Exercise-induced Adrenergic Receptor Signaling as an Immune Adjuvant for Allogeneic Cell Therapies
试验速览
- 阶段
- 1 期
- 状态
- 招募中
- 入组人数
- 200
- 试验地点
- 2
- 主要终点
- Immune Cell Enumeration and Phenotyping
研究概览
简要总结
This study aims to improve the treatment of blood cancer by using exercise to collect healthier immune cells from donors. Allogeneic adoptive cell therapy is a treatment where immune cells from a healthy donor are given to a cancer patient, usually to help prevent or treat cancer relapse after a stem cell transplant. These donor cells can either be directly infused into the patient or grown in a lab to create more specialized immune cells that target and kill cancer. While this therapy has been helpful for many patients, there is a need to make it more effective for a larger group and reduce side effects like graft-versus-host disease (GvHD), where the donor's immune cells attack the patient's healthy tissue.
This Early Phase 1 trial will test whether exercise can help produce better immune cells from donors. The investigators will recruit healthy participants for three study groups:
- Exercise Group: Participants will complete a 20-minute cycling exercise session. The investigators will collect blood samples before, during, and after exercise to study the number and quality of immune cells. The investigators will also use the collected cells to create immune therapies and test their ability to kill cancer cells in the lab and control cancer growth in mice.
- Exercise and Beta Blocker Group: In this group, participants will complete up to five cycling sessions, with at least a week between each session. Before each session, participants will take either a placebo or a drug (beta blocker) that blocks stress hormones like adrenaline. The investigators will collect blood samples before and during exercise to see how blocking these hormones changes the effect of exercise on immune cells.
- Isoproterenol Group: Participants in this group will receive a 20-minute infusion of isoproterenol, a drug that mimics the effects of adrenaline. The investigators will collect blood samples before, during, and after the infusion to see if the drug causes similar immune changes to those caused by exercise.
Participants can join one, two, or all three groups. This research will help understand whether exercise can improve immune cell therapies for treating blood cancer and reduce the risk of GvHD, making these treatments safer and more effective.
详细描述
Background:
Allogeneic cell therapies encompass various approaches, including donor lymphocyte infusions (DLI) and engineered immune cell products like chimeric antigen receptor (CAR) T-cells, gamma delta (γδ) T-cells, cytokine-induced killer (CIK) cells, and cytokine-induced memory-like natural killer (NK) cells. These therapies are commonly employed after allogeneic hematopoietic cell transplantation (alloHCT) to prevent or treat leukemic relapse in high-risk patients. However, while these therapies have shown potential, the success rates for DLI and expanded cell products remain limited. DLI, in particular, carries the risk of inducing graft-versus-host disease (GvHD), where donor T-cells attack healthy tissues, leading to significant morbidity. Furthermore, expanded cell products face challenges related to manufacturing times, efficacy, and cost, which can limit their accessibility and effectiveness. Therefore, there is a critical need to enhance the graft-versus-leukemia/lymphoma (GvL) effects of DLI and improve the efficacy of expanded cell products to achieve better outcomes for a larger number of patients without increasing the risk of GvHD, thereby broadening their use in clinical practice.
Exercise has been shown to contribute to lower cancer risk, improve outcomes in cancer survivors, and act as an adjuvant for several cancer therapies. The present exercise model involves an acute single bout of moderate to vigorous intensity exercise lasting 20 minutes, which evokes a catecholamine-dependent mobilization and redistribution of effector lymphocytes (e.g., natural killer cells, γδ T-cells, and CD8+ T-cells). This response may enhance long-term immunosurveillance by improving the recognition and destruction of premalignant cells and contributing to the suppression of tumor growth. The overarching research question is: Can lymphocytes be collected from blood during the exercise-induced mobilization phase to generate superior cell products for cancer immunotherapy? The overall vision is to develop exercise-mobilized lymphocytes into a therapy that increases the efficacy of both DLI and expanded cell products (e.g., CAR T-cells, γδ T-cells, CIK cells, and cytokine-induced memory-like NK cells) for treating leukemia/lymphoma relapse. This novel approach, termed "DLI-X," has the potential to improve a pre-existing therapy for the treatment of blood cancers at minimal cost.
The goals of this proposal are to conduct head-to-head comparisons between standard DLI and DLI-X, both in vitro and in xenogeneic mouse models engrafted with various human hematological cancers, and to identify the underlying mechanisms driving the enhanced anti-leukemia/lymphoma response of DLI-X.
The overarching hypothesis is that DLI-X and the expanded cell products manufactured from these exercise-mobilized lymphocytes will exhibit enhanced GvL effects against multiple hematological malignancies compared to standard DLI. These effects will be driven by β2-adrenergic receptor (β2-AR)-mediated transcriptomic and proteomic changes that promote target cell recognition and cytotoxicity. Additionally, it is proposed that DLI-X will improve the efficacy of combination therapies such as blinatumomab, a bi-specific T-cell engager, and monoclonal antibodies designed to increase antibody-dependent cellular cytotoxicity (ADCC), thereby enhancing tumor growth suppression and the GvL effects of DLI.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Crossover
- 主要目的
- Basic Science
- 盲法
- Triple (Participant, Investigator, Outcomes Assessor)
入排标准
- 年龄范围
- 21 Years 至 55 Years（Adult）
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •Procedures are in place for protecting against or minimizing the risks to the healthy volunteers recruited for this study. Physical risk to volunteers and matched related donors will be protected through health screening to determine study eligibility, and medical monitoring with an established test termination criterion during the exercise and isoproterenol infusion trials.
- •To protect against the remote risk of an adverse cardiac event occurring during exercise and isoproterenol infusion, the study will only enroll volunteers who are considered "low risk" for maximal stress testing in accordance with the guidelines published by the American College of Sports Medicine (ACSM) and American Heart Association (AHA). Individuals who are considered "low risk" are men and women who are asymptomatic and have no more than one risk factor for cardiovascular disease (CVD). The risks to subjects are therefore extremely low. All infusions will take place in the Clinical and Translational Sciences Research Center (CATS) Infusion Suite, which is a designated University of Arizona campus facility for infusion trials and equipped with appropriate medical personnel and monitoring equipment (i.e. ECG). The graded exercise tests and isoproterenol infusions procedures will be performed under the direction of a licensed and board-certified cardiologist
- •Inclusion Criteria:
- •Participants must:
- •Be between 21 and 55 years of age.
- •Be classified as 'low-risk' for graded exercise/stress testing according to ACSM-AHA criteria.
- •Have no contraindications for the use of isoproterenol, carvedilol, bisoprolol, nadolol, or roflumilast as per FDA guidelines.
排除标准
- •Participants will be excluded if they:
- •Currently use tobacco products or have quit within the last 6 months.
- •Have a body mass index (BMI) greater than 34 kg/m² or waist circumference exceeding 102 cm for men and 88 cm for women.
- •Use any medications known to affect the immune system or regularly take ibuprofen/aspirin, antidepressants, or medications that alter blood pressure or cardiovascular function.
- •Use of hormone replacement therapy.
- •Are pregnant or breastfeeding.
- •Have chronic or debilitating arthritis or have been bedridden in the past three months.
- •Experienced a common illness (e.g., colds) within the past 6 weeks.
- •Have central or peripheral nervous disorders, a history of stroke, or major affective disorder.
- •Are infected with HIV or hepatitis or have any autoimmune disease.
- •Have known cardiovascular disease or contraindications for the use of isoproterenol, carvedilol, bisoprolol, nadolol, or roflumilast.
- •Use any prescription medications or have an allergy to beta-blockers.
- •Have a resting heart rate of less than 50 beats per minute.
- •Suffer from asthma, emphysema, bronchitis, kidney disease, pheochromocytoma, diabetes, overactive thyroid, or a history of severe anaphylactic reactions.
- •Are scheduled for surgery.
- •Additionally, participants who meet the inclusion criteria but present with more than one of the following cardiovascular disease (CVD) risk factors will be excluded unless cleared by a cardiologist:
- •Family History: Myocardial infarction, coronary revascularization, or sudden death before 55 years of age in a father or male first-degree relative, or before 65 years of age in a mother or female first-degree relative.
- •Hypertension: Systolic blood pressure greater than 140 mmHg or diastolic blood pressure greater than 90 mmHg.
- •Dyslipidemia: Total serum cholesterol exceeding 200 mg/dl.
- •Pre-diabetes: Fasting blood glucose levels between 100 mg/dl and 126 mg/dl.
研究组 & 干预措施
Exercise Cohort
After an initial maximal graded exercise test to determine maximal oxygen uptake and peak cycling power, healthy participants will undergo a 20-minute graded exercise test at intensities corresponding to 50, 60, 70 and 80% VO2max (5-minutes per stage)
干预措施: Exercise (Behavioral)
Exercise + Beta Blocker Cohort
Healthy participants will complete a 20-minute graded exercise test at intensities ranging from 50-80-% of the maximal oxygen uptake under the following conditions: (1) Placebo; (2) 10mg bisoprolol ingestion; (3) 80ng nadolol ingestion; (4) 50ng carvedilol ingestion; (5) 10mg bisoprolol + 100mcg roflumilast ingestion. All drugs and placebo will be ingested 2-3h prior to exercise. Trial conditions will be double-blind and cross over with each participant serving as their own cntrol
干预措施: Bisoprolol Fumarate Tablet 10 mg (Drug)
Exercise + Beta Blocker Cohort
Healthy participants will complete a 20-minute graded exercise test at intensities ranging from 50-80-% of the maximal oxygen uptake under the following conditions: (1) Placebo; (2) 10mg bisoprolol ingestion; (3) 80ng nadolol ingestion; (4) 50ng carvedilol ingestion; (5) 10mg bisoprolol + 100mcg roflumilast ingestion. All drugs and placebo will be ingested 2-3h prior to exercise. Trial conditions will be double-blind and cross over with each participant serving as their own cntrol
干预措施: Placebo (Drug)
Exercise + Beta Blocker Cohort
Healthy participants will complete a 20-minute graded exercise test at intensities ranging from 50-80-% of the maximal oxygen uptake under the following conditions: (1) Placebo; (2) 10mg bisoprolol ingestion; (3) 80ng nadolol ingestion; (4) 50ng carvedilol ingestion; (5) 10mg bisoprolol + 100mcg roflumilast ingestion. All drugs and placebo will be ingested 2-3h prior to exercise. Trial conditions will be double-blind and cross over with each participant serving as their own cntrol
干预措施: Nadolol (1 x 80 mg) Tablets (Invamed, Inc) (Drug)
Exercise + Beta Blocker Cohort
Healthy participants will complete a 20-minute graded exercise test at intensities ranging from 50-80-% of the maximal oxygen uptake under the following conditions: (1) Placebo; (2) 10mg bisoprolol ingestion; (3) 80ng nadolol ingestion; (4) 50ng carvedilol ingestion; (5) 10mg bisoprolol + 100mcg roflumilast ingestion. All drugs and placebo will be ingested 2-3h prior to exercise. Trial conditions will be double-blind and cross over with each participant serving as their own cntrol
干预措施: Carvedilol 50 mg (Drug)
Exercise + Beta Blocker Cohort
Healthy participants will complete a 20-minute graded exercise test at intensities ranging from 50-80-% of the maximal oxygen uptake under the following conditions: (1) Placebo; (2) 10mg bisoprolol ingestion; (3) 80ng nadolol ingestion; (4) 50ng carvedilol ingestion; (5) 10mg bisoprolol + 100mcg roflumilast ingestion. All drugs and placebo will be ingested 2-3h prior to exercise. Trial conditions will be double-blind and cross over with each participant serving as their own cntrol
干预措施: Roflumilast 500 Mcg Oral Tablet (Drug)
Isoproterenol Infusion Cohort
To determine if pharmacological activation of beta-adrenergic receptors evokes an immune respponse akin to exercise, healthy participants will receive an intravenous infusion of isoproterenol (50ng/kg/min)
干预措施: Isoproterenol (Drug)
结局指标
主要结局
Immune Cell Enumeration and Phenotyping
时间窗: immediately after the intervention
Whole blood samples will be analyzed for complete blood counts and to quantify lymphocyte and monocyte subtypes using flow cytometry and a comprehensive immunophenotyping panel. This panel is designed to identify major immune cell populations, as well as markers related to differentiation, exhaustion, migration, activation, and inhibition. Specific cell types expressing a surface protein, or combinations of surface proteins, will be reported as the percentage of cells positive for expression and/or by mean fluorescent intensity (MFI). For descriptive purposes, the cell counts of all major lymphocyte and monocyte subtypes will be expressed as cells per microliter (cells/µL) of whole blood. Additionally, isolated peripheral blood mononuclear cells (PBMCs) and expanded cell products will be quantified and phenotyped in a similar manner.
Cytolysis in vitro
时间窗: immediately after the intervention
We will assess whether lymphocytes collected during or after exercise, as well as cell products manufactured from these lymphocytes, are more effective at killing hematologic cancer target cells. Using in vitro assays, such as flow cytometry and bioluminescence-based assays, we will compare the cytolytic activity of both the collected lymphocytes and the manufactured cell products to those obtained under resting conditions. Results will be measured as the time required to achieve 10%, 20%, 30%, 40%, and 50% cytolysis, or as the percentage of target cells killed at specific time points (e.g., 4, 8, 24, and 48 hours). We will also evaluate the impact of combination therapies, such as monoclonal antibodies targeting the tumor model, as appropriate.
Tumor Burden and Tumor Free Survival
时间窗: up to 120-days
Tumor burden will be evaluated in immunocompromised mice engrafted with human tumors by measuring the size, number, and progression of tumors using imaging techniques such as bioluminescence, MRI, or CT scans, along with physical measurements where applicable. Overall tumor burden will be assessed through metrics like peak tumor size and photon intensity in bioluminescence imaging. Tumor-free survival will be defined as the time from treatment until either the recurrence of detectable tumors or the last follow-up without tumor recurrence. Data will be reported as overall tumor reduction (e.g., percentage decrease in tumor size or number), peak tumor burden, and photon intensity, as well as the duration of tumor-free survival in days. Additional analyses will explore the effects of treatment on delaying tumor progression and improving overall survival.
Clinical xGvHD Score
时间窗: up to 120-days
The development of xGvHD (xenogeneic graft-versus-host disease) will be assessed using a clinical scoring system with a possible aggregate score ranging from 0 to 10. Animals will be monitored regularly, and a total score of 5 or higher on two consecutive assessment days will indicate the presence of moderate xGvHD. This scoring system allows for the systematic evaluation of disease severity and progression in response to treatment.
Survival
时间窗: up to 120 days
Survival will be monitored as a critical endpoint in this study. Death will be recorded when any of the following criteria are met: (1) the animal experiences greater than 20% weight loss compared to its baseline weight at two consecutive weigh-ins, indicating significant deterioration in health; or (2) the animal exhibits signs of severe morbidity, characterized by an xGvHD score exceeding 7. These criteria ensure that any adverse effects related to treatment or disease progression are accurately captured, allowing for a comprehensive assessment of the survival outcomes in the context of xGvHD.
次要结局
- Single-Cell Secretome(immediately after the intervention)
- CITE-Seq Analysis of Immune Cell Populations(immediately after the intervention)
- Human Cell Engraftment and Immune Reconstitution:(up to 120-days)
- Pathology and Immunohistochemistry(up to 120-days)