Immune checkpoint proteins (PD-L1 and CTLA-4) in endometrial carcinoma: prognostic role and correlation with CD4+/CD8+ tumor infiltrating lymphocytes (TILs) ratio

Prognostic implication of CD47 and CTLA-4 expressions in endometrial carcinoma

BACKGROUND

CD47 is an immune-regulatory protein that belongs to the immunoglobulin family. It inhibits the phagocytic ability of immune cells. So, it is related to an unfavorable outcome in leukemia and various solid tumors. One of the immune checkpoint molecules is cytotoxic T lymphocyte-associated antigen-4 (CTLA-4) which interferes with anticancer immunity and has an important role in anti-cancer surveillance. This study aimed to investigate CD47 and CTLA-4 mRNA and protein expressions in relation to P53 mutation and different clinicopathological parameters in endometrial carcinoma (EC). We also investigated the relation between CD47 and CTLA-4 expressions in EC.

SUBJECT & METHOD

This study included sixty-eight patients with EC. Tissue samples of the tumor with adequate safety margin were obtained. Part of the tissues was preserved in formalin for histopathological and immunohistochemical examination while the other part was kept frozen at -80 °C for molecular profile.

RESULTS

CD47 and CTLA-4 gene expressions were upregulated in the tissues of EC in comparison with the adjacent control tissues. Significantly higher CD47 and CTLA-4 gene expressions were detected in the serous type, higher stage, muscle invasion ≥50 %, higher grade, LN metastasis, and distant metastasis. CD47 gene expression was a good marker of P53 mutation at a cut-off of 1.65. It showed a high sensitivity of 84 %, a high specificity of 75.3 %, an average PPV of 65.6 %, a high NPV of 88.9 %, and an accuracy of 77.9 % (P < 0.001). Similarly, CTLA-4 gene expression was a good marker of P53 mutation at a cut-off of 3.75. It showed a sensitivity of 88 %, a specificity of 74.3 %, a PPV of 66.7 %, an NPV of 91.4 %, and an accuracy of 79.4 % (P < 0.001).

CONCLUSION

CD47 and CTLA-4 expressions can be considered possible diagnostic and prognostic markers in EC. They were good markers of P53 mutation, and higher tumor grades and stages.

PD-L1 expression and immune infiltration across molecular subtypes of endometrial cancer: An integrative-analysis of molecular classification and immune subtypes

The immune subtypes of the tumor microenvironment in endometrial cancer (EC), associated with different molecular classifications, warrant further investigation to guide EC immunotherapy strategies. This study focused on programmed death-ligand 1 (PD-L1) expression (Clone SP263) and immune cell (IC) markers (CD3, CD8, CD68, CD20, CD21) in 110 EC cases. In this cohort, the molecular subtype distribution was: POLE mutation (POLEmut) 7.3% (8/110), mismatch repair-deficient (MMRd) 21.8% (24/110), p53 abnormal (p53abn) 14.5% (16/110), and non-specific molecular profile (NSMP) 56.4% (62/110). NSMP subtypes exhibited the lowest PD-L1+ cell densities and scores. POLEmut and MMRd subtypes showed higher IC densities, while p53abn and NSMP subtypes had lower IC densities and fewer tertiary lymphoid structures (TLS). Integrative analysis of immune subtypes with PD-L1 and CD8+ tumor infiltrating lymphocytes (TILs) revealed 62.5% of POLEmut and 45.8% of MMRd cases as TIME type Ⅰ (PD-L1+ & CD8high). Conversely, p53abn and NSMP cases were more heterogeneous, with 37.5% of p53abn cases in TIME type Ⅲ (PD-L1+ & CD8low) and 41.9% of NSMP cases in TIME type Ⅱ (PD-L1- & CD8low). Higher CD8+ T cell density was a prognostic marker for disease-free survival in EC, including within NSMP (p < 0.05). In summary, the four WHO molecular subtypes of EC exhibit distinct TIME subtypes, complementing molecular classification and providing insights for optimizing EC immunotherapy strategies.

Network-based drug repurposing identifies small molecule drugs as immune checkpoint inhibitors for endometrial cancer

Endometrial cancer (EC) is the 6th most common cancer in women around the world. Alone in the United States (US), 66,200 new cases and 13,030 deaths are expected to occur in 2023 which needs the rapid development of potential therapies against EC. Here, a network-based drug-repurposing strategy is developed which led to the identification of 16 FDA-approved drugs potentially repurposable for EC as potential immune checkpoint inhibitors (ICIs). A network of EC-associated immune checkpoint proteins (ICPs)-induced protein interactions (P-ICP) was constructed. As a result of network analysis of P-ICP, top key target genes closely interacting with ICPs were shortlisted followed by network proximity analysis in drug-target interaction (DTI) network and pathway cross-examination which identified 115 distinct pathways of approved drugs as potential immune checkpoint inhibitors. The presented approach predicted 16 drugs to target EC-associated ICPs-induced pathways, three of which have already been used for EC and six of them possess immunomodulatory properties providing evidence of the validity of the strategy. Classification of the predicted pathways indicated that 15 drugs can be divided into two distinct pathway groups, containing 17 immune pathways and 98 metabolic pathways. In addition, drug-drug correlation analysis provided insight into finding useful drug combinations. This fair and verified analysis creates new opportunities for the quick repurposing of FDA-approved medications in clinical trials.

Circulating memory PD-1+CD8+ T cells and PD-1+CD8+T/PD-1+CD4+T cell ratio predict response and outcome to immunotherapy in advanced gastric cancer patients

BACKGROUND

Limited benefit population of immunotherapy makes it urgent to select effective biomarkers for screening appropriate treatment population. Herein, we have investigated the predictive values of circulating CD8+ T cells and CD8+T/CD4+T cell ratio in advanced gastric cancer patients receiving immunotherapy.

METHODS

A retrospective cohort analysis of 187 advanced gastric cancer patients receiving sintilimab combined with oxaliplatin and capecitabine therapy in The Affiliated Xinghua People's Hospital, Medical School of Yangzhou University between December 2019 and February 2023 was conducted. The corresponding clinical outcomes of the variables were analyzed by receiver operating characteristic (ROC) curve, chi-square test, Kaplan-Meier methods and Cox proportional hazards regression models.

RESULTS

The optimal cutoff values for percentages of CD8+ T cells, naive CD8+ T cells (CD8+ Tn) and memory CD8+ T cells (CD8+ Tm) expressing programmed cell death -1(PD-1) as well as PD-1+CD8+T/PD-1+CD4+T cell ratio were 21.0, 21.5, 64.3 and 0.669, respectively. It was found that the mean percentages of CD8+ T and CD8+ Tm expressing PD-1 as well as PD-1+CD8+T/PD-1+CD4+T cell ratio were significantly higher in responder (R) than non-responder (NonR) advanced gastric cancer patients associated with a longer progression free survival (PFS) and overall survival (OS). We also observed this correlation in programmed cell death-ligand 1(PD-L1) combined positive score (CPS) ≥ 5 subgroups. Univariate and multivariate Cox regression analyses demonstrated that lower CD8+ T and CD8+ Tm expressing PD-1 as well as PD-1+CD8+T/PD-1+CD4+T cell ratio were independent risk factors in advanced gastric cancer patients receiving immunotherapy plus chemotherapy.

CONCLUSION

The circulating memory PD-1+CD8+ T cells and PD-1+CD8+T/PD-1+CD4+T cell ratio revealed high predictive values for response and prolonged survival outcomes in advanced gastric cancer patients receiving immunotherapy. Memory PD-1+CD8+ T cells and PD-1+CD8+T/PD-1+CD4+T cell ratio might be effective for screening benefit population of immunotherapy in advanced gastric cancer patients based on this preliminary evidence.

New insights for gynecological cancer therapies: from molecular mechanisms and clinical evidence to future directions

Advanced and recurrent gynecological cancers lack effective treatment and have poor prognosis. Besides, there is urgent need for conservative treatment for fertility protection of young patients. Therefore, continued efforts are needed to further define underlying therapeutic targets and explore novel targeted strategies. Considerable advancements have been made with new insights into molecular mechanisms on cancer progression and breakthroughs in novel treatment strategies. Herein, we review the research that holds unique novelty and potential translational power to alter the current landscape of gynecological cancers and improve effective treatments. We outline the advent of promising therapies with their targeted biomolecules, including hormone receptor-targeted agents, inhibitors targeting epigenetic regulators, antiangiogenic agents, inhibitors of abnormal signaling pathways, poly (ADP-ribose) polymerase (PARP) inhibitors, agents targeting immune-suppressive regulators, and repurposed existing drugs. We particularly highlight clinical evidence and trace the ongoing clinical trials to investigate the translational value. Taken together, we conduct a thorough review on emerging agents for gynecological cancer treatment and further discuss their potential challenges and future opportunities.

Upregulated ENC1 predicts unfavorable prognosis and correlates with immune infiltration in endometrial cancer

A better knowledge of the molecular process behind uterine corpus endometrial carcinoma (UCEC) is important for prognosis prediction and the development of innovative targeted gene therapies. The purpose of this research is to discover critical genes associated with UCEC. We analyzed the gene expression profiles of TCGA-UCEC and GSE17025, respectively, using Weighted Gene Co-expression Network Analysis (WGCNA) and differential gene expression analysis. From four sets of findings, a total of 95 overlapping genes were retrieved. On the 95 overlapping genes, KEGG pathway and GO enrichment analysis were conducted. Then, we mapped the PPI network of 95 overlapping genes using the STRING database. Twenty hub genes were evaluated using the Cytohubba plugin, including NR3C1, ATF3, KLF15, THRA, NR4A1, FOSB, PER3, HLF, NTRK3, EGR3, MAPK13, ARNTL2, PKM2, SCD, EIF5A, ADHFE1, RERGL, TUB, and ENC1. The expression levels of NR3C1, PKM2, and ENC1 were shown to be adversely linked with the survival time of UCEC patients using univariate Cox regression analysis and Kaplan-Meier survival calculation. ENC1 were also overexpressed in UCEC tumor tissues or cell lines, as shown by quantitative real-time PCR and Western blotting. Then we looked into it further and discovered that ENC1 expression was linked to tumor microenvironment and predicted various immunological checkpoints. In conclusion, our data indicate that ENC1 may be required for the development of UCEC and may serve as a future biomarker for diagnosis and therapy.

Evaluation of Programmed Death Ligand-1 Immunohistochemical Expression and Tumor-Infiltrating Lymphocytes in Different Types of Endometrial Carcinoma

BACKGROUND: Endometrial cancer (EC) identified at an early stage is successfully treated in a majority of patients with surgery with or without radiotherapy or chemotherapy. For patients with advanced disease, however, the prognosis is poor; 5-year survival rates are less than 50% in patients with lymph node metastases and less than 20% with peritoneal or distant metastases. Previous studies proved that programmed death-1/programmed death ligand-1 (PD1-/PD-L1) blockers are currently effectively used as immunotherapies in a number of tumors such as melanoma and non-small cell lung cancer. AIM: This study was conducted to determine the expression of PD L1 in endometrial carcinoma and to assess its potential role as a biomarker for different types that can be used to screen candidates fit for immunotherapy. MATERIALS AND METHODS: This cross-sectional study was carried out on 32 cases of endometrial carcinoma cases that underwent endometrial biopsies, dilatation, and curettage or radical hysterectomies at Ain Shams University Hospitals Pathology Units from 2018 to 2020 with their clinical and radiological assessments. Correlation between hematoxylin and eosin-stained histopathological sections and PD-L1 immunohistochemical staining of the same sections, mainly emphasizing the tumor-infiltrating lymphocytes, was done. RESULTS: PDL-1-positive expression of both tumor cells and TILs was significantly more frequent in type II endometrial carcinoma (p = 0.04 and 0.03, respectively) using a cut-off value 10%, compared to type I. Moreover, Grade III tumors showed significantly more frequent PDL-1 expression in both tumor cells and TILs than Grade I and II tumors, using 5% and 10% cut-off values indicating that PDL-1 is overexpressed in aggressive tumors. CONCLUSION: PD-L1 staining is significantly related to high-grade tumors and type II endometrial carcinomas, the aggressive types, which support their probable benefit from immunotherapy. Separate assessment of PD-L1-positive staining in both tumor cells or TILs with a cut-off value 10% can significantly reflect the aggressiveness of the tumor and its probable benefit from immunotherapy.