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Karagiannis P, Gilbert AE, Josephs DH, Ali N, Dodev T, Saul L, Correa I, Roberts L, Beddowes E, Koers A, Hobbs C, Ferreira S, Geh JL, Healy C, Harries M, Acland KM, Blower PJ, Mitchell T, Fear DJ, Spicer JF, Lacy KE, Nestle FO, Karagiannis SN. IgG4 subclass antibodies impair antitumor immunity in melanoma. J Clin Invest 2013; 123:1457-74. [PMID: 23454746 PMCID: PMC3613918 DOI: 10.1172/jci65579] [Citation(s) in RCA: 152] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Accepted: 01/03/2013] [Indexed: 12/15/2022] Open
Abstract
Host-induced antibodies and their contributions to cancer inflammation are largely unexplored. IgG4 subclass antibodies are present in IL-10-driven Th2 immune responses in some inflammatory conditions. Since Th2-biased inflammation is a hallmark of tumor microenvironments, we investigated the presence and functional implications of IgG4 in malignant melanoma. Consistent with Th2 inflammation, CD22+ B cells and IgG4(+)-infiltrating cells accumulated in tumors, and IL-10, IL-4, and tumor-reactive IgG4 were expressed in situ. When compared with B cells from patient lymph nodes and blood, tumor-associated B cells were polarized to produce IgG4. Secreted B cells increased VEGF and IgG4, and tumor cells enhanced IL-10 secretion in cocultures. Unlike IgG1, an engineered tumor antigen-specific IgG4 was ineffective in triggering effector cell-mediated tumor killing in vitro. Antigen-specific and nonspecific IgG4 inhibited IgG1-mediated tumoricidal functions. IgG4 blockade was mediated through reduction of FcγRI activation. Additionally, IgG4 significantly impaired the potency of tumoricidal IgG1 in a human melanoma xenograft mouse model. Furthermore, serum IgG4 was inversely correlated with patient survival. These findings suggest that IgG4 promoted by tumor-induced Th2-biased inflammation may restrict effector cell functions against tumors, providing a previously unexplored aspect of tumor-induced immune escape and a basis for biomarker development and patient-specific therapeutic approaches.
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Affiliation(s)
- Panagiotis Karagiannis
- National Institute for Health Research (NIHR) Biomedical Research Centre at Guy’s and St. Thomas’ Hospitals and King’s College London, Cutaneous Medicine and Immunotherapy Unit, St. John’s Institute of Dermatology, Division of Genetics and Molecular Medicine, King’s College London School of Medicine, Guy’s Hospital, King’s College London, London, United Kingdom.
Division of Asthma, Allergy and Lung Biology, Medical Research Council and Asthma UK Centre in Allergic Mechanisms of Asthma, King’s College London, Guy’s Campus, London, United Kingdom.
Skin Tumour Unit, St. John’s Institute of Dermatology, Guy’s Hospital, King’s College London, and Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Division of Imaging Sciences, Rayne Institute, King’s College London School of Medicine, St. Thomas’ Hospital, and King’s College London, London, United Kingdom.
Wolfson Centre for Age-Related Diseases, King’s College London, London, United Kingdom.
Department of Plastic Surgery at Guy’s, King’s, and St. Thomas’ Hospitals, London, United Kingdom.
Clinical Oncology, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Department of Academic Oncology, Division of Cancer Studies, King’s College London, Guy’s Hospital, London, United Kingdom
| | - Amy E. Gilbert
- National Institute for Health Research (NIHR) Biomedical Research Centre at Guy’s and St. Thomas’ Hospitals and King’s College London, Cutaneous Medicine and Immunotherapy Unit, St. John’s Institute of Dermatology, Division of Genetics and Molecular Medicine, King’s College London School of Medicine, Guy’s Hospital, King’s College London, London, United Kingdom.
Division of Asthma, Allergy and Lung Biology, Medical Research Council and Asthma UK Centre in Allergic Mechanisms of Asthma, King’s College London, Guy’s Campus, London, United Kingdom.
Skin Tumour Unit, St. John’s Institute of Dermatology, Guy’s Hospital, King’s College London, and Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Division of Imaging Sciences, Rayne Institute, King’s College London School of Medicine, St. Thomas’ Hospital, and King’s College London, London, United Kingdom.
Wolfson Centre for Age-Related Diseases, King’s College London, London, United Kingdom.
Department of Plastic Surgery at Guy’s, King’s, and St. Thomas’ Hospitals, London, United Kingdom.
Clinical Oncology, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Department of Academic Oncology, Division of Cancer Studies, King’s College London, Guy’s Hospital, London, United Kingdom
| | - Debra H. Josephs
- National Institute for Health Research (NIHR) Biomedical Research Centre at Guy’s and St. Thomas’ Hospitals and King’s College London, Cutaneous Medicine and Immunotherapy Unit, St. John’s Institute of Dermatology, Division of Genetics and Molecular Medicine, King’s College London School of Medicine, Guy’s Hospital, King’s College London, London, United Kingdom.
Division of Asthma, Allergy and Lung Biology, Medical Research Council and Asthma UK Centre in Allergic Mechanisms of Asthma, King’s College London, Guy’s Campus, London, United Kingdom.
Skin Tumour Unit, St. John’s Institute of Dermatology, Guy’s Hospital, King’s College London, and Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Division of Imaging Sciences, Rayne Institute, King’s College London School of Medicine, St. Thomas’ Hospital, and King’s College London, London, United Kingdom.
Wolfson Centre for Age-Related Diseases, King’s College London, London, United Kingdom.
Department of Plastic Surgery at Guy’s, King’s, and St. Thomas’ Hospitals, London, United Kingdom.
Clinical Oncology, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Department of Academic Oncology, Division of Cancer Studies, King’s College London, Guy’s Hospital, London, United Kingdom
| | - Niwa Ali
- National Institute for Health Research (NIHR) Biomedical Research Centre at Guy’s and St. Thomas’ Hospitals and King’s College London, Cutaneous Medicine and Immunotherapy Unit, St. John’s Institute of Dermatology, Division of Genetics and Molecular Medicine, King’s College London School of Medicine, Guy’s Hospital, King’s College London, London, United Kingdom.
Division of Asthma, Allergy and Lung Biology, Medical Research Council and Asthma UK Centre in Allergic Mechanisms of Asthma, King’s College London, Guy’s Campus, London, United Kingdom.
Skin Tumour Unit, St. John’s Institute of Dermatology, Guy’s Hospital, King’s College London, and Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Division of Imaging Sciences, Rayne Institute, King’s College London School of Medicine, St. Thomas’ Hospital, and King’s College London, London, United Kingdom.
Wolfson Centre for Age-Related Diseases, King’s College London, London, United Kingdom.
Department of Plastic Surgery at Guy’s, King’s, and St. Thomas’ Hospitals, London, United Kingdom.
Clinical Oncology, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Department of Academic Oncology, Division of Cancer Studies, King’s College London, Guy’s Hospital, London, United Kingdom
| | - Tihomir Dodev
- National Institute for Health Research (NIHR) Biomedical Research Centre at Guy’s and St. Thomas’ Hospitals and King’s College London, Cutaneous Medicine and Immunotherapy Unit, St. John’s Institute of Dermatology, Division of Genetics and Molecular Medicine, King’s College London School of Medicine, Guy’s Hospital, King’s College London, London, United Kingdom.
Division of Asthma, Allergy and Lung Biology, Medical Research Council and Asthma UK Centre in Allergic Mechanisms of Asthma, King’s College London, Guy’s Campus, London, United Kingdom.
Skin Tumour Unit, St. John’s Institute of Dermatology, Guy’s Hospital, King’s College London, and Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Division of Imaging Sciences, Rayne Institute, King’s College London School of Medicine, St. Thomas’ Hospital, and King’s College London, London, United Kingdom.
Wolfson Centre for Age-Related Diseases, King’s College London, London, United Kingdom.
Department of Plastic Surgery at Guy’s, King’s, and St. Thomas’ Hospitals, London, United Kingdom.
Clinical Oncology, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Department of Academic Oncology, Division of Cancer Studies, King’s College London, Guy’s Hospital, London, United Kingdom
| | - Louise Saul
- National Institute for Health Research (NIHR) Biomedical Research Centre at Guy’s and St. Thomas’ Hospitals and King’s College London, Cutaneous Medicine and Immunotherapy Unit, St. John’s Institute of Dermatology, Division of Genetics and Molecular Medicine, King’s College London School of Medicine, Guy’s Hospital, King’s College London, London, United Kingdom.
Division of Asthma, Allergy and Lung Biology, Medical Research Council and Asthma UK Centre in Allergic Mechanisms of Asthma, King’s College London, Guy’s Campus, London, United Kingdom.
Skin Tumour Unit, St. John’s Institute of Dermatology, Guy’s Hospital, King’s College London, and Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Division of Imaging Sciences, Rayne Institute, King’s College London School of Medicine, St. Thomas’ Hospital, and King’s College London, London, United Kingdom.
Wolfson Centre for Age-Related Diseases, King’s College London, London, United Kingdom.
Department of Plastic Surgery at Guy’s, King’s, and St. Thomas’ Hospitals, London, United Kingdom.
Clinical Oncology, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Department of Academic Oncology, Division of Cancer Studies, King’s College London, Guy’s Hospital, London, United Kingdom
| | - Isabel Correa
- National Institute for Health Research (NIHR) Biomedical Research Centre at Guy’s and St. Thomas’ Hospitals and King’s College London, Cutaneous Medicine and Immunotherapy Unit, St. John’s Institute of Dermatology, Division of Genetics and Molecular Medicine, King’s College London School of Medicine, Guy’s Hospital, King’s College London, London, United Kingdom.
Division of Asthma, Allergy and Lung Biology, Medical Research Council and Asthma UK Centre in Allergic Mechanisms of Asthma, King’s College London, Guy’s Campus, London, United Kingdom.
Skin Tumour Unit, St. John’s Institute of Dermatology, Guy’s Hospital, King’s College London, and Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Division of Imaging Sciences, Rayne Institute, King’s College London School of Medicine, St. Thomas’ Hospital, and King’s College London, London, United Kingdom.
Wolfson Centre for Age-Related Diseases, King’s College London, London, United Kingdom.
Department of Plastic Surgery at Guy’s, King’s, and St. Thomas’ Hospitals, London, United Kingdom.
Clinical Oncology, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Department of Academic Oncology, Division of Cancer Studies, King’s College London, Guy’s Hospital, London, United Kingdom
| | - Luke Roberts
- National Institute for Health Research (NIHR) Biomedical Research Centre at Guy’s and St. Thomas’ Hospitals and King’s College London, Cutaneous Medicine and Immunotherapy Unit, St. John’s Institute of Dermatology, Division of Genetics and Molecular Medicine, King’s College London School of Medicine, Guy’s Hospital, King’s College London, London, United Kingdom.
Division of Asthma, Allergy and Lung Biology, Medical Research Council and Asthma UK Centre in Allergic Mechanisms of Asthma, King’s College London, Guy’s Campus, London, United Kingdom.
Skin Tumour Unit, St. John’s Institute of Dermatology, Guy’s Hospital, King’s College London, and Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Division of Imaging Sciences, Rayne Institute, King’s College London School of Medicine, St. Thomas’ Hospital, and King’s College London, London, United Kingdom.
Wolfson Centre for Age-Related Diseases, King’s College London, London, United Kingdom.
Department of Plastic Surgery at Guy’s, King’s, and St. Thomas’ Hospitals, London, United Kingdom.
Clinical Oncology, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Department of Academic Oncology, Division of Cancer Studies, King’s College London, Guy’s Hospital, London, United Kingdom
| | - Emma Beddowes
- National Institute for Health Research (NIHR) Biomedical Research Centre at Guy’s and St. Thomas’ Hospitals and King’s College London, Cutaneous Medicine and Immunotherapy Unit, St. John’s Institute of Dermatology, Division of Genetics and Molecular Medicine, King’s College London School of Medicine, Guy’s Hospital, King’s College London, London, United Kingdom.
Division of Asthma, Allergy and Lung Biology, Medical Research Council and Asthma UK Centre in Allergic Mechanisms of Asthma, King’s College London, Guy’s Campus, London, United Kingdom.
Skin Tumour Unit, St. John’s Institute of Dermatology, Guy’s Hospital, King’s College London, and Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Division of Imaging Sciences, Rayne Institute, King’s College London School of Medicine, St. Thomas’ Hospital, and King’s College London, London, United Kingdom.
Wolfson Centre for Age-Related Diseases, King’s College London, London, United Kingdom.
Department of Plastic Surgery at Guy’s, King’s, and St. Thomas’ Hospitals, London, United Kingdom.
Clinical Oncology, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Department of Academic Oncology, Division of Cancer Studies, King’s College London, Guy’s Hospital, London, United Kingdom
| | - Alexander Koers
- National Institute for Health Research (NIHR) Biomedical Research Centre at Guy’s and St. Thomas’ Hospitals and King’s College London, Cutaneous Medicine and Immunotherapy Unit, St. John’s Institute of Dermatology, Division of Genetics and Molecular Medicine, King’s College London School of Medicine, Guy’s Hospital, King’s College London, London, United Kingdom.
Division of Asthma, Allergy and Lung Biology, Medical Research Council and Asthma UK Centre in Allergic Mechanisms of Asthma, King’s College London, Guy’s Campus, London, United Kingdom.
Skin Tumour Unit, St. John’s Institute of Dermatology, Guy’s Hospital, King’s College London, and Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Division of Imaging Sciences, Rayne Institute, King’s College London School of Medicine, St. Thomas’ Hospital, and King’s College London, London, United Kingdom.
Wolfson Centre for Age-Related Diseases, King’s College London, London, United Kingdom.
Department of Plastic Surgery at Guy’s, King’s, and St. Thomas’ Hospitals, London, United Kingdom.
Clinical Oncology, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Department of Academic Oncology, Division of Cancer Studies, King’s College London, Guy’s Hospital, London, United Kingdom
| | - Carl Hobbs
- National Institute for Health Research (NIHR) Biomedical Research Centre at Guy’s and St. Thomas’ Hospitals and King’s College London, Cutaneous Medicine and Immunotherapy Unit, St. John’s Institute of Dermatology, Division of Genetics and Molecular Medicine, King’s College London School of Medicine, Guy’s Hospital, King’s College London, London, United Kingdom.
Division of Asthma, Allergy and Lung Biology, Medical Research Council and Asthma UK Centre in Allergic Mechanisms of Asthma, King’s College London, Guy’s Campus, London, United Kingdom.
Skin Tumour Unit, St. John’s Institute of Dermatology, Guy’s Hospital, King’s College London, and Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Division of Imaging Sciences, Rayne Institute, King’s College London School of Medicine, St. Thomas’ Hospital, and King’s College London, London, United Kingdom.
Wolfson Centre for Age-Related Diseases, King’s College London, London, United Kingdom.
Department of Plastic Surgery at Guy’s, King’s, and St. Thomas’ Hospitals, London, United Kingdom.
Clinical Oncology, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Department of Academic Oncology, Division of Cancer Studies, King’s College London, Guy’s Hospital, London, United Kingdom
| | - Silvia Ferreira
- National Institute for Health Research (NIHR) Biomedical Research Centre at Guy’s and St. Thomas’ Hospitals and King’s College London, Cutaneous Medicine and Immunotherapy Unit, St. John’s Institute of Dermatology, Division of Genetics and Molecular Medicine, King’s College London School of Medicine, Guy’s Hospital, King’s College London, London, United Kingdom.
Division of Asthma, Allergy and Lung Biology, Medical Research Council and Asthma UK Centre in Allergic Mechanisms of Asthma, King’s College London, Guy’s Campus, London, United Kingdom.
Skin Tumour Unit, St. John’s Institute of Dermatology, Guy’s Hospital, King’s College London, and Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Division of Imaging Sciences, Rayne Institute, King’s College London School of Medicine, St. Thomas’ Hospital, and King’s College London, London, United Kingdom.
Wolfson Centre for Age-Related Diseases, King’s College London, London, United Kingdom.
Department of Plastic Surgery at Guy’s, King’s, and St. Thomas’ Hospitals, London, United Kingdom.
Clinical Oncology, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Department of Academic Oncology, Division of Cancer Studies, King’s College London, Guy’s Hospital, London, United Kingdom
| | - Jenny L.C. Geh
- National Institute for Health Research (NIHR) Biomedical Research Centre at Guy’s and St. Thomas’ Hospitals and King’s College London, Cutaneous Medicine and Immunotherapy Unit, St. John’s Institute of Dermatology, Division of Genetics and Molecular Medicine, King’s College London School of Medicine, Guy’s Hospital, King’s College London, London, United Kingdom.
Division of Asthma, Allergy and Lung Biology, Medical Research Council and Asthma UK Centre in Allergic Mechanisms of Asthma, King’s College London, Guy’s Campus, London, United Kingdom.
Skin Tumour Unit, St. John’s Institute of Dermatology, Guy’s Hospital, King’s College London, and Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Division of Imaging Sciences, Rayne Institute, King’s College London School of Medicine, St. Thomas’ Hospital, and King’s College London, London, United Kingdom.
Wolfson Centre for Age-Related Diseases, King’s College London, London, United Kingdom.
Department of Plastic Surgery at Guy’s, King’s, and St. Thomas’ Hospitals, London, United Kingdom.
Clinical Oncology, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Department of Academic Oncology, Division of Cancer Studies, King’s College London, Guy’s Hospital, London, United Kingdom
| | - Ciaran Healy
- National Institute for Health Research (NIHR) Biomedical Research Centre at Guy’s and St. Thomas’ Hospitals and King’s College London, Cutaneous Medicine and Immunotherapy Unit, St. John’s Institute of Dermatology, Division of Genetics and Molecular Medicine, King’s College London School of Medicine, Guy’s Hospital, King’s College London, London, United Kingdom.
Division of Asthma, Allergy and Lung Biology, Medical Research Council and Asthma UK Centre in Allergic Mechanisms of Asthma, King’s College London, Guy’s Campus, London, United Kingdom.
Skin Tumour Unit, St. John’s Institute of Dermatology, Guy’s Hospital, King’s College London, and Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Division of Imaging Sciences, Rayne Institute, King’s College London School of Medicine, St. Thomas’ Hospital, and King’s College London, London, United Kingdom.
Wolfson Centre for Age-Related Diseases, King’s College London, London, United Kingdom.
Department of Plastic Surgery at Guy’s, King’s, and St. Thomas’ Hospitals, London, United Kingdom.
Clinical Oncology, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Department of Academic Oncology, Division of Cancer Studies, King’s College London, Guy’s Hospital, London, United Kingdom
| | - Mark Harries
- National Institute for Health Research (NIHR) Biomedical Research Centre at Guy’s and St. Thomas’ Hospitals and King’s College London, Cutaneous Medicine and Immunotherapy Unit, St. John’s Institute of Dermatology, Division of Genetics and Molecular Medicine, King’s College London School of Medicine, Guy’s Hospital, King’s College London, London, United Kingdom.
Division of Asthma, Allergy and Lung Biology, Medical Research Council and Asthma UK Centre in Allergic Mechanisms of Asthma, King’s College London, Guy’s Campus, London, United Kingdom.
Skin Tumour Unit, St. John’s Institute of Dermatology, Guy’s Hospital, King’s College London, and Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Division of Imaging Sciences, Rayne Institute, King’s College London School of Medicine, St. Thomas’ Hospital, and King’s College London, London, United Kingdom.
Wolfson Centre for Age-Related Diseases, King’s College London, London, United Kingdom.
Department of Plastic Surgery at Guy’s, King’s, and St. Thomas’ Hospitals, London, United Kingdom.
Clinical Oncology, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Department of Academic Oncology, Division of Cancer Studies, King’s College London, Guy’s Hospital, London, United Kingdom
| | - Katharine M. Acland
- National Institute for Health Research (NIHR) Biomedical Research Centre at Guy’s and St. Thomas’ Hospitals and King’s College London, Cutaneous Medicine and Immunotherapy Unit, St. John’s Institute of Dermatology, Division of Genetics and Molecular Medicine, King’s College London School of Medicine, Guy’s Hospital, King’s College London, London, United Kingdom.
Division of Asthma, Allergy and Lung Biology, Medical Research Council and Asthma UK Centre in Allergic Mechanisms of Asthma, King’s College London, Guy’s Campus, London, United Kingdom.
Skin Tumour Unit, St. John’s Institute of Dermatology, Guy’s Hospital, King’s College London, and Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Division of Imaging Sciences, Rayne Institute, King’s College London School of Medicine, St. Thomas’ Hospital, and King’s College London, London, United Kingdom.
Wolfson Centre for Age-Related Diseases, King’s College London, London, United Kingdom.
Department of Plastic Surgery at Guy’s, King’s, and St. Thomas’ Hospitals, London, United Kingdom.
Clinical Oncology, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Department of Academic Oncology, Division of Cancer Studies, King’s College London, Guy’s Hospital, London, United Kingdom
| | - Philip J. Blower
- National Institute for Health Research (NIHR) Biomedical Research Centre at Guy’s and St. Thomas’ Hospitals and King’s College London, Cutaneous Medicine and Immunotherapy Unit, St. John’s Institute of Dermatology, Division of Genetics and Molecular Medicine, King’s College London School of Medicine, Guy’s Hospital, King’s College London, London, United Kingdom.
Division of Asthma, Allergy and Lung Biology, Medical Research Council and Asthma UK Centre in Allergic Mechanisms of Asthma, King’s College London, Guy’s Campus, London, United Kingdom.
Skin Tumour Unit, St. John’s Institute of Dermatology, Guy’s Hospital, King’s College London, and Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Division of Imaging Sciences, Rayne Institute, King’s College London School of Medicine, St. Thomas’ Hospital, and King’s College London, London, United Kingdom.
Wolfson Centre for Age-Related Diseases, King’s College London, London, United Kingdom.
Department of Plastic Surgery at Guy’s, King’s, and St. Thomas’ Hospitals, London, United Kingdom.
Clinical Oncology, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Department of Academic Oncology, Division of Cancer Studies, King’s College London, Guy’s Hospital, London, United Kingdom
| | - Tracey Mitchell
- National Institute for Health Research (NIHR) Biomedical Research Centre at Guy’s and St. Thomas’ Hospitals and King’s College London, Cutaneous Medicine and Immunotherapy Unit, St. John’s Institute of Dermatology, Division of Genetics and Molecular Medicine, King’s College London School of Medicine, Guy’s Hospital, King’s College London, London, United Kingdom.
Division of Asthma, Allergy and Lung Biology, Medical Research Council and Asthma UK Centre in Allergic Mechanisms of Asthma, King’s College London, Guy’s Campus, London, United Kingdom.
Skin Tumour Unit, St. John’s Institute of Dermatology, Guy’s Hospital, King’s College London, and Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Division of Imaging Sciences, Rayne Institute, King’s College London School of Medicine, St. Thomas’ Hospital, and King’s College London, London, United Kingdom.
Wolfson Centre for Age-Related Diseases, King’s College London, London, United Kingdom.
Department of Plastic Surgery at Guy’s, King’s, and St. Thomas’ Hospitals, London, United Kingdom.
Clinical Oncology, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Department of Academic Oncology, Division of Cancer Studies, King’s College London, Guy’s Hospital, London, United Kingdom
| | - David J. Fear
- National Institute for Health Research (NIHR) Biomedical Research Centre at Guy’s and St. Thomas’ Hospitals and King’s College London, Cutaneous Medicine and Immunotherapy Unit, St. John’s Institute of Dermatology, Division of Genetics and Molecular Medicine, King’s College London School of Medicine, Guy’s Hospital, King’s College London, London, United Kingdom.
Division of Asthma, Allergy and Lung Biology, Medical Research Council and Asthma UK Centre in Allergic Mechanisms of Asthma, King’s College London, Guy’s Campus, London, United Kingdom.
Skin Tumour Unit, St. John’s Institute of Dermatology, Guy’s Hospital, King’s College London, and Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Division of Imaging Sciences, Rayne Institute, King’s College London School of Medicine, St. Thomas’ Hospital, and King’s College London, London, United Kingdom.
Wolfson Centre for Age-Related Diseases, King’s College London, London, United Kingdom.
Department of Plastic Surgery at Guy’s, King’s, and St. Thomas’ Hospitals, London, United Kingdom.
Clinical Oncology, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Department of Academic Oncology, Division of Cancer Studies, King’s College London, Guy’s Hospital, London, United Kingdom
| | - James F. Spicer
- National Institute for Health Research (NIHR) Biomedical Research Centre at Guy’s and St. Thomas’ Hospitals and King’s College London, Cutaneous Medicine and Immunotherapy Unit, St. John’s Institute of Dermatology, Division of Genetics and Molecular Medicine, King’s College London School of Medicine, Guy’s Hospital, King’s College London, London, United Kingdom.
Division of Asthma, Allergy and Lung Biology, Medical Research Council and Asthma UK Centre in Allergic Mechanisms of Asthma, King’s College London, Guy’s Campus, London, United Kingdom.
Skin Tumour Unit, St. John’s Institute of Dermatology, Guy’s Hospital, King’s College London, and Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Division of Imaging Sciences, Rayne Institute, King’s College London School of Medicine, St. Thomas’ Hospital, and King’s College London, London, United Kingdom.
Wolfson Centre for Age-Related Diseases, King’s College London, London, United Kingdom.
Department of Plastic Surgery at Guy’s, King’s, and St. Thomas’ Hospitals, London, United Kingdom.
Clinical Oncology, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Department of Academic Oncology, Division of Cancer Studies, King’s College London, Guy’s Hospital, London, United Kingdom
| | - Katie E. Lacy
- National Institute for Health Research (NIHR) Biomedical Research Centre at Guy’s and St. Thomas’ Hospitals and King’s College London, Cutaneous Medicine and Immunotherapy Unit, St. John’s Institute of Dermatology, Division of Genetics and Molecular Medicine, King’s College London School of Medicine, Guy’s Hospital, King’s College London, London, United Kingdom.
Division of Asthma, Allergy and Lung Biology, Medical Research Council and Asthma UK Centre in Allergic Mechanisms of Asthma, King’s College London, Guy’s Campus, London, United Kingdom.
Skin Tumour Unit, St. John’s Institute of Dermatology, Guy’s Hospital, King’s College London, and Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Division of Imaging Sciences, Rayne Institute, King’s College London School of Medicine, St. Thomas’ Hospital, and King’s College London, London, United Kingdom.
Wolfson Centre for Age-Related Diseases, King’s College London, London, United Kingdom.
Department of Plastic Surgery at Guy’s, King’s, and St. Thomas’ Hospitals, London, United Kingdom.
Clinical Oncology, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Department of Academic Oncology, Division of Cancer Studies, King’s College London, Guy’s Hospital, London, United Kingdom
| | - Frank O. Nestle
- National Institute for Health Research (NIHR) Biomedical Research Centre at Guy’s and St. Thomas’ Hospitals and King’s College London, Cutaneous Medicine and Immunotherapy Unit, St. John’s Institute of Dermatology, Division of Genetics and Molecular Medicine, King’s College London School of Medicine, Guy’s Hospital, King’s College London, London, United Kingdom.
Division of Asthma, Allergy and Lung Biology, Medical Research Council and Asthma UK Centre in Allergic Mechanisms of Asthma, King’s College London, Guy’s Campus, London, United Kingdom.
Skin Tumour Unit, St. John’s Institute of Dermatology, Guy’s Hospital, King’s College London, and Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Division of Imaging Sciences, Rayne Institute, King’s College London School of Medicine, St. Thomas’ Hospital, and King’s College London, London, United Kingdom.
Wolfson Centre for Age-Related Diseases, King’s College London, London, United Kingdom.
Department of Plastic Surgery at Guy’s, King’s, and St. Thomas’ Hospitals, London, United Kingdom.
Clinical Oncology, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Department of Academic Oncology, Division of Cancer Studies, King’s College London, Guy’s Hospital, London, United Kingdom
| | - Sophia N. Karagiannis
- National Institute for Health Research (NIHR) Biomedical Research Centre at Guy’s and St. Thomas’ Hospitals and King’s College London, Cutaneous Medicine and Immunotherapy Unit, St. John’s Institute of Dermatology, Division of Genetics and Molecular Medicine, King’s College London School of Medicine, Guy’s Hospital, King’s College London, London, United Kingdom.
Division of Asthma, Allergy and Lung Biology, Medical Research Council and Asthma UK Centre in Allergic Mechanisms of Asthma, King’s College London, Guy’s Campus, London, United Kingdom.
Skin Tumour Unit, St. John’s Institute of Dermatology, Guy’s Hospital, King’s College London, and Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Division of Imaging Sciences, Rayne Institute, King’s College London School of Medicine, St. Thomas’ Hospital, and King’s College London, London, United Kingdom.
Wolfson Centre for Age-Related Diseases, King’s College London, London, United Kingdom.
Department of Plastic Surgery at Guy’s, King’s, and St. Thomas’ Hospitals, London, United Kingdom.
Clinical Oncology, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Department of Academic Oncology, Division of Cancer Studies, King’s College London, Guy’s Hospital, London, United Kingdom
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