Abstract 3500: AUR103 an oral small molecule CD47 antagonist in combination with azacytidine and bortezomib exhibits potent anti-tumor activity in myeloma and leukemia models in vitro and in vivo
Authors: Daginakatte Girish C. , Pottayil Sasikumar , Naremaddepalli Sudarshan , Chennakrishnareddy Gundala , Bilugudi Prasad , Tangella Sai Krishna , Patil Sandeep , Gowda Nagesh , Aithal Kiran , Balasubramanian Wesley Roy , Dhudashiya Amit , Dodheri Samiulla , Nellore Kavitha , Samajdar Susanta , Ramachandra Murali 
Published: June 2022

Abstract
The CD47/signal regulatory protein alpha axis is a critical regulator of myeloid cell activation and serves as an immune checkpoint for macrophage mediated phagocytosis. Targeting CD47-SIRPα axis is emerging as one of the promising new immunotherapy approaches that targets innate immune response. Number of clinical trials are in progress to evaluate CD47/SIRPα blocking therapies. Most of these molecules are either anti-CD47 antibodies or SIRPα-Fc recombinant proteins. We have developed a novel small molecule CD47 antagonist, AUR103 as a therapeutic agent for solid and hematological cancers. AUR103 is efficacious as a single agent in tumors with high expression of “eat-me” signals and synergizes well in combination with tumor-targeting antibodies. We hypothesized that agents capable of inducing “eat-me” signals such as calreticulin (CRT) a pro-phagocytic signal, will synergize with AUR103 to enhance phagocytosis and antitumor activity. Here, we report the anti-tumor efficacy of AUR103 in combination with azacytidine and bortezomib in acute myeloid leukemia and multiple myeloma model of cancer, respectively.In the phagocytosis assay, HL-60 human myeloid leukemia or NCI-H929 human multiple myeloma cells were treated with azacytidine or bortezomib for 48 hours. Cells were stained with CFSE and were further treated with AUR103. Cells were then added to human macrophages and allowed to undergo phagocytosis. Phagocytosis of target cells was measured by detecting cells that were double positive for APC and CFSE by FACS. HL-60 cells were orthotopically implanted in NOD SCID mice while NCI-H929 multiple myeloma cells were sub-cutaneously implanted in NOD SCID mice. Tumor bearing mice were treated with AUR103 (10 and 30 mg/kg, b.i.d, and po) as a single agent or in combination with azacytidine (5 mg/kg i.p., twice weekly) or bortezomib (0.4 mg/kg i.v., twice weekly). AUR103 in combination with azacytidine and bortezomib significantly enhanced phagocytosis of HL-60 and NCI-H929 tumor cells, respectively when compared to individual treatments. In the combination efficacy studies, AUR103 combination treatments with azacytidine and bortezomib were well tolerated without any signs of toxicity. In the HL-60 orthotopic model, AUR103 combination with azacytidine significantly reduced the engraftment of HL-60 tumor cells. AUR103 combination with bortezomib resulted in enhanced tumor growth inhibition in NCI-H929 tumor model when compared to individual treatments. These results demonstrate the therapeutic potential of AUR103 in combination with agents that are capable of inducing “eat-me” or pro-phagocytic signals.
Citation Format: Girish C. Daginakatte, Sasikumar Pottayil, Sudarshan Naremaddepalli, Gundala Chennakrishnareddy, Prasad Bilugudi, Sai Krishna Tangella, Sandeep Patil, Nagesh Gowda, Kiran Aithal, Wesley Roy Balasubramanian, Amit Dhudashiya, Samiulla Dodheri, Kavitha Nellore, Susanta Samajdar, Murali Ramachandra. AUR103 an oral small molecule CD47 antagonist in combination with azacytidine and bortezomib exhibits potent anti-tumor activity in myeloma and leukemia models in vitro and in vivo [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3500.