Using the proprietary Big Data PharmGPS® Discovery platform, BioXcel has created a comprehensive relationship map between immune-evasion and immune-activation pathways, comprising interacting genes and all overlapping pharmacological agents and tumors. This map was used to identify clinically validated compounds that would act synergistically in combination with immune-checkpoint inhibitors (ICI) by remodelling the tumor micro-enviroment and transforming cold, non-inflamed tumors into hot immune-sensitive tumors. One of the several compounds thus identified is BXCL701, previously known as Talabostat/PT-100, a DPP inhibitor that by inducing a wide panel of cytokines and chemokines stimulates both the innate and acquired immune system. BXCL701 has a dual immuno-oncology related MOA. Via the Fibroblast Activator Protein (FAP) target, it inhibits the activation of immuno-suppressive fibroblasts and through an angiogenic related effect, it increases immune cell extravasation into the tumor tissue. Via the DPP8/9 targets, it depresses the immuno-suppressive activity of MDSCs by inducing a granulocytic differentiation while it stimulates the priming, migration and cytotoxicity of T-cells and NK cells and the formation of memory T-cells. The hypothesis that BXCL701 immune-mediated MOA would complement the action of ICIs was validated in-vivo in the syngeneic MC38 mouse model of colon adenocarcinoma. Co-administration of BXCL701 combined with anti-PD1 showed a synergistic inhibition of tumor growth as well as synergistic up-regulation of immuno-stimulatory cytokines, IL-2, IL12 and GM-CSF. The effects of the combination on the immune-phenotyping of the circulating and tumor infiltrated immune cells will also be presented. The findings support BXCL701 ability to transform the immune-suppressive tumour microenvironment to an immuno-permissive milieu sensitive to immune-checkpoint inhibitors. Further supporting the therapeutic potential of BXCL701, an analysis of genomic alterations in FAP, DPP8 and DPP9 across a wide range of tumors singled out castration-resistant prostate cancer with a high level of DPP9 amplification (14%) and overexpression of DPP8 in 50% of the patients which could make this patient population uniquely sensitive to the combination as shown by in-vitro and in-vivo experiments. This study provides further evidence of the capability of Big data analytics to generate in-silico hypothesis of synergistic combination effects that can be converted in validated therapeutic opportunities to benefit patients non- responsive to ICI therapy. Citation Format: Luca Rastelli, Snigdha Gupta, Akhil Dahiya, Zeenia Jagga, Krishnan Nandabalan, Sanatan Upmanyu. The synergy between BXCL701, a DPP inhibitor, and immune checkpoint inhibitors discovered using AI and Big Data analytics [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 2629. doi:10.1158/1538-7445.AM2017-2629
e14253 Background: The oral DPP8/9 and FAP inhibitor BXCL701 in combination with a checkpoint inhibitor anti-PD-1 antibody (aPD-1) has demonstrated inhibition of tumor growth as well as up-regulation of immuno-stimulatory cytokines and tumor-infiltrating immune cells in animal models [ASCO 2018]. In the present study, BXCL701 was evaluated for its potential to improve synergistically the survival of animals when combined with anti-CTLA-4 antibody (aCTLA-4), an immune checkpoint blocker, and galunisertib, a transforming growth factor (TGF) β type I receptor inhibitor that counteracts the immunosuppressive influence that TGF β signalling has in the tumor microenvironment. Methods: In vivo studies were conducted utilizing the syngeneic colon cancer model (MC38) in C57BL/6 mice. BXCL701 was administered at the dose of 20 µg qd, p.o, while aPD-1 and aCTLA-4 were administered at the dose of 5 and 10 mpk q2w, i.p. respectively. Finally, galunisertib was administered at 75 mpk bid. Dosing was carried out for 4 weeks and median survival of the animals was calculated. Results: BXCL701 demonstrated a significant improvement in the survival of animals when combined with aCTLA-4. The median survival of animals treated with combination of BXCL701 and aCTLA-4 was significantly increased to 51.5 days in comparison to 40 days observed in BXCL701-treated animals (p < 0.001). Furthermore, in a separate study, addition of BXCL701 to the double combination of aPD-1 and aCTLA-4 resulted in a median survival of 51 days in comparison to 37 days for aPD-1 and aCTLA-4-treated animals (p < 0.05). Similarly, addition of BXCL701 to the combination treatment of aPD-1 and galunisertib increased the median survival to 40.5 days in comparison to 28 days observed in animals treated with galunisertib and aPD-1 combination (p < 0.05). Conclusions: BXCL701, an innate immune activator, synergistically combines with aCTLA-4 and a combination of aPD-1 with galunisertib to improve survival response likely by turning cold tumors to hot tumors. The present study advocates for a clinical evaluation of BXCL701 in combination with these immunomodulators in solid tumors.
The oral DPP8/9 inhibitor BXCL701 in combination with an anti-PD-1 antibody (aPD-1) [AACR 2017] or in triple combination with aPD-1 and pegylated IL-2 (NKTR-214) [ASCO 2018] has demonstrated inhibition of tumor growth or complete regression respectively in animal models of pancreatic cancer. In the present study, the mechanism of action of BXCL701 has been elucidated in a sub-chronic pharmacokinetic / pharmacodynamic study at molecular and cellular level, by administering BXCL701 as a single agent. BXCL701 (20 μg) was administered orally every day for 14 days in tumor (Pan02) bearing mice. Tumor and serum samples were harvested after 0, 1, 8 and 16 hrs after BXCL701 administration on day 1, 7 and 14. Serum samples were analysed for cytokines and tumor tissues were analysed for infiltrating immune cells and gene expression. BXCL701 is known to inhibit regulatory proteases DPP8/9, consequently activating Nlrp1b inflammasome, which in turn activates pro-caspase-1 to mediate pyroptosis in mouse macrophages [Okondo et al, 2018]. Caspase-1 is involved in cleavage of pro-IL-1β and pro-IL-18 to their active forms, IL-1β and IL-18 respectively [Walle et al, 2016,]. IL-18 was observed to be significantly (p<0.05) upregulated (>50 fold) at 8 hrs on day 1 and achieved steady state levels by day 7 in BXCL701-treated animals. Other cytokines like IL-1β, IFN-γ, G-CSF, IL-5, IL-6, CXCL9, MCP-1, KC and Eotaxin were also observed to be upregulated in BXCL701-treated animals at the 8 hr timepoint on day 1, 7 and 14 in comparison to day 1, 0 hr. BXCL701 significantly upregulates T cells (total T cells, CD4+ T helper cells and CD8+ T cells) infiltration along with NK cells within the tumor microenvironment. It also appears to enhance antigen presentation by upregulating MHC class I genes and MHC class I expressing cells within the tumor. The mechanism of action of BXCL701 was evaluated at the molecular level as well. The comparison of genes in tumor tissues from BXCL701-treated animals vs respective vehicle-treated animals on Day 7 and 14 demonstrated that the upregulated gene clusters were innate and adaptive immune response genes, T-cell receptor genes and MHC genes. Also, genes associated with T cell and NK cell mediated apoptosis and cytolysis e.g. FasL, GzmA, were upregulated and indicates enhanced cell death (e.g. upregulation of pdcd1) within tumor. On the other hand, downregulated gene clusters belonged to functional categories like cell cycle, DNA repair, several genes associated with cancer progression (GPCRs and Olfactory receptors) and extra cellular matrix (ECM) modification (collagen and metalloproteases). In conclusion, BXCL701-treatment induces innate and adaptive immune responses that leads to tumor growth inhibition probably via inducing cell death and reducing ECM modification. Citation Format: Veena Agarwal, John MacDougall, shubhendu Trivedi, Dimple Bhatia, Zeenia Jagga, Hemant Banga, Diane Healy, Sreenivas Adurthi, Vince O'Neill. The dipeptidyl peptidase inhibitor BXCL701 activates innate immunity followed by adaptive immunity on a molecular and cellular level in a mouse model of pancreatic cancer [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 962.
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