Combining VPS34 inhibitors with STING agonists enhances type I interferon signaling and anti-tumor efficacy

An immunosuppressive tumor microenvironment promotes tumor growth and is one of the main factors limiting the response to cancer immunotherapy. We have previously reported that inhibition of vacuolar protein sorting 34 (VPS34), a crucial lipid kinase in the autophagy/endosomal trafficking pathway, decreases tumor growth in several cancer models, increases infiltration of immune cells and sensitizes tumors to anti-programmed cell death protein 1/programmed cell death 1 ligand 1 therapy by upregulation of C-C motif chemokine 5 (CCL5) and C-X-C motif chemokine 10 (CXCL10) chemokines. The purpose of this study was to investigate the signaling mechanism leading to the VPS34-dependent chemokine increase. NanoString gene expression analysis was applied to tumors from mice treated with the VPS34 inhibitor SB02024 to identify key pathways involved in the anti-tumor response. We showed that VPS34 inhibitors increased the secretion of T-cell-recruitment chemokines in a cyclic GMP-AMP synthase (cGAS)/stimulator of interferon genes protein (STING)-dependent manner in cancer cells. Both pharmacological and small interfering RNA (siRNA)-mediated VPS34 inhibition increased cGAS/STING-mediated expression and secretion of CCL5 and CXCL10. The combination of VPS34 inhibitor and STING agonist further induced cytokine release in both human and murine cancer cells as well as monocytic or dendritic innate immune cells. Finally, the VPS34 inhibitor SB02024 sensitized B16-F10 tumor-bearing mice to STING agonist treatment and significantly improved mice survival. These results show that VPS34 inhibition augments the cGAS/STING pathway, leading to greater tumor control through immune-mediated mechanisms. We propose that pharmacological VPS34 inhibition may synergize with emerging therapies targeting the cGAS/STING pathway.

Angiopoietin-like protein 4 is a chromatin-bound protein that enhances mammosphere formation in vitro and experimental triple-negative breast cancer brain and liver metastases in vivo

INTRODUCTION:

Metastatic progression in triple-negative breast cancer (TNBC) patients occurs primarily because of nuclear reprogramming that includes chromatin remodeling and epigenetic modifications. The existing and most successful chemotherapies available for metastatic TNBC target nuclear proteins or damage DNA. The objectives here are to investigate an undescribed role for the molecular biology of nuclear angiopoietin-like protein 4 (ANGPTL4) and to characterize the effect of ectopic overexpression of ANGPTL4 in the metastatic biology of TNBC.

MATERIALS AND METHODS:

Lentiviral-mediated transduction was used to overexpress ANGPTL4 in the TNBC cell line MD Anderson–metastatic breast cancer 231. The overexpression of ANGPTL4 was confirmed by western blot and ELISA. Subcellular fractionation, western blot, and immunofluorescence microscopy were used to characterize the intracellular localization of ANGPTL4. Mammosphere culture and the anchorage-independent growth assay analyzed the metastatic potential of the cell line. Xenograft assays assessed the effect of ANGPTL4 overexpression on TNBC metastases in vivo.

RESULTS:

The ANGPTL4 overexpressing cell line formed larger mammospheres and anchorage-independent colonies in vitro and developed larger primary tumors, more liver metastases, and brain metastatic outgrowth in vivo in comparison to a cell line that expressed endogenous levels of ANGPTL4. ANGPTL4, aurora kinase A (AURKA), a mitotic kinase, and Tat-interacting protein p60 kDa (Tip60), a lysine acetyltransferase, associated with chromatin in the ANGPTL4 overexpressing cells but not in cells that expressed endogenous levels of ANGPTL4.

CONCLUSIONS:

The ANGPTL4 overexpressing cell line showed in vitro and in vivo activities that suggest that nuclear ANGPTL4, AURKA, and Tip60 may cooperatively modulate TNBC metastases within chromatin-remodeling complexes or DNA-associated machinery.

Immunologie Studies in von Willebrand’s Disease

Two patients with a severe von Willebrand’s disease characterized by no detectable factor VIII related antigen in their plasma received transfusions of cryoprecipitate. The bleeding time was corrected for a short period of time and returned to its pretransfusional value although the other parameters of the disease were still corrected. Electrophoretic and immunologic properties of factor VIII related antigen infused were determined serially after transfusion. Modifications of these properties occurred progressively after transfusion. The half disappearance time of F. VIIIR. A. was determined and found to be considerably shorter than in hemophilic recipients. This study suggests an alteration in vivo of F. VIIIR. A. infused into von Willebrand recipients.

Modifications of factor VIII related antigen in hemophiliacs with acute hepatitis and sub-clinical liver disease

Modifications of Factor VIII related antigen (F, VIII R. A.) were investigated in three hemophilic patients during the course of post transfusion hepatitis. F. VIII R. A. was found to be elevated and correlated with the increase of the S.G.P.T. During the acute phase of the disease the Factor VIII related protein was tested for its ristocetin cofactor activity, its electrophoretic mobility on crossed antigen-antibody electrophoresis and its elution pattern on Sepharose 4B columns; all these properties proved to be abnormal. Liver function tests and F. VIII R. A. were measured in 36 multitransfused hemophiliacs. There was a significant increase of the F. VIII R. A. in the plasma of patients with abnormal liver function tests. Only a few of the multitransfused hemophiliacs had clinical symptoms of hepatitis, although 72% had elevated transaminase levels.

Response to desipramine treatment in adolescent depression: a fixed-dose, placebo-controlled trial

OBJECTIVE

To determine the efficacy and tolerability of the tricyclic antidepressant desipramine (DMI) in the treatment of DSM-III-R-diagnosed major depressive disorder in adolescents.

METHOD

Sixty adolescents (42 female, 18 male; aged 15 to 19 years) diagnosed with major depressive disorder using clinical interview and Schedule for Affective Disorders and Schizophrenia for School-Age Children were randomized to receive either DMI (200 mg daily in divided doses) or placebo for six consecutive weeks following a 1-week placebo period. Treatment outcome was determined using the Hamilton Depression Rating Scale and the Beck Depression Inventory. Tolerability was determined using a symptom side effects scale. In addition, a variety of laboratory and cardiovascular monitoring was performed.

RESULTS

No significant differences in treatment outcome between DMI- and placebo-treated groups were determined. Neither DMI, nor its metabolite 2-hydroxy-DMI, nor their ratio, was positively correlated to treatment outcome. The DMI group endorsed more side effects but there were no significant between-group differences in any laboratory, electrocardiographic, or other cardiovascular parameters apart from heart rate, which was increased in the DMI-treated group (p = .03).

CONCLUSIONS

Given the findings of this study and our review of previously published reports of tricyclic antidepressant treatment in this population, the routine use of short-term (6 weeks) DMI in the treatment of adolescent depression is not supported by the data on hand. Further investigations into what constitutes optimal psychopharmacological treatment of adolescent depression are warranted.

Prostaglandin E2 level in tissue surrounding aseptic failed total hips. Effects of materials

Production of inflammatory mediators (IM) by cells and specifically macrophages around loosened implants may be responsible for their loosening. Our hypothesis was that different materials give rise to different amounts of these IM. It is thought that alumina/alumina for total hip replacement (THR), which has been used for 15 years in our orthopedic department, may produce less IM than other systems. We initiated a clinical prospective study to measure the level of prostaglandin E2 (PGE2) in tissue surrounding loosened prostheses to quantify PGE2 production regarding the types of material involved in the friction couple, i.e., alumina/alumina versus metal/polyethylene, and the type of fixation, i.e., cemented versus cementless. A total of 29 THR revisions were performed in 28 patients. Four implant groups were identified: alumina/alumina cemented, alumina/alumina cementless, metal/polyethylene cemented, and metal/polyethylene cementless. For each revision, tissues surrounding the failed implants were harvested and processed, and the PGE2 was measured in a blind manner using an immunoassay technique. As the measuring technique was difficult, at least three determinations for each sample were necessary. Some samples were excluded from the analysis for various reasons, for example, second or further revisions involving many different materials in the past, conjunction of metallic and alumina debris and samples taken from non-loosened components. Finally, 15 samples were considered adequate for inclusion in this study. Two groups were analyzed and compared: the alumina/alumina couple and the metal/polyethylene couple. Tissue surrounding the first group demonstrated a PGE2 level of 69 +/- 56 fmol/mg wet weight compared to 202 +/- 156 fmol/mg for the second.(ABSTRACT TRUNCATED AT 250 WORDS)

Role of membrane sialic acid content in the adhesiveness of aged erythrocytes to human cultured endothelial cells

Following our previous observation that the oldest normal red blood cells were the most adherent to human cultured endothelial cells, we attempted to simulate this age-related adherence. Among all the membrane modifications experienced by erythrocytes during their life-span, loss of sialic acids has attracted considerable attention. Using two different preparations of neuraminidase, we performed a sialic acid depletion on the youngest erythrocytes to reach a sialic acid content similar to that observed in physiologically aged erythrocytes. These pretreated youngest cells displayed limited increase in the adhesiveness to endothelial cells, lower than that found with intact oldest cells. To obtain an adhesiveness of pretreated cells similar to that of naturally aged cells, it was necessary to exceed 80% of sialic acid depletion. At this extent of desialation, modifications of the electrophoretic pattern of glycophorins were observed as well as the appearance of peanut agglutinin reactivity which were never found in physiologically aged erythrocytes. Therefore, the sialic acid loss cannot be considered as being a single determinant factor of the naturally aged red cell adhesiveness.

Effects of ex-vivo plasma adsorption over protein A sepharose in acute leukemia

Plasma adsorption over immobilized Staphylococcus aureus Cowan I has resulted in tumor regression in several animal and human trials. Protein A, because of its ability to bind IgGs has been considered as the effective component of Staphylococcus aureus. In 4 patients with acute leukemia, a plasma volume of 1500 cm3 was passed in an ex-vivo system over immobilized SpA-Sepharose and then reinfused. Almost all of the IgGs contained in the plasma volume could thus be removed. Toxic side-effects were mild. No significant clinical improvement could be obtained. Plasma incubation with SpA did not modify blast cell viability or leukemic progenitor cell growth. Along with others, this study shows that Protein A is probably not the mediator of the tumoricidal responses observed in studies using adsorption over Staphylococcus aureus Cowan I. The ex-vivo system prepared for this study could also be used for plasma IgG removal for the treatment of autoimmune or immune-complex related disorders.

A liver-type mutation in a case of pronounced erythrocyte phosphofructokinase deficiency without clinical expression

A marked erythrocyte phosphofructokinase deficiency was detected in a healthy man. His enzymatic activity was only 25% that of normal controls. His father and his son had erythrocytic phosphofructokinase activities of 50-55% that of normal controls. The chromatographic separation of erythrocytic phosphofructokinase isozymes, as well as immunological studies revealed a decrease in L-type phosphofructokinase activity. The lowered erythrocytic L-type phosphofructokinase activity was not accompanied by a decreased level of L-type phosphofructokinase in proteins. The L/M subunit ratio was similar to that of normal subjects. The defect resulted from the synthesis of stable L-type mutant subunit with high electrophoretic mobility. White blood cells, which synthesize mostly the same isozyme as L-type phosphofructokinase also showed a decreased activity and a high electrophoretic mobility. In spite of this important deficiency, and of significant metabolic alterations (a slight decrease in ATP; 2,3-diphosphoglycerate; triose phosphate), hemolysis did not appear in the propositus.

Influence of free Mg2+ on the kinetics of human erythrocyte phosphofructokinase

The influence of Mg2+ on the reaction catalyzed by human erythrocyte phosphofructokinase has been investigated using kinetic methods. The catalytic activity of PFK is dependent upon the presence of Mg2+ which constitutes with ATP the true Mg-ATP2- substrate. Free Mg2+ has no influence on the affinity of the enzyme for Mg-ATP2- substrate. Erythrocyte PFK is more inhibited by ATP4- and uncomplexed citrate than it is by Mg-ATP2- and Mg-citrate. Free Mg2+ relieves the MgATP2- and Mg-citrate inhibition under conditions where free ATP4-is negligible. We can assume that uncomplexed Mg2+ acts as positive effector by direct binding to the enzyme. These results emphasize the role of Mg2+ in the regulation of PFK activity in the erythrocyte.

Effect of piracetam on EEG spectra of boys with learning disorders

Piracetam was compared with placebo in a double-blind cross-over study of 30 learning disabled boys. Power spectral analyses revealed that piracetam caused a decrease in the amount of delta activity and an increase in the average EEG frequency. This result is in agreement with those obtained by other workers in adult patients. Some clinical effects of piracetam may be mediated by increased alertness and/or decreased fatigue.

Minor physical anomalies in childhood autism. Part I. Their relationship to pre- and perinatal complications

In a study of minor physical anomalies and pregnancy complications in autistic children, 45 probands and 52 of their siblings were investigated. While there was a significant association between autism on one hand and minor physical anomalies and pregnancy complications on the other, no such association was found between physical anomalies and pregnancy and birth complications. Further, autistic children with higher anomaly scores had lower IQs, more frequent hospitalizations, and a more normal family history compared to autistic children with lower physical anomaly scores.

Cromolyn DSG effects in hyperkinetic and psychotic children with allergies

Preliminary findings of an open trial of cromolyn in hyperkinetic and psychotic children indicates that the medication is useful, safe and well tolerated. Further controlled studies are suggested to determine the efficacy and indications of cromolyn in child psychiatry. Positive findings could clarify the biochemical mechanisms of hyperkinesis.

Phosphofructokinase isozymes from human organs and blood cells

Phosphofructokinase (PFK) isozymes of blood cells and some human tissues were studied by starch gel electrophoresis and immunoprecipitation by anti-muscle and anti-erythrocyte PFK sera. PFK from muscle, heart, brain and placenta were totally precipitated by both antisera. PFK from blood cells (erythrocytes, lymphocytes, granulocytes, platelets) were precipitated more strongly by anti-erythrocyte PFK serum than by anti-muscle PFK serum. Liver, kidney and monoblast PFK were slightly precipitated by both antisera. From the electrophoretic patterns and the immunoprecipitation curves we may conclude that muscle contains the homotetrameric M4 forms; platelet, liver and kidney the homotetrameric E4 form, and blood cells the M-E hybrids. Monoblasts probably contain a E4 type PFK precursor, and heart, placenta and brain, a modified M4 type PFK. Other isozymes, unrelated with muscle and erythrocyte, were revealed in liver and kidney.

Qualitative and quantitative EEG in psychotic children

The EEGs of hospitalized psychotic boys were analyzed quantitatively by means of visual evaluation, analog frequency analysis, and digital computer period analysis and were compared with those of age- and sex-matched normals. Visual evaluation of the records demonstrated that psychotic children have significantly more beta activity as well as fewer alpha bursts than normal controls. EEG analog frequency analysis showed that psychotic children have a greater percentage of total voltage in the 3-5 cps and 13-33 cps bands, while they show less voltage in the 6-12 cps bands as compared with normal controls. Digital computer period analysis demonstrated more slow, less alpha, and more fast activity, as well as a greater average frequency and frequency deviation in both the primary wave and first derivative measurements in psychotic children than normals, while normals showed a trend towards higher amplitude and amplitude variability. The similarity of the EEG differences between psychotic and normal children to those differences observed between adult chronic schizophrenics and normals, as well as to those between children of "high risk" for becoming schizophrenic and controls, suggests that the above described findings are characteristic for the pathophysiology of schizophrenia.

Immunologic studies in von Willebrand's disease: alteration of factor VIII/von Willebrand protein after transfusion with plasma concentrates in patients with von Willebrand's disease

Two patients with a severe von Willebrand's disease characterized by no detectable factor VIII related antigen in their plasma received transfusions of cryoprecipitate. The bleeding time was corrected for a short period of time and returned to its pretransfusional value although the other parameters of the disease were still corrected. Electrophoretic and immunologic properties of factor VIII related antigen infused were determined serially after transfusion. Modifications of these properties occurred progressively after transfusion. The half disappearance time of F. VIII R.A. was determined and found to be considerably shorter than in hemophilic recipients. This study suggests an alteration in vivo of F. VIII R.A. infused into von Willebrand recipients.

Electrophoretic heterogeneity of normal factor VIII/Von Willebrand protein, and abnormal electrophoretic mobility in patients with Von Willebrand's disease

Crossed antigen-antibody electrophoresis was used to determine the electrophoretic properties of factor VIII/Von Willebrand (F. VIII/VW) protein in normal plasma using a specific rabbit antiserum against purified human factor VIII. The electrohoretic patterns in seven patients with severe Von Willebrand's disease in two different families were studied. In these patients the prolonged bleeding time was related to a functionally abnormal F. VIII/VW protein which was unable to induce platelet aggregation in presence of ristocetin. F. VIII/VW protein had an increased electrophoretic mobility in all the patients. The electrophoretic pattern was similar in different members of the same family but differed from one family to the other. Plasma samples collected after transfusion of normal cryoprecipitate to one member of the first family showed an increasing amount of F. VIII/VW protein, but even one hour after transfusion only one peak migration in an abnormal position was found. However, when mixed in vitro with normal plasma, the plasmas of the same patient showed two peaks, one in position of normal F. VIII/VW protein and one with increased electrophoretic mobility. These results suggest that normal F. VIII/VW protein transfused to recipients with Von Willebrand's disease synthesizing a functionally deficient factor undergoes a rapid alteration.

Computerized Electroencephalogram. A model of understanding the brain function in childhood psychosis and its treatment

Computer analysis of the electroencephalogram (CEEG) in psychotic children before and after pharmacotherapy, normal children of schizophrenic mothers, and matched normal children of normal parents indicated significant intergroup differences. The psychotic children had more slow, as well as very fast, EEG waves. With drug therapy the EEG showed a partial "normalization," as fast EEG activity decreased. The EEG and auditory evoked potential of children of schizophrenic mothers were strikingly similar to those of psychotic children and schizophrenic adults, with significant decreases of the average EEG amplitude and the evoked potential latencies. Psychotic children were distinctly differentiated from the normal children by discriminant function analysis of the EEG and EP. Quantitative analysis of brain functions in the mentally ill can help determine the neurophysiological correlates of behavior, a more scientific diagnostic classification, prognosis, and selection of therapy.

Comparative symptomatological and evoked potential studies with d-amphetamine, thioridazine, and placebo in hyperkinetic children

In a double-blind study, 62 hyperkinetic children were randomly assigned to 8 weeks of treatment with either placebo, thioridazine, or d-amphetamine. The overall clinical symptomatology improved with all three substances, although d-amphetamine was significantly superior to placebo and thioridazine. Out of eight symptom clusters rated by the parents, two improved significantly with placebo, one with thioridazine, and six with d-amphetamine. The d-amphetamine was superior to placebo in reducing muscular tension and superior to thioridazine in decreasing hyperactive-impulsive behavior, psychosomatic problems, and muscular tension. Out of four teachers' symptom clusters, inattentive-passive behavior was significantly improved by thioridazine (which was also superior to placebo), while hyperactivity was reduced by d-amphetamine. Quantitative evaluation of visual evoked potentials (VEPs) revealed an increase in latencies and decrease in amplitudes during thioridazine treatment. Paradoxically, d-amphetamine also increased latencies, while tending to augment amplitudes. Regression and correlation analysis of clinical symptomatology with VEP variables showed that the shorter the pretreatment latencies and the higher the amplitudes, the more disturbed was the child. Short latencies and small amplitudes in the pretreatment period were predictors of good therapeutic outcome with subsequent thioridazine treatment, while short latencies and high amplitudes were indicative of such with d-amphetamine treatment. During therapy, the greater the drug-induced augmentation of latencies, the greater the clinical improvement. Finally, VEP differences between therapy-responsive and -resistant patients were explored and discussed.

Detection of heterozygotes in both parents of homozygous patients with Von Willebrand's disease

Three patients with severe Von Willebrand's disease are shown to be homozygotes. They were born from unaffected parents. New techniques using a factor-VIII-related antigen assay by the Laurell method and a ristocetin-induced platelet aggregation assay demonstrated abnormalities in these two tests in both parents of the probands. Factor-VIII-related of heterogotes could not be differentiated from normal factor-VIII-related antigen by the immunodiffusion technique, crossed immunoelectrophoresis, and filtration on a sepharose 4b column.

Pediatric psychopharmacology outside the U.S.A

To obtain information on the use of psychotropic drugs children outside the U.S.A., 251 questionnaires were mailed to institutions in 53 countries. Seventy-three responses from 34 countries were analyzed. The percentage of patients receiving drugs under the care of these respondents ranged from 0 to 100% (mean 39%). A total of 56 different drugs were selected for eleven psychiatric disorders. No regional differences were apparent, except for infrequently used drugs. Respondents differed widely in the number of drugs selected and maximum dosages. The most popular drugs used in most disorders were diazepam, thioridazine, chlorpromazine, chlordiazepoxide, imipramine, amitriptyline, haloperidol and methylphenidate. Highest agreements among respondents were for imipramine in enuresis, diazepam in anxiety, chlorpromazine in psychosis and thioridazine in hyperkinesis. The results of this survey illustrate important problems in interpreting cross-cultural data in pediatric psychopharmacology, and recommendations for future research are made.

Clinical laboratory test standards in new drug trials

From a population of chronic schizophrenic patients receiving new psychotropic drug treatments, 48 were maintained on placebo medication for periods up to twenty weeks. Clinical pathological laboratory data were collected at the same intervals as in the drug-treated groups. While the range of laboratory findings was similar to the textbook standards, deviations ("abnormalities") were frequent. We conclude that each laboratory undertaking clinical drug evaluations should provide concurrent control data for placebo-treated subjects when reporting observations with novel compounds.