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Dinh L, Savjani RR, Lauria M, Valle L, Hegde JV, Chin RK, Qi X. Potential Dosimetric Predictors of Patient-Reported Quality of Life for Head and Neck Cancer Following Chemoradiation IMRT. Int J Radiat Oncol Biol Phys 2023; 117:e660-e661. [PMID: 37785957 DOI: 10.1016/j.ijrobp.2023.06.2096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) This study aims to identify both acute and late patient patient-reported salivary quality of life outcomes in patients with head and neck cancer treated with chemoradiation therapy on a prospective trial. MATERIALS/METHODS A cohort of 40 patients with head and neck cancers were included in the study. All patients underwent concurrent chemoradiation therapy using IMRT delivery (1 patient on one Linac, 24 patients on a different Linac, and 15 on a helical delivery machine). All patients were asked to complete the University of Washington Quality of Life (UOW-QOL) questionnaire at baseline, immediately after treatment, as well as at 1 month, 3 months, 6 months, 12 month and 18 months post-treatment. For the salivary quality of life (QOL) outcome scores, the possible responses were scored on a discreet scale of 100, 70, 30, and 0, with 100 as normal and 0 as dysfunctional. Dosimetric endpoints achieved based on the treatment plan, such as maximum/mean/minimum doses, V30 (percent volume receiving 30 Gy dose), and Dy (dose received to y percent volume) were collected for the bilateral salivary glands, bilateral temporomandibular joint and bilateral submandibular glands. The associations between these dosimetric parameters and the corresponding salivary QOL scores at each time point were analyzed. A Wilcoxon test was performed to identify any differences in the dosimetry and salivary QOL scores among the four different responses. RESULTS At short-term follow-up including 1- and 6-month, the distribution of the mean dose received by the right parotid was significantly different between the patients that reported a salivary QOL score of 30 and those that reported 100, with p-values of 0.007 for the 1-month comparison and 0.006 for the 6-month comparison. This was also seen for the V30, with p-values of 0.027 for the 1-month comparison and 0.013 for the 6-month comparison. At 3 months, the maximum dose received by the left temporomandibular joint was significantly different between the patients that reported 30 and those that reported 70, with a p-value of 0.038. At 6 months, the average dose distribution of the right submandibular gland received between the patients that reported a score of 30 and 100 was also significantly different, with a p-value of 0.006. At the long-term follow-up time points of 12 and 18 months, no significant differences were found. CONCLUSION The significant differences seen in the data suggest that the dosimetry may have effects on patient reported salivary QOL at short-term follow-up but not long-term. This provides a new perspective into how a patient's QOL over a period of time could be affected by the amount of dose to critical organs. These results also serve as the basis for further investigation into the actual delivered dose, which could differ from the planned dose due to daily anatomic changes over the course of head and neck radiotherapy delivery. These daily volumetric and dosimetric changes may guide early adaptive treatment to improve patient-reported QOL outcomes.
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Courtney PT, Casillas JEJ, Chau LW, Kabarame L, Pascual A, Steinberg ML, Savjani RR, Chin RK. Use of Postoperative PET/CT in Altering Management in Adjuvant Head and Neck Radiation Therapy. Int J Radiat Oncol Biol Phys 2023; 117:e575. [PMID: 37785751 DOI: 10.1016/j.ijrobp.2023.06.1910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Routine clinical practice does not include postoperative positron emission tomography (PET)/CT prior to postoperative radiation therapy (PORT) for head and neck cancer. Besides logistical challenges in obtaining postoperative PET/CT within six weeks after surgery, interpreting PET/CT findings in the postoperative setting can also be difficult. However, given the potential for residual or rapidly recurrent disease, postoperative PET/CT may help identify the need for additional diagnostic evaluation or alter adjuvant therapy. There are limited data evaluating the utility of postoperative PET/CT prior to PORT for head and neck cancer. We sought to evaluate the use and clinical relevance of postoperative PET/CT prior to PORT. MATERIALS/METHODS In this retrospective, single-institution cohort study, we identified patients with head and neck cancer between 2013 and 2020 who received a postoperative PET/CT prior to PORT. We extracted electronic medical record data supplemented with manual chart review to collect patient and disease-related information. We measured the rates of additional diagnostic workup and treatment alterations as a result of postoperative PET/CT findings. RESULTS The cohort included 29 patients who received a postoperative PET/CT prior to PORT. The mean age at diagnosis was 60.8 years (standard deviation: 15.0 years) and 20 (69.0%) were male. Regarding primary site, 10 (34.5%) were oropharynx, 7 (24.1%) were salivary gland, and 6 (20.7%) were oral cavity. The mean time from surgery to postoperative PET was 40.9 days (standard deviation: 27.7 days), and the mean time from postoperative PET/CT to start of PORT was 22.4 days (standard deviation: 20.3 days). A total of 9 (31.0%) patients experienced a change in management as a result of the PET/CT findings. Six (66.7%) patients received a biopsy. All 9 patients had a change in their radiation treatment plan, either dose escalation, target change, or in one case, converting to palliative dosing. Six (66.7%) patients were recommended addition of chemotherapy as a result of additional workup, with 4 (44.4%) of those patients ultimately receiving chemotherapy. Three (33.3%) patients underwent re-resection prior to PORT. CONCLUSION In patients with head and neck cancer who received postoperative PET/CT prior to PORT, a meaningful proportion underwent additional diagnostic evaluation and/or experienced an alteration in adjuvant therapy as a result of the imaging findings. Interestingly, all patients with abnormal postoperative PET findings had changes in their radiation treatment plan, including at least boosting gross disease for patients in whom re-resection or chemotherapy was not pursued. Future work will seek to expand this cohort through 2022 when postoperative PET/CT became more routine at our institution and include oncologic outcomes. Additional studies are needed to identify appropriate candidates for postoperative PET/CT and determine the clinical impact of postoperative PET/CT.
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Ma TM, Wong DJ, Chai-Ho W, Mendelsohn A, St John M, Abemayor E, Chhetri D, Sajed D, Dang A, Chu FI, Xiang M, Savjanji R, Weidhaas J, Steinberg ML, Cao M, Kishan AU, Chin RK. High Recurrence for HPV-Positive Oropharyngeal Cancer With Neoadjuvant Radiation Therapy to Gross Disease Plus Immunotherapy: Analysis From a Prospective Phase Ib/II Clinical Trial. Int J Radiat Oncol Biol Phys 2023; 117:348-354. [PMID: 37141981 DOI: 10.1016/j.ijrobp.2023.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 04/18/2023] [Accepted: 04/25/2023] [Indexed: 05/06/2023]
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Pan X, Feng T, Liu C, Savjani RR, Chin RK, Sharon Qi X. A survival prediction model via interpretable machine learning for patients with oropharyngeal cancer following radiotherapy. J Cancer Res Clin Oncol 2023; 149:6813-6825. [PMID: 36807760 DOI: 10.1007/s00432-023-04644-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 02/08/2023] [Indexed: 02/21/2023]
Abstract
PURPOSE To explore interpretable machine learning (ML) methods, with the hope of adding more prognosis value, for predicting survival for patients with Oropharyngeal-Cancer (OPC). METHODS A cohort of 427 OPC patients (Training 341, Test 86) from TCIA database was analyzed. Radiomic features of gross-tumor-volume (GTV) extracted from planning CT using Pyradiomics, and HPV p16 status, etc. patient characteristics were considered as potential predictors. A multi-level dimension reduction algorithm consisting of Least-Absolute-Selection-Operator (Lasso) and Sequential-Floating-Backward-Selection (SFBS) was proposed to effectively remove redundant/irrelevant features. The interpretable model was constructed by quantifying the contribution of each feature to the Extreme-Gradient-Boosting (XGBoost) decision by Shapley-Additive-exPlanations (SHAP) algorithm. RESULTS The Lasso-SFBS algorithm proposed in this study finally selected 14 features, and our prediction model achieved an area-under-ROC-curve (AUC) of 0.85 on the test dataset based on this feature set. The ranking of the contribution values calculated by SHAP shows that the top predictors that were most correlated with survival were ECOG performance status, wavelet-LLH_firstorder_Mean, chemotherapy, wavelet-LHL_glcm_InverseVariance, tumor size. Those patients who had chemotherapy, with positive HPV p16 status, and lower ECOG performance status, tended to have higher SHAP scores and longer survival; who had an older age at diagnosis, heavy drinking and smoking pack year history, tended to lower SHAP scores and shorter survival. CONCLUSION We demonstrated predictive values of combined patient characteristics and imaging features for the overall survival of OPC patients. The multi-level dimension reduction algorithm can reliably identify the most plausible predictors that are mostly associated with overall survival. The interpretable patient-specific survival prediction model, capturing correlations of each predictor and clinical outcome, was developed to facilitate clinical decision-making for personalized treatment.
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Woods KE, Ma TM, Cook KA, Morris ED, Gao Y, Sheng K, Kishan AU, Hegde JV, Felix C, Basehart V, Narahara K, Shen Z, Tenn S, Steinberg ML, Chin RK, Cao M. A Prospective Phase II Study of Automated Non-Coplanar VMAT for Recurrent Head and Neck Cancer: Initial Report of Feasibility, Safety, and Patient-Reported Outcomes. Cancers (Basel) 2022; 14:cancers14040939. [PMID: 35205686 PMCID: PMC8870161 DOI: 10.3390/cancers14040939] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/07/2022] [Accepted: 02/09/2022] [Indexed: 02/06/2023] Open
Abstract
Simple Summary The delivery of higher radiation doses has been shown to increase local control, and ultimately survival, for head and neck cancer patients, but highly conformal dose distributions are necessary to minimize normal tissue toxicity. Varian’s HyperArc non-coplanar automated treatment planning and delivery technique has been shown to improve dose conformity for intracranial treatment, but its safety and efficacy for head and neck cancer treatment has yet to be verified. This study evaluates the initial results of a prospective clinical trial using HyperArc for recurrent head and neck cancer patients. We demonstrated that HyperArc can enable significant tumor dose escalation compared to conventional volumetric modulated arc therapy (VMAT) planning while minimizing the dose to organs at risk. Treatment delivery was feasible and safe, with minimal treatment-related toxicities and positive patient-reported quality of life measures. Abstract This study reports the initial results for the first 15 patients on a prospective phase II clinical trial exploring the safety, feasibility, and efficacy of the HyperArc technique for recurrent head and neck cancer treatment. Eligible patients were simulated and planned with both conventional VMAT and HyperArc techniques and the plan with superior dosimetry was selected for treatment. Dosimetry, delivery feasibility and safety, treatment-related toxicity, and patient-reported quality of life (QOL) were all evaluated. HyperArc was chosen over conventional VMAT for all 15 patients and enabled statistically significant increases in dose conformity (R50% reduced by 1.2 ± 2.1, p < 0.05) and mean PTV and GTV doses (by 15.7 ± 4.9 Gy, p < 0.01 and 17.1 ± 6.0 Gy, p < 0.01, respectively). The average HyperArc delivery was 2.8 min longer than conventional VMAT (p < 0.01), and the mean intrafraction motion was ≤ 0.5 ± 0.4 mm and ≤0.3 ± 0.1°. With a median follow-up of 12 months, treatment-related toxicity was minimal (only one grade 3 acute toxicity above baseline) and patient-reported QOL metrics were favorable. HyperArc enabled superior dosimetry and significant target dose escalation compared to conventional VMAT planning, and treatment delivery was feasible, safe, and well-tolerated by patients.
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Weidhaas J, Marco N, Scheffler AW, Kalbasi A, Wilenius K, Rietdorf E, Gill J, Heilig M, Desler C, Chin RK, Kaprealian T, McCloskey S, Raldow A, Raja NP, Kesari S, Carrillo J, Drakaki A, Scholz M, Telesca D. Germline biomarkers predict toxicity to anti-PD1/PDL1 checkpoint therapy. J Immunother Cancer 2022; 10:jitc-2021-003625. [PMID: 35115362 PMCID: PMC8804679 DOI: 10.1136/jitc-2021-003625] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND There is great interest in finding ways to identify patients who will develop toxicity to cancer therapies. This has become especially pressing in the era of immune therapy, where toxicity can be long-lasting and life-altering, and primarily comes in the form of immune-related adverse effects (irAEs). Treatment with the first drugs in this class, anti-programmed death 1 (anti-PD1)/programmed death-ligand 1 (PDL1) checkpoint therapies, results in grade 2 or higher irAEs in up to 25%-30% of patients, which occur most commonly within the first 6 months of treatment and can include arthralgias, rash, pruritus, pneumonitis, diarrhea and/or colitis, hepatitis, and endocrinopathies. We tested the hypothesis that germline microRNA pathway functional variants, known to predict altered systemic stress responses to cancer therapies, would predict irAEs in patients across cancer types. METHODS MicroRNA pathway variants were evaluated for an association with grade 2 or higher toxicity using four classifiers on 62 patients with melanoma, and then the panel's performance was validated on 99 patients with other cancer types. Trained classifiers included classification trees, LASSO-regularized logistic regression, boosted trees, and random forests. Final performance measures were reported on the training set using leave-one-out cross validation and validated on held-out samples. The predicted probability of toxicity was evaluated for its association, if any, with response categories to anti-PD1/PDL1 therapy in the melanoma cohort. RESULTS A biomarker panel was identified that predicts toxicity with 80% accuracy (F1=0.76, area under the curve (AUC)=0.82) in the melanoma training cohort and 77.6% accuracy (F1=0.621, AUC=0.778) in the pan-cancer validation cohort. In the melanoma cohort, the predictive probability of toxicity was not associated with response categories to anti-PD1/PDL1 therapy (p=0.70). In the same cohort, the most significant biomarker of toxicity in RAC1, predicting a greater than ninefold increased risk of toxicity (p<0.001), was also not associated with response to anti-PD1/PDL1 therapy (p=0.151). CONCLUSIONS A germline microRNA-based biomarker signature predicts grade 2 and higher irAEs to anti-PD1/PDL1 therapy, regardless of tumor type, in a pan-cancer manner. These findings represent an important step toward personalizing checkpoint therapy, the use of which is growing rapidly.
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McKenzie EM, Tong N, Ruan D, Cao M, Chin RK, Sheng K. Using neural networks to extend cropped medical images for deformable registration among images with differing scan extents. Med Phys 2021; 48:4459-4471. [PMID: 34101198 DOI: 10.1002/mp.15039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/07/2021] [Accepted: 05/27/2021] [Indexed: 11/11/2022] Open
Abstract
PURPOSE Missing or discrepant imaging volume is a common challenge in deformable image registration (DIR). To minimize the adverse impact, we train a neural network to synthesize cropped portions of head and neck CT's and then test its use in DIR. METHODS Using a training dataset of 409 head and neck CT's, we trained a generative adversarial network to take in a cropped 3D image and output an image with synthesized anatomy in the cropped region. The network used a 3D U-Net generator along with Visual Geometry Group (VGG) deep feature losses. To test our technique, for each of the 53 test volumes, we used Elastix to deformably register combinations of a randomly cropped, full, and synthetically full volume to a single cropped, full, and synthetically full target volume. We additionally tested our method's robustness to crop extent by progressively increasing the amount of cropping, synthesizing the missing anatomy using our network, and then performing the same registration combinations. Registration performance was measured using 95% Hausdorff distance across 16 contours. RESULTS We successfully trained a network to synthesize missing anatomy in superiorly and inferiorly cropped images. The network can estimate large regions in an incomplete image, far from the cropping boundary. Registration using our estimated full images was not significantly different from registration using the original full images. The average contour matching error for full image registration was 9.9 mm, whereas our method was 11.6, 12.1, and 13.6 mm for synthesized-to-full, full-to-synthesized, and synthesized-to-synthesized registrations, respectively. In comparison, registration using the cropped images had errors of 31.7 mm and higher. Plotting the registered image contour error as a function of initial preregistered error shows that our method is robust to registration difficulty. Synthesized-to-full registration was statistically independent of cropping extent up to 18.7 cm superiorly cropped. Synthesized-to-synthesized registration was nearly independent, with a -0.04 mm of change in average contour error for every additional millimeter of cropping. CONCLUSIONS Different or inadequate in scan extent is a major cause of DIR inaccuracies. We address this challenge by training a neural network to complete cropped 3D images. We show that with image completion, the source of DIR inaccuracy is eliminated, and the method is robust to varying crop extent.
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Neylon J, Cook KA, Yang Y, Du D, Sheng K, Chin RK, Kishan AU, Lamb JM, Low DA, Cao M. Clinical assessment of geometric distortion for a 0.35T MR-guided radiotherapy system. J Appl Clin Med Phys 2021; 22:303-309. [PMID: 34231963 PMCID: PMC8364259 DOI: 10.1002/acm2.13340] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Purpose To estimate the overall spatial distortion on clinical patient images for a 0.35 T MR‐guided radiotherapy system. Methods Ten patients with head‐and‐neck cancer underwent CT and MR simulations with identical immobilization. The MR images underwent the standard systematic distortion correction post‐processing. The images were rigidly registered and landmark‐based analysis was performed by an anatomical expert. Distortion was quantified using Euclidean distance between each landmark pair and tagged by tissue interface: bone‐tissue, soft tissue, or air‐tissue. For baseline comparisons, an anthropomorphic phantom was imaged and analyzed. Results The average spatial discrepancy between CT and MR landmarks was 1.15 ± 1.14 mm for the phantom and 1.46 ± 1.78 mm for patients. The error histogram peaked at 0–1 mm. 66% of the discrepancies were <2 mm and 51% <1 mm. In the patient data, statistically significant differences (p‐values < 0.0001) were found between the different tissue interfaces with averages of 0.88 ± 1.24 mm, 2.01 ± 2.20 mm, and 1.41 ± 1.56 mm for the air/tissue, bone/tissue, and soft tissue, respectively. The distortion generally correlated with the in‐plane radial distance from the image center along the longitudinal axis of the MR. Conclusion Spatial distortion remains in the MR images after systematic distortion corrections. Although the average errors were relatively small, large distortions observed at bone/tissue interfaces emphasize the need for quantitative methods for assessing and correcting patient‐specific spatial distortions.
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Woods K, Chin RK, Cook KA, Sheng K, Kishan AU, Hegde JV, Tenn S, Steinberg ML, Cao M. Automated Non-Coplanar VMAT for Dose Escalation in Recurrent Head and Neck Cancer Patients. Cancers (Basel) 2021; 13:cancers13081910. [PMID: 33921062 PMCID: PMC8071369 DOI: 10.3390/cancers13081910] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/05/2021] [Accepted: 04/12/2021] [Indexed: 11/29/2022] Open
Abstract
Simple Summary The ability to escalate the radiation dose to head and neck tumors has been shown to offer improved local control, and consequently, survival for recurrent head and neck cancer (rHNC) patients. This study evaluates the HyperArc automated non-coplanar planning technique (originally developed for intracranial treatment) for 20 rHNC patients, and compares this technique to conventional planning methods. HyperArc enables significant tumor dose escalation, with average increases in mean target dose of over 11.5 Gy (26%), while maintaining clinically-equivalent doses to nearby organs. Our results show that the average probability of tumor control is 23% higher for HyperArc than conventional techniques. Abstract This study evaluates the potential for tumor dose escalation in recurrent head and neck cancer (rHNC) patients with automated non-coplanar volumetric modulated arc therapy (VMAT) stereotactic body radiation therapy (SBRT) planning (HyperArc). Twenty rHNC patients are planned with conventional VMAT SBRT to 40 Gy while minimizing organ-at-risk (OAR) doses. They are then re-planned with the HyperArc technique to match these minimal OAR doses while escalating the target dose as high as possible. Then, we compare the dosimetry, tumor control probability (TCP), and normal tissue complication probability (NTCP) for the two plan types. Our results show that the HyperArc technique significantly increases the mean planning target volume (PTV) and gross tumor volume (GTV) doses by 10.8 ± 4.4 Gy (25%) and 11.5 ± 5.1 Gy (26%) on average, respectively. There are no clinically significant differences in OAR doses, with maximum dose differences of <2 Gy on average. The average TCP is 23% (± 21%) higher for HyperArc than conventional plans, with no significant differences in NTCP for the brainstem, cord, mandible, or larynx. HyperArc can achieve significant tumor dose escalation while maintaining minimal OAR doses in the head and neck—potentially enabling improved local control for rHNC SBRT patients without increased risk of treatment-related toxicities.
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Qi XS, Chu FI, Zhang Z, Chin RK, Raldow A, Kishan AU, Lee P, Chang A, Kalbasi A, Kamrava M, Steinberg ML, Low DA. Clinical Development and Evaluation of Megavoltage Topogram for Fast Patient Alignment on Helical Tomotherapy. Adv Radiat Oncol 2020; 5:1334-1341. [PMID: 33305096 PMCID: PMC7718556 DOI: 10.1016/j.adro.2020.05.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 05/16/2020] [Accepted: 05/25/2020] [Indexed: 11/19/2022] Open
Abstract
Purpose To develop and evaluate a fast patient localization tool using megavoltage (MV)-topogram on helical tomotherapy. Methods and Materials Eighty-one MV-topogram pairs for 18 pelvis patients undergoing radiation were acquired weekly under an institutional review board–approved clinical trial. The MV-topogram imaging protocol requires 2 orthogonal acquisitions at static gantry angles of 0 degrees and 90 degrees for a programed scan length. A MATLAB based in-house software was developed to reconstruct the MV-topograms offline. Reference images (digitally reconstructed topograms, digitally reconstructed topograms) were generated using the planning computed tomography and tomotherapy geometry. The MV-topogram based alignment was determined by registering the MV-topograms to the digitally reconstructed topogram using bony landmark on commercial MIM software. The daily shifts in 3 translational directions determined from MV-topograms were compared with the megavoltage computed tomography (MVCT) based patient shifts. Linear-regression and two one-sided tests equivalence tests were performed to investigate the relation and equivalence between the 2 techniques. Seventy-eight MV-topogram pairs for 19 head and neck patients were included to validate the finding. Results The magnitudes of alignment differences of (MVCT − MV-topogram) (and standard deviations) were −0.3 ± 2.1, −0.8 ± 2.4, and 1.6 ± 1.7 mm for pelvis and 0.6 ± 1.2, 0.8 ± 4.2, 1.6 ± 2.6 mm for head and neck; the linear-regression coefficients between 2 imaging techniques were 1.18, 1.10, 0.94, and 0.86, 0.63, 0.38 in the lateral, longitudinal, vertical directions for pelvis and head and neck, respectively. The acquisition time for a pair of MV-topograms was up to 12.7 times less than MVCT scans (coarse scan mode) while covering longer longitudinal length. Conclusions MV-topograms showed equivalent clinical performance to the standard MVCT with significantly less acquisition time for pelvis and H&N patients. The MV-topogram can be used as an alternative or complimentary tool for bony landmark-based patient alignment on tomotherapy.
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Cao M, Stiehl B, Yu VY, Sheng K, Kishan AU, Chin RK, Yang Y, Ruan D. Analysis of Geometric Performance and Dosimetric Impact of Using Automatic Contour Segmentation for Radiotherapy Planning. Front Oncol 2020; 10:1762. [PMID: 33102206 PMCID: PMC7546883 DOI: 10.3389/fonc.2020.01762] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 08/06/2020] [Indexed: 11/13/2022] Open
Abstract
Purpose: To analyze geometric discrepancy and dosimetric impact in using contours generated by auto-segmentation (AS) against manually segmented (MS) clinical contours. Methods: A 48-subject prostate atlas was created and another 15 patients were used for testing. Contours were generated using a commercial atlas-based segmentation tool and compared to their clinical MS counterparts. The geometric correlation was evaluated using the Dice similarity coefficient (DSC) and Hausdorff distance (HD). Dosimetric relevance was evaluated for a subset of patients by assessing the DVH differences derived by optimizing plan dose using the AS and MS contours, respectively, and evaluating with respect to each. A paired t-test was employed for statistical comparison. The discrepancy in plan quality with respect to clinical dosimetric endpoints was evaluated. The analysis was repeated for head/neck (HN) with a 31-subject atlas and 15 test cases. Results: Dice agreement between AS and MS differed significantly across structures: from (L:0.92/R: 0.91) for the femoral heads to seminal vesical of 0.38 in the prostate cohort, and from 0.98 for the brain, to 0.36 for the chiasm of the HN group. Despite the geometric disagreement, the paired t-tests showed the lack of statistical evidence for systematic differences in dosimetric plan quality yielded by the AS and MS approach for the prostate cohort. In HN cases, statistically significant differences in dosimetric endpoints were observed in structures with small volumes or elongated shapes such as cord (p = 0.01) and esophagus (p = 0.04). The largest absolute dose difference of 11 Gy was seen in the mean pharynx dose. Conclusion: Varying AS performance among structures suggests a differential approach of using AS on a subset of structures and focus MS on the rest. The discrepancy between geometric and dosimetric-end-point driven evaluation also indicates the clinical utility of AS contours in optimization and evaluating plan quality despite of suboptimal geometrical accuracy.
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Singhrao K, Fu J, Wu HH, Hu P, Kishan AU, Chin RK, Lewis JH. A novel anthropomorphic multimodality phantom for MRI‐based radiotherapy quality assurance testing. Med Phys 2020; 47:1443-1451. [DOI: 10.1002/mp.14027] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 01/06/2020] [Accepted: 01/07/2020] [Indexed: 12/11/2022] Open
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Hegde JV, Demanes DJ, Veruttipong D, Chin RK, Park SJ, Kamrava M. Head and neck cancer reirradiation with interstitial high-dose-rate brachytherapy. Head Neck 2018; 40:1524-1533. [PMID: 29573121 DOI: 10.1002/hed.25137] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 11/29/2017] [Accepted: 02/01/2018] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND As high-dose-rate (HDR) brachytherapy can preferentially spare normal anatomic structures surrounding the radiation target, we report on our experience using this technique in head and neck cancer reirradiation. METHODS Twenty patients received HDR brachytherapy reirradiation with curative or palliative intent from 2010-2015. Clinical and toxicity outcomes were recorded. Actuarial outcomes were calculated using Kaplan-Meier analysis. RESULTS For curative treatment, actuarial 2-year rates of local control and overall survival (OS) were 73% and 56%, respectively. Palliatively, a 6-month local control rate of 65% was seen. Age >70 years was associated with poorer OS (P = .042). Prior salvage resection showed a trend toward improved local control and OS (P = .069 and P = .063, respectively). Thirty-three percent had grade 3 to 4 late toxicities. CONCLUSION Curative-intent HDR brachytherapy reirradiation can provide excellent local control and encouraging OS. Given the late toxicity rates, patient selection is essential, with particular utility for younger patients or those treated with salvage resection.
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Bui TT, Lagman C, Chung LK, Tenn S, Lee P, Chin RK, Kaprealian T, Yang I. Systematic Analysis of Clinical Outcomes Following Stereotactic Radiosurgery for Central Neurocytoma. Brain Tumor Res Treat 2017; 5:10-15. [PMID: 28516073 PMCID: PMC5433945 DOI: 10.14791/btrt.2017.5.1.10] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 02/01/2017] [Accepted: 02/15/2017] [Indexed: 12/11/2022] Open
Abstract
Central neurocytoma (CN) typically presents as an intraventricular mass causing obstructive hydrocephalus. The first line of treatment is surgical resection with adjuvant conventional radiotherapy. Stereotactic radiosurgery (SRS) was proposed as an alternative therapy for CN because of its lower risk profile. The objective of this systematic analysis is to assess the efficacy of SRS for CN. A systematic analysis for CN treated with SRS was conducted in PubMed. Baseline patient characteristics and outcomes data were extracted. Heterogeneity and publication bias were also assessed. Univariate and multivariate linear regressions were used to test for correlations to the primary outcome: local control (LC). The estimated cumulative rate of LC was 92.2% (95% confidence interval: 86.5-95.7%, p<0.001). Mean follow-up time was 62.4 months (range 3-149 months). Heterogeneity and publication bias were insignificant. The univariate linear regression models for both mean tumor volume and mean dose were significantly correlated with improved LC (p<0.001). Our data suggests that SRS may be an effective and safe therapy for CN. However, the rarity of CN still limits the efficacy of a quantitative analysis. Future multi-institutional, randomized trials of CN patients should be considered to further elucidate this therapy.
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Kamaria M, Shea CR, Chin RK, Cohen EE, Maggiore R, Bolotin D. Eruptive cutaneous squamous cell carcinoma and psoriasis: response to cetuximab. Clin Exp Dermatol 2014; 39:604-7. [PMID: 24758726 DOI: 10.1111/ced.12341] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2014] [Indexed: 11/30/2022]
Abstract
Cutaneous squamous cell carcinomas (CSCCs) comprise 20-30% of nonmelanoma skin cancers (NMSCs), and continue to increase in incidence. We report a case of a patient with severe psoriasis who had recurrent and eruptive CSCCs on her leg, which were successfully treated with cetuximab and radiotherapy. The patient had successful long-term clearance of her skin tumours, with the additional finding of resolution of psoriasis while on cetuximab therapy.
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Willingham SB, Volkmer JP, Gentles AJ, Sahoo D, Dalerba P, Mitra SS, Wang J, Contreras-Trujillo H, Martin R, Cohen JD, Lovelace P, Scheeren FA, Chao MP, Weiskopf K, Tang C, Volkmer AK, Naik TJ, Storm TA, Mosley AR, Edris B, Schmid SM, Sun CK, Chua MS, Murillo O, Rajendran P, Cha AC, Chin RK, Kim D, Adorno M, Raveh T, Tseng D, Jaiswal S, Enger PØ, Steinberg GK, Li G, So SK, Majeti R, Harsh GR, van de Rijn M, Teng NNH, Sunwoo JB, Alizadeh AA, Clarke MF, Weissman IL. The CD47-signal regulatory protein alpha (SIRPa) interaction is a therapeutic target for human solid tumors. Proc Natl Acad Sci U S A 2012. [PMID: 22451913 DOI: 10.1073/pnas.11216231091121623109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2023] Open
Abstract
CD47, a "don't eat me" signal for phagocytic cells, is expressed on the surface of all human solid tumor cells. Analysis of patient tumor and matched adjacent normal (nontumor) tissue revealed that CD47 is overexpressed on cancer cells. CD47 mRNA expression levels correlated with a decreased probability of survival for multiple types of cancer. CD47 is a ligand for SIRPα, a protein expressed on macrophages and dendritic cells. In vitro, blockade of CD47 signaling using targeted monoclonal antibodies enabled macrophage phagocytosis of tumor cells that were otherwise protected. Administration of anti-CD47 antibodies inhibited tumor growth in orthotopic immunodeficient mouse xenotransplantation models established with patient tumor cells and increased the survival of the mice over time. Anti-CD47 antibody therapy initiated on larger tumors inhibited tumor growth and prevented or treated metastasis, but initiation of the therapy on smaller tumors was potentially curative. The safety and efficacy of targeting CD47 was further tested and validated in immune competent hosts using an orthotopic mouse breast cancer model. These results suggest all human solid tumor cells require CD47 expression to suppress phagocytic innate immune surveillance and elimination. These data, taken together with similar findings with other human neoplasms, show that CD47 is a commonly expressed molecule on all cancers, its function to block phagocytosis is known, and blockade of its function leads to tumor cell phagocytosis and elimination. CD47 is therefore a validated target for cancer therapies.
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Zhu M, Chin RK, Tumanov AV, Liu X, Fu Y. Lymphotoxin beta receptor is required for the migration and selection of autoreactive T cells in thymic medulla. FASEB J 2008. [DOI: 10.1096/fasebj.22.1_supplement.669.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Zhu M, Chin RK, Tumanov AV, Liu X, Fu YX. Lymphotoxin β Receptor Is Required for the Migration and Selection of Autoreactive T Cells in Thymic Medulla. THE JOURNAL OF IMMUNOLOGY 2007; 179:8069-75. [DOI: 10.4049/jimmunol.179.12.8069] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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20
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Zhu M, Chin RK, Christiansen PA, Lo JC, Liu X, Ware C, Siebenlist U, Fu YX. NF-kappaB2 is required for the establishment of central tolerance through an Aire-dependent pathway. J Clin Invest 2006; 116:2964-71. [PMID: 17039258 PMCID: PMC1592546 DOI: 10.1172/jci28326] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2006] [Accepted: 08/01/2006] [Indexed: 01/13/2023] Open
Abstract
NF-kappaB2-deficient mice have impaired T and B cell responses. We found, however, that in these mice there was severe infiltration of lymphocytes into multiple organs and increased activity of autoantibodies to peripheral tissue antigens in a manner similar to that of autoimmune regulator-deficient (Aire-deficient) mice. We further demonstrated that NF-kappaB2 was required for thymic Aire gene transcriptional regulation. The Nfkb2(-/-) thymus had distinct cortical and medullar structures, but reduced Aire and target gene expression of peripheral tissue antigens. Engraftment of Nfkb2(-/-) thymic stroma to nude mice recapitulated the autoimmune phenotype of the native Nfkb2(-/-) mice, confirming a key defect in central tolerance. Lymphotoxin beta receptor (LTbetaR) ligation-induced Aire gene expression was also largely abolished in the absence of NF-kappaB2. Thus NF-kappaB2 downstream of LTbetaR plays an important role in the regulation of central tolerance in an Aire-dependent manner.
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Lee Y, Chin RK, Christiansen P, Sun Y, Tumanov AV, Wang J, Chervonsky AV, Fu YX. Recruitment and activation of naive T cells in the islets by lymphotoxin beta receptor-dependent tertiary lymphoid structure. Immunity 2006; 25:499-509. [PMID: 16934497 DOI: 10.1016/j.immuni.2006.06.016] [Citation(s) in RCA: 123] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2006] [Revised: 05/19/2006] [Accepted: 06/15/2006] [Indexed: 12/12/2022]
Abstract
The development of spontaneous insulin-dependent diabetes mellitus is preceded by the organization of tertiary lymphoid organ (TLO) in situ, but its role in the development of tissue destruction and the cytokines that control such structures have not been fully defined. We have now observed that TNF superfamily 14 (TNFSF14) is upregulated in aged nonobese diabetic (NOD) pancreas with the appearance of TLO. Blockade of TNFSF14 signaling caused a substantial reduction in the expression of lymphotoxin beta receptor (LTbetaR)-controlled migration factors within the islets and disrupts organization of tertiary structures, leading to prevention of diabetes. Consistently, enhancing LTbetaR signaling by transgenic expression of TNFSF14 in the islets of NOD mice rapidly promoted de novo formation of local TLO, resulting in diabetes, even in the absence of draining lymph nodes (LN). Thus, the TNFSF14-LTbetaR pathway appears to be critical in the development and maintenance of TLO for the onset of diabetes.
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Chin RK, Zhu M, Christiansen PA, Liu W, Ware C, Peltonen L, Zhang X, Guo L, Han S, Zheng B, Fu YX. Lymphotoxin pathway-directed, autoimmune regulator-independent central tolerance to arthritogenic collagen. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 2006; 177:290-7. [PMID: 16785524 DOI: 10.4049/jimmunol.177.1.290] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Ectopic expression of peripherally restricted Ags by medullary thymic epithelial cells (mTECs) is associated with negative selection. Autoimmune regulator (AIRE) is considered to be the master regulator of these Ags. We show in this study that the ectopic expression of type II collagen (CII) in mTECs and the corresponding central tolerance to CII are AIRE independent but lymphotoxin dependent. The failure to properly express CII in mTECs of Lta(-/-) and Ltbr(-/-) mice leads to overt autoimmunity to CII and exquisite susceptibility to arthritis. These findings define the existence of additional pathways of ectopic peripheral Ag expression, parallel to and independent of AIRE, which may cover an extended spectrum of peripheral Ags in the thymus.
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MESH Headings
- Animals
- Arthritis, Experimental/genetics
- Arthritis, Experimental/immunology
- Autoantigens/biosynthesis
- Autoantigens/genetics
- Autoantigens/immunology
- Cells, Cultured
- Collagen Type II/biosynthesis
- Collagen Type II/genetics
- Collagen Type II/immunology
- Epithelial Cells/immunology
- Epithelial Cells/metabolism
- Genetic Predisposition to Disease
- Immunity, Innate/genetics
- Lymphotoxin-alpha/deficiency
- Lymphotoxin-alpha/genetics
- Lymphotoxin-alpha/physiology
- Lymphotoxin-beta
- Membrane Proteins/deficiency
- Membrane Proteins/genetics
- Mice
- Mice, Inbred C57BL
- Mice, Knockout
- Mice, Nude
- Polyendocrinopathies, Autoimmune/genetics
- Polyendocrinopathies, Autoimmune/immunology
- Polyendocrinopathies, Autoimmune/metabolism
- Self Tolerance/genetics
- Self Tolerance/immunology
- Signal Transduction/genetics
- Signal Transduction/immunology
- Thymus Gland/cytology
- Thymus Gland/immunology
- Thymus Gland/metabolism
- Transcription Factors/biosynthesis
- Transcription Factors/genetics
- Transcription Factors/physiology
- AIRE Protein
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Lian RH, Chin RK, Nemeth HE, Libby SL, Fu YX, Kumar V. A role for lymphotoxin in the acquisition of Ly49 receptors during NK cell development. Eur J Immunol 2004; 34:2699-707. [PMID: 15368286 DOI: 10.1002/eji.200425394] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
NK cells lyse tumor, virus-infected and allogeneic cells through a recognition system involving inhibitory and activating receptors, among which are the Ly49 molecules that recognize MHC class I proteins. To date, little is known about the regulation of Ly49 expression during NK cell development. In this study we report that the acquisition of Ly49 receptors by NK cells is significantly reduced in lymphotoxin (LT) alpha-deficient mice, whereas it is increased in LTalpha transgenic mice. Treating normal mice with LTbetaR-Ig fusion protein reduced Ly49 expression, indicating that regulation of Ly49 receptor expression occurs through the engagement of membrane LT to LTbetaR, and not soluble LT to TNFR. In addition, when LTalpha(-/-) mice were treated exogenously with recombinant IL-15, NK cell numbers as well as Ly49 acquisition were restored to wild-type levels. Finally, using real-time PCR analyses of bone marrow cells obtained from LT-deficient or transgenic mice, we show a direct correlation between LTbetaR activation and increased IL-15 transcription. These data suggest that LTbetaR-mediated signals regulate Ly49 expression at least in part through the activation of IL-15.
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MESH Headings
- Animals
- Antigens, Ly/immunology
- Antigens, Ly/metabolism
- Flow Cytometry
- Gene Expression Regulation/immunology
- Interleukin-15/immunology
- Interleukin-15/metabolism
- Killer Cells, Natural/immunology
- Killer Cells, Natural/metabolism
- Lectins, C-Type
- Lymphocyte Activation/immunology
- Lymphocyte Subsets/immunology
- Lymphocyte Subsets/metabolism
- Lymphotoxin beta Receptor
- Lymphotoxin-alpha/genetics
- Lymphotoxin-alpha/immunology
- Mice
- Mice, Transgenic
- Receptors, NK Cell Lectin-Like
- Receptors, Tumor Necrosis Factor/immunology
- Receptors, Tumor Necrosis Factor/metabolism
- Reverse Transcriptase Polymerase Chain Reaction
- Transcription, Genetic
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Baron BW, Anastasi J, Montag A, Huo D, Baron RM, Karrison T, Thirman MJ, Subudhi SK, Chin RK, Felsher DW, Fu YX, McKeithan TW, Baron JM. The human BCL6 transgene promotes the development of lymphomas in the mouse. Proc Natl Acad Sci U S A 2004; 101:14198-203. [PMID: 15375218 PMCID: PMC521136 DOI: 10.1073/pnas.0406138101] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BCL6, a gene on chromosome 3, band q27, encodes a zinc finger transcriptional repressor that is needed for germinal center formation and has been implicated in the pathogenesis of some human lymphomas when it is mutated or involved in chromosomal rearrangements. To explore further the mechanisms of action of BCL6 in lymphomagenesis, we developed a transgenic mouse model mimicking a common translocation, the t(3, 14)(q27;q32), in human lymphomas. The transgenic mice develop normally and express the transgenic BCL6 protein constitutively in lymphocytes. A small fraction of the animals develop B and T cell lymphomas after a long latency period, but the incidence is dramatically enhanced following administration of N-ethyl-N-nitrosourea, a carcinogen that induces DNA mutations. The N-ethyl-N-nitrosourea-induced lymphomas spread widely, were exclusively T cell, expressed the BCL6 protein, and occurred only in the transgenic mice. Because BCL6 expression has been reported in a number of T cell tumors as well as in the more commonly occurring B cell lymphomas in humans, our transgenic mice provide a model for the study of human lymphomas.
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Subudhi SK, Zhou P, Yerian LM, Chin RK, Lo JC, Anders RA, Sun Y, Chen L, Wang Y, Alegre ML, Fu YX. Local expression of B7-H1 promotes organ-specific autoimmunity and transplant rejection. J Clin Invest 2004; 113:694-700. [PMID: 14991067 PMCID: PMC351315 DOI: 10.1172/jci19210] [Citation(s) in RCA: 124] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2003] [Accepted: 12/10/2003] [Indexed: 12/31/2022] Open
Abstract
A number of studies have suggested B7-H1, a B7 family member, inhibits T cell responses. Therefore, its expression on nonlymphoid tissues has been proposed to prevent T cell-mediated tissue destruction. To test this hypothesis, we generated transgenic mice that expressed B7-H1 on pancreatic islet beta cells. Surprisingly, we observed accelerated rejection of transplanted allogeneic B7-H1-expressing islet beta cells. Furthermore, transgenic B7-H1 expression broke immune tolerance, as some of the mice spontaneously developed T cell-dependent autoimmune diabetes. In addition, B7-H1 expression increased CD8+ T cell proliferation and promoted autoimmunity induction in a T cell adoptive transfer model of diabetes. Consistent with these findings, B7-H1.Ig fusion protein augmented naive T cell priming both in vitro and in vivo. Our results demonstrate that B7-H1 can provide positive costimulation for naive T cells to promote allograft rejection and autoimmune disease pathogenesis.
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