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Ductal carcinoma in situ (DCIS) of the breast is often managed by lumpectomy and radiation or mastectomy, despite its indolent features. Effective non-invasive treatment strategies could reduce the morbidity of DCIS treatment. We have exploited the high heat shock protein 90 (HSP90) activity in premalignant and malignant breast disease to non-invasively detect and selectively ablate tumors using photodynamic therapy (PDT). PDT with the HSP90-targeting photosensitizer, HS201, can not only ablate invasive breast cancers (BCs) while sparing non-tumor tissue, but also induce antitumor immunity. We hypothesized that HS201-PDT would both non-invasively ablate DCIS and prevent progression to invasive BC. We tested in vitro selective uptake and photosensitivity of HS201 in DCIS cell lines compared to the non-selective parental verteporfin, and assessed in vivo antitumor efficacy in mammary fat pad and intraductal implantation models. Selective uptake of HS201 enabled treatment of intraductal lesions while minimizing toxicity to non-tumor tissue. The in vivo activity of HS201-PDT was also tested in female MMTV-neu mice prior to the development of spontaneous invasive BC. Mice aged 5 months were administered HS201, and their mammary glands were exposed to laser light. HS201-PDT delayed the emergence of invasive BC, significantly prolonged disease-free survival (DFS) (p = 0.0328) and tended to improve overall survival compared to the no-treatment control (p = 0.0872). Systemic administration of anti-PD-L1 was combined with HS201-PDT and was tested in a more aggressive spontaneous tumor model, HER2delta16 transgenic mice. A single PDT dose combined with anti-PD-L1 improved DFS compared to the no-treatment control, which was significantly improved with repetitive HS201-PDT given with anti-PD-L1 (p = 0.0319). In conclusion, a non-invasive, skin- and tissue-sparing PDT strategy in combination with anti-PD-L1 antibodies effectively prevented malignant progression of DCIS to invasive BC. This non-invasive treatment strategy of DCIS may be safe and effective, while providing an option to reduce the morbidity of current conventional treatment for patients with DCIS. Clinical testing of HS201 is currently underway.

Project objective: Despite the recent revolution in immune checkpoint inhibitors (ICIs), only modest improvement in overall survival and likely caused by not enough potent cellular immunity among BC patients. Our lab has been focus on inducing cellular immunity against HER2+ BC through vaccination against the tumor-associated antigen HER2. Approximately 20 years ago, we performed an experimental pilot study by administrating HER2 peptide and recombinant protein pulsed dendritic cells (DC vaccine) to six patients with refractory HER2+ advanced or metastatic (stage II (≥ 6 +LN), III, or stage IV) BC. We followed the patients on 2019 found that all of the six patients were still alive, 18 years after vaccination. Their blood sample were analyzed with cytometry by time-of-flight (CyTOF) and found there is a significantly increased presence of CD27 expressing memory T cells in response to HER2 peptide stimulation. Recent report on the SARS-CoV2 mRNA vaccine also suggested that CD27 expressing memory T cells plays a critical role in long-lasting cellular immunity against SARS-CoV2 infection. Therefore, we hypothesized that CD27 plays a critical role in cellular immunity against BC, and the stimulation of CD27 expressing T cells with mAb targeting CD27 significantly increase the cellular immunity triggered by vaccination against tumor-associated antigen. Results: We recapitulate the rise of CD27+ antigen specific T cells among the vaccinated patients using a transgenic mouse model expressing human CD27. When combined the adenoviral-vector based HER2 (Ad-HER2) vaccination with a single dose of human aCD27 antibody (Varlilumab), we found there is a robust increase in the HER2 specific T cells compared to vaccination alone, especially CD27+CD44+ memory CD4 T cells, even after 120 days post vaccination. Using an ICI-insensitive syngeneic HER2+ BC models, we found 50% of mice in the combination group of aCD27 antibody plus Ad-HER2 showed total tumor regression by the end of study. When combined with anti-PD1 antibody, the combination of AdHER2 and Varlilumab leads to total tumor regression in 90% of tumor bearing mice with syngeneic HER2+ BC, indicating that the vaccination against tumor associated antigen HER2 plus anti-CD27 antibody sensitized ICI-insensitive HER2+ BC toward ICI. Conclusions: Our data demonstrates that the administration of anti-CD27 antibody significantly increase the long term presence of CD27+ antigen specific memory T cells after vaccination against tumor associated antigen HER2. As consequence, combination of anti-CD27 with HER2 sensitized the immune unresponsive breast cancer toward anti-PD1 antibody. Our study suggests that the vaccination against tumor-associated antigen with mAb targeting CD27 leads to the robust cellular immunity, which is required for successful ICIs against breast cancer. Citation Format: Bin-Jin Hwang, Erika Crosby, Timothy Trotter, Li-Chung Tsao, Tao Wang, Xiao Yang, Herbert Kim Lyerly, Zachary Hartman. Sensitizing breast cancers to immune checkpoint inhibitors through CD27 agonism and vaccination against tumor-associated antigen [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 696.

Background: The CD47-SIRPα axis is an innate immune checkpoint that primarily regulates myeloid cells. In the context of cancer, tumor cells upregulate CD47 to engage SIRPα inhibitory signaling to block phagocytosis. Thus, inhibition of this axis may enhance myeloid cell phagocytosis and adaptive immune responses against cancer. While our previous studies identified that CD47 mAbs enhance HER2-specific mAb therapy (Tsao et al., 2019), clinical trials have revealed that CD47-targeting mAbs are associated with severe side effects of anemia and thrombocytopenia in patients. We thus hypothesized that targeting SIRPα, which is more restrictively expressed on myeloid cells, may achieve similar but less toxic treatment effects. Methods: To ascertain the impact of SIRPα inhibition against different molecular subtypes of breast cancer, we utilized and validated a novel SIRPα KO mouse, along with SIRPα mAbs in our previously utilized models of Triple-Negative Breast Cancer (TNBC) and HER2+ Breast Cancer (Crosby et al., 2018; Tsao et al., 2019). Using both in vitro and in vivo tumor models, we tested the therapeutic impact of SIRPα inhibition/blockade combined with immunogenic chemotherapy (doxorubicin) in TNBC or combined with HER2-specific mAbs in HER2+ Breast Cancer (HER2+ BC). Results: After validating the loss of SIRPα in KO mice, we found that E0771 TNBC cells had reduced rates of engraftment in SIRPα KO mice compared to controls, but comparable rates of growth once tumors were established. We then treated E0771 engrafted SIRPα KO and wildtype mice with doxorubicin. This treatment elicited tumor rejection in the majority of SIRPα KO mice (70% of injected tumors), compared to only 10% rejection in SIRPα WT mice. To study tumor antigen-specific immunity, we expressed different forms of OVA (secreted, cytoplasmic, membrane) in tumor cells. We found that membrane expressed OVA led to universal tumor rejection (10/10 mice) with high levels of OVA-specific Abs, in contrast to non-membrane expressed forms of OVA. This suggested the importance of tumor-specific Abs in eliciting tumor rejection. To specifically test the antitumor effect of tumor-specific antibodies in the context of SIRPα blockade, we evaluated the impact of a HER2 mAb (Trastuzumab) on HER2+ BC cells. We found enhanced phagocytosis and antitumor effects by SIRPα KO macrophages in comparison to wild-type macrophages, suggesting the potential of targeting SIRPα along with the use of standard-of-care mAb. Conclusion: Our study demonstrates that SIRPα loss can prevent tumor engraftment but may not have a strong effect against established tumors without secondary immune stimulation. However, addition of immunogenic cell death-eliciting chemotherapy or tumor-specific Abs promote tumor phagocytosis and stimulate anti-tumor immunity. These results support further investigation of SIRPα-targeting combination therapies for cancer. Citation Format: Xingru Ma, Zachary Hartman, Li-Chung Tsao, Tao Wang, Cong-Xiao Liu, Xiao Yang, Gangjun Lei, Junping Wei. Inhibition of CD47-SIRPα axis to enhance immunity against different molecular subtypes of breast cancer. [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 5067.

Background: The majority of colorectal carcinomas (CRCs) are insensitive to anti-PD-1/PD-L1 immune checkpoint inhibitor (ICI) antibodies. While there are many causes for ICI insensitivity, recent studies suggest that the suppression of innate immunity through a loss of innate immune adaptor expression could be a root cause of this insensitivity and an important factor in the evolution of tumor immunosuppression. Methods: We interrogated mitochondrial antiviral signaling gene (MAVS) expression through bioinformatics analyses of multiple datasets to validate its suppression in clinical samples. We then engineered MAVS expressing tumor cells and tested its ability to elicit innate and adaptive anti-tumor immunity using both in vitro and in vivo approaches, which we then confirmed using MAVS expressing viral vectors. Finally, we observed that MAVS stimulated PD-L1expression in different types of tumor cells and then assessed the combination of PD-L1 ICI antibodies with MAVS tumor expression in vivo. Results: MAVS was significantly downregulated in CRCs, but its re-expression could stimulate broad cellular interferon-related responses, in both murine and patient-derived CRCs. In vivo, local MAVS expression elicited significant anti-tumor responses in both immune-sensitive and insensitive CRC models, through the stimulation of an interferon responsive axis that elicited tumor antigen-specific adaptive immunity. Critically, we found that tumor-intrinsic MAVS expression triggered systemic adaptive immune responses that enabled abscopal CD8+ T cell cytotoxicity against distant CRCs. As MAVS also induced PD-L1 expression, we further found synergistic anti-tumor responses in combination with anti-PD-L1 ICIs. Conclusion: These data demonstrate that intratumoral MAVS expression results in local and systemic tumor antigen-specific T cell responses, which could be combined with PD-L1 ICI to permit effective anti-tumor immunotherapy in ICI resistant cancers. We are further exploring to overcome the ICI insensitivity of other types of solid tumor, with MAVS-delivery strategies other than viral vectors. Citation Format: Bin-Jin Hwang, Li-Chung Tsao, Chaitanya Acharya, Timothy Trotter, Pankaj Agarwal, Tao Wang, Junping Wei, Xiao-Yi Yang, Gang-jun Lei, Takuya Osada, Herbert Kim Lyerly, Michael A. Morse, Zachary Hartman. Sensitizing immune unresponsive colorectal cancers to immune checkpoint inhibitors through MAVS overexpression [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3531.

We calculate directly determined values for effective temperature ($T_{\rm EFF}$) and radius ($R$) for 191 giant stars based upon high resolution angular size measurements from optical interferometry at the Palomar Testbed Interferometer. Narrow- to wide-band photometry data for the giants are used to establish bolometric fluxes and luminosities through spectral energy distribution fitting, which allow for homogeneously establishing an assessment of spectral type and dereddened $V_{\rm 0}-K_{\rm 0}$ color; these two parameters are used as calibration indices for establishing trends in $T_{\rm EFF}$ and $R$. Spectral types range from G0III to M7.75III, $V_{\rm 0}-K_{\rm 0}$ from 1.9 to 8.5. For the $V_{\rm 0}-K_{\rm 0} = \{1.9,6.5\}$ range, median $T_{\rm EFF}$ uncertainties in the fit of effective temperature versus color are found to be less than 50K; over this range, $T_{\rm EFF}$ drops from 5050K to 3225K. Linear sizes are found to be largely constant at 11 $R_\odot$ from G0III to K0III, increasing linearly with subtype to 50 $R_\odot$ at K5III, and then further increasing linearly to 150 $R_\odot$ by M8III. Three examples of the utility of this data set are presented: first, a fully empirical Hertzsprung-Russell Diagram is constructed and examined against stellar evolution models; second, values for stellar mass are inferred based on measures of $R$ and literature values for $\log g$. Finally, an improved calibration of an angular size prediction tool, based upon $V$ and $K$ values for a star, is presented., Comment: 310 pages, 16 figures, 21 tables, accepted to be published in The Astrophysical Journal