Chang Gung University

OTC2024类器官前沿应用与3D细胞培养论坛圆满落幕，点击图片可查看会后报告，咨询OTC2025类器官论坛请联系：王晨 180 1628 8769 文章来源：外泌体之家 9月份国内新出的细胞外囊泡/外泌体领域论文不完全统计有390篇。IF>10的有92篇；IF>20的有12篇。本期主要内容包括：癌症相关恶病质、成骨作用、胆固醇在外泌体递释RNA药物中的关键作用、纳米封装的肿瘤囊泡用作自体肿瘤疫苗、胃癌转移、增强非小细胞肺癌的免疫治疗、免疫检查点抑制剂相关的心脏毒性、肝细胞癌中T细胞介导的抗肿瘤免疫、结直肠癌免疫逃逸、血友病关节软骨缺损的整体修复、抑制血管钙化和衰老、肺部疫苗接种、肾缺血再灌注损伤和纤维化、糖尿病伤口治疗、衰老和年龄相关功能障碍、水凝胶微针贴片促进慢性伤口愈合、工程益生菌递送双纳米抗体、动脉粥样硬化等方面内容。内容十分丰富，不容错过。外泌体之家 1.北京大学詹启敏、王嫣：GRP75触发白色脂肪组织褐变，促进癌症相关恶病质 Chen, X., et al. (2024). "GRP75 triggers white adipose tissue browning to promote cancer-associated cachexia."  Signal Transduct Target Ther 9(1): 253. IF=40.8 恶病质影响50%-80%的癌症患者，是一种使人虚弱的综合征，导致20%的癌症相关死亡。恶病质的一个关键特征是脂肪组织萎缩，但其如何促成恶病质的发展却知之甚少。该研究在癌症恶病质小鼠模型中证明，白色脂肪组织褐变可能是一种早期发病特征，它发生在体重减轻和骨骼肌萎缩之前。通过分析来自恶病质诱导肿瘤的细胞外囊泡中差异表达的蛋白质，确定了一种分子伴侣——葡萄糖调节蛋白75（GRP75），作为脂肪细胞褐变的关键介质。从机制上讲，GRP75与腺嘌呤核苷酸转位酶2（ANT2）结合形成GRP75-ANT2复合物。稳定的ANT2增强了其与解偶联蛋白1的相互作用，导致后者表达升高，进而促进脂肪细胞褐变。用GRP75抑制剂醉茄素治疗可以逆转这种褐变，并在体内减轻恶病质表型。该研究结果揭示了肿瘤衍生的GRP75在恶病质发展过程中调节白色脂肪组织褐变的一种新机制，并提出了一种以白色脂肪组织为中心的早期恶病质干预潜在靶向方法。 2.解放军总医院唐佩福团队：组蛋白去乙酰化酶抑制可增强来自肌肉的细胞外囊泡，通过miR-873-3p促进成骨作用 Chen, M., et al. (2024). "Histone deacetylase inhibition enhances extracellular vesicles from muscle to promote osteogenesis via miR-873-3p."  Signal Transduct Target Ther 9(1): 256. 有规律的身体活动被广泛认为可以降低各种疾病的风险，其中骨骼肌通过释放对多个器官和组织有益的生物分子发挥关键作用。然而，许多人，特别是老年人和患有某些临床病症的人，无法进行体育锻炼，这就需要采取替代策略来刺激肌肉细胞分泌有益的生物分子。组蛋白乙酰化和去乙酰化对运动诱导的基因表达有显著影响，这表明靶向组蛋白去乙酰化酶（HDACs）可以模拟一些运动反应。这项研究探讨了HDAC抑制剂曲古抑菌素A（TSA）对人骨骼肌成肌细胞（HSMMs）的影响。研究结果表明，TSA诱导的高乙酰化增强了肌管融合，并增加了富含miR-873-3p的细胞外囊泡（EVs）的分泌。这些TSA-EVs通过靶向H2调宁蛋白（CNN2）促进了人骨髓间充质干细胞（hBMSCs）的成骨分化。在体内，对骨质疏松小鼠全身施用TSA-EVs可显著改善骨量。此外，TSA-EVs模拟了运动诱导的EVs的成骨益处，这表明抑制HDAC可以复制运动诱导的对骨骼健康的益处。这些结果表明，TSA诱导的肌肉来源的EVs作为一种治疗策略，在增强骨形成和预防骨质疏松方面具有潜力，特别是对于无法进行运动的人。鉴于各种HDAC抑制剂已获得美国食品药品监督管理局（FDA）的批准，这种方法在骨质疏松治疗的快速临床转化方面具有重大前景。 3.【综述】郑州大学杨帅玺、胡军红、谷晓明：转移前生态位的形成、特征和治疗 Wang, Y., et al. (2024). "Pre-metastatic niche: formation, characteristics and therapeutic implication."  Signal Transduct Target Ther 9(1): 236. IF=40.8 该综述重点关注肿瘤衍生分泌因子、细胞外囊泡和循环肿瘤细胞在形成转移生态位中的作用。 4.中国科学院上海药物研究所甘勇研究员、俞淼荣副研究员与浙江大学胡国庆教授团队合作：胆固醇在外泌体递释RNA药物中的关键作用 Zhuo, Y., et al. (2024). "Direct cytosolic delivery of siRNA via cell membrane fusion using cholesterol-enriched exosomes."  Nat Nanotechnol. IF=38.1 在治疗应用中使用短干扰RNA（siRNA）时，高效的胞质递送是一个重大障碍。该研究表明富含胆固醇的外泌体易于通过膜融合进入癌细胞，实现siRNA的直接胞质递送。分子动力学模拟表明，变形以及与靶细胞膜增加接触有助于膜融合。在体外实验中，与天然的和去除胆固醇的牛奶来源外泌体（MEs）以及传统的转染试剂相比，富含胆固醇的MEs实现了siRNA显著更高的基因沉默效果，诱导了更优的癌细胞凋亡。当对患有原位肿瘤或皮下肿瘤的小鼠进行口服或静脉给药时，富含胆固醇的MEs/siRNA表现出优于脂质纳米颗粒的抗肿瘤活性。总的来说，通过调节外泌体膜的胆固醇含量以促进通过膜融合进入细胞，该研究为基于siRNA的基因治疗提供了一种有前景的方法，为有效、安全和简单的基因治疗策略铺平了道路。 5.南京邮电大学有机电子与信息显示国家重点实验室及化学与生命科学学院汪联辉教授、丁显光教授团队与新加坡国立大学David Tai Leong团队合作：纳米封装的肿瘤囊泡用作自体肿瘤疫苗 Ding, X., et al. (2024). "Non-discriminating engineered masking of immuno-evasive ligands on tumour-derived extracellular vesicles enhances tumour vaccination outcomes."  Nat Nanotechnol. IF=38.1 个性化癌症免疫疗法的成功取决于初始肿瘤抗原向树突状细胞和巨噬细胞的呈递。肿瘤来源的细胞外囊泡（TEVs）含有丰富的肿瘤抗原分子。然而，TEVs 表面存在如分化簇 47（CD47）等抗吞噬信号，这会导致相同的树突状细胞和巨噬细胞无法对其进行吞噬。该研究表明氢氧化铁纳米复合材料可以成功地掩盖 TEV 表面并解除吞噬作用的阻滞，而不影响细胞外囊泡所引发的免疫目标。在被内化后，掩盖物在溶酶体中分解，释放出肿瘤抗原物质。这在动物模型中触发了抗原呈递，并促进了树突状细胞的活化和成熟以及巨噬细胞的重编程，导致肿瘤体积和转移显著减少，在人类恶性胸腔积液临床样本中也是如此。这种直接的掩盖策略消除了临床样本中普遍存在的抗吞噬阻滞，可以普遍应用于所有患者特异性的 TEVs，作为肿瘤抗原剂用于增强免疫治疗。 6.江苏大学张徐、南通大学顾建美、江苏大学李翀：N2 TANs外泌体在体外和体内促进胃癌转移 Zhang, J., et al. (2024). "Exosomal miR-4745-5p/3911 from N2-polarized tumor-associated neutrophils promotes gastric cancer metastasis by regulating SLIT2." Mol Cancer 23(1): 198. IF=27.7 肿瘤细胞重塑肿瘤微环境（TME）细胞的表型和功能，以利于肿瘤进展。先前的研究表明，肿瘤微环境中的中性粒细胞在肿瘤衍生因子的作用下极化为N2肿瘤相关中性粒细胞（TANs），从而促进肿瘤生长、转移、血管生成、治疗抵抗和免疫抑制。外泌体在人类健康和包括癌症在内的疾病中充当关键的细胞间信使。到目前为止，来自N2 TANs的外泌体在胃癌中的生物学作用尚未得到充分表征。该研究首次报告了来自N2 TANs的外泌体在体内外均促进胃癌转移。研究发现来自N2 TANs的外泌体将miR-4745-5p/3911转移到胃癌细胞中，下调SLIT2（slit导向配体2）基因表达。腺病毒介导的SLIT2过表达逆转了N2TANs衍生外泌体对胃癌转移的促进作用。进一步揭示了胃癌细胞通过外泌体HMGB1（高迁移率族蛋白B1）/NF-κB通路诱导中性粒细胞的葡萄糖代谢重编程，该通路介导中性粒细胞N2极化和miR-4745-5p/3911上调。进一步采用微滴式数字PCR（ddPCR）检测人血清样本中N2 TANs外泌体中miR-4745-5p/3911的表达，发现与健康对照者和良性胃病患者相比，胃癌患者中其水平升高。总之，结果表明，N2 TANs通过外泌体miR-4745-5p/3911调节胃癌细胞中的SLIT2促进癌症转移，这为肿瘤微环境细胞衍生外泌体在胃癌转移中的作用提供了新的见解，并为胃癌诊断提供了一个潜在的生物标志物。 7.中国医科大学赵立/刘宏旭研究团队：LAMTOR1降低外泌体PD-L1以增强非小细胞肺癌的免疫治疗效果 Wu, B., et al. (2024). "LAMTOR1 decreased exosomal PD-L1 to enhance immunotherapy efficacy in non-small cell lung cancer." Mol Cancer 23(1): 184.IF=27.7 在利用免疫检查点阻断（ICB）治疗非小细胞肺癌（NSCLC）方面已经取得了巨大进展。针对在肿瘤细胞上表达的程序性细胞死亡蛋白1（PD-1）及其配体PD-L1的疗法在提高患者生存率方面显示出潜力。一个未解决的问题涉及肿瘤微环境（TME）中由外泌体PD-L1诱导的免疫抑制，特别是对于CD8(+)T细胞。研究揭示了LAMTOR1在抑制非小细胞肺癌中外泌体PD-L1以及促进CD8(+)T细胞浸润方面的关键作用。通过与HRS相互作用，LAMTOR1促进PD-L1的溶酶体降解，从而减少外泌体PD-L1的释放。值得注意的是，LAMTOR1促进PD-L1溶酶体降解的能力依赖于一个特定的泛素化位点和一个HRS结合序列。研究结果表明，利用LAMTOR1构建肽可能是一种有前景的策略，以增强非小细胞肺癌免疫治疗的疗效。对LAMTOR1如何抑制外泌体PD-L1释放的发现和理解为改善免疫治疗的潜在治疗策略提供了见解。有必要进行进一步的研究和临床试验，以调查在非小细胞肺癌治疗中靶向LAMTOR1的可行性和有效性。 8. 【综述】中南大学刘傥、黎志宏：癌症相关成纤维细胞衍生的细胞外囊泡介导的癌症治疗抵抗——从生物学机制到临床意义及影响 Lin, Z., et al. (2024). "Cancer therapy resistance mediated by cancer-associated fibroblast-derived extracellular vesicles: biological mechanisms to clinical significance and implications."  Mol Cancer 23(1): 191.IF=27.7 癌症相关成纤维细胞（CAFs）是肿瘤微环境中的一种多样化的基质细胞群体，在癌症进展和患者预后中发挥着基础作用。多项证据表明，CAFs在塑造肿瘤微环境的结构和功能方面起着关键作用，在调节肿瘤行为如转移、侵袭和上皮间质转化（EMT）等方面具有众多功能。CAFs可以通过产生细胞外囊泡（EVs）、多种分泌因子和代谢物与癌细胞广泛相互作用。值得注意的是，CAF衍生的EVs已被确定为癌症治疗抵抗的关键介质，并构成了癌症管理中的新型治疗靶点和生物标志物。本综述旨在总结CAF衍生的EVs在介导癌症对化疗、靶向治疗药物、放疗和免疫治疗的抵抗中的生物学作用和详细分子机制。我们还讨论了CAF衍生的EVs作为癌症临床管理中的新型靶点和临床生物标志物的治疗潜力，从而为提高癌症治疗效果和改善患者预后提供一种新的治疗策略。 9.浙江大学Chen Ting、周建维：揭示细胞外囊泡网络——洞察卵巢癌转移和化疗耐药性 Dai, W., et al. (2024). "Unraveling the extracellular vesicle network: insights into ovarian cancer metastasis and chemoresistance."  Mol Cancer 23(1): 201. IF=27.7 卵巢癌（OC）是最常见且致命的妇科恶性肿瘤之一，其高死亡率主要源于其侵袭性、频繁转移以及对标准疗法的抵抗。最近的研究强调了细胞外囊泡（EVs）在这些过程中的关键作用。EVs由生物体分泌，携带多样且具有生物活性的物质，在细胞间通讯中起着至关重要的作用。在功能上，物质的转移协调了多个过程，不仅积极影响原发性肿瘤，还影响局部和远处的转移前微环境。此外，它们独特的生物学特性使EVs成为新型治疗靶点和有前景的药物递送系统，对癌症患者具有潜在的深远影响。本综述总结了EV生物学的最新进展，深入探讨了EVs促成卵巢癌转移和耐药的复杂机制。它还探索了EVs在卵巢癌临床背景下的最新进展和治疗潜力。尽管已经取得了进展，但卵巢癌中的EV研究仍处于起步阶段。因此，本综述提出了现有研究的局限性，并为未来的研究提供了途径。总之，该综述旨在阐明EVs在卵巢癌中的关键作用，并突出它们在该领域的有前景的潜力。 10. 河北大学李振华团队：通过生物正交代谢工程驱动的细胞外囊泡重定向逆转免疫检查点抑制剂相关的心脏毒性 Fan, M., et al. (2024). "Reversing Immune Checkpoint Inhibitor-Associated Cardiotoxicity via Bioorthogonal Metabolic Engineering-Driven Extracellular Vesicle Redirecting."  Adv Mater: e2412340. IF=27.4 免疫检查点抑制剂（ICIs）引起的心脏毒性与高死亡率相关。T细胞在ICI诱导的心脏损伤中起重要作用。抑制局部T细胞活性被认为是减轻ICI相关心脏毒性的有效策略。肿瘤来源的细胞外囊泡（EVs）通过PD-L1过表达促进免疫抑制。在这项研究中，开发了一种生物正交代谢工程驱动的细胞外囊泡重定向（Biomeder）策略，用于原位工程化具有心肌靶向肽的细胞外囊泡。积累的肿瘤来源的细胞外囊泡（TuEVs）通过增加心肌细胞中的PD-L1水平和/或直接抑制T细胞活性来逆转心脏中的免疫环境。更重要的是，发现TuEVs的重定向进一步破坏了肿瘤中的免疫抑制，这有助于抗肿瘤活性。因此，将TuEVs重定向到心脏同时增强了基于ICI的治疗的抗肿瘤疗效和安全性。此外，Biomeder策略成功扩展到预防ICI诱导的1型糖尿病。这种Biomeder技术是一种用于治疗各种ICI相关不良事件的通用方法。 11. 海军军医大学东方肝胆医院付静：质膜蛋白ADCY7的核易位增强了肝细胞癌中T细胞介导的抗肿瘤免疫 Chen, J., et al. (2024). "Nuclear translocation of plasma membrane protein ADCY7 potentiates T cell-mediated antitumour immunity in HCC."  Gut.IF=23 T细胞介导的反应效力是免疫疗法治疗恶性肿瘤有效性的决定因素；然而，由于广泛的免疫抑制微环境，T细胞疗法在肝细胞癌（HCC）中的临床疗效有限。该研究旨在研究导致肝细胞癌免疫逃逸的关键基因，并提出重塑肝细胞癌微环境的新治疗策略。设计：进行全基因组体内规律间隔成簇短回文重复序列（CRISPR）筛选文库，以确定与免疫耐受相关的关键基因。使用单细胞RNA测序（scRNA-seq）、流式细胞术、肝细胞癌小鼠模型、染色质免疫沉淀和免疫共沉淀来探索腺苷酸环化酶7（ADCY7）在肝细胞癌免疫监测中的功能和机制。结果：全基因组体内CRISPR筛选确定了一种新的免疫调节剂-ADCY7。跨膜蛋白ADCY7通过小窝介导的内吞作用进行亚细胞易位，然后在富含亮氨酸重复序列的蛋白59（LRRC59）和输入蛋白β1（KPNB1）的帮助下易位到细胞核。在细胞核中，它作为CCAAT/增强子结合蛋白α（CEBPA）的转录辅因子，诱导CCL5转录，从而增加CD8(+)T细胞浸润以抑制肝细胞癌进展。此外，ADCY7可以作为外泌体分泌并进入邻近的肿瘤细胞以促进CCL5诱导。具有高ADCY7水平的外泌体促进CD8(+)T细胞在肿瘤内的浸润并抑制肝细胞癌肿瘤生长。结论：该研究描述了ADCY7的非常规功能和亚细胞定位，强调了其在肝细胞癌中T细胞介导的免疫中的关键作用以及作为有前景的治疗靶点的潜力。 12. 南方医科大学基础医学院病理学系梁莉教授团队：TSH/TSHR信号通路促进CD8+ T细胞耗竭和结直肠癌免疫逃逸的分子机制 Zeng, S., et al. (2024). "Local TSH/TSHR signaling promotes CD8(+) T cell exhaustion and immune evasion in colorectal carcinoma."  Cancer Commun (Lond). IF=20.1 背景：肿瘤微环境（TME）中CD8(+)T细胞功能障碍导致肿瘤免疫逃逸和免疫治疗耐受。先前已有报道瘦素、类固醇激素和糖皮质激素等激素对T细胞功能的影响。然而，甲状腺刺激激素（TSH）/甲状腺刺激激素受体（TSHR）信号在CD8(+)T细胞耗竭和肿瘤免疫逃逸中的潜在机制仍知之甚少。本研究旨在探讨TSH/TSHR信号对结直肠癌（CRC）中CD8(+)T细胞功能和免疫逃逸的影响。方法：通过免疫荧光和流式细胞术评估CD8(+)T细胞中TSHR的表达水平。功能研究包括在细胞和小鼠模型中调控TSHR表达以研究其在CD8(+)T细胞中的作用。主要通过RNA测序、蛋白质印迹、染色质免疫沉淀和荧光素酶活性测定获得机制方面的见解。使用免疫荧光、流式细胞术和蛋白质印迹研究结直肠癌组织中TSH和TSHR的来源。结果：TSHR在结直肠癌组织中的癌细胞和CD8(+)T细胞中高表达。TSH/TSHR信号被确定为促进CD8(+)T细胞耗竭的内在途径。在CD8(+)肿瘤浸润淋巴细胞（TILs）中条件性删除TSHR通过蛋白激酶A（PKA）/cAMP反应元件结合蛋白（CREB）信号通路改善效应细胞分化并抑制程序性细胞死亡蛋白1（PD-1）和甲型肝炎病毒细胞受体2（HAVCR2或TIM3）等免疫检查点受体的表达。结直肠癌细胞通过外泌体分泌TSHR以增加CD8(+)T细胞中的TSHR水平，从而导致肿瘤微环境中的免疫抑制。髓源性抑制细胞（MDSCs）是肿瘤微环境中TSH的主要来源。结直肠癌中TSHR的低表达是免疫治疗反应的预测因子。结论：本研究结果强调了内源性TSH/TSHR信号在结直肠癌中CD8(+)T细胞耗竭和免疫逃逸中的作用。TSHR可能适合作为结直肠癌免疫治疗中的预测性和治疗性生物标志物。 13. 南方医科大学陈滨等：载外泌体的新型可注射黏附水凝胶用于血友病关节软骨缺损的整体修复 Yang, Q., et al. (2024). "Novel injectable adhesive hydrogel loaded with exosomes for holistic repair of hemophilic articular cartilage defect." Bioact Mater 42: 85-111. IF=18 14. 中南大学湘雅二医院代谢内分泌科袁凌青教授团队：血管壁微环境——内皮细胞源性外泌体通过m6A依赖方式介导褪黑素抑制血管钙化和衰老 Shan, S. K., et al. (2024). "Vascular wall microenvironment: Endothelial cells original exosomes mediated melatonin-suppressed vascular calcification and vascular ageing in a m6A methylation dependent manner." Bioact Mater 42: 52-67. IF=18 15. 徐州医科大学药学院郑爱萍：Fc增强的外泌体具有更好的上皮层传递和肺分布能力，用于肺部疫苗接种 Meng, F., et al. (2024). "Fc-empowered exosomes with superior epithelial layer transmission and lung distribution ability for pulmonary vaccination."  Bioact Mater 42: 573-586. IF=18 16. 中山大学附属第六医院邱剑光主任、王德娟主任团队联合清华大学深圳国际研究生院徐弢教授团队：生物打印间充质干细胞微纤维来源的细胞外囊泡减轻单侧肾缺血再灌注损伤和纤维化 Guo, Q., et al. (2024). "Bioprinted mesenchymal stem cell microfiber-derived extracellular vesicles alleviate unilateral renal ischemia-reperfusion injury and fibrosis by inhibiting tubular epithelial cells ferroptosis." Bioact Mater 40: 649-664. IF=18 17. 中南大学湘雅医院陈灿：可溶解的微针伤口敷料经皮并持续提供抗炎和促血管生成外泌体用于糖尿病伤口治疗 Cao, Y., et al. (2024). "Dissolvable microneedle-based wound dressing transdermally and continuously delivers anti-inflammatory and pro-angiogenic exosomes for diabetic wound treatment."  Bioact Mater 42: 32-51. IF=18 18. 中南大学湘雅医院李长俊：衰老的骨髓巨噬细胞通过细胞外囊泡介导的旁分泌衰老来驱动全身衰老和年龄相关功能障碍 Hou, J., et al. (2024). "Aged bone marrow macrophages drive systemic aging and age-related dysfunction via extracellular vesicle-mediated induction of paracrine senescence."  Nat Aging. IF=17 19. 厦门大学颜晓梅：红细胞来源的细胞外小泡通过表面展示唾液酸抑制流感病毒 Cai, N., et al. (2024). "Red Blood Cell-Derived Small Extracellular Vesicles Inhibit Influenza Virus through Surface-Displayed Sialic Acids."  Angew Chem Int Ed Engl: e202413946. IF=16.1 20. 军事科学院军事医学研究院辐射医学研究所岳文：装载干细胞线粒体微泡的水凝胶微针贴片促进慢性伤口愈合 Yao, W. D., et al. (2024). "Hydrogel Microneedle Patches Loaded with Stem Cell Mitochondria-Enriched Microvesicles Boost the Chronic Wound Healing."  ACS Nano 18(39): 26733-26750. IF=15.8 21. 南京大学宋玉君：工程益生菌时空递送双纳米抗体通过靶向肿瘤源外泌体逆转肿瘤免疫抑制 Qin, S., et al. (2024). "Spatiotemporal Delivery of Dual Nanobodies by Engineered Probiotics to Reverse Tumor Immunosuppression via Targeting Tumor-Derived Exosomes."  ACS Nano 18(39): 26858-26871. IF=15.8 22. 【综述】南方医科大学崔力：肿瘤微环境来源的外泌体——T细胞免疫治疗的双刃剑 Lu, Y., et al. (2024). "Tumor Microenvironment-Derived Exosomes: A Double-Edged Sword for Advanced T Cell-Based Immunotherapy." ACS Nano.IF=15.8 23. 【综述】重庆医科大学刘博：线粒体细胞外囊泡——诊断和治疗肺部疾病的一个有前途的途径 Ding, F., et al. (2024). "Mitochondrial Extracellular Vesicles: A Promising Avenue for Diagnosing and Treating Lung Diseases." ACS Nano 18(37): 25372-25404. IF=15.8 24. 北京上海交通大学医学院附属仁济医院/上海市肿瘤研究所向冬喜：细胞外囊泡液体活检用适配体引导的荧光极化平台 Pham, C. V., et al. (2024). "An aptamer-guided fluorescence polarisation platform for extracellular vesicle liquid biopsy." J Extracell Vesicles 13(9): e12502. IF=15.5 25. 南京师范大学郭志刚团队：氧化应激过程中8-氧鸟嘌呤DNA糖基酶-synaptotagmin 7通路增加细胞外囊泡释放并促进肿瘤转移 Ma, Y., et al. (2024). "The 8-oxoguanine DNA glycosylase-synaptotagmin 7 pathway increases extracellular vesicle release and promotes tumour metastasis during oxidative stress."  J Extracell Vesicles 13(9): e12505.IF=15.5 26. 中山大学孙逸仙纪念医院林天歆、陈长昊：含有整合素α6的细胞外囊泡通过与CD151的相互作用促进淋巴结转移前生态位形成的淋巴重塑 Lin, Y., et al. (2024). "Integrin α6-containing extracellular vesicles promote lymphatic remodelling for pre-metastatic niche formation in lymph nodes via interplay with CD151."  J Extracell Vesicles 13(10): e12518.IF=15.5 27. 浙江农业科学院刘燕、鲍国连：外膜囊泡包覆纳米地黄多糖增强对细菌感染的保护性免疫 Huang, Y., et al. (2024). "Enhancing protective immunity against bacterial infection via coating nano-Rehmannia glutinosa polysaccharide with outer membrane vesicles."  J Extracell Vesicles 13(9): e12514.IF=15.5 28. 山东大学刘永军、张娜：靶向glypican-3的巨噬细胞递送载药外泌体在小鼠实体瘤模型中提供了有效的细胞治疗 Liu, J., et al. (2024). "Glypican-3-targeted macrophages delivering drug-loaded exosomes offer efficient cytotherapy in mouse models of solid tumours."  Nat Commun 15(1): 8203. IF=14.7 29. 中国科学院上海药物研究所俞淼荣：内质网靶向递送雷公藤红素和PD-L1 siRNA增强免疫原性细胞死亡和增强癌症免疫治疗 Wang, J., et al. (2024). "Endoplasmic reticulum-targeted delivery of celastrol and PD-L1 siRNA for reinforcing immunogenic cell death and potentiating cancer immunotherapy." Acta Pharm Sin B 14(8): 3643-3660. IF=14.7 30. 中国医学科学院药物研究所吴练秋：半合成硫酸软骨素CS-semi5上调miR-122-5p，通过p38/MMP13途径对骨关节炎产生治疗作用 Li, X., et al. (2024). "Semi-synthetic chondroitin sulfate CS-semi5 upregulates miR-122-5p, conferring a therapeutic effect on osteoarthritis via the p38/MMP13 pathway."  Acta Pharm Sin B 14(8): 3528-3542. IF=14.7 31. 【综述】四川大学与杜兰大学医学院合作：细胞外囊泡在肺癌治疗中的应用进展 Huang, G., et al. (2024). "Recent advances to address challenges in extracellular vesicle-based applications for lung cancer."  Acta Pharm Sin B 14(9): 3855-3875. IF=14.7 32. 台湾大学&长庚大学：Mir221-和mir222富集的adsc-外泌体通过调节BNIP3-MAP1LC3B-BBC3/PUMA通路减轻PM暴露加重的心脏缺血-再灌注损伤 Lee, T. L., et al. (2024). "Mir221- and Mir222-enriched adsc-exosomes mitigate PM exposure-exacerbated cardiac ischemia-reperfusion injury through the modulation of the BNIP3-MAP1LC3B-BBC3/PUMA pathway."  Autophagy: 1-20. IF=14.6 33. 厦门大学朱志教授课题组：细胞外囊泡的聚糖指纹图谱助力癌症液体活检 Zhang, G., et al. (2024). "Fingerprint Profiling of Glycans on Extracellular Vesicles via Lectin-Induced Aggregation Strategy for Precise Cancer Diagnostics." J Am Chem Soc. IF=14.4 前期报道：JACS｜厦门大学朱志教授团队：细胞外囊泡的聚糖指纹图谱助力癌症液体活检 34. 南京鼓楼医院骨科钱邦平/邱勇教授课题组：强直性脊柱炎中韧带组织转运白介素- 17a的细胞外小泡介导韧带-骨串扰 Wang, K., et al. (2024). "Extracellular Vesicles Derived from Ligament Tissue Transport Interleukin-17A to Mediate Ligament-To-Bone Crosstalk in Ankylosing Spondylitis."  Adv Sci (Weinh): e2406876.IF=14.3 35. 上海交通大学医学院附属第六人民医院急诊医学科傅一牧团队：基因工程化铈外泌体通过重塑免疫微环境和修复 DNA 损伤治疗动脉粥样硬化 Wei, P., et al. (2024). "Gene-Engineered Cerium-Exosomes Mediate Atherosclerosis Therapy Through Remodeling of the Inflammatory Microenvironment and DNA Damage Repair." Small: e2404463. IF=13 前期报道：Small｜上海交通大学傅一牧团队：基因工程化铈外泌体通过重塑免疫微环境和修复 DNA 损伤治疗动脉粥样硬化 36. 宁波市中医院陈宁刚/浙江大学高建青：来自水果、蔬菜和中药的PELNs在生物治疗和药物递送中的研究进展 Zhao, B., et al. (2024). "Exosome-like nanoparticles derived from fruits, vegetables, and herbs: innovative strategies of therapeutic and drug delivery."  Theranostics 14(12): 4598-4621. IF=12.4 END 免责声明：本文仅作知识交流与分享及科普目的，不涉及商业宣传，不作为相关医疗指导或用药建议。文章如有侵权请联系删除。 OTC2024类器官前沿应用与3D细胞培养论坛圆满落幕，点击图片可查看会后报告，咨询OTC2025类器官论坛请联系：王晨 180 1628 8769

WARRINGTON, Pa., April 17, 2024 (GLOBE NEWSWIRE) -- Windtree Therapeutics, Inc. (Formerly Known As Discovery Laboratories, Inc.) (“Windtree” or “the Company”) (NasdaqCM: WINT), a biotechnology company focused on advancing early and late-stage innovative therapies for critical conditions, today reported financial results for the fourth quarter and fiscal year ended December 31, 2023 and provided key business updates. “The end of 2023 and the past few months have been very productive at Windtree as we advanced clinical programs, executed a license for cardiovascular assets, took actions to strengthen our balance sheet and, most recently, acquired a novel oncology preclinical atypical protein kinase C iota inhibitor (aPKCi inhibitor) platform from Varian Biopharmaceuticals. These actions represent the first part of a portfolio optimization strategy and a potentially transformative next step for Windtree,” said Craig Fraser, CEO. “Later this year, we plan to read out data from both of our ongoing Phase 2 istaroxime trials in cardiogenic shock while we are also supporting our regional partner, Lee’s Pharmaceutical, in starting a Phase 3 program in acute heart failure. In addition, we are actively engaged in global partnership discussions for istaroxime, with the objective of partnering to help advance istaroxime through existing and future clinical trials and gaining potential deal revenue. Given the intent to have the resource intensive, late stage istaroxime program advanced by a larger company, by adding the innovative aPKCi inhibitor platform to our early-stage pipeline, we plan to strengthen our focus on advancing our preclinical programs, including our selective SERCA2a activators. We believe partnering our istaroxime program both regionally and globally, has the potential to allow us to better advance our other pipeline assets and help us to significantly reduce our cash burn, extend runway and leverage our experienced team to advance our innovative early-stage platforms.” Mr. Fraser further added, “Mid to longer term, we believe there could be opportunity to leverage our internal programs, partner deal revenue, a strengthened balance sheet and public company liquidity to selectively execute other potential acquisitions and/or strategic transactions to grow the business and its value.” “The R&D and clinical team has been busy this period. We advanced the istaroxime program in cardiogenic shock with two clinical trials. First, we progressed clinical execution of the SEISMiC Extension Study in the U.S., Europe and Latin America. We also initiated a study of istaroxime in more severe SCAI Stage C cardiogenic shock patients. Earlier this year, we announced preclinical data describing a reduction in arrythmias with both istaroxime and a pure SERCA2a activator in a rat heart ischemia-reperfusion model,” said Dr. Steve Simonson, Chief Medical Officer of Windtree. “Next, we intend to integrate our newly acquired aPKCi inhibitor into our preclinical portfolio, which we believe has an exciting preclinical data package with two formulations in development. We plan to progress the IND-enabling activities for a topical and oral formulation while we create a comprehensive development plan focused on malignancies with unmet needs that are targets for this mechanism of action. While there is scientific rationale for potential broad application of this mechanism of action, we believe there will be options for targeted disease selection and differentiation due to the potential for high target specificity and the opportunity for a topical formulation to treat various cutaneous malignancies. We are assessing our new asset platform and look forward to communicating our future development plans later this year.” Key Business Update ● Entered into an asset purchase agreement with Varian Biopharmaceuticals, Inc. (“Varian”) on April 2, 2024 to acquire certain of its assets, including a proprietary aPKCi inhibitor. The Company also completed a $1.5 million convertible note bridge financing. The acquired Varian asset platform is a novel, potential high-potency, specific, aPKCi inhibitor with possible broad use in oncology and certain rare malignant diseases. The asset platform includes both a topical and oral formulation in development. ● Announced the enrollment of the first subject in its Phase 2 SEISMiC Extension Study of istaroxime in the treatment of early cardiogenic shock in December 2023 as well as initiated a parallel study in more severe, SCAI Stage C cardiogenic shock patients. Study results are expected in the second half of 2024. ● Entered into a license agreement with Lee’s Pharmaceutical (HK) Limited in January 2024 for the development and commercialization of istaroxime in Greater China, including for acute heart failure and cardiogenic shock. In addition to istaroxime, the agreement also licenses preclinical next-generation SERCA2a activators, known as dual mechanism SERCA2a activators, and rostafuroxin, a Phase 2 product candidate for hypertension associated with specific genotypes. We are eligible to receive up to approximately $138 million in milestone payments, plus low double-digit percentage royalties on certain sales. ● Renewed its partnership with Chang Gung University in Taiwan to further research on SERCA2a, an important target for the Company’s cardiovascular portfolio. Windtree personnel from its offices in Taipei, Taiwan will participate in the collaboration. ● Entered into an Exchange and Termination Agreement with affiliates of Deerfield Management Company (collectively, “Deerfield”) in January 2024 pursuant to which Deerfield has agreed to terminate its rights under the Company’s 2017 Exchange and Termination Agreement to receive up to $15 million in development and commercial milestone payments associated with AEROSURF®, an acute pulmonary drug/device combination intended to treat premature infants with respiratory distress syndrome, in exchange for $200,000 and 608,272 shares of common stock. Windtree out-licensed global rights to AEROSURF® in 2022. ● Announced preclinical data on the Company’s lead product candidate, istaroxime, and a preclinical pipeline pure SERCA2a activator drug candidate, CVie-216, showing reductions in ventricular arrythmias in a rat heart model of diabetes with restricted and restored coronary blood flow induced injury. ● Announced that the European Patent Office granted Patent No. 3805243 composition of matter patent coverage for the pure SERCA2a Activator class of drug candidates. The new European patent, titled: “ANDROSTANE DERIVATIVES WITH ACTIVITY AS PURE OR PREDOMINANTLY PURE STIMULATORS OF SERCA2A FOR THE TREATMENT OF Heart Failure,” provides patent protection until October 9, 2039 for the family of compounds with the pure SERCA2a mechanism of action. ● As of December 31, 2023, cash and cash equivalents were $4.3 million and current liabilities were $4.0 million. Select Fourth Quarter 2023 Financial Results Research and development expenses were $3.1 million for the fourth quarter of 2023, compared to $1.2 million for the fourth quarter of 2022. The increase in research and development expenses was primarily due to costs related to the execution of the SEISMiC Extension trial of istaroxime for the treatment of early cardiogenic shock and to $0.9 million in accrued payments to Philip Morris USA Inc. and Philip Morris Products S.A. related to amendments to our license agreements. General and administrative expenses for the fourth quarter of 2023 were $1.9 million, compared to $2.2 million for the fourth quarter of 2022. The decrease in general and administrative expenses is primarily due to (i) a decrease of $0.4 million in non-cash stock-based compensation expense related to headcount reductions and the timing of grants; (ii) a decrease of $0.3 million in insurance and professional fees; and (iii) a decrease of $0.1 million in personnel costs due to headcount reductions; partially offset by (iv) the reversal of $0.5 million in incentive bonus expense during the fourth quarter of 2022. For the fourth quarter ended December 31, 2023, the Company reported an operating loss of $5.0 million, compared to an operating loss of $10.8 million in the fourth quarter of 2022. Included in operating loss for the fourth quarter of 2022 is a non-cash loss on impairment of intangible assets related to rostafuroxin of $6.8 million and a related $1.4 million deferred income tax benefit and a non-cash loss on impairment of goodwill of $0.5 million. The Company reported a net loss of $5.2 million ($0.95 per basic share) on 5.4 million weighted-average common shares outstanding for the quarter ended December 31, 2023, compared to a net loss of $9.7 million ($13.01 per basic share) on 0.7 million weighted average common shares outstanding for the comparable period in 2022. Select 2023 Year-End Financial Results Research and development expenses were $8.3 million for the year ended December 31, 2023, compared to $11.1 million for the year ended December 31, 2022. The decrease in research and development expenses is primarily due to (i) a decrease of $3.0 million related to the KL4 surfactant platform, inclusive of $1.4 million in personnel cost reductions, as the Company continues to focus its resources on the development of its istaroxime pipeline; (ii) a decrease of $0.7 million for expenditures related to the development of istaroxime for AHF; and (iii) a decrease of $0.4 million in non-cash stock-based compensation expense related to headcount reductions and the timing of grants; partially offset by (iv) $0.9 million in accrued payments to Philip Morris USA Inc. and Philip Morris Products S.A. in 2023 related to amendments to our license agreements; and (v) an increase of $0.4 million as we continue the SEISMiC Extension trial of istaroxime for the treatment of early cardiogenic shock. General and administrative expenses for the year ended December 31, 2023 were $9.2 million, compared to $10.8 million for the year ended December 31, 2022. The decrease in general and administrative expenses is primarily due to (i) a decrease of $1.4 million in non-cash stock-based compensation expense related to headcount reductions and the timing of grants; (ii) a decrease of $0.6 million in personnel costs due to headcount reductions; and (iii) a decrease of $0.4 million in insurance costs; partially offset by (iv) an increase of $0.4 million in professional fees; and (v) $0.4 million in severance expense related to a former executive. For the year ended December 31, 2023, the Company reported an operating loss of $20.6 million, compared to an operating loss of $41.3 million for the year ended December 31, 2022. Included in operating loss for the year ended December 31, 2023 is a non-cash loss on impairment of goodwill of $3.1 million. Included in operating loss for the year ended December 31, 2022 is a non-cash loss on impairment of goodwill of $12.6 million and a non-cash loss on impairment of intangible assets related to rostafuroxin of $6.8 million and a related $1.4 million deferred income tax benefit. The Company reported a net loss of $20.3 million ($5.24 per basic share) on 3.9 million weighted-average common shares outstanding for the year ended December 31, 2023, compared to a net loss of $39.2 million ($62.23 per basic share) on 0.6 million weighted average common shares outstanding for the comparable period in 2022. As of December 31, 2023, the Company reported cash and cash equivalents of $4.3 million and current liabilities of $4.0 million. In April 2024, the Company completed a $1.5 million convertible note bridge financing. As a result, we believe that we have sufficient resources available to fund our operations through April 2024. Readers are referred to, and encouraged to read in its entirety, the Company’s Annual Report on Form 10-K for the year ended December 31, 2023, which will be filed with the Securities and Exchange Commission on April 16, 2024, and includes detailed discussions about the Company’s business plans and operations, financial condition, and results of operations. About Windtree Therapeutics Windtree Therapeutics, Inc. is a biotechnology company focused on advancing early and late-stage innovative therapies for critical conditions and diseases. Windtree’s portfolio of product candidates includes istaroxime, a Phase II candidate with SERCA2a activating properties for acute heart failure and associated cardiogenic shock, preclinical SERCA2a activators for heart failure and preclinical precision aPKCi inhibitors that are being developed for potential in rare and broad oncology applications. Windtree also has a licensing business model with partnership out-licenses currently in place. Forward-Looking Statements This press release contains forward-looking statements within the meaning of The Private Securities Litigation Reform Act of 1995. The Company may, in some cases, use terms such as "predicts," "believes," "potential," "proposed," "continue," "estimates," "anticipates," "expects," "plans," "intends," "may," "could," "might," "will," "should" or other words that convey uncertainty of future events or outcomes to identify these forward-looking statements. Such statements are based on information available to the Company as of the date of this press release and are subject to numerous important factors, risks and uncertainties that may cause actual events or results to differ materially from the Company’s current expectations. Examples of such risks and uncertainties include: the Company’s ability to secure significant additional capital as and when needed; the Company’s ability to achieve the intended benefits of the aPKCi asset acquisition with Varian; risks and uncertainties associated with the success and advancement of the clinical development programs for istaroxime and the Company’s other product candidates, including preclinical oncology candidates; the Company’s ability to access the debt or equity markets; the Company’s ability to manage costs and execute on its operational and budget plans; the results, cost and timing of the Company’s clinical development programs, including any delays to such clinical trials relating to enrollment or site initiation; risks related to technology transfers to contract manufacturers and manufacturing development activities; delays encountered by the Company, contract manufacturers or suppliers in manufacturing drug products, drug substances, and other materials on a timely basis and in sufficient amounts; risks relating to rigorous regulatory requirements, including that: (i) the U.S. Food and Drug Administration or other regulatory authorities may not agree with the Company on matters raised during regulatory reviews, may require significant additional activities, or may not accept or may withhold or delay consideration of applications, or may not approve or may limit approval of the Company’s product candidates, and (ii) changes in the national or international political and regulatory environment may make it more difficult to gain regulatory approvals and risks related to the Company’s efforts to maintain and protect the patents and licenses related to its product candidates; risks that the Company may never realize the value of its intangible assets and have to incur future impairment charges; risks related to the size and growth potential of the markets for the Company’s product candidates, and the Company’s ability to service those markets; the Company’s ability to develop sales and marketing capabilities, whether alone or with potential future collaborators; the rate and degree of market acceptance of the Company’s product candidates, if approved; the economic and social consequences of the COVID-19 pandemic and the impacts of political unrest, including as a result of geopolitical tension, including the conflict between Russia and Ukraine, the People’s Republic of China and the Republic of China (Taiwan), and the evolving events in Israel and Gaza, and any sanctions, export controls or other restrictive actions that may be imposed by the United States and/or other countries which could have an adverse impact on the Company’s operations, including through disruption in supply chain or access to potential international clinical trial sites, and through disruption, instability and volatility in the global markets, which could have an adverse impact on the Company’s ability to access the capital markets. These and other risks are described in the Company’s periodic reports, including its Annual Report on Form 10-K, Quarterly Reports on Form 10-Q and Current Reports on Form 8-K, filed with or furnished to the Securities and Exchange Commission and available at Any forward-looking statements that the Company makes in this press release speak only as of the date of this press release. The Company assumes no obligation to update forward-looking statements whether as a result of new information, future events or otherwise, after the date of this press release. Contact Information: Eric Curtis ecurtis@windtreetx.com +++++ Tables to Follow +++++ WINDTREE THERAPEUTICS, INC. AND SUBSIDIARIES Consolidated Balance Sheets (in thousands, except share and per share data) December 31, 2023 December 31, 2022 ASSETS Current Assets: Cash and cash equivalents $ 4,319 $ 6,172 Prepaid expenses and other current assets 1,060 1,205 Total current assets 5,379 7,377 Property and equipment, net 183 262 Restricted cash 150 154 Operating lease right-of-use assets 1,444 1,853 Intangible assets 25,250 25,250 Goodwill - 3,058 Total assets $ 32,406 $ 37,954 LIABILITIES, MEZZANINE EQUITY & STOCKHOLDERS’ EQUITY Current Liabilities: Accounts payable $ 809 $ 249 Accrued expenses 1,618 1,552 Operating lease liabilities - current portion 436 404 Loans payable - current portion 233 252 Other current liabilities 900 - Total current liabilities 3,996 2,457 Operating lease liabilities - non-current portion 1,161 1,624 Restructured debt liability - contingent milestone payments 15,000 15,000 Other liabilities 3,800 3,800 Deferred tax liabilities 5,058 5,061 Total liabilities 29,015 27,942 Mezzanine Equity: Series A redeemable preferred stock, $0.001 par value; 0 and 40,000 shares authorized; 0 and 38,610.119 shares issued and outstanding at 2023 and 2022, respectively - - Stockholders’ Equity: Preferred stock, $0.001 par value; 5,000,000 and 4,960,000 shares authorized; 0 shares issued and outstanding at 2023 and 2022, respectively - - Common stock, $0.001 par value; 120,000,000 shares authorized; 5,996,587 and 772,203 shares issued at 2023 and 2022, respectively; 5,996,586 and 772,202 shares outstanding at 2023 and 2022, respectively 6 - Additional paid-in capital 851,262 837,598 Accumulated deficit (844,823 ) (824,532 ) Treasury stock (at cost); 1 share (3,054 ) (3,054 ) Total stockholders’ equity 3,391 10,012 Total liabilities, mezzanine equity & stockholders’ equity $ 32,406 $ 37,954 WINDTREE THERAPEUTICS, INC. AND SUBSIDIARIES Consolidated Statements of Operations (in thousands, except per share data) Three Months Ended Year Ended December 31, December 31, 2023 2022 2023 2022 Expenses: Research and development $ 3,053 $ 1,216 $ 8,341 $ 11,099 General and administrative 1,906 2,242 9,198 10,790 Loss on impairment of goodwill - 534 3,058 12,624 Loss on impairment of intangible assets - 6,820 - 6,820 Total operating expenses 4,959 10,812 20,597 41,333 Operating loss (4,959 ) (10,812 ) (20,597 ) (41,333 ) Other (expense) income: Interest income 61 52 325 109 Interest expense (12 ) (13 ) (50 ) (53 ) Other expense, net (244 ) (286 ) 31 702 Total other (expense) income, net (195 ) (247 ) 306 758 Loss before income taxes (5,154 ) (11,059 ) (20,291 ) (40,575 ) Deferred income tax benefit - 1,367 - 1,367 Net loss $ (5,154 ) $ (9,692 ) $ (20, 291 ) $ (39,208 ) Net loss per common share Basic and diluted $ (0.95 ) $ (13.01 ) $ (5.24 ) $ (62.23 ) Weighted average number of common shares outstanding Basic and diluted 5,399 745 3,876 630

- Patients in the Nana-val (nanatinostat in combination with valganciclovir) treatment arm achieved clinically meaningful anti-tumor responses with an overall response rate of 50% and a complete response rate of 20% in the intent-to-treat population (71% and 29% in the efficacy-evaluable population) with a generally manageable safety pro -Nana-valdemonstrated substantially greater efficacy than nanatinostat monotherapy, further validating its ‘Kick and Kill’ mechanism of action - - Data were presented in an oral presentation at the 2024 Joint Annual Congress of Taiwan Society of Blood and Marrow Transplantation and The Hematology Society of Taiwan - SAN DIEGO, April 15, 2024 (GLOBE NEWSWIRE) -- Viracta Therapeutics, Inc. (Nasdaq: VIRX), a clinical-stage precision oncology company focused on the treatment and prevention of virus-associated cancers that impact patients worldwide, today reported positive topline results from Stage 1 of the pivotal Phase 2 NAVAL-1 trial from both arms of the relapsed or refractory (R/R) Epstein-Barr virus-positive (EBV+) peripheral T-cell lymphoma (PTCL) cohort. Patients were randomized to either nanatinostat monotherapy (n=10) or to nanatinostat in combination with valganciclovir (Nana-val, n=10). These data were featured in an oral presentation during the 2024 Joint Annual Congress of Taiwan Society of Blood and Marrow Transplantation and The Hematology Society of Taiwan. “Nana-val demonstrated an impressive clinical response in patients with relapsed or refractory EBV-positive PTCL with a generally manageable safety profile, including one patient who was able to proceed to allogeneic stem-cell transplant and remains in response for over 8 months to date,” said Hung Chang, M.D., Professor of Hematology, Linkou Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan and principal investigator in the NAVAL-1 trial. “The substantially greater clinical efficacy of Nana-val relative to nanatinostat monotherapy suggests that both agents in the combination regimen are contributing to its anti-tumor activity as predicted by their mechanisms of action. Nana-val is emerging as a promising, generally well-tolerated, convenient all-oral treatment for patients with relapsed or refractory EBV-positive PTCL.” Darrel P. Cohen, M.D., Ph.D., Chief Medical Officer of Viracta added, “Patients with relapsed or refractory EBV-positive PTCL have a very poor prognosis, worse than those with EBV-negative disease, yet there are presently no EBV-targeted treatment options available. We are encouraged by the Stage 1 data from patients with relapsed or refractory EBV-positive PTCL in the pivotal Phase 2 NAVAL-1 trial that further validates Nana-val’s differentiated ‘Kick and Kill’ mechanism of action. Building on these promising clinical outcomes emerging from the NAVAL-1 trial, which are consistent with those from our preceding Phase 1b/2 study, we will continue to advance Nana-val in this lead indication through regulatory approval as quickly as possible. We look forward to engaging with the FDA on a potential accelerated approval pathway midyear and sharing topline results from Stage 2 together with additional data from Stage 1 in the third quarter of 2024.” Key takeaways from the pivotal Phase 2 NAVAL-1 trial in patients with R/R EBV+ PTCL: Nana-val (nanatinostat in combination with valganciclovir) demonstrated greater efficacy than nanatinostat monotherapy and was generally well-tolerated. The median duration of response continues to mature. Overview: A total of 20 patients with primarily Stage III-IV disease (who had received ≥1 [median of 2] prior systemic PTCL therapies) were randomized (1:1) to receive nanatinostat (20 mg orally once daily, 4 days/week) alone or as Nana-val in combination with valganciclovir (900 mg orally once daily, 7 days/week). Patients who did not respond to nanatinostat monotherapy after 6 weeks of treatment were offered the opportunity to cross over to receive Nana-val. Efficacy was evaluated as of the February 7, 2024 data cutoff date. In the Nana-val arm, the overall response rate (ORR) was 50% and the complete response rate (CRR) was 20% in the intent-to-treat (ITT) population (N=10); the ORR was 71% and the CRR was 29% in the efficacy-evaluable population (N=7). In the nanatinostat monotherapy arm, the ORR and CRR were 10% and 0%, respectively, in the ITT population (N=10), and the ORR was 13% in the efficacy-evaluable population (N=8). Five nanatinostat monotherapy patients crossed over to receive Nana-val, two of whom remain on Nana-val treatment with stable disease as of the data cutoff. Safety was also evaluated as of the February 7, 2024 data cutoff date. The most common treatment-related adverse events in both treatment arms were thrombocytopenia, anemia, fatigue, decreased appetite, nausea, diarrhea, and weight loss. These adverse events were primarily mild to moderate in severity and generally manageable or reversible. A copy of the data presentation is accessible under the “Events and Presentations” section of Viracta’s website at . About the NAVAL-1 Trial NAVAL-1 (NCT05011058) is a global, multicenter, clinical trial of Nana-val in patients with relapsed or refractory (R/R) Epstein-Barr virus-positive (EBV+) lymphoma. This Phase 2 trial employs a Simon two-stage design where, in Stage 1, participants are enrolled into one of three indication cohorts based on EBV+ lymphoma subtype. If two objective responses are achieved within a lymphoma subtype in Stage 1 (n=10), then additional patients will be enrolled in Stage 2 for a total of 21 patients. EBV+ lymphoma subtypes demonstrating promising anti-tumor activity in Stage 2 may be further expanded following discussion with regulators to potentially support registration. About Nana-val (Nanatinostat and Valganciclovir) Nanatinostat is an orally available histone deacetylase (HDAC) inhibitor being developed by Viracta. Nanatinostat is selective for specific isoforms of Class I HDACs, which are key to inducing viral genes that are epigenetically silenced in Epstein-Barr virus (EBV)-associated malignancies. Nanatinostat is currently being investigated in combination with the antiviral agent valganciclovir as an all-oral combination therapy, Nana-val, in various subtypes of EBV-associated malignancies. Ongoing trials include a pivotal, global, multicenter, open-label, Phase 2 basket trial in multiple subtypes of relapsed or refractory (R/R) EBV+ lymphoma (NAVAL-1) as well as a multinational Phase 1b/2 clinical trial in patients with recurrent or metastatic (R/M) EBV+ NPC and other advanced EBV+ solid tumors. About Peripheral T-Cell Lymphoma T-cell lymphomas comprise a heterogeneous group of rare and aggressive malignancies, including peripheral T-cell lymphoma not otherwise specified (PTCL-NOS) and angioimmunoblastic T-cell lymphoma (AITL). There are approximately 5,600 newly diagnosed T-cell lymphoma patients and approximately 2,600 newly diagnosed PTCL-NOS and AITL patients in the U.S. annually. Approximately 70% of these patients are either refractory to first-line therapy, or eventually experience relapse of their disease. Clinical trials are currently recommended for all lines of PTCL therapy, and most patients with R/R PTCL have poor outcomes, with median progression-free survival and median overall survival times reported to be 3.7 and 6.5 months, respectively. Approximately 40% to 65% of PTCL is associated with EBV, the incidence of EBV+ PTCL varies by geography, and reported outcomes for patients with EBV+ PTCL are inferior to those whose disease is EBV-negative. There is no approved targeted treatment specific for EBV+ PTCL, and therefore this represents a high unmet medical need. About EBV-Associated Cancers Approximately 90% of the world's adult population is infected with EBV. Infections are commonly asymptomatic or associated with mononucleosis. Following infection, the virus remains latent in a small subset of cells for the duration of the patient's life. Cells containing latent virus are increasingly susceptible to malignant transformation. Patients who are immunocompromised are at an increased risk of developing EBV-positive (EBV+) lymphomas. EBV is estimated to be associated with approximately 2% of the global cancer burden including lymphoma, nasopharyngeal carcinoma (NPC), and gastric cancer. About Viracta Therapeutics, Inc. Viracta is a clinical-stage precision oncology company focused on the treatment and prevention of virus-associated cancers that impact patients worldwide. Viracta’s lead product candidate is an all-oral combination therapy of its proprietary investigational drug, nanatinostat, and the antiviral agent valganciclovir (collectively referred to as Nana-val). Nana-val is currently being evaluated in multiple ongoing clinical trials, including a pivotal, global, multicenter, open-label Phase 2 basket trial for the treatment of multiple subtypes of relapsed or refractory (R/R) Epstein-Barr virus-positive (EBV+) lymphoma (NAVAL-1), as well as a multinational, open-label Phase 1b/2 clinical trial for the treatment of patients with recurrent or metastatic (R/M) EBV+ nasopharyngeal carcinoma (NPC) and other advanced EBV+ solid tumors. Viracta is also pursuing the application of its “Kick and Kill” approach in other virus-related cancers. For additional information, please visit . Forward-Looking Statements This communication contains "forward-looking" statements within the meaning of the Private Securities Litigation Reform Act of 1995, including, without limitation, statements regarding: the details, timeline and expected progress for Viracta's ongoing and anticipated clinical trials and updates regarding the same, the Company’s expectations related to the FDA submission process and timelines and expectations regarding our target patient populations. Risks and uncertainties related to Viracta that may cause actual results to differ materially from those expressed or implied in any forward-looking statement include, but are not limited to: Viracta's ability to successfully enroll patients in and complete its ongoing and planned clinical trials; Viracta's plans to develop and commercialize its product candidates, including all oral combinations of nanatinostat and valganciclovir; the timing of initiation of Viracta's planned clinical trials; the timing of the availability of data from Viracta's clinical trials; previous preclinical and clinical results may not be predictive of future clinical results; the timing of any planned investigational new drug application or new drug application; Viracta's plans to research, develop, and commercialize its current and future product candidates and the clinical utility, potential benefits, and market acceptance of Viracta's product candidates; Viracta's ability to manufacture or supply nanatinostat, valganciclovir, and pembrolizumab for clinical testing. If any of these risks materialize or underlying assumptions prove incorrect, actual results could differ materially from the results implied by these forward-looking statements. Additional risks and uncertainties that could cause actual outcomes and results to differ materially from those contemplated by the forward-looking statements are included under the caption "Risk Factors" and elsewhere in Viracta's reports and other documents that Viracta has or will file, with the SEC from time to time and available at . The forward-looking statements included in this communication are made only as of the date hereof. Viracta assumes no obligation and does not intend to update these forward-looking statements, except as required by law or applicable regulation. Investor Relations Contact: Ashleigh Barreto Head of Investor Relations & Corporate Communications Viracta Therapeutics, Inc. abarreto@viracta.com SOURCE Viracta Therapeutics, Inc.