1
|
Norberg SM, Bai K, Sievers C, Robbins Y, Friedman J, Yang X, Kenyon M, Ward E, Schlom J, Gulley J, Lankford A, Semnani R, Sabzevari H, Brough DE, Allen CT. The tumor microenvironment state associates with response to HPV therapeutic vaccination in patients with respiratory papillomatosis. Sci Transl Med 2023; 15:eadj0740. [PMID: 37878675 DOI: 10.1126/scitranslmed.adj0740] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 10/03/2023] [Indexed: 10/27/2023]
Abstract
Recurrent respiratory papillomatosis (RRP) is a rare, debilitating neoplastic disorder caused by chronic infection with human papillomavirus (HPV) type 6 or 11 and characterized by growth of papillomas in the upper aerodigestive tract. There is no approved medical therapy, and patients require repeated debulking procedures to maintain voice and airway function. PRGN-2012 is a gorilla adenovirus immune-therapeutic capable of enhancing HPV 6/11-specific T cell immunity. This first-in-human, phase 1 study (NCT04724980) of adjuvant PRGN-2012 treatment in adult patients with severe, aggressive RRP demonstrates the overall safety and clinically meaningful benefit observed with PRGN-2012, with a 50% complete response rate in patients treated at the highest dose. Responders demonstrate greater expansion of peripheral HPV-specific T cells compared with nonresponders. Additional correlative studies identify an association between reduced baseline papilloma HPV gene expression, greater interferon responses and expression of CXCL9 and CXCL10, and greater papilloma T cell infiltration in responders. Conversely, nonresponders were characterized by greater HPV and CXCL8 gene expression, increased neutrophilic cell infiltration, and reduced T cell papilloma infiltration. These results suggest that papilloma HPV gene expression may regulate interferon signaling and chemokine expression profiles within the tumor microenvironment that cooperate to govern clinical response to therapeutic HPV vaccination in patients with respiratory papillomatosis.
Collapse
Affiliation(s)
- Scott M Norberg
- Center for Immune-Oncology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Ke Bai
- Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Cem Sievers
- Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Yvette Robbins
- Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Jay Friedman
- Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Xinping Yang
- Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Meg Kenyon
- Center for Immune-Oncology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | | | - Jeffrey Schlom
- Center for Immune-Oncology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - James Gulley
- Center for Immune-Oncology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | | | | | | | | | - Clint T Allen
- Center for Immune-Oncology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
- Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| |
Collapse
|
2
|
Strohl MP, Rosen CA. Stabilization of Recurrent Respiratory Papillomatosis with Pembrolizumab Therapy: A Case Report. J Voice 2023; 37:637.e1-637.e3. [PMID: 33992478 DOI: 10.1016/j.jvoice.2021.03.017] [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: 01/27/2021] [Revised: 03/23/2021] [Accepted: 03/24/2021] [Indexed: 11/17/2022]
Abstract
Recurrent respiratory papillomatosis (RRP) is a benign neoplastic disease of the respiratory tract that is caused by human papilloma virus (HPV). The current standard of care is surgical excision with adjuvant treatment as needed. Multiple adjuvant treatments have been used with some success, but long-term control of disease remains difficult. We report on a case of a patient with a long history of RRP who had stabilized true vocal fold disease while on pembrolizumab for concurrent early stage lung squamous cell carcinoma.
Collapse
Affiliation(s)
- Madeleine P Strohl
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, CA.
| | - Clark A Rosen
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, CA
| |
Collapse
|
3
|
Hock K, Kennedy A, Howell R, Friedman A, de Alarcon A, Khosla S. Surgery and Adjuvant Therapy Improve Derkay Scores in Adult and Pediatric Respiratory Papillomatosis. Laryngoscope 2022; 132:2420-2426. [PMID: 35119691 DOI: 10.1002/lary.30042] [Citation(s) in RCA: 4] [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: 08/09/2021] [Revised: 01/05/2022] [Accepted: 01/17/2022] [Indexed: 12/16/2022]
Abstract
OBJECTIVES/HYPOTHESIS Comparing Derkay anatomical score at time of procedure, disease characteristics, and mean treatment interval among adult and pediatric patients with recurrent respiratory papillomatosis (RRP). STUDY DESIGN Restrospective study. METHODS Retrospective review of juvenile-onset (JO) and adult-onset (AO) RRP patients treated longitudinally at pediatric and adult institutions from 1999 to 2019. Patients were included if they had a tissue diagnosis of papilloma and had at least a 12-month follow-up. RESULTS One hundred and twelve patients met inclusion criteria (68 JO-RRP and 44 AO-RRP). All patients were stratified into either potassium titanyl phosphate (KTP) (n = 42), CO2 (n = 21), or microdebrider (n = 49) treatment groups. The Derkay score improved between first and last procedure in the KTP group (mean difference, 3.5; P < .001), CO2 group (mean difference, 4.4; P < .001), and microdebrider group (mean difference, 4.1; P < .001), but overall improvement did not differ across groups (P = .73). Baseline mean to last mean Derkay score improved for nine patients during bevacizumab treatments (mean difference, 3.0; P = .01) but did not improve for these same patients during an interval prior to receiving bevacizumab treatments. Baseline mean to last mean Derkay score improved for 19 patients during cidofovir treatments (mean difference, 3.84; P < .001) but did not improve for these same patients during the interval prior to receiving cidofovir treatments. The AO-RRP population had more patients with dysplasia (50%) compared to JO-RRP population (10%) (P < .001). CONCLUSION Various surgical modalities appear to be equally effective treatments for RRP. Adult and pediatric patients have decreased recurrent disease burden when receiving bevacizumab or cidofovir. AO-RRP patients have more concomitant dysplasia. LEVEL OF EVIDENCE 3 Laryngoscope, 132:2420-2426, 2022.
Collapse
Affiliation(s)
- Kiefer Hock
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio, U.S.A.,Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Aimee Kennedy
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio, U.S.A.,Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Rebecca Howell
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio, U.S.A.,Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Aaron Friedman
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio, U.S.A.,Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Alessandro de Alarcon
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio, U.S.A.,Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Sid Khosla
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio, U.S.A.,Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| |
Collapse
|
4
|
Bai K, Norberg SM, Sievers C, Meyer T, Friedman J, Hinrichs C, Allen CT. Durable response in a patient with recurrent respiratory papillomatosis treated with immune checkpoint blockade. Head Neck 2022; 44:E31-E37. [PMID: 35815785 PMCID: PMC9452466 DOI: 10.1002/hed.27144] [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: 04/20/2022] [Revised: 06/14/2022] [Accepted: 06/28/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Immune checkpoint blockade can provide clinical benefit for patients with advanced cancer. Here, we report durable disease control over many years following PD-L1 blockade through induction of a viral antigen-specific T cell response in an adult patient with recurrent respiratory papillomatosis. METHODS Antigen-specific T cell response assays, single cell RNA-sequencing, and RNA-scope was used to study clinical tissues. RESULTS An HPV6 E2-specific T cell clone restricted to HLA-B*55, present at low frequency in the pre-treatment papilloma, significantly expanded after six doses of PD-L1 blockade and remained present and functional at the site of initial response in the larynx as a tissue resident memory T cell for 4 years. An associated reduction in E2 target gene was observed following treatment. CONCLUSIONS Although demonstrated in a single exceptional responder, these results highlight that immune checkpoint blockade may induce durable, viral antigen-specific immunity of sufficient magnitude to control disease in patients with nonmalignant disorders.
Collapse
Affiliation(s)
- Ke Bai
- Section on Translational Tumor Immunology, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, Maryland, USA
| | - Scott M Norberg
- Genitourinary Malignancies Branch, National Cancer Institute, Center for Cancer Research, National Institutes of Health, Bethesda, Maryland, USA
| | - Cem Sievers
- Section on Translational Tumor Immunology, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, Maryland, USA
| | - Tanya Meyer
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Jay Friedman
- Section on Translational Tumor Immunology, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, Maryland, USA
| | | | - Clint T Allen
- Section on Translational Tumor Immunology, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, Maryland, USA
| |
Collapse
|
5
|
Borrelli M, Nasrollahi T, Raskin J, Khan S, Alexander RE. Laryngotracheal Recurrent Papillomatosis: A Case Study and Survey of Surgical and Systemic Management. Ear Nose Throat J 2022; 101:47S-51S. [PMID: 36173000 DOI: 10.1177/01455613221128714] [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] [Indexed: 11/17/2022] Open
Abstract
This case report presents a 72-year-old man with longstanding recurrent respiratory papillomatosis (RRP). He has undergone multiple procedures for the condition, including an apparent urgent surgical airway followed by tracheoplasty repair. Modern management of complicated RRP should include both local debulking and systemic approaches. Systemic bevacizumab (Avastin) has shown some initial success as an effective treatment option, in addition to other medications such as pembrolizumab. Other future care strategies may include an HPV vaccination and other adjuvants; vaccination has been reported to have the possibility of drastically reducing the incidence of RRP.
Collapse
Affiliation(s)
- Michela Borrelli
- 22494Cedars Sinai Sinus Center of Excellence, Los Angeles, CA, USA.,Cedars-Sinai Division of Otolaryngology, Los Angeles, CA, USA
| | - Tasha Nasrollahi
- 22494Cedars Sinai Sinus Center of Excellence, Los Angeles, CA, USA.,Cedars-Sinai Division of Otolaryngology, Los Angeles, CA, USA.,California Northstate University College of Medicine, Elk Grove, CA, USA
| | - Jonathan Raskin
- 22494Cedars Sinai Sinus Center of Excellence, Los Angeles, CA, USA.,Cedars-Sinai Division of Otolaryngology, Los Angeles, CA, USA.,6918Oakland University William Beaumont School of Medicine, Detroit, MI, USA
| | - Sana Khan
- 43986American University of Antigua College of Medicine, Osbourn, AN, USA
| | - Ronda E Alexander
- 22494Cedars Sinai Sinus Center of Excellence, Los Angeles, CA, USA.,2013Montefiore Medical Center, Bronx, NY, USA
| |
Collapse
|
6
|
Abstract
This article aims to educate readers on adjuvant therapies for recurrent respiratory papillomatosis (RRP). Although antivirals are injected locally into papillomas as an adjuvant treatment, new biologics targeting vascular endothelial growth factor or induction of human papillomavirus (HPV)-specific immunity are gaining traction with demonstration of clinical benefit and mechanism of action in retrospective case series and prospective clinical trials. The future of RRP treatment, alone or in combination with surgery, lies in the careful clinical study of vascular and immune targeting agents that balance the risk of adverse events with the chance for elimination of HPV-infected cells.
Collapse
Affiliation(s)
- Clint T Allen
- Section on Translational Tumor Immunology, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Building 10, Room 7N240C, Bethesda, MD 20892, USA.
| |
Collapse
|
7
|
Bai K, Allen C. How Enhancing Immunity to Low-Risk HPV Could Cure Recurrent Respiratory Papillomatosis. Laryngoscope 2021; 131:2041-2047. [PMID: 33720393 DOI: 10.1002/lary.29153] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/13/2020] [Accepted: 09/09/2020] [Indexed: 12/12/2022]
Abstract
Recurrent respiratory papillomatosis (RRP) is currently treated with repeat surgical resection of papillomatous disease that does not address the fundamental underlying issue of chronic infection with low-risk human papillomavirus. Here, we review the biology and immunology of low-risk human papillomavirus (HPV) infections. Antiviral or antiangiogenic adjuvant treatments similarly address the papillomatous disease itself but do not activate HPV immunity. It is likely that only through immune-mediated clearance of low-risk HPV infection can patients with RRP be cured. In some patients, this occurs spontaneously. In others with more aggressive disease, adjuvant immunotherapy to activate immunity may be needed. Based on current understanding of antiviral immune responses, the only rational strategy to clear HPV-infected epithelial cells is through activation of the T-lymphocyte arm of the adaptive immune response. Translation of immunotherapies that are Food and Drug Administration-approved or under clinical study for cancer, such as immune checkpoint blockade or engineered therapeutic vaccines, may provide a path toward tolerable and efficacious adjuvant immunotherapy for RRP. LEVEL OF EVIDENCE: NA Laryngoscope, 131:2041-2047, 2021.
Collapse
Affiliation(s)
- Ke Bai
- Section on Translation Tumor Immunology, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, Maryland, U.S.A
| | - Clint Allen
- Section on Translation Tumor Immunology, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, Maryland, U.S.A
| |
Collapse
|
8
|
Aggarwal C, Cohen RB, Morrow MP, Kraynyak KA, Sylvester AJ, Cheung J, Dickerson K, Schulten V, Knoblock D, Gillespie E, Bauml JM, Yan J, Diehl M, Boyer J, Dallas M, Kim JJ, Weiner DB, Skolnik JM. Immune Therapy Targeting E6/E7 Oncogenes of Human Paillomavirus Type 6 (HPV-6) Reduces or Eliminates the Need for Surgical Intervention in the Treatment of HPV-6 Associated Recurrent Respiratory Papillomatosis. Vaccines (Basel) 2020; 8:vaccines8010056. [PMID: 32013270 PMCID: PMC7158680 DOI: 10.3390/vaccines8010056] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 11/15/2019] [Accepted: 01/23/2020] [Indexed: 01/07/2023] Open
Abstract
: Background: Recurrent respiratory papillomatosis (RRP) is a rare disorder characterized by the generation of papillomas of the aerodigestive tract, usually associated with human papilloma virus (HPV) subtypes 6, 11. INO-3106 is a DNA plasmid-based immunotherapy targeting E6 and E7 proteins of HPV6, in order to create a robust immune T cell response. METHODS Testing of INO-3016 in animal models confirmed immunogenicity of the DNA-based therapy. A single-site open-label Phase 1 study was initiated for patients with HPV6-positive RRP. Patients were dosed with INO-3106 with or without INO-9012, a DNA plasmid immunotherapy that encodes IL-12, delivered intramuscularly (IM) in combination with electroporation (EP) with the CELLECTRA® device. Patients received an escalating dose of INO-3106, 3 mg once and then 6 mg for three additional doses, each dose three weeks apart, with the third and fourth doses co-administered with INO-9012. The primary objective of the study was to evaluate the safety and tolerability of INO-3106 with and without INO-9012. The secondary objective was to determine cellular immune responses to INO-3106 with and without INO-9012. Exploratory objectives included preliminary clinical efficacy to the therapy. RESULTS Three patients were enrolled in this study, of which two had RRP. Study therapy was well-tolerated, with no related serious adverse events and all related adverse events (AEs) were low-grade. Injection site pain was the most common related AE reported. Immunogenicity was evidenced by multiple immune assays showing engagement and expansion of an HPV6-specific cellular response, including cytotoxic T cells. Preliminary efficacy was demonstrated in patients with RRP in the form of reduction in need for surgical intervention for papilloma growth. Prior to intervention, both patients required surgical intervention approximately every 180 days. One patient demonstrated a greater than three-fold increase in surgery avoidance (584 days) and the other patient remains completely surgery-free as of the last contact at 915 days, a greater than 5-fold increase in surgery interval. CONCLUSION INO-3106 with and without INO-9012 was well tolerated, immunogenic and demonstrated preliminary efficacy in patients with HPV6-associated RRP aerodigestive lesions. Further clinical study is indicated.
Collapse
Affiliation(s)
- Charu Aggarwal
- Division of Hematology Oncology, University of Pennsylvania, Philadelphia, PA 19104, USA; (C.A.); (R.B.C.); (J.M.B.)
| | - Roger B. Cohen
- Division of Hematology Oncology, University of Pennsylvania, Philadelphia, PA 19104, USA; (C.A.); (R.B.C.); (J.M.B.)
| | - Matthew P. Morrow
- Inovio Pharmaceuticals, Inc., Plymouth Meeting, PA 19462, USA; (K.A.K.); (A.J.S.); (J.C.); (K.D.); (V.S.); (D.K.); (E.G.); (J.Y.); (M.D.); (J.B.); (J.J.K.); (J.M.S.)
- Correspondence: ; Tel.: +1-267-440-4236
| | - Kimberly A. Kraynyak
- Inovio Pharmaceuticals, Inc., Plymouth Meeting, PA 19462, USA; (K.A.K.); (A.J.S.); (J.C.); (K.D.); (V.S.); (D.K.); (E.G.); (J.Y.); (M.D.); (J.B.); (J.J.K.); (J.M.S.)
| | - Albert J. Sylvester
- Inovio Pharmaceuticals, Inc., Plymouth Meeting, PA 19462, USA; (K.A.K.); (A.J.S.); (J.C.); (K.D.); (V.S.); (D.K.); (E.G.); (J.Y.); (M.D.); (J.B.); (J.J.K.); (J.M.S.)
| | - Jocelyn Cheung
- Inovio Pharmaceuticals, Inc., Plymouth Meeting, PA 19462, USA; (K.A.K.); (A.J.S.); (J.C.); (K.D.); (V.S.); (D.K.); (E.G.); (J.Y.); (M.D.); (J.B.); (J.J.K.); (J.M.S.)
| | - Kelsie Dickerson
- Inovio Pharmaceuticals, Inc., Plymouth Meeting, PA 19462, USA; (K.A.K.); (A.J.S.); (J.C.); (K.D.); (V.S.); (D.K.); (E.G.); (J.Y.); (M.D.); (J.B.); (J.J.K.); (J.M.S.)
| | - Veronique Schulten
- Inovio Pharmaceuticals, Inc., Plymouth Meeting, PA 19462, USA; (K.A.K.); (A.J.S.); (J.C.); (K.D.); (V.S.); (D.K.); (E.G.); (J.Y.); (M.D.); (J.B.); (J.J.K.); (J.M.S.)
| | - Dawson Knoblock
- Inovio Pharmaceuticals, Inc., Plymouth Meeting, PA 19462, USA; (K.A.K.); (A.J.S.); (J.C.); (K.D.); (V.S.); (D.K.); (E.G.); (J.Y.); (M.D.); (J.B.); (J.J.K.); (J.M.S.)
| | - Elisabeth Gillespie
- Inovio Pharmaceuticals, Inc., Plymouth Meeting, PA 19462, USA; (K.A.K.); (A.J.S.); (J.C.); (K.D.); (V.S.); (D.K.); (E.G.); (J.Y.); (M.D.); (J.B.); (J.J.K.); (J.M.S.)
| | - Joshua M. Bauml
- Division of Hematology Oncology, University of Pennsylvania, Philadelphia, PA 19104, USA; (C.A.); (R.B.C.); (J.M.B.)
| | - Jian Yan
- Inovio Pharmaceuticals, Inc., Plymouth Meeting, PA 19462, USA; (K.A.K.); (A.J.S.); (J.C.); (K.D.); (V.S.); (D.K.); (E.G.); (J.Y.); (M.D.); (J.B.); (J.J.K.); (J.M.S.)
| | - Malissa Diehl
- Inovio Pharmaceuticals, Inc., Plymouth Meeting, PA 19462, USA; (K.A.K.); (A.J.S.); (J.C.); (K.D.); (V.S.); (D.K.); (E.G.); (J.Y.); (M.D.); (J.B.); (J.J.K.); (J.M.S.)
| | - Jean Boyer
- Inovio Pharmaceuticals, Inc., Plymouth Meeting, PA 19462, USA; (K.A.K.); (A.J.S.); (J.C.); (K.D.); (V.S.); (D.K.); (E.G.); (J.Y.); (M.D.); (J.B.); (J.J.K.); (J.M.S.)
| | - Michael Dallas
- Inovio Pharmaceuticals, Inc., Plymouth Meeting, PA 19462, USA; (K.A.K.); (A.J.S.); (J.C.); (K.D.); (V.S.); (D.K.); (E.G.); (J.Y.); (M.D.); (J.B.); (J.J.K.); (J.M.S.)
| | - J. Joseph Kim
- Inovio Pharmaceuticals, Inc., Plymouth Meeting, PA 19462, USA; (K.A.K.); (A.J.S.); (J.C.); (K.D.); (V.S.); (D.K.); (E.G.); (J.Y.); (M.D.); (J.B.); (J.J.K.); (J.M.S.)
| | - David B. Weiner
- The Wistar Institute Vaccine and Immunotherapy Center, Philadelphia, PA 19104, USA;
| | - Jeffrey M. Skolnik
- Inovio Pharmaceuticals, Inc., Plymouth Meeting, PA 19462, USA; (K.A.K.); (A.J.S.); (J.C.); (K.D.); (V.S.); (D.K.); (E.G.); (J.Y.); (M.D.); (J.B.); (J.J.K.); (J.M.S.)
| |
Collapse
|