failed ICB.
Citation Format: Nancy D. Marin, Michelle Becker-Hapak, Quazim A. Alayo, Melissa Berrien-Elliot, Lynne Marsala, Naomi Sonnek, Miriam T. Jacobs, Jennifer A. Foltz, Alice Zhou, Jennifer Tran, Pamela Wong, Celia Cubit, Kimberly Hwang, Timothy Schappe, Ryan C. Fields, Matthew A. Ciorba, Todd A. Fehniger. Memory like differentiation enhances in vitro and in vivo NK cell responses against colorectal cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 893.
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Affiliation(s)
| | | | | | | | | | - Naomi Sonnek
- 1Washington University in St. Louis, St. Louis, MO
| | | | | | - Alice Zhou
- 1Washington University in St. Louis, St. Louis, MO
| | | | - Pamela Wong
- 1Washington University in St. Louis, St. Louis, MO
| | - Celia Cubit
- 1Washington University in St. Louis, St. Louis, MO
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Abstract
Interest in adoptive cell therapy for treating cancer is exploding owing to early clinical successes of autologous chimeric antigen receptor (CAR) T lymphocyte therapy. However, limitations using T cells and autologous cell products are apparent as they (1) take weeks to generate, (2) utilize a 1:1 donor-to-patient model, (3) are expensive, and (4) are prone to heterogeneity and manufacturing failures. CAR T cells are also associated with significant toxicities, including cytokine release syndrome, immune effector cell-associated neurotoxicity syndrome, and prolonged cytopenias. To overcome these issues, natural killer (NK) cells are being explored as an alternative cell source for allogeneic cell therapies. NK cells have an inherent ability to recognize cancers, mediate immune functions of killing and communication, and do not induce graft-versus-host disease, cytokine release syndrome, or immune effector cell-associated neurotoxicity syndrome. NK cells can be obtained from blood or cord blood or be derived from hematopoietic stem and progenitor cells or induced pluripotent stem cells, and can be expanded and cryopreserved for off-the-shelf availability. The first wave of point-of-care NK cell therapies led to the current allogeneic NK cell products being investigated in clinical trials with promising preliminary results. Basic advances in NK cell biology and cellular engineering have led to new translational strategies to block inhibition, enhance and broaden target cell recognition, optimize functional persistence, and provide stealth from patients' immunity. This review details NK cell biology, as well as NK cell product manufacturing, engineering, and combination therapies explored in the clinic leading to the next generation of potent, off-the-shelf cellular therapies for blood cancers.
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Affiliation(s)
| | - Miriam T. Jacobs
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Todd A. Fehniger
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO
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Jacobs MT, Jain MD, Gao F, Nastoupil LJ, Spiegel JY, Lin Y, Dahiya S, Lunning M, Lekakis L, Reagan PM, Oluwole OO, McGuirk J, Deol A, Sehgal A, Goy A, Hill BT, Andreadis C, Munoz J, Chavez JC, Bennani NN, Rapoport AP, Vose JM, Miklos DB, Neelapu SS, Ghobadi A, Locke FL. Severity of Cytokine Release Syndrome Influences Outcome After Axicabtagene Ciloleucel for Large B cell Lymphoma: Results from the US Lymphoma CAR-T Consortium. Clin Lymphoma Myeloma Leuk 2022; 22:753-759. [PMID: 35780055 DOI: 10.1016/j.clml.2022.05.004] [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] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 05/01/2022] [Accepted: 05/19/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND The majority of patients with large B-cell lymphoma treated with axicabtagene ciloleucel (axi-cel), an anti-CD19 chimeric antigen receptor (CAR) T-cell therapy, develop cytokine release syndrome (CRS). Whether the lack of development of CRS with axi-cel is associated with inferior lymphoma outcomes is unknown. Additionally, relationship between CRS grade and lymphoma outcome is not well established. METHODS The US Lymphoma CAR T Consortium includes seventeen US academic centers that contribute data independently of manufacturers. We analyzed the modified intent-to-treat population of 275 patients receiving axi-cel in two different ways: 1) Two group analysis comparing no CRS with any grade CRS; 2) Three group analysis comparing grade 0 CRS with grade 1 to 2 CRS, and grade 3-5 CRS. RESULTS In this large multi-center observational cohort of 275 patients receiving axi-cel, 9% (n = 24) did not develop CRS, 84% (n = 232) developed grade 1-2 CRS, and 7% (n = 19) developed grade 3 to 5 CRS. Patients without CRS, compared with those having any grade CRS, had similar overall response rates (ORR), lower complete response (CR) rates and inferior progression free survival (PFS) with no statistically significant difference in overall survival (OS). Patients experiencing grade 1 to 2 CRS had superior CR rate and PFS, as compared to those without CRS or with grade 3 to 5 CRS. Grade 3 to 5 CRS was associated with a worse OS. CONCLUSION Overall, durable responses were seen in patients that did not develop CRS, however grade 1 to 2 CRS was associated with better outcomes while those with grade 3 to 5 experienced the worse outcomes.
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Affiliation(s)
- Miriam T Jacobs
- Washington University School of Medicine and Siteman Cancer Center, St. Louis, MO
| | | | - Feng Gao
- Washington University School of Medicine and Siteman Cancer Center, St. Louis, MO
| | | | | | - Yi Lin
- Mayo Clinic, Rochester, MN
| | - Saurabh Dahiya
- University of Maryland School of Medicine and Greenebaum Comprehensive Cancer Center, Baltimore, MD
| | | | | | | | | | | | - Abhinav Deol
- Karmanos Center Institute/Wayne State University, Detroit, MI
| | | | - Andre Goy
- John Theurer Cancer Center, Hackensack Meridian Health, Hackensack, NJ
| | | | | | | | - Julio C Chavez
- Dept. of Malignant Hematology, Moffitt Cancer Center, Washington, DC
| | | | - Aaron P Rapoport
- University of Maryland School of Medicine and Greenebaum Comprehensive Cancer Center, Baltimore, MD
| | - Julie M Vose
- University of Nebraska Medical Center, Omaha, NE
| | | | | | - Armin Ghobadi
- Washington University School of Medicine and Siteman Cancer Center, St. Louis, MO
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9
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Jain P, Wang Y, Locke FL, Munoz J, Beitinjaneh A, Frank MJ, Dahiya S, Jacobs MT, Hill BT, Lekakis LJ, Miklos DB, Ghobadi A, Neelapu SS, Lin Y, Wang M, Jain MD, Maurer MJ. Brexucabtagene autoleucel for relapsed/refractory mantle cell lymphoma: Real-world experience from the United States lymphoma CAR T consortium. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e19583] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e19583 Background: Brexucabtagene autoleucel (BA) is an FDA approved therapy for relapsed/refractory (R/R) mantle cell lymphoma (MCL), based on results from ZUMA-2 study. We report the safety and efficacy of BA in standard of care practice among centers in the US Lymphoma CAR-T Consortium. Methods: 16 centers participated in this retrospective study. Patients (pts) who underwent leukapheresis by 12/31/2021 with an intent to manufacture BA were included. Baseline clinical characteristics, bridging therapy, adverse events after BA infusion, and post-infusion outcome data were collected. Eligibility for ZUMA-2 was retrospectively determined. Survival outcomes were analyzed using the Kaplan-Meier method. Results: At the data cut-off date, 189 pts underwent leukapheresis, among whom 167 (88%) completed BA infusion, 22 (12%) did not receive infusion. The median age was 67 years. 16% had high risk simplified MIPI, 57% had Ki-67≥50%, 41% had aggressive histology, 49% had TP53 alteration, 51% with POD24 and 10% had CNS involvement. The median number of prior lines of therapy was 3 (range 1-10). 86% had prior BTKi treatment (89% refractory). 130 (78%) pts would not have met ZUMA-2 eligibility criteria. 113 (68%) pts received bridging therapy, which included BTKi, venetoclax, chemotherapy. Median time from leukapheresis to lymphodepletion chemotherapy: 28 days (range 17-140). Cytokine release syndrome (CRS) rate was 90% (8% grade ≥3; 1 grade 5), and immune effector cell-associated neurotoxicity syndrome (ICANS) rate was 61% (32% grade ≥3). Grade 5 ICANS (n = 0). Medications used to manage CRS and ICANS were 125 (76%) for tocilizumab, 112 (68%) for corticosteroid, and 27 (16%) for anakinra. 32 (20%) pts required ICU admission, 18 pts required vasopressors, and 5 pts required mechanical ventilation. Day 30 response was evaluable in 155 pts (89% ORR, 70% CR). The best ORR was 89%, with 80% CR, 9% PR. The ORR/CR rates were 88%/79% for aggressive histology, 89%/77% for high Ki-67% (> 50%), 90%/72% for TP53 altered, 81%/75% for CNS involved, 89%/79% for BTKi-exposed, 91%/83% for BTKi-naïve, and 89%/78% for those not meeting ZUMA-2 eligibility criteria. The median duration of response was not reached and at 6-month was 67% (95% CI 57-75). With a median follow-up of 5.6 months (range 0.2-15.3), median PFS was not reached, the 6-month PFS rate was 63% (95% CI 54-71), and median OS was 15.3 months and the 6-month OS rate was 85% (95% CI 77-90). Conclusions: This multicenter retrospective study demonstrated encouraging safety and efficacy data of BA in R/R MCL in the real-world practice. Despite 78% of the pts being ineligible for ZUMA-2, the responses, CRS, ICANS and outcomes were comparable to ZUMA-2 data. Long term safety and efficacy will be reported.
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Affiliation(s)
- Preetesh Jain
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Yucai Wang
- Mayo Clinic, Division of Hematology, Rochester, MN
| | | | - Javier Munoz
- Division of Hematology, Mayo Clinic, Gilbert, AZ
| | | | | | | | - Miriam T. Jacobs
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | | | | | | | - Armin Ghobadi
- Washington University School of Medicine, St. Louis, MO
| | - Sattva Swarup Neelapu
- The University of Texas MD Anderson Cancer Center, Department of Lymphoma/Myeloma, Houston, TX
| | - Yi Lin
- Mayo Clinic, Rochester, MN
| | - Michael Wang
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Michael D. Jain
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
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10
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Muñoz J, Wang Y, Jain P, Locke FL, Maurer MJ, Beitinjaneh A, Frank MJ, Dahiya S, McGuirk JP, Jacobs MT, Goy AH, Vose JM, Hill BT, Oluwole OO, Deol A, Shah B, Paludo J, Wang TP, Lekakis LJ, Miklos DB, Rapoport AP, Ghobadi A, Neelapu SS, Lin Y, Wang M, Jain MD. Brexucabtagene Autoleucel for Relapsed/Refractory Mantle Cell Lymphoma: Real World Experience from the US Lymphoma CAR T Consortium. Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00426-2] [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: 10/18/2022]
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11
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Spiegel J, Dahiya S, Nastoupil LJ, Tamaresis J, Ghobadi A, Lin Y, Lekakis LJ, Reagan PM, Oluwole OO, McGuirk JP, Deol A, Sehgal AR, Goy AH, Hill BT, Andreadis C, Muñoz J, Ullrickson M, Westin JR, Chavez JC, Jacobs MT, Bennani NN, Rapoport AP, Vose JM, Miklos DB, Neelapu SS, Locke FL, Lunning MA, Jain MD. Long-Term Outcomes of Patients with Large B-Cell Lymphoma Treated with Standard-of-Care Axicabtagene Ciloleucel: Results from the US Lymphoma CAR-T Cell Consortium. Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00239-1] [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: 10/18/2022]
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12
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Berrien-Elliott MM, Foltz JA, Russler-Germain DA, Neal CC, Tran J, Gang M, Wong P, Fisk B, Cubitt CC, Marin ND, Zhou AY, Jacobs MT, Foster M, Schappe T, McClain E, Kersting-Schadek S, Desai S, Pence P, Becker-Hapak M, Eisele J, Mosior M, Marsala L, Griffith OL, Griffith M, Khan SM, Spencer DH, DiPersio JF, Romee R, Uy GL, Abboud CN, Ghobadi A, Westervelt P, Stockerl-Goldstein K, Schroeder MA, Wan F, Lie WR, Soon-Shiong P, Petti AA, Cashen AF, Fehniger TA. Hematopoietic cell transplantation donor-derived memory-like NK cells functionally persist after transfer into patients with leukemia. Sci Transl Med 2022; 14:eabm1375. [PMID: 35196021 PMCID: PMC9210521 DOI: 10.1126/scitranslmed.abm1375] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Natural killer (NK) cells are innate lymphoid cells that eliminate cancer cells, produce cytokines, and are being investigated as a nascent cellular immunotherapy. Impaired NK cell function, expansion, and persistence remain key challenges for optimal clinical translation. One promising strategy to overcome these challenges is cytokine-induced memory-like (ML) differentiation, whereby NK cells acquire enhanced antitumor function after stimulation with interleukin-12 (IL-12), IL-15, and IL-18. Here, reduced-intensity conditioning (RIC) for HLA-haploidentical hematopoietic cell transplantation (HCT) was augmented with same-donor ML NK cells on day +7 and 3 weeks of N-803 (IL-15 superagonist) to treat patients with relapsed/refractory acute myeloid leukemia (AML) in a clinical trial (NCT02782546). In 15 patients, donor ML NK cells were well tolerated, and 87% of patients achieved a composite complete response at day +28, which corresponded with clearing high-risk mutations, including TP53 variants. NK cells were the major blood lymphocytes for 2 months after HCT with 1104-fold expansion (over 1 to 2 weeks). Phenotypic and transcriptional analyses identified donor ML NK cells as distinct from conventional NK cells and showed that ML NK cells persisted for over 2 months. ML NK cells expressed CD16, CD57, and high granzyme B and perforin, along with a unique transcription factor profile. ML NK cells differentiated in patients had enhanced ex vivo function compared to conventional NK cells from both patients and healthy donors. Overall, same-donor ML NK cell therapy with 3 weeks of N-803 support safely augmented RIC haplo-HCT for AML.
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Affiliation(s)
- Melissa M. Berrien-Elliott
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Jennifer A. Foltz
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - David A. Russler-Germain
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Carly C. Neal
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Jennifer Tran
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Margery Gang
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Pamela Wong
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Bryan Fisk
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Celia C. Cubitt
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Nancy D. Marin
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Alice Y. Zhou
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Miriam T. Jacobs
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Mark Foster
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Timothy Schappe
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Ethan McClain
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Samantha Kersting-Schadek
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Sweta Desai
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Patrick Pence
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Michelle Becker-Hapak
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Jeremy Eisele
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Matthew Mosior
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Lynne Marsala
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Obi L. Griffith
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Malachi Griffith
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Saad M. Khan
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - David H. Spencer
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - John F. DiPersio
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Rizwan Romee
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Geoffrey L. Uy
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Camille N. Abboud
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Armin Ghobadi
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Peter Westervelt
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Keith Stockerl-Goldstein
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Mark A. Schroeder
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Fei Wan
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO 63110, USA
| | | | | | - Allegra A. Petti
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Amanda F. Cashen
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Todd A. Fehniger
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO 63110, USA
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13
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Kim MY, Cooper ML, Jacobs MT, Ritchey JK, Hollaway J, Fehniger TA, DiPersio JF. CD7-deleted hematopoietic stem cells can restore immunity after CAR T cell therapy. JCI Insight 2021; 6:e149819. [PMID: 34423790 PMCID: PMC8410010 DOI: 10.1172/jci.insight.149819] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 06/30/2021] [Indexed: 11/17/2022] Open
Abstract
Targeting T cell malignancies with universal CD7-targeting chimeric antigen receptor T cells (UCART7) can lead to profound immune deficiency due to loss of normal T and NK cells. While a small population of endogenous CD7- T cells exists, these cells are unlikely to be able to repopulate the entire immune repertoire after UCART7 treatment, as they are limited in number and proliferative capacity. To rescue T and NK cells after UCART7, we created hematopoietic stem cells genetically deleted for CD7 (CD7-KO HSCs). CD7-KO HSCs were able to engraft immunodeficient mice and differentiate into T and NK cells lacking CD7 expression. CD7-KO T and NK cells could perform effector functions as robustly as control T and NK cells. Furthermore, CD7-KO T cells were phenotypically and functionally distinct from endogenous CD7- T cells, indicating that CD7-KO T cells can supplement immune functions lacking in CD7- T cells. Mice engrafted with CD7-KO HSCs maintained T and NK cell numbers after UCART7 treatment, while these were significantly decreased in control mice. These studies support the development of CD7-KO HSCs to augment host immunity in patients with T cell malignancies after UCART7 treatment.
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MESH Headings
- Animals
- Antigens, CD7/genetics
- Cell Engineering/methods
- Cytotoxicity, Immunologic
- Gene Editing
- Gene Knockout Techniques
- Hematopoietic Stem Cell Transplantation/methods
- Hematopoietic Stem Cells/metabolism
- Humans
- Immunotherapy, Adoptive/adverse effects
- Immunotherapy, Adoptive/methods
- Killer Cells, Natural/immunology
- Killer Cells, Natural/metabolism
- Leukemia, B-Cell/immunology
- Leukemia, B-Cell/therapy
- Mice
- RNA-Seq
- Receptors, Chimeric Antigen/genetics
- Receptors, Chimeric Antigen/immunology
- Single-Cell Analysis
- T-Lymphocytes/immunology
- T-Lymphocytes/metabolism
- T-Lymphocytes/transplantation
- Transplantation Chimera
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14
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Edelstein S, Tannous S, Jacobs MT, Ben-Amram H, Zarka S. BNT 13b2 Pfizer vaccine protects against SARS-CoV-2 respiratory mucosal colonization even after prolonged exposure to positive family members. J Hosp Infect 2021; 113:192-194. [PMID: 33811961 PMCID: PMC8011028 DOI: 10.1016/j.jhin.2021.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 03/24/2021] [Accepted: 03/24/2021] [Indexed: 11/30/2022]
Affiliation(s)
- S Edelstein
- Infectious Diseases Unit, Ziv Medical Center, Safed, Israel.
| | - S Tannous
- Infectious Diseases Unit, Ziv Medical Center, Safed, Israel
| | - M T Jacobs
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - H Ben-Amram
- Clinical Microbiology Lab, Ziv Medical Center, Safed, Israel
| | - S Zarka
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel; Ziv Medical Center, Safed, Israel
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15
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Jacobs MT, Olson M, Ferreira BP, Jin R, Hachem R, Byers D, Witt C, Ghobadi A, DiPersio JF, Pusic I. The use of ruxolitinib for acute graft-versus-host disease developing after solid organ transplantation. Am J Transplant 2020; 20:589-592. [PMID: 31446673 DOI: 10.1111/ajt.15579] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 07/23/2019] [Accepted: 08/09/2019] [Indexed: 01/25/2023]
Abstract
Development of graft-versus-host disease (GvHD) is a rare complication after transfusions or solid organ transplantation. Patients typically present with a skin rash, diarrhea, liver failure, and bone marrow aplasia. A diagnosis of transfusion/transplantation associated-GvHD is made based on the clinical and histologic evidence, yet it is often delayed due to the nonspecific symptoms attributed to the patient's underlying illness. Several therapeutic approaches are being used including both increasing and withdrawing immunosuppression, and the use of cellular therapies. Unfortunately, the success rate of these approaches is low and the mortality of this complication is very high. New approaches are needed. We report on three cases of GvHD developing after solid organ transplantation treated with ruxolitinib.
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Affiliation(s)
- Miriam T Jacobs
- Division of Oncology, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Marissa Olson
- Division of Oncology, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Bruna Pellini Ferreira
- Division of Oncology, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Ramon Jin
- Division of Oncology, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Ramsey Hachem
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Derek Byers
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Chad Witt
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Armin Ghobadi
- Division of Oncology, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - John F DiPersio
- Division of Oncology, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Iskra Pusic
- Division of Oncology, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri
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Jacobs MT, Mohindra NA, Shantzer L, Chen IL, Phull H, Mitchell W, Raymond VM, Banks KC, Nagy RJ, Lanman RB, Christensen J, Patel JD, Clarke J, Patel SP. Use of Low-Frequency Driver Mutations Detected by Cell-Free Circulating Tumor DNA to Guide Targeted Therapy in Non–Small-Cell Lung Cancer: A Multicenter Case Series. JCO Precis Oncol 2018; 2:1-10. [DOI: 10.1200/po.17.00318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To evaluate the clinical outcome of patients with non–small-cell lung cancer treated by targeting low variant allelic frequency (VAF) driver mutations identified through cell-free DNA (cfDNA) next-generation sequencing (NGS). Detection of driver mutations in cancer is critically important in the age of targeted therapy, where both tumor-based as well as cfDNA sequencing methods have been used for therapeutic decision making. We hypothesized that VAF should not be predictive of response and that low VAF alterations detected by cfDNA NGS can respond to targeted therapy. Patients and Methods A multicenter retrospective case review was performed to identify patients with non–small-cell lung cancer who received targeted molecular therapy on the basis of findings of low VAF alterations in cfDNA NGS. Mutations at low VAF were defined as < 0.2% mutated cfDNA molecules in a background of wild-type cfDNA. Results One hundred seventy-two patients underwent cfDNA NGS testing. Of the 172 patients, 12 were identified as having low VAF driver alterations and were considered for targeted therapy. The median progression-free survival (PFS) for all patients was 52 weeks (range, 17 to 88 weeks). For patients with EGFR exon 19 deletion (n = 7), the median PFS was 52 weeks (range, 17 to 60.5 weeks). For patients with EML4-ALK fusions (n = 3), the median PFS was 60 weeks (range, 18 to 88 weeks). The median overall survival for all patients after diagnosis was 57.6 weeks. Conclusion Targeted treatment response for driver mutations detected by cfDNA may be independent of VAF, even in relation to other higher VAF aberrations in plasma, and directly dependent on the underlying disease biology and ability to treat the patient with appropriate targeted therapy.
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Affiliation(s)
- Miriam T. Jacobs
- Miriam T. Jacobs, Washington University School of Medicine in St Louis, St Louis, MO; Nisha A. Mohindra, Northwestern University; Jyoti D. Patel, University of Chicago School of Medicine, Chicago, IL; Lindsey Shantzer and Jeffrey Clarke, Duke University Medical Center, Durham, NC; Ingrid L. Chen, Stony Brook University School of Medicine, Stony Brook, NY; Hardeep Phull, William Mitchell, and Sandip P. Patel, University of California, San Diego, La Jolla; Victoria M. Raymond, Kimberly C. Banks, Rebecca J
| | - Nisha A. Mohindra
- Miriam T. Jacobs, Washington University School of Medicine in St Louis, St Louis, MO; Nisha A. Mohindra, Northwestern University; Jyoti D. Patel, University of Chicago School of Medicine, Chicago, IL; Lindsey Shantzer and Jeffrey Clarke, Duke University Medical Center, Durham, NC; Ingrid L. Chen, Stony Brook University School of Medicine, Stony Brook, NY; Hardeep Phull, William Mitchell, and Sandip P. Patel, University of California, San Diego, La Jolla; Victoria M. Raymond, Kimberly C. Banks, Rebecca J
| | - Lindsey Shantzer
- Miriam T. Jacobs, Washington University School of Medicine in St Louis, St Louis, MO; Nisha A. Mohindra, Northwestern University; Jyoti D. Patel, University of Chicago School of Medicine, Chicago, IL; Lindsey Shantzer and Jeffrey Clarke, Duke University Medical Center, Durham, NC; Ingrid L. Chen, Stony Brook University School of Medicine, Stony Brook, NY; Hardeep Phull, William Mitchell, and Sandip P. Patel, University of California, San Diego, La Jolla; Victoria M. Raymond, Kimberly C. Banks, Rebecca J
| | - Ingrid L. Chen
- Miriam T. Jacobs, Washington University School of Medicine in St Louis, St Louis, MO; Nisha A. Mohindra, Northwestern University; Jyoti D. Patel, University of Chicago School of Medicine, Chicago, IL; Lindsey Shantzer and Jeffrey Clarke, Duke University Medical Center, Durham, NC; Ingrid L. Chen, Stony Brook University School of Medicine, Stony Brook, NY; Hardeep Phull, William Mitchell, and Sandip P. Patel, University of California, San Diego, La Jolla; Victoria M. Raymond, Kimberly C. Banks, Rebecca J
| | - Hardeep Phull
- Miriam T. Jacobs, Washington University School of Medicine in St Louis, St Louis, MO; Nisha A. Mohindra, Northwestern University; Jyoti D. Patel, University of Chicago School of Medicine, Chicago, IL; Lindsey Shantzer and Jeffrey Clarke, Duke University Medical Center, Durham, NC; Ingrid L. Chen, Stony Brook University School of Medicine, Stony Brook, NY; Hardeep Phull, William Mitchell, and Sandip P. Patel, University of California, San Diego, La Jolla; Victoria M. Raymond, Kimberly C. Banks, Rebecca J
| | - William Mitchell
- Miriam T. Jacobs, Washington University School of Medicine in St Louis, St Louis, MO; Nisha A. Mohindra, Northwestern University; Jyoti D. Patel, University of Chicago School of Medicine, Chicago, IL; Lindsey Shantzer and Jeffrey Clarke, Duke University Medical Center, Durham, NC; Ingrid L. Chen, Stony Brook University School of Medicine, Stony Brook, NY; Hardeep Phull, William Mitchell, and Sandip P. Patel, University of California, San Diego, La Jolla; Victoria M. Raymond, Kimberly C. Banks, Rebecca J
| | - Victoria M. Raymond
- Miriam T. Jacobs, Washington University School of Medicine in St Louis, St Louis, MO; Nisha A. Mohindra, Northwestern University; Jyoti D. Patel, University of Chicago School of Medicine, Chicago, IL; Lindsey Shantzer and Jeffrey Clarke, Duke University Medical Center, Durham, NC; Ingrid L. Chen, Stony Brook University School of Medicine, Stony Brook, NY; Hardeep Phull, William Mitchell, and Sandip P. Patel, University of California, San Diego, La Jolla; Victoria M. Raymond, Kimberly C. Banks, Rebecca J
| | - Kimberly C. Banks
- Miriam T. Jacobs, Washington University School of Medicine in St Louis, St Louis, MO; Nisha A. Mohindra, Northwestern University; Jyoti D. Patel, University of Chicago School of Medicine, Chicago, IL; Lindsey Shantzer and Jeffrey Clarke, Duke University Medical Center, Durham, NC; Ingrid L. Chen, Stony Brook University School of Medicine, Stony Brook, NY; Hardeep Phull, William Mitchell, and Sandip P. Patel, University of California, San Diego, La Jolla; Victoria M. Raymond, Kimberly C. Banks, Rebecca J
| | - Rebecca J. Nagy
- Miriam T. Jacobs, Washington University School of Medicine in St Louis, St Louis, MO; Nisha A. Mohindra, Northwestern University; Jyoti D. Patel, University of Chicago School of Medicine, Chicago, IL; Lindsey Shantzer and Jeffrey Clarke, Duke University Medical Center, Durham, NC; Ingrid L. Chen, Stony Brook University School of Medicine, Stony Brook, NY; Hardeep Phull, William Mitchell, and Sandip P. Patel, University of California, San Diego, La Jolla; Victoria M. Raymond, Kimberly C. Banks, Rebecca J
| | - Richard B. Lanman
- Miriam T. Jacobs, Washington University School of Medicine in St Louis, St Louis, MO; Nisha A. Mohindra, Northwestern University; Jyoti D. Patel, University of Chicago School of Medicine, Chicago, IL; Lindsey Shantzer and Jeffrey Clarke, Duke University Medical Center, Durham, NC; Ingrid L. Chen, Stony Brook University School of Medicine, Stony Brook, NY; Hardeep Phull, William Mitchell, and Sandip P. Patel, University of California, San Diego, La Jolla; Victoria M. Raymond, Kimberly C. Banks, Rebecca J
| | - James Christensen
- Miriam T. Jacobs, Washington University School of Medicine in St Louis, St Louis, MO; Nisha A. Mohindra, Northwestern University; Jyoti D. Patel, University of Chicago School of Medicine, Chicago, IL; Lindsey Shantzer and Jeffrey Clarke, Duke University Medical Center, Durham, NC; Ingrid L. Chen, Stony Brook University School of Medicine, Stony Brook, NY; Hardeep Phull, William Mitchell, and Sandip P. Patel, University of California, San Diego, La Jolla; Victoria M. Raymond, Kimberly C. Banks, Rebecca J
| | - Jyoti D. Patel
- Miriam T. Jacobs, Washington University School of Medicine in St Louis, St Louis, MO; Nisha A. Mohindra, Northwestern University; Jyoti D. Patel, University of Chicago School of Medicine, Chicago, IL; Lindsey Shantzer and Jeffrey Clarke, Duke University Medical Center, Durham, NC; Ingrid L. Chen, Stony Brook University School of Medicine, Stony Brook, NY; Hardeep Phull, William Mitchell, and Sandip P. Patel, University of California, San Diego, La Jolla; Victoria M. Raymond, Kimberly C. Banks, Rebecca J
| | - Jeffrey Clarke
- Miriam T. Jacobs, Washington University School of Medicine in St Louis, St Louis, MO; Nisha A. Mohindra, Northwestern University; Jyoti D. Patel, University of Chicago School of Medicine, Chicago, IL; Lindsey Shantzer and Jeffrey Clarke, Duke University Medical Center, Durham, NC; Ingrid L. Chen, Stony Brook University School of Medicine, Stony Brook, NY; Hardeep Phull, William Mitchell, and Sandip P. Patel, University of California, San Diego, La Jolla; Victoria M. Raymond, Kimberly C. Banks, Rebecca J
| | - Sandip P. Patel
- Miriam T. Jacobs, Washington University School of Medicine in St Louis, St Louis, MO; Nisha A. Mohindra, Northwestern University; Jyoti D. Patel, University of Chicago School of Medicine, Chicago, IL; Lindsey Shantzer and Jeffrey Clarke, Duke University Medical Center, Durham, NC; Ingrid L. Chen, Stony Brook University School of Medicine, Stony Brook, NY; Hardeep Phull, William Mitchell, and Sandip P. Patel, University of California, San Diego, La Jolla; Victoria M. Raymond, Kimberly C. Banks, Rebecca J
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Ang CSP, Shen JP, Hardy-Abeloos CJ, Huang JK, Ross JS, Miller VA, Jacobs MT, Chen IL, Xu D, Ali SM, Baumgartner J, Lowy A, Fanta P, Ideker T, Millis SZ, Harismendy O. Genomic Landscape of Appendiceal Neoplasms. JCO Precis Oncol 2018; 2:1700302. [PMID: 32913983 DOI: 10.1200/po.17.00302] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Purpose Appendiceal neoplasms are heterogeneous and are often treated with chemotherapy similarly to colorectal cancer (CRC). Genomic profiling was performed on 703 appendiceal cancer specimens to compare the mutation profiles of appendiceal subtypes to CRC and other cancers, with the ultimate aim to identify potential biomarkers and novel therapeutic targets. Methods Tumor specimens were submitted to a Clinical Laboratory Improvement Amendments-certified laboratory (Foundation Medicine, Cambridge, MA) for hybrid-capture-based sequencing of 3,769 exons from 315 cancer-related genes and 47 introns of 28 genes commonly rearranged in cancer. Interactions between genotype, histologic subtype, treatment, and overall survival (OS) were analyzed in a clinically annotated subset of 76 cases. Results There were five major histopathologic subtypes: mucinous adenocarcinomas (46%), adenocarcinomas (30%), goblet cell carcinoids (12%), pseudomyxoma peritonei (7.7%), and signet ring cell carcinomas (5.2%). KRAS (35% to 81%) and GNAS (8% to 72%) were the most frequent alterations in epithelial cancers; APC and TP53 mutations were significantly less frequent in appendiceal cancers relative to CRC. Low-grade and high-grade tumors were enriched for GNAS and TP53 mutations, respectively (both χ2 P < .001). GNAS and TP53 were mutually exclusive (Bonferroni corrected P < .001). Tumor grade and TP53 mutation status independently predicted OS. The mutation status of GNAS and TP53 strongly predicted OS (median, 37.1 months for TP53 mutant v 75.8 GNAS-TP53 wild type v 115.5 GNAS mutant; log-rank P = .0031) and performed as well as grade in risk stratifying patients. Conclusion Epithelial appendiceal cancers and goblet cell carcinoids show differences in KRAS and GNAS mutation frequencies and have mutation profiles distinct from CRC. This study highlights the benefit of performing molecular profiling on rare tumors to identify prognostic and predictive biomarkers and new therapeutic targets.
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Affiliation(s)
- Celina S-P Ang
- , , , , and , Mount Sinai Hospital, New York, NY; , , , , , , , , , and , University of California, San Diego, La Jolla, CA; , Albany Medical College, Albany, NY; , , and , Foundation Medicine, Cambridge, MA
| | - John Paul Shen
- , , , , and , Mount Sinai Hospital, New York, NY; , , , , , , , , , and , University of California, San Diego, La Jolla, CA; , Albany Medical College, Albany, NY; , , and , Foundation Medicine, Cambridge, MA
| | - Camille J Hardy-Abeloos
- , , , , and , Mount Sinai Hospital, New York, NY; , , , , , , , , , and , University of California, San Diego, La Jolla, CA; , Albany Medical College, Albany, NY; , , and , Foundation Medicine, Cambridge, MA
| | - Justin K Huang
- , , , , and , Mount Sinai Hospital, New York, NY; , , , , , , , , , and , University of California, San Diego, La Jolla, CA; , Albany Medical College, Albany, NY; , , and , Foundation Medicine, Cambridge, MA
| | - Jeffrey S Ross
- , , , , and , Mount Sinai Hospital, New York, NY; , , , , , , , , , and , University of California, San Diego, La Jolla, CA; , Albany Medical College, Albany, NY; , , and , Foundation Medicine, Cambridge, MA
| | - Vincent A Miller
- , , , , and , Mount Sinai Hospital, New York, NY; , , , , , , , , , and , University of California, San Diego, La Jolla, CA; , Albany Medical College, Albany, NY; , , and , Foundation Medicine, Cambridge, MA
| | - Miriam T Jacobs
- , , , , and , Mount Sinai Hospital, New York, NY; , , , , , , , , , and , University of California, San Diego, La Jolla, CA; , Albany Medical College, Albany, NY; , , and , Foundation Medicine, Cambridge, MA
| | - Ingrid L Chen
- , , , , and , Mount Sinai Hospital, New York, NY; , , , , , , , , , and , University of California, San Diego, La Jolla, CA; , Albany Medical College, Albany, NY; , , and , Foundation Medicine, Cambridge, MA
| | - David Xu
- , , , , and , Mount Sinai Hospital, New York, NY; , , , , , , , , , and , University of California, San Diego, La Jolla, CA; , Albany Medical College, Albany, NY; , , and , Foundation Medicine, Cambridge, MA
| | - Siraj M Ali
- , , , , and , Mount Sinai Hospital, New York, NY; , , , , , , , , , and , University of California, San Diego, La Jolla, CA; , Albany Medical College, Albany, NY; , , and , Foundation Medicine, Cambridge, MA
| | - Joel Baumgartner
- , , , , and , Mount Sinai Hospital, New York, NY; , , , , , , , , , and , University of California, San Diego, La Jolla, CA; , Albany Medical College, Albany, NY; , , and , Foundation Medicine, Cambridge, MA
| | - Andrew Lowy
- , , , , and , Mount Sinai Hospital, New York, NY; , , , , , , , , , and , University of California, San Diego, La Jolla, CA; , Albany Medical College, Albany, NY; , , and , Foundation Medicine, Cambridge, MA
| | - Paul Fanta
- , , , , and , Mount Sinai Hospital, New York, NY; , , , , , , , , , and , University of California, San Diego, La Jolla, CA; , Albany Medical College, Albany, NY; , , and , Foundation Medicine, Cambridge, MA
| | - Trey Ideker
- , , , , and , Mount Sinai Hospital, New York, NY; , , , , , , , , , and , University of California, San Diego, La Jolla, CA; , Albany Medical College, Albany, NY; , , and , Foundation Medicine, Cambridge, MA
| | - Sherri Z Millis
- , , , , and , Mount Sinai Hospital, New York, NY; , , , , , , , , , and , University of California, San Diego, La Jolla, CA; , Albany Medical College, Albany, NY; , , and , Foundation Medicine, Cambridge, MA
| | - Olivier Harismendy
- , , , , and , Mount Sinai Hospital, New York, NY; , , , , , , , , , and , University of California, San Diego, La Jolla, CA; , Albany Medical College, Albany, NY; , , and , Foundation Medicine, Cambridge, MA
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Abstract
671 Background: Appendiceal cancers are rare, comprising just 0.5% of all intestinal neoplasia, which has prevented the systematic study of these tumors in randomized clinical trials. Given this absence of clinical data, no evidence-based guidelines exist regarding the best management of this disease. Standard treatment generally follows consensus guidelines for colorectal cancer; however, there are currently no standards to guide chemotherapy selection in the adjuvant or metastatic setting. Methods: Somatic mutation profiles covering ~300 frequently mutated genes were obtained for 385 primary appendiceal tumors (Foundation Medicine). A retrospective review was performed to gather clinico-pathologic data. The primary objective was to assess the somatic mutation profile of each subtype of appendiceal cancer and to compare these to colorectal cancer. Colorectal data was obtained from TCGA cohort via cBioPortal. Results: Appendiceal adenocarcinoma (non-mucinous) and mucinous adenocarcinoma had shared somatic mutations albeit with differing frequencies. The most common mutations were KRAS (60.1% and 80.5%, respectively), GNAS (32.4%, 58.5%), TP53 (42.8%, 19.5%), and SMAD4 (14.8%, 14.6%). Tumors with goblet cell (adenocarcinoid) histology had lower prevalence of KRAS (16.0%) and GNAS mutations (8.0%), but similar prevalence of TP53 mutation (24.0%) and a greater prevalence of ARID1A mutation (20.0%). The mutation profiles of all appendiceal histologies differed from colorectal adenocarcinoma with markedly lower prevalence of ATM (7.9% vs. 71.0%). Chemotherapy data was available for 30 metastatic patients; these patients received an average of 1.76 lines of therapy (range 1-4). All 30 were treated with either 5-FU or capecitabine, 11 (36.7%) with oxaliplatin, 23 (76.7%) with irinotecan and 19 (63.3%) with bevacizumab. Analysis of survival data and correlation with molecular and histologic features is ongoing. Conclusions: Despite clear molecular differences between appendiceal and colorectal tumors, appendiceal tumors are primarily treated with colorectal chemotherapy regimens. There remains a pressing need for both pre-clinical and clinical investigation to develop treatment regimens specific to appendix cancer.
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Affiliation(s)
| | - Miriam T. Jacobs
- Washington University School of Medicine in St. Louis, St. Louis, MO
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Abstract
Current Dutch policy on long-term care is aimed at a stronger connection between formal home care and informal care. We examined if formal and informal caregivers of community-dwelling older adults discuss the care and whether this is related to characteristics of the older adult, the care network and the individual caregivers. Data are derived from 63 community-dwelling older adults, including their health, their perceived control of the care and their care network. In addition, 79 informal and 90 formal caregivers are interviewed on their motives and vision on caregiving. The 112 dyads between those formal and informal caregivers are the units of analysis in the current study. Bivariate analyses reveal that informal caregivers are more likely to discuss the care with formal caregivers when they are residing with the older adult, when they provide a lot of care and/or when they are strongly motivated to keep the older adult at home. This is particularly the case when the care demands are high. Characteristics of the formal caregivers were not important. In conclusion, discussion of care between non-resident informal caregivers and formal caregivers is not self-evident and requires more effort to be established.
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Affiliation(s)
- M T Jacobs
- Afdeling Sociologie, Faculteit der Sociale Wetenschappen, Vrije Universiteit Amsterdam, de Boelelaan 1081, 1081 HV, Amsterdam, The Netherlands,
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Henry LK, Iwamoto H, Field JR, Kaufmann K, Dawson ES, Jacobs MT, Adams C, Felts B, Zdravkovic I, Armstrong V, Combs S, Solis E, Rudnick G, Noskov SY, DeFelice LJ, Meiler J, Blakely RD. A conserved asparagine residue in transmembrane segment 1 (TM1) of serotonin transporter dictates chloride-coupled neurotransmitter transport. J Biol Chem 2011; 286:30823-30836. [PMID: 21730057 DOI: 10.1074/jbc.m111.250308] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Na(+)- and Cl(-)-dependent uptake of neurotransmitters via transporters of the SLC6 family, including the human serotonin transporter (SLC6A4), is critical for efficient synaptic transmission. Although residues in the human serotonin transporter involved in direct Cl(-) coordination of human serotonin transport have been identified, the role of Cl(-) in the transport mechanism remains unclear. Through a combination of mutagenesis, chemical modification, substrate and charge flux measurements, and molecular modeling studies, we reveal an unexpected role for the highly conserved transmembrane segment 1 residue Asn-101 in coupling Cl(-) binding to concentrative neurotransmitter uptake.
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Affiliation(s)
- L Keith Henry
- Departments of Pharmacology, Vanderbilt University School of Medicine, Nashville, Tennessee 37232-8548; Center for Structural Biology, Vanderbilt University School of Medicine, Nashville, Tennessee 37232-8548; Department of Pharmacology, Physiology, and Therapeutics, University of North Dakota, Grand Forks, North Dakota 58203.
| | - Hideki Iwamoto
- Departments of Pharmacology, Vanderbilt University School of Medicine, Nashville, Tennessee 37232-8548
| | - Julie R Field
- Departments of Pharmacology, Vanderbilt University School of Medicine, Nashville, Tennessee 37232-8548
| | - Kristian Kaufmann
- Chemistry, Vanderbilt University School of Medicine, Nashville, Tennessee 37232-8548
| | - Eric S Dawson
- Center for Structural Biology, Vanderbilt University School of Medicine, Nashville, Tennessee 37232-8548; Biochemistry, Vanderbilt University School of Medicine, Nashville, Tennessee 37232-8548; Vanderbilt Center for Neuroscience Drug Discovery, Vanderbilt University School of Medicine, Nashville, Tennessee 37232-8548
| | - Miriam T Jacobs
- Department of Pharmacology, Yale University School of Medicine, New Haven, Connecticut 06520-8066
| | - Chelsea Adams
- Department of Pharmacology, Physiology, and Therapeutics, University of North Dakota, Grand Forks, North Dakota 58203
| | - Bruce Felts
- Department of Pharmacology, Physiology, and Therapeutics, University of North Dakota, Grand Forks, North Dakota 58203
| | - Igor Zdravkovic
- Institute for Biocomplexity and Informatics, Department of Biological Sciences, University of Calgary, Calgary, Alberta T2N 1N4, Canada
| | - Vanessa Armstrong
- Department of Pharmacology, Physiology, and Therapeutics, University of North Dakota, Grand Forks, North Dakota 58203
| | - Steven Combs
- Chemistry, Vanderbilt University School of Medicine, Nashville, Tennessee 37232-8548
| | - Ernesto Solis
- Departments of Pharmacology, Vanderbilt University School of Medicine, Nashville, Tennessee 37232-8548
| | - Gary Rudnick
- Department of Pharmacology, Yale University School of Medicine, New Haven, Connecticut 06520-8066
| | - Sergei Y Noskov
- Institute for Biocomplexity and Informatics, Department of Biological Sciences, University of Calgary, Calgary, Alberta T2N 1N4, Canada
| | - Louis J DeFelice
- Departments of Pharmacology, Vanderbilt University School of Medicine, Nashville, Tennessee 37232-8548; Center for Molecular Neuroscience, Vanderbilt University School of Medicine, Nashville, Tennessee 37232-8548
| | - Jens Meiler
- Departments of Pharmacology, Vanderbilt University School of Medicine, Nashville, Tennessee 37232-8548; Center for Structural Biology, Vanderbilt University School of Medicine, Nashville, Tennessee 37232-8548; Chemistry, Vanderbilt University School of Medicine, Nashville, Tennessee 37232-8548
| | - Randy D Blakely
- Departments of Pharmacology, Vanderbilt University School of Medicine, Nashville, Tennessee 37232-8548; Center for Molecular Neuroscience, Vanderbilt University School of Medicine, Nashville, Tennessee 37232-8548; Psychiatry, Vanderbilt University School of Medicine, Nashville, Tennessee 37232-8548.
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Jacobs MT, Zhang YW, Campbell SD, Rudnick G. Ibogaine, a noncompetitive inhibitor of serotonin transport, acts by stabilizing the cytoplasm-facing state of the transporter. J Biol Chem 2007; 282:29441-7. [PMID: 17698848 DOI: 10.1074/jbc.m704456200] [Citation(s) in RCA: 106] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Ibogaine, a hallucinogenic alkaloid with purported anti-addiction properties, inhibited serotonin transporter (SERT) noncompetitively by decreasing V(max) with little change in the K(m) for serotonin (5-HT). Ibogaine also inhibited binding to SERT of the cocaine analog 2beta-2-carbomethoxy-3-(4-[(125)I]iodophenyl)tropane. However, inhibition of binding was competitive, increasing the apparent K(D) without much change in B(max). Ibogaine increased the reactivity of cysteine residues positioned in the proposed cytoplasmic permeation pathway of SERT but not at nearby positions out of that pathway. In contrast, cysteines placed at positions in the extracellular permeation pathway reacted at slower rates in the presence of ibogaine. These results are consistent with the proposal that ibogaine binds to and stabilizes the state of SERT from which 5-HT dissociates to the cytoplasm, in contrast with cocaine, which stabilizes the state that binds extracellular 5-HT.
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Affiliation(s)
- Miriam T Jacobs
- Department of Pharmacology, Yale University School of Medicine, New Haven, Connecticut 06520-8066, USA
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Affiliation(s)
- M T Jacobs
- Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA
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Tsui SS, Kirshbom PM, Davies MJ, Jacobs MT, Kern FH, Gaynor JW, Greeley WJ, Ungerleider RM. Thromboxane A2-receptor blockade improves cerebral protection for deep hypothermic circulatory arrest. Eur J Cardiothorac Surg 1997; 12:228-35. [PMID: 9288512 DOI: 10.1016/s1010-7940(97)00095-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE Following the use of deep hypothermic circulatory arrest in cardiac surgery, cerebral blood flow and cerebral oxygen metabolism are impaired. These may result from abnormal cerebral vasospasm. Powerful vasoconstrictors including endothelins and thromboxane A2 could mediate these processes. We investigated possible involvement of these two factors by assessing the effects of (a) phosphoramidon-an inhibitor of endothelin converting enzyme, and (b) vapiprost (GR32191B)-a specific thromboxane A2-receptor antagonist, on the recovery of cerebral blood flow and cerebral oxygen metabolism following deep hypothermic circulatory arrest. METHODS A total of 18 1-week-old piglets were randomised into three groups (n = 6 per group). At induction, the control group received saline; group PHOS received phosphoramidon 30 mg kg-1 intravenously. Group VAP received vapiprost 2 mg kg-1 at induction and at 30 min intervals thereafter. All groups underwent cardiopulmonary bypass cooling to 18 degrees C, exposed to 60 min of deep hypothermic circulatory arrest, rewarmed and reperfused for 1 h. Cerebral blood flow was measured with radio-labeled microspheres: cerebral oxygen metabolism was calculated at baseline before deep hypothermic circulatory arrest and at 1 h of reperfusion and rewarming. RESULTS In the control group, cerebral blood flow decreased to 40.2 +/- 2.0% of baseline after deep hypothermic circulatory arrest and cerebral oxygen metabolism decreased to 50.0 +/- 5.5% (P < 0.0005). The responses in group PHOS were similar. In group VAP, cerebral blood flow and cerebral oxygen metabolism were 64.3 +/- 10.6 and 80.1 +/- 9.8% of baseline, respectively, after deep hypothermic circulatory arrest. Thus, treatment with vapiprost significantly improved recovery of cerebral blood flow (P = 0.046) and cerebral oxygen metabolism (P = 0.020) following deep hypothermic circulatory arrest. No such improvement was seen after treatment with phosphoramidon. CONCLUSIONS Thromboxane A2 mediates impairments in cerebral perfusion and metabolism following deep hypothermic circulatory arrest. These changes were attenuated by blockade of thromboxane A2-receptors using vapiprost. Endothelins are not shown to be involved. Better knowledge of injury mechanisms will enable development of more effective cerebral protection strategies and allow safer application of deep hypothermic circulatory arrest.
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Affiliation(s)
- S S Tsui
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
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Kirshbom PM, Page SO, Jacobs MT, Tsui SS, Bello E, Ungerleider RM, Schwinn DA, Gaynor JW. Cardiopulmonary bypass and circulatory arrest increase endothelin-1 production and receptor expression in the lung. J Thorac Cardiovasc Surg 1997; 113:777-83. [PMID: 9104988 DOI: 10.1016/s0022-5223(97)70237-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Endothelin-1 has been shown to be a mediator of pulmonary hypertension after cardiopulmonary bypass and deep hypothermic circulatory arrest. It is not known whether the mechanism is increased production of endothelin-1 or alterations in expression of endothelin-1 receptors in the lung. This study was designed to test the hypothesis that circulatory arrest increases endothelin-1 mRNA levels and endothelin-1 receptor expression in the lung. METHODS AND RESULTS Twenty-four piglets (7 to 30 days old) were studied randomly either at baseline (controls, n = 12) or after cardiopulmonary bypass with 30 minutes of circulatory arrest (deep hypothermic circulatory arrest, n = 12). Lungs and pulmonary arteries were harvested immediately after hemodynamic data collection. Deep hypothermic circulatory arrest significantly increased pulmonary vascular resistance (p < 0.01). Deep hypothermic circulatory arrest also produced a significant increase in endothelin-1 mRNA levels in the pulmonary arteries (149 +/- 55 pg vs 547 +/- 111 pg, p = 0.007). There was no significant change in the pulmonary parenchymal endothelin-1 mRNA levels (4102 +/- 379 pg vs 4623 +/- 308 pg, p = 0.32). Ligand binding studies of the lung parenchyma revealed a single specific endothelin-1 binding site with an EC50 value (effective concentration causing 50% of the maximum response) of about 1 x 10(-8) mol/L, consistent with the endothelin B subtype. Deep hypothermic circulatory arrest resulted in a significant increase in the number of endothelin-1 receptors in the lung (109 +/- 6 fmol/mg total protein to 135 +/- 9 fmol/mg total protein, p = 0.02). CONCLUSIONS Deep hypothermic circulatory arrest increases production of endothelin-1 by the pulmonary vascular endothelium. Endothelin-1 production in the pulmonary parenchyma does not change. Expression of endothelin B receptors in the pulmonary parenchyma also increases after cardiopulmonary bypass with deep hypothermic circulatory arrest. This study supports the hypothesis that deep hypothermic circulatory arrest results in pulmonary vascular endothelial activation with increased endothelin-1 mRNA production.
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Affiliation(s)
- P M Kirshbom
- Department of Surgery, Duke University Medical Center, Durham, N.C., USA
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Kirshbom PM, Jacobs MT, Tsui SS, DiBernardo LR, Schwinn DA, Ungerleider RM, Gaynor JW. Effects of cardiopulmonary bypass and circulatory arrest on endothelium-dependent vasodilation in the lung. J Thorac Cardiovasc Surg 1996; 111:1248-56. [PMID: 8642827 DOI: 10.1016/s0022-5223(96)70228-3] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Endothelial injury with failure of pulmonary endothelium-dependent vasodilatation has been proposed as a possible cause for the increased pulmonary vascular resistance observed after cardiopulmonary bypass, but the mechanisms underlying this response are not understood. An in vivo piglet model was used to investigate the role of endothelium-dependent vasodilatation in postbypass pulmonary hypertension. The pulmonary vascular responses to acetylcholine, a receptor-mediated endothelium-dependent vasodilator, and nitric oxide, an endothelium-independent vasodilator, were studied in one group of animals after preconstriction with the thromboxane A2 analog U46619 (n = 6); a second group was studied after bypass with 30 minutes of deep hypothermic circulatory arrest (n = 6). After preconstriction with U46619, both acetylcholine and nitric oxide caused significant decreases in pulmonary vascular resistance (34% +/- 6% decrease, p = 0.007, and 39% +/- 4% decrease, p = 0.001). After cardiopulmonary bypass with circulatory arrest, acetylcholine did not significantly change pulmonary vascular resistance (0% +/- 8% decrease, p = 1.0), whereas nitric oxide produced a 32% +/- 4% decrease in pulmonary vascular resistance (p = 0.007). These results demonstrate a loss of receptor-mediated endothelium-dependent vasodilatation with normal vascular smooth muscle function after circulatory arrest. Administration of the nitric oxide synthase blocker Ngamma-nitro-L-arginine-methyl-ester after circulatory arrest significantly increased pulmonary vascular resistance; thus, although endothelial cell production of nitric oxide may be diminished, it continues to be a major contributor to pulmonary vasomotor tone after cardiopulmonary bypass with deep hypothermic circulatory arrest. In summary, cardiopulmonary bypass with deep hypothermic circulatory arrest results in selective pulmonary endothelial cell dysfunction with loss of receptor-mediated endothelium-dependent vasodilatation despite preserved ability of the endothelium to produce nitric oxide and intact vascular smooth muscle function.
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Affiliation(s)
- P M Kirshbom
- Department of Surgery, Duke University Medical Center, Durham, N.C., USA
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Tsui SS, Kirshbom PM, Davies MJ, Jacobs MT, Greeley WJ, Kern FH, Gaynor JW, Ungerleider RM. Nitric oxide production affects cerebral perfusion and metabolism after deep hypothermic circulatory arrest. Ann Thorac Surg 1996; 61:1699-707. [PMID: 8651770 DOI: 10.1016/0003-4975(96)00197-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Use of deep hypothermic circulatory arrest (DHCA) in infant cardiac surgery is associated with reduced cerebral perfusion and metabolism during the recovery period. We investigated the impairment of nitric oxide production as a possible cause. METHODS A group of 1-week-old piglets underwent normothermic cardiopulmonary bypass (group A); three other groups (B, C, and D; n = 6 per group) underwent 60 minutes of DHCA at 18 degrees C and 60 minutes of rewarming. The animals were then treated as follows: Groups A and B received L-omega-nitro-arginine-methyl-ester (L-NAME, 50 mg.kg-1); group C, saline solution; and group D, L-arginine (600 mg.kg-1). RESULTS In group A, global cerebral blood flow decreased to 37.3% +/- 4.2% of baseline after L-NAME administration (p < 0.005). In group B, global cerebral blood flow decreased to 44.6% +/- 4.4% of baseline after DHCA and 28.9% +/- 3.4% after L-NAME administration (p < 0.001). Following L-arginine treatment after DHCA (group D), global cerebral blood flow increased from 43.8% +/- 3.0% of baseline to 61.6% +/- 9.1% (p < 0.05); cerebral oxygen metabolism increased from 1.93 +/- 0.16 mL.min-1.100 g-1 after DHCA to 2.42 +/- 0.25 mL.min-1.100 g-1 (p < 0.05). CONCLUSIONS Tonal production of nitric oxide is impaired in the brain after DHCA and is partly responsible for the circulatory and metabolic changes observed. Stimulation of nitric oxide production (L-arginine) significantly improved recovery of cerebral blood flow and cerebral oxygen metabolism after DHCA.
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Affiliation(s)
- S S Tsui
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
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