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Astragalus membranaceus-Derived Anti-Programmed Death-1 Monoclonal Antibodies with Immunomodulatory Therapeutic Effects against Tumors
2020 Mar 3
Abstract
Astragalus membranaceus polysaccharide (APS) components are main ingredients of TCM and have proven efficacy to activate T cells and B cells, enhancing immunity in humans. In this study, elevated cytokine and anti-PD-1 antibody titers were found in mice after immunization with APS. Therefore, phage-display technology was utilized to isolate specific anti-programmed death-1 (PD-1) antibodies from mice stimulated by APS and to confirm whether the isolated anti-PD-1 antibody could inhibit the interaction of PD-1 with the programmed death-ligand 1 (PD-L1), resulting in tumor growth inhibition. The isolated single-chain fragment variable (scFv) S12 exhibited the highest binding affinity of 20 nM to PD-1, completed the interaction between PD-1 and PD-L1, and blocked the effect of PD-L1-induced T cell exhaustion in peripheral blood mononuclear cells in vitro. In the animal model, the tumor growth inhibition effect after scFv S12 treatment was approximately 48%. However, meaningful synergistic effects were not observed when scFv S12 was used as a cotreatment with ixabepilone. Moreover, this treatment caused a reduction in the number of tumor-associated macrophages in the tumor tissue. These experimental results indirectly indicate the ability of APS to induce specific antibodies associated with the immune checkpoint system and the potential benefits for improving immunity in humans.
Ivermectin converts cold tumors hot and synergizes with immune checkpoint blockade for treatment of breast cancer
Published: 02 March 2021
Abstract
We show that treatment with the FDA-approved anti-parasitic drug ivermectin induces immunogenic cancer cell death (ICD) and robust T cell infiltration into breast tumors. As an allosteric modulator of the ATP/P2X4/P2X7 axis which operates in both cancer and immune cells, ivermectin also selectively targets immunosuppressive populations including myeloid cells and Tregs, resulting in enhanced Teff/Tregs ratio. While neither agent alone showed efficacy in vivo, combination therapy with ivermectin and checkpoint inhibitor anti-PD1 antibody achieved synergy in limiting tumor growth (p = 0.03) and promoted complete responses (p < 0.01), also leading to immunity against contralateral re-challenge with demonstrated anti-tumor immune responses. Going beyond primary tumors, this combination achieved significant reduction in relapse after neoadjuvant (p = 0.03) and adjuvant treatment (p < 0.001), and potential cures in metastatic disease (p < 0.001). Statistical modeling confirmed bona fide synergistic activity in both the adjuvant (p = 0.007) and metastatic settings (p < 0.001). Ivermectin has dual immunomodulatory and ICD-inducing effects in breast cancer, converting cold tumors hot, thus represents a rational mechanistic partner with checkpoint blockade.
Use of the Anti-Parasitic Drug Ivermectin to Treat Breast Cancer
Lee, Peter P. MD
Oncology Times: May 5, 2021
Despite significant advances in the treatment of breast cancer, triple-negative breast cancer (TNBC) remains the most difficult subtype to treat. As the name implies, triple-negative breast cancer cells lack three key proteins—receptors for the estrogen and progesterone hormones, and the protein HER2—which are targets for many effective breast cancer drugs today.
With that in mind, our team wanted to uncover new therapeutic combinations that could treat TNBC and provide more treatment options to these patients.
Immune checkpoint inhibitor (ICI) therapy has emerged as a revolutionary approach that harnesses a patient's own immune system to treat cancer. However, checkpoint inhibitors as single agents are only effective in a subset of patients and cancer types. They've had little impact in breast cancer.
Recent studies suggest that efficacy of checkpoint inhibitors is primarily limited to cancers already infiltrated by T cells—often termed “hot” tumors. In contrast, “cold” tumors have little to no T-cell infiltration and generally do not respond to ICI therapy. As such, there is considerable need to identify drugs capable of priming breast tumors (turning “cold” tumors “hot”) to synergize with checkpoint blockade.
A recently described phenomenon, termed immunogenic cell death (ICD), is a form of cell death that stimulates the host immune system. We reasoned that an agent that induces ICD of cancer cells without suppressing immune function would be ideal for combination with ICI therapy.
Seeking such an agent among FDA-approved drugs, our group found that ivermectin, an anti-parasitic drug used worldwide since 1975 to treat close to 1 billion people primarily for river blindness and other parasitic infections, promotes ICD in breast cancer cells. Among our other findings was evidence that ivermectin modulates the P2X4/P2X7 purinergic pathway, suggesting that ivermectin may further harness tumors' intrinsic high extracellular levels of ATP for anti-cancer activity.
These promising in vitro results prompted us to move forward to in vivo studies using a common animal model of TNBC. In this model, breast tumors are “cold,” indicating little or no infiltrating T cells. Ivermectin treatment led to robust T-cell infiltration turning cold tumors into hot tumors with cancer cells showing markers of ICD in vivo.
The ability to turn TNBC tumors from cold to hot suggested that ivermectin could synergize with ICI therapy (such as with anti-PD-1 monoclonal antibodies). Immune checkpoint inhibitors block the PD-1 protein, which acts as a brake on T cells, thus helping the immune system do what it is designed to do: eradicate cancer.
Our findings on this novel therapeutic combination published recently in npj Breast Cancer journal (2021; https://doi.org/10.1038/s41523-021-00229-5). This is the first time a research team has demonstrated that checkpoint inhibitors can be used to successfully treat breast cancer—when combined with ivermectin, an inexpensive, existing safe drug.
In these studies, 40-60 percent of animals treated with the ivermectin plus anti-PD1 antibody combination completely eradicated their tumors. They were able to fight off the cancer again after it was reintroduced. It's the two drugs working together that is the magic. Either drug alone has almost zero effect, but together they have a powerful synergistic effect.
Our team then tested the combination across a spectrum of clinically relevant settings. We found that the therapeutic combination also worked in neoadjuvant models (before surgery) and adjuvant models (after surgery). Most importantly, the combination worked against metastatic breast cancer, potentially curing 50 percent of animals.
Based on its novel dual mechanisms of action (anti-cancer and immunomodulatory) in cancer, ivermectin may also potentiate the anti-tumor activity of other FDA-approved ICIs. Ivermectin is safe and inexpensive at roughly $30 a dose, making it attainable for everyone including cancer patients in developing countries.
These preclinical findings suggest that the combination of ivermectin and anti-PD1 antibody merits clinical testing in breast cancer patients. We are now planning to test optimal dosing levels for a potential first-in-human clinical trial. Interestingly, in the last year, ivermectin has also demonstrated efficacy against COVID-19, and it is being tested in dozens of clinical trials to both prevent and treat the virus.
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