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Definitions

• the present invention relates to methods for treating solid cancer in patients with clonal hematopoiesis of indeterminate potential (CHIP).
• the method includes first determining whether a patient has a CHIP condition by detecting the presence or absence of Tet2 or DNMT3A mutation, and then followed by a therapeutic intervention with dapansutrile in the patient having a CHIP condition.
• CH Clonal hematopoiesis
• HSCs hematopoietic stem cells
• CHIP Clonal hematopoiesis of indeterminate potential refers to the presence of clonal molecular genetic or cytogenetic changes in blood or bone marrow cells in the absence of signs of hematological neoplasm and absence of cytopenia.
• CHIP is a non-malignant condition characterized by mutation and clonal expansion of blood cells. The incidence of CHIP increases with age. CHIP is diagnosed when a test on a person's blood or bone marrow sample shows that blood cells are carrying one of the genetic mutations associated with the condition.
• CHIP is associated with a higher risk of developing hematological malignancies and cardiovascular disease, as well as a reduced lifespan.
• Tumorigenesis is initiated by genomic alterations including point mutations, gene deletion, chromosomal rearrangements leading to cell transformation, self-sufficient proliferation, insensitivity to anti-proliferative signals, evasion of apoptosis and unlimited replicative potential, leading ultimately to tissue invasion and metastasis.
• genomic alterations including point mutations, gene deletion, chromosomal rearrangements leading to cell transformation, self-sufficient proliferation, insensitivity to anti-proliferative signals, evasion of apoptosis and unlimited replicative potential, leading ultimately to tissue invasion and metastasis.
• expansion of tumor cells is linked to a complex network of events that involve both cancer and non-cancer cells. Chronic inflammation is a classic example of such promoting conditions (1, 2).
• the pro-inflammatory cytokine IL- 10 is a potent mediator of many chronic inflammatory diseases (3). Consistent with the linkage of cancer to chronic inflammation, it has been shown that IL-10 is over-expressed in several tumors and functions as an inducer of tumor promoting mechanisms including angiogenesis, immunosuppression, recruitment of tumor-associated macrophages (TAMs) and metastasis (4-6).
• Types of breast cancer include ductal carcinoma in situ (DCIS), invasive ductal carcinoma (IDC), triple negative breast cancer (TNBC), inflammatory breast cancer (IBC), metastatic breast cancer, and breast cancer during pregnancy, among other types.
• DCIS ductal carcinoma in situ
• IDC invasive ductal carcinoma
• TNBC triple negative breast cancer
• IBC inflammatory breast cancer
• metastatic breast cancer metastatic breast cancer
• Triple negative breast cancer tumors are characterized by an absence of estrogen receptors (ER), progesterone receptors (PR), and elevated human epidermal growth factor receptor 2 (HER2) protein levels (7).
• ER estrogen receptors
• PR progesterone receptors
• HER2 human epidermal growth factor receptor 2
• NLRP3 (NOD-hke receptor family, pyrin domain containing 3), also known as NLRP3 or cryopyrin, is one of the sensors of the inflammasome, a macromolecular structure involved in interleukin- 10 (IL- 10) and IL- 18 processing. NLRP3 senses intracellular danger during intracellular infections (bacterial and viral proteins) or tissue injury (ischemia). NLRP3 activation leads to recruitment of ASC (apoptosis-associated speck-like protein containing carboxyterminal caspase recruitment domain) and caspase- 1 leading to inflammasome formation and ultimately cell death.
• ASC apoptosis-associated speck-like protein containing carboxyterminal caspase recruitment domain
• Dapansutrile is a small, synthetic molecule of 0-sulfonyl nitrile which has been demonstrated to selectively inhibit the NLRP3 inflammasome and be safe when orally administered to healthy subjects (8).
• FIG. IB shows Mean ⁇ SEM of IL-ip production from bone marrow adherent cells isolated from tumorbearing mice.
• FIG. 2 Bone marrow (BM) chimeras were generated by transplanting 75%WT:25%Tet2+/+ or Tet2+/- mixed BM.
• BM chimera mice were orthotopically implanted with E0771 breast tumors and given standard or dapansutrile diet.
• FIGs. 3A-3B show total percent of donor-derived cells in peripheral blood (3 A) and tumor (3B) of BM chimera mice from FIG. 2.
• FIGs. 4A-4B show frequency (4 A) and gMFI of MHC-II+ expression (4B) on tumorinfiltrating granulocytes of BM chimera mice from FIG. 2.
• FIGs. 5A-5B show plasma cytokine production of chemokine C-C motif ligand 2 (CCL2, 5 A) and keratinocyte chemoattractant (KC, 5B) of BM chimera mice from FIG. 2
• CH Clonal hematopoiesis
• CH can be defined as somatic mutations in hematopoietic stem cells resulting in clonal expansion of myeloid cells with an increased inflammatory phenotype.
• Tet2 is one of the three enzymes responsible for catalyzing the oxidation of 5 -methylcytosine to 5- hydroxymethylcytosine and further intermediates, which can eventually lead to demethylation.
• the DNMT3A gene provides instructions for making DNA methyltransferase 3a, which is one of the two enzymes responsible for de novo methylation of the fifth position in cytosine bases of DNA, a mark that influences gene expression.
• the inventors have discovered a role for CHIP in driving a solid cancer such as breast cancer and prostate cancer.
• solid tumor infiltrating myeloid cells immunosuppressive tumor-microenvironments (TME) are promoted through dysregulated cytokine signaling.
• TME immunosuppressive tumor-microenvironments
• the link between CHIP and solid tumors is that the infiltrating myeloid cells show up to the TME and have a hyperinflammatory response, furthering the tumor promoting signaling.
• TME immunosuppressive tumor-microenvironments
• CHIP immunosuppressive tumor-microenvironments
• the disease is likely to be more severe or the patient is at greater risk.
• breast cancers CHIP has detrimental effects in all advanced stage breast cancers, this is because when breast cancer progresses, IL- 1 p increases with disease severity.
• the proinflammatory cytokine IL-i promotes breast cancer progression and correlates with disease severity. Activation of the NLRP3 inflammasome in myeloid cells is the main source of IL-1 processing.
• Dapansutrile is a selective NLRP3 inflammasome inhibitor; dapansutrile reduces inflammation by preventing activation of the NLRP3 inflammasome.
• the inventors have discovered a method for introducing a therapeutic intervention of dapansutrile to improve the treatment of a solid cancer, such as breast cancer or prostate cancer in a CHIP patient.
• the method includes first determining whether a patient has a CHIP condition by detecting the presence or absence of Tet2 or DNMT3A mutation, and then followed by a therapeutic intervention with dapansutrile in patients having a CHIP condition.
• the present invention is directed to a method of treating a solid cancer such as breast cancer or prostate cancer a patient.
• the method comprises the steps of: (a) determining clonal mutation of TET2 or DNMT3A in a sample of a patient that has a solid cancer and is treated with a non-dapansutrile treatment, and (bl) treating the patient with an effective amount of dapansutrile in addition to the non-dapansutrile treatment, if the patient has a variant allele frequency (VAF) of TET2 or DNMT3A greater than 0.02, or (b2) continuing treating the patient with the non-dapansutrile treatment, without dapansutrile treatment, if the patient has a VAF of TET2 or DNMT3A ⁇ 0.02.
• VAF variant allele frequency
• a patient that has a solid cancer and is treated with a non- dapansutrile treatment is identified, and a biological sample from the patient is obtained.
• the biological sample for example, can be a blood sample or bone marrow cells from the patient.
• a blood sample is preferred.
• Clonal mutation of TET2 or DNMT3A in patient’s sample is then determined.
• TET2 and DNMT3A are the most commonly mutated CHIP-driver genes. Monocytes and T cells with TET2 or DNMT3A mutation show very similar increase of proinflammatory gene expression.
• Determining clonal mutation of TET2 or DNMT3A in the sample of a cancer patient provides prognosis of the patient.
• the inventors have discovered that patients with high Tet2 or DNMT3A VAF are at greater risk of advancing to late-stage disease and are benefited by dapansutrile treatment.
• Dapansutrile intervention therapy reverses CHIP phenotype and may provide some synergistic effect with other non-dapansutrile treatment by inhibition of NLRP3 activation that attenuates the efficacy of other treatment.
• the threshold for CHIP is set at a variant allele fraction (VAF) of Tet2 or DNMT3A of 2% (meaning 2% of the sequenced alleles contain the mutation, or roughly 4% of the cells contain the mutation, assuming the mutation is heterozygous).
• VAF of Tet2 or DNMT3A can be detected by next generation sequencing or error-corrected sequencing from patient’s blood sample (9, 10).
• VAF can be detected by sample preparation, DNA isolation, target enrichment, high-throughput sequencing, and variant calling as described in Dorsheimer (10).
• the patient After the clonal mutation of TET2 or DNMT3A is determined, if the patient has a variant allele frequency (VAF) of TET2 or DNMT3A greater than 0.02, the patient is treated with an effective amount of dapansutrile in addition to the non-dapansutrile treatment. If the patient has a VAF of TET2 or DNMT3A ⁇ 0.02, the patient is continued with the non- dapansutrile treatment, without adding the dapansutrile treatment.
• VAF variant allele frequency
• an effective amount of dapansutrile is the amount of dapansutrile effective to treat a disease by ameliorating the pathological condition, and/or reducing, improving, and/or eliminating the symptoms of the disease.
• an effective amount is an amount that reduces the grow th of cancer, and/or reduces the tumor size.
• Solid cancer suitable to be treated by the present method includes breast cancer and prostate cancer.
• Breast cancer includes triple negative breast cancer (TNBC), ductal carcinoma in situ (DCIS), invasive ductal carcinoma (IDC), inflammatory breast cancer (IBC), metastatic breast cancer, and breast cancer during pregnancy, among other types.
• TNBC triple negative breast cancer
• DCIS ductal carcinoma in situ
• IBC invasive ductal carcinoma
• IBC inflammatory breast cancer
• metastatic breast cancer metastatic breast cancer
• breast cancer during pregnancy, among other types.
• Non-dapansutrile treatments of breast cancer that are suitable for dapansutrile intervention include, but not limited to, checkpoint inhibitor therapy, which is a form of cancer immunotherapy.
• Checkpoint inhibitor therapy targets immune checkpoints, key regulators of the immune system that when stimulated can dampen the immune response to an immunologic stimulus. Some cancers can protect themselves from attack by stimulating immune checkpoint targets.
• Checkpoint inhibitors currently used for treating breast cancer and suitable for dapansutrile intervention include, but not limited to, inhibitors to programmed cell death protein 1 (PD-1), programmed death ligand 1 (PD-L1), and cytotoxic T lymphocyte associated protein 4 (CTLA-4).
• PD-1 is found on the surface of T cells and is the receptor for PD-L1.
• PD-1 plays a role in down-regulating immune responses by suppressing inflammatory T cell activity. This mechanism helps the body to prevent autoimmune diseases, however, the mechanism can also prevent the cancer cells from being killed (11).
• Non-dapansutrile treatments of breast cancer that are suitable for dapansutrile intervention may also include chemotherapy such as 5-fluorouridine and gemcitibine.
• Non-dapansutrile treatments of prostate cancer that are suitable for dapansutrile intervention include, but not limited to, radiotherapy, chemotherapy, and/or long-term androgen deprivation therapy.
• Chemotherapeutic agents currently approved for prostate cancer are docetaxel or cabaxitaxel, these along with androgen deprivation have proven effective at increasing survival.
• Hormonal strategies targeting androgen production or signaling include abiraterone or enzalutamide.
• Dapansutrile intervention therapy reverses CHIP phenotype and may provide some synergistic effect with chemotherapy by inhibition of NLRP3 activation that attenuates the efficacy of other treatment.
• dapansutrile intervention therapy reverses CHIP phenotype and may provide some synergistic effect with the check point inhibitor treatment such as anti-PD-1 and anti-PD-Ll.
• the dapansutrile treatment and the non-dapansutrile treatment can be administered simultaneously or sequentially.
• the present invention uses purified dapansutrile (3-methanesulfonyl-propionitrile), or the pharmaceutically acceptable solvate thereof, as a therapeutic intervention.
• “Pharmaceutically acceptable solvates,” as used herein, are solvates that retain the desired biological activity of the parent compound and do not impart undesired toxicological effects. “Solvates,” as used herein, are addition complexes in which the compound is combined with an acceptable co-solvent in some fixed proportion. Co-solvents include, but are not limited to, water, acetic acid, ethanol, and other appropriate organic solvents.
• the active compound dapansutrile, or its pharmaceutically acceptable solvate in the pharmaceutical compositions in general is in an amount of about 0.1-5% for an injectable formulation, about 1-90% for a tablet fomrulation, 1-100% for a capsule formulation, about 0.01-20%, 0.05-20%, 0.1-20%, 0.2-15%, 0.5-10%, or 1-5% (w/w) for atopical formulation, and about 0. 1-5% for a patch formulation.
• Pharmaceutically acceptable carriers which are inactive ingredients, can be selected by those skilled in the art using conventional criteria.
• Pharmaceutically acceptable carriers include, but are not limited to, non-aqueous based solutions, suspensions, emulsions, microemulsions, micellar solutions, gels, and ointments.
• the pharmaceutically acceptable carriers may also contain ingredients that include, but are not limited to, saline and aqueous electrolyte solutions; ionic and nonionic osmotic agents such as sodium chloride, potassium chloride, glycerol, and dextrose; pH adjusters and buffers such as salts of hydroxide, phosphate, citrate, acetate, borate; and trolamine; antioxidants such as salts, acids and/or bases of bisulfite, sulfite, metabisulfite, thiosulfite, ascorbic acid, acetyl cysteine, cystein, glutathione, butylated hydroxyanisole, butylated hydroxy toluene, tocopherols, and ascorbyl palmitate; surfactants such as lecithin, phospholipids, including but not limited to phosphatidylcholine, phosphatidylethanolamme and phosphatidyl inositiol; poloxa
• Such pharmaceutically acceptable carriers may be preserved against bacterial contamination using well-known preservatives, these include, but are not limited to, benzalkonium chloride, ethylene diamine tetra-acetic acid and its salts, benzethonium chloride, chlorhexidine, chlorobutanol, methylparaben, thimerosal, and phenylethyl alcohol, or may be formulated as a non-preserved formulation for either single or multiple use.
• preservatives include, but are not limited to, benzalkonium chloride, ethylene diamine tetra-acetic acid and its salts, benzethonium chloride, chlorhexidine, chlorobutanol, methylparaben, thimerosal, and phenylethyl alcohol, or may be formulated as a non-preserved formulation for either single or multiple use.
• a tablet formulation or a capsule formulation of dapansutrile may contain other excipients that have no bioactivity and no reaction with the active compound.
• Excipients of a tablet may include fillers, binders, lubricants and glidants, disintegrators, wetting agents, and release rate modifiers.
• Binders promote the adhesion of particles of the formulation and are important for a tablet formulation. Examples of binders include, but not limited to, carboxymethylcellulose, cellulose, ethylcellulose, hydroxypropylmethylcellulose, methylcellulose, karaya gum, starch, starch, and tragacanth gum, poly(acryhc acid), and polyvinylpyrrolidone.
• a patch formulation of dapansutrile may comprise some inactive ingredients such as 1,3-butylene glycol, dihydroxy aluminum aminoacetate, disodium edetate, D-sorbitol, gelatin, kaolin, methylparaben, polysorbate 80, povidone, propylene glycol, propylparaben, sodium carboxymethylcellulose, sodium polyacrylate, tartaric acid, titanium dioxide, and purified water.
• a patch formulation may also contain skin permeability enhancer such as lactate esters (e.g, lauryl lactate) or diethylene glycol monoethyl ether.
• Topical formulations including dapansutrile can be in a form of gel, cream, lotion, liquid, emulsion, ointment, spray, solution, and suspension.
• the inactive ingredients in the topical formulations for example include, but not limited to, lauryl lactate (emollient/permeation enhancer), di ethylene glycol monoethylether (emollient/permeation enhancer), DMSO (solubility enhancer), silicone elastomer (rheology /texture modifier), capr lic/ capric triglyceride, (emollient), octisalate, (emolhent/UV filter), silicone fluid (emollient/diluent), squalene (emollient), sunflower oil (emollient), and silicone dioxide (thickening agent).
• lauryl lactate emollient/permeation enhancer
• di ethylene glycol monoethylether emollient/permeation enhancer
• diethylene glycol monoethylether is included in the topical gel formulation.
• the pharmaceutical composition of dapansutrile can be applied by systemic administration or local administration.
• Systemic administration includes, but is not limited to oral, parenteral (such as intravenous, intramuscular, subcutaneous or rectal), and inhaled administration.
• parenteral such as intravenous, intramuscular, subcutaneous or rectal
• inhaled administration In systemic administration, the active compound first reaches plasma and then distributes into target tissues. Oral administration is a preferred route of administration for the present invention.
• Local administration includes topical administration.
• Dosing of the composition can vary based on the extent of the subject’s breast cancer and each patient’s individual response.
• plasma concentrations of the active compound delivered can vary; but are generally lxlO' lo -lxlO' 4 moles/liter, and preferably IxlO' xlO' 5 moles/liter.
• dapansutrile is administrated orally to a subject.
• the dosage for oral administration is generally at least 1 mg/kg/day and less than 100 mg/kg/day, preferably 5-100 mg/kg/day, depending on the subject’s age and condition.
• the dosage for oral administration is 1-10, or 1-50, or 1-100, or 5-50, or 5-100, or 10-50, or 10-100 mg/kg/day for a human subject.
• the dosage for oral administration is 100- 10,000 mg/day, and preferably 100-2500, 500-2500, 500-4000, 1000-5000, 2000-5000, 2000- 6000, or 2000-8000 mg/day for a human subject.
• the drug can be orally taken once, twice, three times, or four times a day.
• the patient is treated daily for 14 days up to 1 month, 2 months, or 3 months or for lifespan.
• dapansutrile is administrated intravenously to a subj ect.
• the dosage for intravenous bolus injection or intravenous infusion is generally 0.03 to 5 or 0.03 to 1 mg/kg/day.
• dapansutrile is administrated subcutaneously to the subject.
• the dosage for subcutaneous administration is generally 0.3-20, 0.3-3, or 0.1-1 mg/kg/day.
• dapansutrile is applied topically.
• the topical dapansutrile composition is topically applied at least 1 or 2 times a day, or 3 to 4 times per day, depending on the medical issue and the disease pathology.
• the topical composition comprises about 0.01-20%, or 0.05-20%, or 0.1-20%, or 0.2-15%, 0.5-10, or 1-5 % (w/w) of the active compound.
• 0.2-10 mL of the topical composition is applied to the individual per dose.
• a wide variety of delivery mechanisms of dapansutrile may be suitable for the present invention.
• the non-dapansutrile treatment of the patient will follow the same protocol already established for for the patient.
• the dosage or treatment interval of the non-dapansutrile treatment of the patient may be reduced.
• the present invention is useful in treating a mammal subject, such as humans, horses, dogs and cats.
• the present invention is particularly useful in treating humans.
• mice exhibited increased IL-ip production compared to wild type mice. Furthermore, bone marrow cells from tumor-bearing Tet2 +/ " mice treated with dapansutrile secreted significantly less IL-ip compared to untreated Tet2 +/ ' mice.
• IL- 1 P promotes an immunosuppressive TME.
• the inventors have demonstrated that tumor-bearing Tet2 +/ " mice producing more IL- 1 P in bone marrow adherent cells, which indicates that increases in Tet2+/- mutations lends the host more susceptible to an immunosuppressive TME.
• CHIP Patients with increases in Tet2 VAF are at a greater risk of advancing to late-stage disease, and dapansutrile intervention therapy inhibits the production of IL-1 P and improves the patient condition. Dapansutrile is effective at reversing the CHIP phenotype by inhibiting the production of IL-ip and inhibits NLRP3 inflammasome activity.
• Tet2-CH does not represent a specific disease, per se, but rather serves as a pre-loaded trigger worsening IL-ip mediated disease.
• the inventors have demonstrated a 2-fold increase in tumor growth in Tet2+/- germline mice. To determine if this observation was merely an artifact of Tet2 heterozygosity in the entire organism or truly a phenomena of Tet2 CH, the inventors generated BM chimeric mice using mixed BM with 25% Tet2 CH and showed that tumor growth increased 2-fold in Tet2+/- bone marrow chimeras compared to Tet2+/+ controls, which demonstrated that this was indeed a CH outcome.
• this application shows an NLRP3 -dependent recruitment of myeloid cells to the tumor microenvironment (TME) through induction of plasma CCL2 and KC in Tet2+/- chimeras, resulting in increased tumor-infiltrating granulocy tes. Consistently, the inventors observed a significant increase of donor-derived Tet2+/- mutants in the TME, thereby placing these hyperinflammatory cells in TME. These data demonstrate that recruitment of hyperinflammatory Tet2+/- myeloid cells to the breast cancer TME fuels breast cancer progression.
• dapansutrile presents a therapeutic approach to neutralizing inflammatory diseases mediated by Tet2+/- CH or DNMT3A CH.
• the murine metastatic mammary cancer cell line E0771 was purchased from ATCC. E0771 cells were cultured in RPMI (Coming) supplemented with 10% FBS, 1% HEPES, 100 units/ml penicillin and 0.1 mg/ml streptomycin. Cells were maintained in a humidified 5% CO2 atmosphere at 37°C.
• E0771 cells were mixed with matrigel and implanted orthotopically into the mammary fat pad (day 0). Mice treated with dapansutrile were fed ad libitum with food pellets containing 7.5 g dapansutnle/kg food, which started on day 3 after E0771 cell implantation and continued until being sacrificed. Mice were sacrificed on day 18 for the germline mouse model and day 15 for the chimeric mouse model. Mice typically consume about 4 g of food per day, resulting in an approximate daily dose of 0 mg/kg/day for control groups and 1,000 mg/kg/day for the treatment groups.
• mice that was 75% wild type (WT), and 25% Tet2 homozygous (Tet2+/+) or heterozygous (Tet2+/-).
• WT chimeric bone marrow
• Tet2+/+ Tet2 homozygous
• Tet2+/- Tet2+/- cells
• CD45 pan hematopoietic marker
• Tet2+/+ or Tet2+/- were given via a retro-orbital (RO) sinus injection.
• RO retro-orbital
• mice were bled every four weeks via the submandibular vein. Blood was then processed via hemolysis to remove red blood cells, and subsequently, the white blood cells were stained with fluorescent antibodies for flow cytometry analysis.
• mice were given breast tumors via orthotopic transplantation of breast cancer cells. Tumor progression was assessed by measuring the volume of the tumor in the mouse using calipers. After 15 days, mice were sacrificed, and their bone marrow, peripheral blood, and tumors were harvested for flow cytometry analysis to determine the levels of immune cell populations and relative contribution from WT or Tet2+/+ or Tet2+/- bone marrow cells.
• Bone marrow cells from tumor-bearing mice was collected and filtered through 40pM cell strainer. 3x10 6 cells were plated in 24-well plates and incubated overnight. The next day to non-adherent fraction was removed and the adherent fraction was treated with lOpM dapansutrile and were cultured in RPMI supplemented with 10% FBS, 100 units/ml penicillin and 0.1 mg/ml streptomycin for 24 hours. Cytokines were measured in cell culture supernatants using DuoSet ELISA (R&D Systems).
• Bone marrow isolation and cell staining was performed on ice in staining medium (SM; Hanks Balanced Salt Solution [HBSS lx, Coming 1-022-CM] supplemented with heat inactivated fetal bovine serum [FBS, VWR 97068-05] to a final concentration of 2%).
• Femurs and tibiae were flushed with 3mL of SM and followed by RBC lysis with ACK lysis buffer.
• Peripheral blood was isolated via the heart and placed into RBC lysis buffer. After RBC lysis cells were incubated on ice for 30 minutes with antibody cocktails prior to being washed and resuspended in SM containing propidium iodide to stain dead cells. Flow cytometry was performed on the BD FACSCelesta.
• Bone marrow cells were collected from the four long bones as described above and filtered through a 40pM cell strainer prior to counting. IxlO 6 cells were plated in flat bottom tissue culture plates and incubated overnight. The next day the non-adherent fraction was removed and the adherent fraction was used for downstream experiments.
• adherent bone marrow cells were stimulated ⁇ LPS (lOOng/mL) and cultured for an additional 24 hours.
• Cells were cultured in RPMI supplemented with 10% FBS, 100 units/ml penicillin and 0.1 mg/ml streptomycin.
• conditioned media stimulation E0771 -conditioned media was collected by incubating IxlO 6 cells for 72-hours, supernatant was collected and centrifuged to removed cellular debris. Conditioned media was then added at 1 :2 to normal media for 24 hours. Cytokines were measured in cell culture supernatants using DuoSet ELISA (R&D Systems).
• Example 1A Dapansutrile reduced breast tumor volume in Tet2+Z- mice (germline)
• Myeloid cells are the predominant source of tumor-promoting IL-10 in the breast cancer TME, and TET2 mutations have been reported in tumor-infiltrating leukocytes. Since myeloid cells from Tet2-deficient mice have increased IL-10 gene expression following inflammatory stimulus, we assessed whether mice heterozygous for Tet2 would exhibit more aggressive breast cancer phenotype.
• Tet2 +/ ' mice exhibited a 2-fold increase in tumor growth compared to Tet2+/+ (WT) mice (p ⁇ 0.05). Further, tumor grow th was significantly suppressed in Tet2+/- mice receiving dapansutrile diet compared to Tet2 +/ " mice on standard diet (68% reduction, p ⁇ 0.01). Tumor growth in Tet2+/+ (WT) mice on dapansutnle was also significantly decreased compared to standard diet (p ⁇ 0.05). No changes in tumor growth were observed between Tet2+/+ (WT) or Tet2+/- mice on dapansutrile diet (FIG. 1).
• Example IB Dapansutrile reduced IL-ip production in Tet2+/- mice
• Bone marrow adherent cells were cultured from tumor-bearing mice of Example 1 and stimulated with LPS overnight. Bone marrow cells cultured from tumor-bearing Tet2+/- mice exhibited increased IL-ip production compared to WT (p ⁇ 0.01, FIG. IB). Furthermore, adherent bone marrow cells from tumor-bearmg Tet2+/-mice treated with dapansutrile secreted significantly less IL-ip compared to untreated Tet2+/-mice (p ⁇ 0.05, Figure 2).
• Example 2 Dapansutrile reduced breast tumor volume in a Tet2+/- bone marrow chimeric model
• CH is characterized by clonal expansion of somatic mutations in the hematopoietic compartment.
• Tet2 deficiency was maintained in a bone marrow chimeric model (experimental model for clonal hematopoiesis).
• dapansutrile also suppressed tumor growth in Tet2+/+ chimeric animals, to a baseline level equivalent to dapansutrile-treated Tet2+/- chimeric mice (FIG. 2).
• the results of Examples 1 and 2 indicate that Tet2+/- promotes breast cancer progression, and dapansutrile is effective to reduce the tumor growth.
• Granulocytes and monocytes are differentiated descendants from common progenitors derived from hematopoietic stem cells in the bone marrow.
• FIG. 3A shows that the frequency of donor-derived cells was significantly increased in the peripheral blood of Tet2+/- chimeric mice, comparing with Tet2+/+ mice.
• FIG. 3B shows that the frequency of Tet2+/- donor-derived cells was significantly increased in tumors of Tet2+/- chimeric mice, comparing with Tet2+/+ mice.
• FIG. 4A shows that total tumor-infiltrating granulocytes significantly increased in Tet2+/- chimeras receiving standard diet compared to Tet2+/+ chimeras receiving standard diet (p ⁇ 0.05).
• FIG. 4A also shows that tumor-infiltrating granulocytes were significantly decreased in Tet2+/- chimeras receiving dapansutrile diet compared to Tet2+/- chimeras on standard diet (p ⁇ 0.05).
• FIG. 4B shows tumor-infiltrating granulocytes expressed significantly less MHC-II protein (gMFI) in Tet2+/- chimeras receiving standard diet compared to Tet2+/+ chimeras receiving standard diet (p ⁇ 0.05). The reduced MHC-II expression found in Tet2+/- chimeras was rescued with dapansutrile diet (p ⁇ 0.001).
• FIG. 5 shows plasma chemokines and cytokines in BM chimera mice from FIG. 2.
• Tet2+/- chimeric mice receiving standard diet revealed increased circulating CCL2 and KC compared to Tet2+/+ chimeras on standard diet (p ⁇ 0.05).
• circulating CCL2 and KC were significantly decreased in Tet2+/- chimeras receiving DAPANSUTRILE diet compared to Tet2+/- chimeras on standard diet (p ⁇ 0.05).

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