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De Wolf J, Robin E, Vallee A, Cohen J, Hamid A, Roux A, Leguen M, Beaurepere R, Bieche I, Masliah-Planchon J, Glorion M, Allory Y, Sage E. Donor/recipient origin of lung cancer after lung transplantation by DNA short tandem repeat analysis. Front Oncol 2023; 13:1225538. [PMID: 37841427 PMCID: PMC10568626 DOI: 10.3389/fonc.2023.1225538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 09/06/2023] [Indexed: 10/17/2023] Open
Abstract
Background Lung cancer is more common in posttransplant recipients than in the general population. The objective of this study was to examine the chimerism donor/recipient cell origin of graft cancer in recipients of lung transplant. Methods A retrospective chart review was conducted at Foch Hospital for all lung transplantations from 1989 to 2020. Short tandem repeat PCR (STR-PCR) analysis, the gold standard technique for chimerism quantification, was used to determine the donor/recipient cell origin of lung cancers in transplant patients. Results Fourteen (1.4%) of the 1,026 patients were found to have graft lung cancer after lung transplantation, and one developed two different lung tumors in the same lobe. Among the 15 lung tumors, 10 (67%) presented with adenocarcinoma, four (27%) with squamous cell carcinoma and one with small cell lung cancer. STR analysis showed that the origin of the cancer was the donor in 10 patients (71%), the recipient in three patients (21%), and was undetermined in one patient. Median time to diagnosis was 62 months. Conclusion The prevalence of lung cancer in lung transplant recipients is very low. However, the results of our study showed heterogeneity of genetic alterations, with 21% being of recipient origin. Our results highlight the importance of donor selection and medical supervision after lung transplantation.
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Affiliation(s)
- Julien De Wolf
- Department of Thoracic Surgery and Lung Transplantation, Foch Hospital, Suresnes, France
| | - Edouard Robin
- Department of Thoracic Surgery and Lung Transplantation, Foch Hospital, Suresnes, France
| | - Alexandre Vallee
- Department of Clinical Research and Innovation Foch Hospital, Suresnes, France
| | - Justine Cohen
- Department of Anatomopathology, Foch Hospital, Suresnes, France
| | - Abdul Hamid
- Department of Pneumology, Foch Hospital, Suresnes, France
| | - Antoine Roux
- Department of Pneumology, Foch Hospital, Suresnes, France
| | - Morgan Leguen
- Department of Anesthesiology, Foch Hospital, Suresnes, France
- Université Paris-Saclay, INRAE, UVSQ, VIM, Jouy-en-Josas, France
| | | | - Ivan Bieche
- Genetics Department, Curie Institut, Paris, France
| | | | - Matthieu Glorion
- Department of Thoracic Surgery and Lung Transplantation, Foch Hospital, Suresnes, France
| | - Yves Allory
- Department of Anatomopathology, Foch Hospital, Suresnes, France
- Department of Anatomopathology, Curie Institut, Paris, France
| | - Edouard Sage
- Department of Thoracic Surgery and Lung Transplantation, Foch Hospital, Suresnes, France
- Université Paris-Saclay, INRAE, UVSQ, VIM, Jouy-en-Josas, France
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Choi YJ, Kim SY, Park MS, Lee JG, Paik HC, Lee SH. Incidental Lung Cancer of Explanted Lungs from Lung Transplant Recipients: Incidence, Characteristics, and 5-Year Survival. Yonsei Med J 2020; 61:958-964. [PMID: 33107239 PMCID: PMC7593106 DOI: 10.3349/ymj.2020.61.11.958] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/13/2020] [Accepted: 09/24/2020] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Recent history of malignancy without 5-year disease-free interval is an absolute contraindication for lung transplantation (LTx). However, in rare cases, lung cancer may be incidentally diagnosed in the explanted lung of recipients. We evaluated the prevalence, 5-year survival, and prognosis of incidental lung cancer after LTx. MATERIALS AND METHODS Medical records of patients who underwent LTx at Severance Hospital between January 1, 2012 and June 30, 2019 were reviewed. Patients with incidental lung cancer were included, and those with histologically proven pre-transplant lung cancer were excluded. RESULTS Of the 247 patients who underwent LTx, 6 (2.4%) were diagnosed with incidental lung cancer. Interstitial lung disease (ILD) was the underlying lung disease in all patients. The median interval from the last preoperative computed tomography (CT) screening to LTx was 26 days. The most common histological type of incidental lung cancer was adenocarcinoma (n=4, 66.7%). All Stage IV cases were misdiagnosed as fibrosis on preoperative chest CT. Patients with incidental lung cancer showed lower 5-year survival than those without malignancy (median survival: 8.5 months vs. not reached, p=0.047, respectively). Patients with Stage III or IV demonstrated lower 5-year survival than those with Stage I or II and those without malignancy (median survival: 5 months, 19 months, and not reached, respectively, p=0.011). CONCLUSION Multidisciplinary preoperative screening and serial imaging studies within short intervals are required to differentiate lung malignancy from fibrotic foci. Furthermore, active pathologic examination of suspicious lung lesions is required in patients at high risk for lung cancer.
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Affiliation(s)
- Yong Jun Choi
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Song Yee Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Moo Suk Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Gu Lee
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Hyo Chae Paik
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Hoon Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
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Ume AC, Pugh JM, Kemp MG, Williams CR. Calcineurin inhibitor (CNI)-associated skin cancers: New insights on exploring mechanisms by which CNIs downregulate DNA repair machinery. PHOTODERMATOLOGY, PHOTOIMMUNOLOGY & PHOTOMEDICINE 2020; 36:433-440. [PMID: 32786098 PMCID: PMC11042075 DOI: 10.1111/phpp.12600] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/22/2020] [Accepted: 08/02/2020] [Indexed: 12/31/2022]
Abstract
The use of the calcineurin inhibitors (CNI) cyclosporine (CsA) and tacrolimus remains a cornerstone in post-transplantation immunosuppression. Although these immunosuppressive agents have revolutionized the field of transplantation medicine, its increased skin cancer risk poses a major concern. A key contributor to this phenomenon is a reduced capacity to repair DNA damage caused by exposure to ultraviolet (UV) wavelengths of sunlight. CNIs decrease DNA repair by mechanisms that remain to be fully explored. Though CsA is known to decrease the abundance of key DNA repair enzymes, less is known about how tacrolimus yields this effect. CNIs hold the capacity to inhibit both of the main catalytic calcineurin isoforms (CnAα and CnAβ). However, it is unknown which isoform regulates UV-induced DNA repair, which is the focus of this review. It is with hope that this insight spurs investigative efforts that conclusively addresses these gaps in knowledge. Additionally, this research also raises the possibility that newer CNIs can be developed that effectively blunt the immune response while mitigating the incidence of skin cancers with immunosuppression.
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Affiliation(s)
- Adaku C. Ume
- Department of Neuroscience, Cell Biology & Physiology, College of Science and Mathematics, Wright State University Boonshoft School of Medicine, Dayton, Ohio
| | - Jennifer M. Pugh
- Department of Neuroscience, Cell Biology & Physiology, College of Science and Mathematics, Wright State University Boonshoft School of Medicine, Dayton, Ohio
| | - Michael G. Kemp
- Department of Pharmacology & Toxicology, Wright State University Boonshoft School of Medicine, Dayton, Ohio
| | - Clintoria R. Williams
- Department of Neuroscience, Cell Biology & Physiology, College of Science and Mathematics, Wright State University Boonshoft School of Medicine, Dayton, Ohio
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Rudasill SE, Iyengar A, Sanaiha Y, Khoury H, Mardock AL, Xing H, Kwon MH, Hunter C, Benharash P. Pretransplant malignancy among lung transplant recipients in the modern era. Surgery 2019; 165:1228-1233. [DOI: 10.1016/j.surg.2019.01.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 12/29/2018] [Accepted: 01/19/2019] [Indexed: 02/07/2023]
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Patil PD, Sultan S, Hahn MF, Roy SB, Ross MD, Abdelrazek H, Bremner RM, Thawani N, Walia R, Panchabhai TS. Incidental extensive adenocarcinoma in lungs explanted from a transplant recipient with an idiopathic pulmonary fibrosis flare-up: A clinical dilemma. Respir Med Case Rep 2018; 25:45-48. [PMID: 29942737 PMCID: PMC6011045 DOI: 10.1016/j.rmcr.2018.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 06/10/2018] [Accepted: 06/11/2018] [Indexed: 01/06/2023] Open
Abstract
Patients under consideration for lung transplantation as treatment for end-stage lung diseases such as idiopathic pulmonary fibrosis (IPF) often have risk factors such as a history of smoking or concomitant emphysema, both of which can predispose the patient to lung cancer. In fact, IPF itself increases the risk of lung cancer development by 6.8% to 20%. Solid organ malignancy (non-skin) is an established contraindication for lung transplantation. We encountered a clinical dilemma in a patient who presented with an IPF flare-up and underwent urgent evaluation for lung transplantation. After transplant, the patient's explanted lungs showed extensive adenocarcinoma in situ, with the foci of invasion and metastatic adenocarcinoma in N1-level lymph nodes, as well as usual interstitial pneumonia. Retrospectively, we saw no evidence to suggest malignancy in addition to the IPF flare-up. Clinical diagnostic dilemmas such as this emphasize the need for new noninvasive testing that would facilitate malignancy diagnosis in patients too sick to undergo invasive tissue biopsy for diagnosis. Careful pathological examination of explanted lungs in patients with IPF is critical, as it can majorly influence immunosuppressive regimens, surveillance imaging, and overall prognosis after lung transplant.
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Affiliation(s)
- Pradnya D. Patil
- Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Samir Sultan
- Department of Pulmonary and Critical Care Medicine, University of Arizona College of Medicine, Banner University Medical Center, Phoenix, AZ, USA
| | - M. Frances Hahn
- Department of Pathology, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Sreeja Biswas Roy
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Mitchell D. Ross
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Hesham Abdelrazek
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Ross M. Bremner
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Nitika Thawani
- Department of Radiation Oncology, University of Arizona Cancer Center at St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Rajat Walia
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Tanmay S. Panchabhai
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
- Corresponding author. Department of Pulmonology, Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, 500 W. Thomas Rd., Suite 500, Phoenix, AZ 85013, USA.
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Abstract
Lung transplantation has become an efficient life-saving treatment for patients with end stage respiratory disease. The increasing good outcome following lung transplantation may be explained by growing experience of transplant teams and availability of potent immunosuppressive drugs. Nevertheless, the latter carries an inherent risk for malignancy besides other common side effects such as systemic hypertension, diabetes and renal dysfunction. Malignancies occur in a smaller proportion of patients but explain for a large proportion of deaths following transplantation. From the first year post-transplantation they will represent the third cause of death with an increasing incidence along post lung transplant survival. In this chapter, we will browse the different types of malignancies arising following lung transplantation. According to the different techniques for lung transplantation, specific types of bronchogenic carcinoma will be described in the explanted lung, in the native lung, and in the graft. Risk factors associated to immunosuppressive therapy, but also to occupational and environmental factors, especially smoking, will be discussed. Eventually, we will strive at integrating recommendations for the treatment of malignancies following lung transplantation.
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Affiliation(s)
- Anne Olland
- Lung Transplantation Group, University Hospital Strasbourg, Strasbourg, France.,INSERM (French institute for health and medical research) 1260 Regenerative Nanomedecine, Translational Medicine Federation of Strasbourg, University of Strasbourg, Strasbourg, France
| | - Pierre-Emmanuel Falcoz
- Lung Transplantation Group, University Hospital Strasbourg, Strasbourg, France.,INSERM (French institute for health and medical research) 1260 Regenerative Nanomedecine, Translational Medicine Federation of Strasbourg, University of Strasbourg, Strasbourg, France
| | - Gilbert Massard
- Lung Transplantation Group, University Hospital Strasbourg, Strasbourg, France.,INSERM (French institute for health and medical research) 1260 Regenerative Nanomedecine, Translational Medicine Federation of Strasbourg, University of Strasbourg, Strasbourg, France
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Grewal AS, Padera RF, Boukedes S, Divo M, Rosas IO, Camp PC, Fuhlbrigge A, Goldberg H, El-Chemaly S. Prevalence and outcome of lung cancer in lung transplant recipients. Respir Med 2015; 109:427-33. [PMID: 25616348 DOI: 10.1016/j.rmed.2014.12.013] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 07/20/2014] [Accepted: 12/30/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Lung transplant is the only available therapy for patients with advanced lung disease. The goal of this study was to examine the prevalence, origin, management and outcome of lung cancer in recipients of lung transplant at our institution. METHODS After institutional review board approval, we conducted a retrospective chart review of all lung transplantations in our institution from January 1990 until June 2012. RESULTS The prevalence of lung cancer in the explanted lung was 6 (1.2%) of 462 and all cases were in subjects with lung fibrosis. All 4 subjects with lymph node involvement died of causes related to the malignancy. Nine (1.9%) of 462 patients were found to have bronchogenic carcinoma after lung transplant. The most common location was in the native lung in recipients of a single lung transplant (6 out of 9 patients). In one case, the tumor originated in the allograft and was potentially donor related. The median time to diagnosis after lung transplant was 28 months with a range from 9 months to 10 years. Median survival was 8 months, with tumors involving lymph nodes or distant metastases associated with a markedly worse prognosis (median survival 7 months) than stage I disease (median survival 27 months). CONCLUSIONS The prevalence of lung cancer in lung transplant recipients is low. Using accepted donor screening criteria, donor derived malignancy is exceptionally rare. While stage I disease is associated with improved survival in this cohort, survival is still not comparable to that of the general population, likely influenced by the need for aggressive immune suppression.
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Affiliation(s)
| | | | - Steve Boukedes
- Division of Pulmonary and Critical Care Medicine, Boston, MA 02115, USA
| | - Miguel Divo
- Division of Pulmonary and Critical Care Medicine, Boston, MA 02115, USA
| | - Ivan O Rosas
- Division of Pulmonary and Critical Care Medicine, Boston, MA 02115, USA
| | - Phillip C Camp
- Department of Thoracic Surgery Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Anne Fuhlbrigge
- Division of Pulmonary and Critical Care Medicine, Boston, MA 02115, USA
| | - Hilary Goldberg
- Division of Pulmonary and Critical Care Medicine, Boston, MA 02115, USA
| | - Souheil El-Chemaly
- Division of Pulmonary and Critical Care Medicine, Boston, MA 02115, USA.
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8
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Olland AB, Falcoz PE, Santelmo N, Kessler R, Massard G. Primary Lung Cancer in Lung Transplant Recipients. Ann Thorac Surg 2014; 98:362-71. [DOI: 10.1016/j.athoracsur.2014.04.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Revised: 03/27/2014] [Accepted: 04/01/2014] [Indexed: 02/03/2023]
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Daoudi A, Bousta D, Aarab L, Abdel-Sattar E. Evaluation and characterization of the immunomodulatory activity of the protein extract from Citrullus colocynthisL. FOOD AGR IMMUNOL 2013. [DOI: 10.1080/09540105.2011.641168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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Ori Y, Herman-Edelstein M, Zingerman B, Rozen-Zvi B, Gafter U, Malachi T, Gafter-Gvili A. Effect of immunosuppressive drugs on spontaneous DNA repair in human peripheral blood mononuclear cells. Biomed Pharmacother 2012; 66:409-13. [PMID: 22795807 DOI: 10.1016/j.biopha.2012.06.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Accepted: 06/10/2012] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Immunosuppressive treatment increases the risk of post-transplant cancer. Cyclosporine reduced UV-induced DNA repair by peripheral blood mononuclear cells (PBMC) and increased cancer incidence in kidney transplant recipients. Calcineurin inhibitors (CNI), but not mammalian target of rapamycin (mTOR) inhibitors or mycophenolic acid, suppressed H₂O₂-induced DNA repair in human peripheral blood mononuclear cells (PBMC) in vitro at maintenance drug concentrations. DNA repair, when measured in quiescent cells, is named spontaneous DNA repair, and represents a basal ongoing DNA repair in response to endogenous DNA damage. The effect of immunosuppressive drugs on spontaneous DNA repair has not been investigated. AIM To investigate the effect of currently used immunosuppressive drugs on spontaneous DNA repair. METHODS Spontaneous DNA repair by human PBMC was tested in vitro in the presence of the CNI-cyclosporine and tacrolimus; mycophenolic acid (MPA); and the mTOR inhibitors-sirolimus and everolimus, at low to high nontoxic concentrations. RESULTS Cyclosporine and tacrolimus suppressed spontaneous DNA repair throughout the tested dose range. In contrast, MPA, sirolimus and everolimus did so only at the high doses. CONCLUSION A reduction in CNI dosage may lead to a decrease in the occurrence of post-transplant malignancy.
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Affiliation(s)
- Yaacov Ori
- Department of Nephrology and Hypertension, Rabin Medical Center, Petah-Tikva, Israel
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11
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Mosallaei N, Banaee T, Farzadnia M, Abedini E, Ashraf H, Malaekeh-Nikouei B. Safety Evaluation of Nanoliposomes Containing Cyclosporine A After Ocular Administration. Curr Eye Res 2012; 37:453-6. [DOI: 10.3109/02713683.2012.660595] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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12
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Cyclophilin B expression is associated with in vitro radioresistance and clinical outcome after radiotherapy. Neoplasia 2012; 13:1122-31. [PMID: 22241958 DOI: 10.1593/neo.111398] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2011] [Revised: 11/01/2011] [Accepted: 11/08/2011] [Indexed: 01/16/2023] Open
Abstract
The tools for predicting clinical outcome after radiotherapy are not yet optimal. To improve on this, we applied the COXEN informatics approach to in vitro radiation sensitivity data of transcriptionally profiled human cells and gene expression data from untreated head and neck squamous cell carcinoma (HNSCC) and bladder tumors to generate a multigene predictive model that is independent of histologic findings and reports on tumor radiosensitivity. The predictive ability of this 41-gene model was evaluated in patients with HNSCC and was found to stratify clinical outcome after radiotherapy. In contrast, this model was not useful in stratifying similar patients not treated with radiation. This led us to hypothesize that expression of some of the 41 genes contributes to tumor radioresistance and clinical recurrence. Hence, we evaluated the expression the 41 genes as a function of in vitro radioresistance in the NCI-60 cancer cell line panel and found cyclophilin B (PPIB), a peptidylprolyl isomerase and target of cyclosporine A (CsA), had the strongest direct correlation. Functional inhibition of PPIB by small interfering RNA depletion or CsA treatment leads to radiosensitization in cancer cells and reduced cellular DNA repair. Immunohistochemical evaluation of PPIB expression in patients with HNSCC was found to be associated with outcome after radiotherapy. This work demonstrates that a novel 41-gene expression model of radiation sensitivity developed in bladder cancer cell lines and human skin fibroblasts predicts clinical outcome after radiotherapy in head and neck cancer patients and identifies PPIB as a potential target for clinical radiosensitization.
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Kuschal C, Thoms KM, Schubert S, Schäfer A, Boeckmann L, Schön MP, Emmert S. Skin cancer in organ transplant recipients: effects of immunosuppressive medications on DNA repair. Exp Dermatol 2012; 21:2-6. [PMID: 22151386 DOI: 10.1111/j.1600-0625.2011.01413.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
UV-induced skin cancers comprise a major problem in organ transplant recipients (OTRs). Cyclosporin A, a calcineurin inhibitor, is used as a standard immunosuppressant and clearly increases the skin cancer risk. Azathioprine does not appear to result in such an increase in skin cancer risk, and mTOR inhibitors are associated with an even lesser skin cancer risk. The underlying molecular mechanisms of these clinically important differences among immunosuppressants are still unclear and may relate to other than immunological effects. Insights may be gained by the multistep skin cancer theory and xeroderma pigmentosum, where defective nucleotide excision repair (NER) results in a cellular mutator phenotype and cutaneous carcinogenesis. This viewpoint assay summarizes current knowledge about the influence of the most commonly used immunosuppressive drugs in OTRs on DNA repair. Calcineurin inhibition results in a 200-fold increased skin cancer risk compared with the normal population and inhibits NER. The skin cancer risk under azathioprine is threefold less compared with calcineurin inhibitors, which may relate to inhibition of only the last step of NER, i.e. gap filling. mTOR inhibitors do not reduce NER in the global genome and can inhibit the growth of already initiated tumors, which may account for the markedly reduced skin cancer risk compared with calcineurin inhibitors. We conclude that OTRs may benefit from treatment regimens other than calcineurin inhibitors and speculate that a targeted modulation of calcineurin-dependent signalling may prevent UV-induced tumor formation by enhancing NER not only in OTRs but also in the general population, at least in part.
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Affiliation(s)
- Christiane Kuschal
- Department of Dermatology, Venerology, and Allergology, Georg-August-University, Goettingen, Germany
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Thoms KM, Kuschal C, Oetjen E, Mori T, Kobayashi N, Laspe P, Boeckmann L, Schön MP, Emmert S. Cyclosporin A, but not everolimus, inhibits DNA repair mediated by calcineurin: implications for tumorigenesis under immunosuppression. Exp Dermatol 2011; 20:232-6. [PMID: 21323745 DOI: 10.1111/j.1600-0625.2010.01213.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Unlike other immunosuppressive drugs including everolimus, cyclosporin A causes a dramatic increase of UV-induced skin cancer, a feature that is reminiscent of xeroderma pigmentosum (XP), where defective nucleotide excision repair (NER) of UV-induced DNA damage results in cutaneous carcinogenesis. The molecular basis of the clinically important differential activities of cyclosporin A and everolimus is still unclear. We measured post-UV cell survival of cyclosporin A- and everolimus-treated human fibroblasts and lymphoblasts using a cell proliferation assay (MTT). The cellular NER capacity was assessed by host cell reactivation. Using an ELISA and specific antibodies, cyclobutane pyrimidine and pyrimidine-6,4-pyrimidone photoproduct removal from the cellular genome was measured. The effect of calcineurin on NER was investigated using a calcineurin A expression vector and specific RNAi. Cyclosporin A led to a dose dependent decrease in post-UV cell survival, inhibited NER and blocked photoproduct removal. In contrast, none of these effects where seen in everolimus-treated cells. Overexpression of calcineurin A resulted in increased NER and complemented the Cyclosporin A-induced reduction of NER. Downregulation of calcineurin using RNAi inhibited NER comparable to cyclosporin A-treatment. We conclude that cyclosporin A, but not everolimus, leads to an increased skin cancer risk via a calcineurin signalling-dependent impairment of NER.
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Affiliation(s)
- Kai-Martin Thoms
- Department of Dermatology, Venerology, and Allergology, Georg-August-University, Goettingen, Germany
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Poletto NP, Henriques JAP, Bonatto D. Relationship between endoplasmic reticulum- and Golgi-associated calcium homeostasis and 4-NQO-induced DNA repair in Saccharomyces cerevisiae. Arch Microbiol 2010; 192:247-57. [PMID: 20143049 DOI: 10.1007/s00203-010-0553-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2009] [Revised: 01/23/2010] [Accepted: 01/25/2010] [Indexed: 10/19/2022]
Abstract
Calcium (Ca(2+)) is an important ion that is necessary for the activation of different DNA repair mechanisms. However, the mechanism by which DNA repair and Ca(2+) homeostasis cooperate remains unclear. We undertook a systems biology approach to verify the relationship between proteins associated with Ca(2+) homeostasis and DNA repair for Saccharomyces cerevisiae. Our data indicate that Pmr1p, a Ca(2+) transporter of Golgi complex, interacts with Cod1p, which regulates Ca(2+) levels in the endoplasmic reticulum (ER), and with Rad4p, which is a nucleotide excision repair (NER) protein. This information was used to construct single and double mutants defective for Pmr1p, Cod1p, and Rad4p followed by cytotoxic, cytostatic, and cell cycle arrest analyses after cell exposure to different concentrations of 4-nitroquinoline 1-oxide (4-NQO). The results indicated that cod1Delta, cod1Deltarad4Delta, and cod1Deltapmr1Delta strains have an elevated sensitivity to 4-NQO when compared to its wild-type (WT) strain. Moreover, both cod1Deltapmr1Delta and cod1Deltarad4Delta strains have a strong arrest at G(2)/M phases of cell cycle after 4-NQO treatment, while pmr1Deltarad4Delta have a similar sensitivity and cell cycle arrest profile when compared to rad4Delta after 4-NQO exposure. Taken together, our results indicate that deletion in Golgi- and ER-associated Ca(2+) transporters affect the repair of 4-NQO-induced DNA damage.
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Affiliation(s)
- Nadine Paese Poletto
- Instituto de Biotecnologia, Centro de Ciências Biológicas e da Saúde, Universidade de Caxias do Sul, Rio Grande do Sul, Brazil
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Morelon E, Mahe E, Touraine JL. The role of the transplant physician in the management of skin cancers after organ transplantation. Cancer Treat Res 2009; 146:377-390. [PMID: 19415217 DOI: 10.1007/978-0-387-78574-5_30] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Emmanuel Morelon
- Département de Transplantation, Université Claude-Bernard Lyon 1, Hôpital Edouard Herriot, Pavillon P, Lyon, France
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O'Driscoll M, Jeggo PA. CsA can induce DNA double-strand breaks: implications for BMT regimens particularly for individuals with defective DNA repair. Bone Marrow Transplant 2008; 41:983-9. [DOI: 10.1038/bmt.2008.18] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Tran C, Lübbe J, Sorg O, Doelker L, Carraux P, Antille C, Grand D, Leemans E, Kaya G, Saurat JH. Topical calcineurin inhibitors decrease the production of UVB-induced thymine dimers from hairless mouse epidermis. Dermatology 2006; 211:341-7. [PMID: 16286744 DOI: 10.1159/000088505] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND An increased incidence of ultraviolet-light-related skin tumours is a well-known problem in patients undergoing posttransplantation immunosuppression with systemic calcineurin inhibitors such as cyclosporine A or tacrolimus. UV-related carcinogenesis as a consequence of long-term treatment of sun-exposed sites with topical calcineurin inhibitors is therefore of theoretical concern. RESULTS In this study, we show that tacrolimus acts as a UVB filter when incorporated into liposome membranes. In hairless mice pretreated with 1% pimecrolimus cream, 0.1% tacrolimus ointment or vehicle, the amount of epidermal thymine dimers, measured 1 h after 1 J/cm2 of UVB irradiation, was decreased by 89, 84 and 47%, respectively, as compared to untreated mice. Forty-eight hours after UVB irradiation, 97, 89 and 93% of epidermal thymine dimer levels were removed in pimecrolimus-, tacrolimus- or vehicle-treated mice, respectively. In contrast, 69% of thymine dimers, originally present in much higher amounts than in treated mice, were removed from untreated controls. UVB-induced apoptosis was less pronounced in treated mice. CONCLUSION Taken together, these results suggest that topical calcineurin inhibitors prevent DNA photodamage due to a filter effect of both vehicle and active components, whereas they do not affect the clearance of DNA photoproducts.
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Affiliation(s)
- Christian Tran
- Department of Dermatology, University Hospital, Geneva, Switzerland.
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Ori Y, Herman M, Chagnac A, Malachi T, Gafter U, Korzets A. Spontaneous DNA repair in human mononuclear cells is calcium-dependent. Biochem Biophys Res Commun 2005; 336:842-6. [PMID: 16157301 DOI: 10.1016/j.bbrc.2005.08.186] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2005] [Accepted: 08/24/2005] [Indexed: 11/28/2022]
Abstract
Spontaneous DNA repair in peripheral blood mononuclear cells (PBMC) has been recently described. The aim of this study was to evaluate whether spontaneous DNA repair is Ca(2+)-dependent, as in vitro-stimulated DNA repair. Spontaneous DNA repair in PBMC was measured in a 1mM Ca2+ medium. The effect of extracellular Ca2+ chelation by EGTA, intracellular Ca2+ chelation by bapta-AM, and Ca2+ loading by the ionophore A23187 was examined. The signal transduction pathway was evaluated by inhibiting protein tyrosine kinase with genistein, calmodulin with W7, and calcineurin with cyclosporin A and tacrolimus. Extracellular Ca2+ chelation had no effect on spontaneous DNA repair, while both intracellular chelation and calcium overloading inhibited the DNA repair. Inhibition of protein tyrosine kinase, calmodulin or calcineurin reduced DNA repair. In conclusion, spontaneous DNA repair is mainly Ca(2+)-dependent at a narrow range of intracellular Ca2+ concentrations. The signal transduction cascade includes protein tyrosine kinase, calmodulin, and calcineurin.
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Affiliation(s)
- Yaacov Ori
- Department of Nephrology and Hypertension, Rabin Medical Center, Petah-Tikva, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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20
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Choi Y, Gyoo Park S, Yoo JH, Jung G. Calcium ions affect the hepatitis B virus core assembly. Virology 2005; 332:454-63. [PMID: 15661175 DOI: 10.1016/j.virol.2004.11.019] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2004] [Accepted: 11/16/2004] [Indexed: 10/26/2022]
Abstract
Previous report showed that cytosolic Ca2+ induced by hepatitis B virus X protein (HBx) promotes HBV replication. In this study, in vitro experiments showed that (i) HBV core assembly in vitro was promoted by Ca2+ through the sucrose density gradient and the analytical ultracentrifuge analysis. Also, (ii) transmission electron microscope analysis demonstrated these assembled HBV core particles were the capsids. Ex vivo experiments showed that the treatment of BAPTA-AM and cyclosporine A (CsA) reduced HBV capsids in the transfected HepG2 cells. In addition to that, the treatment of Thapsigargin (TG) increased HBV capsids in the transfected HepG2 cells. Furthermore, we investigated the increased HBV core assembly by HBx. The results show that the increased cytosolic calcium ions by HBx promote the HBV core assembly.
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Affiliation(s)
- Yongwook Choi
- School of Biological Sciences, Seoul National University, San 56-1, Shillim-dong, Kwanak-gu, Seoul 151-742, South Korea
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21
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Thaunat O, Morelon E. Cancers et immunosuppression : effet pro- et antitumoral des traitements immunosuppresseurs. Nephrol Ther 2005; 1:23-30. [PMID: 16895664 DOI: 10.1016/j.nephro.2005.01.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Malignancies are an important cause of morbidity and mortality among transplant patients. Tumor genesis is the consequence of non-specific immunosuppression that enhanced oncogenic virus replication, but may also be due to direct effects of immunosuppressants. Steroids are believed not to be involved in cancer genesis, in contrast to azathioprine, well known to reduce DNA repair ability, particularly in skin cells exposed to UV irradiation. Calcineurin inhibitors, cyclosporine and tacrolimus, are involved in tumor development through various mechanisms: they promote B-cell proliferation by increasing T lymphocyte IL6 secretion, decrease DNA repair ability and may be able to promote metastasis spreading by a direct cellular effect that is independent of their effect on the host's immune cells. In vitro anti-tumoral properties of mycophenolate mofetil have not been valided in animal models or in human. The last developed immunosuppressant mTOR inhibitors, sirolimus and everolimus, effectively control the proliferation of various tumor cell lines, promote tumor cell apoptosis and inhibit metastatic tumor growth and angiogenesis in in vivo mouse models by affecting VEGF production and effect. If these antitumoral features are confirmed in human, this new immunosuppressive family will offer the unique opportunity to reduce both the incidence of rejection and cancer in organ transplant recipients.
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Affiliation(s)
- Olivier Thaunat
- Inserm U 430, institut biomédical des Cordeliers, Paris, France
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22
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André N, Roquelaure B, Conrath J. Molecular effects of cyclosporine and oncogenesis: a new model. Med Hypotheses 2005; 63:647-52. [PMID: 15325009 DOI: 10.1016/j.mehy.2004.03.030] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2004] [Accepted: 03/25/2004] [Indexed: 01/11/2023]
Abstract
Cyclosporine A is the most commonly used immunosuppressive agent during organ transplantation. One of the most feared adverse effects of cyclosporine A is the appearance of de novo cancers. The mechanisms that lead to the genesis of such cancers are thought to be only related to a side effect of cyclosporine A: a depressed immune system. Here, we review different molecular effects induced by cyclosporine A (inhibition of DNA repair, synthesis of TGF Beta, induction of apoptosis of activated T cells, inhibition of apoptosis through the inhibition of the opening of the mitochondrial Permeability Transition Pore) and propose that cyclosporine A can promote the genesis and the spread of cancer not only because of immunosuppression but also because of its ability to facilitate DNA mutations accumulation, to diminish the clearance of altered cells and to transform cancer cells into aggressive cancer cells. This new insights into the mechanisms of genesis of cyclosporine A-related cancers should be taken into account to develop preventive strategies or new immunosuppressive strategies.
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Affiliation(s)
- N André
- Pediatric Oncology Department, Children Hospital of "La Timone", Bd Jean Moulin, 13885 Marseille Cedex 5, France.
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23
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Herman M, Ori Y, Chagnac A, Weinstein T, Korzets A, Zevin D, Malachi T, Gafter U. DNA repair in mononuclear cells: role of serine/threonine phosphatases. THE JOURNAL OF LABORATORY AND CLINICAL MEDICINE 2002; 140:255-62. [PMID: 12389024 DOI: 10.1067/mlc.2002.127738] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Treatment with cyclosporin A (CsA) in kidney-transplant recipients is associated with reduced DNA repair and enhanced cancer incidence. CsA is an inhibitor of the serine/threonine phosphatase calcineurin, also termed PP2B, which is a Ca(2+)/calmodulin-dependent phosphatase. In this study we sought to elucidate the role of calcineurin in DNA repair using CsA and tacrolimus; examine whether UV-induced DNA repair is associated with dephosphorylation; and investigate whether phosphatases other than calcineurin are active in DNA repair, in light of the fact that calcineurin inhibition only partially suppressed DNA repair. Peripheral blood mononuclear cells from healthy donors were used. In vitro, we assayed UV-induced DNA repair by measuring the incorporation of tritiated thymidine in UV-irradiated cells. We gauged phosphatase activity indirectly by measuring free inorganic phosphate (Pi) excreted into the medium. The phosphatase assay was performed under the same conditions and in parallel to the DNA-repair assay. Tacrolimus, like CsA, inhibited DNA repair in a dose-dependent fashion. DNA repair was associated with production of Pi, which correlated with the number of cells performing DNA repair. Phosphatase activity increased after UV irradiation. DNA repair correlated directly with phosphatase activity, whereas CsA reduced both DNA repair and Pi production. Inhibition of calmodulin by trifluoperazine and W7 [N-(6-aminohexyl)-5-chloro-1-naphthalene-sulfonamide] reduced DNA repair in part. We investigated the role of the Ca(2+)-independent phosphatases PP1 and PP2A using specific inhibitors. Calyculin A, which inhibits both phosphatases, reduced DNA repair. Endothall, a PP2A inhibitor, had no effect on DNA repair. Okadaic acid, which is mostly a PP2A inhibitor but also a weak inhibitor of PP1, reduced DNA repair only slightly. We suggest that DNA repair is mediated by way of Ca(2+)-dependent and Ca(2+)-independent pathways, with calcineurin and PP1 being the respective phosphatases involved in each pathway.
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Affiliation(s)
- Michal Herman
- Institute of Nephrology and Hypertension, Rabin Medical Center, Golda-Hasharon Campus, 7 Keren Kayemet Street, Petah-Tikva 49372, Israel
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24
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Tenderich G, Deyerling W, Schulz U, Heller R, Hornik L, Schulze B, Jahanyar J, Koerfer R. Malignant neoplastic disorders following long-term immunosuppression after orthotopic heart transplantation. Transplant Proc 2001; 33:3653-5. [PMID: 11750553 DOI: 10.1016/s0041-1345(01)02574-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- G Tenderich
- Heart-Center North-Rhine Westphalia, Department of Cardio-Thoracic Surgery, Ruhr-University of Bochum, Bad Oeynhausen, Germany
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Herman M, Weinstein T, Korzets A, Chagnac A, Ori Y, Zevin D, Malachi T, Gafter U. Effect of cyclosporin A on DNA repair and cancer incidence in kidney transplant recipients. THE JOURNAL OF LABORATORY AND CLINICAL MEDICINE 2001; 137:14-20. [PMID: 11150019 DOI: 10.1067/mlc.2001.111469] [Citation(s) in RCA: 119] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Cancer incidence is enhanced in transplant recipients. Decreased DNA repair ability is associated with increased cancer incidence. Transplanted patients with cancer were found to have reduced DNA repair. We hypothesized that immunosuppressive therapy may impair DNA repair and thus contribute to the increased cancer incidence in transplanted patients. The objectives of this study were (1) to investigate the effect of two immunosuppressive treatment protocols on DNA repair in kidney transplant recipients; (2) to evaluate the cancer incidence in these patients; and (3) to study the in vitro effect of cyclosporin A (CsA), azathioprine, and prednisolone-separately and in various combinations-on DNA repair. Three groups were studied: (1) a control group; (2) patients treated with azathioprine and prednisone (double-therapy group); and (3) patients treated with CsA, azathioprine, and prednisone (triple-therapy group). The two patient groups did not differ in age, gender, time on dialysis before transplantation, or kidney function or in the number of acute rejections. However, the interval from transplantation to the DNA repair study was shorter in the triple-therapy group (P <.01). DNA repair was induced in peripheral blood mononuclear cells (PBMCs) by ultraviolet irradiation and expressed as tritiated thymidine uptake by these cells. DNA repair in the triple-therapy group was 679 +/- 64 cpm/10(6) cells, significantly less than that in the control group (1049 +/- 69 cpm/10(6) cells, P <.02). In the double-therapy group, DNA repair was similar to that in the control group. The follow-up period was shorter in the triple-therapy group (116 +/- 19 months vs 174 +/- 29 months, P <.01). Five tumors developed in the triple-therapy group, but only one developed in the double-therapy group (P =.05). The in vitro study showed a dose-dependent reduction in PBMC DNA repair by CsA. Azathioprine and prednisolone reduced DNA repair slightly, but CsA reduced DNA repair significantly more than either one or a combination of them. In summary, triple therapy was associated with impaired PBMC DNA repair and increased cancer incidence. CsA was responsible in large part for the reduction in DNA repair ability found in the in vitro and in vivo studies. This may have partly contributed to the enhanced cancer incidence in the kidney transplant recipients.
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Affiliation(s)
- M Herman
- Nephrology and Hypertension Institute, Rabin Medical Center-Golda Campus, Petah Tikva, Israel
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Kreideweiss S, Ahlers C, Nordheim A, Rühlmann A. Ca2+-induced p38/SAPK signalling inhibited by the immunosuppressant cyclosporin A in human peripheral blood mononuclear cells. EUROPEAN JOURNAL OF BIOCHEMISTRY 1999; 265:1075-84. [PMID: 10518804 DOI: 10.1046/j.1432-1327.1999.00830.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
To understand the effects of the immunosuppressant cyclosporin A (CsA) on Ca2+-mediated intracellular signalling pathways in human peripheral blood mononuclear cells (PBMCs), we investigated its effects on the activity profiles of mitogen-activated protein kinase (MAPK) cascades. PBMCs, or subpopulations thereof, were simultaneously stimulated with a phorbol ester and the calcium ionophore ionomycin, in the presence or absence of therapeutic concentrations of CsA. In these primary human cells, CsA significantly inhibited PMA/ionomycin-mediated and ionomycin-mediated activation of the MAPK kinase MKK6, as well as its downstream kinases SAPK2a (p38alpha) and MAPKAP-K2. PMA/ionomycin treatment also mediated activation of SAPK1 (JNKs) which was inhibited by CsA. Treatment with ionomycin alone also resulted in CsA-sensitive activation of SAPK1. With regard to transcription factors targeted by the Ca2+-induced MAPK signalling network, we found CsA to inhibit the ionomycin-mediated phosphorylation of ATF2 at Thr71. We identified the heterodimeric transcription factor ATF2/CREB as constitutively binding to the essential cAMP response element (CRE) site within the Ca2+-regulated DNA polymerase beta promoter and contributing to the activation of this promoter. Our data implicate ATF2 phosphorylation status as a nuclear sensor within PBMCs that monitors converging intracellular Ca2+-signalling pathways.
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Affiliation(s)
- S Kreideweiss
- Medizinische Hochschule Hannover, Institut für Molekularbiologie, Hannover, Germany
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