BACKGROUND: The CD40-CD40L costimulatory pathway regulates adaptive and innate immune responses and has been implicated in the pathogenesis of multiple sclerosis. Frexalimab is a second-generation anti-CD40L monoclonal antibody being evaluated for the treatment of multiple sclerosis. METHODS: In this phase 2, double-blind, randomized trial, we assigned, in a 4:4:1:1 ratio, participants with relapsing multiple sclerosis to receive 1200 mg of frexalimab administered intravenously every 4 weeks (with an 1800-mg loading dose), 300 mg of frexalimab administered subcutaneously every 2 weeks (with a 600-mg loading dose), or the matching placebos for each active treatment. The primary end point was the number of new gadolinium-enhancing T1-weighted lesions seen on magnetic resonance imaging at week 12 relative to week 8. Secondary end points included the number of new or enlarging T2-weighted lesions at week 12 relative to week 8, the total number of gadolinium-enhancing T1-weighted lesions at week 12, and safety. After 12 weeks, all the participants could receive open-label frexalimab. RESULTS: Of 166 participants screened, 129 were assigned to a trial group; 125 participants (97%) completed the 12-week double-blind period. The mean age of the participants was 36.6 years, 66% were women, and 30% had gadolinium-enhancing lesions at baseline. At week 12, the adjusted mean number of new gadolinium-enhancing T1-weighted lesions was 0.2 (95% confidence interval [CI], 0.1 to 0.4) in the group that received 1200 mg of frexalimab intravenously and 0.3 (95% CI, 0.1 to 0.6) in the group that received 300 mg of frexalimab subcutaneously, as compared with 1.4 (95% CI, 0.6 to 3.0) in the pooled placebo group. The rate ratios as compared with placebo were 0.11 (95% CI, 0.03 to 0.38) in the 1200-mg group and 0.21 (95% CI, 0.08 to 0.56) in the 300-mg group. Results for the secondary imaging end points were generally in the same direction as those for the primary analysis. The most common adverse events were coronavirus disease 2019 and headaches. CONCLUSIONS: In a phase 2 trial involving participants with multiple sclerosis, inhibition of CD40L with frexalimab had an effect that generally favored a greater reduction in the number of new gadolinium-enhancing T1-weighted lesions at week 12 as compared with placebo. Larger and longer trials are needed to determine the long-term efficacy and safety of frexalimab in persons with multiple sclerosis. (Funded by Sanofi; ClinicalTrials.gov number, NCT04879628.).
- MeSH
- antigeny CD40 * antagonisté a inhibitory imunologie MeSH
- dospělí MeSH
- dvojitá slepá metoda MeSH
- gadolinium MeSH
- injekce subkutánní MeSH
- intravenózní podání MeSH
- lidé MeSH
- ligand CD40 * antagonisté a inhibitory imunologie MeSH
- magnetická rezonanční tomografie MeSH
- monoklonální protilátky * imunologie terapeutické užití MeSH
- relabující-remitující roztroušená skleróza * diagnostické zobrazování farmakoterapie imunologie MeSH
- roztroušená skleróza diagnostické zobrazování farmakoterapie imunologie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- klinické zkoušky, fáze II MeSH
- randomizované kontrolované studie MeSH
- srovnávací studie MeSH
The foundation of precision immunotherapy in oncology is rooted in computational biology and patient-derived sample sequencing to enrich for and target immunogenic epitopes. Discovery of these tumor-specific epitopes through tumor sequencing has revolutionized patient outcomes in many types of cancers that were previously untreatable. However, these therapeutic successes are far from universal, especially with cancers that carry high intratumoral heterogeneity such as glioblastoma (GBM). Herein, we present the technical aspects of Mannan-BAM, TLR Ligands, Anti-CD40 Antibody (MBTA) vaccine immunotherapy, an investigational therapeutic that potentially circumvents the need for in silico tumor-neoantigen enrichment. We then review the most promising GBM vaccination strategies to contextualize the MBTA vaccine. By reviewing current evidence using translational tumor models supporting MBTA vaccination, we evaluate the underlying principles that validate its clinical applicability. Finally, we showcase the translational potential of MBTA vaccination as a potential immunotherapy in GBM, along with established surgical and immunologic cancer treatment paradigms.
- MeSH
- antigen prezentující buňky chemie MeSH
- antigeny CD40 imunologie MeSH
- epitopy chemie MeSH
- glioblastom imunologie terapie MeSH
- imunofenotypizace MeSH
- imunoterapie metody MeSH
- lékařská onkologie trendy MeSH
- lidé MeSH
- ligandy MeSH
- metastázy nádorů MeSH
- myši MeSH
- nádory mozku imunologie terapie MeSH
- peptidy chemie MeSH
- protinádorové vakcíny MeSH
- výpočetní biologie MeSH
- výsledek terapie MeSH
- zvířata MeSH
- Check Tag
- lidé MeSH
- myši MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
Cilostazol is a phosphodiesterase-3 inhibitor that functions as a platelet aggregation inhibitor and is used for treating peripheral artery diseases and ischemic stroke. Dendritic cells (DCs) play an active role in the immunological processes related to atherosclerosis. Cilostazol has anti-atherogenic and anti-inflammatory effects, but the effects of cilostazol on DC maturation remain unknown. The purpose of this study was to determine the effects of cilostazol on lipopolysaccharide (LPS)-induced maturation of DCs. DC2.4 cells were treated with cilostazol for 12 h and subsequently stimulated with LPS to induce maturation. Cilostazol reduced the expression of maturation-associated markers induced by LPS, such as CD40, CD86, and MHCII, improved the endocytotic function, and decreased production of the tumour necrosis factor alpha (TNF-α) and interleukin-6 (IL-6) of these cells. To further elucidate the mechanisms responsible for the inhibition of DC2.4 maturation by cilostazol, we investigated the effect of cilostazol on LPS-stimulated nuclear factor-kappa B (NF-κB) activation. Our results indicated that cilostazol treatment decreased IκBα degradation and inhibited NF-κB p65 translocation, and the inhibitory effects of cilostazol were cAMP-independent. Therefore, inhibition of NF-κB by cilostazol might result in the suppression of DC maturation. In conclusion, cilostazol suppressed LPS-stimulated DC maturation, which might contribute to its anti-atherosclerosis effect.
- MeSH
- antigeny CD40 imunologie MeSH
- antigeny CD86 imunologie MeSH
- ateroskleróza imunologie patofyziologie MeSH
- buněčná imunita imunologie účinky léků MeSH
- dendritické buňky * chemie imunologie účinky léků MeSH
- fibrinolytika MeSH
- histokompatibilita - antigeny třídy II imunologie MeSH
- inhibitory agregace trombocytů MeSH
- inhibitory fosfodiesterasy 3 MeSH
- interleukin-6 imunologie MeSH
- lipopolysacharidy terapeutické užití MeSH
- NF-kappa B * genetika imunologie účinky léků MeSH
- polymerázová řetězová reakce MeSH
- průtoková cytometrie MeSH
- techniky in vitro MeSH
- tetrazoly * farmakologie imunologie MeSH
- TNF-alfa imunologie MeSH
- vazodilatancia MeSH
- western blotting MeSH
- Publikační typ
- práce podpořená grantem MeSH
Similarly to other blood-feeding arthropods, ticks have evolved immunosuppressive mechanisms enabling them to overcome the host immune system. Although the immunomodulatory effect of tick saliva on several cell populations of the immune system has been extensively studied, little is known about its impact on dendritic cells (DCs). We have examined the effect of Ixodes ricinus tick saliva on DC function in vitro and in vivo. Exposure of DCs to tick saliva in vitro resulted in impaired maturation, upon CD40 or TLR9, TLR3 and TLR7 ligation, as well as reduced Ag presentation capacity. Administration of tick saliva in vivo significantly inhibited maturation and early migration of DCs from inflamed skin to draining lymph nodes, and decreased the capacity of lymph node DCs to present soluble Ag to specific T cells. Moreover, saliva-exposed DCs failed to induce efficient Th1 and Th17 polarization and promoted development of Th2 responses. Our data reveal a complex inhibitory effect exerted by tick saliva on DC function. Given the role of DCs as the key instigators of adaptive immune responses, alteration of their function might represent a major mechanism of tick-mediated immune evasion.
- MeSH
- antigeny CD40 imunologie MeSH
- dendritické buňky imunologie MeSH
- financování organizované MeSH
- imunologická tolerance imunologie MeSH
- klíště imunologie MeSH
- lymfatické uzliny imunologie MeSH
- myši MeSH
- pohyb buněk imunologie MeSH
- prezentace antigenu imunologie MeSH
- sliny imunologie MeSH
- Th1 buňky imunologie MeSH
- Th2 buňky imunologie MeSH
- toll-like receptory imunologie MeSH
- zvířata MeSH
- Check Tag
- myši MeSH
- zvířata MeSH