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Smith R, Yendamuri S, Vedire Y, Rosario S, Zollo R, Washington D, Sass S, Ivanick NM, Reid M, Barbi J. Immunoprofiling bronchoalveolar lavage cells reveals multifaceted smoking-associated immune dysfunction. ERJ Open Res 2023; 9:00688-2022. [PMID: 37342091 PMCID: PMC10277872 DOI: 10.1183/23120541.00688-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 03/22/2023] [Indexed: 06/22/2023] Open
Abstract
Background Bronchoalveolar lavage (BAL) is an underutilised tool in the search for pulmonary disease biomarkers. While leukocytes with effector and suppressor function play important roles in airway immunity and tumours, it remains unclear if frequencies and phenotypes of BAL leukocytes can be useful parameters in lung cancer studies and clinical trials. We therefore explored the utility of BAL leukocytes as a source of biomarkers interrogating the impact of smoking, a major lung cancer risk determinant, on pulmonary immunity. Methods In this "test case" observational study, BAL samples from 119 donors undergoing lung cancer screening and biopsy procedures were evaluated by conventional and spectral flow cytometry to exemplify the comprehensive immune analyses possible with this biospecimen. Proportions of major leukocyte populations and phenotypic markers levels were found. Multivariate linear rank sum analysis considering age, sex, cancer diagnosis and smoking status was performed. Results Significantly increased frequencies of myeloid-derived suppressor cells and PD-L1-expressing macrophages were found in current and former smokers compared to never-smokers. While cytotoxic CD8 T-cells and conventional CD4 helper T-cell frequencies were significantly reduced in current and former smokers, expression of immune checkpoints PD-1 and LAG-3 as well as Tregs proportions were increased. Lastly, the cellularity, viability and stability of several immune readouts under cryostorage suggested BAL samples are useful for correlative end-points in clinical trials. Conclusions Smoking is associated with heightened markers of immune dysfunction, readily assayable in BAL, that may reflect a permissive environment for cancer development and progression in the airway.
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Affiliation(s)
- Randall Smith
- Department of Immunology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
- These authors contributed equally
| | - Sai Yendamuri
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
- These authors contributed equally
- These authors contributed equally to this article as lead authors and supervised the work
| | - Yeshwanth Vedire
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Spencer Rosario
- Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Robert Zollo
- Department of Immunology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Deschana Washington
- Department of Immunology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Stephanie Sass
- Department of Immunology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Nathaniel M. Ivanick
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Mary Reid
- Department of Medicine – Survivorship and Supportive Care, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Joseph Barbi
- Department of Immunology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
- These authors contributed equally to this article as lead authors and supervised the work
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Shepherd DJ, Tabb ES, Kunitoki K, Zhang ML, Kem M, Barth J, Qualls DA, Mooradian MJ, Gainor JF, Mino-Kenudson M, Hung YP. Lymphocyte-activation gene 3 in non-small-cell lung carcinomas: correlations with clinicopathologic features and prognostic significance. Mod Pathol 2022; 35:615-624. [PMID: 34880448 PMCID: PMC9050756 DOI: 10.1038/s41379-021-00974-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 11/11/2021] [Indexed: 12/17/2022]
Abstract
Lymphocyte-activation gene 3 (LAG-3) modulates the tumor microenvironment through immunosuppressive effects. Its associations with clinicopathologic parameters and prognostic significance in non-small-cell lung carcinomas remain unclear. We examined LAG-3 expression in 368 resected non-small-cell lung carcinomas (including 218 adenocarcinomas and 150 squamous-cell carcinomas) using tissue microarrays, with normalization to CD8+ T-cell count (LAG-3/CD8 index), and correlated LAG-3, CD8, and LAG-3/CD8 index with clinicopathologic features, molecular status, and survival. LAG-3 expression in the immune cells (ranged 0.35-540.1 cells/mm²) was identified in 92% of non-small-cell lung carcinomas. In adenocarcinomas and squamous-cell carcinomas, LAG-3 expression correlated with CD8+ T-cell count and PD-L1 expression. In adenocarcinomas, high LAG-3 expression (defined as >median) was additionally associated with smoking history, high T stage, aggressive pathologic features (solid-predominant histologic pattern, lymphovascular invasion, and nodal metastasis), and lack of EGFR mutation. In the entire resected tumor cohort and in adenocarcinomas, high LAG-3 and LAG-3/CD8 index were each associated with worse overall survival. In squamous-cell carcinomas, high CD8 was associated with better overall survival. In an exploratory analysis of pretreatment samples from advanced non-small-cell lung carcinoma patients treated with pembrolizumab, high CD8 was predictive of improved overall and progression-free survival, while high LAG-3, but not high LAG-3/CD8 index, was associated with improved progression-free survival. In conclusion, the clinicopathologic correlations and prognostic impact of LAG-3 in non-small-cell lung carcinoma are histotype-dependent, highlighting differences in the immune microenvironment between adenocarcinomas and squamous-cell carcinomas. The predictive impact of LAG-3 warrants further investigation.
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Affiliation(s)
- Daniel J. Shepherd
- Department of Pathology, Massachusetts General Hospital, Boston, USA,Department of Pathology, Harvard Medical School, Boston, MA, USA
| | - Elisabeth S. Tabb
- Department of Pathology, Massachusetts General Hospital, Boston, USA,Department of Pathology, Harvard Medical School, Boston, MA, USA
| | - Keiko Kunitoki
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - M. Lisa Zhang
- Department of Pathology, Massachusetts General Hospital, Boston, USA,Department of Pathology, Harvard Medical School, Boston, MA, USA
| | - Marina Kem
- Department of Pathology, Massachusetts General Hospital, Boston, USA
| | - Jaimie Barth
- Department of Pathology, Massachusetts General Hospital, Boston, USA
| | - David A. Qualls
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Meghan J. Mooradian
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA,Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Justin F. Gainor
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA,Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Mari Mino-Kenudson
- Department of Pathology, Massachusetts General Hospital, Boston, USA. .,Department of Pathology, Harvard Medical School, Boston, MA, USA. .,Massachusetts General Hospital Cancer Center, Boston, MA, USA.
| | - Yin P. Hung
- Department of Pathology, Massachusetts General Hospital, Boston, USA,Department of Pathology, Harvard Medical School, Boston, MA, USA,Massachusetts General Hospital Cancer Center, Boston, MA, USA
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Poma AM, Bruno R, Pietrini I, Alì G, Pasquini G, Proietti A, Vasile E, Cappelli S, Chella A, Fontanini G. Biomarkers and Gene Signatures to Predict Durable Response to Pembrolizumab in Non-Small Cell Lung Cancer. Cancers (Basel) 2021; 13:cancers13153828. [PMID: 34359727 PMCID: PMC8345106 DOI: 10.3390/cancers13153828] [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: 06/30/2021] [Revised: 07/27/2021] [Accepted: 07/28/2021] [Indexed: 12/15/2022] Open
Abstract
Simple Summary Not all patients with advanced or metastatic non-small cell lung cancer (NSCLC) respond to pembrolizumab, even if their tumor expresses PD-L1. This is a monocentric study aimed at identifying potential predictive biomarkers for pembrolizumab first-line treatment. Tumor microenvironment was characterized by gene expression analysis in 46 tumor samples from 25 NSCLC patients with and 21 without durable clinical benefit. As expected, patients achieving clinical benefit had a greater infiltration of immune cells. In particular, CD8 T-cell and NK cell scores were strongly associated with durable benefit. Single immune cell markers such as XCL1/2 showed a high performance in predicting durable response to pembrolizumab with an AUC of 0.85. In the same series PD-L1 expression levels had an AUC equal to 0.61. Identified predictive biomarkers can improve patients’ selection, thus optimizing treatment definition. Abstract Pembrolizumab has been approved as first-line treatment for advanced Non-small cell lung cancer (NSCLC) patients with tumors expressing PD-L1 and in the absence of other targetable alterations. However, not all patients that meet these criteria have a durable benefit. In this monocentric study, we aimed at refining the selection of patients based on the expression of immune genes. Forty-six consecutive advanced NSCLC patients treated with pembrolizumab in first-line setting were enrolled. The expression levels of 770 genes involved in the regulation of the immune system was analysed by the nanoString system. PD-L1 expression was evaluated by immunohistochemistry. Patients with durable clinical benefit had a greater infiltration of cytotoxic cells, exhausted CD8, B-cells, CD45, T-cells, CD8 T-cells and NK cells. Immune cell scores such as CD8 T-cell and NK cell were good predictors of durable response with an AUC of 0.82. Among the immune cell markers, XCL1/2 showed the better performance in predicting durable benefit to pembrolizumab, with an AUC of 0.85. Additionally, CD8A, CD8B and EOMES showed a high specificity (>0.86) in identifying patients with a good response to treatment. In the same series, PD-L1 expression levels had an AUC of 0.61. The characterization of tumor microenvironment, even with the use of single markers, can improve patients’ selection for pembrolizumab treatment.
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Affiliation(s)
- Anello Marcello Poma
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, via Savi 10, 56126 Pisa, Italy;
| | - Rossella Bruno
- Unit of Pathological Anatomy, University Hospital of Pisa, via Roma 67, 56126 Pisa, Italy; (R.B.); (G.A.); (A.P.)
| | - Iacopo Pietrini
- General Pathology, University of Pisa, via Savi 10, 56126 Pisa, Italy;
| | - Greta Alì
- Unit of Pathological Anatomy, University Hospital of Pisa, via Roma 67, 56126 Pisa, Italy; (R.B.); (G.A.); (A.P.)
| | - Giulia Pasquini
- Unit of Medical Oncology, San Jacopo Hospital of Pistoia, 51100 Pistoia, Italy;
| | - Agnese Proietti
- Unit of Pathological Anatomy, University Hospital of Pisa, via Roma 67, 56126 Pisa, Italy; (R.B.); (G.A.); (A.P.)
| | - Enrico Vasile
- Unit of Pneumology, University Hospital of Pisa, via Paradisa 2, 56126 Pisa, Italy; (E.V.); (S.C.); (A.C.)
| | - Sabrina Cappelli
- Unit of Pneumology, University Hospital of Pisa, via Paradisa 2, 56126 Pisa, Italy; (E.V.); (S.C.); (A.C.)
| | - Antonio Chella
- Unit of Pneumology, University Hospital of Pisa, via Paradisa 2, 56126 Pisa, Italy; (E.V.); (S.C.); (A.C.)
| | - Gabriella Fontanini
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, via Savi 10, 56126 Pisa, Italy;
- Correspondence: ; Tel.: +39-050-992983
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Berele BA, Yang G, Wu T. Prognostic value of programmed cell death ligand-1 expression in the tumor-infiltrating immune cells of patients with lung cancer: A meta-analysis. Mol Clin Oncol 2021; 15:167. [PMID: 34194745 PMCID: PMC8237205 DOI: 10.3892/mco.2021.2329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 06/07/2021] [Indexed: 12/09/2022] Open
Abstract
Several studies have investigated the prognostic significance of programmed cell death ligand 1 (PD-L1)-positive expression in the tumor cells (TC) of patients with lung cancer. However, tumor-infiltrating immune cell (TIIC)-based PD-L1 expression and its prognostic value remain controversial. The present meta-analysis was performed on 11 studies comprising 2,685 patients, which were identified by a systematic search on the PubMed, PMC, Web of Science and Embase databases. The databases were searched for published articles up to October 30, 2020. The studies that evaluated overall survival (OS) or disease-free survival (DFS) expressed as hazard ratios (HRs) in the PD-L1 TIIC of patients with lung cancer were analyzed. All statistical analyses were conducted using Stata software, version 16.0. The results demonstrated that PD-L1 expression in TIICs was not associated with OS [HR=0.98; confidence interval (CI)=0.73-1.33; P=0.53] and DFS (HR=1.05; CI=0.63-1.77; P=0.42) for all the cohort included in the study. However, subgroup analysis revealed that PD-L1 TIICs were associated with improved OS in lung squamous cell carcinoma (HR=0.76; CI=0.58-0.99; P=0.04), while poorer DFS was observed in lung adenocarcinoma (HR=1.30; CI=1.19-1.43; P=0.008) and at the >1% staining cutoff value (HR=1.56; CI=1.12-2.16; P=0.03). However, poor OS (P=0.21) and DFS (P=0.14) were observed in Asian populations, while DFS (P=0.07) for only-membrane staining was not statistically significant. The results of the present study suggested that adding PD-L1 TIICs to the existing diagnostic algorithm may help to guide patient selection for anti-PD-1/PD-L1 therapy. Future large-scale studies are warranted for confirmation of the present findings.
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Affiliation(s)
- Birhanu Aberha Berele
- Department of Pathology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, P.R. China
| | - Guifang Yang
- Department of Pathology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, P.R. China
| | - Ti Wu
- Department of Pathology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, P.R. China
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