Foetal antigens and cancer

The Expression of Anti-Müllerian Hormone Type II Receptor (AMHRII) in Non-Gynecological Solid Tumors Offers Potential for Broad Therapeutic Intervention in Cancer

Simple Summary

Until now, only a few studies have examined the AMHRII expression in tumors. Here, with more than 1000 tumor samples and using several complementary techniques we confirmed AMHRII expression in gynecological cancer and demonstrated AMHRII expression in certain non-gynecological cancers such as colorectal cancers. These findings open the way for new therapeutic approaches targeting AMHRII and emphasize the need to better understand the role of AMH/AMHRII in cancer.

Abstract

The anti-Müllerian hormone (AMH) belongs to the TGF-β family and plays a key role during fetal sexual development. Various reports have described the expression of AMH type II receptor (AMHRII) in human gynecological cancers including ovarian tumors. According to qRT-PCR results confirmed by specific In-Situ Hybridization (ISH) experiments, AMHRII mRNA is expressed in an extremely restricted number of normal tissues. By performing ISH on tissue microarray of solid tumor samples AMHRII mRNA was unexpectedly detected in several non-gynecological primary cancers including lung, breast, head and neck, and colorectal cancers. AMHRII protein expression, evaluated by immunohistochemistry (IHC) was detected in approximately 70% of epithelial ovarian cancers. Using the same IHC protocol on more than 900 frozen samples covering 18 different cancer types we detected AMHRII expression in more than 50% of hepato-carcinomas, colorectal, lung, and renal cancer samples. AMHRII expression was not observed in neuroendocrine lung tumor samples nor in non-Hodgkin lymphoma samples. Complementary analyses by immunofluorescence and flow cytometry confirmed the detection of AMHRII on a panel of ovarian and colorectal cancers displaying comparable expression levels with mean values of 39,000 and 50,000 AMHRII receptors per cell, respectively. Overall, our results suggest that this embryonic receptor could be a suitable target for treating AMHRII-expressing tumors with an anti-AMHRII selective agent such as murlentamab, also named 3C23K or GM102. This potential therapeutic intervention was confirmed in vivo by showing antitumor activity of murlentamab against AMHRII-expressing colorectal cancer and hepatocarcinoma Patient-Derived tumor Xenografts (PDX) models.

Medawar and the immunological paradox of pregnancy: in context

In 1953, Peter Medawar defined 'the immunological paradox of pregnancy', whereby the semi-allogeneic foetus can survive for 9 months in its mother, while a semi-allogeneic graft would be rejected. Here, I revisit the immunological paradox of pregnancy, setting it in the context of the time in which it was proposed. I go on to examine the extent to which Medawar's ideas on the subject have stood the test of time and how they have shaped reproductive immunology.

NK cell subsets in idiopathic recurrent miscarriage and renal transplant patients

The present review article compares NK cell subsets and cytokine patterns determined in the peripheral blood as well as results of functional in-vitro assays using peripheral NK cells of idiopathic recurrent miscarriage (iRM) patients with corresponding results obtained in female healthy controls and female renal transplant recipients with good long-term graft function. Immune mechanisms, inducing transplant rejection in long-term transplant recipients might also be able to induce rejection of semi-allogeneic fetal cells in patients with iRM. Consequently, the immune status of transplant recipients with good stable long-term graft function should be different from the immune status of iRM patients. iRM patients show a strong persistent cytotoxic NK cell response in the periphery. Simultaneously, immunostimulatory Th1 as well as immunosuppressive Th2 type lymphocytes in the blood are strongly activated but plasma levels of immunosuppressive Th2 type cytokines are abnormally low. In-vitro, unstimulated NK cell cultures of iRM patients show a strong spontaneous TGF-ß1 release in the supernatant but lower TGF-ß1 levels after stimulation with tumor cell line K562, suggesting strong consumption of TGF-ß1 by pre-activated NK cells of iRM patients that might contribute to the low systemic Th2 type plasma levels. iRM patients do not show a systemic switch to a Th2 type cytokine pattern and one might hypothesize that low TGF-ß plasma levels indicate low TGF-ß levels in the micromilieu immediately before fetal rejection. Persistent TGF-ß deficiency implies a persistent unfavorable micromilieu for pregnancy resulting in failing tolerance induction due to lack of TGF-ß, a condition that might contribute to iRM.

The flip side of immune surveillance: immune dependency

The growths of many and perhaps all tumors may be stimulated rather than inhibited by a quantitatively low level of immunity. The reason tumors have antigens may be that tumors do not develop in vivo in the absence of at least a minimal immune reaction; in this sense, cancer may be considered an autoimmune disease. This review, based largely on the work of our own laboratory, outlines the data showing that the titration of anti-tumor immunity exhibits the phenomenon of hormesis, i.e. the dose-response curve is non-linear such that low levels of immunity are generally stimulatory but larger quantities of the same immune reactants may inhibit tumor growth. Evidence is also reviewed that suggests that the immune response may vary qualitatively and quantitatively during progression, such that there seems to be, during oncogenesis, a very low level of immune reaction that aids initial tumor growth, followed by a larger reaction that may cause remission of early neoplasms, followed, if the neoplasm survives, by a relative immunologic tolerance to the tumor that may be dependent, at least in part, on suppressor cells. This knowledge may help to explain some clinical observations concerning the relationships among tumor types and the organ distribution of metastases.

Embryonic antigens in malignancy and pregnancy: common denominators in immune regulation

There is mounting that the majority of malignant tumours of humans and rodents carry embryonic determinants (EA) associated with the cell membrane. The evolutionary and developmental purpose of these determinants seems to be related to their biochemical and structural role in the cell membrane. True EAs are uniquely expressed on germinal, embryonic and some fetal cell membranes and are not expressed in adult tissues nor in regenerating tissues. The immunological role of EA in fetal development in utero is still obscure. It is known that maternal IgG and cytotoxic T lymphocytes are produced in response to EA expressed in utero. Immunoregulatory interactions between suppressor, helper and cytotoxic T lymphocytes sensitized to EA during pregnancy have been detected in mice and hamsters bearing a variety of tumours. The same immunological events may occur in humans. The biological product of the retrogenic process that leads to the expression of EA in the emerging malignant cell clone seems to be intimately associated with the promotion of tumour-protective immune responses in the host which mimic the immune responses in pregnancy aimed at protecting the EA+ fetus from maternal immune attack. The description of the immunoregulatory perturbations generated by EA during the induction of cancer may eventually provide effective and predictable attack points for immunological intervention in the control of malignancy. This paper describes methods for detecting EA and considers some immunoregulatory traits found in response to EA expression.

Generation and selection of monoclonal antibodies identifying surface molecules discriminating between fetal and adult fibroblasts

The present report describes the reactivity of two murine monoclonal antibodies, i.e., CB11 and CB43, the first obtained by using embryonic material as immunizer and the second elicited against a human cell line. These reagents recognize two distinct molecules marking a peculiar differentiation stage on fetal/embryonic fibroblasts. The first structure is a single chain of 14.5 kd, the second one a heterodimer of 40-80 kd. Even if these reagents are not strictly fibroblast restricted, translineage expression does not diminish the medical relevance of the reagents; in fact, they may have application in prenatal diagnostics and amniocentesis testing, in which it is necessary to discriminate between fetal and maternal cells.

The implications of embryonic gene expression in neoplasia

The discovery that human as well as animal tumors generally expressed oncofetal antigens (OFAs) and that these antigens generate a variety of immune responses in the tumor-bearing host is of potential major significance in tumor biology. The concept of the reexpression of embryonic or fetal antigens (EAs) encoded by DNA, which is silent in adults but is essential in metazoan development, may mesh with the exciting concept of cancer causation. While this scenario is still only speculative, it provides an interesting forum for reviewing the current data concerning the role of OFAs in cancer processes. The literature describing OFAs and their embryonic counterparts, the EAs, in modern tumor and fetal immunobiology has become extensive and, unfortunately, is quite scattered. This article seeks to synthesize this complicated data base into a cogent presentation focusing on the immunological role of EAs and OFAs in fetal survival in utero and in tumor progression and regression, respectively. The immunogenicity and characteristics of the immune responses to EAs and OFAs will be presented and placed in perspective to the rapidly unraveling story of protooncogenes and oncogenes in tumor induction.

Inhibition of cell proliferation rather than of cell lysis as a measure of immune reactivity in embryo-antigen-challenged mice

An assay system is described in which effector cells added along with suitable target cells inhibit, in a quantitative fashion, the subsequent uptake of 3H-thymidine by those target cells. Effector cells active in this assay, using embryonic fibroblast cells as targets, develop spontaneously in cultures of mouse lymphoid cells, but are apparently different from those described earlier by investigators of activity in cytotoxic assays. Further evidence is presented to show the development of spleen-derived effector cells with cytostatic activity (for embryonic fibroblast target cells) in mice during the course of normal pregnancy, or growth of spontaneously appearing mammary adenocarcinomas. Indeed, such effector cells can also be found within the growing solid mass itself. Different populations of tumour cells isolated from a solid tumour apparently differ in their susceptibility to growth inhibition by tumour-bearer-derived cytostatic effector cells, a phenomenon which may be related to metastatic spread of tumour cells.

Response of tumour-related and normal lymphocytes to antigens on fibroblasts from embryos of varying age

The in vitro cytotoxic immune response of spleen lymphocytes from primiparous and tumour-related mice to embryonic cells from embryos of varying age and tumour cells has been investigated. The results indicate that lymphocytes from both primiparous and tumour-related (i.e., tumour-bearing or tumour-excised) animals give a response which is greater than that from cells from control mice ("virgin cells"). Moreover, in this putative anamnestic response the immune cells detect antigenic differences in the cell populations of embryos of varying age, which are not as readily demonstrable when cytotoxicity is derived from virgin cells. As a further indication of the in vivo priming to embryo-assoicated antigens, the data show that the precursors of cytotoxic cells apparently undergo a blastogenic response in the presence of embryo antigen, and revert to small quiescent cells when antigen is removed, in a way entirely analogous to that described for reactivity of mixed leucocyte cultures to antigens of the major histocompatibility complex. Finally, it seems that in animals immediately after removal of embryonic antigen (and to a lesser degree in virgin or late-embryo-immune mice) there exists a suppressor cell population which inhibits an anti-embryo cytotoxic response far more than an antiallograft response.

Lymphoid cell dependent (K-cell) lysis of human erythrocytes sensitized with Rhesus alloantibodies

An in vitro homologous system using human Rhesus alloantibodies and target erythrocytes labelled with 51Cr has been used to demonstrate the ability of normal peripheral blood lymphoid cells to lyse antibody-coated human red cells. The results obtained suggest that this type of mechanism may be relevant to certain haemolytic diseases in man.

Detection of private and common tumor-associated antigens in murine sarcomas induced by different chemical carcinogens

Two fibrosarcomas of similar histological type, induced in C3Hf mice by either methylcholanthrene or 3,4-benz(a)pyrene, were shown to have individually unique tumor-rejection antigens in classical transplantation-type experiments. By contrast, sera of autochthonous mice, which resisted only transplants of the immunizing sarcoma, were found to contain complement-dependent cytotoxic antibodies, specific for both sarcomas, in vitro. The existence of individually unique as well as common tumor-associated antigens in chemically-induced murine sarcomas is suggested. The private "tumor transplantation-type" antigens elicited tumor rejection responses in vivo. The common tumor-associated antigens, although immunogenic in autochthonous hosts, inducing the production of tumor-specific antibodies, failed to induce transplantation cross-resistance in vivo. This study supports the contention that, in carcinogen-induced murine tumors, and perhaps in human neoplasms as well the evaluation of humoral (and cell-mediated) immune responses in vitro may not reflect tumor rejection-type immune responses in vivo.

Embryonic antigens and growth of murine fibrosarcomata

The amount of embryonic antigens (EA) was estimated in 13 BALB/c fibrosarcomata by in vitro cell mediated cytotoxicity of anti-embryo spleen cells and by quantitative absorption of an anti-embryo antiserum. A direct relationship between amount of EA and tumour growing capacity was found. EA were detected also on fast dividing testicular cells. It is suggested that EA expression on tumour cells is related to a cell membrane function controlling mitosis rather than to a function specifically related to the neoplastic status. Tumour take of low doses of 2 EA-bearing sarcomata was found to be enhanced in anti-embryo immune BALB/c mice in comparison with that in normal and anti-fibroblast immune mice.

Comparison of antigenicity of hepatoma cells, normal liver cells, foetal liver cells and chemically damaged liver cells in guinea-pigs immunized with hepatomata using the macrophage migration inhibition test

The macrophage migration inhibition test has been used to study the immune responses of guinea-pigs immunized with injections of whole cells of both an allogeneic and a syngeneic hepatoma grown as established cell lines in tissue culture.A clear dose-response relationship between tumour cell concentration and migration inhibition was seen in immunized animals and no significant migration inhibition was seen in control animals. There was no cross reaction between the two tumours used. There was no cross reaction between whole isolated normal liver cells and tumour cells, or between foetal liver cells and tumour cells. Whole isolated liver cells from carbon tetrachloride damaged livers caused some degree of migration inhibition in both normal and immunized guinea-pigs but, taking this into account, they did not appear to cross react with hepatoma cells.