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Razmara AM, Farley LE, Harris RM, Judge SJ, Lammers M, Iranpur KR, Johnson EG, Dunai C, Murphy WJ, Brown CT, Rebhun RB, Kent MS, Canter RJ. Preclinical evaluation and first-in-dog clinical trials of PBMC-expanded natural killer cells for adoptive immunotherapy in dogs with cancer. J Immunother Cancer 2024; 12:e007963. [PMID: 38631708 PMCID: PMC11029326 DOI: 10.1136/jitc-2023-007963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Natural killer (NK) cells are cytotoxic cells capable of recognizing heterogeneous cancer targets without prior sensitization, making them promising prospects for use in cellular immunotherapy. Companion dogs develop spontaneous cancers in the context of an intact immune system, representing a valid cancer immunotherapy model. Previously, CD5 depletion of peripheral blood mononuclear cells (PBMCs) was used in dogs to isolate a CD5dim-expressing NK subset prior to co-culture with an irradiated feeder line, but this can limit the yield of the final NK product. This study aimed to assess NK activation, expansion, and preliminary clinical activity in first-in-dog clinical trials using a novel system with unmanipulated PBMCs to generate our NK cell product. METHODS Starting populations of CD5-depleted cells and PBMCs from healthy beagle donors were co-cultured for 14 days, phenotype, cytotoxicity, and cytokine secretion were measured, and samples were sequenced using the 3'-Tag-RNA-Seq protocol. Co-cultured human PBMCs and NK-isolated cells were also sequenced for comparative analysis. In addition, two first-in-dog clinical trials were performed in dogs with melanoma and osteosarcoma using autologous and allogeneic NK cells, respectively, to establish safety and proof-of-concept of this manufacturing approach. RESULTS Calculated cell counts, viability, killing, and cytokine secretion were equivalent or higher in expanded NK cells from canine PBMCs versus CD5-depleted cells, and immune phenotyping confirmed a CD3-NKp46+ product from PBMC-expanded cells at day 14. Transcriptomic analysis of expanded cell populations confirmed upregulation of NK activation genes and related pathways, and human NK cells using well-characterized NK markers closely mirrored canine gene expression patterns. Autologous and allogeneic PBMC-derived NK cells were successfully expanded for use in first-in-dog clinical trials, resulting in no serious adverse events and preliminary efficacy data. RNA sequencing of PBMCs from dogs receiving allogeneic NK transfer showed patient-unique gene signatures with NK gene expression trends in response to treatment. CONCLUSIONS Overall, the use of unmanipulated PBMCs appears safe and potentially effective for canine NK immunotherapy with equivalent to superior results to CD5 depletion in NK expansion, activation, and cytotoxicity. Our preclinical and clinical data support further evaluation of this technique as a novel platform for optimizing NK immunotherapy in dogs.
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Affiliation(s)
- Aryana M Razmara
- Department of Surgery, University of California Davis School of Medicine, Sacramento, California, USA
| | - Lauren E Farley
- Department of Surgery, University of California Davis School of Medicine, Sacramento, California, USA
| | - Rayna M Harris
- Department Population Health and Reproduction, University of California Davis School of Veterinary Medicine, Davis, California, USA
| | - Sean J Judge
- Department of Surgery, University of California Davis School of Medicine, Sacramento, California, USA
| | - Marshall Lammers
- Department of Surgery, University of California Davis School of Medicine, Sacramento, California, USA
| | - Khurshid R Iranpur
- Department of Surgery, University of California Davis School of Medicine, Sacramento, California, USA
| | - Eric G Johnson
- Department of Surgical and Radiological Sciences, University of California Davis School of Veterinary Medicine, Davis, California, USA
| | - Cordelia Dunai
- Department of Dermatology, University of California Davis School of Medicine, Sacramento, California, USA
| | - William J Murphy
- Department of Dermatology, University of California Davis School of Medicine, Sacramento, California, USA
| | - C Titus Brown
- Department Population Health and Reproduction, University of California Davis School of Veterinary Medicine, Davis, California, USA
| | - Robert B Rebhun
- Department of Surgical and Radiological Sciences, University of California Davis School of Veterinary Medicine, Davis, California, USA
| | - Michael S Kent
- Department of Surgical and Radiological Sciences, University of California Davis School of Veterinary Medicine, Davis, California, USA
| | - Robert J Canter
- Department of Surgery, University of California Davis School of Medicine, Sacramento, California, USA
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Razmara AM, Gingrich AA, Toedebusch CM, Rebhun RB, Murphy WJ, Kent MS, Canter RJ. Improved characterization and translation of NK cells for canine immunotherapy. Front Vet Sci 2024; 11:1336158. [PMID: 38379924 PMCID: PMC10877038 DOI: 10.3389/fvets.2024.1336158] [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: 11/10/2023] [Accepted: 01/11/2024] [Indexed: 02/22/2024] Open
Abstract
The field of cancer immunology has seen a meteoric rise in interest and application due to the discovery of immunotherapies that target immune cells, often leading to dramatic anti-tumor effects. However, successful cellular immunotherapy for solid tumors remains a challenge, and the application of immunotherapy to dogs with naturally occurring cancers has emerged as a high yield large animal model to bridge the bench-to-bedside challenges of immunotherapies, including those based on natural killer (NK) cells. Here, we review recent developments in the characterization and understanding of canine NK cells, a critical springboard for future translational NK immunotherapy research. The characterization of canine NK cells is exceptionally pertinent given the ongoing challenges in defining them and contextualizing their similarities and differences compared to human and murine NK cells compounded by the limited availability of validated canine specific reagents. Additionally, we summarize the current landscape of the clinical and translational literature employing strategies to capitalize on endogenous and exogenous NK cell immunotherapy in canine cancer patients. The insights regarding efficacy and immune correlates from these trials provide a solid foundation to design and test novel combinational therapies to enhance NK cell activity with the added benefit of motivating comparative work to translate these findings to human cancers with extensive similarities to their canine counterparts. The compilation of knowledge from basic canine NK phenotype and function to applications in first-in-dog clinical trials will support the canine cancer model and enhance translational work to improve cancer outcomes for both dogs and humans.
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Affiliation(s)
- Aryana M. Razmara
- Department of Surgery, University of California Davis School of Medicine, Sacramento, CA, United States
| | - Alicia A. Gingrich
- MD Anderson Cancer Center, University of Texas, Houston, TX, United States
| | - Christine M. Toedebusch
- Center for Companion Animal Health, Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Robert B. Rebhun
- Center for Companion Animal Health, Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - William J. Murphy
- Department of Dermatology, University of California Davis School of Medicine, Sacramento, CA, United States
| | - Michael S. Kent
- Center for Companion Animal Health, Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Robert J. Canter
- Department of Surgery, University of California Davis School of Medicine, Sacramento, CA, United States
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Gingrich AA, Razmara AM, Gingrich PW, Rebhun RB, Murphy WJ, Kent MS, Brown CT, Siegel JB, Canter RJ. Missing a "Missing Self" Mechanism: Modeling and Detection of Ly49 Expression in Canine NK Cells. Immunohorizons 2023; 7:760-770. [PMID: 37971282 PMCID: PMC10696421 DOI: 10.4049/immunohorizons.2300092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 10/24/2023] [Indexed: 11/19/2023] Open
Abstract
NK cells are a key focus in immuno-oncology, based on their ability to eliminate malignant cells without prior sensitization. Dogs are valuable models for translational immunotherapy studies, especially for NK cells, where critical species differences exist between mice and humans. Given that the mechanism for recognition of "self" by canine NK cells is currently unknown, we sought to evaluate expression of Ly49 in canine NK cells using in silico and high-throughput techniques. We interrogated the identified polymorphism/mutation in canine Ly49 and assessed the potential impact on structure using computational modeling of three-dimensional protein structure and protein-protein docking of canine Ly49 with MHC class I (MHC-I). Bulk and single-cell RNA-sequencing analysis was performed to detect gene expression of Ly49/KLRA1 in resting and activated NK cells. Tertiary protein structure demonstrated significant structural similarity to the known murine system. Molecular docking of canine Ly49 with MHC-I was favorable, converging at a single low-energy conformation. RNA sequencing revealed expression of Ly49/KLRA1 in both resting and activated NK cells and demonstrated almost exclusive expression of the gene in the NK cluster at the single-cell level. Despite prior reports of a mutated, nonfunctional canine Ly49, our data support that the protein product is predicted to bind to MHC-I in a comparable conformation to the murine system and is expressed in canine NK cells with upregulation following activation. Taken together, these data suggest that Ly49 is capable of recognizing MHC-I and therefore regulating NK cell function in dogs.
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Affiliation(s)
- Alicia A. Gingrich
- Department of Surgery, University of California, Davis School of Medicine, Sacramento, CA
| | - Aryana M. Razmara
- Department of Surgery, University of California, Davis School of Medicine, Sacramento, CA
| | - Phillip W. Gingrich
- Department of Biochemistry and Molecular Medicine, University of California, Davis School of Medicine, Sacramento, CA
| | - Robert B. Rebhun
- Department of Surgical and Radiological Sciences, University of California, Davis School of Veterinary Medicine, Davis, CA
| | - William J. Murphy
- Department of Dermatology, University of California, Davis School of Medicine, Sacramento, CA
| | - Michael S. Kent
- Department of Surgical and Radiological Sciences, University of California, Davis School of Veterinary Medicine, Davis, CA
| | - C. Titus Brown
- Department of Population Health and Reproduction, University of California, Davis School of Veterinary Medicine, Davis, CA
| | - Justin B. Siegel
- Department of Biochemistry and Molecular Medicine, University of California, Davis School of Medicine, Sacramento, CA
| | - Robert J. Canter
- Department of Surgery, University of California, Davis School of Medicine, Sacramento, CA
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Cruz SM, Sholevar CJ, Judge SJ, Darrow MA, Iranpur KR, Farley LE, Lammers M, Razmara AM, Dunai C, Gingrich AA, Persky J, Mori H, Thorpe SW, Monjazeb AM, Murphy WJ, Canter RJ. Intratumoral NKp46 + natural killer cells are spatially distanced from T and MHC-I + cells with prognostic implications in soft tissue sarcoma. Front Immunol 2023; 14:1230534. [PMID: 37545516 PMCID: PMC10401426 DOI: 10.3389/fimmu.2023.1230534] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 07/04/2023] [Indexed: 08/08/2023] Open
Abstract
Introduction Soft tissue sarcomas (STS) are rare, heterogenous malignancies with an unmet need for novel immunotherapies. Tumor infiltrating lymphocytes (TILs) have been linked with favorable outcomes in STS patients, though the contribution of natural killer (NK) cells and spatial relationships of TILs with MHC-I expressing cells lacks detailed characterization. Experimental design Using archived and prospectively collected specimens, we evaluated intratumoral NK cells by immunohistochemistry (IHC), flow cytometry, and immunofluorescence (IF). We assessed spatial localization of NK and T cells by multiplex IF, analyzing the effects of MHC-I expression status on NK and T cell clustering. Results Both intratumoral NKp46 and CD56dim expression were associated with significantly improved overall survival (P=0.05), while higher infiltrates of CD56bright NK cells predicted a worse prognosis (P=0.05). The presence of intratumoral NK cells was inversely proportional to CD3+ T cells. Spatial analyses showed NK cells preferentially clustering close to other NK cells with sparse CD3+ T and CD8+ T cells in range (P<0.0001). Additionally, CD3+ T and CD8+ T cells showed significantly greater co-localization with MHC-I+ cells, compared to NK cells (P<0.0001). After neoadjuvant radiotherapy, there was greater CD8 clustering, while after neoadjuvant chemotherapy, there was overall lower TIL clustering. Conclusion Intratumoral NK cells are prognostic in STS and localize closer to MHC-I- cells than T cells. Although both NK and T cells are associated with improved survival in STS, their differential distribution in the TME based on MHC-I expression status may serve as a biomarker for improved immunotherapy treatment selection.
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Affiliation(s)
- Sylvia M. Cruz
- Division of Surgical Oncology, Department of Surgery, University of California, Davis, Sacramento, CA, United States
| | - Cyrus J. Sholevar
- Division of Surgical Oncology, Department of Surgery, University of California, Davis, Sacramento, CA, United States
| | - Sean J. Judge
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Morgan A. Darrow
- Pathology and Laboratory Medicine, University of California, Davis, Sacramento, CA, United States
| | - Khurshid R. Iranpur
- Division of Surgical Oncology, Department of Surgery, University of California, Davis, Sacramento, CA, United States
| | - Lauren E. Farley
- Division of Surgical Oncology, Department of Surgery, University of California, Davis, Sacramento, CA, United States
| | - Marshall Lammers
- Division of Surgical Oncology, Department of Surgery, University of California, Davis, Sacramento, CA, United States
| | - Aryana M. Razmara
- Division of Surgical Oncology, Department of Surgery, University of California, Davis, Sacramento, CA, United States
| | - Cordelia Dunai
- Department of Dermatology, University of California, Davis, Sacramento, CA, United States
| | - Alicia A. Gingrich
- Department of Surgical Oncology, MD Anderson Cancer Center, Houston, TX, United States
| | - Julia Persky
- Division of Surgical Oncology, Department of Surgery, University of California, Davis, Sacramento, CA, United States
| | - Hidetoshi Mori
- Center for Immunology and Infectious Diseases, University of California, Davis, Sacramento, CA, United States
| | - Steven W. Thorpe
- Orthopedic Surgery, University of California, Davis, Sacramento, CA, United States
| | - Arta M. Monjazeb
- Radiation Oncology, University of California, Davis, Sacramento, CA, United States
| | - William J. Murphy
- Department of Dermatology, University of California, Davis, Sacramento, CA, United States
| | - Robert J. Canter
- Division of Surgical Oncology, Department of Surgery, University of California, Davis, Sacramento, CA, United States
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Kleber KT, Iranpur KR, Perry LM, Cruz SM, Razmara AM, Culp WTN, Kent MS, Eisen JA, Rebhun RB, Canter RJ. Using the canine microbiome to bridge translation of cancer immunotherapy from pre-clinical murine models to human clinical trials. Front Immunol 2022; 13:983344. [PMID: 36032113 PMCID: PMC9412231 DOI: 10.3389/fimmu.2022.983344] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 07/26/2022] [Indexed: 11/27/2022] Open
Abstract
The microbiome has clearly been established as a cutting-edge field in tumor immunology and immunotherapy. Growing evidence supports the role of the microbiome in immune surveillance, self-tolerance, and response to immune checkpoint inhibitors such as anti PD-L1 and CTLA-4 blockade (1–6). Moreover, recent studies including those using fecal microbial transplantation (FMT) have demonstrated that response to checkpoint immunotherapies may be conferred or eliminated through gut microbiome modulation (7, 8). Consequently, studies evaluating microbiota-host immune and metabolic interactions remain an area of high impact research. While observations in murine models have highlighted the importance of the microbiome in response to therapy, we lack sufficient understanding of the exact mechanisms underlying these interactions. Furthermore, mouse and human gut microbiome composition may be too dissimilar for discovery of all relevant gut microbial biomarkers. Multiple cancers in dogs, including lymphoma, high grade gliomas, melanomas and osteosarcoma (OSA) closely resemble their human analogues, particularly in regard to metastasis, disease recurrence and response to treatment. Importantly, dogs with these spontaneous cancers also have intact immune systems, suggesting that microbiome analyses in these subjects may provide high yield information, especially in the setting of novel immunotherapy regimens which are currently expanding rapidly in canine comparative oncology (9, 10). Additionally, as onco-microbiotic therapies are developed to modify gut microbiomes for maximal responsiveness, large animal models with intact immune systems will be useful for trialing interventions and monitoring adverse events. Together, pre-clinical mechanistic studies and large animal trials can help fully unlock the potential of the microbiome as a diagnostic and therapeutic target in cancer.
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Affiliation(s)
- Kara T. Kleber
- Division of Surgical Oncology, Department of Surgery, University of California Davis Medical Center, Sacramento, CA, United States
| | - Khurshid R. Iranpur
- Division of Surgical Oncology, Department of Surgery, University of California Davis Medical Center, Sacramento, CA, United States
| | - Lauren M. Perry
- Division of Surgical Oncology, Department of Surgery, University of California Davis Medical Center, Sacramento, CA, United States
| | - Sylvia M. Cruz
- Division of Surgical Oncology, Department of Surgery, University of California Davis Medical Center, Sacramento, CA, United States
| | - Aryana M. Razmara
- School of Veterinary Medicine, University of California Davis, Sacramento, CA, United States
| | - William T. N. Culp
- Center for Companion Animal Health Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California Davis, Davis, CA, United States
| | - Michael S. Kent
- Center for Companion Animal Health Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California Davis, Davis, CA, United States
| | - Jonathan A. Eisen
- Department of Medical Microbiology and Immunology, University of California Davis, Davis, CA, United States
| | - Robert B. Rebhun
- Center for Companion Animal Health Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California Davis, Davis, CA, United States
| | - Robert J. Canter
- Division of Surgical Oncology, Department of Surgery, University of California Davis Medical Center, Sacramento, CA, United States
- *Correspondence: Robert J. Canter,
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Judge SJ, Bloomstein JD, Sholevar CJ, Darrow MA, Stoffel KM, Vick LV, Dunai C, Cruz SM, Razmara AM, Monjazeb AM, Rebhun RB, Murphy WJ, Canter RJ. Transcriptome Analysis of Tumor-Infiltrating Lymphocytes Identifies NK Cell Gene Signatures Associated With Lymphocyte Infiltration and Survival in Soft Tissue Sarcomas. Front Immunol 2022; 13:893177. [PMID: 35874727 PMCID: PMC9300876 DOI: 10.3389/fimmu.2022.893177] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 06/16/2022] [Indexed: 01/26/2023] Open
Abstract
Purpose Clinical successes using current T-cell based immunotherapies have been limited in soft tissue sarcomas (STS), while pre-clinical studies have shown evidence of natural killer (NK) cell activity. Since tumor immune infiltration, especially tumor-infiltrating lymphocytes, is associated with improved survival in most solid tumors, we sought to evaluate the gene expression profile of tumor and blood NK and T cells, as well as tumor cells, with the goal of identifying potential novel immune targets in STS. Experimental Design Using fluorescence-activated cell sorting, we isolated blood and tumor-infiltrating CD3-CD56+ NK and CD3+ T cells and CD45- viable tumor cells from STS patients undergoing surgery. We then evaluated differential gene expression (DGE) of these purified populations with RNA sequencing analysis. To evaluate survival differences and validate primary DGE results, we also queried The Cancer Genome Atlas (TCGA) database to compare outcomes stratified by bulk gene expression. Results Sorted intra-tumoral CD3+ T cells showed significant upregulation of established activating (CD137) and inhibitory genes (TIM-3) compared to circulating T cells. In contrast, intra-tumoral NK cells did not exhibit upregulation of canonical cytotoxic genes (IFNG, GZMB), but rather significant DGE in mitogen signaling (DUSP4) and metabolic function (SMPD3, SLC7A5). Tumors with higher NK and T cell infiltration exhibited significantly increased expression of the pro-inflammatory receptor TLR4 in sorted CD45- tumor cells. TCGA analysis revealed that tumors with high TLR4 expression (P = 0.03) and low expression of STMN1 involved in microtubule polymerization (P < 0.001) were associated with significantly improved survival. Conclusions Unlike T cells, which demonstrate significant DGE consistent with upregulation of both activating and inhibiting receptors in tumor-infiltrating subsets, NK cells appear to have more stable gene expression between blood and tumor subsets, with alterations restricted primarily to metabolic pathways. Increased immune cell infiltration and improved survival were positively correlated with TLR4 expression and inversely correlated with STMN1 expression within tumors, suggesting possible novel therapeutic targets for immunotherapy in STS.
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Affiliation(s)
- Sean J. Judge
- Division of Surgical Oncology, Department of Surgery, University of California, Davis, Sacramento, CA, United States
| | - Joshua D. Bloomstein
- Division of Surgical Oncology, Department of Surgery, University of California, Davis, Sacramento, CA, United States
| | - Cyrus J. Sholevar
- Division of Surgical Oncology, Department of Surgery, University of California, Davis, Sacramento, CA, United States
| | - Morgan A. Darrow
- Department of Pathology and Laboratory Medicine, University of California, Davis, Sacramento, CA, United States
| | - Kevin M. Stoffel
- Department of Dermatology, University of California, Davis, Sacramento, CA, United States
| | - Logan V. Vick
- Department of Dermatology, University of California, Davis, Sacramento, CA, United States
| | - Cordelia Dunai
- Department of Dermatology, University of California, Davis, Sacramento, CA, United States
| | - Sylvia M. Cruz
- Division of Surgical Oncology, Department of Surgery, University of California, Davis, Sacramento, CA, United States
| | - Aryana M. Razmara
- Division of Surgical Oncology, Department of Surgery, University of California, Davis, Sacramento, CA, United States
| | - Arta M. Monjazeb
- Department of Radiation Oncology, University of California, Davis, Sacramento, CA, United States
| | - Robert B. Rebhun
- Center for Companion Animal Health, Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - William J. Murphy
- Department of Dermatology, University of California, Davis, Sacramento, CA, United States,Division of Hematology and Oncology, Department of Medicine, University of California, Davis, Sacramento, CA, United States
| | - Robert J. Canter
- Division of Surgical Oncology, Department of Surgery, University of California, Davis, Sacramento, CA, United States,*Correspondence: Robert J. Canter,
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Rebhun RB, York D, Cruz SM, Judge SJ, Razmara AM, Farley LE, Brady RV, Johnson EG, Burton JH, Willcox J, Wittenburg LA, Woolard K, Dunai C, Stewart SL, Sparger EE, Withers SS, Gingrich AA, Skorupski KA, Al-Nadaf S, LeJeune AT, Culp WT, Murphy WJ, Kent MS, Canter RJ. Inhaled recombinant human IL-15 in dogs with naturally occurring pulmonary metastases from osteosarcoma or melanoma: a phase 1 study of clinical activity and correlates of response. J Immunother Cancer 2022; 10:e004493. [PMID: 35680383 PMCID: PMC9174838 DOI: 10.1136/jitc-2022-004493] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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] [Accepted: 05/03/2022] [Indexed: 01/04/2023] Open
Abstract
PURPOSE Although recombinant human interleukin-15 (rhIL-15) has generated much excitement as an immunotherapeutic agent for cancer, activity in human clinical trials has been modest to date, in part due to the risks of toxicity with significant dose escalation. Since pulmonary metastases are a major site of distant failure in human and dog cancers, we sought to investigate inhaled rhIL-15 in dogs with naturally occurring lung metastases from osteosarcoma (OSA) or melanoma. We hypothesized a favorable benefit/risk profile given the concentrated delivery to the lungs with decreased systemic exposure. EXPERIMENTAL DESIGN We performed a phase I trial of inhaled rhIL-15 in dogs with gross pulmonary metastases using a traditional 3+3 cohort design. A starting dose of 10 µg twice daily × 14 days was used based on human, non-human primate, and murine studies. Safety, dose-limiting toxicities (DLT), and maximum tolerated dose (MTD) were the primary objectives, while response rates, progression-free and overall survival (OS), and pharmacokinetic and immune correlative analyses were secondary. RESULTS From October 2018 to December 2020, we enrolled 21 dogs with 18 dogs reaching the 28-day response assessment to be evaluable. At dose level 5 (70 μg), we observed two DLTs, thereby establishing 50 µg twice daily × 14 days as the MTD and recommended phase 2 dose. Among 18 evaluable dogs, we observed one complete response >1 year, one partial response with resolution of multiple target lesions, and five stable disease for an overall clinical benefit rate of 39%. Plasma rhIL-15 quantitation revealed detectable and sustained rhIL-15 concentrations between 1-hour and 6 hour postnebulization. Decreased pretreatment lymphocyte counts were significantly associated with clinical benefit. Cytotoxicity assays of banked peripheral blood mononuclear cells revealed significant increases in peak cytotoxicity against canine melanoma and OSA targets that correlated with OS. CONCLUSIONS In this first-in-dog clinical trial of inhaled rhIL-15 in dogs with advanced metastatic disease, we observed promising clinical activity when administered as a monotherapy for only 14 days. These data have significant clinical and biological implications for both dogs and humans with refractory lung metastases and support exploration of combinatorial therapies using inhaled rhIL-15.
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Affiliation(s)
- Robert B Rebhun
- Department of Surgical and Radiological Sciences, University of California, Davis, California, USA
| | - Daniel York
- Department of Surgical and Radiological Sciences, University of California, Davis, California, USA
| | - Sylvia Margret Cruz
- Division of Surgical Oncology, Department of Surgery, University of California Davis Medical Center, Sacramento, California, USA
| | - Sean J Judge
- Division of Surgical Oncology, Department of Surgery, University of California Davis Medical Center, Sacramento, California, USA
| | - Aryana M Razmara
- Division of Surgical Oncology, Department of Surgery, University of California Davis Medical Center, Sacramento, California, USA
| | - Lauren E Farley
- Division of Surgical Oncology, Department of Surgery, University of California Davis Medical Center, Sacramento, California, USA
| | - Rachel V Brady
- College of Veterinary Medicine, Colorado State University, Fort Collins, Colorado, USA
| | - Eric G Johnson
- Department of Surgical and Radiological Sciences, University of California, Davis, California, USA
| | - Jenna H Burton
- Department of Clinical Sciences, Colorado State University College of Veterinary Medicine, Fort Collins, Colorado, USA
| | - Jennifer Willcox
- Department of Surgical and Radiological Sciences, University of California, Davis, California, USA
| | - Luke A Wittenburg
- Department of Surgical and Radiological Sciences, University of California, Davis, California, USA
| | - Kevin Woolard
- Department of Pathology, University of California, Davis, California, USA
| | - Cordelia Dunai
- Department of Dermatology, University of California, Davis, California, USA
| | - Susan L Stewart
- Department of Public Health Sciences, University of California, Davis, California, USA
| | - Ellen E Sparger
- Department of Medicine and Epidemiology, University of California, Davis, California, USA
| | - Sita S Withers
- Department of Veterinary Clinical Sciences, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Alicia A Gingrich
- Division of Surgical Oncology, Department of Surgery, University of California Davis Medical Center, Sacramento, California, USA
| | - Katherine A Skorupski
- Department of Surgical and Radiological Sciences, University of California, Davis, California, USA
| | - Sami Al-Nadaf
- Department of Surgical and Radiological Sciences, University of California, Davis, California, USA
| | - Amandine T LeJeune
- Department of Surgical and Radiological Sciences, University of California, Davis, California, USA
| | - William Tn Culp
- Department of Surgical and Radiological Sciences, University of California, Davis, California, USA
| | - William J Murphy
- Department of Dermatology, University of California Davis Medical Center, Sacramento, California, USA
- Division of Hematology and Oncology, Department of Medicine, University of California Davis Medical Center, Sacramento, California, USA
| | - Michael S Kent
- Department of Surgical and Radiological Sciences, University of California, Davis, California, USA
| | - Robert J Canter
- Division of Surgical Oncology, Department of Surgery, University of California, Davis, California, USA
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Razmara AM, Wittenburg LA, Al-Nadaf S, Toedebusch RG, Meyers FJ, Toedebusch CM. Prevalence and Clinicopathologic Features of Canine Metastatic Melanoma Involving the Central Nervous System: A Retrospective Analysis and Comparative Review. Front Oncol 2022; 12:868004. [PMID: 35692802 PMCID: PMC9186031 DOI: 10.3389/fonc.2022.868004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 04/25/2022] [Indexed: 11/20/2022] Open
Abstract
Background Central nervous system (CNS) involvement is the leading cause of death in malignant melanoma. Rodent models, while vital to mechanistic investigation, have had limited success identifying effective therapies for melanoma brain metastases. The companion dog with de novo melanoma is a promising complementary model for developmental therapeutic investigation, as these tumors occur in an immunologically outbred host that has shared environmental exposures with humans. However, relatively little is known regarding the prevalence and clinicopathological features of canine melanoma metastasis to the CNS. To further validate the dog as an appropriate model for human metastatic melanoma, the aims of this study were to determine the rate of CNS metastasis and associated clinicopathologic features in canine malignant melanoma. Methods Medical records of dogs diagnosed with malignant melanoma from 1985-2019 at the University of California Davis Veterinary Medical Teaching Hospital were assessed retrospectively. Clinicopathologic features were compared between dogs with CNS metastasis (CNS+) and dogs without CNS metastasis (CNS-). Site of CNS involvement and associated neurological signs were analyzed via Wilcoxon-Mann-Whitney rank sum and Fisher’s exact tests. Survival data were analyzed via Kaplan-Meier estimates. Results CNS metastasis was identified in 38% of dogs in this study (20/53). The oral cavity was the most common site of primary melanoma in both groups [CNS+: n=12 (60%) vs. CNS-: n=22 (67%); p>0.99]. The total burden of metastatic disease was higher in the CNS+ group (CNS+: 4, 95% CI 3-5 vs. CNS-: 3, 95% CI 1-3; p<0.001). The cerebrum was the most common site of CNS metastasis (n=15, 75%) and seizures were the most observed neurological sign (n=9, 64%). There was no difference in overall survival between CNS+ and CNS- groups. However, the median survival time following onset of neurological signs was 9.5 days (95% CI 1-43), with 5 dogs euthanized within 24 hours of the onset of neurological signs. Conclusions Canine and human MM patients share similar rates of CNS metastasis and clinical presentation. This study will guide clinical management of canines with malignant melanoma and inform future studies using dogs with spontaneously occurring melanoma as a preclinical model for human melanoma brain metastases.
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Affiliation(s)
- Aryana M. Razmara
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
- UCD Comprehensive Cancer Center, Sacramento, CA, United States
| | - Luke A. Wittenburg
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
- UCD Comprehensive Cancer Center, Sacramento, CA, United States
| | - Sami Al-Nadaf
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
- UCD Comprehensive Cancer Center, Sacramento, CA, United States
| | - Ryan G. Toedebusch
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
- UCD Comprehensive Cancer Center, Sacramento, CA, United States
| | - Frederick J. Meyers
- UCD Comprehensive Cancer Center, Sacramento, CA, United States
- Department of Internal Medicine, Division of Hematology and Oncology, Center for Precision Medicine, University of California, Davis School of Medicine, Sacramento, CA, United States
| | - Christine M. Toedebusch
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
- UCD Comprehensive Cancer Center, Sacramento, CA, United States
- *Correspondence: Christine M. Toedebusch,
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9
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Sholevar C, Judge SJ, Nielsen R, Farley LE, Dunai C, Razmara AM, Cooke DT, Brown EG, Rebhun RB, Murphy WJ, Canter RJ. Tissue resident lung natural killer (NK) cells demonstrate enhanced responses to IL-15 compared to peripheral populations. The Journal of Immunology 2022. [DOI: 10.4049/jimmunol.208.supp.165.09] [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: 01/04/2023]
Abstract
Abstract
Tissue resident NK cells with unique phenotype and function have been identified in organs such as the lung and liver. We have shown that inhaled (IH) rhIL-15 can lead to durable clinical responses in dogs with naturally occurring osteosarcoma or melanoma lung metastases, suggesting that lung NK populations can be targeted therapeutically. Thus, we set out to evaluate the phenotype of resting and rhIL-15-stimulated lung NK cells isolated from murine and human lung. C57BL/6 and BALB/c mice were exposed to IH or systemic IL-15 at escalating doses, and NK cells were isolated by negative selection from lungs and spleen of wild type mice for co-culture. In human patients undergoing surgery for malignancy, non-tumor lung tissue was isolated for flow cytometry and ex vivo stimulation with IL-15. Using mouse spleen or human blood as controls, we observed a higher proportion of lung NK cells per live CD45+ cells in baseline mouse and human samples. Lung NK also had higher expression of activation markers CD69 and HLA-DR (human), but lower expression of the inhibitory receptor TIGIT. Ex vivo culture with IL-15 also resulted in greater upregulation of Ki67 on lung NK cells. Compared to systemic delivery of IL-15, IH IL-15 resulted in greater upregulation of Ki67 and lower upregulation of TIGIT in lung NK cells. Subset analysis of CD49a+ lung NK cells showed similar results in both mouse and human models for activation marker and Ki67 expression after IL-15. Taken together, our results suggest that lung NK cells possess a more active baseline phenotype and exhibit preferential stimulation in response to rhIL-15 compared to circulating NK cells. Ultimately, targeting of lung resident NK cells may be a viable therapeutic strategy in patients with lung metastases.
Supported by NIH/ NCI 1R03CA252793 NIH/NCI U01 CA224166-01 NIH/NCI T32 CA251007-01
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Affiliation(s)
- Cyrus Sholevar
- 1Department of Surgery, Univ. of California Davis Med. Ctr
| | - Sean J Judge
- 1Department of Surgery, Univ. of California Davis Med. Ctr
| | | | | | - Cordelia Dunai
- 2University of California, Davis
- 3University of Liverpool, United Kingdom
| | | | - David T Cooke
- 1Department of Surgery, Univ. of California Davis Med. Ctr
| | - Erin G Brown
- 1Department of Surgery, Univ. of California Davis Med. Ctr
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10
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Razmara AM, Judge SJ, Gingrich AA, Cruz SM, Culp WTN, Kent MS, Rebhun RB, Canter RJ. Natural Killer and T Cell Infiltration in Canine Osteosarcoma: Clinical Implications and Translational Relevance. Front Vet Sci 2021; 8:771737. [PMID: 34869744 PMCID: PMC8635198 DOI: 10.3389/fvets.2021.771737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 10/08/2021] [Indexed: 11/29/2022] Open
Abstract
Metastatic osteosarcoma has a bleak prognosis in both humans and dogs, and there have been minimal therapeutic advances in recent decades to improve outcomes. Naturally occurring osteosarcoma in dogs is shown to be a highly suitable model for human osteosarcoma, and limited data suggest the similarities between species extend into immune responses to cancer. Studies show that immune infiltrates in canine osteosarcoma resemble those of human osteosarcoma, and the analysis of tumor immune constituents as predictors of therapeutic response is a promising direction for future research. Additionally, clinical studies in dogs have piloted the use of NK transfer to treat osteosarcoma and can serve as valuable precursors to clinical trials in humans. Cytotoxic lymphocytes in dogs and humans with osteosarcoma have increased activation and exhaustion markers within tumors compared with blood. Accordingly, NK and T cells have complex interactions among cancer cells and other immune cells, which can lead to changes in pathways that work both for and against the tumor. Studies focused on NK and T cell interactions within the tumor microenvironment can open the door to targeted therapies, such as checkpoint inhibitors. Specifically, PD-1/PD-L1 checkpoint expression is conserved across tumors in both species, but further characterization of PD-L1 in canine osteosarcoma is needed to assess its prognostic significance compared with humans. Ultimately, a comparative understanding of T and NK cells in the osteosarcoma tumor microenvironment in both dogs and humans can be a platform for translational studies that improve outcomes in both dogs and humans with this frequently aggressive disease.
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Affiliation(s)
- Aryana M Razmara
- Department of Surgery, School of Medicine, University of California, Davis, Davis, CA, United States
| | - Sean J Judge
- Department of Surgery, School of Medicine, University of California, Davis, Davis, CA, United States
| | - Alicia A Gingrich
- Department of Surgery, School of Medicine, University of California, Davis, Davis, CA, United States
| | - Sylvia M Cruz
- Department of Surgery, School of Medicine, University of California, Davis, Davis, CA, United States
| | - William T N Culp
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Michael S Kent
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Robert B Rebhun
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Robert J Canter
- Department of Surgery, School of Medicine, University of California, Davis, Davis, CA, United States
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