OX40 Is a Potent Immune-Stimulating Target in Late-Stage Cancer Patients
被引:395
作者:
Curti, Brendan D.
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Providence Portland Med Ctr, Robert W Franz Canc Res Ctr, Earle A Chiles Res Inst, Portland, OR 97213 USAProvidence Portland Med Ctr, Robert W Franz Canc Res Ctr, Earle A Chiles Res Inst, Portland, OR 97213 USA
Curti, Brendan D.
[1
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Kovacsovics-Bankowski, Magdalena
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Providence Portland Med Ctr, Robert W Franz Canc Res Ctr, Earle A Chiles Res Inst, Portland, OR 97213 USAProvidence Portland Med Ctr, Robert W Franz Canc Res Ctr, Earle A Chiles Res Inst, Portland, OR 97213 USA
Kovacsovics-Bankowski, Magdalena
[1
]
Morris, Nicholas
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Providence Portland Med Ctr, Robert W Franz Canc Res Ctr, Earle A Chiles Res Inst, Portland, OR 97213 USAProvidence Portland Med Ctr, Robert W Franz Canc Res Ctr, Earle A Chiles Res Inst, Portland, OR 97213 USA
Morris, Nicholas
[1
]
Walker, Edwin
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Providence Portland Med Ctr, Robert W Franz Canc Res Ctr, Earle A Chiles Res Inst, Portland, OR 97213 USAProvidence Portland Med Ctr, Robert W Franz Canc Res Ctr, Earle A Chiles Res Inst, Portland, OR 97213 USA
Walker, Edwin
[1
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Chisholm, Lana
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Providence Portland Med Ctr, Robert W Franz Canc Res Ctr, Earle A Chiles Res Inst, Portland, OR 97213 USAProvidence Portland Med Ctr, Robert W Franz Canc Res Ctr, Earle A Chiles Res Inst, Portland, OR 97213 USA
Chisholm, Lana
[1
]
Floyd, Kevin
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Providence Portland Med Ctr, Robert W Franz Canc Res Ctr, Earle A Chiles Res Inst, Portland, OR 97213 USAProvidence Portland Med Ctr, Robert W Franz Canc Res Ctr, Earle A Chiles Res Inst, Portland, OR 97213 USA
Floyd, Kevin
[1
]
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Walker, Joshua
[2
]
Gonzalez, Iliana
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Providence Portland Med Ctr, Robert W Franz Canc Res Ctr, Earle A Chiles Res Inst, Portland, OR 97213 USAProvidence Portland Med Ctr, Robert W Franz Canc Res Ctr, Earle A Chiles Res Inst, Portland, OR 97213 USA
Gonzalez, Iliana
[1
]
Meeuwsen, Tanisha
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Providence Portland Med Ctr, Robert W Franz Canc Res Ctr, Earle A Chiles Res Inst, Portland, OR 97213 USAProvidence Portland Med Ctr, Robert W Franz Canc Res Ctr, Earle A Chiles Res Inst, Portland, OR 97213 USA
Meeuwsen, Tanisha
[1
]
Fox, Bernard A.
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Providence Portland Med Ctr, Robert W Franz Canc Res Ctr, Earle A Chiles Res Inst, Portland, OR 97213 USAProvidence Portland Med Ctr, Robert W Franz Canc Res Ctr, Earle A Chiles Res Inst, Portland, OR 97213 USA
Fox, Bernard A.
[1
]
Moudgil, Tarsem
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Providence Portland Med Ctr, Robert W Franz Canc Res Ctr, Earle A Chiles Res Inst, Portland, OR 97213 USAProvidence Portland Med Ctr, Robert W Franz Canc Res Ctr, Earle A Chiles Res Inst, Portland, OR 97213 USA
Moudgil, Tarsem
[1
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Miller, William
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Providence Portland Med Ctr, Robert W Franz Canc Res Ctr, Earle A Chiles Res Inst, Portland, OR 97213 USAProvidence Portland Med Ctr, Robert W Franz Canc Res Ctr, Earle A Chiles Res Inst, Portland, OR 97213 USA
Miller, William
[1
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Haley, Daniel
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Providence Portland Med Ctr, Robert W Franz Canc Res Ctr, Earle A Chiles Res Inst, Portland, OR 97213 USAProvidence Portland Med Ctr, Robert W Franz Canc Res Ctr, Earle A Chiles Res Inst, Portland, OR 97213 USA
Haley, Daniel
[1
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Coffey, Todd
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Providence Portland Med Ctr, Robert W Franz Canc Res Ctr, Earle A Chiles Res Inst, Portland, OR 97213 USAProvidence Portland Med Ctr, Robert W Franz Canc Res Ctr, Earle A Chiles Res Inst, Portland, OR 97213 USA
Coffey, Todd
[1
]
Fisher, Brenda
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Providence Portland Med Ctr, Robert W Franz Canc Res Ctr, Earle A Chiles Res Inst, Portland, OR 97213 USAProvidence Portland Med Ctr, Robert W Franz Canc Res Ctr, Earle A Chiles Res Inst, Portland, OR 97213 USA
Fisher, Brenda
[1
]
Delanty-Miller, Laurie
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Providence Portland Med Ctr, Robert W Franz Canc Res Ctr, Earle A Chiles Res Inst, Portland, OR 97213 USAProvidence Portland Med Ctr, Robert W Franz Canc Res Ctr, Earle A Chiles Res Inst, Portland, OR 97213 USA
Delanty-Miller, Laurie
[1
]
Rymarchyk, Nicole
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Providence Portland Med Ctr, Robert W Franz Canc Res Ctr, Earle A Chiles Res Inst, Portland, OR 97213 USAProvidence Portland Med Ctr, Robert W Franz Canc Res Ctr, Earle A Chiles Res Inst, Portland, OR 97213 USA
Rymarchyk, Nicole
[1
]
Kelly, Tracy
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Providence Portland Med Ctr, Robert W Franz Canc Res Ctr, Earle A Chiles Res Inst, Portland, OR 97213 USAProvidence Portland Med Ctr, Robert W Franz Canc Res Ctr, Earle A Chiles Res Inst, Portland, OR 97213 USA
Kelly, Tracy
[1
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Crocenzi, Todd
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Providence Portland Med Ctr, Robert W Franz Canc Res Ctr, Earle A Chiles Res Inst, Portland, OR 97213 USAProvidence Portland Med Ctr, Robert W Franz Canc Res Ctr, Earle A Chiles Res Inst, Portland, OR 97213 USA
Crocenzi, Todd
[1
]
Bernstein, Eric
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Providence Portland Med Ctr, Robert W Franz Canc Res Ctr, Earle A Chiles Res Inst, Portland, OR 97213 USAProvidence Portland Med Ctr, Robert W Franz Canc Res Ctr, Earle A Chiles Res Inst, Portland, OR 97213 USA
Bernstein, Eric
[1
]
Sanborn, Rachel
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Providence Portland Med Ctr, Robert W Franz Canc Res Ctr, Earle A Chiles Res Inst, Portland, OR 97213 USAProvidence Portland Med Ctr, Robert W Franz Canc Res Ctr, Earle A Chiles Res Inst, Portland, OR 97213 USA
Sanborn, Rachel
[1
]
Urba, Walter J.
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Providence Portland Med Ctr, Robert W Franz Canc Res Ctr, Earle A Chiles Res Inst, Portland, OR 97213 USAProvidence Portland Med Ctr, Robert W Franz Canc Res Ctr, Earle A Chiles Res Inst, Portland, OR 97213 USA
Urba, Walter J.
[1
]
Weinberg, Andrew D.
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Providence Portland Med Ctr, Robert W Franz Canc Res Ctr, Earle A Chiles Res Inst, Portland, OR 97213 USAProvidence Portland Med Ctr, Robert W Franz Canc Res Ctr, Earle A Chiles Res Inst, Portland, OR 97213 USA
Weinberg, Andrew D.
[1
]
机构:
[1] Providence Portland Med Ctr, Robert W Franz Canc Res Ctr, Earle A Chiles Res Inst, Portland, OR 97213 USA
[2] Oregon Hlth & Sci Univ, Vaccine & Gene Therapy Inst, Beaverton, OR USA
OX40 is a potent costimulatory receptor that can potentiate T-cell receptor signaling on the surface of T lymphocytes, leading to their activation by a specifically recognized antigen. In particular, OX40 engagement by ligands present on dendritic cells dramatically increases the proliferation, effector function, and survival of T cells. Preclinical studies have shown that OX40 agonists increase antitumor immunity and improve tumor-free survival. In this study, we performed a phase I clinical trial using a mouse monoclonal antibody (mAb) that agonizes human OX40 signaling in patients with advanced cancer. Patients treated with one course of the anti-OX40 mAb showed an acceptable toxicity profile and regression of at least one metastatic lesion in 12 of 30 patients. Mechanistically, this treatment increased T and B cell responses to reporter antigen immunizations, led to preferential upregulation of OX40 on CD4(+) FoxP3(+) regulatory T cells in tumor-infiltrating lymphocytes, and increased the antitumor reactivity of T and B cells in patients with melanoma. Our findings clinically validate OX40 as a potent immune-stimulating target for treatment in patients with cancer, providing a generalizable tool to favorably influence the antitumor properties of circulating T cells, B cells, and intratumoral regulatory T cells. (C) 2013 AACR.
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Inst Oncol & Radiotherapy, Tel Hashomer, IsraelChaim Sheba Med Ctr, Div Hematol Bone Marrow Transplantat, IL-52621 Tel Hashomer, Israel
Berger, Raanan
;
Rotem-Yehudar, Rinat
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Curetech Ltd, Yavne, IsraelChaim Sheba Med Ctr, Div Hematol Bone Marrow Transplantat, IL-52621 Tel Hashomer, Israel
Rotem-Yehudar, Rinat
;
Slama, Gideon
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Curetech Ltd, Yavne, IsraelChaim Sheba Med Ctr, Div Hematol Bone Marrow Transplantat, IL-52621 Tel Hashomer, Israel
Slama, Gideon
;
Landes, Shimon
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机构:
Curetech Ltd, Yavne, IsraelChaim Sheba Med Ctr, Div Hematol Bone Marrow Transplantat, IL-52621 Tel Hashomer, Israel
Landes, Shimon
;
Kneller, Abraham
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Chaim Sheba Med Ctr, Div Hematol Bone Marrow Transplantat, IL-52621 Tel Hashomer, IsraelChaim Sheba Med Ctr, Div Hematol Bone Marrow Transplantat, IL-52621 Tel Hashomer, Israel
Kneller, Abraham
;
Leiba, Merav
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Chaim Sheba Med Ctr, Div Hematol Bone Marrow Transplantat, IL-52621 Tel Hashomer, IsraelChaim Sheba Med Ctr, Div Hematol Bone Marrow Transplantat, IL-52621 Tel Hashomer, Israel
Leiba, Merav
;
Koren-Michowitz, Maya
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Chaim Sheba Med Ctr, Div Hematol Bone Marrow Transplantat, IL-52621 Tel Hashomer, IsraelChaim Sheba Med Ctr, Div Hematol Bone Marrow Transplantat, IL-52621 Tel Hashomer, Israel
Koren-Michowitz, Maya
;
Shimoni, Avichai
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Chaim Sheba Med Ctr, Div Hematol Bone Marrow Transplantat, IL-52621 Tel Hashomer, IsraelChaim Sheba Med Ctr, Div Hematol Bone Marrow Transplantat, IL-52621 Tel Hashomer, Israel
Shimoni, Avichai
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Nagler, Arnon
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Chaim Sheba Med Ctr, Div Hematol Bone Marrow Transplantat, IL-52621 Tel Hashomer, IsraelChaim Sheba Med Ctr, Div Hematol Bone Marrow Transplantat, IL-52621 Tel Hashomer, Israel
机构:
Univ Washington, Seattle, WA 98195 USA
Seattle Canc Care Alliance, Fred Hutchinson Canc Res Ctr, Seattle, WA USASidney Kimmel Comprehens Canc Ctr, Baltimore, MD 21231 USA
Chow, Laura Q. M.
;
Hwu, Wen-Jen
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Univ Texas MD Anderson Canc Ctr, Houston, TX 77030 USASidney Kimmel Comprehens Canc Ctr, Baltimore, MD 21231 USA
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St Lukes Episcopal Hosp, Ctr Canc, Houston, TX 77030 USASidney Kimmel Comprehens Canc Ctr, Baltimore, MD 21231 USA
Camacho, Luis H.
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Kauh, John
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Emory Univ, Winship Canc Inst, Atlanta, GA 30322 USASidney Kimmel Comprehens Canc Ctr, Baltimore, MD 21231 USA
Kauh, John
;
Odunsi, Kunle
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Roswell Pk Canc Inst, Buffalo, NY 14263 USASidney Kimmel Comprehens Canc Ctr, Baltimore, MD 21231 USA
Odunsi, Kunle
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Pitot, Henry C.
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Mayo Clin, Coll Med, Rochester, MN USASidney Kimmel Comprehens Canc Ctr, Baltimore, MD 21231 USA
Pitot, Henry C.
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Hamid, Omid
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Angeles Clin, Santa Monica, CA USASidney Kimmel Comprehens Canc Ctr, Baltimore, MD 21231 USA
Hamid, Omid
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Bhatia, Shailender
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Martins, Renato
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Univ Washington, Seattle, WA 98195 USA
Seattle Canc Care Alliance, Fred Hutchinson Canc Res Ctr, Seattle, WA USASidney Kimmel Comprehens Canc Ctr, Baltimore, MD 21231 USA
Martins, Renato
;
Eaton, Keith
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Univ Washington, Seattle, WA 98195 USA
Seattle Canc Care Alliance, Fred Hutchinson Canc Res Ctr, Seattle, WA USASidney Kimmel Comprehens Canc Ctr, Baltimore, MD 21231 USA
机构:
Inst Res Biomed, CH-6500 Bellinzona, SwitzerlandGarvan Inst Med Res, Program Immunol, Sydney, NSW 2010, Australia
Jarrossay, David
;
Ho, Edwin
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Garvan Inst Med Res, Program Immunol, Sydney, NSW 2010, AustraliaGarvan Inst Med Res, Program Immunol, Sydney, NSW 2010, Australia
Ho, Edwin
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Avery, Danielle T.
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Garvan Inst Med Res, Program Immunol, Sydney, NSW 2010, AustraliaGarvan Inst Med Res, Program Immunol, Sydney, NSW 2010, Australia
Avery, Danielle T.
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Ma, Cindy S.
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Garvan Inst Med Res, Program Immunol, Sydney, NSW 2010, AustraliaGarvan Inst Med Res, Program Immunol, Sydney, NSW 2010, Australia
Ma, Cindy S.
;
Yu, Di
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机构:
Monash Univ, Sch Biomed Sci, Fac Med Nursing & Hlth Serv, Dept Immunol Clayton, Clayton, Vic 3800, AustraliaGarvan Inst Med Res, Program Immunol, Sydney, NSW 2010, Australia
Yu, Di
;
Sallusto, Federica
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Inst Res Biomed, CH-6500 Bellinzona, SwitzerlandGarvan Inst Med Res, Program Immunol, Sydney, NSW 2010, Australia
Sallusto, Federica
;
Tangye, Stuart G.
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Garvan Inst Med Res, Program Immunol, Sydney, NSW 2010, Australia
St Vincents Hosp, St Vincents Clin Sch, Darlinghurst, NSW 2010, AustraliaGarvan Inst Med Res, Program Immunol, Sydney, NSW 2010, Australia
Tangye, Stuart G.
;
Mackay, Charles R.
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Monash Univ, Sch Biomed Sci, Fac Med Nursing & Hlth Serv, Dept Immunol Clayton, Clayton, Vic 3800, AustraliaGarvan Inst Med Res, Program Immunol, Sydney, NSW 2010, Australia
机构:
Mem Sloan Kettering Canc Ctr, Dept Immunol, Howard Hughes Med Inst, New York, NY 10065 USAMem Sloan Kettering Canc Ctr, Dept Immunol, Howard Hughes Med Inst, New York, NY 10065 USA
Curran, Michael A.
;
Montalvo, Welby
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Mem Sloan Kettering Canc Ctr, Dept Immunol, Howard Hughes Med Inst, New York, NY 10065 USAMem Sloan Kettering Canc Ctr, Dept Immunol, Howard Hughes Med Inst, New York, NY 10065 USA
Montalvo, Welby
;
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Yagita, Hideo
;
Allison, James P.
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Mem Sloan Kettering Canc Ctr, Dept Immunol, Howard Hughes Med Inst, New York, NY 10065 USAMem Sloan Kettering Canc Ctr, Dept Immunol, Howard Hughes Med Inst, New York, NY 10065 USA
机构:
Inst Oncol & Radiotherapy, Tel Hashomer, IsraelChaim Sheba Med Ctr, Div Hematol Bone Marrow Transplantat, IL-52621 Tel Hashomer, Israel
Berger, Raanan
;
Rotem-Yehudar, Rinat
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机构:
Curetech Ltd, Yavne, IsraelChaim Sheba Med Ctr, Div Hematol Bone Marrow Transplantat, IL-52621 Tel Hashomer, Israel
Rotem-Yehudar, Rinat
;
Slama, Gideon
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h-index: 0
机构:
Curetech Ltd, Yavne, IsraelChaim Sheba Med Ctr, Div Hematol Bone Marrow Transplantat, IL-52621 Tel Hashomer, Israel
Slama, Gideon
;
Landes, Shimon
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h-index: 0
机构:
Curetech Ltd, Yavne, IsraelChaim Sheba Med Ctr, Div Hematol Bone Marrow Transplantat, IL-52621 Tel Hashomer, Israel
Landes, Shimon
;
Kneller, Abraham
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h-index: 0
机构:
Chaim Sheba Med Ctr, Div Hematol Bone Marrow Transplantat, IL-52621 Tel Hashomer, IsraelChaim Sheba Med Ctr, Div Hematol Bone Marrow Transplantat, IL-52621 Tel Hashomer, Israel
Kneller, Abraham
;
Leiba, Merav
论文数: 0引用数: 0
h-index: 0
机构:
Chaim Sheba Med Ctr, Div Hematol Bone Marrow Transplantat, IL-52621 Tel Hashomer, IsraelChaim Sheba Med Ctr, Div Hematol Bone Marrow Transplantat, IL-52621 Tel Hashomer, Israel
Leiba, Merav
;
Koren-Michowitz, Maya
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Chaim Sheba Med Ctr, Div Hematol Bone Marrow Transplantat, IL-52621 Tel Hashomer, IsraelChaim Sheba Med Ctr, Div Hematol Bone Marrow Transplantat, IL-52621 Tel Hashomer, Israel
Koren-Michowitz, Maya
;
Shimoni, Avichai
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Chaim Sheba Med Ctr, Div Hematol Bone Marrow Transplantat, IL-52621 Tel Hashomer, IsraelChaim Sheba Med Ctr, Div Hematol Bone Marrow Transplantat, IL-52621 Tel Hashomer, Israel
Shimoni, Avichai
;
Nagler, Arnon
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Chaim Sheba Med Ctr, Div Hematol Bone Marrow Transplantat, IL-52621 Tel Hashomer, IsraelChaim Sheba Med Ctr, Div Hematol Bone Marrow Transplantat, IL-52621 Tel Hashomer, Israel
机构:
Univ Washington, Seattle, WA 98195 USA
Seattle Canc Care Alliance, Fred Hutchinson Canc Res Ctr, Seattle, WA USASidney Kimmel Comprehens Canc Ctr, Baltimore, MD 21231 USA
Chow, Laura Q. M.
;
Hwu, Wen-Jen
论文数: 0引用数: 0
h-index: 0
机构:
Univ Texas MD Anderson Canc Ctr, Houston, TX 77030 USASidney Kimmel Comprehens Canc Ctr, Baltimore, MD 21231 USA
机构:
St Lukes Episcopal Hosp, Ctr Canc, Houston, TX 77030 USASidney Kimmel Comprehens Canc Ctr, Baltimore, MD 21231 USA
Camacho, Luis H.
;
Kauh, John
论文数: 0引用数: 0
h-index: 0
机构:
Emory Univ, Winship Canc Inst, Atlanta, GA 30322 USASidney Kimmel Comprehens Canc Ctr, Baltimore, MD 21231 USA
Kauh, John
;
Odunsi, Kunle
论文数: 0引用数: 0
h-index: 0
机构:
Roswell Pk Canc Inst, Buffalo, NY 14263 USASidney Kimmel Comprehens Canc Ctr, Baltimore, MD 21231 USA
Odunsi, Kunle
;
Pitot, Henry C.
论文数: 0引用数: 0
h-index: 0
机构:
Mayo Clin, Coll Med, Rochester, MN USASidney Kimmel Comprehens Canc Ctr, Baltimore, MD 21231 USA
Pitot, Henry C.
;
Hamid, Omid
论文数: 0引用数: 0
h-index: 0
机构:
Angeles Clin, Santa Monica, CA USASidney Kimmel Comprehens Canc Ctr, Baltimore, MD 21231 USA
Hamid, Omid
;
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机构:
Bhatia, Shailender
;
Martins, Renato
论文数: 0引用数: 0
h-index: 0
机构:
Univ Washington, Seattle, WA 98195 USA
Seattle Canc Care Alliance, Fred Hutchinson Canc Res Ctr, Seattle, WA USASidney Kimmel Comprehens Canc Ctr, Baltimore, MD 21231 USA
Martins, Renato
;
Eaton, Keith
论文数: 0引用数: 0
h-index: 0
机构:
Univ Washington, Seattle, WA 98195 USA
Seattle Canc Care Alliance, Fred Hutchinson Canc Res Ctr, Seattle, WA USASidney Kimmel Comprehens Canc Ctr, Baltimore, MD 21231 USA
机构:
Inst Res Biomed, CH-6500 Bellinzona, SwitzerlandGarvan Inst Med Res, Program Immunol, Sydney, NSW 2010, Australia
Jarrossay, David
;
Ho, Edwin
论文数: 0引用数: 0
h-index: 0
机构:
Garvan Inst Med Res, Program Immunol, Sydney, NSW 2010, AustraliaGarvan Inst Med Res, Program Immunol, Sydney, NSW 2010, Australia
Ho, Edwin
;
Avery, Danielle T.
论文数: 0引用数: 0
h-index: 0
机构:
Garvan Inst Med Res, Program Immunol, Sydney, NSW 2010, AustraliaGarvan Inst Med Res, Program Immunol, Sydney, NSW 2010, Australia
Avery, Danielle T.
;
Ma, Cindy S.
论文数: 0引用数: 0
h-index: 0
机构:
Garvan Inst Med Res, Program Immunol, Sydney, NSW 2010, AustraliaGarvan Inst Med Res, Program Immunol, Sydney, NSW 2010, Australia
Ma, Cindy S.
;
Yu, Di
论文数: 0引用数: 0
h-index: 0
机构:
Monash Univ, Sch Biomed Sci, Fac Med Nursing & Hlth Serv, Dept Immunol Clayton, Clayton, Vic 3800, AustraliaGarvan Inst Med Res, Program Immunol, Sydney, NSW 2010, Australia
Yu, Di
;
Sallusto, Federica
论文数: 0引用数: 0
h-index: 0
机构:
Inst Res Biomed, CH-6500 Bellinzona, SwitzerlandGarvan Inst Med Res, Program Immunol, Sydney, NSW 2010, Australia
Sallusto, Federica
;
Tangye, Stuart G.
论文数: 0引用数: 0
h-index: 0
机构:
Garvan Inst Med Res, Program Immunol, Sydney, NSW 2010, Australia
St Vincents Hosp, St Vincents Clin Sch, Darlinghurst, NSW 2010, AustraliaGarvan Inst Med Res, Program Immunol, Sydney, NSW 2010, Australia
Tangye, Stuart G.
;
Mackay, Charles R.
论文数: 0引用数: 0
h-index: 0
机构:
Monash Univ, Sch Biomed Sci, Fac Med Nursing & Hlth Serv, Dept Immunol Clayton, Clayton, Vic 3800, AustraliaGarvan Inst Med Res, Program Immunol, Sydney, NSW 2010, Australia
机构:
Mem Sloan Kettering Canc Ctr, Dept Immunol, Howard Hughes Med Inst, New York, NY 10065 USAMem Sloan Kettering Canc Ctr, Dept Immunol, Howard Hughes Med Inst, New York, NY 10065 USA
Curran, Michael A.
;
Montalvo, Welby
论文数: 0引用数: 0
h-index: 0
机构:
Mem Sloan Kettering Canc Ctr, Dept Immunol, Howard Hughes Med Inst, New York, NY 10065 USAMem Sloan Kettering Canc Ctr, Dept Immunol, Howard Hughes Med Inst, New York, NY 10065 USA
Montalvo, Welby
;
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机构:
Yagita, Hideo
;
Allison, James P.
论文数: 0引用数: 0
h-index: 0
机构:
Mem Sloan Kettering Canc Ctr, Dept Immunol, Howard Hughes Med Inst, New York, NY 10065 USAMem Sloan Kettering Canc Ctr, Dept Immunol, Howard Hughes Med Inst, New York, NY 10065 USA