Cancer

Coding Dimension ID: 
280
Coding Dimension path name: 
Cancer

Mechanisms to maintain the self-renewal and genetic stability of human embryonic stem cells

Funding Type: 
Comprehensive Grant
Grant Number: 
RC1-00148
ICOC Funds Committed: 
$2 570 000
Disease Focus: 
Cancer
Genetic Disorder
Stem Cell Use: 
Embryonic Stem Cell
Cell Line Generation: 
Embryonic Stem Cell
oldStatus: 
Closed
Public Abstract: 
Human embryonic stem cells (hESCs) are capable of unlimited self-renewal, a process to reproduce self, and retain the ability to differentiate into all cell types in the body. Therefore, hESCs hold great promise for human cell and tissue replacement therapy. Because DNA damage occurs during normal cellular proliferation and can cause DNA mutations leading to genetic instability, it is critical to elucidate the mechanisms that maintain genetic stability during self-renewal. This is the overall goal of this proposal. Based on our recent findings, I propose to investigate two major mechanisms that might be important to maintain genetic stability in hESCs. First, I propose to elucidate pathways that promote efficient DNA repair in hESCs. Second, based on our recent findings, I hypothesize that another primary mechanism to maintain genetic stability in self-renewing hESCs is to eliminate DNA-damaged hESCs by inducing their differentiation. Therefore, I propose to identify the pathways that regulate the self-renewing capability of hESCs in the presence and absence of DNA damage. In summary, the proposed research will contribute significantly to our understanding of the pathways important to maintain self-renewal and genetic stability in hESCs. This information will provide the foundation to improve the culturing condition of hESCs to promote efficient self-renewal with minimum genetic instability, a prerequisite for the development of hESCs into human therapeutics. One major objective of the proposed research is to improve the genetic manipulation technologies in hESCs, including transgenic and gene targeting technologies. While mouse models are valuable tools to study the mechanisms of the pathogenesis in human diseases, many differences between mouse and human cells can lead to distinct phenotypes as well as the common phenomenon that certain therapeutic interventions work well in mouse models but poorly in humans. Therefore, it is of high priority to create disease-specific hESCs as powerful genetic tools to study the mechanism of the pathogenesis in human diseases. In addition, the unlimited supply of primary cells derived from the disease-specific hESCs will become valuable reagents for drug discovery. There are two ways to generate the disease-specific hESCs. One approach is through nuclear transfer that has been proven extremely difficult in human context and so far unsuccessful. The other is to employ the transgenic and gene targeting techniques to create disease-specific hESCs. Therefore, the proposed research will significantly improve our capability to generate disease-specific hESCs. After experimenting with various existing hESC lines, we found that only the non-federally-approved hESC lines developed recently at Harvard University is most suitable for genetic manipulation technologies. Since the research involving the HUES lines can not be supported by federal government, CIRM is in a unique position to support this proposed research.
Statement of Benefit to California: 
Human embryonic stem cells (hESCs) are capable of unlimited self-renewal, a process to reproduce self, and retain the ability to differentiate into all cell types in the body. Therefore, hESCs hold great promise for human cell and tissue replacement therapy. The major goal of the human stem cell research supported by proposition 71 is to improve and even realize the therapeutic potential of hESCs. DNA damage occurs during normal cellular proliferation of hESCs and can cause genetic mutations that will be passaged to derivatives. Any cells with genetic mutations are not suitable for therapeutic purpose since they can cause cancers in the recipient. Therefore, to achieve the therapeutic potential of hESCs, it is critical to elucidate the mechanisms that prevent genetic mutations during the self-renewal of hESCs. This is the overall goal of this proposal. Successful completion of the proposed research will help to optimize the culturing conditions that promotes efficient self-renewal with minimum genetic instability. One high-priority area of hESC research is to create disease-specific hESCs, which can be used as powerful genetic tools to study the mechanism of the pathogenesis in human diseases. In addition, the unlimited supply of primary cells derived from the disease-specific hESCs will become valuable reagents for drug discovery. There are two ways to generate the disease-specific hESCs. One approach is through nuclear transfer that has been proven extremely difficult in human context and so far unsuccessful. The other is to develop the transgenic and gene targeting techniques to create disease-specific hESCs. One major objective of my proposed research is to improve the genetic manipulation technologies in hESCs, including transgenic and gene targeting technologies. The successful completion of the proposed research will significantly improve our capability to generate disease-specific hESCs. In addition, the disease-specific hESCs (ATM-/- and p53-/- hESCs) generated in the course of the proposed studies are valuable tools to study the basis of neuronal degeneration in Ataxia-telangiectsia and development of human epithelial tumors as a result of p53-deficiency. Both of these phenotypes are not observed in mouse models. In summary, the proposed research will benefit California citizens by contributing to the eventual realization of the therapeutic potential of hESCs.
Progress Report: 
  • The goal of this proposal is to investigate the mechanisms that maintain the genomic stability of human ES cells (hESCs). We are focusing on the tumor suppression pathways ATM and p53, which are well established guardians of the genome in differentiated cells. In addition, we are investigating the pathways that govern the self-renewal of hESCs, which might be coordinated with DNA damage responses to maintain the genomic stability in hESCs. During the reporting period, we made significant progress towards our goals. First, we developed high efficiency homologous recombination technology to successfully disrupted ATM and p53 in hESCs. Analysis of the mutant ES cells indicate the roles of ATM and p53 in maintaining genomic stability in hESCs. Second, we identified pathways that are important for the self-renewal of hESCs. Third, we employed the knock-in tech
  • The goal of this proposal is to investigate the mechanisms that maintain the genomic stability of human ES cells (hESCs). We are focusing on the tumor suppression pathways ATM and p53, which are well established guardians of the genome in differentiated cells. In addition, we are investigating the pathways that govern the self-renewal of hESCs, which might be coordinated with DNA damage responses to maintain the genomic stability in hESCs. During the reporting period, we made significant progress towards our goals. First, we developed a bacterial artificial chromosome based gene targeting technology that allows high efficiency homologous recombination in hESCs, and published the first homozygous knockout mutant hESCs in the world (Aims 1 and 3). This achievement, which was described in a publication in the top stem cell journal Cell Stem Cell, has attracted worldwide attention and will help to open up the entire field of hESCs (Song et al., 2010, Cell Stem Cell 6, 180-189). We employed the same technology to generate homozygous phosphorylation site knock-in mutant hESCs to study the mechanism underlying ATM activation in hESCs (Aim 3). Second, we identified a novel Pin1-Nanog pathway that is critical for the self-renewal of hESCs (Aim 2). Using small molecule compounds that inhibit this pathway, we were able to suppress the potential of ES cells to form teratomas. This finding, which is published in the Proceeding National Academy of Science, provides a druggable target to address the teratomas risk associated with the human ES cell based therapy (Moretto-Zita et al., 2010, PNAS, Epub 7/9). Third, to identify ES cell-specific DNA repair pathways, we have identified several ES cell-specific interaction between proteins and DNA breaks (Aim 3).
  • We have made several significant progresses during the past year. We found the important roles of p53 in the differentiation of hESCs. We also identified that Nanog is a major coordinator of the self-renewal and proliferation of ES cells. We found that ATM is important to maintain the genetic stability of cells differentiated from hESCs. In addition, we identified an important phosphorylation event in activating ATM in hESCs. Finally, we identified a novel pathway to activate DNA damage in ES cells.

Functions of RB family proteins in human embryonic stem cells

Funding Type: 
SEED Grant
Grant Number: 
RS1-00298
ICOC Funds Committed: 
$520 777
Disease Focus: 
Cancer
Stem Cell Use: 
Embryonic Stem Cell
oldStatus: 
Closed
Public Abstract: 
Nearly one out of every two Californians born today will develop cancer at some point in their lives, and it is likely that one in five persons will die of the disease. We propose to study the mechanisms of action of the RB gene, which is mutated in a broad range of human cancers, including pediatric cancers of the eye and the bone, and adult tumors such as lung, breast, prostate and liver cancers. RB normally acts as a tumor suppressor. When RB is mutated, cells lose the ability to sense when to cycle or not and they divide too much, thereby initiating cancer. Because RB is mutated in so many human cancers, therapies that could re-introduce RB function in cancer cells would benefit a great number of cancer patients. A key question is to determine in which cell type loss of RB function is most detrimental. Knowing the answer to this question would help to diagnose cancer early and target specific cells within tumors, making treatment more effective. Recent evidence suggests that loss of RB may initiate cancer in stem cells . Because human embryonic stem cells (hESCs) give rise to any other stem cells, we will study the role of RB in hESCs. The results of these experiments will thus be applicable to a broad range of human cancers. Specifically, we will use novel tools that will allow us to precisely alter RB levels in hESCs. We will then study the consequences of these manipulations for the proliferation of these cells; lower levels of RB may promote proliferation, while higher levels of RB may slow proliferation and push these embryonic stem cells to become more mature. We will then investigate the molecular mechanisms underlying these observations, beginning with the cellular pathway leading to retinal development because of RB’s involvement in retinal cancer. Because RB is usually deleted in cancer cells, there is no simple way to re-express RB function in these cells. However, two genes related to RB, p107 and p130, are rarely deleted in cancers and can compensate for loss of RB in mouse cells. Therefore, we will also study the role of p107 and p130 in hESCs, to determine if the functions of these two genes also overlap with RB function in these human cells and their progeny. If this is the case, knowing how to control the expression of p107 and p130 in hESCs may result in the development of a novel therapeutic strategy against human cancers associated with loss of RB. A better knowledge of the cells from which cancer arises and of the molecular mechanisms by which cancer initiates will lead in the future to the development of novel means to diagnose cancer earlier, thereby increasing the chances of a successful therapy. In addition, because of the central role of RB family members in multiple cellular functions, these experiments in hESCs may provide novel insight into the basic biology of these stem cells, which will eventually allow us to manipulate these cells more efficiently to treat a broad range of human diseases.
Statement of Benefit to California: 
Despite significant decreases in the incidence and mortality rates of cancers in California over the past decade, nearly one out of every two Californians born today will still develop cancer at some point in their lives, and it is likely that one in five persons will die of the disease. Overall, in 2007, more than 50,000 people will die of cancer in California. These statistics underscore the need for the development of novel approaches to detect and treat human cancers. Stem cells hold the promise of treatments and cures for human diseases that affect millions of people. In particular, recent models suggest that cancer may arise from mutant stem cells whose progeny form the bulk of the tumor. Thus, in the future, one anti-cancer strategy may be to replace mutant stem cells in patients with normal stem cells. Another approach may be to repair the defects in these mutant stem cells. However, these approaches will only be possible when the mechanisms controlling the proliferation of these stem cells and their capacity to produce their functional progeny are better understood under normal and pathological conditions. We propose to study the mode of action of a key cancer gene, the RB gene, in human embryonic stem cells (hESCs). RB is inactivated in a broad range of human tumors, including adult lung, brain, breast, and prostate cancers, as well as pediatric eye and bone tumors. Thus, RB is a major target for the development of therapeutic strategies that may benefit a wide range of cancer patients. However, the mechanisms by which RB mutation triggers cancer are still poorly understood, hampering the development of such anti-cancer strategies. We believe that by studying RB function in hESCs, we will gain novel insights into both the mechanisms of action of RB and the biology of these stem cells. Exploring the effects of altering RB levels in hESCs will increase our knowledge of RB's mode of action and will eventually provide new ways to treat human cancers. In addition, these experiments may identify novel means of manipulating hESCs to control the fate of these cells when transplanted into patients. Because hESCs have the capacity to form any type of cell in the human body, these experiments will be relevant to the numerous cancer types associated with loss of RB function and may be ultimately translated into novel anti-cancer strategies. In addition, the results of these experiments may lead to novel avenues of research and may lay the groundwork for the development of therapies against diseases occurring in organs in which RB plays a central role, such as the eyes and the bones. Thus, the proposed research may benefit a broad range of patients, from young children to senior citizens, in California and elsewhere.
Progress Report: 
  • Human embryonic stem cells (hESCs) hold promise for treating a broad range of human diseases. However, at the time when we submitted this proposal, there was a striking paucity of published studies on how the fate of hESCs is controlled. For instance, we know that hESCs can form tumors upon transplantation, but the mechanisms governing cell division in these cells were still largely unknown. Given the central role of the retinoblastoma (RB) family of genes at the interface between proliferation and differentiation, our goal was to study the function of RB and its family members p107 and p130 in human embryonic stem cells (hESCs). In the last two years, we have examined the consequences of altering the function of RB, p107, and p130 for the proliferation, self-renewal, and differentiation potential of hESCs.
  • We have found that overexpression of RB results in cell cycle arrest in hESC populations, indicating that the RB pathway can be functionally activated in these cells. We have also found that loss of RB function does not result in significant changes in the biology of hESCs. In contrast, inactivation of several RB family members at the same time leads to self-renewal, proliferation, and differentiation defects.
  • Together, these studies indicate that the level of activity of the RB family is critical in hESCs: too much or too little RB family function results in loss of proliferative potential.
  • Our future goal is to precisely manipulate the levels of RB family genes to determine if we can identify conditions to manipulate the fate of hESCs, reducing their ability to proliferate (suppressing cancer) while allowing them to differentiate into specific lineages.

hESC as tools to investigate the neural crest origin of Ewing's sarcoma

Funding Type: 
SEED Grant
Grant Number: 
RS1-00249
ICOC Funds Committed: 
$675 001
Disease Focus: 
Solid Tumor
Cancer
Pediatrics
Stem Cell Use: 
Embryonic Stem Cell
oldStatus: 
Closed
Public Abstract: 
Human embryonic stem cells (hESC) hold great promise as sources of tissue for regenerative medicine and therapeutics. In addition, their utility as tools to study the origins and biology of human disease must not be underestimated. hESC give rise to tissue-specific adult stem cells and, ultimately, to all mature tissues in the body. As such, disruptions to normal stem cell function can have catastrophic consequences and result in life-threatening or debilitating disease. Understanding how such diseases arise will afford novel insights into how we can better prevent and treat them. Laboratory based studies with hESC therefore stand to make extraordinary contributions to human health. Human tumors, and in particular the cancers that affect children, often look like tissues that have not developed normally and whose growth has gone unchecked. In fact, recent studies have shown that, in many cases, tumors arise because genetic mutations in the DNA of normal stem cells lead to disordered development, resulting in formation of malignant rather than normal tissues. For example, leukemia can arise when a mutation occurs in a normal blood stem cell, thus inducing formation of cancerous rather than normal blood. Analogous situations exist in other human tissues and their respective tumors. However, because of the relative rarity of normal stem cells in other parts of the body and our inability to effectively isolate them, very little is yet known about how these stem cells go awry and create cancer. hESC, therefore, represent an invaluable resource for the generation of tissue-specific stem cells and for studies of the genesis of human, and in particular, pediatric cancer. Several different human cancers are believed to arise either directly or indirectly from stem cells called neural crest stem cells (NCSC). NCSC exist in small numbers throughout the body and contribute to the formation of multiple different tissues including the peripheral nervous system and the pigment cells of our skin. It is our central hypothesis that NCSC-derived tumors arise because genetic mutations in NCSC lead to disordered tissue development and the initiation of cancer. Ewing’s sarcoma family tumors (ESFT) are highly aggressive tumors that primarily affect children and young adults. ESFT have a specific mutation in their DNA and this mutation leads to the creation of a cancer-causing gene. We believe that expression of this abnormal gene in NCSC disrupts normal stem cell differentiation and development and, ultimately, leads to ESFT formation. In this proposal we will use hESC as tools to prove or disprove this theory. Unfortunately, despite highly toxic and aggressive treatment, the survival rate for patients diagnosed with ESFT remains poor. By creating novel hESC-based models to study the origin and biology of ESFT we aim to gain novel insights into the origin and biology of these tumors that will aid in the development of more effective, less toxic therapies.
Statement of Benefit to California: 
Human embryonic stem cells (hESC) represent a tremendous resource as tools to study numerous human diseases, including cancer. Cancer claims the lives of over 50,000 Californians, including over 300 children, annually. Laboratory based studies using hESC, such as those proposed in this application, stand to make extraordinary and unique contributions to our understanding of the origin and biology of human cancer. These contributions will ultimately aid in the development of novel therapeutic strategies designed to improve survival and quality of life of cancer patients. In this proposal we will exploit the power of hESC to study the cellular origins of sarcomas. Sarcomas arise in the bones and soft tissues and primarily affect children and young adults. Despite intensive therapy, the survival rate of patients diagnosed with sarcoma remains poor. The proposed research will provide much needed insight into sarcoma biology and will enable development of novel sarcoma-targeted therapies. In addition, the hESC-derived models that we establish will be readily adaptable to and available for studies of other human cancers.
Progress Report: 
  • Recent studies have shown that mutations in the DNA of adult stem cells can lead to the formation of cancerous rather than normal tissues. However, with the exception of blood, adult stem cells are rare and not readily accessible for isolation or study. Thus, very little is yet known about how these stem cells are hijacked to cause cancer.
  • Our laboratory is studying how mutations in stem cells give rise to Ewing sarcoma. Ewing sarcoma family tumors (ESFT) are highly aggressive tumors that primarily affect children and young adults. ESFT have a specific mutation in their DNA that leads to the creation of a cancer-causing gene called EWS-FLI1. It is our hypothesis that expression of EWS-FLI1 in adult stem cells generates ESFT. In particular, we are interested in a very rare population of adult stem cells called neural crest stem cells (NCSC) and these cells have been the focus of our CIRM-funded grant.
  • We initially proposed that human embryonic stem cells (hESC) could be used to generate NCSC and that these cells would be invaluable tools with which to study the origin of ESFT. In the first year of the grant we successfully achieved this goal and the work has been published. In the second year of the grant we have studied the consequences of activating the EWS-FLI1 on these cells. Importantly, our work shows that NCSC that express EWS-FLI1 do not differentiate normally. Instead they acquire properties of cancer stem cells. Thus, we propose that ESFT arise from NCSC that acquire a genetic mutation that prevents them from developing normally. These abnormal stem cells then go on to develop into full blown tumors.
  • By creating novel stem cell models to study the origin of ESFT we are gaining new insights into how these tumors arise in children. These insights will ultimately aid in the development of more effective therapies that can be designed to destroy abnormal cancer-causing stem cells whilst sparing normal stem cells.

Development of Therapeutic Antibodies Targeting Human Acute Myeloid Leukemia Stem Cells

Funding Type: 
Disease Team Research I
Grant Number: 
DR1-01485
ICOC Funds Committed: 
$19 999 996
Disease Focus: 
Blood Cancer
Cancer
Collaborative Funder: 
UK
Stem Cell Use: 
Cancer Stem Cell
Cell Line Generation: 
Cancer Stem Cell
oldStatus: 
Active
Public Abstract: 
Acute myeloid leukemia (AML) is a cancer of the blood and bone marrow that is rapidly fatal within months if untreated. Even with aggressive treatment, including chemotherapy and bone marrow transplantation, five-year overall survival rates range between 30-40%. Evidence indicates that not all cells in this cancer are the same, and that there is a rare population of leukemia stem cells (LSC) that are responsible for maintaining the disease. Thus, in order to cure this cancer, all LSC must be eliminated, while at the same time sparing the normal blood forming stem cells in the bone marrow. We propose to develop therapeutic antibodies directed against surface markers present in much larger amounts on LSC than on the surface of normal blood forming stem cells. We recently identified and validated several such protein markers including CD47, which we determined contributes to leukemia development by blocking the ingestion and removal of leukemia cells by immune system cells called macrophages. In this way, CD47 acts as a “don’t eat me” signal on LSC. Moreover, we determined that monoclonal antibodies (mAbs) directed against CD47, able to block its interaction with macrophages, mask the “don’t eat me” signal resulting in ingestion and elimination of leukemia in mouse pre-clinical models. We propose a combination of clinical studies, basic research, and pre-clinical development to prepare a therapeutic antibody directed against CD47 and/or other LSC-specific proteins for Initial New Drug (IND) filing with the FDA, and then a Phase I clinical trial to be conducted at {REDACTED} and in the Collaborative Funding Partner country. In collaboration with the pioneering Collaborative Funding Partner country AML Working Group, we will track expression of the LSC proteins in patient samples and correlate with clinical outcomes. This will allow us to identify particular LSC proteins that must be targeted to achieve cure, thereby prioritizing candidate therapeutic antibodies for clinical development. Concurrently, we will conduct basic research and pre-clinical development to prepare these candidates. Basic research during years 1 and 2 will focus on the characterization of anti-CD47 mAb efficacy, investigation of mAb targeting of additional LSC molecules, and determination of efficacy in combinations with anti-CD47. Pre-clinical development during years 1 and 2 will focus on blocking anti-CD47 mAbs, including antibody humanization and large animal model pharmacologic and toxicity studies. Similar studies will be conducted with the most promising antibodies resulting from our basic research. During years 3-4, we will proceed with GMP grade production of the best candidate, followed by efficacy testing in mouse models and large animal models. Finally, in year 4, we will prepare an IND filing with the FDA/MHRA and develop a Phase I clinical trial with this antibody for the treatment of AML. Ultimately, therapeutic antibodies specifically targeting AML LSC offer the possibility of less toxicity with the potential for cure.
Statement of Benefit to California: 
Acute myeloid leukemia (AML) is an aggressive malignancy of the bone marrow with nearly 13,000 new diagnoses annually in the US and 2,200 in the Collaborative Funding Partner country. Current standard of care for medically fit patients consists of several cycles of high dose chemotherapy, and often includes allogeneic hematopoietic cell transplantation. Even with these aggressive treatments, which cause significant morbidity and mortality, relapse is common and the five-year overall survival is 30-40%, but <10% in patients with relapsed or refractory disease or in the majority of AML patients who are over age 65. The goal of this research proposal is to prepare therapeutic antibodies directed against AML stem cell-specific antigens for IND filing with the FDA and a Phase I clinical trial. There are several potential benefits of this research for California: (1) most importantly, this research has the potential to revolutionize current clinical practice and provide a targeted therapy for AML that offers the possibility of less toxicity with the potential for cure; (2) this research will directly contribute to the California economy by funding a contract manufacturing organization to generate and produce GMP-grade clinical antibody, by employing several individuals who will be essential for the conduct of these studies, and through the purchase of equipment and reagents from California vendors; (3) additional clinical and economic benefits for California will derive from the potential application of clinical agents developed here to a number of other human cancers and cancer stem cells; (4) our animal models indicate that a significant fraction of patients with fatal AML can be cured, resulting in savings on their clinical care plus their return as productive contributors to the California economy; (5) if our therapeutic antibodies show clinical benefit in AML, they will be commercialized, and under CIRM policy, profits derived from treating insured patients and lower cost therapies for uninsured patients, would enrich the state and the lives of its citizens; (6) finally, this research has the potential to maintain California as the national and world-wide leader in stem cell technology.
Progress Report: 
  • Our program is focused on producing new therapeutic candidates to prolong remission and potentially cure highly lethal cancers where patients have few alternative treatment options. We have selected Acute Myelogenous Leukemia (AML) as the initial clinical indication for evaluating our novel therapeutics, but anticipate a full development program encompassing many other types of solid tumor cancers.
  • Our strategy is to develop an antibody that binds to and eliminates the cancer-forming stem cells in leukemia and other solid tumors. While current cancer treatments (e.g. surgery, chemotherapy, radiation) will frequently get rid of the bulk of the tumor, they rarely touch the tiny number of cancer stem cells that actually re-generate the masses of cancer cells that have been eliminated. When the latter occurs, the patient is described as having a relapse, leading to a disease recurrence with poor prognosis. Our strategy is to eliminate the small number of cancer-regenerating stem cells by targeting cell membrane proteins expressed by these cells.
  • We have discovered that many cancer cells coat themselves with a protein called CD47 that prevents them from being eaten and disposed of by the patient’s blood cells. In this context, CD47 can be considered a ‘don’t eat me’ signal that protects the cancer cells from being phagocytosed i.e. ‘eaten’. The antibody we are developing binds to and covers the ‘don’t eat me’ CD47 protein, so that the patient’s blood cells are now able to ‘eat’ the cancer cells by standard physiological responses, and eliminate them from the body.
  • Developing an antibody such as this for use in humans requires many steps to evaluate it is safe, while at the same ensuring it targets and eliminates the cancer forming stem cells. The antibody must also ‘look’ like a human antibody, or else the patient will ‘see’ it as a foreign protein and reject it. To achieve these criteria, we have made humanized antibodies that bind to human CD47. We have shown that the antibodies eliminate cancer cells in two ways: (i) blood cells from healthy humans rapidly “ate” and killed leukemia cells collected from separate cancer patients when the anti-human CD47 antibody was added to a mixture of both cell types in a research laboratory test tube; (ii) the anti-human CD47 antibody eliminates human leukemia cells collected from patients, then transferred into special immunodeficient mice which are unable to eliminate the human tumor cells themselves. In these experiments, the treated mice remained free of the human leukemia cells for many weeks post-treatment, and could be regarded as being cured of malignancy.
  • To show the antibodies were safe, we administered to regular mice large amounts of a comparable anti-mouse CD47 antibody on a daily basis for a period of many months. No adverse effects were noted. Unfortunately our antibody to human CD47 did not bind to mouse CD47, so it’s safety could not be evaluated directly in mice. Since the anti-human CD47 antibody does bind to non-human primate CD47, safety studies for our candidate therapeutic need to be conducted in non-human primates. These studies have been initiated and are in progress. Following administration of the anti-human CD47 antibodies, the non-human primates will be monitored for clinical blood pathology, which, as in humans, provides information about major organ function as well as blood cell function in these animals.
  • The next step after identifying an antibody with strong anti-cancer activity, but one that can be safely administered to non-human primates without causing any toxic effects, is to make large amounts of the antibody for use in humans. Any therapeutic candidate that will be administered to humans must be made according to highly regulated procedures that produce an agent that is extremely “clean”, meaning free of viruses, other infectious agents, bacterial products, and other contaminating proteins. This type of production work can only be performed in special facilities that have the equipment and experience for this type of clinical manufacturing. We have contracted such an organization to manufacture clinical grade anti-human CD47 antibodies. This organization has commenced the lengthy process of making anti-CD47 antibody that can be administered to humans with cancer. It will take another 18 months to complete the process of manufacturing clinical grade material in sufficient quantities to run a Phase I clinical trial in patients with Acute Myelogenous Leukemia.
  • Our program is focused on producing new therapeutic candidates to prolong remission and potentially cure highly lethal cancers where patients have few alternative treatment options. Our strategy is to develop an antibody that will eliminate the cancer stem cells which are the source of the disease, and responsible for the disease recurrence that can occur months-to-years following the remission achieved with initial clinical treatment. The cancer stem cells are a small proportion of the total cancer cell burden, and they appear to be resistant to the standard treatments of chemotherapy and radiation therapy. Therefore new therapeutic approaches are needed to eliminate them.
  • In year 2 of the CIRM award, we have continued to develop a clinical-grade antibody that will eliminate the cancer stem cells in Acute Myelogenous Leukemia (AML). We have identified several antibodies that cause human leukemia cells to be eaten and destroyed by healthy human white blood cells when tested in cell culture experiments. These antibodies bind to a protein called CD47 that is present on the outer surface of human leukemia cells. The anti-CD47 antibodies can eliminate leukemia growing in mice injected with AML cells obtained from patients. We have now extensively characterized the properties of our panel of anti-CD47 antibodies, and have identified the lead candidate to progress though the process of drug development. There are several steps in this process, which takes 18-24 months to fully execute. In the last 12 months, we have focused on the following steps:
  • (i) ‘Humanization’ of the antibody: The antibody needs to be optimized so that it looks like a normal human protein that the patient’s immune system will not eliminate because it appears ‘foreign’ to them.
  • (ii) Large scale production of the antibody: To make sufficient quantities of the antibody to complete the culture and animal model experiments required to progress to clinical safety trials with patients, we have contracted with a highly experienced manufacturing facility capable of such large-scale production. We have successfully transferred our antibody to them, and they have inserted it into a proprietary expression cell that will produce large amounts of the protein. This process is managed through weekly interactions with this contract lab. They send us small amounts of the material from each step of their manufacturing process and we test it in our models to ensure the antibody they are preparing retains its anti-cancer properties throughout production.
  • (iii) Pre-clinical safety studies: The antibody must be tested extensively in animals to ensure it does not cause serious limiting damage to any of the normal healthy tissues in the recipient. We have spent much of the last 12 months performing these types of safety experiments. The antibody has been administered to both mice and non-human primates and we have evaluated their overall health status, as well as analyzing their blood cells, blood enzyme levels, and urine, for up to 28 days. We have also collected samples of their organs and tissues to evaluate for abnormalities. Thus far, these assessments have appeared normal except for the development of a mild anemia a few days after the initial antibody injection. Subsequent experiments indicate that this anemia can be managed with existing approved clinical strategies
  • (iv) Determination of optimal dose: We have used mice injected with human cancer cells from AML patients, and determined how much antibody must be injected into these mice to produce a blood level that destroys the leukemia cells. This relationship between antibody dose and anti-cancer activity in the mouse cancer model enables us to estimate the dose to administer to patients.
  • Hematologic tumors and many solid tumors are propagated by a subset of cells called cancer stem cells. These cells appear to be resistant to the standard cancer treatments of chemotherapy and radiation therapy, and therefore new therapeutic approaches are needed to eliminate them. We have developed a monoclonal antibody (anti-CD47 antibody) that recognizes and causes elimination of these cancer stem cells and other cells in the cancer, but not normal blood-forming stem cells or blood cells. Cancer stem cells regularly produce a cell surface ‘invisibility cloak’ called CD47, a ‘don’t eat me signal’ for cells of the native immune system. Anti-CD47 antibody counters the ‘cloak, allowing the patient’s natural immune system eating cells, called macrophages, to eliminate the cancer stem cells.
  • As discussed in our two-year report, we optimized our anti-CD47 antibody so that it looks like a normal human protein that the patient’s immune system will not eliminate because it appears ‘foreign’. In this third year of the grant, we initiated the pre-clinical development of this humanized antibody, and assigned the antibody the development name of Hu5F9. Our major accomplishments in the third year of our grant are as follows:
  • (i) In addition to the hematological malignancies we have studied in previous years, we have now demonstrated the Hu5F9 is effective at inhibiting the growth and spread throughout the body [metastasis] of a large panel of human solid tumors, including breast, bladder, colon, ovarian, glioblastoma [a very aggressive brain cancer], leiomyosarcoma, head & neck squamous cell carcinoma, and multiple myeloma.
  • (ii) We have performed extensive studies optimizing the production and purification of Hu5F9 to standards compatible with use in humans, including that it is sterile, free of contaminating viruses, microorganisms, and bacterial products. We will commence manufacturing of Hu5F under highly regulated sterile conditions to produce what is known as GMP material, suitable for use in humans.
  • (iii) Another step to show Hu5F9 is safe to administer to humans is to administer it to experimental animals and observe its effects. We have demonstrated that Hu5F9 is safe and well tolerated when administered to experimental animals. Notably, no major abnormalities are detected when blood levels of the drug are maintained in the potentially therapeutic range for an extended duration of time.
  • (iv) We have initiated discussions with the FDA regarding the readiness of our program for initiating clinical trials, which we anticipate to start in the first quarter of 2014. To prepare for these trials we have established a collaboration between the Stanford Cancer Institute and the University of Oxford in the United Kingdom, currently our partners in this CIRM-funded program.
  • To our knowledge, CD47 is the first common target in all human cancers, one which has a known function that enables cancers to grow and spread, and one which we have successfully targeted for cancer therapy. Our studies show that Hu5F9 is a first-in-class therapeutic candidate that offers cancer treatment a totally new mechanism of enabling the patient’s immune system to remove cancer stem cells and their metastases.
  • Hematologic tumors and many solid tumors are driven by a subset of cells called cancer stem cells. These cancer stem cells must be eliminated for cures, however, they have been found to be resistant to the standard cancer treatments of chemotherapy and radiation therapy. Therefore, new therapeutic approaches are needed to target these abnormal stem cells. Previously, we found that cancer stem cells have developed a clever way to hide from the patient’s immune system. They display a protein called CD47 on their surface that signals to the immune system “don’t eat me”, thereby preventing their elimination. We have developed a monoclonal antibody (anti-CD47 antibody) that blocks this signal leading to elimination of these cancer stem cells, but not normal most normal cells, by the natural immune system. In our pre-clinical studies, we showed that anti-CD47 antibodies eliminates cancer cells and cancer stem cells from many different types of human cancer including: leukemia, breast cancer, colon cancer, prostate cancer, ovarian cancer, and others. In addition, anti-CD47 antibodies are effective at preventing and even eliminating metastases in animal models. These results indicate that anti-CD47 antibodies have great potential for the treatment of human cancer.
  • In order to develop this approach into a clinical therapeutic, we first optimized our anti-CD47 antibody so that it looks like a normal human protein that the patient’s immune system will not reject. Over the course of this grant project, we have conducted the pre-clinical development of this humanized antibody, termed Hu5F9-G4.
  • (1) Hu5F9-G4 has been manufactured according to Good Manufacturing Practices (GMP) as required by the United States Food and Drug Administration (FDA) for administration to humans. The drug product was manufactured and tested to be free of contaminants and is now ready for clinical use.
  • (2) Hu5F9-G4 has undergone extensive testing to investigate potential toxic effects in humans. According to FDA regulatory guidelines, Hu5F9-G4 was tested in experimental animals where it was given in various increasing doses. In all studies, Hu5F9-G4 was well-tolerated and caused no serious side effects.
  • (3) We have developed a phase 1 first-in-human clinical trial protocol for the investigation of Hu5F9-G4 in patients with solid tumors. In addition, we have prepared all the necessary documentation and clinical operations plans necessary to execute this clinical trial.
  • (4) We have submitted the necessary information on anti-cancer activity, manufacturing, safety, and clinical trial plans to the FDA in an Investigational New Drug (IND) application. This application was approved by FDA for the clinical trial in patients with solid tumors.
  • (5) We continue to develop parallel clinical trial plans for a phase 1 study in patients with acute myeloid leukemia (AML), and anticipate submitting our regulatory filing in 2015.
  • In summary, our studies show that Hu5F9-G4 is a first-in-class therapeutic candidate that offers cancer treatment through a totally new mechanism of enabling the patient’s immune system to remove cancer stem cells and prevent their metastases.

Stem Cell-Mediated Oncocidal Gene Therapy of Glioblastoma (GBM)

Funding Type: 
Disease Team Research I
Grant Number: 
DR1-01426
ICOC Funds Committed: 
$19 162 435
Disease Focus: 
Brain Cancer
Cancer
Stem Cell Use: 
Adult Stem Cell
Cell Line Generation: 
Adult Stem Cell
oldStatus: 
Closed
Public Abstract: 
Brain tumors (BTs) are incurable, whether they start in the brain or spread there from other sites. Despite advances in surgical, radiation, pharmacologic, and gene therapies, survival with a BT remains dismal. Current therapies are limited by their inability to reach widely disseminated tumor cells that become dispersed within normal brain structures. Interestingly, the therapeutic property that is needed to overcome this major obstacle to effective treatment of BTs matches well with one of the better accepted attributes of neural stem cells (NSCs): an attraction for sites of pathology in the adult brain, including primary & metastatic cancer. If armed with a proper tumor-killing gene, NSCs (whether administered into the brain or into the bloodstream), that are drawn to cancers, will dramatically reduce tumor burden, and will track after even single migrating tumor cells. The NSCs perform this action without themselves becoming tumorigenic or augmenting the pre-existing tumor, and this can be assured by having NSCs express a suicide gene that can be activated and cause NSCs to die. The tumor homing phenomenon of NSCs was first revealed by researchers on this proposed team and, in fact, the central concepts presented here have since been extended to many other kinds of disease. In this proposal, we will use a number of authentic mouse models of primary BTs to pre-clinically test therapeutic NSCs. Human NSCs (hNSCs) will be derived from 3 distinct sources, with each having been proffered as therapeutic, but never having been compared head-to-head in treating tumors. Each of these hNSCs will be modified using two therapeutic genes: TRAIL, which is a protein that specifically kills tumor cells, but does not harm normal cells and tissues, and cytosine deaminase which converts a non-toxic chemical into a toxic chemotherapeutic. We expect our research to identify the best hNSC + therapeutic gene combination to advance for clinical trial in patients with BTs, following our obtaining regulatory approval for using hNSC therapy at the end of this project. Because immunocompatibility of the hNSCs with recipient patients is not a concern in BT therapy, a limited number of hNSC lines can be used for treating all prospective patients. Furthermore, BT treatment does not require long-term NSC survival and can be combined with commonly used BT therapies. Finally, NSCs can be imaged in patients and therefore monitored after administration. Developing this approach for treatment of BT patients offers an ideal setting and opportunity for achieving dramatic results from stem cell therapy, and the results of this project will likely be applicable to the treatment of other cancers.
Statement of Benefit to California: 
Brain tumors (BTs) are incurable, whether they start in the brain or spread there from other sites. Despite advances in surgical, radiation, drug, & gene therapies, survival with a BT is extremely short, because current therapies are limited by their inability to reach tumor cells that spread widely to normal brain structures. Interestingly, the therapeutic property that is needed to overcome this major treatment obstacle matches well with one of the better accepted attributes of neural stem cells (NSCs): an attraction for sites of disease in the adult brain, including primary & metastatic cancer. If engineered to be armed with a tumor-killing gene, NSCs (whether administered into the brain or into the bloodstream), that are attracted to cancers, could dramatically reduce patient tumor burden, and track after even single migrating tumor cells, in a manner that has never been achieved. The NSCs would perform this action without themselves causing tumors or increasing growth of the patient’s tumor, and this would be assured by engineering the NSCs to self-destruct. The tumor homing phenomenon of NSCs was first revealed by researchers on this proposed team and, in fact, the central concepts presented here have since been extended to many other kinds of disease. In this proposal, we will use a number of authentic mouse models of primary BTs to test therapeutic NSCs before testing them in humans. Human NSCs (hNSCs) will be derived from 3 distinct sources, with each having been proposed as therapeutic, but never having been compared head-to-head in treating cancer. Each of these stem cells will be modified using two different therapeutic genes: TRAIL, a protein that specifically kills tumor cells, but does not harm normal cells and tissues, and cytosine deaminase, which converts a non-toxic chemical into a chemotherapy drug that kills the tumor. We expect our research to identify the best hNSC + therapeutic gene combination to advance for evaluation in clinical trials in patients with intracranial BTs, after we have performed all necessary animal safety testing and submitted a complete plan for review by the US FDA and NIH. Members of this proposed team have experience in bringing cancer therapies to clinical trial, hold the IP surrounding the use of stem cells against cancer, have begun discussions with the FDA and NIH, and have enlisted a GMP facility. Because immune system compatibility between donor and recipient of the hNSCs with the recipient is not a concern in BT therapy, a small number of donors could be used to produce genetically modified hNSCs to treat all prospective patients. Developing this approach for treatment of BTs offers an ideal setting and opportunity for achieving dramatic results from stem cell therapy, and accomplishing substantial improvements in quantity and quality of life for BT patients would no doubt increase California's worldwide visibility in offering the best possible medical care for cancer patients.
Progress Report: 
  • During the first year of this project we have made substantial progress toward achieving the ultimate goal of developing a stem cell (SC) therapy for treating patients with recurrent glioblastoma (GBM). At the outset, we began investigating three SC candidates as the cellular vehicle to carry a therapeutic payload and disperse within the tumor of GBM patients: mesenchymal stem cells (MSCs); fetal neural stem cells (fNSCs); and adult neural stem cells (aNSCs). In addition, we were considering two therapeutic genes as the payload, cytosine deaminase (CD) and tumor necrosis factor related apoptosis-inducing ligand (TRAIL), and two routes of therapeutic SC administration for treating brain tumor patients, intravascular and direct intratumoral. Thus, at the start of the project, there were twelve possibilities (3 stem cell vehicles x 2 therapeutic genes x 2 routes of administration) to investigate and compare prior to determining the best combination to develop for a GBM clinical trial. From this starting point we have been able to rapidly eliminate the aNSCs from consideration due to their slow rate of proliferation that would limit their expansion to sufficient number for use in a clinical product for patients. Next we determined that SC access to intracranial tumor through intravascular injection was negligible, and that it is highly unlikely that SC administration by this route would result in a sufficient number of SCs reaching intracranial tumor for achieving therapeutic benefit in treating patients with recurrent GBM. Thus, our work to date has resulted in the narrowing options for SC + therapeutic gene + route of delivery to four: two cellular vehicle candidates (fNSCs and MSCs) and two therapeutic gene payloads (CD and TRAIL). During the first year of this project, each of the four combinations has been tested and have demonstrated anti-tumor activity. During early year 2 research we will determine the most effective combination based on preclinical testing results using multiple human GBM models. The decision regarding most effective therapeutic gene + stem cell vehicle will be achieved within six months, and from that point, in going forward, project emphasis will focus on the development of a specific product candidate, including manufacturing process and assay development, GLP/GMP product manufacturing, further preclinical animal studies to demonstrate efficacy and safety, and development of a clinical protocol. In association with the research accomplished to date we have developed and applied several approaches that will prove useful for SC research and clinical application in general. Foremost among these is the use of micron-sized particles of iron oxide (MPIOs) for labeling SCs prior to their injection into animal subjects, and then monitoring the movement of labeled SCs using magnetic resonance imaging (MRI). This is a powerful technique with implications for understanding the distribution and persistence of SCs in patients receiving SC therapies. For our project, this method is informing us about the distribution of labeled SCs within and around brain tumors, as well as with regard to how long the SCs remain in animal subjects. In addition to the MRI detection of iron particle labeled SCs, we have developed and refined a technique for determining the amount of human SC DNA in animal subject tissues, which has a sensitivity of detecting one human cell among more than a million host cells. Similar to the MRI detection of labeled SCs, the DNA detection method provides us a very sensitive approach for monitoring SC biodistribution and persistence in animal subjects, and it is broadly applicable to all SC research in which rodent models are used for pre-clinical investigation of SCs for treating disease. We are also developing novel approaches for the use of optical imaging to visualize stem cells labeled with fluorescent reporters, and for monitoring the anti-tumor activity of therapeutic stem cells administered to animal subjects. These novel approaches are contributing to the repertoire of techniques available to expedite the identification and application of therapeutic SCs in clinical settings. This project is a collaboration among outstanding scientists and clinicians at five of California’s leading medical research institutions: the Sanford-Burnham and Salk Institutes in La Jolla, and the San Francisco, Los Angeles, and San Diego campuses of the University of California (including Ludwig Institute at UCSD). By leveraging complementary expertise of these investigators, we have made rapid progress in the preclinical animal studies, design of the clinical trial protocol, and the product development studies that will lead to preparation of a gene-modified SC product for the clinical trial. These activities will culminate in an IND application to FDA that will allow us to test the safety and efficacy of our SC product in patients with this devastating illness.
  • This project was initiated in April of 2010, and was for comparing
  • • three types of stem cells
  • • two distinct therapeutic gene modifications of stem cells, and
  • • intravascular administration vs. direct tumor injection of stem cells
  • in order to identify the most efficacious stem cell + therapeutic gene + route of administration for treating patients with recurrent glioblastoma (GBM), a brain tumor that has a dismal prognosis, and that badly needs innovative approaches for improving treatment outcomes.
  • Major conclusions from this project, as concerns the objectives indicated above, are:
  • 1. Stem cells administered by the vascular route do not reach brain tumors established in rodent subjects, to an extent which demonstrable therapeutic stem cell anti-tumor activity should be anticipated. In most instances, intravascular administration results in no detectable stem cells in intracranial tumor in rodent models. Therefore, therapeutic stem cells need to be administered direct into brain tumors in order to achieve a sufficient number and concentration of stem cells for observing anti-tumor effect.
  • 2. Neural stem cells and mesenchymal stem cells delivered directly into intracranial tumor display similar extents of dispersion in tumor, indicating these stem cell types should perform comparably as concerns their ability to disseminate within, and deliver therapy to tumor.
  • 3. However, unmodified (non-immortalized) neural stem cells, derived from single adult or fetal sources, have insufficient proliferative capacity for production as therapeutic stem cells to be used in clinical trials that enroll multiple patients. Because of the ready availability of mesenchymal stem cells (MSCs), from many donors, combined with the proliferative capacity of MSCs, MSCs were determined as the preferred candidate for developing therapeutic stem cells to treat patients with recurrent GBM.
  • 4. Studies conducted with therapeutic stem cell + tumor cell mixtures indicated superior anti-tumor activity of cytosine deaminase modified stem cells + 5-fluorocytosine (FC), relative to secretable TRAIL modified stem cells, when anti-tumor activity is examined in liquid media (cell culture). The two types of therapeutic stem cells showed comparable anti-tumor activities when administered directly into brain tumor in animal (rodent) subjects.
  • 5. In relation to other types of therapies (e.g., chemotherapeutics, antibodies, liposomal drugs) being tested by members of this disease team, manufactured therapeutic stem cells displayed low (modest) anti-tumor activity in animal subjects with brain tumor.
  • Technical advances, discovery, and products developed in association this project, and that can be shared/transferred in support of other CIRM funded research, include:
  • • Development of approaches for delivering stem cells through distinct routes of administration in rodent subjects.
  • • Development of a method, based on the use of polymerase chain reaction, for detecting human cells in rodent tissues, with a sensitivity of detection of one human cell per 100,000 mouse cells.
  • • Development of a cell labeling approach that enables tracking of stem cell migration in rodent subjects.
  • • Development of a histochemical method for detection of labeled human cells in rodent tissues.
  • • Development and characterization of multiple, tumorigenic human glioblastoma xenograft models for use in therapeutic testing.

[REDACTED]: A New Cancer Therapeutic to Reduce CSC Frequency

Funding Type: 
Disease Team Therapy Planning I
Grant Number: 
DR2-05352
ICOC Funds Committed: 
$65 120
Disease Focus: 
Cancer
oldStatus: 
Closed
Public Abstract: 
A important benefit of the tremendous progress in stem cell research has been the recognition that stem cell pathways are frequently re-activated in cancer cells conferring stem cell-like properties on a subset of tumor cells. This understanding is the basis for the emerging field of cancer stem cell (CSC) research. The cancer stem cell paradigm is a new approach in cancer research that has profound implications for new anti-cancer drug development. It is now widely understood that tumors are comprised of different cell types. Experimental evidence has accumulated from many laboratories indicating that different tumor cells vary dramatically in their ability to grow a new tumor. The tumor cells capable of re-growing a new tumor are the CSCs, whereas the bulk of the tumor cells lack this capacity. This property of seeding new tumor growth is analogous to the growth of distant metastases that is a major cause of mortality in cancer patients. The highly tumorigenic cells CSCs share certain properties with normal stem cells, but have accumulated cancer causing mutations clearly making them abnormal. It is now widely appreciated that may current therapies fail to effectively target the CSC population, and thus the CSCs mediate recurrence of disease after treatment. New drugs that target CSCs to kill them or cause them to differentiate into less dangerous, non-tumorigenic cells have the potential to provide significant benefit to patients and to dramatically improve cancer treatment. This project is focused on developing a new anti-cancer drug that has been shown to effectively block CSC self renewal in a variety of common types of cancer. New therapeutic agents that are effective in targeting cancer stem cells may reduce metastases and relapse after treatment thus providing a chance for improved long term survival of cancer patients. In the first phase of the project, we will complete the manufacturing of the drug for subsequent use in clinical trial and also execute safety studies that are necessary before initiating clinical trials. Next, we will test the safety of the drug in patients in Phase 1 clinical trials. Lastly, we will determine the efficacy in breast cancer patients in Phase 2 trials. This project will utilize innovative clinical trial designs to identify the patient populations most likely to benefit from treatment with this new treatment. We intend to focus our clinical testing on an important subset of women with breast cancer for whom effective therapies are currently lacking. Our project is a unique partnership of industry and academic researchers and clinicians dedicated to bringing new medicines to patients most in need of effective therapy.
Statement of Benefit to California: 
This project will benefit the state of California and its citizens in several significant ways. The goal of the work funded by this grant is to develop a new cancer treatment. This agent attacks cancer stem cells - the most dangerous type of tumor cells because they have the unique ability to resist many current therapies and re-grow and metastasize to distant sites in the body. The funds from this study will be used to support innovative drug development and clinical testing in women with advanced breast cancer. Thus, this therapy will benefit cancer patients with a critical need for new treatment options. We have observed that agents that reduce cancer stem cells in tumors also inhibit the spread of metastatic disease. Patients with advanced cancers which have disseminated to distant organs typically require high cost hospital stays. Our new treatment is intended to ameliorate the incidence and relapse of metastatic cancer, thus reducing the requirement for hospitalization and associated specialized care for this class of advanced cancer patients. In addition to the medical benefits of this project, funds from this grant will create and maintain high quality jobs in the state of California. California has been a recognized leader in biomedical research over the past several decades because of its excellent academic institutions and innovative companies attracting researchers from all over the country and the world. Many companies have made significant investments in establishing research facilities in California. Thus, biomedical research generates significant economic activity in the state. Continued leadership in the life sciences field relies on being at the forefront of cutting edge fields that are focal points of research interest and investment. Novel anti-cancer therapeutics, in general, and cancer stem cell-based therapeutic approaches, in particular, are excellent examples of important and innovative directions in drug development. CIRM will provide an important source of funding to support cancer stem cell therapeutics which hold the promise of becoming breakthrough medications in cancer treatment.
Progress Report: 
  • Our project is focused on developing a new anti-cancer drug that has been shown to effectively block cancer stem cell (CSC) self renewal in a variety of major tumor types. During the reporting period our group made significant advances on several fronts in advancing our novel stem cell directed therapy toward clinical development. In particular, we have associated cancer causing mutations in breast cancer in the molecular target of our therapeutic and shown that tumors bearing this type of mutation are exquisitely sensitive to our treatment. Based on this discovery, we have developed methodologies and reagents to identify patients who are most likely to benefit from treatment with our agent. Thus, this project is an excellent example of how "personalized medicine" is becoming a reality in cancer drug development. Furthermore, our results highlight the promise of targeting inappropriate activation of stem cell pathways as new strategy in cancer treatment.
  • During the reporting period we have assembled an experienced team of scientists and clinicians at our institution and also at collaborating institutions to execute the pre-clinical and clinical development of our new anti-cancer treatment. We have developed a detailed clinical strategy which involves a close collaboration between academic medical centers and the biotech industry. We have planned a series of clinical trials which will test the safety and efficacy of our anti-cancer drug and also test our hypothesis regarding selecting patients most likely to respond to treatment. This trials will take place at multiple sites including several in California.
  • In addition, we have made tremendous and tangible progress in advancing our therapeutic toward clinical testing. These steps include the completion of GMP manufacture of the drug for IND-enabling safety studies and for use in subsequent Phase 1 clinical trials and the initiation of IND-enabling safety studies.

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