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Simple Summary: This review describes the potential of Peronema canescens extract as a source of immunomodulatory agents. This plant extract also has a wide range of bioactivities; however, information and research on this matter are very limited. This review discusses the bioactivity of Peronema canescens extract, its potential as a source of immunomodulatory agents, and suggestions for its development. Immunomodulators are pivotal in managing various health conditions by regulating the immune response by either enhancing or suppressing it to maintain homeostasis. The growing interest in natural sources of immunomodulatory agents has spurred the investigation of numerous medicinal plants, including Peronema canescens, commonly known in Asia as sungkai. Traditionally used for its medicinal properties in Southeast Asia, Peronema canescens belongs to the Verbenaceae family and has garnered significant attention. This review discusses the immunomodulatory activity of the active compounds in Peronema canescens and explores the potential directions for future research. [ABSTRACT FROM AUTHOR]

Abstract Pomalidomide‐dexamethasone (Pd) has been a standard care treatment for relapsed and refractory multiple myeloma since 2013. However, the outcomes of Pd after exposure to CD38 antibodies are not known. Here we describe the real‐world use and efficacy of pomalidomide in a Danish, nationwide cohort of daratumumab‐exposed patients. We identified 328 patients that were treated with pomalidomide. Of these, 137 received Pd, 65 daratumumab‐pomalidomide‐dexamethasone (DPd), 43 pomalidomide‐cyclophosphamide‐dexamethasone (PCd), 19 carfilzomib‐pomalidomide‐dexamethasone (KPD), 11 pomalidomide‐bortezomib‐dexamethasone (PVd), and 52 pomalidomide in other combinations. Patients treated with Pd in this cohort had a partial response or better (≥ PR) rate of 35.8% and median time to next treatment (mTNT) of 4.9 months, almost identical to the results of previous prospective clinical trials. Although treatment with the various pomalidomide‐containing triplet regimens resulted in higher ≥ PR rates (PCd: 46.5%, PVd: 63.6%, DPd: 55.4%, KPd: 63.2%), the mTNT achieved was not significantly better than with Pd in most cases (PCD: 5.4, PVD: 5.3, DPD: 4.7 months). The exception to this was KPd (mTNT 7.4 months), but this regimen was mainly used earlier in the course of the disease (median time from diagnosis 2.3 years vs. 3.7–4.3 years). The most important predictor of outcomes was not the choice of index regimen (p = 0.72), but prior exposure (p = 0.0116). Compared to CD38 antibody‐naïve patients, triple‐class‐exposed patients achieved reduced ≥ PR rate (38.0% vs. 47.3%), shorter mTNT (4.0 vs. 5.9 months), and shorter median overall survival (12.4 vs. 24.2 months) with pomalidomide treatment.

N-acetylcysteine (NAC), an acetylated derivative of the amino acid L-cysteine, has been widely used as a mucolytic agent and antidote for acetaminophen overdose since the 1960s and the 1980s, respectively. NAC possesses antioxidant, cytoprotective, anti-inflammatory, antimicrobial, and mucolytic properties, making it a promising therapeutic agent for a wide range of diseases in both humans and domesticated animals. Oxidative stress and inflammation play a major role in the onset and progression of all these diseases. NAC's primary role is to replenish glutathione (GSH) stores, the master antioxidant in all tissues; however, it can also reduce levels of pro-inflammatory tumor necrosis factor-alpha (TNF-∝) and interleukins (IL-6 and IL-1β), inhibit the formation of microbial biofilms and destroy biofilms, and break down disulfide bonds between mucin molecules. Many experimental studies have been conducted on the use of NAC to address a wide range of pathological conditions; however, its effectiveness in clinical trials remains limited and studies often have conflicting results. The purpose of this review is to provide a concise overview of promising NAC usages for the treatment of different human and domestic animal disorders. [ABSTRACT FROM AUTHOR]

Aim: Treatment options for triple-class exposed (TCE) patients with multiple myeloma (MM) in Japan are limited. Materials & methods: Retrospective observational study using the Medical Data Vision database (April 2008-April 2021). Eligible adults with MM received a new post-TCE treatment. Treatments, healthcare resource utilization (HCRU) and costs (per patient per month [PPPM]) were analyzed with subgroup analyses by prior stem cell transplantation (SCT vs No SCT). Results: Of 459 TCE patients, 216 (47%) had post-TCE treatment of whom 194 (90%) had no prior SCT. Median duration of the first post-TCE line of therapy (LOT) was 2 months; 49% of No SCT patients received a subsequent LOT. Total healthcare costs were comparable between No SCT and SCT groups (¥1.3 million PPPM each; US$12,328 and $12,391, respectively), driven by treatment costs. Median post-index overall survival (n = 216) was 15.8 months (95% CI: 10.5, 22.3). Conclusion: New treatments with better effectiveness are needed for patients with TCE MM in Japan. [ABSTRACT FROM AUTHOR]

Background: Patients with relapsed or refractory multiple myeloma (RRMM) who have exhausted lenalidomide benefits require improved therapies. The 3-cohort phase 2 MM-014 trial (NCT01946477) explored pomalidomide in early lines of treatment for lenalidomide-exposed RRMM. In cohort B, pomalidomide plus daratumumab and dexamethasone (DPd) showed promising efficacy (median follow-up 28.4 months), as previously reported. Here, we report final overall survival (OS) in cohort B., Methods: Patients aged ≥ 18 years were treated in 28-day cycles: pomalidomide 4 mg orally daily from days 1 to 21; daratumumab 16 mg/kg intravenously on days 1, 8, 15, and 22 (cycles 1-2), days 1 and 15 (cycles 3-6), and day 1 (cycle ≥ 7); and dexamethasone 40 mg (age ≤ 75 years) or 20 mg (age > 75 years) orally on days 1, 8, 15, and 22. The primary endpoint was ORR. OS and safety were secondary endpoints., Results: Among 112 patients enrolled, 85 (75.9%) had lenalidomide-refractory disease and 27 (24.1%) had lenalidomide-relapsed disease. At a median follow-up of 41.9 months (range, 0.4-73.1), median OS was 56.7 months (95% confidence interval, 46.5-not reached). Treatment-emergent adverse events related to, and leading to discontinuation of, pomalidomide, dexamethasone, or daratumumab occurred in 7 (6.3%), 9 (8.0%), and 6 (5.4%) patients, respectively., Conclusion: With long-term follow-up, our results show favorable OS with DPd. The safety profile was consistent with previous reports, with no new safety signals identified. IMiD agent-based therapy can still be considered in patients with RRMM who experience progressive disease on or after lenalidomide., Competing Interests: Disclosure N.J.B. declares research funding from Bristol Myers Squibb (BMS); honoraria from AbbVie, Amgen, BMS/Celgene, Forus, Genentech, GlaxoSmithKline (GSK), Janssen, Karyopharm, Pfizer, Sanofi, and Takeda; and payment for expert testimony from BMS/Celgene, Karyopharm, and Pfizer. C.S. declares no competing financial interests. D.R. declares research funding from BMS; consulting fees from Amgen, BMS, and Janssen; honoraria from Amgen, BMS, GSK, Sanofi, and Takeda; payment for expert testimony from BMS and Janssen; and board membership with Canadian Myeloma Research Network (CMRG; Chief Medical Officer). M.S. declares payment for expert testimony from BMS, Gilead/Kite, Janssen, Novartis, Pfizer, and Sanofi; and participation on a data safety monitoring or advisory board with Janssen. J.M. declares consulting fees from BeiGene and Pharmacyclics; and participation on a data safety monitoring or advisory board with BeiGene. J.G.B. declares research funding from 2seventy bio, AbbVie, Acetylon, Amgen, BMS/Celgene, bluebird bio, C4 Therapeutics, CARsgen, Cartesian, Celularity, CRISPR, EMD Serono, Fate, Genentech, GSK, Ichnos, Incyte, Janssen, Karyopharm, Lilly, Novartis, Poseida, Sanofi, Takeda, and Teva; and consulting fees from bluebird bio, BMS/Celgene, CRISPR, Janssen, Kite, Legend, Roche, Secura, and Takeda. J.S. declares honoraria from BMS, Janssen, Pfizer, and Sanofi. G.J.S. declares research funding from AbbVie, Actinium, Actuate, Agios, AltruBio, Amgen, Aptevo, Arog, Astellas, AVM Bio, BioMea, Biopath, Biosight, BMS/Celgene, Celator, Cellectis, Celularity, Cogent, Constellation, Daiichi Sankyo, Deciphera, Delta-Fly, Fate, Forma, FujiFilm, Gamida, Genentech/Roche, Geron, Gilead/Kite, Glycomimetics, Immunogene, Incyte, Janssen, Jazz, Karyopharm, Kiadis, Kronos Bio, Kura, Loxo, Marker, Mateon, Novartis, Onconova, Ono-UK, Orca, Pfizer, PrECOG, Regimmune, Samus, Sangamo, Sellas, Stemline, Syros, Takeda, Tolero, and Trovagene; consulting fees from BMS/Celgene, Curios, and Daiichi Sankyo; honoraria from AbbVie, Agios, Amgen, Astellas, AstraZeneca, AVM Biotech, BMS, Celgene, Gamida, Gilead, GSK, Incyte, Karyopharm, Novartis, Ono, and Stemline; participation on a data safety monitoring or advisory board with Agios, Amgen, AstraZeneca, AVM Biotech, BMS, Gamida, Gilead, GSK, Incyte, Novartis, and Ono; and stock or stock options with Amgen, BMS, and Janssen/Johnson & Johnson. S.G. declares consulting fees from AstraZeneca, BMS, Kite, and Sanofi; and honoraria from Kite and Seagen. K.S. declares research funding from BMS; and honoraria from Amgen, BMS, and Sanofi. C.S.S. declares no competing financial interests. M.A-R. declares honoraria from BMS, Eisai, and Merck Sharp Dohme. M.B. declares no competing financial interests. D.Q. declares no competing financial interests. G.F. declares honoraria from Amgen, BMS, and Sanofi. H.L. declares employment and stock/stock options with BMS. C.G. declares employment and equity ownership with BMS. P.S. declares employment with BMS. D.S. declares research funding from BMS; consulting fees from BMS, Janssen, and Karyopharm; honoraria from BMS and Janssen; participation on a data safety monitoring or advisory board with BMS; and stock or stock options with COTA., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

N-acetylcysteine (NAC), an acetylated derivative of the amino acid L-cysteine, has been widely used as a mucolytic agent and antidote for acetaminophen overdose since the 1960s and the 1980s, respectively. NAC possesses antioxidant, cytoprotective, anti-inflammatory, antimicrobial, and mucolytic properties, making it a promising therapeutic agent for a wide range of diseases in both humans and domesticated animals. Oxidative stress and inflammation play a major role in the onset and progression of all these diseases. NAC’s primary role is to replenish glutathione (GSH) stores, the master antioxidant in all tissues; however, it can also reduce levels of pro-inflammatory tumor necrosis factor-alpha (TNF-∝) and interleukins (IL-6 and IL-1β), inhibit the formation of microbial biofilms and destroy biofilms, and break down disulfide bonds between mucin molecules. Many experimental studies have been conducted on the use of NAC to address a wide range of pathological conditions; however, its effectiveness in clinical trials remains limited and studies often have conflicting results. The purpose of this review is to provide a concise overview of promising NAC usages for the treatment of different human and domestic animal disorders.

Breast cancer treatment using plant-virus-based nanoparticles (PVNPs) has achieved considerable success in preclinical studies. PVNP-based breast cancer therapies include non-targeted and targeted nanoplatforms for delivery of anticancer therapeutic chemo and immune agents and cancer vaccines for activation of local and systemic antitumor immunity. Interestingly, PVNP platforms combined with other tumor immunotherapeutic options and other modalities of oncotherapy can improve tumor efficacy treatment. These applications can be achieved by encapsulation of a wide range of active ingredients and conjugating ligands for targeting immune and tumor cells. This review presents the current breast cancer treatments based on PVNP platforms. [ABSTRACT FROM AUTHOR]

Introduction: Recently, the recovery of waste products from plants as a source of biologically active compounds has increased interest. Therefore, the current research aims to evaluate the anti-inflammatory, immunomodulatory and antimicrobial activities of the fixed oil of Cucumis melo L seeds, as well as to investigate its physicochemical parameters and chemical composition. Methods: Anti-inflammatory activity was examined using carrageenan-induced rat paw edema assay. The antimicrobial activity was assayed against Staphylococcus aureus, Micrococcus luteus, Enterococcus faecalis, Staphylococcus epidermidis, Pseudomonas aeruginosa, and Candida albicans by well diffusion method. The chemical composition of the oil was determined by gas chromatography/mass spectrometry (GC/MS), α-tocopherol was estimated by high-performance liquid chromatography (HPLC). Results: Cucumis melo oil had no toxicity and possessed a promising anti-inflammatory activity. Moreover, the oil exhibited a reasonable decrease in the pro-inflammatory cytokines, including interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α), and a significant increase in the anti-inflammatory cytokine (IL-10). The oil exhibited a reasonable antimicrobial activity against all tested organisms. The major identified compound in the unsaponifiable matter was (1-methyldodecyl) benzene (8.76%), while the major fatty acid was methyl linoleate (14.10%). The results of physicochemical characterization revealed the better quality of Cucumis melo oil. The amount of α-tocopherol in the oil was 23.5 μg/mL, which is considered a reasonable amount. Conclusion: These findings indicate that the fixed oil of Cucumis melo L seeds might be used as a safe natural anti-inflammatory, immunomodulatory and antimicrobial agent.

BackgroundDespite the introduction of effective, novel agents, the outcome of patients with refractory multiple myeloma remains poor, particularly those who are refractory to both proteasome inhibitors (PIs) and immunomodulatory agents (IMiDs). Limited data are available on the role of autologous hematopoietic stem cell transplantation in this population.MethodsPatients with refractory myeloma who underwent first autologous hematopoietic stem cell transplantation (auto-HCT) between March 2000 and October 2015 were retrospectively analyzed. Those who had primary refractory disease and those with relapsed and refractory disease were included. Disease that was refractory to at least 1 PI and at least 1 IMiD was classified as double-refractory multiple myeloma (DR-MM).ResultsIn total, 233 patients were identified, including 105 (45%) classified with DR-MM and 128 (55%) classified with nondouble-refractory myeloma (NDR-MM). At a median follow-up of 42 months for surviving patients, at least a partial response was observed in 188 patients (81%; 83 patients in the DR-MM group [79%] and 105 patients in the NDR-MM [82%]; P = .77). A near complete response or better was observed in 52 patients (22%; 25 patients in the DR-MM group [24%] and 27 patients in the NDR-MM group [21%]; P = .77). The median progression-free survival was 17.6 months (14.4 months in the DR-MM group and 18.2 months in the NDR-MM group), and the 2-year progression-free survival rate was 38% (35% in the DR-MM group and 40% in the NDR-MM group; P = .40). The median overall survival was 48 months (38.9 months in the DR-MM group and 56.6 months in the NDR-MM group), and the 2-year overall survival rate was 74% (71% in the DR-MM group and 76% in the NDR-MM group; P = .27).ConclusionsThe current findings indicate that auto-HCT is an effective and safe therapy in patients with refractory multiple myeloma, including those who are refractory to IMiDs and PIs. Cancer 2017;123:3568-75. © 2017 American Cancer Society.

Paracoccin (PCN) is a bifunctional protein primarily present in the cell wall of Paracoccidioides brasiliensis, a human pathogenic dimorphic fungus. PCN has one chitinase region and four potential lectin sites and acts as both a fungal virulence factor and an immunomodulator of the host response. The PCN activity on fungal virulence, mediated by the chitinase site, was discovered by infecting mice with yeast overexpressing PCN (PCN-ov). PCN-ov are characterized by increased chitin hydrolysis, a narrow cell wall, and augmented resistance to phagocytes' fungicidal activity. Compared to wild-type (wt) yeast, infection with PCN-ov yeast causes a more severe disease, which is attributed to the increased PCN chitinase activity. In turn, immunomodulation of the host response was demonstrated by injecting, subcutaneously, recombinant PCN in mice infected with wt-P. brasiliensis. Through its carbohydrate binding site, the injected recombinant PCN interacts with Toll-like receptor 2 (TLR2) and Toll-like receptor 4 (TLR4) N-glycans on macrophages, triggers M1 polarization, and stimulates protective Th1 immunity against the fungus. The PCN-treatment of wt yeast-infected mice results in mild paracoccidioidomycosis. Therefore, PCN paradoxically influences the course of murine paracoccidioidomycosis. The disease is severe when caused by yeast that overexpress endogenous PCN, which exerts a robust local chitinase activity, followed by architectural changes of the cell wall and release of low size chito-oligomers. However, the disease is mild when exogenous PCN is injected, which recognizes N-glycans on systemic macrophages resulting in immunomodulation.

Approximately 30% of individuals with severe SARS-CoV-2 infections also develop neurological and psychiatric complaints. In rare cases, the occurrence of autoimmune encephalitis has been reported after SARS-CoV-2 infection. In this systematic review, we have identified eight SARS-CoV-2-associated cases of anti-NMDA receptor encephalitis. All had cerebrospinal fluid antibodies against the NMDA receptor and a recent onset of working memory deficits, altered mental status, or psychiatric symptoms, such as confusion, agitation, auditory hallucination, catatonia and speech dysfunction. All patients received high-dose steroid and immunoglobulin therapeutics and conditions improved in each case. These findings suggest that clinical attention should be paid to warning signs of autoimmune encephalitis in severe COVID-19 cases. If characteristic features of autoimmune encephalitis are present, autoantibody diagnostics should be performed and confirmed cases should be treated with immunotherapy to minimize neurological impairments. [ABSTRACT FROM AUTHOR]

The use of medicinal plants is increasing due to the search for alternative resources to treat diseases such as hypertensions and infection. Along with the development in science, preventive action should take place to prevent our body from suffering from these diseases. This can be done by increasing the human immune status with immunomodulatory agents. Binahong empirically have benefits for wound healing. The purpose of this research was to investigate the immunomodulatory effect of ethanolic extract of binahong leaves. The non-specific modulatory effects of the ethanolic extracts of binahong leaves on the immune systems were measured based on phagocytosis index and phagocytosis capacity. Tests were conducted on strain Balb/C male mice at the age of 6-8 weeks. Mice were administered orally with the extract of binahong leaves (doses of 25, 50, 75 mg/kgBW) for 14 days. The test results with the index parameters and macrophages phagocytosis capacity at doses of 50 and 75 mg/kgBW did not significantly increased when compared with the controls. From these results, we concluded that the ethanolic extract of binahong leaves with a dose of 25, 50 and 75 mg/kgBW cannot significantly the activity of macrophages by phagocytosis index parameters and phagocytosis capacity significantly.

Breast cancer treatment using plant-virus-based nanoparticles (PVNPs) has achieved considerable success in preclinical studies. PVNP-based breast cancer therapies include non-targeted and targeted nanoplatforms for delivery of anticancer therapeutic chemo and immune agents and cancer vaccines for activation of local and systemic antitumor immunity. Interestingly, PVNP platforms combined with other tumor immunotherapeutic options and other modalities of oncotherapy can improve tumor efficacy treatment. These applications can be achieved by encapsulation of a wide range of active ingredients and conjugating ligands for targeting immune and tumor cells. This review presents the current breast cancer treatments based on PVNP platforms.

Summary: Second‐generation immunomodulatory agents, such as lenalidomide, have a more favourable side‐effect profile than the first‐generation thalidomide, but their optimum combination and duration for patients with newly diagnosed transplant‐ineligible myeloma (ND‐TNE‐MM) has not been defined. The most appropriate delivery and dosing regimens of these therapies for patients at advanced age and frailty status is also unclear. The Myeloma XI study compared cyclophosphamide, thalidomide and dexamethasone (CTDa) to cyclophosphamide, lenalidomide and dexamethasone (CRDa) as induction therapy, followed by a maintenance randomisation between ongoing therapy with lenalidomide or observation for patients with ND‐TNE‐MM. CRDa deepened response but did not improve progression‐free (PFS) or overall survival (OS) compared to CTDa. However, analysis by age group highlighted significant differences in tolerability in older, frailer patients that may have limited treatment delivery and impacted outcome. Deeper responses and PFS and OS benefits with CRDa over CTDs were seen in patients aged ≤70 years, with an increase in toxicity and discontinuation observed in older patients. Our results highlight the importance of considering age and frailty in the approach to therapy for patients with ND‐TNE‐MM, highlighting the need for prospective validation of frailty adapted therapy approaches, which may improve outcomes by tailoring treatment to the individual. [ABSTRACT FROM AUTHOR]

Leishmania, parasite, antiprotozoal agents, immunomodulation effect, tegumentary leishmaniasis, immunomodulatory agent Drug treatment is clearly essential, but the usual anti-leishmaniasis drugs can have severe adverse effects and toxicity, resulting in therapeutic failure or patient dropout from therapy. Keywords: Leishmania; parasite; antiprotozoal agents; immunomodulatory agent; immunomodulation effect; tegumentary leishmaniasis EN Leishmania parasite antiprotozoal agents immunomodulatory agent immunomodulation effect tegumentary leishmaniasis 1 3 3 01/21/22 20220118 NES 220118 Leishmaniases comprises a class of diseases that are caused by I Leishmania i protozoa. [Extracted from the article]

Immunotherapy (IT) has been studied as a new and alternative treatment option for locally advanced, persistent, recurrent, or relapsed cervical cancer in an effort to extend the life and possibly cure patients with advanced stage disease. Targeted immune checkpoint inhibitors augment anticancer immunity and prolong patient's life span without immune-related adverse events (irAEs). Here, we present a case of a 56-year-old woman, gravida 2 para 0, diagnosed with squamous cell carcinoma of the cervix stage IVB who received IT coupled with subcutaneous injection of immunomodulatory agent (OK-432) during her standard treatment of concurrent chemoradiation therapy (CCRT) and as a maintenance therapy after CCRT due to relapsed cervical cancer. This form of treatment strategy showed good response as reflected by a decrease in tumor biomarker with no notable serious irAEs.

Introduction: A proportion of patients with multiple myeloma (MM) are older and/or have comorbidities, requiring dose adjustments. Data from OPTIMISMM (NCT01734928) supported the use of pomalidomide, bortezomib, and dexamethasone (PVd) for treating relapsed/refractory MM. This subanalysis of OPTIMISMM assessed outcome by frailty and/or bortezomib dose adjustment., Methods: Patient frailty (nonfrail vs. frail) was classified using age, Charlson Comorbidity Index, and Eastern Cooperative Oncology Group performance status. Data from patients requiring a bortezomib dose reduction, interruption, and/or withdrawal during PVd treatment were assessed., Results: Among 559 patients, 93 of 281 (33.1%) and 93 of 278 (33.5%) patients who received PVd and bortezomib and dexamethasone (Vd), respectively, were frail. Overall response rate (ORR) and median progression-free survival (PFS) were higher in nonfrail vs. frail with PVd treatment (ORR, 82.8% vs. 79.6%; PFS, 14.7 vs. 9.7 months); significantly higher than with Vd regardless of frailty. Grade ≥ 3 treatment-emergent adverse events (TEAEs) were higher with PVd vs. Vd, regardless of frailty. Discontinuations of PVd were lower in nonfrail vs. frail patients (19.2% vs. 30.1%); the median duration of treatment was similar (DoT; 8.8 vs. 8.9 months, respectively). Patients who received PVd with a bortezomib dose adjustment (n = 240) had a longer median DoT (9.3 vs. 4.5 months) and PFS (12.1 vs. 8.4 months) vs. those without., Conclusion: Frail patients treated with PVd demonstrated a higher ORR and a longer PFS and DoT vs. Vd, despite a higher frequency of grade ≥ 3 TEAEs leading to pomalidomide, bortezomib, and/or dexamethasone discontinuation. Therefore, PVd treatment may improve patient outcomes, regardless of frailty., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)

• The combination of vorinostat and lenalidomide as maintenance post-transplantation is tolerable and induces durable response. • With a median follow-up of 89.8 months from autologous stem cell transplantation, the median progression-free survival was 64.3 months (range, 21.7 months to not reached [NR]) and overall survival was not reached (range, 53.0 months to NR). • The use of lenalidomide plus vorinostat could prove to be a promising maintenance strategy in patients with newly diagnosed multiple myeloma. Post-autologous stem cell transplantation (ASCT) maintenance therapy with lenalidomide is standard of care for patients with multiple myeloma (MM). Effective and tolerable drug combinations may further enhance the clinical response post-ASCT. Vorinostat, a histone deacetylase inhibitor, induces antiproliferative and proapoptotic effects in patients with MM. We hypothesized that combination maintenance therapy would further prolong the clinical response achieved from transplantation. We previously reported that the combination of lenalidomide and vorinostat as maintenance post-ASCT was tolerable in 16 patients with MM. We now present the long-term follow up of these patients. Progression-free survival (PFS) and overall survival (OS) outcomes were characterized using the Kaplan-Meier method. Five patients (31%) had high-risk disease, and the median number of lines of therapy before ASCT was 1 (range, 1 to 5). With a median follow-up of 89.8 months from ASCT, the median PFS was 64.3 months (range, 21.7 months to not reached [NR]), and OS was not reached (median, 53.0 months to NR). At the time of this report, 5 patients remained on the study. The combination of vorinostat and lenalidomide as maintenance post-ASCT is tolerable and induces a durable response. A phase III randomized study of lenalidomide versus a combination with vorinostat is warranted. [ABSTRACT FROM AUTHOR]

Epstein–Barr virus (EBV)-positive mucocutaneous ulcer is a B-cell lymphoproliferative disorder occurring in elderly or iatrogenic immunocompromised patients. We report a 27-year-old male patient with Crohn's disease (CD) who developed immunomodulator-associated lymphoproliferative disorder. The patient was diagnosed with CD at the age of 17 and was treated with maintenance therapy including high-dose infliximab and azathioprine. When he was admitted to our hospital with a diagnosis of intestinal obstruction, his abdominal computed tomography findings showed not only colonic wall thickening and narrowing of the descending colon but also multiple liver tumor lesions. His ileus symptom improved with conservative therapy, and a pathological evaluation of the tissue biopsy specimens from the descending colon and liver lesions indicated a morphological diagnosis of EBV-positive diffuse large B-cell lymphoma. This was a case of iatrogenic immunodeficiency-associated lymphoproliferative disorder due to an immunomodulator. The treatment was initiated with chemotherapy, but he died of disease progression 10 months after the diagnosis of lymphoma. Although cases of lymphoproliferative disorder due to treatment modalities used for CD are rare in Japan, an increase in the risk of lymphoproliferative diseases should be considered in patients with CD treated with immunomodulatory agents. [ABSTRACT FROM AUTHOR]

We analyzed gene expression levels of CRBN, cMYC, IRF4, BLIMP1, and XBP1 in 224 patients with multiple myeloma treated with pomalidomide and low-dose dexamethasone in the STRATUS study (ClinicalTrials.gov: NCT01712789; EudraCT number: 2012-001888-78). Clinical responses were observed at all CRBN expression levels. A trend in progression-free survival (PFS; p = .038) and a potential trend in overall survival (OS; p = .059) favoring high CRBN expressers were observed; however, no notable difference in overall response rate (ORR) was observed. ORR (30%), median PFS (17.7 weeks), and median OS (52.3 weeks) in low-CRBN expressers were comparable to those in the STRATUS intent-to-treat population (ORR, 33%; median PFS, 20.0 weeks; median OS, 51.7 weeks). A trend in ORR (p = .050) favoring higher cMYC expressers was observed with no notable difference in PFS or OS. This analysis does not support exploring CRBN as a biomarker for selecting patients for pomalidomide therapy. [ABSTRACT FROM AUTHOR]

Stimulator of interferon genes (STING) agonists show promise as immunomodulatory agents for cancer therapy. In this study, we report the discovery of a novel orally available STING agonist, SAP-04 , that exhibits potent immunomodulatory effects for cancer therapy. By optimizing the amidobenzimidazole core with various pyridine-based heterocyclic substituents, we identified a monomeric variant that displayed more efficient STING agonistic activity than the corresponding dimer. SAP-04 efficiently induced cytokine secretion related to innate immunity by directly binding of the compound to the STING protein, followed by sequential signal transduction for the STING signaling pathway and type I interferon (IFN) responses. Further pharmacological validation in vitro and in vivo demonstrated the potential utility of SAP-04 as an immunomodulatory agent for cancer therapy in vivo. The in vivo anticancer effect was observed in a 4T1 breast tumor syngeneic mouse model through oral administration of the compound. Our findings suggest a possible strategy for developing synthetically accessible monomeric variants as orally available STING agonists. [Display omitted] • STING agonists offer potential for cancer immunomodulation. • We found SAP-04 , an orally available, potent STING agonist. • SAP-04 , optimized from amidobenzimidazole, outperformed the dimer version. • SAP-04 induced cytokine secretion, and showed in vivo anticancer effects in mice through oral administration. [ABSTRACT FROM AUTHOR]

Trypanosoma cruzi causes the lethal Chagas disease, which is endemic in Latin America. Flowers of Moringa oleifera (Moringaceae) express a trypsin inhibitor (MoFTI) whose toxicity to T. cruzi trypomastigotes was previously reported. Here, we studied the effects of MoFTI on the viability of human peripheral blood mononuclear cells (PBMCs) as well as on the production of cytokines and nitric oxide (NO) by T. cruzi-infected PBMCs. Incubation with MoFTI (trypsin inhibitory activity: 62 U/mg) led to lysis of trypomastigotes (LC50 of 43.5 µg/mL) but did not affect the viability of PBMCs when tested at concentrations up to 500 µg/mL. A selectivity index > 11.48 was determined. When T. cruzi-infected PBMCs were treated with MoFTI (43.5 or 87.0 µg/mL), the release of the pro-inflammatory cytokine TNF-α and INF-γ, as well as of NO, was stimulated. The release of the anti-inflammatory cytokine IL-10 also increased. In conclusion, the toxicity to T. cruzi and the production of IL-10 by infected PBMCs treated with MoFTI suggest that this molecule may be able to control parasitemia while regulating the inflammation, preventing the progress of Chagas disease. The data reported here stimulate future investigations concerning the in vivo effects of MoFTI on immune response in Chagas disease.

The use of plant products as immunomodulator has a long history. For eternal era, plant, mineral and animal products are used as drugs for the treatment of various diseases. The present-day synthetic compounds find their leads in natural products. The process of immunomodulation amends the immune system of an individual by prying with its usual functions. Research of immunomodulators from natural sources has been extensively studied for modulation of immune system along with protection and prevention of diseases. Catechin, a flavonoid has been investigated for its potential anti-inflammatory effects. Analgesic effects have been observed for catechin in experimental animals. The present study is focused on exploring the in silico interaction of catechin with some chemokines and inflammatory targets. In this study, catechin was docked with tumour necrosis factor alpha (TNF-a), interleukin (IL)-1ß, IL-6, inducible nitric oxide synthase (iNOS) and cyclooxygenase 2 (COX-2). Docking studies revealed the interaction of catechin with these targets. The result of present study provides insight for the discovery of novel molecules for immunomodulation and treatment of inflammatory disorders. Findings from the present study show that catechin interact with several chemokines and inflammatory mediators. Further studies quantitative structure activity relationship and quantitative structure property relationship on catechin and associated flavonoids are necessary to develop and establish studies which may serve a stepping stone for the development of novel and safe immunomodulator. Catechin, can, therefore, can be considered as a candidate for development of an immunomodulatory agent. [ABSTRACT FROM AUTHOR]

Summary: In the Medical Research Council (MRC) Myeloma IX trial (ISRCTN684564111) patients were randomised to sodium clodronate or zoledronic acid and induction treatment: cyclophosphamide, vincristine, doxorubicin and dexamethasone (CVAD) or cyclophosphamide, thalidomide and dexamethasone (CTD) followed by autologous stem cell transplant (ASCT) in the intensive pathway; attenuated CTD or melphalan and prednisolone (MP) in the non‐intensive pathway. Subsequent randomisation allocated patients to either thalidomide or observation. The European Organisation for Research and Treatment of Cancer (EORTC) quality of life (QoL) questionnaires, QLQ‐C30 and QLQ‐MY24, were administered at baseline, 3, 6 and 12 months and annually thereafter, enabling the effect of sequential treatment on patient‐reported health‐related QoL (HR‐QoL) to be investigated. The protocol specified four subscales of interest: Pain, Fatigue, Global Health Status/Quality of Life and Physical Functioning at 3, 6 and 12 months that were compared using linear models. The intensive pathway showed significant differences in favour of CTD for Fatigue at 3 months and Physical Functioning at 12 months. The non‐intensive pathway and maintenance phase reported significant differences at 3 months; Pain (improved with attenuated CTD) and Global Health status/Quality of Life (improved with observation). The improved outcomes in MRC Myeloma IX were accompanied by some beneficial and few detrimental effects on HR‐QoL. [ABSTRACT FROM AUTHOR]

Background: Lenalidomide is effective for the treatment of low-risk myelodysplastic syndromes with deletion 5q abnormalities. However, whether lenalidomide leads to a significant improvement in treatment response and overall survival (OS) in cases of acute myeloid leukemia (AML) remains controversial. A systematic review and a meta-analysis were performed to evaluate the efficacy and safety of lenalidomide in the treatment of AML.Methods: Clinical studies were identified from the Cochrane Central Register of Controlled Trials, PubMed, Embase, and ClinicalTrials.gov. Efficacy outcomes included overall response rate (ORR), complete remission (CR), and OS. Safety was evaluated based on the incidence of grade 3 and 4 treatment-related adverse events (AEs).Results: Eleven studies were included in our meta-analysis; collectively these studies featured 407 AML patients. Pooled estimates for overall ORR and CR were 31% (95% CI: 26%–36%) and 21% (95% CI: 16%–27%), respectively. Thrombocytopenia, anemia, neutropenia, and infection were the most common grade 3 and 4 AEs.Conclusion: Lenalidomide may have some clinical activity in AML, but the population that would benefit from lenalidomide and incorporating lenalidomide into combination drug strategies need to be better defined. [ABSTRACT FROM AUTHOR]

Summary: The number of novel therapies for the treatment of myeloma is rapidly increasing, as are the clinical trials evaluating them in combination with other novel and established therapies. Proteasome inhibitors, immunomodulatory agents and monoclonal antibodies are the most well known and studied classes of novel agents targeting myeloma, with histone deacetylase inhibitors, nuclear export inhibitors and several other approaches also being actively investigated. However, in parallel with the development and clinical use of these novel myeloma therapies is the emergence of novel mechanisms of resistance, many of which remain elusive, particularly for more recently developed agents. Whilst resistance mechanisms have been best studied for proteasome inhibitors, particularly bortezomib, class effects do not universally apply to all class members, and within‐class differences in efficacy, toxicity and resistance mechanisms have been observed. Although immunomodulatory agents share the common cellular target cereblon and thus resistance patterns relate to cereblon expression, the unique cell surface antigens to which monoclonal antibodies are directed means these agents frequently exhibit unique within‐class differences in clinical efficacy and resistance patterns. This review describes the major classes of novel therapies for myeloma, highlights the major clinical trials within each class and discusses known resistance mechanisms. [ABSTRACT FROM AUTHOR]

Alpha-ketoglutarate (AKG), an endogenous intermediary metabolite in the Krebs cycle, is a molecule involved in multiple metabolic and cellular pathways. It functions as an energy donor, a precursor in the amino acid biosynthesis, a signalling molecule, as well as a regulator of epigenetic processes and cellular signalling via protein binding. AKG is an obligatory co-substrate for 2-oxoglutarate-dependent dioxygenases, which catalyse hydroxylation reactions on various types of substrates. It regulates the activity of prolyl-4 hydroxylase, which controls the biosynthesis of collagen, a component of bone tissue. AKG also affects the functioning of prolyl hydroxylases, which, in turn, influences the function of the hypoxia-inducible factor, an important transcription factor in cancer development and progression. Additionally, it affects the functioning of enzymes that influence epigenetic modifications of chromatin: ten-eleven translocation hydroxylases involved in DNA demethylation and the Jumonji C domain containing lysine demethylases, which are the major histone demethylases. Thus, it regulates gene expression. The metabolic and extrametabolic function of AKG in cells and the organism open many different fields for therapeutic interventions for treatment of diseases. This review presents the results of studies conducted with the use of AKG in states of protein deficiency and oxidative stress conditions. It also discusses current knowledge about AKG as an immunomodulatory agent and a bone anabolic factor. Additionally, the regulatory role of AKG and its structural analogues in carcinogenesis as well as the results of studies of AKG as an anticancer agent are discussed. [ABSTRACT FROM AUTHOR]

Immunotherapy (IT) has been studied as a new and alternative treatment option for locally advanced, persistent, recurrent, or relapsed cervical cancer in an effort to extend the life and possibly cure patients with advanced stage disease. Targeted immune checkpoint inhibitors augment anticancer immunity and prolong patient's life span without immune-related adverse events (irAEs). Here, we present a case of a 56-year-old woman, gravida 2 para 0, diagnosed with squamous cell carcinoma of the cervix stage IVB who received IT coupled with subcutaneous injection of immunomodulatory agent (OK-432) during her standard treatment of concurrent chemoradiation therapy (CCRT) and as a maintenance therapy after CCRT due to relapsed cervical cancer. This form of treatment strategy showed good response as reflected by a decrease in tumor biomarker with no notable serious irAEs. [ABSTRACT FROM AUTHOR]

Brown rice has nutritional benefits due to its abundant nutrients and high dietary fiber content. However, it is often consumed in a fermented form for improved chewy texture and digestibility. In this study, a polysaccharide, FBR-4a, was isolated from fermented brown rice and its chemical composition was analyzed. In addition, its immune-stimulating activity was determined using RAW264.7 cells. FBR-4a is a carbohydrate and consists of nine types of monosaccharides, including galactose, arabinose, rhamnose, mannose, fucose, xylose, glucose, galacturonic acid, and glucuronic acid. FBR-4a increased the gene expression of iNOS and IL-6 and enhanced the production of immune-stimulatory molecules (nitric oxide [NO], IL-6, and TNF-α) in RAW264.7 cells. Western blot analysis showed that FBR-4a phosphorylated the mitogen-activated protein kinases, NF-κB and c-Jun (major component of AP-1 transcription factor) in RAW264.7 cells, in a concentration-dependent manner. FBR-4a-induced IL-6 and NO production was completely suppressed by IκBα and JNK inhibition, but not by ERK and p38 inhibition. Furthermore, the phosphorylation of c-Jun was also suppressed by IκBα and JNK inhibition. These findings suggest that FBR-4a isolated from fermented brown rice has immune potentiation activity on macrophages through IκBα and JNK signaling pathways, which play a central role in IL-6 and NO production. [ABSTRACT FROM AUTHOR]

Purpose: Pomalidomide is a distinct immunomodulatory agent approved for the treatment of relapsed and refractory multiple myeloma. QT interval was monitored in prior studies, and although there was no indication that pomalidomide could induce QT prolongation, a formal analysis was not previously conducted. Therefore, we present here the results of a study evaluating the effects of pomalidomide on QT interval corrected for heart rate (QTc) using Fridericia's formula (QTcF) and other electrocardiogram (ECG) parameters.Methods: Healthy male volunteers with normal or clinically acceptable laboratory tests and ECG results were randomized to receive single oral doses of placebo, pomalidomide 4 mg, pomalidomide 20 mg, and moxifloxacin 400 mg (positive control) in different sequences. Subjects were evaluated by digital ECG monitoring and underwent blood sampling and standard safety monitoring.Results: Seventy-two subjects were enrolled. In ECG evaluations performed after dosing with pomalidomide 4 mg (therapeutic dose) or 20 mg (supratherapeutic dose), the upper limit of the two-sided 90 % CI for mean change from baseline and placebo-corrected QTcF was <10 ms at all postdose time points, which is below the defined threshold of regulatory concern. In contrast, moxifloxacin induced a clear prolongation in QT interval. Changes in heart rate and other ECG parameters after pomalidomide dosing were clinically insignificant.Conclusions: Pomalidomide given as a single oral dose of up to 20 mg was not associated with QT prolongation in healthy male subjects. [ABSTRACT FROM AUTHOR]