Dose Group Research Articles

Дозовая зависимость смертности от болезней системы кровообращения у работников ядерной индустрии (систематический обзор и pooled-анализ): отсутствие эффекта малых доз и подтверждение порога, установленного НКДАР и МКРЗ при 0,5 Гр

Based on the maintained database (source database) on effects in nuclear workers (NW), a selection of major studies of the relationship between mortality from diseases of the circulatory system (CVD; codes 390–459 according to ICD-9 and I00–I99 according to ICD-10) and external radiation dose. The sample included 30 papers and covered cohorts from 6 countries plus an NW cohort from 15 countries. For the sample, in most cases based on published standardized mortality rates (SMR), the relative risks (RR) of mortality from CVD were calculated for the selected dose groups with subsequent processing of the material for outliers. Initial: n = 207; final sample: n = 199; covers very low (0–10 mSv; 15.8 % of the sample), low (>10–100 mSv; 45.8 %) and moderate (>100–1000 mSv; 36.4 %) doses; data for high doses (>1000 mSv; n = 4; 2 % of the sample), due to dubiousness, were excluded. A systematic review and pooled analysis of the RR for mortality from CVD depending on the dose on an ordinal scale was performed on the final sample. For the entire dose range (0–1000 mSv) and for moderate doses, statistically significant trends in increasing RR were found when expressed in five types of regressions (except for the logarithmic one for the entire range). Although the r values were small (0.230–0.293), the effect was clear. The ERR per 1 Gy (Sv) calculated for moderate doses using linear regression was 0.54. This value is higher than those obtained previously in meta-analyses, but should be considered as the most adequate. No dose relationship was found for the very low + low dose range (0–100 mGy); the r coefficients for the regressions were either negligible or negative at statistical insignificance. For the subthreshold dose range for CVD mortality after exposure (according to UNSCEAR and ICRP: 500 mSv), only a weak trend towards an increase in RR was found, statistically insignificant, despite the large sample size (n = 191), while for the dose range 500–1000 mSv, the highest tendency among the pooled analyzes was revealed to increase the risk depending on the level of exposure (r = 0.297–0.423; statistically insignificant due to the small sample size: n = 8). It is concluded that for mortality from CVD after irradiation, the threshold value of 0.5 Gy established by UNSCEAR and ICRP and confirmed in the present pooled analysis should be strictly adhered to. Due to the lack of effects of low doses, it is inappropriate to raise the issue of low dose effects in the context of these pathologies.

Effects of epimedium total flavone capsules on post-stroke cognitive impairment in rats

To investigate the effect of epimedium total flavone capsules on post-stroke cognitive impairment(PSCI) in rats. The transient middle cerebral artery occlusion(tMCAO) model was constructed on selected rats, and rats with impaired neurological function were randomly divided into the model group, low, middle, and high dose groups of epimedium total flavone capsules, and nimodipine tablet group. The cognitive function of rats was measured after administration. Pathological changes in brain tissue were observed after hematoxylin-eosin staining(HE). Neuronal nuclei(NeuN) and glial fibrillary acidic protein(GFAP) distribution in brain tissue were tested by immunofluorescent staining. The level of amyloid beta 1-42(Aβ_(1-42)), neuron specific enolase(NSE), acetylcholine(ACH), dopamine(DA), 5-hydroxytryptamine(5-HT), norepinephrine(NE), interleukin-1β(IL-1β), tumor necrosis factor-α(TNF-α), and hypersensitive C-reactive protein(hs-CRP) in rat serum was tested. Moreover, Western blot was utilized to test the expression of nuclear factor-kappaB(NF-κB), p-NF-κB, alpha inhibitor of NF-κB(IκBα) protein, and p-IκBα protein in the hippocampus. The experimental results showed that epimedium total flavone capsules can improve the cognitive function of model rats, and the mechanism may be related to the regulation of the expression of p-IκBα and p-NF-κB proteins, so as to inhibit inflammatory response induced by ischemia-reperfusion.

Anti‐obesity potential of Polygonum minus Huds.: in vitro and in vivo evaluation

SummaryPolygonum minus (PM) has a rich traditional usage for health benefits, yet its potential as a natural‐based solution for obesity management remains unexplored. This study evaluated the antioxidant properties, inhibition of pancreatic lipase and α‐glucosidase activities, and metabolite profiles of PM aerial extracts harvested at 8, 10, and 12 weeks using 1H NMR‐based metabolomics. PM harvested at 12 weeks exhibited significant antioxidant and enzyme inhibition activities. NMR metabolomics unveiled nine major metabolites correlated to the bioactivities of 12‐week PM. LC–MS/MS profiling enabled the identification of flavonoids and phenolic acids, with the majority having sulfate, gallate, and glycoside moieties. Notably, in vivo experiments demonstrated that rats treated with 200 mg kg−1 and 400 mg kg−1 PM exhibited significantly lower (P < 0.05) total body weight gain (39.03% and 52.59%, respectively) compared to negative control rats (69.95%), with the lower dose group also exhibiting reduced (P < 0.05) fasting blood glucose levels. This study highlights the potential of 12‐week PM as a natural‐based solution in obesity management.

Reducing Recurrent Urinary Tract Infections in Women with MV140 Impacts Personal Burden of Disease: Secondary Analyses of a Randomized Placebo-controlled Efficacy Study

BackgroundRecurrent urinary tract infection (rUTI) remains a major health burden for women. A randomized, double-blind, placebo-controlled trial (RCT; NCT02543827) reported that female patients with rUTI receiving a sublingual vaccine, MV140, had a reduction in rUTI and increase in UTI-free rate compared with placebo. ObjectiveTo determine the impact of MV140 on the personal burden of disease in women with rUTI using secondary endpoint data from the pivotal RCT evaluating MV140. Design, setting, and participantsIn the primary RCT, female patients with rUTI enrolled in Spain and UK (from October 2015 to April 2019) were randomized to placebo (6 mo) or MV140 (3 or 6 mo), and followed for 12 mo. Individuals analyzed in this secondary analysis included those in the placebo and 3-mo (recommended dose) groups. InterventionA polybacterial sublingual vaccine, MV140 (four inactivated whole-cell bacteria—Escherichia coli, Klebsiella pneumoniae, Proteus vulgaris, and Enterococcus faecalis), or placebo. Outcome measurements and statistical analysisSymptom severity scoring, antibiotic use, safety, and multiple aspects of quality of life (QoL; Short-Form Questionnaire [SF-36]) were assessed. Results and limitationsCompared with the placebo group (n = 76), the 3-mo vaccinated group (n = 74) experienced fewer overall UTI symptoms (mean symptom score 102.2 ± 222.9 vs 194.2 ± 178.8; p = 0.0002), fewer days on antibiotics (12.4 ± 17.7 vs 28.7 ± 25.2; p = 0.0001), and improved total, general, and physical SF-36 QoL improvement (differences in means for total SF-36 score 15.7; 95% confidence interval [CI] 8.80, 22.64; p < 0.0001), with only social function QoL showing no impact (4.07; 95% CI –4.93, 13.08; p = 0.3744). ConclusionsThree months of MV140 is associated with a reduction of the personal burden of UTI by reducing overall UTI symptoms and antibiotic use, improving QoL in women with rUTI. Patient summaryThree months of MV140 vaccine, which has previously been shown to reduce the risk of urinary tract infection safely, is associated with a reduction in the personal burden of disease.

Establishment of a Mouse Degenerative Model of Patellar Tendinopathy with Upregulation of Inflammation.

There is no mouse model of patellar tendinopathy. This study aimed to establish a mouse inflammatory and degenerative patellar tendon injury model, which will facilitate research on patellar tendinopathy using advanced molecular tools including transgenic models. Collagenase at different doses (low dose (LD), medium dose (MD), high dose (HD)) or saline was injected over the mouse patellar tendon. At weeks 1, 2, 4, and 8 post-injection, the tendons were harvested for histology and further examined by micro-computed tomography (microCT) imaging at week 8. The optimal dose group and the saline group were further evaluated by immunohistochemical staining, gait pattern, and biomechanical properties. The histopathological score increased dose-dependently post-collagenase injection. Ectopic mineralization was observed and increased with collagenase dose. The LD group was selected for further analysis. The expression of IL-10, TNF-α, and MMP-1 significantly increased post-injection. The changes of limb idleness index (ΔLII) compared to preinjury state were significantly higher, while the ultimate load, stiffness, ultimate stress, and maximum Young's modulus were significantly lower in the LD group compared to the saline group. A mouse inflammatory degenerative model of patellar tendon injury resembling tendinopathy was established as indicated by the dose-dependent increase in tendon histopathology, ectopic calcification, decrease in biomechanical properties, and pain-associated gait changes.

Comparing the safety and efficacy of nintedanib starting dose in patients with connective tissue disease-associated interstitial lung diseases

Objective This study aimed to analyse whether initiating nintedanib treatment at a reduced dose could improve the treatment continuation rate while maintaining efficacy in patients with connective tissue disease (CTD)-associated interstitial lung disease. Method In total, 51 patients (age 61.6 ± 13.2 years; 38 women, 13 men) were retrospectively analysed. The primary endpoint was the cumulative discontinuation rate due to adverse events. Secondary endpoints included changes in drug dosage, efficacy evaluated based on annual changes in forced vital capacity (FVC), and safety assessed based on the frequency of adverse events. Results Eighteen patients who started treatment at the standard dose of 300 mg (standard dosage group) were compared with 33 patients who started treatment at a reduced dose (reduced dosage group). Systemic sclerosis was the most common CTD (n = 32), followed by idiopathic inflammatory myopathies and, rarely, rheumatoid arthritis. Both groups exhibited comparable cumulative discontinuation rates due to adverse events and similar frequencies of adverse events. No significant differences were observed in maintenance doses between the two groups; however, patients in the reduced dosage group had a lower cumulative dose for up to 52 weeks than those in the standard dosage group. No significant differences were observed in changes in FVC between the two groups. Conclusion There was no evidence for a difference between the two groups in terms of discontinuation rates, efficacy, and safety. To provide further evidence, future studies using more precise dose-escalation protocols are warranted.

Effect of steroid pulses in severe BK virus allograft nephropathy with extensive interstitial inflammation.

As there is no specific antiviral treatment currently available for BK polyomavirus associated nephropathy (BKVAN), its management relies on immunosuppression reduction in kidney transplant patients. Data on efficacy of steroid pulses in this indication are lacking. We performed a retrospective monocenter study on 64 patients diagnosed with biopsy-proven BKVAN. Patients within the "pulse group" (n = 37) received IV methylprednisolone 10mg/kg 3 days consecutively. In the "low dose" steroid group (n = 27), patients were continued oral prednisone 5mg daily. Mean follow up was 78 months in the steroid pulse group and 56 months in the low dose group (p=0.15). Mean eGFR values at diagnosis were comparable, as well as other demographic characteristics. Mean BK plasma viral load was higher in "pulse" than in "low dose" steroid group. Pulse group had higher inflammation and tubulitis (p <0.05). Graft loss reached 57% in the "pulse" group versus 41% in the "low dose" group, p=0.20. Rejection events were similar. No major adverse event was statistically associated with steroid pulse, including infections, cancer, and de novo diabetes. No significant differences were found in the evolution of both groups of patients, despite patients receiving "pulse" steroids were identified as the most severe sharing higher BK viral load and more frequent active lesions on histology.

Assessing the hepatotoxicity of phosphogypsum leachate in zebrafish (Danio rerio)

The improper disposal of large amounts of phosphogypsum generated during the production process of the phosphorus chemical industry (PCI) still exists. The leachate formed by phosphogypsum stockpiles could pose a threat to the ecological environment and human health. Nevertheless, information regarding the harmful effects of phosphogypsum leachate on organisms is still limited. Herein, the physicochemical characteristics of phosphogypsum leachate were analyzed, and its toxicity effect on zebrafish (Danio rerio), particularly in terms of hepatotoxicity and potential mechanisms, were evaluated. The results indicated that P, NH3-N, TN, F−, As, Cd, Cr, Co, Ni, Zn, Mn, and Hg of phosphogypsum leachate exceeded the V class of surface water environmental quality standards (GB 3838–2002) to varying degrees. Acute toxicity test showed that the 96 h LC50 values of phosphogypsum leachate to zebrafish was 2.08 %. Under exposure to phosphogypsum leachate, zebrafish exhibited concentration-dependent liver damage, characterized by vacuolization and infiltration of inflammatory cells. The increased in Malondialdehyde (MDA) content and altered activities of antioxidant enzymes in the liver indicated the induction of oxidative stress and oxidative damage. The expression of apoptosis-related genes (P53, PUMA, Caspase3, Bcl-2, and Bax) were up-regulated at low dosage group and down-regulated at medium and high dosage groups, suggesting the occurrence of hepatocyte apoptosis or necrosis. Additionally, phosphogypsum leachate influenced the composition of the zebrafish gut microbiota by reducing the relative abundance of Bacteroidota, Aeromonas, Flavobacterium, Vibrio, and increasing that of Rhodobacter and Pirellula. Correlation analysis revealed that gut microbiota dysbiosis was associated with phosphogypsum leachate-induced hepatotoxicity. Altogether, exposure to phosphogypsum leachate caused liver damage in zebrafish, likely through oxidative stress and apoptosis, with the intestinal flora also playing a significant role. These findings contribute to understanding the ecological toxicity of phosphogypsum leachate and promote the sustainable development of PCI.

Three-dimensional texture analyses of multi-quantitative relaxation time maps for evaluating cartilage repair with the treatment of allogeneic human adipose-derived mesenchymal progenitor cells

BackgroundTo explore the ability of three-dimensional texture analyses based on gray-level run-length matrix (GLRLM) for examining the spatial distribution of pixel values on magnetic resonance imaging (MRI) relaxation time maps and detecting the compositional variation of cartilage repair following treatment with allogeneic human adipose-derived mesenchymal progenitor cells (haMPCs). MethodsParticipants with knee osteoarthritis were randomly divided into three groups with intra-articular haMPCs injections: low-, medium-, and high-dose groups. We analyzed five GLRLM parameters in the T1rho, T2 and T2star maps, including run length non-uniformity (RLNonUni), gray-level non-uniformity (GLevNonU), long run emphasis (LngREmph), short run emphasis (ShrtREmp), and fraction of images in runs. We used the relative D values (the ratio of difference values to baseline) as the objective to avoid errors caused by individual differences. We calculated the two-tailed Pearson's linear correlation coefficient (r) to investigate the correlations of the texture parameters with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores. ResultsCompared with the base time, significant reduction of WOMAC score was observed in both high and medium doses groups at terminal time, indicating relief of pain symptoms in high and medium groups with the treatment of allogeneic haMPCs. Significant differences were observed in the GLRLM parameters of cartilage MR relaxation time maps in different doses groups. In both T1rho and T2 relaxation time maps, the high-dose group showed significant increases in relative D values of RLNonUni, GLevNonU, LngREmph and ShrtREmp, which indicated significant changes in the uniformity of relaxation time maps. For T2star map, GLRLM parameters such as GLevNonU and ShrtREmp, especially LngREmph, showed significant increases in relative D values in high-dose group. Among all GLRLM features, LngREmph of three relaxation time maps had performed excellent linear correlations with WOMAC scores. ConclusionsTexture analysis of the cartilage may allow the detection of compositional variation in cartilage repair with the treatment of allogeneic haMPCs. This technique displays potential applications in understanding the mechanism of stem cell repair of the cartilage and assessing the treatment response.

Suitability of reduced dose glucocorticoids therapy regimen for antibody-associated vasculitis patients with TB: a retrospective study.

Immunosuppressive therapy is the major treatment approach for patients with anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV). Due to impaired cellular immunological function and the use of glucocorticoids and immunosuppressants, AAV patients are predisposed to opportunistic infections, including tuberculosis (TB). This retrospective study aims to analyze the clinical characteristics of patients with AAV and TB and explore suitable glucocorticoid regimens for them. So as to provide a basis for future clinical guidelines and have important value for guiding clinical treatment. This study retrospectively reviewed 58 AAV patients (18-80 years old) with TB admitted to Changsha Central Hospital Affiliated with the University of South China from 2016.1 to 2023.4 Patients were divided into standard-dose and reduced-dose glucocorticoid groups before retrospectively analyzing their medical records. A total of 58 AAV patients with TB were enrolled, with 15 dying throughout the monitoring period. Through analysis data, compared with the standard-dose group, the reduced group had less proteinuria and hematuria. In survival analysis, the reduced-dose glucocorticoid group had lower mortality than the standard-dose group (P = 0.03); however, no significant difference was noted in the use of immunoglobulin (P = 0.39), tuberculosis activity (P = 0.64), and age stratification (P = 0.40). The BVAS score before treatment and 6 months post-treatment suggest that the two regimens cause the same risk of ESKD (P > 0.05). In conclusion, the reduced glucocorticoid dose group can achieve the same curative effect as the standard dose group and has less damage to the kidney in hematuria and proteinuria. Therefore, the reduced glucocorticoid dose treatment regimen may be more suitable for AAV patients with TB.

A Preliminary Study on Quantitative Analysis of Collagen and Apoptosis Related Protein on 1064 nm Laser-Induced Skin Injury.

To investigate the associated factors concerning collagen and the expression of apoptosis-related proteins in porcine skin injuries induced by laser exposure, live pig skin was irradiated at multiple spots one time, using a grid-array method with a 1064 nm laser at different power outputs. The healing process of the laser-treated areas, alterations in collagen structure, and changes in apoptosis were continuously observed and analyzed from 6 h to 28 days post-irradiation. On the 28th day following exposure, wound contraction and recovery were notably sluggish in the medium-high dose group, displaying more premature and delicate type III collagen within the newly regenerated tissues. The collagen density in these groups was roughly 37-58% of that in the normal group. Between days 14 and 28 after irradiation, there was a substantial rise in apoptotic cell count in the forming epidermis and granulation tissue of the medium-high dose group, in contrast to the normal group. Notably, the expression of proapoptotic proteins Bax, caspase-3, and caspase-9 surged significantly 14 days after irradiation in the medium-high dose group and persisted at elevated levels on the 28th day. During the later stage of wound healing, augmented apoptotic cell population and insufficient collagen generation in the newly generated skin tissue of the medium-high dose group were closely associated with delayed wound recovery.

Effect of early dose reduction of osimertinib on efficacy in the first-line treatment for EGFR-mutated non-small cell lung cancer

SummaryOsimertinib is used as the first-line therapy for patients with epidermal growth factor receptor (EGFR)-mutated non-small cell lung cancer (NSCLC). However, early dose reduction is often required due to adverse events (AEs). This study aimed to evaluate the effect of early dose reduction of osimertinib on efficacy and safety. This was a retrospective study including patients with EGFR-mutated NSCLC who were started on osimertinib as the first-line therapy between August 2018 and December 2021. Patients whose doses were reduced to less than 80 mg/day within 6 months of osimertinib initiation or started at 40 mg/day were defined as the dose reduction group. The primary endpoint was progression-free survival (PFS). Factors affecting PFS were explored using the Cox proportional hazards model. A total of 85 patients were included in this study. No significant differences in patient characteristics were observed between the dose reduction (n = 25) and standard dose groups (n = 60). The median PFS in the dose reduction group was significantly prolonged compared with that in the standard dose group (26.0 months vs. 12.0 months, p = 0.03). Multivariable analysis of 84 patients, excluding a patient with unknown brain metastasis, revealed that EGFR exon 21 L858R mutation, malignant pleural effusion or pleural metastasis, liver metastasis, and dose reduction within 6 months were independent factors affecting PFS. Early dose reduction of osimertinib is an effective therapeutic strategy for prolonging PFS in patients with EGFR-mutated NSCLC.

Bajitianwan formula extract ameliorates bone loss induced by iron overload via activating RAGE/PI3K/AKT pathway based on network pharmacology and transcriptomic analysis.

Osteoporosis (OP) is closely related to iron overload. Bajitianwan (BJTW) is a traditional Chinese medicine formulation used for treating senile diseases such as dementia and osteoporosis. Modern pharmacological researches have found that BJTW has beneficial effect on bone loss and memory impairment in aging rats. This paper aimed to explore the role and mechanism of BJTW in ameliorating iron overload-induced bone loss. Furthermore, BJTW effectively improved the bone micro-structure of the femur in mice, and altered bone metabolism biomarkers alkaline phosphatase (ALP) and osteocalcin (OCN) in serum, as well as oxidative indexes superoxide dismutase (SOD), catalase (CAT), glutathione reductase (GR) glutathione (GSH) and malondialdehyde (MDA) in liver. As for network pharmacology, 73 components collected from BJTW regulated 99 common targets merged in the BJTW and OP. The results of RNA-seq indicated that there were 418 potential targets in BJTW low dose group (BJTW-L) and 347 potential targets in BJTW high dose group (BJTW-H). Intriguingly, both PI3K-AKT signaling pathway and the AGEs-RAGE signaling pathway were contained in the KEGG pathways enrichment results of network pharmacology and transcriptomics, which were considered as the potential mechanism. Additionally, we verified that BJTW regulated the expression of related proteins in RAGE/PI3K-AKT pathways in MC3T3-E1 cells. In summary, BJTW has potent effect on protecting against iron overload-induced OP, and its mechanism may be related to the activation of the RAGE/PI3K-AKT signaling pathways.

Performance of the Iterative OSEM and HYPER Algorithm for Total-body PET at SUVmax with a Low 18F-FDG Activity, a Short Acquisition Time and Small Lesions.

The primary objective of this comparative investigation was to examine the qualitative attributes of image reconstructions utilizing two distinct algorithms, namely OSEM and HYPER Iterative, in total-body 18F- FDG PET/CT under various acquisition durations and injection activities. An initial assessment was executed using a NEMA phantom to compare image quality engendered by OSEM and HYPER Iterative algorithms. Parameters such as BV, COV, and CRC were meticulously evaluated. Subsequently, a prospective cohort study was conducted on 50 patients, employing both reconstruction algorithms. The study was compartmentalized into distinct acquisition time and dosage groups. Lesions were further categorized into three size-based groups. Quantifiable metrics including SD of noise, SUVmax, SNR, and TBR were computed. Additionally, the differences in values, namely &#916;SUVmax, &#916;TBR, %&#916;SUVmax, %&#916;SD, and %&#916;SNR, between OSEM and HYPER Iterative algorithms were also calculated. The HYPER Iterative algorithm showed reduced BV and COV compared to OSEM in the phantom study, with constant acquisition time. In the clinical study, lesion SUVmax, TBR, and SNR were significantly elevated in images reconstructed using the HYPER Iterative algorithm in comparison to those generated by OSEM (p &#60; 0.001). Furthermore, an amplified increase in SUVmax was predominantly discernible in lesions with dimensions less than 10 mm. Metrics such as %&#916;SNR and %&#916;SD in HYPER Iterative exhibited improvements correlating with reduced acquisition times and dosages, wherein a more pronounced degree of enhancement was observable in both &#916;SUVmax and &#916;TBR. The HYPER Iterative algorithm significantly improves SUVmax and reduces noise level, with particular efficacy in lesions measuring ≤ 10 mm and under conditions of abbreviated acquisition times and lower dosages.

The opportunities and challenges of the disease-modifying immunotherapy for type 1 diabetes: A systematic review and meta-analysis

There are multiple disease-modifying immunotherapies showing the potential of preventing or delaying the progression of type 1 diabetes (T1D). We designed and performed this systematic review and meta-analysis to gain an overview of what a role immunotherapy plays in the treatment of T1D. We searched PubMed, Embase and Cochrane Central Register of Controlled Trials (CENTRAL) from inception to December 2023. We included clinical trials of immunotherapy conducted in patients with T1D that reported the incidence of hypoglycemia or changes from baseline in at least one of following outcomes: 2 h and 4 h mixed-meal-stimulated C-peptide area under the curve (AUC), fasting C-peptide, daily insulin dosage, glycated hemoglobin (HbA1c) and fasting plasma glucose (FPG). The results were computed as the weighted mean differences (WMDs) or odds ratios (ORs) and 95% confidence intervals (CIs) in random-effect model. In all, 34 clinical trials were included. When compared with control groups, 2 h C-peptide AUC was marginally higher in patient treated with nonantigen-based immunotherapies (WMD, 0.04nmol/L, 95% CI, 0.00–0.09 nmol/L, P=0.05), which was mainly driven by the effects of T cell-targeted therapy. A greater preservation in 4 h C-peptide AUC was observed in patients with nonantigen-based immunotherapies (WMD, 0.10nmol/L, 95% CI, 0.04–0.16 nmol/L, P=0.0007), which was mainly driven by the effects of tumor necrosis factor α (TNF-α) inhibitor and T cell-targeted therapy. After excluding small-sample trials, less daily insulin dosage was observed in patient treated with nonantigen-based immunotherapies when compared with control groups (WMD, −0.07units/kg/day, 95% CI, −0.11 to −0.03units/kg/day, P=0.0004). The use of antigen-based immunotherapies was also associated with a lower daily insulin dosage versus control groups (WMD, −0.11units/kg/day, 95% CI, −0.23 to −0.00units/kg/day, P=0.05). However, changes of HbA1c or FPG were comparable between nonantigen-based immunotherapies or antigen-based immunotherapies and control groups. The risk of hypoglycemia was not increased in patients treated with nonantigen-based immunotherapies or patients treated with antigen-based immunotherapies when compared with control groups. In conclusion, nonantigen-based immunotherapies were associated with a preservation of 2 h and 4 h C-peptide AUC in patients with T1D when compared with the controls, which was mainly driven by the effects of TNF-a inhibitor and T cell-targeted therapy. Both nonantigen-based immunotherapies and antigen-based immunotherapies tended to reduce the daily insulin dosage in patients with T1D when compared with the controls. However, they did not contribute to a substantial improvement in HbA1c or FPG. Both nonantigen-based immunotherapies and antigen-based immunotherapies were well tolerated with not increased risk of hypoglycemia in patients with T1D.

Abstract 3307: c-Met targeting chaperone-mediated protein degrader for therapeutic intervention in NSCLC

Abstract The interaction between E3 ligases and chaperones is crucial for proteostasis, regulating more than 10% of total proteasomes and over 30% of human E3 ligases (Kevei, 2017). Chaperones also can recognize their substrates and direct them to degradation by the ubiquitin-proteasome system (UPS). Developing a targeted protein degradation (TPD) technology that utilizes these advantageous attributes of chaperones, termed chaperone-mediated protein degradation (CMPD) technology, would broaden the range of disease-causing target proteins and would efficiently degrade them by recruiting various intracellular E3 ligases through interaction with chaperones, compare to other TPD approaches. The c-mesenchymal-epithelial transition (c-MET) is recognized as primary cause of drug-resistance to EGFR inhibitors in non-small cell lung cancer (NSCLC). Herein, to degrade the c-MET, we synthesized bifunctional small molecule compound inducing c-MET and chaperones in proximity, termed CMPD-MET degrader, and evaluate it in MET-mutant NSCLC cell lines and mouse xenograft models. The efficacy and potency of CMPD-MET degrader were assessed using H596 and H1437 cells in vitro. Cell proliferation was measured using MTT assay and c-Met degradation assay was conducted, along with the examination of proteasome-dependent degradation via western blot. An in vivo H596 xenograft model gauged impact of CMPD-MET degrader via I.P. administration. In NSCLC with MET Exon 14 skipping mutation cell line H596 and H1437, treatment a OZD-MET degrader resulted inhibition of cell proliferation with IC50&amp;lt; 5 µM and subsequent proteasome-dependent c-MET degradation with DC50 ranging from 4-6 µM for 24h. The degradation of c-MET levels significantly induced by OZD-MET degrader, especially, the c-Met was degraded by 70.4% and 51.7% at 5 µM for 24h in H596 and H1437 cells, respectively. Also, OZ-MET degrader effectively suppressed c-MET mediated signaling and showed cleavage of PARP-1 in a dose-dependent manner. OZD-MET degrader induced selective degradation of c-MET showing at least more than about 5-fold selectivity over other chaperones-regulated client proteins.In the H596 xenograft model, OZD-MET degrader was administered in 5 dosage groups (minimum dose is 2.5 mg/kg) resulted in dramatic reduction in tumor size compared to the vehicle-treated group. Remarkably, administration of OZD-MET degrader revealed more than 90% degradation of c-Met in tumor tissues compared to the vehicle groups via western blots and fluorescence image. In contrast, c-MET inhibitor treated group showed no effect on degradation of c-MET in tumor tissues. In summary, we developed a novel c-Met targeting chaperone-mediated protein degrader, showed highly potent and selective proteasome-dependent c-MET degradation and notable inhibition of tumor size in xenograft models. These results provide a strong foundation for further evaluation in clinical trials. Citation Format: Han Jung Chae, Jisun Kim, SunHye Lee, Ho Yoo, Hyun-Kyoung Kim, Young-Jin Yu. c-Met targeting chaperone-mediated protein degrader for therapeutic intervention in NSCLC [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 3307.

Abstract 7264: OPN-9840, a non-covalent potent pan-TEAD inhibitor, exhibits single agent efficacy in preclinical malignant mesothelioma models

Abstract The Hippo pathway regulates critical cellular processes during development. In ~10% of human cancers, Hippo pathway dysregulation results in YAP/TAZ overactivation and increased TEAD-dependent transcription that promotes tumor growth and therapy resistance - often by supporting drug-tolerant persister survival. In 40% of malignant mesotheliomas (MM), neurofibromatosis 2 (NF2) gene mutations inactivate the Merlin protein, an upstream negative regulator of TEAD. Preclinical studies indicate high TEAD dependency in NF2-mutant MM. We have discovered an array of potent covalent and non-covalent small molecule inhibitors that occupy the palmitate-binding pocket of TEAD proteins, with varying paralog selectivity profiles. OPN-9840 is an oral non-covalent pan-TEAD inhibitor displaying dose-dependent and on-target in vitro and in vivo efficacy for NCI-H226, an NF2-mutant MM cell line. OPN-9840 showed equivalent binding in thermal shift assays (10°C delta Tm) for depalmitoylated TEAD1-4 proteins, and blocked TEAD reporter activity (IC50 100nM) and NCI-H226 cell growth (IC50 400nM). In an NCI-H226 xenograft model, OPN-9840 dosed orally for 14 days exhibited dose-dependent tumor growth inhibition (TGI) from 5 to 50 mg/kg PO (88 to &amp;gt;100% TGI) with tumor regression in the 15 (2/8 mice) and 50 mg/kg (4/8 mice) dose groups. qPCR of OPN-9840-treated tumors confirmed 50-70% downregulation of canonical TEAD targets, CTGF and CYR61. OPN-9840 shows a favorable safety profile, including a lack of cytotoxicity (IC50&amp;gt;50µM) in HEK293T and HepG2 cells. Additionally, OPN-9840 caused no body weight loss in the NCI-H226 xenograft model following 14 days of dosing. In vitro evaluation of OPN-9840 in the blood-brain barrier (BBB) specific parallel artificial membrane permeability assay exhibited high BBB penetration potential (-Log Pe = 4.7). High oral exposure was achieved at all dose levels (AUC0-24 &amp;gt; 100,000 h•ng/mL) after 14 days in the NCI-H226 study. We next investigated synergy between TEAD inhibition and targeted therapy in MM. Combined treatment of one of our pan-TEAD covalent compounds, OPN-9652 (from a separate chemical series to OPN-9840), at 50 mg/kg with 1 mg/kg trametinib resulted in NCI-H226 xenograft tumor regression (130% TGI) whereas trametinib alone only led to decreased tumor growth (74% TGI). RNA-Seq of treated tumors revealed that OPN-9652 and trametinib synergistically inhibited TEAD downstream target genes, including ANKRD1 and CTGF. OPN-9652 as a single agent caused significant downregulation of E2F targets, such as MYC and TP53, suggesting decreased proliferation. In summary, OPN-9840 is a potent pan-TEAD inhibitor that shows monotherapy efficacy in MM. As we observed synergy between another pan-TEAD inhibitor, OPN-9652, with trametinib, we are exploring synergy of OPN-9840 with additional targeted therapies in tumor types beyond MM. Citation Format: Pan-Yu Chen, Bernice Matusow, James Tsai, Peipei Li, Hoa Nguyen, Gaston Habets, Gideon Bollag, Somenath Chowdhury. OPN-9840, a non-covalent potent pan-TEAD inhibitor, exhibits single agent efficacy in preclinical malignant mesothelioma models [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 7264.

Abstract 2358: YH41723 (IMC-202), a Novel TIGITxPD-L1 bispecific antibody, leads to potent anti-tumor immunity through T cell engaging and T/NK cell activation

Abstract Immune checkpoint inhibitors (ICIs) have been making innovative advances in current cancer therapy. In particular, the PD-L1/PD-1 blockades changed the paradigm of anti-cancer treatment, showing high efficiency compared to conventional therapy. However, drug resistance has been observed in many patients receiving PD-1/PD-L1 monoclonal antibodies (mAbs), and there are still many limitations in restoring T cell. To overcome this, various ICI targets including T cell immunoreceptor with Ig and ITIM domain (TIGIT) are being studied. TIGIT is a T cell co-inhibitory receptor, highly expressed on regulatory T (Treg) cells and memory T cells and natural killer (NK) cells. In combination with PD-1/PD-L1 inhibition, the activation of CD226 through the blocking of TIGIT/PVR ligation is important for T cell activation. In this study, we demonstrated the synergistic effect that can be obtained by simultaneously blocking of PD-L1 and TIGIT and effect of T cell engager function using TIGITxPD-L1 bispecific antibody (BsAb). We generated an anti-TIGITxPD-L1 BsAb, YH41723 (IMC-202), with Fc-engineering to enhance the effector function. In order to confirm superior efficacy of YH41723 compared to combination of two monoclonal antibodies, PD-L1 mAb+TIGIT mAb, we verified the CD8+ T cell-mediated tumor killing effect by T cell engager function of YH41723. We also observed strong antibody-dependent cell-mediated cytotoxicity (ADCC) effect of YH41723 against various cancer cell lines. In addition, YH41723 showed superior anti-tumor efficacy than combination treatment in NK cell-mediated tumor killing assay. We further confirmed the significant Treg cell depletion efficacy of YH41723 in vitro compared to combination. We tested in vivo anti-cancer efficacy of YH41723 in hPD-L1 KI CT26 with BALB/c-H/K-dKO mouse models (B cell-deficient mice). As a result, YH41723 showed superior tumor growth inhibition effect compared with anti-PD-L1 mAb and anti-TIGIT mAb combination. Even, 7 of 8 mice showed complete regression in 30 mg/kg dosing group. 60 days after the last administration, we further performed tumor re-challenge test. The tumor-free state of tumor re-challenged mice was sustained, indicating that the immune memory was generated by YH41723. Taken together, YH41723 showed strong efficacy in NK/T cell activation and Treg depletion in vitro and excellent anti-tumor efficacy in vivo, supporting that YH41723 as an effective anti-cancer immunotherapy and combination candidate with other ICIs. Citation Format: Min Hyeok Jee, Young Bong Park, Byeong-Yun An, Hee Ra Jung, Eunjung Lee, Jun Hwan Kim, Ji Eun Park, Ji Young Yoon, Seung Mi Jeong, Yang Kyun Ryu, Sung Ho Kim, Heung Tae Kim, Se-Woong Oh, Yeol Hong Kim. YH41723 (IMC-202), a Novel TIGITxPD-L1 bispecific antibody, leads to potent anti-tumor immunity through T cell engaging and T/NK cell activation [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2358.

Abstract 5760: Intra-tissue quantitative analysis using LC/MS will determine the mechanisms of interstitial pneumonia induced by antibody-drug conjugates

Abstract Background: Antibody-drug conjugates (ADCs) are a new class of therapeutics that combine a monoclonal antibody with a cytotoxic agent (known as their payloads) via a synthetic linker. While ADCs are one of game changer and are the fastest growing classes with novel clinical benefits recently, interstitial pneumonia (ILD) is a clinical problem as a fatal adverse event. However, the mechanism of ADC-induced ILD is under investigation. Purpose: We clarify ADC-ILD mechanism by analyzing released payload distribution in the lung using a novel Trophoblast cell surface antigen 2 (TROP2)-targeting ADC. Material and Methods: TROP2-eribulin is a novel TROP2-targeting ADC composed of the TROP2 antibody and cytotoxic payload eribulin conjugated by a cleavable linker. Four human cancer cell lines (A549, HeLa, NCI-H2110 and SKOV3) and one human- leukemia monocytic cell line (THP-1) were used in this study. Cell surface TROP2 antigen expression was evaluated by flow cytometry. We investigated the concentration and distribution of the TROP2-eribulin and the payload released from the TROP2-eribulin in tumor and lung tissue, using TROP2 low and high expression human cancer xenograft model that were treated with various doses of TROP2-eribulin. The concentration of erbulin was analyzed by liquid chromatograph mass spectrometry, and tissue distribution of ADCs was assessed by immunofluorescence (IF) assay. Results: In vitro analysis showed that the concentration of intracellularly released eribulin was significantly higher in NCI-H2110 with high TROP2 expression compared to A549 with low TROP2 expression (P &amp;lt; 0.05). In vivo analysis, the concentration of released eribulin in tumor tissue was approximately 10-fold higher in the NIC-H2110 xenograft model than the A549 xenograft model, while analysis of lung tissue showed that TROP2-eribulin was distributed in lung tissue in a dose-dependent manner of TROP2-eribulin regardless of TROP2 expression, with significantly more eribulin released in the high-dose group of TROP2-eribulin than in the other dose groups (P &amp;lt; 0.05). IF assay showed that TROP2-eribuilin localized to alveolar macrophages. In the analysis using THP-1 cell, which mimic macrophage function, the concentration of eribulin released from TROP2-eribuilin was significantly reduced by the use of an Fc receptor inhibitor (P &amp;lt; 0.05). Conclusions: Nonspecific uptake of ADC by alveolar macrophages via Fcγ receptors releases cytotoxic payload into lung tissue, regardless of tumor antigen expression levels. This understanding can help elucidate the pathogenesis of ADC-induced ILD. Citation Format: Shigehiro Koganemaru, Hirobumi Fuchigami, Chihiro Morizono, Hiroko Shinohara, Yasutoshi Kuboki, Keiji Furuuchi, Toshimitsu Uenaka, Toshihiko Doi, Masahiro Yasunaga. Intra-tissue quantitative analysis using LC/MS will determine the mechanisms of interstitial pneumonia induced by antibody-drug conjugates [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 5760.

Abstract 3739: Different combination regimens for OX40 agonists and PD-1 inhibitors exert different antitumor effects in OX40 humanized mice

Abstract OX40, also known as CD134 or TNFRSF4, is a member of the tumor necrosis factor receptor (TNFR) superfamily which mainly expressed on the surface of activated T cells including Treg cells. Engagement of OX40 with its ligand, TNFSF4, leads to effector T cell expansion and cytokine release, inhibits activation-induced cell death (AICD) and promotes the survival of antigen-specific memory T cells. In contrast to the massive hit of immune checkpoint inhibitors like PD-1 and PD-L1, the benefit of agonistic antibodies in clinical trials has not been completely demonstrated to date. On one hand, higher doses could leads to T cell exhaustion or AICD, paradoxically, with no efficacy improvement. Another hand, the limited understanding of the biology of immune checkpoints underlying “accelerator and brake” should account for the slow clinical progress of OX40-targeted biologics. It seems that the dosing sequence or timing of anti-OX40 and anti-PD-1 is an important consideration in combination therapies. Given this, we firstly evaluated the antitumor effects of two different anti-human OX40 agonists in syngeneic MC38 and Pan02 tumor models, respectively, in hOX40 knockin mice. We observed tumor regressions upon treatment of OX40 agonistic Ab1 in a dose-dependence way in the homozygous hOX40 knockin mice engrafted with MC38 tumors. The anti-hOX40 Ab1 at high-dose (10 mg/kg) led to ~60% TGI, but no response at very low dose (0.1 mg/kg). Furthermore, the homozygous hOX40 knockin mice inoculated with Pan02 pancreatic tumors were treated with a novel strong anti-hOX40 agonist (Ab2) and surrogate anti-mPD-1. Notably, Anit-hOX40 (Ab2) alone at low dose (1 mg/kg, Q3D*9 doses) exerted strong anti-tumor potency (TGI=59.3%, p&amp;lt; 0.005) and no statistical significant antitumor difference was observed between high-dose group (at 5mg/kg) and low-dose group (at 1 mpk) as monotherapy, though anti-hOX40 (Ab2) at 5mg/kg showed the best therapeutic response (TGI=72%, p=0.0002) among all treatment groups. In contrast, the second therapeutic response was observed in the combo group treated with first dosing of 5mg/kg anti-hOX40 (Ab2) combining delayed dosing of 10mg/kg anti-mPD-1 (TGI=64%, p&amp;lt; 0.005) and the concurrent dosing group of Ab2 (5 mg/kg, Q3D × 9 doses) plus anti-mPD-1 (2 mg/kg, Q3D × 9 doses) (TGI=62.3%, p= 0.001). In conclusion, different human-specific OX40 agonists displayed different anti-tumor activity as monotherapy, and different dose led to different antitumor potency for the same agonist. In terms of different combination regimens, although no advanced benefit was observed for the combination of anti-mPD-1/anti-OX40 (Ab2) in comparison to strong anti-OX40 agonist (Ab2) alone, it demonstrated that the dosing timing and sequence of either anti-PD-1 or anti-hOX40 did has impact on the therapeutic outcome. Citation Format: Yi Li, Yanlei Zhang, Xiaolei Qiu, Dongxiao Feng, Ruilin Sun, Daniel X. He. Different combination regimens for OX40 agonists and PD-1 inhibitors exert different antitumor effects in OX40 humanized mice [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 3739.