IntroductionColorectal cancer (CRC) is the second leading cause of cancer-related deaths worldwide. Current first- and second-line therapies rely on oxaliplatin- or irinotecan-based combination chemotherapies combined with antibody-mediated inhibition of EGFR- or VEGF-dependent signaling, but these regimens are associated with significant side effects that limit long-term use and effectiveness. ADAM10 has emerged as a potential therapeutic target in CRC due to its role in activating oncogenic pathways such as Notch and EGFR; however, prior approaches targeting ADAM10 showed high toxicity. ADAM10 exists in an open, active conformation and a closed, auto-inhibited conformation, with the active form being more prevalent in tumor cells, providing a rationale for conformation-specific targeting.MethodsTo investigate the therapeutic potential of 1H5, cellular viability was assessed using viability assays, and ADAM10 dependency was evaluated by shRNA-mediated knockdown. Modulation of oncogenic signaling pathways and target gene expression was validated by Western blotting and RT-qPCR, while transcriptomic changes were analyzed by bulk RNA sequencing. The effects of 1H5 on cell migration and invasion were assessed using wound-healing and transwell invasion assays, and therapeutic efficacy was evaluated in vivo using xenograft and syngeneic mouse models.ResultsWe show that 1H5 inhibits Notch and EGFR signaling and reduces proliferation of human CRC cell lines. We also found that 1H5 inhibits Wnt/β-catenin signaling in CRC cells and reduces their migration and invasion capacity. Finally, treatment studies in CRC cell line-derived xenograft models revealed marked antitumorigenic properties of 1H5.DiscussionTogether, these findings demonstrate that selective targeting of the active conformation of ADAM10 enables simultaneous inhibition of multiple oncogenic pathways involved in CRC growth and progression and represents a promising therapeutic strategy warranting further clinical evaluation.

Type I interferons (IFNs) are a group of nonredundant pleiotropic cytokines that play an important role in eliciting antiviral responses and have also been shown to have antineoplastic effects. Deficits in this signaling pathway have been shown to increase susceptibility to viral infection and decrease immune surveillance to block tumorigenesis. Prior studies demonstrate that inhibition of the type I IFN pathway markedly compromises the anti-neoplastic effects of chemotherapies, such as anthracycline-based drugs like doxorubicin, and dramatically decreases the number of tumor-free mice in experimental settings. Recent large-scale clinical studies revealed that circulating anti-type I interferon autoantibodies capable of neutralizing type I IFN signaling contributed to disease severity in patients infected by SARS-CoV-2 and may be responsible for nearly 20% of COVID-19 deaths. These IFN autoantibodies were directly capable of hindering innate antiviral responses, thus allowing viral replication to occur more robustly and spread to distal tissues. Additional studies revealed that these type I IFN autoantibodies are quite prevalent in the aging population, found at high levels in nearly 1 in 15 over the age of 65 and confer a 100-fold risk of severe life-threatening viral illness. Despite their high prevalence and ability to block IFN signaling, no study to date has examined the role of type I IFN autoantibodies in cancer progression and tumor response. Here, we investigate whether neutralizing type I IFN autoantibodies can block critical innate immune signaling pathways that result in a higher conversion of pre-malignant cells to malignant tumors. We hypothesize that carriers of type I IFN autoantibodies may respond poorly to primary anticancer therapies, including standard chemotherapy regimens and immunotherapies. Furthermore, using a first-in-class therapeutic decoy, we test whether blockade of type I IFN autoantibodies can provide a synergistic benefit when combined with standard anticancer agents. Eduardo Garcia-Reino, Nicholas Gao, Thanuka Udumulla, Elie Sosa, Nana Ayoluwa, Pargol Mashati, Andrew Patera, Jean-Laurant Casanova, Prem Premsrirut. A novel therapeutic approach to treat patients with Type I interferon autoantibodies [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 2879.

RNA interference (RNAi) is emerging as a powerful strategy for therapeutic targeting of "undruggable" targets. However, efficacy of currently used siRNA-based therapies is often hindered by transient effects and limited modeling possibilities. Artificial microRNAs (amiRNAs or miRNA scaffolds) present a durable and precise approach to gene silencing, opening new avenues for developing long lasting targeted therapies. In this study, we engineered highly expressed primary miRNAs (pri-miRNAs) with sequence determinants known to enhance processing efficacy and precision. The resulting amiRNAs were extensively tested both in vitro and in vivo and proved to efficiently silence a target gene when virally delivered via adeno-associated virus (AAV) into mice brains. This study provides a set of novel amiRNAs with potential therapeutic application as well as a pipeline to generate and validate novel amiRNAs from endogenous pri-miRNAs.

Abstract A plethora of evidence has shown that 10-20% of cases of severe COVID-19 occur in individuals harboring autoantibodies that neutralize type I interferons (IFNs) and thus block their ability to initiate innate defenses and dampen viral replication. These autoantibodies are, therefore, currently the strongest and most common determinants of a growing range of severe viral diseases, especially in the elderly; yet, no routine test is available to the general population to gain knowledge of their immune insufficiency and potential risk from future infections. Here, we developed a set of assays to establish the levels of anti-IFN autoantibodies and their neutralizing activity and performed validation studies in a cohort of hospitalized COVID patients (N=388) to assess their sensitivity and specificity. Consistent with previous findings, our tests developed in a CLIA-certified laboratory were able to detect anti-IFN autoantibodies in a sizable fraction of patients with severe and critical COVID-19 pneumonia. Taken together, our results suggest that anti-IFN autoantibody testing should be considered for standard clinical screening.

Diminished hepatocyte regeneration is a key feature of acute and chronic liver diseases and after extended liver resections, resulting in the inability to maintain or restore a sufficient functional liver mass. Therapies to restore hepatocyte regeneration are lacking, making liver transplantation the only curative option for end-stage liver disease. Here, we report on the structure-based development and characterization (nuclear magnetic resonance [NMR] spectroscopy) of first-in-class small molecule inhibitors of the dual-specificity kinase MKK4 (MKK4i). MKK4i increased liver regeneration upon hepatectomy in murine and porcine models, allowed for survival of pigs in a lethal 85% hepatectomy model, and showed antisteatotic and antifibrotic effects in liver disease mouse models. A first-in-human phase I trial (European Union Drug Regulating Authorities Clinical Trials [EudraCT] 2021-000193-28) with the clinical candidate HRX215 was conducted and revealed excellent safety and pharmacokinetics. Clinical trials to probe HRX215 for prevention/treatment of liver failure after extensive oncological liver resections or after transplantation of small grafts are warranted.

This communication takes note of unexpected factors that can influence the results of RT-PCR in quantitation of copy numbers such as in determination of viral loads and in viral identification. We show that the presence of serum separator gel in authorized collection tubes for hepatitis C (HCV) viral load determinations causes underestimation of viral loads by blocking viral diffusion into plasma and that the presence of more than one targeted virus in a multiplex RT-PCR viral assay, while not affecting analytical specificity, results in raising of the minimal detectable viral titer and therefore a decreased analytical sensitivity. Our results suggest the possibility that HCV samples should be placed in cell lysis buffer for full viral load determination and that multiplex assays should be carefully validated and modified if necessary to minimize loss of sensitivity.

Mpox is a neglected zoonotic disease endemic in West and Central Africa. The Mpox outbreak with more than 90,000 cases worldwide since 2022 generated great concern about future outbreaks and highlighted the need for a simple and rapid diagnostic test. The Mpox virus, MPV, is a member of the Orthopoxvirus (OPV) genus that also contains other pathogenic viruses including variola virus, vaccinia virus, camelpox virus, and cowpox virus. Phylogenomic analysis of 200 OPV genomes identified 10 distinct phylogroups with the New World OPVs placed on a very long branch distant from the Old World OPVs. Isolates derived from infected humans were found to be distributed across multiple phylogroups interspersed with isolates from animal sources, indicating the zoonotic potential of these viruses. In this study, we developed a simple and sensitive colorimetric LAMP assay for generic detection of Old World OPVs. We also developed an MPV-specific probe that differentiates MPV from other OPVs in the N1R LAMP assay. In addition, we described an extraction-free protocol for use directly with swab eluates in LAMP assays, thereby eliminating the time and resources needed to extract DNA from the sample. Our direct LAMP assays are well-suited for low-resource settings and provide a valuable tool for rapid and scalable diagnosis and surveillance of OPVs and MPV.

Abstract Colorectal cancer (CRC) is the third most diagnosed cancer in the USA and accounts for more than 600,000 deaths annually worldwide, primarily due to relapse with highly aggressive, chemo-resistant disease characterized by poorly differentiated cancer cells with stem cell-like properties. A common signature of these chemo-resistant tumors is dysregulation of Notch receptor signaling, as well as upregulation of its metalloprotease activator, ADAM10. Although small molecule inhibition of either Notch or ADAM10 has been shown to produce potent anti-tumor effects, these therapeutic strategies have failed in clinical trials primarily due to systemic toxicities, especially cytotoxic effects on the gastrointestinal tract and musculoskeletal system, highlighting the need for development of more targeted approaches. We have previously demonstrated that ADAM10 predominantly exists in an inhibited state in normal tissues but is activated in tumor cells through a conformational change in the extracellular domain, thus providing a potential target for tumor-specific modulation of ADAM10 activity. Here, we look to characterize a novel human monoclonal antibody agent (1H5) that selectively targets an exposed extracellular region of activated ADAM10 on tumor cells. We previously demonstrated that treatment with a murine version of the antibody (8C7), specific for the activated form of both mouse and human ADAM10, conferred a significant reduction in tumor burden against human CRC cell lines in cell culture and transplants in xenograft models, and relapse was prevented when 8C7 was combined with chemotherapy. Here, we demonstrate that the 1H5 monoclonal antibody effectively reduces cell viability in numerous colorectal cancer cell lines in vitro and induces marked tumor regression in established xenograft models through inhibition of Notch signaling. Through the use of additional genetic tools combined with in vitro and in vivo models, our preclinical study aims to fully evaluate 1H5 as novel therapeutic agent to treat aggressive colorectal cancer. We aim to propel this novel agent toward clinical-stage development. Citation Format: Pargol Mashati, Dan Sun, Eduardo Garcia Reino, Jessica A. Blandino, Ben Mason, Nayanendu Saha, Dimitar B. Nikolov, Prem Premsrirut. A novel human monoclonal antibody targeting active ADAM10 demonstrates anti-tumor effects in colorectal cancer [abstract]. In: Proceedings of the AACR-NCI-EORTC Virtual International Conference on Molecular Targets and Cancer Therapeutics; 2023 Oct 11-15; Boston, MA. Philadelphia (PA): AACR; Mol Cancer Ther 2023;22(12 Suppl):Abstract nr C111.

The viral agent SARS-CoV-2 clearly affects several organ systems, including the cardiovascular system. Angiopoietins are involved in vascular integrity and angiogenesis. Angiopoietin-1 (Ang1) promotes vessel stabilization, while angiopoietin-2 (Ang2), which is usually expressed at low levels, is significantly elevated in inflammatory and angiogenic conditions. Interleukin-6 (IL-6) is known to induce defective angiogenesis via the activation of the Ang2 pathway. Vasculitis and vasculopathy are some of the defining features of moderate to severe COVID-19-associated systemic disease. We investigated the serum levels of angiopoietins, as well as interleukin-6 levels and anti-SARS-CoV2 IgG titers, in hospitalized COVID-19 patients across disease severity and healthy controls. Ang2 levels were elevated in COVID-19 patients across all severity compared to healthy controls, while Ang1 levels were decreased. The patients with adverse outcomes (death and/or prolonged hospitalization) had relatively lower and stable Ang1 levels but continuously elevated Ang2 levels, while those who had no adverse outcomes had increasing levels of both Ang1 and Ang2, followed by a decrease in both. These results suggest that the dynamic levels of Ang1 and Ang2 during the clinical course may predict adverse outcomes in COVID-19 patients. Ang1 seems to play an important role in controlling Ang2-related inflammatory mechanisms in COVID-19 patients. IL-6 and anti-SARS-CoV2 spike protein IgG levels were significantly elevated in patients with severe disease. Our findings represent an informative pilot assessment into the role of the angiopoietin signaling pathway in the inflammatory response in COVID-19.

Mpox is a neglected zoonotic disease endemic in West and Central Africa. The 2022 Mpox outbreak with more than 18,000 cases worldwide generated great concern about future outbreaks and highlighted the need for a simple and rapid diagnostic test. The Mpox virus, MPXV, is a member of the Orthopoxvirus genus that also contains other pathogenic viruses including variola virus, vaccinia virus, camelpox virus, and cowpox virus. Phylogenomic analysis of all available Orthopoxvirus genomes identified 10 distinct phylogroups, with isolates from infected humans distributed across various phylogroups interspersed with isolates from animal sources, indicating the zoonotic potential of these viruses. In this study, we developed a simple and sensitive colorimetric pan-Orthopoxvirus LAMP assay for broader Orthopoxvirus detection. We also developed an MPXV-specific probe that differentiates MPXV from other Orthopoxviruses on the N1R gene which differs by only a few nucleotides. In addition, we described an extraction-free protocol for use directly with swab eluates in LAMP assays, thereby eliminating the time and resources needed to extract DNA from the sample. Our direct LAMP assays are well-suited for low-resource settings and provide a valuable tool for rapid and scalable diagnosis and surveillance of Orthopoxviruses and MPXV.

Serrated colorectal cancer (CRC) is an aggressive and treatment-resistant form of colorectal carcinogenesis that accounts for one-fourth of the patients with CRC1. At the molecular level, serrated CRC is characterized by epigenetic modifications termed the CpG Island Methylator Phenotype (CIMP) and the presence of somatic mutations that activate the mitogen-activated protein kinase (MAPK) pathway1,2,3. The BRAFV600E is an early genetic change in serrated polyps, but it is not sufficient to drive tumor formation. Combinations of mutations and epigenetic modifications in P16INK4A, MLH1, ZNFR3, RNF43, and TGFBR2 are often seen in most patients4. Therefore, a combinatorial approach to develop BrafV600E-driven serrated CRC organoids harboring a variety of the above mutants will enable in vitro studies of the tumorigenic potential of each combination as well as allow engraftment into animals. In turn, the latter will allow for applying preclinical in-vivo pharmacology modalities in vitro, thereby bypassing the time required to create a specific knock-in/out strain for each genetic modification desired. Here, we describe a pipeline to directly genetically manipulate specific organoid systems in vitro. We first established organoid cultures from the small and large intestine of unique Tet-inducible RNAi mice where efficient gene knock-down can contribute to microsatellite instability. Using CRISPR/Cas9, we then edited these to generate CRC organoid models containing the BrafV600E mutation in combination with knock outs or knock-ins of cell cycle regulators and negative regulators of the Wnt pathway. These deficiencies mimic the progressive mutational changes upon acquisition BrafV600E. Our data lay the groundwork for future use of RNAi technology in combination with sequential gene editing for in vitro pharmacology and modeling diseases with complex genetic architecture both in vitro and in vivo. Citation Format: Prem K. Premsrirut, Huaien Wang, Eduardo J. Garcia Reino, Isabella Breen, Ana A. Vasileva. Utility of intestinal organoids to model serrated colon cancer in vitro [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 946.

Background. The Omicron SARS-CoV-2 variant resulted in significant community-based transmission. Numerous occupational settings have employed surveillance testing strategies to minimize occupational exposure and return workers safely to work following isolation. Methods. From an occupational COVID-19 testing program, we obtained longitudinal (February 2021-January 2022) saliva-based RT-qPCR results and starting December 27th, 2021, daily on-site molecular over-the-counter (OTC) nasal swab-based isothermal nucleic acid amplification test (molecular OTC; Cue Health COVID-19 test) results. We quantified the fraction of tests with PCR cycle threshold (Ct) values <30 on each day post detection from suspected and confirmed Omicron infections (n=37), compared results to molecular OTC testing, and measured workplace and household transmission. We evaluated return-to-work timing using a post-isolation, two-test threshold of Ct >30, or two negative molecular OTC tests over a 24 hour period, or a single PCR test >30 plus negative molecular OTC test. Results. From the paired testing cohort, 37 (48%) individuals tested positive; all 37 were vaccinated. All individuals tested positive [≤]1 day after a previous negative test, and 19 (51.3%) remained PCR-positive with Ct values <30 at day 5. While 3 (8.1%) remained PCR-positive with a Ct value <30 on day 10, no individuals remained PCR-positive on day 12. The average time to PCR clearance/return-to-work was 7.94 days (median=9.5 days). Time to clearance for those boosted (n=8; 7.75 days) and those not yet boosted (8.04 days) did not differ (p=0.49). Peak viral load measured by PCR was 1.97 days from the initial positive test. There were no cases of transmission after returning to work. Conclusions. A large percentage of individuals remain contagious at day 5 post first positive test based on serial PCR testing and can continue until day 12. Early discontinuation of isolation can utilize a two test framework separated by 24 hours. Rapid onsite tests may be useful.

Effective management of the COVID-19 pandemic requires widespread and frequent testing of the population for SARS-CoV-2 infection. Saliva has emerged as an attractive alternative to nasopharyngeal samples for surveillance testing as it does not require specialized personnel or materials for its collection and can be easily provided by the patient. We have developed a simple, fast, and sensitive saliva-based testing workflow that requires minimal sample treatment and equipment. After sample inactivation, RNA is quickly released and stabilized in an optimized buffer, followed by reverse transcription loop-mediated isothermal amplification (RT-LAMP) and detection of positive samples using a colorimetric and/or fluorescent readout. The workflow was optimized using 1,670 negative samples collected from 172 different individuals over the course of 6 months. Each sample was spiked with 50 copies/μL of inactivated SARS-CoV-2 virus to monitor the efficiency of viral detection. Using pre-defined clinical samples, the test was determined to be 100% specific and 97% sensitive, with a limit of detection of 39 copies/mL. The method was successfully implemented in a CLIA laboratory setting for workplace surveillance and reporting. From April 2021-February 2022, more than 30,000 self-collected samples from 755 individuals were tested and 85 employees tested positive mainly during December and January, consistent with high infection rates in Massachusetts and nationwide.

The performance of Covid-19 diagnostic tests must continue to be reassessed with new variants of concern. The objective of this study was to describe the discordance in saliva SARS-CoV-2 PCR and nasal rapid antigen test results during the early infectious period. We identified a high-risk occupational case cohort of 30 individuals with daily testing during an Omicron outbreak in December 2021. Based on viral load and transmissions confirmed through epidemiological investigation, most Omicron cases were infectious for several days before being detectable by rapid antigen tests.

The negative impact of continued school closures during the height of the COVID-19 pandemic warrants the establishment of new cost-effective strategies for surveillance and screening to safely reopen and monitor for potential in-school transmission. Here, we present a novel approach to increase the availability of repetitive and routine Covid-19 testing that may ultimately reduce the overall viral burden in the community. We describe implementation of a testing program that included students, faculty and staff from K-12 schools and universities participating in the SalivaClear pooled surveillance method (Mirimus Clinical Labs, Brooklyn, NY). Over 400,000 saliva specimens were self-collected from students, faculty and staff from 93 K-12 schools and 18 universities and tested in pools of up to 24 samples over a 20-week period during this pandemic. Peaks of positive cases were seen in the days following the Halloween, Thanksgiving and New Year holidays. Pooled testing did not significantly alter the sensitivity of the molecular assay in terms of both qualitative (100% detection rate on both pooled and individual samples) and quantitative (comparable cycle threshold (CT) values between pooled and individual samples) measures. Pooling samples substantially reduced the costs associated with PCR testing and allowed schools to rapidly assess transmission and adjust prevention protocols as necessary. By establishing low-cost, weekly testing of students and faculty, pooled saliva analysis enabled schools to determine whether transmission had occurred, make data-driven decisions, and adjust safety protocols. Pooled testing is a fundamental component to the reopening of schools, minimizing transmission among students and faculty.

The COVID-19 pandemic has had a profound, detrimental effect on economies and societies worldwide. Where the pandemic has been controlled, extremely high rates of diagnostic testing for the SARS-CoV-2 virus have proven critical, enabling isolation of cases and contact tracing. Recently, diagnostic testing has been supplemented with wastewater measures to evaluate the degree to which communities have infections. Whereas much testing has been done through traditional, centralized, clinical, or environmental laboratory methods, point-of-care testing has proven successful in reducing time to result. As the pandemic progresses and becomes more broadly distributed, further decentralization of diagnostic testing will be helpful to mitigate its spread. This will be particularly both challenging and critical in settings with limited resources due to lack of medical infrastructure and expertise as well as requirements to return results quickly. In this article, we validate the tiny isothermal nucleic acid quantification system (TINY) and a novel loop-mediated isothermal amplification (LAMP)-based assay for the point-of-care diagnosis of SARS-CoV-2 infection in humans and also for in-the-field, point-of-collection surveillance of wastewater. The TINY system is portable and designed for use in settings with limited resources. It can be powered by electrical, solar, or thermal energy and is robust against interruptions in services. These applied testing examples demonstrate that this novel detection platform is a simpler procedure than reverse-transcription quantitative polymerase chain reaction, and moreover, this TINY instrument and LAMP assay combination has the potential to effectively provide both point-of-care diagnosis of individuals and point-of-collection environmental surveillance using wastewater.

Background: The negative impact of continued school closures during the height of the COVID-19 pandemic warrants the establishment of cost-effective strategies for surveillance and screening to safely reopen and monitor for potential in-school transmission. Here, we present a novel approach to increase the availability of repetitive and routine Covid-19 testing that may ultimately reduce the overall viral burden in the community.  Methods: We implemented a testing program that included students, faculty and staff from K-12 schools and universities participating in the SalivaClear™ pooled surveillance method (Mirimus Clinical Labs, Brooklyn, NY).  Findings: Over 250,000 saliva specimens were self-collected from students, faculty and staff from 93 K-12 schools and 18 universities. Pool sizes of up to 24 samples were tested over a 20-week period. Pooled testing did not significantly alter the sensitivity of the molecular assay in terms of both qualitative (100% detection rate on both pooled and individual samples) and quantitative (comparable cycle threshold (CT) values between pooled and individual samples) measures. Pooling samples substantially reduced the costs associated with PCR testing and allowed schools to rapidly assess transmission and adjust prevention protocols as necessary. In one instance, in-school transmission of the virus was determined within the main office and led to review and revision of heating, ventilating and air-conditioning systems.  Interpretation: By establishing low-cost, weekly testing of students and faculty, pooled saliva analysis enabled schools to determine whether transmission had occurred, make data-driven decisions, and adjust safety protocols. Pooled testing is a fundamental component to the reopening of schools, minimizing transmission among students and faculty. Funding: Skoll Foundation generously provided funding to Mobilizing Foundation and Mirimus for these studies. Declaration of Interests: None. Ethics Approval Statement: The SUNY Downstate Health Sciences University Institutional Review Board (IRB) reviewed and approved the study protocol (IRB #1232938-3).

Early in the SARS-CoV-2 pandemic, convalescent plasma (CP) therapy was proposed as a treatment for severely ill patients. We conducted a CP treatment protocol under the Mayo Clinic Extended Access Program at University Hospital Brooklyn (UHB). Potential donors were screened with a lateral flow assay (LFA) for IgM and IgG antibodies against the SARS-CoV-2 S1 receptor-binding domain (RBD). Volunteers that were LFA positive were tested with an ELISA to measure IgG titers against the RBD. Subjects with titers of at least 1:1024 were selected to donate. Most donors with positive LFA had acceptable titers and were eligible to donate. Out of 171 volunteers, only 65 tested positive in the LFA (38.0%), and 55 (32.2%) had titers of at least 1:1024. Before our donation program started, 31 CP units were procured from the New York Blood Center (NYBC). Among the 31 CP units that were obtained from the NYBC, 25 units (80.6%) were positive in the LFA but only 12 units (38.7%) had titers of at least 1:1024. CP was administered to 28 hospitalized COVID-19 patients. Patients who received low titer CP, high titer CP and patients who did not receive CP were followed for 45 days after presentation. Severe adverse events were not associated with CP transfusion. Death was a less frequent outcome for patients that received high titer CP (>1:1024) 38.6% mortality, than patients that received low titer CP (≤1:1024) 77.8% mortality.