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Optimizing CD45-Targeted Astatine-211-Radioimmunotherapy for Malignant and Non-Malignant Blood Disorders
ABSTRACT CD45 is expressed on almost all normal and neoplastic hematopoietic cells but not on non-blood cells and has, therefore, been pursued as a drug target. Initially centered on augmenting conditioning before hematopoietic cell transplantation (HCT) for blood cancers, there is increasing interest in expanding CD45-directed therapies into other settings, with radioimmunotherapy (RIT) being the major therapeutic modality so far. Investigators at our institution pioneered CD45 RIT with b-emitters such as iodine-131 (131I) using the murine monoclonal antibody (mAb), BC8. A phase 3 trial testing 131I-BC8 (131I-apamistamab [Iomab-B]) with allogeneic HCT in older adults with relapsed/refractory acute myeloid leukemia showed improved outcomes over conventional care, validating this approach. More recently, attention has shifted toward a-emitters that deliver substantially higher decay energies over much shorter distances than b-emitters, rendering them more suitable for precise and potent target cell killing. In our work, we focus on astatine-211 (211At) for its ideal half-life and decay without a-emitting daughters. For clinical application, mAbs are conjugated with the bifunctional boron cage molecule, isothiocyantophenethyl-ureido-closo-decaborate(2-) (B10-NCS), to enable stable protein astatination. Three early-phase trials testing 211At-BC8-B10 as augmentation of HCT conditioning for patients with malignant and non-malignant blood disorders are ongoing, with emerging data indicating significant anti-tumor efficacy. Nonetheless, relapses still occur. Other important limitations include marked infusion toxicities and human antimouse antibody (HAMA) responses related to the murine nature of BC8 and dimer formation after 211At labeling of mAb-B10 conjugates with tissue residualization from 211At atom oxidation. The latter may contribute to the risk of liver cell injury, the dose limiting extramedullary toxicity of CD45 RIT. As a first step toward our goal of optimizing CD45 RIT, we have raised new, fully human CD45 mAbs as basis for novel therapeutics. In preliminary in vivo studies in immunodeficient mice, we found some of these mAbs to have greater anti-tumor efficacy than a humanized version of BC8 (HuBC8) we generated as a reference mAb. We will now conduct comparative in vivo CD45+ cell targeting (“biodistribution”) and anti-tumor efficacy studies to select a lead candidate mAb for clinical application and use protein engineering to maximize the selectivity and efficacy of targeted radiation delivery. We will use immunodeficient mice xenotransplanted with human leukemia cells for this purpose as no human approaches are available and in vitro testing is inadequate to measure both the targeting and biologic RIT effects on human leukemia cells. Mice provide the in vivo milieu needed for comprehensive evaluation. Development of improved mAb astatination methodologies to minimize off-target toxicities of 211At-RIT will further increase therapy specificity and reduce toxicity. In parallel, we will conduct genome-scale, unbiased target identification/validation studies to identify partner drugs for rational combination therapies aimed at enhancing the anti-tumor efficacy of 211At-CD45 RIT.
Antibody-guided design of a human astrovirus vaccine
PROJECT SUMMARY Viral diarrheal diseases cause substantial global morbidity and mortality. Diarrheal disease is the second leading cause of childhood mortality in the world, accounting for over 10% of all deaths of children under 5 years old. Gobally, over 1 billion cases of diarrheal diseases occur every year, making prevention of these diseases a public health concern of the highest priority. Human astrovirus (HAstV) infection is a leading cause of viral diarrhea in children and has been shown to cause chronic gastrointestinal disease and fatal neurological disease in immunocompromised patients. There are nearly 4 million cases of HAstV infection each year in the United States alone, and there are no clinically approved HAstV-specific vaccines or therapeutics. Antibody-guided vaccine development leverages a deep understanding of productive antiviral antibody responses in order to design vaccine immunogens that deliberately focus the induced response toward highly conserved epitopes with the goal of reliably inducing broad, durable immunity. Using a cutting-edge monoclonal antibody (mAb) discovery approach based on next-generation antigen barcoding, single cell multi-omics, and sophisticated bioinformatics, we will exhaustively screen the HAstV- specific antibody repertoires of geographically distinct donor cohorts to uncover the structural and immunogenetic features that differentiate broad and potently neutralizing HAstV mAbs. A more complete understanding of these exceptional – and potentially very rare – mAbs will accelerate the development of HAstV vaccines and therapeutics. We have assembled a collaborative, multidisciplinary group of investigators with a long history of productive collaboration and with highly complementary areas of expertise. We expect our work will result in the discovery of thousands of novel anti-HAstV mAbs from cohorts of healthy adult and pediatric participants. Detailed genetic, functional, and structural characterization of these mAbs will reveal conserved sites of viral vulnerability, uncover the precise molecular mechanisms of viral neutralization, and inform our development of a broadly protective HAstV vaccine.
Engineering inducible morphotype switching control in Mycobacterium abscessus for investigating infection outcomes and discovering pathophysiological-targeted treatments
PROJECT SUMMARY Antibiotic-resistant nontuberculous mycobacteria (NTM) infections are rising at a rate of 8% each year and account for ~$1.7 billion in annual U.S. healthcare costs. Mycobacterium abscessus (Mabs), the most common rapidly growing NTM infection, is notoriously nicknamed the “antibiotic nightmare” for its extensive intrinsic and inducible broad-range multidrug resistance to antibiotic countermeasures. As part of its natural infection cycle, Mabs undergoes a morphotypical conversion from smooth to rough, characterized by irreversible genetic changes resulting in the loss of cell envelope glycopeptidolipids (GPLs). This morphotypic conversion is intimately associated with disease progression, ultimately leading to debilitating, refractory Mabs pulmonary disease. Specific stimuli triggering Mabs morphotypical conversion are unknown, thus preventing directed investigations into morphotype-specific immunological responses and the discovery of morphotype-specific therapeutic targets. This project leverages cutting-edge molecular genetic tools, including CRISPR (clustered regularly interspersed short palindromic repeats) interference (CRISPRi) and inducible knockdown control of CRISPRi via the anhydrotetracycline-inducible TetR-regulated promoter-operator system, to create six unique, reversible Mabs smooth to conditional rough morphotype strains. These molecular morphoswitchable strains allow precise investigator-mediated on-off control of Mabs surface GPLs, enabling investigations into Mabs morphological plasticity, unique pathophysiology traits associated with each morphotype, and the complex interplay between Mabs and morphotype-specific immunological responses. In Aim 1, we implement CRISPRi inducible knockdown tunable control of Mabs morphotype switching by targeting six, independent genetic targets directly involved in GPL biosynthesis (mps1, mps2) or transport (mmpS4, mmpL4a, mmpL4b, gap) and validate in vitro morphoswitching. In Aim 2, we establish and confirm Mabs morphoswitching and intracellular growth in infected THP-1 macrophages. Subsequently, we evaluate differential and distinct innate cellular immune responses elicited by Mabs smooth and Mabs conditional rough morphotypes during intracellular infection in human primary monocyte-derived macrophages. Collectively, these studies create a suite of characterized and reversible Mabs smooth and conditional rough morphoswitchable strains with controlled, regulated, and on- demand expression of Mabs surface GPLs. By enabling precisely timed and controlled induction of the Mabs conditional rough morphotype during intracellular growth, we can molecularly dissect and investigate fundamental Mabs host-pathogen interactions and immunological responses that so substantially influence negative clinical outcomes.
New Frontiers in Understanding and Treating Migraine Headaches
In this presentation I will describe how the CGRP project started and culminated in the development of gepants and mAbs for successful therapy. The outstanding question regarding the preponderance of female migraineurs also remains. I will present views on the reason behind this and suggest that understanding the hormonal influence will pave the way to alleviating hormone related migraine.
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