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Mukthavaram R, Jiang P, Pastorino S, Nomura N, Lin F, Kesari S. Evaluation of the EMulate Therapeutics Voyager's ultra-low radiofrequency energy in murine model of glioblastoma. Bioelectron Med 2024; 10:10. [PMID: 38594769 PMCID: PMC11005219 DOI: 10.1186/s42234-024-00143-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 02/20/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Glioblastoma (GBM) presents as an aggressive brain cancer, notorious for its recurrence and resistance to conventional treatments. This study aimed to assess the efficacy of the EMulate Therapeutics Voyager®, a non-invasive, non-thermal, non-ionizing, battery-operated, portable experimental medical device, in treating GBM. Using ultra-low radiofrequency energy (ulRFE) to modulate intracellular activity, previous preliminary results in patients have been encouraging. Now, with a focus on murine models, our investigation seeks to elucidate the device's mechanistic impacts, further optimizing its therapeutic potential and understanding its limitations. METHODS The device employs a silicone over molded coil to deliver oscillating magnetic fields, which are believed to interact with and disrupt cellular targets. These fields are derived from the magnetic fluctuations of solvated molecules. Xenograft and syngeneic murine models were chosen for the study. Mice were injected with U-87 MG or GL261 glioma cells in their flanks and were subsequently treated with one of two ulRFE cognates: A1A, inspired by paclitaxel, or A2, based on murine siRNA targeting CTLA4 + PD1. A separate group of untreated mice was maintained as controls. RESULTS Mice that underwent treatments with either A1A or A2 exhibited significantly reduced tumor sizes when compared to the untreated cohort. CONCLUSION The EMulate Therapeutics Voyager® demonstrates promising potential in inhibiting glioma cells in vivo through its unique ulRFE technology and should be further studied in terms of biological effects in vitro and in vivo.
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Affiliation(s)
- Rajesh Mukthavaram
- Neuro-Oncology Program, Moores Cancer Center, UC San Diego, La Jolla, CA, USA
| | - Pengfei Jiang
- Neuro-Oncology Program, Moores Cancer Center, UC San Diego, La Jolla, CA, USA
| | - Sandra Pastorino
- Neuro-Oncology Program, Moores Cancer Center, UC San Diego, La Jolla, CA, USA
| | - Natsuko Nomura
- Neuro-Oncology Program, Moores Cancer Center, UC San Diego, La Jolla, CA, USA
- Department of Translational Neurosciences, Pacific Neuroscience Institute & Saint John's Cancer Institute at Providence Saint John's Health Center, 2200 Santa Monica Blvd., Santa Monica, CA, 90404, USA
| | - Feng Lin
- Curescience Institute, 5820 Oberlin Drive Ste 202, San Diego, CA, 92121, USA
| | - Santosh Kesari
- Department of Translational Neurosciences, Pacific Neuroscience Institute & Saint John's Cancer Institute at Providence Saint John's Health Center, 2200 Santa Monica Blvd., Santa Monica, CA, 90404, USA.
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Conley AP, Roland CL, Bessudo A, Gastman BR, Villaflor VM, Larson C, Reid TR, Caroen S, Oronsky B, Stirn M, Williams J, Burbano E, Coyle A, Barve MA, Wagle N, Abrouk N, Kesari S. BETA prime: a first-in-man phase 1 study of AdAPT-001, an armed oncolytic adenovirus for solid tumors. Cancer Gene Ther 2024; 31:517-526. [PMID: 38146006 PMCID: PMC11016464 DOI: 10.1038/s41417-023-00720-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 11/30/2023] [Accepted: 12/12/2023] [Indexed: 12/27/2023]
Abstract
AdAPT-001 is an oncolytic adenovirus (OAV) with a transforming growth factor beta (TGF-ß) trap, which neutralizes the immunosuppressive and profibrotic cytokine, TGF-ß. The aim or purpose of this phase 1 study was to assess the safety and tolerability and, secondarily, the efficacy of AdAPT-001 after single intratumoral injection (IT) (Part 1) and multidose IT injection (Part 2) in patients with superficially accessible, advanced refractory solid tumors. Part 1 enrolled 9 patients with a 3 + 3 single dose-escalation safety run-in involving 2.5 × 1011, 5.0 × 1011, 1.0 × 1012 viral particles (vps). No dose-limiting toxicities or treatment-related serious adverse events (SAEs) were seen. In Part 2, a dose-expansion phase, 19 patients received AdAPT-001 at 1.0 × 1012 vps until disease progression according to Response Evaluation Criteria in Solid Tumors or RECIST 1.1. The overall responses to treatment included confirmed partial responses (3), durable stable disease ≥ 6 months (5), and progressive disease (13). AdAPT-001 is well tolerated. Evidence of an anti-tumor effect was seen in both injected and uninjected lesions. The recommended Phase 2 dose was 1.0 × 1012 vp administered by intratumoral injection once every 2 weeks. Combination of AdAPT-001 with a checkpoint inhibition is enrolling.
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Affiliation(s)
- Anthony P Conley
- Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Christina L Roland
- Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Alberto Bessudo
- California Cancer Associates for Research & Excellence, San Diego, CA, 92127, USA
| | - Brian R Gastman
- Department of Dermatology & Plastic Surgery, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Victoria M Villaflor
- Department of Medical Oncology & Therapeutics Research, City of Hope, Duarte, CA, 91010, USA
| | | | | | | | | | | | | | | | | | - Minal A Barve
- Mary Crowley Cancer Research, Dallas, TX, 75230, USA
| | - Naveed Wagle
- Pacific Neuroscience Institute and Saint John's Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA, 90404, USA
| | - Nacer Abrouk
- Clinical Trials Innovations, Mountain View, CA, 94040, USA
| | - Santosh Kesari
- Pacific Neuroscience Institute and Saint John's Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA, 90404, USA
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Kesari S, Wagle N, Carrillo JA, Sharma A, Nguyen M, Truong J, Gill JM, Nersesian R, Nomura N, Rahbarlayegh E, Barkhoudarian G, Sivakumar W, Kelly DF, Krauss H, Bustos MA, Hoon DSB, Anker L, Singh AS, Sankhala KK, Juarez TM. Pilot Study of High-Dose Pemetrexed in Patients with Progressive Chordoma. Clin Cancer Res 2024; 30:323-333. [PMID: 38047868 DOI: 10.1158/1078-0432.ccr-23-2317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 10/26/2023] [Accepted: 11/09/2023] [Indexed: 12/05/2023]
Abstract
PURPOSE Chordomas are ultrarare tumors of the axial spine and skull-base without approved systemic therapy. Most chordomas have negative expression of thymidylate synthase (TS), suggesting a potential for responding to the antifolate agent pemetrexed, which inhibits TS and other enzymes involved in nucleotide biosynthesis. We evaluated the therapeutic activity and safety of high-dose pemetrexed in progressive chordoma. PATIENTS AND METHODS Adult patients with previously treated, progressive chordoma participated in an open-label, single-institution, single-arm, pilot clinical trial of intravenous pemetrexed 900 mg/m2 every 3 weeks and supportive medications of folic acid, vitamin B12, and dexamethasone. The primary endpoint was objective response rate according to RECIST v1.1. Secondary endpoints included adverse events, progression-free survival (PFS), tumor molecular profiles, and alterations in tissue and blood-based biomarkers. RESULTS Fifteen patients were enrolled and the median number of doses administered was 15 (range, 4-31). One patient discontinued treatment due to psychosocial issues after four cycles and one contracted COVID-19 after 13 cycles. Of the 14 response-evaluable patients, 2 (14%) achieved a partial response and 10 (71%) demonstrated stable disease. Median PFS was 10.5 months (95% confidence interval: 9 months-undetermined) and 6-month PFS was 67%. Adverse events were expected and relatively mild, with one grade 3 creatinine increased, and one each of grade 3 and 4 lymphopenia. No grade 5 adverse events, unexpected toxicities, or dose-limiting toxicities were observed. Several patients reported clinical improvement in disease-related symptoms. CONCLUSIONS High-dose pemetrexed appears tolerable and shows objective antitumor activity in patients with chordoma. Phase II studies of high-dose pemetrexed are warranted.
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Affiliation(s)
- Santosh Kesari
- Pacific Neuroscience Institute, Santa Monica, California
- Saint John's Cancer Institute at Providence Saint John's Health Center, Santa Monica, California
| | - Naveed Wagle
- Pacific Neuroscience Institute, Santa Monica, California
- Saint John's Cancer Institute at Providence Saint John's Health Center, Santa Monica, California
| | - Jose A Carrillo
- Pacific Neuroscience Institute, Santa Monica, California
- Saint John's Cancer Institute at Providence Saint John's Health Center, Santa Monica, California
| | - Akanksha Sharma
- Pacific Neuroscience Institute, Santa Monica, California
- Saint John's Cancer Institute at Providence Saint John's Health Center, Santa Monica, California
| | - Minhdan Nguyen
- Pacific Neuroscience Institute, Santa Monica, California
- Saint John's Cancer Institute at Providence Saint John's Health Center, Santa Monica, California
| | - Judy Truong
- Pacific Neuroscience Institute, Santa Monica, California
- Saint John's Cancer Institute at Providence Saint John's Health Center, Santa Monica, California
| | - Jaya M Gill
- Pacific Neuroscience Institute, Santa Monica, California
- Saint John's Cancer Institute at Providence Saint John's Health Center, Santa Monica, California
| | - Raffi Nersesian
- Pacific Neuroscience Institute, Santa Monica, California
- Saint John's Cancer Institute at Providence Saint John's Health Center, Santa Monica, California
| | - Natsuko Nomura
- Pacific Neuroscience Institute, Santa Monica, California
- Saint John's Cancer Institute at Providence Saint John's Health Center, Santa Monica, California
| | - Elnaz Rahbarlayegh
- Pacific Neuroscience Institute, Santa Monica, California
- Saint John's Cancer Institute at Providence Saint John's Health Center, Santa Monica, California
| | - Garni Barkhoudarian
- Pacific Neuroscience Institute, Santa Monica, California
- Saint John's Cancer Institute at Providence Saint John's Health Center, Santa Monica, California
| | | | - Daniel F Kelly
- Pacific Neuroscience Institute, Santa Monica, California
| | - Howard Krauss
- Pacific Neuroscience Institute, Santa Monica, California
| | - Matias A Bustos
- Saint John's Cancer Institute at Providence Saint John's Health Center, Santa Monica, California
| | - Dave S B Hoon
- Saint John's Cancer Institute at Providence Saint John's Health Center, Santa Monica, California
| | - Lars Anker
- Providence St. Joseph Hospital Orange, Orange, California
| | - Arun S Singh
- UCLA Health, Santa Monica Cancer Care, Santa Monica, California
| | - Kamalesh K Sankhala
- Cedars-Sinai Medical Center, Samuel Oschin Cancer Center, Los Angeles, California
| | - Tiffany M Juarez
- Pacific Neuroscience Institute, Santa Monica, California
- Saint John's Cancer Institute at Providence Saint John's Health Center, Santa Monica, California
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Kumar A, Kouznetsova VL, Kesari S, Tsigelny IF. Parkinson's Disease Diagnosis Using miRNA Biomarkers and Deep Learning. FRONT BIOSCI-LANDMRK 2024; 29:4. [PMID: 38287819 DOI: 10.31083/j.fbl2901004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/05/2023] [Accepted: 11/20/2023] [Indexed: 01/31/2024]
Abstract
BACKGROUND The current standard for Parkinson's disease (PD) diagnosis is often imprecise and expensive. However, the dysregulation patterns of microRNA (miRNA) hold potential as a reliable and effective non-invasive diagnosis of PD. METHODS We use data mining to elucidate new miRNA biomarkers and then develop a machine-learning (ML) model to diagnose PD based on these biomarkers. RESULTS The best-performing ML model, trained on filtered miRNA dysregulated in PD, was able to identify miRNA biomarkers with 95.65% accuracy. Through analysis of miRNA implicated in PD, thousands of descriptors reliant on gene targets were created that can be used to identify novel biomarkers and strengthen PD diagnosis. CONCLUSIONS The developed ML model based on miRNAs and their genomic pathway descriptors achieved high accuracies for the prediction of PD.
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Affiliation(s)
- Alex Kumar
- REHS Program, San Diego Supercomputer Center, UC San Diego, La Jolla, CA 92093, USA
| | - Valentina L Kouznetsova
- San Diego Supercomputer Center, UC San Diego, La Jolla, CA 92093, USA
- BiAna, La Jolla, CA 92038, USA
- CureScience Institute, San Diego, CA 92121, USA
| | - Santosh Kesari
- Pacific Neuroscience Institute, Santa Monica, CA 90404, USA
| | - Igor F Tsigelny
- San Diego Supercomputer Center, UC San Diego, La Jolla, CA 92093, USA
- BiAna, La Jolla, CA 92038, USA
- CureScience Institute, San Diego, CA 92121, USA
- Department of Neurosciences, UC San Diego, La Jolla, CA 92093, USA
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5
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Juarez TM, Gill JM, Heng A, Carrillo JA, Wagle N, Nomura N, Nguyen M, Truong J, Dobrawa L, Sivakumar W, Barkhoudarian G, Kelly DF, Kesari S. A phase I dose-escalation study of pulsatile afatinib in patients with recurrent or progressive brain cancer. Neurooncol Adv 2024; 6:vdae049. [PMID: 38680990 PMCID: PMC11046985 DOI: 10.1093/noajnl/vdae049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024] Open
Abstract
Background Afatinib (BIBW2992; Gilotrif®) is a selective and irreversible inhibitor of the epidermal growth factor receptor (ErbB; EGFR) family. It inhibits EGFR, HER2, and HER4 phosphorylation, resulting in tumor growth inhibition and regression. This phase I dose-escalation trial of pulsatile afatinib examined the safety, drug penetration into the central nervous system, preliminary antitumor activity, and recommended phase II dose in patients with progressive or recurrent brain cancers. Methods Afatinib was taken orally once every 4 days or once every 7 days depending on dose cohort, until disease progression or unacceptable toxicity. Results A total of 24 patients received the investigational agent and were evaluable for safety analyses, and 21 patients were evaluable for efficacy. Dosing was administered at 80 mg every 4 days, 120 mg every 4 days, 180 mg every 4 days, or 280 mg every 7 days. A recommended phase II dose of pulsatile afatinib was established at 280 mg every 7 days as there were no dose-limiting toxicities in any of the dosing cohorts and all toxicities were deemed manageable. The most common drug-related toxicities were diarrhea, rash, nausea, vomiting, fatigue, stomatitis, pruritus, and limb edema. Out of the 21 patients evaluable for efficacy, 2 patients (9.5%) exhibited partial response based on Response Assessment in Neuro-Oncology criteria and disease stabilization was seen in 3 patients (14.3%). Conclusions Afatinib taken orally was safe and well-tolerated up to 280 mg every 7 days in brain cancer patients.
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Affiliation(s)
- Tiffany M Juarez
- Pacific Neuroscience Institute and Saint John’s Cancer Institute at Providence Saint John’s Health Center, Neuro-Oncology, Santa Monica, California, USA
| | - Jaya M Gill
- Pacific Neuroscience Institute and Saint John’s Cancer Institute at Providence Saint John’s Health Center, Neuro-Oncology, Santa Monica, California, USA
| | - Annie Heng
- Pacific Neuroscience Institute and Saint John’s Cancer Institute at Providence Saint John’s Health Center, Neuro-Oncology, Santa Monica, California, USA
| | - Jose A Carrillo
- Pacific Neuroscience Institute and Saint John’s Cancer Institute at Providence Saint John’s Health Center, Neuro-Oncology, Santa Monica, California, USA
| | - Naveed Wagle
- Pacific Neuroscience Institute and Saint John’s Cancer Institute at Providence Saint John’s Health Center, Neuro-Oncology, Santa Monica, California, USA
| | - Natsuko Nomura
- Pacific Neuroscience Institute and Saint John’s Cancer Institute at Providence Saint John’s Health Center, Neuro-Oncology, Santa Monica, California, USA
| | - Minhdan Nguyen
- Pacific Neuroscience Institute and Saint John’s Cancer Institute at Providence Saint John’s Health Center, Neuro-Oncology, Santa Monica, California, USA
| | - Judy Truong
- Pacific Neuroscience Institute and Saint John’s Cancer Institute at Providence Saint John’s Health Center, Neuro-Oncology, Santa Monica, California, USA
| | - Lucia Dobrawa
- Pacific Neuroscience Institute and Saint John’s Cancer Institute at Providence Saint John’s Health Center, Neuro-Oncology, Santa Monica, California, USA
| | - Walavan Sivakumar
- Pacific Neuroscience Institute and Saint John’s Cancer Institute at Providence Saint John’s Health Center, Neurosurgery, Santa Monica, California, USA
| | - Garni Barkhoudarian
- Pacific Neuroscience Institute and Saint John’s Cancer Institute at Providence Saint John’s Health Center, Neurosurgery, Santa Monica, California, USA
| | - Daniel F Kelly
- Pacific Neuroscience Institute and Saint John’s Cancer Institute at Providence Saint John’s Health Center, Neurosurgery, Santa Monica, California, USA
| | - Santosh Kesari
- Pacific Neuroscience Institute and Saint John’s Cancer Institute at Providence Saint John’s Health Center, Neuro-Oncology, Santa Monica, California, USA
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Kuang A, Kouznetsova VL, Kesari S, Tsigelny IF. Diagnostics of Thyroid Cancer Using Machine Learning and Metabolomics. Metabolites 2023; 14:11. [PMID: 38248814 PMCID: PMC10818630 DOI: 10.3390/metabo14010011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 12/14/2023] [Accepted: 12/18/2023] [Indexed: 01/23/2024] Open
Abstract
The objective of this research is, with the analysis of existing data of thyroid cancer (TC) metabolites, to develop a machine-learning model that can diagnose TC using metabolite biomarkers. Through data mining, pathway analysis, and machine learning (ML), the model was developed. We identified seven metabolic pathways related to TC: Pyrimidine metabolism, Tyrosine metabolism, Glycine, serine, and threonine metabolism, Pantothenate and CoA biosynthesis, Arginine biosynthesis, Phenylalanine metabolism, and Phenylalanine, tyrosine, and tryptophan biosynthesis. The ML classifications' accuracies were confirmed through 10-fold cross validation, and the most accurate classification was 87.30%. The metabolic pathways identified in relation to TC and the changes within such pathways can contribute to more pattern recognition for diagnostics of TC patients and assistance with TC screening. With independent testing, the model's accuracy for other unique TC metabolites was 92.31%. The results also point to a possibility for the development of using ML methods for TC diagnostics and further applications of ML in general cancer-related metabolite analysis.
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Affiliation(s)
- Alyssa Kuang
- Haas Business School, University of California at Berkeley, Berkeley, CA 94720, USA;
| | - Valentina L. Kouznetsova
- San Diego Supercomputer Center, University of California at San Diego, La Jolla, CA 92093, USA;
- BiAna, La Jolla, CA 92038, USA
- CureScience Institute, San Diego, CA 92121, USA
| | - Santosh Kesari
- Pacific Neuroscience Institute, Santa Monica, CA 90404, USA;
| | - Igor F. Tsigelny
- San Diego Supercomputer Center, University of California at San Diego, La Jolla, CA 92093, USA;
- BiAna, La Jolla, CA 92038, USA
- CureScience Institute, San Diego, CA 92121, USA
- Department of Neurosciences, University of California at San Diego, La Jolla, CA 92093, USA
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Kesari S, Liu A, Gill JM, Nguyen M, Truong J, Nersesian R, Chacon E, Sharma A, Wagle N, Griffiths C, Frazer G, Zats M, Kang S, West MB, Kopke RD, Juarez T. Response to OKN-007 and NAC in a Patient with Unilateral Hearing Loss and Chronic Tinnitus from Vestibular Schwannoma. Int Tinnitus J 2023; 27:40-46. [PMID: 38050883 DOI: 10.5935/0946-5448.20230007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
BACKGROUND Tinnitus is the perception of sound in the absence of external acoustic stimulation. Being one of the most common diseases of the ear, it has a global prevalence ranging from 4.1 to 37.2%. To date, it has been difficult to treat tinnitus as its pathophysiology is poorly understood and there are limited treatment options. OBJECTIVE To investigate the effect of OKN-007 (also known as HPN-07), a nitrone-based investigational drug, in combination with oral N-acetylcycsteine (NAC), for the treatment of hearing loss and chronic tinnitus under an individual expanded access protocol. PATIENT CASE We report the case of a patient who presented with left-sided ear fullness, mild tinnitus, and mild high frequency sensorineural hearing loss with 100% word recognition. A large enhancing mass seen on MRI revealed a vestibular schwannoma. He underwent subtotal resection of the tumor resulting in a moderate-to-profound sensorineural hearing loss and catastrophic tinnitus. The patient was treated with intravenous OKN-007 at 60 mg/kg dosed three times per week and oral NAC 2500 mg twice daily. RESULTS Post-treatment audiometric testing revealed an average of 16.66 dB in hearing threshold improvement in three frequencies (125, 250 and 500 Hz) with residual hearing in the affected left ear. His tinnitus loudness matching improved from 90 dB to 19 dB post-treatment. His Tinnitus Handicap Inventory improved from 86/100 (Catastrophic) to 40/100 (Moderate). He also experienced improvements in sleep, concentration, hearing, and emotional well-being, and reported significantly decreased levels of tinnitusrelated distress. CONCLUSIONS This case report highlights the feasibility and therapeutic potential of the combination of OKN-007 and NAC in treating hearing loss and tinnitus that warrants further investigation.
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Affiliation(s)
- Santosh Kesari
- Department of Translational Neurosciences, Saint John's Cancer Institute at Providence Saint John's Health Center, Santa Monica, California, USA
- Pacific Neuroscience Institute, California, USA
| | - Andy Liu
- Department of Translational Neurosciences, Saint John's Cancer Institute at Providence Saint John's Health Center, Santa Monica, California, USA
- Pacific Neuroscience Institute, California, USA
| | - Jaya M Gill
- Pacific Neuroscience Institute, California, USA
| | - Minhdan Nguyen
- Department of Translational Neurosciences, Saint John's Cancer Institute at Providence Saint John's Health Center, Santa Monica, California, USA
- Pacific Neuroscience Institute, California, USA
| | - Judy Truong
- Department of Translational Neurosciences, Saint John's Cancer Institute at Providence Saint John's Health Center, Santa Monica, California, USA
- Pacific Neuroscience Institute, California, USA
| | - Raffi Nersesian
- Department of Translational Neurosciences, Saint John's Cancer Institute at Providence Saint John's Health Center, Santa Monica, California, USA
| | - Emma Chacon
- Department of Translational Neurosciences, Saint John's Cancer Institute at Providence Saint John's Health Center, Santa Monica, California, USA
| | - Akanksha Sharma
- Department of Translational Neurosciences, Saint John's Cancer Institute at Providence Saint John's Health Center, Santa Monica, California, USA
- Pacific Neuroscience Institute, California, USA
| | - Naveed Wagle
- Department of Translational Neurosciences, Saint John's Cancer Institute at Providence Saint John's Health Center, Santa Monica, California, USA
- Pacific Neuroscience Institute, California, USA
| | | | | | - Max Zats
- Pacific Neuroscience Institute, California, USA
| | | | | | | | - Tiffany Juarez
- Department of Translational Neurosciences, Saint John's Cancer Institute at Providence Saint John's Health Center, Santa Monica, California, USA
- Pacific Neuroscience Institute, California, USA
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8
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Tsui A, Kouznetsova VL, Kesari S, Fiala M, Tsigelny IF. Role of Senataxin in Amyotrophic Lateral Sclerosis. J Mol Neurosci 2023; 73:996-1009. [PMID: 37982993 DOI: 10.1007/s12031-023-02169-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 10/23/2023] [Indexed: 11/21/2023]
Abstract
Amyotrophic lateral sclerosis (ALS) is a progressive, uncurable neurodegenerative disorder characterized by the degradation of motor neurons leading to muscle impairment, failure, and death. Senataxin, encoded by the SETX gene, is a human helicase protein whose mutations have been linked with ALS onset, particularly in its juvenile ALS4 form. Using senataxin's yeast homolog Sen1 as a model for study, it is suggested that senataxin's N-terminus interacts with RNA polymerase II, whilst its C-terminus engages in helicase activity. Senataxin is heavily involved in transcription regulation, termination, and R-loop resolution, enabled by recruitment and interactions with enzymes such as ubiquitin protein ligase SAN1 and ribonuclease H (RNase H). Senataxin also engages in DNA damage response (DDR), primarily interacting with the exosome subunit Rrp45. The Sen1 mutation E1597K, alongside the L389S and R2136H gain-of-function mutations to senataxin, is shown to cause negative structural and thus functional effects to the protein, thus contributing to a disruption in WT functions, motor neuron (MN) degeneration, and the manifestation of ALS clinical symptoms. This review corroborates and summarizes published papers concerning the structure and function of senataxin as well as the effects of their mutations in ALS pathology in order to compile current knowledge and provide a reference for future research. The findings compiled in this review are indicative of the experimental and therapeutic potential of senataxin and its mutations as a target in future ALS treatment/cure discovery, with some potential therapeutic routes also being discussed in the review.
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Affiliation(s)
- Andrew Tsui
- REHS Program, San Diego Supercomputer Center, University of California, San Diego, La Jolla, CA, USA
| | - Valentina L Kouznetsova
- San Diego Supercomputer Center, University of California, San Diego, La Jolla, CA, USA
- CureScience Institute, San Diego, CA, USA
- BiAna, San Diego, La Jolla, CA, USA
| | | | - Milan Fiala
- Department of Integrative Biology and Physiology, School of Medicine, UCLA, Los Angeles, CA, USA
| | - Igor F Tsigelny
- San Diego Supercomputer Center, University of California, San Diego, La Jolla, CA, USA.
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA.
- CureScience Institute, San Diego, CA, USA.
- BiAna, San Diego, La Jolla, CA, USA.
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9
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Lin F, Lin EZ, Anekoji M, Ichim TE, Hu J, Marincola FM, Jones LD, Kesari S, Ashili S. Advancing personalized medicine in brain cancer: exploring the role of mRNA vaccines. J Transl Med 2023; 21:830. [PMID: 37978542 PMCID: PMC10656921 DOI: 10.1186/s12967-023-04724-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 11/13/2023] [Indexed: 11/19/2023] Open
Abstract
Advancing personalized medicine in brain cancer relies on innovative strategies, with mRNA vaccines emerging as a promising avenue. While the initial use of mRNA vaccines was in oncology, their stunning success in COVID-19 resulted in widespread attention, both positive and negative. Regardless of politically biased opinions, which relate more to the antigenic source than form of delivery, we feel it is important to objectively review this modality as relates to brain cancer. This class of vaccines trigger robust immune responses through MHC-I and MHC-II pathways, in both prophylactic and therapeutic settings. The mRNA platform offers advantages of rapid development, high potency, cost-effectiveness, and safety. This review provides an overview of mRNA vaccine delivery technologies, tumor antigen identification, combination therapies, and recent therapeutic outcomes, with a particular focus on brain cancer. Combinatorial approaches are vital to maximizing mRNA cancer vaccine efficacy, with ongoing clinical trials exploring combinations with adjuvants and checkpoint inhibitors and even adoptive cell therapy. Efficient delivery, neoantigen identification, preclinical studies, and clinical trial results are highlighted, underscoring mRNA vaccines' potential in advancing personalized medicine for brain cancer. Synergistic combinatorial therapies play a crucial role, emphasizing the need for continued research and collaboration in this area.
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Affiliation(s)
- Feng Lin
- CureScience Institute, 5820 Oberlin Drive Ste 202, San Diego, CA, 92121, USA.
| | - Emma Z Lin
- University of California San Diego, La Jolla, CA, 92093, USA
| | - Misa Anekoji
- CureScience Institute, 5820 Oberlin Drive Ste 202, San Diego, CA, 92121, USA
| | - Thomas E Ichim
- Therapeutic Solutions International, Oceanside, CA, 92056, USA
| | - Joyce Hu
- Sonata Therapeutics, Watertown, MA, 02472, USA
| | | | - Lawrence D Jones
- CureScience Institute, 5820 Oberlin Drive Ste 202, San Diego, CA, 92121, USA
| | - Santosh Kesari
- Saint John's Cancer Institute, Santa Monica, CA, 90404, USA
| | - Shashaanka Ashili
- CureScience Institute, 5820 Oberlin Drive Ste 202, San Diego, CA, 92121, USA
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10
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Jin J, Kouznetsova VL, Kesari S, Tsigelny IF. Synergism in actions of HBV with aflatoxin in cancer development. Toxicology 2023; 499:153652. [PMID: 37858775 DOI: 10.1016/j.tox.2023.153652] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/30/2023] [Accepted: 10/16/2023] [Indexed: 10/21/2023]
Abstract
Aflatoxin B1 (AFB1) is a fungal metabolite found in animal feeds and human foods. It is one of the most toxic and carcinogenic of aflatoxins and is classified as a Group 1 carcinogen. Dietary exposure to AFB1 and infection with chronic Hepatitis B Virus (HBV) make up two of the major risk factors for hepatocellular carcinoma (HCC). These two major risk factors raise the probability of synergism between the two agents. This review proposes some collaborative molecular mechanisms underlying the interaction between AFB1 and HBV in accelerating or magnifying the effects of HCC. The HBx viral protein is one of the main viral proteins of HBV and has many carcinogenic qualities that are involved with HCC. AFB1, when metabolized by CYP450, becomes AFB1-exo-8,9-epoxide (AFBO), an extremely toxic compound that can form adducts in DNA sequences and induce mutations. With possible synergisms that exist between HBV and AFB1 in mind, it is best to treat both agents simultaneously to reduce the risk by HCC.
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Affiliation(s)
- Joshua Jin
- IUL Scientific Program, San Diego, CA, USA
| | - Valentina L Kouznetsova
- San Diego Supercomputer Center, University of California at San Diego, La Jolla, CA, USA; BiAna, La Jolla, CA, USA; Curescience Institute, San Diego, CA, USA
| | | | - Igor F Tsigelny
- San Diego Supercomputer Center, University of California at San Diego, La Jolla, CA, USA; BiAna, La Jolla, CA, USA; Curescience Institute, San Diego, CA, USA; Department of Neurosciences, University of California at San Diego, La Jolla, CA, USA.
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11
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Tim B, Kouznetsova VL, Kesari S, Tsigelny IF. Targeting of insulin receptor endocytosis as a treatment to insulin resistance. J Diabetes Complications 2023; 37:108615. [PMID: 37788593 DOI: 10.1016/j.jdiacomp.2023.108615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 09/02/2023] [Accepted: 09/25/2023] [Indexed: 10/05/2023]
Abstract
BACKGROUND Insulin resistance is the decreased effectiveness of insulin receptor function during signaling of glucose uptake. Insulin receptors are regulated by endocytosis, a process that removes receptors from the cell surface to be marked for degradation or for re-use. OBJECTIVES Our goal was to discover insulin-resistance-related genes that play key roles in endocytosis which could serve as potential biological targets to enhance insulin sensitivity. METHODS The gene mutations related to insulin resistance were elucidated from ClinVar. These were used as the seed set. Using the GeneFriends program, the genes associated with this set were elucidated and used as an enriched set for the next step. The enriched gene set network was visualized by Cytoscape. After that, using the VisANT program, the most significant cluster of genes was identified. With the help of the DAVID program, the most important KEGG pathway corresponding to the gene cluster and insulin resistance was found. Eleven genes part of the KEGG endocytosis pathway were identified. Finally, using the ChEA3 program, seven transcription factors managing these genes were defined. RESULTS Thirty-two genes of pathogenic significance in insulin resistance were elucidated, and then co-expression data for these genes were utilized. These genes were organized into clusters, one of which was singled out for its high node count of 58 genes and low p-value (p = 4.117 × 10-7). DAVID Pathways, a functional annotation tool, helped identify a set of 11 genes from a single cluster associated with the endocytosis pathway related to insulin resistance. These genes (AMPH, BIN1, CBL, DNM1, DNM2, DNM3, ITCH, SH3GL1, SH3GL2, SH3GL3, and SH3KBP1) are all involved in either clathrin-mediated endocytosis of the insulin receptor (IR) or clathrin-independent endocytosis of insulin-resistance-related G protein-coupled receptors (GPCR). They represent prime therapeutic targets to improve insulin sensitivity through modulation of transmembrane cell signaling. Using the ChEA3 database, we also found seven transcription factors (REST, MYPOP, CAMTA2, MYT1L, ZBTB18, NKX6-2, and CXXC5) that control the expression of these 11 genes. Inhibiting these key transcription factors would be another strategy to downregulate endocytosis. CONCLUSION We believe that delaying removal of insulin receptors from the cell surface would prolong signaling of glucose uptake and counteract the symptoms of insulin resistance.
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Affiliation(s)
- Bryce Tim
- IUL Science Program, San Diego, CA, USA
| | - Valentina L Kouznetsova
- San Diego Supercomputer Center, University of California, San Diego, CA, USA; CureScience Institute, San Diego, CA, USA; BiAna, La Jolla, CA, USA
| | | | - Igor F Tsigelny
- San Diego Supercomputer Center, University of California, San Diego, CA, USA; Department of Neurosciences, University of California, San Diego, CA, USA; CureScience Institute, San Diego, CA, USA; BiAna, La Jolla, CA, USA.
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12
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Choudhary A, Yu J, Kouznetsova VL, Kesari S, Tsigelny IF. Two-Stage Deep-Learning Classifier for Diagnostics of Lung Cancer Using Metabolites. Metabolites 2023; 13:1055. [PMID: 37887380 PMCID: PMC10609149 DOI: 10.3390/metabo13101055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/18/2023] [Accepted: 09/26/2023] [Indexed: 10/28/2023] Open
Abstract
We developed a machine-learning system for the selective diagnostics of adenocarcinoma (AD), squamous cell carcinoma (SQ), and small-cell carcinoma lung (SC) cancers based on their metabolomic profiles. The system is organized as two-stage binary classifiers. The best accuracy for classification is 92%. We used the biomarkers sets that contain mostly metabolites related to cancer development. Compared to traditional methods, which exclude hierarchical classification, our method splits a challenging multiclass task into smaller tasks. This allows a two-stage classifier, which is more accurate in the scenario of lung cancer classification. Compared to traditional methods, such a "divide and conquer strategy" gives much more accurate and explainable results. Such methods, including our algorithm, allow for the systematic tracking of each computational step.
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Affiliation(s)
- Ashvin Choudhary
- School of Life Science, University of California, Los Angeles, CA 90095, USA;
| | - Jianpeng Yu
- School of Computer Science, Carnegie Mellon University, Pittsburgh, PA 15213, USA;
| | - Valentina L. Kouznetsova
- San Diego Supercomputer Center, University of California, San Diego, CA 92093, USA;
- IUL, La Jolla, CA 92038, USA
- CureScience Institute, San Diego, CA 92121, USA
| | - Santosh Kesari
- Pacific Neuroscience Institute, Santa Monica, CA 90404, USA;
| | - Igor F. Tsigelny
- San Diego Supercomputer Center, University of California, San Diego, CA 92093, USA;
- IUL, La Jolla, CA 92038, USA
- CureScience Institute, San Diego, CA 92121, USA
- Department of Neurosciences, University of California, San Diego, CA 92093, USA
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13
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Liu A, Alalami H, Fan X, Patil C, Gill JM, Kesari S, Hu J. Long-term survival after salvage pemetrexed for refractory primary T-cell lymphoma of the CNS. CNS Oncol 2023; 12:CNS100. [PMID: 37435740 PMCID: PMC10410685 DOI: 10.2217/cns-2022-0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 06/12/2023] [Indexed: 07/13/2023] Open
Abstract
Primary T-cell CNS lymphoma is a rare and aggressive malignancy. High-dose methotrexate (MTX) based chemotherapy regimens are used as standard first-line treatment, followed by consolidative strategies to improve the duration of response. Although MTX-based therapy has been shown to be efficacious, treatment options for MTX-refractory disease are not well-defined. Here, we report a case of a 38-year-old man with refractory primary T-cell CNS lymphoma who demonstrated a complete response to pemetrexed treatment. He subsequently received conditioning chemotherapy consisting of thiotepa, busulfan and cyclophosphamide followed by autologous stem cell transplantation. The patient continues to remain recurrence-free to date at 9 years post-treatment.
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Affiliation(s)
- Andy Liu
- Pacific Neuroscience Institute & Saint John's Cancer Institute at Providence Saint John’s Health Center, Santa Monica, CA 90404, USA
| | - Huda Alalami
- Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Xuemo Fan
- Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Chirag Patil
- Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Jaya M Gill
- Pacific Neuroscience Institute & Saint John's Cancer Institute at Providence Saint John’s Health Center, Santa Monica, CA 90404, USA
| | - Santosh Kesari
- Pacific Neuroscience Institute & Saint John's Cancer Institute at Providence Saint John’s Health Center, Santa Monica, CA 90404, USA
| | - Jethro Hu
- Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
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14
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Barkhoudarian G, Badruddoja M, Blondin N, Chowdhary S, Cobbs C, Duic JP, Flores JP, Fonkem E, McClay E, Nabors LB, Salacz M, Taylor L, Vaillant B, Gill J, Kesari S. An expanded safety/feasibility study of the EMulate Therapeutics Voyager™ System in patients with recurrent glioblastoma. CNS Oncol 2023; 12:CNS102. [PMID: 37462385 PMCID: PMC10410686 DOI: 10.2217/cns-2022-0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 07/06/2023] [Indexed: 08/08/2023] Open
Abstract
Aim: The EMulate Therapeutics Voyager™ is a simple, wearable, home-use device that uses an alternating electromagnetic field to alter biologic signaling within cells. Objective: To assess the safety/feasibility of the Voyager in the treatment of recurrent glioblastoma (rGBM). Methods: In this study, patients with rGBM were treated with Voyager as monotherapy or in combination with standard chemotherapy at the Investigator's discretion. Safety was assessed by incidence of adverse events associated with the Voyager. Patients were followed until death. Results: A total of 75 patients were enrolled and treated for at least one day with the Voyager (safety population). Device-related adverse events were uncommon and generally did not result in interruption or withdrawal from treatment. There were no serious adverse events associated with Voyager. A total of 60 patients were treated for at least one month (clinical utility population). The median progression-free survival (PFS) was 17 weeks (4.3 months) in the Voyager only group (n = 24) and 21 weeks (5.3 months) in the Voyager + concurrent therapy group (n = 36). The median overall survival (OS) was 7 months in the Voyager only group and 9 months in the Voyager + concurrent therapy group. In patients treated with Voyager + concurrent therapy, the median OS for patients enrolled with their 1st or 2nd recurrence (n = 26) was 10 months, while in patients enrolled with their 3rd or 4th recurrence (n = 10) OS was 7 months. Conclusion: The data support the safety and feasibility of the Voyager for the treatment of rGBM. Further prospective study of the device is warranted. Trial Registration Number: NCT02296580 (ClinicalTrials.gov).
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Affiliation(s)
- Garni Barkhoudarian
- Saint John's Cancer Institute & Pacific Neuroscience Institute at Providence St. John's Health Center, Santa Monica, CA 90404, USA
| | | | - Nicholas Blondin
- Associated Neurologists of Southern Connecticut, Fairfield, CT 06824, USA
| | | | - Charles Cobbs
- Swedish Medical Center, Ben and Catherine Ivy Center For Advanced Brain Tumor Treatment, Seattle, WA 98122, USA
| | | | | | | | - Edward McClay
- cCARE (California Cancer Associates for Research & Excellence), Encinitas, CA 92024, USA
| | - Louis Burt Nabors
- University of Alabama, Division of Neuro-Oncology, Birmingham, AL 35294-3410, USA
| | - Michael Salacz
- University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Lynn Taylor
- University of Washington, Seattle, WA 98195, USA
| | | | - Jaya Gill
- Saint John's Cancer Institute & Pacific Neuroscience Institute at Providence St. John's Health Center, Santa Monica, CA 90404, USA
| | - Santosh Kesari
- Saint John's Cancer Institute & Pacific Neuroscience Institute at Providence St. John's Health Center, Santa Monica, CA 90404, USA
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15
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Zamiri K, Kesari S, Paul K, Hwang SH, Hammock B, Kaczor-Urbanowicz KE, Urbanowicz A, Gao L, Whitelegge J, Fiala M. Therapy of autoimmune inflammation in sporadic amyotrophic lateral sclerosis: Dimethyl fumarate and H-151 downregulate inflammatory cytokines in the cGAS-STING pathway. FASEB J 2023; 37:e23068. [PMID: 37436778 PMCID: PMC10619685 DOI: 10.1096/fj.202300573r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/08/2023] [Accepted: 06/16/2023] [Indexed: 07/13/2023]
Abstract
In sporadic amyotrophic lateral sclerosis (sALS), IL-17A- and granzyme-positive cytotoxic T lymphocytes (CTL), IL-17A-positive mast cells, and inflammatory macrophages invade the brain and spinal cord. In some patients, the disease starts following a trauma or a severe infection. We examined cytokines and cytokine regulators over the disease course and found that, since the early stages, peripheral blood mononuclear cells (PBMC) exhibit increased expression of inflammatory cytokines IL-12A, IFN-γ, and TNF-α, as well as granzymes and the transcription factors STAT3 and STAT4. In later stages, PBMCs upregulated the autoimmunity-associated cytokines IL-23A and IL-17B, and the chemokines CXCL9 and CXCL10, which attract CTL and monocytes into the central nervous system. The inflammation is fueled by the downregulation of IL-10, TGFβ, and the inhibitory T-cell co-receptors CTLA4, LAG3, and PD-1, and, in vitro, by stimulation with the ligand PD-L1. We investigated in two sALS patients the regulation of the macrophage transcriptome by dimethyl fumarate (DMF), a drug approved against multiple sclerosis and psoriasis, and the cyclic GMP-AMP synthase/stimulator of interferon genes (cGAS/STING) pathway inhibitor H-151. Both DMF and H-151 downregulated the expression of granzymes and the pro-inflammatory cytokines IL-1β, IL-6, IL-15, IL-23A, and IFN-γ, and induced a pro-resolution macrophage phenotype. The eicosanoid epoxyeicosatrienoic acids (EET) from arachidonic acid was anti-inflammatory in synergy with DMF. H-151 and DMF are thus candidate drugs targeting the inflammation and autoimmunity in sALS via modulation of the NFκB and cGAS/STING pathways.
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Affiliation(s)
- Kurosh Zamiri
- University of California, Los Angeles, Department of Integrative Biology and Physiology, UCLA School of Life Sciences, Los Angeles, CA, USA
| | - Santosh Kesari
- Pacific Neuroscience Institute and Saint John’s Cancer Institute at Providence Saint John’s Health Center, Santa Monica, CA
| | - Ketema Paul
- University of California, Los Angeles, Department of Integrative Biology and Physiology, UCLA School of Life Sciences, Los Angeles, CA, USA
| | - Sung Hee Hwang
- Department of Entomology and Nematology, and UC Davis Comprehensive Cancer Center, University of California – Davis, One Shields Ave, Davis, CA 95616, USA
| | - Bruce Hammock
- UCLA Institute for Quantitative and Computational Biosciences, University of California at Los Angeles, CA, USA
| | - Karolina Elżbieta Kaczor-Urbanowicz
- UCLA Institute for Quantitative and Computational Biosciences, University of California at Los Angeles, CA, USA
- Institute of Control and Computation Engineering, Warsaw University of Technology, Warsaw, Poland
| | - Andrzej Urbanowicz
- UCLA Institute for Quantitative and Computational Biosciences, University of California at Los Angeles, CA, USA
- Institute of Control and Computation Engineering, Warsaw University of Technology, Warsaw, Poland
| | - Lucy Gao
- Semel Institute, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Julian Whitelegge
- Semel Institute, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Milan Fiala
- University of California, Los Angeles, Department of Integrative Biology and Physiology, UCLA School of Life Sciences, Los Angeles, CA, USA
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16
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Perez JA, Parcero Valdes JJ, Corral Moreno R, Gomez Cuevas LI, Lopez JJ, Ichim T, McGreevy K, Lin F, Kesari S, Datta S. Intravenous Administration of Umbilical Cord-Derived Mesenchymal Stem Cells (UC-MSC) for Acute Respiratory Distress Syndrome Due to COVID-19 Infection. Cureus 2023; 15:e44110. [PMID: 37638263 PMCID: PMC10452932 DOI: 10.7759/cureus.44110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2023] [Indexed: 08/29/2023] Open
Abstract
The COVID-19 pandemic has posed significant therapeutic challenges in addressing acute respiratory distress syndrome (ARDS). This serious illness has caused numerous fatalities worldwide and has had profound health and economic impacts. Previous studies have shown that mesenchymal stem cells (MSCs) can suppress ARDS. In this case series, we report on the treatment of nine patients with a single intravenous dose of 100 million hypoxic cultured umbilical cord-derived MSCs (UC-MSCs). Following the intravenous administration of UC-MSCs, obtained from the lining of the umbilical cord, longitudinal laboratory analysis revealed a sustained decrease in inflammatory markers and stabilized pulmonary function in eight out of nine patients. UC-MSCs possess immunomodulatory and anti-inflammatory properties, enabling them to attenuate the cytokine storm and potentially aid in lung repair. Importantly, no adverse events associated with the treatment were observed. These findings collectively suggest that a cell-based approach significantly enhances the survival rate of ARDS induced by SARS-CoV-2 and offers a promising treatment option in both preclinical and clinical settings.
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Affiliation(s)
- Jesus A Perez
- Medicine, Instituto de Medicina Regenerativa SA de CV, Tijuana, MEX
| | | | | | | | - Jose J Lopez
- Neurology, Instituto de Medicina Regenerativa SA de CV, Tijuana, MEX
| | - Thomas Ichim
- Immunology, CureScience Institute, San Diego, USA
| | - Kristen McGreevy
- Clinical Sciences, Pacific Neuroscience Institute, Santa Monica, USA
| | - Feng Lin
- Research and Development, CureScience Institute, San Diego, USA
| | - Santosh Kesari
- Translational Neurosciences, Pacific Neuroscience Institute, Santa Monica, USA
| | - Souvik Datta
- Clinical Research, Rhenix Lifesciences, Hyderabad, IND
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17
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Datta S, Lin F, Jones LD, Pingle SC, Kesari S, Ashili S. Traumatic brain injury and immunological outcomes: the double-edged killer. Future Sci OA 2023; 9:FSO864. [PMID: 37228857 PMCID: PMC10203904 DOI: 10.2144/fsoa-2023-0037] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 04/20/2023] [Indexed: 05/27/2023] Open
Abstract
Traumatic brain injury (TBI) is a significant cause of mortality and morbidity worldwide resulting from falls, car accidents, sports, and blast injuries. TBI is characterized by severe, life-threatening consequences due to neuroinflammation in the brain. Contact and collision sports lead to higher disability and death rates among young adults. Unfortunately, no therapy or drug protocol currently addresses the complex pathophysiology of TBI, leading to the long-term chronic neuroinflammatory assaults. However, the immune response plays a crucial role in tissue-level injury repair. This review aims to provide a better understanding of TBI's immunobiology and management protocols from an immunopathological perspective. It further elaborates on the risk factors, disease outcomes, and preclinical studies to design precisely targeted interventions for enhancing TBI outcomes.
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Affiliation(s)
- Souvik Datta
- Rhenix Lifesciences, 237 Arsha Apartments, Kalyan Nagar, Hyderabad, TG 500038, India
| | - Feng Lin
- CureScience, 5820 Oberlin Drive #202, San Diego, CA 92121, USA
| | | | | | - Santosh Kesari
- Saint John's Cancer Institute, Santa Monica, CA 90404, USA
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18
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Li Y, Lim C, Dismuke T, Malawsky DS, Oasa S, Bruce ZC, Offenhäuser C, Baumgartner U, D’Souza RCJ, Edwards SL, French JD, Ock LS, Nair S, Sivakumaran H, Harris L, Tikunov AP, Hwang D, Del Mar Alicea Pauneto C, Maybury M, Hassall T, Wainwright B, Kesari S, Stein G, Piper M, Johns TG, Sokolsky-Papkov M, Terenius L, Vukojević V, Gershon TR, Day BW. Preventing recurrence in Sonic Hedgehog Subgroup Medulloblastoma using the OLIG2 inhibitor CT-179. Res Sq 2023:rs.3.rs-2949436. [PMID: 37333134 PMCID: PMC10275055 DOI: 10.21203/rs.3.rs-2949436/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
Recurrence is the primary life-threatening complication for medulloblastoma (MB). In Sonic Hedgehog (SHH)-subgroup MB, OLIG2-expressing tumor stem cells drive recurrence. We investigated the anti-tumor potential of the small-molecule OLIG2 inhibitor CT-179, using SHH-MB patient-derived organoids, patient-derived xenograft (PDX) tumors and mice genetically-engineered to develop SHH-MB. CT-179 disrupted OLIG2 dimerization, DNA binding and phosphorylation and altered tumor cell cycle kinetics in vitro and in vivo, increasing differentiation and apoptosis. CT-179 increased survival time in GEMM and PDX models of SHH-MB, and potentiated radiotherapy in both organoid and mouse models, delaying post-radiation recurrence. Single cell transcriptomic studies (scRNA-seq) confirmed that CT-179 increased differentiation and showed that tumors up-regulated Cdk4 post-treatment. Consistent with increased CDK4 mediating CT-179 resistance, CT-179 combined with CDK4/6 inhibitor palbociclib delayed recurrence compared to either single-agent. These data show that targeting treatment-resistant MB stem cell populations by adding the OLIG2 inhibitor CT-179 to initial MB treatment can reduce recurrence.
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Affiliation(s)
- Yuchen Li
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, 4006, Australia
- These authors contributed equally
- The University of Queensland, Brisbane, QLD, 4072, Australia
| | - Chaemin Lim
- These authors contributed equally
- Center for Nanotechnology in Drug Delivery and Division of Pharmacoengineering and Molecular Pharmaceutics, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, NC 27599, USA
- College of Pharmacy, Chung-Ang University, 221 Heukseok-dong, Dongiak-gu, Seoul 06974, Republic of Korea
| | - Taylor Dismuke
- These authors contributed equally
- Department of Neurology, University of North Carolina School of Medicine, Chapel Hill, NC, 27599, USA
| | - Daniel S. Malawsky
- Department of Neurology, University of North Carolina School of Medicine, Chapel Hill, NC, 27599, USA
- Wellcome Sanger Institute, Hinxton, Cambridgeshire, UK
| | - Sho Oasa
- Department of Clinical Neuroscience, Center for Molecular Medicine (CMM), Karolinska Institutet, 17176 Stockholm, Sweden
| | - Zara C. Bruce
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, 4006, Australia
| | | | - Ulrich Baumgartner
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, 4006, Australia
- The University of Queensland, Brisbane, QLD, 4072, Australia
- School of Biomedical Sciences, Queensland University of Technology, Brisbane, QLD, 4072, Australia
| | - Rochelle C. J. D’Souza
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, 4006, Australia
- The University of Queensland, Brisbane, QLD, 4072, Australia
| | - Stacey L. Edwards
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, 4006, Australia
| | - Juliet D. French
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, 4006, Australia
| | - Lucy S.H. Ock
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, 4006, Australia
| | - Sneha Nair
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, 4006, Australia
| | - Haran Sivakumaran
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, 4006, Australia
| | - Lachlan Harris
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, 4006, Australia
- The University of Queensland, Brisbane, QLD, 4072, Australia
| | - Andrey P. Tikunov
- Department of Neurology, University of North Carolina School of Medicine, Chapel Hill, NC, 27599, USA
- Department of Pediatrics, Emory University, Atlanta, GA 30323, USA
| | - Duhyeong Hwang
- Center for Nanotechnology in Drug Delivery and Division of Pharmacoengineering and Molecular Pharmaceutics, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, NC 27599, USA
- Department of Pharmaceutical Engineering, Dankook University, 119 Dandae-ro, Dongnam-gu, Cheonan 31116, Republic of Korea
| | - Coral Del Mar Alicea Pauneto
- Department of Neurology, University of North Carolina School of Medicine, Chapel Hill, NC, 27599, USA
- Department of Pharmacology, University of North Carolina School of Medicine, Chapel Hill, NC, 27599, USA
| | - Mellissa Maybury
- Child Health Research Centre, The University of Queensland, Brisbane, QLD, 4101, Australia
| | - Timothy Hassall
- The University of Queensland, Brisbane, QLD, 4072, Australia
- Oncology Service, Queensland Children’s Hospital, Children’s Health Queensland Hospital & Health Service, Brisbane, QLD, 4101, Australia
| | | | - Santosh Kesari
- Curtana Pharmaceuticals, Inc. Austin, TX 78756, United States
| | | | - Michael Piper
- The University of Queensland, Brisbane, QLD, 4072, Australia
- School of Biomedical Sciences, Queensland University of Technology, Brisbane, QLD, 4072, Australia
| | | | - Marina Sokolsky-Papkov
- Center for Nanotechnology in Drug Delivery and Division of Pharmacoengineering and Molecular Pharmaceutics, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, NC 27599, USA
| | - Lars Terenius
- Department of Clinical Neuroscience, Center for Molecular Medicine (CMM), Karolinska Institutet, 17176 Stockholm, Sweden
| | - Vladana Vukojević
- Department of Clinical Neuroscience, Center for Molecular Medicine (CMM), Karolinska Institutet, 17176 Stockholm, Sweden
| | - Timothy R. Gershon
- Department of Neurology, University of North Carolina School of Medicine, Chapel Hill, NC, 27599, USA
- Department of Pediatrics, Emory University, Atlanta, GA 30323, USA
| | - Bryan W. Day
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, 4006, Australia
- The University of Queensland, Brisbane, QLD, 4072, Australia
- School of Biomedical Sciences, Queensland University of Technology, Brisbane, QLD, 4072, Australia
- Lead contact
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19
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Darabi S, Xiu J, Samec T, Kesari S, Carrillo J, Aulakh S, Walsh KM, Sengupta S, Sumrall A, Spetzler D, Glantz M, Demeure MJ. Capicua (CIC) mutations in gliomas in association with MAPK activation for exposing a potential therapeutic target. Med Oncol 2023; 40:197. [PMID: 37291277 DOI: 10.1007/s12032-023-02071-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 06/02/2023] [Indexed: 06/10/2023]
Abstract
Gliomas are the most prevalent neurological cancer in the USA and care modalities are not able to effectively combat these aggressive malignancies. Identifying new, more effective treatments require a deep understanding of the complex genetic variations and relevant pathway associations behind these cancers. Drawing connections between gene mutations with a responsive genetic target can help drive therapy selections to enhance patient survival. We have performed extensive molecular profiling of the Capicua gene (CIC), a tumor and transcriptional suppressor gene, and its mutation prevalence in reference to MAPK activation within clinical glioma tissue. CIC mutations occur far more frequently in oligodendroglioma (52.1%) than in low-grade astrocytoma or glioblastoma. CIC-associated mutations were observed across all glioma subtypes, and MAPK-associated mutations were most prevalent in CIC wild-type tissue regardless of the glioma subtype. MAPK activation, however, was enhanced in CIC-mutated oligodendroglioma. The totality of our observations reported supports the use of CIC as a relevant genetic marker for MAPK activation. Identification of CIC mutations, or lack thereof, can assist in selecting, implementing, and developing MEK/MAPK-inhibitory trials to improve patient outcomes potentially.
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Affiliation(s)
- Sourat Darabi
- Hoag Family Cancer Institute, Newport Beach, CA, USA
| | | | | | - Santosh Kesari
- Hoag Family Cancer Institute, Newport Beach, CA, USA
- Pacific Neuroscience Institute, Providence Saint John's Health Center, Santa Monica, CA, USA
| | - Jose Carrillo
- Hoag Family Cancer Institute, Newport Beach, CA, USA
- Pacific Neuroscience Institute, Providence Saint John's Health Center, Santa Monica, CA, USA
| | | | - Kyle M Walsh
- Duke University School of Medicine, Durham, NC, USA
| | - Soma Sengupta
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | | | | | | | - Michael J Demeure
- Hoag Family Cancer Institute, Newport Beach, CA, USA
- Translational Genomics Research Institute, Phoenix, AZ, USA
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Sampson JH, Singh Achrol A, Aghi MK, Bankiewicz K, Bexon M, Brem S, Brenner A, Chandhasin C, Chowdhary S, Coello M, Ellingson BM, Floyd JR, Han S, Kesari S, Mardor Y, Merchant F, Merchant N, Randazzo D, Vogelbaum M, Vrionis F, Wembacher-Schroeder E, Zabek M, Butowski N. Targeting the IL4 receptor with MDNA55 in patients with recurrent glioblastoma: Results of a phase IIb trial. Neuro Oncol 2023; 25:1085-1097. [PMID: 36640127 PMCID: PMC10237418 DOI: 10.1093/neuonc/noac285] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND MDNA55 is an interleukin 4 receptor (IL4R)-targeting toxin in development for recurrent GBM, a universally fatal disease. IL4R is overexpressed in GBM as well as cells of the tumor microenvironment. High expression of IL4R is associated with poor clinical outcomes. METHODS MDNA55-05 is an open-label, single-arm phase IIb study of MDNA55 in recurrent GBM (rGBM) patients with an aggressive form of GBM (de novo GBM, IDH wild-type, and nonresectable at recurrence) on their 1st or 2nd recurrence. MDNA55 was administered intratumorally as a single dose treatment (dose range of 18 to 240 ug) using convection-enhanced delivery (CED) with up to 4 stereo-tactically placed catheters. It was co-infused with a contrast agent (Gd-DTPA, Magnevist®) to assess distribution in and around the tumor margins. The flow rate of each catheter did not exceed 10μL/min to ensure that the infusion duration did not exceed 48 h. The primary endpoint was mOS, with secondary endpoints determining the effects of IL4R status on mOS and PFS. RESULTS MDNA55 showed an acceptable safety profile at doses up to 240 μg. In all evaluable patients (n = 44) mOS was 11.64 months (80% one-sided CI 8.62, 15.02) and OS-12 was 46%. A subgroup (n = 32) consisting of IL4R High and IL4R Low patients treated with high-dose MDNA55 (>180 ug) showed the best benefit with mOS of 15 months, OS-12 of 55%. Based on mRANO criteria, tumor control was observed in 81% (26/32), including those patients who exhibited pseudo-progression (15/26). CONCLUSIONS MDNA55 demonstrated tumor control and promising survival and may benefit rGBM patients when treated at high-dose irrespective of IL4R expression level.Trial Registration: Clinicaltrials.gov NCT02858895.
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Affiliation(s)
- John H Sampson
- Duke University Medical Center, Department of Neurosurgery, Durham, North Carolina, USA
| | - Achal Singh Achrol
- Loma Linda University Medical Center, Department of Neurosurgery, Loma Linda, California, USA
| | - Manish K Aghi
- University of California San Francisco, Department of Neurological Surgery, San Francisco, California, USA
| | - Krystof Bankiewicz
- Ohio State University College of Medicine, Department of Neurological Surgery, Columbus, Ohio, USA
| | | | - Steven Brem
- Hospital of the University of Pennsylvania, Department of Neurosurgery, Philadelphia, Pennsylvania, USA
| | - Andrew Brenner
- University of Texas Health Science Center San Antonio, San Antonio, Texas, USA
| | | | | | | | - Benjamin M Ellingson
- University of California, Los Angeles, Brain Tumor Imaging Laboratory (BTIL), California, USA
| | - John R Floyd
- University of Texas Health Science Center San Antonio, San Antonio, Texas, USA
| | - Seunggu Han
- Oregon Health & Science University, Portland, Oregon, USA
| | - Santosh Kesari
- Pacific Neurosciences Institute, Santa Monica, California, USA
| | | | | | | | - Dina Randazzo
- Duke University Medical Center, Department of Neurosurgery, Durham, North Carolina, USA
| | - Michael Vogelbaum
- H. Lee Moffitt Cancer Center & Research Institute, Department of Neuro-Oncology, Tampa, Florida, USA
| | - Frank Vrionis
- Boca Raton Regional Hospital, Boca Raton, Florida, USA
| | | | | | - Nicholas Butowski
- University of California San Francisco, Department of Neurological Surgery, San Francisco, California, USA
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21
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Szu JI, Tsigelny IF, Wojcinski A, Kesari S. Biological functions of the Olig gene family in brain cancer and therapeutic targeting. Front Neurosci 2023; 17:1129434. [PMID: 37274223 PMCID: PMC10232966 DOI: 10.3389/fnins.2023.1129434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 04/26/2023] [Indexed: 06/06/2023] Open
Abstract
The Olig genes encode members of the basic helix-loop-helix (bHLH) family of transcription factors. Olig1, Olig2, and Olig3 are expressed in both the developing and mature central nervous system (CNS) and regulate cellular specification and differentiation. Over the past decade extensive studies have established functional roles of Olig1 and Olig2 in development as well as in cancer. Olig2 overexpression drives glioma proliferation and resistance to radiation and chemotherapy. In this review, we summarize the biological functions of the Olig family in brain cancer and how targeting Olig family genes may have therapeutic benefit.
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Affiliation(s)
- Jenny I. Szu
- Department of Translational Neurosciences, Providence Saint John’s Health Center, Saint John’s Cancer Institute, Santa Monica, CA, United States
| | - Igor F. Tsigelny
- San Diego Supercomputer Center, University of California, San Diego, San Diego, CA, United States
- CureScience, San Diego, CA, United States
| | - Alexander Wojcinski
- Department of Translational Neurosciences, Providence Saint John’s Health Center, Saint John’s Cancer Institute, Santa Monica, CA, United States
- Pacific Neuroscience Institute, Santa Monica, CA, United States
| | - Santosh Kesari
- Department of Translational Neurosciences, Providence Saint John’s Health Center, Saint John’s Cancer Institute, Santa Monica, CA, United States
- Pacific Neuroscience Institute, Santa Monica, CA, United States
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22
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Kesari S, Wang F, Juarez T, Ashili S, Patro CPK, Carrillo J, Nguyen M, Truong J, Levy J, Sommer J, Freed DM, Xiu J, Takasumi Y, Bouffet E, Gill JM. Activity of pemetrexed in pre-clinical chordoma models and humans. Sci Rep 2023; 13:7317. [PMID: 37147496 PMCID: PMC10163028 DOI: 10.1038/s41598-023-34404-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 04/28/2023] [Indexed: 05/07/2023] Open
Abstract
Chordomas are rare slow growing tumors, arising from embryonic remnants of notochord with a close predilection for the axial skeleton. Recurrence is common and no effective standard medical therapy exists. Thymidylate synthase (TS), an intracellular enzyme, is a key rate-limiting enzyme of DNA biosynthesis and repair which is primarily active in proliferating and metabolically active cells. Eighty-four percent of chordoma samples had loss of TS expression which may predict response to anti-folates. Pemetrexed suppresses tumor growth by inhibiting enzymes involved in folate metabolism, resulting in decreased availability of thymidine which is necessary for DNA synthesis. Pemetrexed inhibited growth in a preclinical mouse xenograft model of human chordoma. We report three cases of metastatic chordoma that had been heavily treated previously with a variety of standard therapies with poor response. In two cases, pemetrexed was added and objective responses were observed on imaging with one patient on continuous treatment for > 2 years with continued shrinkage. One case demonstrated tumor growth after treatment with pemetrexed. The two cases which had a favorable response had a loss of TS expression, whereas the one case with progressive disease had TS present. These results demonstrate the activity of pemetrexed in recurrent chordoma and warrant a prospective clinical trial which is ongoing (NCT03955042).
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Affiliation(s)
- Santosh Kesari
- Department of Translational Neurosciences, Pacific Neuroscience Institute, Santa Monica, CA, USA.
- Saint John's Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA, USA.
| | - Feng Wang
- Department of Medical Oncology, Cancer Center, West China Hospital, West China Medical School, Sichuan University, Sichuan, Chengdu, China.
| | - Tiffany Juarez
- Saint John's Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA, USA
| | | | - C Pawan K Patro
- CureScience, San Diego, CA, USA
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - Jose Carrillo
- Department of Translational Neurosciences, Pacific Neuroscience Institute, Santa Monica, CA, USA
- Saint John's Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA, USA
| | - Minhdan Nguyen
- Department of Translational Neurosciences, Pacific Neuroscience Institute, Santa Monica, CA, USA
- Saint John's Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA, USA
| | - Judy Truong
- Department of Translational Neurosciences, Pacific Neuroscience Institute, Santa Monica, CA, USA
- Saint John's Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA, USA
| | - Joan Levy
- Chordoma Foundation, Durham, NC, USA
| | | | | | | | - Yuki Takasumi
- Saint John's Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA, USA
| | - Eric Bouffet
- The Hospital for Sick Children (SickKids), University of Toronto, Toronto, Canada
| | - Jaya M Gill
- Department of Translational Neurosciences, Pacific Neuroscience Institute, Santa Monica, CA, USA
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23
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Yao JZ, Tsigelny IF, Kesari S, Kouznetsova VL. Diagnostics of ovarian cancer via metabolite analysis and machine learning. Integr Biol (Camb) 2023; 15:7109962. [PMID: 37032481 DOI: 10.1093/intbio/zyad005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 02/05/2023] [Accepted: 03/04/2023] [Indexed: 04/11/2023]
Abstract
Ovarian cancer (OC) is the second most common cancer of the female reproductive system. Due to the asymptomatic nature of early stages of OC and an increasingly poor prognosis in later stages, methods of screening for OC are much desired. Furthermore, screening and diagnosis processes, in order to justify use on asymptomatic patients, must be convenient and non-invasive. Recent developments in machine-learning technologies have made this possible via techniques in the field of metabolomics. The objective of this research was to use existing metabolomics data on OC and various analytic methods to develop a machine-learning model for the classification of potentially OC-related metabolite biomarkers. Pathway analysis and metabolite-set enrichment analysis were performed on gathered metabolite sets. Quantitative molecular descriptors were then used with various machine-learning classifiers for the diagnostics of OC using related metabolites. We elucidated that the metabolites associated with OC used for machine-learning models are involved in five metabolic pathways linked to OC: Nicotinate and Nicotinamide Metabolism, Glycolysis/Gluconeogenesis, Aminoacyl-tRNA Biosynthesis, Valine, Leucine and Isoleucine Biosynthesis, and Alanine, Aspartate and Glutamate Metabolism. Several classification models for the identification of OC using related metabolites were created and their accuracies were confirmed through testing with 10-fold cross-validation. The most accurate model was able to achieve 85.29% accuracy. The elucidation of biological pathways specific to OC using metabolic data and the observation of changes in these pathways in patients have the potential to contribute to the development of screening techniques for OC. Our results demonstrate the possibility of development of the machine-learning models for OC diagnostics using metabolomics data.
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Affiliation(s)
- Jerry Z Yao
- REHS Program, San Diego Supercomputer Center, UC San Diego, La Jolla, CA, USA
| | - Igor F Tsigelny
- San Diego Supercomputer Center, UC San Diego, La Jolla, CA, USA
- BiAna, La Jolla, CA, USA
- Department of Neurosciences, UC San Diego, La Jolla, CA, USA
- CureScience, San Diego, CA, USA
| | - Santosh Kesari
- Department of Neuro-oncology, Pacific Neuroscience Institute, Santa Monica, CA, USA
| | - Valentina L Kouznetsova
- San Diego Supercomputer Center, UC San Diego, La Jolla, CA, USA
- BiAna, La Jolla, CA, USA
- CureScience, San Diego, CA, USA
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24
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Pingle SC, Lin F, Anekoji MS, Patro CK, Datta S, Jones LD, Kesari S, Ashili S. Exploring the role of cerebrospinal fluid as analyte in neurologic disorders. Future Sci OA 2023; 9:FSO851. [PMID: 37090492 PMCID: PMC10116372 DOI: 10.2144/fsoa-2023-0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 03/22/2023] [Indexed: 04/25/2023] Open
Abstract
The cerebrospinal fluid (CSF) is a clear ultrafiltrate of blood that envelopes and protects the central nervous system while regulating neuronal function through the maintenance of interstitial fluid homeostasis in the brain. Due to its anatomic location and physiological functions, the CSF can provide a reliable source of biomarkers for the diagnosis and treatment monitoring of different neurological diseases, including neurodegenerative diseases such as Alzheimer's disease, Parkinson's disease, amyotrophic lateral sclerosis, and primary and secondary brain malignancies. The incorporation of CSF biomarkers into the drug discovery and development can improve the efficiency of drug development and increase the chances of success. This review aims to consolidate the current use of CSF biomarkers in clinical practice and explore future perspectives for the field.
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Affiliation(s)
- Sandeep C Pingle
- CureScience Institute, 5820 Oberlin Drive #202, San Diego, CA 92121, USA
| | - Feng Lin
- CureScience Institute, 5820 Oberlin Drive #202, San Diego, CA 92121, USA
- Author for correspondence:
| | - Misa S Anekoji
- CureScience Institute, 5820 Oberlin Drive #202, San Diego, CA 92121, USA
| | - C Pawan K Patro
- CureScience Institute, 5820 Oberlin Drive #202, San Diego, CA 92121, USA
| | - Souvik Datta
- Rhenix Lifesciences, 237 Vengal Rao Nagar, Hyderabad, TG, 500038, India
| | - Lawrence D Jones
- CureScience Institute, 5820 Oberlin Drive #202, San Diego, CA 92121, USA
| | - Santosh Kesari
- Department of Translational Neurosciences, Saint John's Cancer Institute at Providence Saint John's Health Center & Pacific Neuroscience Institute, Santa Monica, CA 90404, USA
| | - Shashaanka Ashili
- CureScience Institute, 5820 Oberlin Drive #202, San Diego, CA 92121, USA
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25
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Chakrabarti S, Biswas N, Karnani K, Padul V, Jones LD, Kesari S, Ashili S. Binned Data Provide Better Imputation of Missing Time Series Data from Wearables. Sensors (Basel) 2023; 23:1454. [PMID: 36772494 PMCID: PMC9919790 DOI: 10.3390/s23031454] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/23/2023] [Accepted: 01/23/2023] [Indexed: 06/18/2023]
Abstract
The presence of missing values in a time-series dataset is a very common and well-known problem. Various statistical and machine learning methods have been developed to overcome this problem, with the aim of filling in the missing values in the data. However, the performances of these methods vary widely, showing a high dependence on the type of data and correlations within the data. In our study, we performed some of the well-known imputation methods, such as expectation maximization, k-nearest neighbor, iterative imputer, random forest, and simple imputer, to impute missing data obtained from smart, wearable health trackers. In this manuscript, we proposed the use of data binning for imputation. We showed that the use of data binned around the missing time interval provides a better imputation than the use of a whole dataset. Imputation was performed for 15 min and 1 h of continuous missing data. We used a dataset with different bin sizes, such as 15 min, 30 min, 45 min, and 1 h, and we carried out evaluations using root mean square error (RMSE) values. We observed that the expectation maximization algorithm worked best for the use of binned data. This was followed by the simple imputer, iterative imputer, and k-nearest neighbor, whereas the random forest method had no effect on data binning during imputation. Moreover, the smallest bin sizes of 15 min and 1 h were observed to provide the lowest RMSE values for the majority of the time frames during the imputation of 15 min and 1 h of missing data, respectively. Although applicable to digital health data, we think that this method will also find applicability in other domains.
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Affiliation(s)
| | | | - Khushi Karnani
- Department of BioSciences and BioEngineering, Indian Institute of Technology, Guwahati 781039, India
| | - Vijay Padul
- Rhenix Lifesciences, Hyderabad 500038, India
| | | | - Santosh Kesari
- Department of Translational Neurosciences, Pacific Neuroscience Institute and Saint John’s Cancer Institute at Providence Saint John’s Health Center, Santa Monica, CA 90404, USA
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26
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Kesari S, Williams J, Burbano E, Stirn M, Caroen S, Oronsky B, Reid T, Larson C. Case Report of AdAPT-001-Mediated Sensitization to a Previously Failed Checkpoint Inhibitor in a Metastatic Chordoma Patient. Case Rep Oncol 2023; 16:172-176. [PMID: 37008834 PMCID: PMC10051040 DOI: 10.1159/000529503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 01/27/2023] [Indexed: 03/30/2023] Open
Abstract
Chordoma is a rare, but aggressive bone tumor with a high recurrence rate that primarily arises at the cranial and caudal ends of the axial skeleton. Systemic chemotherapies are not effective against the tumor, and outside of surgical resection and radiation, no approved options are available. Prognosis depends on the extent of surgical resection, with the more the better, and adjuvant radiotherapy. Herein is presented the first-ever case of a recurrent chordoma patient that responded to the combination of one dose of an experimental TGF-beta trap carrying oncolytic adenovirus, known as AdAPT-001, followed by immune checkpoint inhibitor therapy, despite prior progression on an anti-PD-1. This case report highlights the potential of AdAPT-001 as a treatment modality in combination with checkpoint inhibition for recurrent chordoma.
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Affiliation(s)
- Santosh Kesari
- Pacific Neuroscience Institute and Saint John’s Cancer Institute at Providence Saint John’s Health Center, Santa Monica, CA, USA
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27
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Haroon J, Becerra S, Mahdavi K, Jordan K, Rindner E, Surya R, Venkatraman V, Spivak N, Kuhn T, Kesari S, Bystritsky A, Jordan S. The use of focused ultrasound and DCE K-trans imaging to evaluate permeability of the Blood-Brain Barrier: A case-report. Brain Stimul 2023. [DOI: 10.1016/j.brs.2023.01.738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
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28
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Meysami S, Raji CA, Glatt RM, Popa ES, Ganapathi AS, Bookheimer T, Slyapich CB, Pierce KP, Richards CJ, Lampa MG, Gill JM, Rapozo MK, Hodes JF, Tongson YM, Wong CL, Kim M, Porter VR, Kaiser SA, Panos SE, Dye RV, Miller KJ, Bookheimer SY, Martin NA, Kesari S, Kelly DF, Bramen JE, Siddarth P, Merrill DA. Handgrip Strength Is Related to Hippocampal and Lobar Brain Volumes in a Cohort of Cognitively Impaired Older Adults with Confirmed Amyloid Burden. J Alzheimers Dis 2023; 91:999-1006. [PMID: 36530088 PMCID: PMC9912728 DOI: 10.3233/jad-220886] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Strength and mobility are essential for activities of daily living. With aging, weaker handgrip strength, mobility, and asymmetry predict poorer cognition. We therefore sought to quantify the relationship between handgrip metrics and volumes quantified on brain magnetic resonance imaging (MRI). OBJECTIVE To model the relationships between handgrip strength, mobility, and MRI volumetry. METHODS We selected 38 participants with Alzheimer's disease dementia: biomarker evidence of amyloidosis and impaired cognition. Handgrip strength on dominant and non-dominant hands was measured with a hand dynamometer. Handgrip asymmetry was calculated. Two-minute walk test (2MWT) mobility evaluation was combined with handgrip strength to identify non-frail versus frail persons. Brain MRI volumes were quantified with Neuroreader. Multiple regression adjusting for age, sex, education, handedness, body mass index, and head size modeled handgrip strength, asymmetry and 2MWT with brain volumes. We modeled non-frail versus frail status relationships with brain structures by analysis of covariance. RESULTS Higher non-dominant handgrip strength was associated with larger volumes in the hippocampus (p = 0.02). Dominant handgrip strength was related to higher frontal lobe volumes (p = 0.02). Higher 2MWT scores were associated with larger hippocampal (p = 0.04), frontal (p = 0.01), temporal (p = 0.03), parietal (p = 0.009), and occipital lobe (p = 0.005) volumes. Frailty was associated with reduced frontal, temporal, and parietal lobe volumes. CONCLUSION Greater handgrip strength and mobility were related to larger hippocampal and lobar brain volumes. Interventions focused on improving handgrip strength and mobility may seek to include quantified brain volumes on MR imaging as endpoints.
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Affiliation(s)
- Somayeh Meysami
- Pacific Brain Health Center, Pacific Neuroscience Institute and Foundation, Santa Monica, CA, USA
- Saint John’s Cancer Institute at Providence Saint John’s Health Center, Santa Monica, CA, USA
| | - Cyrus A. Raji
- Mallinckrodt Institute of Radiology, Washington University, St. Louis, MO, USA
| | - Ryan M. Glatt
- Pacific Brain Health Center, Pacific Neuroscience Institute and Foundation, Santa Monica, CA, USA
- Providence Saint John’s Health Center, Santa Monica, CA, USA
| | - Emily S. Popa
- Pacific Brain Health Center, Pacific Neuroscience Institute and Foundation, Santa Monica, CA, USA
| | - Aarthi S. Ganapathi
- Pacific Brain Health Center, Pacific Neuroscience Institute and Foundation, Santa Monica, CA, USA
| | - Tess Bookheimer
- Pacific Brain Health Center, Pacific Neuroscience Institute and Foundation, Santa Monica, CA, USA
| | - Colby B. Slyapich
- Pacific Brain Health Center, Pacific Neuroscience Institute and Foundation, Santa Monica, CA, USA
| | - Kyron P. Pierce
- Pacific Brain Health Center, Pacific Neuroscience Institute and Foundation, Santa Monica, CA, USA
| | - Casey J. Richards
- Pacific Brain Health Center, Pacific Neuroscience Institute and Foundation, Santa Monica, CA, USA
| | - Melanie G. Lampa
- Pacific Brain Health Center, Pacific Neuroscience Institute and Foundation, Santa Monica, CA, USA
| | - Jaya M. Gill
- Pacific Brain Health Center, Pacific Neuroscience Institute and Foundation, Santa Monica, CA, USA
| | - Molly K. Rapozo
- Pacific Brain Health Center, Pacific Neuroscience Institute and Foundation, Santa Monica, CA, USA
| | - John F. Hodes
- Pacific Brain Health Center, Pacific Neuroscience Institute and Foundation, Santa Monica, CA, USA
- Drexel University College of Medicine, Philadelphia, PA, USA
| | - Ynez M. Tongson
- Providence Saint John’s Health Center, Santa Monica, CA, USA
| | - Claudia L. Wong
- Pacific Brain Health Center, Pacific Neuroscience Institute and Foundation, Santa Monica, CA, USA
- Providence Saint John’s Health Center, Santa Monica, CA, USA
| | - Mihae Kim
- Pacific Brain Health Center, Pacific Neuroscience Institute and Foundation, Santa Monica, CA, USA
- Providence Saint John’s Health Center, Santa Monica, CA, USA
| | - Verna R. Porter
- Pacific Brain Health Center, Pacific Neuroscience Institute and Foundation, Santa Monica, CA, USA
- Saint John’s Cancer Institute at Providence Saint John’s Health Center, Santa Monica, CA, USA
- Providence Saint John’s Health Center, Santa Monica, CA, USA
| | - Scott A. Kaiser
- Pacific Brain Health Center, Pacific Neuroscience Institute and Foundation, Santa Monica, CA, USA
- Providence Saint John’s Health Center, Santa Monica, CA, USA
| | - Stella E. Panos
- Pacific Brain Health Center, Pacific Neuroscience Institute and Foundation, Santa Monica, CA, USA
- Saint John’s Cancer Institute at Providence Saint John’s Health Center, Santa Monica, CA, USA
- Providence Saint John’s Health Center, Santa Monica, CA, USA
| | - Richelin V. Dye
- Pacific Brain Health Center, Pacific Neuroscience Institute and Foundation, Santa Monica, CA, USA
- Behavioral Health Institute, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Karen J. Miller
- Pacific Brain Health Center, Pacific Neuroscience Institute and Foundation, Santa Monica, CA, USA
- Saint John’s Cancer Institute at Providence Saint John’s Health Center, Santa Monica, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
| | - Susan Y. Bookheimer
- Pacific Brain Health Center, Pacific Neuroscience Institute and Foundation, Santa Monica, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
| | - Neil A. Martin
- Pacific Brain Health Center, Pacific Neuroscience Institute and Foundation, Santa Monica, CA, USA
- Saint John’s Cancer Institute at Providence Saint John’s Health Center, Santa Monica, CA, USA
- Providence Saint John’s Health Center, Santa Monica, CA, USA
| | - Santosh Kesari
- Pacific Brain Health Center, Pacific Neuroscience Institute and Foundation, Santa Monica, CA, USA
- Saint John’s Cancer Institute at Providence Saint John’s Health Center, Santa Monica, CA, USA
- Providence Saint John’s Health Center, Santa Monica, CA, USA
| | - Daniel F. Kelly
- Pacific Brain Health Center, Pacific Neuroscience Institute and Foundation, Santa Monica, CA, USA
- Saint John’s Cancer Institute at Providence Saint John’s Health Center, Santa Monica, CA, USA
- Providence Saint John’s Health Center, Santa Monica, CA, USA
| | - Jennifer E. Bramen
- Pacific Brain Health Center, Pacific Neuroscience Institute and Foundation, Santa Monica, CA, USA
- Saint John’s Cancer Institute at Providence Saint John’s Health Center, Santa Monica, CA, USA
- Providence Saint John’s Health Center, Santa Monica, CA, USA
| | - Prabha Siddarth
- Pacific Brain Health Center, Pacific Neuroscience Institute and Foundation, Santa Monica, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
| | - David A. Merrill
- Pacific Brain Health Center, Pacific Neuroscience Institute and Foundation, Santa Monica, CA, USA
- Saint John’s Cancer Institute at Providence Saint John’s Health Center, Santa Monica, CA, USA
- Providence Saint John’s Health Center, Santa Monica, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
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Liau LM, Ashkan K, Brem S, Campian JL, Trusheim JE, Iwamoto FM, Tran DD, Ansstas G, Cobbs CS, Heth JA, Salacz ME, D’Andre S, Aiken RD, Moshel YA, Nam JY, Pillainayagam CP, Wagner SA, Walter KA, Chaudhary R, Goldlust SA, Lee IY, Bota DA, Elinzano H, Grewal J, Lillehei K, Mikkelsen T, Walbert T, Abram S, Brenner AJ, Ewend MG, Khagi S, Lovick DS, Portnow J, Kim L, Loudon WG, Martinez NL, Thompson RC, Avigan DE, Fink KL, Geoffroy FJ, Giglio P, Gligich O, Krex D, Lindhorst SM, Lutzky J, Meisel HJ, Nadji-Ohl M, Sanchin L, Sloan A, Taylor LP, Wu JK, Dunbar EM, Etame AB, Kesari S, Mathieu D, Piccioni DE, Baskin DS, Lacroix M, May SA, New PZ, Pluard TJ, Toms SA, Tse V, Peak S, Villano JL, Battiste JD, Mulholland PJ, Pearlman ML, Petrecca K, Schulder M, Prins RM, Boynton AL, Bosch ML. Association of Autologous Tumor Lysate-Loaded Dendritic Cell Vaccination With Extension of Survival Among Patients With Newly Diagnosed and Recurrent Glioblastoma: A Phase 3 Prospective Externally Controlled Cohort Trial. JAMA Oncol 2023; 9:112-121. [PMID: 36394838 PMCID: PMC9673026 DOI: 10.1001/jamaoncol.2022.5370] [Citation(s) in RCA: 123] [Impact Index Per Article: 123.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/27/2022] [Indexed: 11/19/2022]
Abstract
Importance Glioblastoma is the most lethal primary brain cancer. Clinical outcomes for glioblastoma remain poor, and new treatments are needed. Objective To investigate whether adding autologous tumor lysate-loaded dendritic cell vaccine (DCVax-L) to standard of care (SOC) extends survival among patients with glioblastoma. Design, Setting, and Participants This phase 3, prospective, externally controlled nonrandomized trial compared overall survival (OS) in patients with newly diagnosed glioblastoma (nGBM) and recurrent glioblastoma (rGBM) treated with DCVax-L plus SOC vs contemporaneous matched external control patients treated with SOC. This international, multicenter trial was conducted at 94 sites in 4 countries from August 2007 to November 2015. Data analysis was conducted from October 2020 to September 2021. Interventions The active treatment was DCVax-L plus SOC temozolomide. The nGBM external control patients received SOC temozolomide and placebo; the rGBM external controls received approved rGBM therapies. Main Outcomes and Measures The primary and secondary end points compared overall survival (OS) in nGBM and rGBM, respectively, with contemporaneous matched external control populations from the control groups of other formal randomized clinical trials. Results A total of 331 patients were enrolled in the trial, with 232 randomized to the DCVax-L group and 99 to the placebo group. Median OS (mOS) for the 232 patients with nGBM receiving DCVax-L was 19.3 (95% CI, 17.5-21.3) months from randomization (22.4 months from surgery) vs 16.5 (95% CI, 16.0-17.5) months from randomization in control patients (HR = 0.80; 98% CI, 0.00-0.94; P = .002). Survival at 48 months from randomization was 15.7% vs 9.9%, and at 60 months, it was 13.0% vs 5.7%. For 64 patients with rGBM receiving DCVax-L, mOS was 13.2 (95% CI, 9.7-16.8) months from relapse vs 7.8 (95% CI, 7.2-8.2) months among control patients (HR, 0.58; 98% CI, 0.00-0.76; P < .001). Survival at 24 and 30 months after recurrence was 20.7% vs 9.6% and 11.1% vs 5.1%, respectively. Survival was improved in patients with nGBM with methylated MGMT receiving DCVax-L compared with external control patients (HR, 0.74; 98% CI, 0.55-1.00; P = .03). Conclusions and Relevance In this study, adding DCVax-L to SOC resulted in clinically meaningful and statistically significant extension of survival for patients with both nGBM and rGBM compared with contemporaneous, matched external controls who received SOC alone. Trial Registration ClinicalTrials.gov Identifier: NCT00045968.
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Affiliation(s)
- Linda M. Liau
- Department of Neurosurgery, University of California, Los Angeles
| | | | - Steven Brem
- Department of Neurosurgery, Penn Brain Tumor Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Jian L. Campian
- Division of Neurology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - John E. Trusheim
- Givens Brain Tumor Center, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Fabio M. Iwamoto
- Columbia University Irving Medical Center, New York, New York
- New York-Presbyterian Hospital, New York, New York
| | - David D. Tran
- Preston A. Wells, Jr. Center for Brain Tumor Therapy, Division of Neuro-Oncology, Lillian S. Wells Department of Neurosurgery, University of Florida College of Medicine, Gainesville
| | - George Ansstas
- Department of Neurological Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Charles S. Cobbs
- Ben and Catherine Ivy Center for Advanced Brain Tumor Treatment, Swedish Medical Center, Seattle, Washington
| | - Jason A. Heth
- Taubman Medical Center, University of Michigan, Ann Arbor
| | - Michael E. Salacz
- Neuro-Oncology Program, Rutgers Cancer Institute of New Jersey, New Brunswick
| | | | - Robert D. Aiken
- Glasser Brain Tumor Center, Atlantic Healthcare, Summit, New Jersey
| | - Yaron A. Moshel
- Glasser Brain Tumor Center, Atlantic Healthcare, Summit, New Jersey
| | - Joo Y. Nam
- Department of Neurological Sciences, Rush Medical College, Chicago, Illinois
| | | | | | | | | | - Samuel A. Goldlust
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey
| | - Ian Y. Lee
- Department of Neurosurgery, Henry Ford Health System, Detroit, Michigan
| | - Daniela A. Bota
- Department of Neurology and Chao Family Comprehensive Cancer Center, University of California, Irvine
| | | | - Jai Grewal
- Long Island Brain Tumor Center at NSPC, Lake Success, New York
| | - Kevin Lillehei
- Department of Neurosurgery, University of Colorado Health Sciences Center, Boulder
| | - Tom Mikkelsen
- Department of Neurosurgery, Henry Ford Health System, Detroit, Michigan
| | - Tobias Walbert
- Department of Neurosurgery, Henry Ford Health System, Detroit, Michigan
| | - Steven Abram
- Ascension St Thomas Brain and Spine Tumor Center, Howell Allen Clinic, Nashville, Tennessee
| | | | - Matthew G. Ewend
- Department of Neurosurgery, UNC School of Medicine and UNC Health, Chapel Hill, North Carolina
| | - Simon Khagi
- The Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | | | - Jana Portnow
- Department of Medical Oncology & Therapeutics Research, City of Hope, Duarte, California
| | - Lyndon Kim
- Division of Neuro-Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Nina L. Martinez
- Jefferson Hospital for Neurosciences, Jefferson University, Philadelphia, Pennsylvania
| | - Reid C. Thompson
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David E. Avigan
- Beth Israel Deaconess Medical Center, Harvard Medical School, Cambridge, Massachusetts
| | - Karen L. Fink
- Baylor Scott & White Neuro-Oncology Associates, Dallas, Texas
| | | | - Pierre Giglio
- Medical University of South Carolina Neurosciences, Charleston
| | - Oleg Gligich
- Mount Sinai Medical Center, Miami Beach, Florida
| | | | - Scott M. Lindhorst
- Hollings Cancer Center, Medical University of South Carolina, Charleston
| | - Jose Lutzky
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida
| | | | - Minou Nadji-Ohl
- Neurochirurgie Katharinenhospital, Klinikum der Landeshauptstadt Stuttgart, Stuttgart, Germany
| | | | - Andrew Sloan
- Seidman Cancer Center, University Hospitals–Cleveland Medical Center, Cleveland, Ohio
| | - Lynne P. Taylor
- Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts
| | - Julian K. Wu
- Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts
| | - Erin M. Dunbar
- Piedmont Physicians Neuro-Oncology, Piedmont Brain Tumor Center, Atlanta, Georgia
| | | | - Santosh Kesari
- Pacific Neurosciences Institute and Saint John’s Cancer Institute, Santa Monica, California
| | - David Mathieu
- Centre de Recherche du CHUS, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | | | - David S. Baskin
- Department of Neurosurgery, Houston Methodist Hospital, Houston, Texas
| | - Michel Lacroix
- Geisinger Neuroscience Institute, Danville, Pennsylvania
| | | | | | | | - Steven A. Toms
- Departments of Neurosurgery and Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Victor Tse
- Kaiser Permanente, Redwood City, California
| | - Scott Peak
- Kaiser Permanente, Redwood City, California
| | - John L. Villano
- University of Kentucky Markey Cancer Center, Department of Medicine, Neurosurgery, and Neurology, University of Kentucky, Lexington
| | | | | | | | - Kevin Petrecca
- Department of Neurology and Neurosurgery, Montreal Neurological Institute-Hospital, McGill University, Montreal, Quebec, Canada
| | - Michael Schulder
- Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, Uniondale, New York
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Abstract
Persistent post-COVID syndrome, also referred to as long COVID, is a pathologic entity, which involves persistent physical, medical, and cognitive sequelae following COVID-19, including persistent immunosuppression as well as pulmonary, cardiac, and vascular fibrosis. Pathologic fibrosis of organs and vasculature leads to increased mortality and severely worsened quality of life. Inhibiting transforming growth factor beta (TGF-β), an immuno- and a fibrosis modulator, may attenuate these post-COVID sequelae. Current preclinical and clinical efforts are centered on the mechanisms and manifestations of COVID-19 and its presymptomatic and prodromal periods; by comparison, the postdrome, which occurs in the aftermath of COVID-19, which we refer to as persistent post-COVID-syndrome, has received little attention. Potential long-term effects from post-COVID syndrome will assume increasing importance as a surge of treated patients are discharged from the hospital, placing a burden on healthcare systems, patients' families, and society in general to care for these medically devastated COVID-19 survivors. This review explores underlying mechanisms and possible manifestations of persistent post-COVID syndrome, and presents a framework of strategies for the diagnosis and management of patients with suspected or confirmed persistent post-COVID syndrome.
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Affiliation(s)
- Bryan Oronsky
- EpicentRx Inc, La Jolla, 11099 North Torrey Pines Road, Suite 160, La Jolla, CA 92037 USA
| | - Christopher Larson
- EpicentRx Inc, La Jolla, 11099 North Torrey Pines Road, Suite 160, La Jolla, CA 92037 USA
| | | | | | - Santosh Kesari
- Providence St. John’s Health Center, Santa Monica, CA USA
| | - Michelle Lybeck
- EpicentRx Inc, La Jolla, 11099 North Torrey Pines Road, Suite 160, La Jolla, CA 92037 USA
| | - Tony R. Reid
- EpicentRx Inc, La Jolla, 11099 North Torrey Pines Road, Suite 160, La Jolla, CA 92037 USA
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31
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Patro CPK, Biswas N, Pingle SC, Lin F, Anekoji M, Jones LD, Kesari S, Wang F, Ashili S. MTAP loss: a possible therapeutic approach for glioblastoma. J Transl Med 2022; 20:620. [PMID: 36572880 PMCID: PMC9791736 DOI: 10.1186/s12967-022-03823-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 12/11/2022] [Indexed: 12/27/2022] Open
Abstract
Glioblastoma is the most lethal form of brain tumor with a recurrence rate of almost 90% and a survival time of only 15 months post-diagnosis. It is a highly heterogeneous, aggressive, and extensively studied tumor. Multiple studies have proposed therapeutic approaches to mitigate or improve the survival for patients with glioblastoma. In this article, we review the loss of the 5'-methylthioadenosine phosphorylase (MTAP) gene as a potential therapeutic approach for treating glioblastoma. MTAP encodes a metabolic enzyme required for the metabolism of polyamines and purines leading to DNA synthesis. Multiple studies have explored the loss of this gene and have shown its relevance as a therapeutic approach to glioblastoma tumor mitigation; however, other studies show that the loss of MTAP does not have a major impact on the course of the disease. This article reviews the contrasting findings of MTAP loss with regard to mitigating the effects of glioblastoma, and also focuses on multiple aspects of MTAP loss in glioblastoma by providing insights into the known findings and some of the unexplored areas of this field where new approaches can be imagined for novel glioblastoma therapeutics.
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Affiliation(s)
- C. Pawan K. Patro
- CureScience, 5820 Oberlin Dr, 202, San Diego, CA 92121 USA ,grid.4280.e0000 0001 2180 6431Present Address: Cancer Science Institute, National University of Singapore, Singapore, 117599 Singapore
| | | | | | - Feng Lin
- CureScience, 5820 Oberlin Dr, 202, San Diego, CA 92121 USA
| | - Misa Anekoji
- CureScience, 5820 Oberlin Dr, 202, San Diego, CA 92121 USA
| | | | - Santosh Kesari
- grid.416507.10000 0004 0450 0360Department of Translational Neurosciences, Pacific Neuroscience Institute and Saint John’s Cancer Institute at Providence Saint John’s Health Center, CA 90404 Santa Monica, USA
| | - Feng Wang
- grid.412901.f0000 0004 1770 1022Department of Medical Oncology, Cancer Center, West China Medical School, West China Hospital, Sichuan University, Chengdu, Sichuan China
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32
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Hammond TC, Lee RC, Oronsky B, Reid TR, Caroen S, Juarez TM, Gill J, Heng A, Kesari S. Clinical Course of Two Patients with COVID-19 Respiratory Failure After Administration of the Anticancer Small Molecule, RRx-001. Int Med Case Rep J 2022; 15:735-738. [PMID: 36545548 PMCID: PMC9762260 DOI: 10.2147/imcrj.s389690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
Two critically ill COVID-19 infected patients, who had exhausted all available treatment options, were treated with the small-molecule RRx-001 with subsequent improvement. RRx-001, a first-in-class small molecule with anti-inflammatory, vascular normalizing and macrophage-repolarizing properties, has been safely administered 300+ patients in clinical trials. This is the first report of RRx-001 treatment of COVID-19.
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Affiliation(s)
- Terese Catherine Hammond
- Providence St. Johns Health Center, Santa Monica, CA, USA,John Wayne Cancer Institute, Santa Monica, CA, USA
| | - Raymond C Lee
- Providence St. Johns Health Center, Santa Monica, CA, USA,Cardiovascular Thoracic Institute, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Bryan Oronsky
- EpicentRx, Inc., La Jolla, CA, USA,Correspondence: Bryan Oronsky, EpicentRx, Inc, 11099 North Torrey Pines Road, La Jolla, CA, 92037, USA, Tel +1 858 947-6635, Fax +1 858 724-3080, Email
| | | | | | | | - Jaya Gill
- Pacific Neuroscience Institute, Santa Monica, CA, USA
| | - Annie Heng
- John Wayne Cancer Institute, Santa Monica, CA, USA
| | - Santosh Kesari
- Providence St. Johns Health Center, Santa Monica, CA, USA,John Wayne Cancer Institute, Santa Monica, CA, USA,Pacific Neuroscience Institute, Santa Monica, CA, USA
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33
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Bota DA, Taylor TH, Piccioni DE, Duma CM, LaRocca RV, Kesari S, Carrillo JA, Abedi M, Aiken RD, Hsu FPK, Kong XT, Hsieh C, Bota PG, Nistor GI, Keirstead HS, Dillman RO. Phase 2 study of AV-GBM-1 (a tumor-initiating cell targeted dendritic cell vaccine) in newly diagnosed Glioblastoma patients: safety and efficacy assessment. J Exp Clin Cancer Res 2022; 41:344. [PMID: 36517865 PMCID: PMC9749349 DOI: 10.1186/s13046-022-02552-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 11/28/2022] [Indexed: 12/15/2022] Open
Abstract
Abstract
Background
Vaccine immunotherapy may improve survival in Glioblastoma (GBM). A multicenter phase II trial was designed to determine: (1) the success rate of manufacturing the Aivita GBM vaccine (AV-GBM-1), (2) Adverse Events (AE) associated with AV-GBM-1 administration, and (3) survival.
Methods
Fresh suspected glioblastoma tissue was collected during surgery, and patients with pathology-confirmed GBM enrolled before starting concurrent Radiation Therapy and Temozolomide (RT/TMZ) with Intent to Treat (ITT) after recovery from RT/TMZ. AV-GBM-1 was made by incubating autologous dendritic cells with a lysate of irradiated autologous Tumor-Initiating Cells (TICs). Eligible patients were adults (18 to 70 years old) with a Karnofsky Performance Score (KPS) of 70 or greater, a successful TIC culture, and sufficient monocytes collected. A cryopreserved AV-GBM-1 dose was thawed and admixed with 500 μg of Granulocyte-Macrophage Colony-Stimulating Factor (GM-CSF) before every subcutaneous (s.c.) administration.
Results
Success rates were 97% for both TIC production and monocyte collection. AV-GBM-1 was manufactured for 63/63 patients; 60 enrolled per ITT; 57 started AV-GBM-1. The most common AEs attributed to AV-GBM-1 were local injection site reactions (16%) and flu-like symptoms (10%). Treatment-emergent AEs included seizures (33%), headache (37%), and focal neurologic symptoms (28%). One patient discontinued AV-GBM-1 because of seizures. Median Progression-Free Survival (mPFS) and median Overall Survival (mOS) from ITT enrollment were 10.4 and 16.0 months, respectively. 2-year Overall Survival (OS) is 27%.
Conclusions
AV-GBM-1 was reliably manufactured. Treatment was well-tolerated, but there were numerous treatment-emergent central nervous system AEs. mPFS was longer than historical benchmarks, though no mOS improvement was noted.
Trial registration
NCT, NCT03400917, Registered 10 January 2018,
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34
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Ganapathi AS, Glatt RM, Bookheimer TH, Popa ES, Ingemanson ML, Richards CJ, Hodes JF, Pierce KP, Slyapich CB, Iqbal F, Mattinson J, Lampa MG, Gill JM, Tongson YM, Wong CL, Kim M, Porter VR, Kesari S, Meysami S, Miller KJ, Bramen JE, Merrill DA, Siddarth P. Differentiation of Subjective Cognitive Decline, Mild Cognitive Impairment, and Dementia Using qEEG/ERP-Based Cognitive Testing and Volumetric MRI in an Outpatient Specialty Memory Clinic. J Alzheimers Dis 2022; 90:1761-1769. [PMID: 36373320 PMCID: PMC9789480 DOI: 10.3233/jad-220616] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Distinguishing between subjective cognitive decline (SCD), mild cognitive impairment (MCI), and dementia in a scalable, accessible way is important to promote earlier detection and intervention. OBJECTIVE We investigated diagnostic categorization using an FDA-cleared quantitative electroencephalographic/event-related potential (qEEG/ERP)-based cognitive testing system (eVox® by Evoke Neuroscience) combined with an automated volumetric magnetic resonance imaging (vMRI) tool (Neuroreader® by Brainreader). METHODS Patients who self-presented with memory complaints were assigned to a diagnostic category by dementia specialists based on clinical history, neurologic exam, neuropsychological testing, and laboratory results. In addition, qEEG/ERP (n = 161) and quantitative vMRI (n = 111) data were obtained. A multinomial logistic regression model was used to determine significant predictors of cognitive diagnostic category (SCD, MCI, or dementia) using all available qEEG/ERP features and MRI volumes as the independent variables and controlling for demographic variables. Area under the Receiver Operating Characteristic curve (AUC) was used to evaluate the diagnostic accuracy of the prediction models. RESULTS The qEEG/ERP measures of Reaction Time, Commission Errors, and P300b Amplitude were significant predictors (AUC = 0.79) of cognitive category. Diagnostic accuracy increased when volumetric MRI measures, specifically left temporal lobe volume, were added to the model (AUC = 0.87). CONCLUSION This study demonstrates the potential of a primarily physiological diagnostic model for differentiating SCD, MCI, and dementia using qEEG/ERP-based cognitive testing, especially when combined with volumetric brain MRI. The accessibility of qEEG/ERP and vMRI means that these tools can be used as adjuncts to clinical assessments to help increase the diagnostic certainty of SCD, MCI, and dementia.
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Affiliation(s)
- Aarthi S. Ganapathi
- Pacific Brain Health Center, Pacific Neuroscience Institute and Foundation, Santa Monica, CA, USA
| | - Ryan M. Glatt
- Pacific Brain Health Center, Pacific Neuroscience Institute and Foundation, Santa Monica, CA, USA,Providence Saint John’s Health Center, Santa Monica, CA, USA
| | - Tess H. Bookheimer
- Pacific Brain Health Center, Pacific Neuroscience Institute and Foundation, Santa Monica, CA, USA
| | - Emily S. Popa
- Pacific Brain Health Center, Pacific Neuroscience Institute and Foundation, Santa Monica, CA, USA
| | | | - Casey J. Richards
- Pacific Brain Health Center, Pacific Neuroscience Institute and Foundation, Santa Monica, CA, USA
| | - John F. Hodes
- Pacific Brain Health Center, Pacific Neuroscience Institute and Foundation, Santa Monica, CA, USA
| | - Kyron P. Pierce
- Pacific Brain Health Center, Pacific Neuroscience Institute and Foundation, Santa Monica, CA, USA
| | - Colby B. Slyapich
- Pacific Brain Health Center, Pacific Neuroscience Institute and Foundation, Santa Monica, CA, USA
| | - Fatima Iqbal
- Pacific Brain Health Center, Pacific Neuroscience Institute and Foundation, Santa Monica, CA, USA
| | - Jenna Mattinson
- Pacific Brain Health Center, Pacific Neuroscience Institute and Foundation, Santa Monica, CA, USA
| | - Melanie G. Lampa
- Pacific Brain Health Center, Pacific Neuroscience Institute and Foundation, Santa Monica, CA, USA
| | - Jaya M. Gill
- Pacific Brain Health Center, Pacific Neuroscience Institute and Foundation, Santa Monica, CA, USA,Providence Saint John’s Cancer Institute, Santa Monica, CA, USA
| | - Ynez M. Tongson
- Providence Saint John’s Health Center, Santa Monica, CA, USA
| | - Claudia L. Wong
- Pacific Brain Health Center, Pacific Neuroscience Institute and Foundation, Santa Monica, CA, USA,Providence Saint John’s Health Center, Santa Monica, CA, USA
| | - Mihae Kim
- Pacific Brain Health Center, Pacific Neuroscience Institute and Foundation, Santa Monica, CA, USA,Providence Saint John’s Health Center, Santa Monica, CA, USA
| | - Verna R. Porter
- Pacific Brain Health Center, Pacific Neuroscience Institute and Foundation, Santa Monica, CA, USA,Providence Saint John’s Health Center, Santa Monica, CA, USA
| | - Santosh Kesari
- Pacific Brain Health Center, Pacific Neuroscience Institute and Foundation, Santa Monica, CA, USA,Providence Saint John’s Health Center, Santa Monica, CA, USA,Providence Saint John’s Cancer Institute, Santa Monica, CA, USA
| | - Somayeh Meysami
- Pacific Brain Health Center, Pacific Neuroscience Institute and Foundation, Santa Monica, CA, USA,Providence Saint John’s Cancer Institute, Santa Monica, CA, USA
| | - Karen J. Miller
- Pacific Brain Health Center, Pacific Neuroscience Institute and Foundation, Santa Monica, CA, USA,
Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, USA
| | - Jennifer E. Bramen
- Pacific Brain Health Center, Pacific Neuroscience Institute and Foundation, Santa Monica, CA, USA,Providence Saint John’s Cancer Institute, Santa Monica, CA, USA
| | - David A. Merrill
- Pacific Brain Health Center, Pacific Neuroscience Institute and Foundation, Santa Monica, CA, USA,Providence Saint John’s Health Center, Santa Monica, CA, USA,Providence Saint John’s Cancer Institute, Santa Monica, CA, USA,
Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, USA,Correspondence to: David A. Merrill, MD, PhD, Pacific Brain Health Center, Pacific Neuroscience Institute and Foundation, Santa Monica, CA, USA. Tel.: +1 310 582 7547; Fax: +1 310 829 0124; E-mail:
| | - Prabha Siddarth
- Pacific Brain Health Center, Pacific Neuroscience Institute and Foundation, Santa Monica, CA, USA,
Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, USA
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35
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Meysami S, Raji CA, Chwa WJ, Popa ES, Ganapathi AS, Bookheimer T, Slyapich CB, Pierce KP, Richards CJ, Gill JM, Lampa MG, Rapozo MK, Hodes JF, Glatt RM, Tongson YM, Wong CL, Kim M, Porter VR, Kaiser SA, Panos SE, Dye RV, Miller KJ, Bookheimer SY, Martin NA, Kesari S, Kelly DF, Siddarth P, Roach JC, Bramen JE, Merrill DA. Preliminary Evaluation of Longitudinal Brain MRI Volumetric Quantification in Persons with Cognitive Decline and Confirmed Amyloid Burden Undergoing Multi‐Modal Interventions at an Outpatient Memory Clinic. Alzheimers Dement 2022. [DOI: 10.1002/alz.063695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Somayeh Meysami
- Pacific Brain Health Center, Pacific Neuroscience Institute Foundation Santa Monica CA USA
- David Geffen School of Medicine at University of California Los Angeles Los Angeles CA USA
| | - Cyrus A. Raji
- Mallinckrodt Institute of Radiology, Washington University St. Louis MO USA
| | - Won Jong Chwa
- Mallinckrodt Institute of Radiology, Washington University St. Louis MO USA
| | - Emily S. Popa
- Pacific Brain Health Center, Pacific Neuroscience Institute Foundation Santa Monica CA USA
| | - Aarthi S. Ganapathi
- Pacific Brain Health Center, Pacific Neuroscience Institute Foundation Santa Monica CA USA
| | - Tess Bookheimer
- Pacific Brain Health Center, Pacific Neuroscience Institute Foundation Santa Monica CA USA
| | - Colby B. Slyapich
- Pacific Brain Health Center, Pacific Neuroscience Institute Foundation Santa Monica CA USA
| | - Kyron P. Pierce
- Pacific Brain Health Center, Pacific Neuroscience Institute Foundation Santa Monica CA USA
| | - Casey J. Richards
- Pacific Brain Health Center, Pacific Neuroscience Institute Foundation Santa Monica CA USA
| | - Jaya M. Gill
- Pacific Brain Health Center, Pacific Neuroscience Institute Foundation Santa Monica CA USA
| | - Melanie G. Lampa
- Pacific Brain Health Center, Pacific Neuroscience Institute Foundation Santa Monica CA USA
| | - Molly K. Rapozo
- Pacific Brain Health Center, Pacific Neuroscience Institute Foundation Santa Monica CA USA
| | - John F. Hodes
- Pacific Brain Health Center, Pacific Neuroscience Institute Foundation Santa Monica CA USA
- Drexel University College of Medicine Philadelphia PA USA
| | - Ryan M. Glatt
- Pacific Brain Health Center, Pacific Neuroscience Institute Foundation Santa Monica CA USA
- Providence Saint John's Health Center Santa Monica CA USA
| | | | - Claudia L. Wong
- Pacific Brain Health Center, Pacific Neuroscience Institute Foundation Santa Monica CA USA
- Providence Saint John's Health Center Santa Monica CA USA
| | - Mihae Kim
- Pacific Brain Health Center, Pacific Neuroscience Institute Foundation Santa Monica CA USA
- Providence Saint John's Health Center Santa Monica CA USA
| | - Verna R. Porter
- Pacific Brain Health Center, Pacific Neuroscience Institute Foundation Santa Monica CA USA
- David Geffen School of Medicine at University of California Los Angeles Los Angeles CA USA
- Providence Saint John's Health Center Santa Monica CA USA
| | - Scott A. Kaiser
- Pacific Brain Health Center, Pacific Neuroscience Institute Foundation Santa Monica CA USA
- Providence Saint John's Health Center Santa Monica CA USA
| | - Stella E. Panos
- Pacific Brain Health Center, Pacific Neuroscience Institute Foundation Santa Monica CA USA
- Providence Saint John's Health Center Santa Monica CA USA
- Saint John's Cancer Institute at Providence Saint John's Health Center Santa Monica CA USA
| | - Richelin V. Dye
- Pacific Brain Health Center, Pacific Neuroscience Institute Foundation Santa Monica CA USA
- Behavioral Health Institute, Loma Linda University School of Medicine Loma Linda CA USA
| | - Karen J. Miller
- Pacific Brain Health Center, Pacific Neuroscience Institute Foundation Santa Monica CA USA
- David Geffen School of Medicine at University of California Los Angeles Los Angeles CA USA
| | - Susan Y. Bookheimer
- Pacific Brain Health Center, Pacific Neuroscience Institute Foundation Santa Monica CA USA
- David Geffen School of Medicine at University of California Los Angeles Los Angeles CA USA
| | - Neil A. Martin
- Pacific Brain Health Center, Pacific Neuroscience Institute Foundation Santa Monica CA USA
- Providence Saint John's Health Center Santa Monica CA USA
- Saint John's Cancer Institute at Providence Saint John's Health Center Santa Monica CA USA
| | - Santosh Kesari
- Pacific Brain Health Center, Pacific Neuroscience Institute Foundation Santa Monica CA USA
- Providence Saint John's Health Center Santa Monica CA USA
- Saint John's Cancer Institute at Providence Saint John's Health Center Santa Monica CA USA
| | - Daniel F. Kelly
- Pacific Brain Health Center, Pacific Neuroscience Institute Foundation Santa Monica CA USA
- Providence Saint John's Health Center Santa Monica CA USA
- Saint John's Cancer Institute at Providence Saint John's Health Center Santa Monica CA USA
| | - Prabha Siddarth
- Pacific Brain Health Center, Pacific Neuroscience Institute Foundation Santa Monica CA USA
- David Geffen School of Medicine at University of California Los Angeles Los Angeles CA USA
| | | | - Jennifer E. Bramen
- Pacific Brain Health Center, Pacific Neuroscience Institute Foundation Santa Monica CA USA
- Saint John's Cancer Institute at Providence Saint John's Health Center Santa Monica CA USA
| | - David A. Merrill
- Pacific Brain Health Center, Pacific Neuroscience Institute Foundation Santa Monica CA USA
- David Geffen School of Medicine at University of California Los Angeles Los Angeles CA USA
- Providence Saint John's Health Center Santa Monica CA USA
- Saint John's Cancer Institute at Providence Saint John's Health Center Santa Monica CA USA
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36
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Meysami S, Raji CA, Popa ES, Ganapathi AS, Bookheimer T, Slyapich CB, Pierce KP, Richards CJ, Gill JM, Lampa MG, Rapozo MK, Hodes JF, Glatt RM, Tongson YM, Wong CL, Kim M, Porter VR, Kaiser SA, Panos SE, Dye RV, Miller KJ, Bookheimer SY, Martin NA, Kesari S, Kelly DF, Siddarth P, Bramen JE, Merrill DA. Handgrip Strength is Related to Regional Brain Volumes in a Cohort of Cognitively Impaired Older Adults with Confirmed Amyloid Burden. Alzheimers Dement 2022. [DOI: 10.1002/alz.068108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Somayeh Meysami
- Pacific Brain Health Center, Pacific Neuroscience Institute Foundation Santa Monica CA USA
- David Geffen School of Medicine at University of California Los Angeles Los Angeles CA USA
| | - Cyrus A. Raji
- Mallinckrodt Institute of Radiology, Washington University St. Louis MO USA
| | - Emily S. Popa
- Pacific Brain Health Center, Pacific Neuroscience Institute Foundation Santa Monica CA USA
| | - Aarthi S. Ganapathi
- Pacific Brain Health Center, Pacific Neuroscience Institute Foundation Santa Monica CA USA
| | - Tess Bookheimer
- Pacific Brain Health Center, Pacific Neuroscience Institute Foundation Santa Monica CA USA
| | - Colby B. Slyapich
- Pacific Brain Health Center, Pacific Neuroscience Institute Foundation Santa Monica CA USA
| | - Kyron P. Pierce
- Pacific Brain Health Center, Pacific Neuroscience Institute Foundation Santa Monica CA USA
| | - Casey J. Richards
- Pacific Brain Health Center, Pacific Neuroscience Institute Foundation Santa Monica CA USA
| | - Jaya M. Gill
- Pacific Brain Health Center, Pacific Neuroscience Institute Foundation Santa Monica CA USA
| | - Melanie G. Lampa
- Pacific Brain Health Center, Pacific Neuroscience Institute Foundation Santa Monica CA USA
| | - Molly K. Rapozo
- Pacific Brain Health Center, Pacific Neuroscience Institute Foundation Santa Monica CA USA
| | - John F. Hodes
- Pacific Brain Health Center, Pacific Neuroscience Institute Foundation Santa Monica CA USA
- Drexel University College of Medicine Philadelphia PA USA
| | - Ryan M. Glatt
- Pacific Brain Health Center, Pacific Neuroscience Institute Foundation Santa Monica CA USA
- Providence Saint John's Health Center Santa Monica CA USA
| | | | - Claudia L. Wong
- Pacific Brain Health Center, Pacific Neuroscience Institute Foundation Santa Monica CA USA
- Providence Saint John's Health Center Santa Monica CA USA
| | - Mihae Kim
- Pacific Brain Health Center, Pacific Neuroscience Institute Foundation Santa Monica CA USA
- Providence Saint John's Health Center Santa Monica CA USA
| | - Verna R. Porter
- Pacific Brain Health Center, Pacific Neuroscience Institute Foundation Santa Monica CA USA
- David Geffen School of Medicine at University of California Los Angeles Los Angeles CA USA
- Providence Saint John's Health Center Santa Monica CA USA
| | - Scott A. Kaiser
- Pacific Brain Health Center, Pacific Neuroscience Institute Foundation Santa Monica CA USA
- Providence Saint John's Health Center Santa Monica CA USA
| | - Stella E. Panos
- Pacific Brain Health Center, Pacific Neuroscience Institute Foundation Santa Monica CA USA
- Providence Saint John's Health Center Santa Monica CA USA
- Saint John's Cancer Institute at Providence Saint John's Health Center Santa Monica CA USA
| | - Richelin V. Dye
- Pacific Brain Health Center, Pacific Neuroscience Institute Foundation Santa Monica CA USA
- Behavioral Health Institute, Loma Linda University School of Medicine Loma Linda CA USA
| | - Karen J. Miller
- Pacific Brain Health Center, Pacific Neuroscience Institute Foundation Santa Monica CA USA
- David Geffen School of Medicine at University of California Los Angeles Los Angeles CA USA
| | - Susan Y. Bookheimer
- Pacific Brain Health Center, Pacific Neuroscience Institute Foundation Santa Monica CA USA
- David Geffen School of Medicine at University of California Los Angeles Los Angeles CA USA
| | - Neil A. Martin
- Pacific Brain Health Center, Pacific Neuroscience Institute Foundation Santa Monica CA USA
- Providence Saint John's Health Center Santa Monica CA USA
- Saint John's Cancer Institute at Providence Saint John's Health Center Santa Monica CA USA
| | - Santosh Kesari
- Pacific Brain Health Center, Pacific Neuroscience Institute Foundation Santa Monica CA USA
- Providence Saint John's Health Center Santa Monica CA USA
- Saint John's Cancer Institute at Providence Saint John's Health Center Santa Monica CA USA
| | - Daniel F. Kelly
- Pacific Brain Health Center, Pacific Neuroscience Institute Foundation Santa Monica CA USA
- Providence Saint John's Health Center Santa Monica CA USA
- Saint John's Cancer Institute at Providence Saint John's Health Center Santa Monica CA USA
| | - Prabha Siddarth
- Pacific Brain Health Center, Pacific Neuroscience Institute Foundation Santa Monica CA USA
- David Geffen School of Medicine at University of California Los Angeles Los Angeles CA USA
| | - Jennifer E. Bramen
- Pacific Brain Health Center, Pacific Neuroscience Institute Foundation Santa Monica CA USA
- Saint John's Cancer Institute at Providence Saint John's Health Center Santa Monica CA USA
| | - David A. Merrill
- Pacific Brain Health Center, Pacific Neuroscience Institute Foundation Santa Monica CA USA
- David Geffen School of Medicine at University of California Los Angeles Los Angeles CA USA
- Providence Saint John's Health Center Santa Monica CA USA
- Saint John's Cancer Institute at Providence Saint John's Health Center Santa Monica CA USA
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37
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White N, Baig S, Vidic I, Mastorakos G, Smith R, Dale A, McDonald C, Beaumont T, Seibert T, Peddi S, Hattangadi-Gluth J, Farid N, Kesari S, Rudie J. MODL-17. SEGMENTATION OF PRE AND POST-TREATMENT GLIOMA TISSUE TYPES INCLUDING RESECTION CAVITIES. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac209.1145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
PURPOSE
Measuring gliomas is a time-intensive process with significant inter-rater variability in post-surgical residual tumor and resection cavities. This likely contributes to the delayed assessment of progression and in-field recurrences from radiation. Automated segmentation of pre and post-treatment gliomas could reduce inter-rater variability and increase workflow efficiency for routine longitudinal radiographic assessment and treatment planning. We evaluated whether a 3D neural network is comparable to expert assessment of pre and post-treatment diffuse gliomas tissue types and resection cavities.
METHODS
A retrospective cohort of 647 MRIs of patients with diffuse gliomas (average 55.1 years, 45% female, 396 pre-treatment and 251 post-treatment, median 237 days post-surgery) from The Cancer Imaging Archive were stratified by operation status and tumor grade and randomly split into training (536) and testing (111) samples. T1, T1-post-contrast, T2, and FLAIR images were registered, skull-stripped, and interpolated to 1x1x1. Four classes — edema/infiltrative/post-treatment changes (ED), enhancing tissue (ET), necrotic core (NCR), and resection cavities (RC) — were manually segmented by an expert neuroradiologist. Using these segmentations and the four input image modalities, a nnU-Net, a state-of-the-art 3D U-Net convolutional neural network, was trained to predict segmentations of the four classes.
RESULTS
Segmentation performance in the test set for the ED, ET, and RC classes was at the level of inter-rater reliability with median Dice scores ranging from 0.85 to 1 and relative volume errors ranging from -0.05 to 0.02. There was a near-perfect correlation between manually segmented and predicted total lesion volumes (r2 values ranging from 0.95 to 0.98 among classes).
CONCLUSIONS
Accurate, automated volumetric quantification of diffuse glioma tissue volumes may improve response assessment in clinical trials and reduce provider burden and errors in measurement.
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Affiliation(s)
| | - Saif Baig
- Nassau University Medical Center , East Meadow, NY , USA
| | | | | | | | - Anders Dale
- University of California San Diego , La Jolla, CA , USA
| | | | | | - Tyler Seibert
- University of California San Diego , La Jolla, CA , USA
| | | | | | | | - Santosh Kesari
- Providence Saint John’s Health Center, St. John’s Cancer Institute , Santa Monica, CA , USA
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38
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Armijo K, Sweed N, Hsiao S, Pircher T, Marrin M, Cho L, Kreitzburg K, Blouw B, Fisher D, Dugan M, Kesari S. INNV-19. THE DETECTION OF DISSEMINATED PINEAL PARENCHYMAL TUMOR OF INTERMEDIATE DIFFERENTIATION (PPTID) IN CEREBROSPINAL FLUID (CSF) USING CELL CAPTURE AND IMMUNOCYTOCHEMISTRY. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac209.559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
BACKGROUND
Pineal parenchymal tumors of intermediate differentiation (PPTID) account for 21% to 54% of pineal parenchymal tumors and may be complicated by cerebrospinal dissemination (most commonly at time of reoccurrence; up to 4-10 years post resection). The integral membrane protein synaptophysin is expressed in neuroendocrine cells and virtually all neuraxial neurons that contribute to synaptic transmission. PPTID frequently demonstrates synaptophysin independently of other neural differentiation markers. Cerebrospinal fluid (CSF) cell capture assays have demonstrated utility for assessing disseminated intracranial neoplasms, thus we explore this technology for monitoring a patient with PPTID.
METHODS
A 30-year-old female patient with PPTID diagnosed two years prior was suspected for intracranial dissemination and underwent five CSF collections over the course of 64 days. Per collection, approximately 7 mL of CSF was submitted for each cytology and cell capture. Cytology was performed at Providence Saint John’s Health Center. The CNSide™ platform (Biocept, Inc.) was used to capture and stain cells for DAPI, synaptophysin, and CD45. Multiple capture antibody cocktails (termed 1986, 1822, and gTP1—originally developed for use in carcinoma, melanoma, and glioma) were tested. Cells of interest (COI) were defined by positive immunoreactivity for both DAPI and synaptophysin and no immunoreactivity for CD45. Results were quantified and compared longitudinally.
RESULTS
CSF analysis on days 0, 9, 21, 36, and 64 demonstrated negative results by cytology and 51, 96, 170, 130, and 43 COI/mL by the CNSide platform, respectively. Cumulative mean capture rates for cocktails 1986, 1822, and gTP1 were 47, 14, and 36 COI/mL/sample, respectively.
DISCUSSION
A significant amount of PPTID patients will develop cerebrospinal dissemination. The importance of craniospinal control in this setting has been previously demonstrated. Our work suggests that cell capture assays paired with immunocytochemistry can be used as sensitive means to monitor disseminated PPTID and may impact treatment decisions.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Santosh Kesari
- Providence Saint John’s Health Center, St. John’s Cancer Institute , Santa Monica, CA , USA
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Hsiao S, Pircher T, Sweed N, Armijo K, Marrin M, Cho L, Dugan M, Kesari S. INNV-06. DETECTION OF MUTANT P53 POSITIVE GLIOBLASTOMA CELLS IN CEREBROSPINAL FLUID (CSF) USING A MICROFLUIDIC BASED IMMUNOASSAY. Neuro Oncol 2022. [PMCID: PMC9660766 DOI: 10.1093/neuonc/noac209.546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
BACKGROUND
Metastatic involvement of the CSF by non-CNS neoplasms surpasses that of primary brain tumors, although conventional glioblastoma (GBM) can occasionally be identified in the CSF. Here, we apply Biocept’s CNSide test to examine a patient CSF sample with GBM, verified with an antibody against mutant p53. The p53 pathway is deregulated in 84% of glioblastoma patients and point mutations lead to expression of mutant p53 protein.
METHODS
A CSF sample from 65-year-old male patient, with GBM diagnosed by MRI & CT, and prior identified p53 mutation on R273C by NGS was collected into Biocept’s CSF collection tubes at Providence Saint John’s Health Center. CSF-cells were incubated, 2 days post collection, with a proprietary antibody cocktail, including anti-CD9, followed with a biotinylated secondary, which enables enrichment of capture antibody labeled cells in a streptavidin coated microfluidic device. Cells were fixed and permeabilized immunofluorescence was performed against mutant p53, CD45, fluorescently labeled streptavidin, for capture antibody detection, and DAPI. Microfluidic chips were scanned and analyzed on a Bioview system. The specificity of the mutant p53 antibody was verified using the same test on tumor cells with either wildtype p53 vs various p53 mutations.
RESULTS
CSF analysis by the CNSide platform detected 3 tumor cells / mL. Immunofluorescence confirmed strong expression of mutant p53 protein on about 1/3 of cells identified as tumor cells. Besides the patient R273C mutation, we demonstrated detection of P223L/V274F, E285K and Q331R mutations on tumor cell lines.
DISCUSSION
Our work suggests that a microfluidic based GBM capture test paired with appropriate biomarkers can be used as sensitive means to detect GBM cells in CSF and may be useful for diagnostics and treatment monitoring. Further, we demonstrated the utility of a mutant p53 antibody to identify tumor cells. Technical and clinical studies are needed to substantiate this hypothesis.
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Affiliation(s)
| | | | | | | | | | | | | | - Santosh Kesari
- Providence Saint John’s Health Center, St. John’s Cancer Institute , Santa Monica, CA , USA
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Stuhlmiller T, Turkarslan S, Friedland J, Shapiro M, Kesari S, Patel A, Baliga N. EPCO-10. SYSTEMS BIOLOGY-BASED THERAPEUTIC PREDICTIONS WITH GBMSYGNAL AND CLINICAL CORRELATES IN THE REAL-WORLD LONGITUDINAL OUTCOMES REGISTRY XCELSIOR. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac209.445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Glioblastoma is an aggressive disease with multiple disrupted signaling networks in the same tumor, demanding the development of personalized combination regimens. Using SYstems Genetics Network AnaLysis we analyzed TCGA multiomics datasets for 422 glioblastoma patients to generate a predictive disease network model (gbmSYGNAL). This model seeks to uncover how subsets of mutations causally modulate regulators (transcription factors, miRNAs, etc.) that mechanistically regulate gene modules (“regulons”) associated with disease progression. Using the real-world registry XCELSIOR (NCT03793088), we identified 55 anti-cancer therapies utilized in glioblastoma treatment (N = 354 patients) and associated them with positive or negative regulon activity within individual patients across the TCGA cohort. A median of 12 regulons were targeted by each drug. Interestingly, nilotinib targeted only 5 regulons but they were found to be active in 38% of patients and regulons overactive in >35% of patients were targeted by repurposed anti-cancer drugs including celecoxib, hydroxychloroquine, and tocilizumab. Standard-of-care treatments lomustine and bevacizumab were predicted to be active in only 28% and 23% of patients, respectively. Using gbmSYGNAL, we then prioritized drugs for 12 additional patients from the XCELSIOR registry. Median overactive regulons per patient was 110 (range 55-254) represented by a median 28 molecular targets (range 17-37). Surprisingly, regulons targeted by metformin were predicted to be overactive in all patients. Certain regulons displayed a binary pattern (high “on” activity or completely “off” per patient) including those targeted by pemetrexed, pembrolizumab, and valproic acid while others showed a gradient of activity across patients including selinexor, panobinostat, palbociclib, and alpelisib. Systems biology analysis of commercially available NGS data combined with the XCELSIOR direct patient engagement platform yielded therapeutically actionable insights for glioblastoma patients in real time. Correlation with clinical outcomes is ongoing for ~50 additional patients and will be presented at the meeting.
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Affiliation(s)
| | | | | | | | - Santosh Kesari
- Saint John’s Cancer Institute at Providence St. John’s Health Center, Santa Monica, CA , Santa Monica, CA , USA
| | - Anoop Patel
- University of Washington , Seattle, WA , USA
| | - Nitin Baliga
- Institute for Systems Biology , Seattle, WA , USA
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Bott T, Bozoyan N, Babcock T, Cushman K, Sharma A, Wagle N, Carrillo J, Juarez T, Kesari S. QLTI-26. INTEGRATION OF NEURO-ONCOLOGY CLINICAL PATHWAYS IN PROVIDENCE SOUTHERN CALIFORNIA CLINICAL RESEARCH NETWORK. Neuro Oncol 2022. [PMCID: PMC9660907 DOI: 10.1093/neuonc/noac209.928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
INTRODUCTION
ClinicalPath is an evidence-based oncology decision support and analytics tool for cancer care. ClinicalPath’s treatment recommendations are prioritized based on efficacy, toxicity, and cost by a nationwide committee of oncologists. The pathways are updated quarterly and are expected to speed the integration of new treatments into practice, standardize therapy, improve quality, and decrease cost. The pathway system also allows for local clinical trial mapping to promote clinical trial awareness and increase enrollment. ClinicalPath provides clinical pathways delivering personalized, evidence-based oncology guidance at the point of care. ClinicalPath’s network in North America serves more than 2,000 cancer physicians, within 54 practices in 31 states (15 academic medical centers, 29 hospital systems, and 9 community practices). Population: Our population is derived from multiple hospitals in Southern California within the Providence Health System. Methodology: Medical oncologists and Advanced Practice Providers received training on ClinicalPath before go-live. ClinicalPath was integrated into the Epic EHR in multiple Southern CA hospitals in a single month.
RESULTS
After 3 months of utilization within our Southern California region, 342 treatment decisions were made across all cancers, and 85.1% of cancer patients were treated on pathway. Of which, 7 treatment decisions were made within the neuro-oncology specialty, and 85.7% of those cancer patients were treated on pathway.
CONCLUSION
We successfully integrated and initiated ClinicalPath in a multiple hospital-affiliated community oncology clinical trial network. We are actively working across our Southern California Region to map locally available clinical trials to promote awareness and increase enrollment. Provider utilization and patient on-pathway rates are actively monitored and will be updated.
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Affiliation(s)
- Thomas Bott
- Providence St Joseph Health System Office , Irvine, CA , USA
| | - Nanor Bozoyan
- Providence St Joseph Health System Office , Irvine, CA , USA
| | | | | | | | - Naveed Wagle
- Providence Saint John Cancer Institute , Santa Monica, CA , USA
| | - Jose Carrillo
- Pacific Neuroscience Institute , Santa Monica, CA , USA
| | - Tiffany Juarez
- Providence Saint John Cancer Institute , Santa Monica, CA , USA
| | - Santosh Kesari
- Providence Saint John’s Health Center, St. John’s Cancer Institute , Santa Monica, CA , USA
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42
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Chow J, Carrillo J, Kesari S, Sharma A, Nguyen M, Truong J, Wagle N. NCMP-07. CASE SERIES OF REGULARLY SCHEDULED MANNITOL INFUSIONS SHOWING WITH PROLONGED CLINICAL BENEFIT FOR MANAGEMENT OF CEREBRAL EDEMA IN GLIOMAS. Neuro Oncol 2022. [PMCID: PMC9660650 DOI: 10.1093/neuonc/noac209.735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Gliomas account for the vast majority of malignant primary tumors arising in the central nervous system. Elevated intracranial pressure (ICP) may be a potentially devastating complication of brain tumors and hydrocephalus. Brain tumors may occupy significant space causing displacement and compression of delicate structures within a finite intracranial compartment. The compliance relationship is nonlinear and decreases as the combined volume of the intracranial contents increases. When these compensatory mechanisms have been exhausted, significant increases in pressure develop with relatively small increases in volume. The diagnosis of elevated ICP is generally based on clinical findings and corroborated by imaging studies and the patient's medical history. The best therapy for intracranial hypertension (ICH) is the resolution of the proximate cause of elevated ICP such as the evacuation of a blood clot, resection of a tumor, or cerebrospinal fluid (CSF) diversion in the setting of hydrocephalus. If these modalities have been exhausted or unavailable, osmotic diuretics such as mannitol can be utilized. This medication reduces brain volume by drawing free water out of the tissue and into the circulation, where it is excreted by the kidneys, thus dehydrating brain parenchyma. The common belief is that effects are usually present within minutes, peak at approximately one hour, and last 4 to 24 hours. We report a series of 33 patients treated for a minimum of 1 month of regularly scheduled maintenance infusions of Mannitol 1g/kg every two weeks, 64% showed improved clinical outcomes or stabilization of edema clinical symptoms. Patients expressed improvements in headaches, dizziness, and cognitive ability. This supports the bi-weekly maintenance use of Mannitol in glioma patients with symptomatic cerebral edema. A controlled trial should be supported. This series also suggest a mechanism of action with a more durable response than osmotic diuresis.
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Affiliation(s)
- Jared Chow
- Providence Saint John Cancer Institute , SANTA MONICA, CA , USA
| | - Jose Carrillo
- Pacific Neuroscience Institute , Santa Monica, CA , USA
| | - Santosh Kesari
- Providence Saint John’s Health Center, St. John’s Cancer Institute , Santa Monica, CA , USA
| | | | - Minh Nguyen
- Providence Saint John Cancer Institute , SANTA MONICA, CA , USA
| | - Judy Truong
- Providence Saint John Cancer Institute , SANTA MONICA, CA , USA
| | - Naveed Wagle
- Providence Saint John Cancer Institute , SANTA MONICA, CA , USA
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43
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Ekhator C, Kesari S, Tadipatri R, Fonkem E, Grewal J. INNV-26. EMERGENCE OF VIRTUAL TUMOR BOARD [VTB] IN NEURO-ONCOLOGY: OPPORTUNITIES AND CHALLENGES. Neuro Oncol 2022. [PMCID: PMC9660878 DOI: 10.1093/neuonc/noac209.566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
INTRODUCTION
Virtual tumor board [VTB] platforms are an important aspect of cancer management. They enable easier access to a multidisciplinary team of experts. In order to deliver high-quality cancer care, it is necessary to coordinate numerous therapies and providers, and maintain open lines of communication among all professionals involved. Design/
METHODS
We performed a systematic search of all VTBs incorporating a platform designed for this specific role. We reviewed the records of Genomet, Medical University of South Carolina[MUSC] and Xcures virtual tumor boards. Summary data examined include year of launch, demographics, characteristics of cases, average response time, advantages, and how they handle protected health information.
RESULTS
30% of VTBs examined launched in 2017. All had a HIPAA compliant online environment. Xcures records reveals median age of female patients was 57yrs and the median age of male patients was 55 years. The data showed that 44% with a confirmed treatment preferred VTB integrated option. 76% of patients in Xcures registry consist of primary CNS tumors. There are at least 556 patients in the tumor registry which included 46% Glioblastoma cases [96% primary, 4% secondary]. MUSC VTB shows 112 thoracic tumor cases and 9 neuro-Oncology cases. Genomet VTB data shows age range from 6 months to 84 years [mean age 44.5 years] with 69.6% males and 30.4% females, 43.5% glioblastoma, 8.7% adenocarcinoma, 8.7% infratentorial tumor. Average response time observed in all cases was ≤ 24 hours.
CONCLUSION
VTBs allow for quicker expert analysis of cases. More studies are needed to gain additional insight into user engagement metrics.
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Affiliation(s)
- Chukwuyem Ekhator
- College of Osteopathic Medicine, New York Institute of Technology , Old Westbury, NY , USA
| | - Santosh Kesari
- Saint John’s Cancer Institute at Providence St. John’s Health Center, Santa Monica, CA , Santa Monica, CA , USA
| | - Ramya Tadipatri
- Department of Neurology, Barrow Neurological Institute, Phoenix, AZ , phoenix, AZ , USA
| | - Ekokobe Fonkem
- Baylor Scott and White Health Neuroscience Center Dallas Texas , Texas, TX , USA
| | - Jai Grewal
- Mount Sinai South Nassau Hospital, Oceanside, NY , Oceanside, NY , USA
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44
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Wagle N, Barkhoudarian G, Chaiken L, Wollman R, Sharma A, Carrillo J, Nguyen M, Truong J, Chow J, Chacon E, Kesari S. CTNI-51. FEASIBILITY AND SAFETY OF NEUROSURGICAL RESECTION AND INTRA-OPERATIVE RADIATION THERAPY USING THE XOFT AXXENT ELECTRONIC BRACHYTHERAPY SYSTEM AND BEVACIZUMAB IN RECURRENT GLIOBLASTOMA. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac209.316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Glioblastoma (GBM) is the most common and aggressive primary brain tumor. External beam radiation therapy (EBRT) is widely recognized as an effective treatment for primary GBM. EBRT applied after GBM resection is associated with an increase in overall survival. Beyond upfront therapy with radiation and temozolomide chemotherapy, there is no standard therapy that has been proven effective. Re-irradiation with ERBT is minimally effective and with significant comorbidities. Our study uses IORT at the time of re-resection in patients who have recurrent, operable GBM after failure of who received primary EBRT and temozolamide in their first course of treatment. IORT allows the delivery of a large effective radiation dose applied directly to the tumor bed at the time of resection. This affords direct radiation to be delivered to the micro- and macroscopic tumor remnants in the vicinity of the resection cavity immediately following gross resection. In contrast, the more distant, surrounding brain tissue does not receive high radiation exposure. This Phase II study continues to accrue subjects with the primary endpoint of overall survival and several secondary endpoints that includes progression free survival, quality of life, and adverse events/safety. To date, five patients have been treated on this protocol. The technical feasibility and safety of administering intraoperative radiation with the Xoft System has been established in this cohort. Preliminary GLIOX Trial findings demonstrate the safety and feasibility of using the Xoft Axxent® Electronic Brachytherapy System to administer intracranial radiation during resection of recurrent glioblastomas. We will report new and expansive study results to include these early findings.
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Affiliation(s)
- Naveed Wagle
- Providence Saint John Cancer Institute , Santa Monica, CA , USA
| | | | - Lisa Chaiken
- Saint John Cancer Insitutue , Los Angeles, CA , USA
| | | | | | - Jose Carrillo
- Pacific Neuroscience Institute , Santa Monica, CA , USA
| | - Minh Nguyen
- Providence Saint John Cancer Institute , Santa Monica, CA , USA
| | - Judy Truong
- Providence Saint John Cancer Institute , Santa Monica, CA , USA
| | - Jared Chow
- Providence Saint John Cancer Institute , Santa Monica, CA , USA
| | - Emma Chacon
- Saint John Cancer Insitutue , Los Angeles, CA , USA
| | - Santosh Kesari
- Providence Saint John’s Health Center, St. John’s Cancer Institute , Santa Monica, CA , USA
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45
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Carillo J, Wagle N, Sharma A, Juarez T, Nguyen M, Truong J, Byun T, Bott T, Bozoyan N, Park D, Kesari S. QLTI-22. IMPROVING BRAIN CANCER PATIENT ACCESS TO CLINICAL TRIALS ACROSS SEVEN COMMUNITY HOSPITALS, THE PROVIDENCE SOUTHERN CALIFORNIA CLINICAL RESEARCH NETWORK. Neuro Oncol 2022. [PMCID: PMC9660920 DOI: 10.1093/neuonc/noac209.924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Despite current FDA approved treatments for glioblastoma (GBM), prognosis remains poor. The rare patient population and limited access to clinical trials are factors in this poor prognosis. Clinical trials need to increase enrollment of patients with glioblastoma and other brain cancers to more rapidly develop more effective treatments. Clinical trials are featured on NCCN guidelines, and are considered “Standard of Care” by many experts. Multiple studies have shown that access to clinical trials is associated with improved survival in GBM, however, less than 25% of patients have access or are offered clinical trials. Access to clinical trials can be even more limited in community hospitals, while a large proportion of brain tumors are treated in smaller centers. Community hospitals care for a significant number of brain tumors annually. We have developed a Clinical Research Network for Neuro-Oncology within the Providence Network involving seven hospitals to date. In the past 3 years, we have grown the number of clinical trials available in outlying cities and counties spanning a distance of 60 miles. Between the seven hospitals in our network, we have 15 clinical trials currently open for brain cancer patients, of which, 3 trials were phase I studies. Over the past 2 years, we have enrolled 104 GBM patients in clinical trials. The ability to enhance access to clinical trials by Neuro-Oncologists treating patients in the community is feasible and promising.
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Affiliation(s)
- Jose Carillo
- Providence Saint John Cancer Institute , Santa Monica, CA , USA
| | - Naveed Wagle
- Providence Saint John Cancer Institute , Santa Monica, CA , USA
| | | | - Tiffany Juarez
- Providence Saint John Cancer Institute , Santa Monica, CA , USA
| | - Minh Nguyen
- Providence Saint John Cancer Institute , Santa Monica, CA , USA
| | - Judy Truong
- Providence Saint John Cancer Institute , Santa Monica, CA , USA
| | - Timothy Byun
- Providence Saint Joseph Medical Center , Orange, CA , USA
| | - Thomas Bott
- Providence St Joseph Health System Office , Irvine, CA , USA
| | - Nanor Bozoyan
- Providence St Joseph Health System Office , Irvine, CA , USA
| | - David Park
- Providence Saint Jude Medical Center , Fullerton, CA , USA
| | - Santosh Kesari
- Providence Saint John’s Health Center, St. John’s Cancer Institute , Santa Monica, CA , USA
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Stuhlmiller T, Wasserman A, Quinn J, Shapiro M, Kesari S. BIOS-03. REAL WORLD CLINICAL OUTCOMES OF PATIENTS WITH DIFFUSE MIDLINE GLIOMA IN A LONGITUDINAL OUTCOMES REGISTRY. Neuro Oncol 2022. [PMCID: PMC9661128 DOI: 10.1093/neuonc/noac209.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
We utilized the longitudinal clinical outcomes registry XCELSIOR (NCT03793088) to understand real world outcomes and treatment patterns among patients with diffuse midline glioma. A total of 74 patients were identified with a diagnosis of diffuse midline glioma by pathology or imaging (36 pediatric and 38 adult patients). Median age at diagnosis was 20 years. As of 6/1/2022, 45 patients had expired. Median overall survival (mOS) of the entire cohort was 16.2 months. Cox proportional hazard ratio analysis identified age as the only significant covariate for OS (pediatric HR = 1.59, p=0.04). Pediatric patients had a mOS of 12.9 months and adult patients a mOS of 18.9 months from diagnosis. Frequency of primary tumor location in this dataset was brainstem (35%), thalamus (23%), and pons (20%). Pons location was associated with worst survival (mOS 11.4 months, n=15 patients). The most common anti-cancer interventions among all patients were ONC201 (39 patients), temozolomide (37 patients), bevacizumab (23 patients), panobinostat (8 patients), and immune checkpoint inhibitors (3 patients each, pembrolizumab and nivolumab). In this dataset, no interventions were statistically significant in a Cox proportional hazard model, but both immune checkpoint inhibitors (HR = -1.24, p=0.11) and ONC201 (HR = -0.38, p=0.27) trended toward benefit in the entire population. The subpopulation of patients treated with ONC201 whose tumor also harbored a TP53 mutation displayed a tendency toward activity (n=8); TP53-mutant patients treated with ONC201 had a mOS of 25.0 months vs. TP53 wild-type patients treated with ONC201 had a mOS of 20.3 months. Annotation of data for additional patients is ongoing and updated analyses will be presented at the meeting.
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Affiliation(s)
| | | | | | | | - Santosh Kesari
- Saint John’s Cancer Institute at Providence St. John’s Health Center, Santa Monica, CA , Santa Monica, CA , USA
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Johnson M, Bell A, Shah Y, Viets-Layng K, Mauer E, Xiu J, Elemento O, Glantz M, Walker P, Chen C, Dunbar E, Fonkem E, Kesari S, Brenner A, Newton H, Low J, Sumrall A, Korn W, Ashley D, Wainwright D. BIOM-43. THE GENOMIC, TRANSCRIPTOMIC, AND EPIGENOMIC LANDSCAPE OF ISOCITRATE DEHYDROGENASE WILD TYPE GLIOBLASTOMA ACROSS THE AGE CONTINUUM. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac209.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
BACKGROUND
Older age is a poor prognostic factor for glioblastoma (GBM) patients. We tested whether the intrinsic molecular landscape of the tumor may contribute to this poor prognosis.
METHODS
In accordance with the 2021 WHO classification scheme, we included only isocitrate dehydrogenase (IDH) wild type GBM. Based on published literature, we defined older as age > 65. RNA expression, gene amplification, tumor mutational burden (TMB) and mutational profiles were analyzed in three unique datasets: Tempus (n = 1,410), Caris (n = 1,432), and TCGA (n = 557). Comparison were made between < 65 and ³ 65 year olds using Pearson’s Chi-squared tests, Fisher’s exact tests, or Wilcoxon rank-sum where appropriate.
RESULTS
From our evaluable gene sets, TERT promoter mutations were more prevalent in patients ³ 65 years old (Caris 82.64 vs 77.27%, p = 0.016; Tempus 58.0 vs 49.0%, p = 0.002). There were no significant differences in PDCD1, CD274, CD3E, TNFRSF18, CD40, CD8A, TNFRSF4, CTLA4, HAVCR2, TNFSF9, CD274, or CDKN2A; PDL-1 (by IHC); dMMR/MSI-H, TMB; CDK6 amplification, EGFR amplification, EGFR, EGFRvIII, EGFR fusions, MET fusions, PTEN, TP53, or NF-1. MGMT promoter methylation (Caris data) was more common in the older group (49.73 v 34.14%, p < 0.001). TGCA data demonstrated that gene expression, TMB, and methylation did not change significantly with age. Additionally, PCOLCE2 and SLC10A4 were differentially methylated, and missense mutations, of any type, were more common in the older group (p=0.006).
CONCLUSION
Despite worse survival outcomes for older patients with IDHwt GBM as compared to younger counterparts, the molecular landscape is similar at the genomic, transcriptomic and epigenomic levels. The key exception is TERT promoter mutations that are more common in older GBM patients. Poorer survival is therefore not likely to be attributable solely to intratumoral factors.
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Affiliation(s)
- Margaret Johnson
- The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center , Durham , USA
| | - April Bell
- Northwestern University, Feinberg School of Medicine , Chicago, IL , USA
| | - Yajas Shah
- Weill Cornell Medicine, Elemento Lab , New York, NY , USA
| | | | | | | | - Olivier Elemento
- Institute for Computational Biomedicine, Weill Cornell Medicine , New York, NY , USA
| | - Michael Glantz
- Penn State Health Milton S. Hershey Medical Center , Hershey, PA , USA
| | | | - Clark Chen
- University of Minnesota Medical School, Department of Neurosurgery , Minneapolis, MN , USA
| | - Erin Dunbar
- Piedmont Brain Tumor Center, Piedmont Atlanta Hospital , Atlanta, GA , USA
| | | | - Santosh Kesari
- Providence Saint John’s Health Center, St. John’s Cancer Institute , Santa Monica, CA , USA
| | | | | | - Justin Low
- The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center , Durham, NC , USA
| | - Ashley Sumrall
- Atrium Health Levine Cancer Institute, , Charlotte, NC , USA
| | | | - David Ashley
- The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center , Durham, NC , USA
| | - Derek Wainwright
- Northwestern University, Feinberg School of Medicine , Chicago, IL , USA
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Kumthekar P, Youssef M, Blondin N, Azadi A, Piccioni D, Glantz M, Carillo J, Sharma A, Avgeropoulos N, Makar S, Blouw B, Natasha A, Fisher D, Huynh L, Peters J, Matsutani M, Sales E, Sweed N, Dugan M, Kesari S. BIOM-05. THE HER2 FLIP: HER2 AMPLIFICATION OF TUMOR CELLS IN THE CEREBROSPINAL FLUID (CSF-TCS) OF PATIENTS WITH SOLID TUMOR LEPTOMENINGEAL METASTASIS. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac209.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
INTRODUCTION
Patients with leptomeningeal metastasis (LM) have limited treatment options and a poor outcome. However, they may benefit from targeted therapy. LM patients with HER2-positive primary breast cancer treated with IT trastuzumab demonstrated clinical benefit (Malani, 2020), and improved PFS (Figura, 2019). HER2 amplification in the primary and metastatic tumors can be divergent. Biocept’s CNSideTM is a CLIA validated test that can detect CSF tumor cells (CSF-TCs) and interrogate those cells with FISH and NGS. We analyzed HER2 amplification on CSF-TCs in LM patients with breast cancer, non-small cell lung cancer (NSCLC) and upper GI cancer.
METHODS
CSF was collected from patients with suspected or confirmed LM with breast cancer (N =134 patients), NSCLC (Nf28 patients) or upper GI cancer (Nf2 patients). CSF TCs were tested for HER2 amplification by FISH using CNSide.
RESULTS
HER2 amplification in CSF-TCs was detected in 46% (76/164) of all patients. Of the breast cancer patients, 37% (49/134) flipped HER2 status in the LM tumor, 38% (41/108) switched from a HER2 negative or equivocal primary tumor to HER2 positive CSF-TCs, and 27% (7/26) from a HER2 positive primary tumor to HER2 negative CSF-TCs. For the NSCLC patients, 50% (14/28) showed HER2 amplification on the CSF-TCs. For the upper GI cancer patients, HER2 amplification in CSF-TCs was detected in both patients, one patient had an equivocal HER2 primary tumor and HER2 positive CSF-TCs.
CONCLUSION
HER2 amplification was detected in a substantial fraction of CSF-TCs from patients with LM from breast, upper GI, and NSCL cancers. This finding may have important therapeutic (justifying the use of intra-CSF trastuzumab), prognostic (HER2 positivity in NSCLC is associated with poorer prognosis and a higher frequency of CNS metastases) and pathophysiologic implications (a potential role of HER2 amplification in the genesis of CNS metastases). Additional investigations are underway.
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Affiliation(s)
| | | | | | - Amir Azadi
- Banner MD Anderson Cancer Center , Phoenix, AZ , USA
| | - David Piccioni
- Moores Cancer Center at UC San Diego Health , San Diego, CA , USA
| | - Michael Glantz
- Penn State Health Milton S. Hershey Medical Center , Hershey, PA , USA
| | - Jose Carillo
- Providence Saint John Cancer Institute , Santa Monica, CA , USA
| | | | | | - Sherif Makar
- Advent Health Medical Group Neuro-Oncology , Orlando, FL , USA
| | | | | | | | | | | | | | | | | | | | - Santosh Kesari
- Saint John’s Cancer Institute at Providence St. John’s Health Center, Santa Monica, CA , Santa Monica, CA , USA
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49
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Perez JA, Lopez JJ, Torres Badillo CC, Gill J, Kesari S, Novak P, Temnikov M, Byshovets R, Bychkov O. Phase 1 First-in-Human Dose Escalation and Dose Expansion Study of KLS-1 (64Zinc Aspartate) in Patients With Cancer and Neurodegenerative Diseases. Cureus 2022; 14:c78. [PMID: 36397903 PMCID: PMC9647232 DOI: 10.7759/cureus.c78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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50
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Kesari S, Bessudo A, Gastman BR, Conley AP, Villaflor VM, Nabell LM, Madere D, Chacon E, Spencer C, Li L, Larson C, Reid T, Caroen S, Oronsky B, Stirn M, Williams J, Barve MA. BETA PRIME: Phase I study of AdAPT-001 as monotherapy and combined with a checkpoint inhibitor in superficially accessible, treatment-refractory solid tumors. Future Oncol 2022; 18:3245-3254. [PMID: 35950603 DOI: 10.2217/fon-2022-0481] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AdAPT-001 is an investigational therapy consisting of a replicative type 5 adenovirus armed with a TGF-β receptor-immunoglobulin Fc fusion trap, designed to neutralize isoforms 1 and 3 of the profibrotic and immunosuppressive cytokine, TGF-β. In preclinical studies with an immunocompetent mouse model, AdAPT-001 eradicated directly treated 'cold' tumors as well as distant untreated tumors, and, from its induction of systemic CD8+ T cell-mediated antitumor immunity, protected the mice from rechallenge with tumor cells. AdAPT-001 also sensitized resistant tumors to checkpoint blockade. This manuscript describes the rationale and design of the first-in-human phase I, dose-escalation and dose-expansion study of AdAPT-001 alone and in combination with a checkpoint inhibitor in adults with treatment-refractory superficially accessible solid tumors.
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Affiliation(s)
- Santosh Kesari
- Saint John's Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA 90404, USA
| | - Alberto Bessudo
- California Cancer Associates for Research & Excellence, San Diego, CA 92127, USA
| | - Brian R Gastman
- Department of Dermatology & Plastic Surgery, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Anthony P Conley
- Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Victoria M Villaflor
- Department of Medical Oncology & Therapeutics Research, City of Hope, Duarte, CA 91010, USA
| | - Lisle M Nabell
- Comprehensive Cancer Center, University of Alabama, Birmingham, AL 35205, USA
| | - DeLisa Madere
- Saint John's Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA 90404, USA
| | - Emma Chacon
- Saint John's Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA 90404, USA
| | - Christina Spencer
- California Cancer Associates for Research & Excellence, San Diego, CA 92127, USA
| | - Li Li
- Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | | | - Tony Reid
- EpicentRx, Inc., La Jolla, CA 92037, USA
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