Viewing Study NCT06616688



Ignite Creation Date: 2024-10-26 @ 3:41 PM
Last Modification Date: 2024-10-26 @ 3:41 PM
Study NCT ID: NCT06616688
Status: NOT_YET_RECRUITING
Last Update Posted: None
First Post: 2024-09-25

Brief Title: Innovative Therapeutic Treatments to Inhibit Perineural Invasion in Pancreatic Adenocarcinoma
Sponsor: None
Organization: None

Study Overview

Official Title: Innovative Therapeutic Treatments to Inhibit Perineural Invasion in Pancreatic Adenocarcinoma
Status: NOT_YET_RECRUITING
Status Verified Date: 2024-09
Last Known Status: None
Delayed Posting: No
If Stopped, Why?: Not Stopped
Has Expanded Access: No
If Expanded Access, NCT#: N/A
Has Expanded Access, NCT# Status: N/A
Acronym: PNIPDAC
Brief Summary: The overall goal of this project is to develop new therapeutic approaches to limit Perineural invasion PNI in pancreatic ductal adenocarcinoma PDAC PNI has its higher incidence in PDAC in which it is a recognized risk factor of poor survival Considering the clinical relevance of PNI and its role in PDAC it is urgent to identify molecular PNI signatures to develop new therapeutic strategies We have recently identified a molecule that is activated in pancreatic cancer cells and initiate PNI In this project we will hamper the signaling of this molecule in vitro in human and murine organoids cocultured with myelinated Schwann cells neuronal cocultures and in vivo in a mouse model faithfully reproducing human PNI Thus we will enroll patients undergoing surgical resection for PDAC and a small piece of the resected tissue performed for normal clinical practice after pathology evaluation will be used to develop organoids

This project is designed as an observational multicentric transversal study San Raffaele Hospital OSR is the only center enrolling patients

The main goal of this Aim is to validate the effectiveness of NP-loaded hydrogel-based developed by CNR Nanotec Lecce in vitro in organoids which represent a suitable system to study PDAC
Detailed Description: STUDY DESIGN The overarching goal of this project is to develop new therapeutic approaches to limit PNI formation and therefore PDAC formation and metastasis PNI has its higher incidence in PDAC in which it is a recognized risk factor of poor survival Considering the clinical relevance of PNI and its role in PDAC it is urgent to identify molecular PNI signatures to develop new therapeutic strategies We have recently identified a molecule FGFBP1 that is activated in pancreatic cancer cells and initiate PNI

This project is designed as an observational multicentric cross-sectional study OSR is the only center enrolling patients OSR will send organoids derived from biological samples of enrolled patients to the participating center UO 3 ASL3 Lecce that will perform proteomic analyses to determine the level of expression of FGFBP1 inhibitor loaded in Nanoparticles hydrogels Thus the effectiveness of NP-loaded hydrogel carrying FGFBP1 inhibitors will be generated and validated by CNR Nanotec Lecce Aim 1 UO 2 whose biochemical release will be tested by mass spectrometry by UO 3 ASL3 Lecce their biological effectiveness will be validated on myelinated Schwann cells neuronal cocultures seeded with human organoids carrying NP-loaded hydrogels Aim 2 - OSR and in vivo in TPAC mice a recently developed animal model of PDAC whose pancreas will be injected with NP-loaded hydrogels Aim 3 - OSR

Study duration Duration of enrollment 18 months Duration of total follow-up no follow-up needed for enrolled patients Duration of total study period 24 months

STUDY POPULATION Study Participants Adult patients undergoing surgical pancreatic resection as per clinical practice with clinically and radiologically confirmed diagnosis of ductal adenocarcinoma All patients will be enrolled at the OSR Pancreatic and Transplant Surgery Unit

Inclusion Criteria

Age 18 years also fertile patients ca be included
Surgical resection for suspected PDAC as per clinical practice We will use this material both for controls and for the case samples

Exclusion Criteria

Patients who are not able to sign an informed consent
Patients with suspected PDAC non confirmed at pathological report Screening Failures Participants who consented to participate in the clinical study who do not meet one or more criteria required for participation in the study during the screening procedures are considered screen failures

STUDY OBJECT Study object description This is an observational study which does not require additional experimental procedures for the patients enrolled

All patients will be treated according to guidelines regardless of their decision to participate in the study All patients who do participate will sign the informed consent form attached to this protocol

In Aim 1 no human material required UO 2 CNR-Nanotech Lecce will develop and characterize NP loaded hydrogels capable of releasing FGFBP1 inhibitors Hydrogels will be characterized by rheometry mechanical testing morphological analysis permeabilitydiffusion test swelling and stabilitydegradation tests in physiological conditions Cell studies viability morphology motility proliferation will allow to evaluate the interaction between hydrogels and murine pancreatic cells to select the best performing compositions

Obtained nanoparticles will be characterized their surface charge hydrodynamic diameter particle distribution and their stability in biological buffers will be monitored via light scattering technique Nanoparticles morphology will be studied using both scanning and transmission electron microscopy FGFBP1 inhibitors loading and release profiles under different stimuli will be monitored by advanced analytical techniques chromatographic separations and detection by mass spectroscopy Biocompatibility of the best nanoformulations will be assessed by performing viability assays pro-inflammatory activities assays cell cycle monitoring hemolysis assay These investigations will be carried out thanks to availability of instrumentation as flow cytometer multimode plate reader and Laser Scanning Confocal Microscopy coupled with cell culture facility Effective FGFBP1 inhibitor release will be tested by mass spectrometry analyses by UO 3 ASL3 Lecce using mass spectroscopy assays

In Aim 2 UO 1 OSR will generate human and murine organoids from patients enrolled for surgical procedure after confirmed diagnosis of PDAC and from TPAC mice respectively

Organoids recapitulate the epithelial architecture of their organ of origin and reproduce the environmental signals present in both normal tissue and cancer while retaining the original genetic mutations

Human pancreatic organoids will be prepared from PDAC patients whose diagnosis has been confirmed clinically and radiologically Patients will be informed and asked to sign a consent for tissue collection Resected specimens collected in sterile conditions will be transferred to the pathologist for a preliminary histological characterization After isolating the tumor the pathologist will provide us a small part of it that we will store in a 50 mL sterile tube in the presence of basal medium at 4C for 16 hours to eliminate fat and blood cells Next we will separate cells from the surrounding fibrous tissue by mechanical dissection followed by enzymatic digestion with 0125 mgml collagenase 0125 mgml dispase and 0125 mgml DNAase To remove the undigested material we will pass it through a 40 μm cell strainer All collected material will then be centrifuged resuspend in cold Matrigel and plate in pre - warmed 4 well culture plates

Murine organoids will be aldo prepared from the pancreas of TPAC mice a recently developed animal model that develops PDAC and PNI from 12 months of age and faithfully reproduces the features of human cancer

Both human and mouse collected tissue will be first mechanically dissociated and then enzymatically digested to obtain single cells As control we will either prepare naïve organoids and organoids embedded with hydrogels unloaded with FGFBP1 inhibitor All cells will be resuspended in cold Matrigel and plated in pre-warmed 4 well culture plates

Organoids will be also established from murine pancreas of the TPAC animal model characterized by extensive PNI in PDAC and from healthy murine pancreas as control

To validate the effectiveness of NP-loaded hydrogel-based developed by UO 1 CNR Nanotec Lecce in blocking FGFBP1 expression and limit PNI formation in PDAC we will first perform proteomic analyses UO 3 ASL3 Lecce to monitor effective release of the inhibitor

Effective inhibition of FGFBP1 will also be determined signaling in organoids loaded with FGFBP1 inhibitor hydrogels and relative controls by qRT-PCR mRNA and Western Blotting analyses protein by looking at specific downstream signaling effectors The effect of hydrogels will be monitoed releasing FGFBP1 inhibitor onto organoids growth and formation by scanning electron microscope and by immunofluorescence analyses for CK19 a marker of exocrine ductal cells and Sox 9 a marker of ductal lineage of pancreatic neoplasms Schwann cells neuronal cocultureswill be established from E135 mouse dorsal root ganglia neurons as in Taveggia and Bolino 2018 embed them in Matrigel to maintain comparable culture conditions with organoids and let the cultures to myelinate for 21 days in the presence of 50 ugml ascorbic acid Our preliminary data indicate that PDAC organoids seeded onto myelinated cocultures induce rapid and extensive myelin degeneration as assessed by MBP staining Moreover this event is rapidly blocked if PDAC organoids do not express FGFBP1 Thus human and mouse organoids containing FGFBP1 inhibitor NP hydrogels and relative controls will be seeded onto myelinated Schwann cells neuronal cocultures The cultures will be manteined for additional 3 7 10 15 and 21 days and monitor the extent of myelination and of axonal integrity by immunofluorescence analyses for MBP and NF

Since in our preliminary data blocking FGFBP1 signaling rescues myelination we expect that neuronal myelinated cocultures in contact with organoids loaded with NP hydrogels releasing FGFBP1 inhibitor will not degenerate unlike controls Of particular interest it will be to compare possible differences between human - and mouse-derived organoids

In Aim 3 no human material required UO 1 will inject in the pancreas of TPAC mice a recently developed animal model for PDAC NP-loaded hydrogels releasing FGFB1 inhibitor

The expression level of FGFBP1 will be first assesed at mRNA and protein level and the expression of CK19 and Sox 9 cancer cells NF 200 axons and GFAP SCs All analyses will be done on 5 micegroup to reach statistical significance In parallel the expression levels of these protein will be also evaluated by Western Blotting analyses following standard protocols To validate the effectiveness of NP-loaded hydrogels carrying FGFBP1 inhibitor they will be inserted directly into the tail of the pancreas parenchyma of TPAC mice by surgical procedures In parallel we hydrogels not containing nanoparticles will be injected in the pancreas of TPAC mice that will serve as negative controls Tumor formation will be monitored by ultrasound analyses 10- 20- 30- 40- and 50-days post-hydrogel injection Mice positive for tumor formation will undergo MRI analyses at the OSR Preclinical Imaging Facility to determine the presence of metastasis in close organs liver peritoneum At the end of each time point mice will be sacrificed perfused in 4 PFA and the whole abdominal cavity included in OCT to analyze the histological characteristics of the primary tumor and assess the presence of PNI in the posterior nerve trunks and ganglia 12 μm thick transverse sections will be cut at the cryostate collected on Superfrost plus glass slides and processed for hematoxylin and eosin staining and immunofluorescence for CK 19 Sox 9 cancer cells and NF200 axons Spleen duodenum stomach liver kidneys lungs peritoneum and diaphragm will also be collected in 10 buffered formalin embedded in paraffin wax and 3 μm sections stained with hematoxylin and eosin staining to detect metastasis formation

SUBJECT RECRUITMENT AND SCREENING All surgically candidate patients for PDAC will be considered eligible for enrolling in the present study The optimal goal would be to recruit at least 50 patients in the study period 18 months enrollment A subject identification code will be assigned consecutively ie PNI_XXX XXX is the progressive subject number in increasing order starting from 001

A patient identification list will be kept Baseline Assessments Baseline procedures coincide with the signing of informed consent for participation in the study Being indeed a cross-sectional study no other procedures ad hoc for the study are planned for the participating patient

SAMPLE HANDLING NP Loaded hydrogels releasing FGFBP1 inhibitors will be developed by UO 2 CNR Nanotec Lecce

UO 1 will prepare human- and mouse-derived organoids carrying NP Loaded hydrogels releasing FGFBP1 inhibitors UO 3 ASL3 Lecce will determine effective release of FGFBP1 inhibitors in organoids by proteomic analyses

Organoids will be established from surgically resected PDAC patients whose diagnosis of ductal adenocarcinoma was confirmed both clinically and radiologically at the OSR Pancreatic and Transplant Surgery Unit Organoids will be established at the laboratory of Axo-Glial Interaction Unit within OSR All organoids of human and murine origin will be stored at the OSR CRB and in the laboratory of Axo-Glial interaction Unit at OSR for future studies except part of and those carrying NP-loaded hydrogels that will be sent to the ASL3 Lecce for proteomic analysis to validate effective release of the FGFBP1 inhibitor After the analyses which will last approximately 2 weeks all organoids sent to ASL3 Leccesamples will return to OSR and destroyed

Developed organoids carrying NP-loaded hydrogels will be validated in vitro onto Schwann cells neuronal myelinated cocultures for their effectiveness in limitingblocking myelin degeneration Preliminary data in fact indicate that blocking FGFBP1 activity blocks myelin degeneration in vitro and limit metastasis and PNI formation in vivo in mice

NP-loaded hydrogels upon validation will also be implanted directly in the pancreas of TPAC mice a recently developed model of PDAC We will monitor tumor and PNI formation radiologically ultrasound and MRI and by histopathological analyses

DATA MANAGEMENT Source Data All information in original records and certified copies of original records of clinical findings observations or other activities in a clinical study necessary for the reconstruction and evaluation of the study Source data are contained in source documents original records or certified copies Any data recorded directly on the CRFs ie no prior written or electronic record of data is considered to be source data

Source Documents Original documents data and records eg hospital records clinical and office charts laboratory notes memoranda All parameters asked for in the case report form CRF will be documented in the source documents

STATISTICS Description of Statistical Methods All generated data will be collected randomly 5 10X images collected at confocal microscope and assessed blindly on samples of comparable size especially for all in vitro analyses Based on our experience we use a minimum of 5 biological replicates for each in vitro experiment Thus we will rely on the G-Power analyses to determine the minimum sample size required to obtain statically significant results with an impactful biological value

Based on our previous comparable analyses the data distribution will be assumed to be normal All statistical analyses will be performed on at least five different experiments Statistical detailed analyses will be assessed using Prism 9 Software package GraphPad and normally comprehend Mann-Whitney test ANOVA with adjusted Bonferroni correction Unpaired t test analyses Ordinary OneWay Anova Two-Way Anova Tukeys multiple comparison test

All data generated during these procedures such as optimization and characterization results obtained as function of the process parameters for hydrogel and nanoparticles preparation will be collected and stored through dedicated repositories eg Zenodo research data repository and in data storage media Dropbox Business

Study Oversight

Has Oversight DMC: None
Is a FDA Regulated Drug?: None
Is a FDA Regulated Device?: None
Is an Unapproved Device?: None
Is a PPSD?: None
Is a US Export?: None
Is an FDA AA801 Violation?: None