Dendritic cell vaccine trials in gliomas: Untangling the lines

Glioblastoma is a deadly brain tumor without any significantly successful treatments to date. Tumor antigen-targeted immunotherapy platforms including peptide and dendritic cell (DC) vaccines, have extended survival in hematologic malignancies. The relatively "cold" tumor immune microenvironment and heterogenous nature of glioblastoma have proven to be major limitations to translational application and efficacy of DC vaccines. Furthermore, many DC vaccine trials in glioblastoma are difficult to interpret due to a lack of contemporaneous controls, absence of any control comparison, or inconsistent patient populations. Here we review glioblastoma immunobiology aspects that are relevant to DC vaccines, review the clinical experience with DC vaccines targeting glioblastoma, discuss challenges in clinical trial design, and summarize conclusions and directions for future research for the development of effective DC vaccines for patients.

Interdependencies of the Neuronal, Immune and Tumor Microenvironment in Gliomas

Gliomas are the most common primary brain malignancy and are universally fatal. Despite significant breakthrough in understanding tumor biology, treatment breakthroughs have been limited. There is a growing appreciation that major limitations on effective treatment are related to the unique and highly complex glioma tumor microenvironment (TME). The TME consists of multiple different cell types, broadly categorized into tumoral, immune and non-tumoral, non-immune cells. Each group provides significant influence on the others, generating a pro-tumor dynamic with significant immunosuppression. In addition, glioma cells are highly heterogenous with various molecular distinctions on the cellular level. These variations, in turn, lead to their own unique influence on the TME. To develop future treatments, an understanding of this complex TME interplay is needed. To this end, we describe the TME in adult gliomas through interactions between its various components and through various glioma molecular phenotypes.

Abstract 3193: Developing non-exhausted tumor infiltrating lymphocytes (TILs) as a therapy for glioblastoma

Glioblastoma is the most prevalent primary brain malignancy, with a median survival of less than 21 months despite treatment with surgery, radiation, and chemotherapy. Significant intra-tumoral heterogeneity, combined with the immunosuppressive micro-environment and the limited immune population present within the privileged CNS has resulted in the failure of immunotherapy approaches. We seek to address these challenges by isolating Tumor Infiltrating Lymphocytes (TILs) which are already neoantigen specific and expanding them ex vivo before re-administering them to the patient. This allows us to greatly increase the available pool of T cells which are specific for a diversity of tumor neoantigens in the patient, while also reversing exhaustion by the addition of stimulatory co-culturing agents. We report the successful expansion of glioblastoma associated TILs from both surgically resected tumors (5 of 7 samples, 71%) and liquid aspirate from the surgical field collected in Lukens traps (4 of 6 samples, 66%). TILs were expanded with high-dose IL2 initially in the presence of tumor digest (PreREP) followed by activation and expansion with CD3/CD28 nanobeads (REP). Flow cytometry performed on PreREP TILs revealed that 50-90% of the population consisted of effector memory T cells (CCR7-CD45RA-) with 5-40% consisting of central memory T cells (CCR7+CD45RA-). The addition of stimulatory agents such as anti-4-1BB (Urelumab) during the PreREP phase increased cell yields, as well as skewing the population towards a non-exhausted CD8+ phenotype (reduced expression of PD1, LAG3, TIM3). These cells have demonstrated tumor antigen specific activation based on IFNγ and TNFα secretion following stimulation with autologous tumor digests and patient matched neurosphere cultures. TIL expansion with Urelumab doubled CD8% in the product (16% to 31%) and reduced CD4% (78% to 65%). Expanded TILs had more potent cytotoxic CD8+ T cells responses characterized by significantly increased numbers of tumor antigen specific IFNγ+ (std: 1000, Ure: 6000) and TNFα+ (std:2000, Ure:20,000))cells compared to traditionally expanded TILs. We have demonstrated that TIL isolation from resected clinical glioma is feasible and can generate large quantities of immune cells whose functional status can be altered by the addition of stimulatory agents. And most importantly these TILs are reactive and specific for tumor antigens. Following additional assessment of in vitro cytotoxicity against matched tumor neurospheres in vitro we will evaluate safety and feasibility of our novel TIL approach in patients with glioblastoma.

Citation Format: Kelly M. Hotchkiss, Pamela Noldner, Kirit Singh, Anoop Patel, Peter Fecci, Scott Antonia, Beth H. Shaz, Mustafa Khasraw. Developing non-exhausted tumor infiltrating lymphocytes (TILs) as a therapy for glioblastoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 3193.

Abstract 4061: Systemic autologous lymphocyte transfer can enhance tumor-infiltrating lymphocyte infiltration in glioblastoma and license co-stimulatory immunotherapy

Glioblastoma is an immunologically ‘cold’ malignancy where few tumor infiltrating lymphocytes (TILs) are present. We sought to overcome this by ‘seeding’ the tumor with TILs via administration of autologous lymphocytes (ALT). We hypothesized that prior administration of ALT will enhance subsequent immunomodulatory therapies (e.g. immune checkpoint blockade (ICB) or co-stimulation). To evaluate this, we initially generated a pro-infiltrative TIL phenotype. CD45.1 splenocytes (C57/Bl6 background) were co-cultured with either IL2 and Concanavalin A (Con A) or IL7 and Con A for 5 days. Flow cytometric analysis found that both conditions resulted in similar CD4:CD8 ratios (20:80%) but IL7 co-culture upregulated expression of VLA-4, a pro migratory integrin. We then compared the entry of TILs into tumor bearing CNS when co-cultured with either IL2 or IL7. 8–10-week-old C57/Bl6 mice (n=5-6 per group) were implanted orthotopically with 30,000 CT2AvIII cells (syngeneic glioma) which established for 14 days. Mice received (1) CD45.1 lymphocytes activated with IL-7 and Con A (single intravenous (IV) injection, 1 × 107 cells) or (2) CD45.1 lymphocytes activated with IL2 and serial Con-A stimulation. Mice were sacrificed 3- and 48-hours following ALT and brains analysed for CD45.1+CD3+ populations. Groups were compared using a Mann-Whitney U test. Mice in Group 1 demonstrated significantly enhanced entry of CD8+ effector and memory T cells into tumor bearing hemispheres at both time points following administration compared to Group 2 (p = 0.005, p = 0.0159 respectively). By 48 hours post ALT, IL7 co-culture resulted in an average 810.1% expansion of CD8 T cell numbers in tumor bearing CNS compared to counts at Day 0. We then evaluated if mice with a TIL enriched CNS might be more responsive to ICB or co-stimulatory therapy. 8–10-week-old C57/Bl6 mice (n=5-7 per group) were implanted with 30,000 CT2AvIII cells that established over 10 days. On day 10, mice received IV ALT of either IL7 T cells only, or IL-7 and treatment courses of IP ICB (anti-PD1, anti-CTLA 4 or anti-41BB). Mice given ICB following IL7 ALT demonstrated a median survival (aPD1: 27 days, aCTLA-4: 25 days) similar to mice given IL7 ALT alone (25 days). However, 4/7 mice who received IL7 ALT and anti-41BB were still alive 45 days post tumor implantation (p=0.0004). Taken together, we demonstrated that certain ex vivo autologous lymphocyte co-culture conditions can generate a T cell population which infiltrates tumor bearing CNS in significant numbers. Further, we found that seeding a tumor with TILs prior to stimulatory therapy yields long term survival in vivo. Future work will focus on optimizing ex vivo culturing approaches for ALT and determine whether therapeutic efficacy is due to expansion of resident TILs at the tumor site, or ongoing recruitment of endogenous T cells from the periphery.

Citation Format: Kirit Singh, Kelly M. Hotchkiss, Eliese Moelker, Gary E. Archer, John H. Sampson, Mustafa Khasraw. Systemic autologous lymphocyte transfer can enhance tumor-infiltrating lymphocyte infiltration in glioblastoma and license co-stimulatory immunotherapy. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 4061.

Generation of Tumor Targeted Dendritic Cell Vaccines with Improved Immunogenic and Migratory Phenotype

Our group has employed methodologies for effective ex vivo generation of dendritic cell (DC) vaccines for patients with primary malignant brain tumors. In order to reliably produce the most potent, most representational vaccinated DC that will engender an antitumor response requires the ability to orchestrate multiple methodologies that address antigen cross-presentation, T-cell costimulation and polarization, and migratory capacity. In this chapter, we describe a novel method for augmenting the immunogenicity and migratory potential of DCs for their use as vaccines. We have elucidated methodologies to avoid the phenomenon known as immunodominance in generating cancer vaccines. We have found that culturing DC progenitors in serum-free conditions for the duration of the differentiation protocol results in a more homogeneously mature population of DCs that exhibit enhanced immunogenicity compared to DCs generated in serum-containing culture conditions. Furthermore, we demonstrate our method for generating high mobility DCs that readily migrate toward lymphoid organ chemoattractants using CCL3 protein. The combination of these two approaches represents a facile and clinically tractable methodology for generating highly mature DCs with excellent migratory capacity.

E-cigarette Aerosol Mixtures Inhibit Biomaterial-Induced Osseointegrative Cell Phenotypes

OBJECTIVES

Smoking is a known contributor to the failure of dental implants. Despite a decline in cigarette use, the popularity of e-cigarettes has exploded. However, little is known about how e-cigarettes affect the biologic response to implants. This study examines the effect of e-cigarette aerosol mixtures (ecig-AM) on macrophage activation and osteoblastogenesis of mesenchymal stem cells (MSCs) in response to titanium (Ti) implant surfaces.

METHODS

Ecig-AMs were prepared by bubbling aerosol through PBS. Human-derived MSCs or murine-derived macrophages were plated on smooth, rough-hydrophobic, or rough-hydrophilic Ti surfaces in media supplemented with ecig-AM. In macrophages, expression of inflammatory markers was measured by qPCR and macrophage immunophenotype characterized by flow cytometry after 24 hours of exposure. In MSCs, expression of osteogenic markers and inflammatory cytokines was measured by qPCR and ELISA, while alkaline phosphatase activity (ALP) was determined by colorimetric assay.

RESULTS

Ecig-AM polarized primary macrophages into a pro-inflammatory state with higher effect on ecig-AM with flavorants and nicotine. Metabolic activity of MSCs decreased in a concentration dependent fashion and was stronger in ecig-AM containing nicotine. MSCs reduced expression of osteogenic markers in response to ecig-AM, but increased RANKL secretion, particularly at the highest ecig-AM concentrations. The effect of ecig-AM exposure was lessened when macrophages or MSCs were cultured on rough-hydrophilic substrates.

SIGNIFICANCE

Ecig-AM activated macrophages into a pro-inflammatory phenotype and impaired MSC-to-osteoblast differentiation in response to Ti implant surfaces. These effects were potentiated by flavorants and nicotine, suggesting that e-cigarette use may compromise the osseointegration of dental implants.

For whom the T cells troll? Bispecific T-cell engagers in glioblastoma

Glioblastoma is the the most common primary brain tumor in adults. Onset of disease is followed by a uniformly lethal prognosis and dismal overall survival. While immunotherapies have revolutionized treatment in other difficult-to-treat cancers, these have failed to demonstrate significant clinical benefit in patients with glioblastoma. Obstacles to success include the heterogeneous tumor microenvironment (TME), the immune-privileged intracranial space, the blood-brain barrier (BBB) and local and systemic immunosuppressions. Monoclonal antibody-based therapies have failed at least in part due to their inability to access the intracranial compartment. Bispecific T-cell engagers are promising antibody fragment-based therapies which can bring T cells close to their target and capture them with a high binding affinity. They can redirect the entire repertoire of T cells against tumor, independent of T-cell receptor specificity. However, the multiple challenges posed by the TME, immune privilege and the BBB suggest that a single agent approach may be insufficient to yield durable, long-lasting antitumor efficacy. In this review, we discuss the mechanism of action of T-cell engagers, their preclinical and clinical developments to date. We also draw comparisons with other classes of multispecific antibodies and potential combinations using these antibody fragment therapies.

Enhancing T Cell Chemotaxis and Infiltration in Glioblastoma

Glioblastoma is an immunologically 'cold' tumor, which are characterized by absent or minimal numbers of tumor-infiltrating lymphocytes (TILs). For those tumors that have been invaded by lymphocytes, they are profoundly exhausted and ineffective. While many immunotherapy approaches seek to reinvigorate immune cells at the tumor, this requires TILs to be present. Therefore, to unleash the full potential of immunotherapy in glioblastoma, the trafficking of lymphocytes to the tumor is highly desirable. However, the process of T cell recruitment into the central nervous system (CNS) is tightly regulated. Naïve T cells may undergo an initial licensing process to enter the migratory phenotype necessary to enter the CNS. T cells then must express appropriate integrins and selectin ligands to interact with transmembrane proteins at the blood-brain barrier (BBB). Finally, they must interact with antigen-presenting cells and undergo further licensing to enter the parenchyma. These T cells must then navigate the tumor microenvironment, which is rich in immunosuppressive factors. Altered tumoral metabolism also interferes with T cell motility. In this review, we will describe these processes and their mediators, along with potential therapeutic approaches to enhance trafficking. We also discuss safety considerations for such approaches as well as potential counteragents.

Targeting Immunometabolism in Glioblastoma

We have only recently begun to understand how cancer metabolism affects antitumor responses and immunotherapy outcomes. Certain immunometabolic targets have been actively pursued in other tumor types, however, glioblastoma research has been slow to exploit the therapeutic vulnerabilities of immunometabolism. In this review, we highlight the pathways that are most relevant to glioblastoma and focus on how these immunometabolic pathways influence tumor growth and immune suppression. We discuss hypoxia, glycolysis, tryptophan metabolism, arginine metabolism, 2-Hydroxyglutarate (2HG) metabolism, adenosine metabolism, and altered phospholipid metabolism, in order to provide an analysis and overview of the field of glioblastoma immunometabolism.

Wnt signaling modulates macrophage polarization and is regulated by biomaterial surface properties

Macrophages are among the first cells to interact with biomaterials and ultimately determine their integrative fate. Biomaterial surface characteristics like roughness and hydrophilicity can activate macrophages to an anti-inflammatory phenotype. Wnt signaling, a key cell proliferation and differentiation pathway, has been associated with dysregulated macrophage activity in disease. However, the role Wnt signaling plays in macrophage activation and response to biomaterials is unknown. The aim of this study was to characterize the regulation of Wnt signaling in macrophages during classical pro- and anti-inflammatory polarization and in their response to smooth, rough, and rough-hydrophilic titanium (Ti) surfaces. Peri-implant Wnt signaling in macrophage-ablated (MaFIA) mice instrumented with intramedullary Ti rods was significantly attenuated compared to untreated controls. Wnt ligand mRNA were upregulated in a surface modification-dependent manner in macrophages isolated from the surface of Ti implanted in C57Bl/6 mice. In vitro, Wnt mRNAs were regulated in primary murine bone-marrow-derived macrophages cultured on Ti in a surface modification-dependent manner. When macrophageal Wnt secretion was inhibited, macrophage sensitivity to both physical and biological stimuli was abrogated. Loss of macrophage-derived Wnts also impaired recruitment of mesenchymal stem cells and T-cells to Ti implants in vivo. Finally, inhibition of integrin signaling decreased surface-dependent upregulation of Wnt genes. These results suggest that Wnt signaling regulates macrophage response to biomaterials and that macrophages are an important source of Wnt ligands during inflammation and healing.

Novel in vitro comparative model of osteogenic and inflammatory cell response to dental implants

OBJECTIVES

Roughened dental implants promote mesenchymal stem cell (MSCs) osteoblastic differentiation, and hydrophilic modifications induce anti-inflammatory macrophages activation. While the effect of different surface modifications on osseointegration of commercial dental implants have been compared in vivo and clinically, the initial cellular response to these modifications often overlooked. We aimed to characterize the macrophage inflammatory response and MSC osteogenesis across different commercially available implants in vitro.

METHODS

Six commercially available rough implants [OsseoSpeed™ (Astra-Tech™, Implant A); Osseotite^® (Biomet 3i™, Implant B); TiUnite™ (Nobel-Biocare^®, Implant C); Ti-SLA^®, (Implant D), Roxolid^® (RXD-SLA, Implant E), RXD-SLActive^® (Implant F) (Straumann^®)] were examined. Macrophages and MSCs were seeded directly on implants and cultured in custom vials. mRNA and protein levels of pro- (IL1B, IL6, IL17A, CXCL10, TNFa) and anti- (IL4, IL10, TGFB1) inflammatory markers were measured after 24 and 48h in macrophages. Osteoblastic differentiation of MSCs was assessed after seven days by alkaline phosphatase activity, osteocalcin, and angiogenic, osteogenic, and inflammatory markers by ELISA and qPCR (n=6/variable, ANOVA, post hoc Tukey HSD with α=0.05).

RESULTS

Hydrophilic implant F induced the highest level of osteogenic factor released from MSCs and anti-inflammatory factors from macrophages with the lowest level of pro-inflammatory factors. Alternatively, implants A and C supported lower levels of osteogenesis and increased secretion of pro-inflammatory factors.

SIGNIFICANCE

In this study, we successfully evaluated differences in cell response to commercially available clinical implants using an in vitro model. Data from this model suggest that not all surface modification procedures generate the same cell response.

Titanium surface characteristics, including topography and wettability, alter macrophage activation

Biomaterial surface properties including chemistry, topography, and wettability regulate cell response. Previous studies have shown that increasing surface roughness of metallic orthopaedic and dental implants improved bone formation around the implant. Little is known about how implant surface properties can affect immune cells that generate a wound healing microenvironment. The aim of our study was to examine the effect of surface modifications on macrophage activation and cytokine production. Macrophages were cultured on seven surfaces: tissue culture polystyrene (TCPS) control; hydrophobic and hydrophilic smooth Ti (PT and oxygen-plasma-treated (plasma) PT); hydrophobic and hydrophilic microrough Ti (SLA and plasma SLA), and hydrophobic and hydrophilic nano-and micro-rough Ti (aged modSLA and modSLA). Smooth Ti induced inflammatory macrophage (M1-like) activation, as indicated by increased levels of interleukins IL-1β, IL-6, and TNFα. In contrast, hydrophilic rough titanium induced macrophage activation similar to the anti-inflammatory M2-like state, increasing levels of interleukins IL-4 and IL-10. These results demonstrate that macrophages cultured on high surface wettability materials produce an anti-inflammatory microenvironment, and this property may be used to improve the healing response to biomaterials.

STATEMENT OF SIGNIFICANCE

Metals like titanium (Ti) are common in orthopaedics and dentistry due to their ability to integrate with surrounding tissue and good biocompatibility. Roughness- and wettability-increasing surface modifications promote osteogenic differentiation of stem cells on Ti. While these modifications increase production of osteoblastic factors and bone formation, little is known about their effect on immune cells. The initial host response to a biomaterial is controlled primarily by macrophages and the factors they secrete in response to the injury caused by surgery and the material cues. Here we demonstrate the effect of surface roughness and wettability on the activation and production of inflammatory factors by macrophages. Control of inflammation will inform the design of surface modification procedures to direct the immune response and enhance the success of implanted materials.