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Fujisawa T, Tsuchiya T, Kato M, Mizuide M, Takakura K, Nishimura M, Kutsumi H, Matsuda Y, Arai T, Ryozawa S, Itoi T, Isayama H, Saya H, Yahagi N. STNM01, the RNA oligonucleotide targeting carbohydrate sulfotransferase 15, as second-line therapy for chemotherapy-refractory patients with unresectable pancreatic cancer: An open label, phase I/IIa trial. EClinicalMedicine 2023; 55:101731. [PMID: 36425867 PMCID: PMC9678806 DOI: 10.1016/j.eclinm.2022.101731] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 10/16/2022] [Accepted: 10/18/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The impact of stroma-targeting therapy on tumor immune suppression is largely unexplored. An RNA oligonucleotide, STNM01, has been shown to repress carbohydrate sulfotransferase 15 (CHST15) responsible for tumor proteoglycan synthesis and matrix remodeling. This phase I/IIa study aimed to evaluate the safety and efficacy of STNM01 in patients with unresectable pancreatic ductal adenocarcinoma (PDAC). METHODS This was an open-label, dose-escalation study of STNM01 as second-line therapy in gemcitabine plus nab-paclitaxel-refractory PDAC. A cycle comprised three 2-weekly endoscopic ultrasound-guided locoregional injections of STNM01 at doses of 250, 1,000, 2,500, or 10,000 nM in combination with S-1 (80-120 mg twice a day for 14 days every 3 weeks). The primary outcome was the incidence of dose-liming toxicity (DLT). The secondary outcomes included overall survival (OS), tumor response, changes in tumor microenvironment on immunohistopathology, and safety (jRCT2031190055). FINDINGS A total of 22 patients were enrolled, and 3 cycles were repeated at maximum; no DLT was observed. The median OS was 7.8 months. The disease control rate was 77.3%; 1 patient showed complete disappearance of visible lesions in the pancreas and tumor-draining lymph nodes. Higher tumoral CHST15 expression was associated with poor CD3+ and CD8+ T cell infiltration at baseline. STNM01 led to a significant reduction in CHST15, and increased tumor-infiltrating CD3+ and CD8+ T cells in combination with S-1 at the end of cycle 1. Higher fold increase in CD3+ T cells correlated with longer OS. There were 8 grade 3 adverse events. INTERPRETATION Locoregional injection of STNM01 was well tolerated in patients with unresectable PDAC as combined second-line therapy. It prolonged survival by enhancing T cell infiltration in tumor microenvironment. FUNDING The present study was supported by the Japan Agency for Medical Research and Development (AMED).
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Key Words
- 5-FU, fluorouracil
- AMED, Japan Agency for Medical Research and Development
- CHST15, carbohydrate sulfotransferase 15
- CI, confidence interval
- CS-E, chondroitin sulfate E
- CTCAE, Common Terminology Criteria for Adverse Events
- Carbohydrate sulfotransferase 15 (CHST15)
- DCR, disease control rate
- DLT, dose-liming toxicity
- ECM, extracellular matrix
- EMT, epithelial mesenchymal transition
- EUS-FNI, endoscopic ultrasound-guided fine needle injection
- Endoscopic ultrasound-guided fine needle injection
- FAS, full analysis set
- GM-CSF, Granulocyte-macrophage colony-stimulating factor
- IQR, interquartile range
- IRB, Institutional Review Board
- LV, leucovorin
- MTD, maximum tolerated dose
- OS, overall survival
- PDAC, pancreatic ductal adenocarcinoma
- PFS, progression free survival
- STNM01
- TEAE, treatment emergent adverse event
- TGF, transforming growth factor
- Tumor-infiltrating CD3+ and CD8+ T cells
- Unresectable pancreatic cancer
- nal-IRI, nanoliposomal irinotecan
- sCD44v6, soluble CD44 variant 6
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Affiliation(s)
- Toshio Fujisawa
- Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Takayoshi Tsuchiya
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Motohiko Kato
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Masafumi Mizuide
- Department of Gastroenterology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Kazuki Takakura
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Makoto Nishimura
- Department of Gastroenterology, Hepatology and Nutrition, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Hiromu Kutsumi
- Center for Clinical Research and Advanced Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Yoko Matsuda
- Oncology Pathology, Department of Pathology and Host-Defense, Kagawa University, Takamastu, Kagawa, Japan
| | - Tomio Arai
- Department of Pathology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Itabashi-ku, Tokyo, Japan
| | - Shomei Ryozawa
- Department of Gastroenterology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Hiroyuki Isayama
- Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Hideyuki Saya
- Division of Gene Regulation, Institute for Advanced Medical Research, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Naohisa Yahagi
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
- Corresponding author. Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Shinjuku-ku, Tokyo, 160-8542, Japan.
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Kishimoto T, Takamiya A, Liang KC, Funaki K, Fujita T, Kitazawa M, Yoshimura M, Tazawa Y, Horigome T, Eguchi Y, Kikuchi T, Tomita M, Bun S, Murakami J, Sumali B, Warnita T, Kishi A, Yotsui M, Toyoshiba H, Mitsukura Y, Shinoda K, Sakakibara Y, Mimura M; PROMPT collaborators. The project for objective measures using computational psychiatry technology (PROMPT): Rationale, design, and methodology. Contemp Clin Trials Commun 2020; 19:100649. [PMID: 32913919 DOI: 10.1016/j.conctc.2020.100649] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 08/06/2020] [Accepted: 08/16/2020] [Indexed: 01/08/2023] Open
Abstract
Introduction Depressive and neurocognitive disorders are debilitating conditions that account for the leading causes of years lived with disability worldwide. However, there are no biomarkers that are objective or easy-to-obtain in daily clinical practice, which leads to difficulties in assessing treatment response and developing new drugs. New technology allows quantification of features that clinicians perceive as reflective of disorder severity, such as facial expressions, phonic/speech information, body motion, daily activity, and sleep. Methods Major depressive disorder, bipolar disorder, and major and minor neurocognitive disorders as well as healthy controls are recruited for the study. A psychiatrist/psychologist conducts conversational 10-min interviews with participants ≤10 times within up to five years of follow-up. Interviews are recorded using RGB and infrared cameras, and an array microphone. As an option, participants are asked to wear wrist-band type devices during the observational period. Various software is used to process the raw video, voice, infrared, and wearable device data. A machine learning approach is used to predict the presence of symptoms, severity, and the improvement/deterioration of symptoms. Discussion The overall goal of this proposed study, the Project for Objective Measures Using Computational Psychiatry Technology (PROMPT), is to develop objective, noninvasive, and easy-to-use biomarkers for assessing the severity of depressive and neurocognitive disorders in the hopes of guiding decision-making in clinical settings as well as reducing the risk of clinical trial failure. Challenges may include the large variability of samples, which makes it difficult to extract the features that commonly reflect disorder severity. Trial Registration UMIN000021396, University Hospital Medical Information Network (UMIN).
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Key Words
- AMED, Japan Agency for Medical Research and Development
- Adabag, Adaptive Bagging
- Adaboost, Adaptive Boosting
- BD, Bipolar disorder
- BDI-II, Beck Depression Inventory, Second Edition
- BNN, Bayesian Neural Networks
- CDR, Clinical Dementia Rating
- CDT, Clock Drawing Test
- CNN, Convolutional Neural Networks
- CPP, cepstral peak prominence
- DSM-5, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition
- Depression
- F0, fundamental frequency
- F1, F2, F3, first, second, and third formant frequencies
- FedRAMP, Federal Risk and Authorization Management Program
- GCNN, Gated Convolutional Neural Networks
- GDS, Geriatric Depression Scale
- HAM-D, Hamilton Depression Rating Scale
- IEC, International Electrotechnical Commission
- ISO, International Organization for Standardization
- LM, Wechsler Memory Scale-Revised Logical Memory
- LSTM, Long Short-Term Memory Networks
- M.I.N.I., Mini-International Neuropsychiatric Interview
- MADRS, Montgomery-Asberg Depression Rating Scale
- MARS, Motor Agitation and Retardation Scale
- MCI, mild cognitive impairment
- MDD, Major depressive disorder
- MFCC, mel-frequency cepstrum coefficients
- MMSE, Mini-Mental State Examination
- MRI, magnetic resonance imaging
- Machine learning
- MoCA, Montreal Cognitive Assessment
- NPI, Neuropsychiatric Inventory
- Natural language processing
- Neurocognitive disorder
- PET, positron emission tomography
- PROMPT, Project for Objective Measures Using Computational Psychiatry Technology
- PSQI, Pittsburgh Sleep Quality Index
- RF, Random Forest
- RGB, red, green, blue
- SCID, Structural Clinical Interview for DSM-5
- SVM, Support Vector Machine
- SVR, Support Vector Regression
- Screening
- UI, uncertainty interval
- UMIN, University Hospital Medical Information Network
- UV, ultraviolet
- YLDs, years lived with disability
- YMRS, Young Mania Rating Scale
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Azuma K, Yamanaka S. Recent policies that support clinical application of induced pluripotent stem cell-based regenerative therapies. Regen Ther 2016; 4:36-47. [PMID: 31245486 PMCID: PMC6581825 DOI: 10.1016/j.reth.2016.01.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Revised: 01/07/2016] [Accepted: 01/28/2016] [Indexed: 02/04/2023] Open
Abstract
In Japan, a research center network consisting of Kyoto University to provide clinical-grade induced Pluripotent Stem Cells (iPSC) and several major research centers to develop iPSC-based regenerative therapies was formed for the clinical application of iPSCs. This network is under the supervision of a newly formed funding agency, the Japan Agency for Medical Research and Development. In parallel, regulatory authorities of Japan, including the Ministry of Health, Labour and Welfare, and Pharmaceuticals and Medical Devices Agency, are trying to accelerate the development process of regenerative medicine products (RMPs) by several initiatives: 1) introduction of a conditional and time-limited approval scheme only applicable to RMPs under the revised Pharmaceuticals and Medical Devices Act, 2) expansion of a consultation program at the early stage of development, 3) establishment of guidelines to support efficient development and review and 4) enhancement of post-market safety measures such as introduction of patient registries and setting user requirements with cooperation from relevant academic societies and experts. Ultimately, the establishment of a global network among iPSC banks that derives clinical-grade iPSCs from human leukocyte antigens homozygous donors has been proposed. In order to share clinical-grade iPSCs globally and to facilitate global development of iPSC-based RMPs, it will be necessary to promote regulatory harmonization and to establish common standards related to iPSCs and differentiated cells based on scientific evidence.
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Key Words
- AMED, Japan Agency for Medical Research and Development
- BLA, Biological License Approval
- CFR, Code of Federal Regulations
- CiRA, Center for iPS Cell Research and Application
- DMF, Drug Master File
- ESC, embryonic stem cell
- FDA, Food and Drug Administration
- FY, fiscal year
- GAiT, Global Alliance for iPS Cell Therapies
- GCTP, Good Gene, Cell, Cellular and Tissue-based Products Manufacturing Practice
- GMP, good manufacturing practice
- HLA, human leukocyte antigen
- Haplobank
- IBRI, Institution of Biomedical Research and Innovation
- ICH, The International Conference on Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use
- IND, Investigational New Drug
- INTERMACS, Interagency Registry for Mechanically Assisted Circulatory Support
- IRB, Institutional Review Board
- J-MACS, Japanese Registry for Mechanically Assisted Circulatory Support
- JST, Japan Science and Technology Agency
- Japan
- LVAD, left ventricular assist device
- METI, Ministry of Economy, Trade and Industry
- MEXT, Ministry of Education, Culture, Sports, Science and Technology
- MHLW, Ministry of Health, Labour and Welfare
- NEDO, New Energy and Industrial Technology Development Organization
- NIBIO, National Institute of Biomedical Innovation
- NIHS, National Institute of Health Science
- PAL, Pharmaceutical Affairs Law
- PIC/S, The Pharmaceutical Inspection Convention and Pharmaceutical Inspection Co-operation Scheme
- PMD Act, Pharmaceuticals and Medical Devices Act
- PMDA, Pharmaceuticals and Medical Devices Agency
- Policy
- R&D, research and development
- RM Act, the Act on the Safety of Regenerative Medicine
- RMP, regenerative medicine product
- Regenerative medicine
- Regulation
- Riken CDB, Riken Center for Developmental Biology
- U.S., United States
- WHO, World Health Organization
- iPS cells
- iPSC, induced pluripotent stem cell
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Affiliation(s)
- Kentaro Azuma
- Center for iPS Cell Research and Application, Kyoto University, Kyoto 606-8507, Japan
| | - Shinya Yamanaka
- Center for iPS Cell Research and Application, Kyoto University, Kyoto 606-8507, Japan
- Gladstone Institute of Cardiovascular Disease, San Francisco, California 94158, USA
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