David Fruman, PhD
mTOR Kinase Inhibitors: Cancer Therapeutics Repurposed for Treatment of Autoimmune Disease
Specific Aims and Research Plan:
Rapamycin (RAP) is an immunosuppressive drug used to prevent organ rejection. RAP is a partial inhibition of the cellular kinase mTOR. A novel class of mTOR kinase inhibitors (TOR-KIs) block mTOR activity through a distinct biochemical mechanism. TOR-KIs have much greater anti-cancer activity thanRAP in preclinical tumor models, and have entered clinical trials for oncology. However, the potential application of TOR-KIs for autoimmune disease has not been addressed. TOR-KIs achieve anticancer activity at doses that are well tolerated and do not cause generalized immunosuppression. Preliminary data indicate that TOR-KIs selectively suppress autoimmunity without impairing host defense. Therefore, TORKIsh hold promise as novel treatments for multiple sclerosis. In this project we will use an experimental autoimmune encephalomyelitis (EAE) model of MS in mice to test the efficacy of TOR-KIs, while testing safety using a model in which mice are infected with a virus in the central nervous system.The objective is to test the hypothesis that TOR-KIs can reduce the incidence and severity of EAE while preserving anti-viral immunity. We will use TOR-KI compounds that are currently in clinical trials for oncology, are known to be well tolerated in mice at doses with anti-cancer activity, and are available for purchase from commercial vendors.
Using these compounds we will address two specific aims:1. Determine whether TOR-KI treatment reduces the incidence and severity of EAE in mice. We will collaborate with Dr. Craig Walsh, whose lab has experience with the myelin oligodendrocyte glycoprotein (MOG) model of mouse EAE. We will evaluate the disease course in mice treated with titrated doses of TOR-KIs, and will determine the mechanism of protection at the cellular level.Specifically, we will test the hypothesis that TOR-KIs increase the generation of regulatory T cells(Tregs) and promote the retention of activated T cells in secondary lymphoid tissues.2. Determine whether TOR-KI treatment impairs the immune response to a neurotropic virus. A major obstacle for immunosuppressive therapy in MS is the potential for emergence of viral infections in theCNS. We will collaborate with Dr. Thomas Lane to determine how TOR-KIs affect the response to a neurotropic strain of mouse hepatitis virus (MHV). Preliminary data indicate that AZD8055 treatment does not impair the clearance of MHV from the central nervous system. We will repeat and expand these studies to compare parameters of immune activation in mice treated with TOR-KIs compared to mice treated with vehicle alone.Innovation and Translational Potential. This proposal is innovative because we are “re-purposing” an existing class of experimental drugs for a clinical application that is fundamentally different. TOR kinase inhibitors (TOR-KIs) have been developed specifically for use as cancer therapeutics. The goal of this study is to test the innovative hypothesis thatTOR-KIs can oppose autoimmunity and ameliorate the disease course in a mouse model of multiple sclerosis (MS). If the results support this hypothesis, our work has the potential to expand TOR-KI clinicaltrials from oncology into autoimmune diseases including MS.
Kim Green, PhD
Treating Traumatic Brain Injuries via a novel method of brain microglia elimination
Specific Aims:
1) To determine if elimination of microglia via CSF1R antagonists can facilitate recovery following TBI.
We will use induce TBI in rodents and assess the effects of microglia elimination on learning, memory, and motor function. We will use the weight drop model due to its ability to mimic a blast and produce both a focal injury at the site of the impact and a rebound injury, which occurs from the brains impact on the opposite site to the original site of impact, causing a hematoma. Microglia will be eliminated immediately after the insult, via oral administration of CSF1R antagonists, and cognition and motor skills tested 3 months later. We will then examine infarct size, microglia numbers and localization and synaptic markers to understand any changes that may underlie recovery in the absence of microglia.
2) To discover if there is a therapeutic window following TBI in which elimination of microglia is beneficial.
In addition, to understand the therapeutic window, we will also include groups in which we will eliminate microglia at 1 or 4 months after TBI, and then test cognition 3 months later.
The goal of this pilot proposal is to show that removal of microglia is beneficial for recovery following TBI and to understand if a therapeutic window exists with this approach. These data will be used to apply for larger grants from the NIH and DOD, which we hope can eventually lead to clinical trials.
Jung-Ah Lee, PhD
A Technology Driven Safety Intervention for Older Adults New To Anticoagulation Therapy
Abstract
Older adults are at substantial risk for cardiovascular disorders (e.g. atrial fibrillation, venous thromboembolism, heart failure, etc.) that require long-term oral anticoagulation treatment (OAT). However, the need for frequent visits to healthcare clinics to monitor international normalized ratio (INR), lifestyle limitations (e.g. diet and activity restrictions), and side effects (e.g. bleeding) associated with OAT has resulted to dissatisfaction and poor quality of life (QOL) and consequently poor adherence and treatment efficacy of OAT, prompting the need for alternative strategies to ensure that older adults on OAT are more optimally and consistently treated. The use of virtual reality and interactive gaming (VR-IG) – defined as “any form of human computer interface that allows the user to ‘interact’ with and become ‘immersed’ in a computer generated environment in a naturalistic fashion” – has gained recognition as an approach to deliver health education and services to individuals of all ages. Numerous studies support the effectiveness VR-IG in improving knowledge about health and awareness of risk factors, increasing self management, and reducing healthcare resource use. However, there is a paucity of research examining the effectiveness of VR-IG on knowledge, attitudes, self care management, adherence, and QOL in older adults with chronic illness; there are no studies examining the feasibility and effectiveness of VR-IG in older adults requiring long-term OAT. The current study proposes to design a theory-based, elderly-centered VR-IG intervention and test its feasibility and effectiveness using a two-phased approach. Phase 1 aims to develop a VR-IG platform using the principles of Participatory Action Research where patients provide feedback on specific program components (e.g. look and feel, game play elements, art and animation, sound track, mechanism for healthcare provider feedback, and other production features) and make decisions that will impact the design of the VR-IG intervention. In Phase 2 we propose to conduct a pilot study in 10-15 older adults (≥ 60) on long-term OAT to test the feasibility and acceptability of the study procedures and data collection instruments and assess effectiveness of the VR-IG program on several biobehavioral outcomes in preparation for a randomized clinical trial and submission of a larger extramural grant. The specific aims for Phase 2 include: 1) assess changes in cognitive function (knowledge, attitudes), emotional well-being (QOL, depression, anxiety); and perceived control; 2) evaluate changes in adherence (e.g. self-management), adverse outcomes (e.g. bleeding, thromboembolic events), and treatment efficacy; and 3) obtain data on receipt of health services and total intervention costs that can be used for future cost-effectiveness analysis. Data will be collected at baseline, three months, and six months. An extramural grant proposal to conduct a randomized controlled trial and examine the effectiveness of the VR-IG intervention vs. usual care will be submitted to the National Institute of Health-National Institute of Aging using preliminary data from this pilot study. This study will address the tremendous gaps in literature related to use of VR-IG in older adults on OAT and will potentially provide researchers and clinicians with a better understanding of the biobehavioral underpinnings associated with use of VR-IG in older adults with other chronic conditions. This information will provide evidence for rational recommendations for healthcare delivery models and strategies that can be integrated in OAT management and treatment guidelines.
Hannah Park, PhD
Quantitative Analysis of Potential Plasma Methylation Markers for Breast Cancer
Specific aims
We hypothesize that bisulfite pyrosequencing of the optimized 6-gene panel can differentiate between malignant and benign breast lesions and can potentially serve as biomarkers for early detection, diagnosis, and prognosis. To test this hypothesis, we propose to study the following specific aims:1) Analyze methylation of the six-gene panel in plasma from women with malignant (n=117) versus benign breast biopsies (n=289) by bisulfite pyrosequencing;2) Determine the most relevant genes, CpG sites, and thresholds for each gene/CpG site for which, alone or in combination, methylation status will yield the highest sensitivity and specificity for differentiating between patients who were diagnosed with breast cancer at the time of original biopsy (n=117) and patients whose biopsies did not indicate malignancy and remained cancer-free for up to 15 years (n=254).3) Determine the most relevant genes, CpG sites, thresholds, and combinations which are associated with future breast cancer diagnosis (n=35).4) Determine the most relevant genes, CpG sites, thresholds, and combinations which are associated with survival in women diagnosed with breast cancer (n=152).The proposed studies will validate or invalidate in quantitative, reproducible, and standardized terms, the six genes as potential biomarkers for early detection, diagnosis, and prognosis prediction of breast cancer.
Leslie Thompson, PhD
ZFN-Mediated Knockdown of Mutant Htt in Patient-Derived iPS Cells
Specific Aims:
Huntington’s disease (HD) is a devastating autosomal dominant neurodegenerative disease that inevitably leads to death. The disease is caused by an expanded polyglutamine repeat within the Huntingtin (Htt) protein. Symptoms of the disease include a movement disorder, cognitive dysfunction and psychiatric manifestations. Progressive loss of medium spiny neurons in the striatum and shrinkage of the cortex is observed. Current treatments are palliative and do not modify disease progression, therefore a completely unmet medical need exists. One potential approach to treating diseases such as HD is the use of stem cell transplantation. Our preliminary data and other studies suggest that neural stem cells transplanted into a mouse model of HD delays disease progression. But a major drawback to this approach is that patients would likely need to be immunosuppressed for the remainder of their lives and such treatment could itself affect disease progression. A potential solution to this problem would be to use patient-derived induced pluripotent stem cells (iPSCs). Such cells, or specialized cells derived from them, could be used to treat patients in an autologous manner without immune rejection. Since iPSCs derived from patients, although histocompatible, carry a mutant allele, specialized cells derived from them may not restore function either inthe short or long term. Here we propose to engineer HD patient-derived iPSCs using the Zinc-finger nuclease(ZFN) technology to inhibit the expression of mutant Htt. Such an approach could also be applicable to many diseases caused by mutations that are autosomal dominant.
Specifically we propose to:
Aim 1: Carry out knockdown of the Htt encoding mRNA using an short hairpin RNA (shRNA) inserted into a safe harbor locus in HD iPSCs. Using methods for introducing genetic elements into a safe harbor locus using ZFNs, we will introduce an HD miRNA to knockdown the Htt encoding mRNA. Previous studies have shown that a 50-65% reduction in Htt encoding mRNA and or protein ameliorates disease in HD mouse models. The hypothesis to be tested is that generalized knockdown of Htt encoding mRNA in patient-derived cells would “normalize” otherwise defective cells.
Aim 2: Carry out allele specific shRNA inserted into a safe harbor locus in HD iPSCs. For these experiments, we will introduce an allele-specific miRNA that targets the mutant HD allele into a safe harbor locus to specifically target the mutant HD mRNA. The hypothesis to be tested is that allele-specific miRNAs could specifically reduce mutant Htt encoding transcripts in patient-derived cells.
