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Cheng S, Li S, Yang P, Wang R, Zhou P, Li J. Dissecting the tumour immune microenvironment in merkel cell carcinoma based on a machine learning framework. ARTIFICIAL CELLS, NANOMEDICINE, AND BIOTECHNOLOGY 2023; 51:397-407. [PMID: 37676035 DOI: 10.1080/21691401.2023.2244998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/13/2023] [Accepted: 08/02/2023] [Indexed: 09/08/2023]
Abstract
Merkel cell carcinoma (MCC) is a primary cutaneous neoplasm of neuroendocrine carcinoma of the skin, which is characterized by molecular heterogeneity with diverse tumour microenvironment (TME). However, we are still lack knowledge of the cellular states and ecosystems in MCC. Here, we systematically identified and characterized the landscape of cellular states and ecotypes in MCC based on a machine learning framework. We obtained 30 distinct cellular states from 9 immune cell types and investigated the B cell, CD8 T cell, fibroblast, and monocytes/macrophage cellular states in detail. The functional profiling of cellular states were investigated and found the genes highly expressed in cellular states were significantly enriched in immune- and cancer hallmark-related pathways. In addition, four ecotypes were further identified which were with different patient compositions. Transcriptional regulation analysis revealed the critical transcription factors (i.e. E2F1, E2F3 and E2F7), which play important roles in regulating the TME of MCC. In summary, the findings of this study may provide rich knowledge to understand the intrinsic subtypes of MCCs and the pathways involved in distinct subtype oncogenesis, and will further advance the knowledge in developing a specific therapeutic strategy for these MCC subtypes.
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Affiliation(s)
- Shaowen Cheng
- Department of Wound Repair, The First Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Si Li
- College of Biomedical Information and Engineering, Hainan Medical University, Haikou, China
| | - Ping Yang
- Department of Radiotherapy, The First Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Rong Wang
- Department of Wound Repair, The First Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Ping Zhou
- Department of Radiotherapy, The First Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Jingquan Li
- The First Affiliated Hospital of Hainan Medical University, Haikou, China
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2
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Tao Q, Du JX, Zhang S, Lin W, Luo Y, Liu Y, Zeng J, Chen XL. Longitudinal multi-functional analysis identified responses of T cells, B cells, and monocytes as hallmarks of immunotherapy tolerance in patients with merkel cell carcinoma. PLoS One 2023; 18:e0293922. [PMID: 37983224 PMCID: PMC10659156 DOI: 10.1371/journal.pone.0293922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 10/21/2023] [Indexed: 11/22/2023] Open
Abstract
PURPOSE Merkel cell carcinoma (MCC) is a neuroendocrine carcinoma originating in the skin. Studies are needed to determine the mechanisms of immune escape in patients with MCC, and malignant cell conditions that promote immune evasion. METHODS We used Single-cell RNA sequencing (scRNA-seq) to determine cellular features associated with MCC disease trajectory. A longitudinal multi-omics study was performed using scRNA-seq data of peripheral blood harvested from four-time points. Six major cell types and fifteen cell subgroups were identified and confirmed their presence by expression of characteristic markers. The expression patterns and specific changes of different cells at different time points were investigated. Subsequently, bulk RNA data was used to validate key findings. RESULTS The dynamic characteristics of the cells were identified during the critical period between benign improvement and acquisition of resistance. Combined with the results of the validation cohort, the resistance program expressed in the relapse stage is mainly associated with T cell exhaustion and immune cell crosstalk disorder. Coinciding with immune escape, we also identified a decrease non-classical monocytes and an expansion of classical monocytes with features of high inflammation and immune deficiency. CONCLUSION Changes in cellular status, such as depletion of T cells and dysregulation of B cell proliferation and differentiation, may lead to drug resistance in MCC patients. Meanwhile, the widespread decreased antigen presentation ability and immune disorders caused by deletion of MHC class II gene expression should not be ignored.
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Affiliation(s)
- Quyuan Tao
- School of Basic Medical Science, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Jia-xin Du
- School of Basic Medical Science, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Shijing Zhang
- School of Basic Medical Science, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Wenjia Lin
- School of Basic Medical Science, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Yongxin Luo
- School of Basic Medical Science, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Ying Liu
- School of Basic Medical Science, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Jingyan Zeng
- Shenzhen Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xin-lin Chen
- School of Basic Medical Science, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
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3
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Öğüt B, Bayram EK, İnan MA, Kestel S, Erdem Ö. Association of Merkel Cell Polyomavirus Status With p53, RB1, and PD-L1 Expression and Patient Prognosis in Merkel Cell Carcinomas: Clinical, Morphologic, and Immunohistochemical Evaluation of 17 Cases. Appl Immunohistochem Mol Morphol 2023:00129039-990000000-00100. [PMID: 37126387 DOI: 10.1097/pai.0000000000001127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 03/27/2023] [Indexed: 05/02/2023]
Abstract
BACKGROUND Merkel cell carcinoma (MCC) is a rare, aggressive, primary neuroendocrine carcinoma of the skin whose main risk factors are immunosuppression, UV radiation exposure, and Merkel cell polyomavirus. Programmed death-1/programmed death ligand-1 (PD-L1)-based immunotherapy is currently the first choice for treating patients with metastatic MCC. METHODS MCC biopsies (17) were evaluated for their nucleus and cytoplasm characteristics and growth patterns, as well as for intratumor lymphocytes, mitotic number, and lymphovascular invasion. Paraffin-embedded tissue samples of the biopsies were stained with MCPyV large T-antigen (LTag), RB1, p53, and PD-L1. RESULTS We observed MCPyV LTag expression in 9 out of the 17 tumors, and all 9 cases were positive for RB1 (P<0.000). p53 staining was not significantly correlated with MCPyV LTag. We observed no relationship between p53 expression and any other parameters, and PD-L1 expression was low in the MCC samples. We evaluated PD-L1 using both the combined positive score and tumor proportion score (TPS), and found that TPS was correlated with MCPyV LTag expression (P=0.016). Tumors with tumor-infiltrating lymphocytes showed a better prognosis than those without these lymphocytes (P=0.006). DISCUSSION Our data demonstrated that RB1 was effective for immunohistochemically investigating the MCPyV status of tumors. TPS was superior to the combined positive score in evaluating PD-L1 in MCC. Tumor-infiltrating lymphocytes were the only parameters that were associated with survival. Further studies with larger series are required to confirm these results.
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Affiliation(s)
- Betül Öğüt
- Department of Pathology, Faculty of Medicine, Gazi University, Ankara, Turkey
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4
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DeCoste RC, Walsh NM, Gaston D, Ly TY, Pasternak S, Cutler S, Nightingale M, Carter MD. RB1-deficient squamous cell carcinoma: the proposed source of combined Merkel cell carcinoma. Mod Pathol 2022; 35:1829-1836. [PMID: 36075957 DOI: 10.1038/s41379-022-01151-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 07/05/2022] [Accepted: 08/12/2022] [Indexed: 12/24/2022]
Abstract
Merkel cell carcinoma (MCC) is an aggressive cutaneous neuroendocrine (NE) carcinoma arising from integration of Merkel cell polyomavirus (MCPyV) DNA into a host cell or from ultraviolet light-induced genetic damage (proportions vary geographically). Tumors in the latter group include those with "pure" NE phenotype and those "combined" with other elements, most often squamous cell carcinoma (SCC). We performed comprehensive genomic profiling (CGP) of MCPyV+ and MCPyV- (pure and combined) tumors, to better understand their mutational profiles and shed light on their pathogenesis. Supplemental immunohistochemistry for Rb expression was also undertaken. After eliminating low quality samples, 37 tumors were successfully analyzed (14 MCPyV+, 8 pure MCPyV- and 15 combined MCPyV-). The SCC and NE components were sequenced separately in 5 combined tumors. Tumor mutational burden was lower in MCPyV+ tumors (mean 1.66 vs. 29.9/Mb, P < 0.0001). MCPyV- tumors featured frequent mutations in TP53 (95.6%), RB1 (87%), and NOTCH family genes (95.6%). No recurrently mutated genes were identified in MCPyV+ tumors. Mutational overlap in the NE and SCC components of combined tumors was substantial ('similarity index' >24% in 4/5 cases). Loss of Rb expression correlated with RB1 mutational (P < 0.0001) and MCPyV- status (P < 0.0001) in MCCs and it was observed more frequently in the SCC component of combined MCC than in a control group of conventional cutaneous SCC (P = 0.0002). Our results (i) support existing evidence that MCPyV+ and MCPyV- MCCs are pathogenetically distinct entities (ii) concur with earlier studies linking the NE and SCC components of combined MCCs via shared genetic profiles and (iii) lend credence to the proposal that an Rb-deficient subset of SCC's is the source of phenotypically divergent combined MCCs.
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Affiliation(s)
- Ryan C DeCoste
- Department of Pathology and Laboratory Medicine, QEII Health Sciences Centre, Nova Scotia Health (Central Zone), Halifax, NS, Canada. .,Department of Pathology, Dalhousie University, Halifax, NS, Canada.
| | - Noreen M Walsh
- Department of Pathology and Laboratory Medicine, QEII Health Sciences Centre, Nova Scotia Health (Central Zone), Halifax, NS, Canada.,Department of Pathology, Dalhousie University, Halifax, NS, Canada.,Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Daniel Gaston
- Department of Pathology and Laboratory Medicine, QEII Health Sciences Centre, Nova Scotia Health (Central Zone), Halifax, NS, Canada.,Department of Pathology, Dalhousie University, Halifax, NS, Canada
| | - Thai Yen Ly
- Department of Pathology and Laboratory Medicine, QEII Health Sciences Centre, Nova Scotia Health (Central Zone), Halifax, NS, Canada.,Department of Pathology, Dalhousie University, Halifax, NS, Canada
| | - Sylvia Pasternak
- Department of Pathology and Laboratory Medicine, QEII Health Sciences Centre, Nova Scotia Health (Central Zone), Halifax, NS, Canada.,Department of Pathology, Dalhousie University, Halifax, NS, Canada
| | - Sam Cutler
- Department of Pathology, Dalhousie University, Halifax, NS, Canada
| | - Mat Nightingale
- Department of Pathology, Dalhousie University, Halifax, NS, Canada
| | - Michael D Carter
- Department of Pathology and Laboratory Medicine, QEII Health Sciences Centre, Nova Scotia Health (Central Zone), Halifax, NS, Canada.,Department of Pathology, Dalhousie University, Halifax, NS, Canada
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Nakamura M, Morita A. Immune activity in Merkel cell carcinoma. J Dermatol 2021; 49:68-74. [PMID: 34766373 PMCID: PMC9299685 DOI: 10.1111/1346-8138.16232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/24/2021] [Accepted: 11/02/2021] [Indexed: 12/11/2022]
Abstract
Merkel cell carcinoma (MCC) is widely known as a highly malignant skin cancer. The pathogenesis of MCC, however, remains mysterious due to the extremely small number of cases and its prevalence in the elderly. Despite its high‐grade malignancy, spontaneous regression occurs with some frequency. The immune activity of the tumor underlies this peculiar behavior. In recent years, immune checkpoint blockade therapies, including the anti‐programmed death ligand 1 antibody, have provided successful results. These therapies, however, are ineffective in approximately half the patients with advanced MCC and few treatments are available for those patients. In this review, we summarize the increasing body of evidence relating to the immune activity of MCC and immunological biomarkers. The interesting and sometimes peculiar behavior of MCC, such as their spontaneous regression, is largely due to their high immunosensitivity. Understanding the tumor immunokinetics of MCC should provide critical insight for understanding cancer immunotherapy. Here, we introduce a new classification for MCC according to its immune activity. Combined application of programmed death ligand 1 (a prognostic factor and predictor of the efficacy of immune checkpoint inhibitors in various cancers) with glucose‐6‐phosphate dehydrogenase (a new promising biomarker for MCC) may enable classification of MCC based on its immune status. Whether the new classification can be used to predict the efficacy of immune checkpoint blockade therapies remains to be evaluated in future studies, but the classification may facilitate future treatment selection.
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Affiliation(s)
- Motoki Nakamura
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Akimichi Morita
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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Ricco G, Andrini E, Siepe G, Mosconi C, Ambrosini V, Ricci C, Casadei R, Campana D, Lamberti G. Multimodal Strategy in Localized Merkel Cell Carcinoma: Where Are We and Where Are We Heading? Int J Mol Sci 2021; 22:ijms221910629. [PMID: 34638968 PMCID: PMC8508588 DOI: 10.3390/ijms221910629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/21/2021] [Accepted: 09/23/2021] [Indexed: 02/07/2023] Open
Abstract
Merkel cell carcinoma (MCC) is an aggressive neuroendocrine tumor of the skin whose incidence is rising. Multimodal treatment is crucial in the non-metastatic, potentially curable setting. However, the optimal management of patients with non-metastatic MCC is still unclear. In addition, novel insights into tumor biology and newly developed treatments (e.g., immune checkpoint inhibitors) that dramatically improved outcomes in the advanced setting are being investigated in earlier stages with promising results. Nevertheless, the combination of new strategies with consolidated ones needs to be clarified. We reviewed available evidence supporting the current treatment recommendations of localized MCC with a focus on potentially ground-breaking future strategies. Advantages and disadvantages of the different treatment modalities, including surgery, radiotherapy, chemotherapy, and immunotherapy in the non-metastatic setting, are analyzed, as well as those of different treatment modalities (adjuvant as opposed to neoadjuvant). Lastly, we provide an outlook of remarkable ongoing studies and of promising agents and strategies in the treatment of patients with non-metastatic MCC.
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Affiliation(s)
- Gianluca Ricco
- Department of Experimental Diagnostic and Specialized Medicine (DIMES), Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy; (G.R.); (E.A.); (V.A.); (G.L.)
- NET Team Bologna—ENETS Center of Excellence, 40138 Bologna, Italy; (C.M.); (C.R.); (R.C.)
| | - Elisa Andrini
- Department of Experimental Diagnostic and Specialized Medicine (DIMES), Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy; (G.R.); (E.A.); (V.A.); (G.L.)
- NET Team Bologna—ENETS Center of Excellence, 40138 Bologna, Italy; (C.M.); (C.R.); (R.C.)
| | - Giambattista Siepe
- Radiation Oncology, IRCCS Azienda Ospedaliero—Universitaria di Bologna, 40138 Bologna, Italy;
| | - Cristina Mosconi
- NET Team Bologna—ENETS Center of Excellence, 40138 Bologna, Italy; (C.M.); (C.R.); (R.C.)
- Department of Radiology, IRCCS Azienda Ospedaliero—Universitaria di Bologna, 40138 Bologna, Italy
| | - Valentina Ambrosini
- Department of Experimental Diagnostic and Specialized Medicine (DIMES), Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy; (G.R.); (E.A.); (V.A.); (G.L.)
- NET Team Bologna—ENETS Center of Excellence, 40138 Bologna, Italy; (C.M.); (C.R.); (R.C.)
- IRCCS Azienda Ospedaliero—Universitaria di Bologna, 40139 Bologna, Italy
| | - Claudio Ricci
- NET Team Bologna—ENETS Center of Excellence, 40138 Bologna, Italy; (C.M.); (C.R.); (R.C.)
- IRCCS Azienda Ospedaliero—Universitaria di Bologna, 40139 Bologna, Italy
- Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
| | - Riccardo Casadei
- NET Team Bologna—ENETS Center of Excellence, 40138 Bologna, Italy; (C.M.); (C.R.); (R.C.)
- IRCCS Azienda Ospedaliero—Universitaria di Bologna, 40139 Bologna, Italy
- Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
| | - Davide Campana
- Department of Experimental Diagnostic and Specialized Medicine (DIMES), Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy; (G.R.); (E.A.); (V.A.); (G.L.)
- NET Team Bologna—ENETS Center of Excellence, 40138 Bologna, Italy; (C.M.); (C.R.); (R.C.)
- Division of Medical Oncology, IRCCS Azienda Ospedaliero—Universitaria di Bologna, 40138 Bologna, Italy
- Correspondence: ; Tel.: +39-051-2142886
| | - Giuseppe Lamberti
- Department of Experimental Diagnostic and Specialized Medicine (DIMES), Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy; (G.R.); (E.A.); (V.A.); (G.L.)
- NET Team Bologna—ENETS Center of Excellence, 40138 Bologna, Italy; (C.M.); (C.R.); (R.C.)
- Division of Medical Oncology, IRCCS Azienda Ospedaliero—Universitaria di Bologna, 40138 Bologna, Italy
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7
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Krump NA, You J. From Merkel Cell Polyomavirus Infection to Merkel Cell Carcinoma Oncogenesis. Front Microbiol 2021; 12:739695. [PMID: 34566942 PMCID: PMC8457551 DOI: 10.3389/fmicb.2021.739695] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 08/09/2021] [Indexed: 11/13/2022] Open
Abstract
Merkel cell polyomavirus (MCPyV) infection causes near-ubiquitous, asymptomatic infection in the skin, but occasionally leads to an aggressive skin cancer called Merkel cell carcinoma (MCC). Epidemiological evidence suggests that poorly controlled MCPyV infection may be a precursor to MCPyV-associated MCC. Clearer understanding of host responses that normally control MCPyV infection could inform prophylactic measures in at-risk groups. Similarly, the presence of MCPyV in most MCCs could imbue them with vulnerabilities that-if better characterized-could yield targeted intervention solutions for metastatic MCC cases. In this review, we discuss recent developments in elucidating the interplay between host cells and MCPyV within the context of viral infection and MCC oncogenesis. We also propose a model in which insufficient restriction of MCPyV infection in aging and chronically UV-damaged skin causes unbridled viral replication that licenses MCC tumorigenesis.
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Affiliation(s)
| | - Jianxin You
- Department of Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
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8
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Merkel Cell Carcinoma of the Head and Neck: Epidemiology, Pathogenesis, Current State of Treatment and Future Directions. Cancers (Basel) 2021; 13:cancers13143506. [PMID: 34298720 PMCID: PMC8305628 DOI: 10.3390/cancers13143506] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/07/2021] [Accepted: 07/07/2021] [Indexed: 12/12/2022] Open
Abstract
Merkel cell carcinoma (MCC) is a rare, cutaneous neuroendocrine malignancy with increasing incidence. The skin of the head and neck is a common subsite for MCC with distinctions in management from other anatomic areas. Given the rapid pace of developments regarding MCC pathogenesis (Merkel cell polyoma virus (MCPyV)-positive or virus-negative, cell of origin), diagnosis, staging and treatment, and up to date recommendations are critical for optimizing outcomes. This review aims to summarize currently available literature for MCC of the head and neck. The authors reviewed current literature, including international guidelines regarding MCC pathogenesis, epidemiology, diagnosis, staging, and treatment. Subsequently recommendations were derived including the importance of baseline imaging, MCPyV serology testing, primary site surgery, nodal evaluation, radiotherapy, and the increasing role of immune modulating agents in MCC. MCPyV serology testing is increasingly important with potential distinctions in treatment response and surveillance between virus-positive and virus-negative MCC. Surgical management continues to balance optimizing local control with minimal morbidity. Similarly, radiotherapy continues to have importance in the adjuvant, definitive, and palliative setting for MCC of the head and neck. Immunotherapy has changed the paradigm for advanced MCC, with increasing work focusing on optimizing outcomes for non-responders and high-risk patients, including those with immunosuppression.
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Stachyra K, Dudzisz-Śledź M, Bylina E, Szumera-Ciećkiewicz A, Spałek MJ, Bartnik E, Rutkowski P, Czarnecka AM. Merkel Cell Carcinoma from Molecular Pathology to Novel Therapies. Int J Mol Sci 2021; 22:6305. [PMID: 34208339 PMCID: PMC8231245 DOI: 10.3390/ijms22126305] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 05/24/2021] [Accepted: 06/02/2021] [Indexed: 02/07/2023] Open
Abstract
Merkel cell carcinoma (MCC) is an uncommon and highly aggressive skin cancer. It develops mostly within chronically sun-exposed areas of the skin. MCPyV is detected in 60-80% of MCC cases as integrated within the genome and is considered a major risk factor for MCC. Viral negative MCCs have a high mutation burden with a UV damage signature. Aberrations occur in RB1, TP53, and NOTCH genes as well as in the PI3K-AKT-mTOR pathway. MCC is highly immunogenic, but MCC cells are known to evade the host's immune response. Despite the characteristic immunohistological profile of MCC, the diagnosis is challenging, and it should be confirmed by an experienced pathologist. Sentinel lymph node biopsy is considered the most reliable staging tool to identify subclinical nodal disease. Subclinical node metastases are present in about 30-50% of patients with primary MCC. The basis of MCC treatment is surgical excision. MCC is highly radiosensitive. It becomes chemoresistant within a few months. MCC is prone to recurrence. The outcomes in patients with metastatic disease are poor, with a historical 5-year survival of 13.5%. The median progression-free survival is 3-5 months, and the median overall survival is ten months. Currently, immunotherapy has become a standard of care first-line therapy for advanced MCC.
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Affiliation(s)
- Karolina Stachyra
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (K.S.); (M.D.-Ś.); (E.B.); (M.J.S.); (P.R.)
- Faculty of Medicine, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Monika Dudzisz-Śledź
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (K.S.); (M.D.-Ś.); (E.B.); (M.J.S.); (P.R.)
| | - Elżbieta Bylina
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (K.S.); (M.D.-Ś.); (E.B.); (M.J.S.); (P.R.)
- Department of Clinical Trials, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland
| | - Anna Szumera-Ciećkiewicz
- Department of Pathology and Laboratory Diagnostics, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland;
- Department of Diagnostic Hematology, Institute of Hematology and Transfusion Medicine, 00-791 Warsaw, Poland
| | - Mateusz J. Spałek
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (K.S.); (M.D.-Ś.); (E.B.); (M.J.S.); (P.R.)
| | - Ewa Bartnik
- Institute of Genetics and Biotechnology, Faculty of Biology, University of Warsaw, 02-106 Warsaw, Poland;
| | - Piotr Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (K.S.); (M.D.-Ś.); (E.B.); (M.J.S.); (P.R.)
| | - Anna M. Czarnecka
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (K.S.); (M.D.-Ś.); (E.B.); (M.J.S.); (P.R.)
- Department of Experimental Pharmacology, Mossakowski Medical Research Centre, Polish Academy of Sciences, 02-106 Warsaw, Poland
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Donizy P, Wu CL, Kopczynski J, Pieniazek M, Biecek P, Ryś J, Hoang MP. Prognostic Role of Tumoral PD-L1 and IDO1 Expression, and Intratumoral CD8+ and FoxP3+ Lymphocyte Infiltrates in 132 Primary Cutaneous Merkel Cell Carcinomas. Int J Mol Sci 2021; 22:ijms22115489. [PMID: 34071045 PMCID: PMC8197111 DOI: 10.3390/ijms22115489] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/17/2021] [Accepted: 05/21/2021] [Indexed: 01/21/2023] Open
Abstract
The association of immune markers and clinicopathologic features and patient outcome has not been extensively studied in Merkel cell carcinoma (MCC). We correlated tumoral PD-L1 and IDO1 expression, and intratumoral CD8+ and FoxP3+ lymphocytes count with clinicopathologic variables, Merkel cell polyomavirus (MCPyV) status, and patient outcomes in a series of 132 MCC. By univariate analyses, tumoral PD-L1 expression >1% and combined tumoral PD-L1 >1% and high intratumoral FoxP3+ lymphocyte count correlated with improved overall survival (OS) (p = 0.016, 0.0072), MCC-specific survival (MSS) (p = 0.019, 0.017), and progression-free survival (PFS) (p = 0.043, 0.004, respectively). High intratumoral CD8+ and FoxP3+ lymphocyte count correlated with longer MSS (p = 0.036) and improved PFS (p = 0.047), respectively. Ulceration correlated with worse OS and worse MSS. Age, male gender, and higher stage (3 and 4) significantly correlated with worse survival. MCPyV positivity correlated with immune response. By multivariate analyses, only ulceration and age remained as independent predictors of worse OS; gender and stage remained for shorter PFS. Tumoral PD-L1 expression and increased density of intratumoral CD8+ lymphocytes and FoxP+ lymphocytes may represent favorable prognosticators in a subset of MCCs. Tumoral PD-L1 expression correlated with intratumoral CD8+ and FoxP3+ lymphocytes, which is supportive of an adaptive immune response.
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MESH Headings
- Adaptive Immunity
- Age Factors
- Aged
- Aged, 80 and over
- B7-H1 Antigen/biosynthesis
- Biomarkers, Tumor
- CD8-Positive T-Lymphocytes/chemistry
- CD8-Positive T-Lymphocytes/immunology
- Carcinoma, Merkel Cell/chemistry
- Carcinoma, Merkel Cell/immunology
- Carcinoma, Merkel Cell/mortality
- Carcinoma, Merkel Cell/virology
- Female
- Forkhead Transcription Factors/analysis
- Head and Neck Neoplasms/chemistry
- Head and Neck Neoplasms/immunology
- Head and Neck Neoplasms/mortality
- Head and Neck Neoplasms/virology
- Humans
- Indoleamine-Pyrrole 2,3,-Dioxygenase/biosynthesis
- Kaplan-Meier Estimate
- Lymphocyte Count
- Lymphocytes, Tumor-Infiltrating/immunology
- Male
- Merkel cell polyomavirus/isolation & purification
- Middle Aged
- Multivariate Analysis
- Neoplasm Proteins/biosynthesis
- Neoplasm Staging
- Neoplasms, Second Primary/chemistry
- Neoplasms, Second Primary/immunology
- Neoplasms, Second Primary/mortality
- Neoplasms, Second Primary/virology
- Prognosis
- Progression-Free Survival
- Proportional Hazards Models
- Sex Factors
- Skin Neoplasms/chemistry
- Skin Neoplasms/immunology
- Skin Neoplasms/mortality
- Skin Neoplasms/virology
- Skin Ulcer/etiology
- T-Lymphocyte Subsets/immunology
- Tumor Virus Infections
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Affiliation(s)
- Piotr Donizy
- Department of Clinical and Experimental Pathology, Wroclaw Medical University, 50-556 Wroclaw, Poland;
| | - Cheng-Lin Wu
- Department of Pathology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan;
| | - Janusz Kopczynski
- Department of Surgical Pathology, Holy Cross Cancer Centre, 25-734 Kielce, Poland;
| | - Malgorzata Pieniazek
- Department of Oncology and Division of Surgical Oncology, Wroclaw Medical University, 53-413 Wroclaw, Poland;
| | - Przemyslaw Biecek
- Department of Mathematics and Information Science, Warsaw University of Technology, 00-628 Warsaw, Poland;
| | - Janusz Ryś
- Department of Pathology, Center of Oncology, M. Sklodowska-Curie Memorial Institute, 31-115 Krakow, Poland;
| | - Mai P. Hoang
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
- Correspondence:
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11
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Merkel cell carcinoma-derived exosome-shuttle miR-375 induces fibroblast polarization by inhibition of RBPJ and p53. Oncogene 2020; 40:980-996. [PMID: 33311552 PMCID: PMC7862059 DOI: 10.1038/s41388-020-01576-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 11/02/2020] [Accepted: 11/18/2020] [Indexed: 12/13/2022]
Abstract
Merkel cell carcinoma (MCC) is a highly invasive and metastatic skin cancer. While high expression of miR-375 is a characteristic of MCC, it seems not to contribute to the malignant phenotype of MCC cells. miR-375 enrichment in MCC-derived extracellular vesicles suggests its intercellular signaling function. Here, we demonstrate that horizontally transferred miR-375 causes fibroblast polarization toward cancer-associated fibroblasts (CAFs). The polarization is evidenced by phenotypic changes and induction of α-SMA, CXCL2, and IL-1β. Fibroblast polarization is inhibited by specific antagomirs and mimicked by experimental miR-375 expression. Mechanistically, miR-375 downregulates RBPJ and p53, two key players regulating fibroblast polarization. In clinical MCC samples, in situ hybridization located miR-375 in CAFs, which correlated with high α-SMA protein and low RBPJ and TP53 expression; single-cell RNAseq revealed a disparate fibroblast polarization negatively correlating with p53 pathway-related gene expression. Thus, the functional role of miR-375 in MCC is to generate a pro-tumorigenic microenvironment by inducing fibroblast polarization.
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12
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Yusuf M, Gaskins J, Mandish S, May ME, Wall W, Fisher W, Tennant P, Jorgensen J, Bumpous J, Dunlap N. Tumor infiltrating lymphocyte grade in Merkel cell carcinoma: relationships with clinical factors and independent prognostic value. Acta Oncol 2020; 59:1409-1415. [PMID: 32687000 DOI: 10.1080/0284186x.2020.1794033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Surrogate markers of the host immune response are not currently included in AJCC staging for Merkel cell carcinoma (MCC), and have not been consistently associated with clinical outcomes. We performed an analysis of a large national database to investigate tumor infiltrating lymphocyte (TIL) grade as an independent predictor of overall survival (OS) for patients with MCC and to characterize the relationship between TIL grade and other clinical prognostic factors. MATERIAL AND METHODS The NCDB was queried for patients with resected, non-metastatic MCC with known TIL grade (absent, non-brisk and brisk). Multivariable Cox regression modeling was performed to define TIL grade as a predictor of OS adjusting for other relevant clinical factors. Multinomial, multivariable logistic regression was performed to characterize the relationship between TIL grade and other clinical prognostic factors. Multiple imputation was performed to account for missing data bias. RESULTS Both brisk (HR 0.55, CI 0.36-0.83) and non-brisk (HR 0.77, CI 0.60-0.98) were associated with decreased adjusted hazard of death relative to absent TIL grade. Adverse clinical factors such as 1-3 positive lymph nodes, lymphovascular invasion (LVI) and immunosuppression were associated with increased likelihood of non-brisk TIL relative to absent TIL grade (p values <.05). Extracapsular extension (ECS) was associated with decreased likelihood of brisk TIL relative to absent TIL grade (p<.05). DISCUSSION Histopathologic TIL grade was independently predictive for OS in this large national cohort. Significant differences in the likelihood of non-brisk or brisk TIL relative to absent grade were present with regards to LVI, ECS and immune status. TIL grade may be a useful prognostic factor to consider in addition to more granular characterization of TIL morphology and immunophenotype.
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Affiliation(s)
- Mehran Yusuf
- Department of Radiation Oncology, University of Louisville Hospital, Louisville, KY, USA
| | - Jeremy Gaskins
- Department of Bioinformatics and Biostatistics, University of Louisville, Louisville, KY, USA
| | - Steven Mandish
- Department of Radiation Oncology, University of Louisville Hospital, Louisville, KY, USA
| | - Michael E. May
- Department of Radiation Oncology, University of Louisville Hospital, Louisville, KY, USA
| | - Weston Wall
- Department of Dermatology, Medical College of Georgia, Augusta, GA, USA
| | - William Fisher
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Paul Tennant
- Department of Otolaryngology-Head and Neck Surgery and Communicative Disorders, University of Louisville Hospital, Louisville, KY, USA
| | - Jeffrey Jorgensen
- Department of Otolaryngology-Head and Neck Surgery and Communicative Disorders, University of Louisville Hospital, Louisville, KY, USA
| | - Jeffrey Bumpous
- Department of Otolaryngology-Head and Neck Surgery and Communicative Disorders, University of Louisville Hospital, Louisville, KY, USA
| | - Neal Dunlap
- Department of Radiation Oncology, University of Louisville Hospital, Louisville, KY, USA
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13
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Abstract
PURPOSE OF REVIEW Merkel cell carcinoma (MCC) is a rare and aggressive skin cancer, which is associated in 80% of cases with the Merkel cell polyomavirus (MCPyV). Advanced stages respond to immune checkpoint inhibitors in 50% of cases. Major issues remain unanswered regarding its oncogenesis and optimal treatment. RECENT FINDINGS MCPyV-negative and MCPyV-positive MCCs have been hypothesized to derive from distinct cells, although the cell of origin remains a matter of debate. The crucial role the MCPyV small T oncoprotein was recently confirmed by its ability to inactivate p53, together with its contribution to the metastatic progression. In advanced cases, tumoral microenvironment may adequately predict responses to immunotherapies, and several mechanisms of primary and secondary resistance have been investigated. SUMMARY Identifying the mechanisms of oncogenesis allow experimentation of new therapeutic targets, which remain mandatory even at the era of immunotherapies. Although new insights in the mechanisms of primary and secondary resistance pave the way for development of further immunotherapy strategies, neoadjuvant strategies may challenge our whole approach of the disease.
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14
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Butala AA, Jain V, Reddy VK, Sebro RA, Song Y, Karakousis G, Mitchell TC, Lukens JN, Shabason JE. Impact of Tumor-Infiltrating Lymphocytes on Overall Survival in Merkel Cell Carcinoma. Oncologist 2020; 26:63-69. [PMID: 32886418 DOI: 10.1634/theoncologist.2020-0070] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 08/06/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Merkel cell carcinoma (MCC) is a rare and aggressive neuroendocrine carcinoma of the skin. As the clinical course can be variable, prognostic markers are needed to better stratify patients. Prior literature, composed of small series with limited sample size, has demonstrated that tumor-infiltrating lymphocytes (TILs) are an important prognostic marker in MCC. To validate these findings on a population level, we sought to analyze and report the prognostic value of TILs in a large national data set. MATERIALS AND METHODS A retrospective observational cohort study was conducted of patients with nonmetastatic MCC from 2010 to 2015 using the National Cancer Database. Individual variables trending toward significance using a univariable analysis were included in a multivariable Cox proportional hazards model to assess their independent effect on overall survival (OS). TILs were subclassified into none, nonbrisk, and brisk and the survival analysis was performed. Propensity score-weighted multivariable analysis (PS MVA) was performed to adjust for additional confounding. RESULTS A total of 2,182 patients met inclusion criteria: 611 (28.0%) were identified as having TILs present, and 1,571 (72.0%) had TILs absent in the tumor. On MVA, subdivision of TIL status into nonbrisk (hazard ratio [HR], 0.750; 95% confidence interval [CI], 0.602-0.933) and brisk (HR, 0.499; 95% CI, 0.338-0.735) was associated with incrementally improved OS compared with no TILs. The association of nonbrisk and brisk TILs with improved OS was retained on PS MVA (Nonbrisk: HR, 0.720; 95% CI, 0.550-0.944; Brisk: HR, 0.483; 95% CI, 0.286-0.814). CONCLUSION The presence of nonbrisk and brisk TILs is associated with incrementally improved OS in patients with nonmetastatic MCC in a large national data set. This pathologic feature can aid with risk stratification, estimation of prognosis, and, importantly, decision-making with respect to treatment intensification in high-risk patients. IMPLICATIONS FOR PRACTICE Merkel cell carcinoma (MCC) is an aggressive neuroendocrine cutaneous malignancy with variable clinical course. Prognostic markers are needed to better risk stratify patients. We present the largest retrospective observational cohort study of patients with nonmetastatic MCC using the National Cancer Database. Our analysis demonstrates an association between increasing degrees of tumor-infiltrating lymphocytes and incrementally improved survival. These conclusions improve pathologic risk stratification, and decision-making with respect to treatment intensification. Intensification may include adjuvant radiation therapy to the primary site after wide excision despite small tumor size, to the nodal basin in sentinel lymph node-negative patients, or offering closer follow-up.
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Affiliation(s)
- Anish A Butala
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Varsha Jain
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Vishruth K Reddy
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ronnie A Sebro
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yun Song
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Giorgos Karakousis
- Department of Surgical Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Tara C Mitchell
- Department of Medical Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - J Nicholas Lukens
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jacob E Shabason
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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15
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The presence of Merkel cell carcinoma polyomavirus is associated with a distinct phenotype in neoplastic Merkel cell carcinoma cells and their tissue microenvironment. PLoS One 2020; 15:e0232517. [PMID: 32687503 PMCID: PMC7371188 DOI: 10.1371/journal.pone.0232517] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 06/26/2020] [Indexed: 12/11/2022] Open
Abstract
AIMS Merkel cell carcinoma (MCC) is an aggressive primary neuroendocrine tumor of the skin, associated with Merkel cell polyomavirus (MCPyV) in 49-89% of cases, depending on the country of origin and the techniques of detection. The presence of MCPyV defines heterogeneity in MCC; MCPyV-negative cases bear a much higher mutational load, with a distinct ultraviolet signature pattern featuring C > T transitions, as a consequence of exposure to ultraviolet light radiation. MCC stroma has not been thoroughly studied, although MCC patients benefit from therapy targeting PD1/PDL1. METHODS AND RESULTS In this study, using Tissue Microarrays and immunohistochemistry, we have analyzed a series of 219 MCC cases in relation to the presence of MCPyV, and confirmed that the presence of MCPyV is associated with changes not only in the neoplastic cells, but also in the composition of the tumor stroma. Thus, MCPyV, found in 101/176 (57,4%) analyzable cases, exhibits changes in its tumor morphology, the density of the inflammatory infiltrate, the phenotype of the neoplastic cells, and the cell composition of the tumor stroma. MCPyV presence is negatively correlated with a higher level of p53 expression, and associated with a very high frequency (86%) of HLA-I expression loss, a higher apoptotic index, and a stroma richer in T-cells, cytotoxic T-cells, macrophages, PDL1-positive macrophages, and B-cells. CONCLUSIONS Our findings provide evidence of the basic heterogeneity of MCC, supporting the hypothesis that the presence of MCPyV may induce a rich inflammatory response, which is at least partially avoided through loss of HLA-I antigen expression. On the other hand, MCPyV-negative cases show a much higher frequency of stronger p53 expression and, probably, p53 alterations.
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16
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Global PD-L1 Signals and Tumor-Infiltrating Lymphocytes: Markers of Immunogenicity in Different Subsets of Merkel Cell Carcinoma and Potential Therapeutic Implications. Am J Dermatopathol 2020; 41:819-825. [PMID: 31634167 DOI: 10.1097/dad.0000000000001390] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
We previously studied the genetic and immunohistochemical profiles of subsets of Merkel cell carcinoma (MCC) stratified by morphology and Merkel cell polyomavirus (MCPyV) status. Recent advances in the immunotherapy of this disease prompted us to examine markers of immunogenicity [PD-L1 expression and tumor-infiltrating lymphocytes (TILS) in these subsets]. The observed clinical responses to checkpoint inhibition of the PD-1/PD-L1 pathway have not correlated with PD-L1 expression by MCC cells, and recent evidence suggests that functions of this pathway within the immune tumor microenvironment may be relevant. We conducted a semiquantitative (high, moderate, and minimal) immunohistochemical evaluation of the global PD-L1 signal in 52 cases of MCC, segregated in 3 subsets [pure MCPyV-positive (n = 28), pure MCPyV-negative (n = 9), and combined MCPyV-negative (n = 15)]. TILS were categorized as brisk, nonbrisk, or absent. Intersubset comparisons revealed that high global PD-L1 signals were exclusively associated with pure MCPyV-positive MCCs contrasted with virus-negative cases (P = 0.0003). Moderate signals were seen across all 3 groups. Brisk TILS were significantly associated with MCPyV-positive MCCs compared with MCPyV-negative cases (P = 0.029). Neither parameter (PD-L1 or TILS) was significantly different between the MCPyV-negative groups. Of potential clinical relevance, MCPyV seems to convey greater immunogenicity to MCCs than the high mutational burden/greater neoantigen load of MCPyV-negative cases. Interesting too is the fact that subset-related profiles of these markers mirrored those noted at genetic and immunohistochemical levels, separating pure MCPyV-positive MCCs from the virus-negative subsets.
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17
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Nirenberg A, Steinman H, Dixon J, Dixon A. Merkel cell carcinoma update: the case for two tumours. J Eur Acad Dermatol Venereol 2020; 34:1425-1431. [DOI: 10.1111/jdv.16158] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 11/26/2019] [Indexed: 01/03/2023]
Affiliation(s)
- A. Nirenberg
- Australasian College of Cutaneous Oncology Docklands Vic. Australia
| | - H. Steinman
- Campbell University of School of Osteopathic Medicine Lillington NC USA
- US Dermatology Partners Grapevine TX USA
| | - J. Dixon
- Baker Heart and Diabetes Institute Melbourne Vic. Australia
| | - A. Dixon
- Australasian College of Cutaneous Oncology Docklands Vic. Australia
- American Osteopathic College of Dermatology Kirskville MO USA
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18
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Walsh NM, Saggini A, Pasternak S, Carter MD, Fleming K, Ly TY, Doucette S. p63 expression in Merkel cell carcinoma: comparative immunohistochemistry invokes TAp63 as the dominant isoform involved. Hum Pathol 2020; 97:60-67. [PMID: 31978504 DOI: 10.1016/j.humpath.2020.01.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 01/08/2020] [Accepted: 01/10/2020] [Indexed: 12/11/2022]
Abstract
The literature suggests that p63 expression in Merkel cell carcinoma (MCC) is associated with a poor prognosis. p63 immunohistochemistry marks the 2 main isoforms of this transcriptional protein: TAp63 (tumor suppressor-like properties) and ∆Np63 (oncogenic properties). Little information about the isoform of relevance in MCC exists. p40 immunohistochemistry specifically marks ∆Np63, and using comparative, semiquantitative expression of p63 and p40, we sought to clarify the issue. Our cohort of 53 cases (28 men and 25 women, median age 79 years, interquartile range 71-88) was stratified by morphology and viral status. Immunohistochemistry (p63, p40, and cytokeratin 5/6) was performed, H-scores for nuclear expression of p63 and p40 were derived (2 observers; positivity ≥ 10), and interobserver agreement was evaluated. Clinical, pathological, and outcome data were documented. The results were analyzed statistically. Mortality amounted to 57% (median follow-up 686 days, interquartile range 292-1599). Positivity for Merkel cell polyomavirus was observed in 29 (55%) of cases. Expression of p63 and p40 was present in 36 (69%) and 4 (8%) of cases, respectively. Increased age (P = .0241), negative Merkel cell polyomavirus status (P = .0185), and p63 positivity (P = .0012) were significantly associated with mortality. The latter 2 variables were highly correlated (P = .004). The interclass correlation between the 2 sets of H-scores was 0.95. Our findings support an association between p63 expression and reduced overall survival in MCC and show consistency in scoring this prognostic parameter. TAp63 is the dominant isoform of the protein involved. The paradoxical tumor suppressor-like activity of this isoform in p63-positive MCCs with reduced overall survival requires further study.
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Affiliation(s)
- Noreen M Walsh
- Department of Pathology, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, Central Zone, Halifax, Nova Scotia, Canada B3H 1V8; Dalhousie University, Halifax, Nova Scotia, Canada B3H 1V8; Department of Medicine, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, Central Zone, Halifax, Nova Scotia, Canada B3H 1V8.
| | - Andrea Saggini
- Anatomic Pathology, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy 00133
| | - Sylvia Pasternak
- Department of Pathology, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, Central Zone, Halifax, Nova Scotia, Canada B3H 1V8; Dalhousie University, Halifax, Nova Scotia, Canada B3H 1V8; Department of Medicine, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, Central Zone, Halifax, Nova Scotia, Canada B3H 1V8
| | - Michael D Carter
- Department of Pathology, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, Central Zone, Halifax, Nova Scotia, Canada B3H 1V8; Dalhousie University, Halifax, Nova Scotia, Canada B3H 1V8
| | - Kirsten Fleming
- Department of Pathology, Abbotsford Regional Hospital and Cancer Centre, Fraser Health Authority, Abbotsford, British Columbia, Canada V2S 0C2; Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada V6T 1Z3
| | - Thai Yen Ly
- Department of Pathology, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, Central Zone, Halifax, Nova Scotia, Canada B3H 1V8; Dalhousie University, Halifax, Nova Scotia, Canada B3H 1V8
| | - Steve Doucette
- Dalhousie University, Halifax, Nova Scotia, Canada B3H 1V8; Research Methods Unit, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada B3H 1V7
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19
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Foci of Programmed Cell Death-Ligand 1 (PD-L1)-positive Tumor Areas With Tumor-infiltrating Leukocytes (TILs) Evocative of a PD-1/PD-L1-related Adaptive Immune Resistance are Frequent in Merkel Cell Carcinoma. Appl Immunohistochem Mol Morphol 2020; 28:17-22. [DOI: 10.1097/pai.0000000000000792] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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20
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Femia D, Prinzi N, Anichini A, Mortarini R, Nichetti F, Corti F, Torchio M, Peverelli G, Pagani F, Maurichi A, Mattavelli I, Milione M, Bedini N, Corti A, Di Bartolomeo M, de Braud F, Pusceddu S. Treatment of Advanced Merkel Cell Carcinoma: Current Therapeutic Options and Novel Immunotherapy Approaches. Target Oncol 2019; 13:567-582. [PMID: 30073632 DOI: 10.1007/s11523-018-0585-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Advanced Merkel cell carcinoma (MCC) is a very aggressive, rare neuroendocrine tumor of the skin with a high frequency of locoregional recurrence and metastasis, and a high mortality rate. Surgical resection, sentinel lymph node biopsy, and radiotherapy represent the gold standard of treatment in patients with localized disease, while chemotherapy has a significant role in the treatment of advanced disease. However, no definitive evidence on the survival impact of radiotherapy in the advanced stages has been provided to date, and response to chemotherapy remains brief in the majority of cases, indicating an urgent need for alternative approaches. Biological and genome sequencing studies have implicated multiple molecular pathways in MCC, thus leading to the development of new agents that target angiogenic factors, anti-apoptosis molecules, poly-ADP ribose polymerase, intracellular signal proteins such as the PI3K/AKT/mTOR pathway, and peptide receptors such as somatostatin receptors. More recently, immunotherapy agents such as avelumab, pembrolizumab, and nivolumab, which act by blocking the programmed cell-death (PD)-1/PD-L1 immune checkpoint, have shown promising results, especially in the advanced setting, and should now be considered standard of care for metastatic MCC. Current research is focusing on developing new immunotherapeutic strategies, identifying predictive biomarker to aid in the selection of patients responsive to immunotherapy, and defining combination approaches to increase efficacy in refractory patients.
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Affiliation(s)
- Daniela Femia
- Department of Medical Oncology Unit-1, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano and ENETS Center of Excellence, Via Venezian 1, 20133, Milan, Italy
| | - Natalie Prinzi
- Department of Medical Oncology Unit-1, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano and ENETS Center of Excellence, Via Venezian 1, 20133, Milan, Italy
| | - Andrea Anichini
- Department of Research, Human Tumors Immunobiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano and ENETS Center of Excellence, Milan, Italy
| | - Roberta Mortarini
- Department of Research, Human Tumors Immunobiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano and ENETS Center of Excellence, Milan, Italy
| | - Federico Nichetti
- Department of Medical Oncology Unit-1, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano and ENETS Center of Excellence, Via Venezian 1, 20133, Milan, Italy
| | - Francesca Corti
- Department of Medical Oncology Unit-1, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano and ENETS Center of Excellence, Via Venezian 1, 20133, Milan, Italy
| | - Martina Torchio
- Department of Medical Oncology Unit-1, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano and ENETS Center of Excellence, Via Venezian 1, 20133, Milan, Italy
| | - Giorgia Peverelli
- Department of Medical Oncology Unit-1, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano and ENETS Center of Excellence, Via Venezian 1, 20133, Milan, Italy
| | - Filippo Pagani
- Department of Medical Oncology Unit-1, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano and ENETS Center of Excellence, Via Venezian 1, 20133, Milan, Italy
| | - Andrea Maurichi
- Melanoma and Sarcoma Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, ENETS Center of Excellence, Milan, Italy
| | - Ilaria Mattavelli
- Melanoma and Sarcoma Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, ENETS Center of Excellence, Milan, Italy
| | - Massimo Milione
- 1st Pathology Division, Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori and ENETS Center of Excellence, Milan, Italy
| | - Nice Bedini
- Radiation Oncology 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano and ENETS Center of Excellence, Milan, Italy
| | | | - Maria Di Bartolomeo
- Department of Medical Oncology Unit-1, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano and ENETS Center of Excellence, Via Venezian 1, 20133, Milan, Italy
| | - Filippo de Braud
- Department of Medical Oncology Unit-1, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano and ENETS Center of Excellence, Via Venezian 1, 20133, Milan, Italy.,University of Milan, Milan, Italy
| | - Sara Pusceddu
- Department of Medical Oncology Unit-1, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano and ENETS Center of Excellence, Via Venezian 1, 20133, Milan, Italy.
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21
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Immune Checkpoint Inhibitors and Beyond: An Overview of Immune-Based Therapies in Merkel Cell Carcinoma. Am J Clin Dermatol 2019; 20:391-407. [PMID: 30784027 DOI: 10.1007/s40257-019-00427-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Merkel cell carcinoma (MCC) is an aggressive skin cancer. Until 2017, patients with advanced disease were typically treated with conventional chemotherapies, with a median response duration of 3 months. Increased evidence of the role of the immune system in controlling this cancer has paved the way for immune-based therapies, with programmed cell death protein 1 (PD-1)/programmed cell death protein ligand 1 (PD-L1) inhibitors at the frontline. Avelumab, an anti-PD-L1 antibody, was the first-ever drug approved in advanced MCC after showing meaningful efficacy in a second-line setting. Objective responses were observed in one-third of patients and, most importantly, were durable with half of patients and one-third of patients still alive at 1 and 2 years, respectively. When used in a first-line setting, PD-1/PD-L1 inhibitors (avelumab, pembrolizumab, nivolumab) are even more promising as objective responses are observed in approximately 50-70% of patients within the first 4-8 weeks of treatment. Safety profiles are acceptable with 10-20% of patients experiencing adverse events grade ≥ 3. PD-1/PD-L1 inhibitors are considered the standard of care in advanced MCC and are currently being investigated in the adjuvant and neoadjuvant settings. However, innovative treatments are still needed in the metastatic setting, as approximately 50% of these patients will not persistently respond to currently available immunotherapies, and no predictors of response are available yet. Therefore, other immunotherapeutic strategies are now being investigated-ideally in combinations-to enhance the various aspects of the immune response against tumoral cells.
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22
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Godeau M, Pages-Laurent C, Severino-Freire M, Guinard E, Tauber M, Larrieu-Ciron D, Lamant L, Evrard SM, Riffaud L, Sibaud V, Boulinguez S, Meyer N. A case of merkel leptomeningeal evolution after complete remission upon anti-PD-1 treatment. Eur J Cancer 2019; 113:55-57. [PMID: 30981092 DOI: 10.1016/j.ejca.2019.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 02/22/2019] [Accepted: 03/14/2019] [Indexed: 01/02/2023]
Affiliation(s)
- Marion Godeau
- Department of Dermatology, Paul Sabatier - Toulouse III University, IUC and CHU de Toulouse, Toulouse, France
| | - Cécile Pages-Laurent
- Department of Dermatology, Paul Sabatier - Toulouse III University, IUC and CHU de Toulouse, Toulouse, France
| | - Maella Severino-Freire
- Department of Dermatology, Paul Sabatier - Toulouse III University, IUC and CHU de Toulouse, Toulouse, France
| | - Elisabeth Guinard
- Department of Dermatology, Paul Sabatier - Toulouse III University, IUC and CHU de Toulouse, Toulouse, France
| | - Marie Tauber
- Department of Dermatology, Paul Sabatier - Toulouse III University, IUC and CHU de Toulouse, Toulouse, France
| | - Delphine Larrieu-Ciron
- Department of Neuro-oncology, Paul Sabatier - Toulouse III University, IUC and CHU de Toulouse, Toulouse, France
| | - Laurence Lamant
- Department of Pathology, Paul Sabatier - Toulouse III University, IUC and CHU de Toulouse, Toulouse, France
| | - Solene M Evrard
- Department of Pathology, Paul Sabatier - Toulouse III University, IUC and CHU de Toulouse, Toulouse, France
| | - Laurence Riffaud
- Department of Dermatology, Paul Sabatier - Toulouse III University, IUC and CHU de Toulouse, Toulouse, France
| | - Vincent Sibaud
- Department of Dermatology, Paul Sabatier - Toulouse III University, IUC and CHU de Toulouse, Toulouse, France
| | - Serge Boulinguez
- Department of Dermatology, Paul Sabatier - Toulouse III University, IUC and CHU de Toulouse, Toulouse, France
| | - Nicolas Meyer
- Department of Dermatology, Paul Sabatier - Toulouse III University, IUC and CHU de Toulouse, Toulouse, France.
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Giraldo NA, Nguyen P, Engle EL, Kaunitz GJ, Cottrell TR, Berry S, Green B, Soni A, Cuda JD, Stein JE, Sunshine JC, Succaria F, Xu H, Ogurtsova A, Danilova L, Church CD, Miller NJ, Fling S, Lundgren L, Ramchurren N, Yearley JH, Lipson EJ, Cheever M, Anders RA, Nghiem PT, Topalian SL, Taube JM. Multidimensional, quantitative assessment of PD-1/PD-L1 expression in patients with Merkel cell carcinoma and association with response to pembrolizumab. J Immunother Cancer 2018; 6:99. [PMID: 30285852 PMCID: PMC6167897 DOI: 10.1186/s40425-018-0404-0] [Citation(s) in RCA: 117] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 09/06/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND We recently reported a 56% objective response rate in patients with advanced Merkel cell carcinoma (MCC) receiving pembrolizumab. However, a biomarker predicting clinical response was not identified. METHODS Pretreatment FFPE tumor specimens (n = 26) were stained for CD8, PD-L1, and PD-1 by immunohistochemistry/immunofluorescence (IHC/IF), and the density and distribution of positive cells was quantified to determine the associations with anti-PD-1 response. Multiplex IF was used to test a separate cohort of MCC archival specimens (n = 16), to identify cell types expressing PD-1. RESULTS Tumors from patients who responded to anti-PD-1 showed higher densities of PD-1+ and PD-L1+ cells when compared to non-responders (median cells/mm2, 70.7 vs. 6.7, p = 0.03; and 855.4 vs. 245.0, p = 0.02, respectively). There was no significant association of CD8+ cell density with clinical response. Quantification of PD-1+ cells located within 20 μm of a PD-L1+ cell showed that PD-1/PD-L1 proximity was associated with clinical response (p = 0.03), but CD8/PD-L1 proximity was not. CD4+ and CD8+ cells in the TME expressed similar amounts of PD-1. CONCLUSIONS While the binomial presence or absence of PD-L1 expression in the TME was not sufficient to predict response to anti-PD-1 in patients with MCC, we show that quantitative assessments of PD-1+ and PD-L1+ cell densities as well as the geographic interactions between these two cell populations correlate with clinical response. Cell types expressing PD-1 in the TME include CD8+ T-cells, CD4+ T-cells, Tregs, and CD20+ B-cells, supporting the notion that multiple cell types may potentiate tumor regression following PD-1 blockade.
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Affiliation(s)
- Nicolas A Giraldo
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Peter Nguyen
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- The Bloomberg~Kimmel Institute for Cancer Immunotherapy, Baltimore, MD, USA
| | - Elizabeth L Engle
- Department of Oncology, Johns Hopkins University School of Medicine, The Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
- The Bloomberg~Kimmel Institute for Cancer Immunotherapy, Baltimore, MD, USA
| | - Genevieve J Kaunitz
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Tricia R Cottrell
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sneha Berry
- Department of Oncology, Johns Hopkins University School of Medicine, The Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
- The Bloomberg~Kimmel Institute for Cancer Immunotherapy, Baltimore, MD, USA
| | - Benjamin Green
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- The Bloomberg~Kimmel Institute for Cancer Immunotherapy, Baltimore, MD, USA
| | - Abha Soni
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jonathan D Cuda
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Julie E Stein
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Joel C Sunshine
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Farah Succaria
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Haiying Xu
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- The Bloomberg~Kimmel Institute for Cancer Immunotherapy, Baltimore, MD, USA
| | - Aleksandra Ogurtsova
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ludmila Danilova
- Department of Biostatistics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- The Bloomberg~Kimmel Institute for Cancer Immunotherapy, Baltimore, MD, USA
| | - Candice D Church
- Division of Dermatology, Department of Medicine, University of Washington Medical Center, Seattle, WA, USA
| | - Natalie J Miller
- Division of Dermatology, Department of Medicine, University of Washington Medical Center, Seattle, WA, USA
| | - Steve Fling
- Cancer Immunotherapy Trials Network, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Lisa Lundgren
- Cancer Immunotherapy Trials Network, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Nirasha Ramchurren
- Division of Dermatology, Department of Medicine, University of Washington Medical Center, Seattle, WA, USA
| | | | - Evan J Lipson
- Department of Oncology, Johns Hopkins University School of Medicine, The Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
- The Bloomberg~Kimmel Institute for Cancer Immunotherapy, Baltimore, MD, USA
| | - Mac Cheever
- Cancer Immunotherapy Trials Network, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Robert A Anders
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Paul T Nghiem
- Division of Dermatology, Department of Medicine, University of Washington Medical Center, Seattle, WA, USA
| | - Suzanne L Topalian
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- The Bloomberg~Kimmel Institute for Cancer Immunotherapy, Baltimore, MD, USA
| | - Janis M Taube
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Department of Oncology, Johns Hopkins University School of Medicine, The Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA.
- The Bloomberg~Kimmel Institute for Cancer Immunotherapy, Baltimore, MD, USA.
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Pasternak S, Carter MD, Ly TY, Doucette S, Walsh NM. Immunohistochemical profiles of different subsets of Merkel cell carcinoma. Hum Pathol 2018; 82:232-238. [PMID: 30067951 DOI: 10.1016/j.humpath.2018.07.022] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 07/13/2018] [Accepted: 07/19/2018] [Indexed: 11/30/2022]
Abstract
The literature records many examples of Merkel cell carcinoma (MCC) exhibiting aberrant immunohistochemical profiles. These can lead to diagnostic difficulty. The objectives of the current study were (1) to examine the immunohistochemical profile of different subsets of MCC to determine whether predictable subset-specific patterns exist and (2) to establish whether shared immunophenotypic patterns might reveal links between individual subsets, as demonstrated previously at a genetic level. In 52 cases of MCC, stratified by viral status and morphology, we studied 5 markers commonly used in the diagnostic evaluation of these tumors (CK20, CK7, chromogranin, neurofilament and TTF-1). Expression of these proteins was recorded as quantitative (H-scores) and absolute (positive vs negative) variables. In general, our data indicate that the "classical" or expected panel (CK20+, NF+, Chromo+, TTF-1, CK7-) is observed significantly more often in pure Merkel cell polyomavirus (MCPyV)-positive than in MCPyV-negative cases (78% vs 25%; P = .002). Neurofilament was less frequently encountered in MCPyV-negative than in MCPyV-positive tumors (66.7% vs 100%; P = .001) and expression of TTF-1 (37.5% vs 3.6%; P = .003) and CK7 (45.8 vs 14.3; P = .02) was more frequent. No significant immonophenotypic differences were observed between pure and combined MCPyV-negative tumors. Recognition of the more aberrant immunohistochemical profile of MCPyV-negative MCC should inform the diagnostic approach to this tumor. Moreover, the shared aberrant immunophenotype in pure and combined MCPyV-negative tumors supports a link between these entities and serves to separate them from MCPyV-positive tumors.
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Affiliation(s)
- Sylvia Pasternak
- Department of Pathology, Queen Elizabeth II Health Sciences Center, Nova Scotia Health Authority, Central Zone, Halifax, NS, B3H 1V8, Canada; Dalhousie University, Halifax, NS, B3H 1V8, Canada; Department of Medicine, Queen Elizabeth II Health Sciences Center, Nova Scotia Health Authority, Central Zone, Halifax, NS, B3H 1V8, Canada.
| | - Michael D Carter
- Department of Pathology, Queen Elizabeth II Health Sciences Center, Nova Scotia Health Authority, Central Zone, Halifax, NS, B3H 1V8, Canada; Dalhousie University, Halifax, NS, B3H 1V8, Canada
| | - Thai Yen Ly
- Department of Pathology, Queen Elizabeth II Health Sciences Center, Nova Scotia Health Authority, Central Zone, Halifax, NS, B3H 1V8, Canada; Dalhousie University, Halifax, NS, B3H 1V8, Canada
| | - Steve Doucette
- Dalhousie University, Halifax, NS, B3H 1V8, Canada; Research Methods Unit, Capital District Health Authority, Halifax, NS, B3H 1V7, Canada
| | - Noreen M Walsh
- Department of Pathology, Queen Elizabeth II Health Sciences Center, Nova Scotia Health Authority, Central Zone, Halifax, NS, B3H 1V8, Canada; Dalhousie University, Halifax, NS, B3H 1V8, Canada; Department of Medicine, Queen Elizabeth II Health Sciences Center, Nova Scotia Health Authority, Central Zone, Halifax, NS, B3H 1V8, Canada
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25
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Lamarca A, Nonaka D, Breitwieser W, Ashton G, Barriuso J, McNamara MG, Moghadam S, Rogan J, Mansoor W, Hubner RA, Clark C, Chakrabarty B, Valle JW. PD-L1 expression and presence of TILs in small intestinal neuroendocrine tumours. Oncotarget 2018; 9:14922-14938. [PMID: 29599916 PMCID: PMC5871087 DOI: 10.18632/oncotarget.24464] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 02/03/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The extent of resistance to immune surveillance in patients with well-differentiated (Wd) (grade 1/2) small-intestinal neuroendocrine tumours (Si-NETs) is unknown. METHODS Patients diagnosed with Wd Si-NETs (excluding appendix, which are considered to have a different biology to other midgut NETs) were eligible. Tumoural programmed death (PD)-ligand(L) 1 (PD-L1)/PD-L2/PD-1 and tumour infiltrating lymphocytes (TILs) [presence and phenotype] were analysed in archival tissue by immunohistochemistry (IHC); reverse transcription quantitative polymerase chain reaction (RT-qPCR) was used for confirmation of IHC results. RESULTS Of 109 patients screened, 62 were eligible: 54.8% were male; median age was 63.7 years (95%-CI 59.7-67.2); disease stage II: 4.8%, III: 40.3% and IV: 54.8%; 41.9% were functional. Analysed samples (67.1% from primary tumours, 32.9% from metastases) were of grade 1 (67.1%) or 2 (32.86%) with a median Ki-67 of 2%. From the total of 62 eligible patients, 70 and 63 samples were suitable for IHC and RT-qPCR analysis, respectively. PD-L1 expression within tumour cells and TILs were identified in 12.8% and 24.3% of samples respectively; 30% of samples showed PD-L1 expression within tumour cells and/or TILs. PD-1 was present in TILs in 22.8% of samples. Majority of samples showed significant presence of CD4+ (focal 42.86%; moderate 2.86%) and CD8+ (focal 92.86%; moderate 4.29%) TILs. IHC findings were confirmed with RT-qPCR; which showed higher expression levels of PD-L1 (p-value 0.007) and PD-1 (p-value 0.001) in samples positive for IHC compared to negative-IHC. CONCLUSIONS Thirty-percent of patients express PD-L1 within tumour cells and/or TILs. Identification of presence of TILs was also significant and warrant the investigation of immunotherapy in this setting.
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Affiliation(s)
- Angela Lamarca
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Daisuke Nonaka
- Department of Histopathology, The Christie NHS Foundation Trust, Manchester, UK
- Division of Molecular and Clinical Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Wolfgang Breitwieser
- Molecular Biology Core Facility, Cancer Research UK Manchester Institute, Manchester, UK
| | - Garry Ashton
- Manchester Cancer Research Centre (MCRC) BioBank, University of Manchester, Manchester, UK
| | - Jorge Barriuso
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
- Division of Molecular and Clinical Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Mairéad G. McNamara
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
- Division of Molecular and Clinical Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Sharzad Moghadam
- Manchester Cancer Research Centre (MCRC) BioBank, University of Manchester, Manchester, UK
| | - Jane Rogan
- Manchester Cancer Research Centre (MCRC) BioBank, University of Manchester, Manchester, UK
| | - Wasat Mansoor
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Richard A. Hubner
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Christopher Clark
- Molecular Biology Core Facility, Cancer Research UK Manchester Institute, Manchester, UK
| | - Bipasha Chakrabarty
- Department of Histopathology, The Christie NHS Foundation Trust, Manchester, UK
| | - Juan W. Valle
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
- Division of Molecular and Clinical Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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26
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Merkel cell carcinomas infiltrated with CD33 + myeloid cells and CD8 + T cells are associated with improved outcome. J Am Acad Dermatol 2017; 78:973-982.e8. [PMID: 29273486 DOI: 10.1016/j.jaad.2017.12.029] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 12/06/2017] [Accepted: 12/07/2017] [Indexed: 01/12/2023]
Abstract
BACKGROUND Merkel cell carcinoma (MCC) is a rare tumor of the skin that has an aggressive behavior. Immunity is the main regulator of MCC development, and many interactions between lymphocytes and tumor cells have been proven. However, the impact of tumor-infiltrating myeloid cells needs better characterization. OBJECTIVE To characterize tumor-infiltrating myeloid cells in MCC and their association with other immune effectors and patient outcome. METHODS MCC cases were reviewed from an ongoing prospective cohort study. In all, 103 triplicate tumor samples were included in a tissue microarray. Macrophages, neutrophils, and myeloid-derived suppressor cells were characterized by the following markers: CD68, CD33, CD163, CD15, CD33, and human leukocyte antigen-DR. Associations of these cell populations with programmed cell death ligand 1 expression, CD8 infiltrates, and vascular density were assessed. Impact on survival was analyzed by log-rank tests and a Cox multivariate model. RESULTS The median density of macrophages was 216 cells/mm2. CD68+ and CD33+ macrophage densities were associated with CD8+ T-cell infiltrates and programmed cell death ligand 1 expression. In addition, MCC harboring CD8+ T cell infiltrates and brisk CD33+ myeloid cell infiltrates were significantly and independently associated with improved outcomes (recurrence-free and overall survival). LIMITATIONS Sampling bias and the retrospective design were potential study limitations. CONCLUSION Infiltration of CD33+ myeloid cells and CD8+ T lymphocytes defines a subset of MCC associated with improved outcome.
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27
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Abstract
Merkel cell carcinoma (MCC) is a rare but highly aggressive skin cancer with neuroendocrine features. MCC pathogenesis is associated with either the presence of Merkel cell polyomavirus or chronic exposure to ultraviolet light (UV), which can cause a characteristic pattern of multiple DNA mutations. Notably, in the Northern hemisphere, the majority of MCC cases are of viral aetiology; by contrast, in areas with high UV exposure, UV-mediated carcinogenesis is predominant. The two aetiologies share similar clinical, histopathological and prognostic characteristics. MCC presents with a solitary cutaneous or subcutaneous nodule, most frequently in sun-exposed areas. In fact, UV exposure is probably involved in both viral-mediated and non-viral-mediated carcinogenesis, by contributing to immunosuppression or DNA damage, respectively. Confirmation of diagnosis relies on analyses of histological features and immunological marker expression profiles of the lesion. At primary diagnosis, loco-regional metastases are already present in ∼30% of patients. Excision of the tumour is the first-line therapy; if not feasible, radiotherapy can often effectively control the disease. Chemotherapy was the only alternative in advanced-stage or refractory MCC until several clinical trials demonstrated the efficacy of immune-checkpoint inhibitors.
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28
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Carter MD, Gaston D, Huang WY, Greer WL, Pasternak S, Ly TY, Walsh NM. Genetic profiles of different subsets of Merkel cell carcinoma show links between combined and pure MCPyV-negative tumors. Hum Pathol 2017; 71:117-125. [PMID: 29079179 DOI: 10.1016/j.humpath.2017.10.014] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 10/06/2017] [Accepted: 10/13/2017] [Indexed: 01/31/2023]
Abstract
Tumorigenesis in Merkel cell carcinoma (MCC) is driven by (1) clonal integration of the Merkel cell polyomavirus (MCPyV) in neoplastic cells and/or (2) genetic damage by ultraviolet (UV) light. A higher mutational burden, a UV-mutational signature, and many mutations in the TP53 and RB1 genes characterize the virus-negative subset. MCPyV-negative MCCs include combined (often squamous and neuroendocrine) and pure (neuroendocrine) tumors. Because a combined morphology could elude detection microscopically, we sought a genetic link between combined and pure virus-negative tumors. From a global cohort of 46 cases, 9 pure MCPyV-positive, 9 pure MCPyV-negative, and 10 combined MCPyV-negative MCCs were studied by genome-wide microarray in search of copy number aberrations. The entire cohort (n=46) was evaluated by next-generation sequencing for mutations in selected tumor suppressor genes and oncogenes. More copy number aberrations and a greater fraction of the genome were changed in combined and pure MCPyV-negative tumors relative to MCPyV-positive cases (P<.01 for all comparisons). No difference in these parameters was found between the 2 MCPyV-negative groups. Copy number loss of RB1 or an inactivating RB1 mutation (either or both) was common in combined (8/10, 80%) and pure (7/9, 78%) MCPyV-negative tumors but not MCPyV-positive cases (1/9, 11%). A similar trend was seen for TP53 (combined [2/10, 20%] and pure virus-negative tumors [5/9, 56%] showed gene copy number loss or mutations contrasted with pure virus-positive cases [0/9, 0%]). The shared genetic profiles of combined and pure MCPyV-negative tumors link these subsets and separate them from MCPyV-positive tumors.
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Affiliation(s)
- Michael D Carter
- Department of Pathology and Laboratory Medicine (DPLM), Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority (Central Zone), Halifax, Nova Scotia, Canada B3H 1V8; Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada B3H 1V8.
| | - Dan Gaston
- Department of Pathology and Laboratory Medicine (DPLM), Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority (Central Zone), Halifax, Nova Scotia, Canada B3H 1V8; Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada B3H 1V8
| | - Weei-Yuarn Huang
- Department of Pathology and Laboratory Medicine (DPLM), Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority (Central Zone), Halifax, Nova Scotia, Canada B3H 1V8; Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada B3H 1V8
| | - Wenda L Greer
- Department of Pathology and Laboratory Medicine (DPLM), Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority (Central Zone), Halifax, Nova Scotia, Canada B3H 1V8; Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada B3H 1V8
| | - Sylvia Pasternak
- Department of Pathology and Laboratory Medicine (DPLM), Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority (Central Zone), Halifax, Nova Scotia, Canada B3H 1V8; Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada B3H 1V8
| | - Thai Yen Ly
- Department of Pathology and Laboratory Medicine (DPLM), Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority (Central Zone), Halifax, Nova Scotia, Canada B3H 1V8; Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada B3H 1V8
| | - Noreen M Walsh
- Department of Pathology and Laboratory Medicine (DPLM), Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority (Central Zone), Halifax, Nova Scotia, Canada B3H 1V8; Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada B3H 1V8; Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada B3H 1V8
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29
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Laniosz V, Onajin O, Sominidi-Damodaran S, Meves A, Gibson LE, Baum CL. Natural killer cell response is a predictor of good outcome in MCPyV + Merkel cell carcinoma: A case series of 23 patients. J Am Acad Dermatol 2017; 77:31-32. [DOI: 10.1016/j.jaad.2017.02.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 02/04/2017] [Accepted: 02/07/2017] [Indexed: 10/19/2022]
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30
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Mitteldorf C, Berisha A, Tronnier M, Pfaltz MC, Kempf W. PD-1 and PD-L1 in neoplastic cells and the tumor microenvironment of Merkel cell carcinoma. J Cutan Pathol 2017; 44:740-746. [PMID: 28569410 DOI: 10.1111/cup.12973] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 05/24/2017] [Accepted: 05/26/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Merkel cell carcinoma (MCC) is an aggressive neoplasm, which is often associated with Merkel cell polyomavirus (MCPyV). Programmed death-1 (PD-1) and its ligand PD-L1 are key players of the tumor microenvironment (TME). METHODS Fourteen paraffin-embedded tissue samples of MCC were stratified by their MCPyV detection. Apart from PD-L1 and PD-1, the TME was further characterized for the expression of CD33, FOXP3 and MxA. RESULTS We observed PD-1 in 2 of 12 tumors. PD-L1 expression by tumor cells was found in 7 of 8 MCPyV(+) samples and was detected particularly in the periphery. The tumor cells were surrounded by a shield of PD-L1/CD33 immune cells. Expression of PD-L1 by the tumor cells was higher in areas with a denser immune infiltrate. CD33(+) cells without direct tumor contact were PD-L1 negative. Only a low number of FOXP3(+) regulatory T-cells was admixed. Tumor cells of MCPyV(-) samples were mostly PD-L1 negative. CONCLUSIONS Our data demonstrate that PD-L1 expression occurs in tumor and immune cells, in areas in which they are close in contact. Interferon seems to play a role in this interaction. We postulate that PD-L1(+)/CD33(+) cells shield the tumor against attacking PD-1(+) immune cells. Therefore, next to anti-PD-1/PD-L1 antibodies, blockade of CD33 seems to be a promising therapeutic approach.
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Affiliation(s)
| | | | - Michael Tronnier
- Department of Dermatology, HELIOS-Klinikum Hildesheim, Hildesheim, Germany
| | - Monique C Pfaltz
- Department of Psychiatry and Psychotherapy, University Hospital Zürich, Zürich, Switzerland
| | - Werner Kempf
- Kempf und Pfaltz histologische Diagnostik, Zürich, Switzerland.,Department of Dermatology, University Hospital Zürich, Zürich, Switzerland
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31
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Ritter C, Fan K, Paschen A, Reker Hardrup S, Ferrone S, Nghiem P, Ugurel S, Schrama D, Becker JC. Epigenetic priming restores the HLA class-I antigen processing machinery expression in Merkel cell carcinoma. Sci Rep 2017; 7:2290. [PMID: 28536458 PMCID: PMC5442125 DOI: 10.1038/s41598-017-02608-0] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 04/12/2017] [Indexed: 12/22/2022] Open
Abstract
Merkel cell carcinoma (MCC) is a rare and aggressive, yet highly immunogenic skin cancer. The latter is due to its viral or UV-associated carcinogenesis. For tumor progression MCC has to escape the host’s immuno-surveillance, e.g. by loss of HLA class-I expression. Indeed, a reduced HLA class-I expression was observed in MCC tumor tissues and MCC cell lines. This reduced HLA class-I surface expression is caused by an impaired expression of key components of the antigen processing machinery (APM), including LMP2 and LMP7 as well as TAP1 and TAP2. Notably, experimental provisions of HLA class-I binding peptides restored HLA class-I surface expression on MCC cells. Silencing of the HLA class-I APM is due to histone deacetylation as inhibition of histone deacetylases (HDACs) not only induced acetylation of histones in the respective promoter regions but also re-expression of APM components. Thus, HDAC inhibition restored HLA class-I surface expression in vitro and in a mouse xenotransplantation model. In contrast to re-induction of HLA class-I by interferons, HDAC inhibitors did not interfere with the expression of immuno-dominant viral proteins. In summary, restoration of HLA class-I expression on MCC cells by epigenetic priming is an attractive approach to enhance therapies boosting adaptive immune responses.
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Affiliation(s)
- Cathrin Ritter
- Department of Translational Skin Cancer Research, University Hospital Essen, Essen, Germany.,German Cancer Consortium (DKTK), Essen, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Kaiji Fan
- Department of Translational Skin Cancer Research, University Hospital Essen, Essen, Germany.,Department of Dermatology, Medical University of Graz, Graz, Austria
| | - Annette Paschen
- Department of Dermatology, University Hospital Essen, Essen, Germany
| | - Sine Reker Hardrup
- Department of Immunology and Vaccinology, Technical University of Denmark, Frederiksberg, Denmark
| | - Soldano Ferrone
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Paul Nghiem
- Division of Dermatology, Department of Medicine, University of Washington, Seattle, WA, United States
| | - Selma Ugurel
- Department of Dermatology, University Hospital Essen, Essen, Germany
| | - David Schrama
- Department of Dermatology, University Hospital Würzburg, Würzburg, Germany
| | - Jürgen C Becker
- Department of Translational Skin Cancer Research, University Hospital Essen, Essen, Germany. .,German Cancer Consortium (DKTK), Essen, Germany. .,German Cancer Research Center (DKFZ), Heidelberg, Germany. .,Department of Dermatology, University Hospital Essen, Essen, Germany.
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Walsh NM. Complete spontaneous regression of Merkel cell carcinoma (1986-2016): a 30 year perspective. J Cutan Pathol 2016; 43:1150-1154. [PMID: 27596690 DOI: 10.1111/cup.12812] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 08/16/2016] [Accepted: 08/30/2016] [Indexed: 01/12/2023]
Affiliation(s)
- Noreen M Walsh
- Departments of Pathology and Medicine, Nova Scotia Health Authority and Dalhousie University, Halifax, Nova Scotia, Canada
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