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Combination of BBIT20 and Immunotherapy Enhances Antitumor Activity in Pancreatic Cancer
1, 2 , 1, 3 , 1, 4 , 5, 6 , 3 , * 1
1  LAQV/REQUIMTE, Laboratory of Microbiology, Department of Biological Sciences, Faculty of Pharmacy (FFUP), University of Porto, 4050-313 Porto, Portugal
2  CEB – Centre of Biological Engineering, University of Minho, Braga 4710-057, Portugal
3  Experimental Pathology and Therapeutics Group-Research Center, Porto Comprehensive Cancer Center (Porto.CCC) & RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto), 4200-072 Porto, Portugal
4  Faculty of Pharmacy (FFUC), University of Coimbra, Coimbra 3000-548, Portugal
5  Coimbra Institute for Clinical and Biomedical Research (iCBR), University of Coimbra, Coimbra 3000-548, Portugal
6  Faculty of Medicine (FMUC), University of Coimbra, Coimbra 3000-354, Portugal
Academic Editor: Farrukh Aqil

Abstract:

Introduction: Pancreatic cancer (PC) is a hard-to-treat malignancy characterized by its highly aggressive tumor biology and a strongly immunosuppressive tumor microenvironment. Due to its characteristics, immune checkpoint inhibitors, such as anti-PD-1 antibodies, have yielded limited outcomes in this disease. Targeting DNA damage repair pathways has shown to improve tumor immunogenicity, potentiating immunotherapy efficacy. BBIT20, a monoterpene indole alkaloid derivative, is a first-in-class inhibitor of the homologous recombination DNA damage repair pathway. This work used a syngeneic model of PC to explore the potential of BBIT20 to inhibit tumor growth by promoting immune-mediated responses, alone or in combination with anti-PD-1 immunotherapy. Methods: KPC cells were injected subcutaneously into C57BL/6J mice, which were then treated with a vehicle, BBIT20 (2 mg/kg), anti-PD-1 (100 μg/animal), or both. Tumor progression was monitored by caliper measurements, and tumors were collected at the experimental endpoint. PD-L1 expression and levels of inflammatory mediators and immune cell populations, including cytotoxic T lymphocytes and macrophage subsets were assessed by immunohistochemistry. Results: BBIT20 reduced disease progression while anti-PD-1 alone produced only a modest inhibitory effect, when compared with vehicle-treated animals. The combination of both agents significantly enhanced the antitumor response, indicating a synergistic effect relative to each treatment alone. Immunohistochemical analyses are currently being conducted to investigate treatment-associated alterations in immune cell activation and infiltration within PC tumors. Quantification of PD-L1, CD8, and CD206, and additional markers is in progress, with BBIT20-treated tumors exhibiting decreased PD-L1 expression. Conclusions: BBIT20 revealed a synergistic effect with anti-PD-1 in PC, potentiating tumor growth inhibition and reducing PD-L1 expression. These findings support the ability of BBIT20 to improve immunotherapy efficacy in PC through immune-stimulating activity. Acknowledgments:This work received support from the PT national funds (FCT/MECI) through the project 2024.13556.PEX (https://doi.org/10.54499/2024.13556.PEX).

Keywords: Anti-PD-1; DNA damage repair; Immune system; Pancreatic cancer
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