Finding new lanes: Chimeric antigen receptor (CAR) T-cells for myeloid leukemia

BACKGROUND

Myeloid leukemia represents a heterogeneous group of cancers of blood and bone marrow which arise from clonal expansion of hematopoietic myeloid lineage cells. Acute myeloid leukemia (AML) has traditionally been treated with multi-agent chemotherapy, but conventional therapies have not improved the long-term survival for decades. Chronic myeloid leukemia (CML) is an indolent disease which requires lifelong treatment, is associated with significant side effects, and carries a risk of progression to potentially lethal blast crises.

RECENT FINDINGS

Recent advances in molecular biology, virology, and immunology have enabled researchers to grow and modify T lymphocytes ex-vivo. Chimeric antigen receptor (CAR) T-cell therapy has been shown to specifically target cells of lymphoid lineage and induce remission in acute lymphoblastic leukemia (ALL) patients. While the success of CAR T-cells against ALL is considered a defining moment in modern oncology, similar efficacy against myeloid leukemia cells remains elusive. Over the past 10 years, numerous CAR T-cells have been developed that can target novel myeloid antigens, and many clinical trials are finally starting to yield encouraging results. In this review, we present the recent advances in this field and discuss strategies for future development of myeloid targeting CAR T-cell therapy.

CONCLUSIONS

The field of CAR T-cell therapy has rapidly evolved over the past few years. It represents a radically new approach towards cancers, and with continued refinement it may become a viable therapeutic option for patients of acute and chronic myeloid leukemia.

Abstract OT1-13-02: Molecular testing for minority patients with or at high risk for cancer

PURPOSE: Meharry Medical College is a participant in eMERGE (Electronic Medical Records and Genomics); a multicenter network sponsored by NHGRI/NIMHD with the primary goal to develop, disseminate, and apply approaches to research that combine biorepositories with electronic medical records (EMR) for genomic discovery and medicine implementation research. The consortium also focuses on ethical issues involving privacy, confidentiality, and interaction with the broader community. Individual institutions created protocols around research questions individualized to their populations.

METHODS: We enrolled 500 African Americans with or at high-risk for the four most common cancers (prostate, colorectal, breast, lung) to examine possible genetic and proteomic differences to account for health disparities in this population. We will perform DNA, RNA, and proteomics analyses pertinent to these cancers and obtain corresponding clinical history from the EMR with planned long-term follow up.

RESULTS: 500 subjects (211 female) were enrolled over 11 months from Nashville General Hospital including the following cancer/at-risk participants (Breast 59/37; Colorectal 17/128; prostate 31/136; lung 16/76). Most individuals stated that they participated for potential benefit to themselves, family members, or humankind and only 11 percent of potential participants declined. Little concern has been voiced for providing samples for genetic analysis. A genetic counselor will meet with the participants that are found to have pathogenic or likely pathogenic mutations while study investigators will share results with those that are not found to have mutations. Participants will be queried regarding understanding of the genetic testing results and followed for one year to evaluate if they underwent recommended testing and to follow for cancer outcomes.

CONCLUSION: The inclusion of diverse groups in genomic research is critical to identify possible reasons for health disparities and to study the understanding of genetic testing and ethical issues surrounding this topic. In this study, African-Americans are participating willingly in clinical research to examine possible genetic and/or social bases for cancer disparities.

ACKNOWLEDGEMENT: NIMHD (U54MD007593) to the Meharry Translational Research Center (MeTRC); National Human Genome Research Institute (NHGRI); National Institute of Allergy and Infectious Disease (NIAID).

Citation Format: Singh R, Bayan MA, Kadari S, Nganteh MN, Jacksonm M, Woodson LM, Shamsuddin AS, Lemus BY, Pratap S, Murray JJ, Adunyah SE, Lammers PE. Molecular testing for minority patients with or at high risk for cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr OT1-13-02.

Molecular and cellular genetics of non-Hodgkin lymphoma: Diagnostic and prognostic implications

Non-Hodgkin lymphoma (NHL) is a diverse collection of malignant neoplasms with lymphoid-cell origin which includes all the malignant lymphomas that are not classified as Hodgkin lymphoma. NHL is one of the most common types of cancer diagnosed in men and women in the developed world. In the United States of America, the past few decades have seen a significant rise in the incidence of NHL and it accounts for about 4% of all cancers now. The overall survival of NHL has improved drastically over the past ten years. This can be attributed to better understanding of pathogenesis, refined classification, enhanced supportive care, and data from collaborative clinical trials. The prognosis of a newly diagnosed NHL patient depends, among other factors, on the specific subtype of lymphoma, stage of the disease, and age of the patient. Advances in the fields of molecular biology and innovations in cytogenetic techniques have led to the discovery of several oncogenic pathways involved in lymphomagenesis, which in turn has amplified the diagnostic and therapeutic approaches available for NHL. Our comprehension of the genetic features that determine the character of NHL, and ultimately guide the therapy, has undergone significant shift and it is essential that scientists as well as clinicians stay in tune with this rapidly evolving knowledge. In this review we have summarized the current concepts about cellular and molecular genetics of the common subtypes of NHL and their clinical implications.

Pre-Clinical Evaluation of rHDL Encapsulated Retinoids for the Treatment of Neuroblastoma

Despite major advances in pediatric cancer research, there has been only modest progress in the survival of children with high risk neuroblastoma (NB) (HRNB). The long term survival rates of HRNB in the United States are still only 30-50%. Due to resistance that often develops during therapy, development of new effective strategies is essential to improve the survival and overcome the tendency of HRNB patients to relapse subsequent to initial treatment. Current chemotherapy regimens also have a serious limitation due to off target toxicity. In the present work, we evaluated the potential application of reconstituted high density lipoprotein (rHDL) containing fenretinide (FR) nanoparticles as a novel approach to current NB therapeutics. The characterization and stability studies of rHDL-FR nanoparticles showed small size (<40 nm) and high encapsulation efficiency. The cytotoxicity studies of free FR vs. rHDL/FR toward the NB cell lines SK-N-SH and SMS-KCNR showed 2.8- and 2-fold lower IC50 values for the rHDL encapsulated FR vs. free FR. More importantly, the IC50 value for retinal pigment epithelial cells (ARPE-19), a recipient of off target toxicity during FR therapy, was over 40 times higher for the rHDL/FR as compared to that of free FR. The overall improvement in in vitro selective therapeutic efficiency was thus about 100-fold upon encapsulation of the drug into the rHDL nanoparticles. These studies support the potential value of this novel drug delivery platform for treating pediatric cancers in general, and NB in particular.

Fatal case of sorafenib-associated idiosyncratic hepatotoxicity in the adjuvant treatment of a patient with renal cell carcinoma

Background

Sorafenib is an orally available kinase inhibitor with activity at Raf, PDGFβ and VEGF receptors that is licensed for the treatment of advanced renal cell carcinoma (RCC) and hepatocellular carcinoma (HCC). Current evidence-based post-nephrectomy management of individuals with localized RCC consists of surveillance-based follow up. The SORCE trial is designed to investigate whether treatment with adjuvant sorafenib can reduce recurrence rates in this cohort.

Case presentation

Here we report an idiosyncratic reaction to sorafenib resulting in fatal hepatotoxicity and associated renal failure in a 62 year-old man treated with sorafenib within the SORCE trial.

Conclusion

This is the first reported case of sorafenib exposure associated fatal toxicity in the adjuvant setting and highlights the unpredictable adverse effects of novel adjuvant therapies.

In utero exposure to benzo(a)pyrene predisposes offspring to cardiovascular dysfunction in later-life

In utero exposure of the fetus to benzo(a)pyrene [B(a)P], a polycyclic aromatic hydrocarbon, is thought to dysregulate cardiovascular development. To investigate the effects of in utero B(a)P exposure on cardiovascular development, timed-pregnant Long Evans Hooded (LEH) rats were exposed to diluent or B(a)P (150, 300, 600 and 1200 μg/kg/BW) by oral gavage on embryonic (E) days E14 (the metamorphosing embryo stage) through E17 (the 1st fetal stage). There were no significant effects of in utero exposure to B(a)P on the number of pups born per litter or in pre-weaning growth curves. Pre-weaning profiles for B(a)P metabolite generation from cardiovascular tissue were shown to be dose-dependent and elimination of these metabolites was shown to be time-dependent in exposed offspring. Systolic blood pressure on postnatal day P53 in the middle and high exposure groups of offspring were significantly elevated as compared to controls. Microarray and quantitative real-time PCR results were directly relevant to a biological process pathway in animal models for "regulation of blood pressure". Microarray and quantitative real-time PCR analysis revealed upregulation of mRNA expression for angiotensin (AngII), angiotensinogen (AGT) and endothelial nitric oxide synthase (eNOS) in exposed offspring. Biological network analysis and gene set enrichment analysis subsequently identified potential signaling mechanisms and molecular pathways that might explain the elevated systolic blood pressures observed in B(a)P-exposed offspring. Our findings suggest that in utero exposure to B(a)P predispose offspring to functional deficits in cardiovascular development that may contribute to cardiovascular dysfunction in later life.

Methods to increase response rates to postal questionnaires

BACKGROUND

Postal questionnaires are widely used for data collection in epidemiological studies but non-response reduces the effective sample size and can introduce bias. Finding ways to increase response rates to postal questionnaires would improve the quality of health research.

OBJECTIVES

To identify effective strategies to increase response rates to postal questionnaires.

SEARCH STRATEGY

We aimed to find all randomised controlled trials of strategies to increase response rates to postal questionnaires. We searched 14 electronic databases to February 2003 and manually searched the reference lists of relevant trials and reviews, and all issues of two journals. We contacted the authors of all trials or reviews to ask about unpublished trials. Where necessary, authors were also contacted to confirm methods of allocation used and to clarify results presented. We assessed the eligibility of each trial using pre-defined criteria.

SELECTION CRITERIA

Randomised controlled trials of methods to increase response rates to postal questionnaires.

DATA COLLECTION AND ANALYSIS

We extracted data on the trial participants, the intervention, the number randomised to intervention and comparison groups and allocation concealment. For each strategy, we estimated pooled odds ratios and 95% confidence intervals in a random effects model. Evidence for selection bias was assessed using Egger's weighted regression method and Begg's rank correlation test and funnel plot. Heterogeneity among trial odds ratios was assessed using a chi-square test at a 5% significance level and the degree of inconsistency between trial results was quantified using I(2).

MAIN RESULTS

We found 372 eligible trials. The trials evaluated 98 different ways of increasing response rates to postal questionnaires and for 62 of these the combined trials included over 1,000 participants. We found substantial heterogeneity among trial results in half of the strategies. The odds of response were at least doubled using monetary incentives (odds ratio 1.99, 95% CI 1.81 to 2.18; heterogeneity p<0.00001, I(2)=78%), recorded delivery (2.04, 1.60 to 2.61; p=0.0004, I(2)=69%), a teaser on the envelope - e.g. a comment suggesting to participants that they may benefit if they open it (3.08, 1.27 to 7.44) and a more interesting questionnaire topic (2.44, 1.99 to 3.01; p=0.74, I(2)=0%). The odds of response were substantially higher with pre-notification (1.50, 1.29 to 1.74; p<0.00001, I(2)=90%), follow-up contact (1.44, 1.25 to 1.65; p<0.0001, I(2)=68%), unconditional incentives (1.61, 1.27 to 2.04; p<0.00001, I(2)=91%), shorter questionnaires (1.73, 1.47 to 2.03; p<0.00001, I(2)=93%), providing a second copy of the questionnaire at follow-up (1.51, 1.13 to 2.00; p<0.00001, I(2)=83%), mentioning an obligation to respond (1.61, 1.16 to 2.22; p=0.98, I(2)=0%) and university sponsorship (1.32, 1.13 to 1.54; p<0.00001, I(2)=83%). The odds of response were also increased with non-monetary incentives (1.13, 1.07 to 1.21; p<0.00001, I(2)=71%), personalised questionnaires (1.16, 1.07 to 1.26; p<0.00001, I(2)=67%), use of coloured as opposed to blue or black ink (1.39, 1.16 to 1.67), use of stamped return envelopes as opposed to franked return envelopes (1.29, 1.18 to 1.42; p<0.00001, I(2)=72%), an assurance of confidentiality (1.33, 1.24 to 1.42) and first class outward mailing (1.12, 1.02 to 1.23). The odds of response were reduced when the questionnaire included questions of a sensitive nature (0.94, 0.88 to 1.00; p=0.51, I(2)=0%), when questionnaires began with the most general questions (0.80, 0.67 to 0.96), or when participants were offered the opportunity to opt out of the study (0.76, 0.65 to 0.89; p=0.46, I(2)=0%).

AUTHORS' CONCLUSIONS

Health researchers using postal questionnaires can increase response rates using the strategies shown to be effective in this systematic review.

Signal transduction in human macrophages by gp83 ligand of Trypanosoma cruzi: trypomastigote gp83 ligand up-regulates trypanosome entry through protein kinase C activation

We found that Trypanosoma cruzi trypomastigote cloned surface ligand (gp83 trans-sialidase) signals macrophages to up-regulate parasite entry by activating protein kinase C (PKC). Incubation of r-gp83 ligand with macrophages activates PKC and this activation is abolished when r-gp83 is depleted by immunoprecipitation with anti-r-gp83 antibodies, which recognize the secreted gp83 of trypomastigotes by immunoblotting. This activation is seen as early as 15 min with maximal activity at 60 min and correlates with the concentration of macrophage cell cytosol. Bisindolylmaleimide I, a PKC inhibitor, abolished the activation of PKC induced by r-gp83 ligand. Incubation of macrophages with r-gp83 ligand significantly enhanced the number of trypanosomes per cell. Bisindolylmaleimide I also inhibited the enhancement of trypomastigote uptake by macrophages induced by the r-ligand. These results demonstrate that T. cruzi uses a novel mechanism to signal cells in the process of trypanosome entry, via a secreted trypanosome ligand which signals macrophages through activation of PKC.

Carcinoma of penis--role of phimosis

The importance of phimosis and lack of penile hygiene to explain the high incidence of carcinoma of the penis found locally is discussed.

Diffusion of alkali and alkaline earth chlorides through a parchment-supported silver iodide membrane

Diffusion rates of KCl, NaCl, LiCl, BaCl2, CaCl2, and MgCl2 through a parchment-supported silver iodide membrane have been measured at various temperatures using a constant flow method. Activation energies and various Eyring activation parameters for the diffusion of these electrolytes have also been evaluated. The diffusion rate sequences obtained are KCl > NaCl > LiCl and BaCl2 > CaCl2 > MgCl2 and they point towards the weak field strength of the membrane fixed charged groups. Diffusion coefficients and the various Eyring activation parameters have been related to the ionic hydrated sizes and the various thermodynamic quantities of ionic hydration thus emphasizing the importance of ion hydration in diffusion across the membrane.