Human gastrin- releasing peptide receptor expression in women with uterine cervix cancer

Introduction

²¹²Pb-DOTAM-GRPR1 is a pharmaceutical radioimmunoconjugate consisiting of an α-particle-emitting radionuclide lead-212 (²¹²Pb), a metal chelator DOTAM (1,4,7,10-tetrakis(carbamoylmethyl)-1,4,7,10-tetraazacyclododecane), and a gastrin-releasing peptide receptor (GRPR)-targeted antagonist currently being evaluated as therapy in uterine cervix and other cancer types. Previous studies have revealed that a variable proportion of uterine cervix cancer tumors overexpress the radiopharmaceutical target GRPR when assessed by cell proportion and staining intensity immunoreactive scores (IRS). Tumor response to ²¹²Pb-DOTAM-GRPR1 strongly associates with GRPR overexpression, and therefore, it seems reasonable to assess uterine cervix cancer GRPR immunoreactivity for greater insight into the feasibility of using ²¹²Pb-DOTAM-GRPR1 as a radiopharmaceutical treatment.

Methods

We examined a series of 33 uterine cervix cancer paraffin-embedded tumors in order to establish whether this tumor type overexpresses GRPR at an IRS score of 6 or higher, as ²¹²Pb-DOTAM-GRPR1 is currently being evaluated in clinical trials against tumors showing such a level of expression.

Results

The results show that five of five (100%) primary adenocarcinomas and 10 of 16 (63%) primary squamous cell tumors overexpress GRPR at an IRS score of 6 or higher.

Discussion

The frequency of overexpression in this study suggests that ²¹²Pb-DOTAM-GRPR1 radiopharmaceutical treatment may be useful in the management of persistent, recurrent, or metastatic uterine cervix cancer patients. A phase I clinical trial involving patients with metastatic uterine cervix cancer is currently underway (NCT05283330).

PDI inhibitor LTI6426 enhances panobinostat efficacy in preclinical models of multiple myeloma

The histone deacetylase inhibitor (HDACi), panobinostat (Pano), is approved by the United States Food and Drug Administration (FDA) and European Medicines Agency (EMA) for treatment of relapsed/refractory multiple myeloma (MM). Despite regulatory approvals, Pano is used on a limited basis in MM due largely to an unfavorable toxicity profile. The MM treatment landscape continues to evolve, and for Pano to maintain a place in that paradigm it will be necessary to identify treatment regimens that optimize its effectiveness, particularly those that permit dose reductions to eliminate unwanted toxicity. Here, we propose such a regimen by combining Pano with LTI6426, a first-in-class orally bioavailable protein disulfide isomerase (PDI) inhibitor. We show that LTI6426 dramatically enhances the anti-MM activity of Pano in vitro and in vivo using a proteasome inhibitor resistant mouse model of MM and a low dose of Pano that exhibited no signs of toxicity. We go on to characterize a transcriptional program that is induced by the LTI6426/Pano combination, demonstrating a convergence of the two drugs on endoplasmic reticulum (ER) stress pathway effectors ATF3 (Activating Transcription Factor 3), DDIT3/CHOP (DNA Damage Inducible Transcript 3, a.k.a. C/EBP Homologous Protein), and DNAJB1 (DnaJ homolog subfamily B member 1, a.k.a. HSP40). We conclude that LTI6426 may safely enhance low-dose Pano regimens and that ATF3, DDIT3/CHOP, and DNAJB1 are candidate pharmacodynamic biomarkers of response to this novel treatment regimen.

ATF3 Coordinates Antitumor Synergy between Epigenetic Drugs and Protein Disulfide Isomerase Inhibitors

Histone deacetylase inhibitors (HDACi) are largely ineffective in the treatment of solid tumors. In this study, we describe a new class of protein disulfide isomerase (PDI) inhibitors that significantly and synergistically enhance the antitumor activity of HDACi in glioblastoma and pancreatic cancer preclinical models. RNA-sequencing screening coupled with gene silencing studies identified ATF3 as the driver of this antitumor synergy. ATF3 was highly induced by combined PDI and HDACi treatment as a result of increased acetylation of key histone lysine residues (acetylated histone 3 lysine 27 and histone 3 lysine 18) flanking the ATF3 promoter region. These chromatin marks were associated with increased RNA polymerase II recruitment to the ATF3 promoter, a synergistic upregulation of ATF3, and a subsequent apoptotic response in cancer cells. The HSP40/HSP70 family genes DNAJB1 and HSPA6 were found to be critical ATF3-dependent genes that elicited the antitumor response after PDI and HDAC inhibition. In summary, this study presents a synergistic antitumor combination of PDI and HDAC inhibitors and demonstrates a mechanistic and tumor suppressive role of ATF3. Combined treatment with PDI and HDACi offers a dual therapeutic strategy in solid tumors and the opportunity to achieve previously unrealized activity of HDACi in oncology. SIGNIFICANCE: This study uses a first-in-class PDI inhibitor entering clinical development to enhance the effects of epigenetic drugs in some of the deadliest forms of cancer.

Tuning isoform selectivity and bortezomib sensitivity with a new class of alkenyl indene PDI inhibitor

Protein disulfide isomerase (PDI, PDIA1) is an emerging therapeutic target in oncology. PDI inhibitors have demonstrated a unique propensity to selectively induce apoptosis in cancer cells and overcome resistance to existing therapies, although drug candidates have not yet progressed to the stage of clinical development. We recently reported the discovery of lead indene compound E64FC26 as a potent pan-PDI inhibitor that enhances the cytotoxic effects of proteasome inhibitors in panels of Multiple Myeloma (MM) cells and MM mouse models. An extensive medicinal chemistry program has led to the generation of a diverse library of indene-containing molecules with varying degrees of proteasome inhibitor potentiating activity. These compounds were generated by a novel nucleophilic aromatic ring cyclization and dehydration reaction from the precursor ketones. The results provide detailed structure activity relationships (SAR) around this indene pharmacophore and show a high degree of correlation between potency of PDI inhibition and bortezomib (Btz) potentiation in MM cells. Inhibition of PDI leads to ER and oxidative stress characterized by the accumulation of misfolded poly-ubiquitinated proteins and the induction of UPR biomarkers ATF4, CHOP, and Nrf2. This work characterizes the synthesis and SAR of a new chemical class and further validates PDI as a therapeutic target in MM as a single agent and in combination with proteasome inhibitors.

Abstract 3840: ATF3 drives synergy between protein disulfide isomerase (PDI) inhibitors and epigenetic cancer therapy

The clinical potential of epigenetic cancer therapy has not been fully realized. Histone deacetylase inhibitors (HDACi), for example, only benefit a minor fraction of all cancer patients despite thousands of preclinical studies demonstrating their antitumor effects. In this study we show that a new structural class of protein disulfide isomerase (PDI) that was discovered by our lab dramatically enhances the antitumor effects of HDACi and select other epigenetic modifiers. We set out to identify synergistic interactions between our lead PDI inhibitor, E64FC26, and FDA-approved drugs in the NCI Approved Oncology Drug Set VIII of ~130 marketed drugs. We identified robust and previously uncharacterized synergy with all four HDACi in the set (i.e., panobinostat, romidepsin, vorinostat, and belinostat) in a broad range of solid and heme-malignancies. For example, E64FC26 potentiated panobinostat-induced cytotoxicity by 240-fold in PANC-1 pancreatic cancer cells and by 20-fold in T98G glioblastoma cells. Synergy with HDACi involved an apoptotic response measured by the activation of caspase 3, 8, 9 and the cleavage of the caspase 3 substrate PARP. PDI mediates proper protein folding, and western blotting and confocal microscopy confirmed the accumulation of misfolded poly-ubiquitinated protein aggregates in treated cells, which we showed was a critical component underlying the synergistic effects of the combination. To further understand the mechanism, we profiled the transcriptomes of combination treated cells using comparative RNA-Seq. These experiments revealed a convergence on ATF3 and DDIT3, two candidates in the ER stress pathway. RNA-Seq results were confirmed by qPCR and western blotting analysis in a range of tumor types. ATF3 played an apparent dominant role in driving the synergy between PDI and HDAC inhibitors, as knockdown of ATF3 completely ameliorated synergy between the two drug classes. We further clarified this molecular mechanism to show that PDI inhibition induces an ER stress response that leads to the induction of ATF3, which is further potentiated in the presence of HDACi, leading to the synergistic effects of the drug combination. These effects were not limited to HDACi, as similar results were observed in combinations with other epigenetic targeted therapies. We went on to characterize the efficacy and tolerability of PDI and HDAC inhibitor combinations in multiple mouse models, including pancreatic and glioblastoma xenograft models as well as multiple myeloma xenotransplant models. In summary, this study presents the potent antitumor combination of PDI and HDAC inhibitors and demonstrates a key mechanistic role of the ATF3 transcription factor. The combination of our developmental PDI inhibitor and HDACi offers a new dual therapeutic strategy and the opportunity to amplify and rescue previously unrealized activity of epigenetic therapy in oncology.

Citation Format: Ravyn M. Duncan, Leticia Reyes, Katelyn Moats, Reeder M. Robinson, Holly A. Stessman, Nathan G. Dolloff. ATF3 drives synergy between protein disulfide isomerase (PDI) inhibitors and epigenetic cancer therapy [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 3840.

Pasteurella multocida isolated from wild birds of North America: a serotype and DNA fingerprint study of isolates from 1978 to 1993

Serotype and DNA fingerprint methods were used to study Pasteurella multocida isolated from 320 wild birds of North America. Isolates were collected during 1978-93. The HhaI profiles of 314 isolates matched the HhaI profile of somatic reference type 1, stain X-73; somatic type 1 antigen was expressed by 310 isolates, and the serotype of four isolates was undetected. Differentiation of the 314 isolates was observed by digestion of DNA with HpaI. None of the HpaII profiles matched the HpaII profile of X-73 (designated HhaI 001/HpaII 001). Three HpaII profiles were recognized among the somatic type 1 isolates: HpaII 002 (n = 18), HpaII 003 (n = 122), and HpaII 004 (n = 174). Profile HpaII 002 was found among isolates collected during 1979-83. Profile HpaII 003 was identified from isolates collected during 1979-89, with the exception of two isolates in 1992. The HpaII 004 profile was identified from isolates collected during 1983-93. Of the six remaining isolates, four expressed somatic type 4 and had HhaI profiles identical to the somatic type 4 reference strain P-1662 profile (designated HhaI 004); these isolates were differentiated by digestion of DNA with HpaII. One isolate was identified as serotype F:11, and another was serotype A:3,4. In the present study, 314 of 316 (99.4%) isolates from wild birds in the Central, Mississippi, and Pacific flyways during 1978-93, were P. multocida somatic type 1.

Serotypes and DNA fingerprint profiles of Pasteurella multocida isolated from raptors

Pasteurella multocida isolates from 21 raptors were examined by DNA fingerprint profile and serotyping methods. Isolates were obtained from noncaptive birds of prey found in 11 states from November 28, 1979, through February 10, 1993. Nine isolates were from bald eagles, and the remaining isolates were from hawks, falcons, and owls. Seven isolates were members of capsule group A, and 14 were nonencapsulated. One isolate was identified as somatic type 3, and another was type 3,4,7; both had unique HhaI DNA fingerprint profiles. Nineteen isolates expressed somatic type 1 antigen; HhaI profiles of all type 1 isolates were identical to each other and to the HhaI profile of the reference somatic type 1, strain X-73. The 19 type 1 isolates were differentiated by sequential digestion of DNA with HpaII; four HpaII fingerprint profiles were obtained. The HpaII profile of one isolate was identical to the HpaII profile of strain X-73. Incidence of P. multocida somatic type 1 in raptors suggests that this type may be prevalent in other wildlife or wildlife environments.

Kidney lesions associated with mortality in chickens inoculated with waterfowl influenza viruses

Seventy-six type A influenza viruses recovered from waterfowl in Wisconsin, California, South Dakota, Florida, Texas, Alabama, and Nebraska were tested for virulence in chickens. The challenge to chickens was intravenous inoculation of first-, second-, or third-egg-passage virus. Each of the virus strains was tested separately in three or four chickens. Eighteen of the 76 viruses caused the death of one or more chickens following inoculation. Postmortem lesions were similar in all dead birds. In decreasing order of frequency, gross lesions included: swollen kidneys evident as accentuated lobular patterns, urates in the pericardial sac, and urates on the surface of the liver. Microscopic lesions present in kidneys were consistent with visceral gout. Mortality was associated with inoculations having higher concentrations of infectious virus. These results indicate that the influenza A viruses circulating in duck populations may include strains potentially pathogenic for chickens.

Basic principles of splinting the hand

This article presents the basic principles needed in the fabrication of static and dynamic splints. The principles are defined, and examples are used as illustrations. The biomechanics of dynamic splinting are described, with special attention given to low-profile dynamic splinting. Several low-profile dynamic splints are described, with current indications presented in case studies with supporting documentation for appropriate splinting protocols.

An outbreak of type E botulism among common loons (Gavia immer) in Michigan's upper peninsula

An epizootic of type E botulism (Clostridium botulinum) occurred among common loons (Gavia immer) along the Lake Michigan shore of Michigan's Upper Peninsula (USA) during October and November 1983. An estimated 592 dead loons washed ashore along the Garden Peninsula. Type E botulinal toxin was demonstrated in blood samples and stomach contents of dead loons, and in samples of three species of dead fish found on the Lake Michigan shore. We suspect that loons acquired botulism by ingesting sick or dead fish containing type E toxin.

A survey of the prevalence of selected bacteria in wild birds

We determined the prevalence of six genera of bacteria from a sample of 387 cloacal swabs from 364 passerines and woodpeckers. The prevalence of bacteria were as follows: Escherichia coli (1%), Pseudomonas spp. (22%), Salmonella spp. (0%), Staphylococcus spp. (15%), Streptococcus spp. (18%), and Yersinia spp. (1%). The prevalence of Streptococcus spp. was higher in omnivorous species than in granivorous species (20% versus 8%). Individuals captured at feeders had a lower prevalence of both Streptococcus spp. (15% versus 33%) and Escherichia coli (0.5% versus 4%) than birds that did not have access to feeders. These differences are probably not due to the feeder per se, but instead to other site related differences. The prevalence of bacteria did not differ between male and female black-capped chickadees, Parus atricapillus. For 279 color marked black-capped chickadees, we calculated the cumulative mortality rate during 12 wk following swabbing. Although the cumulative mortality rates of infected birds were consistently higher than the rates of non-infected birds, none of these differences were significant. Infections may cause slight reductions in survival rates, but we were not able to confirm this with our data.

Characterization of an avian cholera epizootic in wild birds in western Nebraska

Avian cholera killed an estimated 2500 birds in western Nebraska and eastern Wyoming from 28 November 1985 to late January 1986. Wild mallards (Anas platyrhynchos) suffered the most losses. Other wild waterfowl, wild turkeys (Meleagris gallopavo), a few domestic fowl, and a bald eagle (Haliaeetus leucocephalus) also died. Pasteurella multocida serotype 1 was the predominant isolate from these carcasses. Cold, wet weather persisted throughout the outbreak, but daily losses in the flock of 50,000 mallards using the area were low. Pasteurella multocida was isolated from nasal swabs of 35 of 37 cattle from a feedlot in which many of these mallards were feeding. Eighty percent of the cattle isolates had antigenic characteristics of serotype 3 or serotype 3 with cross-reactivity. Isolates from wild mallards, wild turkeys, and the bald eagle were virulent to game-farm mallards when inoculated subcutaneously, but P. multocida isolates from cattle were not.

Outbreak of avian cholera on the wintering grounds of the Mississippi Valley Canada goose flock

Avian cholera is reported for the first time in Canada geese, Branta canadensis, of the Mississippi Valley population. The disease was detected in weekly surveillance transects and was responsible for the loss of about 850 geese during the winter of 1978-1979 at localized areas in southern Illinois. Necropsies performed on 480 geese that died at Union County Conservation Area and on 133 birds at Horseshoe Lake Conservation Area during January and February 1979 revealed that the majority of losses (64%) were caused by avian cholera. Lead poisoning was responsible for the death of 14% of the geese analyzed and the remaining 22%, most of which were decomposed, were undiagnosed. Lethal lead levels and Pasteurella multocida occurred concomitantly in a few instances.

The susceptibility of the mallard duck (Anas platyrhynchos) to Clostridium botulinum C2 toxin

Most strains of Clostridium botulinum type C, after having lost their capacity to produce their dominant toxin (C1) as a result of being "cured" of their prophages, continue to produce C2, a trypsin-activable toxin reported by other investigators. While of relatively low toxicity when administered perorally to the adult mallard duck (Anas platyrhynchos), it was highly toxic when given parenterally. By the intravenous route, for example, it was more than 1,000 times as toxic as C1 toxin by the same route, when compared on the basis of mouse intraperitoneal toxicity. The cause of death in every instance was massive pulmonary edema and hemorrhage rather than the respiratory paralysis that occurs in C1 intoxication.

Bordetella bronchiseptica associated with pulmonary disease in mountain voles (Microtus montanus)

Bordetella bronchiseptica was isolated from the lungs of all of six mountain voles (Microtus montanus) found dead or dying of pulmonary infection near the Bear River Research Station in northern Utah in January, 1973. The possibility of concomitant viral or mycoplasmal infection was not ruled out.

A relationship between avian carcasses and living invertebrates in the epizootiology of avian botulism

A survey of the sources of Clostridium botulinum type C toxin possibly utilized as food by aquatic birds in an epizootic area of avian botulism in northern Utah showed that living aquatic and terrestrial invertebrates normally found in close association with dead, decomposing birds commonly carried the toxin. Of 461 samples associated with 21 species of avian carcasses, 198 were toxin-positive. Invertebrate species not normally scavengers of vertebrate tissues were less commonly and less highly toxic, particularly when captured 30 cm or more from a carcass; six of 237 samples of such aquatic invertebrates low-level toxin. Of the species tested, blow fly larvae (Calliphoridae) were the most consistently and highly toxic, although others, particularly adult and larval stages of several species of beetles (Coleoptera), contained toxin at levels probably significant in the epizootiology of the disease. An estimated 0.05 to 0.25 g of the most toxic fly larvae or 15 g of the most toxic beetles tested carried a mediam lethal dose for an adult mallard duck. Examination of stomach contents of aquatic birds dead of botulism showed that some had consumed invertebrates.