Targeted T-cell Therapy in Stage IV Breast Cancer: A Phase I Clinical Trial.

PURPOSE: This study reports a phase I immunotherapy trial in 23 women with metastatic breast cancer consisting of eight infusions of anti-CD3 × anti-HER2 bispecific antibody (HER2Bi) armed anti-CD3-activated T cells (ATC) in combination with low-dose IL-2 and granulocyte-macrophage colony-stimulating factor to determine safety, maximum tolerated dose (MTD), technical feasibility, T-cell trafficking, immune responses, time to progression, and overall survival (OS). EXPERIMENTAL DESIGN: ATC were expanded from leukapheresis product using IL2 and anti-CD3 monoclonal antibody and armed with HER2Bi. In 3+3 dose escalation design, groups of 3 patients received 5, 10, 20, or 40 × 10(9) armed ATC (aATC) per infusion. RESULTS: There were no dose-limiting toxicities and the MTD was not defined. It was technically feasible to grow 160 × 10(9) ATC from a single leukapheresis. aATC persisted in the blood for weeks and trafficked to tumors. Infusions of aATC induced anti-breast cancer responses and increases in immunokines. At 14.5 weeks after enrollment, 13 of 22 (59.1%) evaluable patients had stable disease and 9 of 22 (40.9%) had progressive disease. The median OS was 36.2 months for all patients, 57.4 months for HER2 3+ patients, and 27.4 months for HER2 0-2+ patients. CONCLUSIONS: Targeting HER2(+) and HER2(-) tumors with aATC infusions induced antitumor responses, increases in Th1 cytokines, and IL12 serum levels that suggest that aATC infusions vaccinated patients against their own tumors. These results provide a strong rationale for conducting phase II trials.

Long-term bone marrow culture and its clinical potential in chronic wound healing.

Bone marrow-derived cells have long been regarded to play a crucial role in the homeostasis of skin. We have previously described the clinical benefit of directly applying autologous bone marrow aspirate and cultured bone marrow cells to recalcitrant chronic skin wounds. The initial response to treatment appears to be vascular in nature with the formation of new blood vessels. The difficulty in consistently growing adequate numbers of cells for delivery to patients was, however, a limiting factor. Here, in a subsequent protocol, we describe an improved bone marrow culture system yielding a reliable growth of bone marrow cells and leading to a greater clinical response. Cells expressing markers of endothelial progenitors including CD133, CD146, and particularly CD14 are enhanced in these cultures. CD14-isolated cells produced colonies in endothelial cell assays and sprouting in matrigel assays. Angiogenic cytokines, including angiogenin, epithelial neutrophil-activating protein-78, growth-regulated oncogene, growth-regulated oncogene-alpha, Interleukin-8, CXC16, and monocyte chemoattractant protein-1, were found to be elevated in these cultures. Administration of improved culture cells to patients with chronic wounds present for >1 year lead to an enhanced clinical response.

Allogeneic bone marrow supports human islet beta cell survival and function over six months.

In this study, we have established a new strategy increasing human islet longevity utilizing allogeneic whole bone marrow (BM) co-cultured with human islets. The cultured islets' function and survival have been evaluated by analysis of insulin secretion in response to high-glucose-challenge, morphological evaluation of cell growth. Human islet only culture failed to reveal evidence of long term survival, growth or function in terms of insulin release or insulin response to glucose challenge. These results indicate that BM increases islet survival and function with the eventual formation of pancreatic endocrine tissue capable of sustaining beta cell fuction.

Shc proteins are strong, independent prognostic markers for both node-negative and node-positive primary breast cancer.

Activated Shc signaling proteins are implicated in many pathways associated with aggressive disease, and many breast cancer cell lines derived from highly aggressive tumors contain high levels of activated, tyrosine phosphorylated (PY)-Shc (the M(r) 46000 and M(r) 52000 isoforms) relative to levels of an inhibitory M(r) 66000 Shc isoform. It was, therefore, hypothesized that high amounts of PY-Shc relative to the M(r) 66000 Shc isoform would serve as a marker for aggressive neoplasms. Semiquantitative immunohistochemical analyses of PY-Shc and p66 Shc were performed on archival primary breast tumor specimens from 116 women, 17 of whom experienced relapse (6.1 years median follow-up of nonrelapsed patients). Consistent with our hypothesis, staining intensities demonstrated that increased amounts of PY-Shc (P = 0.01) and decreased expression of p66-Shc protein (P = 0.028) correlated with disease recurrence. Modeled as the ratio of PY-Shc to p66 Shc, the Shc ratio correlated strongly with nodal status (P = 0.003), tumor stage (P = 0.0025), and disease stage (P = 0.002) and was 2-fold higher in primary tumors of patients who subsequently relapsed (P < 0.001). Univariate Cox proportional hazards analysis of relapse-free survival demonstrated the prognostic value of PY-Shc (P = 0.01), p66 Shc (P = 0.04), and the Shc ratio (P = 0.004) as continuous variables, with a hazard ratio (HR) of 10 (P = 0.007) for the Shc ratio. Shc ratio cut points of <0.35 and >0.65 were identified and independently validated to maximize negative predictive value and positive predictive value. Patients with low Shc ratios (n = 36) had a 0.08 HR of relapse (P = 0.007) compared with patients with high Shc ratios, experiencing an 8-year cumulative 2.9% and 55% relapse hazard, respectively, compared with a 22% relapse hazard in the total cohort. The Shc ratio had similar prognostic value for disease-specific survival. In multivariate models, the Shc ratio, both as a continuous variable and as a cut point-categorized variable, was independent of all measured covariates (including nodal status, tumor stage, disease stage, grade, estrogen receptor status, and adjuvant therapy) and was a stronger prognostic marker than all but nodal status. All relapsed node-positive patients had very high Shc ratios (>0.80; P = 0.006) in their primary tumors. Furthermore, the Shc ratio was a strong, independent prognostic indicator in node-negative patients (79 patients, 10 recurrences), with a HR of 0.086 (P = 0.02) that was independent of clinical markers and adjuvant therapy. Patients with low and high Shc ratios experienced a 3.6% and 64% relapse hazard, respectively, compared with 20% in the total node-negative cohort.

IL-13 signal transduction in human monocytes: phosphorylation of receptor components, association with Jaks, and phosphorylation/activation of Stats.

Interleukin (IL)-13 regulates monocyte function and is a potent stimulator of 15-lipoxygenase expression. In different cell types, the functional IL-13 receptor complex can be comprised of variable protein components and has not been thoroughly examined in human monocytes. Here, we identify the receptor components and upstream signaling events initiated by IL-13 in primary human blood monocytes. The expression, phosphorylation and associated Jak kinases of the known, variable receptor components, IL-4R(alpha), IL-2Rgammac, IL-13R(alpha)1 and IL-13R(alpha)2, were examined. We determined that IL-4R(alpha) and IL13R(alpha)1 are phosphorylated upon exposure to IL-13. Although IL-2Rgammac is also expressed, it is not phosphorylated upon exposure to IL-13. Evaluation of the presence of IL-13R(alpha)2 failed to reveal significant mRNA or protein expression. Earlier, our laboratory showed that IL-13 induced the phosphorylation of Jak2 and Tyk2 in monocytes and that expression of both Jaks was essential for downstream signaling by IL-13. Here, we report that Jak2 is associated with IL-4R(alpha), and Tyk2 is associated with the IL-13R(alpha)1 component of the IL-13 receptor complex. Additionally, Stat proteins 1alpha, 3, 5A, 5B, and 6 are phosphorylated in response to IL-13. Further, the nuclear translocation and DNA binding of each of these Stats were induced by IL-13. These data represent the first complete report of the functional IL-13 receptor complex and early signaling events in human monocytes. This information is critical for understanding the IL-13 response of monocytes in inflammation.