Protection of Regulatory T Cells from Fragility and Inactivation in the Tumor Microenvironment

Fragility of regulatory T (Treg) cells manifested by the loss of neuropilin-1 (NRP1) and expression of IFNγ undermines the immune suppressive functions of Treg cells and contributes to the success of immune therapies against cancers. Intratumoral Treg cells somehow avoid fragility; however, the mechanisms by which Treg cells are protected from fragility in the tumor microenvironment are not well understood. Here, we demonstrate that the IFNAR1 chain of the type I IFN (IFN1) receptor was downregulated on intratumoral Treg cells. Downregulation of IFNAR1 mediated by p38α kinase protected Treg cells from fragility and maintained NRP1 levels, which were decreased in response to IFN1. Genetic or pharmacologic inactivation of p38α and stabilization of IFNAR1 in Treg cells induced fragility and inhibited their immune suppressive and protumorigenic activities. The inhibitor of sumoylation TAK981 (Subasumstat) upregulated IFNAR1, eliciting Treg fragility and inhibiting tumor growth in an IFNAR1-dependent manner. These findings describe a mechanism by which intratumoral Treg cells retain immunosuppressive activities and suggest therapeutic approaches for inducing Treg fragility and increasing the efficacy of immunotherapies.

Ovarian cancer immunogenicity is governed by a narrow subset of progenitor tissue-resident memory T cells

Despite repeated associations between T cell infiltration and outcome, human ovarian cancer remains poorly responsive to immunotherapy. We report that the hallmarks of tumor recognition in ovarian cancer-infiltrating T cells are primarily restricted to tissue-resident memory (TRM) cells. Single-cell RNA/TCR/ATAC sequencing of 83,454 CD3+CD8+CD103+CD69+ TRM cells and immunohistochemistry of 122 high-grade serous ovarian cancers shows that only progenitor (TCF1low) tissue-resident T cells (TRMstem cells), but not recirculating TCF1+ T cells, predict ovarian cancer outcome. TRMstem cells arise from transitional recirculating T cells, which depends on antigen affinity/persistence, resulting in oligoclonal, trogocytic, effector lymphocytes that eventually become exhausted. Therefore, ovarian cancer is indeed an immunogenic disease, but that depends on ∼13% of CD8+ tumor-infiltrating T cells (∼3% of CD8+ clonotypes), which are primed against high-affinity antigens and maintain waves of effector TRM-like cells. Our results define the signature of relevant tumor-reactive T cells in human ovarian cancer, which could be applicable to other tumors with unideal mutational burden.

TGF-β-mediated silencing of genomic organizer SATB1 promotes Tfh cell differentiation and formation of intra-tumoral tertiary lymphoid structures

The immune checkpoint receptor PD-1 on T follicular helper (Tfh) cells promotes Tfh:B cell interactions and appropriate positioning within tissues. Here, we examined the impact of regulation of PD-1 expression by the genomic organizer SATB1 on Tfh cell differentiation. Vaccination of CD4^CreSatb1^f/f mice enriched for antigen-specific Tfh cells, and TGF-β-mediated repression of SATB1 enhanced Tfh differentiation of human T cells. Mechanistically, high Icos expression in Satb1^-/- CD4⁺ T cells promoted Tfh cell differentiation by preventing T follicular regulatory cell skewing and resulted in increased isotype-switched B cell responses in vivo. Ovarian tumors in CD4^CreSatb1^f/f mice accumulated tumor antigen-specific, LIGHT⁺CXCL13⁺IL-21⁺ Tfh cells and tertiary lymphoid structures (TLS). TLS formation decreased tumor growth in a CD4⁺ T cell and CXCL13-dependent manner. The transfer of Tfh cells, but not naive CD4⁺ T cells, induced TLS at tumor beds and decreased tumor growth. Thus, TGF-β-mediated silencing of Satb1 licenses Tfh cell differentiation, providing insight into the genesis of TLS within tumors.

IgA transcytosis and antigen recognition govern ovarian cancer immunity

Most ovarian cancers are infiltrated by prognostically relevant activated T cells^1–3, yet exhibit low response rates to immune checkpoint inhibitors⁴. Memory B cell and plasma cell infiltrates have previously been associated with better outcomes in ovarian cancer^5,6, but the nature and functional relevance of these responses are controversial. Here, using 3 independent cohorts that in total comprise 534 patients with high-grade serous ovarian cancer, we show that robust, protective humoral responses are dominated by the production of polyclonal IgA, which binds to polymeric IgA receptors that are universally expressed on ovarian cancer cells. Notably, tumour B-cell-derived IgA redirects myeloid cells against extracellular oncogenic drivers, which causes tumour cell death. In addition, IgA transcytosis through malignant epithelial cells elicits transcriptional changes that antagonize the RAS pathway and sensitize tumour cells to cytolytic killing by T cells, which also contributes to hindering malignant progression. Thus, tumour-antigen-specific and -antigen-independent IgA responses antagonize the growth of ovarian cancer by governing coordinated tumour cell, T cell and B cell responses. These findings provide a platform for identifying targets that are spontaneously recognized by intratumoural B-cell-derived antibodies, and suggest that immunotherapies that augment B cell responses may be more effective than approaches that focus on T cells, particularly for malignancies that are resistant to checkpoint inhibitors.

In patients with high-grade serous ovarian cancer, robust and protective humoral responses are dominated by B-cell-derived polyclonal IgA that binds to polymeric IgA receptors that are universally expressed on ovarian cancer cells.

Methyltransferase inhibitors restore SATB1 protective activity against cutaneous T cell lymphoma in mice

Cutaneous T cell lymphoma (CTCL) has a poorly understood etiology and no known cure. Using conditional knockout mice, we found that ablation of the genomic organizer special AT-rich sequence-binding protein 1 (Satb1) caused malignant transformation of mature, skin-homing, Notch-activated CD4+ and CD8+ T cells into progressively fatal lymphoma. Mechanistically, Satb1 restrained Stat5 phosphorylation and the expression of skin-homing chemokine receptors in mature T cells. Notably, methyltransferase-dependent epigenetic repression of SATB1 was universally found in human Sézary syndrome, but not in other peripheral T cell malignancies. H3K27 and H3K9 trimethylation occluded the SATB1 promoter in Sézary cells, while inhibition of SUV39H1/2 methyltransferases (unlike EZH2 inhibition) restored protective SATB1 expression and selectively abrogated the growth of primary Sézary cells more effectively than romidepsin. Therefore, inhibition of methyltransferases that silence SATB1 could address an unmet need for patients with mycosis fungoides/Sézary syndrome, a set of incurable diseases.

The Unfolded Protein Response Mediator PERK Governs Myeloid Cell-Driven Immunosuppression in Tumors through Inhibition of STING Signaling

The primary mechanisms supporting immunoregulatory polarization of myeloid cells upon infiltration into tumors remain largely unexplored. Elucidation of these signals could enable better strategies to restore protective anti-tumor immunity. Here, we investigated the role of the intrinsic activation of the PKR-like endoplasmic reticulum (ER) kinase (PERK) in the immunoinhibitory actions of tumor-associated myeloid-derived suppressor cells (tumor-MDSCs). PERK signaling increased in tumor-MDSCs, and its deletion transformed MDSCs into myeloid cells that activated CD8⁺ T cell-mediated immunity against cancer. Tumor-MDSCs lacking PERK exhibited disrupted NRF2-driven antioxidant capacity and impaired mitochondrial respiratory homeostasis. Moreover, reduced NRF2 signaling in PERK-deficient MDSCs elicited cytosolic mitochondrial DNA elevation and, consequently, STING-dependent expression of anti-tumor type I interferon. Reactivation of NRF2 signaling, conditional deletion of STING, or blockade of type I interferon receptor I restored the immunoinhibitory potential of PERK-ablated MDSCs. Our findings demonstrate the pivotal role of PERK in tumor-MDSC functionality and unveil strategies to reprogram immunosuppressive myelopoiesis in tumors to boost cancer immunotherapy.

BTN3A1 governs antitumor responses by coordinating αβ and γδ T cells

Gamma delta (γδ) T cells infiltrate most human tumors, but current immunotherapies fail to exploit their in situ major histocompatibility complex-independent tumoricidal potential. Activation of γδ T cells can be elicited by butyrophilin and butyrophilin-like molecules that are structurally similar to the immunosuppressive B7 family members, yet how they regulate and coordinate αβ and γδ T cell responses remains unknown. Here, we report that the butyrophilin BTN3A1 inhibits tumor-reactive αβ T cell receptor activation by preventing segregation of N-glycosylated CD45 from the immune synapse. Notably, CD277-specific antibodies elicit coordinated restoration of αβ T cell effector activity and BTN2A1-dependent γδ lymphocyte cytotoxicity against BTN3A1⁺ cancer cells, abrogating malignant progression. Targeting BTN3A1 therefore orchestrates cooperative killing of established tumors by αβ and γδ T cells and may present a treatment strategy for tumors resistant to existing immunotherapies.

Immune pressure against ovarian cancer depends on antigen-specific CD69+CD103+TRM T cells

The relationship between stem-like, tissue resident memory (TRM) and exhausted T cells at tumor beds is incompletely understood. We found that more than 50% of the CD8+ T cells in human ovarian carcinomas are TRM cells. RNA seq of TRM and their re-circulating counterparts infiltrating multiple human ovarian carcinomas showed a very distinctive phenotype, characterized by co-upregulation of effector and exhaustion markers, along with increased clonality and marked proliferative and lipid metabolism signatures. Interestingly, both populations showed very little overlap in TCR repertoire. Single cell analysis of TRM population showed that this is a heterogeneous population composed of different clusters defined by gene expression and TCR repertoire. A distinctive cluster shows higher expression of cytotoxic mediators and exhaustion markers, along with higher clonality and higher proliferation rate, with a TCR repertoire shared by CD103+TCF7+ stem-like cells. Single cell ATACseq showed that TRM and their counterpart have different chromatin structure and, within both populations also appear variables epigenetic landscapes. In addition, the presence of TRM is correlated with better prognosis, while tumor antigen-specific TRM T cells transferred into syngeneic tumor-bearing mice were more effective at delaying tumor growth than their tumor antigen-specific re-circulating counterparts. Together, our data indicate that productive immune pressure against malignant progression depends on a subset of CD8+ stem-like T cells differentiating into a narrow cluster of TRM T cells of ~300 TCR clones, which represent true tumor antigen-specific effector lymphocytes.

Satb1 deficiency licenses TFH-differentiation and Tertiary Lymphoid Structure formation in cancer

Tertiary Lymphoid Structures (TLS) are commonly identified in human tumors with improved outcome, but how they are orchestrated remains elusive. Here we show that silencing of the master genomic organizer Satb1 results in enhanced antigen-specific T Follicular Helper (TFH) differentiation. Increased TFH thereby promoted antigen-specific intra-tumoral CD19+B220+ B cell responses and spontaneous TLS assembly upon ovarian tumor challenge. Mechanistically, Satb1 deficiency drives increased TFH formation through de-repression of ICOS and PD-1. Accordingly, TGF-β1-driven downregulation of Satb1 licenses activated human CD4+ T-cells for enhanced antigen-specific T Follicular Helper (TFH) differentiation. Furthermore, Satb1 deficiency abrogates the generation of PD-1highCXCR5+Foxp3+ T Follicular Regulatory (TFR) cells during the TFH differentiation process. Importantly, functional TFH cell accumulation, in the absence of Satb1 specifically in CD4+ T cells, resulted in corresponding isotype-switched B cell responses and spontaneous formation of TLS, while B cell depletion accelerated malignant progression. Our results indicate that the formation of TLS in cancer depends on enhanced B cell responses driven by TFH cells generated through Satb1 down-regulation.

SATB1 as a novel therapeutic target for methyltransferase inhibitors against Cutaneous T Cell Lymphoma

Cutaneous T cell lymphoma (CTCL) is a clinically unmet need. Using conditional knockout mice, we found that ablation of the genomic organizer Special AT rich sequence binding protein 1 (Satb1) induces a progressively fatal lymphoma characterized by mature, skin homing, Notch activated CD4 and CD8 T cells. Mechanistically, Satb1 restrains Stat5 phosphorylation and the expression of skin homing chemokine receptors in mature T cells. Notably, SUV39H1 and 2 methyltransferase dependent epigenetic repression of SATB1 is universally found in human Sezary Syndrome, but not other peripheral T cell malignancies. Accordingly, H3K27 and H3K9 trimethylation occlude the SATB1 promoter in Sezary cells. Inhibition of SUV39H1 and 2 methyltransferases with novel drugs, unlike EZH2 inhibition, restores SATB1 expression, selectively abrogating the growth of primary Sezary cells more effectively than Romidepsin. Therefore, SATB1 acts as a tumor suppressor in mature T cells upon NOTCH1 deregulation, and inhibition of methyltransferases that silence SATB1 could address an unmet need for patients with mycosis fungoides and Sezary syndrome.

AMPK Alpha-1 Intrinsically Regulates the Function and Differentiation of Tumor Myeloid-Derived Suppressor Cells

Myeloid-derived suppressor cells (MDSC) represent a primary mechanism of immune evasion in tumors and have emerged as a major obstacle for cancer immunotherapy. The immunoinhibitory activity of MDSC is tightly regulated by the tumor microenvironment and occurs through mechanistic mediators that remain unclear. Here, we elucidated the intrinsic interaction between the expression of AMP-activated protein kinase alpha (AMPKα) and the immunoregulatory activity of MDSC in tumors. AMPKα signaling was increased in tumor-MDSC from tumor-bearing mice and patients with ovarian cancer. Transcription of the Ampkα1-coding gene, Prkaa1, in tumor-MDSC was induced by cancer cell-derived granulocyte-monocyte colony-stimulating factor (GM-CSF) and occurred in a Stat5-dependent manner. Conditional deletion of Prkaa1 in myeloid cells, or therapeutic inhibition of Ampkα in tumor-bearing mice, delayed tumor growth, inhibited the immunosuppressive potential of MDSC, triggered antitumor CD8⁺ T-cell immunity, and boosted the efficacy of T-cell immunotherapy. Complementarily, therapeutic stimulation of AMPKα signaling intrinsically promoted MDSC immunoregulatory activity. In addition, Prkaa1 deletion antagonized the differentiation of monocytic-MDSC (M-MDSC) to macrophages and re-routed M-MDSC, but not granulocytic-MDSC (PMN-MDSC), into cells that elicited direct antitumor cytotoxic effects through nitric oxide synthase 2-mediated actions. Thus, our results demonstrate the primary role of AMPKα1 in the immunosuppressive effects induced by tumor-MDSC and support the therapeutic use of AMPK inhibitors to overcome MDSC-induced T-cell dysfunction in cancer. SIGNIFICANCE: AMPKα1 regulates the immunosuppressive activity and differentiation of tumor-MDSC, suggesting AMPK inhibition as a potential therapeutic strategy to restore protective myelopoiesis in cancer.

Immune pressure against ovarian cancer depends on antigen-specific TRM T cells

Conventional memory T cells classically include central memory T (TCM) cells, residing in lymphoid organs, and effector memory T (TEM) cells, circulating through various tissues. Recently, a novel population of memory T cells has gained interest, namely tissue resident memory T (TRM) cells, which persist in tissues and do not recirculate. It is described that these cells reside in human tumors playing a role in tumor-specific T-cell responses. We found by flow cytometry that between 50%–80% of the CD8+ T cells in human ovarian carcinomas are CD103+CD69+TRM cells. RNA-seq of TRM and their re-circulating counterparts from 7 different human carcinomas showed a very distinctive phenotype, characterized by co-upregulation of effector (GZMB, IFNG) and exhaustion (PD-1, TIM3) markers, along with transcription factors and signaling molecules likely involved in the acquisition of the TRM phenotype. Unexpectedly, we found very little overlap between the TCR repertoire of both populations in multiple tumors, and TRM T cells consistently showed significantly higher clonality. Tumor antigen-specific TRM T cells intratumorally transferred into syngeneic mice were more effective at delaying tumor growth compared with their tumor antigen-specific recirculating counterparts. Finally, both the acquisition and the maintenance of a TRM phenotype within the CD8 T cell compartment at tumor beds are dependent on exposure to tumor cognate antigen. Together, our data indicate that TRM CD8+ T cells, but not their CD103− counterparts, represent tumor antigen-specific effector lymphocytes actively exerting anti-tumor immune pressure in the ovarian cancer microenvironment.

Butyrophilin 3A1 is a Dynamic T Cell Regulator in Ovarian Cancer

Ovarian carcinoma microenvironmental T cells exert clinically relevant pressure against malignant progression; however current immunotherapies rarely induce ovarian cancer regression. Here we investigate CD277-containing butyrophilin 3A1 (BTN3A1), a poorly investigated immunoregulatory pathway driven by myeloid and tumor cells in ovarian tumor beds. We show that BTN3A1 is overexpressed in ovarian cancer and is associated with a significant survival disadvantage in these patients (n=200). Concomitantly, ectopic expression of BTN3A1 on APCs inhibits αβ T cell proliferation and Th1 cytokine production. Proteomic analyses and binding assays demonstrate that BTN3A1 interacts with the CD45 phosphatase and elements of the TCR. Consequently, TCR ligation in the presence of BTN3A1 inhibits the segregation of CD45 from the immune synapse and blunts downstream signaling by antagonizing the phosphorylation of CD3Zeta, Lck, and Zap70. We developed fully human αCD277 antibodies which rescue αβ T cell proliferation and Th1 cytokine responses, while driving the infiltration of T cells into tumor beds, delaying ovarian tumor progression in novel BTN3A1+ humanized mice and xenograft studies. Paradoxically, αCD277 antibodies promote the activation of γδ T cells by driving a conformational transformation of BTN3A1. Thus, co-transfer of γδ and Ag-specific αβ T cells in the presence of αCD277 antibodies synergize to further impair malignant progression in vivo. Overall, we show that BTN3A1 drives αβ T cell dysfunction in ovarian cancer, while αCD277 antibodies transform this molecule from immunosuppressive to immunostimulatory by rescuing αβ T cells and activating γδ T cells, thus dynamically unleashing T cell-driven antitumor immunity.

Satb1 deficiency licenses TFH-differentiation

T Follicular Helper cells (TFH) provide both co-stimulation and stimulatory cytokines to B cells to facilitate affinity maturation, class switch recombination, and plasma cell differentiation within the germinal center. However, is not clear how TFH differentiation is regulated. We found that deficiency of the chromatin organizer Satb1 results in increased TFH formation in CD4Cre+Satb1flx/flx mice through up-regulation of the canonical TFH markers ICOS and PD-1 and suppression of Foxp3+PD-1highCXCR5+ T follicular regulatory (TFR) cells as well. Accordingly, CD4Cre+Satb1flx/flx mice, or RAG1−/− mice transferred with Satb1-deficient CD4+ T cells showed a dramatic accumulation of CD4+CXCR5+PD-1high upon ovarian tumor challenge, compared to their Satb1+ counterparts, which was associated with reduced tumor growth. Importantly, intratumoral administration of Satb1-deficient CD4+ T cells re-directed to target ovarian cancer cells through chimeric receptors, but not their Satb1+ counterparts, induce the formation of Tertiary Lymphoid Structures in most tumors.

Conclusion

Satb1 controls three mechanisms relevant for TFH differentiation and, subsequently, antigen-specific humoral responses; namely, PD- 1 expression, ICOS de-repression and TFR formation. Our results suggest a novel role for Satb1 as a major regulator of TFH differentiation and TLS during tumor formation.

Polymorphic UHRF1BP1 drives superior anti-tumor immunity in ovarian cancer

Despite the emergence of immunotherapy for the treatment of cancer, many of the fundamental mechanisms which characterize tumors that are amenable to immunotherapy and/or drive superior endogenous anti-tumor immune responses likely remain uncharacterized. We have identified a single-nucleotide polymorphism, rs13205210, in the gene encoding UHRF1BP1 (UBP). This polymorphism is associated with a dramatic survival benefit in ovarian cancer patients. The function of the protein encoded by this gene remains elusive, however we demonstrate UBP-ablated ovarian tumor cells display global modulation of methylated cytosine, suggesting it has a role as an epigenetic integrator. Interestingly, this polymorphism is also associated with systemic lupus erythematosus, an immune-driven pathology. Accordingly, we demonstrate that human ovarian tumors with polymorphic UBP display increased frequency of activated CD8+ T cells, as well as a type I IFN signature. In vivo, inducible autochthonous murine ovarian tumors driven by oncogenic Kras and ablation of p53, in which UBP was conditionally deleted, demonstrated a significantly enhanced overall survival with a concomitant type I IFN and CXCR3-chemokine signature, as well as an enhanced T cell infiltrate compared to controls. RNA-seq analyses of UBP-deficient ovarian tumors revealed an elevation of inflammatory cytokines and the activation of canonical inflammatory pathways. Furthermore, ectopic expression of polymorphic human UBP in ovarian tumor cells drove elevated NF-kB signaling under inflammatory conditions. Overall our work suggests that UBP functions as a regulator of inflammation, which is unleashed in the polymorphic variant leading to enhanced anti-tumor immunity.

Frontline Science: Microbiota reconstitution restores intestinal integrity after cisplatin therapy

Due to their cytotoxic activities, many anticancer drugs cause extensive damage to the intestinal mucosa and have antibiotic activities. Here, we show that cisplatin induces significant changes in the repertoire of intestinal commensal bacteria that exacerbate mucosal damage. Restoration of the microbiota through fecal-pellet gavage drives healing of cisplatin-induced intestinal damage. Bacterial translocation to the blood stream is correspondingly abrogated, resulting in a significant reduction in systemic inflammation, as evidenced by decreased serum IL-6 and reduced mobilization of granulocytes. Mechanistically, reversal of dysbiosis in response to fecal gavage results in the production of protective mucins and mobilization of CD11b+ myeloid cells to the intestinal mucosa, which promotes angiogenesis. Administration of Ruminococcus gnavus, a bacterial strain selectively depleted by cisplatin treatment, could only partially restore the integrity of the intestinal mucosa and reduce systemic inflammation, without measurable increases in the accumulation of mucin proteins. Together, our results indicate that reconstitution of the full repertoire of intestinal bacteria altered by cisplatin treatment accelerates healing of the intestinal epithelium and ameliorates systemic inflammation. Therefore, fecal microbiota transplant could paradoxically prevent life-threatening bacteremia in cancer patients treated with chemotherapy.

Abstract B22: IT-141, a stabilized polymer micelle formulation, prolongs the pharmacodynamic effect of SN-38

IT-141 is a formulation of SN-38 encapsulated in an iron-stabilized polymer micelle. SN-38 is the active metabolite of irinotecan (CPT-11) which in combination with 5-FU and leucovorin is first-line FDA approved therapy for metastatic colorectal cancer. Although SN-38 is 1,000 times more potent than irinotecan alone, there is about 100-fold lower concentration of SN-38 in plasma from irinotecan. In the clinic only 2% to 10% of the administered dose of irinotecan is converted by carboxylesterases to SN-38 and there is great interpatient variability with toxicity. In vitro, IT-141 demonstrated nanomolar IC50s against a panel of human cancer cell lines in comparison to irinotecan's micromolar IC50 concentrations. SN-38 binds to the topoisomerase I-DNA complex resulting in double stranded breaks and cell death. We compared the mechanism of action of IT-141 compared to irinotecan treatment in HT-29 xenografts tumors. We demonstrated the incidence of double stranded breaks by immunohistochemistry (IHC) of γ- H2AX expression in tumors treated with IT-141 compared to irinotecan treatment at different time points (24, 48, 72 and 144 hours). In irinotecan treated tumors, γ- H2AX expression peaked at 72 hours followed by a sharp decrease in expression at 144 hours. In IT-141 treated tumors, γ- H2AX positive staining increased steadily from 24 through 144 hours. This shift in the kinetics of the mechanism corroborates the biodistribution studies where IT-141 delivered 34-fold more SN-38 to the tumor compared to irinotecan. The AUC and Cmax in IT-141 treated tumors was 30.9 μg*h/g and 12.2 μg/g respectively compared to an AUC of 1.1 μg*h/g and a Cmax of 0.2 μg/g in the irinotecan treated tumors. In an HT-29 xenograft model IT-141 inhibited tumor growth by 157% compared to a 57% with irinotecan. IT-141 demonstrates successful encapsulation of SN-38 leading to a safer, more effective formulation. Our DNA damage assay demonstrated that IT-141 extended the pharmacodynamic effect over irinotecan in treated tumors. Further studies are required to determine the duration of IT-141's pharmacodynamics effect. This data validates the increased tumor accumulation of SN-38 and increased efficacy of IT-141 over irinotecan.

Citation Format: Jyothi Sethuraman, Tara Lee Costich, Adam Carie, Taylor Buley, Tyler Ellis, J. Edward Semple, Tomas Vojkovsky, Kevin Sill, Suzanne Bakewell. IT-141, a stabilized polymer micelle formulation, prolongs the pharmacodynamic effect of SN-38. [abstract]. In: Proceedings of the AACR Precision Medicine Series: Cancer Cell Cycle - Tumor Progression and Therapeutic Response; Feb 28-Mar 2, 2016; Orlando, FL. Philadelphia (PA): AACR; Mol Cancer Res 2016;14(11_Suppl):Abstract nr B22.

Abstract 1321: IT-147: A stabilized polymer micelle formulation of epothilone D for treatment of solid tumors

IT-147 is a formulation of epothilone D encapsulated in a stabilized polymer micelle. Epothilones are a class of cytotoxic chemotherapeutics that induce apoptosis via microtubule stabilization. Epothilone D is a poor substrate for P-glycoprotein efflux pumps and has demonstrated equivalent activity against drug-sensitive and multidrug-resistant human cancer cell lines. This offers a distinct advantage over other microtubule stabilizing agents such as taxanes, however clinical utility is limited by a narrow therapeutic window due to dose limiting toxicities such as peripheral sensory neuropathy, GI toxicities, and cognitive abnormalities. We have optimized a lead formulation comprising 2% epothilone D (w/w) encapsulated in a polymer micelle that is crosslinked with iron to provide micelle stability upon dilution. IT-147 has an average diameter of 70 nm. The iron-mediated crosslinking provides pH-dependent release of epothilone D such that drug can be released in the tumor microenvironment as well as in the endosome/lysosome upon cellular entry. In addition, the geometrical arrangement of iron molecules around the core of the micelle imparts superparamagnetic properties that allow for imaging of intact nanoparticles by MRI. IT-147 demonstrates a low nanomolar IC50 against a panel of human cancer cell lines in vitro. In vivo, IT-147 demonstrates a 4-fold increase in maximum tolerated dose in a mouse model compared to epothilone D free drug. Pharmacokinetics (PK) in a cannulated rat model for a 20 mg/kg epothilone D dose demonstrates a 6.5-fold increase in area under the time versus concentration curve (AUC), and a 14.3-fold increase in the terminal half-life compared to free drug. Dose escalation of IT-147 to 30 and 40 mg/kg epothilone D in the rat PK model results in linear increases in AUC from 53.5 h*μg/mL at 20 mg/kg to 82.9 and 110.8 h*μg/mL at 30 and 40 mg/kg, respectively. Treatment with IT-147 at the MTD in an HCT116 tumor xenograft model led to tumor stasis during the course of treatment, and MRI imaging of mice treated with IT-147 demonstrates tumor accumulation over 24 and 48 hours post administration. Taken together, data for IT-147 demonstrates successful encapsulation of epothilone D leading to a safer, more effective formulation with the potential for MRI imaging as a predictor for response.

Citation Format: Adam Carie, Taylor Buley, Bradford Sullivan, J.Edward Semple, Tyler Ellis, Tara Lee Costich, Jyothi Sethuraman, Rick Crouse, Kevin Sill, Suzanne Bakewell. IT-147: A stabilized polymer micelle formulation of epothilone D for treatment of solid tumors. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 1321.

Abstract LB-190: IT-141 and IT-147, iron stabilized micellar nanoparticles for therapeutic and diagnostic applications

Site-specific delivery of oncology drugs using nanoparticle technology has been a decades-long goal. IT-141 and IT-147 are polymer micelles that encapsulate (i.e. physically entrap without covalent bonds) hydrophobic chemotherapeutics in the core of the micelle. IT-141 incorporates SN-38, the active moiety of irinotecan, in its core with a weight loading (v/v) of 2%. IT-141 shows increased pharmacokinetics in rat plasma, increased maximum tolerated dose (MTD) and improved anti-tumor efficacy in HCT116 and HT-29 xenograft models over irinotecan in all studies. IT-147 incorporates epothilone D, a microtubule-stabilizing anti-metabolite with a weight loading (v/v) of 2%. IT-147 shows increased pharmacokinetics in rat plasma, increased MTD and improved anti-tumor efficacy in HCT116 colorectal, A549 lung and NCI-H460 lung xenograft models over epothilone D free drug treatment. Both micelles are 70-100 nm diameter clusters of surfactant triblock copolymers stabilized by the interaction between iron and multiple polymer chains. The iron-polymer dative bonds are unstable at low pH, providing a mechanism for environment-dependent micelle stability and subsequent drug release. Furthermore, these stabilized micelles in vivo possess relaxivity constants suitable to provide contrast in magnetic resonance imaging (MRI). The spin-lattice relaxivity value (r1) was 7-16 mM-1s-1 and the spin-spin relaxivity values (r2) were 65-80 mM-1s-1. Small molecule complexes of iron do not typically provide sufficient MR contrast. Because contrast is not observed with individual iron complexes, and the MR contrast is directly related to the properties of the iron-stabilized nanoparticle, only intact nanoparticles provide contrast in MRI. When these iron-stabilized micelle formulations are administered to tumor bearing xenograft mice, increased contrast in the tumor is observed, peaking between 24 and 48 hours. MRI was performed with IT-141 in HCT116, HT-29, and A549 subcutaneous tumor models. IT-147 contrast imaging was performed in HCT116 and NCI-H460 subcutaneous, and MCF-7 orthotopic tumor models. Our technology has produced stable micelles that encapsulate chemotherapeutic drugs to include SN-38, daunorubicin, epothilone D, panobinostat, paclitaxel, and aminopterin with improved pharmacokinetics, decreased toxicity and increased efficacy. The MRI imaging results hold potential for use in the clinic where delivery of the chemotherapeutic-loaded nanoparticle can be monitored non-invasively.

Citation Format: Kevin Sill, Tara Lee Costich, Adam Carie, Jyothi Sethuraman, Taylor Buley, Tyler Ellis, Tomas Vojkovsky, Bradford Sullivan, J. Edward Semple, Suzanne Bakewell. IT-141 and IT-147, iron stabilized micellar nanoparticles for therapeutic and diagnostic applications. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr LB-190.

Abstract 2996: IT-139 targets GRP78 in stressed cancer cells

IT-139, sodium trans-[tetrachlorobis(1H-indazole)ruthenate(III)] is a first in class small molecule that has successfully completed a phase I clinical trial against solid refractory cancers. 11 of 41 patients achieved stable disease with manageable side effects and 8 patients showed tumor size reduction including a durable partial response. Preclinical studies suggest IT-139 down-regulates the chaperone GRP78, but the mechanism of action is not fully understood. GRP78 (also known as BiP and HSPA5) is the primary sensor and regulator of the endoplasmic reticulum (ER). In cancer cells it is preferably expressed on the cell surface, but also translocates to the mitochondria and cytosol where it regulates critical oncogenic signaling pathways, thus making GRP78 an excellent target for therapy. Here we show in vitro results of IT-139 treatment in a panel of cancer cell lines. IC50 levels measured at 72 hour varied ranging from 15 μM to 180 μM. Annexin V/PI staining by flow cytometry in HCT-116, HT-29, A375 and A549 cell lines at 24 hour show early and late apoptosis, which corresponds to their relative IC50s. UPR induction and overexpression of GRP78 has been reported to cause cell cycle arrest in G1. But in IT-139 treated cell lines HCT116, HT-29, A549 and LnCAP, cell cycle arrest occurred in G2, whereas in A375 cells IT-139 induced cell cycle arrest at G1. These data suggest an inhibition of GRP78 levels and that cell cycle arrest status is also dependent upon the cell line. Electron microscopic (EM) images of HCT-116 and HT-29 cells treated with IT-139 at 24 hours showed significant vacuolization, ER expansion and disorganization of intracellular organelles, strongly suggesting ER stress. However, there is an absence of double membrane vacuoles or autophagosome formation in response to the ER stress. Also, immunofluorescent analysis displayed no LC3-II punctate distribution, although protein immunoblots showed LC3 and p62 protein levels increasing in IT-139 treated cells. These data suggest an inhibition of autophagy. Additionally, EM images showed vacuolated mitochondria and distortion of cristae. In all cell lines treated with IT-139 even below their corresponding IC50 concentration, JC-1 staining showed an increased loss of mitochondrial membrane potential. These observations hypothetically indicate an inhibition of stress-induced GRP78. Quantitative real-time PCR showed IT-139 treatment in combination with thapsigargin exhibits a significant fold change decrease in the GRP78 mRNA expression. These results suggest that IT-139 downregulates GRP78 leading to an increase in ER stress, mitochondrial damage, decreased autophagy, increased apoptosis and cell death.

Citation Format: Jyothi Sethuraman, Tara Lee Costich, Tomas Vojkovsky, Rick Crouse, Valentin Cognet, Suzanne Bakewell. IT-139 targets GRP78 in stressed cancer cells. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 2996.

Abstract 1317: IT-143: A nanoparticle delivery platform that encapsulates daunorubicin and widens therapeutic window

Daunorubicin is an anthracycline family chemotherapeutic with a narrow therapeutic window. Employing our nanoparticle drug delivery platform we encapsulated daunorubicin non-covalently in the hydrophobic core of a polymer micelle (IT-143). IT-143 is a nanoparticle formulation comprised of a hydroxamic acid triblock polymer with ferric crosslinking that increases stability for improved drug circulation and results in a pH dependent release of the encapsulated daunorubicin. Formulation characterization demonstrates a 3.7% weight loading (v/v) of daunorubicin resulting in an average micellar size of 58 nm. In vitro cytotoxicity is comparable to daunorubicin free drug with an IC50 ranging between 60-100 nM, dependent on cell line, compared to 67-114 nM for daunorubicin. In vivo we compared IT-143 plasma pharmacokinetics to daunorubicin administered as free drug and the Cmax was extended from 0.18 μg/mL for daunorubicin to 27.0 μg/mL for IT-143 at the 3 mg/kg dose, and to 49.4 μg/mL at the 6 mg/kg dose. We increased the maximum tolerated dose (MTD) from 7.5 mg/kg to 17.5 mg/kg in mice and improved anti-tumor efficacy. Furthermore, IT-143 eliminated in vivo toxicity compared to equivalent daunorubicin dosed at its MTD. Efficacy studies in 3 xenograft models (HCT116, HT-1080 and HOS-MNNG) compared intravenous bolus administration of IT-143 at equivalent and equitoxic dose to daunorubicin treatment. IT-143 inhibited HCT116 colorectal tumor volume growth by 21% compared to 7% at the equivalent daunorubicin dose, and by 51% at the 17.5 mg/kg dose. In the HT-1080 fibrosarcoma model IT-143 inhibited tumor volume by 38% compared to 37% inhibition at the equivalent daunorubicin dose, and by 94% at the 17.5 mg/kg dose. In the HOS-MNNG osteosarcoma model IT-143 did not inhibit tumor volume compared to 21% inhibition at the equivalent daunorubicin dose, but inhibited tumor volume by 34% at the 17.5 mg/kg dose. The encapsulation of daunorubicin as IT-143 exhibits increased dosage of daunorubicin with decreased toxicities not possible with free daunorubicin. These studies indicate that IT-143 widens the therapeutic window of daunorubicin treatment, providing a safer way to reduce patient toxicity yet increasing antitumor efficacy.

Citation Format: Tara Lee Costich, Rick Crouse, Adam Carie, Taylor Buley, Tyler Ellis, Lauren Repp, J.Edward Semple, Tomas Vojkovsky, Suzanne Bakewell, Kevin Sill. IT-143: A nanoparticle delivery platform that encapsulates daunorubicin and widens therapeutic window. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 1317.

Abstract 284: IT-139 holds potential for combination therapy

IT-139, sodium trans-[tetrachlorobis(1H-indazole)ruthenate(III)] is a ruthenium based small molecule that has successfully completed a phase I clinical trial in 41 patients with mild to moderate systemic toxicities. There were no dose limiting hematologic toxicities observed. IT-139 holds potential for continued clinical development because of its aqueous solubility, long half-life and manageable toxicity. Stable disease was observed in 11 of the 41 patients of the Phase I clinical trial, but we believe IT-139's future clinical development will be in combination therapy. In vitro studies revealed potential for additive and synergistic combinations. Few in vivo combination studies were completed previously due to challenges associated with administration. Here we show that by overcoming the administration challenges in our animal models we were able to identify a dependable maximum tolerated dose (MTD), optimize dosing regimens for combination xenograft efficacy studies and extend the length of treatment in efficacy studies. In an HCT116 subcutaneous model, increased efficacy was demonstrated when IT-139 was dosed in combination with oxaliplatin over oxaliplatin alone. In an A549 lung carcinoma subcutaneous model, increased efficacy was observed when IT-139 was dosed in combination with cisplatin over cisplatin alone. Increased toxicity from the combined treatment was observed after the initial treatment and the chemotherapeutic dose was reduced for the duration of the study. However, clinical pharmacokinetic results confirmed IT-139's long plasma half-life and metabolic studies have confirmed its high affinity for plasma proteins. Based on these data we staggered the dosing of IT-139 by 24 hrs allowing us to dose both IT-139 and a chemotherapeutic agent at their MTDs. This dosing regimen saw an increase in efficacy in an HT-29 colorectal xenograft model treated with IT-139 and the anti-metabolite 5-FU over treatment with 5-FU alone. We also observed improved efficacy with IT-139 dosed weekly instead of the q4d schedule, suggesting that the pharmacokinetics of IT-139 allows less frequent dosing without compromising efficacy. The toxicology report from IT-139 dosed at 50 mg/kg shows microscopic alterations in the liver and kidney. Minimal to moderate hepatocellular alterations were noted in periportal regions at 48 hrs. Renal tubular necrosis was noted at 24, 48 and 72 hrs, but tubular regeneration was noted at 48 and 72 hrs time points. In the combination therapy (IT-139 at 50 mg/kg plus oxaliplatin) mice there were no results in the liver and kidneys to suggest exacerbation of the noted alterations. There were no observations of either liver or kidney toxicity in the Phase I human study. These findings further attest to the potential of IT-139 in combination therapy, but suggest further investigation to identify the optimal dosing regimen. Current mechanism of action studies will collaborate and support our in vivo studies for the future success of IT-139's return to the clinic.

Citation Format: Tara Lee Costich, Jyothi Sethuraman, Rick Crouse, Suzanne Bakewell. IT-139 holds potential for combination therapy. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 284.

Abstract 3499: Nanoparticle formulation of SN-38 by the IVECT method results in a safer, more effective treatment for colorectal cancer

Polymeric micelles represent an emerging class of nano-scale vehicles with unmatched potential for delivering potent, targeted chemotherapy. Intezyne's advanced tri-block copolymer system, the IVECT(TM) Method, has been proven to encapsulate a wide variety of therapeutic and diagnostic agents into a proprietary micelle with unique physiochemical properties. Conventional micelles become destabilized rapidly upon dilution into the bloodstream and release a significant portion of their drug payload systemically, harming healthy tissues and limiting therapeutic effects. Intezyne's IVECT Method utilizes a unique cross-linked stabilizer block that maintains micellar structure for a longer period of time post administration and is designed such that a downshift in pH at the tumor activates drug release by destroying the zinc cross-link, allowing for focused drug exposure. The IVECT Method's unmatched plasma stability allows for longer circulation times while protecting healthy tissues, and it maximizes tumor retention and efficacy through the enhanced permeability and retention (EPR) effect and pH-responsive cross-linker. Intezyne's lead product IT-141 encapsulates the extremely potent active metabolite of irinotecan, SN-38. Recently, IT-141 has demonstrated 14-fold greater plasma exposure and 8-fold greater tumor accumulation vs. irinotecan. This superior pharmacokinetic profile confers 500% greater anti-tumor activity at half the dose (30mg/kg, 3X Q4D, vs. 60mg/kg irinotecan). In xenograft models, IT-141 has demonstrated tumor regression of up to 88%, with 60% of tumors regressing completely. The IVECT copolymer is safe and well tolerated at up to 6 times the therapeutic doses, with no sick mouse syndrome, and can be lyophilized for long-term storage (>1 year). Intezyne is preparing its IND for IT-141. The Company has additional programs in development that focus on delivering best-in-class chemotherapies.

Note: This abstract was not presented at the AACR 101st Annual Meeting 2010 because the presenter was unable to attend.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 3499.