1
|
Tolonen T, Roine T, Alho K, Leppämäki S, Tani P, Koski A, Laine M, Salmi J. Abnormal wiring of the structural connectome in adults with ADHD. Netw Neurosci 2023; 7:1302-1325. [PMID: 38144696 PMCID: PMC10631790 DOI: 10.1162/netn_a_00326] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 06/19/2023] [Indexed: 12/26/2023] Open
Abstract
Current knowledge of white matter changes in large-scale brain networks in adult attention-deficit/hyperactivity disorder (ADHD) is scarce. We collected diffusion-weighted magnetic resonance imaging data in 40 adults with ADHD and 36 neurotypical controls and used constrained spherical deconvolution-based tractography to reconstruct whole-brain structural connectivity networks. We used network-based statistic (NBS) and graph theoretical analysis to investigate differences in these networks between the ADHD and control groups, as well as associations between structural connectivity and ADHD symptoms assessed with the Adult ADHD Self-Report Scale or performance in the Conners Continuous Performance Test 2 (CPT-2). NBS revealed decreased connectivity in the ADHD group compared to the neurotypical controls in widespread unilateral networks, which included subcortical and corticocortical structures and encompassed dorsal and ventral attention networks and visual and somatomotor systems. Furthermore, hypoconnectivity in a predominantly left-frontal network was associated with higher amount of commission errors in CPT-2. Graph theoretical analysis did not reveal topological differences between the groups or associations between topological properties and ADHD symptoms or task performance. Our results suggest that abnormal structural wiring of the brain in adult ADHD is manifested as widespread intrahemispheric hypoconnectivity in networks previously associated with ADHD in functional neuroimaging studies.
Collapse
Affiliation(s)
- Tuija Tolonen
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Timo Roine
- Department of Neuroscience and Biomedical Engineering, Aalto University, Espoo, Finland
- Turku Brain and Mind Center, University of Turku, Turku, Finland
| | - Kimmo Alho
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
- AMI Centre, Aalto Neuroimaging, Aalto University, Espoo, Finland
| | | | - Pekka Tani
- Department of Psychiatry, Helsinki University Hospital, Helsinki, Finland
| | - Anniina Koski
- Department of Psychiatry, Helsinki University Hospital, Helsinki, Finland
| | - Matti Laine
- Turku Brain and Mind Center, University of Turku, Turku, Finland
- Department of Psychology, Åbo Akademi University, Turku, Finland
| | - Juha Salmi
- Department of Neuroscience and Biomedical Engineering, Aalto University, Espoo, Finland
- AMI Centre, Aalto Neuroimaging, Aalto University, Espoo, Finland
| |
Collapse
|
2
|
Salmi J, Soveri A, Salmela V, Alho K, Leppämäki S, Tani P, Koski A, Jaeggi SM, Laine M. Working memory training restores aberrant brain activity in adult attention-deficit hyperactivity disorder. Hum Brain Mapp 2020; 41:4876-4891. [PMID: 32813290 PMCID: PMC7643386 DOI: 10.1002/hbm.25164] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/25/2020] [Accepted: 07/29/2020] [Indexed: 01/01/2023] Open
Abstract
The development of treatments for attention impairments is hampered by limited knowledge about the malleability of underlying neural functions. We conducted the first randomized controlled trial to determine the modulations of brain activity associated with working memory (WM) training in adults with attention-deficit hyperactivity disorder (ADHD). At baseline, we assessed the aberrant functional brain activity in the n-back WM task by comparing 44 adults with ADHD with 18 healthy controls using fMRI. Participants with ADHD were then randomized to train on an adaptive dual n-back task or an active control task. We tested whether WM training elicits redistribution of brain activity as observed in healthy controls, and whether it might further restore aberrant activity related to ADHD. As expected, activity in areas of the default-mode (DMN), salience (SN), sensory-motor (SMN), frontoparietal (FPN), and subcortical (SCN) networks was decreased in participants with ADHD at pretest as compared with healthy controls, especially when the cognitive load was high. WM training modulated widespread FPN and SN areas, restoring some of the aberrant activity. Training effects were mainly observed as decreased brain activity during the trained task and increased activity during the untrained task, suggesting different neural mechanisms for trained and transfer tasks.
Collapse
Affiliation(s)
- Juha Salmi
- Department of Neuroscience and Biomedical EngineeringAalto UniversityEspooFinland
- Department of Psychology and Speech‐Language PathologyUniversity of TurkuTurkuFinland
- Turku Institute for Advanced StudiesUniversity of TurkuTurkuFinland
| | - Anna Soveri
- Department of Clinical MedicineUniversity of TurkuTurkuFinland
| | - Viljami Salmela
- Department of Psychology and LogopedicsUniversity of HelsinkiHelsinkiFinland
- AMI Centre, Aalto NeuroimagingAalto UniversityEspooFinland
| | - Kimmo Alho
- Department of Psychology and LogopedicsUniversity of HelsinkiHelsinkiFinland
- AMI Centre, Aalto NeuroimagingAalto UniversityEspooFinland
| | - Sami Leppämäki
- Department of PsychiatryHelsinki University HospitalHelsinkiFinland
| | - Pekka Tani
- Department of PsychiatryHelsinki University HospitalHelsinkiFinland
| | - Anniina Koski
- Department of PsychiatryHelsinki University HospitalHelsinkiFinland
| | - Susanne M. Jaeggi
- School of EducationUniversity of California IrvineIrvineCaliforniaUSA
- Department of Cognitive SciencesUniversity of California IrvineIrvineCaliforniaUSA
| | - Matti Laine
- Department of PsychologyÅbo Akademi UniversityTurkuFinland
- Brain and Mind CenterUniversity of TurkuTurkuFinland
| |
Collapse
|
3
|
Salmi J, Metwaly M, Tohka J, Alho K, Leppämäki S, Tani P, Koski A, Vanderwal T, Laine M. ADHD desynchronizes brain activity during watching a distracted multi-talker conversation. Neuroimage 2019; 216:116352. [PMID: 31730921 DOI: 10.1016/j.neuroimage.2019.116352] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 06/28/2019] [Revised: 11/07/2019] [Accepted: 11/10/2019] [Indexed: 11/15/2022] Open
Abstract
Individuals with attention-deficit/hyperactivity disorder (ADHD) have difficulties navigating dynamic everyday situations that contain multiple sensory inputs that need to either be attended to or ignored. As conventional experimental tasks lack this type of everyday complexity, we administered a film-based multi-talker condition with auditory distractors in the background. ADHD-related aberrant brain responses to this naturalistic stimulus were identified using intersubject correlations (ISCs) in functional magnetic resonance imaging (fMRI) data collected from 51 adults with ADHD and 29 healthy controls. A novel permutation-based approach introducing studentized statistics and subject-wise voxel-level null-distributions revealed that several areas in cerebral attention networks and sensory cortices were desynchronized in participants with ADHD (n = 20) relative to healthy controls (n = 20). Specifically, desynchronization of the posterior parietal cortex occurred when irrelevant speech or music was presented in the background, but not when irrelevant white noise was presented, or when there were no distractors. We also show regionally distinct ISC signatures for inattention and impulsivity. Finally, post-scan recall of the film contents was associated with stronger ISCs in the default-mode network for the ADHD and in the dorsal attention network for healthy controls. The present study shows that ISCs can further our understanding of how a complex environment influences brain states in ADHD.
Collapse
Affiliation(s)
- Juha Salmi
- Department of Neuroscience and Biomedical Engineering, School of Science, Aalto University, Rakentajanaukio 2, Espoo, Finland; Department of Psychology and Speech-Language Pathology, University of Turku, Turku, Finland; Turku Institute for Advanced Studies, University of Turku, Turku, Finland; Department of Psychology, Åbo Akademi University, Turku, Finland; Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland; AMI Centre, Aalto Neuroimaging, Aalto University, Espoo, Finland.
| | - Mostafa Metwaly
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Jussi Tohka
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Kimmo Alho
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland; AMI Centre, Aalto Neuroimaging, Aalto University, Espoo, Finland
| | - Sami Leppämäki
- Department of Psychiatry, Helsinki University Hospital, Helsinki, Finland
| | - Pekka Tani
- Department of Psychiatry, Helsinki University Hospital, Helsinki, Finland
| | - Anniina Koski
- Department of Psychiatry, Helsinki University Hospital, Helsinki, Finland
| | - Tamara Vanderwal
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Matti Laine
- Department of Psychology, Åbo Akademi University, Turku, Finland; Turku Brain and Mind Center, University of Turku, Turku, Finland
| |
Collapse
|
4
|
Heiniö C, Sorsa S, Siurala M, Grönberg-Vähä-Koskela S, Havunen R, Haavisto E, Koski A, Hemminki O, Zafar S, Cervera-Carrascon V, Munaro E, Kanerva A, Hemminki A. Effect of Genetic Modifications on Physical and Functional Titers of Adenoviral Cancer Gene Therapy Constructs. Hum Gene Ther 2019; 30:740-752. [PMID: 30672366 DOI: 10.1089/hum.2018.240] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 12/26/2022] Open
Abstract
After the discovery and characterization of the adenovirus in the 1950s, this prevalent cause of the common cold and other usually mild diseases has been modified and utilized in biomedicine in several ways. To date, adenoviruses are the most frequently used vectors and therapeutic (e.g., oncolytic) agents with a number of beneficial features. They infect both dividing and nondividing cells, enable high-level, transient protein expression, and are easy to amplify to high concentrations. As an important and versatile research tool, it is of essence to understand the limits and advantages that genetic modification of adenovirus vectors may entail. Therefore, a retrospective analysis was performed of adenoviral gene therapy constructs produced in the same laboratory with similar methods. The aim was to assess the impact of various modifications on the physical and functional titer of the virus. It was found that genome size (designed within "the 105% golden rule") did not significantly affect the physical titer of the adenovirus preparations, regardless of the type of transgene (e.g., immunostimulatory vs. other), number of engineered changes, and size of the mutated virus genome. One statistically significant exception was noted, however. Chimeric adenoviruses (5/3) had a slightly lower physical titer compared to Ad5-based viruses, although a trend for the opposite was true for functional titers. Thus, 5/3 chimeric viruses may in fact be appealing from a safety versus efficacy viewpoint. Armed viruses had lower functional and physical titers than unarmed viruses, while five genomic modifications started to decrease functional titer. Importantly, even highly modified armed viruses generally had good titers compatible with clinical testing. In summary, this paper shows the plasticity of adenovirus for various vector, oncolytic, and armed oncolytic uses. These results inform future generations of adenovirus-based drugs for human use. This information is directly transferable to academic laboratories and the biomedical industry involved in vector design and production optimization.
Collapse
Affiliation(s)
- Camilla Heiniö
- 1 Cancer Gene Therapy Group, Translational Immunology Research Program, University of Helsinki, Helsinki, Finland
| | - Suvi Sorsa
- 1 Cancer Gene Therapy Group, Translational Immunology Research Program, University of Helsinki, Helsinki, Finland.,2 TILT Biotherapeutics Ltd., Helsinki, Finland
| | - Mikko Siurala
- 1 Cancer Gene Therapy Group, Translational Immunology Research Program, University of Helsinki, Helsinki, Finland.,2 TILT Biotherapeutics Ltd., Helsinki, Finland
| | | | - Riikka Havunen
- 1 Cancer Gene Therapy Group, Translational Immunology Research Program, University of Helsinki, Helsinki, Finland.,2 TILT Biotherapeutics Ltd., Helsinki, Finland
| | | | - Anniina Koski
- 1 Cancer Gene Therapy Group, Translational Immunology Research Program, University of Helsinki, Helsinki, Finland
| | - Otto Hemminki
- 1 Cancer Gene Therapy Group, Translational Immunology Research Program, University of Helsinki, Helsinki, Finland.,3 Department of Urology, Helsinki University Hospital, Helsinki, Finland
| | - Sadia Zafar
- 1 Cancer Gene Therapy Group, Translational Immunology Research Program, University of Helsinki, Helsinki, Finland
| | - Víctor Cervera-Carrascon
- 1 Cancer Gene Therapy Group, Translational Immunology Research Program, University of Helsinki, Helsinki, Finland.,2 TILT Biotherapeutics Ltd., Helsinki, Finland
| | - Eleonora Munaro
- 1 Cancer Gene Therapy Group, Translational Immunology Research Program, University of Helsinki, Helsinki, Finland
| | - Anna Kanerva
- 1 Cancer Gene Therapy Group, Translational Immunology Research Program, University of Helsinki, Helsinki, Finland.,4 Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland
| | - Akseli Hemminki
- 1 Cancer Gene Therapy Group, Translational Immunology Research Program, University of Helsinki, Helsinki, Finland.,2 TILT Biotherapeutics Ltd., Helsinki, Finland.,5 Comprehensive Cancer Center, Helsinki University Hospital, Helsinki, Finland
| |
Collapse
|
5
|
Hemminki O, Oksanen M, Taipale K, Liikanen I, Koski A, Joensuu T, Kanerva A, Hemminki A. Oncograms Visualize Factors Influencing Long-Term Survival of Cancer Patients Treated with Adenoviral Oncolytic Immunotherapy. Mol Ther Oncolytics 2018; 9:41-50. [PMID: 29989063 PMCID: PMC6035494 DOI: 10.1016/j.omto.2018.04.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 04/17/2018] [Indexed: 02/07/2023]
Abstract
The first US Food and Drug Administration (FDA)- and EMA-approved oncolytic virus has been available since 2015. However, there are no markers available that would predict benefit for the individual patient. During 2007–2012, we treated 290 patients with advanced chemotherapy-refractory cancers, using 10 different oncolytic adenoviruses. Treatments were given in a Finnish Medicines Agency (FIMEA)-regulated individualized patient treatment program (the Advanced Therapy Access Program [ATAP]), which required long-term follow-up of patients, which is presented here. Focusing on the longest surviving patients, some key clinical and biological features are presented as “oncograms.” Some key attributes that could be captured in the oncogram are suggested to predict treatment response and survival after oncolytic adenovirus treatment. The oncogram includes immunological laboratory parameters assessed in peripheral blood (leukocytes, neutrophil-to-lymphocyte ratio, interleukin-8 [IL-8], HMGB1, anti-viral neutralizing antibody status), features of the patient (gender, performance status), tumor features (histological tumor type, tumor load, region of metastases), and oncolytic virus-specific features (arming of the virus). The retrospective approach used here facilitates verification in a prospective controlled trial setting. To our knowledge, the oncogram is the first holistic attempt to identify the patients most likely to benefit from adenoviral oncolytic virotherapy.
Collapse
Affiliation(s)
- Otto Hemminki
- Cancer Gene Therapy Group, Department of Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Department of Urology, Helsinki University Hospital, Helsinki, Finland
| | - Minna Oksanen
- Cancer Gene Therapy Group, Department of Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Kristian Taipale
- Cancer Gene Therapy Group, Department of Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Ilkka Liikanen
- Cancer Gene Therapy Group, Department of Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Anniina Koski
- Cancer Gene Therapy Group, Department of Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland
| | | | - Anna Kanerva
- Cancer Gene Therapy Group, Department of Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland
| | - Akseli Hemminki
- Cancer Gene Therapy Group, Department of Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Docrates Hospital, Helsinki, Finland.,TILT Biotherapeutics Ltd., Helsinki, Finland.,Helsinki University Hospital Comprehensive Cancer Center, Helsinki, Finland
| |
Collapse
|
6
|
Taipale K, Tähtinen S, Havunen R, Koski A, Liikanen I, Pakarinen P, Koivisto-Korander R, Kankainen M, Joensuu T, Kanerva A, Hemminki A. Interleukin 8 activity influences the efficacy of adenoviral oncolytic immunotherapy in cancer patients. Oncotarget 2018; 9:6320-6335. [PMID: 29464075 PMCID: PMC5814215 DOI: 10.18632/oncotarget.23967] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 12/12/2017] [Indexed: 12/20/2022] Open
Abstract
After the landmark approval of T-VEC, oncolytic viruses are finding their way to the clinics. However, response rates have still room for improvement, and unfortunately there are currently no available markers to predict responses for oncolytic immunotherapy. Interleukin 8 (IL-8) production is upregulated in many cancers and it also connects to several pathways that have been shown to impair the efficacy of adenoviral immunotherapy. We studied the role of IL-8 in 103 cancer patients treated with oncolytic adenoviruses. We found high baseline serum IL-8 concentration to be independently associated with poor prognosis (p<0.001). Further, normal baseline IL-8 was associated with improved prognostic potential of calculation of the neutrophil-to-lymphocyte ratio (p<0.001). Interestingly, a decrease in IL-8 concentration after treatment with oncolytic adenovirus predicted better overall survival (p<0.001) and higher response rate, although this difference was not significant (p=0.066). We studied the combination of adenovirus and IL-8 neutralizing antibody ex vivo in single cell suspensions and in co-cultures of tumor-associated CD15+ neutrophils and CD3+ tumor-infiltrating lymphocytes derived from fresh patient tumor samples. These results indicate a role for IL-8 as a biomarker in oncolytic virotherapy, but additionally provide a rationale for targeting IL-8 to improve treatment efficacy. In conclusion, curtailing the activity of IL-8 systemically or locally in the tumor microenvironment could improve anti-tumor immune responses resulting in enhanced efficacy of adenoviral immunotherapy of cancer.
Collapse
Affiliation(s)
- Kristian Taipale
- Cancer Gene Therapy Group, University of Helsinki, Faculty of Medicine, Helsinki, Finland
| | - Siri Tähtinen
- Cancer Gene Therapy Group, University of Helsinki, Faculty of Medicine, Helsinki, Finland
| | - Riikka Havunen
- Cancer Gene Therapy Group, University of Helsinki, Faculty of Medicine, Helsinki, Finland
| | - Anniina Koski
- Cancer Gene Therapy Group, University of Helsinki, Faculty of Medicine, Helsinki, Finland.,Department of Neurosurgery, HUCH, Helsinki, Finland
| | - Ilkka Liikanen
- Cancer Gene Therapy Group, University of Helsinki, Faculty of Medicine, Helsinki, Finland
| | - Päivi Pakarinen
- Department of Obstetrics and Gynecology, HUCH, Helsinki, Finland
| | | | - Matti Kankainen
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
| | | | - Anna Kanerva
- Cancer Gene Therapy Group, University of Helsinki, Faculty of Medicine, Helsinki, Finland.,Department of Obstetrics and Gynecology, HUCH, Helsinki, Finland
| | - Akseli Hemminki
- Cancer Gene Therapy Group, University of Helsinki, Faculty of Medicine, Helsinki, Finland.,Docrates Cancer Center, Helsinki, Finland.,TILT Biotherapeutics Ltd., Helsinki, Finland.,Helsinki University Hospital Comprehensive Cancer Center, Helsinki, Finland
| |
Collapse
|
7
|
Koski A, Kuokkanen H, Tukiainen E. Postoperative Wound Complications after Internal Fixation of Closed Calcaneal Fractures: A Retrospective Analysis of 126 Consecutive Patients with 148 Fractures. Scand J Surg 2016; 94:243-5. [PMID: 16259176 DOI: 10.1177/145749690509400313] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aim: The aim of the study was to analyse the number of soft-tissue complications after internal fixation of calcaneal fractures and to evaluate risk factors leading to these complications. Material: A retrospective analysis of 126 consecutive patients with 148 operatively treated calcaneal fractures was performed. Only primarily closed fractures were included in the study. Results: Wound healing was problematic in 35 cases (24 per cent). The wound was infected in 23 cases (16 per cent) and a wound edge necrosis was observed in 12 cases (8 per cent). The soft tissue complication needed operative treatment in 20 cases (14 per cent). The complications did not lead to amputations in any case. In the end of the follow up all wounds had healed. Conclusions: The statistical analysis identified a longer delay in surgery and longer operation time to be positive risk factors for wound complications.
Collapse
Affiliation(s)
- A Koski
- Helsinki University Central Hospital, Department of Plastic Surgery, Helsinki, Finland.
| | | | | |
Collapse
|
8
|
Hemminki O, Parviainen S, Juhila J, Turkki R, Linder N, Lundin J, Kankainen M, Ristimäki A, Koski A, Liikanen I, Oksanen M, Nettelbeck DM, Kairemo K, Partanen K, Joensuu T, Kanerva A, Hemminki A. Immunological data from cancer patients treated with Ad5/3-E2F-Δ24-GMCSF suggests utility for tumor immunotherapy. Oncotarget 2015; 6:4467-81. [PMID: 25714011 PMCID: PMC4414204 DOI: 10.18632/oncotarget.2901] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 12/14/2014] [Indexed: 11/25/2022] Open
Abstract
Oncolytic viruses that selectively replicate in tumor cells can be used for treatment of cancer. Accumulating data suggests that virus induced oncolysis can enhance anti-tumor immunity and break immune tolerance. To capitalize on the immunogenic nature of oncolysis, we generated a quadruple modified oncolytic adenovirus expressing granulocyte-macrophage colony-stimulating factor (GMCSF). Ad5/3-E2F-Δ24-GMCSF (CGTG-602) was engineered to contain a tumor specific E2F1 promoter driving an E1 gene deleted at the retinoblastoma protein binding site (“Δ24”). The fiber features a knob from serotype 3 for enhanced gene delivery to tumor cells. The virus was tested preclinically in vitro and in vivo and then 13 patients with solid tumors refractory to standard therapies were treated. Treatments were well tolerated and frequent tumor- and adenovirus-specific T-cell immune responses were seen. Overall, with regard to tumor marker or radiological responses, signs of antitumor efficacy were seen in 9/12 evaluable patients (75%). The radiological disease control rate with positron emission tomography was 83% while the response rate (including minor responses) was 50%. Tumor biopsies indicated accumulation of immunological cells, especially T-cells, to tumors after treatment. RNA expression analyses of tumors indicated immunological activation and metabolic changes secondary to virus replication.
Collapse
Affiliation(s)
- Otto Hemminki
- Cancer Gene Therapy Group, Transplantation Laboratory & Haartman Institute, University of Helsinki, Helsinki, Finland
| | - Suvi Parviainen
- Cancer Gene Therapy Group, Transplantation Laboratory & Haartman Institute, University of Helsinki, Helsinki, Finland
| | - Juuso Juhila
- Cancer Gene Therapy Group, Transplantation Laboratory & Haartman Institute, University of Helsinki, Helsinki, Finland
| | - Riku Turkki
- Institute for Molecular Medicine Finland (FIMM), Helsinki, Finland
| | - Nina Linder
- Institute for Molecular Medicine Finland (FIMM), Helsinki, Finland
| | - Johan Lundin
- Institute for Molecular Medicine Finland (FIMM), Helsinki, Finland.,Division of Global Health/IHCAR, Karolinska Institutet, Stockholm, Sweden
| | | | - Ari Ristimäki
- Department of Pathology, HUSLAB and Haartman Institute, Helsinki, University Central Hospital and Genome-Scale Biology, Research Programs Unit, University of Helsinki, Helsinki, Finland
| | - Anniina Koski
- Cancer Gene Therapy Group, Transplantation Laboratory & Haartman Institute, University of Helsinki, Helsinki, Finland
| | - Ilkka Liikanen
- Cancer Gene Therapy Group, Transplantation Laboratory & Haartman Institute, University of Helsinki, Helsinki, Finland
| | - Minna Oksanen
- Cancer Gene Therapy Group, Transplantation Laboratory & Haartman Institute, University of Helsinki, Helsinki, Finland
| | | | | | | | | | - Anna Kanerva
- Cancer Gene Therapy Group, Transplantation Laboratory & Haartman Institute, University of Helsinki, Helsinki, Finland.,Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Helsinki, Finland
| | - Akseli Hemminki
- Cancer Gene Therapy Group, Transplantation Laboratory & Haartman Institute, University of Helsinki, Helsinki, Finland.,Docrates Cancer Center, Helsinki, Finland.,TILT Biotherapeutics Ltd, Helsinki, Finland
| |
Collapse
|
9
|
Taipale K, Liikanen I, Koski A, Kanerva A, Oksanen M, Hemminki A. Analysis of predictive and prognostic factors in 290 patients treated with oncolytic adenoviruses. J Immunother Cancer 2015. [PMCID: PMC4649390 DOI: 10.1186/2051-1426-3-s2-p344] [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: 12/01/2022] Open
|
10
|
Bramante S, Koski A, Liikanen I, Vassilev L, Oksanen M, Siurala M, Heiskanen R, Hakonen T, Joensuu T, Kanerva A, Pesonen S, Hemminki A. Oncolytic virotherapy for treatment of breast cancer, including triple-negative breast cancer. Oncoimmunology 2015; 5:e1078057. [PMID: 27057453 DOI: 10.1080/2162402x.2015.1078057] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [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: 06/03/2015] [Revised: 07/21/2015] [Accepted: 07/22/2015] [Indexed: 10/23/2022] Open
Abstract
Breast cancer is a heterogeneous disease, characterized by several distinct biological subtypes, among which triple-negative breast cancer (TNBC) is one associated with a poor prognosis. Oncolytic virus replication is an immunogenic phenomenon, and viruses can be armed with immunostimulatory molecules to boost virus triggered antitumoral immune responses. Cyclophosphamide (CP) is a chemotherapy drug that is associated with cytotoxicity and immunosuppression at higher doses, whereas immunostimulatory and anti-angiogenic properties are observed at low continuous dosage. Therefore, the combination of oncolytic immuno-virotherapy with low-dose CP is an appealing approach. We investigated the potency of oncolytic adenovirus Ad5/3-D24-GMCSF on a TNBC cell line and in vivo in an orthotopic xenograft mouse model, in combination with low-dose CP or its main active metabolite 4-hydroperoxycyclophosphamide (4-HP-CP). Furthermore, we summarized the breast cancer-specific human data on this virus from the Advanced Therapy Access Program (ATAP). Low-dose CP increased the efficacy of Ad5/3-D24-GMCSF in vitro and in a TNBC mouse model. In ATAP, treatments appeared safe and well-tolerated. Thirteen out of 16 breast cancer patients treated were evaluable for possible benefits with modified RECIST 1.1 criteria: 1 patient had a minor response, 2 had stable disease (SD), and 10 had progressive disease (PD). One patient is alive at 1,771 d after treatment. Ad5/3-D24-GMCSF in combination with low-dose CP showed promising efficacy in preclinical studies and possible antitumor activity in breast cancer patients refractory to other forms of therapy. This preliminary data supports continuing the clinical development of oncolytic adenoviruses for treatment of breast cancer, including TNBC.
Collapse
Affiliation(s)
- Simona Bramante
- University of Helsinki, Faculty of Medicine, Department of Pathology, Cancer Gene Therapy Group , Helsinki, Finland
| | - Anniina Koski
- University of Helsinki, Faculty of Medicine, Department of Pathology, Cancer Gene Therapy Group , Helsinki, Finland
| | - Ilkka Liikanen
- University of Helsinki, Faculty of Medicine, Department of Pathology, Cancer Gene Therapy Group , Helsinki, Finland
| | | | - Minna Oksanen
- University of Helsinki, Faculty of Medicine, Department of Pathology, Cancer Gene Therapy Group , Helsinki, Finland
| | - Mikko Siurala
- University of Helsinki, Faculty of Medicine, Department of Pathology, Cancer Gene Therapy Group, Helsinki, Finland; TILT Biotherapeutics Ltd., Helsinki, Finland
| | | | | | | | - Anna Kanerva
- University of Helsinki, Faculty of Medicine, Department of Pathology, Cancer Gene Therapy Group, Helsinki, Finland; Helsinki University Central Hospital, Department of Obstetrics and Gynecology, Helsinki, Finland
| | - Sari Pesonen
- University of Helsinki, Faculty of Medicine, Department of Pathology, Cancer Gene Therapy Group, Helsinki, Finland; Oncos Therapeutics Ltd., Helsinki, Finland
| | - Akseli Hemminki
- University of Helsinki, Faculty of Medicine, Department of Pathology, Cancer Gene Therapy Group, Helsinki, Finland; TILT Biotherapeutics Ltd., Helsinki, Finland; Helsinki University Central Hospital, Department of Oncology, Helsinki, Finland
| |
Collapse
|
11
|
Koski A, Bramante S, Kipar A, Oksanen M, Juhila J, Vassilev L, Joensuu T, Kanerva A, Hemminki A. Biodistribution Analysis of Oncolytic Adenoviruses in Patient Autopsy Samples Reveals Vascular Transduction of Noninjected Tumors and Tissues. Mol Ther 2015; 23:1641-52. [PMID: 26156245 DOI: 10.1038/mt.2015.125] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 06/30/2015] [Indexed: 12/20/2022] Open
Abstract
In clinical trials with oncolytic adenoviruses, there has been no mortality associated with treatment vectors. Likewise, in the Advanced Therapy Access Program (ATAP), where 290 patients were treated with 10 different viruses, no vector-related mortality was observed. However, as the patient population who received adenovirus treatments in ATAP represented heavily pretreated patients, often with very advanced disease, some patients died relatively soon after receiving their virus treatment mandating autopsy to investigate cause of death. Eleven such autopsies were performed and confirmed disease progression as the cause of death in each case. The regulatory requirement for investigating the safety of advanced therapy medical products presented a unique opportunity to study tissue samples collected as a routine part of the autopsies. Oncolytic adenoviral DNA was recovered in a wide range of tissues, including injected and noninjected tumors and various normal tissues, demonstrating the ability of the vector to disseminate through the vascular route. Furthermore, we recovered and cultured viable virus from samples of noninjected brain metastases of an intravenously treated patient, confirming that oncolytic adenovirus can reach tumors through the intravascular route. Data presented here give mechanistic insight into mode of action and biodistribution of oncolytic adenoviruses in cancer patients.
Collapse
Affiliation(s)
- Anniina Koski
- Cancer Gene Therapy Group, Department of Pathology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Simona Bramante
- Cancer Gene Therapy Group, Department of Pathology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Anja Kipar
- Finnish Centre for Laboratory Animal Pathology, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland.,School of Veterinary Science and Department of Infection Biology, Institute of Global Health, University of Liverpool, Liverpool, UK.,Present address: Institute of Veterinary Pathology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Minna Oksanen
- Cancer Gene Therapy Group, Department of Pathology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Juuso Juhila
- Cancer Gene Therapy Group, Department of Pathology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Lotta Vassilev
- Cancer Gene Therapy Group, Department of Pathology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | | | - Anna Kanerva
- Cancer Gene Therapy Group, Department of Pathology, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland
| | - Akseli Hemminki
- Cancer Gene Therapy Group, Department of Pathology, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Docrates Hospital, Helsinki, Finland.,TILT Biotherapeutics Ltd., Helsinki, Finland.,Department of Oncology, Helsinki University Hospital, Helsinki, Finland
| |
Collapse
|
12
|
Taipale K, Liikanen I, Juhila J, Karioja-Kallio A, Oksanen M, Turkki R, Linder N, Lundin J, Ristimäki A, Kanerva A, Koski A, Joensuu T, Vähä-Koskela M, Hemminki A. T-cell subsets in peripheral blood and tumors of patients treated with oncolytic adenoviruses. Mol Ther 2015; 23:964-973. [PMID: 25655312 PMCID: PMC4427873 DOI: 10.1038/mt.2015.17] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [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: 10/15/2014] [Accepted: 01/06/2015] [Indexed: 02/08/2023] Open
Abstract
The quality of the antitumor immune response is decisive when developing new immunotherapies for cancer. Oncolytic adenoviruses cause a potent immunogenic stimulus and arming them with costimulatory molecules reshapes the immune response further. We evaluated peripheral blood T-cell subsets of 50 patients with refractory solid tumors undergoing treatment with oncolytic adenovirus. These data were compared to changes in antiviral and antitumor T cells, treatment efficacy, overall survival, and T-cell subsets in pre- and post-treatment tumor biopsies. Treatment caused a significant (P < 0.0001) shift in T-cell subsets in blood, characterized by a proportional increase of CD8(+) cells, and decrease of CD4(+) cells. Concomitant treatment with cyclophosphamide and temozolomide resulted in less CD4(+) decrease (P = 0.041) than cyclophosphamide only. Interestingly, we saw a correlation between T-cell changes in peripheral blood and the tumor site. This correlation was positive for CD8(+) and inverse for CD4(+) cells. These findings give insight to the interconnections between peripheral blood and tumor-infiltrating lymphocyte (TIL) populations regarding oncolytic virotherapy. In particular, our data suggest that induction of T-cell response is not sufficient for clinical response in the context of immunosuppressive tumors, and that peripheral blood T cells have a complicated and potentially misleading relationship with TILs.
Collapse
Affiliation(s)
- Kristian Taipale
- Cancer Gene Therapy Group, Department of Pathology and Transplantation laboratory, Haartman Institute, University of Helsinki, Helsinki, Finland
| | - Ilkka Liikanen
- Cancer Gene Therapy Group, Department of Pathology and Transplantation laboratory, Haartman Institute, University of Helsinki, Helsinki, Finland
| | | | | | - Minna Oksanen
- Cancer Gene Therapy Group, Department of Pathology and Transplantation laboratory, Haartman Institute, University of Helsinki, Helsinki, Finland
| | - Riku Turkki
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
| | - Nina Linder
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
| | - Johan Lundin
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
| | - Ari Ristimäki
- Department of Pathology, HUSLAB and Haartman Institute, Helsinki University Central Hospital and Genome-Scale Biology, Research Programs Unit, University of Helsinki, Helsinki, Finland
| | - Anna Kanerva
- Cancer Gene Therapy Group, Department of Pathology and Transplantation laboratory, Haartman Institute, University of Helsinki, Helsinki, Finland; Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Helsinki, Finland
| | - Anniina Koski
- Cancer Gene Therapy Group, Department of Pathology and Transplantation laboratory, Haartman Institute, University of Helsinki, Helsinki, Finland
| | | | - Markus Vähä-Koskela
- Cancer Gene Therapy Group, Department of Pathology and Transplantation laboratory, Haartman Institute, University of Helsinki, Helsinki, Finland
| | - Akseli Hemminki
- Cancer Gene Therapy Group, Department of Pathology and Transplantation laboratory, Haartman Institute, University of Helsinki, Helsinki, Finland; TILT Biotherapeutics Ltd., Helsinki, Finland.
| |
Collapse
|
13
|
Bramante S, Koski A, Liikanen I, Oksanen M, Joensuu T, Pesonen S, Hemminki A. 438. Oncolytic Immunotherapy for Treatment of Breast Cancer, Including Triple-Negative Breast Cancer. Mol Ther 2015. [DOI: 10.1016/s1525-0016(16)34047-3] [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: 11/26/2022] Open
|
14
|
Bramante S, Kaufmann JK, Veckman V, Liikanen I, Nettelbeck DM, Hemminki O, Vassilev L, Cerullo V, Oksanen M, Heiskanen R, Joensuu T, Kanerva A, Pesonen S, Matikainen S, Vähä-Koskela M, Koski A, Hemminki A. Treatment of melanoma with a serotype 5/3 chimeric oncolytic adenovirus coding for GM-CSF: Results in vitro, in rodents and in humans. Int J Cancer 2015; 137:1775-83. [PMID: 25821063 DOI: 10.1002/ijc.29536] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [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: 09/17/2014] [Accepted: 02/20/2015] [Indexed: 12/26/2022]
Abstract
Metastatic melanoma is refractory to irradiation and chemotherapy, but amenable to immunological approaches such as immune-checkpoint-inhibiting antibodies or adoptive cell therapies. Oncolytic virus replication is an immunogenic phenomenon, and viruses can be armed with immunostimulatory molecules. Therefore, oncolytic immuno-virotherapy of malignant melanoma is an appealing approach, which was recently validated by a positive phase 3 trial. We investigated the potency of oncolytic adenovirus Ad5/3-D24-GMCSF on a panel of melanoma cell lines and animal models, and summarized the melanoma-specific human data from the Advanced Therapy Access Program (ATAP). The virus effectively eradicated human melanoma cells in vitro and subcutaneous SK-MEL-28 melanoma xenografts in nude mice when combined with low-dose cyclophosphamide. Furthermore, virally-expressed granulocyte-macrophage colony-stimulating factor (GM-CSF) stimulated the differentiation of human monocytes into macrophages. In contrast to human cells, RPMI 1846 hamster melanoma cells exhibited no response to oncolytic viruses and the chimeric 5/3 fiber failed to increase the efficacy of transduction, suggesting limited utility of the hamster model in the context of viruses with this capsid. In ATAP, treatments appeared safe and well-tolerated. Four out of nine melanoma patients treated were evaluable for possible therapy benefit with modified RECIST criteria: one patient had minor response, two had stable disease, and one had progressive disease. Two patients were alive at 559 and 2,149 days after treatment. Ad5/3-D24-GMCSF showed promising efficacy in preclinical studies and possible antitumor activity in melanoma patients refractory to other forms of therapy. This data supports continuing the clinical development of oncolytic adenoviruses for treatment of malignant melanoma.
Collapse
Affiliation(s)
- Simona Bramante
- Cancer Gene Therapy Group, Department of Pathology and Transplantation Laboratory and Haartman Institute, University of Helsinki, Finland
| | - Johanna K Kaufmann
- Oncolytic Adenovirus Group, German Cancer Research Center (Deutsches Krebsforschungszentrum [DKFZ]), Heidelberg, Germany
| | - Ville Veckman
- Unit of Systems Toxicology, Finnish Institute of Occupational Health, Topeliuksenkatu 41 a, Helsinki, Finland
| | - Ilkka Liikanen
- Cancer Gene Therapy Group, Department of Pathology and Transplantation Laboratory and Haartman Institute, University of Helsinki, Finland
| | - Dirk M Nettelbeck
- Oncolytic Adenovirus Group, German Cancer Research Center (Deutsches Krebsforschungszentrum [DKFZ]), Heidelberg, Germany
| | - Otto Hemminki
- Cancer Gene Therapy Group, Department of Pathology and Transplantation Laboratory and Haartman Institute, University of Helsinki, Finland
| | | | - Vincenzo Cerullo
- Cancer Gene Therapy Group, Department of Pathology and Transplantation Laboratory and Haartman Institute, University of Helsinki, Finland.,Laboratory of Immunovirotherapy, Division of Biopharmaceutics and Pharmacokinetics, Faculty of Pharmacy, University of Helsinki, Finland
| | - Minna Oksanen
- Cancer Gene Therapy Group, Department of Pathology and Transplantation Laboratory and Haartman Institute, University of Helsinki, Finland
| | | | | | - Anna Kanerva
- Cancer Gene Therapy Group, Department of Pathology and Transplantation Laboratory and Haartman Institute, University of Helsinki, Finland.,Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Helsinki, Finland
| | - Sari Pesonen
- Cancer Gene Therapy Group, Department of Pathology and Transplantation Laboratory and Haartman Institute, University of Helsinki, Finland
| | - Sampsa Matikainen
- Unit of Systems Toxicology, Finnish Institute of Occupational Health, Topeliuksenkatu 41 a, Helsinki, Finland
| | - Markus Vähä-Koskela
- Cancer Gene Therapy Group, Department of Pathology and Transplantation Laboratory and Haartman Institute, University of Helsinki, Finland
| | - Anniina Koski
- Cancer Gene Therapy Group, Department of Pathology and Transplantation Laboratory and Haartman Institute, University of Helsinki, Finland
| | - Akseli Hemminki
- Cancer Gene Therapy Group, Department of Pathology and Transplantation Laboratory and Haartman Institute, University of Helsinki, Finland.,TILT Biotherapeutics Ltd., Helsinki, Finland
| |
Collapse
|
15
|
Liikanen I, Koski A, Merisalo-Soikkeli M, Hemminki O, Oksanen M, Kairemo K, Joensuu T, Kanerva A, Hemminki A. Serum HMGB1 is a predictive and prognostic biomarker for oncolytic immunotherapy. Oncoimmunology 2015; 4:e989771. [PMID: 25949903 PMCID: PMC4404794 DOI: 10.4161/2162402x.2014.989771] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 11/15/2014] [Indexed: 12/13/2022] Open
Abstract
With the emergence of effective immunotherapeutics, which nevertheless harbor the potential for toxicity and are expensive to use, biomarkers are urgently needed for identification of cancer patients who respond to treatment. In this clinical-epidemiological study of 202 cancer patients treated with oncolytic adenoviruses, we address the biomarker value of serum high-mobility group box 1 (HMGB1) protein. Overall survival and imaging responses were studied as primary endpoints and adjusted for confounding factors in two multivariate analyses (Cox and logistic regression). Mechanistic studies included assessment of circulating tumor-specific T-cells by ELISPOT, virus replication by quantitative PCR, and inflammatory cytokines by cytometric bead array. Patients with low HMGB1 baseline levels (below median concentration) showed significantly improved survival (p = 0.008, Log-Rank test) and radiological disease control rate (49.2% vs. 30.0%, p = 0.038, χ2 test) as compared to high-baseline patients. In multivariate analyses, the low HMGB1 baseline status was a strong prognostic (HR 0.638, 95% CI 0.462–0.881) and the best predictive factor for disease control (OR 2.618, 95% CI 1.004–6.827). Indicative of an immune-mediated mechanism, antitumor T-cell activity in blood and response to immunogenic-transgene coding viruses associated with improved outcome only in HMGB1-low patients. Our results suggest that serum HMGB1 baseline is a useful prognostic and predictive biomarker for oncolytic immunotherapy with adenoviruses, setting the stage for prospective clinical studies.
Collapse
Key Words
- ATAP, Advanced Therapy Access Program; CD40L, CD40-ligand; CI, confidence interval; CT, contrast-enhanced computed tomography; DAMP, damage-associated molecular pattern; GMCSF, granulocyte-macrophage colony stimulating factor; HMGB1, high-mobility group box 1; HR, hazard ratio; IL-6, -8, -10, interleukin-6, -8, -10; ILT2, immunoglobulin-like transcript 2; MRI, magnetic resonance imaging; OR, odds ratio; PET, positron emission tomography; RECIST, Response Evaluation Criteria In Solid Tumors; TNF-a, tumor-necrosis factor-α; WHO, World Health Organization.
- HMGB1
- cancer
- immunotherapy
- oncolytic adenovirus
- predictive markers
- prognostic markers
- tumor biomarkers
Collapse
Affiliation(s)
- Ilkka Liikanen
- Transplantation laboratory; Cancer Gene Therapy Group (CGTG); Haartman Institute; University of Helsinki ; Helsinki, Finland
| | - Anniina Koski
- Transplantation laboratory; Cancer Gene Therapy Group (CGTG); Haartman Institute; University of Helsinki ; Helsinki, Finland
| | - Maiju Merisalo-Soikkeli
- Transplantation laboratory; Cancer Gene Therapy Group (CGTG); Haartman Institute; University of Helsinki ; Helsinki, Finland
| | - Otto Hemminki
- Transplantation laboratory; Cancer Gene Therapy Group (CGTG); Haartman Institute; University of Helsinki ; Helsinki, Finland
| | - Minna Oksanen
- Transplantation laboratory; Cancer Gene Therapy Group (CGTG); Haartman Institute; University of Helsinki ; Helsinki, Finland
| | | | | | - Anna Kanerva
- Transplantation laboratory; Cancer Gene Therapy Group (CGTG); Haartman Institute; University of Helsinki ; Helsinki, Finland ; Department of Obstetrics and Gynecology; HUCH , Helsinki, Finland
| | - Akseli Hemminki
- Transplantation laboratory; Cancer Gene Therapy Group (CGTG); Haartman Institute; University of Helsinki ; Helsinki, Finland ; TILT Biotherapeutics Ltd. ; Helsinki, Finland
| |
Collapse
|
16
|
Bramante S, Koski A, Kipar A, Diaconu I, Liikanen I, Hemminki O, Vassilev L, Parviainen S, Cerullo V, Pesonen SK, Oksanen M, Heiskanen R, Rouvinen-Lagerström N, Merisalo-Soikkeli M, Hakonen T, Joensuu T, Kanerva A, Pesonen S, Hemminki A. Serotype chimeric oncolytic adenovirus coding for GM-CSF for treatment of sarcoma in rodents and humans. Int J Cancer 2014; 135:720-30. [PMID: 24374597 DOI: 10.1002/ijc.28696] [Citation(s) in RCA: 30] [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: 06/25/2013] [Accepted: 11/13/2013] [Indexed: 12/29/2022]
Abstract
Sarcomas are a relatively rare cancer, but often incurable at the late metastatic stage. Oncolytic immunotherapy has gained attention over the past years, and a wide range of oncolytic viruses have been delivered via intratumoral injection with positive safety and promising efficacy data. Here, we report preclinical and clinical results from treatment of sarcoma with oncolytic adenovirus Ad5/3-D24-GMCSF (CGTG-102). Ad5/3-D24-GMCSF is a serotype chimeric oncolytic adenovirus coding for human granulocyte-macrophage colony-stimulating factor (GM-CSF). The efficacy of Ad5/3-D24-GMCSF was evaluated on a panel of soft-tissue sarcoma (STS) cell lines and in two animal models. Sarcoma specific human data were also collected from the Advanced Therapy Access Program (ATAP), in preparation for further clinical development. Efficacy was seen in both in vitro and in vivo STS models. Fifteen patients with treatment-refractory STS (13/15) or primary bone sarcoma (2/15) were treated in ATAP, and treatments appeared safe and well-tolerated. A total of 12 radiological RECIST response evaluations were performed, and two cases of minor response, six cases of stable disease and four cases of progressive disease were detected in patients progressing prior to virus treatment. Overall, the median survival time post treatment was 170 days. One patient is still alive at 1,459 days post virus treatment. In summary, Ad5/3-D24-GMCSF appears promising for the treatment of advanced STS; a clinical trial for treatment of refractory injectable solid tumors including STS is ongoing.
Collapse
Affiliation(s)
- Simona Bramante
- Cancer Gene Therapy Group Department of Pathology and Transplantation Laboratory, Haartman Institute, University of Helsinki, Helsinki, Finland
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Hemminki O, Immonen R, Närväinen J, Kipar A, Paasonen J, Jokivarsi KT, Yli-Ollila H, Soininen P, Partanen K, Joensuu T, Parvianen S, Pesonen SK, Koski A, Vähä-Koskela M, Cerullo V, Pesonen S, Gröhn OH, Hemminki A. In vivo magnetic resonance imaging and spectroscopy identifies oncolytic adenovirus responders. Int J Cancer 2013; 134:2878-90. [PMID: 24248808 DOI: 10.1002/ijc.28615] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [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: 07/11/2013] [Revised: 09/26/2013] [Accepted: 10/10/2013] [Indexed: 12/20/2022]
Abstract
At present, it is not possible to reliably identify patients who will benefit from oncolytic virus treatments. Conventional modalities such as computed tomography (CT), which measure tumor size, are unreliable owing to inflammation-induced tumor swelling. We hypothesized that magnetic resonance imaging (MRI) and spectroscopy (MRS) might be useful in this regard. However, little previous data exist and neither oncolytic adenovirus nor immunocompetent models have been assessed by MRS. Here, we provide evidence that in T2-weighted MRI a hypointense core area, consistent with coagulative necrosis, develops in immunocompetent Syrian hamster carcinomas that respond to oncolytic adenovirus treatment. The same phenomenon was observed in a neuroblastoma patient while he responded to the treatment. With relapse at a later stage, however, the tumor of this patient became moderately hyperintense. We found that MRS of taurine, choline and unsaturated fatty acids can be useful early indicators of response and provide detailed information about tumor growth and degeneration. In hamsters, calprotectin-positive inflammatory cells (heterophils and macrophages) were found in abundance; particularly surrounding necrotic areas in carcinomas and T cells were significantly increased in sarcomas, when these had been treated with a granulocyte-macrophage colony-stimulating factor-producing virus, suggesting a possible link between oncolysis, necrosis (seen as a hypointense core in MRI) and/or immune response. Our study indicates that both MRI and MRS could be useful in the estimation of oncolytic adenovirus efficacy at early time points after treatment.
Collapse
Affiliation(s)
- O Hemminki
- Cancer Gene Therapy Group Transplantation Laboratory & Haartman Institute, University of Helsinki, Helsinki, Finland
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Koski A, Ahtinen H, Liljenback H, Roivainen A, Koskela A, Oksanen M, Partanen K, Laasonen L, Kairemo K, Joensuu T, Hemminki A. [(18)F]-fluorodeoxyglucose positron emission tomography and computed tomography in response evaluation of oncolytic adenovirus treatments of patients with advanced cancer. Hum Gene Ther 2013; 24:1029-41. [PMID: 24099555 DOI: 10.1089/hum.2013.123] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Computed tomography (CT) is the most commonly used radiological response evaluation method in contemporary oncology. However, it may not be optimally suitable for assessment of oncolytic virus treatments because of paradoxical inflammatory tumor swellings, which result from virus treatments, particularly when viruses are armed with immunostimulatory molecules. Here we investigated the prognostic utility of CT and [(18)F]-fluorodeoxyglucose (FDG) positron emission tomography (PET) in oncolytic virus treatments. We also investigated possible appearance of false-positive FDG signals in FDG-PET imaging of humans and hamsters treated with oncolytic adenoviruses. First, immunocompetent Syrian hamsters were treated with intratumoral adenovirus injections, tumor growth was followed up, and [(18)F]-FDG-uptake was quantitated with small animal PET/CT. Second, we describe a retrospective patient series, essentially 17 individual case reports, of advanced cancer patients treated with oncolytic adenoviruses in the context of an Advanced Therapy Access Program (ATAP) who underwent radiological response evaluation with both contrast-enhanced CT and FDG-PET. Third, we collected a retrospective case series of radiological response and survival data of 182 patients treated with oncolytic adenoviruses in ATAP to evaluate the prognostic reliability of CT and FDG-PET. Overall, responses in CT and FDG-PET correlated well with each other and were equally reliable as prognostic markers for long survival after oncolytic adenovirus treatment. Interestingly, we observed that new FDG-avid lymph nodes appearing in FDG-PET after virus treatments may represent inflammatory responses and therefore should not be interpreted as treatment failure in the absence of other signs or verification of disease progression. We also observed indications that FDG-PET might be more sensitive in detection of responses than tumor size.
Collapse
Affiliation(s)
- Anniina Koski
- 1 Cancer Gene Therapy Group, Department of Pathology and Transplantation Laboratory, Haartman Institute, University of Helsinki , 00290 Helsinki, Finland
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Koski A, Karli E, Kipar A, Escutenaire S, Kanerva A, Hemminki A. Mutation of the fiber shaft heparan sulphate binding site of a 5/3 chimeric adenovirus reduces liver tropism. PLoS One 2013; 8:e60032. [PMID: 23585829 PMCID: PMC3621953 DOI: 10.1371/journal.pone.0060032] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 02/21/2013] [Indexed: 11/18/2022] Open
Abstract
Natural tropism to the liver is a major obstacle in systemic delivery of adenoviruses in cancer gene therapy. Adenovirus binding to soluble coagulation factors and to cellular heparan sulphate proteoglycans via the fiber shaft KKTK domain are suggested to cause liver tropism. Serotype 5 adenovirus constructs with mutated KKTK regions exhibit liver detargeting, but they also transduce tumors less efficiently, possibly due to altered fiber conformation. We constructed Ad5/3lucS*, a 5/3 chimeric adenovirus with a mutated KKTK region. The fiber knob swap was hypothesized to facilitate tumor transduction. This construct was studied with or without additional coagulation factor ablation. Ad5/3lucS* exhibited significantly reduced transduction of human hepatic cells in vitro and mouse livers in vivo. Combination of coagulation factor ablation by warfarinization to Ad5/3lucS* seemed to further enhance liver detargeting. Cancer cell transduction by Ad5/3lucS* was retained in vitro. In vivo, viral particle accumulation in M4A4-LM3 xenograft tumors was comparable to controls, but Ad5/3lucS* transgene expression was nearly abolished. Coagulation factor ablation did not affect tumor transduction. These studies set the stage for further investigations into the effects of the KKTK mutation and coagulation factor ablation in the context of 5/3 serotype chimerism. Of note, the putative disconnect between tumor transduction and transgene expression could prove useful in further understanding of adenovirus biology.
Collapse
Affiliation(s)
- Anniina Koski
- Cancer Gene Therapy Group, Molecular Cancer Biology Program and Transplantation Laboratory and Haartman Institute, University of Helsinki, Helsinki, Finland
| | - Eerika Karli
- Cancer Gene Therapy Group, Molecular Cancer Biology Program and Transplantation Laboratory and Haartman Institute, University of Helsinki, Helsinki, Finland
| | - Anja Kipar
- Finnish Centre for Laboratory Animal Pathology, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
- Veterinary Pathology, School of Veterinary Science and Department of Infection Biology, Institute of Global Health, University of Liverpool, Liverpool, United Kingdom
| | - Sophie Escutenaire
- Cancer Gene Therapy Group, Molecular Cancer Biology Program and Transplantation Laboratory and Haartman Institute, University of Helsinki, Helsinki, Finland
| | - Anna Kanerva
- Cancer Gene Therapy Group, Molecular Cancer Biology Program and Transplantation Laboratory and Haartman Institute, University of Helsinki, Helsinki, Finland
- Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Helsinki, Finland
| | - Akseli Hemminki
- Cancer Gene Therapy Group, Molecular Cancer Biology Program and Transplantation Laboratory and Haartman Institute, University of Helsinki, Helsinki, Finland
| |
Collapse
|
20
|
Kanerva A, Nokisalmi P, Diaconu I, Koski A, Cerullo V, Liikanen I, Tähtinen S, Oksanen M, Heiskanen R, Pesonen S, Joensuu T, Alanko T, Partanen K, Laasonen L, Kairemo K, Pesonen S, Kangasniemi L, Hemminki A. Antiviral and antitumor T-cell immunity in patients treated with GM-CSF-coding oncolytic adenovirus. Clin Cancer Res 2013; 19:2734-44. [PMID: 23493351 DOI: 10.1158/1078-0432.ccr-12-2546] [Citation(s) in RCA: 130] [Impact Index Per Article: 11.8] [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]
Abstract
PURPOSE Multiple injections of oncolytic adenovirus could enhance immunologic response. In the first part of this article, the focus was on immunologic aspects. Sixty patients previously naïve to oncolytic virus and who had white blood cells available were treated. Thirty-nine of 60 were assessed after a single virus administration, whereas 21 of 60 received a "serial treatment" consisting of three injections within 10 weeks. In the second part, we focused on 115 patients treated with a granulocyte macrophage colony-stimulating factor (GM-CSF)-coding capsid chimeric adenovirus, CGTG-102. RESULTS Following serial treatment, both increase and decrease in antitumor T cells in blood were seen more frequently, findings which are compatible with induction of T-cell immunity and trafficking of T cells to tumors, respectively. Safety was good in both groups. In 115 patients treated with CGTG-102 (Ad5/3-D24-GMCSF), median overall survival was 111 days following single and 277 days after serial treatment in nonrandomized comparison. Switching the virus capsid for avoiding neutralizing antibodies in a serial treatment featuring three different viruses did not impact safety or efficacy. A correlation between antiviral and antitumor T cells was seen (P = 0.001), suggesting that viral oncolysis can result in epitope spreading and breaking of tumor-associated immunologic tolerance. Alternatively, some patients may be more susceptible to induction of T-cell immunity and/or trafficking. CONCLUSIONS These results provide the first human data linking antiviral immunity with antitumor immunity, implying that oncolytic viruses could have an important role in cancer immunotherapy.
Collapse
Affiliation(s)
- Anna Kanerva
- Cancer Gene Therapy Group, Department of Pathology and Transplantation Laboratory, Haartman Institute, University of Helsinki, Helsinki, Finland
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Cerullo V, Koski A, Vähä-Koskela M, Hemminki A. Chapter eight--Oncolytic adenoviruses for cancer immunotherapy: data from mice, hamsters, and humans. Adv Cancer Res 2013; 115:265-318. [PMID: 23021247 DOI: 10.1016/b978-0-12-398342-8.00008-2] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Adenovirus is one of the most commonly used vectors for gene therapy and two products have already been approved for treatment of cancer in China (Gendicine(R) and Oncorine(R)). An intriguing aspect of oncolytic adenoviruses is that by their very nature they potently stimulate multiple arms of the immune system. Thus, combined tumor killing via oncolysis and inherent immunostimulatory properties in fact make these viruses in situ tumor vaccines. When further engineered to express cytokines, chemokines, tumor-associated antigens, or other immunomodulatory elements, they have been shown in various preclinical models to induce antigen-specific effector and memory responses, resulting both in full therapeutic cures and even induction of life-long tumor immunity. Here, we review the state of the art of oncolytic adenovirus, in the context of their capability to stimulate innate and adaptive arms of the immune system and finally how we can modify these viruses to direct the immune response toward cancer.
Collapse
Affiliation(s)
- Vincenzo Cerullo
- Laboratory of Immunovirotherapy, Division of Biopharmaceutics and Pharmacokinetics, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland.
| | | | | | | |
Collapse
|
22
|
Von Euler M, Kanerva A, Nokisalmi P, Koski A, Diaconu I, Cerullo V, Joensuu TK, Oksanen M, Pesonen S, Kangasniemi L, Ranki T, Heiskanen R, Hemminki A. CGTG-102 (Ad5/3-D24-GMCSF), a novel oncolytic adenovirus, in patients with refractory solid tumors: Experience from an advanced therapy access program. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.e13035] [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: 11/20/2022] Open
Abstract
e13035 Background: Following preclinical testing CGTG-102, a 5/3 chimeric oncolytic adenovirus armed with human GMCSF, has been used to treat 115 refractory cancer patients. Methods: Eligibility criteria included refractory advanced solid tumors, no major organ deficiencies and written informed consent. Patients were treated with either a single treatment or serial treatments with one or more viruses. Intra tumoral administration was performed under ultrasound guidance. The initial dose, 8 x 1010 Viral Particles (VP), was based on published safety results and preclinical testing and escalated in later patients. A routinely tolerated dose of 3 x 1011 VP was deemed optimal and is the target dose for clinical development. To reduce regulatory T-cells, low-dose cyclophosphamide 50 mg/day was given. Adverse Reactions (AR) were scored according to CTCAE 3.0. Imaging was done by CT before and ~2 months after treatment. Response was scored according to RECIST 1.1, including injected and non-injected lesions. Decrease not fulfilling PR was scored as minor response (MR). Results: The most common ARs were pain (82%), fever (81%), fatigue (79%), nausea (54%) and hemoglobin decrease (48%). Pain is mostly tumor pain or pain in the injected tumor, which may be causally related to the MOA of the therapy. Most ARs were G1 or G2; 6 were G4: 2 Hb decrease, 2 pulmonary embolism and single reports of thrombocytopenia and pericardial effusion, most probably due to the underlying disease.Imaging was performed when clinically useful. 65/115 are evaluable by imaging: 3% PR, 11% MR, 40% SD and 46% PD. Best results were obtained in Breast Cancer, Melanoma, Soft Tissue Sarcoma, Mesothelioma and Ovarian Cancer. Median survival in this heavily pre-treated refractory population is 164d, 95% CI 122d – 206d. Mean survival is 281d reflecting that approx. 30% survive more than 300d and 15% up to 600d. A wide range of samples are being analyzed to further characterize the viral and immunological aspects of the therapy. Conclusions: CGTG-102 is a novel oncolytic adenovirus with good safety profile and encouraging signs of efficacy. Formal clinical studies are underway in several tumor types in both US and EU.
Collapse
Affiliation(s)
| | - Anna Kanerva
- Cancer Gene Therapy Group, Helsinki University Central Hospital, Helsinki, Finland
| | - Petri Nokisalmi
- Cancer Gene Therapy Group, Helsinki University Central Hospital, Helsinki, Finland
| | - Anniina Koski
- Cancer Gene Therapy Group, Helsinki University Central Hospital, Helsinki, Finland
| | - Iulia Diaconu
- Cancer Gene Therapy Group, Helsinki University Central Hospital, Helsinki, Finland
| | - Vincenzo Cerullo
- Cancer Gene Therapy Group, Helsinki University Central Hospital, Helsinki, Finland
| | | | - Minna Oksanen
- Cancer Gene Therapy Group, Helsinki University Central Hospital, Helsinki, Finland
| | - Sari Pesonen
- Cancer Gene Therapy Group, Helsinki University Central Hospital, Helsinki, Finland
| | | | | | | | - Akseli Hemminki
- Cancer Gene Therapy Group, Helsinki University Central Hospital, Helsinki, Finland
| |
Collapse
|
23
|
Kangasniemi L, Parviainen S, Pisto T, Koskinen M, Jokinen M, Kiviluoto T, Cerullo V, Jalonen H, Koski A, Kangasniemi A, Kanerva A, Pesonen S, Hemminki A. Effects of capsid-modified oncolytic adenoviruses and their combinations with gemcitabine or silica gel on pancreatic cancer. Int J Cancer 2011; 131:253-63. [PMID: 21834073 DOI: 10.1002/ijc.26370] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Accepted: 07/18/2011] [Indexed: 12/25/2022]
Abstract
Conventional cancer treatments often have little impact on the course of advanced pancreatic cancer. Although cancer gene therapy with adenoviruses is a promising developmental approach, the primary receptor is poorly expressed in pancreatic cancers which might compromise efficacy and thus targeting to other receptors could be beneficial. Extended stealth delivery, combination with standard chemotherapy or circumvention of host antiadenoviral immune response might improve efficacy further. In this work, capsid-modified adenoviruses were studied for transduction of cell lines and clinical normal and tumor tissue samples. The respective oncolytic viruses were tested for oncolytic activity in vitro and in vivo. Survival was studied in a peritoneally disseminated pancreas cancer model, with or without concurrent gemcitabine while silica implants were utilized for extended intraperitoneal virus delivery. Immunocompetent mice and Syrian hamsters were used to study the effect of silica mediated delivery on antiviral immune responses and subsequent in vivo gene delivery. Capsid modifications selectively enhanced gene transfer to malignant pancreatic cancer cell lines and clinical samples. The respective oncolytic viruses resulted in increased cell killing in vitro, which translated into a survival benefit in mice. Early proinfammatory cytokine responses and formation of antiviral neutralizing antibodies was partially avoided with silica implants. The implant also shielded the virus from pre-existing neutralizing antibodies, while increasing the pancreas/liver gene delivery ratio six-fold. In conclusion, capsid modified adenoviruses would be useful for testing in pancreatic cancer trials. Silica implants might increase the safety and efficacy of the approach.
Collapse
Affiliation(s)
- Lotta Kangasniemi
- Cancer Gene Therapy Group, Molecular Cancer Biology Program, Transplantation Laboratory, Haartman Institute and Finnish Institute of Molecular Medicine, University of Helsinki, Finland
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Hemminki A, Kangasniemi L, Ranki T, Pesonen S, Koski A, Escutenaire S, Diaconu I, Joensuu T, von Euler M, Cerullo V. 1109 POSTER Personalized Cancer Immunotherapy With Oncolytic Adenoviruses Armed With Immunostimulatory Molecules GMCSF or CD40L. Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)70752-3] [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: 10/17/2022]
|
25
|
Cerullo V, Diaconu I, Kangasniemi L, Rajecki M, Escutenaire S, Koski A, Romano V, Rouvinen N, Tuuminen T, Laasonen L, Partanen K, Kauppinen S, Joensuu T, Oksanen M, Holm SL, Haavisto E, Karioja-Kallio A, Kanerva A, Pesonen S, Arstila PT, Hemminki A. Immunological effects of low-dose cyclophosphamide in cancer patients treated with oncolytic adenovirus. Mol Ther 2011; 19:1737-46. [PMID: 21673660 DOI: 10.1038/mt.2011.113] [Citation(s) in RCA: 127] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Patients with advanced solid tumors refractory to and progressing after conventional therapies were treated with three different regimens of low-dose cyclophosphamide (CP) in combination with oncolytic adenovirus. CP was given with oral metronomic dosing (50 mg/day, N = 21), intravenously (single 1,000 mg dose, N = 7) or both (N = 7). Virus was injected intratumorally. Controls (N = 8) received virus without CP. Treatments were well tolerated and safe regardless of schedule. Antibody formation and virus replication were not affected by CP. Metronomic CP (oral and oral + intravenous schedules) decreased regulatory T cells (T(regs)) without compromising induction of antitumor or antiviral T-cell responses. Oncolytic adenovirus given together with metronomic CP increased cytotoxic T cells and induced Th1 type immunity on a systemic level in most patients. All CP regimens resulted in higher rates of disease control than virus only (all P < 0.0001) and the best progression-free (PFS) and overall survival (OS) was seen in the oral + intravenous group. One year PFS and OS were 53 and 42% (P = 0.0016 and P < 0.02 versus virus only), respectively, both which are unusually high for chemotherapy refractory patients. We conclude that low-dose CP results in immunological effects appealing for oncolytic virotherapy. While these first-in-human data suggest good safety, intriguing efficacy and extended survival, the results should be confirmed in a randomized trial.
Collapse
Affiliation(s)
- Vincenzo Cerullo
- Cancer Gene Therapy Group, Transplantation Laboratory, Haartman Institute and Finnish Institute of Molecular Medicine, University of Helsinki, Helsinki, Finland
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Hemminki O, Bauerschmitz G, Hemmi S, Lavilla-Alonso S, Diaconu I, Guse K, Koski A, Desmond RA, Lappalainen M, Kanerva A, Cerullo V, Pesonen S, Hemminki A. Oncolytic adenovirus based on serotype 3. Cancer Gene Ther 2010; 18:288-96. [PMID: 21183947 DOI: 10.1038/cgt.2010.79] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Oncolytic adenoviruses have been safe in clinical trials but the efficacy has been mostly limited. All published trials have been performed with serotype 5 based viruses. The expression level of the Ad5 receptor CAR may be variable in advanced tumors. In contrast, the Ad3 receptor remains unclear, but is known to be abundantly expressed in most tumors. Therefore, we hypothesized that a fully serotype 3 oncolytic adenovirus might be useful for treating cancer. Patients exposed to adenoviruses develop high titers of serotype-specific neutralizing antibodies, which might compromise re-administration. Thus, having different serotype oncolytic viruses available might facilitate repeated dosing in humans. Ad3-hTERT-E1A is a fully serotype 3 oncolytic adenovirus controlled by the promoter of the catalytic domain of human telomerase. It was effective in vitro on cell lines representing seven major cancer types, although low toxicity was seen in non-malignant cells. In vivo, the virus had anti-tumor efficacy in three different animal models. Although in vitro oncolysis mediated by Ad3-hTERT-E1A and wild-type Ad3 occurred more slowly than with Ad5 or Ad5/3 (Ad3 fiber knob in Ad5) based viruses, in vivo the virus was at least as potent as controls. Anti-tumor efficacy was retained in presence of neutralizing anti-Ad5 antibodies whereas Ad5 based controls were blocked. In summary, we report generation of a non-Ad5 based oncolytic adenovirus, which might be useful for testing in cancer patients, especially in the context of high anti-Ad5 neutralizing antibodies.
Collapse
Affiliation(s)
- O Hemminki
- Cancer Gene Therapy Group, Molecular Cancer Biology Program and Haartman Institute and Transplantation Laboratory and Finnish Institute for Molecular Medicine, University of Helsinki, Helsinki, Finland
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Hyder N, Wong FP, Koski A, Tisserat N, Stowell L. First Report of Rapid Blight Caused by Labyrinthula terrestris on Poa annua in Colorado. Plant Dis 2010; 94:919. [PMID: 30743572 DOI: 10.1094/pdis-94-7-0919b] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
A disease characteristic of rapid blight caused by the net slime mold, Labyrinthula terrestris (1,2), was observed on three annual bluegrass (Poa annua) putting greens from a golf course in Adams County, Colorado in April 2009. Symptoms included water-soaked lesions and browning and bronzing of leaves. With microscopic observation, the fusiform cells typically associated with Labyrinthula spp. (1) were detected inside symptomatic leaf tissue. The pathogen was isolated by placing symptomatic leaves on a selective medium modified from Bigelow et al. (1) (12 g of granulated agar [Fisher Scientific, Pittsburg, PA], 10 ml of horse serum [Hema Resource and Supply, Aurora, OR], and 250 μg of ampicillin, streptomycin sulfate, and penicillin G [Sigma, St. Louis, MO] in artificial seawater at 4.0 dS/m electrical conductivity [Instant Ocean, Atlanta, GA]). Irregular-shaped digitate colonies of fusiform cells developed within 1 to 2 days. The isolated organism was then used to fulfill Koch's postulates on 2-week-old Poa trivialis 'Sabre III' seedlings and 4-week-old Poa annua seedlings planted in a 90:10 peat moss/sand mixture in 6-cm-diameter pots. Plants were inoculated with a 9 × 106 cells/ml suspension of L. terrestris cells in artificial seawater (4.0 dS/m) as described by Peterson et al. (2) and irrigated daily with artificial seawater (4.0 dS/m). Negative controls consisted of either P. trivialis or P. annua plants irrigated with artificial seawater only. There were three replications for each treatment and the experiment was repeated for each grass species. Pots were maintained at 28 to 33°C in the greenhouse with ambient light. Within 8 to 10 days of inoculation, 95% of the plants showed symptoms of severe rapid blight, while noninoculated plants showed some minor salt stress symptoms but were otherwise healthy. The organism was successfully reisolated from several plants from each replication using the method described above. Results were the same for all experiments. Rapid blight is frequently associated with high soil salinity (>2.5 dS/m total dissolved salts) (1) and sodium levels above 110 mg/kg (Mehlich-3 extraction) in diagnostic samples. Soil salinity levels from the site affected by the disease were below this guideline. However, sodium levels measured an average of 184 mg/kg. The ability of this pathogen to cause disease on plants growing in soils not measuring high in salinity, and only with elevated sodium, should be considered when attempting to ascertain rapid blight as a cause of turf damage. References: (1) D. M. Bigelow et al. Mycologia 97:185, 2005. (2) P. D. Peterson et al. Online publication. doi:10.1094/ATS-2005-0328-01-RS. Applied Turfgrass Science, 2005.
Collapse
Affiliation(s)
- N Hyder
- University of California, Riverside 92521
| | - F P Wong
- University of California, Riverside 92521
| | - A Koski
- Colorado State University, Fort Collins 80523
| | - N Tisserat
- Colorado State University, Fort Collins 80523
| | | |
Collapse
|
28
|
Hemminki A, Pesonen S, Koski A, Cerullo V, Escutenaire S, Haavisto E, Kangasniemi L, Simula P, Joensuu TK. Safety and efficacy of Ad5/3-D24-GMCSF, a serotype 5/3 chimeric oncolytic adenovirus expressing granulocyte macrophage colony-stimulating factor (GM-CSF), in treatment of metastatic and refractory solid tumors. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e13506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
29
|
Koski A, Rajecki M, Guse K, Kanerva A, Ristimäki A, Pesonen S, Escutenaire S, Hemminki A. Systemic adenoviral gene delivery to orthotopic murine breast tumors with ablation of coagulation factors, thrombocytes and Kupffer cells. J Gene Med 2010; 11:966-77. [PMID: 19670332 DOI: 10.1002/jgm.1373] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Rapid clearance of adenoviruses from blood by macrophage lineage cells of the liver and spleen, and binding to platelets, hinder their successful systemic use for cancer gene therapy. Vitamin K dependent coagulation factors are important mediators for the adenovirus liver tropism. Here we aim to determine the effects of coagulation factor, thrombocyte and liver macrophage (Kupffer cell) ablation on biodistribution of serotype 5 adenoviruses in mice with orthotopic breast tumors. METHODS Prior to intravenous injection of adenoviruses, mice bearing orthotopic breast tumors were pretreated with warfarin to inhibit vitamin K dependent coagulation factor synthesis, an anti-platelet antibody causing thrombocytopenia or an inhibitor of the Kupffer cell scavenger receptor or their combination. Virus availability in blood after injection was determined from blood samples and transgene expression in tissues analyzed 72 hours afterwards with In Vivo Imaging and luciferase assays. RESULTS Warfarin pretreatment reduced gene delivery to liver, spleen and lung. Kupffer cell ablation increased persistence of adenoviruses in blood but didn't affect biodistribution significantly. Depletion of Kupffer cells combined with thrombocytopenia doubled the systemic gene delivery of 5/3 chimeric adenovirus to tumors (p < 0.05). Triple ablation of platelets, Kupffer cells and coagulation factors increased the tumor to liver ratio of systemic adenovirus gene delivery by 81% (p < 0.05). CONCLUSIONS Depletion of coagulation factors can reduce transduction of liver, spleen and lung. Kupffer cell depletion is the most feasible method of increasing amount adenovirus in systemic blood flow and in combination with ablation of thrombocytes can increase the transduction of adenovirus to tumors.
Collapse
Affiliation(s)
- Anniina Koski
- Cancer Gene Therapy Group, Molecular Cancer Biology Program and Transplantation Laboratory, Haartman Institute, University of Helsinki, Finland
| | | | | | | | | | | | | | | |
Collapse
|
30
|
Kortejärvi H, Shawahna R, Koski A, Malkki J, Ojala K, Yliperttula M. Very rapid dissolution is not needed to guarantee bioequivalence for biopharmaceutics classification system (BCS) I drugs. J Pharm Sci 2010; 99:621-5. [DOI: 10.1002/jps.21879] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
31
|
Bem RA, Farnand AW, Wong V, Koski A, Rosenfeld ME, van Rooijen N, Frevert CW, Martin TR, Matute-Bello G. Depletion of resident alveolar macrophages does not prevent Fas-mediated lung injury in mice. Am J Physiol Lung Cell Mol Physiol 2008; 295:L314-25. [PMID: 18556802 DOI: 10.1152/ajplung.00210.2007] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Activation of the Fas/Fas ligand (FasL) system in the lungs results in a form of injury characterized by alveolar epithelial apoptosis and neutrophilic inflammation. Studies in vitro show that Fas activation induces apoptosis in alveolar epithelial cells and cytokine production in alveolar macrophages. The main goal of this study was to determine the contribution of alveolar macrophages to Fas-induced lung inflammation in mice, by depleting alveolar macrophages using clodronate-containing liposomes. Liposomes containing clodronate or PBS were instilled by intratracheal instillation. After 24 h, the mice received intratracheal instillations of the Fas-activating monoclonal antibody Jo2 or an isotype control antibody and were studied 18 h later. The Jo2 MAb induced increases in bronchoalveolar lavage fluid (BALF) total neutrophils, lung caspase-3 activity, and BALF total protein and worsened histological lung injury in the macrophage-depleted mice. Studies in vitro showed that Fas activation induced the release of the cytokine KC in a mouse lung epithelial cell line, MLE-12. These results suggest that the lung inflammatory response to Fas activation is not primarily dependent on resident alveolar macrophages and may instead depend on cytokine release by alveolar epithelial cells.
Collapse
Affiliation(s)
- R A Bem
- Research Service of the Veterans Affairs Puget Sound Health Care System, University of Washington, Seattle, Washington, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Koskela RS, Sorsa JA, Koski A, Mutanen P, Gibbs GW, Yu ITS, Tse LA, de Vocht F, Burstyn I, Ferro G, Olsson A, Hashibe M, Kromhout H, Boffetta P, Olsson AC, Fevotte J, Mannetje AT, Fletcher T, Zaridze D, Szeszenia-Dabrowska N, Rudnai P, Lissowska J, Fabianova E, Cassidy A, Mates D, Bencko V, Foretova L, Janout V, Brennan P, Boffetta P, Schubauer-Berigan MK, Deddens JA, Steenland K, Sanderson WT, Petersen MR. Cancer 2. Occup Environ Med 2007. [DOI: 10.1136/oem.64.12.e19] [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: 11/04/2022]
|
33
|
Chen Y, Aguirre AD, Hsiung PL, Desai S, Herz PR, Pedrosa M, Huang Q, Figueiredo M, Huang SW, Koski A, Schmitt JM, Fujimoto JG, Mashimo H. Ultrahigh resolution optical coherence tomography of Barrett's esophagus: preliminary descriptive clinical study correlating images with histology. Endoscopy 2007; 39:599-605. [PMID: 17611914 DOI: 10.1055/s-2007-966648] [Citation(s) in RCA: 138] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND STUDY AIMS Endoscopic ultrahigh resolution optical coherence tomography (UHR OCT) achieves an axial image resolution of approximately 5 microm, which is 2 - 3 times finer than standard endoscopic OCT imaging. This study investigated the capability of endoscopic UHR OCT for imaging patients with Barrett's esophagus. PATIENTS AND METHODS Fivty volunteers previously diagnosed with Barrett's esophagus underwent UHR OCT. Imaging was performed at 1.3 microm wavelengths with approximately 5 microm axial and approximately 15 microm transverse resolutions using a 1.8 mm/diameter linear-scanning catheter introduced through the accessory channel of a standard endoscope. OCT images were compared with endoscopic diagnosis and pinch biopsy histological appearances. RESULTS UHR OCT images of normal esophagus, Barrett's esophagus, high grade dysplasia and esophageal adenocarcinoma were evaluated. UHR OCT images of the normal esophagus exhibited characteristic layered architecture with uniform epithelium, while images of Barrett's esophagus corresponded to crypt-like glandular structures. High grade dysplasia and esophageal adenocarcinoma images exhibited more heterogeneous structures corresponding to irregular, heterogeneous tissue morphology from distorted and cribriform or villiform glandular architecture. Fine features can be discerned more clearly with endoscopic UHR OCT. CONCLUSIONS This study evaluated new endoscopic OCT technology and demonstrated the feasibility of carrying out UHR OCT imaging in conjunction with standard endoscopy for in vivo real-time imaging of Barrett's esophagus, dysplasia, and esophageal adenocarcinoma. A survey of normal and abnormal upper gastrointestinal tissues was performed using a research prototype OCT system with the highest axial resolution to date, and can serve as a baseline for future investigation.
Collapse
Affiliation(s)
- Y Chen
- Department of Electrical Engineering and Computer Science and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Koski A, Vuori E, Ojanperä I. Relation of postmortem blood alcohol and drug concentrations in fatal poisonings involving amitriptyline, propoxyphene and promazine. Hum Exp Toxicol 2005; 24:389-96. [PMID: 16138729 DOI: 10.1191/0960327105ht542oa] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Drugs and alcohol often occur together in fatal poisonings, complicating the process of determining the cause of death. Especially when found in concentrations generally regarded as toxic but not lethal, the question arises whether the combination of sublethal amounts was the likely cause of death. In this study, we examined poisoning deaths involving amitriptyline, propoxyphene and promazine, which are, after benzodiazepines, the most frequently occurring drugs in Finnish alcohol-related poisonings. From the forensic toxicology database, covering the years 1995-2002, we extracted 332 fatal poisonings, calculated median blood alcohol and drug concentrations, constructed concentration-concentration and concentration-response curves and evaluated the significance of the presence of therapeutic amounts of benzodiazepines. Median amitriptyline and propoxyphene concentrations were lower in alcohol-related cases than in clean drug poisonings. Correspondingly, the median blood alcohol concentrations in all drug-related poisonings were 1.5-2.2 mg/g lower than that found in clean alcohol poisonings. Alcohol concentration proved to be a more sensitive indicator of alcohol-drug interaction than drug concentration. This result suggests that when alcohol is present, relatively small overdoses of the studied drugs may result in fatal poisoning. In this context, fatal drug and alcohol concentrations and the issue of determining the most important agent in fatal drug-alcohol intoxications are discussed.
Collapse
Affiliation(s)
- A Koski
- Department of Forensic Medicine, Laboratory of Toxicology, University of Helsinki, Finland.
| | | | | |
Collapse
|
35
|
Lang J, Tisserat N, Koski A, Christensen D, Qian Y. First Report of Brown Stripe of Saltgrass Caused by Bipolaris heveae in Colorado. Plant Dis 2005; 89:913. [PMID: 30786540 DOI: 10.1094/pd-89-0913a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Inland saltgrass (Distichlis spicata var. stricta (L.) Greene) is indigenous to western North America and Australia and is a dioecious, rhizomatous, perennial, warm-season grass. It is commonly found in areas where salinity, alkalinity, and drought have eliminated many other types of vegetation (1). It has potential for revegetation of mine spoils or use along roadsides (2). During September 2004, multiple lenticular, brown lesions were observed on leaves of saltgrass accession no. 1023 at the Horticulture Field Research Center, Colorado State University, Fort Collins. Segments of symptomatic leaf tissue were surface sterilized in 0.5% sodium hypochlorite and placed on one-quarter-strength potato dextrose agar and incubated at 25°C in the dark. Dark green fungal colonies with aerial mycelium consistently grew on the medium. Slightly curved, ellipsoidal, pale-to-golden brown, smooth conidia 46 to 80 μm long and 13 to 17 μm wide (average 64.5 × 14.7 μm) with 6 to 9 septations formed after 7 days in cultures grown on V8 juice agar. The morphology and bipolar germination of conidia was consistent with the genus Bipolaris, however, conidia were often shorter than previously reported (3). The rDNA internal transcribed spacer (ITS) regions of one isolate were amplified using polymerase chain reaction (PCR) with universal fungal rDNA primers ITS1 and ITS4. PCR products were sequenced (555 bp) and exhibited 99% nucleotide identity to Bipolaris heveae isolates collected from zoysiagrass and bermudagrass in Japan (3) and rubber in Nigeria (4). To confirm pathogenicity, a suspension of 104 conidia per ml of water containing 0.1% Tween 20 was sprayed on saltgrass leaves to runoff. Plants were covered with transparent plastic bags and incubated at 25°C in the dark. After 72 h, the bags were removed and plants were placed in the greenhouse. Brown stripe symptoms were observed on all plants after 7 days, and B. heveae was consistently isolated from symptomatic tissue. To our knowledge, this is the first report of brown stripe on inland saltgrass caused by B. heveae. References: (1) D. J. Hansen et al. Am. J. Bot. 63:635, 1976. (2) K. A. Pavlicek et al. J. Range Manag. 30:377, 1977. (3) T. Tsukiboshi et al. Mycoscience 46:17, 2005. (4) G. Zhang and M. L. Berbee. Mycologia 93:1048, 2001.
Collapse
Affiliation(s)
- J Lang
- Department of Bioagricultural Sciences and Pest Management, Colorado State University, Fort Collins 80523
| | - N Tisserat
- Department of Bioagricultural Sciences and Pest Management, Colorado State University, Fort Collins 80523
| | - A Koski
- Department of Horticulture and Landscape Architecture, Colorado State University, Fort Collins 80523
| | - D Christensen
- Department of Horticulture and Landscape Architecture, Colorado State University, Fort Collins 80523
| | - Y Qian
- Department of Horticulture and Landscape Architecture, Colorado State University, Fort Collins 80523
| |
Collapse
|
36
|
Tossavainen T, Juhola M, Koski A. Lossless compression of eye movement signals. Stud Health Technol Inform 2000; 68:369-73. [PMID: 10724908] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
Compression of digital signals is widely employed in several areas such as speech signals. Concerning biomedical signals almost merely ECG signals have so far been compressed, in fact, in very many applications. To our knowledge, this compression study is the first one presented in the case of eye movement signal which are investigated in several medical specialties. In this study eye movements are electro-oculographically recorded. Tests performed to signals of patients of an equilibrium laboratory gave compression ratios generated with essential lossless compression methods.
Collapse
Affiliation(s)
- T Tossavainen
- Department of Computer Science, University of Tampere, Finland
| | | | | |
Collapse
|
37
|
Abstract
We identify objects from their visually observable morphological features. Automatic methods for identifying living objects are often needed in new technology, and these methods try to utilize shapes. When it comes to identifying plant species automatically, machine vision is difficult to implement because the shapes of different plants overlap and vary greatly because of different viewing angles in field conditions. In the present study we show that chlorophyll a fluorescence, emitted by plant leaves, carries information that can be used for the identification of plant species. Transient changes in fluorescence intensity when a light is turned on were parameterized and then subjected to a variety of pattern recognition procedures. A Self-Organizing Map constructed from the fluorescence signals was found to group the signals according to the phylogenetic origins of the plants. We then used three different methods of pattern recognition, of which the Bayesian Minimum Distance classifier is a parametric technique, whereas the Multilayer Perceptron neural network and k-Nearest Neighbor techniques are nonparametric. Of these techniques, the neural network turned out to be the most powerful one for identifying individual species or groups of species from their fluorescence transients. The excellent recognition accuracy, generally over 95%, allows us to speculate that the method can be further developed into an application in precision agriculture as a means of automatically identifying plant species in the field.
Collapse
Affiliation(s)
- E Tyystjärvi
- University of Turku, Department of Biology, Laboratory of Plant Physiology, BioCity A, Finland.
| | | | | | | |
Collapse
|
38
|
Abstract
We have studied the lossless encoding of ECG signals. With suitable code we aim to reduce the storage space needed by ECG signals. Several methods designed for ECG compression use lossy, i.e. irreversible techniques, in which the original signal is lost, but the restored approximation is almost equal to the original. We aimed, however, to use reversible methods which are able to restore the original signal exactly. We have examined various methods and developed a new approach based on structural recognition and extraction of ECG complexes. Comparative conclusions are drawn from the compression efficiency of lossless and lossy methods. In this study, the effect of sampling frequency, resolution and filtering is also examined.
Collapse
Affiliation(s)
- A Koski
- Department of Computer Science, University of Turku, Finland.
| |
Collapse
|
39
|
Abstract
In this paper, we have studied the use of continuous probability density function hidden Markov models for the ECG signal analysis problem. Our previous work has focused on syntactic pattern recognition methods in signal processing. Hidden Markov model is basically a non-deterministic probabilistic finite state machine, which can be constructed inductively. It has been widely used in speech recognition and DNA modelling. We have found that hidden Markov models are very suitable for ECG recognition and analysis problems and that they are able to model accurately segmented ECG signals.
Collapse
Affiliation(s)
- A Koski
- Department of Computer Science, University of Turku, Finland.
| |
Collapse
|
40
|
Abstract
We have studied the problem of approximating a digital signal with a suitable continuous broken line. We use the approximative broken line for further analysis of the signal as detection of peaks, waves, and other structural features. We can also save considerable amount of storage space with an approximation that does not lose too much significant information about the original signal. Our work is based on examining different distance metrics and different segmentation methods with respect to the remaining residual error in the resulting approximation. The aim of the work has been to develop a method that can perform segmentation with an acceptable amount of residual error without a need to define a large set of parameters that control the segmentation process. Our contribution is to examine the effect of the estimated compression ratio of the resulting approximation and finding an estimate of this compression ratio. We first define a target in the form of a compression ratio of the resulting approximation and then by applying our method, try to find a suitable threshold parameter to achieve this target. We have tested our method with electrocardiogram (ECG) signals and the compression ratio of the approximation has been found to be a suitable target to control the segmentation process.
Collapse
Affiliation(s)
- A Koski
- Department of Computer Science, University of Turku, Finland.
| | | |
Collapse
|
41
|
Abstract
A significant problem exists in predicting normal values for pulmonary function in subjects unable to stand for measurement of height. We studied 196 normal men and women to determine the relationship between sitting and standing height. Two predictors of standing height are recommended: (1) standing-to-sitting height ratio; and (2) multiple regression equations using sitting height and age. Either of these relationships can be selected as a predictor of height for substitution into any standard spirometric prediction equations. Spirometric prediction equations using age and sitting height are also presented.
Collapse
Affiliation(s)
- W P Temple
- Pulmonary Disease Section, Veterans Administration Medical Center, Portland, OR 97207
| | | | | |
Collapse
|
42
|
Abstract
The 1969 Oregon spirometric predictive equations were evaluated by retesting 199 of the 988 original sample population after 15 years. The 1969 data were used to test for sample bias between the retested and not-retested groups. There was no significant difference in mean values for age, height, or test results except for a five-year age difference in men. Regression analysis of residuals and the differences between calculated and predicted values of annual decrements of FVC, FEV1, and FEF25-75% on age revealed no statistically significant age trend. Although residual means were statistically significant for FVC and FEV1 for men and FVC and FEF25-75% for women, the differences between calculated and predicted annual decrements were significant only for women in FEF25-75%. Although group performance was accurately predicted for most tests, test SDs and SEMs demonstrated considerable individual variation. Lower limits of normality are suggested to assist in evaluating previously-tested patients.
Collapse
Affiliation(s)
- J F Morris
- Pulmonary Disease Section, Veterans Administration Medical Center, Portland, Oregon 97207
| | | | | | | | | |
Collapse
|
43
|
Morris JF, Temple WP, Koski A. Normal values for the ratio of one-second forced expiratory volume to forced vital capacity. Am Rev Respir Dis 1973; 108:1000-3. [PMID: 4741868 DOI: 10.1164/arrd.1973.108.4.1000] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
|
44
|
Cauffman J, Beegle DA, Hawes RM, Koski A, Mackellar L. Outcomes of a reality therapy workshop. Sch Health Rev 1971; 2:2-4. [PMID: 5206305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
|
45
|
|