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Aberrant metabolic reprogramming is known to drive triple negative breast cancer progression and metastasis. The increase in glycolytic flux in cancer cells creates a lactate-rich tumor microenvironment (TME) that is exploited by tumors to their advantage by activating immunosuppressive cell populations, such as Tregs and MDSCs, that thrive on lactate as a fuel source. Therefore, blockade of lactate export from glycolytic cancer cells while inhibiting lactate entry into suppressive immune cells is a novel therapeutic strategy to treat cancer. Lactate transport in cells is predominantly mediated by MCT1 and MCT4 transporters. We have developed a compound, NGY-091, that is a first-in-class small molecule dual inhibitor of the MCT1 and MCT4 lactate transporters. NGY-091 treatment exhibited a potent in vitro cytotoxicity against breast cancer cells with various levels of MCT1 and MCT4 expressions. The on-target activity of NGY-091 was validated by measuring intracellular and extracellular lactate levels. NGY-091 strongly blocked MCT1 mediated lactate import and lactate export through MCT4 in vitro. Furthermore, a direct in vivo tumor cell killing was evident in human TNBC CDX (MDA MB 231) and PDX models with the treatment of NGY-091. In a syngeneic model of 4T1, we observed a significant reduction in tumor growth and synergistic tumor regression when combined with immune checkpoint blockade therapy. Profiling of lymphoid and myeloid cells in NGY-091 treated tumors by flow cytometry revealed a significant alteration in immune architecture suggesting activation of antitumor immunity. NGY-091 treated tumors induced a profound increase in effector T cell populations, CD8/Treg ratio and tumor-suppressive M1 macrophages while significantly downregulating M2 macrophages. To further investigate if NGY-091 directly alters immune cell activation and functionality in vitro, we treated CD4 T, CD8 T, Tregs and MDSCs in a lactate-rich culture condition mimicking lactate level in the TME. NGY-091 treatment strongly increased effector CD4 and CD8 T cells while significantly reducing suppressive function of Treg and MDSCs in vitro. These findings indicate the direct effect of NGY-091 on immune cell and validate the in vivo observations in 4T1 tumors. Therefore, NGY-091 intervenes two key hallmarks of cancer – metabolism and immunity and provides a novel avenue to therapeutically target aggressive breast cancer. Citation Format: Sambad Sharma, Sanath Wijerathna, Kerui Wu, Abhishek Tyagi, Shih-Ying Wu, Kounosuke Watabe, Nelly Kuklin, Jaime Escobedo, Vincent Sandanayaka. Therapeutic efficacy of NGY-091 against triple negative breast cancer is mediated by direct cell killing and activation of antitumor immunity [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P3-07-21.

Multiple antibodies blocking PD-1 or PD-L1 have been approved for clinical use. However, not all patients successfully respond to monotherapy and the need for combinations has become more apparent. CTX-8371 combines PD-1/PD-L1 targeting in one bispecific, tetravalent molecule. CTX-8371 potently blocks PD-1/PD-L1 in vitro and in vivo. This robust activity may be explained by the unique mechanism of action (MOA) of CTX-8371 which involves cell surface PD-1 cleavage. Here we present further in vivo evidence of PD-1 cleavage by CTX-8371 detected during a dose range finding (DRF) study in cynomolgus macaques. Results of this study as well as in vitro receptor occupancy (RO) and the PK/PD profile of CTX-8371 in tumor-bearing mice are described. CTX-8371 was administered to female cynomolgus monkeys (n=3/group) in a single intravenous infusion at 2 mg/kg or weekly infusions at 10 or 50 mg/kg, for a total of 2 doses. PBMCs were isolated before, 24 hours after the first dose, or 24 hours after the second dose (for 10 and 50 mg/kg groups). Immunophenotyping, including PD-1 and PD-L1, was performed on PBMCs by flow cytometry. Mean serum concentration-time data was analyzed to derive PK parameters using noncompartmental and two-compartment models. PK was also determined in tumor-bearing mice using an MSD ELISA-based assay and non-compartmental analysis. In monkeys, CTX-8371 administration resulted in a marked decrease of PD-1+CD4+ and PD-1+CD8+ T cells in PBMCs on days 2 and 9 at all dose levels, indicating PD-1 cleavage from the cell surface. These results confirm in vitro, and in vivo MOA data obtained from mouse studies. Clearance and half-life of CTX-8371 were calculated to be ~6.87 mL/day/kg and 5.45 days, respectively, which fall within the expected ranges for a human IgG1 antibody in non-human primates (NHP) with linear PK. CTX-8371 infusion was well tolerated in cynomolgus monkeys. In tumor-bearing mice, the dose which results in 50% of maximum tumor growth inhibition was found to be 1-2 mg/kg. The minimum effective dose, at which at least 50% of animals exhibit greater than 50% tumor growth inhibition over two consecutive days, was 1mg/kg. It was observed that 11% (1/9), 78% (7/9) and 100% (9/9) of mice in 0.1 mg/kg, 1 mg/kg and 10 mg/kg dose groups, respectively, meet the above criteria. CTX-8371 also showed dose-dependent in vitro RO on T cells from peripheral blood of human, cynomolgus monkey, and transgenic hPD-1hPD-L1 mice. Data presented here confirm the unique MOA of CTX-8371, cleavage of PD-1 from the cell surface. The dual blockade of PD-1 and PD-L1, combined with PD-1 cleavage, may offer superior benefit compared to current checkpoint inhibitor therapies. RO data as well as murine and NHP PK/PD analyses will guide a projected human dose for future development. Citation Format: Diana I. Albu, Xianzhe Wang, Yan Qin, Vivian Li, Purushothama Nanjappa, Amy Daniel Ulumben, Ruturaj Jadhav, Jason Kong, Austin Ablicki, Neal Schilling, Thomas Schuetz, Susan Kalled, Bing Gong, Nelly Kuklin. Dose range finding study in non-human primates confirms the unique mechanism of action of CTX-8371, a novel bispecific antibody blocking PD-1 and PD-L1 [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 3431.

e15056 Background: Checkpoint blockade therapies targeting PD-1 and PD-L1 have shown great success for the treatment of various malignancies. However, a substantial fraction of patients with PD-L1-positive tumors remain unresponsive to these therapies. Novel therapy with significantly greater activity than the leading PD-1/PD-L1 inhibitors is expected to bring additional clinical benefit to patients. Here we describe the preclinical evaluation of CTX-8371, which combines anti-PD-1 and anti-PD-L1 monoclonal antibodies in one bispecific tetravalent molecule. Methods: The immune-enhancing activity of CTX-8371 was tested in vitro in T cell activation assays and tumor cell killing assay. CTX-8371 anti-tumor efficacy in vivo was assessed using mouse tumor cells expressing human PD-L1 implanted in transgenic mice humanized at the PD-1 and PD-L1 loci. CTX-8371 anti-tumor activity was also tested in xenograft tumor models. The mechanism of action of CTX-8371 was investigated in vitro using Jurkat cells expressing PD-1 or PD-L1, human PBMCs, and in vivo in tumor-bearing, chimeric PD-1/PD-L1 transgenic mice. CTX-8371 PK was determined in mice using an MSD ELISA-based assay and in cynomolgus monkeys using a qualified ELISA method. Dose range finding and toxicokinetic studies were performed in cynomolgus monkeys. Results: CTX-8371 potently enhanced T cell activation and function in vitro and showed curative efficacy as monotherapy in multiple solid tumor models, isografts or xenografts. Furthermore, CTX-8371 demonstrated superior anti-tumor efficacy compared to Keytruda or atezolizumab in checkpoint inhibitors-sensitive and resistant syngeneic mouse tumor models. Mechanistically, in addition to blocking PD-1 interaction with PD-L1, CTX-8371 bispecific antibody facilitated cell to cell bridging between cells expressing PD-1 and cells expressing PD-L1. Furthermore, we show that simultaneous binding of CTX-8371 to both PD-1 and PD-L1 resulted in long term PD-1 shedding. This suggests that CTX-8371 may prevent or overcome T cell exhaustion within the tumor microenvironment, thus providing additional advantage over existing therapies. Lastly, excellent tolerability was observed in non-human primates given 2 weekly drug infusions at up to 50 mg/kg dose. Conclusions: CTX-8371 displays multiple mechanisms of action over monoclonal PD1/PD-L1 blockade. These unique pharmacological properties of CTX-8371 could explain the enhanced T cell responses to tumor antigens and superior efficacy over current monoclonal antibody therapies. With favorable PK/PD and toxicology profiles in mice and cynomolgus monkeys, CTX-8371 warrants further advancement to clinical testing.

Protein phosphorylation is frequently used as an indicator of cellular signaling activity. Elevated phosphorylation of tyrosine kinase receptors plays an important role in cancer pathogenesis. However, phosphoproteins are usually poorly preserved in clinical tissue samples that are routinely fixed in 10% formalin. Nonetheless, in oncology clinical trials, use of phosphoproteins as biomarkers has been considered to be of great value in evaluating the effectiveness of a given drug candidate. Therefore, it is worthy of investigating whether alternative fixatives would improve the preservation of phosphoproteins in tissue. We compared the IHC staining of a number of phosphoproteins in xenograft and human surgical tumor tissues fixed in three different fixatives: 10% formalin, 4% paraformaldehyde (PFA), and Streck’s tissue fixative (STF). We found that STF significantly enhanced the staining intensity of phosphoproteins compared with 10% formalin or 4% PFA. STF fixative also showed superiority of preservation of phosphoproteins in human surgical samples. Our results indicate that the choice of fixative could significantly affect the usability of clinical tissue samples for evaluating phosphoprotein by IHC. (J Histochem Cytochem 57:257–264, 2009)

The aim of our investigation was to improve the effectiveness of DNA vaccines against herpes simplex virus (HSV) infection. We chose coimmunization with DNA encoding cytokines known to emphasize components of immune defense that best correlate with immune protection. These include interferon-producing T and NK cells and the IgG2a isotype immunoglobulin. Our results show that the coadministration of plasmid DNA encoding IL-12 or IL-18 along with glycoprotein B (gB) DNA improves immune induction. Recipients of the coimmunization procedure had elevated humoral as well as IFN-gamma-producing T cell responses and showed greater resistance to vaginal challenge with a lethal dose of HSV-1. The adjuvant effects were observed when the vaccines were administered either systemically or mucosally. By most assays, the adjuvant effect of IL-18 was superior to IL-12, although gB DNA plus IL-18 failed to induce levels of immunity achieved by UV-inactivated HSV immunization. Mucosal immunization proved as an effective means of inducing systemic immunity, but was less effective than the systemic route for inducing protection from vaginal challenge. Our results also demonstrated that protection from such challenges was mainly a property of IFN-gamma. Thus, immunized IFN-gamma-/- mice remained susceptible to challenges even while generating readily measurable immune responses. The approach of using DNA vaccines combined with DNA encoding cytokines holds promise and represents a potentially useful approach for vaccines.