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Estrogen induces dynamic ER and RING1B recruitment to control gene and enhancer activities in luminal breast cancer – Science Advances

INTRODUCTION

The steroid hormones 17-estradiol (E2) and progesterone (P4) are the major female sex hormones (1). E2 plays essential roles during development of the mammary glands and the reproductive system and is required for brain, skin, and bone homeostasis (2). More than 70% of all human breast cancers express the estrogen receptor (ER), and most of these are E2 dependent for growth (3). Upon E2 stimulation, liganded ER translocates into the nucleus and is recruited to chromatin through multiple mechanisms, including binding to a cognate DNA sequence known as estrogen response elements (EREs). ER directly regulates genes involved in cell proliferation and cell cycle by interacting with a plethora of chromatin remodelers, epigenetic regulators, and transcription factors (TFs) (4). Despite the extensive literature on how E2 and ER cooperate to induce expression of pro-oncogenic regulators of cell growth and survival, a greater understanding of the mechanisms underpinning this process is required to develop new therapeutic strategies for treatment of luminal [ER-positive (ER+)] breast cancer.

Although EREs are found in both promoters and enhancers, ER predominantly binds to EREs at enhancers (5, 6). This observation suggests that liganded ER regulates gene expression via modulation of enhancer-promoter interactions. Cancer cells have permissive chromatin accessibility and an enhancer landscape that instruct oncogenes and cell cycle genes to induce aberrant cell proliferation (7, 8). Enhancer-bound ER is essential for the expression of E2-induced genes (9, 10). Most of our understanding of how hormones regulate gene transcription and chromatin architecture has been derived from studying the effects of acute hormone administration, typically within minutes of exposure to E2 in steroid-deprived cells (11, 12). The impact of prolonged hormone exposure on gene expression and chromatin landscape in breast cancer cells is less studied. In addition, it is still not fully understood how ER target genes and enhancer activity are linked to the maintenance thereof and how the epigenetic landscape is modified following E2 addition, both immediately and in the long term. Addressing these central questions might provide a better understanding of how estrogen influences breast cancer initiation and progression over time.

Polycomb repressive complex 1 and 2 (PRC1 and PRC2) are essential regulators of development and are strongly implicated in cancer (13). Although PRC1/2 are mostly associated with gene repression, increasing evidence indicates that they can also be recruited to actively transcribed genes in multiple biological processes (14). We recently demonstrated that PRC1 complexes are recruited to active enhancers and promoters in several cancer types, including ER+ and triple-negative breast cancer (TNBC). Enhancers containing PRC1 are also co-occupied by ER in ER+ breast cancer cells (15). Independent studies showed that the PRC1 subunits PCGF2 (Polycomb Group Ring Ringer 2) and CBX8 (Chromobox 8) also play important roles in breast cancer: PCGF2 positively regulates expression of ESR1 (encoding ER), and CBX8 regulation of gene expression in breast cancer is both dependent and independent of its association with other PRC1 subunits (16, 17). How PRC1 proteins are recruited to chromatin and the molecular mechanisms that regulate their novel roles as activators of gene transcription in breast cancer remain to be determined.

Here, we show that comprehensive analyses of accessible chromatin and transcriptome landscapes identify unique chromatin stages that are dynamically assembled in response to E2. We found that RING1B is an essential epigenetic factor required for both initiation and maintenance of such chromatin stages both dependently and independently of its enzymatic activity and binding to nucleosomes. Mechanistically, RING1B is recruited to FOXA1-GRHL2-ERbound active enhancers and genes in response to E2 stimulation, is required for full engagement of ER, and is required for E2-induced chromatin opening genome-wide. We further show that RING1B depletion induces an epigenetic reprogramming that results in changes in the enhancer landscape. We also demonstrate that RING1B depletion blocks cell proliferation and diminishes cell fitness. Last, we identified RING1B binding events at single-nucleotide resolution co-occupied by ER and TFs functionally involved in estrogen signaling including FOXA1 and GRHL2. We propose RING1B as a critical factor regulating the E2-ERmediated epigenetic changes that are required for breast cancer cell proliferation.

Hormones induce alterations in the chromatin structure that are accompanied by massive changes in the transcriptional landscape (18). Nevertheless, most studies to date determined the immediate effects in gene transcription and chromatin accessibility after acute administration, typically minutes, of E2 and P4, among others (11, 18). Our previous studies indicated that RING1B regulated genes and enhancers bound by ER in luminal breast cancer cells when cultured in the presence of serum that contains low levels of E2 [referred hereafter as full media (FM)] (fig. S1A) (15). To precisely determine transcription and chromatin accessibility mediated by liganded ER, we deprived cells of E2 by culturing them in media containing charcoal-stripped serum [hereafter defined as hormone-deprived (HD) media] for 72 hours. HD induces growth arrest of ER+ cells, and proliferation can be stimulated by administration of E2 (19). For our studies, we stimulated the cells with 10 nM E2 for 4, 8, 12, and 24 hours and then examined gene expression profile changes by RNA sequencing (RNA-seq) and mapped the chromatin landscape by assay of transposase accessible chromatin sequencing (ATAC-seq). These experiments were performed using control and RING1B-depleted cells from two independent transductions and E2 inductions (fig. S1A).

We first delineated the effects of prolonged administration of E2 in regulating gene expression changes and chromatin accessibility in control cells. RNA-seq revealed that distinct gene expression patterns emerged along the E2 time course [fold change (FC) > 2, q value < 0.01]. While ~100 genes were down-regulated (group 1), ~1200 genes were dynamically up-regulated during the course of E2 (groups 2 to 5). Unexpectedly, a small number of genes was continuously up-regulated from HD to 24 hours after E2 (group 2), with most genes being transcriptionally induced at the 12- and 24-hour time points (groups 3 and 5) (fig. S1B). Notably, a large set of genes was up-regulated specifically at 12 hours and then down-regulated at 24 hours (group 3), suggesting that massive chromatin architecture changes may occur between 8 and 24 hours after E2 administration. Genes up-regulated in each of the clusters were well-known E2-responsive genes including CXCL12 and FMN1 (early response) as well as E2F1 and CCNA2 (late response) (fig. S1C) (20). Gene set enrichment analysis (GSEA) confirmed successful E2 stimulation, since the induced genes were enriched for the early and late E2 response pathways and were also cell cycle and E2F targets (fig. S1D). These results indicated that E2 induced gene expression changes in a time-dependent manner that requires exquisite orchestration and coordination of dynamic changes in gene transcription to induce proliferation of luminal breast cancer cells.

Chromatin is extensively remodeled upon hormone administration (18, 21, 22). We next sought to determine chromatin accessibility changes after estrogen induction and how these changes correlated with gene expression. Distribution of genome-wide ATAC-seq peaks indicated that chromatin was most dynamic at promoters and intergenic regions in response to E2 (fig. S1E). In agreement with the massive changes in gene transcription observed between 8 and 24 hours upon E2 administration (fig. S1B, clusters 3 to 5), TF binding sites of key breast cancer TFs such as FOXA1/2, JUNB, SP1, and GRHL2 (23), as well as the chromatin organization factor CTCF (24), became increasingly accessible after 4 and 8 hours (fig. S1F), suggesting that chromatin accessibility changes primarily occur during the first 8 hours of E2 induction. By clustering genome-wide ATAC-seq peaks (fig. S1G), we confirmed that the most changes in accessibility occur at 8 hours. To determine whether gene expression correlated with chromatin accessibility, we interrogated ATAC-seq peaks 2.5 kb from genome-wide transcription start sites (TSS). The greatest changes in chromatin accessibility around TSS were observed after 8 hours of E2 induction (fig. S1H), suggesting that changes in chromatin landscape occur before differences in gene transcription observed after 12 and 24 hours of E2 administration. However, we did not observe complete correlation between transcription of E2-induced genes and chromatin accessibility changes. For instance, CXCL12 and FMN1 genes, which belong to group 2 in the RNA-seq classification (fig. S1B), exhibited diverse ATAC-seq profiles (fig. S1I). The TSS of CCND1, a gene that was strongly induced at 12 hours but decreased at 24 hours, demonstrated significant accessibility at 8 hours, while GREB1, which was induced at both 12 and 24 hours, was most accessible at 24 hours. Overall, these results indicate that (i) E2 dynamically modulates genetic programs, (ii) massive chromatin accessibility changes occur during the first 8 hours of E2 exposure, and (iii) global correlation of chromatin opening with gene up-regulation was modest, possibly because of secondary effects of the estrogen response.

We recently noted that RING1B may be functionally involved in E2-mediated gene regulation (15). Whether RING1B is required for E2-induced gene expression changes and chromatin accessibility is not known. Analysis of all and unique differentially expressed genes induced by E2 (FC > 2, q value < 0.05) in control cells compared to RING1B-depleted cells (fig. S2A) revealed that E2-mediated gene regulation strongly depends on RING1B (Fig. 1, A and B). RING1B depletion predominantly down-regulated early and late E2-responsive genes, epithelial-to-mesenchymal transition, G2M checkpoints, as well as E2F and MYC targets (Fig. 1C). These results were further confirmed by reverse transcription quantitative polymerase chain reaction (RT-qPCR), by both stable short hairpin RNA (shRNA) and acute (small interfering RNA) RING1B depletion, and also in MCF7 cells, another ER+ breast cancer cell line (fig. S2, B to D). Interferon- and interferon- response were the only pathways up-regulated after RING1B depletion (Fig. 1C). However, interferon genes were not occupied by RING1B or ER, suggesting that RING1B does not directly regulate the interferon pathway.

(A) RNA-seq heat maps of all deregulated genes in control and RING1B-depleted T47D cells. Fold change > 2, q value < 0.05. N = 2. (B) Genome browser screenshots of RNA-seq tracks at TFF1 and GREB1 loci in control and RING1B KD cells. (C) GSEAs of RING1B-depleted cells compared to control cells. NES, normalized enrichment score. (D) Western blot analysis after replacement of RING1B with shRNA-resistant and HA-tagged RING1B mutants. VINCULIN was used as a loading control. RT-qPCR analysis of endogenous RING1B normalized to the housekeeping gene RPO in shCTR and shRING1B cells expressing HA-RING1BR98A or HA-RING1BI53A. N = 2. (E) Volcano plots (adjusted P value) of deregulated genes in T47D-shCTR (RING1BWT) and cells expressing RING1B mutants after 24 hours of E2. (F) Venn diagram of up-regulated genes after 24 hours of E2 in the three cell lines from (E). (G) Western blot of ER, RING1B, and HA, from shCTR and shRING1B cells before and after HA-RING1BWT expression. VINCULIN was used as a loading control. Volcano plots (adjusted P value) of deregulated genes in the RING1B rescue cells after 24 hours of E2. (H) GSEA of RING1B rescue cells 24 hours after 24 hours of E2. (I) Binary ATAC-seq heat map in control and RING1B-depleted cells during E2 administration. (J) Genome browser screenshots of ATAC-seq peaks at the TFF1 locus in control and RING1B KD cells. (K) ATAC-seq signals in control and RING1B KD cells in HD condition and the E2 time course. (L) Genome browser screenshots of ATAC-seq peaks at the GREB1 locus in control and RING1B KD cells.

RING1B is an E3 ligase that can also bind to the histone H2A/H2B dimer. These functions are dictated by specific amino acids on the RING1B protein. Specifically, isoleucine at position 53 (I53) interacts with the E2-ligase, UBCH5C, to ubiquitinate its substrate (25), and mutation to alanine (I53A) disrupts RING1B E3 ligase activity. Similarly, arginine 98 (R98) inserts into an acidic pocket of H2A residues, and mutation of R98 to alanine (R98A) results in a 50-fold decrease in RING1B interaction with the nucleosome concomitant with reduced H2A ubiquitination (26). Thus, we wondered whether these functions are required for the E2-mediated transcriptional response. We generated T47D cells expressing hemagglutinin (HA)tagged versions of RING1B with an alanine at position 53 in place of isoleucine (RING1BI53A) or an alanine at position 98 in place of arginine (RING1BR98A). Cells were transduced with lentiviruses expressing HA-RING1BI53A or HA-RING1BR98A (resistant to shRNA against RING1B) containing an internal ribosomal entry site mCherry. Fluorescence-activated cell sorting (FACS)sorted mCherry+ cells were then transduced with shRNA-RING1B lentivirus to deplete endogenous RING1B (Fig. 1D). In agreement with our previous results, neither RING1B depletion nor the expression of both RING1B mutants affected global H2AK119ub1 levels (fig. S2E). Cellular fractionation assays showed that HA-RING1BR98A was displaced from the insoluble chromatin. Similarly to HA-RING1BWT, HA-RING1BI53A remained at both soluble and insoluble chromatin fractions (fig. S2F). These results confirm that the R98 residue of RING1B is required for strong association of RING1B to chromatin. T47D cells expressing endogenous and wild-type RING1B (RING1BWT), HA-RING1BI53A, or HA-RING1BR98A were cultured in HD media for 72 hours (Fig. 1, A and B, and fig. S1, A and B), and E2 was administered for 24 hours. Cells expressing the RING1B mutants only partially responded to E2 compared to WT, as demonstrated by global gene expression changes (Fig. 1E). Specifically, RING1BR98A mutation significantly down-regulated the E2-mediated transcriptional response compared to RING1BI53A cells (Fig. 1E), suggesting that RING1B nucleosomal binding is more functionally important than its enzymatic activity in mediating the estrogen response. Only ~20% of the genes up-regulated in RING1BWT (171 of 835) were also up-regulated in the mutant cells (Fig. 1F), indicating that some E2-induced genes do not require RING1B enzymatic activity (360 of 427) nor binding to nucleosomes (192 of 223). About 50% of genes up-regulated in RING1BWT (454 of 835) were not induced in the RING1B mutants, confirming that RING1B enzymatic activity and interaction with histone H2A/H2B dimers were required for their transcriptional activation. RNA-seq experiments performed in RING1B rescue cells (shRING1B + HA-RING1BWT) before and after 24 hours of E2 administration showed a similar gene expression profile compared to shCTR cells in the presence of 24 hours of E2 (Fig. 1G and fig. S1D). GSEA revealed a full functional rescue when HA-RING1BWT was ectopically expressed in shRING1B cells (compare Fig. 1H and fig. S1D).

E2 induced dynamic changes in chromatin accessibility and gene transcription (fig. S1). Since RING1B depletion hampered expression of E2-responsive genes, we expected to detect reduced accessibility at these regulatory sites. Thousands of de novo sites that demonstrated increased accessibility upon E2 administration were dependent on RING1B (Fig. 1, I to L). These effects of RING1B loss were not due to defects in cell cycle or proliferation (fig. S2, G and H), further suggesting that RING1B is required for the initiation and maintenance of gene transcription induced by E2 in luminal breast cancer cells.

Chromatin is heavily remodeled during E2 administration (fig. S1); therefore, we sought to determine the enhancer landscape generated upon E2 induction. We first interrogated whether E2 administration following RING1B depletion affected global levels of histone modifications associated with Polycomb-mediated repression (H2AK119ub1 and H3K27me3), gene activation (H3K4me3), and active enhancers (H3K4me1 and H3K27ac). In agreement with our previous report, we did not detect changes in global H2AK119ub1 after RING1B depletion (15), irrespective of E2 induction (Fig. 2A and fig. S2). Although H3K27me3 levels remained constant, accumulation of global H3K27ac following E2 stimulation was hindered in RING1B-depleted cells (Fig. 2A). However, RING1B depletion did not affect either the expression or the protein level of EP300, the main histone acetyltransferase that deposits H3K27ac (fig. S3, A and B) (27). The general genome-wide distribution of H3K27ac was mostly unchanged upon 24 hours of E2 in control and RING1B-depleted cells (Fig. 2B), suggesting a potential role of RING1B in regulating a specific set of enhancers that are mediated by E2.

(A) Western blots of histone modifications in control and RING1B-depleted cells in HD condition and upon E2 administration. Histones were extracted using sulfuric acid. (B) H3K27ac ChIP-seq signal across the right arm of the chromosome 17 in control and RING1B-depleted cells. (C) SEs identified in each E2 time point. (D) Venn diagram of SEs and genes associated with SEs in each E2 time point. (E) Genome browser screenshots of H3K27ac ChIP-seq in SEs identified in the HD and 24 hours of E2 condition (BCAM SE), only after 24 hours of E2 (GREB1 SE), and at all the time points analyzed (DSCAM SE). (F) H3K27ac signal in control and RING1B KD cells at sites that acquired H3K27ac after 24 hours of E2 in control cells. Significance was determined by Mann-Whitney U test. (G) Genome browser screenshots of H3K27ac in control and RING1B KD cells before and after 8 and 24 hours of E2. (H) RT-qPCR analyses of enhancer RNA expression at the GREB1 and E2F6 SEs in control and RING1B-depleted cells in the HD condition and after 24 hours of E2. mRNA expression was normalized to the housekeeping gene RPO. N = 3.

Because super-enhancers (SEs) regulate oncogenic pathways in cancer (28), we focused our attention to SE dynamics (gain and loss) in response to E2. Potential target genes of the 752 SEs identified in hormone-deprived cells included key breast cancer TFs such as FOXA1 and GATA3 (Fig. 2C). In estrogen-treated cells, 598 and 859 SEs were identified with potential target genes including GREB1 and E2F6 (Fig. 2C). There was a relatively high overlap in the three experimental conditions between SEs and SE target genes (Fig. 2, D and E), suggesting that a unique subset of SEs are dynamically regulated upon E2 administration. Genome-wide H3K27ac at de novo enhancers gained in response to E2 was significantly reduced in RING1B-depleted cells compared to control (Fig. 2, F and G) concomitant with a reduction of enhancer RNA levels (Fig. 2H). RING1B depletion did not reduce H3K27ac at sites that were already decorated with high levels of H3K27ac before E2 stimulation (fig. S3, C and D), indicating that RING1B functions primarily at sites of de novo enhancers following E2 induction.

How the Polycomb group of proteins are recruited to chromatin is under constant examination (14, 29). Our previous studies identified co-occupancy of RING1B and ER at enhancers and promoters containing EREs and FOXA1 motifs in luminal breast cancer cells (15). We thus hypothesized that E2 administration may regulate deposition of RING1B at chromatin. Since ER is recruited to chromatin within minutes of E2 addition (9), we mapped genome-wide ER, FOXA1, and RING1B binding following 45 min of E2 stimulation as well as at 8 and 24 hours to investigate potential binding dynamics over prolonged E2 exposure. To minimize potential secondary effects on gene transcription due to stable RING1B depletion, we generated new T47D cells with doxycycline-inducible RING1B knockdown (fig. S4, A and B). RING1B depletion was initiated 48 hours before hormone deprivation for 72 hours and E2 stimulation.

Notably, RING1B binding at chromatin was dependent on estrogen (Fig. 3A). As expected, E2 treatment led to massive ER localization to chromatin (6, 3032), while recruitment of FOXA1 was mostly independent of E2 (33) (Fig. 3A). Upon E2 induction, RING1B was recruited to a large majority of ER/FOXA1 cotargets (Fig. 3, B and C). We also observed RING1B occupancy at genomic sites not cobound by ER/FOXA1 that lose RING1B binding after 45 min of E2 induction (Fig. 3, B to D), indicating a redistribution of RING1B during the early estrogen response. Specifically, we found 455 peaks corresponding to 245 genes occupied by RING1B in the absence of E2, while 4212 peaks corresponding to 2092 genes were found to be RING1B targets after 45 min of E2 induction. In agreement with previous reports, the number of ER binding sites increased ~5-fold after 45 min of E2, while the number of FOXA1 binding sites modestly increased (Fig. 3E).

(A) RING1B, ER, and FOXA1 ChIP-seq signals in control cells before (HD) and after 45 of E2. Number of RING1B peaks in HD = 455, after 45 of E2 = 4212. ER peaks in HD = 328, after 45 of E2 = 2015. FOXA1 peaks in HD = 102,304, after 45 of E2 = 140,846. (B) ChIP-seq heat maps of RING1B, ER and FOXA1 ChIP-seq signal before and after 45 of E2. Heat maps are clustered by RING1B occupancy. (C and D) Genome browser screenshots of RING1B, ER, FOXA1, and H3K27ac in control cells at CT62 (C) and SKOR1 (D) before and after 45 of E2. (E) Venn diagrams of target genes before (HD) and after 45 of E2. (F) ChIP-seq heat maps of RING1B in control and RING1B-depleted cells. (G) RING1B, ER, and FOXA1 ChIP-seq signals in control cells before (HD) and after 45 of E2. Significance was determined by Mann-Whitney U test. (H and I) Genome browser screenshots of ChIP-seqs at ESR1, BCL2L1, and BCL2L1 SEs (H) and GRHL1 (I). (J) FOXA1, RING1B, and ER ChIP-qPCR of RING1B, ER, and FOXA1 cobound sites in control and FOXA1-depleted cells. N = 2. (K) Western blots of ER, FOXA1, and RING1B in MDA-MB-231 cells expressing HA-ER and HA-FOXA1 and after E2 administration. VINCULIN was used as a loading control. (L) RT-qPCR analyses of TFF1 and GREB1 in MDA-MB-231 as in (K). (M) ChIP-qPCR of ER, RING1B, and FOXA1 cotargets in T47D. Results are presented as fold recruitment over cells not transfected with HA-ER and HA-FOXA1. N = 2.

We then asked whether RING1B depletion regulated recruitment of ER and FOXA1. To this end, we first confirmed that knockdown of RING1B diminished chromatin-bound RING1B genome-wide (Fig. 3F). Analysis of RING1B, ER, and FOXA1 co-occupied sites after 45 min of E2 administration revealed that loss of RING1B did not alter FOXA1 binding nor H3K27ac deposition but significantly reduced ER recruitment (Fig. 3G and fig. S4, C and D). We then divided the RING1B chromatin immunoprecipitation sequencing (ChIP-seq) signal in quartiles to determine whether ER and FOXA1 recruitment depended on RING1B binding levels. ER occupancy levels strongly correlated with that of RING1B and were significantly reduced following RING1B depletion in the first two quartiles, whereas FOXA1 occupancy remained relatively unchanged in all four quartiles (fig. S4E). Significant reduction of ER binding was observed at the promoters and enhancers of genes with key oncogenic functions in breast cancer including ESR1, GRHL2, and BCL2L1 (Fig. 3H). We also found that genes co-occupied by RING1B and FOXA1, but not ER, contained EREs (P value of 1 10100) (Fig. 3I), suggesting that RING1B can be recruited to ER binding motifs in the absence of ER. Last, we performed ChIP-seq of the RING1B mutants to determine whether their chromatin occupancy was altered. In agreement with the lack of response to E2 of both cell lines expressing HA-RING1B mutants in a stable shRING1B background (Fig. 1, G and H), neither RING1BI53A nor RING1BR98A was stably associated with chromatin (fig. S4F). These results suggest that interaction of RING1B with the nucleosomes and its enzymatic activity to nonhistone substrates are required for its stabilization to chromatin both in the absence and presence of E2.

The pioneer factor FOXA1 is a key determinant of ER recruitment and function. Since E2 administration also induces massive RING1B recruitment to chromatin, we next asked whether FOXA1 served as a pioneer factor for RING1B. FOXA1 depletion by shRNA (fig. S4G) strongly impaired recruitment of both ER and RING1B (Fig. 3J), indicating that FOXA1 binding is also required for E2-mediated RING1B recruitment to chromatin. Moreover, ectopic expression of HA-tagged ER and FOXA1 in the TNBC cell line MDA-MB-231, in which FOXA1 is repressed by RING1B (15), was sufficient to induce expression of GREB1 and TFF1 concomitant with recruitment of RING1B, ER, and FOXA1 to their promoters and enhancers (Fig. 3, K to M). These results confirm that expression of ER and FOXA1 in TNBC cells can induce expression of estrogen-responsive genes following E2 induction with concomitant RING1B recruitment at the regulatory sites of these genes. These observations highlight the cooperative interplay between RING1B and ER/FOXA1 in regulating E2-induced genes.

ER binding to chromatin during the early estrogen response is cyclic (30); thus, we next sought to determine whether RING1B is recruited to chromatin in a similar manner and whether dynamic chromatin cycling occurs during prolonged E2 stimulation. While FOXA1 binding profiles remained relatively similar along the time course of E2 induction (fig. S5A), RING1B and ER demonstrated dynamic chromatin occupancy following hours of E2 administration (Fig. 4, A and B). We identified six clusters of distinct RING1B binding profiles containing EREs and GRHL2 binding motifs (Fig. 4A) concomitant with significant up-regulation of the associated RING1B target genes after 8 hours of E2 administration (fig. S5B). Notably, cluster 6, which exhibited stable RING1B occupancy at all time points following E2 exposure, also contained genes that were stably up-regulated in response to E2 (Fig. 4A and fig. S5B). We then interrogated the RING1B occupancy at genes that were transcriptionally active in HD and became repressed during E2 administration (Fig. 1A). Only 12% of these genes (23 of 184) were occupied by RING1B. This result indicated that RING1B was not playing a major role as a transcriptional repressor in T47D cells and suggested that the canonical repressive function of PRC1 is mediated by RING1A.

(A and B) ChIP-seq heat maps of RING1B (A) and ER (B) signals before (HD) and after 45, 8 hours, and 24 hours of E2. Six ChIP-seq clusters were identified from 7053 peaks (A) and 5100 peaks (B). The top-enriched motif in each cluster is shown. (C) E2-induced expression changes of genes associated with peaks within each ER ChIP-seq cluster. Box plots are represented by z score. (D) Heat map clustering analysis of RING1B and ER ChIP-seq before (HD) and after 45, 8 hours, and 24 hours of E2. Number of peaks: cluster 1 = 2196, cluster 2 = 1397, cluster 3 = 540, cluster 4 = 1721, cluster 5 = 1960, cluster 6 = 4339. (E) TF motif analysis of the six clusters. (F) Box plots of RNA-seq signal in control and RING1B KD cells at the different E2 time points. TPM, transcripts per million. (G) ATAC-seq peak intensity and dynamics upon E2 at RING1B and ER cotargets in control and RING1B-depleted cells. (H) PRC1 subunits ChIP-qPCR of RING1B/ER cotarget genes before (HD) and after 45 and 24 hours of E2. N = 3. (I) Genome browser screenshots of RING1B, ER, FOXA1, and H3K27ac ChIP-seq and ATAC-seq signals at E2F6 and GREB1 SEs in control and RING1B-depleted cells during E2 administration.

ER followed a similar recruitment pattern as RING1B (ER clusters 1, 2, 4, and 5) but demonstrated more dynamic occupancy profiles at 45 min (cluster 6), 8 hours (cluster 5), and 24 hours (cluster 3). As expected, EREs were strongly enriched at ER target genes (Fig. 4B). Genes stably occupied by ER along the E2 time course, similar to cluster 6 of RING1B occupancy, were significantly up-regulated (Fig. 4C, clusters 1 and 2). Genes with ER bound only at 24 hours (cluster 3) exhibited small changes, albeit significant, in gene expression, whereas genes occupied by ER only at 45 min and 24 hours (clusters 4 and 6) demonstrated significant up-regulation at these time points. The small set of genes containing ER only at 8 hours (cluster 5) appeared to be repressed when compared to the HD condition, suggesting that ER also facilitates gene repression (Fig. 4C) (4, 34).

We then wondered whether RING1B and ER bound the same genomic targets during the E2 response, so we grouped RING1B and ER binding patterns into six clusters (Fig. 4D). Four of these clusters (clusters 2, 3, 4, and 5) contained genomic sites targeted by both RING1B and ER at some point during the E2 time course and contained EREs as the number one TF binding motif (Fig. 4E). Contrastingly, clusters 1 and 6, which have little to no ER binding, primarily contained GRHL2 and FOXA1 binding motifs with substantially less enrichment for EREs (Fig. 4E).

We next determined the impact of RING1B loss on the expression of genes occupied by RING1B and ER containing the highest ERE and FOXA1 binding motifs. We first identified RING1B and ER cotargets up-regulated in shCTR cells after addition of E2 (clusters 2 to 5) and determined their expression following RING1B depletion. We found that RING1B directly regulated genes in clusters 1, 2, and 3 (Fig. 4F and fig. S5C), but RING1B depletion was not sufficient to significantly affect expression of genes in clusters 4 and 5 (fig. S5C). These results indicate that in a set of genes co-occupied by RING1B, ER, and FOXA1 (not shown), RING1B is required for their full transcriptional activation upon E2 administration. Among the down-regulated genes in clusters 2 and 3 were key genes involved in breast cancer progression (e.g., GREB1, FMN1, TFF1, and FKBP4) (Fig. 1, A to D) (3537).

We then assessed whether RING1B and ER induces the expression of their direct targets in response to E2 by increasing chromatin accessibility at these sites. To this end, we restricted our analysis of ATAC-seq peaks to those located at the promoters and TSS of genes up-regulated at any time point during E2 stimulation that are RING1B and ER cotargets. We found that overall chromatin accessibility at E2-stimulated genes in control cells is dynamic with cyclical opening and closing during the E2 response from 0 to 24 hours (Fig. 4G), similar to the cycling of ER on and off the chromatin (30). In contrast, RING1B depletion abrogates this cyclical trend of chromatin accessibility, with a significant reduction in accessibility compared to shCTR at 8 and 12 hours after E2 addition. A cluster of genes gained significant accessibility at 8 hours in RING1B-depleted cells (Fig. 4G). Nonetheless, these results suggest that correlation between chromatin accessibility and gene expression during the estrogen response is gene specific and time dependent.

Once we established the recruitment pattern of RING1B and ER and the impact of RING1B loss on gene transcription and chromatin accessibly, we next asked whether RING1B was recruited to chromatin in a PRC1 context. We recently showed that in T47D cells cultured in FM containing constant E2, RING1B only associated with cPRC1 subunits. Whether RING1B was recruited to chromatin as part of a PRC1 complex upon acute E2 administration was not known. We thus performed ChIP-qPCR experiments using antibodies against cPRC1 (CBX4 and CBX8) and ncPRC1 (RYBP) subunits and PCGF2 and PCGF4 orthologs that can be part of both cPRC1 and ncPRC1 complexes. PCGF2 and CBX4 were recruited to both promoters and enhancers co-occupied by RING1B, ER, and FOXA1 after 24 hours of E2 administration, but not after 45 min of E2. RYBP was not recruited to any of the regulatory sites analyzed, indicating that RING1B only associated with a cPRC1 complex containing CBX4 and PCGF2 24 hours after E2 administration (Fig. 4H). We then sought to determine the role of RING1B in the recruitment of ER and FOXA1 during prolonged E2 administration. We found that after 24 hours of E2 induction, RING1B recruitment was reduced by ~70% in RING1B-depleted cells, and ER recruitment was significantly reduced at the GREB1 SE, concomitant with drastic reduction of ATAC-seq signal and gene expression (Figs. 1B, and 4I and fig. S5D). These results suggest that RING1B may have a strong impact on late ER binding events or stable recruitment during extended exposure to estrogen.

We then interrogated the genome-wide RING1B dependency on ER and FOXA1 recruitment to chromatin at 8 and 24 hours after E2 induction. Since GRHL2 binding sites were strongly enriched in two of the RING1B binding clusters (Fig. 4A), we also asked whether GRHL2 recruitment was dependent on RING1B (Fig. 5A). GRHL2 was recently demonstrated to be bound to FOXA1-occupied enhancers in ER+ cancer cells (38). Similar to FOXA1 binding profiles, GRHL2 was observed to be already bound to chromatin in the absence of E2, and RING1B depletion did not affect its occupancy at randomly selected RING1B-FOXA1-GRHL2 cotarget genes (Fig. 5B).

(A) RING1B is recruited to clusters containing either FOXA1 and GRHL2 or FOXA1 and ER. (B) FOXA1 and GRHL2 ChIP-qPCR of FOXA1/GRHL2 cobound genes in control and RING1B-depleted cells. Immunoglobulin G (IgG) was used as a negative control. N = 2. (C) Dynamics of ER ChIP-seq signals during E2 and effect in ER recruitment upon RING1B depletion at clusters 2 to 5 identified in Fig. 4D. Significance was determined by Mann-Whitney U test. (D) Genome browser screenshots of RING1B, ER, FOXA1, and H3K27ac ChIP-seq at FMN1 and TFF1 loci in HD, 45, 8 hours, and 24 hours of E2 in control and RING1B-depleted cells. The gray box is a zoomed-in view of a genomic region upstream of the TSS of FMN1 containing an ERE and a FOXA1 binding site. (E) Growth curve of T47D and MCF7 control and RING1B KD cells cultured in HD media or HD supplemented with E2. N = 3. ***P < 0.001, two-tailed t-test. (F) Colony formation assay of T47D and MCF7 control and RING1B-depleted cells cultured in HD media or HD supplemented with E2 for 14 days (T47D) and 21 days (MCF7). N = 3. (G) Growth curve of T47D control and RING1B KD cells treated with tamoxifen (TAM; 100 ng/ml) and fulvestrant (30 ng/ml) for 7 days. N = 3.

We next determined whether RING1B modulated FOXA1 and ER recruitment during prolonged exposure to E2 at RING1B-FOXA1-ER cotargets. While FOXA1 recruitment to chromatin was modestly affected by the loss of RING1B (fig. S6A), ER recruitment was diminished by ~50% at 24 hours in clusters 2 to 4 (Fig. 5C). Moreover, clusters 2 and 3 exhibited the strongest ER recruitment (Fig. 5C) and contained genes that were significantly deregulated upon RING1B depletion (Fig. 4F). ER recruitment was severely affected at key genes such as FMN1 and TFF1 upon RING1B depletion (Fig. 5D). The requirement of RING1B in ER recruitment was time dependent: At FMN1, RING1B was required for full ER recruitment after 45 min and 24 hours of E2 treatment, whereas at the TFF1 enhancer, ER recruitment at 45 min was not affected by the loss of RING1B but was strongly affected at 24 hours. RING1B was also recruited to EREs not occupied by ER and with low FOXA1 occupancy upstream of the FMN1 promoter 24 hours after E2 induction (Fig. 5D, right). Reduced ER binding (Figs. 3 and 5), enhancer regulation (Fig. 2), chromatin accessibility, and lack of full response to E2 (Fig. 1) in RING1B-depleted cells resulted in a reduced proliferation over time (Fig. 5E) and decreased cellular fitness (Fig. 5F). Notably, TCGA data from 1082 patients with breast invasive carcinoma showed a positive correlation of RNF2 (encoding RING1B) expression with ESR1 (encoding ER), ER cofactors such as GATA3, FOXA1, EP300, and KMT2C, and RING1B/ER cotarget genes (e.g., TFF1 and FMN1) (fig. S7, A to C). Moreover, RING1B depletion enhanced the negative effect in cell proliferation mediated by tamoxifen and fulvestrant, selective ER modulator and downregulator, respectively, further supporting a cooperative role of RING1B in regulating the ER pathway. In FOXA1-depleted cells where RING1B exhibits reduced chromatin binding (Fig. 3G), we also observed a strong impairment in cell fitness, corroborating the importance of RING1B and ER in maintaining the cellular identity of luminal breast cancer cells (fig. S6B).

Standard ChIP experiments performed with cross-linking agents do not discriminate between direct and indirect binding of proteins to DNA. While TFs are typically recruited to chromatin through the recognition of cognate DNA motifs, they can also occupy sites devoid of these motifs via interaction with other factors. Moreover, most epigenetic machineries do not directly bind DNA and are recruited to specific genomic locations via interaction with TFs, RNA molecules, or histone modifications. Although we did not observe interaction of RING1B with ER or FOXA1, our ChIP-seq experiments revealed a high degree of chromatin colocalization of RING1B with ER, FOXA1, and GRHL2 in the presence of E2 (Figs. 3 to 5). To determine how these factors associate and network functionally at chromatin during E2 stimulation and to detect all their possible protein-protein-DNA and protein-DNA interaction events, we performed ChIP-exo experiments (39) and applied the ChExMix pipeline (40). ChIP-exo greatly improves the resolution of binding sites from hundreds of base pairs to a single-nucleotide resolution by including a 5-3 exonuclease that degrades the DNA protruding from the occupied binding site (41). We performed RING1B, ER, FOXA1, and GRHL2 ChIP-exo (to the best of our knowledge, RING1B and GRHL2 ChIP-exo are not yet reported) in two biological replicates (reads merged for downstream analysis). In agreement with our ChIP-seq experiments (Fig. 3), ChIP-exo tags for ER and RING1B were strongly enriched at chromatin upon E2 induction, while FOXA1 enrichment was similar between HD and E2 conditions (Fig. 6, A and B). Also, GRHL2 binding to chromatin was not dependent on E2 stimulation (Fig. 5B and Fig. 6, A to B). Genome browser screenshots of RING1B, FOXA1, and ER ChIP-seq and ChIP-exo assays showed a comparable enrichment following E2 administration (Fig. 6C).

(A) Number of ER, RING1B, FOXA1, and GRHL2 ChIP-exo tags identified in HD and after 45 of E2. (B) Genome browser screenshots of GRHL2, RING1B, ER, and FOXA1 ChIP-exo at CDC27 and MYC loci in HD and after 45 of E2. (C) Genome browser screenshots of RING1B, ER, and FOXA1 ChIP-seq and ChIP-exo at RARA and GREB1 enhancers in HD and after 45 of E2. (D) Heat maps and sequence color plots of binding subtypes identified in ER, FOXA1, GRHL2, and RING1B ChIP-exo after 45 of E2. On the right of each sequence color plot, see the distribution of the ChIP-exo tag patterns at each of the main subclass binding events identified in ER, RING1B, FOXA1, and GRHL2 ChIP-exo experiments and the number of events. (E) MEME analysis of known TF motifs identified within 100 bp from the summit of the RING1B tags. (F) Distribution of ESR1 (ER) and JUN cognate sequences respective to the submit of the RING1B tags. (G) Genome browser screenshots of RING1B and ER ChIP-seq and ChIP-exo in HD and after 45 of E2. Boxes represent distance between the submit of ChIP-exo tags. (H) Distribution of FOXA1, GRHL2, and RING1B ChIP-exo tags relative to stranded ER tags containing a full ERE motif [ER subtype 1 in (D)]. (I) Distribution of FOXA1, GRHL2, and RING1B ChIP-exo tags relative to stranded ER tags containing half ERE motif [ER subtype 3 in (D)].

We then identified binding event subtypes for each of the four factors upon E2 administration. ER ChIP-exo tags (~80%) contained EREs, of which 182 and 592 harbored full EREs and half EREs, respectively, suggesting that ER was recruited to chromatin as a homodimer in ~30% of the binding events (Fig. 6D, upper left). We found 128 events in which ERE was not detected, suggesting that ER may potentially bind a novel motif. In addition, most of the FOXA1 and GRHL2 were bound at their cognate sequences (both single and double motifs), albeit with subtle differences between the subtypes (Fig. 6D, upper right and bottom left). However, we were unable to determine the existence of a RING1B cognate DNA binding motif, although we identified four RING1B binding types based on the shape of the tags, suggesting that RING1B is not recruited to a specific DNA sequence but rather is recruited by RNA or by multiple TFs, or both (Fig. 6D, bottom right). Next, we determined the binding motifs located within 100 base pairs (bp) upstream and downstream of the RING1B ChIP-exo tags to identify potential TF corecruitment with RING1B. In agreement with our model, we found significant enrichment of ERE (ESR1) motifs, indicative of a potential ER binding as well as motifs of known ER cofactors such FOS/JUN, E2F, and AP-2 families (Fig. 6E). Notably, the JUN binding motif was only 3 bp from the RING1B binding sites, and ERE (ESR1) motifs were found approximately 10 bp around RING1B (Fig. 6F). We confirmed the binding prediction of ER ~10 bp next to RING1B (Fig. 6G), which was not possible to achieve with standard-resolution ChIP-seq. Last, we determined the tag distribution of RING1B, FOXA1, and GRHL2 relative to the main ER binding subtypes, as a homodimer or a monomer. Notably, the distribution of RING1B, FOXA1, and GRHL2 binding is influenced by the ER binding pattern. All three factors can be recruited up to 30 bp upstream and downstream of the palindromic ER homodimer motif (Fig. 6H). However, since the ER monomer motif is directional, we could determine the relative binding localization of these factors in a strand-specific manner, which reveals that most of the RING1B recruitment is downstream and GRHL2 upstream of ER monomers (Fig. 6I). FOXA1 binding does not appear to be influenced by ER as its distribution with respect to ER is relatively even compared to that of RING1B and GRHL2. This finding suggests that at half ERE sites, FOXA1 plays a crucial role in recruiting ER to the chromatin, which is in line with prior findings (42). However, when ER binds as a homodimer at full ERE sites, the binding distribution of all three factorsRING1B, GRHL2, and FOXA1seems to be heavily influenced by ER binding (Fig. 6H). This suggests that at full ERE sites, ER can influence FOXA1, GRHL2, and RING1B binding. Together, these results demonstrate a high-resolution view of the intimate binding profiles of RING1B with breast cancer TFs including ER, FOXA1, and GRHL2, further supporting our overall finding of functional cooperativity between these factors in the estrogen response of luminal breast cancer.

Despite knowing for over 80 years that estrogen drives breast cancer proliferation, the exact molecular mechanisms of liganded ER and its effects on gene regulation and chromatin organization are still not well understood. A deeper understanding is needed to uncover novel therapeutic strategies for treating ER-dependent breast cancers and other estrogen-regulated human diseases. Much effort has been dedicated toward characterizing the intricate network of functional interactions between ER, oncogenic TFs, and epigenetic machineries, with particular emphasis on how these factors are assembled upon acute E2 exposure (4, 43, 44). Nevertheless, there is a limited understanding of the hierarchical events that occur at the genomic and epigenomic level following hours of exposure to estrogens. Given the plasticity of the breast cancer genome during hormone-stimulated proliferation (22), it is crucial to uncover the changes in chromatin organization and epigenetic events that occur during prolonged periods of estrogen exposure. Our results reveal that the Polycomb protein RING1B is at the core of the epigenetic factory that positively regulates the transcriptional response to estrogen in ER+ breast cancer cells (see model, fig. S8).

The mechanisms that regulate the tethering of Polycomb proteins to chromatin are under constant investigation (13). Although we know much about PRC1 and PRC2 recruitment mechanisms in embryonic stem cells, very little is known in adult stem cells and cancer cells (14, 29). There is a significant gap in knowledge of how PRC1 complexes regulate genes during initiation and progression in cancer (45) and how different PRC1 variants are dynamically assembled and recruited to chromatin. In ESCs, PRC1 complexes are mainly involved in maintaining repression of developmental genes (46), but recent studies indicate that PRC1 acquires dual functions during early cell specification and in adult stem cells. While PRC1 complexes still repress lineage-specific genes, they also facilitate gene transcription. Examples are found during neuronal and mesodermal differentiation, in epidermal and intestinal stem cells, as well as in breast cancer and melanoma (17, 4751). At least two outstanding questions remain: (i) Why do differentiating cells and somatic stem cells require PRC1 complexes to regulate both gene expression and repression? (ii) What is driving this functional switch? It would be fascinating to determine whether PRC1 complexes acquire gene activating functions in premalignant cells as a by-product of tumor evolution or whether PRC1 drives cancer development by gaining novel activating functions. It is not yet known whether RING1B exhibits activating functions by regulating active genes and enhancers in differentiating adult mammary stem cells (MaSC) during mammary gland development and whether these functions differ during in MaSC self-renewal.

In ER+ breast cancer cells, ER is rapidly recruited to chromatin and ubiquitinated (52) after ligand binding. Ubiquitinated ER cycles on and off ERE sites to activate target gene transcription (30, 53). A large number of ER cofactors are recruited to chromatin in a tightly coordinated and dynamic manner within minutes after ligand administration (10, 54). Our results expand upon this knowledge and indicate that bursts of ER-driven transcriptional activity continue to occur many hours following estrogen stimulation. A large proportion of these transcriptional changes occur independently of chromatin accessibility. Instead, we propose that chromatin accessibility may be also required for recruitment of factors involved in gene repression (55, 56). Nevertheless, future analysis of both gene transcription and chromatin accessibility at the single-cell level will be instrumental to delineate in greater detail how hormone-induced transcriptional changes are coupled to changes in chromatin structure.

Previous study from our lab has shown that cPRC1 colocalizes with ER at active genes and enhancers to regulate their expression (15). However, the molecular mechanism by which RING1B regulates ER function is not known. Here, we propose that minutes after E2 administration, RING1B is recruited to chromatin by RNA molecules and/or ER cofactors in a cPRC1-independent context and that upon prolonged and constant E2 administration, a cPRC1 complex, containing CBX4 and PCGF2, is engaged to chromatin to maintain the transcriptional activity of enhancers and promoters required for proliferation of luminal breast cancer cells. Our efforts aimed to determine whether the RING1B enzymatic activity or interaction with the nucleosome is required for the regulation of estrogen-induced genes revealed a much more complex scenario than previously anticipated. Whether RING1B is an E3 ligase of nonhistone substrates in luminal breast cancer cells is not known. We hypothesize that in a subset of RING1B-ER cotarget genes and enhancers, RING1B binds to nucleosomes and ubiquitinates either a TF (e.g., ER, FOXA1, and GRHL2) or an epigenetic factor to stabilize their function (4, 30, 57). Ligand-bound ER is recruited to chromatin along with a number of E3 ligases (e.g., E6AP and BRCA1) that serve as coactivators not only to promote ER-driven gene expression but also to mediate ER ubiquitination and subsequent proteolysis through a mechanism known as activation-coupled ER degradation (4, 58, 59). RING1B might prove to be another E3 ligase of ER, although we did not detect RING1B-ER direct interaction in our previous study under stringent pull-down conditions (15), which may not capture transient interaction or indirect interaction through other cofactors. Mechanistically, our results suggest that the enzymatic activity of RING1B is required for its stable binding to chromatin, supporting a role of RING1B in monoubiquitinating cofactors recruited to RING1B/ER cotarget genes and enhancers. Further analyses are required to determine the exact role of RING1Bs activity in regulating specific sets of RING1B-ER cotargets during estrogen stimulation. Nonetheless, we propose that RING1B is required for maintaining the positive feedback loop of ER cycles in response to estrogen in luminal breast cancer.

We observed RING1B recruitment to EREs not occupied by ER. EREs can be occupied by ER and ER. ER has antiproliferative effects (60), is not expressed in T47D cells, and is not regulated by RING1B. These observations suggest that either RING1B is recruited to these sites after ER displacement or, in contrast, RING1B is a sensor that dictates future ER recruitment. We hypothesize the latter for two main reasons: (i) RING1B is recruited before the first on and off cycle of ER recruitment and displacement, which occurs at around 120 min after E2 addition (30), and (ii) after 24 hours of E2 administration, ER and RING1B are corecruited to sites that were previously only occupied by RING1B upon 45 min of estrogen exposure.

Last, our results establish the existence of relevant cooperative and functional interactions between RING1B, ER, and other key TFs central in regulating the estrogen-mediated transcriptional program. We propose that a defined binding arrangement of these factors dictates their interrelationships, resulting in a dynamic gene-regulatory network deployed during the early and late stimulation with estrogen to ensure rapid and constant transcriptional programs in luminal breast cancer.

MDA-MB-231, T47D, and MCF7 [American Type Culture Collection (ATCC) catalog #HTB-26, #HTB-133, and #HTB-22) were maintained at 37C with 5% CO2 and split every 2 to 3 days according to ATCC recommendations. Culture media was supplemented with 1 penicillin/streptomycin and 1 glutaMAX, and complete culture media for each cell line were as follows: MDA-MB-231, Dulbeccos modified Eagles medium with 10% fetal bovine serum (FBS); T47D, RPMI 1640 with 10% FBS and insulin (10 g/ml); MCF7, Eagles Minimum Essential Medium (EMEM) with 10% FBS and insulin (10 g/ml). When estrogen (10 nM E2, Sigma-Aldrich E2758-250MG) was added, cells were maintained in phenol-red free media and 5% charcoal-depleted FBS for 72 hours before treating with ethanol (vehicle) or E2. Cells were routinely tested to be free of mycoplasma infection.

For the 5-bromo-2-deoxyuridine (BrdU) incorporation analysis, cells (2 105/ml) were incubated for 30 min in culture medium containing 10 M BrdU. Then, cells were harvested, washed twice with 1 phosphate-buffered saline (PBS), and fixed in cold 70% ethanol overnight at 4C. After removal of ethanol, DNA was denatured with 2 N HCl supplemented with 0.5% Triton X-100 for 30 min at room temperature, then neutralized with two washes of 0.1 M sodium tetraborate (pH 9), and resuspended in 70% ethanol. Then, cells were recovered by centrifugation, washed once with 1 PBS, and resuspended in 100 l of blocking buffer [0.5% Tween 20 and 1% bovine serum albumin (BSA) in 1 PBS] containing 10 l of mouse anti-BrdU antibody (Becton Dickinson, #347580), and incubated at room temperature for 30 min. After a wash with 1 PBS, cells were incubated 15 min at room temperature with goat anti-mouse Alexa 647 antibody (Thermo Fisher Scientific, #A21236) diluted in blocking buffer. Last, cells were washed with 1 PBS once and resuspended in 1 PBS containing propidium iodide (5 g/ml) (Sigma) and analyzed using BD FACSCanto II (BD Biosciences) in the Flow Cytometry Shared Resource, Sylvester Comprehensive Cancer Center.

Cell proliferation was evaluated using the Cell Proliferation Dye eFluor 670 (Thermo Fisher Scientific) following the manufacturers specifications. Briefly, 5 million cells were incubated during 5 min at 37C with 10 M eFluor 670 in 1 PBS and 0.1% BSA. The reaction was stopped by adding complete media and incubated for 5 min at 37C. After washing the cells once with complete media, the cells were cultured under normal conditions. After 24 hours, cell populations were evaluated using BD FACSCanto II (BD Biosciences).

To produce shRNA lentiviruses, 2 106 human embryonic kidney 293T cells (ATCC #CRL-3216) were plated into a 10-cm2 plate and transfected 16 hours later with 8 g of pLKO-shRNAs (Addgene, #10879 for CTR; Sigma-Aldrich, #TRCN0000033697 for RING1B; and Sigma-Aldrich, #TRCN0000014881 for FOXA1), 2 g of pCMV-VSV-G, and 6 g of pCMV-dR8.91 plasmids using calcium phosphate. Seventy-two hours after transfection, the viral supernatant was collected, passed through a 0.45 M polyethersulfone filter, and used to transduce MDA-MB-231 and T47D cells. Specifically, 3 105 cells were plated into a six-well plate followed by the addition of viral media with polybrene (8 g/ml; Millipore-Sigma, #TR-1003-G). Cells were centrifuged for 1 hour at 1000g at 32C and then incubated overnight with fresh viral media. Viruses were removed and complete culture medium was added for cell recovery. Cells were selected 24 hours after recovery with puromycin (2 g/ml; Biogems, #5855822) and were maintained in selection. All experiments were performed within 2 weeks after transduction. The shRING1B oligos were cloned into the pLKO-tet-on plasmid, and LT3GEPIR-shRenilla luciferase was used as the doxycycline-inducible control. Lentiviruses were produced from the two plasmids as described above. Cells were treated with doxycycline (100 ng/ml) for 2 days before culturing them in HD media for 72 hours.

Doxycycline-inducible T47D shCTR and shRING1B cells were treated with doxycycline (100 ng/ml) for 3 days. After induction, 4000 shCTR and shRING1B cells were plated into individual wells in a 96-well plate. The medium was replaced 1 day after plating, and the cells were treated with 100 nM tamoxifen (4-hydroxytamoxifen; Sigma-Aldrich, H7904-5MG) or 30 nM fulvestrant (ICI 182780; Tocris, catalog #1047). The treatment medium was changed every 2 days, and the number of viable cells in culture was measured on days 0, 3, 5, and 7 using the CellTiter-Glo Luminescent Cell Viability Assay (Promega, G7572).

Stable T47D and MCF7 shCTR and shRING1B cells were first cultured in hormone-deprived media for 3 days. After hormone deprivation, 3000 T47D shCTR and shRING1B cells and 2000 MCF7 shCTR and shRING1B cells were each plated into three individual wells on a six- well plate. Cells were cultured in 2 ml of media containing either vehicle (ethanol) or vehicle plus 10 nM estrogen. Medium was refreshed every 3 days. After 2 weeks of culture (T47D) and 3 weeks of culture (MCF7), medium was removed, and colonies were stained with crystal violet (0.25 g of Crystal Violet; Sigma-Aldrich, C3886-25G; 13.5 ml of 37% Formaldehyde; Sigma-Aldrich, 252549-100; 5 ml of methanol; VWR, BDH20864.400; 1 PBS to 500 ml; Sigma-Aldrich, P3813-10PAK) for 20 min. After staining, the wells were gently washed by dipping the plates into a tub of running tap water to avoid disturbing the colonies on the plate surface. The plates were air-dried after thorough washing, and the colonies were imaged using an Epson V750 Pro photoscanner at 1200 dpi resolution. Colonies were quantified and analyzed using the ImageJ Plugin ColonyArea.

Cells were lysed in high-salt buffer [300 nM NaCl, 50 mM tris-HCl (pH 8), 10% glycerol, and 0.2% NP-40] supplemented with protease inhibitors (Sigma-Aldrich, #04693132001) and sonicated 5 min at 4C with a Bioruptor in 30 seconds ON-OFF cycles. After centrifugation at 16,000g for 15 min, soluble material was quantified by Bradford assay (Bio-Rad, #5000006). Western blotting was performed using standard protocols and imaged on an Odyssey CLx imaging system (Li-COR), and various exposures within the linear range were captured using Image Studio software. Images were rotated, resized, and cropped using Adobe Photoshop CC 2019 and imported into Adobe Illustrator CC 2019 to be assembled into figures.

MDA-MB-231 cells were grown to 50 to 60% confluency before dissociation with trypsin. A total of 5.6 106 cells were pelleted and washed with 1 PBS. Seven micrograms of HA-FOXA1-pCDNA3 and 8 g of HA-ER-pCDNA3 or 5 g of GFP-pCDNA3 were added to the cell pellet. Pellet was resuspended in Resuspension Buffer (Neon Transfection System 100 L Kit; Thermo Fisher Scientific, MPK10025) to a total volume of 100 l. Cells were electroporated with a Neon Transfection System (Thermo Fisher Scientific, MPK5000) at 1400 V, 10-ms pulse width, and a pulse number of 4. A total of 1.12 107 transfected cells were plated onto one P150 plate. Medium was replaced 24 hours later with growth media containing 10 nM E2, and the cells were collected for Western blotting, RT-qPCR, and ChIP assays 48 hours later.

A total of 6 105 freshly harvested cells were washed with cold 1 PBS and pelleted. Each pellet of cells was resuspended in 500 l of cold lysis buffer [10 mM tris-HCl (pH 8), 50 mM sodium bisulfite, 1% Triton X-100, 10 mM MgCl2, 8.6% sucrose, and 10 mM sodium butyrate, adjusted to pH 6.5] before centrifugation at 20,000g for 15 min at 4C. The supernatant was discarded and the pellet was kept on ice. Pellet was again resuspended in 500 l of cold lysis buffer before centrifugation at 20,000g for 15 min at 4C. The supernatant was also discarded. This step was repeated two more times. After a total of four rounds of lysis buffer treatment, the pellet was incubated for 1 hour at 4C in 100 l of 0.4 M H2SO4 and then centrifuged at 20,000g for 5 min. The supernatant was placed in a new microtube, and 900 l of acetone was added to the supernatant and stored at 20C overnight. The next day, samples were centrifuged at 20,000g for 10 min, and the supernatant was discarded. The pellet containing the histone was air-dried for 2 to 5 min and then resuspended in 30 to 50 l of water. Concentration of histones was measured by a Bradford assay.

ATAC-seq experiments were performed as we previously described (15). FASTQ data were processed using the ATAC-seq/ENCODE pipeline from the Kundaje lab (https://github.com/kundajelab/atac_dnase_pipelines) with default parameters and aligned to the hg19 genome. Homer annotatePeaks and findMotifsGenome were used for peak annotation and motif analysis, respectively. The TCseq Bioconductor package was used to visualize temporal patterns of ATAC-seq peaks. ATAC-seq heat maps and boxplots were created with R v.3.5.1 ComplexHeatmap and ggplot2 packages, respectively. Binary ATAC-seq heat maps were generated using Python v2.7.3 (https://gist.github.com/daler/07eb1a95f1e4639f22bd). Bedtools v2.26.0 was used to determine peak overlaps and NGS Plot v2.61 was used to generate density plots.

Cells were grown to 70 to 80% confluency on 150-cm2 plates, and typically six plates were used. Before and after treatment with 10 nM E2 for 45 min, 8 hours, and 24 hours, cells were washed once with 1 PBS. Cells were then cross-linked for 10 min in 10 ml of 1 PBS with 1 ml of 11% formaldehyde buffer [50 mM Hepes-KOH (pH 7.5), 100 mM NaCl, 1 mM EDTA, 0.5 mM EGTA, 11% formaldehyde; Thermo Fisher Scientific, #28908] before quenching with 0.5 ml of 2.5 M glycine for 5 min. Cells were then washed two times with 1 PBS. Cross-linked cells were harvested and washed once more with cold 1 PBS, and the pellet was flash-frozen in liquid nitrogen and stored at 80C. Magnetic beads were preblocked and antibody-bound before the addition of chromatin. For each ChIP, 50 l of Dynabeads Protein G (Invitrogen, #10004D) was washed three times with 1 ml of 0.5% BSA in 1 PBS (Sigma-Aldrich, A9418), using a magnetic stand to collect the magnetic beads in between washes. Beads were suspended in 250 l of the BSA solution, and 5 g (for nonhistone proteins) or 2 g (for histone modifications) of antibody was added (RING1B: Active Motif, #39664; ER: Diagenode, #15100066; FOXA1: Abcam, #ab23738; H3K27Ac: Abcam, #ab4729; GRHL2: Sigma, #HPA004820). For ChIP-seq experiments, 1 g of spike-in antibody was also added (Active Motif, #61686). Beads were incubated on a rotating platform overnight at 4C. The next day, the beads were washed three more times in the BSA solution before the chromatin was added. To prepare the chromatin, each pellet was resuspended in 2.5 ml of LB1 [50 mM Hepes-KOH (pH 7.5), 140 mM NaCl, 1 mM EDTA, 10% glycerol, 0.5% IGEPAL CA-630 (Sigma-Aldrich, I8896), and 10% Triton X-100] and rocked at 4C for 10 min. After spinning down at 1350g for 5 min at 4C, the pellets were resuspended in 2.5 ml of LB2 [10 mM tris-HCl (pH 8), 200 mM NaCl, 1 mM EDTA, and 0.5 mM EGTA] and rocked at room temperature for 10 min. Nuclei were pelleted at 1350g for 5 min at 4C before resuspension in 2 ml of LB3 [10 mM tris-HCl (pH 8), 100 mM NaCl, 1 mM EDTA, 0.5 mM EGTA, 0.1% Na-deoxycholate, and 0.5% N-lauroylsarcosine] and sonication using the Bioruptor Pico (Diagenode, #B01060010) at 4C in Bioruptor tubes with beads (Diagenode, #C01020031)10 cycles of 30 s on, 30s off, repeat with brief vortex in between. Two hundred microliters of 10% Triton X-100 was added to the sonicated lysate, which was spun at 20,000g for 15 min at 4C to pellet the debris. The chromatin (20 l) was decross-linked in 80 l of 1 PBS at 65C for 3 hours, purified using the QIAquick PCR Purification Kit (Qiagen, #28106), and quantified using Qubit. Chromatin (30 g) was added to the preblocked beads and gently mixed overnight on rotators at 4C. Spike-in chromatin (50 ng; Active Motif, #53083) was also added. The next day, the supernatant was discarded and the beads were washed 5 with radioimmunoprecipitation assay buffer [50 mM Hepes-KOH (pH 7.5), 500 mM LiCl, 1 mM EDTA, 1% IGEPAL, and 0.7% Na-deoxycholate], collecting the beads on the magnetic rack in between washes. Beads were washed once more with 1 ml of TE with 50 mM NaCl and spun down at 960g for 3 min at 4C to remove residual TE buffer. Beads were eluted in 210 l of elution buffer [50 mM tris-HCl (pH 8), 10 mM EDTA, and 1% SDS] at 65C for 15 min with brief vortexing every 2 min. Beads were spun down, and 200 l of supernatant was transferred to a new tube and decross-linked overnight at 65C with shaking at 1000 rpm. One percent of the chromatin input is also decross-linked in the same volume of elution buffer. The next day, 200 l of TE is added to the decross-linked samples, which were treated for 2 hours at 37C with ribonuclease A (0.2 g/ml) followed by 2 hours of proteinase K (0.2 g/ml; New England Biolabs, #P8107) at 55C. The immunoprecipitated DNA was purified using the QIAquick PCR Purification Kit and quantified via Qubit. Immunoprecipitated DNA was used to either perform ChIP-qPCR or generate libraries using the NEBNext Ultra DNA Library Prep Kit for Illumina (New England Biolabs, #E7370) following the manufacturers instructions. Libraries were visualized on a Tapestation 2200 using D1000 DNA ScreenTape (Agilent Technologies, #50675582) and quantified on a Qubit 3 fluorometer with Qubit double-stranded DNA high-sensitivity reagents (Thermo Fisher Scientific, #Q32851) following the manufacturers instructions, then pooled and sequenced (single-end, 75 bp) on a NextSeq 500. Processed data were viewed using the University of California, Santa Cruz (UCSC) genome browser. ChIP-qPCR was performed on a Bio-Rad CFX96 Real-Time System with iTaq Universal SYBR Green Supermix (Bio-Rad, #1725124) and analyzed with CFX Manager software (Bio-Rad).

All ChIP-seq data generated in this study were analyzed according to the following methodology: FASTQ data were processed with Trimmomatic v0.32 to remove low-quality reads and then aligned to the human genome hg19 using Burrows-Wheeler Aligner (BWA) v0.7.13 with the following parameters: aln -q 5 -l 32 -k 2. Duplicate reads were removed using Picard v1.126. Peaks were called using MACS2.1 with default parameters shiftsize 160 nomodel p 0.01 for all data. Whole-cell extract (input) from the corresponding cells was used as controls. Peaks with signal (fold enrichment over input generated from MACS2) > 4 and a q value < 0.05 were used for downstream analysis. BigWig file output from MACS v 2.1.0.20150731 was visualized in the UCSC genome browser. Homer annotatePeaks v4.8.3 was used for peak annotation. Bedtools v2.26.0 intersect was used to determine peak overlaps. NGS Plot v2.61 was used to generate heat maps and density plots.

ChIP-exo was performed using the ChIP-exo 5.0 protocol (39) with minor adaptations. Protein A Mag Sepharose (GE Healthcare) beads were preblocked and bound with antibody before the ChIP. Ten microliters of beads was washed three times with 500 l of 0.5% BSA in 1 PBS at 4C. Five micrograms of antibody was added to the washed beads, and the beads were resuspended in 250 l of the 0.5% BSA solution and allowed to incubate overnight on a rotating platform at 4C. The next day, the beads were washed three times in 500 l of 0.5% BSA solution. Sixty micrograms of chromatin was added to the beads, and the IP was performed in a total volume of 500 l of IP dilution buffer [20 mM tris-HCl (pH 8.0), 2 mM EDTA, 150 mM NaCl, and 1% Triton X-100] with protease inhibitors (Roche) at 4C overnight. A total of 120 g of chromatin (two samples with 60 g of chromatin) was used for each ChIP-exo experiment. In addition, NEBNext Multiplex Oligos for Illumina Index Primers and the Universal PCR Primer for Illumina were used instead of the ExA2_iNN and the ExA1-58 oligos. All other steps were identical to the original ChIP-exo 5.0 protocol.

FASTQ data were processed with cutadapt v1.15 (--nextseq-trim=20 -m 10) to remove low-quality reads and then aligned to the human genome hg19 using BWA v0.7.13 (aln -q 5 -l 32 -k 2). Peaks and motif subtypes were determined using ChExMix v0.41 and MEME v5.0.5 after filtering blacklisted regions and enabling a probability-based duplicate filter (--readfilter). Motif matching and motif distributions were determined using MEME-chip v5.0.2 with the JASPAR 2016 motif database. Peak distributions were determined using gaussian kernel function estimates of ChExMix motif aligned peaks.

SE and typical enhancers were defined using the ROSE pipeline with default parameters using H3K27ac ChIP-seq peaks as input.

FASTQ data were processed with cutadapt v1.15 (--nextseq-trim=20 -m 18) to remove low-quality reads. Expected gene counts were obtained using RSEM v1.3.0 and STAR v2.5.3a alignment to the human hg19 transcriptome (GENCODE V19 annotation). RUVseq v1.12.0 was used to adjust gene counts by removing unwanted variance using exogenous ERCC spike-in RNA. Differential expression was determined using DESeq2 v1.18.1 and R (version 3.4.1) with a q value < 0.05 and an FC > 2 (Wald test). Heat maps were generated using variance stabilized gene counts from DESeq2. For GSEAs, the Wald statistic of each time point compared to hormone-deprived conditions was used as input for the Preranked module of GSEA v3.0 on Hallmark gene sets (-scoring_scheme weighted nrom meandiv).

Acknowledgments: We are indebted to members of the Morey laboratory and Dr. Gloria Mas for discussions and the Oncogenomics Core Facility at the Sylvester Comprehensive Cancer Center for performing high-throughput sequencing. We also thank the Flow Cytometry Core Facility for assistance with cell sorting. We are grateful to F. Beckedorff for assisting with the ATAC-seq analysis and M. J. Rossi for providing technical help with the ChIP-exo experiments. Funding: This work was supported by Sylvester Comprehensive Cancer Center funds, AACR-Bayer Innovation and Discovery grant (18-80-44-MORE), Flight Attendant Medical Research Institute (FAMRI) Breast Cancer Developmental Grant, American Cancer Society (ACS; IRG-17-183-16), Stanley J. Glaser Foundation Research Award (UM-SJG-2020-3), Leukemia and Lymphoma Society Specialized Center of Research grant (LLS-SCOR), and the Lampert Breast Cancer Research Fund to L.M. Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health under Award Number P30CA240139. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Author contributions: L.M. and Y.Z. designed the study and analyzed the experiments with input from J.M.S. and R.E.V. Y.Z. conducted all the experiments except histone extractions, growth curves, and expression profiles in MCF7 cells (L.G.-M.), ATAC-seq analysis and colony formation assays (H.L.C.), and cell cycle profiles and BrdU assays (N.W. in the laboratory of R.E.V.). Bioinformatics analyses were performed by Y.Z., H.L.C., and D.L.K. (Bioinformatics core, Sylvester Comprehensive Cancer Center). D.L.K. performed ChIP-exo analysis. L.M. supervised the experiments and provided intellectual support toward interpretation of the results. L.M. and H.L.C. wrote the manuscript. Competing interests: The authors declare that they have no competing interests. Data and materials availability: All data needed to evaluate the conclusions in the paper are present in the paper and/or the Supplementary Materials. Additional data related to this paper may be requested from the authors. The genome-wide data of this study are deposited in the NCBI Gene Expression Omnibus (GEO) database: GSE137579.

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Estrogen induces dynamic ER and RING1B recruitment to control gene and enhancer activities in luminal breast cancer - Science Advances

Developing a COVID-19 Vaccine Quickly Proving to be a Daunting Task But Progress Still Expected – OrthoSpineNews

PALM BEACH, Florida,June 3, 2020/PRNewswire/ Rapid development of a vaccine to prevent the global health crisis is a global imperative, and defining the stakes and potential hurdles is critical because regulatory and medical decisions are based on benefit/risk calculations. The benefit of developing an effective vaccine is very high, and even greater if it can be deployed in time to prevent repeated or continuous epidemics. A recentarticlein the NEW ENGLAND JOURNAL of Medicine said: The need to rapidly develop a vaccine against SARS-CoV-2 comes at a time of explosion in basic scientific understanding, including in areas such as genomics and structural biology, that is supporting a new era in vaccine development. Over the past decade, the scientific community and the vaccine industry have been asked to respond urgently to epidemics of H1N1 influenza, Ebola, Zika, and now SARS-CoV-2. An H1N1 influenza vaccine was developed relatively rapidly, largely because influenza-vaccine technology was well developed and key regulators had previously decided that vaccines made using egg- and cell-based platforms could be licensed under the rules used for a strain change. Although a monovalent H1N1 vaccine was not available before the pandemic peaked in the Northern Hemisphere, it was available soon afterward as a stand-alone vaccine and was ultimately incorporated into commercially available seasonal influenza vaccines.Active biotech companies with recent developments include:Hoth Therapeutics, Inc.(NASDAQ:HOTH),Gilead Sciences, Inc.(NASDAQ:GILD),Inovio Pharmaceuticals, Inc.(NASDAQ:INO),Sorrento Therapeutics, Inc.(NASDAQ:SRNE),Vaxart, Inc.(NASDAQ:VXRT).

Thearticlecontinued: Multiple platforms are under development. Among those with the greatest potential for speed are DNA- and RNA-based platforms, followed by those for developing recombinant-subunit vaccines. RNA and DNA vaccines can be made quickly because they require no culture or fermentation, instead using synthetic processes. Developers and regulators experience with these platforms for personal oncology vaccines can facilitate rapid testing and release. There are no approved RNA vaccines to date, but RNA vaccines have entered clinical trials, and regulators have experience in reviewing clinical trial applications and with associated manufacturing of the vaccines.

Hoth Therapeutics, Inc.(NASDAQ:HOTH)BREAKING NEWS:Hoth Therapeutics Provides Shareholder Update on Therapeutics Pipeline Management provides pipeline update for assets including its COVID-19 vaccine and peptide therapeutic Hoth Therapeutics today is providing an update on its pipeline of therapeutics including six compounds in various stages of clinical development, targeting atopic dermatitis, lupus as well as a COVID-19 vaccine and peptide therapeutic.

Hoth has assembled a unique and portfolio of therapeutics, that is each addressing significant unmet market needs globally, stated Mr.Robb Knie, CEO of Hoth Therapeutics.We have partnered with some of the most renowned doctors, clinics, and scientific institutions as we strive to bring these innovative therapeutic solutions through the clinic. We have several significant milestones upcoming throughout the rest of 2020 into next year including our human study for BioLexa, targeting the treatment of eczema in adolescents.Management remains committed to developing, and bringing these novel treatments to market and improving the lives of those that require them.

BioLexa Platform (Dermatological) The BioLexa Platform is a proprietary antimicrobial therapy designed for the treatment of atopic dermatitis or eczema through a non-corticosteroid approach. InJanuary 2020, Hoth concluded its In-life 28-day animal study. The BioLexa Platform has recorded positive results from its pilot project in 2019 and most recently obtained strong data from initial animal testing. Additionally the Company is preparing to begin its first trial in humans later this year.

VNLG-152 (Dermatological) Earlier this year, Hoth acquired the full licensing rights of VNLG-152 novel retinamides (Retinoic acid metabolism blocking agents, or RAMBAs) for the treatment of dermatological diseases. The Company previously announced that pre-clinical work is underway at Weill Cornell Medicine to examine the efficacy of RAMBAs in blocking acne pathogenic gene expression and carcinogenesis in mice. Currently, Hoth is exploring whether VNLG-152 is capable of blocking this inflammatory response. Immediately after identifying an effective dose of VNLG-152, the researchers will conduct studies on mouse skin to determine if this drug is effective in blocking acne-like inflammation. As the Weill Cornell lab reopens later this month Hoth has intentions to finalize results of its preclinical work.

WEG-232 (Dermatological) Last year Hoth entered into a research agreement with theGeorge Washington University(GW) to explore the potential use of WEG-232 for topical and/or systemic therapy to counter the dermatological related side-effects of Erlotinib therapy in cancer patients. Erlotinib is a drug that is used to combat various cancers and has been known to cause varying degrees of skin rashes, lesions, hair loss and nail changes to patient.A recent research study suggested the topical application of WEG-232 could be very effective in suppressing erlotinib induced-facial rash/hair loss with approximate 71% reduction. It concluded that WEG-232 may be used as an effective intervention to prevent EGFR-TKI-induced cutaneous toxicity. Hoth looks forward to filing a pre-IND with the FDA this year to receive guidance and begin its human trial.

VaxCelerate (COVID-19) VaxCelerateis self-assembling vaccine (SAV) platform designed to protect patients at risk of Coronavirus (COVID-19) infection. VaxCelerate is believed to offer unique advantages over other compounds in combination therapy. In infectious applications, it allows rapid development against viruses and other pathogens. The vaccine focuses on both DNA and internal / external mutated proteins providing the immune system with more potential targets to attack. VaxCelerate is currently in animal trials and will share those results as the testing completes.

Novel Peptide Therapeutic (COVID-19) The Company recently licensedtechnology and intellectual property exclusively fromVirginia Commonwealth University(VCU) for a novel peptide therapeutic to prevent spike protein binding, a potential leading cause of COVID-19.This treatment could be a breakthrough in slowing the transmission of the virus. Current research is being led by inventor,Michael H. Peters, Ph.D., Professor, Department of Chemical and Life Science Engineering at VCU, College of Engineering.The work is being aided, in part, by powerful supercomputers as part of the COVID-19 High Performance Computing Consortium through a virtual system that scientists can use to interactively share computing resources known as the Extreme Science and Engineering Discovery Environment. Hoth hopes to have an update as to further collaboration with VCU in the month ahead.

AEA loaded into Z-pods(Lupus) Developedin partnership with Zyl Therapeutics, Hoths AEZ-loaded Z-podsare currently being tested for approval in the treatment of Cutaneous Lupus Erythematosus(CLE). Scientists have demonstrated that topical administration with AEA-loaded nanoparticles significantly prevents the development of CLE in an established animal model of lupus.

Exon Skipping Approach (Allergic Disease) During Q4 of 2019, Hoth enteredinto a licensing agreement withNorth Carolina State University(NC State) to studyNC StatesExon Skipping Approach for Treating Allergic Diseases. This Exon Skipping Approach was developed by Dr.Glenn Cruse, Principal Investigator and Assistant Professor in the Department of Molecular Biomedical Sciences at the NCState College of Veterinary Medicine. During Dr. Cruses research, a new approach for the technique of antisense oligonucleotide-mediated exon skipping to specifically target and down-regulate IgE receptor expression in mast cells was identified.Through this collaborative project, NCSU looks to establish the most effective approach for targeting genes that regulate surface expression of FcRI in mast cells that mediate allergic airway inflammation.Read the full Press Release and more for HOTH at:https://www.financialnewsmedia.com/news-hoth

Other industry developments from around the markets include:

Gilead Sciences, Inc.(NASDAQ:GILD)recentlyannouncedtopline results from the Phase 3 SIMPLE trial in hospitalized patients with moderate COVID-19 pneumonia. This open-label study evaluated 5-day and 10-day courses of the investigational antiviral remdesivir plus standard of care, versus standard of care alone. The study demonstrated that patients in the 5-day remdesivir treatment group were 65 percent more likely to have clinical improvement at Day 11 compared with those in the standard of care group (OR 1.65 [95% CI 1.09-2.48]; p=0.017). The odds of improvement in clinical status with the 10-day treatment course of remdesivir versus standard of care were also favorable, trending toward but not reaching statistical significance (OR 1.31 [95% CI 0.88-1.95]; p=0.18). No new safety signals were identified with remdesivir across either treatment group. Gilead plans to submit the full data for publication in a peer-reviewed journal in the coming weeks.

Our understanding of the spectrum of SARS-CoV-2 infection severity and presentations of COVID-19 continues to evolve, saidFrancisco Marty, MD, an infectious diseases physician at Brigham and Womens Hospital, and associate professor of medicine atHarvard Medical School. These study results offer additional encouraging data for remdesivir, showing that if we can intervene earlier in the disease process with a 5-day treatment course, we can significantly improve clinical outcomes for these patients.

Inovio Pharmaceuticals, Inc.(NASDAQ:INO)recentlyannouncedthe publication of the preclinical study data for IN0-4800, its COVID-19 DNA vaccine, demonstrating robust neutralizing antibody and T cell immune responses against coronavirus SARS-CoV-2. The study was published in the peer-reviewed journal Nature Communications titled, Immunogenicity of a DNA vaccine candidate for COVID-19 by INOVIO scientists and collaborators from The Wistar Institute, theUniversity ofTexas, Public Health England,Fudan University, and Advaccine.

Dr.Kate Broderick, INOVIOs Senior Vice President of R&D and the Team Lead for COVID-19 vaccine development, said,These positive preclinical results from our COVID-19 DNA vaccine (INO-4800) not only highlight the potency of our DNA medicines platform, but also build on our previously reported positive Phase 1/2a data from our vaccine against the coronavirus that causes MERS, which demonstrated near-100% seroconversion and neutralization from a similarly designed vaccine INO-4700. The potent neutralizing antibody and T cell immune responses generated in multiple animal models are supportive of our currently on-going INO-4800 clinical trials.

Sorrento Therapeutics, Inc.(NASDAQ:SRNE)recentlyannouncedit has received clearance from the U.S. Food and Drug Administration (FDA) for its investigational new drug (IND) application for STI-6129, a CD38-targeting antibody drug conjugate (ADC). STI-6129 utilizes several technology platforms that are under development by Sorrento Therapeutics, including a CD38 specific antibody identified from its fully human G-MABantibody library, its proprietary drug payload Duostatin 5 and its site-specific C-LOCK conjugation technology.

That the FDA cleared our STI-6129 IND application to proceed to human trials is another important milestone forSorrento, stated Dr.Henry Ji, Chairman and CEO of Sorrento Therapeutics. Together with our CD38 CAR-T program, this has the potential to provide additional therapeutic options for patients in need. We are looking forward to further evaluating the safety and efficacy of STI-6129 in clinical trials.

Vaxart, Inc.(NASDAQ:VXRT)a clinical-stage biotechnology company developing oral recombinant vaccines that are administered by tablet rather than by injection, recentlyannouncedthat it has selected its lead COVID-19 vaccine candidate and has contracted with KindredBio to manufacture bulk vaccine under cGMP to complement the manufacturing capacity of partner Emergent BioSolutions.

All our COVID-19 vaccine constructs were highly immunogenic in preclinical testing, and we are taking the candidate forward that is expected to generate the broadest immune response in humans, saidSean Tucker, Ph.D., chief scientific officer of Vaxart. In a phase 2 efficacy study that was recently published in theLancet Infectious Diseases, we have demonstrated that our oral H1 flu tablet vaccine protected against influenza infection after just one dose. Based on these results, we believe our vaccines are ideal to protect against mucosal respiratory viruses such as SARS-CoV-2, the virus that causes COVID-19.

InJanuary 2020, Vaxart initiated a program to develop a COVID-19 vaccine based on its VAASToral vaccines platform. The Company evaluated multiple vaccine candidates in its preclinical models and has chosen the lead candidate for cGMP manufacturing and clinical testing based on the magnitude and the breadth of the immune response. Vaxart has contracted with Emergent BioSolutions (Emergent) and Kindred Biosciences, Inc. (KindredBio) to produce bulk vaccine under cGMP for upcoming clinical trials. The vaccine tablets will be manufactured at Vaxart.

DISCLAIMER: FN Media Group LLC (FNM), which owns and operates Financialnewsmedia.com and MarketNewsUpdates.com, is a third- party publisher and news dissemination service provider, which disseminates electronic information through multiple online media channels. FNM is NOT affiliated in any manner with any company mentioned herein. FNM and its affiliated companies are a news dissemination solutions provider and are NOT a registered broker/dealer/analyst/adviser, holds no investment licenses and may NOT sell, offer to sell or offer to buy any security. FNMs market updates, news alerts and corporate profiles are NOT a solicitation or recommendation to buy, sell or hold securities.The material in this release is intended to be strictly informational and is NEVER to be construed or interpreted as research material. All readers are strongly urged to perform research and due diligence on their own and consult a licensed financial professional before considering any level of investing in stocks. All material included herein is republished content and details which were previously disseminated by the companies mentioned in this release. FNM is not liable for any investment decisions by its readers or subscribers. Investors are cautioned that they may lose all or a portion of their investment when investing in stocks. For current services performed FNM expects to be compensatedforty six hundred dollarsfor coverage of news issued by Hoth Therapeutics, Inc. by a non-affiliated third party.

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Developing a COVID-19 Vaccine Quickly Proving to be a Daunting Task But Progress Still Expected - OrthoSpineNews

Induced Pluripotent Stem Cells Market Growth Dynamics …

Induced pluripotent stem cells (iPSCs) hold profound potential in replacing the use of embryonic stem cells (ESCs) as important tool for drug discovery and development, disease modeling, and transplantation medicine. Advent of new approaches in reprogramming of somatic cells to produce iPSCs have considerably advanced stem cell research, and hence the induced pluripotent stem cells market. The iPSC technology has shown potential for disease modeling and gene therapy in various areas of regenerative medicine. Notable candidates are Parkinsons disease, spinal cord trauma, myocardial infarction, diabetes, leukemia, and heart ailments.

Over the past few years, researchers have come out with several clinically important changes in reprogramming process; a case in point is silencing retroviruses in the human genome. Molecular mechanisms that underlie reprogramming have gained better understanding. However, the tools based on this growing understanding are still in nascent stage. Several factors affect the efficiency of reprogramming, most notably chromosomal instability and tumor expression. These have hindered researchers to utilize the full therapeutic potential of iPSCs, reflecting an unmet need, and hence, a vast potential in the induced pluripotent stemcellsmarket.

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Global Induced Pluripotent Stem Cells Market: Growth Dynamics

The growing application of induced pluripotent stem cells in generating patient-specific stem cells for drug development and human disease models is a key dynamic shaping their demands. Growing focus on personalized regenerative cell therapies among medical researchers and healthcare proponents in various countries have catalyzed their scope of induced pluripotent stem cells market. Advent of new methods to induce safe reprogramming of cells have helped biotechnology companies improve the clinical safety and efficacy of the prevailing stem cells therapies. The relentless pursuit of alternative source of cell types for regenerative therapies has led industry players and the research fraternity to pin hopes on iPSCs to generate potentially a wide range of human cell types with therapeutic potential.

Advances pertaining to better utilizing of retrovirus and lentivirus as reprogramming transcription factors in recent years have expanded the avenue for players in the induced pluripotent stem cells market. Increasing focus on decreasing the clinical difference between ESCs and iPSCs in all its entirety has shaped current research in iPSC technologies, thus unlocking new, exciting potential for biotechnology and pharmaceutical industries.

Global Induced Pluripotent Stem Cells Market: Notable Development

Over the past few years, fast emerging markets in the global induced pluripotent stem cells are seeing the advent of patents that unveil new techniques for reprogramming of adult cells to reach embryonic stage. Particularly, the idea that these pluripotent stem cells can be made to form any cells in the body has galvanized companies to test their potential in human cell lines. Also, a few biotech companies have intensified their research efforts to improve the safety of and reduce the risk of genetic aberrations in their approved human cell lines. Recently, this has seen the form of collaborative efforts among them.

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Lineage Cell Therapeutics and AgeX Therapeutics have in December 2019 announced that they have applied for a patent for a new method for generating iPSCs. These are based on NIH-approved human cell lines, and have been undergoing clinical-stage programs in the treatment of dry macular degeneration and spinal cord injuries. The companies claim to include multiple techniques for reprogramming of animal somatic cells.

Such initiatives by biotech companies are expected to impart a solid push to the evolution of the induced pluripotent stem cells.

Global Induced Pluripotent Stem Cells Market: Regional Assessment

North America is one of the regions attracting colossal research funding and industry investments in induced pluripotent stem cells technologies. Continuous efforts of players to generate immune-matched supply of pluripotent cells to be used in disease modelling has been a key accelerator for growth. Meanwhile, Asia Pacific has also been showing a promising potential in the expansion of the prospects of the market. The rising number of programs for expanding stem cell-based therapy is opening new avenues in the market.

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Induced Pluripotent Stem Cells Market Growth Dynamics ...

Doctor has seen a surge in men asking for penis injections – Metro.co.uk

Dr Shirin Lakhani says she receives five enquiries a day about penis injections (Picture: Getty/Metro.co.uk

Could time in lockdown be upping the pressure for men to last longer in bed and have rock-hard erections at a moments notice?

A leading intimate health specialist and doctor, Dr Shirin Lakhani, says shes seen a dramatic rise in enquiries for her P-shot procedure a treatment that sees blood injected into the penis since lockdown came into place.

She reckons this may be down to all the stress of the pandemic from lost income to health-related anxieties causing erectile issues and other struggles in bed, along with dips in sex drives.

But she also believes that all the time cooped up at home might allow previously hidden sexual issues to become apparent to the persons partner.

As a result, Dr Lakhani has seen a huge increase in the number of men getting in touch to ask about her treatment, receiving five enquiries a day since lockdown began.

The P-shot procedure, also known as the Priapus Shot, involves injecting the penis with a patients own platelet rich plasma, which its thought can stimulate the growth of new tissue and increase blood flow, thus strengthening erections and enhancing the peniss appearance, too.

Its similar to the vampire facial youve likely heard about except the needle is going into your penis instead of your face.

The treatment costs 1,200, so yes, its on the pricey side.

A lot of the men Im hearing from have struggled with sexual intercourse for years but have until now managed to hide the fact that they are unable to get an erection or cant ejaculate, says Dr Lakhani. Before lockdown they managed to hide their problem behind the fact that they were tired from work or because they were physically away a lot due to work.

Now though with the country stuck in lockdown problems such as these are impossible to ignore.

Once upon a time sexual dysfunction, or the difficulty by an individual or couple during any normal sexual activity, including pleasure, desire, preference, arousal or orgasm, was very much a taboo subject.

At times like this people are turning to social media more and beginning to realise how many options there are out there to help treat sexual dysfunction. And with studies showing that at least a third of us have experienced these types of problems at some point in our lives, its certainly widespread.

The P-shot is among a large swell in cosmetic procedures aimed squarely at boosting mens genitals, from one type of injection that a surgeon claims can increase the size of a penis by two inches to the trend for getting filler to make the testicles larger.

If you do choose to go down the route of injections or other cosmetic treatments, remember that these are medical treatments that need to be done by a professional in a safe and sanitised setting. Just because were talking about injections rather than in-depth surgery doesnt mean the risks disappear, and getting shots from a dodgy practitioner could leave you with far more severe penis problems than you started with.

But while such cosmetic treatments could help to tweak certain parts of a mans appearance and sexual performance, its vital to explore all options before rushing into any procedure.

Longterm difficulties getting or maintaining an erection can be caused by all sorts of factors, including depression, stress, heart disease, and high cholesterol all of which need addressing by a medical professional.

If erectile dysfunction is a symptom of another issue, its crucial to talk to your GP to get to the root of the problem rather than just tackling one more obvious way an illness might be rearing its head.

Plus, you could end up saving yourself time, pain, and money by figuring out a more obvious cause and solution for problems in the bedroom reducing your stress levels and improving communication with your partner are both free, FYI.

The main thing is that in this day and age no man should suffer these symptoms in silence, says Dr Lakhani. They can not only impact on a man physically but also over a prolonged period of time place a huge pressure on mental health.

Being comfortable in your own skin is a major factor in promoting sexual health. Its not about being perfect, its about body confidence, good health and communication with your partner.

Many men and women dont talk about their intimate health and find it embarrassing to seek help but it doesnt have to be a taboo subject.

We should feel comfortable enough to talk about the issues we experience with intimate health and everyone should be allowed to enjoy sex.

Do you have a story to share? Get in touch by emailing MetroLifestyleTeam@Metro.co.uk.

Share your views in the comments section below.

MORE: What you need to know about safely sending nudes

MORE: You can now order face masks with penises and boobs on them

MORE: The man who created a dating app for small penises has made another for big ones

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Doctor has seen a surge in men asking for penis injections - Metro.co.uk

Creating hairy human skin: Not as easy as you think – Science Codex

For more than 40 years, scientists and commercial companies have been recreating human skin in laboratories around the world. Yet all of these products lack important aspects of normal skin--hair, nerves, and fat.

In new research, cultured human skin cells embedded with fat and nerves and capable of growing hair are a reality. The achievement represents more than five years of study that started in the laboratory of Karl Koehler, PhD (then at Indiana University School of Medicine) and completed in Koehler's new laboratory at Boston Children's Hospital in the departments of otolaryngology and communication enhancement and plastic and oral surgery research. The technique appears in a paper published this week in Nature.

"In this latest work, we discovered a way to grow both layers of human skin together," says Koehler, referring to the top and bottom layers of human skin (the epidermis and dermis, respectively). "Those cells talk to each other in a skin organoid culture - or skin in a dish we created - and sprout hair follicles accompanied by fat cells and neurons."

Taking the discovery a step further, the team transplanted the human hairy skin into mice. The mice eventually sprouted human hair follicles at the site of transplantation. Potential applications include testing cosmetics, drugs, and burn treatments.

Skin in a dish includes mini organs

Skin in a dish models are not new. And like many, Koehler and his colleagues thought that the challenge of growing fully functional, hairy skin cells, had long been solved. Skin cells are some of the first cells to have been grown in cultures outside of the body and incubator.

But the skin that people make in a dish never has mini organs or appendages, like hair follicles or sweat glands, embedded in the skin. These mini organs are important for heat regulation, touch sensation, and appearance.

In 2018, the team published a paper showing they could generate hairy skin from mouse stem cells. To create human hairy skin cells, the team started with human induced pluripotent stem cells, which are human adult skin cells that are coaxed back to an embryonic form.

"So we applied a cocktail of growth factors and small molecules, kind of a cooking recipe for human pluripotent stem cells," says Koehler.

The team first noticed co-development of skin epidermis and the dermis. The interaction and signaling between the two tissue layers led to budding of hair follicles at 70 days, which lines up well with the timing of hair development in the human fetus.

In addition to growing hair, the organoids produce fat and muscle-like cells of the skin, as well as, nerves similar to those that mediate touch sensation. "The fat is an unsung hero of the skin and recent studies suggest it plays a critical role in wound healing," says Jiyoon Lee, PhD, first-author on the paper and research associate in the department of otolaryngology at Boston Children's Hospital.

The organoids also produce Merkel cells, specialized touch responsive cells of the skin that have also been implicated in diseases such as Merkel cell carcinoma. "The inclusion of these other cell types likely expands the potential uses of the skin organoid model to research on sensory disorders and cancer," she adds.

Mice grew pigmented human hairs

To see if the technique worked in a living animal, the team cultured the organoids for over four months and then implanted them on the back of mice specially developed not to reject the grafts. "We noticed that within a month, tiny brown hairs sprang up from the transplant site," explains Lee. "This showed us, amazingly, that pigment cells also developed in the organoids."

They compared the transplanted skin with adult human skin samples observing several unique features of human skin in the transplants. One includes 'rete ridges' or valleys in the wavy pattern of human epidermis that helps anchor it into skin membranes. And, the transplanted hair developed elaborate sebaceous glands that produced sebum, the natural oil that lubricates human skin.

An unexpected and fortuitous discovery

This new discovery is literally an outgrowth of work Koehler began at Indiana University when working on a system of recapitulating the inner ear. His goal at the time was to create cells that sense auditory stimuli - sound - to model hearing loss disorders and test gene therapies for hearing loss and balance disorders.

There, he manipulated human induced pluripotent stem cells with the same cocktail of chemicals and proteins used during normal embryonic development guiding them to become inner ear structures.

In the production of this technique, as the inner ear cells were budding during early development, the team found that skin tissue formed as a byproduct.

"This was surprising and we initially tried to get rid of the skin tissue, thinking it was a pesky off-target tissue, like a weed in a garden," recalls Koehler. "Once we saw the scientific value of growing hairy skin in dish, we switched tactics, trying to eliminate the inner ear organoids in favor of growing skin."

In their purification attempts, they discovered that the skin tissue contained both layers of skin, epidermis and dermis. In culture, the skin formed outgrowing hair follicles.

A proof of concept

Translating any mouse study into humans is a long road. "But we think we have developed a proof of concept showing that the cells integrate into skin and form outgrowing hair follicles," says Koehler.

The team hopes that in the long term, they can use the technology to seed wound beds with cultured skin to reconstruct skin, such as in the case of extensive burns or scars.

And while it might be tempting to think of the approach as a "cure" for baldness, Koehler cautions that many challenges lay ahead. "We now have a technique that could generate nearly unlimited hair follicles for transplantation" he says. "But immune rejection is a major hurdle and generating follicles tailored to an individual will be incredibly costly and take a year or more." To meet these challenges, the team is working on ways to accelerate development in a dish, engineer organoids to evade immune detection, or produce similar skin organoids from adult patient-derived cells.

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Creating hairy human skin: Not as easy as you think - Science Codex

Sickle cell treatment then and now – SCNow

Five years ago, we had only one treatment for sickle cell disease, a disease that should not be taken lightly.

This disease can be a pain-generating disease that actually affects all organs of the body. This can start at the heart, blood vessels, brain, joints, bones and also the lungs.

Sickle cell is due to a mutation of a tiny gene that leads to an unstable hemoglobin. The sickles in the hemoglobin, when stressed, deprive tissue from oxygen that can lead to what we call crisis.

Crisis starts with pain, but it can also lead to stroke, heart attack and limb loss. Sickle cell crisis is when the abnormal cell gets stuck in the small blood vessels.

Sickle cell disease affects approximately 100,000 people in the United States. For years, the only therapeutic option was Hydroxyurea. This drug has been in existence since 1984. We know that this drug works, since it has proved to be effective in increasing hemoglobin, reducing pain and acute chest syndrome.

This drug has also decreased the number of blood transfusions in patients who suffer from sickle cell disease. Unfortunately, Hydroxyurea is chemotherapy and requires close monitoring. This therapy works over time with each patient; therefore, not all patients will respond equally. Since Hydroxyurea was introduced, there has been a need for new treatments. For the past several years, more therapies have started to emerge.

The first notable drug that has been FDA approved in 2017, since Hydroxyurea, is L-glutamine (Endari). This drug works on the inflammatory part of the disease. It has also proved to decrease the number of pain crisis and lessen acute chest syndrome.

The second drug is Voxelotor. This drug is a once-daily pill that stabilizes the oxygenated hemoglobin. Trials have proved to make patients less anemic, but events are not necessarily less painful. More long-term studies are looking at this issue. This drug is available, and FDA approved, through an accelerated program.

The third drug is Crizanlizumab. This drug helps with the stickiness of the red blood cells against the sticky vessel wall. This is one of the detrimental aspects of this disease. A randomized study called SUSTAIN proved that this intravenous drug decreases the number of painful crisis. This drug was FDA approved through a breakthrough therapy program.

Lastly, there is gene therapy. This type of treatment consists of an auto stem cell transplant of a viral infected, anti-sticking hemoglobin. This therapy still requires chemotherapy to wipe out the bone marrow so that space can be made for the transplant. The results of this treatment have been very successful.

Many promising therapies are seeing the light and are changing the care of this complex disease so that patients with sickle cell disease can lead a semi-normal lifestyle.

Dr. Ziad Skaff is board certified in hematology and oncology. He serves as chief of staff of MUSC Health-Florence Medical Center and Medical Director of Oncology Services. Dr. Skaff is associated with MUSC Health Hematology & Oncology, located at 805 Pamplico Highway, Medical Pavilion A, Suite 315. To schedule an appointment, call 843-674-6460.

Link:
Sickle cell treatment then and now - SCNow

FTC Sends Wave of Warning Letters to Stop Unsupported Claims Products and Therapies Effectively Prevent or Treat COVID-19 – MyChesCo

WASHINGTON, D.C. The Federal Trade Commission announced it has sent letters warning 35 more marketers nationwide to stop making unsubstantiated claims that their products and therapies can treat or prevent COVID-19, the disease caused by the novel coronavirus.

This is the sixth set of warning letters the FTC has announced as part of its ongoing efforts to protect consumers from health-related COVID-19 scams. In all, the Commission has sent similar letters to more than 160 companies and individuals.

Most of the letters announced this week target treatments offered in clinics or medical offices, including intravenous (IV) Vitamin C and D infusions, supposed stem cell therapy, and vitamin injections that may at first glance appear to be based in medicine or proven effective. However, currently there is no scientific evidence that these, or any, products or services can treat or cure COVID-19.

The FTC sent the letters to the companies and individuals listed below. The recipients are grouped based on the type of therapy, product, or service they pitched as preventing or treating COVID-19.

Intravenous (IV) and Ozone Therapies, Immunity Boosting Injections:

Stem Cell Treatments:

Electromagnetic Field Blocking Patches:

Essential Oils:

Homeopathic Treatments:

Vitamins, Supplements, Silver, and Chinese Herbal Treatments:

In the letters, the FTC states that one or more of the efficacy claims made by the marketers are unsubstantiated because they are not supported by scientific evidence, and therefore violate the FTC Act. The letters advise the recipients to immediately stop making all claims that their products can treat or cure COVID-19, and to notify the Commission within 48 hours about the specific actions they have taken to address the agencys concerns.

The letters also note that if the false claims do not cease, the Commission may seek a federal court injunction and an order requiring money to be refunded to consumers. In April, the FTC announced itsfirst case against a marketer of such products, Marc Ching, doing business as Whole Leaf Organics.

The FTC worked in coordination with the Office of the Texas Attorney General in issuing the warning letter to Hot Springs Biofeedback, and appreciates its assistance.

Thanks for visiting! MyChesCo brings reliable information and resources to Chester County, Pennsylvania. Please consider supporting us in our efforts. Your generous donation will help us continue this work and keep it free of charge. Show your support today by clicking here and becoming a patron.

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FTC Sends Wave of Warning Letters to Stop Unsupported Claims Products and Therapies Effectively Prevent or Treat COVID-19 - MyChesCo

Ide-cel Appears Active in Almost Three-Fourths of Heavily Pretreated Patients with Myeloma – Cancer Network

Idecabtagene vicleucel (ide-cel; bb2121), a BCMA-targeting CAR T-cell therapy, yielded a response in73% of patients with heavily pretreated relapsed/refractory multiple myeloma, according to topline findings from the pivotal phase 2 KarMMA trial shared during the 2020 ASCO Virtual Scientific Program.

In the study, 33% of patients had a complete response with ide-cel. The median duration of response (DOR) was 10.7 months, and the median progression-free survival (PFS) was 8.8 months (95% CI, 5.6-11.6).

Ide-cel demonstrated frequent, deep, and durable responses in heavily pretreated, highly relapsed/refractory patients with myeloma, said Nikhil C. Munshi, MD, director of Basic and Correlative Science, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, professor of Medicine, Harvard Medical School. Overall, ide-cel provides an attractive option for the treatment of patients with triple-class exposed relapsed/refractory myeloma.

In March 2020, Bristol Myers Squibb and bluebird bio, Inc., the codevelopers of ide-cel, submitted a Biologics License Application (BLA) to the FDA for the use of the CAR T-cell therapy as a treatment for adult patients with multiple myeloma who have received at least 3 prior therapies, including an immunomodulatory agent, a proteasome inhibitor, and an anti-CD38 antibody.

However, earlier this month, the FDA issued a Refusal to File letter to the companies regarding the BLA. In its initial review, the agency concluded that additional information was needed for the Chemistry, Manufacturing and Control module of the BLA. The FDA did not ask for any further clinical or nonclinical data according to the companies, which plan to resubmit the application by the end of July of this year.

The phase 2 KarMMA trial (NCT03361748) included 128 patients with relapsed/refractory multiple myeloma who received at least 3 prior therapies, including an immunomodulatory agent, a proteasome inhibitor, and an anti-CD38 antibody.

The median age was 61 months (range 33-78), 35% of patients had high-risk cytogenetics, 51% had high tumor burden, 39% had extramedullary disease, and 85% had 50% tumor BCMA expression. ECOG performance status was 0 (45%), 1 (53%), or 2 (2%). R-ISS disease stage was I (11%), 2 (70%), or III (16%). Patients had received a median of 6 (range, 3-16) prior antimyeloma regimens.

Ninety-four percent of patients had received 1 prior autologous stem cell transplant, and 34% had received more than 1. Eighty-eight percent of patients received bridging therapies during CAR T-cell manufacturing; however, only 4% of patients responded to the treatment. Regarding refractory status, 94% of patients were refractory to anti-CD38 antibodies and 84% were triple refractory.

Patients were treated at CAR+ T cell doses of 150 x 106 (n = 4), 300 x 106 (n = 70), or 450 x 106 (n = 54). The median follow-up was 18 months, 15.8 months, and 12.4 months, respectively. Across all patients, the median follow-up was 13.3 months. The primary end point was ORR, with secondary end points including CR, DOR, PFS, overall survival (OS), and quality of life.

Across all patients, the 73% ORR (95% CI, 65.8-81.1; P <.0001) included a 33% CR rate (95% CI, 24.7-40.9; P <.0001), a 20% very good partial response rate, and a 21% partial response rate. The overall CR rate comprised 26% of patients who achieved a CR/stringent CR (sCR) and were minimal residual disease (MRD)-negative, and 7% of patients who achieved a CR/sCR but who did not have MRD data. The median time to first response was 1 month (range, 0.5-8.8) and the median time to CR was 2.8 months (range, 1-11.8).

Durable responses were observed across all doses, said Munshi. At the dose of 450 x 106 CAR+ T cells, the ORR was 82% and the CR/sCR rate was 39%.

Clinically meaningful efficacy in terms of ORR was observed across subgroups, irrespective of age, risk categorization, tumor burden, BCMA expression level, extramedullary disease, triple-refractory status, penta-refractory status, and bridging therapy.

PFS increased as the target dose increased. At the 450 x 106 CAR+ T-cell dose, the median PFS was 12.1 months (95% CI, 8.8-12.3). The median PFS also increased by depth of response with a median of 20.2 months (95% CI, 12.3not evaluable) among patients who achieved a CR/sCR.

Munshi said the survival data are immature. At the time of the analysis, the median OS was 19.4 months (95% CI, 18.2not evaluable) and the 1-year OS rate was 78%.

Cytokine release syndrome (CRS) frequency increased with dose but was mostly low-grade, said Munshi. Overall, 84% of patients had 1 CRS event, with the majority (78%) being grade 1/2. There were 5 cases of grade 3 CRS, 1 case of grade 4, and 1 case of grade 5. The median time to onset of CRS was 1 day (range, 1-12), and the median duration of CRS was 5 days (range, 1-63). Fifty-two percent of patients received tocilizumab (Actemra) for CRS management, and 15% of patients received corticosteroids.

Neurotoxicity was mostly low grade and was similar across target doses, said Munshi. Overall, 18% of patients had 1 neurotoxicity event. There were 19 cases of grade 1/2 neurotoxicity and 4 cases of grade 3. There were no grade 4 or 5 incidents. The median time to onset of neurotoxicity was 2 days (range, 1-10), and the median duration was 3 days (range, 1-26). Two percent of patients received tocilizumab for neurotoxicity, and 8% of patients received corticosteroids.

The other significant adverse event, according to Munshi, was cytopenia91% of patients had any grade neutropenia (89% grade 3), and 63% (52% grade 3) had any grade thrombocytopenia. The median time to recovery of grade 3 neutropenia and thrombocytopenia was 2 months and 3 months, respectively, said Munshi.

There were 5 deaths within 8 weeks of ide-cel infusion2 following myeloma progression and 3 from AEs (CRS, aspergillus pneumonia, and GI hemorrhage). There was also 1 other AE-related death (CMV pneumonia) that occurred within 6 months, in the absence of myeloma progression.

Reference:

Munshi NC, Anderson Jr LD, Jagannath S, et al. Idecabtagene vicleucel (ide-cel; bb2121), a BCMA-targeted CAR T-cell therapy, in patients with relapsed and refractory multiple myeloma (RRMM): Initial KarMMa results. Presented at: 2020 ASCO Virtual Scientific Program; May 29-31, 2020. Abstract 8503.

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Ide-cel Appears Active in Almost Three-Fourths of Heavily Pretreated Patients with Myeloma - Cancer Network

Cirmtuzumab Added to Ibrutinib Induces Responses in R/R MCL and CLL – Targeted Oncology

Compelling objective responses and safety results were demonstrated with the combination of cirmtuzumab (UC-961) and ibrutinib (Imbruvica) in cohorts of patients with mantle cell lymphoma (MCL) and chronic lymphocytic leukemia (CLL), who were treated in the phase 1b/2 clinical trial (NCT03088878).1

A group of investigators led by Hun Ju Lee, MD, hypothesized that cirmtuzumab/ibrutinib would increase activity, deepen responses, and extend the durability of responses compared to ibrutinib alone based on the mechanism of action of cirmtuzumab, a monoclonal antibody that addresses re-expressed ROR1 in hematologic malignancies and solid tumors. As a single agent, cirmtuzumab led to antitumor activity in an earlier study and it was suggested that the drug could be additive to the effects of Brutons tyrosine kinase (BTK) inhibitors. It was also hypothesized that the addition of cirmtuzumab to ibrutinib would not interfere with the tolerable safety profile of either agent.

The study enrolled patients with relapsed/refractory (r/r) MCL or r/r CLL and small lymphocytic leukemia (SLL) who had measurable disease and little or no prior exposure to BTK inhibitor therapy. Overall, the study included 46 patients, 12 of whom were evaluable to be enrolled in the MCL cohort and 34 evaluable for the CLL/SLL cohort. At baseline, the MCL cohort showed a median of 2.5 prior treatment regimens (range, 1.0-5.0). The prior regimens consisted of chemotherapy, biologics, PI3K/BCL-2 inhibitors, stem cell transplant, and chimeric antigen receptor (CAR) T-cell therapy. In the CLL/SLL cohort, the median number of prior regimens was 2.0 (range, 1.0-9.0), which consisted of chemotherapy, biologics, and PI3K/BCL-2 inhibitors.

Ten out of 12 evaluable patients in the MCL cohort had an objective response as their best response (83.3%). Of the patients with MCL who had an objective response, 58.3% had a complete response (CR), 25% had a partial response (PR), and 16.7% had stable disease (SD). These responses led to a clinical benefit rate of 100% in the MCL cohort. Thirty of the 34 evaluable patients with CLL or SLL achieved an objective response, which included a CR in 3% of the cohort, a PR or PR with lymphocytosis in 85%, and SD in 12%. The clinical benefit rate for the CLL/SLL cohort was also 100%. Neither cohort had any cases of progressive disease.

Lee et al noted in a swimmer plot that the majority of patients in the MCL cohort who achieved CRs did so in less than 5 months. A large majority of the complete responders in the MCL cohort also had prior ibrutinib. In a presentation of the poster, Lee stated that this signaled synergy between cirmtuzumab and ibrutinib. The CLL/SLL cohort did not show any notable signals for response.

The waterfall plots showed significant tumor regression in both cohorts.

At a median follow-up of 8.3 months, the MCL cohort showed a 17.5-month median progression-free survival (PFS), which showed favorable comparability to historical data from a pooled analysis of 3 clinical trials published in a 2019 issue of Haematologica2 that showed a PFS of 12.5 months with ibrutinib monotherapy in patients with r/r MCL and 10.3 months in patients with more than 1 prior line of therapy.

Median follow-up in the CLL cohort was 12.8 months, but the median PFS had not yet been reached.

The safety analysis showed that the combination of cirmtuzumab and ibrutinib was well tolerated in patients with MCL and CLL, with most adverse events (AEs) being grades 1 or 2 in severity. There were no dose-limiting toxicities or grade 3 events observed in the study that were found to be related to cirmtuzumab. Fatigue, diarrhea, and contusion were frequent AEs that were potentially related to cirmtuzumab alone or in combination with ibrutinib. Six subjects (8.6%) experienced any-grade neutropenia, which is known to occur in 50% to 60% of patients who received ibrutinib, according to the prescribing information.

Serious treatment-related AEs occurred in 1 patient with MCL and 9 patients with CLL, which were likely related to ibrutinib or ibrutinib plus cirmtuzumab. The serious AEs of grade 3 or higher included atrial fibrillation in 5 patients; pneumonia in 3; and pericardial hemorrhage, pleural effusion, pyrexia, hyperkalemia, gastrointestinal hemorrhage, and staph infection, which occurred in 1 patient each.

A larger proportion of patients in the MCL cohort (86.7%) experienced treatment-emergent AEs (TEAEs) of any grade than in the CLL cohort (83.6%). The same was true for grade 3 or higher TEAEs. The combination regimen was overall well tolerated.

Three patients with CLL in the study discontinued treatment due to AEs. There was also 1 patient who opted for alternative therapy and another patient who required therapy for pre-existing prostate cancer. Three patients with MCL discontinued treatment due to PD. Also, one patient with CLL was diagnosed with coronavirus disease 2019 but has a good prognosis overall.

At the time of data cutoff, the majority of the study population had completed 1 year of treatment with cirmtuzumab/ibrutinib. Sixteen individuals from the CLL cohort has also enrolled in the extended therapy while continuing treatment with cirmtuzumab plus ibrutinib.

Overall the study of cirmtuzumab in combination with ibrutinib was encouraging.

All patients in the study were 18 years of age or older with an ECOG performance status of 3 or lower, radiographically measurable disease, and in need of treatment of their disease. The study was conducted in 3 parts: dose escalation, dose expansion, and phase 2 randomization to cirmtuzumab/ibrutinib versus ibrutinib alone. Part 1 has completed enrollment, whereas parts 2 and 3 continue to accrue patients.

References:

1. Lee HJ, Choi MY, Siddiqi T, et al. Clinical activity of cirmtuzumab, an anti-ROR1 antibody, in combination with ibrutinib: Interim results of a phase Ib/II study in mantle cell lymphoma (MCL) or chronic lymphocytic leukemia (CLL). J Clin Oncol. 2020;38(suppl)8036. doi:10.1200/JCO.2020.38.15_suppl.8036

2. Rule S, Dreyling M, Goy A, et al. Ibrutinib for the Treatment of Relapsed/Refractory Mantle Cell Lymphoma: Extended 3.5-year Follow Up From a Pooled Analysis. Haematologica. 2019;104(5):e211-e214. doi:10.3324/haematol.2018.205229

Continued here:
Cirmtuzumab Added to Ibrutinib Induces Responses in R/R MCL and CLL - Targeted Oncology

Better Outcomes Observed With CAR T-Cell Therapy in Younger Patients With R/R DLBCL – Targeted Oncology

Chimeric antigen receptor (CAR) T-cell therapy lead to poor overall survival (OS) outcomes it patients who were 75 years or older with relapsed/refractory diffuse large B-cell lymphoma (DLBCL) compared with patients aged 70 to 74 years, but progression-free survival was comparable between the 2 groups, according to results from a real-world analysis.

The primary objective of this study was to evaluate the efficacy and safety of CAR T cells in patients with relapsed/refractory DLBCL who are 70 years old or older. The retrospective analysis enrolled patients who were treated with either axicabtagene ciloleucel (axi-cel) or tisagenlecleucel (tisa-cel) at 5 academic medical centers in the United States. Patients were divided to 2 groups by age, including those aged 70 to 74 years old and those who were 75 years or older.

For this analysis, investigators collected baseline patient demographics, tumor characteristics, and CAR-T infusion data, then calculated the cumulative illness rating score (CIRS) and the hematopoietic cell transplantation-specific comorbidity index (HCT-CI).

The median PFS was among patients between the ages of 70 and 74 was 12 months compared with 9.4 months in those who were 75 years of age or older. The difference was P = 0.22, which was not significant. PFS was improved with the use of axi-cel in patients with transformed lymphomas (HR, 0.07; P<.001). LDH above the upper limit of normal prior to infusion was associated with a worse PFS (HR, 6.5; P<.001), and this group also was associated with a worse OS (HR, 7.4; P =.001).

The median OS was not reached in the 70 to 74 age group and was 7.8 months for the 75 year or older group, showing a difference of P = 0.049.

In the analysis, CIRS scores of 6 or greater, (OR, 3.92; P =.002), as well as axi-cel (OR, 44.9; P =.006) were associated with grade 3/4 cytokine release syndrome (CRS). Patients 75 years or older were also associated with grade 3/4 CRS (OR, 6.1; P =.003), as well as CIRS of 6 or greater (OR, 3.92; P =.04) and the use of axi-cel as treatment (OR, 44.9; P <.0001).

A worse OS was observed among those who were aged 75 years or older, but investigators did not see a difference in PFS among these patients compared to the younger group in the analysis.

Overall, higher CIRS appeared predictive of more grade 3/4 CIRS and ICANS, according to this analysis. LDH above the upper limit of normal prior to CAR T-cell infusion appeared to be associated with a worse PFS and OS in these patients.

In the younger group, the ECOG performance status was 0 in 10 patients (21.3%), 1 in 33 patients (70.2 %) or 2 or greater in 4 patients (8.5%), while the status in the older age group was 0 in 6 patients (21.4%), 1 in 18 patients (64.3%), and 2 or greater in 4 patients (14.3%). Seventeen patients (36.3%) in the younger age group had transformed from indolent lymphoma compared with 9 patients (30%) in the older age group. The cell of origin in the younger versus older age groups was GCB in 25 (53/2%) versus 15 (50.0%), ABC in 16 (34.0%) versus 11 (36.7%), and unknown in 6 (12.8%) versus 4 (13.3%), respectively.

Nine patients in the younger group (19.1%) were double- or triple-hit versus 3 patients (10%) in patients 75 years or older. The median number of prior lines was 2 (range, 2-9) in the younger group and 3 (range, 2-6) in the older group, and 11 patients (23.4%) between the ages of 70 and 74 years had received prior autologous stem cell transplant versus 2 patients (6.7%) in the older group. Fourteen patients (29.8%) had a bridging therapy in the younger group versus 15 patients (50.0%) in the older group and the median number of days between T cell collection and infusion was 28 days (range, 22-52) in the younger group versus 33 days (range, 22-63) in the older group. Forty patients (85.1%) received axi-cel and 7 patients (14.9%) received tisa-cel in the younger arm, compared with 21 patients (70.0%) and 9 (30.0%) in the older arm, respectively.

CAR T-cell therapy has revolutionized the treatment landscape for patients with relapsed/refractory DLBCL, according to the study authors. The 2 CAR T-cell agents in this real-word study were approved by the FDA based on the ZUMA-1 study (axi-cel) and the JULIET study (tis-cel). CAR T cells have now become the standard of care for patients with relapsed/refractory DLBCL.

On criticism regarding CAR T-cell therapy is that much is unknown about its efficacy and toxicity in patients who are over the age of 70. To some extent, question were answered with this real-world data.

Reference

Fitzgerald L, Kittai A, Nastoupil LJ, et al. Real-world outcomes of elderly patients with relapsed/refractory (R/R) diffuse large B-cell lymphoma (DLBCL) treated with chimeric antigen receptor T-cell (CAR-T) therapy.J Clin Oncol38: 2020 (suppl; abstr 8039). doi: 10.1200/JCO.2020.38.15_suppl.8039

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Better Outcomes Observed With CAR T-Cell Therapy in Younger Patients With R/R DLBCL - Targeted Oncology