Effect of Imprime Pgg on Innate Immune-Activating Pharmacodynamic Changes in A Phase I Clinical Study in Healthy Human Volunteers

33 Background: Imprime PGG (Imprime) is currently in clinical development as combination therapy with checkpoint inhibitors. Imprime, a yeast-derived, soluble β-1,3/1,6 glucan is a Pathogen Associated Molecular Pattern (PAMP) that complexes with endogenous anti-beta glucan antibodies (ABA) and activates innate immune effector cells to trigger the anti-cancer immunity cycle. In this study, we sought to investigate the immunopharmacodynamic (IPD) responses of Imprime in healthy human subjects. Methods: Group 1 (n=12) received a single IV infusion of Imprime 4 mg/kg, Group 2 (n=12) received three weekly infusions of 4mg/kg Imprime. Group 3 (n=12) received infusions of 4 mg/kg or 2 mg/kg Imprime on weeks 1, 2 and 5. In groups 1 and 2, six subjects each received premedication with diphenhydramine 50 mg IV and dexamethasone 8 mg IV. IPD changes were measured at various times before, during and after Imprime administration. Results: Peak levels of complement activation products, C5a and SC5b-9 were detected at the end of infusion (EOI). A 2 to 3-fold increase in neutrophil and monocyte numbers were seen 4 hours post-Imprime infusion. Chemokines, especially IL-8 and MCP-1, were consistently detected at EOI. Cellular analyses showed Imprime binding to neutrophils, monocytes, subsets of DC and B cells. 24 hrs after EOI, a population of intermediate monocytes expressing higher levels of the activation markers CD86, PD-L1, and HLA-DR, was observed. Approximately one week post-Imprime, increased switched memory B cells and plasmablasts were detected. Consistent increase in expression of innate immune activation marker genes was evident as well. A substantial drop in free ABA and a concomitant increase in circulating immune complexes were seen at the EOI. Adverse events (AE) were limited to infusion related reactions. Importantly, the IPD changes and the AE were seen in subjects with higher ABA levels. The effect of pre-medications on some of the IPD will also be presented. Conclusions: These human data provide the first evidence linking pre-treatment ABA levels and Imprime IPD, substantiating the use of these pre-treatment ABA levels for patient selection.