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How Instagram Changed Food Forever in the 2010s – Robb Report

December 11th, 2019 10:44 am

Against my better judgement, I tapped the button to start the video. Immediately from out of frame a beef tenderloin comes flying, slamming down onto a large, filthy grill. Then, as the camera phone pans left, our hero is revealed. Its Salt Bae. And hes got a knife.

What happens next should be against the laws of God and man alike. The internet-famous butcher and chef Nusret Gke butterflies a perfectly good slab of meat, manhandles it some more and fills it with slices of cheap cheddar and asparagus. The video cuts to him planting mini-flags in his beef roulade, slicing it and then inexplicably squeezing the life out of it for the camera, looking quite pleased with himself the whole time. It ends with his trademark salt sprinkle cascading sodium down his forearm onto Frankensteins monster. To date, the video has been watched 8.2 million times since it posted in January 2018. And in the two intervening years, his follower count has nearly doubled to 24 million, despite the fact that, by most accounts, his restaurants are as bad as his cheesy asparagus beef roll looks.

Meanwhile, a few days after Salt Bae posted that video, Daniel Riesenberger, a.k.a.@danthebaker, uploaded his own clip. Off a tiny road outside of downtown Columbus, Ohio, in a black corrugated metal building that also houses the Sbarro Culinary Innovation Center, Riesenberger bakes bread. On Instagram we can follow the journey. His video was nothing flashy, just Riesenberger excited that he had a little mill now in his production kitchen where he could grind his own rye fresh for his breads. That video is flanked by other posts showing dough proofing, videos of him shaping loaves, shots of crumb (holes in a loaf) and pastry experiments hes working on. The chronicling of his work has brought Dan the Baker more than 40,000 followers. And it led me to visit his storefront earlier this year.

In the past, Riesenberger may have toiled in obscurity and anonymity. And I, a person living in Los Angeles, probably would have never heard of him. But just how Instagram introduced me to Salt Bae, the platform also led me to discover Dan the Baker. To my delight, when I sought him out, I found Riesenberger wasnt just showing off pretty pictures. His bakes were the genuine article. The texture and crumb of his oat porridge bread were some of the best Id had and the laminated dough in his croissants and cruffins rivaled the quality of big-city patisseries. Social media had not steered me wrong.

The Salt Bae-Dan the Baker dichotomy exemplifies the food worlds love-hate affair with Instagram in its first decade of existence. There was a kind of Newtons Law to the platform, where every action appeared to have an equal and opposite reactioneach positive effect seemed to carry an annoying inverse. Yet, no matter how restaurants or diners feel about it, Instagram has become a necessity that has reshaped how we eat, how chefs run their business and how we decide where to dine.

Instagram has let us indulge our most superficial tendencies, allowing whole empires to be built on the dumbest possible things. This decade a class of food emerged with the express purpose of getting us to pull out our phones and take a picture. Theres plenty of excitement about extremely superficial stuff that makes no sense to me, says Christian Puglisi of Relae in Copenhagen. But we need to live in an Instagrammable world for anybody to care, so unfortunately that appeals to doing some things that just look good on camera but do not really make a lot of sense if you think it through.

The camera-friendly ploys worked. People lined up around blocks for Cronuts, rainbow bagels, unicorn Frappuccinos, ramen burgers and, of course, Black Tap CrazyShakes.

Black Tap, the New York burger joint, rose to fame with a made-for-Instagram concoction that featured whole other desserts perched atop a shake. Accessing the frosty treat required digging through slices of cheesecake or perhaps a Choco Taco. Its like the restaurant version of the horror film The Ring, where anyone who watches the haunted tape dies. Except every person who sees a photo of a Black Tap shake gets type 2 diabetes. And if you bought it just so you could post it to Instagram and throw it away before eating, it didnt matter to them. The bank deposited the money either way.

And yet, not everyone was so cynical with how they used Instagram. A person or restaurants posts could give the public a glimpse into the creative process, and bring to attention people who wouldnt have otherwise received itlike Dan the Baker. Or like a young chef in Australia who has become known around the world because of his social media use.

From his little restaurant in Sydney, Josh Niland got creative with seafood. Through his posts he showed off butchery skills that had greats from Dan Barber to Grant Achatz requesting an audience when he finally came stateside this year. And his work came in service of something noblea more eco-conscious way of preparing fish that cuts down on food waste. Gaining Instagram followers showed me Oh, wow, people like this, Niland says. People message me to ask what to do with the fish theyve got, and I love the interaction. It helps me be in front of more people to talk about what Im doing. It puts my work to good use.

Chef Magnus Nilsson likes to tell a story thats not directly about dining, but speaks to what he sees at restaurants now. He recently found himself at a small party where John Legend just happened to sit down at the piano and play three songs for the gathered revelers. I sat very very close because although Im not a John Legend fan, this was a beautiful momenthow often do you get to hear an artist of that caliber playing piano and singing a few meters away? Nilsson says. And I turned around and looking back it was a wall of cell phones. Everyone was experiencing the moment through their phones. None of them were having the experienceI dont think that they were even listening. It was just sad.

Its not that different at restaurants this decade. Diners have turned into food paparazzi, swarming dishes with cameras the moment they land on the table. I think theres a really positive aspect to Instagram, but its also a little annoying to see people take pictures of their food for 20 minutes before they even touch it, says Gio Osso of Virtu in Scottsdale, Ariz. Its getting cold, what are you doing? Or for a dessert course you want to say, Your ice cream is melting, you dont need 15 pictures of it. That constant urge to document the meal also means theyre disconnected from the people right in front of themdiners are mediating the restaurant experience through an LED screen.

I think the phone has decreased the interaction of human beings, says Matthew Accarrino of SPQR in San Francisco. That sentiment may not just be alarmism. A 2017 study that appeared in the American Journal of Preventative Medicine, showed a significant association between social media use and increased depression, as people who spent more time on it reported increased feelings of social isolation. Social media may show you the whole world, but it may also make you feel alienated from it, as you see all these other people living their best lives.

And yet, it does have the power to connect communities of people who love food as well as bring diners closer to chefs and restaurateurs than in the past, like how I found Dan the Baker. It has been great for us, because another level of interaction with people who want to talk to you, says Jessica Koslow of Sqirl in Los Angeles.

It can help you get your message across to people, says Michael Tusk of Quince in San Francisco. And it doesnt have to just be pictures of food, you can use it for positive change by connecting for education purposes or showing people whats going on in your community.

That ambivalence is baked in to social media for Nilsson. Being part of this world is enables me to actually do something with my creative expression, he says. I mean, people wouldnt be coming to Fviken if it wasnt for a certain amount of interest in my person and a certain amount of hype, so its very complex.

Back when Matthew Accarrino was coming up as a young cook in New York in the pre-social media era, it was harder to know what food looked like inside the citys best restaurants. If he wanted to see Le Bernardin dishes, he might as well just go press his face up against the glass to see what the people were eating inside. But now I can type Le Bernardin into Instagram and see anything anyones ever taken a picture of, he says. The information is there, and it speeds the flow of that information to anyone.

The way starving chefs used to find out about the heights of fine dining was by waiting for cookbooks to be published. I came from a town of 3000 people. I thought you had to be from France to be a chef. I didnt know that was anything that I could ever even aspire to be, says Josh Habiger of Bastion in Nashville. My first job was in a diner. I remember seeing the Charlie Trotter cookbook and being like Whoa, this is food? This is more like art.'

Now chefs dont have to wait for a long publishing cycle to see the coolest new thing. We get ideas all the time from Instagram all the time. Probably every single day one of the cooks will show us something on Instagram to say, Look what these guys are doing,' says Alexander Hong of Sorrel in San Francisco. We get to see different flavor combinations or techniques, its a great great tool.

And yet, theres a downside. Scrolling through Instagram can reveal a lot of conformity because people are able to see and then quickly mimic the leaders like Ren Redzepi. I think theres a unifying thread through modern cuisine and I dont know if its a good thing or a bad thing. But food being produced in Copenhagen shouldnt look like food in Los Angeles, San Francisco or Tokyo, says Michael Cimarusti of Providence in Los Angeles. There should definitely be differences there, but I think thats part of the modern world that we live in, where everything is accessible within seconds from all the way around the world due to social media. I think it occurs at the detriment of your own creativity.

But even if theres some level of conformity, thats not necessarily a bad thing. Just this fall, persimmons hanging from strings inside restaurants flooded certain corners of Instagram. Chefs were drying the fruit to make the traditional Japanese delicacy hoshigaki. Id see pictures of Josh Skenes or Inua in Japan posting pictures and Im like, Thats so cool,' says Andy Doubrava of Rustic Canyon in Santa Monica, Calif. Hes not exactly sure what hell do with them, but Instagram allowed this Michelin-starred chef to find inspiration, guidance and the confidence to try something he hadnt before. And when its done right, the delicious results are passed along to us the diners. Its the best we can hope for from Instagram.

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Scabies At ICE Facility In Aurora: Officials Trying To Contain Infestation Of Mites – CBS Denver

December 11th, 2019 10:44 am

AURORA, Colo. (CBS4) Crews at the U.S. Immigration and Customs Enforcementfacility in Aurora are trying to keep scabies from spreading. Its a highly contagious infestation of mites that burrow into the skin. The people living in one dorm are being kept away from everyone else.

A spokeswoman says these cases typically involve someone who is already infected when they arrive at the southern border. Scabies is treated with a topical medicine.

ICE officials released the following statement Monday:

With the recent influx of migrants entering from the U.S. southern border, U.S. Immigration and Customs Enforcement (ICE) has confirmed six cases of scabies at our Aurora Contract Detention Facility (ACDF). On-site medical personnel are credited with reducing the risk of further spreading the disease by quickly cohorting the six infected detainees along with 19 others who were also exposed to the disease.

Each ICE detainee receives a medical examination upon arrival at the facility to check for potential signs of illness.However, ICE has no way of knowing what diseases or viruses a person may have been exposed before they enter the facility.

A topical ointment will be administered to ICE detainees once the ointment is received at ACDF, which is anticipated to be Dec. 10. Once the treatment is administered, detainees will be removed from cohort. ICE and the on-site medical professionals employed by GEO took the necessary steps to quickly isolate the exposed detainees, provide proper medical care and prevent further spread of the disease. Preventative steps included early recognition and following the guidelines established by the CDC and the ICE Health Services Corps (IHSC).

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I belong here: Advocate works to raise profile of black women with breast cancer – San Antonio Express-News

December 11th, 2019 10:44 am

The first time Maimah Karmo attended the San Antonio Breast Cancer Symposium, she felt out of place.

Karmo was in awe of the breadth of expertise at the conference, which is one of the largest annual gatherings of breast cancer specialists and researchers. A breast cancer survivor herself, Karmo had been involved in advocacy for years as the founder and CEO of the Tigerlily Foundation, a national nonprofit that educates and supports younger women who are affected by the disease.

As she walked around the Henry B. Gonzlez Convention Center then, Karmo recognized the importance of the work around her, but she was struck by the dearth of black women like her. She knew that as a group, black women were about 40 percent more likely to die from breast cancer than white women, so their absence was notable.

On ExpressNews.com: Research finds outcome disparities for black women with early-stage breast cancer

I felt so overwhelmed. Im like, theyre doctors, theyre researchers, theyre smarter than me. I didnt want to talk. I didnt know what to say, Karmo said of her first experience with the symposium. And then over time I go, Wait, I belong here. Im the one theyre talking about. So why arent there more of me at the table?

After last years conference, Karmo decided shed had enough. It was time, she believed, for the voices of black women living with breast cancer to get higher priority. On Tuesday morning, as the international conference got underway at the convention center, Karmo was instead at a dining room at the Menger Hotel, where she was leading a series of presentations and panels on the disparities in treatment and outcomes for black women with metastatic, or late-stage, breast cancer.

Throughout the morning, a series of speakers highlighted the numerous barriers that black women face when it comes to breast cancer, from accessing preventative health care to participating in clinical trials. Those problems, Karmo told those gathered, have been exacerbated by the black communitys distrust of a medical system that has historically mistreated and experimented on black people.

On ExpressNews.com: The number of deaths from prostate cancer was not increased by finasteride, study led by San Antonio researcher finds

Shawn Johnson, a student at Harvard Medical School, drove that point home when he recounted the history of the Tuskegee study, during which researchers withheld treatment for black men with syphilis so they could observe the sexually transmitted diseases effect on the body. The participants, he said, were not told about the purpose of the research and were not offered penicillin, which became the standard treatment for the illness about 15 years into the four-decade-long study.

We cant forget how we got here, he said.

Johnson also noted the way in which black women have been excluded from breast cancer clinical trials, which play a key role in advancing treatment of the disease and provide those who have already been diagnosed with earlier access to promising treatments. He called up information from one clinical trial that included about 4,000 people, only 20 of whom were black women.

Its important that we begin to speak up, said Nikia Hammonds-Blakely, an advocate and public speaker who was first diagnosed with breast cancer at age 16. Because it really informs the work.

Hammonds-Blakely said some women may also be unable to access preventative care like mammograms due to economic barriers, such as a lack of access to transportation.

Dr. Tatiana Prowell, an associate professor of oncology with Johns Hopkins Medicine who also serves as a medical officer and breast cancer scientific liaison to the Food and Drug Administration, said its time to rethink the way clinical trials are conducted. Studies would be more inclusive if the medical system took steps to reconsider criteria for eligibility and decentralized some of the ongoing testing and scans to take unnecessary burdens off patients.

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Dr. Lori Wilson, a cancer surgeon affiliated with Howard University, said she has been diagnosed with three different types of breast cancer since 2013. She learned her cancer had become metastatic earlier this year.

The thing to know is that we need to make sure that we understand that theres still gaps in survival, that even though weve done so much, we have come so far, there is a difference between breast cancer in white women and black women and that we need more research to know why, Wilson said.

Lauren Caruba covers health care and medicine in the San Antonio and Bexar County area. Read her on our free site, mySA.com, and on our subscriber site, ExpressNews.com. | lcaruba@express-news.net | Twitter: @LaurenCaruba

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Amazon and Apple will be our doctors in the future, says tech guru Peter Diamandis – Fast Company

December 11th, 2019 10:44 am

Healthcare is the biggest business in the world, and it is phenomenally broken, says Peter Diamandis, cofounder of the X-Prize, Singularity University, and Health Longevity Inc. So, do I think Apple and Google and Amazon can do a better job? A thousandfold.

In his upcoming book,The Future Is Faster Than You Think, which will hit bookshelves in late January 2020, Diamandis makes the case for why he believes big tech companies are going to be running healthcare by 2030. In December, he came to Fast Companys offices to make the case for why Big Tech is the doctor of the future.

Were going to see Apple and Amazon and Google and all the data-driven companies that are in our homes right now become our healthcare providers, he says, referring to smart speakers such as Googles Assistant, Amazons Alexa, and Apples HomePod. While many of these home voice assistants started with simple tasks like restocking home pantries and surfacing cooking tutorials, theyre already starting to move into the business of managing family well-being.

Amazon has put significant effort into making Alexa a health resource. In the United Kingdom, it has partnered with the National Health Service to answer basic health questions such as What are the symptoms for shingles? or What do you do if you have a cold? It has also made Alexa compliant with U.S. HIPAA laws and signed partnerships with major healthcare insurers and providers so patients can access or remit health information through the device. To date, there are nearly 2,000 health wellness skills on its platform.

Healthcare is the biggest business in the world, and it is phenomenally broken.

Similarly, the Google Assistant uses search to serve up information about medications, symptoms, and diseases, as well as physicians and medical services. Both the Google Home and the Echo have a Mayo Clinic-developed skill called First Aid that helps people navigate minor injuries. Meanwhile, Apples HealthKit takes a slightly different approach to tackling personal health. The kit connects to Apples own products such as the HomePod, iPhone, and Apple Watch as well as a bevy of devices from other companies, such as scales and blood pressure cuffs. The HealthKit can also tap into electronic medical records and other apps connected to hospitals and doctors. Essentially, it becomes a single repository for all your precious health data.

[Photo: courtesy of Apple]Diamandis believes the involvement of home health devices has the potential to lower costs by shifting care away from hospitals, where expenses can be much higher. This is the general idea behind telemedicine, but Diamandis thinks that big consumer tech companies will play a big role in driving that vision. He also thinks that these companies, which have mastered using personal data to anticipate user behavior, can use personal health data to make predictions about a persons long-term health prospects and advise them accordingly.

Diamandis posits that the more information is available about youyour genetic makeup, your health history, what you ate for breakfast, the bacteria in your bowel movement, how you slept last night, what kind of sound youre exposed to every daythe better artificial intelligence will be at spotting your potential for illness and suggesting care before the problem becomes intractable. This approach might shift the medical establishment from a structure that treats disease once its wreaking havoc in your body to one that prevents the disease from striking in the first place. It is literally hundreds if not thousands of times cheaper to do that, he says.

It is literally hundreds if not thousands of times cheaper to do that.

It is this cost savings that he believes will allow for new models of healthcare. Diamandis predicts Apple and Amazon will come up with a service where a person pays a company to keep them healthy, rather than to cover the cost of illness, based on their health history and daily activities. And big tech could not only influence a person to make healthier decisions, it could force them. Amy Webb, professor of strategic foresight at New York Universitys Stern School of Business, has spoken at length about the possibility that in a futuristic situation when Amazon, Google, and Apple run your entire house as well as your healthcare, smart refrigerators could cut you off from snacking between meals and smart garages could keep you from accessing your car in favor of walking to work.

Diamandis believes that by knowing a persons predisposition for disease, these companies could help them live a healthy lifestyle with their particular abnormalities in mind. Can you prevent those things, so we dont have these extraordinary costs? he asks. It will be these services, he believes, that will lead healthy people to dispense with traditional health insurance, leading to its ultimate demise.

Diamandiss vision of healthcare in 2030 raises a lot of questions. First and foremost, do these big tech companies want to become healthcare providers? So far, the only one that has really signaled its desire to become your doctor is Amazon. In addition to its work with Alexa, the company has launched its own health clinic for employees and is working on a secretive health project with JP Morgan and Berkshire Hathaway called Haven. But Apple and Google, at least so far, seem content to integrate their technology with traditional health providers as a way of advancing their practices. Meanwhile, the insurance industry is more likely to adapt to a preventative health model than it is to collapse completely. A survey from last year shows insurers are increasingly signing contracts with healthcare providers for continuous, value-based careall for a flat raterather than a negotiated fee for a particular service.

But Diamandis is right to bet on artificial intelligence in some regards;it is already predicting the onset of disease with some success. Whats unclear is how far forward these predictions can reach and how meaningful big data is to understanding how our bodies work. For example, while it may seem clever to sequence the genome of every new child born, one of Diamandiss ideas, it actually isnt as effective as a blood test for catching certain disorders, reporting has shown. Furthermore, the promise of predictive medicine may rest on a flawed assumption.

In a recent paper, Henrik Vogt, a post-doctoral fellow at the University of Oslo Center for Medical Ethics, lays out why big data may not deliver in the way Diamandis suggests. He says that as technology gets better at spotting indications of illness or the prospect of sickness in the body, it will surface more and more signals. But a predisposition for a disease does not equal a diagnosis. The main problem for big data screening is that monitoring many features of the body with highly sensitive technologies is bound to detect many abnormalities but without the ability to tell which, if any, will become clinically manifest. As a result, more people may be labeled with more harmless conditions, he writes.

We have to accept that there will always be some degree of risk, morbidity, and mortality.

Even if a person has a high likelihood for a disease, they may never present symptoms, Vogt notes. As more services and devicessuch as direct-to-consumer gene sequencing and wearables with heart rate variation detectionget more sophisticated, there is more visibility into a persons body. But there is also a lot of noise in this information. Not every little genetic abnormality may be meaningful. Different bodies may have different idiosyncrasies. While there is more room for prevention as we are all more aware of our disease risk, Vogt makes the case that there is also a risk of overtreatment, which could be costly and may also cause patients harm. Vogt also explained via email that there might be issues in investing too much in big data rather than another approach, such as social or institutional change.

That is not to say there isnt a huge opportunity to mitigate disease through data and intelligence, Vogt writes, but doctors need to rethink risk. We have to accept that there will always be some degree of risk, morbidity, and mortality, Vogt writes.

That perspective flies in the face of precision medicine, which tends to assumes the human body is like a machine, Vogt explains over email, something that can be measured, analyzed, and ultimately controlled. The historian Yuval Harari, for example, rather uncritically built his book Homo Deus on this assumption: that organism is algorithm,' he says. But human bodies dont work like that; they are unique in composition and environmental circumstance.Both for biological and statistical reasons, there are limits to how precisely and accurately the trajectory of a human life can be predicted. This obviously limits the promise of predictive medicine.

This point of view is crucial, because it is at the heart of some of the skepticism surrounding a big data-focused approach to medicine. It is the reason thatApple has doctors on staffto advise on the development of its medically minded hardware. For big data to really drive better health outcomes, as Vogt points out, there will have to be standards about what information is actionable and what is not.

Diamandis seems to concede that big data is not everything, Ultimately whats best is human and AI collaboratively, he says. But I thinkfor reading x-rays, MRIs, CT scans, genome data, and so forth, that once we put human ego aside, machine learning is a much better way to do that.

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The Outer Line: The impact of endurance training on the cardiac health of women – VeloNews

December 11th, 2019 10:44 am

Female cyclists are at a lower risk of suffering Sudden Cardiac Death than male athletes, but women should still learn about ways to screen for heart problems before engaging in endurance sports.

Dr. Mehreen Quhreshi is a cardiologist with advanced training in stress testing and cardiac imaging from Columbia University Medical Center in New York. She practices in Harrisburg, Pennsylvania and serves as the director of the Preventative Cardiology Program and the Nuclear Stress Lab at UPMC Pinnacle Heart and Vascular Institute. Dr. Bill Apollo, an amateur bike racer, runner, and duathlete is a Harrisburg, Pennsylvania-based cardiologist, who directs the UPMC Pinnacle Sports and Exercise Cardiology Clinic.

At the Paris Olympics in 1900, endurance sports were exclusively dominated by men; a mere 22 women participated, competing in the five gentrified events of croquet, equestrian, golf, tennis, and sailing. It took until the latter half of the twentieth century for the world to witness women competing in major Olympic endurance sports such as cycling (Los Angeles, 1984) and triathlon (Sydney, 2000).

Wider womens participation in the Olympics roughly coincided with the establishment of Title IX of the United States Educational Amendments of 1972, which mandated equal access for women in any program that received Federal funding including sports in public schools and universities. These two major developments fueled an explosion of female participation in a variety of events at all skill levels. The percentage of women finishers in marathons in the U.S. rose from only 10% in 1980 to a robust 45% by 2015. Women set a new record for Olympic participation at the 2016 Rio Olympics, with nearly equal numbers (5,176 athletes, or 45% of total), and with representation in all events included in the games.

Paradoxically, women have generally been under-represented in medical research studies looking at cardiac health, adaptation to endurance training and its potential consequences. Despite this surge of female athletic participation, we still havent achieved gender equality when it comes to understanding and caring for the female athletes heart. And recent small-scale studies suggest that there are in fact important cardiac differences between the sexes.

Some of the key questions are: to what extent do underlying genetic and hormonal factors impact normal changes in a womans heart related to exercise? How do these influences alter her risk for developing chronic heart problems or sudden cardiac death during competition? Are women better equipped to handle endurance training by design? Some recent research suggests that pregnancy subjects the female body to cardiac stresses similar to those that male athletes experience in even the most competitive events, including events like the Tour de France.

Below we examine the current understanding of cardiac development and risks in women endurance athletes, how and why women may differ from men in this regard, and recommended precautions that should be taken in training and competition by elite female endurance athletes.

Sudden cardiac death (SCD) during athletic competition is fortunately a rare occurrence, and it tends to affect men more commonly than women. In fact, a womans risk of SCD during endurance sports is estimated to be some 10 times lower than for her male colleagues. Professional cycling, during the past 3 seasons, has seen a total of 6 elite men tragically die directly from heart problems during races (5 in road racing, 1 on the track), with the most recent being Robbert de Greef in March 2019. During the same time period, there were zero incidents involving women, and indeed there are no known reports of SCD during elite womens cycling events for the past 20 years. Professional female cyclists are far more likely to die from training accidents (usually involving automobile collisions) than from heart problems.

Interestingly, these observations regarding SCD in cycling seem not to be true for other endurance sports. Marathon running has a huge participant base much larger than the womens pro peloton with nearly a half million participants in 2019 alone. This huge statistical sampling clarifies the measure of SCD risk: 1 incident per 150,000 participants overall, but more commonly occurring in men (1/ 100,000), and much less likely to occur in women (1/243,000).

Despite this fairly low risk of SCD in women, the sheer volume of running participants makes it easier to find reports of SCD. For example, Taylor Ceepo, age 22, died in May 2019 less than 1 mile from the finish line at the Rite-Aid Cleveland Marathon. The medical examiners report indicated that Ceepo experienced sudden cardiac death in association with physical exertion, pseudoephedrine use (a fairly benign over-the-counter decongestant) and cardiomyopathy. Her tragedy should remind us that even in very young and apparently healthy women, undiagnosed heart disease is still a common killer (3rd behind unintentional injuries and cancer in her age group), and her autopsy findings highlight the importance of screening women for underlying heart problems.

The most common causes of SCD are generally driven by age rather than sex. Athletes under age 35 both men and women alike are susceptible to genetically inherited structural heart problems including hypertrophic cardiomyopathy (HCM) and arrhythmogenic right ventricular cardiomyopathy (ARVC), as well as potentially lethal heart rhythm problems called channelopathies. Above age 35, coronary artery disease predominates, with women being preferentially protected by their higher estrogen levels, until they reach menopause. Initially, the ten-fold higher incidence of SCD in men was thought to be simply due to the much larger numbers of men participating in endurance sports. But now that participation rates are becoming nearly equal, womens risk of SCD is still not as high as that experienced in the male population.

Several theories exist that might explain why women appear to be more protected from SCD during intense competition. One explanation may lie in the sympathetic nervous system, which is responsible for the bodys fight or flight response. Male physiology is observed to be wound more tightly, meaning that their arteries and blood vessels tend to constrict more during intense activity than women. The increased blood pressure adds resistance to blood the heart is pumping out. When this increased pressure load is coupled with an outpouring of adrenaline during competition, the strains placed on the heart may trigger lethal rhythm problems in susceptible individuals generally those with underlying inherited cardiac problems or acquired fibrosis (scarring) from long-term training. For unclear reasons, even in the context of equal training volumes, men more commonly develop potentially lethal fibrosis substrate, placing them at higher risk of SCD than women.

Another possible explanation relates to obvious hormonal differences between men and women. In some animal models, testosterone has been shown to affect the way the heart conducts impulses making men, at least in theory more susceptible than women to developing electrical instability resulting in malignant heart arrhythmias. Clinically, testosterone promotes thickening of the heart muscle, which may explain why men are more susceptible than women in developing complications from diseases like HCM and ARVC. Estrogens, on the other hand, are protective in this regard, and delay that same process of heart muscle thickening. Despite equal patterns of genetic transmission of HCM and ARVC between both sexes, hormonal differences may explain why these maladies tend to remain latent for a longer period of time in women, presumably translating to a survival advantage and lower risk of SCD.

Sports medicine screening programs are designed to identify potential cardiac risks in individuals who exhibit no outward symptoms of heart problems. Such programs aim to increase participation but to do so with a reasonable level of caution, to ensure the safety of the athlete. Despite the lower risk of SCD in women, screening is still important.

Pre-participation screening typically involves a comprehensive medical history review, focused physical examination, and in some cases an electrocardiogram (EKG). EKG tests are proven to be more sensitive than history and physical examination alone in detecting pathology, especially regarding heart rhythm issues. EKG interpretation should always be completed by a skilled reader able to distinguish the fine line between normal adaptation to exercise and pathology. Guidelines like the International Recommendations for EKG Interpretation in Athletes will increase reading accuracy and reduce the number of false findings, which often lead to expensive and unnecessary longitudinal testing. Men exhibit changes in their EKG patterns more often than women, and these variations in many instances are considered normal purely as the result of physiologic adaptation to training. On the other hand, women are less likely to stray from normal parameters, so most EKG changes are concerning and more likely represent a real problem.

Consistent endurance training induces physiologic remodeling, or normal adaptations to the heart resulting in improved efficiency of an athletes engine. Cyclists are unique because they typically perform the most prolonged exercise pattern more hours per day and more days per year than nearly any other athletes. Cyclists often sustain markedly elevated heart rates for extended periods of time during two distinct types of high cardiac output workouts. First, high intensity aerobic workouts at near peak efficiency, coupled with sustained elevations in heart rate, create a dynamic stress, or a volume load on the heart. And second, long tempo efforts punctuated by intense anaerobic dashes create static stress, exposing the heart to a pressure load because of sustained increases in blood pressure.

Cyclists therefore typically exhibit prominent changes in heart structure due to a combination of dynamic stress (volume overload) and static stress (pressure overload) resulting in generally increased cardiac mass, with mildly enlarged hearts and mildly increased heart wall thickness at least in men. Statistically, women are generally smaller than men with lower lean body mass. Due to their higher estrogen levels, women tend to adapt to exercise in a qualitatively similar manner, but quantitatively different than men showing only minimal heart enlargement and virtually no heart wall thickening. In fact, only about 7% of healthy women show any significant increase in their heart size due to habitual exercise, whereas 47% of men show cardiac enlargement.

Symptoms of heart problems in women are often different to those reported by men. For example, women are less likely to experience classic chest pain due to a heart problem, but may report more subtle symptoms like indigestion, heartburn, fatigue, or poor exercise performance. Misinterpretation of these sometimes confusing symptoms often leads to a delay in diagnosis and poorer long-term outcomes for women. An unexplained decline in athletic performance is obviously concerning to any elite athlete whether male or female because this may be the only clue to a serious underlying heart problem.

However, in young women, such nonspecific symptoms are often incorrectly blamed on things like menstrual problems, eating disorders, iron deficiency anemia, pregnancy, or thyroid disease. In many cases it is the womans primary care provider who must be savvy enough to exclude these other diagnoses, realizing there is a potential heart problem and then making an appropriate referral to a cardiologist.

Estrogen generally protects women from developing CAD at young ages, but the risk rises as they reach menopause. And paradoxically, some young women may actually be at increased risk for CAD because of a syndrome called Relative Energy Deficiency in Sports (RED-S). Sports which favor lean body mass are often associated with heavy training loads and dieting to achieve optimal body weight. In some women this results in the Female Athlete Triad of menstrual dysfunction, unexplained decline in performance (with or without an eating disorder), and decreased bone density, leading to increased probability of fractures.

Prolonged endurance training in young women can lead to menstrual irregularities resulting in the same kind of reduced estrogen levels typically seen in older postmenopausal women. These athletes should be evaluated for the more traditional cardiac risk factors such as high blood pressure, cholesterol problems, and diabetes, with appropriate intervention to modify their risk. Treatment of the Female Athlete Triad is challenging and may require a multidisciplinary approach to improve an athletes overall energy balance. Strategies include decreasing training volume, modifying dietary habits, medically replacing estrogen levels, promoting bone health with dietary supplements, and seeking appropriate professional help to correct eating disorders if present. Due to the focused and highly competitive nature of many endurance athletes, this is often a tall order to fill since they may resist decreasing their training volume.

Regular exercise is the cornerstone of prevention and treatment of many cardiac and non-cardiac diseases. But some researchers suggest that the benefits of exercise are like a drug the benefits of moderate training reach a plateau and exceeding that plateau, or overdosing, may be detrimental to the athletes health. Several studies have reported unexpected abnormalities in endurance athletes primarily in men suggesting either transient or permanent heart damage which puts them at risk for chronic heart issues. Findings have included a five-fold increased risk of atrial fibrillation (AFIB), increased coronary artery calcium deposits (which indicate clinically silent CAD), and scarring of the heart muscle. However, there are several general guidelines that all athletes should be aware of:

The biological adaptation to handle the stress of pregnancy may be a key reason for the apparently better female adaptation to endurance training. Recent research has highlighted that during pregnancy, the body functions at a basal metabolic rate of 2.2 times the normal burning up to 4000 calories a day. Extended over a period of 40 weeks, pregnancy can essentially be considered the ultimate endurance event a true test on the limits of human performance. Under typical circumstances, a body functioning above 2.5 times the normal metabolic rate over a prolonged period will begin to break down. But most women emerge from pregnancy and go on to live healthy lives, having tolerated a level of metabolic strain considered by some to be similar to that experienced by athletes participating in some of the most competitive endurance events.

There are also massive changes in the amount of fluid in a womans body during pregnancy, creating cardiac stresses similar to endurance training. In order to support the developing fetus, she must increase her blood volume by a massive 50%, and her cardiac output by 40-50% constituting the ultimate dynamic stress on the heart. The female body appears to require less adaptation by the heart muscle and chambers to accommodate these changes.

More overlap in research examining the similarities between the effects of endurance training in women and the cardiac demands placed on them during pregnancy may help to explain these gender-based differences in adaptation to exercise and related cardiac risk. Additional research specifically devoted to women is critical to a better understanding of how gender influences normal cardiac adaptation to exercise, as well as to more accurately identify pathologic conditions which sometimes seem to overlap with normal physiology.

Despite the substantially lower risk of SCD in women, cardiac risk screening of female endurance athletes and at-risk pregnant women is still important, and should be carried out by clinicians familiar with the differences in adaptive physiology between men and women. Women often experience challenging and atypical cardiac symptoms, requiring a high index of suspicion on the part of their doctors often at the primary care level to identify these underlying problems. As the current generation of elite female athletes matures into tomorrows Masters champions, we will undoubtedly learn a great deal more about the long-term cardiac implications of endurance training in women.

Link:
The Outer Line: The impact of endurance training on the cardiac health of women - VeloNews

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MEET THE CANDIDATES: RICHARD QUIGLEY – Island Echo

December 11th, 2019 10:44 am

In the 5th of our interviews with the candidates seeking to become Member of Parliament for the Isle of Wight this Thursday, Island Echo gave Labour candidate, Richard Quigley, the opportunity to make the case for voting for a Labour MP to represent the Island.

Those who see lack of connectivity as the biggest issue facing Islanders have the opportunity to vote for the pro-fixed link independent, Carl Feeney. Islanders for whom the so-called climate emergency is the greatest concern have the option of voting for the Green candidate, Vix Lowthion. Leavers in favour of the hardest of hard Brexits can vote for the independent pro-Brexit candidate, Daryll Pitcher. And if your answer is none of the above, then you have the option to choose quirky independent, Karl Love.

However, for many voters, the issue of paramount importance is who will enter Downing Street and form a government on 13th December. Will it be Jeremy Corbyn and Labour or Boris Johnson and the Tories? Voters will also be deciding whether they want Boris Withdrawal Agreement implemented and get Brexit done, or would they prefer further negotiations and a second referendum under Labour?

Interview:

Richard Quigley grew up in Retford, Nottinghamshire, a coal mining area. He remembers the Miners Strike of 1982 from when he was growing up. Interestingly, his parents were Conservative councillors.

Richards political awakening began when he left school for university and joined the protests against the poll tax. Richard has been a member of the Labour Party for four years, having been inspired to join by the leadership of Jeremy Corbyn, Richard first moved to the Island in 2003. He is a small businessman in the catering trade, and owner of fish and chip shop, Corries Cabin, in Cowes. Richards father-in-law was a Cowes window cleaner, and it was he who suggested his son-in-law set up his business there.

Richard is married to Leah and they have two daughters, aged 17 and 12. Richard has also worked as a stand up comedian.

Small businesses have had their best years under Labour. Labour governments put money into the economy. All businesses need customers.

I joined because of Jeremy Corbyn. I find it inspirational to find someone who gets out of bed each morning to try and make this country a better place to live in. I dont think we can say the same about the Tories. I see the election as a battle between Corbyn and Johnson. It is an absolute privilege for me to be the parliamentary candidate and try to change whats going on.

I dont think Jeremy Corbyn is an anti-semite. He has spent the whole of his life fighting racism and prejudice. There is no place for anti-semitism in society. Of course, when you uncover anti-semitism in order to deal with it, this draws attention to the problem. But uncovering it is the right thing to do. I have never come across anti-semitism on the Island and would never accept racism in my friendship group.

There is no evidence that Jeremy Corbyn ever supported the IRA. If he was a supporter of terrorism, then MI5 would have uncovered this. Jeremy Corbyn is (using the words of Winston Churchill) in favour of jaw-jaw rather than war-war.

We would end austerity in our first term. We would invest for return in both council houses and people. We would transform the NHS from being a National Sickness Service to an organisation that invests in preventative medicine.

Tories believe that everything is static, that the economy is a zero-sum game. But when you go to a bank to ask for a loan, you create money. You dont have to travel to the moon to dig it up. Are you in favour of a fixed link? Im 50/50 on this issue. I totally see the economic and social benefits of a fixed link. I also see the drawbacks.

We need a properly funded feasibility study, followed by an all-Island referendum on the issue.

I voted to remain. Im one of the 48 per cent. Ive been a European citizen for 48 years of my life. Those who voted for leave are not stupid. The problem is that there is no clarity as to which version of Brexit needs to be implemented. We need to find the optimal version of Brexit and then put it to the people. I agree with Jeremy Corbyns stance of neutrality on the issue.

I fully understand Working Class voters being upset with the idea of their win being taken away from them. But they are the people who would be most harmed by a no deal Brexit.

I get out of bed every morning believing we can do it. 8 or 9 years ago, Labour was a wasted vote on the Island. However, we doubled our vote share in 2017. There are 30,000 Islanders who dont turn out to vote. We have a great team running a great campaign. Were on the road to success. I just hope success comes this time round.

There were some big majorities overturned in the 2017 General Election. Just look at Kensington, the wealthiest constituency in the country.

Because I genuinely care about Islanders and the Island. Im passionate about opportunities for young people and rebuilding communities. I dont need to do this as a career. I would be happy just to sit on the backbenches and represent Islanders.

The big thing for me, when looking at the country and the Island, is that many people are not happy with what they see and the way the party they usually vote for is behaving.

Some of you may not have considered voting before. Lend me your vote on Thursday and judge me on what we achieve.

If we can spend 550 billion pounds to bale out the banks (9,000 pounds for every man, woman and child in the country) then surely we can afford a hundred quid a head to help save the NHS.

Having given a platform to all candidates standing for election in the Isle of Wight constituency, tomorrow (Wednesday) Island Echo will publish an in-depth interview with the odds-on favouriteand sitting MP, Bob Seely (Conservative).

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MEET THE CANDIDATES: RICHARD QUIGLEY - Island Echo

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OH needs to work more with other professions on wellbeing strategies, says SOM – Personnel Today

December 11th, 2019 10:44 am

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Occupational health professionals should get more involved in the provision of wellbeing services and need to work more with other professional groups to improve health outcomes, according to SOM, the Society of Occupational Medicine.

In a new report, The value of occupational health to workplace wellbeing, SOM argued that OH practitioners knowledge, skills and competencies can add significant value to organisations wellbeing programmes.

But OH will need to collaborate and work more with other professionals such as HR or diversity and inclusion specialists, rather than in silos, for wellbeing provision to be successful.

This was for two reasons, the report said. Firstly, some programmes might be tied to wider employer initiatives such as job redesign, flexible working, employee benefits, diversity and inclusion and cultural transformation. Secondly, the benefits of wellbeing programmes might not be seen explicitly in health outcomes, for example through employee engagement or staff retention.

A survey of 62 SOM members found that 84% offered workplace wellbeing programmes as a preventative measure to improve the health of staff; 50% introduced them to support other metrics, such as reducing sickness absence; and 45% thought they would improve productivity.

Two-thirds (66%) said their HR department was responsible for wellbeing activities, 60% said OH had some responsibility in this area and 40% said they had appointed a wellbeing manager or similar position to oversee the development and deployment of wellbeing programmes.

Mindfulness and mental wellbeing activities formed part of 84% of SOM members wellbeing programmes. Half said their programme included activity/exercise and 45% identified management training as a core component in their wellbeing offer.

SOMs report identifies four major areas of knowledge, skills and competencies required by OH practitioners to implement workplace health and wellbeing programmes. These were: building the business case for health and wellbeing; acquiring and using evidence; knowledge of health and wellbeing; and building and sustaining a programme of activities.

The report concluded: It is clear from the available evidence that in addition to technical and functional knowledge of health conditions and the ability to appraise evidence critically, occupational health practitioners can add value to workplace health and wellbeing programmes by acquiring and using skills related to change management processes.

Specific challenges in developing such skills across the occupational health professions may relate to adding new material into what may be already crowded curricula in academic and professional qualifications.

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Lineage Cell Therapeutics and AgeX Therapeutics Announce Issuance of US Patent for Method of Generating Induced Pluripotent Stem Cells – BioSpace

December 11th, 2019 10:43 am

The issuance of this patent highlights Lineages dominant position in the field of cell therapy, stated Brian M. Culley, CEO of Lineage. Our efforts to develop new treatments rely on well-characterized and NIH-approved human cell lines. These lines are not genetically manipulated, which avoids the safety concerns associated with genetic aberrations arising from the creation of iPS cells. We believe the Lineage cell lines provide the safest option for our current clinical-stage programs, particularly in immune-privileged anatomical sites such as the eye (OpRegen for the treatment of dry AMD) and spinal cord (OPC1, for the treatment of spinal cord injury). However, the vast intellectual property estate which underlies our cell therapy platform has never been limited to these particular cell lines. As one example, this newly-issued patent provides us with proprietary methods for producing induced pluripotent stem cells, or, as it was practiced by us prior to Yamanaka, Analytical Reprogramming Technology (ART). In certain settings, an ART/iPS approach might offer important advantages, such as for an autologous treatment or when the selection of preferential attributes from a series of iPS lines is desirable. Questions as to which stem cell technology is preferred ultimately will be answered by clinical safety and efficacy and likely will be indication-specific, so we believe it is in the best interest of our shareholders to generate patented technology which enables us to pursue programs in either or both formats which we believe will ensure the highest probability of success.

This patent broadly describes multiple techniques for reprogramming cells of the body back to the all-powerful stem cell state, said Dr. Michael D. West, CEO of AgeX and first inventor on the patent. Perhaps more significantly, it includes certain factors that address some of the difficulties currently encountered with iPS cells. It also reflects the foundational work our scientists have undertaken to apply reprogramming technology to age-reversal, specifically, induced Tissue Regeneration (iTR) which is currently a focus of AgeX product development.

Induced Pluripotent Stem Cells (iPS) are typically derived from adult skin or blood cells which have been reprogrammed or induced to retrace their developmental age and regain the potential to form all of the young cell and tissue types of the body. In 2010 inventors of the -723 patent issued today demonstrated that this reversal of developmental aging even extended to the telomere clock of cell aging. This reprogramming technology provides an alternate source of starting material for the manufacture of potentially any type of human cell needed for therapeutic purposes. Because iPSCs can be derived directly from adult tissues, they can be used to generate pluripotent cells from patients with known genetic abnormalities for drug discovery or as an alternative source of cell types for regenerative therapies.

U.S. Patent No. 10,501,723, entitled Methods of Reprogramming Animal Somatic Cells was assigned to Advanced Cell Technology of Marlborough, Massachusetts (now Astellas Institute for Regenerative Medicine) and licensed to Lineage and sublicensed to AgeX Therapeutics for defined fields of use. Inventors of the patent include Michael D. West, CEO of AgeX and previous CEO of Advanced Cell Technology, Karen B. Chapman, Ph.D., and Roy Geoffrey Sargent, Ph.D.

About Lineage Cell Therapeutics, Inc.

Lineage Cell Therapeutics is a clinical-stage biotechnology company developing novel cell therapies for unmet medical needs. Lineages programs are based on its proprietary cell-based therapy platform and associated development and manufacturing capabilities. With this platform Lineage develops and manufactures specialized, terminally-differentiated human cells from its pluripotent and progenitor cell starting materials. These differentiated cells are developed either to replace or support cells that are dysfunctional or absent due to degenerative disease or traumatic injury or administered as a means of helping the body mount an effective immune response to cancer. Lineages clinical assets include (i) OpRegen, a retinal pigment epithelium transplant therapy in Phase I/IIa development for the treatment of dry age-related macular degeneration, a leading cause of blindness in the developed world; (ii) OPC1, an oligodendrocyte progenitor cell therapy in Phase I/IIa development for the treatment of acute spinal cord injuries; and (iii) VAC2, an allogeneic cancer immunotherapy of antigen-presenting dendritic cells currently in Phase I development for the treatment of non-small cell lung cancer. Lineage is also evaluating potential partnership opportunities for Renevia, a facial aesthetics product that was recently granted a Conformit Europenne (CE) Mark. For more information, please visit http://www.lineagecell.com or follow the Company on Twitter @LineageCell.

About AgeX Therapeutics

AgeX Therapeutics, Inc. (NYSE American: AGE) is focused on developing and commercializing innovative therapeutics for human aging. Its PureStem and UniverCyte manufacturing and immunotolerance technologies are designed to work together to generate highly-defined, universal, allogeneic, off-the-shelf pluripotent stem cell-derived young cells of any type for application in a variety of diseases with a high unmet medical need. AgeX has two preclinical cell therapy programs: AGEX-VASC1 (vascular progenitor cells) for tissue ischemia and AGEX-BAT1 (brown fat cells) for Type II diabetes. AgeXs revolutionary longevity platform induced Tissue Regeneration (iTR) aims to unlock cellular immortality and regenerative capacity to reverse age-related changes within tissues. AGEX-iTR1547 is an iTR-based formulation in preclinical development. HyStem is AgeXs delivery technology to stably engraft PureStem cell therapies in the body. AgeX is developing its core product pipeline for use in the clinic to extend human healthspan and is seeking opportunities to establish licensing and collaboration agreements around its broad IP estate and proprietary technology platforms. For more information, please visit http://www.agexinc.com or connect with the company on Twitter, LinkedIn, Facebook, and YouTube.

Forward-Looking Statements

Lineage cautions you that all statements, other than statements of historical facts, contained in this press release, are forward-looking statements. Forward-looking statements, in some cases, can be identified by terms such as believe, may, will, estimate, continue, anticipate, design, intend, expect, could, plan, potential, predict, seek, should, would, contemplate, project, target, tend to, or the negative version of these words and similar expressions. Such statements include, but are not limited to, Lineages exploration of alternative cell therapy platforms. Forward-looking statements involve known and unknown risks, uncertainties and other factors that may cause Lineages actual results, performance or achievements to be materially different from future results, performance or achievements expressed or implied by the forward-looking statements in this press release, including risks and uncertainties inherent in Lineages business and other risks in Lineages filings with the Securities and Exchange Commission (the SEC). Lineages forward-looking statements are based upon its current expectations and involve assumptions that may never materialize or may prove to be incorrect. All forward-looking statements are expressly qualified in their entirety by these cautionary statements. Further information regarding these and other risks is included under the heading Risk Factors in Lineages periodic reports with the SEC, including Lineages Annual Report on Form 10-K filed with the SEC on March 14, 2019 and its other reports, which are available from the SECs website. You are cautioned not to place undue reliance on forward-looking statements, which speak only as of the date on which they were made. Lineage undertakes no obligation to update such statements to reflect events that occur or circumstances that exist after the date on which they were made, except as required by law.

View source version on businesswire.com: https://www.businesswire.com/news/home/20191210005404/en/

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Magenta Therapeutics Demonstrates First-ever Successful Gene Therapy Transplant Without Chemotherapy in Primates Using a Single Dose of Antibody-drug…

December 11th, 2019 10:43 am

CAMBRIDGE, Mass.--(BUSINESS WIRE)--Magenta Therapeutics (NASDAQ: MGTA), a clinical-stage biotechnology company developing novel medicines to bring the curative power of immune reset to more patients, today announced that new results from its CD117-ADC patient preparation program were presented at the 61st Annual Meeting of the American Society of Hematology (ASH). These results, which were highlighted in an oral presentation at ASH by John Tisdale, M.D., Director, Molecular and Clinical Hematology Section, National Institutes of Health, showed the first-ever successful transplant of gene-modified cells in non-human primates using a targeted, single-agent antibody-drug conjugate (ADC), without the use of chemotherapy or radiation.

Todays conditioning regimens involve high doses of chemotherapy, often paired with radiation, to remove the disease-causing cells. As a result, patients undergoing gene therapy or stem cell transplant are all faced with a difficult choice: whether to endure severe toxicity and risk infertility and cancer for the chance for a cure. Magentas portfolio of targeted ADCs represents an extremely promising new option to prepare patients for gene therapy or transplant with no need for toxic chemotherapy or radiation, said Dr. Tisdale. The results presented today show that a single dose of single agent CD117-ADC achieves the same level of depletion as four doses of busulfan chemotherapy to enable successful engraftment and persistence of stem cells modified with the -globin gene, the gene that causes sickle cell disease and -thalassemia when mutated. Importantly, the animals undergoing preparation with CD117-ADC showed none of the damaging toxicities associated with busulfan conditioning.

Magenta is the only company with the people, platforms and a product engine committed to comprehensively transforming immune and blood system reset, which includes revolutionizing the toxic methods that are used to prepare patients for gene therapy and transplant today. said Jason Gardner, D.Phil., Chief Executive Officer and President, Magenta Therapeutics. The gene therapy field has learned that higher levels of stem cell depletion, which meant higher doses of busulfan, were needed to ensure long-term engraftment of the gene-modified cells and persistence of gene therapy. Across all the modalities we have tested, we have seen that ADCs are most effective at achieving these high levels of stem cell depletion without chemotherapy to enable engraftment and long-term durability of the transplant. Todays impressive results provide important validation of the ADC approach as well as the CD117 target for patient preparation and underscore Magentas leadership in the field of conditioning.

Results from the CD117-ADC Patient Preparation Program

Title: A Single Dose of CD117 Antibody Drug Conjugate Enables Autologous Gene-Modified Hematopoietic Stem Cell Transplant (Gene Therapy) in Nonhuman Primates (Abstract #610)Presenter: John Tisdale, M.D., Director, Molecular and Clinical Hematology Section, National Institutes of Health, Bethesda, Md.

Magentas most advanced patient preparation program, CD117-ADC, targets CD117, a protein expressed on hematopoietic stem cells. CD117-ADC is designed to remove the genetically mutated cells in the bone marrow that cause certain genetic diseases, such as sickle cell disease, enabling curative stem cell transplant or gene therapy.

Results presented by Dr. Tisdale showed:

About Magenta Therapeutics

Magenta Therapeutics is a clinical-stage biotechnology company developing medicines to bring the curative power of immune system reset through stem cell transplant to more patients with autoimmune diseases, genetic diseases and blood cancers. Magenta is combining leadership in stem cell biology and biotherapeutics development with clinical and regulatory expertise, a unique business model and broad networks in the stem cell transplant world to revolutionize immune reset for more patients.

Magenta is based in Cambridge, Mass. For more information, please visit http://www.magentatx.com.

Follow Magenta on Twitter: @magentatx.

Forward-Looking Statement

This press release may contain forward-looking statements and information within the meaning of The Private Securities Litigation Reform Act of 1995 and other federal securities laws. The use of words such as may, will, could, should, expects, intends, plans, anticipates, believes, estimates, predicts, projects, seeks, endeavor, potential, continue or the negative of such words or other similar expressions can be used to identify forward-looking statements. The express or implied forward-looking statements included in this press release are only predictions and are subject to a number of risks, uncertainties and assumptions, including, without limitation risks set forth under the caption Risk Factors in Magentas Registration Statement on Form S-1, as updated by Magentas most recent Quarterly Report on Form 10-Q and its other filings with the Securities and Exchange Commission. In light of these risks, uncertainties and assumptions, the forward-looking events and circumstances discussed in this press release may not occur and actual results could differ materially and adversely from those anticipated or implied in the forward-looking statements. You should not rely upon forward-looking statements as predictions of future events. Although Magenta believes that the expectations reflected in the forward-looking statements are reasonable, it cannot guarantee that the future results, levels of activity, performance or events and circumstances reflected in the forward-looking statements will be achieved or occur. Moreover, except as required by law, neither Magenta nor any other person assumes responsibility for the accuracy and completeness of the forward-looking statements included in this press release. Any forward-looking statement included in this press release speaks only as of the date on which it was made. We undertake no obligation to publicly update or revise any forward-looking statement, whether as a result of new information, future events or otherwise, except as required by law.

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Why Sangamo Therapeutics Stock Sank Today – The Motley Fool

December 11th, 2019 10:43 am

What happened

Shares of Sangamo Therapeutics (NASDAQ:SGMO) were sinking 11.7% lower as of 3:28 p.m. EST on Tuesday. This marked the second consecutive day of double-digit-percentage declines for the biotech stock after Sangamo announced preliminary results on Monday from a phase 1/2 clinical study evaluating experimental gene-editing therapy ST-400 in treating rare blood disease transfusion-dependent beta thalassemia (TDT).

Those preliminary results were for the first three patients in Sangamo's Thales clinical trial targeting beta thalassemia. The good news was that all three patients receiving ST-400 quickly experienced reconstitution of their hematopoietic stem cells after gene editing as well as demonstrating neutrophil engraftment -- the first day where the patients' neutrophil counts were at least 500 cells per microliter for three consecutive days.

Image source: Getty Images.

The not-so-good news related to the adverse effects experienced by the patients. One patient experienced a serious adverse event with hypersensitivity during the ST-400 infusion, although the issue resolved by the end of the infusion. Also, another patient's fetal hemoglobin levels increased by less than 1 gram per deciliter through week 26 of the study. The goal of ST-400 is to boost fetal hemoglobin levels enough to minimize the negative effects of beta thalassemia.

University of Minnesota Associate Professor Angela Smith, a principal investigator of the Thales study, noted that "the full effects of the treatment may take as long as 12 to 18 months or more to manifest." She added, "Longer-term follow-up, including from additional patients, will be necessary to understand the safety profile and potential clinical benefit of ST-400 in beta-thalassemia."

Adrian Woolfson, Sangamo's head of research and development, stated, "Our understanding of ST-400 will continue to evolve as we follow the progress of these and additional patients in the coming year, and those dosed in Sanofi's BIVV003 clinical trial, which is evaluating the same gene-editing approach in sickle cell disease."

This cautious language from both Smith and Woolfson underscores the tentative nature of the preliminary results.

Investors will have to wait a while to learn just how much promise ST-400 holds. Sangamo expects to announce additional study results late next year after enrollment in the Thales study is completed and after all six patients in the study have been observed for longer periods.

Sangamo's last week or so has demonstrated the volatility associated with biotech stocks, especially those with no approved drugs on the market. Sangamo jumped last week on positive results from another study (of hemophilia gene therapy SB-525) but gave up those gains and then some on the news for ST-400.

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SYNIMMUNE GmbH Reports Interim Results of First-in-Human Study of Fc-Optimized Antibody FLYSYN for the Treatment of Acute Myeloid Leukemia – BioSpace

December 11th, 2019 10:43 am

Tbingen, Germany, 10 December 2019 -SYNIMMUNE GmbH, a biotechnology company focusing on the development of innovative and effective anti-tumor antibodies for orphan hematopoietic malignancies, announced today that interim results of its first-in-human clinical study of FLYSYN, a novel Fc-optimized antibody, for the treatment of acute myeloid leukemia (AML) were presented at the 61stAmerican Society of Hematology (ASH) Annual Meeting in Orlando, Florida. The data were presented in a poster titled Interim Results of a First in Human Study with the Fc-Optimized FLT3 Antibody FLYSYN for Treatment of Acute Myeloid Leukemia with Minimal Residual Disease.

The phase I study of FLYSYN is being conducted at multiple centers in Germany (University Hospitals of Tbingen, Ulm, Heidelberg, Hanover and Leipzig) and will enroll up to 31 AML patients that have achieved a complete morphological remission but display minimal residual disease (MRD). The poster reports on an interim analysis of 21 adult patients (median age: 60 years) who were treated in 5 cohorts receiving a single administration of increasing doses of FLYSYN (0.5 to 45 mg/m body surface area).

FLYSYN was very well tolerated and only one patient experienced grade 3 neutropenia which was potentially related to FLYSYN treatment. Other adverse events of grade 1 or 2 included gastrointestinal toxicities and laboratory abnormalities which were manageable with supportive care. No dose limiting toxicities occurred during the dose-escalation phase and no anti-drug antibodies were detected after treatment.

A total of 7 patients (33%) achieved an MRD response defined as a log reduction of expression of an MRD marker gene and one patient achieved an enduring complete molecular remission (MRD negative) for more than one year.

Our data indicate that FLYSYN is safe and very well tolerated. The preliminary efficacy data are promising. We are very much looking forward to further test FLYSYN as monotherapy for MRD positive AML patients, commented Prof. Helmut Salih, Principle Investigator of the study and Medical Director of the Clinical Collaboration Unit Translational Immunology at Tbingen University Hospital.

These interim results are very encouraging and we are looking forward to further results from the last treatment cohort of 10 patients who will receive three repetitive doses of 15 mg/m body surface area of FLYSYN by mid-2020, said Dr. Martin Steiner, CEO of SYNIMMUNE GmbH. Today, the majority of AML patients with MRD relapse within several months. We are looking forward to continue development of FLYSYN, which is intended to delay or even prevent such relapse, and we believe that FLYSYN could become an attractive maintenance treatment option for many AML patients.

About FLYSYN:

The chimeric and Fc-optimized IgG1 antibody FLYSYN binds specifically and with high avidity to the humanfms-like tyrosine kinase 3 (FLT3). An increased expression of this cell surface receptor is measured on myeloid precursor cells in 70-100% of AML patients, while only small amounts of FLT3 are expressed on monocytes and progenitor stem cells, thereby avoiding off-target effects and stem cell toxicity. Therefore, FLT3 is a suitable and highly selective target for therapeutic antibodies to treat leukemia patients. FLYSYN contains a genetic optimization of its Fc-part, resulting in optimized binding to Natural Killer (NK) cells and thus substantially improved antibody-dependent cell-mediated cytotoxicity (ADCC). FLYSYN is a monospecific antibody for the treatment of AML patients at a stage of minimal residual disease (MRD). Most AML patients achieve complete remission (CR) with MRD after regular chemotherapy, but the majority relapses to AML within several months, requiring additional courses of chemotherapy or stem cell transplantation. FLYSYN is intended to delay or prevent such relapse in AML patients with MRD.

About SYNIMMUNE GmbH:

SYNIMMUNE GmbH is a biotechnology company dedicated to the development of innovative and effective mono- and bispecific anti-tumor antibodies for the treatment of patients suffering from life-threatening diseases, with a focus on orphan hematopoietic malignancies. SYNIMMUNEs lead product candidate is the antibody FLYSYN, which is currently in afirst-in-humanphase I clinical study in acute myeloid leukemia (AML). SYNIMMUNE GmbH is a spin-off of the Department of Immunology of the University of Tbingen initially supported by the GO-Bio program from the German Ministry of Education and Research (BMBF). The Company is financed by investments by the German KfW and private equity. For more information, please visit:www.synimmune.de

Contact:

SYNIMMUNE GmbH

Dr. Martin Steiner, CEOPhone: +49 (0) 7071- 708 382Steiner[at]Synimmune.de

Media requests:

MC Services AG

Katja Arnold, Andreas JungferPhone: +49 (0) 89 210 228 0katja.arnold[at]mc-services.eu

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Gracell Announces Progressive Outcomes from Multiple Human Clinical Trials to Investigate FasTCAR and Dual CAR Cell Platform Technologies | DNA RNA…

December 11th, 2019 10:43 am

DetailsCategory: DNA RNA and CellsPublished on Tuesday, 10 December 2019 10:40Hits: 255

- FasTCAR-19 (GC007F) shows a high response rate, with 34 of 35 evaluable r/r B-ALL patients achieving CR on Day 28, where 32 patients achieving MRD negative CR

- Dual CAR-19-22 (GC022) shows sound safety profile and effectiveness, with 15/16 evaluable r/r B-ALL patients achieving MRD-CR on Day 28

- Dual CAR-BCMA-19 (GC012) demonstrates excellent tumor eliminating capabilities in preclinical study aligned with encouraging safety and efficacy data for r/r MM treatment

SUZHOU, Chinaand SHANGHAI, China I December 9, 2019 I Gracell Biotechnologies Co., Ltd ("Gracell"), a clinical-stage immune cell therapy company, today announced the progressive clinical outcomes for leading product candidates FasTCAR-19, Dual CAR-19-22, and Dual CAR-BCMA-19 at the American Society of Hematology (ASH) Annual Meeting in Orlando, Florida, held from December 7-10. Multiple pilot studies intend to evaluate the safety and efficacy of Gracell's first-in-class FasTCAR-19 (GC007F), Dual CAR-19-22 (GC012F) and Dual CAR-BCMA-19 (GC022F) cell therapy.

FasTCAR-19FasTCAR-19 or GC007F uses Gracell's patented FasTCARTM solution, which genetically modifies a patient's T-cells to express CD19-specific chimeric antigen receptor (CAR) for the treatment of B-cell acute lymphoblastic leukemia (B-ALL).

Utilizing the unique bioprocessing, FasTCAR-19 cells can be produced overnight through viral transfection in use of Gracell's proprietary fully-closed manufacturing system (from apheresis to filling). These cells are considered far more potent and durable in comparison to current market alternatives. To date, all 37 patient samples have been successfully manufactured. The process has been proven efficient, stable and duplicable, with a median 36.8% (range 13.1%-70.3%) transfection success and a median copies of 0.95 (range 0.2-4.21).

As of November, this investigational study enrolled 37 adult and adolescent patients aged from 14 to 70 years, who suffered from r/r B-ALL and had failed to respond to multiple prior lines of therapy, from eight clinical centers. All patients received a single infusion of FasTCAR-19 at one of the three-dose level (low: 0.6*10^5/kg; mid: 1.0*10^5/kg, and high: 1.6*10^5/kg), followed by prior conditioning regimen of fludarabine-cyclophosphamide (FC).

The treatment efficacy was assessed in 35 patients over 28 days of follow-up, of which:

During the over six month-durable remission period, FasTCAR-19 demonstrated a good level of persistence in line with previous clinical trials. In terms of safety, all 37 patients tolerated the single infusion of FasTCAR-19 at different dose levels, with no dose-limiting toxicities observed. The most common safety concerns were cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) where mild to moderate side effects were observed. Across 30 patients in the low to mid doses group, only 5 (16.7%) manageable Grade 3 CRS and 5 (16.7%) manageable Grade 3 ICANS were reported; while the remaining 23 (76.7%) had Grade 1-2 CRS. The low to mid doses group will likely be selected for extensive study in future clinical trials.

Beyond single-antigen CAR, Dual CAR-T cells can deliver promising clinical outcomesSingle-antigen CAR-T cells have demonstrated considerable efficacy; however, antigen loss and high relapse rate have been observed in a significant number of patients. To combat this, treatments containing two separate CARs and dual transduction (GC022 targeting CD19 and CD22, GC012 targeting BCMA and CD19) were developed. Following positive results from in vitro and in vivo studies, human clinical trials have commenced testing the safety and feasibility of Dual CAR-19-22 and Dual CAR-BCMA-19 to treat B-ALL and MM, respectively.

Dual CAR-19-22Dual CAR-19-22 or GC022 has achieved a manufacturing success rate of 20/20, without any patient loss due to manufacturing failure. Enrolled patients aged from 4-45 years old who has B-ALL, received a single infusion of Dual CAR-19-22 at one of the three-dose levels (low: 0.5*10^6/kg; mid: 2.0*10^6/kg, and high: 3.0*10^6/kg), under conventional bioprocessing. The study demonstrated a very good safety profile and high efficacy at mid to high doses.

The treatment efficacy was assessed in 20 patients with a 28-day follow-up, of which:

Dual CAR-19-22 proved effective on patients who had previously been treated with CD19 CAR-T cells and/or received allogeneic hematopoietic stem cell transplantation (allo-HSCT) for r/r B-ALL but failed to benefit from prior treatments. Among these five patients, four (80%) patients achieved MRD-CR with a 28-day follow-up. Surpassing the 3-month durable remission period, fifteenpatients still retain ongoing response.

Furthermore, Dual CAR-19-22 demonstrated an excellent safety profile, with 6/20 (30%) patients indicating no CRS, 14/20 (70%) reporting Grade 1 CRS. No ICANS events were reported.

Dual CAR-BCMA-19Dual CAR-BCMA-19 or GC012 has been demonstrated effective in eliminating multiple myeloma (MM) tumor cells both in vitro and in vivo. The first-in-human study showed a good safety profile and effectiveness. Beyond, FasTCARTM has successfully been applied to Dual CAR-BCMA-19, expected to enhance proliferation, potency, and migration in the human body.

"We are delighted to see that patients with relapsed/refractory B-ALL continue to gain substantial clinical benefit from FasTCAR-19. Furthermore, Dual CAR-19-22 with conventional bioprocess can generate promising clinical data. This marks our confidence to utilize FasTCAR technology to both Dual CAR programs for various indications," said Dr. William Cao, CEO of Gracell. "The results from our latest clinical trials reveal the immense potential of FasTCAR technology, and we are eager to see Gracell's highly efficacious, yet affordable therapies benefit more patients in China and worldwide."

About B-ALLAcute lymphoblastic leukemia (ALL), although rare, is one of the most common forms of cancer in children between the ages of two and five and adults over the age of 501. In 2015, ALL affected around 837,000 people globally and resulted in 110,000 deaths worldwide2. It is also the most common cause of cancer and death from cancer among children. ALL is typically treated initially with chemotherapy aimed at bringing about remission. This is then followed by further chemotherapy carried out over several years.

About MMMultiple myeloma (MM) is a cancer that forms in a type of white blood cell known as a plasma cell. MM cells are abnormal plasma cells (a type of white blood cell) that build up in the bone marrow and form tumors in many bones of the body. Healthy plasma cells make antibodies to help the body fight infection and disease. As the number of MM cells increases, more antibodies are produced. This can cause the blood to thicken and keep the bone marrow from making enough healthy blood cells. MM cells can also damage and weaken the bone. In 2018, MM affected around 160,000 people globally and resulted in 106,000 deaths worldwide3. Different types of treatments are available for patients with plasma cell neoplasms. Chemotherapy and targeted therapy are typical treatments; while stem cell transplant, biologic therapy, and radiation therapy, even surgery are also adopted.

About GracellGracell Biotechnologies Co., Ltd. ("Gracell") is a clinical-stage biopharma company, committed to developing highly reliable and affordable cell gene therapies for cancer. Gracell is dedicated to resolving the remaining challenges in CAR-T, such as high production costs, lengthy manufacturing process, lack of off-the-shelf products, and inefficacy against solid tumors. Led by a group of world-class scientists, Gracell is advancing FasTCARTM, TruUCARTM (off-the-shelf CAR), Dual CAR and Enhanced CAR-T cell therapies for leukemia, lymphoma, myeloma, and solid tumors.

1https://www.cancer.org/cancer/acute-lymphocytic-leukemia/about/key-statistics.html2https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5055577/3https://gco.iarc.fr/today/fact-sheets-cancers

SOURCE: Gracell

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Gracell Announces Progressive Outcomes from Multiple Human Clinical Trials to Investigate FasTCAR and Dual CAR Cell Platform Technologies | DNA RNA...

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Autolus Therapeutics Announces New Data Showcasing Clinical Progress of Programmed T Cell Therapy Pipeline in Blood Cancers – GlobeNewswire

December 11th, 2019 10:43 am

AUTO1 shows 87% MRD negative complete response in adult patients with r/r ALL, with no severe cytokine release syndrome

Data presented at 61st American Society of Hematology Annual Meeting form basis for advancement of AUTO1 into pivotal clinical trial in adult ALL

Investor call to be held December 9 at 8:30 am ET / 1:30 pm GMT to review data

LONDON, Dec. 07, 2019 (GLOBE NEWSWIRE) -- Autolus Therapeutics plc(Nasdaq: AUTL) announced today new data highlighting progress on its next-generation programmed T cell therapies to treat patients with acute lymphoblastic leukemia (ALL) and adults with relapsed/refractory diffuse large B cell lymphoma (DLBCL). The data were presented in oral presentations at the 61stAmerican Society of Hematology(ASH) Annual Meeting and Exposition inOrlando, FL. Additional data on pediatric patients with ALL will be presented on December 8.

The data on AUTO1 presented at this years ASH meeting demonstrate the favorable safety profile and high level of clinical activity of AUTO1 in both adults and pediatric patients with ALL, and we look forward to initiation of the pivotal program in adult ALL in the first half of 2020, said Dr. Christian Itin, chairman and chief executive officer of Autolus.

Acute Lymphoblastic Leukemia Data Presented

Title: AUTO1 A novel fast off CD19CAR delivers durable remissions and prolonged CAR T cell persistence with low CRS or neurotoxicity in adult ALL (Abstract # 226)

Updated results for ALLCAR19, the Phase 1 trial evaluating AUTO1 in adults with recurrent/refractory ALL, were presented by Dr. Claire Roddie MB, PhD, FRCPath, honorary senior lecturer,Cancer Institute, University College London (UCL), in an oral presentation. The trial is designed to assess the primary endpoints of safety ( Grade 3 toxicity) and feasibility of product generation, as well as other secondary endpoints, including efficacy. The trial enrolled patients with a high tumor burden (44% had 50% BM blasts), who were considered high-risk for experiencing cytokine release syndrome (CRS). Product was manufactured for 19 patients; product for 13 of those patients was manufactured using a semi-automated closed process, which will be used for commercial supply.

As of the data cut-off date of November 25, 16 patients had received at least one dose of AUTO1. AUTO1 was well tolerated, with no patients experiencing Grade 3 CRS, and 3 of 16 patients (19%), who had high leukemia burden, experiencing Grade 3 neurotoxicity that resolved swiftly with steroids.

Of 15 patients evaluable for efficacy, 13 (87%) achieved MRD negative CR at 1 month and all patients had ongoing CAR T cell persistence at last follow up. CD19-negative relapse occurred in 22% (2 of 15) patients. In the patients dosed with AUTO1 manufactured in the closed process, 9 of 9 (100%) achieved MRD negative CR at 1 month and 6 months event free survival, and overall survival in this cohort was 100%.

Adult ALL patients, who face a median survival of less than one year after their ALL recurs or relapses, have a significant need for a CAR T cell therapy that is highly active, safe and is a standalone therapy not requiring a stem cell transplant, said Dr. Hagop M. Kantarjian, Chair of the Department of Leukemia at The University of Texas MD Anderson Cancer Center.

The novel CD 19 CAR-T therapy, AUTO1, is potentially transformative as a standalone curative option for patients with r/r ALL, especially in adults, given its favorable safety profile, said Dr. Max Topp associate professor of Internal Medicine, Hematology and Oncology at the University of Wuerzburg.

Title: Therapy of pediatric B-ALL with a lower affinity CD19 CAR leads to enhanced expansion and prolonged CAR T cell persistence in patients with low bone marrow tumor burden, and is associated with a favorable toxicity profile (Abstract # 225)

Dr. Sara Ghorashian, honorary senior lecturer, Great Ormond Street Institute of Child Health, University College London, presented updated data from the phase 1 CARPALL study of AUTO1 in pediatric ALL patients with low bone marrow tumor burden. The trial is intended to assess the primary endpoints of safety and proportion of patients in molecular complete remission at 1 month. The study recruited a total of 25 patients and stratified them into 2 cohorts. Fourteen patients were treated in cohort 1, which utilized a manual manufacturing process; product was unable to be generated in 3 patients. Median follow-up was 27 months in cohort 1. Seven patients were treated in cohort 2, which utilized the semi-automated closed manufacturing process, which will be used for commercial supply. The aim of cohort 2 was to demonstrate feasibility of manufacture at scale. Product was generated for 100% of patients. Median follow-up was 7 months in cohort 2.

AUTO1 was well-tolerated overall, with no patients experiencing Grade 3 CRS and 1 of 21 (5%) experiencing Grade 4 neurotoxicity, which was considered unrelated to CAR T therapy.

Nineteen of 21 treated patients (90%) achieved molecular complete remission at 1 month post infusion. Consistent with pre-clinical data, CAR T cell expansion was excellent and detectable by flow in a number of patients up to 36 months. Persistence was noted in 15 of 21 patients at last follow-up, up to 36 months. In cohort 2, 100% of patients achieved molecular complete remission at 1 month post infusion.

In the 14 patients in cohort 1, the overall survival at 6 months was 86% and at 12 months was 71%; event free survival (EFS) at 6 months was 71% and at 12 months was 54%. The patients in cohort 2 are not yet evaluable for these parameters. Overall, nine patients relapsed; 5 of 8 evaluable relapses were due to loss of CD19 antigen on the tumor cells.

Title: Clonal dynamics of early responder and long-term surviving CAR-T cells in humans (Abstract # 52)

Dr. Luca Biasco, senior research associate at University College London, presented a detailed analysis of CAR T products, and insertion site analysis from the CARPALL phase 1 patients. This analysis revealed highly polyclonal engraftment, even at very late time-points. Dr. Biasco hypothesized that the propensity for high level polyclonal long-term engraftment was due to favorable phenotype of the CAR T product and the binding kinetic of the receptor.

Diffuse Large B-cell Lymphoma Data Presented

Title: Phase 1/2 study of AUTO3, the first bicistronic chimeric antigen receptor (CAR) targeting CD19 and CD22 followed by an anti-PD1 in patients with relapsed/refractory (r/r) Diffuse Large B Cell Lymphoma (DLBCL): Results of cohort 1 and 2 of the ALEXANDER study (Abstract # 246)

Dr. Kirit Ardeshna, consultant hematologist, Department of Hematology, University College London Hospital NHS Foundation Trust, presented updated data from the ALEXANDER Phase 1/2 study of AUTO3, the first bicistronic CAR T targeting CD19 and CD22 followed by an anti-PD1, in diffuse large B cell lymphoma (DLBCL). 16 patients were treated, and fourteen patients were evaluable at one month. AUTO3 was well-tolerated, with no patients experiencing Grade 3 CRS with primary treatment, and 1 of 14 experiencing Grade 3 neurotoxicity that resolved swiftly with steroids. Five of 14 had a complete response, with 4 of 5 complete responses ongoing, the longest at 18 months.

DLBCL is an aggressive and rapidly progressing cancer, and early response is critical to ensuring positive outcomes for these patients. These early data show the promise of AUTO3 in DLBCL, and we expect to advance AUTO3 to a decision point in relapsed/refractory DLBCL by the middle of next year, said Dr. Christian Itin, chairman and chief executive officer of Autolus. In addition, we look forward to presenting the data from the AMELIA trial of AUTO3 in pediatric ALL during poster sessions on Sunday, December 8, 6:00 8:00 PM ET.

Investor call to review data on Monday, December 9

Autolus management will host an investor conference call on Monday, December 9, at 8:30 a.m. EDT/ 1:30pm GMT, to review the data presented at ASH.

To listen to the webcast and view the accompanying slide presentation, please go to:https://www.autolus.com/investor-relations/news-and-events/events.

The call may also be accessed by dialing (866) 679-5407 for U.S. and Canada callers or (409) 217-8320 for international callers. Please reference conference ID 9796038. After the conference call, a replay will be available for one week. To access the replay, please dial (855) 859-2056 for U.S. and Canada callers or (404) 537-3406 for international callers. Please reference conference ID 9796038.

About AUTO1

AUTO1 is a CD19 CAR T cell investigational therapy designed to overcome the limitations in safety - while maintaining similar levels of efficacy - compared to current CD19 CAR T cell therapies.Designed to have a fast target binding off-rate to minimize excessive activation of the programmed T cells, AUTO1 may reduce toxicity and be less prone to T cell exhaustion, which could enhance persistence and improve the T cells' abilities to engage in serial killing of target cancer cells. In 2018, Autolus signed a license agreement under which Autolus acquired global rights fromUCL Business plc(UCLB), the technology-transfer company of UCL, to develop and commercialize AUTO1 for the treatment of B cell malignancies. AUTO1 is currently being evaluated in two Phase 1 studies, one in pediatric ALL and one in adult ALL.

About AUTO3

AUTO3 is a programmed T cell therapy containing two independent chimeric antigen receptors targeting CD19 and CD22 that have each been independently optimized for single target activity. By simultaneously targeting two B cell antigens, AUTO3 is designed to minimize relapse due to single antigen loss in patients with B cell malignancies. AUTO3 is currently being tested in pediatric ALL in the AMELIA clinical trial and in diffuse large B cell lymphoma in the ALEXANDER clinical trial.

AboutAutolus Therapeutics plc

Autolus is a clinical-stage biopharmaceutical company developing next-generation, programmed T cell therapies for the treatment of cancer. Using a broad suite of proprietary and modular T cell programming technologies, the company is engineering precisely targeted, controlled and highly active T cell therapies that are designed to better recognize cancer cells, break down their defense mechanisms and eliminate these cells. Autolus has a pipeline of product candidates in development for the treatment of hematological malignancies and solid tumors. For more information please visit http://www.autolus.com.

Forward-Looking Statement

This press release contains forward-looking statements within the meaning of the "safe harbor" provisions of the Private Securities Litigation Reform Act of 1995. Forward-looking statements are statements that are not historical facts, and in some cases can be identified by terms such as "may," "will," "could," "expects," "plans," "anticipates," and "believes." These statements include, but are not limited to, statements regarding Autolus financial condition and results of operations, as well as statements regarding the anticipated development of Autolus product candidates, including its intentions regarding the timing for providing further updates on the development of its product candidates, and the sufficiency of its cash resources. Any forward-looking statements are based on management's current views and assumptions and involve risks and uncertainties that could cause actual results, performance or events to differ materially from those expressed or implied in such statements. For a discussion of other risks and uncertainties, and other important factors, any of which could cause our actual results to differ from those contained in the forward-looking statements, see the section titled "Risk Factors" in Autolus' Annual Report on Form 20-F filed on November 23, 2018 as well as discussions of potential risks, uncertainties, and other important factors in Autolus' future filings with the Securities and Exchange Commission from time to time. All information in this press release is as of the date of the release, and the company undertakes no obligation to publicly update any forward-looking statement, whether as a result of new information, future events, or otherwise, except as required by law.

Investor and media contact: Silvia TaylorVice President, Corporate Affairs and Communications Autolus+1-240-801-3850s.taylor@autolus.com

UK:Julia Wilson+44 (0) 7818 430877j.wilson@autolus.com

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Autolus Therapeutics Announces New Data Showcasing Clinical Progress of Programmed T Cell Therapy Pipeline in Blood Cancers - GlobeNewswire

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Fate Therapeutics Presents its First Off-the-shelf, iPSC-derived CAR T-Cell Cancer Immunotherapy Program at ASH Annual Meeting – GlobeNewswire

December 11th, 2019 10:42 am

FT819 Exhibits Enhanced Tumor Clearance In Vivo Compared to Primary CAR T Cells in Preclinical Leukemia Model

Master Engineered iPSC Line for FT819 Fully Characterized for Complete Elimination of TCR Expression and Integration of Novel 1XX CAR into TRAC Locus with No Evidence of Off-target Effects

Company Plans to Submit an IND Application for FT819 during 1H20

SAN DIEGO, Dec. 10, 2019 (GLOBE NEWSWIRE) -- Fate Therapeutics, Inc. (NASDAQ: FATE), a clinical-stage biopharmaceutical company dedicated to the development of programmed cellular immunotherapies for cancer and immune disorders, announced new in vivo preclinical data for FT819, its first off-the-shelf, iPSC-derived chimeric antigen receptor (CAR) T-cell product candidate, at the 61st American Society of Hematology (ASH) Meeting and Exposition in Orlando, Florida.

FT819 is derived from a clonal master engineered induced pluripotent stem cell (iPSC) line with complete elimination of T-cell receptor (TCR) expression and a novel 1XX CAR targeting CD19 inserted into the T-cell receptor alpha constant (TRAC) locus. The cell product candidate is being developed under a collaboration with Memorial Sloan Kettering Cancer Center (MSK) led by Michel Sadelain, M.D., Ph.D. The Company has now selected a single engineered iPSC clone, and generated and fully-characterized the master engineered iPSC bank for GMP production of FT819.

CAR T-cell therapy continues to deliver remarkable outcomes for patients with hematologic malignancies, and next-generation approaches are needed to enable broad and timely patient access and reduce the cost and complexity of therapy, said Scott Wolchko, President and Chief Executive Officer of Fate Therapeutics. With early evidence of clinical activity for our off-the-shelf, iPSC-derived NK cell programs, we are excited to lead in bringing next-generation CAR T-cell therapies to patients and plan to submit an IND for FT819 in the first half of 2020.

The Companys iPSC product platform unites stem cell biology and precision genetic engineering to create renewable master engineered iPSC lines that can be repeatedly used to mass produce cancer-fighting immune cells, replacing the high production costs, weeks of manufacturing time, and complex engineering processes required for current-generation CAR T-cell immunotherapies with an off-the-shelf product that has the potential to reach many more patients.

At ASH, scientists from the Company and MSK presented new in vivo preclinical data demonstrating that FT819 exhibits durable tumor control and extended survival. In a stringent xenograft model of disseminated lymphoblastic leukemia, FT819 demonstrated enhanced tumor clearance and control of leukemia as compared to primary CAR19 T cells. At Day 35 following administration, a bone marrow assessment showed that FT819 persisted and continued to demonstrate tumor clearance, whereas primary CAR T cells, while persisting, were not able to control tumor growth. Over the past twelve months, the collaboration team has worked to optimize its processes for making T cells from iPSCs, and has now shown the production of pure T-lymphocytes consisting of both CD8+ and CD4+ T cells having a global gene expression profile that is highly-similar to primary T cells based on a principal component analysis.

As proof-of-principle for the unique advantages arising from selecting a single engineered iPSC clone for the production of CAR T-cell therapy, the scientists assessed 747 clones after engineering a pool of cells using CRISPR. It was found that only about 2% of clones met the Companys standards for overall quality including containing both bi-allelic disruption of the TCR, proper insertion of the CAR into the TRAC locus without random transgene integrations, and no evidence of off-target genomic modifications or translocations. The Company selected the top-performing clone for generation of the master engineered iPSC bank for GMP production of FT819.

Fate Therapeutics has exclusively licensed from MSK foundational intellectual property covering the production and composition of iPSC-derived T cells. In August, the Company announced that the U.S. Patent and Trademark Office issued U.S. Patent No. 10,370,452 covering compositions and uses of effector T cells expressing a CAR, where such T cells are derived from a pluripotent stem cell, including an iPSC. The foundational patent, which expires in 2034, is owned by MSK and is licensed exclusively to Fate Therapeutics for all human therapeutic uses.

About Fate Therapeutics iPSC Product PlatformThe Companys proprietary induced pluripotent stem cell (iPSC) product platform enables mass production of off-the-shelf, engineered, homogeneous cell products that can be administered with multiple doses to deliver more effective pharmacologic activity, including in combination with cycles of other cancer treatments. Human iPSCs possess the unique dual properties of unlimited self-renewal and differentiation potential into all cell types of the body. The Companys first-of-kind approach involves engineering human iPSCs in a one-time genetic modification event and selecting a single engineered iPSC for maintenance as a clonal master iPSC line. Analogous to master cell lines used to manufacture biopharmaceutical drug products such as monoclonal antibodies, clonal master iPSC lines are a renewable source for manufacturing cell therapy products which are well-defined and uniform in composition, can be mass produced at significant scale in a cost-effective manner, and can be delivered off-the-shelf for patient treatment. As a result, the Companys platform is uniquely capable of overcoming numerous limitations associated with the production of cell therapies using patient- or donor-sourced cells, which is logistically complex and expensive and is subject to batch-to-batch and cell-to-cell variability that can affect clinical safety and efficacy. Fate Therapeutics iPSC product platform is supported by an intellectual property portfolio of over 250 issued patents and 150 pending patent applications.

About Fate Therapeutics, Inc.Fate Therapeutics is a clinical-stage biopharmaceutical company dedicated to the development of first-in-class cellular immunotherapies for cancer and immune disorders. The Company has established a leadership position in the clinical development and manufacture of universal, off-the-shelf cell products using its proprietary induced pluripotent stem cell (iPSC) product platform. The Companys immuno-oncology product candidates include natural killer (NK) cell and T-cell cancer immunotherapies, which are designed to synergize with well-established cancer therapies, including immune checkpoint inhibitors and monoclonal antibodies, and to target tumor-associated antigens with chimeric antigen receptors (CARs). The Companys immuno-regulatory product candidates include ProTmune, a pharmacologically modulated, donor cell graft that is currently being evaluated in a Phase 2 clinical trial for the prevention of graft-versus-host disease, and a myeloid-derived suppressor cell immunotherapy for promoting immune tolerance in patients with immune disorders. Fate Therapeutics is headquartered in San Diego, CA. For more information, please visit http://www.fatetherapeutics.com.

Forward-Looking StatementsThis release contains "forward-looking statements" within the meaning of the Private Securities Litigation Reform Act of 1995 including statements regarding the safety and therapeutic potential of the Companys cell product candidates, including FT819, its ongoing and planned clinical studies, and the expected clinical development plans for FT819. These and any other forward-looking statements in this release are based on management's current expectations of future events and are subject to a number of risks and uncertainties that could cause actual results to differ materially and adversely from those set forth in or implied by such forward-looking statements. These risks and uncertainties include, but are not limited to, the risk that the Company may cease or delay planned development and clinical trials of any of its product candidates for a variety of reasons (including any delay in enrolling patients in current and planned clinical trials, requirements that may be imposed by regulatory authorities on the conduct of clinical trials or to support regulatory approval, difficulties in manufacturing or supplying the Companys product candidates for clinical testing, or the occurrence of any adverse events or other negative results that may be observed during development), the risk that results observed in preclinical studies of its product candidates, including FT819, may not be replicated in future clinical trials or studies, and the risk that its product candidates may not produce therapeutic benefits or may cause other unanticipated adverse effects. For a discussion of other risks and uncertainties, and other important factors, any of which could cause the Companys actual results to differ from those contained in the forward-looking statements, see the risks and uncertainties detailed in the Companys periodic filings with the Securities and Exchange Commission, including but not limited to the Companys most recently filed periodic report, and from time to time in the Companys press releases and other investor communications.Fate Therapeutics is providing the information in this release as of this date and does not undertake any obligation to update any forward-looking statements contained in this release as a result of new information, future events or otherwise.

Contact:Christina TartagliaStern Investor Relations, Inc.212.362.1200christina@sternir.com

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Fate Therapeutics Presents its First Off-the-shelf, iPSC-derived CAR T-Cell Cancer Immunotherapy Program at ASH Annual Meeting - GlobeNewswire

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Oral Azacitidine: First Maintenance Therapy for AML – Medscape

December 11th, 2019 10:42 am

ORLANDO, Florida For the first time, there is a maintenance therapy for patients with acute myeloid leukemia (AML) in remission that can improve overall survival a new oral formulation of an old drug, azacitidine, known as CC-486 (Celgene).

Dr Andrew Wei

"Oral azacitidine represents a new therapeutic standard for patients with AML in remission," said lead author Andrew H. Wei, MBBS, PhD, from the Alfred Hospital in Melbourne, Australia.

"It's not too hard to get these patients into remission," commented another expert. "The problem comes in keeping them in remission."

Wei noted that standard treatment with intensive induction chemotherapy (IC) for AML induces complete remission (CR) in 60% to 80% of patients aged 60 years or younger and in 40% to 60% of patients aged 60 years or older.

However, the majority of patients who attain CR will eventually relapse, and relapse is the primary obstacle to long-term survival, he said.

Despite various attempts, there has been no success over the past 30 years in defining maintenance treatment for these patients, Wei said.

The new results suggest that oral azacitidine could be an effective maintenance therapy.

Wei presented the results here at the American Society of Hematology 2019 annual meeting. They come from the QUAZAR AML-001 study, conducted in 472 patients with poor-risk AML in first remission.

The results show that CC-486 significantly improved outcomes compared with placebo plus best supportive care in terms of median overall survival (24.7 vs 14.8 months) and median relapse-free survival (10.2 vs 4.8 months).

The trial was funded by Celgene, which said it will be submitting the data for regulatory approval for the new oral formulation of azacitidine, CC-486.

Experts approached for comment agreed that maintenance oral azacitidine will become the new standard of care for patients with AML in first remission.

"Unlike therapy for acute lymphoblastic leukemia (ALL), maintenance therapy has not been part of the treatment algorithm for AML patients in first remission," Harry P. Erba, MD, PhD, director of the Leukemia Program at the Duke Cancer Institute, Durham, North Carolina, told Medscape Medical News.

He explained that trials for maintenance after first remission in AML have failed. Recently, Erba noted, the HOVON97 trial with injectable azacitidine demonstrated improvement in relapse-free survival compared with observation for older AML patients achieving remission after induction therapy. "However, there was no improvement in overall survival," he said.

"Remission in AML is short lived," Erba said. Oral azacitidine represents the first maintenance therapy in AML that has shown both significant and clinically meaningful improvements in overall and relapse-free survival and will represent a new standard of care for patients with AML in remission, Erba said. "Maintenance oral azacitidine will be practice changing," he predicted.

HOVON97 was a small study of injectable azacitidine used as maintenance therapy for 12 months, but it was slow to accrue and did not meet its accrual target.

"In HOVON97, at 12 months, only one third of patients received less than the 12 cycles of therapy," Wei said. He explained that with injectable azacitidine, patients have to come into the hospital/clinic for 7 days a month, 84 days a year. Oral azacitidine is more convenient as patients do not have to come into the clinic, he said.

Wei pointed out that about 40 patients in the QUAZAR study, which started in 2013, are still on maintenance therapy, with one patient now having received 80 cycles of therapy (approximately 7 years). "Long-term maintenance therapy with azacitidine is possible," he said.

Another expert was also impressed by the new results. "This is an important clinical trial that addresses an unmet need in AML care," said John Mascarenhas, MD, director of the Adult Leukemia Program and leader of clinical investigation within the Myeloproliferative Disorders Program at Mount Sinai's Tisch Cancer Institute in New York City.

"Older patients can often receive induction chemotherapy but frequently do not ultimately do well, as the disease relapses and survival is limited," he explained.

"This large, randomized, double-blind, controlled study of intermediate or poor risk AML patients over the age of 55 years supports the use of maintenance oral azacitidine after initial remission to extend overall and relapse-free survival in older AML patients not eligible for transplant," Mascarenhas said.

"This is still not a curative approach," Wei said, but added that it prolongs relapse-free survival for older patients while maintaining a quality of life for as long as possible.

The QUAZAR phase 3 study enrolled patients with poor- or intermediate-risk cytogenetics who had an Eastern Cooperative Oncology Group performance status 3 and who had achieved complete remission (CR) or complete remission with incomplete count recovery (CRi) after induction therapy with or without consolidation therapy. In addition, patients were not candidates for stem cell transplants.

Patients had predominantly de novo AML (89%). Other baseline characteristics of note:

85% of patients had intermediate-risk and 15% had poor-risk cytogenetics

79% achieved CR and 21% achieved CRi after induction therapy

78% received at least one cycle of consolidation therapy

43% of patients had MRD-positive disease

Patients were randomized to receive oral azacitidine 200 mg daily on days 1 to 14 of a repeat 28-day cycle (n = 278) or matching placebo (n = 274). Treatment was continued indefinitely until blast count was more than 15% or patients experienced unacceptable toxicity or went on to transplant.

At a median follow up of over 41.2 months (3 years, 5 months), median OS was significantly longer for patients receiving oral azacitidine at 24.7 months vs 14.8 months for placebo (P < .0009; hazard ratio [HR], 0.69).

Relapse-free survival was also significantly prolonged, to 10.2 months for patients on oral azacitidine vs 4.8 months for placebo (HR, 0.65; P < .0001).

Patients on oral azacitidine reported more grade 1 and 2 gastrointestinal (GI) adverse events, such as nausea (65% vs 24% on placebo), vomiting (60% vs 10%) and diarrhea (50% vs 22%), and also had more cytopenia. The most common grade 3 or 4 adverse events were neutropenia (41% with oral azacitidine vs 24% on placebo), thrombocytopenia (23% vs 22%), and anemia (14% vs 13%).

Although Erba supported the use of oral azacitidine as maintenance therapy, he pointed out that it was hard to convince patients, especially older ones, to continue on maintenance therapy indefinitely. "The toxicities of continuing on a drug indefinitely are real issues," he said, explaining that most elderly patients cannot cope with even grade 1 or 2 nausea, diarrhea, and vomiting over the long term.

But he noted that regardless of the higher incidence of some adverse events with oral azacitidine, the health-related quality-of-life of patients on oral azacitidine was similar to those on placebo.

Both experts said that longer-term follow-up is needed.

"We need a longer follow-up to see how the curves plateau," Erba said. He would also like to see a comparative analysis of the data in patients who are minimal residual disease (MRD)-negative vs those who are MRD-positive.

"The final results of this study, including the impact of measurable residual disease on outcome in this setting, will potentially have practice-changing implications," said Mascarenhas.

At the press conference, Wei pointed out that based on the data from QUAZAR, oral azacitidine is likely to be evaluated in the front-line setting of AML. "The elderly make up about two thirds of all AML patients, and oral azacitidine will be a better option than 7 days per month for chemotherapy treatment in the clinic," he said. "Oral azacitidine in the future may also be the backbone for other combinations."

The study was funded by Celgene.

Wei receives honoraria from AbbVie, Macrogenics, Pfizer, Astellas, Janssen, Servier, Celgene, Amgen, AstraZeneca, Novartis, and Genentech; is on the Board of Directors or serves on the advisory committees for AbbVie, Macrogenics, Pfizer, Astellas, Servier, Celgene, Amgen, Novartis, and Genentech; and receives research funding from AbbVie, Servier, Celgene, Amgen, AstraZeneca, and Novartis. As a former employee of the Walter and Eliza Hall Institute, Wei receives a fraction of its royalty stream related to venetoclax.

A partial list of Erba's conflict of interest includes consulting with Agios, Novartis, Daiichi Sankyo, MacroGenics, Jazz Pharmaceuticals, Seattle Genetics, GlycoMimetics, Amgen, Pfizer, Celgene, AbbVie, Covance, Immunogen, Astellas Pharma, Incyte; on the Speakers Bureau/lecture fees from Agios, Novartis, MacroGenics, Jazz Pharmaceuticals, Celgene; receiving research funding from Novartis, Daiichi Sankyo, MacroGenics, GlycoMimetics, Celgene; on the Data and Safety Monitoring board of GlycoMimetics; and Chair on independent review boards for several trials across several companies.

American Society of Hematology (ASH) 2019 Annual Meeting: Abstract LBA 3. Presented December 10, 2019.

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A direct heterotypic interaction between the DIX domains of Dishevelled and Axin mediates signaling to -catenin – Science

December 11th, 2019 10:42 am

DIX domains drive Wnt-catenin signaling

Dishevelled (Dvl) stimulates Wnt-catenin signaling by recruiting Axin, a component of the -catenin destruction complex, to the Wnt signalosome, thus stabilizing -catenin. Both Dvl-mediated activation and Axin-mediated repression of signaling require homopolymerization through the DIX domains of each protein. Through structural analysis and biochemical assays with the DIX domain of human Dvl and the DIX domain of human Axin (DAX), Yamanishi et al. found that the heterotypic interface between DIX and DAX resembled the interfaces observed in the individual homopolymers and that DIX-DAX heteropolymerization was favored over DAX-DAX homopolymerization. These findings support a model in which Dvl-Axin heterodimerization, mediated by DIX domains, drives the recruitment of Axin to the Wnt signalosome and disruption of the -catenin destruction complex.

The Wnt-catenin signaling pathway regulates embryonic development and tissue homeostasis throughout the animal kingdom. Signaling through this pathway crucially depends on the opposing activities of two cytoplasmic multiprotein complexes: the Axin destruction complex, which destabilizes the downstream effector -catenin, and the Dishevelled signalosome, which inactivates the Axin complex and thus enables -catenin to accumulate and operate a transcriptional switch in the nucleus. These complexes are assembled by dynamic head-to-tail polymerization of the DIX domains of Axin or Dishevelled, respectively, which increases their avidity for signaling effectors. Axin also binds to Dishevelled through its DIX domain. Here, we report the crystal structure of the heterodimeric complex between the two DIX domains of Axin and Dishevelled. This heterotypic interface resembles the interfaces observed in the individual homopolymers, albeit exhibiting a slight rearrangement of electrostatic interactions and hydrogen bonds, consistent with the heterotypic interaction being favored over the homotypic Axin DIX interaction. Last, cell-based signaling assays showed that heterologous polymerizing domains functionally substituted for the DIX domain of Dishevelled provided that these Dishevelled chimeras retained a DIX head or tail surface capable of binding to Axin. These findings indicate that the interaction between Dishevelled and Axin through their DIX domains is crucial for signaling to -catenin.

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A direct heterotypic interaction between the DIX domains of Dishevelled and Axin mediates signaling to -catenin - Science

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Dosage analysis of the 7q11.23 Williams region identifies BAZ1B as a major human gene patterning the modern human face and underlying…

December 11th, 2019 10:42 am

INTRODUCTION

Anatomically modern humans (AMHs) exhibit a suite of craniofacial and prosocial characteristics that are reminiscent of traits distinguishing domesticated species from their wild counterparts (13). This has led to the formulation of a self-domestication hypothesis according to which modern humans (3) went through a domestication process in the course of their evolution. Recent evidence, along with the well-warranted distinction between domestication and selective breeding (4), is also extending this notion to other species that might have undergone a self-domestication phase, such as cats, dogs, and bonobos (3). Thus, as self-domestication represents a special case of domestication, the most parsimonious hypothesis must posit the same core mechanisms to underlie both. For this reason, the self-domestication hypothesis also entails the prediction that key aspects of modern humans anatomy and cognition can be illuminated by studies of the so-called domestication syndrome, the core set of domestication-related traits that was recently proposed to result from mild neural crest (NC) deficits (5). However, both the neurocristopathic basis of domestication and its extension to the evolution of AMHs remain to be tested experimentally.

Williams-Beuren syndrome [WBS; OMIM (Online Mendelian Inheritance in Man) 194050] and Williams-Beuren region duplication syndrome (7dupASD; OMIM 609757), caused respectively by the hemideletion or hemiduplication of 28 genes at the 7q11.23 region [WBS critical region (WBSCR)], represent a paradigmatic pair of neurodevelopmental conditions whose NC-related craniofacial dysmorphisms and cognitive/behavioral traits (6, 7) bear directly on domestication-related traits relevant for AMHs (facial reduction and retraction, pronounced friendliness, and reduced reactive aggression) (fig. S1A). Structural variants in WBS genes, for example in the case of GTF2I and its paralogs, have been shown to underlie stereotypical hypersociability in domestic dogs and foxes (8, 9).

Among the WBSCR genes, we focus here on the chromatin regulator BAZ1B (also known as Williams syndrome transcription factor, WSTF), on the basis of the following lines of evidence that implicate it in domestication-relevant craniofacial features: (i) its established role in NC maintenance and migration in Xenopus laevis and the craniofacial defects observed in knockout mice (10, 11); (ii) the observation that its expression is affected by domestication-related events in canids (12); (iii) the first formulation of the neurocristopathic hypothesis of domestication, which included BAZ1B among the genes influencing NC development (5); (iv) the most comprehensive studies focusing on regions of the modern human genome associated with selective sweep signals compared to Neanderthals/Denisovans (hereafter archaics) (13, 14), one of which specifically included BAZ1B within the detected portions of the WBSCR; and (v) the thus far most detailed study systematically exploring high-frequency (HF) (>90%) changes in modern humans for which archaic humans carry the ancestral state, which found BAZ1B enriched for mutations in modern humans (most of which fall in the regulatory regions of the gene) (15).

Our previous work had established the largest cohort of 7q11.23 patient-derived induced pluripotent stem cell (iPSC) lines and revealed major disease-relevant transcriptional dysregulation that was already apparent at the pluripotent state and became further exacerbated upon differentiation (16). Here, we first harness this resource to dissect the impact of BAZ1B dosage on the NC of patients with WBS and 7dupASD, both in terms of function (i.e., NC migration and induction) and of transcriptional and chromatin dysregulation, thereby defining the BAZ1B dosagedependent circuits controlling the NC. Next, we apply these experimentally determined BAZ1B-dependent circuits underlying craniofacial morphogenesis to interrogate the evidence from paleogenomic analyses, which were thus far only of a correlative nature. We find major convergence between the BAZ1B control and the genes harboring regulatory changes in the modern human lineage. Together, the definition of the role of BAZ1B dosage in craniofacial neurocristopathy and its application to domestication-relevant paleogenomics demonstrate a major contribution of BAZ1B to the modern human face and offer experimental validation for the prediction at the heart of NC-based accounts of (self-) domestication: that the modern human face acquired its shape as an instance of mild neurocristopathy.

To dissect the role of BAZ1B in the craniofacial dysmorphisms that characterize WBS and 7dupASD, we started from our previous characterization of WBS patient and 7dupASD patientspecific iPSC lines and differentiated derivatives (16) and selected a cohort of 11 NC stem cell (NCSC) lines (four from patients with WBS, three from patients with 7dupASD, and four from control individuals), which also represent the largest cohort of patient-specific NCSCs described so far. Given the centrality of the cranial NC for the development of the face, we first validated the cranial identity of our NCSC cohort by transcriptomic profiling through a manually curated gene expression signature (fig. S2A), confirming their suitability for the study of craniofacial dysregulations. We then knocked down BAZ1B via RNA interference in all lines across the three genetic conditions, including also NCSCs derived from a particularly informative patient with atypical WBS (hereafter atWBS) bearing a partial deletion of the region that spares BAZ1B and six additional genes (Fig. 1A) (17). To establish a high-resolution gradient of BAZ1B dosages, we selected two distinct short hairpin RNA (shRNA) against BAZ1B (i.e., sh1 and sh2) along with a scrambled shRNA sequence (hereafter scr) as negative control, for a total of 32 NCSC lines. Knockdown (KD) efficiency was evaluated at the RNA level by quantitative polymerase chain reaction (qPCR) (Fig. 1B and fig. S1C), confirming the attainment of the desired gradient with an overall reduction of about 40% for sh1 and 70% for sh2, as well as reduction at the protein level, as detected by Western blot (fig. S1E).

(A) Schematic representation of the KD strategy on our iPSC-derived NCSC cohort. (B) BAZ1B mRNA levels in all the interfered lines (scr, sh1, and sh2) as measured by qPCR. Data represent aggregates of samples with the same number of BAZ1B copies (7dup, CTL + atWBS, and WBS). Glyceraldehyde-3-phosphate dehydrogenase (GAPDH) is used as a normalizer. (C) Eight- and 16-hour time points from the wound-healing assay analyses performed on a 7dupASD and a WBS NCSC line upon BAZ1B KD. Cells from the same line infected with the scr sh were used as references for the migration (n = 2). (D) Days 7, 10, and 12 of NC differentiation from embryoid bodies (EBs) of an scr-interfered iPSC line and its respective BAZ1B KD (n = 3). (E) mRNA levels of NC markers at day 12 of differentiation in three individual experimental replicates [bright-field images are reported in (D)]. An iPSC line is included as a negative control. Students t test was used (ns, not significant; *P < 0.05, **P < 0.01, ***P < 0.001, and ****P < 0. 0001).

NCSCs need to migrate to reach specific target regions in the developing embryo and give rise to distinct cell types and tissues, including craniofacial structures that are major areas of change in human evolution. Since BAZ1B KD was shown to affect the migration of the NC in X. laevis and to promote cancer cell invasion in different lung cancer cell lines (10, 18), we hypothesized that the BAZ1B dosage imbalances entailed in the 7q11.23 syndromes could result in a defective regulation of NCSC migration and might underlie the NC-related alterations typical of patients with WBS and 7dupASD. To test this, we compared the migration properties of patient-specific BAZ1B KD NCSC lines (sh2) to their respective control NCSC line (scr) by the well-established wound-healing assay. The 7dupASD NCSC KD lines took longer to fill the wound when compared to the respective control lines (scr), as indicated by images taken at 8 and 16 hours after a gap was created on the plate surface (Fig. 1C and fig. S1F). We instead observed an opposite behavior for the WBS BAZ1B KD lines, which were faster than the respective scr lines in closing the gap (Fig. 1C and fig. S1F). In contrast to the previous observations from X. laevis (10), we also observed a minor delay in NC induction as a consequence of BAZ1B KD (Fig. 1D and fig. S1D), by means of a differentiation protocol based on NC delamination from adherent embryoid bodies (EBs), which recapitulates the initial steps of NC generation (19). In particular, starting from 2 to 3 days after attachment of EBs, we observed a lower number of outgrowing cells in the KD line (Fig. 1D, days 7 and 10), coupled with an evidently higher cell mortality. Cells were eventually able to acquire the typical NC morphology, although lower differentiation efficiency was evident, as shown by images taken at day 12. In addition, the delay in NC formation was associated with a down-regulation of well-established critical regulators of NC migration and maintenance, including NR2F1, NR2F2, TFAP2A, and SOX9 (Fig. 1E). These results show that BAZ1B regulates the developing NC starting from its earliest migratory stages and that the symmetrically opposite 7q11.23 dosages alterations prime NCSCs to symmetrically opposite deficits upon BAZ1B interference. In turn, the central role of the NC in the development of facial morphology allows relating such findings to the symmetrically opposite craniofacial dysmorphisms of the two 7q11.23 syndromes.

Having defined the functional impact of BAZ1B dosage on NC function, we predicted that a main molecular readout of its dosage imbalances would be at the level of transcriptional regulation, given its critical role as transcriptional regulator in different cell and animal models (2022). To test this hypothesis and gain mechanistic insights into the specific BAZ1B dosagedependent downstream circuits, we subjected 32 interfered NCSC lines to high-coverage RNA sequencing (RNA-seq) analysis. As shown in fig. S2A, a manually curated signature from an extensive literature review (2328) validated the cranial identity of our NCSC lines, while clustering by Pearson correlation excluded the presence of any genotype- or hairpin-specific expression change. Confirming our previous observations in the two largest cohorts of iPSC lines (29), a principal component analysis (PCA) corroborated the significant impact of individual genetic backgrounds on transcriptional variability, with most KD lines clustering with their respective control scr line. This was consistent with the narrow range of experimentally interfered BAZ1B dosages and pointed to a selective BAZ1B dosagedependent transcriptional vulnerability (fig. S2B).

To dissect it, we thus resorted to a combination of classical pairwise comparative analysis, contrasting shBAZ1B-interfered NCSC lines (sh1 + sh2) with their respective controls (scr), with a complementary regression analysis using BAZ1B expression levels as independent variables, subtracting the contribution of individual genetic backgrounds. This design increases robustness and sensitivity in the identification of genes that, across multiple genetic backgrounds and target gene dosages, might have a different baseline (scr) across individuals while still being robustly dysregulated upon BAZ1B interference.

The two analyses identified a total of 448 genes with false discovery rate (FDR) < 0.1 (1192 with P < 0.01 and FDR < 0.25) whose transcriptional levels followed BAZ1B dosage, in either a direct (202; 539 with P < 0.01 and FDR < 0.25) or an inverse (246; 653 with P < 0.01 and FDR < 0.25) fashion. In addition, genes identified in the regression analysis included around 90% of the differentially expressed genes (DEGs) (27 of 29, FDR < 0.1) found in the comparative analysis (Fig. 2A). Consistent with the differential efficiency of the two short hairpins, we found a globally stronger transcriptional impact for the group of samples targeted by sh2 (fig. S2C) and a milder but nevertheless clearly distinguishable effect of sh1, resulting in particularly informative gradient of dosages over the scr control lines.

(A) Overlap between genes directly or inversely following BAZ1B levels identified in the pairwise comparative analysis (scr versus shBAZ1B) and in the regression analysis on BAZ1B-level sensitive genes on iPSC-derived NCSCs (FDR < 0.1). (B) Volcano plot reporting DEGs identified in the RNA-seq analysis on iPSC-derived NCSCs [fold change (FC) > 1.25; FDR < 0.1]. (C) Top most specific enrichments for GO biological processes among the DEGs in the RNA-seq analysis on iPSC-derived NCSCs. (D) Heat map representing DEGs that are dysregulated in genetic disorders involving mental retardation (Mental), intellectual disability (Intellectual), and/or facial dysmorphisms (Face) according to OMIM database classification. cnv, copy number variant. (E) Putative regulators of genes that follow BAZ1B levels identified by a master regulator analysis. Regulators were divided in four different groups based on their main functions.

Particularly noteworthy among the genes that we found correlated with BAZ1B levels were (i) crucial regulators of cranial NC, further highlighting a convergent BAZ1B dosagedependent dysregulation of the foundational CUL3-centered regulatory axis orchestrating NC-mediated craniofacial morphogenesis (30), and (ii) genes associated with variation of human facial shape or causative of dysmorphic facial features and mild intellectual disability when mutated (Fig. 2B and table S1).

Gene Ontology (GO) analysis performed on genes directly following BAZ1B levels suggested specific enrichments in biological processes such as histone phosphorylation, chromosome localization, RNA processing, and splicing. Genes inversely following BAZ1B levels were instead enriched in categories particularly relevant for NC and NC-derivative functions, such as cell migration and cardiovascular and skeletal development (Fig. 2C). By querying the OMIM database, we found that several DEGs were associated with genetic disorders whose phenotypes include mental retardation, intellectual disability, and/or facial dysmorphisms (Fig. 2D), underscoring the pertinence of BAZ1B-dependent dysregulation across both the neurocristopathic and cognitive axes.

Last, a master regulator analysis identified candidate regulators of BAZ1B DEGs, including factors involved in enhancer marking [CEBPB, p300, RBBP5, HDAC2 (histone deacetylase 2), KDM1A, and TCF12], promoter activation [TBP (TATA boxbinding protein), TAF1 (TBP-associated factor 1), and POL2 (polymerase 2)], and chromatin remodeling (CTCF, RAD21, and YY1) (Fig. 2E and fig. S2D), several of which are themselves causative genes of intellectual disability syndromes with neurocristopathic involvement, as in the case of our recently identified Gabrielede Vries syndrome caused by YY1 haploinsufficiency (31, 32). Chromatin remodeling was indeed the most prominently enriched group within the overall domain of transcriptional regulation. Two master regulators are particularly noteworthy, as they are themselves regulated by BAZ1B dosage. The first is EGR1 (FDR < 0.1), which is itself among the genes inversely correlated with BAZ1B levels, which is implicated in cranial development (in animal models) (33, 34) and whose promoter has been recently shown to feature a bivalent state in human embryonic cranial NC (23, 35). The second is MXI1, identified as master regulator of genes directly following BAZ1B levels (FDR < 0.001), which is itself found among the genes inversely correlated with BAZ1B and is itself a regulator of BAZ1B, pointing to a cross-talk between the two (fig. S2C). Notably, two differentially expressed targets of MXI1, TGFB2 and NFIB, are also involved in intellectual disability and craniofacial defects (30, 36, 37).

The transcriptional readout and functional impact of BAZ1B dosage (at the level of NC induction and migration) established its role as a master controller of the NC. We thus predicted, on the basis of its molecular function, that BAZ1B would directly bind to key NC target genes and that for some of these, the binding would be dosage sensitive. These genes would be, in turn, the most likely direct targets to mediate the dosage-dependent transcriptional and functional phenotypes described above. To test this prediction, we set out to both identify BAZ1B direct targets and characterize their promoter and enhancer states, so as to mechanistically link their transcriptional dysregulation with BAZ1B dosagedependent chromatin binding. Given the absence of chromatin immunoprecipitation (ChIP)grade BAZ1B antibodies, to carry out our ChIP coupled with sequencing (ChIP-seq) on scr and KD lines, we first designed a tagging strategy to establish, by CRISPR-Cas9 editing, a series of in-frame 3xFLAG endogenously tagged BAZ1B alleles in representative iPSCs of the four genotypes (Fig. 3A and fig. S3, A and B). These were then differentiated to NCSCs (fig. S3C) and subjected to ChIP-seq with anti-FLAG antibody, enabling a faithful characterization of BAZ1B genome-wide occupancy across dosages (one tagged allele in WBS, two tagged alleles in atWBS and CTL, and two tagged alleles in the context of 1.5-fold dosages in 7dupASD).

(A) Schematic representation of the strategy for CRISPR-Cas9mediated tagging of endogenous BAZ1B. Briefly, iPSCs from the four genotypes were electroporated with the donor plasmid and the Cas9/single-guide RNA ribonucleoprotein complex; clones were selected via hygromycin and PCR, differentiated to NCSCs, and then subjected to ChIP-seq. (B) PCA showing the distribution of the four BAZ1B-tagged NCSC lines according to their chromatin profiles. (C) Overlap between genes expressed in our NCSC lines (purple) and genes bound by BAZ1B at their enhancer (red) or promoter (blue) regions. (D) Top most specific enrichments for GO biological processes among the genes that are bound by BAZ1B and expressed in our NCSC cohort. (E) Most represented BAZ1B DNA binding motifs identified by HOMER show high similarity to neural and NCSC-specific transcription factors motifs. (F) BAZ1B differentially bound regions according to its copy number (FDR < 0.1; n = 2). (G) Overlap between genes that are differentially expressed have their enhancers differentially marked concordantly (H3K27ac, H3K4me1, and H3K27me3) and are bound by BAZ1B at enhancers.

PCA shows a clear separation of the samples by BAZ1B copy number, with CTL and atWBS samples clustering more closely and WBS and 7dupASD samples clustering at opposing positions (Fig. 3B). To call NC-specific enhancer regions and promoter-enhancer associations, we exploited for chromatin annotation the unprecedented resolution afforded by the patients cohort with its underlying variability and proceeded to (i) select chromosomal regions featuring H3K4me1 and H3K27ac in at least two individuals; (ii) exclude regions marked with H3K4me3 in at least two individuals;(iii) eliminate regions bearing a transcription start site (TSS); and (iv) associate each putative enhancer to the closest TSS, identifying a total of 30,8470 putative enhancer regions. Notably, BAZ1B binds 75% of its targets at their enhancer regions (6747 genes), with the remaining 2297 targets bound at promoters (Fig. 3C). In addition, 40% of genes expressed in NC are bound by BAZ1B, either exclusively at enhancers (27.4%) or exclusively at promoters (3.5%) or at both regions (9%). This highlights its pervasiveness within the NC epigenome (Fig. 3C) and is also reflected in the key functional enrichments observed for the BAZ1B direct targets that are also expressed and that include axon guidance, tube development, dendrite development, outflow tract morphogenesis, odontogenesis, wound healing, and endochondral bone morphogenesis (Fig. 3D). Many of the phenomena captured by these GO categories (e.g., odontogenesis and endochondral bone morphogenesis) are linked to recent changes in the bone structure of modern (versus archaic) humans, with Homo sapiens having characteristically smaller teeth than its extinct relatives.

Last and consistent with the enrichments in NC-defining categories uncovered above, the analysis of BAZ1B bound regions revealed major convergence with the binding motifs of critical NC regulators, including two motifs similar to those of TFAP2A and NEUROG2, and one equally associated to TAL1, TCF12, AP4, and ASCL1 (Fig. 3E and text S1A). Thus, BAZ1B binding regions are enriched for target sites of major regulators of NC and its neural derivatives (38, 39), among which TFAP2A stands out given its core role in neural border formation and NC induction and differentiation (40) through the binding and stabilization of NC-specific enhancers, in concert with NR2F1, NR2F2, and EP300 (41).

Last, we identified 81 regions that are quantitatively bound by BAZ1B depending on its copy number (FDR < 0.1) (Fig. 3F), 153 regions differentially bound concordantly in WBS and 7dupASD compared to control and atWBS samples (FDR < 0.1) (fig. S4A), and 176 and 25 regions differentially bound preferentially in WBS (fig. S4B) and 7dupASD (FDR < 0.1) (fig. S4C), respectively.

Given the prominence of its binding to distal regulatory regions, we then set out to define the BAZ1B dosagedependent impact on NCSC-specific enhancers by integrating H3K27ac, H3K4me1, H3K27me3, and H3K4me3 profiles. We thus performed a regression analysis on BAZ1B levels for the distribution of the three histone marks in the aforementioned regions and found H3K27ac to be the most affected, with 7254 genes differentially acetylated at their enhancers, followed by a differential distribution of the H3K4me1 (4048) and H3K27me3 (2136) marks (fig. S4D). This enabled the overlay of epigenomic and transcriptomic profiles, uncovering that among the 1192 DEGs identified in the regression RNA-seq analysis, 21.3% (257 of 1192) are associated to enhancers that are both bound by BAZ1B and differentially H3K27-acetylated in a manner concordant with BAZ1B levels (fig. S4E), with a stronger overlap for genes whose expression is inversely correlated with BAZ1B levels (160 versus 97). The same held for DEGs that have a concordant differential distribution of H3K4me1 mark at enhancers (123 versus 55), underscoring the consistency of the impact of BAZ1B dosage on distal regulation (fig. S4F). In contrast, a lower number of genes (36) showed a concordant differential distribution of the H3K27me3 mark and, at the same time, were bound by BAZ1B at enhancers (fig. S4G), indicating that BAZ1B preferentially affects active chromatin. From this integrative analysis, we could thus lastly identify a core set of 30 bona fide direct targets of BAZ1B, which are genes whose expression tightly follows BAZ1B levels and whose enhancers are bound by BAZ1B and clearly differentially modified (Fig. 3G, fig. S4H, and text S1B). Together, this first dosage-faithful analysis of BAZ1B occupancy in a diverse cohort of human NCSCs establishes its pervasive and mostly distal targeting of the NC-specific epigenome, with a preferential activator role on the critical transcriptional circuits that define NC fate and function.

Mild NC deficits have been put forth as a unifying explanatory framework for the defining features of the so-called domestication syndrome, with BAZ1B listed among the putative underlying genes because of its previously reported role in the NC of model organisms (5, 10, 11). The recent observation that its expression is affected by domestication-related mobile element insertion methylation in gray wolves (12) further supported its role in domestication, offering an intriguing parallel to the paleogenomic results that had detected BAZ1B within the regions of the modern genome reflective of selective sweeps and found it enriched for putatively regulatory mutations in AMHs (15).

Having defined the molecular circuits through which BAZ1B regulates NC, and since NC changes have been implicated in the domestication syndrome (5), since craniofacial differences correlate with self-domestication (1), and since 7q11.23 dosage-related craniofacial differences in humans relate to the H. sapiens versus Neanderthal comparison (fig. S1A), we set out to test the role of BAZ1B dosage in the differences between modern and archaic humans. For this, we carried out a systematic integrative analysis of the overlaps between our empirically defined BAZ1B dosagesensitive genes (blue Venn in Fig. 4B) and a combination of uniquely informative datasets highlighting differences between modern humans and archaics (Neanderthals/Denisovans) (represented in Fig. 4A by skulls illustrating the more gracile and juvenile profile in AMH relative to Neanderthals visible in the overall shape of the neurocranium, reduced prognathism, brow ridges, and nasal projections) (1, 1315). Specifically, as shown in Fig. 4B, these datasets include (i) genes associated with signals of positive selection in the modern branch compared to archaic lineages (purple Venn) (13, 14); (ii) genes harboring (nearly) fixed mutations in moderns versus archaics (pink Venn); and (iii) genes associated with signals of positive selection in the four paradigmatic domesticated species dog, cat, cattle, and horse (1) (orange Venn), to reveal statistically significant overlaps between them and genes associated with signals of positive selection in the modern branch compared to archaic lineages. In turn, the list of genes harboring (nearly) fixed mutations in moderns versus archaics contains three classes: (i) genes harboring high-frequency changes (15), (ii) genes harboring high-frequency missense mutations (red barplot), and (iii) genes enriched for high-frequency mutations in regulatory regions (green barplot) [data based on (15)] (Fig. 4C). As shown in the barplots, the obviously very limited number of high-quality coverage archaic genomes available results in a much higher number of nearly fixed changes identified in archaics (left/negative side of the plot) versus modern humans (right side) (Fig. 4C), setting a comparatively much higher threshold for the identification of nearly fixed modern changes.

(A) Archaic (Neanderthal) and modern skulls, illustrating the target domesticated phenotype that was captured by our analysis. Skull images were derived from work under a CC BY-SA 2.0 license (https://creativecommons.org/licenses/by-sa/2.0/deed.en) by hairymuseummatt. (B) Overlap between BAZ1B levelsensitive genes and datasets, which bring out differences between AMHs and archaics, as well as genes under positive selection in modern humans and domesticates. (C) Barplots showing the occurrence of high-frequency changes, missense mutations, and mutations in regulatory regions in genes from the AMH (nearly) fixed mutation dataset (pink Venn in B). (D) Heat map representing the amount of overlaps for each list selected from (B). Gene overlaps and detailed list descriptions are reported in table S2. (E) Rendering of a typical WBS face (left) against the background of a typical modern face (right). Red segments indicate areas of the lower face where the two faces most sharply depart (nose, philtrum, and lower front of the mandible). The lower midface region is most often associated with mutations in genes figuring prominently in our intersections, as discussed in the text and table S3.

These analyses are visualized in Fig. 4D (and detailed in tables S2 and S3) through a matrix that intersects all BAZ1B dosagedependent genes (partitioned in the two categories of directly and inversely correlated and ordered across the full range of biological significance and regulatory proximity, from simply DEGs to bona fide direct targets) with the evolutionary changes underlying domestication and self-domestication, yielding the following key insights (color coded for degree of overlap and marked for significance in hypergeometric tests). First, the most significant pattern was obtains at the intersection with the top 10% genes showing an excess of (nearly) fixed mutations in the regulatory regions of modern humans compared to archaics, across both directly and inversely BAZ1B leveldependent genes (table S2). This same category of nearly fixed modern regulatory changes is also the only one that returns a statistically significant overlap with the most stringent core of BAZ1B dosagedependent targets (i.e., DEGs whose enhancers are both directly bound by BAZ1B and differentially marked upon its decrease), demonstrating that BAZ1B directly controls, in an exquisitely dosage-dependent manner, this coherent and particularly relevant set of genes that underwent regulatory changes in human evolution. Second, the overall strongest overlaps map to the class of genes that are inversely correlated to BAZ1B levels, which we found to be strongly and specifically enriched for head morphogenesis and NC categories (Fig. 2C), thereby confirming craniofacial morphogenesis as the key domain of functionally relevant overlap between BAZ1B dosage and (self-) domestication changes relevant to the evolution of AMHs. Third, despite the spuriously inflated number of apparently fixed mutations in archaics (15), the overall extent of overlap between genes affected by BAZ1B dosage and our modern and archaic sets does not reveal significantly more hits for archaics. Globally, we found consistently more overlapping genes between the BAZ1B targets and the modern human data and even no statistically significant overlap for any list of the archaic-specific mutations when crossed against genes directly correlated to BAZ1B level. We find this noteworthy, given the evidence that the Neanderthal face also displays derived characteristics (42) that could be the result of modifications of genes that could overlap with those highlighted in this work. Last, the (lower) midface emerges as a particularly salient area of functionally relevant overlap (as illustrated in Fig. 4E and detailed in table S3), given the specific genes that our analysis unearthed: (i) COL11A1, one of the few craniofacial genes highlighted across domestication studies (dog, house sparrow, and pig breeds), which lies in a region of the human genome that resisted archaic introgression (13) and is associated with Marshall syndrome; (ii) XYLT1, one of the five genes (along with ACAN, SOX9, COL2A1, and NFIX) that affect lower and midfacial protrusion, are among the top differentially methylated genes compared to archaics and were also highlighted in a recent study on regulatory changes that shaped the modern human facial and vocal anatomy (tables S1 and S3) (43); and (iii) NFIB, which belongs to the same gene family as NFIX and shares some of its functions. In sum, the direct and dosage-sensitive control by BAZ1B of genes that underwent regulatory changes in human evolution and whose altered expression underlies neurocristopathic facial dysmorphisms is consistent with the hypothesis of mild neurocristopathy as the mechanistic core selected in the self-domestication of the modern human face.

As recently reconstructed (3), the idea of human self-domestication dates back, at least in terms of scientific record, to Johann Friedrich Blumenbach at the onset of the 19th century. Following on his seminal account of domestication systematized in Variations of Animals and Plants under Domestication (44), Charles Darwin also considered the analogy between modern humans and domesticated species in The Descent of Man (45), yet his emphasis on controlled breeding as a key aspect of domestication led him to frame domestication and self-domestication as distinct phenomena and thereby leave Blumenbachs intuition largely undeveloped (46). Since then, the possibility that the anatomical and cognitive-behavioral hallmarks of AMHs could result from an evolutionary process bearing such significant similarities to the domestication of animals as to share the same underlying cause has been refined into the full-fledged self-domestication hypothesis (1, 2). As recently argued (1, 3), convergent lines of evidence also indicate that self-domestication is temporally aligned with the emergence of AMH, although the process may have acquired further momentum with the gradual expansion of our species (1, 3). However, despite spurring considerable interest, the self-domestication hypothesis has thus far failed to marshal conclusive evidence largely because of two factors: (i) the lack of a coherent explanation, even at a theoretical level, of what developmental and genetic mechanisms could underlie domestication in general and (ii) the absence of suitable experimental systems in which those mechanisms could be specifically tested in the case of human self-domestication. The first problem was tackled by the recent proposition of mild NC deficits as a central and unifying functional layer underlying domestication (5). This constituted a major conceptual advance, particularly because it generated the testable hypothesis of an altered NC gene expression program in domesticated species relative to their wild-type ancestors. For humans, given the obvious lack of gene expression data from archaic hominins, we reasoned that this hypothesis could be verified by examining the genetic changes between archaic and modern humans in light of the gene regulatory networks directly inferred from human neurocristopathies. We thus set out to test whether specific human neurodevelopmental disorders, carefully selected on the basis of both craniofacial and cognitive-behavioral traits relevant to domestication, could illuminate the regulatory circuits shaping the modern human face and hence be harnessed for an empirical validation of the self-domestication hypothesis. Specifically, we reasoned that WBS and 7dupASD, through their uniquely informative set of symmetrically opposite phenotypes at the level of face morphology (fig. S1A) and sociality, constituted a paradigmatic test case to probe the heuristic potential of neurodevelopmental disease modeling for the experimental understanding of human evolution. The following key insights confirm the validity of this approach.

First, we identified the 7q11.23 region BAZ1B gene as a master regulator of the modern human face on the basis of a molecular and functional dissection in the thus far largest cohort of WBS patient and 7dupASD patientspecific NCSCs and across an exhaustive range of BAZ1B dosages. Notably, our cohort also included NCSCs from a patient with rare WBS featuring a much milder WBS gestalt and harboring an atypical, BAZ1B-sparing deletion that served as a particularly informative control, as confirmed by the clustering of atypical NCSC lines with controls when probed for BAZ1B occupancy. In particular, exploiting the fine-grained resolution of BAZ1B dosages recapitulated in our cohort, we could couple classical pairwise comparisons with a more sophisticated regression analysis on BAZ1B levels, thereby revealing major BAZ1B dosagedependent transcriptional alterations pivoting around clusters of pathways that are crucial for NC development and maintenance, as well as for its downstream skeletal and cardiac outputs.

Second, we repurposed the versatility of CRISPR-Cas9 to generate an allelic series of endogenously tagged BAZ1B across 7q11.23 dosages (including the BAZ1B-sparing atypical patient as uniquely relevant control) to define its dosage-dependent genome-wide occupancy. Taking advantage of previous extensive work on the NCSC chromatin landscape (41, 4749), we were able to define a pivotal role for BAZ1B in NCSC enhancer regulation, consistent with its preferential binding of distal regulatory regions, and to partition its dosage-dependent regulation into bona fide direct and indirect targets. The overall balance between the numbers of genes up- or down-regulated upon BAZ1B KDtogether with the greater overlap, sheer size, and significance of enrichments in chromatin remodeling categories over other domains of transcription regulationfurther corroborates the inclusion of BAZ1B among the factors acting upstream of enhancer and promoter modulations to enable or reinforce rather than specify their net outcome. Last, this molecular readout was translated to the functional level with the definition of an impairment in both NCSC migration and outgrowth from EBs upon decrease in BAZ1B, providing the first validation of BAZ1B involvement in key functions of the developing human NC.

Third, our investigation provides the first experimental evidence for the neurocristopathic hypothesis that had been put forth to explain the domestication syndrome and had pointed to BAZ1B as one of the candidates underlying this syndrome (5). Among the key NC hubs affected by BAZ1B dosage, we uncovered three additional critical genesEDN3, MAGOH, and ZEB2that had also been predicted in the same model because they are associated with behavioral changes found in domesticates, thereby defining a regulatory hierarchy for this coherent set of genes underlying domestication.

Last, the empirical determination of BAZ1B dosagesensitive genes in NC models from AMHs with accentuated domestication-relevant traits allowed us to expose, in a functionally relevant manner, the genetic differences between modern versus archaic. This brought to the fore the significant convergence between BAZ1B-dependent circuits and genes harboring regulatory changes in the human lineage, reinforcing the notion that regulatory regions contain some of the most significant changes relevant for the modern lineage. This is also reinforced by the recent identification of AMH-specific hypermethylation in the regulatory region of BAZ1B itself (43).

Last, it is noteworthy that genes implicated in NC development also play significant roles in the establishment of brain circuits that are critical for cognitive processes like language or theory of mind prominently affected in 7q11.23 syndromes. Among the genes downstream of BAZ1B that we uncovered in this study, FOXP2, ROBO1, and ROBO2 have long been implicated in brain wiring processes critical for vocal learning in several species (50, 51), including humans, and will warrant further mechanistic dissection in light of the distinctive linguistic profile of WBS individuals. In conclusion, our findings establish the heuristic power of neurodevelopmental disease modeling for the study of human evolution.

Ethics approvals were reported in the study that established the original iPSC cohort (16) and also apply to the additional samples included in this study (7dupASD3 and CTL4R).

WBS1, WBS2, WBS3, WBS4, 7dupASD1, atWBS1, and CTL2 fibroblasts were reprogrammed using the mRNA Reprogramming Kit (Stemgent), while the 7dupASD2 and CTL1R lines were reprogrammed with the microRNA Booster Kit (Stemgent). The CTL3 line was reprogrammed by transfection with the STEMCCA polycistronic lentiviral vector followed by Cre-mediated excision of the integrated polycistron. 7dupASD3 and CTL4R fibroblasts were reprogrammed using the Simplicon RNA Reprogramming Kit (Millipore).

Before differentiation, iPSC lines were cultured on Matrigel hESC-qualified Matrix (BD Biosciences)coated plates, diluted 1:40 in Dulbeccos minimum essential medium/F-12, and grown in mTeSR 1 medium (STEMCELL Technologies). They were passaged upon treatment with Accutase (Sigma-Aldrich) and then plated in mTeSR 1 medium supplemented with 5 M Y-27632 (Sigma-Aldrich).

Differentiation into NCSCs was performed as previously described (52), with the exception of NCSCs used in the experiment reported in Fig. 1 (D and E) (19).

NCSCs were detached using Accutase and counted, and 1 106 cells per experimental condition were fixed in 4% paraformaldehyde and then blocked in 10% bovine serum albumin. Cells were incubated for 1 hour with primary antibodies conjugated to fluorophores (HNK1fluorescein isothiocyanate and nerve growth factor receptorAlex Fluor 647; BD Biosciences). Analyses were performed on a FACSCalibur instrument (BD Biosciences), and data were analyzed with FCS express software (Tree Star). Fluorescence-activated cell sorting characterization for 7dupASD3 and CTL4R lines is reported in fig. S1B; for all the other lines, see (16).

BAZ1B KD was performed using validated pLKO.1 TRC vector TRCN0000013338 (referred to as sh1) and TRCN0000013341 (referred to as sh2). A pLKO.1 TRC vector containing a scrambled short hairpin sequence was used as a negative control.

Second generation lentiviral vectors were produced through calcium phosphate transfection of human embryonic kidney 293T cells and ultracentrifugation (2 hours, 20C, 20,000 rpm).

NCSCs (3 to 4 105) were infected upon splitting and then selected by adding puromycin (1 g/ml) to the medium.

RNA was extracted using the RNeasy Micro Plus Kit (QIAGEN) according to the manufacturers instructions. Retrotranscribed cDNA was obtained from 0.5 to 1 g of total RNA using the SuperScript VILO retrotranscription kit (Thermo Fisher Scientific).

Real-time qPCR was performed on a 7500 Fast Real-Time PCR system (Applied Biosystems) using SYBR Green Master Mix (Applied Biosystems) as the detecting reagent. A total cDNA amount corresponding to 15 ng of starting RNA was used for each reaction. Each sample was analyzed in triplicate and normalized to GAPDH. Relative mRNA quantity was calculated by the comparative cycle threshold (Ct) method using the formula 2Ct [BAZ1B, CCTCGCAGTAAGAAAGCAAAC (forward) and ACTCATCCAGCTCCTTTTGAC (reverse); GAPDH, GCACCGTCAAGGCTGAGAAC (forward) and AGGGATCTCGCTCCTGGAA (reverse); NR2F1, AGAAGCTCAAGGCGCTACAC (forward) and GGGTACTGGCTCCTCACGTA (reverse); NR2F2, GCAAGTGGAGAAGCTCAAGG (forward) and GCTTTCCACATGGGCTACAT (reverse); TFAP2A, GCCTCTCGCTCCTCAGCTCC (forward) and CGTTGGCAGCTTTACGTCTCCC (reverse); and SOX9, AGTACCCGCACTTGCACAAC (forward) and GTAATCCGGGTGGTCCTTCT (reverse)].

Library preparation for RNA-seq was performed according to the TruSeq Total RNA sample preparation protocol (Illumina), starting from 250 ng to 1 g of total RNA. cDNA library quality was assessed in an Agilent 2100 Bioanalyzer using the High Sensitivity DNA Kit. Libraries were sequenced with the Illumina HiSeq machine at a read length of 50base pair (bp) paired end and a coverage of 35 million of reads per sample.

NCSCs were lysed in radioimmunoprecipitation assay buffer [10 mM tris (pH 8.0), 1% Triton X-100, 0.1% sodium deoxycholate, 0.1% SDS, 140 mM NaCl, and 1 mM EDTA] supplemented with protease inhibitor cocktail (Sigma-Aldrich) and 0.5 mM phenylmethylsulfonyl fluoride (Sigma-Aldrich) for 1 hour at 4C.

Protein extracts (30 to 50 g per sample) were supplemented with NuPAGE LDS sample buffer (Thermo Fisher Scientific) and 50 mM dithiothreitol (Thermo Fisher Scientific) and denatured at 95C for 3 min. Then, extracts were run on a precast NuPAGE 4 to 12% bis-tris Gel (Thermo Fisher Scientific) in NuPAGE MOPS SDS Running Buffer (Thermo Fisher Scientific) and transferred to a 0.45-m nitrocellulose membrane (GE Healthcare) for 1 hour at 100 V in a buffer containing 20% absolute ethanol and 10% 0.25 M tris base and 1.9 M glycine. The membranes were blocked in TBST [50 mM tris (pH 7.5), 150 mM NaCl, and 0.1% Tween 20] and 5% milk for 1 hour, incubated with primary antibodies overnight at 4C and with secondary antibodies for 1 hour at room temperature. Primary [BAZ1B (Abcam) and glyceraldehyde-3-phosphate dehydrogenase (GAPDH; Millipore)] and secondary antibodies were diluted in TBST and 5% milk. Blots were detected with the ECL Prime Western Blotting Detection Reagents (Sigma-Aldrich) and scanned using the ChemiDoc system (Bio-Rad).

Cells (5 104 to 7 104) were plated in each of the two Matrigel-coated wells of silicone culture-inserts (Ibidi) attached to six-well culture plates. After 24 hours, the insert was removed, medium was changed to remove dead cells, and time lapse was performed for 24 hours at the rate of one image every 10 min at 10 magnification; each condition was analyzed in duplicate. Images were acquired with the BX61 upright microscope equipped with a motorized stage from Olympus or the Nikon Eclipse Ti inverted microscope equipped with a motorized stage from Nikon and analyzed with ImageJ.

iPSCs were pretreated with 10 M rho kinase inhibitor for 4 hours, and then 2 106 cells were electroporated using the Neon system with the Cas9/single-guide RNA ribonucleoprotein complex and the donor plasmid (synthesized by GeneArt). The donor plasmid contained three FLAG tags followed by a self-cleaving peptide (P2A) and a hygromycin resistance (HygroR). The 3xFLAG-P2A-HygroR cassette was flanked by BAZ1B-specific homology arms (5 HA and 3 HA) to promote homologous recombination and then subcloned into a bacterial backbone (Fig. 3A).

After 48 hours, iPSC medium was supplemented with hygromycin B (50 g/l), and selection medium was maintained for 15 days. Fifteen to 20 clones per iPSC line were then subjected to PCR to (i) evaluate the presence of the cassette and the insertion in the correct genomic locus and (ii) distinguish heterozygously tagged from homozygously tagged clones (fig. S3A). We could isolate a clone with a homozygous integration from the CTL, the atWBS, and the typical WBS but not from the 7dupASD line. In the 7dupASD clone, the FLAG tag was present in two of three copies, as shown by a digital PCR analysis (fig. S3B).

DNA (60 ng) was amplified in a reaction volume containing the following reagents: QuantStudio 3D Digital PCR Master Mix v2 (Thermo Fisher Scientific), Custom TaqMan Copy Number Assays SM 20 FAM labeled (Thermo Fisher Scientific), and TaqMan Copy Number Reference Assay 20 (Thermo Fisher Scientific) VIC labeled (Thermo Fisher Scientific). The mix was loaded on a chip using the QuantStudio 3D Digital PCR Chip Loader. The chips were then loaded on the ProFlex PCR System (Thermo Fisher Scientific), and data were analyzed using the QuantStudio 3D AnalysisSuite Cloud Software. The entire process was performed by the qPCR Service at Cogentech, Milano [Custom (FLAG) TaqMan Copy Number Assays: forward primer, TGGACAGTCCAGAGGACGAA; reverse primer, CACCCTTGTCGTCATCGTCTT; and probe, FAMACAGAAGAAGGACTACAAAGACG and TaqMan Copy Number Reference Assay: TERT (VIC) (catalog number 4403316)].

Approximately 2 105 cells were used (~100 g of chromatin) for histone mark IP, and 1 mg of chromatin was used for BAZ1B-FLAG IP. Cells were fixed with phosphate-buffered saline, containing 1% formaldehyde (Sigma-Aldrich), for 10 min to cross-link proteins and DNA, when the reaction was then stopped by adding 125 mM glycine for 5 min. Cells were lysed with SDS buffer containing 100 mM NaCl, 50 mM tris-HCl (pH 8.0), 5 mM EDTA (pH 8.0), and 10% SDS, at which point chromatin pellets were resuspended in IP buffer containing 1 volume of SDS buffer and 0.5 volume of Triton dilution buffer [100 mM tris-HCl (pH 8.5), 5 mM EDTA (pH 8.0), and 5% Triton X-100]. Chromatin was then sonicated using the S220 Focused-ultrasonicator (Covaris) to generate <300 bp DNA fragments (for histone mark IPs) or the Branson Digital Sonifier to generate 500 to 800 bp DNA fragments (for BAZ1B-FLAG IP).

Sonicated chromatin was incubated overnight at 4C with primary antibodies [H3K27ac (Abcam), H3K4me1 (Abcam), H3K4me3 (Abcam), H3K27me3 (Cell Signaling Technology), and FLAG (Sigma-Aldrich)] and then for 3 hours with Dynabeads Protein G (Thermo Fisher Scientific). Beads were washed three times with low-salt wash buffer [0.1% SDS, 1% Triton X-100, 2 mM EDTA, 20 mM tris-HCl (pH 8.0), and 150 mM NaCl] and once with high-salt wash buffer [0.1% SDS, 1% Triton X-100, 2 mM EDTA, 20 mM tris-HCl (pH 8.0), and 500 mM NaCl]. Immunocomplexes were eluted in decross-linking buffer (1% SDS and 100 mM NaHCO3) at 65C for 2 hours. DNA was purified using QIAquick PCR columns (QIAGEN) and quantified with a Qubit dsDNA HS assay kit (Thermo Fisher Scientific). DNA libraries were prepared by the sequencing facility at European Institute of Oncology according to the protocol described by Blecher-Gonen and colleagues (53), and DNA was sequenced on the Illumina HiSeq 2000 platform. For the FLAG ChIP, samples were run in duplicate.

RNA-seq data were quantified using Salmon 0.91 to calculate read counts and transcripts per million in a transcript- and gene-wise fashion, using the quasi-mapping offline algorithm (54) on the GRCh38 (National Center for Biotechnology Information) database. edgeR was used for differential gene expression analysis (DEA), using generalized linear regression methods, to identify pattern of differential expression following two different schemes:

1) A factorial analysis based on the definition of one group of scrambled and one group of KD samples to identify genes dysregulated similarly across short hairpins characterized by different efficiencies.

2) A numerical analysis in which log-normalized [Trimmed Mean of M-values (TMM)] BAZ1B levels, as quantified by RNA-seq, was used as independent variable.

All analyses were performed dropping individual variations (~individual+KD or ~individual+BAZ1B) to account for the genetic background of each individual. In particular, this design is expected to permit the identification of genes, which change expression level upon KD even in situations in which genotype-specific makeups would lead BAZ1B-dependent genes to have unique expression levels in scramble lines. In the factorial analysis, DEGs were identified and characterized by filtering for fold change (FC) > 1.25 and FDR < 0.05 unless explicitly indicated.

To our knowledge, performing a regression analysis at a gene-specific level has never been performed. We were able to do this because of the availability of a large set of samples (11 individuals) and because of the two short hairpins robustly respectively reducing BAZ1B expression levels, respectively by ~40 and ~70% in all individuals lines. To validate the quality of our numerical differential expression analysis, we took advantage of HipSci data (55, 56) and iPSCpoweR tools (29). We took 50 of 105 possible combinations of 13 random individual RNA-seq data from the healthy HipSci cohort, representing both sexes and having at least two technical replicates per individual. Unfortunately, HipSci does not contain at least 13 individuals with three clones per individual. Thus, we performed four alternative DEAs with edgeR (table S4) on the 50 different random combinations of 13 individuals identified (200 DEAs in total, on 22 samples, two clones per individual), using the same model matrix used for the regression analysis (~individual+BAZ1B) and using BAZ1B levels of scramble and sh2 lines. All analyses identified very low number of spurious DEGs (fig. S2E). Thus, we used the Edg2 pipeline (table S4) because it does not discard genes with higher variability (Edg2 and Edg4 versus Edg1 and Edg3), and it is based on a better suited algorithm (Edg2 versus Edg4). With our model matrix, filtering by P < 0.01 (and FDR < 0.25), using Edg2 on a random HipSci data, we obtained an average of 93.32 DEGs (on average) with a median equal to 43 (table S5). GO enrichments were performed using topGO R package version 2.28.0.

Master regulatory analysis was performed via hypergeometric test by measuring gene set enrichments in lists of transcription factor targets provided by the TFBS tools database (57). Both GO and transcription factor enrichment analyses were performed considering background genes expressed in at least two samples in our NCSC cohort.

ChIP-seq experiments were analyzed both qualitatively and quantitatively. Reads were trimmed with the FASTX-Toolkit (-Q33 -t 20 -l 22), aligned with Bowtie 1.0 (-v 2 -m 1) on the Human hg38 reference genome, and peaks were called using MACS 2.1.1. H3K4me1, H3K27ac, H3K4me3, and H3K27me3 peaks were called with --broad using default parameters and q < 0.05.

Qualitative analysis, including intersection and comparison of bed files, was performed using BedTools version 2.23.

To define enhancer regions, we intersected those marked by H3K4me1 and H3K27ac in at least two samples, discarded regions with H3K4me3 in at least two samples, and discarded regions overlapping with TSS. Motif enrichment was performed by using HOMER v4.10.

Quantification of reads per region was performed with DeepTools 3.0.2. Differential mark deposition was conducted by means of edgeR 3.24.1 inside R 3.3.3. To define mark deposition following BAZ1B levels, we used the same design as for RNA-seq data (~individual+BAZ1B).

To identify BAZ1B bound regions and to avoid losing identification of lowly covered regions, we resorted to (i) aggregation of all sample aligned reads and (ii) peak calling with MACS2 using extsize 800 and q < 0.25. BAZ1B binding coverage was calculated with DeepTools, with the same parameters used for histone marks, on the identified peak regions. Differentially bound regions were identified with edgeR.

The archaic/modern lists were generated from the material presented in (15). We used high-coverage genotypes for three archaic individuals: one Denisovan (58), one Neanderthal from the Denisova cave in Altai mountains (59), and another Neanderthal from Vindija cave, Croatia (60). The data are publicly available at http://cdna.eva.mpg.de/neandertal/Vindija/VCF/, with the human genome version hg19 as reference. High-frequency (HF) differences were defined as positions where more than 90% of present-day humans carry a derived allele, while at least the Denisovan and one Neanderthal carry the ancestral allele. High-frequency changes in archaics were defined as occurring at less than 1% in present-day humans, while at least two archaic individuals carry the derived allele. The HF lists used here were examined as presented in (15), with the exception of the HF lists in regulatory regions, which were extracted from the same dataset but not presented as such in the original paper.

Supplementary material for this article is available at http://advances.sciencemag.org/cgi/content/full/5/12/eaaw7908/DC1

Fig. S1. BAZ1B KD validation in iPSC-derived NCSCs and evaluation of its impact on NCSC migration.

Fig. S2. BAZ1B KD affects the transcriptome of iPSC-derived NCSCs.

Fig. S3. Generation of BAZ1B-FLAG iPSC lines and differentiation to NCSCs.

Fig. S4. BAZ1B KD induces a significant chromatin remodeling at distal regions.

Text S1A. Detailed description of HOMER motif enrichments performed on BAZ1B ChIP-seq data.

Text S1B. List of key direct targets of BAZ1B involved in neural- and NC-related development and relevant associated literature.

Table S1. Genes relevant for NC and NC-derived features whose expression follows BAZ1B levels.

Table S2A. Significant genes in human evolution.

Table S2B. Regulatory excess in archaic humans, overlap with BAZ1B targets.

Table S2C. Mutation excess in archaic humans, overlap with BAZ1B targets.

Table S2D. Regulatory changes (exclusive) in archaic humans, overlap with BAZ1B targets.

Table S2E. Missense mutations in archaic humans, overlap with BAZ1B targets.

Table S2F. Mutation excess in archaic humans corrected for length, overlap with BAZ1B targets.

Table S2G. Regulatory excess in modern humans, overlap with BAZ1B targets.

Table S2H. Mutation excess in modern humans, overlap with BAZ1B targets.

Table S2I. Regulatory changes (exclusive) in modern humans, overlap with BAZ1B targets.

Table S2J. Missense mutations in modern humans, overlap with BAZ1B targets.

Table S2K. Mutation excess in modern humans corrected for length, overlap with BAZ1B targets.

Table S2L. Genes under positive selection in domesticated animals, overlap with BAZ1B targets.

Table S2M. Genes under positive selection from Peyrgne et al. (13) in modern humans, overlap with BAZ1B targets.

Table S2N. Genes under positive selection from Racimo (14) in modern humans, overlap with BAZ1B targets.

Table S3. Crucial genes identified in the overlap between BAZ1B datasets and archaic versus modern human datasets reported in this study.

Table S4. Alternative differential expression analysis functions tested with iPSCpower to assess the efficacy of our design matrix (~individual+BAZ1B). R code provided.

Table S5. Number of genes differentially expressed following BAZ1B data in our numerical analysis compared to an analysis conducted on randomized HipSci data, using Edg2 function (see table S4).

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CAR-T therapies shine at ASH – PharmaTimes

December 11th, 2019 10:42 am

CAR-T therapies being developed by Bristol Myers Squibb and Janssen have all hit targets in early-mid-stage trials, raising hopes of new treatment options for difficult to treat blood cancers.

First up, Johnson & Johnsons Janssen unveiled initial results from the Phase Ib/II CARTITUDE-1 study assessing the efficacy and safety of JNJ-68284528 (JNJ-4528) an investigational B cell maturation antigen (BCMA)-directed chimeric antigen receptor T cell (CAR-T) therapy in treating relapsed or refractory multiple myeloma.

The study enrolled patients who have received at least three prior lines of therapy or are double refractory to a proteasome inhibitor (PI) and an immunomodulatory drug (IMiD); have received a PI, IMiD and an anti-CD38 antibody; and who progressed on or within 12 months of their last line of therapy.

Results from the Phase Ib portion of the CARTITUDE-1 study showed early and deep responses among patients (n=29) with a median of five prior multiple myeloma treatment regimens treated with JNJ-4528, with 100 percent of patients achieving a response at a median six-month follow-up, the firm said.

The overall response rate (ORR) included 69% of patients achieving a complete response (CR) or better; 86% of patients achieving a very good partial response (VGPR) or better; and 14% of patients achieving a partial response (PR).

Also key, 100% of evaluable patients achieved early minimal residual disease (MRD)-negative disease status at day 28 post-infusion, while at the six-month follow-up, 27 of 29 patients were progression-free.

The results highlight a compelling clinical profile for the treatment in this setting, said Deepu Madduri, assistant professor of Medicine, Haematology and Medical Oncology, Tisch Cancer Institute at Mount Sinai, New York, and principal study investigator.

US regulators have granted JNJ-4528 a breakthrough designation in the US based on the data.

Liso-cel also on target

Elsewhere, Bristol-Myers Squibb's CAR-T cell therapy liso-cel (lisocabtagene maraleucel) showed promise across two trials involving patients with blood cancers.

The studies included an evaluation of liso-cel in patients with relapsed or refractory chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma (SLL) (TRANSCEND CLL 004); and a study in second-line patients with relapsed or refractory large B-cell non-Hodgkins lymphoma (NHL) patients who were ineligible for high-dose chemotherapy and hematopoietic stem cell transplant (PILOT).

The Phase II PILOT assessed the CAR-T therapy in patients with relapsed/refractory large B-cell NHL who had received only one prior line of immunochemotherapy and were deemed ineligible for HSCT due to patient factors including age, comorbidities or performance status.

All patients eligible for evaluation achieved a response with six (50%) patients achieving a CR. Seven of 12 (58%) patients maintained response levels at three months following liso-cel infusion.

Of the 13 patients, 61.5% had at least one treatment related side effect of grade 3 or higher and these were primarily cytopenias. Four patients had prolonged grade 3 or higher cytopenias.

The Phase I/II TRANSCEND CLL 004 study included patients who had a median of five prior lines of therapy. All (23/23) had received prior ibrutinib and most (21/23) were refractory to or had relapsed on the BTK inhibitor. There were nine patients (39%) that had failed both a BTK inhibitor and venetoclax, and most (83%) were considered to high-risk features.

The overall response rate (ORR) after median follow-up of 11 months for patients receiving liso-cel was 81.5%, with 45.5% achieving a complete response (CR). In patients that had failed a BTK inhibitor and venetoclax, the ORR was 89% with 67 achieving a CR.

Among 20 patients evaluable for minimal residual disease (MRD), the majority achieved undetectable MRD in the blood (75%) and bone marrow (65%) by next-generation sequencing, the firms noted.

On the safety side, treatment-emergent adverse events (TEAE) of any grade occurred in all patients, with 96% experiencing one classed as a grade 3 or higher, including anemia (78%), thrombocytopenia (70%), neutropenia (56.5%), leukopenia (43.5%), febrile neutropenia (26%), lymphopenia (26%) and cytokine release syndrome (9%).

Also, 74% of patients had cytokine release syndrome (CRS) of any grade with 9% of patients experiencing grade 3 CRS. Thirty-nine percent had neurological events of any grade, while 22% had grade 3 or higher.

As we continue to evaluate liso-cel in important new disease settings and areas of unmet medical need, we are encouraged to see the early results from these studies, said Stanley Frankel, senior vice president, Cellular Therapy Development for BMS.

Data from all studies were presented at the American Society of Hematology (ASH) Annual Meeting in Orlando, Florida.

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CAR-T therapies shine at ASH - PharmaTimes

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First 2 Adults with Severe Hemophilia A Respond Well to Gene Therapy BAY 2599023 in Clinical Trial – Hemophilia News Today

December 10th, 2019 5:46 pm

Bayersinvestigationalgene therapy BAY 2599023 safely and effectively increased the levels ofclotting factor VIII (FVIII) and prevented or lessened bleeding in the first two people with severe hemophilia A treated ina Phase 1/2 clinical trial, preliminary data show.

The ongoing trial (NCT03588299; 2017-000806-39) is enrolling up to 30 eligible adult patients. More information, including recruiting sites in the U.S. and Europe, is availablehere.

These early results will be presented in the poster, First-in-human Gene Therapy Study of AAVhu37 Capsid Vector Technology in Severe Hemophilia A, at the 61st American Society of Hematology (ASH) Annual Meeting & ExpositionrunningDec. 710 in Orlando, Florida.

BAY 2599023 initially by Dimension Therapeutics as DTX201 is being developed by Bayer in collaboration with Ultragenyx Pharmaceuticals. The potential gene therapy aims to promote a sustained production of FVIII and overcome its deficit in hemophilia A patients, reducing or eliminating the need for prophylatic, or preventive, FVIII replacement therapy and the occurrence of bleeding events.

Administered as a single infusion, the therapy uses a modified and harmless version of the adeno-associated virus (AAV), called AAVhu37, to deliver a shorter but functionalcopy of the FVIII gene to liver cells, where clotting factors are produced. This version of the FVIII gene is known as B-domain deleted FVIII gene.

Preclinical studies showed that AAVhu37 effectively delivered the FVIII gene to liver cells, had a favorable distribution, and induced a durable FVIII production.

In addition, preclinical data showed that BAY 2599023 had a good safety profile, and the potential to promote FVIII production to levels considered to be therapeutic over a long period of time.

The ongoing, dose-establishingPhase 1/2 trial (NCT03588299; 2017-000806-39) is evaluating the safety, tolerability and early effectiveness of three ascending doses of BAY 2599023 in adult men with severe hemophilia A who have been previously treated with FVIII products.

It is the first clinical trial to evaluate a gene therapy based on the AAVhu37.

Up to 30 enrolled patients will be given a single intravenous infusion of one of three doses of BAY 2599023. The studys primary goal is to measure safety through reports of adverse events. Secondary goals include measuring FVIII activity and assessing the number of patients who reach more than 5% of FVIII production at six and 12 months after treatment at the different doses.

Data on the first two men treated at BAY 2599023s starting dose (0.5 x 1013 gene copies/kg) will be presented at the meeting. These men had more than 150 days of treatment with FVIII products, no history of FVIII inhibitors, and no detectable immune response against AAVhu37.

No adverse events were reported after more than 15 weeks of safety evaluations (about four months). Blood levels of liver enzymes also remained within a normal range, and either of these patients needed to be treated with corticosteroids.

The first man reached a stable FVIII production of around 5%, and was free of bleeding events or a need for prophylactic treatment for six weeks. The second patient, who had 99 bleeds in the year before receiving the gene therapy, reached a stable FVIII production of around 17%, and has been bleed-free for more than 5.5 months (at the time of data collection).

These preliminary data suggest that BAY 2599023 is safe and effective in promoting the production of FVIII and in reducing or preventing the occurrence of bleeding events and the need for prophylactic treatment, the researchers wrote.

Overall, data generated from this first dose cohort demonstrate that successful translation from pre-clinical to clinical development and proof-of-mechanism for BAY 2599023 was achieved, they concluded.

Marta Figueiredo holds a BSc in Biology and a MSc in Evolutionary and Developmental Biology from the University of Lisbon, Portugal. She is currently finishing her PhD in Biomedical Sciences at the University of Lisbon, where she focused her research on the role of several signalling pathways in thymus and parathyroid glands embryonic development.

Total Posts: 121

Margarida graduated with a BS in Health Sciences from the University of Lisbon and a MSc in Biotechnology from Instituto Superior Tcnico (IST-UL). She worked as a molecular biologist research associate at a Cambridge UK-based biotech company that discovers and develops therapeutic, fully human monoclonal antibodies.

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First 2 Adults with Severe Hemophilia A Respond Well to Gene Therapy BAY 2599023 in Clinical Trial - Hemophilia News Today

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Watch out, Keytruda. Ferring’s bladder cancer gene therapy rival has new dataand they look competitive – FiercePharma

December 10th, 2019 5:46 pm

On the heels of an FDA speedy review for Keytrudas potential use in non-muscle invasive bladder cancer (NMIBC), its close rival, a gene therapy by Ferring Pharmaceuticals spinout FerGene, has posted late-stage data. By the looks of it, the two drugs are up for a fight.

Among patients with high-risk NMIBC superficial disease thats unresponsive to standard-of-care Bacillus Calmette-Gurin (BCG), nadofaragene firadenovec eliminated tumors in 53%, or 55 of 103 patients,at month three in a phase 3 study, FerGene unveiled Thursday at the Society of Urologic Oncology meeting.

By comparison, in Keytrudas own registrational trial on the same target patient population, the Merck & Co. PD-1 completely cleared tumors in 41.2%, or 42 of 102 patients, after three months, according to an update at the European Society for Medical Oncology annual meeting in September.

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The length of time responses lasted appeared similar between the two drugs in their separate studies. For Keytruda, 24 patients (23.5%) continued to show no signs of disease after a year. As for nadofaragene firadenovec, 24.3%, or 25 patients, were still tumor-free at month 12.

In terms of safety, Keytruda recorded Grade 3/4 side effects in12.7% of patients, while FerGene said there were no Grade 4/5 events in its study.

We are pleased with these Phase 3 data results, including the complete response rates and favorable safety profile seen with nadofaragene firadenovec, Nigel Parker, scientific founder of FKD Therapies, said in a statement. The data have also helped FKD'snew drug application earn an FDA priority review.

RELATED:Merck's Keytruda is bound for new bladder cancer territory. But can it hold up against gene therapy?

Ferring recently gained commercial rights to the gene therapy from FKD, and, with $400 million in help from Blackstone Life Sciences, spun it into FerGene. Interestingly, it was Merck that licensed the drugout to FKD in the first place in 2011 in return for an equity stake in the then-newly formed Finnish company.

Priority reviews in hand, the two companies could be looking at FDA approvals soon. The burning question is, how does FerGene plan to price a gene therapy, which belongs to a class of drug thats notoriously costly? In a statement sentto FiercePharma, Ferring said it's too early to discuss pricing, that its top priority is still to get nadofaragene firadenovec approved andinvest into R&Dto study the product in more indications.

Keytruda is meant to be given ata fixed dose every three weeks. Nadofaragene firadenovec, which uses an adenovirus vector to deliver the gene interferon alfa-2b to stimulate an innate immune response to fight cancer, is administered into the bladder every three months.

Merck does have an upper hand against FerGene. The Big Pharma has been the sole supplier of BCG in the U.S. and several other key markets globally for several years now. So, it could offer BCG and Keytruda as a one-two punch for NMIBC, similar to the wayBayer is billing Nexavar and Stivarga as a part of the same continuumin first- and second-line liver cancer.

RELATED:Merck limits orders for bladder cancer drug as demand outstrips supply

There are other players eyeing the same patient population. Sesen Bio has Vicinium, an antibody-drug conjugate that targets epithelial cell adhesion molecule antigens on the surface of tumor cells to deliver a toxin payload. In its own phase 3 trial dubbed Vista also in high-risk, BCG-unresponsive NMIBC, Vicinium eradicated tumors in 40% of 89 patients at month three, according to an update the company provided in August. However, its response seems to wane over time more quickly than its rivals', as only 17% of patients showed no signs of tumor activity after 12 months.

The Cambridge, Massachusetts-based biotech recently held two meetings with the FDA and confirmed a submission process, including the design for a post-marketing confirmatory trial. It would enroll BCG-refractory patients who, because of supply constraints, haven't received an optimal BCG dose, which the company said represents a broader patientpopulation in light of anongoing shortage.

Sesen now expects to submit a biologics license application under rolling review by year-end with potential approval in 2020.

As for its pricing, during a presentation at the H.C. Wainwright investor conference in September, Sesens president and CEO Thomas Cannell pointed out that PD-1/L1s would cost about $150,000 to $200,000 per patient per year in NMIBC.

Weve done two rounds of market research with payers, and they think thats reasonable, he said. They think at those levels, there will probably be minimal prior authorization or step edits in terms of restricting a treatments use.

Assuming an official launch in 2021, Jefferies analysts, in a Nov. 12 note to clients, pegged $167.5 million for Viciniums U.S. sales in 2024. Before the priority designation, SVB Leerinks Daina Graybosch predicted a Keytruda launch in NMIBC in 2022 and forecastU.S. sales of $250 million in the indication for the Merck PD-1 inhibitor in 2025.

Editor's Note: The story has been updated with a statement from Ferring Pharma.

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Watch out, Keytruda. Ferring's bladder cancer gene therapy rival has new dataand they look competitive - FiercePharma

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