On 2023-09-29 21:10:20, user disqus_mtg7x7eXMb wrote:
The pre-print Kim et al. [1] shows promising pharmacodynamic data for an LRA (Galunisertib, given as 20 mg/kg for 14 days, in multiple cycles) to purge the SIV reservoir in HAART treated SIV infected monkeys. They corroborate the finding with the use of a radiolabeled anti-env imaging probe, which the authors claim can be used to detect tissue areas of increased viral replication in the body when the probe uptake in those areas increases.
This radiolabeled probe was already used in a 2022 publication [2] from the same team (Samer et al. JCI-Insight, reference number 35 of the Kim et al. pre-print [1]), to show the increase in SIV viral production in monkeys treated with HAART following the LRA administration given for a shorter period of time at lower doses (5-10 mg/kg for 7 days).
In the 2023 pre-print, however, the first cycle of the LRA did not induce those very high increases in probe uptake in lymph nodes or the gut of animals as reported in the 2022 [2] paper in which the animals received the LRA at lower doses for a shorter period compared to the 2023 pre-print [1].
Why higher doses and longer duration of the LRA in 2023 are not revealing those high increases in probe uptake seen in the 2022 paper?
One possible explanation is that those high increases in SUV uptakes seen in the 2022 paper are the result of non-specific uptake of the probe, based on certain details of the 2022 published images (more in note-*1).
The latter seems a reasonable explanation for the Samer et al. paper [2] given that the LRA showed a systemic effect (see Suppl Fig S6 in Samer et al., in which the effect of the LRA is measured in the peripheral blood mononuclear cells), hence it is unlikely that the red spots in the PET images show up only in the Axillary cluster of lymph nodes ipsilateral to the injection sites and not in any other lymph nodes clusters in the body. See for instance video 3 and video 4 of the [2] paper in the links repasted below for quick access (under note-1*), the two animals with the highest increase in Lymph nodes uptakes show red spots only in the Axillary nodes ipsilateral to the injection sites, but not on the opposite site of the Axillary nodes nor in other lymph nodes clusters of the body, such as the inguinal lymph nodes.
The authors however showed that the LRA did induce an increase in viral replication from PCR of inguinal nodes tissues shown in Table 2 and Fig 4A of [2]. For instance, the A14X064 showed ~100 fold increase in CAVL-RNA in inguinal nodes, yet from video 4 https://insight.jci.org/art... the only nodes that light up in red in the PET images are the Left Axillary nodes ipsilateral to the extravasation of the injection site on the Left arm of the monkey. <br />
Lack of increase in specific binding of the probe in the lymph nodes, despite the evidence of increase in viral RNA in some of those tissues based on PCR, points to a lack of reproducibility of the anti-env imaging system, or, at most, to a poor sensitivity of the imaging system.
On the other hand, this lack of reproducibility that comes across by comparing the 2022 and 2023 imaging data, which are based on previous two publications from the same imaging team in 2015 [3] and 2018 [4], questions indeed those earlier two nonhuman primates papers [3, 4] too, in which the authors showed evidence that this imaging system is capable of detecting residual levels of viral replication in HAART treated animals, the latter being an attribute of an imaging systems very sensitive to detect changes in target (gp120) molarity. <br />
The latter consideration assumes that the binding affinities of the radiolabeled F(ab’)2 fragment of the 7d3 used in [1, 2] and the radiolabeled 7d3 used in [3, 4] are similar, which seems a fair assumption based on what is implied in the Methods sections of the [1, 2] articles, although in vitro binding data have not been reported in the [1, 2] articles (more in note-*2).
Similarly, there is no evidence of increase in gut SUV levels after the first two weeks of Galunisterib administration in the 2023 pre-print Kim et al. [1]. This contrasts with the observation reported in the 2022 [2] of a substantial increase in gut uptake seen for instance in animals (A14X027 (video 1) or A14X013 (video 7) or A14X064 (video 4)) after only one week of the LRA administered at lower doses for shorter periods compared to the [1] 2023 study in pre-print.
An alternative explanation for the increase in gut radiotracer uptake seen in the 2022 paper is that the increase in bowel uptake reflects a well-known phenomenon of non-specific intraluminal uptake of the radiolabeled antibody\F(ab’)2 fragments [5, 6] (see more under note-*3.1)).
In other words, the hypothesis that the increases in probe uptake in lymph nodes and the gut seen in the 2022 paper after the first LRA-cycle are fully explained by non-specific uptake of the probe appears consistent with the lack of increase in probe uptake in the same anatomic compartments in the 2023 study in which animals received the same LRA at higher doses for longer periods of time.
Finally, another important difference between the 2022 [2] and the 2023 [1] imaging data is that in the latter [1], the increase in probe uptake (given as SUV, standardized uptake value) is now seen in the lymph nodes, gut (and many other regions of the body, the latter a feature that points to a non-specific nature of the biodistribution) at later cycles of the LRA administration, when also the heart (blood pool) probe uptake is increasing, which is happening in all animals at the later cycles of [1]. As described by mathematicians in the 80’s, when changes in input function take place, the use of the SUV to quantitate changes in probe uptake could be misleading and requires mathematical modeling of the time activity curves generated in serial imaging along with an input function [7], or at least a normalization on the blood pool (heart).
This phenomenon of the increase in heart uptake (which indicates blood pool) following Galunisertib administration was not noted in the animals of the [2] publication. Only in one animal of the previous 2022 publication, the authors claimed increase in the radiotracer uptake of the heart. However, the figures and videos associated to this particular animal (A14X004) reveal a potentially important inconsistency, as described under note-*3.2.
It would be helpful, in general, to standardize measurements of covariates generated in different labs, especially in studies that are closely related to each other like the [1] and [2] studies. Note under note-*4 lack of standardization in measurements of CAVL viral RNA and CAVL viral DNA between [2] and [1] studies.
Notes and Bibliography
note-*1. Figure 3H of [2] shows that the highest increases in lymph node (LN) uptake are in monkeys A14X060, A14X064, and A14X013. In these animals, PET images show clear evidence of significant extravasation of the injected probe into the subcutaneous tissues ipsilateral to the high LN uptake. A fourth animal (A14X027) has a slight increase in LN uptake with smaller extravasation. The four animals above are 4 of the 5 animals that the authors claim in the Abstract of [2] show increase in probe uptakes in lymph nodes caused by the administration of the LRA. It is well known, however, that when radiolabeled antibodies\fragments are intentionally or unintentionally (infiltration) administered by subcutaneous or intradermal route, they find their way into the lymphatics and then non-specifically concentrate in regional draining nodes [8], as it appears to be the case for the animals listed above since the radiotracer uptake in LNs was much higher on the side of infiltration than the contralateral side or than in distant nodes. For this reason, the SUV analysis should not have included those LNs in Figure 3H. Without those LNs, however, it looks like from the published images that there is no increase in probe uptake in the LNs, as claimed in the abstract of [2] in which a causal link between Galunisertib administration and increase in LNs in probe uptake is inferred from the data analysis.<br />
Video1…8 from the JCI-I link<br />
Video 1 (A14x027, suv-scale=1.5) : https://insight.jci.org/art...<br />
Video 2 (A14x037, suv-scale=1.5): https://insight.jci.org/art...<br />
Video 3 (A14x060, suv-scale=1.5): https://insight.jci.org/art...<br />
Video 4 (A14x064, suv-scale=1.5): https://insight.jci.org/art...<br />
Video 5 (A14x004, suv-0.3, kidney and liver removed) : https://insight.jci.org/art...<br />
Video 6 (A14xX005, suv-scale=1.5): https://insight.jci.org/art...<br />
Video 7 (A14x013, suv-scale=1.5): https://insight.jci.org/art...<br />
Video 8 (A14x004, suv-scale=1.5): https://insight.jci.org/art...
note-*2. In Samer et al. [2] we read “The 64Cu-DOTA-F(ab′)2 p7D3 was previously validated in SIV-uninfected macaques (62)”, with ref 62 being ref [3] of this document. In the pre-print Kim et al. for the characterization of the probe the Samer et al. [2] reference is provided. <br />
However, in ref [3] only the intact 64Cu-DOTA-7D3 and not the F(ab’)2 was tested in vitro in data presented in Suppl Figure S1 of [3]. In particular, Suppl Fig S1C of [3] shows approximately 2-fold only difference in radiotracer uptake in a competition assay using gp120 expressing cell lines, that are known to express gp120 at much higher levels than primary cells (e.g. pbmc, spleen or lymph node cells). Of note, the competition assay of S1C shows rapid loss in binding when the radiotracer is incubated with only 25% more of the non-radiolabeled (cold) ligand, which is unexpected for high affinity binding ligands. <br />
All these four imaging NHP studies [1-4], produced by the same imaging team, lack autoradiography analyses. The latter ex-vivo technique generates powerful data for the in vivo inference, as typically done in oncological pre-clinical research, because, as mathematicians have shown when they first attempted to extract quantitative information from the PET images [7], what the in vivo imaging is revealing is not a signal proportional to the absolute concentration of the target, but rather a signal that is proportional to the binding capacity of the probe, which is the product of the probe affinity times the concentration of the target. The implication is that if the latter is very low, we can have in our hands a very high affinity ligand, yet we will not be able to generate an SUV level that is predominantly explained by specific binding of the probe. In absence of autoradiography data, some evidence of binding capacity can be generated by implementing in vitro cell binding assays using primary cells (e.g. PBMC or splenocytes or lymph node cells from infected animals and compare the binding to same cells from uninfected animals). This was done only in the first publication [3] in Nature Methods, in which a two-fold (only) difference in SUV uptake was observed by comparing uninfected and infected spleen and lymph node cells (S1B) ex vivo incubated with the radiotracer. <br />
However, the binding data were generated using cryopreserved cells without cold-competition assays; the latter would be useful to rule out, for instance, putative higher non-specific uptake due to higher cell death in the infected cells following their thawing. In general, it would be helpful to increase the sample size of S1B of the 2015 publication [3] (for instance only one well for uninfected lymph node cells were used for that piece of data, which precludes any robust conclusion from the data), as well as to produce autoradiography studies, as mentioned above, in which tissue sections are incubated with close to kd concentration of the probe and after washing, the tissue sections uptakes are compared to the non-specific uptake generated by pre-incubating the adjacent tissue sections with large amount of the cold (i.e, non-radiolabeled) probe to block all gp120 receptors in the tissue sections.
Additional validations of the observed increased SUV uptakes in SIV infected animals, or following the administration of an LRA, as claimed in the 4 NHP publications, is particularly warranted given the state-of-art research in this area and given that, because of the high costs and demanding resources associated to these studies, few laboratories in the world have the capacity of reproducing these experimental data.
note-*3.1 The study [2] did not appear to exclude in the analysis of the gut areas that are consistent with the intraluminal antibody excretion in bowel segments, because details of how the gut SUV uptake was obtained were missing from the Methods section of the [2] publication. The new [1] pre-print states “To quantify the signal in the gut tissue, the body segment below the stomach to above the cervix was initially isolated. The Gut’s SUV was then calculated by extracting the spleen, both kidneys, liver, and bones within the designated body region using Boolean operations.” The latter approach , if adopted also in the [2] publication with those high levels of gut SUV probe uptake seen soon after cycle 1 in some of the animals, again proves that those areas are consistent with the intraluminal antibody excretion (e.g. stools) in bowel segments were not excluded in the analysis, however, this is not what is commonly done in antibody imaging studies [5], because it is known that this phenomenon of non specific uptake in the gut due to the excretion of these types of radiotracers can occur.
note-*3.2 Figure 3F in [2] is a figure obtained from Supplemental Video 5 (https://insight.jci.org/art... ), with baseline and post-LRA images displayed with SUV-rainbow-scale = 0.3 for animal A14X004. Based on the legends, all other animals are displayed at SUV-scale =1.5. (baseline is before LRA (i.e first panel to the left) and middle and right panels are images at week 1 post LRA for one week and week 2 post-LRA for another week, respectively). <br />
Based on the legends, and consistent with the CT anatomy of the Video 5, the Video 8 https://insight.jci.org/art... shows the same images, before subtracting liver and kidney, displayed at 1.5 SUV. If we try to picture how the Video 8 (baseline, left panel) would look like by putting our hand on top of the liver and kidney to mask these two organs, it appears that what is left is an image that is the same image displayed in Video 5 (first panel to the left) or Figure 3F (first panel to the left). However, the legends state that the scales are different for Video5\Fig3F (0-0.3) and Video 8 (0-1.5), hence also the colors of the baseline images of Video 5 and 8 should be the different.<br />
In other words, Video 8 and Figure3F\Video 5 are incompatible. The evidence that Video 5 and Video 8 of reference [2] require to be harmonized for the validity of the whole dataset, can be also deduced by looking at the rainbow scale of the images. The rainbow scale goes from black to blue to green to yellow to red. So if we fix it to max SUV=1.5, it means that if an SUV uptake is 1.5 or higher, it will show up as red, and all the other colors would indicate levels below SUV=1.5 …for instance green is around 0.7. Now, if the rainbow is fixed to max Suv=0.3, it means that whatever is 0.3 or higher will be red, and green is in the middle, around 0.15. If Figure 3F\Video 5 is correct but the mistake was done in Video 8 (left panel was set at SUV scale 0.3 instead of 1.5 like written in the legends), then once displayed on a scale 1.5, the left panel of Video 8 should show a liver and kidney in color bluish...(which is not seen in the liver and kidney of any other animals, hence the latter scenario would point to a very fast biodistribution of the probe, which is consistent with a damage of the probe). <br />
Two different versions of the Samer et al. paper can be found online, the PMC version and the JCI-Insight version, which differ primarily on the biodistribution of the A14X004 (video 5 and video 8).
Some of the differences between JCI-Insight link (https://insight.jci.org/art... current version online modified in June 2023) and the PMC-link (dated November 2022 https://www.ncbi.nlm.nih.go... ) are here outlined:
A)<br />
JCI-I: However, a probe generated using a rhesus IgG1 Fab against an irrelevant antigen 64Cu-DOTA-F(ab′)2 pIgG1 in an SIV-infected macaque was used as further control (Supplemental Figure 8 and Supplemental Video 9). <br />
PMC: However, a probe generated using a rhesus IgG1 Fab against an irrelevant antigen 64Cu-DOTA-F(ab′)2 pIgG1 in an SIV-infected macaque was used as further control (Supplemental Figure 8 and Supplemental Video 2). <br />
Note, Suppl video 2 in PMC link shows images of A14X037, hence unrelated to the sentence above in the PMC link.<br />
B)<br />
JCI-I: A smaller increase in the gut was also present in A14X004 and A14X060 (Figure 3G, Supplemental Video 5, and Supplemental Video 8).<br />
PMC: A smaller increase in the gut was also present in A14X004 and A14X060 (Figure 3G, Supplemental Video 5, and Supplemental Figure 1). <br />
In this case too, Supplemental Figure 1 in PMC link shows figure title TGF-β inhibits HIV-1 latency reactivation by PMA in ACH-2 cells, hence unrelated to sentence in the PMC link.<br />
Consistent with the changes above, the supplemental materials in PMC do not show Supplemental Video 8 and Video 9. The videos legend, however, is the same on both links, i.e. points to the existence of additional two videos (called movie S1 and movie S2) in both the PMC and JCI-I links. None of the two links however call movie S1 or movie S2 in the main text, so this is an editing mistake probably propagated for 3 corrections made on the JCI-Insight publication, the last one dated June 14th 2023 based on the Version History section linked to the publication https://insight.jci.org/art... .
C) Video 1 link of the PMC link does not contain the animal ID listed in the legend, but animal A14x004 displayed at 0-1.5 SUV scale (what became Video 8 in the JCI-I link)<br />
D) the PMC link date is Nov 2022, the JCI-I link shows that changes were made in June 2023 based on the third upload of the supplementary material file.
note-*4. Figure S3 from the [1] pre-print shows CAVL-RNA in the gut with unit measurement [copies/ml] and ranges 0-30; in the 2022 [2] paper Fig 4A shows the same covariate but with unit measurement [copies/10to6] cell-eq and ranges (0.1-1,000) log-scale; <br />
Figure S4A from the [1] pre-print show CAVL-DNA in different organs with unit measurement [log copies/10to4 cell-eq, range 0-5]…; in the 2022 [2] paper Fig 4C shows the same covariate but with unit measurement [copies/10to 6] y-axis transformation unclear;
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https://insight.jci.org/art...
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