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Summary Background Pembrolizumab (PD-1 inhibitor) and cetuximab (EGFR inhibitor) are active as single agents and in combination with cytotoxic chemotherapy for recurrent or metastatic head and neck squamous cell carcinoma (HNSCC). Given each drug's single agent activity and unique mechanism of action, we aimed to evaluate the anti-tumour activity of PD-1 blockade with EGFR inhibition in recurrent or metastatic HNSCC. Methods This study is an open-label, non-randomised, multi-arm, phase 2 trial done at four academic centres in the USA. Participants were required to have platinum-resistant or platinum-ineligible, recurrent or metastatic HNSCC, be at least 18 years old, have an Eastern Cooperative Oncology Group performance status 0–1, have measurable disease per Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1, and to have received no previous immunotherapy or EGFR inhibition. All participants received pembrolizumab 200 mg intravenously every 3 weeks, combined with an initial loading dose of cetuximab 400 mg/m2 intravenously followed by 250 mg/m2 intravenously weekly (21 day cycle). The primary endpoint was overall response rate defined as the proportion of participants with a partial or complete responses (per RECIST version 1.1) by 6 months in the intention-to-treat population. The safety population included all participants who received at least one dose of pembrolizumab. Herein, the final analysis of cohort 1 (no previous PD-1, PD-L1, or EGFR inhibition for recurrent or metastatic HNSCC) is reported. Three additional cohorts (two for participants with a previous response to immunotherapy followed by relapse or progression, with or without previous cetuximab exposure, and one for cutaneous HNSCC) will be reported separately once fully accrued. This study is registered with ClinicalTrials.gov , NCT03082534 , and remains open as the three additional cohorts are actively accruing participants. Findings Between March 22, 2017, and July 16, 2019, 33 participants were enrolled to cohort 1. All 33 participants received at least one dose of pembrolizumab. Median follow-up duration was 7·3 months (IQR 3·9–10·9). By 6 months, the overall response rate was 45% (95% CI 28–62), with 15 of 33 participants achieving a partial response. The most common grade 3–4 treatment-related adverse event was oral mucositis (three [9%] of 33 participants), and serious treatment-related adverse events occurred in five (15%) participants. No treatment-related deaths occurred. Interpretation Pembrolizumab combined with cetuximab shows promising clinical activity for recurrent or metastatic HNSCC, and merits further investigation. Funding Merck Sharp & Dohme.

Electronic cigarettes (e-cigarettes) are the preferred smoking-cessation aid in the United States; however, there is little evidence regarding long-term effectiveness among those who use them. We used the Population Assessment of Tobacco and Health Study to compare long-term abstinence between matched US smokers who tried to quit with and without use of e-cigarettes as a cessation aid. We identified a nationally representative cohort of 2,535 adult US smokers in 2014–2015 (baseline assessment), who, in 2015–2016 (exposure assessment), reported a past-year attempt to quit and the cessation aids used, and reported smoking status in 2016–2017 (outcome assessment; self-reported ≥12 months continuous abstinence). We used propensity-score methods to match each e-cigarette user with similar nonusers. Among US smokers who used e-cigarettes to help quit, 12.9% (95% confidence interval (CI): 9.1%, 16.7%) successfully attained long-term abstinence. However, there was no difference compared with matched non–e-cigarette users (cigarette abstinence difference: 2%; 95% CI: −3%, 7%). Furthermore, fewer e-cigarette users were abstinent from nicotine products in the long term (nicotine abstinence difference: −4%; 95% CI: −7%, −1%); approximately two-thirds of e-cigarette users who successfully quit smoking continued to use e-cigarettes. These results suggest e-cigarettes may not be an effective cessation aid for adult smokers and, instead, may contribute to continuing nicotine dependence.

Background: Cirmtuzumab is a humanized monoclonal antibody that targets the receptor tyrosine kinase like orphan receptor 1 (ROR1), which is expressed on poor prognosis breast cancer, ovarian cancer, other solid tumors, CLL and mantle cell lymphoma. One clinical study showed increased expression of ROR1 in breast cancers after neoadjuvant chemotherapy and a preclinical PDX breast cancer model showed cirmtuzumab and paclitaxel to have at least additive efficacy1. A recently completed Phase 1 trial of cirmtuzumab in CLL showed the antibody to be both safe and effective in inhibiting tumor cell ROR1 signaling in patients with CLL2. Methods: The primary aim of this trial was to determine the safety of cirmtuzumab and weekly paclitaxel in patients with advanced Her2 negative breast cancer based upon dose limiting toxicities (DLTs) in the first cycle of treatment. Secondary endpoints were clinical activity, pharmacokinetics and correlative biomarkers on tumor specimens. Eligible patients were those with locally advanced, unresectable or metastatic Her2 negative breast cancer who had not received paclitaxel in the metastatic setting, had not developed metastatic disease within 6 months of (neo)adjuvant paclitaxel, had ECOG performance status of 0-2, and had adequate laboratory parameters. Any number of prior lines of therapy were allowed. Study treatment included fixed dose 600 mg cirmtuzumab given days 1 and 15 of cycle 1 and then day 1 of each subsequent 28-day cycle. Paclitaxel was given weekly at a dose of 80mg/m2. Patients were evaluated in dose cohorts of 5 for DLTs with a target of 15 evaluable patients. Results: To date, 6 patients evaluable for safety and 5 patients evaluable for DLTs were treated. Age range was 30 to 59 years. Three of 6 safety-evaluable patients had triple negative breast cancer at study enrollment. Prior lines of chemotherapy in the metastatic setting ranged from 0-3. No discontinuations for toxicity and no DLTs have been observed to date. Adverse events (AEs) have been consistent with the known safety profile of paclitaxel, with 3 episodes of grade 3 neutropenia in 2 patients and 1 episode of grade 3 hyperglycemia. All other AEs were grade 1 or 2. Partial responses have been observed in 2/5 patients with one patient response ongoing with cirmtuzumab alone for at least 17 weeks after stopping paclitaxel. Pharmacokinetic analysis of serial plasma samples for free unbound antibody from two patients provided results similar to those observed in CLL patients treated with cirmtuzumabwith a projected half-life of 30 days2. No decline in antibody concentration over time was observed consistent with the absence of neutralizing antibodies. Conclusions: Preliminary information indicates that the combination of fixed dose cirmtuzumab plus paclitaxel is well-tolerated and safe. Responses to therapy have been observed and preliminary pharmacokinetic results are consistent with sustained potentially therapeutic levels. Updated safety, clinical activity, pharmacokinetics and biomarker analyses will be presented. 1Zhang S et al. Proc Natl Acad Sci USA. 116(4): 1370-1377. PMID 30622177. 2Choi MY et al. Cell Stem Cell 22(6): 951-959. PMID 29859176. Funding sources: CIRM UC San Diego Alpha Stem Cell Clinic and Sanford Stem Cell Clinical Center; Oncternal Therapeutics, Inc.; UC San Diego Moores Cancer Center Padres Pedal the Cause Grant; Gonick Breast Cancer Research Fund Citation Format: Rebecca A Shatsky, Richard B Schwab, Teresa L Helsten, Emily I Pittman, Ruifeng Chen, James B Breitmeyer, Catriona HM Jamieson, Thomas J Kipps, Barbara A Parker. Phase 1b trial of cirmtuzumab and paclitaxel for locally advanced, unresectable and metastatic breast cancer [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P3-10-18.

This retrospective cross-sectional single-center study included patients with category III exposure to rabies virus between January and December 2019. Exposure characteristics and clinical data were compared and statistically analyzed between groups who were willing and unwilling to receive the rabies immunoglobin (RIG) injection, and the determinants of its administration were identified by stepwise multivariate logistic regression analyses. In total, 1,757 patients with category III exposure were enrolled: 845 men (48.1%) and 912 women (51.9%; median age: 28 [9-50] years). Among them, 1,297 (73.8%) received the RIG injection (median age: 28 [8-50] years) and 460 (26.2%) refused to receive the injection (median age: 25 [15-48] years). Patients aged 16-25 years (odds ratio [OR] = 3.006, 95% confidence interval [CI] = 1.957-4.619), 26-45 years (OR = 2.940, 95% CI = 2.011-4.298), 46-55 years (OR = 3.647, 95% CI = 2.233-5.959), and above 56 years (OR = 6.660, 95% CI = 4.009-11.062); those with injuries caused by cats (OR = 1.937, 95% CI = 1.476-2.542); and people with scratch (OR = 3.319, 95% CI = 2.510-4.390) and minor (OR = 35.281, 95% CI = 18.524-64.198), and moderate (OR = 12.711, 95% CI = 7.221-22.375) injuries were more likely to refuse injection. The RIG administration level in the settings studied herein was found to be insufficient. Educational and awareness programs on rabies prevention, especially those targeted at people not injured by dogs, people with minor injuries, and the elderly should be considered.

Influenza virus infection is widely believed to cause mild symptoms, but can lead to high mortality and severe disease complicated by secondary bacterial pneumonia. Traditional Chinese medicine (TCM) has been proposed as a promising agent to treat respiratory viral infections. A herbal formula Lianhuaqingwen capsule (LHQW) comprising two prescriptions: Maxing Shigan decoction and Yinqiao San, has been used clinically to treat respiratory infection with immune regulatory effects. However, little is known about the capacity of LHQW against influenza-induced secondary bacterial pneumonia.This study aimed to evaluate the efficacy and underlying mechanism of LHQW on influenza A virus A/PR/8/34 (PR8) secondary methicillin-resistant Staphy-lococcus aureus (MRSA) infection.The anti-adhesion activity of LHQW against PR8-induced MRSA infection was assessed in human lung epithelial (A549) cells and the effect of LHQW on the expression of intracellular adhesion molecule 1 (ICAM-1) was detected. Also, the mRNA expression levels of inflammatory cytokines upon lipopolysaccharide (LPS) stimulation in PR8-infected A549 cells were determined. The body weight change, survivals, viral titers, colonies and the pathological parameters after LHQW treatment in severe pneumonia model have all been systematically determined.LHQW significantly reduced the adhesion of MRSA to PR8-infected A549 cells in a dose-dependent manner by suppressing the up-regulation of bacterial receptors. LHQW also markedly declined the overexpression of IL-6, IL-8, and TNF-α induced by LPS stimulated-A549 cells following influenza virus infection. Furthermore, the abnormal changes of lung index in dual-infection mice were relieved after administered with LHQW in preventive and therapeutic mode, but with no significantly difference (P 0.05). LHQW could not effectively improve survival rate or prolong the survival time of mice (P 0.05). LHQW (1000 mg/kg/d) administered prophylactically significantly decreased the lung viral titers (P 0.05), slightly downregulated IL-6 but TNF-α, IL-1β levels and improved lung pathological inflammation including neutrophil infiltration, necrosis, which is consistent with the expression of inflammatory factors.LHQW inhibited influenza-induced bacterial adhesion by down-regulating the adhesion molecules with the improvement trend on severe pneumonia, indicating that it can be used as an adjuvant medication in severe viral-bacterial pneumonia therapy rather than as a single medication.

Jianpiyifei II granule (JPYF II) is an oriental herbal formula used clinically in China to treat chronic obstructive pulmonary disease (COPD). The aim of the present study was to investigate the anti-inflammatory and antioxidative activities of JPYF II in a mouse model of COPD induced by lipopolysaccharide (LPS) and cigarette smoke (CS) and in RAW264.7 cells stimulated with cigarette smoke extract (CSE). Mice were given LPS via intratracheal instillation on days 1 and 15 and exposed to CS generated from 4 cigarettes/day for 28 days. The mice were treated with 0.75, 1.5, or 3 g/kg/d JPYF II by intragastric administration in low, middle, and high dose groups, respectively, for two weeks. RAW264.7 cells were stimulated by CSE and treated with JPYF II at doses of 12.5, 25, or 50 μg/mL. In the mouse model of LPS and CS-induced COPD, JPYF II decreased inflammatory cell counts in broncho alveolar lavage fluid (BALF), in addition to mRNA expression of proinflammatory cytokines and metalloproteinases (MMPs) in lung tissues. In addition, JPYF II elevated catalase (CAT) and glutathione peroxidase (GSH-Px) activities and reduced the levels of malondialdehyde (MDA) and IκBα and p65 phosphorylation and inflammatory cell infiltration in the lung tissues. In RAW264.7 cells stimulated with CSE, JPYF II inhibited the mRNA levels of inflammatory mediators and the phosphorylation of IκBα and p65. Our results suggest that JPYF II enhanced anti-inflammatory and antioxidative activities in a mouse model of COPD induced by LPS and CS and in RAW264.7 cells stimulated with CSE via inhibition of the NF-κB pathway.

Rift Valley fever virus (RVFV), a recognized category A priority pathogen, causes large outbreaks of Rift Valley fever with some fatalities in humans in humans and huge economic losses in livestock. As wild-type RVFV must be handled in BSL-3 or BSL-4 laboratories, we constructed a high-titer vesicular stomatitis virus (VSV) pseudotype bearing RVFV envelope glycoproteins to detect neutralizing antibodies in vitro under BSL-2 conditions. The neutralizing properties of 39 amino acid mutant sites that have occurred naturally over time in the RVFV envelope glycoproteins were analyzed with their corresponding pseudoviral mutants separately. Compared with the results in the primary strain, the variants showed no statistically significant differences. We next established a Balb/c mouse pseudovirus infection model for detecting neutralizing antibodies against pseudovirus. Five immunizations with pseudoviral DNA protected the mice from infection with the pseudovirus. Bioluminescence imaging, which we used to evaluate viral dissemination and distribution in the mice, showed a good relationship between the neutralizing antibodies titers in vitro. These pseudovirus methods will allow for the safe determination of neutralizing antibodies in vivo and in vitro, and will assist with studies on vaccines and drugs against RVFV with the long term objective of Rift Valley fever prevention.

Rabies is a fatal zoonosis which could affect all mammals. Glycoprotein (G protein) from the rabies virus plays an important role in the binding of virus to target cells. However, expression of the G protein with native conformation has been a great challenge for many years. In this study, we solved this problem by replacing the original signal peptide of rabies virus G protein with the one from the heavy chain of human IgG. The expression levels of recombinant G protein dramatically increased from a few μg/L to 50 mg/L in the culture supernatants. The identity of the recombinant G protein was confirmed by western blotting using both 6XHis mAb 6E2 and rabies G protein mAb 7G3. The correct conformation of the recombinant G protein was shown by using rabies virus neutralizing antibodies. In addition, the recombinant G protein had immune-reactivities with mice sera raised against rabies vaccines and vice versa. Taken together, our data suggested that by replacing the signal peptide, the expression level of the G protein with native conformation could be significantly improved. This would help the development of a rabies subunit vaccine, structural studies of rabies G protein, elucidation of the signal pathway of RABV infection.

6033Background: Pembrolizumab (a humanized monoclonal antibody blocking programmed death receptor-1[PD-1]), and cetuximab (a chimeric monoclonal antibody inhibiting epidermal growth factor receptor...

Stem cell transplantation to improve the onset and survival of animals or humans with prostate cancer has not been studied adequately. In this study, we examined whether intravenous administration of human umbilical cord blood (HUCB) mononuclear cells into TRAMP (transgenic adenocarcinoma of the mouse prostate) mice can delay the onset of prostate cancer and improve survival of these mice before and after the development of cancer. Twenty TRAMP mice were randomly divided into 2 groups. One group of 10 mice received 200 x10(6) HUCB mononuclear cells retro-orbitally into the venous plexus at the age of 6 weeks. Another group of 10 mice did not receive HUCB cells and served as control mice. The presence of tumor was detected by abdominal palpation, which was confirmed by biopsy. When 4 of the 10 control mice developed the tumor, they were treated with the same dose of HUCB cells. Either at the time of death or sacrifice, various tissues were examined for the presence of HUCB cell total RNA by reverse transcriptase PCR. Also, the tissues were examined histologically for the presence of metastasis and carcinoma. Kaplan-Meier survival plots were used to assess the lifespan of the mice. The data show that the control mice developed the tumor much earlier than the treated mice (control vs treated: 238+/-38 vs 311+/-40 days; P

Several studies have shown that transplantation of embryonic stem cells into diabetic animals either improved or normalized blood glucose levels. In this study, we examined the dose-dependent effect of early (prediabetic stage) intravenous administration of human umbilical cord blood (HUCB) mononuclear cells on blood glucose levels, survival, and insulitis in nonobese diabetic (NOD) mice with autoimmune type 1 diabetes. The results show that mice treated with HUCB cells significantly lowered their blood glucose levels and increased their lifespan, as compared with untreated mice. Also, a significant reduction in insulitis was observed in treated than in untreated mice. The mice that received the highest dosage (200 x 10(6)) of cells had greater reduction in blood glucose levels and the degree of insulitis than the mice that received lower dosage (100-150 x 10(6)) of cells. Prolonged lifespan in the former group of mice seems to be related to better control of blood glucose levels. Thus, administration of HUCB cells in the prediabetic stage without any immunosuppression improves type 1 diabetes by protecting the islets from insulitis in NOD mice.

Recent in vitro and in vivo studies have shown that either animal- or human-derived embryonic stem cells can differentiate into insulin-secreting cells and lower blood glucose levels. However, studies utilizing human umbilical cord blood (HUCB) mononuclear cells to improve blood glucose levels in diabetic animals have received little attention. In this study, we examined the effect of transplanted HUCB mononuclear cells on blood glucose levels, survival, and renal pathology in obese mice with spontaneous development of type 2 diabetes. The results show that injection of HUCB mononuclear cells into orbital plexus of mice caused improvement not only in blood glucose levels and survival rate but also normalization of glomerular hypertrophy and tubular dilatation. Thus, transplantation of HUCB mononuclear cells appears to be another modality of stem cell therapy in diabetes mellitus.

In previous studies we observed that human umbilical cord blood (HUCB) could have a protective effect on the onset of disease and time of death in MRL Lpr/Lpr mice which have an autoimmune disease that may be considered similar to human lupus. We believed a temporary xenograph may have occurred in these animals with the disease process delayed and the life span markedly increased. When HUCB is stored at 4 degrees C in gas permeable bags, there is a decrease of the cell reaction in mixed lymphocyte cultures. The blood, however, maintains a significant number of cells capable of producing replatable colonies. This study attempted to determine the effect of HUCB on SOD1 mice (transgenic B6SJL-TgN(SOD1-G93A)1GUR), which have a mutation of the human transgene, (CuZn superoxide dismutase gene SOD1) that has been associated with amyotrophic lateral sclerosis. We previously developed evidence that the survival of lethally irradiated mice was related to the number of human mononuclear cells administered. In the present study, we decided to investigate the effect of a relatively large dose of human mononuclear cord blood cells on SOD1 mice subjected to a sublethal dose of irradiation preceded by antikiller sera (rabbit anti-asialo). The SOD1 mice show evidence of paralysis at 4 to 5 months. The average expected lifetime of these mice is reported to be 130 days (Jackson Laboratory). In this experiment, there were 23 mice. Two mice died before the onset of paralysis. The remainder were divided into three groups: group I: control group of 4 untreated mice; group II: an experimental group of 6 mice treated with antikiller sera, 800 cGy irradiation plus 5 x 10(6) congenic bone marrow mononuclear cells; group III: another experimental group of 11 mice treated with antikiller sera, 800 cGy irradiation plus 34.2-35.6 x 10(6) HUCB mononuclear cells, previously stored for 17-20 days at 4 degrees C in gas permeable bags. The results were as follows: the average age at death was: (I) 127 days for the untreated control group, (II) 138 days for the group that received 800 cGy of irradiation and congenic bone marrow (BM) and (III) 148 days for the group that received irradiation and HUCB. (P < 0.001 HUCB vs control, p < 0.01 HUCB vs BM). The longest surviving mouse in each group was 131, 153, and 182 days old respectively. In summary, large doses of HUCB mononuclear cells produced considerable delay in the onset of symptoms and death of SOD1 mice. These preliminary results may not only indicate that amyotrophic lateral sclerosis is an autoimmune disease, but may also indicate a possible treatment for a devastating disease and possibly others.