BCCMA: Basic and Translational Mechanisms of Cancer Initiation of the Urothelium in Veterans Exposed to Carcinogens: Defining the Molecular and Spatial Features of Carcinoma in situ of the Bladder

BCCMA：暴露于致癌物的退伍军人尿路上皮癌症发生的基本和转化机制：定义膀胱原位癌的分子和空间特征

• 批准号: 10258562
• 负责人: Joshua James Meeks
• 金额: --
• 依托单位: JESSE BROWN VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-10-01 至 2025-09-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10258562
• 关键词: Address; Artificial Intelligence; Award; Bacillus Calmette-Guerin Therapy; Biological Warfare; Bladder; Blood; Cancer Detection; Carcinogens; Carcinoma in Situ; Cause of Death; Cell Cycle; Cell Proliferation; Cells; Chemical Warfare; Chemicals; Colorectal Cancer; CpG Islands; Cystoscopy; DNA Methylation; Data; Detection; Diagnosis; Diagnostic; Early Diagnosis; Early treatment; Eligibility Determination; Enhancers; Ensure; Epigenetic Process; Epithelial; Evaluation; Exposure to; Foundations; Frequencies; Functional disorder; Gene Expression; Gene Mutation; Genetic; Genetic Processes; Genetic Transcription; Genomics; Goals; Hazardous Chemicals; Human; Imaging technology; Immune; Immune Evasion; Immunologics; Immunosuppression; Immunotherapy; Indolent; Induced Mutation; KDM1A gene; Knowledge; Laboratories; Lead; Lesion; Link; Lymphocyte; Maintenance; Malignant Neoplasms; Malignant neoplasm of lung; Malignant neoplasm of prostate; Malignant neoplasm of urinary bladder; Measures; Medical center; Methods; Modeling; Molecular; Morbidity - disease rate; Muscle; Mutation; Neoplasm Metastasis; Occupational; Occupational Exposure; Operative Surgical Procedures; PPAR gamma; Pathologic; Pathway interactions; Patient Self-Report; Patients; Precision therapeutics; Predictive Value; Predisposition; Prevention; Primary Health Care; Proliferating; RB1 gene; RNA; Reagent; Recommendation; Recording of previous events; Recurrence; Regulatory Pathway; Reporting; Resources; Risk; Role; S phase; Scientist; Screening procedure; Second Primary Neoplasms; Site; Smoker; Smoking; Somatic Mutation; T-Lymphocyte; Testing; Therapeutic; Time; Tobacco smoke; Tobacco smoking behavior; Transcriptional Regulation; Tumor-infiltrating immune cells; Urine; Urologic Surgical Procedures; Urothelium; Veterans; artificial intelligence algorithm; base; bladder cancer prevention; bladder carcinoma in situ; cancer initiation; cancer invasiveness; cancer risk; combat; digital; effective therapy; epigenetic therapy; exhaust; exhaustion; exome; high risk; image guided; imaging biomarker; immune activation; immunoregulation; improved; inhibitor; molecular marker; molecular targeted therapies; neoantigens; new therapeutic target; novel diagnostics; novel therapeutics; personalized management; prevent; promoter; research and development; response; risk stratification; screening guidelines; small molecule inhibitor; success; synergism; targeted sequencing; therapy resistant; transcriptome; treatment response; tumor; tumor progression; tumor-immune system interactions; urinary

PROJECT SUMMARY ABSTRACT Herein, a group of collaborative merit review applications (CMA) aim to advance the precision management of bladder cancer (BCa), especially focused on the early stage initiation of urothelium as a model of dynamic epithelial changes in response to smoking and deployment-related carcinogens. Malignancies are the second most common cause of death among Veterans and BCa is the fourth most common cancer in the VA. Among tumor types, 70% of BCa is confined to the superficial part of the bladder (Stages T1, Ta, and CIS), with the remainder invasive of the muscle or metastatic. If BCas are identified at an earlier stage, nearly all of these tumors are treatable with a combination of surgery and intracavitary therapy. Yet, there are currently no validated or recommended screening procedures to identify asymptomatic BCas and there are no methods to identify at-risk patients at an earlier and more curable stage. The proposed CMAs aim to address these limitations and to significantly disrupt BCa prevention, detection, risk stratification and precision treatment by dissecting the genetic and molecular foundations of early stage BCa. The projects include the following: CMA1 aims to determine the genetic and immune-suppressive landscape of CIS to identify new therapeutics and immunotherapies. CMA2 investigates the plasticity of the urothelium to determine how PPARg can direct epithelial differentiation as a possible modulator of CIS. CMA3 will examine the epigenetic basis of urothelial differentiation and the role of LSD1-inhibitor, Methysticin, as a chemopreventative agent to restore the epigenetic imbalance of the urothelium. Finally, CMA4 will develop artificial intelligence algorithms for enhanced cystoscopy imaging technologies or BCa detection and risk stratification. These CMAs are linked both intrinsically among each other and extrinsically with all contributors already supported by VA R&D with Merit Awards focused on BCa to maximize synergy and ensure success. Rationale: More than 80% of Veterans report a history of tobacco smoking with 90% of Veterans with BCa self-reported smokers. Unlike lung, prostate or colorectal cancer, there are no screening protocols recommended for Veterans at risk for BCa. There is no primary care recommendation for uniform evaluation of blood in the urine, and no urinary tests have a high negative predictive value that can replace cystoscopy. Almost all patients with BCa develop blood in the urine at some time, but there is often delays in pursuing an evaluation by months to years that lead to tumor progression due to lack of referrals to urologic surgery for evaluation. Once diagnosed, the urothelium is often challenging to follow and up 20% of invasive tumors will progress to higher stage cancer. Treatment for early stage invasive bladder cancer is dependent on BCG immunotherapy, but BCG is frequently unavailable and underutilized for maintenance and 30% of BCas become BCG unresponsive. Therefore, the three major challenges for improving survival for patients with BCa are 1) early detection of high-risk tumors 2) identification of progression to higher stage cancer and 3) treatment resistance to BCG immunotherapy. Our preliminary data suggest that the urothelium has plasticity in early stage BCa that, if understood at the genetic, epigenetic and molecular level, could be treated and driven to a more indolent cancer. Based on our preliminary studies and the gaps in diagnosis and treatment we hypothesize that the urothelium can be influenced by the state of epithelial differentiation and driven towards a more stable state if detected at early time point.

项目摘要摘要 此处是一组协作功绩审查应用程序（CMA），旨在提高精度 膀胱癌（BCA）的管理，特别是专注于尿路上皮的早期开始 响应于吸烟和部署相关的致癌物的动态上皮变化模型。 恶性肿瘤是退伍军人中第二大最常见的死亡原因，BCA是第四 VA中最常见的癌症。在肿瘤类型中，有70％的BCA仅限于浅表部分 膀胱（T1，TA和顺式），其余的肌肉或转移性侵入性。如果BCAS 在较早的阶段鉴定出来，几乎所有这些肿瘤都可以通过手术结合进行治疗 和腔内疗法。但是，目前尚无验证或建议的筛选程序 要识别无症状的BCA，并且没有方法可以鉴定早期的风险患者 更可治愈的阶段。拟议的CMA旨在解决这些局限性并严重破坏 通过剖析遗传和 早期BCA的分子基础。项目包括以下内容：CMA1旨在确定 独联体的遗传和免疫抑制景观，以识别新的治疗剂和 免疫疗法。 CMA2研究了尿路上皮的可塑性，以确定PPARG如何 直接上皮分化作为顺式调节剂。 CMA3将检查表观遗传基础 尿路上皮分化和LSD1抑制剂甲基固醇的作用，作为化学预防剂 恢复尿路上皮的表观遗传失衡。最后，CMA4将发展人工智能 增强膀胱镜检查技术或BCA检测和风险分层的算法。 这些CMA彼此内在互相链接，并且已经与所有贡献者进行了外在链接 在VA R＆D的支持下，功绩奖的重点是BCA，以最大程度地提高协同作用并确保成功。 理由：超过80％的退伍军人报告了烟草吸烟的史，有90％的退伍军人 BCA自我报告的吸烟者。与肺，前列腺或结直肠癌不同，没有筛查方案 推荐给有BCA风险的退伍军人。没有针对制服的初级保健建议 评估尿液中的血液，并且没有尿液测试具有高的阴性预测值 更换膀胱镜检查。几乎所有BCA患者在某个时候都在尿液中出血，但是有 经常在数月到几年之前追求评估的延误，导致由于缺乏而导致肿瘤进展 转介给泌尿外科手术进行评估。一旦诊断出，尿路上皮通常具有挑战性 增加20％的侵入性肿瘤将发展为更高的阶段癌。早期侵入性的治疗 膀胱癌取决于BCG免疫疗法，但BCG通常无法使用，并且 未充分利用维护，而30％的BCA变得无反应。因此，三个专业 改善BCA患者生存的挑战是1）早期检测高危肿瘤2） 鉴定为高级癌症的进展和3）对BCG免疫疗法的治疗耐药性。 我们的初步数据表明，尿路上皮在早期BCA中具有可塑性，如果在 遗传，表观遗传学和分子水平可以治疗并驱动到更腐烂的癌症。 根据我们的初步研究以及诊断和治疗的差距，我们假设 尿路上皮可以受上皮分化状态的影响，并驱动到更稳定的 说明如果在早期检测到。