e16613 Background: Intravesical instillations of Bacillus Calmette-Guérin (BCG) is the current standard of care for high-risk Non-Muscle Invasive Bladder Cancer (NMIBC) patients. TARA-002, a preparation of inactivated Streptococcus pyogenes, is currently in a Phase-2 (ADVANCED-2) clinical trial for the treatment of NMIBC. Interim analysis found that the rates of high-grade complete response (CR) at month 6 were 72% overall, 64% in BCG-naïve subjects and 100% in BCG-unresponsive patients with TARA-002 treatment. As TARA-002 and BCG are regarded as broad immunopotentiators, we compared the anti-tumor activity and mechanisms of action of TARA-002 and BCG using bladder cancer models. Methods: TARA-002 internalization in HEK293 Wild Type (WT) and TLR2 Knockout (KO) and Bladder Cancer (BC) cells (RT112 and T24) was evaluated by confocal microscopy. Flow Cytometry analysis of Annexin V, marker of apoptosis, was used to evaluate TARA-002 and BCG cytotoxicity in mouse and rat BC cells (MBT2, MB49 and AY27) after 24 h treatment. Cytokine analysis was conducted on 5637 BC cells co-cultured with peripheral blood mononuclear cells (PBMCs) following treatment with either BCG or TARA-002 for 24 h. Lastly, the MB49 orthotopic bladder cancer mouse model evaluated tumor growth inhibition and survival upon TARA-002 intravesical treatment. Results: Unlike BCG, which relies on fibronectin receptors for internalization, TARA-002 internalization was unaffected by fibronectin receptor blockade and was instead shown to be TLR2-dependent as the HEK293 TLR2-KO cells consistently displayed lower levels of intracellular TARA-002 compared to the WT counterpart. Furthermore, TARA-002 exhibited significant dose-dependent cytotoxicity against BC cell lines, while BCG showed only modest tumor-killing effects. Co-culture of 5637 BC cells and PBMCs showed that TARA-002 treatment increased pro-inflammatory Th1 cytokines (TNF-a, IFN-g, IL-12p70) and reduced IL-8 levels, a marker linked to poor BC prognosis, compared to BCG. Finally, intravesical instillations of TARA-002 in the BCG-unresponsive MB49 orthotopic model showed a strong anti-tumor effect and significantly enhanced survival outcomes. Since BCG exposure induces trained immunity, it is plausible that BCG-induced trained immunity may enhance the response to TARA-002, potentially explaining its improved efficacy in BCG-treated patients compared to the BCG-naïve population. To evaluate this hypothesis, preclinical tests are being conducted at the time of submission. Conclusions: Our results suggest that the mechanism of action of TARA-002 differs from that of BCG, leading to variations in their biological activity. This leads to more potent anti-tumor activity of TARA-002 in both in vitro and in vivo models compared to BCG, accompanied by an enhanced immune-mediated pro-inflammatory response.
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