Triple-negative breast cancer (TNBC) has high rates of recurrence despite chemotherapy and immune checkpoint blockade (ICB). Tumor-associated macrophages (TAMs) can either suppress or support anti-tumor immunity, but the mechanisms governing these states and therapeutic targets remain unclear. Here, integrating public scRNAseq datasets with TNBC cohorts, we identify a prognostic myeloid signature defined by CXCL9hi/C1Qlow TAM programs, associated with improved survival and increased lymphocyte activation pathways. Using immunocompetent p53-null syngeneic TNBC models spanning basal-like (2153L) and claudin-low (T12) subtypes, we show that immunomodulatory cyclophosphamide (CTX) reprograms hematopoiesis toward the monocytic lineage and induces an interferon (IFN) conditioned tumor milieu that supports CXCL9+ monocyte-derived macrophages (Mo.Macs) in basal-like disease. Combining CTX with the next generation MERTK-selective inhibitor UNC2371 (MRX-2843) drives complete remissions in both models, but durable long-term responses occurred selectively in the basal-like subtype model. The expansion of antigen-presenting CXCL9+ Mo.Macs and reduction of C1q+ phagocytic TAMs are observed in responding tumors. Mechanistically, MERTK inhibition relieves MAPK/SOCS1 mediated restraint of IFN signaling driving a positive feedback loop of IRF7/STAT1/IRF1 driven CXCL9 induction. Functionally, tumor control requires CXCL9-CXCR3 dependent CD4+ T cell recruitment, accumulation of stem-like memory CD4+ T cells, and germinal center like immune organization in tumor-draining lymph nodes. PD-1 blockade further increases durability, preventing recurrence in most treated basal-like tumors. Together, these findings define an IFN licensed, MERTK regulated myeloid checkpoint that can be therapeutically targeted to convert suppressive TNBC microenvironments into durable adaptive immunity, supporting clinical translation of CTX + MRX-2843 based combinations in basal-like TNBC.

Abstract Breast cancer is the most prevalent cancer and accounts for the second-highest cancer mortality rate in women. Recently, immune checkpoint blockade (ICB) in combination with chemotherapy has become the standard-of-care for Triple-Negative Breast Cancer (TNBC) patients. CD8 T cell infiltration is a predictive marker for ICB and is associated with a better prognosis, whereas suppressive myeloid cell infiltration is associated with a poor prognosis. Tumor-associated macrophages (TAMs) are suppressive myeloid cells that are common targets for solid tumor microenvironment (TME) re-education. While it is known that TAMs orchestrate lymphoid cell activation/inhibition, little is known about TAM programming, derivation, and functionality in tumors. MerTK and Axl (TAMr) are receptor tyrosine kinases expressed by monocytes and TAMs that act as negative regulators of STAT1 signaling in these cells. TAMr inhibition with a MerTKi, MRX-2843, synergizes with Interferon (IFN) to reprogram TAMs in vitro. These reprogrammed cells produce anti-tumor markers such as Cxcl9 and iNOS. Reprogramming of the bone marrow, with immunomodulatory cyclophosphamide drives myeloid cells into the monocytic lineage resulting in increased activated monocyte production. Moreover, IFN signaling is increased within the tumor. When CTX is combined with MRX-2843 long-term durable responses (LTR) are observed in the basal 2153L model, but not in the claudin low T12 model which recurs. Through scRNAseq we identified that IFN signaling maintains lymph activating Mo.Macs that release high levels of Cxcl9 in 2153L. Furthermore, 2153L ‘heats up’ early during treatment by Cxcl9 monocytes recruiting both antigen experienced effector CD8 and stem-like memory CD4 T cells to the TME. Importantly, germinal center formation with the tumor draining lymph of combination treated 2153L tumor bearing mice was observed, suggesting that CD4 and B Cell interactions may drive anti-tumor adaptive immunity. In addition, CD8 T Cells express PD-1 and IFN signaling drives PD-L1 expression on monocytes in combination treated mice. The addition of ICB to the CTX + MRX-2843 regimen prevented recurrence in 60% of mice. This study revealed that MRX-2843 synergizes with CTX to drive Cxcl9 and antigen presentation in monocytic cells, resulting in adaptive memory activation via germinal centers. Furthermore, TAM RTK receptors regulate IFN signaling in monocytic derived cells and when inhibited can synergize with chemotherapy to drive long term durable responses in TNBC pre-clinical models. TAM reprogramming with MRX-2843 + CTX + ICB, therefore, may represent a novel therapeutic approach for patients with basal TNBC. Citation Format: Alex J. Smith, Zachary Schrank, Nan Guan, Diego Pedroza, Sebastian Calderon, Xueying Yuan, Na Zhao, Zoe Gabriel, Yang Gao, Charlotte Rivas, Fengshuo Liu, Chuck Perou, Shelton Earp, Jeffrey M. Rosen. Combination treatment of mertki and immunomodulatory chemotherapy results in cxcl9 positive macrophage reprogramming and anti tumor adaptive memory in triple negative breast cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2026; Part 1 (Regular Abstracts); 2026 Apr 17-22; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2026;86(7 Suppl):Abstract nr 1576.

Women diagnosed with metastatic triple negative breast cancer (mTNBC) have limited treatment options, are more prone to develop resistance and are associated with high mortality. A cold tumor immune microenvironment (TIME) characterized by low T cells and high tumor associated macrophages (TAMs) in mTNBC is associated with the failure of standard-of-care chemotherapy and immune checkpoint blockade (ICB) treatment. We demonstrate that the combination of immunomodulatory low-dose Cyclophosphamide (CTX) coupled with anti-CSF-1R antibody targeted therapy (SNDX-ms6352) and anti-PD-1 (ICB), was highly effective against aggressive metastatic Trp53 null TNBC transplantable syngeneic models that present with high macrophage infiltration. Mechanistically, CSF-1R inhibition along with CTX disrupted the M-CSF/CSF-1R axis which upregulated IL-17, IL-5 and type II interferon resulting in elevated B- and T cell infiltration. Addition of an anti-PD-1 maintenance dose helped overcome de novo PD-L1 intra-tumoral heterogeneity (ITH) associated recurrence in lung and liver mTNBC.

Glioblastoma (GBM) is the most common and aggressive primary brain tumor in adults, with a dismal 5-year survival rate of ~6.5%. Vasogenic cerebral edema is a severe complication that occurs in the majority of GBM patients, leading to a significant increase in intracranial pressure, neurological deficits, and increased mortality rates. GBM-associated edema is almost exclusively managed by the corticosteroid dexamethasone, the use of which is associated with immunosuppression and interference with radiation therapy. While there is considerable research on edema formation, little is known about how edema resolution occurs in GBM, particularly in response to dexamethasone or other anti-edema therapies. This gap in understanding highlights the need for new approaches to treat edema effectively. The water channel aquaporin-4 (AQP4), a key player in the brain’s water homeostasis, is upregulated in GBM compared to the normal brain. To investigate the role of AQP4 in GBM-associated edema, we used the RCAS/tv-a system to generate de novo GBM with different driver mutations in Aqp4 knockout (KO) and wild-type (WT) mice. Our results indicated that Aqp4 KO tumor-bearing mice had shortened survival and increased edema content. Additionally, Aqp4 loss decreased astrocyte coverage specifically in the tumor core but not the tumor periphery. Our single cell RNA-seq data suggested that Aqp4 loss led to an astrocytic shift towards a less reactive, progenitor-like state, while also decreasing the myeloid and CD8+ T cell population in the tumor microenvironment. Interestingly, tumor-bearing mice treated with anti-VEGFA antibody, which has anti-edema properties, showed increased expression of Aqp4 and reduced vessel leakage. This suggests that AQP4 plays a critical role in mediating the effects of anti-VEGFA therapy. Overall, this study highlights the important role of AQP4 in the resolution of edema, while also revealing its additional effects on astrocyte activation and the immune microenvironment in GBM.

Supplementary Figure S2 shows a dot blot for Figure 4C.

Supplementary Figure S3 shows a representative immunofluorescence image for Figure 5.

Supplementary Table S1 lists targets in the dot blots for Figures 3D and 4C.

Supplementary Table S2 lists antibody information for immunofluorescence in Figure 5.

Supplementary Figure S5 shows a representative immunofluorescence image for Figure 5.

Supplementary Table S3 lists antibody combinations used for immune cell detection in Figure 5.

Supplementary Figure S4 shows a representative immunofluorescence image for Figure 5.

Supplementary Figure S1 shows a dot blot for Figure 3D.

It has been proposed that cerebrospinal fluid (CSF) can enter and leave the retina and optic nerve along perivascular spaces surrounding the central retinal vessels as part of an aquaporin-4 (AQP4) dependent ocular ‘glymphatic’ system. Here, we injected fluorescent dextrans and antibodies into the CSF of mice at the cisterna magna and measured their distribution in the optic nerve and retina. We found that uptake of dextrans in the perivascular spaces and parenchyma of the optic nerve is highly sensitive to the cisternal injection rate, where high injection rates, in which dextran disperses fully in the sub-arachnoid space, led to uptake along the full length of the optic nerve. Accumulation of dextrans in the optic nerve did not differ significantly in wild-type and AQP4 knockout mice. Dextrans did not enter the retina, even when intracranial pressure was greatly increased over intraocular pressure. However, elevation of intraocular pressure reduced accumulation of fluorescent dextrans in the optic nerve head, and intravitreally injected dextrans left the retina via perivascular spaces surrounding the central retinal vessels. Human IgG distributed throughout the perivascular and parenchymal areas of the optic nerve to a similar extent as dextran following cisternal injection. However, uptake of a cisternally injected AQP4-IgG antibody, derived from a seropositive neuromyelitis optica spectrum disorder subject, was limited by AQP4 binding. We conclude that large molecules injected in the CSF can accumulate along the length of the optic nerve if they are fully dispersed in the optic nerve sub-arachnoid space but that they do not enter the retina.

Tumor-associated neutrophils (TANs) have been shown to promote immunosuppression and tumor progression, and a high TAN frequency predicts poor prognosis in triple-negative breast cancer (TNBC). Dysregulation of CREB binding protein (CBP)/P300 function has been observed with multiple cancer types. The bromodomain (BRD) of CBP/P300 has been shown to regulate its activity. In this study, we found that IACS-70654, a novel and selective CBP/P300 BRD inhibitor, reduced TANs and inhibited the growth of neutrophil-enriched TNBC models. In the bone marrow, CBP/P300 BRD inhibition reduced the tumor-driven abnormal differentiation and proliferation of neutrophil progenitors. Inhibition of CBP/P300 BRD also stimulated the immune response by inducing an IFN response and MHCI expression in tumor cells and increasing tumor-infiltrated CTLs. Moreover, IACS-70654 improved the response of a neutrophil-enriched TNBC model to docetaxel and immune checkpoint blockade. This provides a rationale for combining a CBP/P300 BRD inhibitor with standard-of-care therapies in future clinical trials for neutrophil-enriched TNBC.

Tumor-associated neutrophils (TANs) have been shown to promote immunosuppression and tumor progression, and a high TAN frequency predicts poor prognosis in triple-negative breast cancer (TNBC). Dysregulation of CREB-binding protein (CBP)/P300 function has been observed with multiple cancer types. The bromodomain (BRD) of CBP/P300 has been shown to regulate its activity. In this study, we found that IACS-70654, a selective CBP/P300 BRD inhibitor, reduced TANs and inhibited the growth of neutrophil-enriched TNBC models. In the bone marrow, CBP/P300 BRD inhibition reduced the tumor-driven abnormal differentiation and proliferation of neutrophil progenitors. Inhibition of CBP/P300 BRD also stimulated the immune response by inducing an IFN response and MHCI expression in tumor cells and increasing tumor-infiltrated cytotoxic T cells. Moreover, IACS-70654 improved the response of a neutrophil-enriched TNBC model to docetaxel and immune checkpoint blockade. This provides a rationale for combining a CBP/P300 BRD inhibitor with standard-of-care therapies in future clinical trials for neutrophil-enriched TNBC.

COPYRIGHT © 2023 Szu, Parpura, Amiry-Moghaddam and Smith. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. Editorial: Mechanisms and consequences of Aquaporin-4 redistribution in neurological disease

Lung cancer is the leading global cause of cancer-related deaths. Although smoking cessation is the best prevention, 50% of lung cancer diagnoses occur in people who have quit smoking. Research into treatment options for high-risk patients is constrained to rodent models, which are time-consuming, expensive, and require large cohorts. Embedding precision-cut lung slices (PCLS) within an engineered hydrogel and exposing this tissue to vinyl carbamate, a carcinogen from cigarette smoke, creates an in vitro model of lung cancer premalignancy. Hydrogel formulations are selected to promote early lung cancer cellular phenotypes and extend PCLS viability to six weeks. Hydrogel-embedded PCLS are exposed to vinyl carbamate, which induces adenocarcinoma in mice. Analysis of proliferation, gene expression, histology, tissue stiffness, and cellular content after six weeks reveals that vinyl carbamate induces premalignant lesions with a mixed adenoma/squamous phenotype. Putative chemoprevention agents diffuse through the hydrogel and induce tissue-level changes. The design parameters selected using murine tissue are validated with hydrogel-embedded human PCLS and results show increased proliferation and premalignant lesion gene expression patterns. This tissue-engineered model of human lung cancer premalignancy is the foundation for more sophisticated ex vivo models that enable the study of carcinogenesis and chemoprevention strategies.

Protein synthesis is frequently dysregulated in cancer and selective inhibition of mRNA translation represents an attractive cancer therapy. Here, we show that therapeutically targeting the RNA helicase eIF4A with zotatifin, the first-in-class eIF4A inhibitor, exerts pleiotropic effects on both tumor cells and the tumor immune microenvironment in a diverse cohort of syngeneic triple-negative breast cancer (TNBC) mouse models. Zotatifin not only suppresses tumor cell proliferation but also directly repolarizes macrophages toward an M1-like phenotype and inhibits neutrophil infiltration, which sensitizes tumors to immune checkpoint blockade. Mechanistic studies revealed that zotatifin reprograms the tumor translational landscape, inhibits the translation of Sox4 and Fgfr1, and induces an interferon (IFN) response uniformly across models. The induction of an IFN response is partially due to the inhibition of Sox4 translation by zotatifin. A similar induction of IFN-stimulated genes was observed in breast cancer patient biopsies following zotatifin treatment. Surprisingly, zotatifin significantly synergizes with carboplatin to trigger DNA damage and an even heightened IFN response, resulting in T cell-dependent tumor suppression. These studies identified a vulnerability of eIF4A in TNBC, potential pharmacodynamic biomarkers for zotatifin, and provide a rationale for new combination regimens consisting of zotatifin and chemotherapy or immunotherapy as treatments for TNBC.

Abstract Lung cancer chemoprevention is critical to addressing cancer burden in high-risk populations. Chemoprevention clinical trials rely on data from preclinical models; however, in vivo studies have high financial, technical, and staffing requirements. Precision cut lung slices (PCLS) provide an ex vivo model that maintains the structure and function of native tissues. This model can be used for mechanistic investigations and drug screenings and reduces the number of animals and time required to test hypotheses compared with in vivo studies. We tested the use of PCLS for chemoprevention studies, demonstrating recapitulation of in vivo models. Treatment of PCLS with the PPARγ agonizing chemoprevention agent iloprost produced similar effects on gene expression and downstream signaling as in vivo models. This occurred in both wild-type tissue and Frizzled 9 knockout tissue, a transmembrane receptor required for iloprost's preventive activity. We explored new areas of iloprost mechanisms by measuring immune and inflammation markers in PCLS tissue and media, and immune cell presence with immunofluorescence. To demonstrate the potential for drug screening, we treated PCLS with additional lung cancer chemoprevention agents and confirmed activity markers in culture. PCLS offers an intermediate step for chemoprevention research between in vitro and in vivo models that can facilitate drug screening prior to in vivo studies and support mechanistic studies with more relevant tissue environments and functions than in vitro models. Prevention Relevance: PCLS could be a new model for premalignancy and chemoprevention research, and this work evaluates the model with tissue from prevention-relevant genetic and carcinogen exposed in vivo mouse models, in addition to evaluating chemoprevention agents.