Citations

686 Background: Immune checkpoint inhibitors (ICI) have been used to treat advanced muscle invasive and/or metastatic bladder cancer. However, ICIs are only effective in 30-40% of cases. In light of potentially significant IRAE’s, tools to predict individual patient level benefits are desirable. AI technology offers the opportunity to apply computational methods to predict outcomes from readily available digitized pathology slides. We investigated the utility of an AI platform integrating computational biomarkers based on morphological characterization of digitized H&E slide whole images (WSI) to predict response to ICI. Methods: We analyzed H&E-stained whole slide images (WSI) of bladder tumor tissue collected from transurethral resection of bladder tumor (TURBT) from 116 patients with advanced or metastatic bladder cancer at a single institution between 2015-2020. Adjacent multiplex IHC stained specimens were analyzed myeloid and lymphoid marker panels. 20 patients from the overall cohort treated with ICI were designated ‘responders’ (complete response, partial response, stable disease) and 20 patients were identified as non-responders (progressive disease) based on ICI best clinical/radiographic response. WSIs were divided into small non-overlapping image patches. These image tiles were processed into multiple AI encoder models to extract morphological features. The tile morphological features, represented by high dimensional vectors, were combined by an aggregation model to represent the whole slide morphology and then used to classify the patients into responders vs non-responders to immunotherapy. Area-under-the-receiver operating characteristic (AUC) was used to measure the performance of response prediction. Results: Our method shows AUC of 0.708 at classification of the patients (n=40) into responder and non-responder groups. With a cutoff that identifies the top 50% patients (n=20) of high probability of responding to immunotherapy predicted by our models, 75% of them are responders. In the bottom 50% patients (n=20) of the low scores, 75% of them are non-responders. . Multiplex IHC (myeloid and lymphoid panel) was performed using adjacent sections and were characterized yielding deeper mechanistic insight into the inflammatory populations driving predictive morphologic patterns. Conclusions: By applying innovative AI morphological analysis on patient WSIs, we generated a computational biomarker that shows promising ability to predict patient response to immunotherapy in bladder cancer. This approach merits future prospective validation and additional patient level analysis in broader cohorts. [Table: see text]

Intrahepatic macrophages in nonalcoholic steatohepatitis (NASH) are heterogenous and include proinflammatory recruited monocyte-derived macrophages. The receptor for advanced glycation endproducts (RAGE) is expressed on macrophages and can be activated by damage associated molecular patterns (DAMPs) upregulated in NASH, yet the role of macrophage-specific RAGE signaling in NASH is unclear. Therefore, we hypothesized that RAGE-expressing macrophages are proinflammatory and mediate liver inflammation in NASH. Compared with healthy controls, RAGE expression was increased in liver biopsies from patients with NASH. In a high-fat, -fructose, and -cholesterol–induced (FFC)-induced murine model of NASH, RAGE expression was increased, specifically on recruited macrophages. FFC mice that received a pharmacological inhibitor of RAGE (TTP488), and myeloid-specific RAGE KO mice (RAGE-MKO) had attenuated liver injury associated with a reduced accumulation of RAGE + recruited macrophages. Transcriptomics analysis suggested that pathways of macrophage and T cell activation were upregulated by FFC diet, inhibited by TTP488 treatment, and reduced in RAGE-MKO mice. Correspondingly, the secretome of ligand-stimulated BM-derived macrophages from RAGE-MKO mice had an attenuated capacity to activate CD8 + T cells. Our data implicate RAGE as what we propose to be a novel and potentially targetable mediator of the proinflammatory signaling of recruited macrophages in NASH.

Primary Myelofibrosis (PMF) is an aggressive myeloproliferative neoplasm (MPN) characterized by constitutional symptoms, cytopenias, splenomegaly, extramedullary hematopoiesis, bone marrow (BM) fibrosis, and a propensity to transform to acute myeloid leukemia (AML). Despite advances in understanding the underlying genetic abnormalities in MPN and the development of JAK2 inhibitors to treat MF, there is an urgent need to devise new treatment strategies, particularly for triple negative myelofibrosis (TN-MF) cases that lack mutations in the JAK2 kinase pathway and who have inferior outcomes. To identify potential oncogenic drivers in TN-MF, we performed cytogenetic analyses and targeted exome sequencing of 98 genes commonly mutated in myeloid malignancies in 584 MF patients identified from the Total Cancer Care database at Moffitt Cancer Center. Notably, there were no significant differences in the somatic mutation profiles (other than JAK2 activating mutations) between TN vs. JAK2/CALR/MPL mutant MF patients. However, trisomy of chromosome 8 occurs more frequently in TN-MF vs. other subtypes (26.7% vs. 6.2%, p=0.0001). To identify oncogenic drivers in trisomy 8+ TN-MF, we performed scRNA-seq analysis from 18,651 cells ( n=15,850 from 3 normal donors and n=2,801 from a trisomy 8+ TN-MF patient) and identified a total of 1,260 genes that are differentially regulated in hematopoietic stem cells (HSCs) of trisomy 8+ TN-MF compared to normal donors. Among these, 131 genes were located on chromosome 8 and MYC was one of the top 5 genes that are significantly upregulated in trisomy 8+ HSCs. Additional immunohistochemistry staining demonstrated that MYC protein levels in BM cells were significantly higher in trisomy 8+ TN-MF patients vs. trisomy 8- patients. To assess whether MYC might be a driver of MPN, we established an Mx1-Cre +/-;Rosa26 LSL-MYC/LSL-MYC transgenic mouse model that inducibly overexpresses MYC in HSCs following treatment of polyinosinic-polycytidylic acid (pIpC). Forced MYC expression induced profound anemia, monocytosis, megakaryocytic atypia, splenomegaly, increased BM collagen deposition/fibrosis, extramedullary hematopoiesis in spleen and liver, and significantly reduced OS vs. Mx1-Cre +/- wild type controls (median OS 258 days vs. not reached (NR), p<0.0001). MYC also promoted expansion of HSCs, myeloid progenitors, and Gr-1 +/CD11b + mature myeloid cells in BM and spleen; thus, MYC was sufficient to provoke MF-like disease independent of JAK2 pathway mutations. Subsequent scRNA-seq analysis of 25,232 cells ( n=13,552 from control and n=11,680 from a MYC transgenic mouse) revealed that S100a9 mRNA levels were increased by MYC in most major hematopoietic cell types. Supporting oncogenic roles of S100A9 in MYC-driven MF, deletion of S100a9 in Mx1-Cre +/-;Rosa26 LSL-MYC/LSL-MYC;S100a9 -/- mice abolished MYC-induced MF phenotypes and significantly improved OS (median OS NR vs. 225 days, p=0.0345). To test whether inhibition of MYC can suppress MF disease progression in vivo, lethally irradiated CD45.1 +/CD45.2 + WT mice were transplanted with BM cells harvested from CD45.2 + Mx1-Cre +/-;Rosa26 LSL-MYC/LSL-MYC mice that were treated with pIpC 20 weeks prior to transplant. MYCi975, a small molecule that inhibits MYC, reduced MYC and S100a9 protein levels in BM and spleen cells. Further, MYCi975 effectively suppressed MYC-driven MF phenotypes and disease progression, and significantly improved OS (median OS NR vs. 252 days, p=0.0109). In summary, our studies are the first to describe an oncogenic role of MYC in MF pathogenesis, where MYC provokes an alarmin-driven inflammatory circuit, and where the MYC-S100A9 axis represents a therapeutic vulnerability for TN-MF patients. Accordingly, our results provide a strong rationale for testing agents targeting MYC or S100A9 in early phase clinical trials in MPNs having increased MYC levels or activity.

We describes the development of a poly-lactic-coglycolic acid (PLGA) nanoparticle-based system for conjugation of targeting peptides to PLGA nanoparticles and delivery of the therapeutic gene SOX9 to damaged astrocytes in a mouse stroke model.

The A‐splice variant of Na + ‐dependent, electrogenic bicarbonate transporter‐1 (SLC4A4, NBCe1‐A) is generally believed to be the only SLC4A4 isoform expressed in the mammalian proximal tubule, and to have critical roles in filtered bicarbonate reabsorption, proximal tubule ammonia metabolism and proximal tubule organic anion metabolism. The purpose of the current study was to examine expression of other splice variants in the mouse kidney. We used recently generated mice with TALEN‐generated deletion of A and D NBCe1 splice‐variants, but with intact expression of the B, C and E isoforms. RT‐PCR using primers specific to the B, C and E isoforms showed mRNA of non‐A,D splice variants was expressed in the kidney of mice with intact NBCe1‐A expression and with NBCe1‐A‐specific deletion. We then used an antibody that recognizes portions of NBCe1 present in all splice isoforms and examined immunolabel in the kidney of NBCe1‐A‐deletion mice. There was basolateral immunolabel in the proximal convoluted tubule in the cortex, and lesser intensity basolateral immunolabel in the proximal tubule straight tubule in both the cortex and outer medulla. Specificity of this antibody was demonstrated by identifying that mice with deletion of all splice variants had no detectable immunolabel. An antibody specific to the A‐splice variant showed basolateral immunolabel throughout the entire proximal tubule of mice with intact NBCe1‐A expression, but no detectable immunolabel in mice with NBCe1‐A‐specific deletion. Thus, an NBCe1 splice variant other than NBCe1‐A appears to be expressed in the mouse proximal tubule. In acid‐loaded NBCe1‐A‐deletion mice, immunolabel observed using the pan‐specific anti‐NBCe1 antibody showed increased immunolabel in the proximal straight tubule, particularly in the outer medulla. These studies show that splice variants of NBCe1 other than NBCe1‐A/D are present in the mouse kidney and that their expression appears to be increased with acid‐loading. We conclude that these splice variants may have important roles in proximal tubule filtered bicarbonate reabsorption, ammonia metabolism and organic anion metabolism. Support or Funding Information The studies were supported by funds from the NIH (R01–DK045788 to IDW, R01‐DK107798 to IDW and JWV, and R01‐EY017732 to MFR) and the Department of Veterans Affairs (1I01BX000818 to IDW).

The proximal tubule electrogenic, sodium‐coupled bicarbonate transporter, NBCe1, has a critical role in two proximal tubule acid‐base functions, bicarbonate reabsorption and ammonia metabolism. A third component of acid‐base homeostasis involves organic anion metabolism. The purpose of the current study was to determine NBCe1's role in organic anion metabolism by comparing mice with NBCe1 deletion to wild‐type (WT) littermates. Because NBCe1 KO causes early post‐natal mortality, we studied mice at day 8±1. Also, because NBCe1 deletion causes metabolic acidosis, we compared effects of NBCe1 deletion to that of experimental metabolic acidosis in adult WT mice. Both NBCe1 knockout (KO) and acidosis decreased citrate excretion, but their effect on proximal tubule citrate transporters differed. NaDC‐1 is the primary apical citrate transporter, and NBCe1 KO decreased NaDC‐1 mRNA expression and it decreased proximal tubule apical immunolabel. In contrast, acidosis in WT mice increased NaDC‐1 mRNA increased and proximal tubule apical immunolabel. The basolateral citrate transporter is NaDC‐3. NBCe1 deletion decreased NaDC‐3 expression whereas metabolic acidosis increased expression. A second key urinary organic anion is 2‐oxoglutarate. NBCe1 KO increased 2‐oxoglutarate excretion ~15‐fold, whereas metabolic acidosis decreased excretion by ~85%. NBCe1 deletion did not alter expression of the enzyme involved in 2‐oxoglutarate generation (Glud1), whereas metabolic acidosis increased it. There were no substantial changes in expression of the 2‐oxoglutarate dehydrogenase complex components, Ogdh, Dlst or Dld, with either NBCe1 KO or acidosis. Expression of the putative apical 2‐oxoglutarate transporter, OAT10, was decreased similarly by NBCe1 KO and by acidosis. Thus, effects of NBCe1 KO on 2‐oxoglutarate excretion did not correlate with changes in proteins involved in production, metabolism, basolateral transport (NaDC‐3) or its putative apical transporter (OAT10). 2‐oxoglutarate is proposed to stimulate urine alkalinization by activating the Oxgr1 receptor in pendrin‐positive intercalated cells. However, NBCe1 KO causes a urine pH of ~4.2 despite increased 2‐oxoglutarate excretion. Pendrin, the primary mechanism of collecting duct bicarbonate secretion, exhibited significantly decreased expression with NBCe1 KO. Expression of the 2‐oxoglutarate receptor, Oxgr1, was unaffected by NBCe1 KO, whereas it was decreased by metabolic acidosis. In summary: 1) NBCe1 is necessary for normal expression of the proximal tubule citrate transporters, NaDC‐1 and NaDC‐3; 2) NBCe1 is necessary for normal 2‐oxoglutarate metabolism through mechanisms independent of expression of known transport and metabolic pathways; and, 3) the lack of 2‐oxoglutarate urinary alkalinization in NBCe1 KO mice likely results from decreased expression of its target transporter, pendrin. Thus, NBCe1 expression is necessary for normal renal metabolism of the key organic acids, citrate and 2‐oxoglutarate. We conclude that NBCe1 expression is necessary for normal regulation of each of the three major components of proximal tubule acid‐base homeostasis, filtered bicarbonate reabsorption, ammonia metabolism and organic anion transport. Support or Funding Information Funds from the NIH (R01–DK045788 to IDW, R01‐EY017732 to MFR and R01‐DK095879 to KHS) and from the Department of Veterans Affairs (1I01BX000818 to IDW) supported these studies.