@article{MinevLanderFelleretal.2019, author = {Minev, Boris R. and Lander, Elliot and Feller, John F. and Berman, Mark and Greenwood, Bernadette M. and Minev, Ivelina and Santidrian, Antonio F. and Nguyen, Duong and Draganov, Dobrin and Killinc, Mehmet O. and Vyalkova, Anna and Kesari, Santosh and McClay, Edward and Carabulea, Gabriel and Marincola, Francesco M. and Butterfield, Lisa H. and Szalay, Aladar A.}, title = {First-in-human study of TK-positive oncolytic vaccinia virus delivered by adipose stromal vascular fraction cells}, series = {Journal of Translational Medicine}, volume = {17}, journal = {Journal of Translational Medicine}, doi = {10.1186/s12967-019-2011-3}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-224105}, year = {2019}, abstract = {Background ACAM2000, a thymidine kinase (TK)-positive strain of vaccinia virus, is the current smallpox vaccine in the US. Preclinical testing demonstrated potent oncolytic activity of ACAM2000 against several tumor types. This Phase I clinical trial of ACAM2000 delivered by autologous adipose stromal vascular fraction (SVF) cells was conducted to determine the safety and feasibility of such a treatment in patients with advanced solid tumors or acute myeloid leukemia (AML). Methods Twenty-four patients with solid tumors and two patients with AML participated in this open-label, non-randomized dose-escalation trial. All patients were treated with SVF derived from autologous fat and incubated for 15 min to 1 h with ACAM2000 before application. Six patients received systemic intravenous application only, one patient received intra-tumoral application only, 15 patients received combination intravenous with intra-tumoral deployment, 3 patients received intravenous and intra-peritoneal injection and 1 patient received intravenous, intra-tumoral and intra-peritoneal injections. Safety at each dose level of ACAM2000 (1.4 × 106 plaque-forming units (PFU) to 1.8 × 107 PFU) was evaluated. Blood samples for PK assessments, flow cytometry and cytokine analysis were collected at baseline and 1 min, 1 h, 1 day, 1 week, 1 month, 3 months and 6 months following treatment. Results No serious toxicities (> grade 2) were reported. Seven patients reported an adverse event (AE) in this study: self-limiting skin rashes, lasting 7 to 18 days—an expected adverse reaction to ACAM2000. No AEs leading to study discontinuation were reported. Viral DNA was detected in all patients' blood samples immediately following treatment. Interestingly, in 8 patients viral DNA disappeared 1 day and re-appeared 1 week post treatment, suggesting active viral replication at tumor sites, and correlating with longer survival of these patients. No major increase in cytokine levels or correlation between cytokine levels and skin rashes was noted. We were able to assess some initial efficacy signals, especially when the ACAM2000/SVF treatment was combined with checkpoint inhibition. Conclusions Treatment with ACAM2000/SVF in patients with advanced solid tumors or AML is safe and well tolerated, and several patients had signals of an anticancer effect. These promising initial clinical results merit further investigation of therapeutic utility. Trial registration Retrospectively registered (ISRCTN\#10201650) on October 22, 2018.}, language = {en} } @article{BavendiekBerlinerAguirreDavilaetal.2019, author = {Bavendiek, Udo and Berliner, Dominik and Aguirre D{\´a}vila, Lukas and Schwab, Johannes and Maier, Lars and Philipp, Sebastian A. and Rieth, Andreas and Westenfeld, Ralf and Piorkowski, Christopher and Weber, Kristina and H{\"a}nselmann, Anja and Oldhafer, Maximiliane and Schallhorn, Sven and von der Leyen, Heiko and Schr{\"o}der, Christoph and Veltmann, Christian and St{\"o}rk, Stefan and B{\"o}hm, Michael and Koch, Armin and Bauersachs, Johann}, title = {Rationale and design of the DIGIT-HF trial (DIGitoxin to Improve ouTcomes in patients with advanced chronic Heart Failure): a randomized, double-blind, placebo-controlled study}, series = {European Journal of Heart Failure}, volume = {21}, journal = {European Journal of Heart Failure}, organization = {DIGIT-HF Investigators and Committees}, doi = {10.1002/ejhf.1452}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-221548}, pages = {676-684}, year = {2019}, abstract = {Aims Despite recent advances in the treatment of chronic heart failure (HF), mortality and hospitalizations still remain high. Additional therapies to improve mortality and morbidity are urgently needed. The efficacy of cardiac glycosides - although regularly used for HF treatment - remains unclear. DIGIT-HF was designed to demonstrate that digitoxin on top of standard of care treatment improves mortality and morbidity in patients with HF and a reduced ejection fraction (HFrEF). Methods Patients with chronic HF, New York Heart Association (NYHA) functional class III-IV and left ventricular ejection fraction (LVEF) ≤ 40\%, or patients in NYHA functional class II and LVEF ≤ 30\% are randomized 1:1 in a double-blind fashion to treatment with digitoxin (target serum concentration 8-18 ng/mL) or matching placebo. Randomization is stratified by centre, sex, NYHA functional class (II, III, or IV), atrial fibrillation, and treatment with cardiac glycosides at baseline. A total of 2190 eligible patients will be included in this clinical trial (1095 per group). All patients receive standard of care treatment recommended by expert guidelines upon discretion of the treating physician. The primary outcome is a composite of all-cause mortality or hospital admission for worsening HF (whatever occurs first). Key secondary endpoints are all-cause mortality, hospital admission for worsening HF, and recurrent hospital admission for worsening HF. Conclusion The DIGIT-HF trial will provide important evidence, whether the cardiac glycoside digitoxin reduces the risk for all-cause mortality and/or hospital admission for worsening HF in patients with advanced chronic HFrEF on top of standard of care treatment.}, language = {en} }