Combined Therapeutic Approach Research Articles

Lopinavir and ritonavir act synergistically with azoles against Candida auris in vitro and in a mouse model of disseminated candidiasis

The emergence of Candida auris has created a global health challenge. Azole antifungals are the most affected antifungal class because of the extraordinary capability of C. auris to develop resistance against these drugs. Here, we used a combinatorial therapeutic approach to sensitize C. auris to azole antifungals. We have demonstrated the capability of the HIV protease inhibitors lopinavir and ritonavir, at clinically relevant concentrations, to be used with azole antifungals to treat C. auris infections both in vitro and in vivo. Both lopinavir and ritonavir exhibited potent synergistic interactions with the azole antifungals, particularly with itraconazole against 24/24 (100%) and 31/34 (91%) of tested C. auris isolates, respectively. Furthermore, ritonavir significantly interfered with the fungal efflux pump, resulting in a significant increase in Nile red fluorescence by 44%. In a mouse model of C. auris systemic infection, ritonavir boosted the activity of lopinavir to work synergistically with fluconazole and itraconazole and significantly reduced the kidney fungal burden by a 1.2 log (∼94%) and 1.6 log (∼97%) CFU, respectively. Our results urge further comprehensive assessment of azoles and HIV protease inhibitors as a novel drug regimen for the treatment of serious invasive C. auris infections.

ANXIETY AND DEPRESSION AS POTENTIAL PSYCHOPATHOLOGICAL FACTORS FOR ORAL LICHEN PLANUS

Objective The present study aimed to evaluate the possible relationship between oral lichen planus (OLP) and symptoms of depression and anxiety, as well as combined therapeutic approaches in the treatment of OLP. Study Design Searches were performed in PubMed (Medline), BVS (Lilacs), and Cochrane library databases to identify relevant scientific articles using the following search terms: "oral lichen planus", "depression", "anxiety" and "treatment", in such a way that 33 publications were initially found. After application of inclusion and exclusion criteria, a total of 16 articles were selected for the main body reading. Results According to the analyzed literature, potential relationship between OLP and depression and anxiety was suggested, although there were divergences between the different studies. Currently, there is still no consensus on a gold-standard treatment for these lesions, even emphasizing the use of alternative therapies that have demonstrated some efficacy. In addition, recidivism is notable among patients with OLP, since psychological factors hypothetically affect healing during treatment. Conclusion The emergence of OLP lesions can be related to psychopathological risk factors such as depression and anxiety and, even if they are not standardized, alternative therapies are effective, while each case of OLP has its peculiarity. The present study aimed to evaluate the possible relationship between oral lichen planus (OLP) and symptoms of depression and anxiety, as well as combined therapeutic approaches in the treatment of OLP. Searches were performed in PubMed (Medline), BVS (Lilacs), and Cochrane library databases to identify relevant scientific articles using the following search terms: "oral lichen planus", "depression", "anxiety" and "treatment", in such a way that 33 publications were initially found. After application of inclusion and exclusion criteria, a total of 16 articles were selected for the main body reading. According to the analyzed literature, potential relationship between OLP and depression and anxiety was suggested, although there were divergences between the different studies. Currently, there is still no consensus on a gold-standard treatment for these lesions, even emphasizing the use of alternative therapies that have demonstrated some efficacy. In addition, recidivism is notable among patients with OLP, since psychological factors hypothetically affect healing during treatment. The emergence of OLP lesions can be related to psychopathological risk factors such as depression and anxiety and, even if they are not standardized, alternative therapies are effective, while each case of OLP has its peculiarity.

Development of multifunctional polymeric nanoparticles co-loaded with ZnPc and Fe2+ ions for synergetic PDT/CDT therapy

Recently photodynamic therapy (PDT)-based combinational therapeutic approaches have been extensively studied to circumvent the hurdle of tissue hypoxia in solid tumors. In this paper, we reported a facile way to prepare multifunctional nanoparticles (NPs) for synergetic PDT/chemodynamic therapy (CDT). Specifically, photosensitizer ZnPc was firstly loaded inside polymeric NPs by a reprecipitation method, followed by surface coating of Fe2+ ions-chelated polydopamine (PDA) shell, which was polymerized via photo-generated 1O2 from the ZnPc-loaded NPs. The resulting ZnPc@PDA-Fe2+ could not only generate 1O2 upon 660-nm photo-irradiation but also produce OH when exposed to H2O2 through the Fenton reaction. Taking advantage of the ZnPc and Fe2+ co-loaded NPs, in vitro combination therapy was performed on Hela cells. As a result, a higher therapeutic effect was achieved compared to single-modality PDT, corresponding to an improved cell inhibitory rate from 59% to 80%. These results demonstrate that our facilely prepared NPs are promising PDT/CDT nanoagents for efficient cancer therapy.

Combinatorial islet protective therapeutic approaches in β-cell transplantation: Rationally designed solutions using a target product profile.

While progress has been made in the development of islet cell transplantation (ICT) as a viable alternative to the use of exogenous insulin therapy in the treatment of type 1 diabetes, it has not yet achieved its full potential in clinical studies. Ideally, ICT would enable lifelong maintenance of euglycemia without the need for exogenous insulin, blood glucose monitoring or systemic immune suppression. To achieve such an optimal result, therapeutic approaches should simultaneously promote long-term islet viability, functionality, and localized immune protection. In practice, however, these factors are typically tackled individually. Furthermore, while the requirements of optimal ICT are implicitly acknowledged across numerous publications, the literature contains few comprehensive articulations of the target product profile (TPP) for an optimal ICT product, including key characteristics of safety and efficacy. This review aims to provide a novel TPP for ICT and presents promising tried and untried combinatorial approaches that could be used to achieve the target product profile. We also highlight regulatory barriers to the development and adoption of ICT, particularly in the United States, where ICT is only approved for use in academic clinical trials and is not reimbursed by insurance carriers. Overall, this review argues that the clear definition of a TPP in addition to the use of combinatorial approaches could help to overcome the clinical barriers to the widespread adoption of ICT for the treatment of type 1 diabetes.

Engineered extracellular vesicles mediated CRISPR-induced deficiency of IQGAP1/FOXM1 reverses sorafenib resistance in HCC by suppressing cancer stem cells

BackgroundSorafenib resistance poses therapeutic challenges in HCC treatment, in which cancer stem cells (CSCs) plays a crucial role. CRISPR/Cas9 can be utilized as a potential technique to overcome the drug resistance. However, a safe, efficient and target specific delivery of this platform remains challenging. Extracellular vesicles (EVs), the active components of cell to cell communication, hold promising benefits as delivery platform.ResultsHerein we report the normal epithelial cell –derived EVs engineered with HN3(HLC9-EVs) show competing tumor targeting ability. Anchoring HN3 to the membrane of the EVs through LAMP2, drastically increased the specific homing of HLC9-EVs to GPC3+Huh-7 cancer cells rather than co-cultured GPC3−LO2 cells. Combination therapy of HCC with sorafenib and HLC9-EVs containing sgIF to silence IQGAP1 (protein responsible for reactivation of Akt/PI3K signaling in sorafenib resistance) and FOXM1 (self-renewal transcription factor in CSCs attributed to sorafenib resistance), exhibited effective synergistic anti-cancer effect both in vitro and in vivo. Our results also showed that disruption of IQGAP1/FOXM1 resulted in the reduction of CD133+ population that contribute to the stemness of liver cancer cells.ConclusionBy reversing sorafenib resistance using combination therapeutic approach with engineered EVs encapsulated CRISPR/Cas9 and sorafenib, our study foreshadows a path for a better, accurate, reliable and successful anti-cancer therapy in the future.Graphical

Abstract B002: Development of bifunctional CRBN-SOS1 degraders for treatment of mutant KRAS cancers

Abstract Although oncogenic Kirsten rat sarcoma virus (KRAS) was once deemed undruggable, recent advances have revealed promising anti-tumor effects with pan-KRAS and KRAS-mutant specific inhibitors in both preclinical and clinical settings. Despite the success of these inhibitors, the diversity of tumors as well as tumor sensitivity results in acquired drug resistance suggesting that combinational therapeutic approaches would be necessary to avoid this problem. An attractive combination strategy would be to couple KRAS inhibition with a blockade of its guanine exchange factor, Son of Sevenless (SOS1). This would keep KRAS in its inactive state as well as mitigate upstream MAPK pathway reactivation notoriously associated with inhibition in this pathway. Utilizing our PRODEGY platform, we developed bifunctional SOS1 degraders for the treatment of patients with KRAS mutant cancers. These degraders have shown rapid and potent CRBN-mediated degradation which exhibit DC50s <10nM in a H358 SOS1-HiBiT cell line. Our high-throughput HiBiT data translated into effective SOS1 degradation in KRAS mutant cells harboring G12C, G12D, G12V, G12S, or G13D mutations. SOS1 degradation was validated to be dependent on the proteasome and CRBN as cotreatment with proteasomal inhibitors (MG132 or MLN4924) or treatment in a CRBN KO cells abolished degradation. Treatment of our SOS1 degraders resulted in the suppression of multiple signaling markers downstream of SOS1. Given its role in RAS activation, we observed a reduction in active KRAS, HRAS and MRAS protein upon treatment of SOS1 degraders in KRAS G12C MIA PaCa-2 cells. Furthermore, pERK and pS6 levels were decreased in a more potent or comparable manner compared to the SOS1 inhibitor, BI3406, in multiple KRAS mutant cell lines. Out competing SOS1 degraders with other CRBN binders highlighted that inhibition of pERK and pS6 was due to CRBN-mediated degradation. To determine functional activity of our SOS1 degraders, we developed and optimized 3D proliferation assays in multiple KRAS mutant (G12C, G12V, G12S, G13D) cell lines which yielded IC50s ranging from 0.5 – 70nM. Similarly, 100- to 300-fold IC50 value shifts were observed in SOS1 KO and CRBN KO H358 cell lines validating that the anti-proliferative activity of SOS1 degraders is specific to its targets. Treatment of SOS1 degraders in KRAS-mutant xenograft models resulted in >90% degradation of SOS1 in tumors and subsequently led to significant tumor growth inhibition as a single agent. Combination treatment of the KRAS G12C inhibitor AMG510 and SOS1 degraders produced strong synergistic antiproliferative effects in H358 and MIA PaCa-2 cell lines. Additionally, synergy was observed with SOS1 degraders and the EGFR inhibitor, Erlotinib, as well as the MEK inhibitor, Trametinib, in KRAS G13D mutant LoVo cells. The ability of our SOS1 degraders to have potency alone as well as in combination with multiple types of different RTK/RAS/MAPK pathway inhibitor highlights the value of SOS1 degraders as a potential therapeutic option for a range of KRAS mutant cancers. Citation Format: Kyle Begovich, Angela Schoolmeesters, Navin Rajapakse, Maneesh Kumar, Elena Martinez-Terroba, Arvind Shakya, Brandon Whitefield, Nataraj Pagadala, Aparajita Chourasia, Leah Fung. Development of bifunctional CRBN-SOS1 degraders for treatment of mutant KRAS cancers [abstract]. In: Proceedings of the AACR Special Conference: Targeting RAS; 2023 Mar 5-8; Philadelphia, PA. Philadelphia (PA): AACR; Mol Cancer Res 2023;21(5_Suppl):Abstract nr B002.

Abstract 4098: Chimeric antigen receptor (CAR) T cells overexpressing Bcl-xL increase proliferation and antitumor activity alone and in combination with BH3 mimetics

Abstract Background: Chimeric antigen receptor (CAR) T cells have become a well-established treatment option for patients, with six products approved for different hematologic diseases and new approvals allowing for their therapeutic use as early as second line. However, relapse rates of around 50% have been observed in all patient subsets, with one major mechanism associated with CAR T failure being cancer cell resistance to apoptosis. A form of cancer therapeutic named BH3-mimetics has been designed to inhibit members of the anti-apoptotic B cell lymphoma-2 (Bcl-2) family and, therefore, directly activate the apoptotic machinery in malignant cells. We hypothesized that integration of these anti-apoptotic molecules into CAR T cells would induce resistance towards the BH3 mimetics and allow combinational therapeutic approaches. Methods: 4-1BB and CD28 CAR constructs were designed to overexpress one of four anti-apoptotic proteins: wildtype Bcl-2, a Venetoclax-resistant Bcl-2 variant (G101V), B cell extra-large (Bcl-xL), or myeloid cell leukemia-1 (Mcl-1). CAR T cells made from these constructs were tested against leukemia (Nalm6) and lymphoma (JeKo-1) cell lines in combination with three different BH-3 mimetics: Venetoclax (ABT-199, an FDA-approved Bcl-2 inhibitor), Navitoclax (ABT-263, a Bcl-2/Bcl-xL inhibitor), and AZD5991 (an Mcl-1 inhibitor). Results: CAR T cells with a 4-1BB costimulatory domain tended to have increased killing over CARs with CD28 and were less susceptible to apoptosis; therefore, 4-1BB CARs were used for all further testing. Integration of Bcl-2 family proteins into CAR T cells didn’t impair or even increase tumor cell clearance in vitro; however, in combination with Venetoclax, Navitoclax, or AZD5991, killing capacity significantly increased compared to control CAR T cells. Even without combination with drugs, CAR T cells overexpressing Bcl-xL and Bcl-2 (both wildtype and mutant) provided higher anti-tumor activity and prolonged survival against JeKo-1 cells in vivo, whereas only Bcl-xL overexpression showed increased tumor control compared to regular 4-1BB CARs against Nalm6 cells. Conclusion: Of the tested antiapoptotic proteins, Bcl-xL overexpressing CAR T cells proved superior, having higher proliferation and increased anti-tumor activity in combination with or without BH3 mimetics, providing a new strategy to optimize CAR T cell function for the treatment of leukemia and lymphoma. Citation Format: Felix Korell, Michael Olson, Diego Salas-Benito, Mark B. Leick, Rebecca C. Larson, Harrison Silva, Alessandro Gasparetto, Trisha R. Berger, Amanda Bouffard, Michael C. Kann, Markus Mergen, Tamina Kienka, Marc Wehrli, Stefanie R. Bailey, Anthony Letai, Marcela V. Maus. Chimeric antigen receptor (CAR) T cells overexpressing Bcl-xL increase proliferation and antitumor activity alone and in combination with BH3 mimetics. [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 4098.

Abstract 1578: Novel Cereblon mediated bifunctional degraders of SOS1 for treatment of pan-KRAS mutant tumors

Abstract KRAS, a GTPase that regulates cellular growth, is the most frequently mutated oncogene with implications in non-small cell lung, pancreatic and colorectal cancers. Hyperactivation of KRAS in mutant alleles favors KRAS in its active GTP-bound state over its inactive GDP-bound state. Once deemed undruggable, recent advances have revealed promising anti-tumor effects with pan-KRAS and KRAS-mutant specific inhibitors in both preclinical and clinical settings. Despite the success of these inhibitors, the diversity of tumors as well as tumor sensitivity results in acquired drug resistance suggesting that combinational therapeutic approaches would be necessary to avoid this problem. An attractive dual approach would be to couple KRAS inhibition with a blockade of its guanine exchange factor (GEF), SOS1, to keep KRAS in its inactive state as well as prevent upstream pathway reactivation. Utilizing our PRODEGY platform, we developed bifunctional SOS1 degraders for the treatment of patients with KRAS mutant cancers. These degraders have shown rapid and potent Cereblon (CRBN)-mediated degradation which exhibit DC50s <10nM in a H358 SOS1-HiBiT cell line. Our high- throughput HiBiT data translated into effective SOS1 degradation in KRAS mutant cells harboring G12C, G12D, G12V, G12S, or G13D mutations. SOS1 degradation was validated to be dependent on the proteasome and CRBN as cotreatment with proteasomal inhibitors (MG132 or MLN4924) or treatment in a CRBN KO cells abolished degradation. Additionally, treatment of SOS1 degraders resulted in suppression of downstream signaling markers, pERK and pS6, in both 3D immunoblots and high-throughput assays with pERK IC50s <10nM. Chemical competitor assays also revealed that inhibition of pERK and pS6 was dependent on CRBN-mediated competition. To determine functional activity of our SOS1 degraders, we developed and optimized 3D proliferation assays in multiple KRAS mutant (G12C, G12D, G12V, G12S, G13D) cell lines which yielded IC50s ranging from 0.5 - 70nM. Similarly, 100- to 300-fold IC50 value shifts were observed in SOS1 KO and CRBN KO H358 cell lines validating that the anti-proliferative activity of SOS1 degraders is specific to its targets. Treatment of SOS1 degraders in KRAS-mutant xenograft models resulted in >75% degradation of SOS1 in tumors and subsequently led to significant tumor growth inhibition as a single agent. SOS1 degradation also provided synergistic anti-proliferation effects with other RAS/MAPK/AKT inhibition in in vitro studies. For example, combination treatment of AMG510 and SOS1 degraders resulted in strong synergistic effects in KRAS G12C H358 cells. Together, our data SOS1 degradation could be a valuable potential treatment option for a range of KRAS mutant cancers. Citation Format: Kyle Begovich, Angela Schoolmeesters, Navin Rajapakse, Maneesh Kumar, Arvind Shakya, Brandon Whitefield, Elena Martinez-Terroba, Nataraj Pagadala, Shenlin Huang, Aparajita H. Chourasia, Leah Fung. Novel Cereblon mediated bifunctional degraders of SOS1 for treatment of pan-KRAS mutant tumors [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 1578.

LBA01-08 EFFICACY OF TARGETED MAST CELL INHIBITION THERAPY IN CHRONIC PROSTATITIS/CHRONIC PELVIC PAIN SYNDROME

You have accessJournal of UrologyCME1 Apr 2023LBA01-08 EFFICACY OF TARGETED MAST CELL INHIBITION THERAPY IN CHRONIC PROSTATITIS/CHRONIC PELVIC PAIN SYNDROME Praveen Thumbikat, Goutham Pattabiraman, Catherine Osborn, Stephen Murphy, and Anthony Schaeffer Praveen ThumbikatPraveen Thumbikat More articles by this author , Goutham PattabiramanGoutham Pattabiraman More articles by this author , Catherine OsbornCatherine Osborn More articles by this author , Stephen MurphyStephen Murphy More articles by this author , and Anthony SchaefferAnthony Schaeffer More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003360.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a component of urologic chronic pelvic pain syndrome (UCPPS) and affects men, leading to chronic pain in the pelvic region or genitalia that is often accompanied by increased urinary frequency and urgency as well as sexual dysfunction. CPPS has an estimated prevalence rate of 6-12% of the male population with most diagnoses between the ages of 35-45. We have previously demonstrated that mast cells can be critical mediators of both chronic pelvic pain and lower urinary tract symptoms (LUTS). In this pilot clinical study, we therefore sought to identify subtypes of CP/CPPS characterized by mast cell dysfunction and evaluate the therapeutic efficacy of functional mast cell targeting on mast cell tryptase levels as well as on symptoms of pain and voiding dysfunction. METHODS: Men with CP/CPPS were recruited and evaluated in an open label, interventional uncontrolled trial after therapy with cromolyn sodium and cetirizine hydrochloride. The primary endpoint was a change in mast cell tryptase concentrations after treatment while secondary endpoints were changes in the NIH-CPSI and AUA-SI. Isolated cells from post-prostatic massage urine were evaluated for immune changes using mRNA expression analysis. RESULTS: 31 patients with a diagnoses of Category III CP/CPPS were consented, 25 patients qualified and 20 completed the study after meeting a prespecified threshold for active tryptase in expressed prostatic secretions. After treatment with cromolyn sodium and cetirizine dihydrochloride for 3-weeks, active tryptase concentrations were significantly reduced from 49.03±14.05 ug/ml to 25.49±5.48 ug/ml (p<0.05). The NIH-CPSI total score was reduced with a mean difference of 5.2±1 along with reduction in the pain, urinary and quality of life sub scores (p<0.001). A reduction in the AUA-SI was observed following treatment (p<0.05). NanoString mRNA analysis of isolated cells revealed downregulation of immune related pathways including Th1 and Th17 T cell differentiation and TLR signaling. Marked reduction in CD45+ cells and specifically macrophages and neutrophil abundance was observed. CONCLUSIONS: This pilot study presents a method to identify CP/CPPS patients with mast cell dysfunction and target them for therapeutic intervention using a novel, safe combination therapeutic approach. The resulting subgroup of CP/CPPS patients were shown to have a therapeutic response as measured primarily by a reduction in mast cell tryptase, a potential surrogate biomarker and reduction in CP/CPPS symptoms. These pilot studies will form the basis for future randomized placebo-controlled studies to evaluate these agents as CP/CPPS therapies. Source of Funding: This work was supported by the National Institute of Diabetes and Digestive and Kidney (NIDDK) grant R01DK083609 to Praveen Thumbikat. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of this abstract © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1179 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Praveen Thumbikat More articles by this author Goutham Pattabiraman More articles by this author Catherine Osborn More articles by this author Stephen Murphy More articles by this author Anthony Schaeffer More articles by this author Expand All Advertisement PDF downloadLoading ...

Boosting neuregulin 1 type-III expression hastens SMA motor axon maturation

Intercellular communication between axons and Schwann cells is critical for attaining the complex morphological steps necessary for axon maturation. In the early onset motor neuron disease spinal muscular atrophy (SMA), many motor axons are not ensheathed by Schwann cells nor grow sufficiently in radial diameter to become myelinated. These developmentally arrested motor axons are dysfunctional and vulnerable to rapid degeneration, limiting efficacy of current SMA therapeutics. We hypothesized that accelerating SMA motor axon maturation would improve their function and reduce disease features. A principle regulator of peripheral axon development is neuregulin 1 type III (NRG1-III). Expressed on axon surfaces, it interacts with Schwann cell receptors to mediate axon ensheathment and myelination. We examined NRG1 mRNA and protein expression levels in human and mouse SMA tissues and observed reduced expression in SMA spinal cord and in ventral, but not dorsal root axons. To determine the impact of neuronal NRG1-III overexpression on SMA motor axon development, we bred NRG1-III overexpressing mice to SMA∆7 mice. Neonatally, elevated NRG1-III expression increased SMA ventral root size as well as axon segregation, diameter, and myelination resulting in improved motor axon conduction velocities. NRG1-III was not able to prevent distal axonal degeneration nor improve axon electrophysiology, motor behavior, or survival of older mice. Together these findings demonstrate that early SMA motor axon developmental impairments can be ameliorated by a molecular strategy independent of SMN replacement providing hope for future SMA combinatorial therapeutic approaches.

Novel Therapeutic Combination Targets the Growth of Letrozole-Resistant Breast Cancer through Decreased Cyclin B1

As breast cancer cells transition from letrozole-sensitive to letrozole-resistant, they over-express epidermal growth factor receptor (EGFR), mitogen-activated protein kinase (MAPK), and human epidermal growth factor receptor 2 (HER2) while acquiring enhanced motility and epithelial-to-mesenchymal transition (EMT)-like characteristics that are attenuated and reversed by glyceollin treatment, respectively. Interestingly, glyceollin inhibits the proliferation and tumor progression of triple-negative breast cancer (TNBC) and estrogen-independent breast cancer cells; however, it is unlikely that a single phytochemical would effectively target aromatase-inhibitor (AI)-resistant metastatic breast cancer in the clinical setting. Since our previous report indicated that the combination of lapatinib and glyceollin induced apoptosis in hormone-dependent AI-resistant breast cancer cells, we hypothesized that combination therapy would also be beneficial for hormone independent letrozole-resistant breast cancer cells (LTLT-Ca) compared to AI-sensitive breast cancer cells (AC-1) by decreasing the expression of proteins associated with proliferation and cell cycle progression. While glyceollin + lapatinib treatment caused comparable inhibitory effects on the proliferation and migration in both cell lines, combination treatment selectively induced S and G2/M phase cell cycle arrest of the LTLT-Ca cells, which was mediated by decreased cyclin B1. This phenomenon may represent a unique opportunity to design novel combinatorial therapeutic approaches to target hormone-refractory breast tumors.

Emerging role of substance and energy metabolism associated with neuroendocrine regulation in tumor cells.

Cancer is the second most common cause of mortality in the world. One of the unresolved difficult pathological mechanism issues in malignant tumors is the imbalance of substance and energy metabolism of tumor cells. Cells maintain life through energy metabolism, and normal cells provide energy through mitochondrial oxidative phosphorylation to generate ATP, while tumor cells demonstrate different energy metabolism. Neuroendocrine control is crucial for tumor cells' consumption of nutrients and energy. As a result, better combinatorial therapeutic approaches will be made possible by knowing the neuroendocrine regulating mechanism of how the neuroendocrine system can fuel cellular metabolism. Here, the basics of metabolic remodeling in tumor cells for nutrients and metabolites are presented, showing how the neuroendocrine system regulates substance and energy metabolic pathways to satisfy tumor cell proliferation and survival requirements. In this context, targeting neuroendocrine regulatory pathways in tumor cell metabolism can beneficially enhance or temper tumor cell metabolism and serve as promising alternatives to available treatments.

Impaired Integrated Stress Response and Mitochondrial Integrity Modulate Genotoxic Stress Impact and Lower the Threshold for Immune Signalling.

Mitochondria-nucleus communication during stress dictates cellular fate with consequences on the etiopathology of multiple age-related diseases. Impaired mitochondrial quality control through loss of function of the mitochondrial protease HtrA2 associates with accumulation of damaged mitochondria and triggers the integrated stress response, implicating the transcription factor CHOP. Here we have employed a combined model of impaired mitochondria quality control, namely HtrA2 loss of function, and/or integrated stress response, namely CHOP loss of function, and genotoxicity to address the distinctive roles of these cellular components in modulating intracellular and intercellular responses. The genotoxic agents employed were cancer therapeutic agents such as irradiation with X-ray and protons or treatment with the radiomimetic bleomycin. The irradiation had an enhanced effect in inducing DNA damage in cells with CHOP loss of function, while the bleomycin treatment induced more DNA damage in all the transgenic cells as compared to the control. The genetic modifications impaired the transmission of DNA damage signalling intercellularly. Furthermore, we have dissected the signalling pathways modulated by irradiation in selected genotypes with RNA sequencing analysis. We identified that loss of HtrA2 and CHOP function, respectively, lowers the threshold where irradiation may induce the activation of innate immune responses via cGAS-STING; this may have a significant impact on decisions for combined therapeutic approaches for various diseases.

A Polyaminobiaryl-Based β-secretase Modulator Alleviates Cognitive Impairments, Amyloid Load, Astrogliosis, and Neuroinflammation in APPSwe/PSEN1ΔE9 Mice Model of Amyloid Pathology

The progress in Alzheimer's disease (AD) treatment suggests a combined therapeutic approach targeting the two lesional processes of AD, which include amyloid plaques made of toxic Aβ species and neurofibrillary tangles formed of aggregates of abnormally modified Tau proteins. A pharmacophoric design, novel drug synthesis, and structure-activity relationship enabled the selection of a polyamino biaryl PEL24-199 compound. The pharmacologic activity consists of a non-competitive β-secretase (BACE1) modulatory activity in cells. Curative treatment of the Thy-Tau22 model of Tau pathology restores short-term spatial memory, decreases neurofibrillary degeneration, and alleviates astrogliosis and neuroinflammatory reactions. Modulatory effects of PEL24-199 towards APP catalytic byproducts are described in vitro, but whether PEL24-199 can alleviate the Aβ plaque load and associated inflammatory counterparts in vivo remains to be elucidated. We investigated short- and long-term spatial memory, Aβ plaque load, and inflammatory processes in APPSwe/PSEN1ΔE9 PEL24-199 treated transgenic model of amyloid pathology to achieve this objective. PEL24-199 curative treatment induced the recovery of spatial memory and decreased the amyloid plaque load in association with decreased astrogliosis and neuroinflammation. The present results underline the synthesis and selection of a promising polyaminobiaryl-based drug that modulates both Tau and, in this case, APP pathology in vivo via a neuroinflammatory-dependent process.

Magnetite nanoparticles as a kinetically favorable source of iron to enhance GBM response to chemoradiosensitization with pharmacological ascorbate

Ferumoxytol (FMX) is an FDA-approved magnetite (Fe3O4) nanoparticle used to treat iron deficiency anemia that can also be used as an MR imaging agent in patients that can't receive gadolinium. Pharmacological ascorbate (P-AscH-; IV delivery; plasma levels ≈ 20 mM) has shown promise as an adjuvant to standard of care chemo-radiotherapy in glioblastoma (GBM). Since ascorbate toxicity mediated by H2O2 is enhanced by Fe redox cycling, the current study determined if ascorbate catalyzed the release of ferrous iron (Fe2+) from FMX for enhancing GBM responses to chemo-radiotherapy. Ascorbate interacted with Fe3O4 in FMX to produce redox-active Fe2+ while simultaneously generating increased H2O2 fluxes, that selectively enhanced GBM cell killing (relative to normal human astrocytes) as opposed to a more catalytically active Fe complex (EDTA-Fe3+) in an H2O2 – dependent manner. In vivo, FMX was able to improve GBM xenograft tumor control when combined with pharmacological ascorbate and chemoradiation in U251 tumors that were unresponsive to pharmacological ascorbate therapy. These data support the hypothesis that FMX combined with P-AscH- represents a novel combined modality therapeutic approach to enhance cancer cell selective chemoradiosentization in the management of glioblastoma.

When Just One Phosphate Is One Too Many: The Multifaceted Interplay between Myc and Kinases.

Myc transcription factors are key regulators of many cellular processes, with Myc target genes crucially implicated in the management of cell proliferation and stem pluripotency, energy metabolism, protein synthesis, angiogenesis, DNA damage response, and apoptosis. Given the wide involvement of Myc in cellular dynamics, it is not surprising that its overexpression is frequently associated with cancer. Noteworthy, in cancer cells where high Myc levels are maintained, the overexpression of Myc-associated kinases is often observed and required to foster tumour cells' proliferation. A mutual interplay exists between Myc and kinases: the latter, which are Myc transcriptional targets, phosphorylate Myc, allowing its transcriptional activity, highlighting a clear regulatory loop. At the protein level, Myc activity and turnover is also tightly regulated by kinases, with a finely tuned balance between translation and rapid protein degradation. In this perspective, we focus on the cross-regulation of Myc and its associated protein kinases underlying similar and redundant mechanisms of regulation at different levels, from transcriptional to post-translational events. Furthermore, a review of the indirect effects of known kinase inhibitors on Myc provides an opportunity to identify alternative and combined therapeutic approaches for cancer treatment.

Multidrug-Loaded Lipid Nanoemulsions for the Combinatorial Treatment of Cerebral Cavernous Malformation Disease

Cerebral cavernous malformation (CCM) or cavernoma is a major vascular disease of genetic origin, whose main phenotypes occur in the central nervous system, and is currently devoid of pharmacological therapeutic strategies. Cavernomas can remain asymptomatic during a lifetime or manifest with a wide range of symptoms, including recurrent headaches, seizures, strokes, and intracerebral hemorrhages. Loss-of-function mutations in KRIT1/CCM1 are responsible for more than 50% of all familial cases, and have been clearly shown to affect cellular junctions, redox homeostasis, inflammatory responses, and angiogenesis. In this study, we investigated the therapeutic effects of multidrug-loaded lipid nanoemulsions in rescuing the pathological phenotype of CCM disease. The pro-autophagic rapamycin, antioxidant avenanthramide, and antiangiogenic bevacizumab were loaded into nanoemulsions, with the aim of reducing the major molecular dysfunctions associated with cavernomas. Through Western blot analysis of biomarkers in an in vitro CCM model, we demonstrated that drug-loaded lipid nanoemulsions rescue antioxidant responses, reactivate autophagy, and reduce the effect of pro-angiogenic factors better than the free drugs. Our results show the importance of developing a combinatorial preventive and therapeutic approach to reduce the risk of lesion formation and inhibit or completely revert the multiple hallmarks that characterize the pathogenesis and progression of cavernomas.

Natural history study and tissue procurement of neuroendocrine neoplasms (NENs).

TPS659 Background: Neuroendocrine neoplasms (NENs) are a rare spectrum of malignant neoplasms originating from neuroendocrine cells, most commonly affecting the gastrointestinal tract, pancreas, and lungs. Tumors may vary from low grade neuroendocrine tumors (NET) to high grade neuroendocrine carcinomas (NEC). The annual occurrence of NENs is increasing worldwide and currently the incidence in the US is about 6 cases per 100,000 people per year. A variety of therapeutic options are available for advanced NENs, however, when to apply a given option, what combination therapeutic approach should be used, how long treatment should be continued is unclear and controversial. Moreover, unlike common cancers, pre-clinical models for NENs are sorely limited. Without robust pre-clinical models our understanding of tumor pathophysiology and novel drug development can be challenging. Methods: A prospective study to evaluate the natural history and sample acquisition of NENs comprehensively and longitudinally. Patients ≥ 18 years old with histological confirmation of NENs, biochemical evidence of NENs, or by imaging studies of NENs are eligible. Participants are invited to NIH for biannual evaluations or as clinically indicated. Patients complete individual medical history, family history, and laboratory assessments including blood, saliva, and tumor for RNA/DNA analysis. A tumor analysis via a 500+ gene panel (Illumina TruSight Oncology 500 Panel) is performed for comprehensive genomic and epigenomic analysis. When feasible, fresh tissue is collected to develop pre-clinical models for drug testing. If clinically indicated, anatomic and functional imaging is performed. We aim to 1) create a repository of biological samples and conduct future investigations to understand the basic biology of NENs with the goal to develop novel treatment approaches, biomarkers of treatment response, and new prognostic and diagnostic models, 2) acquire clinical data so that the overall genomic, proteomic, and metabolomic alternations can be correlated to clinical parameters, 3) establish organoid cultures, cell line models, and xenograft models corresponding to NENs of various grades for drug screening. This protocol will evaluate the natural history of NENs, allow tissue acquisition, and study this heterogenous group of neoplasms with unique tumor biology, and current clinical management to stabilize correlations with clinical outcomes and develop novel therapies. Clinical trial information: NCT05237934 .

Treatment of advanced non-small cell lung cancer with driver mutations: current applications and future directions.

With the improved understanding of driver mutations in non-small cell lung cancer (NSCLC), expanding the targeted therapeutic options improved the survival and safety. However, responses to these agents are commonly temporary and incomplete. Moreover, even patients with the same oncogenic driver gene can respond diversely to the same agent. Furthermore, the therapeutic role of immune-checkpoint inhibitors (ICIs) in oncogene-driven NSCLC remains unclear. Therefore, this review aimed to classify the management of NSCLC with driver mutations based on the gene subtype, concomitant mutation, and dynamic alternation. Then, we provide an overview of the resistant mechanism of target therapy occurring in targeted alternations ("target-dependent resistance") and in the parallel and downstream pathways ("target-independent resistance"). Thirdly, we discuss the effectiveness of ICIs for NSCLC with driver mutations and the combined therapeutic approaches that might reverse the immunosuppressive tumor immune microenvironment. Finally, we listed the emerging treatment strategies for the new oncogenic alternations, and proposed the perspective of NSCLC with driver mutations. This review will guide clinicians to design tailored treatments for NSCLC with driver mutations.

Porous Framework Materials for Bioimaging and Cancer Therapy.

Cancer remains one of the most pressing diseases in the world. Traditional treatments, including surgery, chemotherapy, and radiotherapy still show certain limitations. Recently, numerous cancer treatments have been proposed in combination with novel materials, such as photothermal therapy, chemodynamic therapy, immunotherapy, and a combination of therapeutic approaches. These new methods have shown significant advantages in reducing side effects and synergistically enhancing anti-cancer efficacy. In addition to the above approaches, early diagnosis and in situ monitoring of lesion areas are also important for reducing side effects and improving the success rate of cancer therapy. This depends on the decent use of bioimaging technology. In this review, we mainly summarize the recent advances in porous framework materials for bioimaging and cancer therapy. In addition, we present future challenges relating to bioimaging and cancer therapy based on porous framework materials.