1
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Sconocchia T, Foßelteder J, Sconocchia G, Reinisch A. Langerhans cell histiocytosis: current advances in molecular pathogenesis. Front Immunol 2023; 14:1275085. [PMID: 37965340 PMCID: PMC10642229 DOI: 10.3389/fimmu.2023.1275085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 10/16/2023] [Indexed: 11/16/2023] Open
Abstract
Langerhans cell histiocytosis (LCH) is a rare and clinically heterogeneous hematological disease characterized by the accumulation of mononuclear phagocytes in various tissues and organs. LCH is often characterized by activating mutations of the mitogen-activated protein kinase (MAPK) pathway with BRAFV600E being the most recurrent mutation. Although this discovery has greatly helped in understanding the disease and in developing better investigational tools, the process of malignant transformation and the cell of origin are still not fully understood. In this review, we focus on the newest updates regarding the molecular pathogenesis of LCH and novel suggested pathways with treatment potential.
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Affiliation(s)
- Tommaso Sconocchia
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Johannes Foßelteder
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Giuseppe Sconocchia
- Institute of Translational Pharmacology, National Research Council (CNR), Rome, Italy
| | - Andreas Reinisch
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Graz, Graz, Austria
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2
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Jaber Y, Netanely Y, Naamneh R, Saar O, Zubeidat K, Saba Y, Georgiev O, Kles P, Barel O, Horev Y, Yosef O, Eli-Berchoer L, Nadler C, Betser-Cohen G, Shapiro H, Elinav E, Wilensky A, Hovav AH. Langerhans cells shape postnatal oral homeostasis in a mechanical-force-dependent but microbiota and IL17-independent manner. Nat Commun 2023; 14:5628. [PMID: 37699897 PMCID: PMC10497507 DOI: 10.1038/s41467-023-41409-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 08/29/2023] [Indexed: 09/14/2023] Open
Abstract
The postnatal interaction between microbiota and the immune system establishes lifelong homeostasis at mucosal epithelial barriers, however, the barrier-specific physiological activities that drive the equilibrium are hardly known. During weaning, the oral epithelium, which is monitored by Langerhans cells (LC), is challenged by the development of a microbial plaque and the initiation of masticatory forces capable of damaging the epithelium. Here we show that microbial colonization following birth facilitates the differentiation of oral LCs, setting the stage for the weaning period, in which adaptive immunity develops. Despite the presence of the challenging microbial plaque, LCs mainly respond to masticatory mechanical forces, inducing adaptive immunity, to maintain epithelial integrity that is also associated with naturally occurring alveolar bone loss. Mechanistically, masticatory forces induce the migration of LCs to the lymph nodes, and in return, LCs support the development of immunity to maintain epithelial integrity in a microbiota-independent manner. Unlike in adult life, this bone loss is IL-17-independent, suggesting that the establishment of oral mucosal homeostasis after birth and its maintenance in adult life involve distinct mechanisms.
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Affiliation(s)
- Yasmin Jaber
- Institute of Biomedical and Oral Research, Faculty of Dental Medicine, Hebrew University, Jerusalem, Israel
| | - Yasmine Netanely
- Institute of Biomedical and Oral Research, Faculty of Dental Medicine, Hebrew University, Jerusalem, Israel
| | - Reem Naamneh
- Institute of Biomedical and Oral Research, Faculty of Dental Medicine, Hebrew University, Jerusalem, Israel
| | - Or Saar
- Faculty of Dental Medicine, Hebrew University, Jerusalem, Israel; Department of Periodontology, Hadassah Medical Center, Jerusalem, Israel
| | - Khaled Zubeidat
- Institute of Biomedical and Oral Research, Faculty of Dental Medicine, Hebrew University, Jerusalem, Israel
| | - Yasmin Saba
- Institute of Biomedical and Oral Research, Faculty of Dental Medicine, Hebrew University, Jerusalem, Israel
| | - Olga Georgiev
- Institute of Biomedical and Oral Research, Faculty of Dental Medicine, Hebrew University, Jerusalem, Israel
| | - Paz Kles
- Faculty of Dental Medicine, Hebrew University, Jerusalem, Israel; Department of Periodontology, Hadassah Medical Center, Jerusalem, Israel
| | - Or Barel
- Institute of Biomedical and Oral Research, Faculty of Dental Medicine, Hebrew University, Jerusalem, Israel
| | - Yael Horev
- Faculty of Dental Medicine, Hebrew University, Jerusalem, Israel; Department of Periodontology, Hadassah Medical Center, Jerusalem, Israel
| | - Omri Yosef
- The Lautenberg Center for Immunology and Cancer Research, Israel-Canada Medical Research Institute, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Luba Eli-Berchoer
- Institute of Biomedical and Oral Research, Faculty of Dental Medicine, Hebrew University, Jerusalem, Israel
| | - Chen Nadler
- Faculty of Dental Medicine, Hebrew University, Jerusalem, Israel
- Department of Oral Medicine, Sedation & Maxillofacial Imaging, Hadassah Medical Center, Jerusalem, Israel
| | - Gili Betser-Cohen
- Division of Identification and Forensic Science, Police National HQ, Jerusalem, Israel
| | - Hagit Shapiro
- System Immunology Department, Weizmann Institute of Science, Rehovot, Israel
| | - Eran Elinav
- System Immunology Department, Weizmann Institute of Science, Rehovot, Israel
- Microbe & Cancer Division, DKFZ, Heidelberg, Germany
| | - Asaf Wilensky
- Faculty of Dental Medicine, Hebrew University, Jerusalem, Israel; Department of Periodontology, Hadassah Medical Center, Jerusalem, Israel
| | - Avi-Hai Hovav
- Institute of Biomedical and Oral Research, Faculty of Dental Medicine, Hebrew University, Jerusalem, Israel.
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3
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Hagey DW, Kvedaraite E, Akber M, Görgens A, Javadi J, Von Bahr Greenwood T, Björklund C, Åkefeldt SO, Hannegård-Hamrin T, Arnell H, Dobra K, Herold N, Svensson M, El Andaloussi S, Henter JI, Lourda M. Myeloid cells from Langerhans cell histiocytosis patients exhibit increased vesicle trafficking and an altered secretome capable of activating NK cells. Haematologica 2023; 108:2422-2434. [PMID: 36924254 PMCID: PMC10483349 DOI: 10.3324/haematol.2022.282638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 03/09/2023] [Indexed: 03/18/2023] Open
Abstract
Langerhans cell histiocytosis (LCH) is a potentially life-threatening inflammatory myeloid neoplasia linked to pediatric neurodegeneration, whereby transformed LCH cells form agglomerated lesions in various organs. Although MAP-kinase pathway mutations have been identified in LCH cells, the functional consequences of these mutations and the mechanisms that cause the pathogenic behavior of LCH cells are not well understood. In our study, we used an in vitro differentiation system and RNA-sequencing to compare monocyte-derived dendritic cells from LCH patients to those derived from healthy controls or patients with Crohn's disease, a non-histiocytic inflammatory disease. We observed that interferon-γ treatment exacerbated intrinsic differences between LCH patient and control cells, including strikingly increased endo- and exocytosis gene activity in LCH patients. We validated these transcriptional patterns in lesions and functionally confirmed that LCH cells exhibited increased endo- and exocytosis. Furthermore, RNA-sequencing of extracellular vesicles revealed the enrichment of pathological transcripts involved in cell adhesion, MAP-kinase pathway, vesicle trafficking and T-cell activation in LCH patients. Thus, we tested the effect of the LCH secretome on lymphocyte activity and found significant activation of NK cells. These findings implicate extracellular vesicles in the pathology of LCH for the first time, in line with their established roles in the formation of various other tumor niches. Thus, we describe novel traits of LCH patient cells and suggest a pathogenic mechanism of potential therapeutic and diagnostic importance.
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Affiliation(s)
- Daniel W Hagey
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, 141 52 Sweden; Childhood Cancer Research Unit, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, 171 77 Sweden.
| | - Egle Kvedaraite
- Childhood Cancer Research Unit, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, 171 77 Sweden; Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, Karolinska University Hospital, Stockholm, 141 52 Sweden; Department of Clinical Pathology and Cancer Diagnostics, Karolinska University Hospital, Stockholm, 171 76 Sweden
| | - Mira Akber
- Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, Karolinska University Hospital, Stockholm, 141 52 Sweden
| | - André Görgens
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, 141 52 Sweden; Institute for Transfusion Medicine, University Hospital Essen, Essen, 451 47 Germany
| | - Joman Javadi
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, 141 52 Sweden
| | - Tatiana Von Bahr Greenwood
- Childhood Cancer Research Unit, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, 171 77 Sweden; Pediatric Oncology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, 171 76 Sweden
| | - Caroline Björklund
- Department of Pediatric Hematology and Oncology, Umeå University Hospital, Umeå, 901 89 Sweden
| | - Selma Olsson Åkefeldt
- Childhood Cancer Research Unit, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, 171 77 Sweden; Theme of Children's Health, Karolinska University Hospital, Stockholm, 171 76 Sweden
| | - Tova Hannegård-Hamrin
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, 171 77 Sweden; Department of Pediatric Anesthesia and Intensive Care, Karolinska University Hospital, Stockholm, 171 76 Sweden
| | - Henrik Arnell
- Pediatric Gastroenterology, Hepatology and Nutrition, Astrid Lindgren Children's Hospital, Karolinska University Hospital; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, 171 76 Sweden
| | - Katalin Dobra
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, 141 52 Sweden
| | - Nikolas Herold
- Childhood Cancer Research Unit, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, 171 77 Sweden; Pediatric Oncology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, 171 76 Sweden
| | - Mattias Svensson
- Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, Karolinska University Hospital, Stockholm, 141 52 Sweden
| | - Samir El Andaloussi
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, 141 52 Sweden
| | - Jan-Inge Henter
- Childhood Cancer Research Unit, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, 171 77 Sweden; Pediatric Oncology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, 171 76 Sweden
| | - Magda Lourda
- Childhood Cancer Research Unit, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, 171 77 Sweden; Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, Karolinska University Hospital, Stockholm, 141 52 Sweden.
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4
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Gao XM, Li J, Cao XX. Signaling pathways, microenvironment, and targeted treatments in Langerhans cell histiocytosis. Cell Commun Signal 2022; 20:195. [PMID: 36536400 PMCID: PMC9764551 DOI: 10.1186/s12964-022-00917-0] [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: 03/21/2022] [Accepted: 06/11/2022] [Indexed: 12/23/2022] Open
Abstract
Langerhans cell histiocytosis (LCH) is an inflammatory myeloid malignancy in the "L-group" histiocytosis. Mitogen-activated protein kinase (MAPK) pathway activating mutations are detectable in nearly all LCH lesions. However, the pathogenic roles of MAPK pathway activation in the development of histiocytosis are still elusive. This review will summarize research concerning the landscape and pathogenic roles of MAPK pathway mutations and related treatment opportunities in Langerhans cell histiocytosis. Video abstract.
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Affiliation(s)
- Xue-min Gao
- grid.506261.60000 0001 0706 7839Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730 China ,grid.506261.60000 0001 0706 7839State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jian Li
- grid.506261.60000 0001 0706 7839Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730 China ,grid.506261.60000 0001 0706 7839State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xin-xin Cao
- grid.506261.60000 0001 0706 7839Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730 China ,grid.506261.60000 0001 0706 7839State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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5
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Astigarraga I, García-Obregón S, Pérez-Martínez A, Gutiérrez-Carrasco I, Santa-María V, Rodríguez-Vigil Iturrate C, Lorite Reggiori M, Murciano Carrillo T, Torrent M. Histiocitosis de células de Langerhans. Avances en la patogenia y práctica clínica. An Pediatr (Barc) 2022. [DOI: 10.1016/j.anpedi.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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6
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Langerhans cell histiocytosis. Advances in pathogenesis and clinical practice. An Pediatr (Barc) 2022; 97:130.e1-130.e7. [PMID: 35869015 DOI: 10.1016/j.anpede.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 05/02/2022] [Indexed: 11/23/2022] Open
Abstract
Langerhans cell histiocytosis (LCH) is a type of myeloid neoplasia that can affect different organs or tissues and exhibits substantial variability in its clinical presentation and biological behaviour, so it may mimic different diseases. Performance of different clinical assessments and laboratory and imaging tests is recommended to determine the extent of involvement, which may be of a single location or multisystemic, and the presence or absence of dysfunction in risk organs, such as the haematopoietic system, liver and spleen. The diagnosis must be confirmed by histological examination of a biopsy sample. Molecular tests have identified mutations in the mitogen-activated protein kinase (MAPK) pathway, which has expanded treatment options. The diagnosis is complex and there is controversy regarding the management of certain cases. Treatment recommendations depend on the location of the lesions and the extent of involvement. International collaborative studies have demonstrated the effectiveness of prolonged combination therapies such as vinblastine and prednisone in severe or multisystemic forms, and anti-inflammatory drugs such as indomethacin and other cytostatic combinations have proven beneficial. Langerhans cell histiocytosis is a good example of the importance of precision medicine and the benefit of identifying molecular targets, common to different neoplasms, to develop new therapies. MAPK pathway inhibitors offer an alternative treatment option in refractory cases and neurodegenerative forms of LCH. Molecular testing can contribute to the prognosis, treatment and follow-up of LCH, especially in severe forms of disease.
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7
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Åkefeldt SO, Ismail MB, Belot A, Salvatore G, Bissay N, Gavhed D, Aricò M, Henter JI, Valentin H, Delprat C. Neutralizing Anti-IL-17A Antibody Demonstrates Preclinical Activity Enhanced by Vinblastine in Langerhans Cell Histiocytosis. Front Oncol 2022; 11:780191. [PMID: 35127485 PMCID: PMC8814633 DOI: 10.3389/fonc.2021.780191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 12/30/2021] [Indexed: 11/13/2022] Open
Abstract
Langerhans cell histiocytosis (LCH) is an inflammatory myeloid neoplasm characterised by the accumulation into granulomas of apoptosis-resistant pathological dendritic cells (LCH-DCs). LCH outcome ranges from self-resolving to fatal. Having previously shown that, (i) monocyte-derived DCs (Mo-DCs) from LCH patients differentiate into abnormal and pro-inflammatory IL-17A-producing DCs, and (ii) recombinant IL-17A induces survival and chemoresistance of healthy Mo-DCs, we investigated the link between IL-17A and resistance to apoptosis of LCH-DCs. In LCH granulomas, we uncovered the strong expression of BCL2A1 (alias BFL1), an anti-apoptotic BCL2 family member. In vitro, intracellular IL-17A expression was correlated with BCL2A1 expression and survival of Mo-DCs from LCH patients. Based on the chemotherapeutic drugs routinely used as first or second line LCH therapy, we treated these cells with vinblastine, or cytarabine and cladribine. Our preclinical results indicate that high doses of these drugs decreased the expression of Mcl-1, the main anti-apoptotic BCL2 family member for myeloid cells, and killed Mo-DCs from LCH patients ex vivo, without affecting BCL2A1 expression. Conversely, neutralizing anti-IL-17A antibodies decreased BCL2A1 expression, the downregulation of which lowered the survival rate of Mo-DCs from LCH patients. Interestingly, the in vitro combination of low-dose vinblastine with neutralizing anti-IL-17A antibodies killed Mo-DCs from LCH patients. In conclusion, we show that BCL2A1 expression induced by IL-17A links the inflammatory environment to the unusual pro-survival gene activation in LCH-DCs. Finally, these preclinical data support that targeting both Mcl-1 and BCL2A1 with low-dose vinblastine and anti-IL-17A biotherapy may represent a synergistic combination for managing recurrent or severe forms of LCH.
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Affiliation(s)
- Selma Olsson Åkefeldt
- Childhood Cancer Research Unit, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.,UnivLyon, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Mohamad Bachar Ismail
- UnivLyon, Université Claude Bernard Lyon 1, Villeurbanne, France.,Laboratoire Microbiologie Santé et Environnement, Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon.,Faculty of Science, Lebanese University, Tripoli, Lebanon
| | - Alexandre Belot
- UnivLyon, Université Claude Bernard Lyon 1, Villeurbanne, France.,Centre International de Recherche en Infectiologie (CIRI), Univ Lyon, Inserm, U1111, Université Claude Bernard, Lyon 1, CNRS, UMR5308, ENS de Lyon, Lyon, France.,Pediatric Nephrology, Rheumatology, Dermatology Unit, HFME, Hospices Civils de Lyon, Bron, France
| | - Giulia Salvatore
- UnivLyon, Université Claude Bernard Lyon 1, Villeurbanne, France.,Radiotherapy Unit, Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Firenze, Italy
| | - Nathalie Bissay
- UnivLyon, Université Claude Bernard Lyon 1, Villeurbanne, France.,Unité de recherche "Lymphoma Immuno-Biology", Faculté de Médecine Lyon-Sud, Oullins, France
| | - Désirée Gavhed
- Childhood Cancer Research Unit, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | | | - Jan-Inge Henter
- Childhood Cancer Research Unit, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Hélène Valentin
- Centre de Recherche en Cancérologie de Lyon (CRCL) - INSERM U1052 - CNRS UMR5286 - Centre Léon Bérard, Lyon, France
| | - Christine Delprat
- UnivLyon, Université Claude Bernard Lyon 1, Villeurbanne, France.,Centre de Recherche en Cancérologie de Lyon (CRCL) - INSERM U1052 - CNRS UMR5286 - Centre Léon Bérard, Lyon, France
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8
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Mitchell J, Kelly J, Kvedaraite E, von Bahr Greenwood T, Henter JI, Pellicci DG, Berzins SP, Kannourakis G. Foxp3+ Tregs from Langerhans cell histiocytosis lesions co-express CD56 and have a definitively regulatory capacity. Clin Immunol 2020; 215:108418. [DOI: 10.1016/j.clim.2020.108418] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 03/30/2020] [Accepted: 04/09/2020] [Indexed: 12/13/2022]
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9
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Roessner A, Smolle M, Haybäck J. [Giant cell tumor of bone : Morphology, molecular pathogenesis, and differential diagnosis]. DER PATHOLOGE 2020; 41:134-142. [PMID: 32086536 DOI: 10.1007/s00292-020-00760-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The histological picture of giant cell tumor of bone is characterized by numerous osteoclast-like giant cells. However, these are not the actual tumor cells, but constitute a reactive infiltrate. Rather, the tumor cells are mononuclear mesenchymal cells, which even reveal an osteoblastic line of differentiation. The CD68-positive macrophages form the second group of mononuclear cells. The receptor activator of nuclear factor kappa-B/ligand (RANK/RANKL) system, which belongs to the tumor necrosis factor (TNF) cytokine family, is decisively involved in the activation of the giant cells. It is generally accepted that a RANKL expression of mononuclear stromal cells is responsible for the development and differentiation of osteoclast-like giant cells. Therefore, the RANKL inhibitor denosumab constituted an essential element for giant cell tumor therapy over the last several years, as it blocks the maturation of osteoclasts and thus the osteolytic activity and the spread of tumor. However, with time it became evident that the not risk-free therapy with denosumab may lead to extensive recurrences upon withdrawal, so this therapy is applied with caution today.At the molecular genetic level, the giant cell tumors of bone are characterized by point mutations in the H3F3A gene. The detection of this mutation is used for the diagnostic differentiation from other bone lesions containing giant cells. Giant cell osteosarcomas rarely contain H3F3A mutations. Chondroblastoma is characterized by mutations in the H3F3B gene.
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Affiliation(s)
- Albert Roessner
- Institut für Pathologie, Medizinische Fakultät, Otto-von-Guericke-Universität Magdeburg, Leipziger Straße 44, 39120, Magdeburg, Deutschland.
| | - Maria Smolle
- Universitätsklinik für Orthopädie und Traumatologie, Medizinische Universität Graz, Graz, Österreich
| | - Johannes Haybäck
- Institut für Pathologie, Medizinische Fakultät, Otto-von-Guericke-Universität Magdeburg, Leipziger Straße 44, 39120, Magdeburg, Deutschland.,Institut für Pathologie, Neuropathologie und Molekularpathologie, Medizinische Universität Innsbruck, Innsbruck, Österreich.,Diagnostik und Forschungszentrum für Molekulare BioMedizin, Institut für Pathologie, Medizinische Universität Graz, Graz, Österreich
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10
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Kemps PG, Zondag TC, Steenwijk EC, Andriessen Q, Borst J, Vloemans S, Roelen DL, Voortman LM, Verdijk RM, van Noesel CJM, Cleven AHG, Hawkins C, Lang V, de Ru AH, Janssen GMC, Haasnoot GW, Franken KLMC, van Eijk R, Solleveld-Westerink N, van Wezel T, Egeler RM, Beishuizen A, van Laar JAM, Abla O, van den Bos C, van Veelen PA, van Halteren AGS. Apparent Lack of BRAF V600E Derived HLA Class I Presented Neoantigens Hampers Neoplastic Cell Targeting by CD8 + T Cells in Langerhans Cell Histiocytosis. Front Immunol 2020; 10:3045. [PMID: 31998317 PMCID: PMC6967030 DOI: 10.3389/fimmu.2019.03045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 12/12/2019] [Indexed: 12/14/2022] Open
Abstract
Langerhans Cell Histiocytosis (LCH) is a neoplastic disorder of hematopoietic origin characterized by inflammatory lesions containing clonal histiocytes (LCH-cells) intermixed with various immune cells, including T cells. In 50-60% of LCH-patients, the somatic BRAF V600E driver mutation, which is common in many cancers, is detected in these LCH-cells in an otherwise quiet genomic landscape. Non-synonymous mutations like BRAF V600E can be a source of neoantigens capable of eliciting effective antitumor CD8+ T cell responses. This requires neopeptides to be stably presented by Human Leukocyte Antigen (HLA) class I molecules and sufficient numbers of CD8+ T cells at tumor sites. Here, we demonstrate substantial heterogeneity in CD8+ T cell density in n = 101 LCH-lesions, with BRAF V600E mutated lesions displaying significantly lower CD8+ T cell:CD1a+ LCH-cell ratios (p = 0.01) than BRAF wildtype lesions. Because LCH-lesional CD8+ T cell density had no significant impact on event-free survival, we investigated whether the intracellularly expressed BRAF V600E protein is degraded into neopeptides that are naturally processed and presented by cell surface HLA class I molecules. Epitope prediction tools revealed a single HLA class I binding BRAF V600E derived neopeptide (KIGDFGLATEK), which indeed displayed strong to intermediate binding capacity to HLA-A*03:01 and HLA-A*11:01 in an in vitro peptide-HLA binding assay. Mass spectrometry-based targeted peptidomics was used to investigate the presence of this neopeptide in HLA class I presented peptides isolated from several BRAF V600E expressing cell lines with various HLA genotypes. While the HLA-A*02:01 binding BRAF wildtype peptide KIGDFGLATV was traced in peptides isolated from all five cell lines expressing this HLA subtype, KIGDFGLATEK was not detected in the HLA class I peptidomes of two distinct BRAF V600E transduced cell lines with confirmed expression of HLA-A*03:01 or HLA-A*11:01. These data indicate that the in silico predicted HLA class I binding and proteasome-generated neopeptides derived from the BRAF V600E protein are not presented by HLA class I molecules. Given that the BRAF V600E mutation is highly prevalent in chemotherapy refractory LCH-patients who may qualify for immunotherapy, this study therefore questions the efficacy of immune checkpoint inhibitor therapy in LCH.
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Affiliation(s)
- Paul G Kemps
- Immunology Laboratory Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, Netherlands
| | - Timo C Zondag
- Department of Immunology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Eline C Steenwijk
- Immunology Laboratory Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, Netherlands
| | - Quirine Andriessen
- Immunology Laboratory Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, Netherlands
| | - Jelske Borst
- Immunology Laboratory Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, Netherlands
| | - Sandra Vloemans
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, Netherlands
| | - Dave L Roelen
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, Netherlands
| | - Lenard M Voortman
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, Netherlands
| | - Robert M Verdijk
- Department of Pathology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Carel J M van Noesel
- Department of Pathology, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Arjen H G Cleven
- Department of Pathology, Leiden University Medical Center, Leiden, Netherlands
| | - Cynthia Hawkins
- Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Veronica Lang
- Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Arnoud H de Ru
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, Netherlands
| | - George M C Janssen
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, Netherlands
| | - Geert W Haasnoot
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, Netherlands
| | - Kees L M C Franken
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, Netherlands
| | - Ronald van Eijk
- Department of Pathology, Leiden University Medical Center, Leiden, Netherlands
| | | | - Tom van Wezel
- Department of Pathology, Leiden University Medical Center, Leiden, Netherlands
| | - R Maarten Egeler
- Immunology Laboratory Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, Netherlands.,Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Auke Beishuizen
- Department of Pediatric Oncology, Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Jan A M van Laar
- Department of Immunology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Oussama Abla
- Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Cor van den Bos
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands.,Department of Pediatric Oncology, Emma Children's Hospital, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Peter A van Veelen
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, Netherlands
| | - Astrid G S van Halteren
- Immunology Laboratory Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
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11
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Allen CE, Beverley PCL, Collin M, Diamond EL, Egeler RM, Ginhoux F, Glass C, Minkov M, Rollins BJ, van Halteren A. The coming of age of Langerhans cell histiocytosis. Nat Immunol 2020; 21:1-7. [PMID: 31831887 DOI: 10.1038/s41590-019-0558-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Carl E Allen
- Scientific Member of the Steering Committee, Nikolas Symposia, Piraeus, Greece
- Baylor College of Medicine, Texas Children's Cancer Center, Houston, TX, USA
| | - Peter C L Beverley
- Scientific Member of the Steering Committee, Nikolas Symposia, Piraeus, Greece.
- TB Research Centre, National Heart and Lung Institute, Imperial College London, London, UK.
| | - Matthew Collin
- Scientific Member of the Steering Committee, Nikolas Symposia, Piraeus, Greece
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Eli L Diamond
- Scientific Member of the Steering Committee, Nikolas Symposia, Piraeus, Greece
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - R Maarten Egeler
- Scientific Member of the Steering Committee, Nikolas Symposia, Piraeus, Greece
- University of Leiden, Leiden, the Netherlands
- University of Toronto, Toronto, Ontario, Canada
| | - Florent Ginhoux
- Scientific Member of the Steering Committee, Nikolas Symposia, Piraeus, Greece
- University of California, San Diego, La Jolla, CA, USA
| | - Christopher Glass
- Scientific Member of the Steering Committee, Nikolas Symposia, Piraeus, Greece
- Singapore Immunology Network, A*Star Singapore, Singapore, Singapore
| | - Milen Minkov
- Scientific Member of the Steering Committee, Nikolas Symposia, Piraeus, Greece
- Sigmund Freud University, Department of Pediatrics and Adolescent Medicine, Clinic Floridsdorf of the City of Vienna, Vienna, Austria
| | - Barrett J Rollins
- Scientific Member of the Steering Committee, Nikolas Symposia, Piraeus, Greece
- Department of Medical Oncology, Dana-Farber Cancer Institute, Department of Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Astrid van Halteren
- Scientific Member of the Steering Committee, Nikolas Symposia, Piraeus, Greece
- Leiden University Medical Center and Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
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12
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Martin-Garcia D, Silva-Vilches C, Will R, Enk AH, Lonsdorf AS. Tumor-derived CCL20 affects B16 melanoma growth in mice. J Dermatol Sci 2019; 97:57-65. [PMID: 31883833 DOI: 10.1016/j.jdermsci.2019.12.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 11/08/2019] [Accepted: 12/08/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Chemokine ligand-20 (CCL20) expressed in the epidermis is a potent impetus for the recruitment of CC-chemokine receptor 6 (CCR6)-expressing subsets of DCs, B-cells and memory T-cells into the skin. CCL20 and CCR6+ immune cells have been detected in chronic inflammatory skin diseases and several malignancies, including melanoma. Yet, the functional contribution of the CCR6/CCL20 axis for melanoma progression remains controversial. OBJECTIVE The functional contribution of CCR6-expressing immune cell subsets and local CCL20 in the tumor microenvironment for the immune control of melanoma was studied. METHODS Homeostatic and inducible CCL20 secretion of murine (B16, Ret) and human (A375, C32) melanoma cells was analyzed by ELISA. To assess the functional relevance of CCR6/CCL20 interactions on local tumor progression, prestimulated or retrovirally transduced B16/F1 melanoma cells overexpressing CCL20 (B16-CCL20) were injected subcutaneously into C57BL/6 Wt mice and congenic CCR6-deficient (CCR6-/-) mice. Infiltrating leucocytes were examined by flow cytometry in tumors and draining lymph nodes (DLNs). RESULTS Melanoma cell lines up-regulate CCL20 secretion upon stimulation with pro-inflammatory cytokines in vitro. While only moderate changes in phenotype and composition of leucocytes were detected in advanced tumors and DLNs, mice injected with CCR6+ B16-CCL20 cells developed smaller tumors compared to B16-Control injected littermates, with CCR6-/- mice displaying the most pronounced reduction in tumor growth and incidence. CONCLUSION Our results suggest that CCR6/CCL20 interactions and individual independent effects of CCL20 and CCR6 in the microenvironment may be essential for melanoma progression and suggest a decisive role of this chemokine axis for melanoma pathogenesis beyond chemoattraction.
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Affiliation(s)
- Diego Martin-Garcia
- Department of Dermatology, University Hospital, Ruprecht-Karls-University of Heidelberg, Germany
| | - Cinthia Silva-Vilches
- Department of Dermatology, University Hospital, Ruprecht-Karls-University of Heidelberg, Germany
| | - Rainer Will
- Genomics and Proteomics Core Facility, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Alexander H Enk
- Department of Dermatology, University Hospital, Ruprecht-Karls-University of Heidelberg, Germany
| | - Anke S Lonsdorf
- Department of Dermatology, University Hospital, Ruprecht-Karls-University of Heidelberg, Germany.
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13
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Karamova AE, Chikin VV, Znamenskaya LF, Nefedova MA, Mikhina VA, Battalova NS. Langerhans cell histiocytosis in an adult patient. VESTNIK DERMATOLOGII I VENEROLOGII 2019. [DOI: 10.25208/0042-4609-2019-95-4-57-66] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Aim: to present a clinical case of a rare dermatosis — Langerhans cell histiocytosis (LCH) in an adult patient.Materials and methods. A clinical and laboratory examination of a 64-year-old woman who had complained of rashes on the skin of the scalp, neck, trunk and lower extremities accompanied by itching was carried out. A histological study of skin biopsy samples from the lesion area, as well as an immunohistochemical study of Langerhans cell markers — langerin and S-100 protein — were performed.Results. Clinical manifestations of the disease, the presence of histiocytic infiltrate in the epidermis and dermis during the histological study and immunohistochemical detection of langerin infiltrate cells and S-100 protein were all consistent with the diagnosis of LCH. The therapy with methotrexate subcutaneously significantly improved the patient’s condition.Conclusion. Verification of the LCH diagnosis requires a histological study of skin biopsy samples and an immunohistochemical study of Langerhans cell markers. The efficacy of methotrexate in the treatment of this disease has been confirmed.
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Affiliation(s)
- A. E. Karamova
- State Research Center of Dermatovenereology and Cosmetology, Ministry of Health of the Russian Federation
| | - V. V. Chikin
- State Research Center of Dermatovenereology and Cosmetology, Ministry of Health of the Russian Federation
| | - L. F. Znamenskaya
- State Research Center of Dermatovenereology and Cosmetology, Ministry of Health of the Russian Federation
| | - M. A. Nefedova
- State Research Center of Dermatovenereology and Cosmetology, Ministry of Health of the Russian Federation
| | - V. A. Mikhina
- State Research Center of Dermatovenereology and Cosmetology, Ministry of Health of the Russian Federation
| | - N. S. Battalova
- State Research Center of Dermatovenereology and Cosmetology, Ministry of Health of the Russian Federation
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14
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High levels of plasma interleukin-17A are associated with severe neurological sequelae in Langerhans cell histiocytosis. Cytokine 2019; 126:154877. [PMID: 31629106 DOI: 10.1016/j.cyto.2019.154877] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 10/01/2019] [Accepted: 10/03/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Langerhans cell histiocytosis (LCH) is a granulomatous inflammatory myeloid neoplasia associated with a cytokine storm in both serum and lesions. Increased levels of plasma interleukin-17A (IL-17A) in LCH patients have been reported, but this finding was not confirmed in all studies. Neurodegeneration is a devastating complication of LCH (ND-LCH). We aimed to revisit the issue of plasma IL-17A levels in LCH, by using a larger number of patients, and also to investigate the relationship between IL-17A and LCH sequelae, especially ND-LCH. METHODS Plasma samples from 68 LCH patients and 127 controls were analyzed for IL-17A levels by two ELISAs with different anti-IL-17A capture antibodies: either polyclonal or neutralizing monoclonal antibodies in 17polyAb-ELISA or 17mAb-ELISA, respectively. RESULTS Both ELISAs had a similar capacity to specifically detect recombinant or native human IL-17A, as well as plasma IL-17A from LCH patients. We confirmed the finding of higher levels of plasma IL-17A in LCH patients compared to controls (p < 0.0001). The association of IL-17A with LCH was independent of the ELISA used, and of gender, age, disease class activity, and pattern of tissue-organ involvement (single-system versus multi-system). ROC analyses (p < 0.0001) allow to discriminate LCH patients from the control group, supporting the notion that IL-17A may be a potential biomarker for LCH. More interestingly, high IL-17A levels were significantly associated with LCH patients having sequelae, with the highest plasma levels in patients with ND-LCH (p < 0.0001). CONCLUSION The association between high levels of IL-17A and LCH was confirmed. IL-17A may be associated with ND-LCH development. This might have therapeutic implications, offering a novel target for precision therapy of ND-LCH.
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15
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Hogstad B, Berres ML, Chakraborty R, Tang J, Bigenwald C, Serasinghe M, Lim KPH, Lin H, Man TK, Remark R, Baxter S, Kana V, Jordan S, Karoulia Z, Kwan WH, Leboeuf M, Brandt E, Salmon H, McClain K, Poulikakos P, Chipuk J, Mulder WJM, Allen CE, Merad M. RAF/MEK/extracellular signal-related kinase pathway suppresses dendritic cell migration and traps dendritic cells in Langerhans cell histiocytosis lesions. J Exp Med 2017; 215:319-336. [PMID: 29263218 PMCID: PMC5748846 DOI: 10.1084/jem.20161881] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 06/22/2017] [Accepted: 08/30/2017] [Indexed: 01/07/2023] Open
Abstract
Langerhans cell histiocytosis (LCH) is an inflammatory myeloid neoplasia characterized by granulomatous lesions containing pathological CD207+ dendritic cells (DCs) with constitutively activated mitogen-activated protein kinase (MAPK) pathway signaling. Approximately 60% of LCH patients harbor somatic BRAFV600E mutations localizing to CD207+ DCs within lesions. However, the mechanisms driving BRAFV600E+ LCH cell accumulation in lesions remain unknown. Here we show that sustained extracellular signal-related kinase activity induced by BRAFV600E inhibits C-C motif chemokine receptor 7 (CCR7)-mediated DC migration, trapping DCs in tissue lesions. Additionally, BRAFV600E increases expression of BCL2-like protein 1 (BCL2L1) in DCs, resulting in resistance to apoptosis. Pharmacological MAPK inhibition restores migration and apoptosis potential in a mouse LCH model, as well as in primary human LCH cells. We also demonstrate that MEK inhibitor-loaded nanoparticles have the capacity to concentrate drug delivery to phagocytic cells, significantly reducing off-target toxicity. Collectively, our results indicate that MAPK tightly suppresses DC migration and augments DC survival, rendering DCs in LCH lesions trapped and resistant to cell death.
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Affiliation(s)
- Brandon Hogstad
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Marie-Luise Berres
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY.,Department of Internal Medicine III, University Hospital, RWTH Aachen, Aachen, Germany
| | - Rikhia Chakraborty
- Texas Children's Cancer Center, Texas Children's Hospital, Houston, TX.,Division of Pediatric Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Jun Tang
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY.,Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Camille Bigenwald
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Madhavika Serasinghe
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Karen Phaik Har Lim
- Texas Children's Cancer Center, Texas Children's Hospital, Houston, TX.,Division of Pediatric Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Howard Lin
- Texas Children's Cancer Center, Texas Children's Hospital, Houston, TX.,Division of Pediatric Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Tsz-Kwong Man
- Texas Children's Cancer Center, Texas Children's Hospital, Houston, TX.,Division of Pediatric Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Romain Remark
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Samantha Baxter
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Veronika Kana
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Stefan Jordan
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Zoi Karoulia
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Wing-Hong Kwan
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Marylene Leboeuf
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Elisa Brandt
- Department of Internal Medicine III, University Hospital, RWTH Aachen, Aachen, Germany
| | - Helene Salmon
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Kenneth McClain
- Texas Children's Cancer Center, Texas Children's Hospital, Houston, TX.,Division of Pediatric Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Poulikos Poulikakos
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jerry Chipuk
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Willem J M Mulder
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Carl E Allen
- Texas Children's Cancer Center, Texas Children's Hospital, Houston, TX .,Division of Pediatric Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Miriam Merad
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY
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16
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Lorillon G, Tazi A. How I manage pulmonary Langerhans cell histiocytosis. Eur Respir Rev 2017; 26:26/145/170070. [PMID: 28877978 DOI: 10.1183/16000617.0070-2017] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 07/12/2017] [Indexed: 02/07/2023] Open
Abstract
Pulmonary Langerhans cell histiocytosis (PLCH) is a rare sporadic cystic lung disease of unknown aetiology that is characterised by the infiltration and destruction of the wall of distal bronchioles by CD1a+ Langerhans-like cells. In adults, PLCH is frequently isolated and affects young smokers of both sexes. Recent multicentre studies have led to the more standardised management of patients in clinical practice. Smoking cessation is essential and is occasionally the only suitable intervention. Serial lung function testing is important because a significant proportion of patients may experience an early decline in forced expiratory volume in 1 s and develop airflow obstruction. Cladribine was reported to dramatically improve progressive PLCH in some patients. Its efficacy and tolerance are currently being evaluated. Patients who complain of unexplained dyspnoea with decreased diffusing capacity of the lung for carbon monoxide should be screened for pulmonary hypertension by Doppler echocardiography, which must be confirmed by right heart catheterisation. Lung transplantation is a therapeutic option for patients with advanced PLCH.The identification of the BRAFV600E mutation in approximately half of Langerhans cell histiocytosis lesions, including PLCH, and other mutations of the mitogen-activated protein kinase (MAPK) pathway in a subset of lesions has led to targeted treatments (BRAF and MEK (MAPK kinase) inhibitors). These treatments need to be rigorously evaluated because of their potentially severe side-effects.
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Affiliation(s)
- Gwenaël Lorillon
- National Reference Centre for Histiocytoses, Pulmonary Dept, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France
| | - Abdellatif Tazi
- National Reference Centre for Histiocytoses, Pulmonary Dept, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France .,University Paris Diderot, Sorbonne, Paris Cité, Inserm UMR-1153 (CRESS), Biostatistics and Clinical Epidemiology Research Team (ECSTRA), Paris, France
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17
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Abstract
Hematologic neoplasms that primarily present in bone are rare; this article describes the most common examples of hematologic tumors primarily presenting in bone, including plasma cell myeloma, solitary plasmacytoma of bone, primary non-Hodgkin lymphoma of bone, acute lymphoblastic leukemia/lymphoma, and Langerhans cell histiocytosis. The macroscopic and microscopic features, differential diagnosis, diagnostic workup, and prognosis of all these different entities are discussed, with special emphasis on common differential diagnosis.
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Affiliation(s)
- Arjen H G Cleven
- Department of Pathology, Leiden University Medical Center, PO Box 9600, L1-Q, Leiden 2300 RC, The Netherlands.
| | - Pancras C W Hogendoorn
- Department of Pathology, Leiden University Medical Center, PO Box 9600, L1-Q, Leiden 2300 RC, The Netherlands
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18
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Morimoto A, Oh Y, Nakamura S, Shioda Y, Hayase T, Imamura T, Kudo K, Imashuku S. Inflammatory serum cytokines and chemokines increase associated with the disease extent in pediatric Langerhans cell histiocytosis. Cytokine 2017; 97:73-79. [PMID: 28582647 DOI: 10.1016/j.cyto.2017.05.026] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 05/23/2017] [Accepted: 05/27/2017] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Langerhans cell histiocytosis (LCH) is characterized by immature dendritic cell proliferation, infiltration of LCH lesions by various inflammatory cells, and a lesional cytokine storm. It is classified into three groups on the basis of disease extent, namely, multisystem with risk-organ involvement (MS+), multisystem without risk-organ involvement (MS-), and single-system (SS) disease. We comprehensively analyzed whether serum levels of cytokines/chemokines reflect the disease extent. METHODS Serum samples from 52 children with LCH (eight, 25, and 19 with MS+, MS-, and SS, respectively) and 34 control children were analyzed quantitatively for 48 humoral factors. DNA samples extracted from biopsied LCH lesions from 12 patients were tested for BRAF V600E status. RESULTS The LCH patients had significantly higher serum levels of IL-1Ra, IL-3, IL-6, IL-8, IL-9, IL-10, IL12, IL-13, IL-15, IL-17, IL-18, TNF-α, G-CSF, M-CSF, MIF, HGF, VEGF, CCL2, CCL3, CCL7, CXCL1, and CXCL9 than the controls by univariate analysis. Of these IL-9, IL-15 and MIF were significant by multivariate analysis; but not differed between MS and SS diseases. MS disease associated with significantly higher IL-2R, IL-3, IL-8, IL-18, M-CSF, HGF, CCL2, CXCL1, and CXCL9 levels than SS disease by univariate analysis. Of these, CCL2 and M-CSF were significant by multivariate analysis. IL-18 levels were significantly higher in MS+ disease than MS- disease. The LCH patients with BRAF V600E mutation had higher serum levels of CCL7. CONCLUSION Numerous inflammatory cytokines and chemokines play a role in LCH. Of those, more specific ones reflect the disease extent (MS vs. SS and MS+ vs. MS-) or the BRAF V600E mutation status. It is thought that the most responsible cytokines and chemokines involved in the poor outcome may become future candidate therapeutic targets in LCH.
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Affiliation(s)
- Akira Morimoto
- Department of Pediatrics, Jichi Medical University, School of Medicine, Shimotsuke, Japan.
| | - Yukiko Oh
- Department of Pediatrics, Jichi Medical University, School of Medicine, Shimotsuke, Japan
| | - Sachie Nakamura
- Department of Pediatrics, Jichi Medical University, School of Medicine, Shimotsuke, Japan
| | - Yoko Shioda
- Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan
| | - Tomomi Hayase
- Department of Pediatrics, Jichi Medical University, School of Medicine, Shimotsuke, Japan
| | - Toshihiko Imamura
- Department of Pediatrics, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kazuko Kudo
- Department of Pediatrics, Fujita Health University, Toyoake, Japan
| | - Shinsaku Imashuku
- Division of Laboratory Medicine, Uji-Tokushukai Medical Center, Uji, Japan
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19
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Cazzolla AP, Troiano G, Zhurakivska K, Maiorano E, Favia G, Lacaita MG, Marzo G, Dicuonzo F, Andresciani S, Muzio LL. Langerhans cell histiocytosis of the maxillae in a child treated only with chemotherapy: a case report. J Med Case Rep 2017; 11:130. [PMID: 28482919 PMCID: PMC5422897 DOI: 10.1186/s13256-017-1286-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 03/30/2017] [Indexed: 12/29/2022] Open
Abstract
Background Langerhans cell histiocytosis is a sporadic disease caused by an uncontrolled pathogenic clonal proliferation of dendritic cells that have Langerhans cell characteristics. New treatment protocols provided by the HISTSOC-LCH-III (NCT00276757) trial show an improvement in the survival of children with langerhans cell histiocytosis. Case presentation We report a case of Langerhans cell histiocytosis, which presented as an osteolytic lesion of the left pre-maxillae enclosing the deciduous incisor and canine in a 7-month-old white Italian boy. He was treated with chemotherapy. He achieved complete remission after 7 months and after 24 months no signs of recurrence were observed. Conclusions As a result of this treatment, anesthetic sequelae and loss of teeth were avoided; in addition, we prevented a loss of the vertical dimension of occlusion.
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Affiliation(s)
| | - Giuseppe Troiano
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Khrystyna Zhurakivska
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy. .,Clinica Odontoiatrica, Via Rovelli 50, 71122, Foggia, Italy.
| | - Eugenio Maiorano
- Department of Pathological Anatomy, University of Bari, Bari, Italy
| | - Gianfranco Favia
- Department of Translational Medicine, University of Bari, Bari, Italy
| | | | - Giuseppe Marzo
- Department of Life, Health & Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Franca Dicuonzo
- Department of Neuroradiology, Policlinico of Bari, Bari, Italy
| | | | - Lorenzo Lo Muzio
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
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20
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Abstract
Langerhans cell histiocytosis (LCH) is a rare disease affecting both genders and can occur at any age. It often evolves through successive flares, and its severity varies from benign forms that don't require treatment to life threatening disease. Some patients have important functional impairment with psychological and social consequences and prolonged disability. LCH may affect only one organ, with uni- or multifocal involvement or be multisystem disease involving multiple organs. The organs most frequently involved are bones, lung, skin and the endocrinal system. Pulmonary LCH is strongly related to smoking. Some patients have mixed histocytosis combining LCH and other histiocytic disorders. The diagnosis relies on the histological study of tissues samples, and shows tissue infiltration with large cell with pale cytoplasm and reniform nucleus, staining for CD1a and Langerin (CD207) on immunohistochemistry. The BRAFV600E mutation is observed in tissue samples in approximately half of patients and the activation of the RAS-RAF-MEK-ERK pathway has been shown to be constantly activated in LCH lesions, regardless the BRAF status. These findings represent an important forward step in the understanding of the physiopathology of the disease. Treatment must be adapted to the severity of the disease and goes from conservative observation to systemic chemotherapy. Therapies targeting the RAS-RAF-MEK-ERK pathway are promising treatments for progressive disease.
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Affiliation(s)
- Mathilde de Menthon
- Assistance publique-Hôpitaux de Paris, hôpital Saint-Louis, département de médecine interne, 75010 Paris, France.
| | - Véronique Meignin
- Assistance publique-Hôpitaux de Paris, hôpital Saint-Louis, Inserm UMR_S1165, service de pathologie, 75010 Paris, France
| | - Alfred Mahr
- Assistance publique-Hôpitaux de Paris, hôpital Saint-Louis, département de médecine interne, 75010 Paris, France; Université Paris-Diderot, Sorbonne Paris Cité, Inserm UMR 1153 CRESS, équipe de recherche en biostatistiques et épidémiologie clinique, 75010 Paris, France
| | - Abdellatif Tazi
- Université Paris-Diderot, Sorbonne Paris Cité, Inserm UMR 1153 CRESS, équipe de recherche en biostatistiques et épidémiologie clinique, 75010 Paris, France; Assistance publique-Hôpitaux de Paris, hôpital Saint-Louis, centre national de référence de l'histiocytose langerhansienne, service de pneumologie, 75010 Paris, France
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21
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Egeler RM, Katewa S, Leenen PJM, Beverley P, Collin M, Ginhoux F, Arceci RJ, Rollins BJ. Langerhans cell histiocytosis is a neoplasm and consequently its recurrence is a relapse: In memory of Bob Arceci. Pediatr Blood Cancer 2016; 63:1704-12. [PMID: 27314817 DOI: 10.1002/pbc.26104] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 05/19/2016] [Accepted: 05/19/2016] [Indexed: 01/01/2023]
Abstract
Langerhans cell histiocytosis (LCH) remains a poorly understood disorder with heterogeneous clinical presentations characterized by focal or disseminated lesions that contain excessive CD1a+ langerin+ cells with dendritic cell features known as "LCH cells." Two of the major questions investigated over the past century have been (i) the origin of LCH cells and (ii) whether LCH is primarily an immune dysregulatory disorder or a neoplasm. Current opinion is that LCH cells are likely to arise from hematopoietic precursor cells, although the stage of derailment and site of transformation remain unclear and may vary in patients with different extent of disease. Over the years, evidence has provided the view that LCH is a neoplasm. The demonstration of clonality of LCH cells, insufficient evidence alone for neoplasia, is now bolstered by finding driver somatic mutations in BRAF in up to 55% of patients with LCH, and activation of the RAS-RAF-MEK-ERK (where MEK and ERK are mitogen-activated protein kinase and extracellular signal-regulated kinase, respectively) pathway in nearly 100% of patients with LCH. Herein, we review the evidence that recurrent genetic abnormalities characterized by activating oncogenic mutations should satisfy prerequisites for LCH to be called a neoplasm. As a consequence, recurrent episodes of LCH should be considered relapsed disease rather than disease reactivation. Mapping the complete genetic landscape of this intriguing disease will provide additional support for the conclusion that LCH is a neoplasm and is likely to provide more potential opportunities for molecularly targeted therapies.
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Affiliation(s)
- R Maarten Egeler
- Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children/University of Toronto, Toronto, Ontario, Canada
| | - Satyendra Katewa
- Department of Pediatric Hematology/Oncology & BMT, Soni Manipal Hospital, Main Sikar Road, Sector 5, Jaipur, Rajasthan, India
| | - Pieter J M Leenen
- Department of Immunology, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Matthew Collin
- Department of Haematological Sciences, Institute of Cellular Medicine, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Florent Ginhoux
- Singapore Immunology Network (SIgN), Agency for Science, Technology and Research (A*STAR), Singapore, 138648
| | - Robert J Arceci
- Department of Child Health, University of Arizona, College of Medicine - Phoenix, Ron Matricaria Institute of Molecular Medicine, Phoenix, Arizona
| | - Barrett J Rollins
- Division of Medical Oncology, Dana-Farber Cancer Institute, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Sunnapwar A, Menias CO, Ojili V, Policarpio Nicolas M, Katre R, Gangadhar K, Nagar A. Abdominal manifestations of histiocytic disorders in adults: imaging perspective. Br J Radiol 2016; 89:20160221. [PMID: 27332519 DOI: 10.1259/bjr.20160221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Histiocytic disorders (HDs) are a diverse group of diseases characterized by pathologic infiltration of normal tissues by cells of the mononuclear phagocyte system. The spectrum of these diseases ranges from treatable infectious diseases to rapidly progressive, life-threatening conditions. Although they are rare and difficult diagnoses, HDs can be diagnosed with the help of clinical and laboratory analyses, imaging features and tissue biopsy. The clinicopathology and imaging spectrum of select entities belonging to this disorder are presented in this review.
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Affiliation(s)
- Abhijit Sunnapwar
- 1 University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | | | - Vijaynadh Ojili
- 1 University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | | | - Rashmi Katre
- 1 University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | | | - Arpit Nagar
- 4 Ohio State University, Wexner Medical Center, Columbus, OH, USA
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23
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Imashuku S, Arceci RJ. Strategies for the Prevention of Central Nervous System Complications in Patients with Langerhans Cell Histiocytosis. Hematol Oncol Clin North Am 2015; 29:875-93. [DOI: 10.1016/j.hoc.2015.06.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Abstract
Langerhans cell histiocytosis (LCH) is heterogeneous disease characterized by common histology of inflammatory lesions containing Langerin(+) (CD207) histiocytes. Emerging data support a model in which MAPK activation in self-renewing hematopoietic progenitors may drive disseminated high-risk disease, whereas MAPK activation in more differentiated committed myeloid populations may induce low-risk LCH. The heterogeneous clinical manifestations with shared histology may represent the final common pathway of an acquired defect of differentiation, initiated at more than one point. Implications of this model include re-definition of LCH as a myeloid neoplasia and re-focusing therapeutic strategies on the cells and lineages of origin.
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Affiliation(s)
- Matthew Collin
- Human Dendritic Cell Laboratory, Institute of Cellular Medicine, Newcastle University, Framlington Place, Newcastle upon Tyne NE2 4HH, UK
| | - Venetia Bigley
- Human Dendritic Cell Laboratory, Institute of Cellular Medicine, Newcastle University, Framlington Place, Newcastle upon Tyne NE2 4HH, UK
| | - Kenneth L McClain
- Texas Children's Cancer Center, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Carl E Allen
- Texas Children's Cancer Center, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA.
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25
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Néel A, Artifoni M, Donadieu J, Lorillon G, Hamidou M, Tazi A. Histiocytose langerhansienne de l’adulte. Rev Med Interne 2015; 36:658-67. [DOI: 10.1016/j.revmed.2015.04.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 01/30/2015] [Accepted: 04/30/2015] [Indexed: 12/21/2022]
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26
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Palma BD, Guasco D, Pedrazzoni M, Bolzoni M, Accardi F, Costa F, Sammarelli G, Craviotto L, De Filippo M, Ruffini L, Omedè P, Ria R, Aversa F, Giuliani N. Osteolytic lesions, cytogenetic features and bone marrow levels of cytokines and chemokines in multiple myeloma patients: Role of chemokine (C-C motif) ligand 20. Leukemia 2015; 30:409-16. [PMID: 26419509 DOI: 10.1038/leu.2015.259] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Revised: 09/07/2015] [Accepted: 09/10/2015] [Indexed: 01/17/2023]
Abstract
The relationship between bone marrow (BM) cytokine and chemokine levels, cytogenetic profiles and skeletal involvement in multiple myeloma (MM) patients is not yet defined. This study investigated a cohort of 455 patients including monoclonal gammopathy of uncertain significance (MGUS), smoldering MM and symptomatic MM patients. Skeletal surveys, positron emission tomography (PET)/computerized tomography (CT) and magnetic resonance imaging (MRI) were used to identify myeloma bone disease. Significantly higher median BM levels of both C-C motif Ligand (CCL)3 and CCL20 were found in MM patients with radiographic evidence of osteolytic lesions as compared with those without, and in all MM patients with positive PET/CT scans. BM levels of CCL3, CCL20, Activin-A and Dickkopf-1 (DKK-1) were significantly higher in patients with high bone disease as compared with patients with low bone disease. Moreover, CCL20 BM levels were significant predictors of osteolysis on X-rays by multivariate logistic analysis. On the other hand, DKK-1 levels were related to the presence of MRI lesions independently of the osteolysis at the X-rays. Our data define the relationship between bone disease and the BM cytokine and chemokine patterns highlighting the tight relationship between CCL20 BM levels and osteolysis in MM.
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Affiliation(s)
- B Dalla Palma
- Department of Clinical and Experimental Medicine, Myeloma Unit, University of Parma, Parma, Italy.,Hematology and BMT Center, Azienda Ospedaliero-Universitaria Parma, Parma, Italy
| | - D Guasco
- Department of Clinical and Experimental Medicine, Myeloma Unit, University of Parma, Parma, Italy
| | - M Pedrazzoni
- Department of Clinical and Experimental Medicine, Myeloma Unit, University of Parma, Parma, Italy.,Clinica e Terapia Medica, Azienda Ospedaliero-Universitaria Parma, Parma, Italy
| | - M Bolzoni
- Department of Clinical and Experimental Medicine, Myeloma Unit, University of Parma, Parma, Italy
| | - F Accardi
- Department of Clinical and Experimental Medicine, Myeloma Unit, University of Parma, Parma, Italy
| | - F Costa
- Department of Clinical and Experimental Medicine, Myeloma Unit, University of Parma, Parma, Italy
| | - G Sammarelli
- Department of Clinical and Experimental Medicine, Myeloma Unit, University of Parma, Parma, Italy
| | - L Craviotto
- Department of Clinical and Experimental Medicine, Myeloma Unit, University of Parma, Parma, Italy
| | - M De Filippo
- Radiology Unit, University of Parma, Parma, Italy
| | - L Ruffini
- Nuclear Medicine Unit, Azienda Ospedaliero-Universitaria Parma, Parma, Italy
| | - P Omedè
- Myeloma Unit, Division of Hematology, University of Torino, Torino, Italy
| | - R Ria
- Department of Biomedical Sciences and Human Oncology, Internal Medicine, University of Bari, Bari, Italy
| | - F Aversa
- Department of Clinical and Experimental Medicine, Myeloma Unit, University of Parma, Parma, Italy.,Hematology and BMT Center, Azienda Ospedaliero-Universitaria Parma, Parma, Italy
| | - N Giuliani
- Department of Clinical and Experimental Medicine, Myeloma Unit, University of Parma, Parma, Italy.,Hematology and BMT Center, Azienda Ospedaliero-Universitaria Parma, Parma, Italy
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Quispel WT, Stegehuis-Kamp JA, Santos SJ, Egeler RM, van Halteren AGS. Activated Conventional T-Cells Are Present in Langerhans Cell Histiocytosis Lesions Despite the Presence of Immune Suppressive Cytokines. J Interferon Cytokine Res 2015; 35:831-9. [PMID: 26381039 DOI: 10.1089/jir.2014.0190] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Langerhans cell histiocytosis (LCH) lesions are characterized by neoplastic CD1a(+)/Langerin(+) histiocytes (LCH-cells) and display many features of chronic inflammation. Cancer cells can escape immune-surveillance through intra-tumoral secretion of immune-suppressive cytokines. We therefore studied by immunohistochemistry the local cytokine milieu and phenotypic characteristics of T-cells and LCH-cells present in LCH lesions collected from 25 therapy naïve patients. LCH biopsies predominantly expressed interleukin-10 (IL-10) (10/25), transforming growth factor-beta (TGF-β) (9/25), or both cytokines (6/25). The absolute number of CD3(+)T-cells and the CD3(+)FOXP3(-) conventional cell (T-CONV) versus the CD3(+)FOXP3(+) regulatory T-cell (T-REG) was comparable for each suppressive cytokine profile (5:1). IL-10-expressing lesions contained, however, a higher proportion of T-CONV expressing the activation markers CD25 98% (38%-100%) and inducible costimulatory molecule (ICOS) 86% (47%-100%) than lesions wherein solely TGF-β was detected (CD25(+) 20% (6%-54%); ICOS(+) 29% (7%-51%)). Virtually all T-REG expressed CD25 and ICOS in IL-10 lesions, whereas TGF-β(+) lesions contained a lower proportion of ICOS(+) T-REG (P=0.05). IL-10(+) lesions contained more LCH-cells expressing high intensity of ICOS ligand (ICOSL) compared with TGF-β(+) lesions (P=0.03). ICOS expression by lesion-infiltrating T-CONV and T-REG positively correlated to the extent of ICOSL expression by LCH-cells (P=0.004). Our study points out that the combined detection of interlesional IL-10 and ICOSL expression by LCH-cells is associated with the highest prevalence of activated T-CONV. Immune profiling of LCH-affected tissues obtained at the time of diagnosis may set the stage for the development of new types of therapies, which aim at local boosting of immune cells that recognize and eliminate neoplastic LCH-cells.
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Affiliation(s)
- Willemijn T Quispel
- 1 Immunology Laboratory, Willem Alexander Children's Hospital (WAKZ), Leiden University Medical Center , Leiden, The Netherlands
| | - Janine A Stegehuis-Kamp
- 1 Immunology Laboratory, Willem Alexander Children's Hospital (WAKZ), Leiden University Medical Center , Leiden, The Netherlands
| | - Susy J Santos
- 1 Immunology Laboratory, Willem Alexander Children's Hospital (WAKZ), Leiden University Medical Center , Leiden, The Netherlands
| | - R Maarten Egeler
- 1 Immunology Laboratory, Willem Alexander Children's Hospital (WAKZ), Leiden University Medical Center , Leiden, The Netherlands .,2 Division of Hematology/Oncology, Hospital for Sick Children, University of Toronto , Toronto, Canada
| | - Astrid G S van Halteren
- 1 Immunology Laboratory, Willem Alexander Children's Hospital (WAKZ), Leiden University Medical Center , Leiden, The Netherlands
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Quispel WT, Stegehuis-Kamp JA, Blijleven L, Santos SJ, Lourda M, van den Bos C, van Halteren AGS, Egeler RM. The presence of CXCR4 + CD1a + cells at onset of Langerhans cell histiocytosis is associated with a less favorable outcome. Oncoimmunology 2015; 5:e1084463. [PMID: 28255525 PMCID: PMC5323006 DOI: 10.1080/2162402x.2015.1084463] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 07/25/2015] [Accepted: 08/13/2015] [Indexed: 01/09/2023] Open
Abstract
PURPOSE Langerhans Cell Histiocytosis (LCH) is a neoplastic disorder characterized by tissue accumulating CD1a+ histiocytes which frequently carry somatic mutations. Irrespective of mutation status, these LCH-cells display constitutively active kinases belonging to the MAPK pathway. We evaluated, in retrospect, the contribution of individual components of the MAPK-activating and chemotaxis-promoting TNF-CXCR4-CXCL12 axis to LCH manifestation and outcome. EXPERIMENTAL DESIGN CXCR4, CXCL12 and TNF protein expression was immunohistochemically analyzed in 70 LCH-affected biopsies. The presence of CXCR4+CD1a+ cells in peripheral blood (PB) and/or bone marrow (BM) samples was evaluated by flowcytometry in 13 therapy-naive LCH-patients. RESULTS CXCL12 was detected in 68/70 (97%) biopsies. CXCR4+LCH-cells were present in 50/70 (71%) biopsies; their presence was associated with higher levels of intralesional TNF. Circulating CD1a+CXCR4+ cells were detected in 4/13 (31%) therapy-naïve LCH-patients which displayed BRAFV600E (2/4), MAP2K1 (1/4) or no (1/4) mutations in their tissues. These CD11c co-expressing CD1a+CXCR4+cells migrated to CXCL12 in chemotaxis assays. Lesional CXCR4+LCH-cells were detected in 18/20 cases who presented with LCH manifestation at multiple sites and in 5/23 (22%) patients who developed additional lesions after initially presenting with a single lesion. The CXCR4 status at onset proved to be an independent risk factor for LCH reactivation in multivariate analysis (odds ratio 10.4, p = 0.034). CONCLUSIONS This study provides the first evidence that CXCR4 is involved in the homing and retention of LCH-cells in CXCL12-expressing tissues and qualifies CXCR4 as a candidate prognostic marker for less favorable disease outcome.
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Affiliation(s)
- Willemijn T Quispel
- Immunology Laboratory, Willem Alexander Children's Hospital/Leiden University Medical Center , Leiden, the Netherlands
| | - Janine A Stegehuis-Kamp
- Immunology Laboratory, Willem Alexander Children's Hospital/Leiden University Medical Center , Leiden, the Netherlands
| | - Laura Blijleven
- Immunology Laboratory, Willem Alexander Children's Hospital/Leiden University Medical Center , Leiden, the Netherlands
| | - Susy J Santos
- Immunology Laboratory, Willem Alexander Children's Hospital/Leiden University Medical Center , Leiden, the Netherlands
| | - Magda Lourda
- Childhood Cancer Research Unit, Department of Women's and Children's Health, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden; Center for Infectious Medicine, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Cor van den Bos
- Department of Pediatric Oncology; Emma Children's Hospital/Academic Medical Center , Amsterdam, the Netherlands
| | - Astrid G S van Halteren
- Immunology Laboratory, Willem Alexander Children's Hospital/Leiden University Medical Center , Leiden, the Netherlands
| | - R Maarten Egeler
- Immunology Laboratory, Willem Alexander Children's Hospital/Leiden University Medical Center, Leiden, the Netherlands; Division of Hematology/Oncology, Hospital for Sick Children/University of Toronto, Toronto, Canada
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29
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Obert J, Tazi A. [Pulmonary manifestations of Langerhans cell histiocytosis]. Rev Mal Respir 2015; 32:850-66. [PMID: 26003197 DOI: 10.1016/j.rmr.2015.01.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 01/13/2015] [Indexed: 01/20/2023]
Abstract
Pulmonary Langerhans cell histiocytosis is a rare diffuse cystic interstitial pneumonia of unknown etiology that occurs selectively in young smokers of both genders. The multicenter studies conducted by the reference center have better defined the short and medium terms natural history of the disease and the clinical management of patients. A substantial proportion of patients experience a dramatic decline in their lung function soon after diagnosis. Importantly, smoking cessation is associated with a decreased risk of subsequent deterioration. Cladribine, a purine analogue, chemotherapy may dramatically improve lung function in patients with progressive pulmonary Langerhans cell histiocytosis, but this treatment should be used only in the setting of clinical research. Specific pulmonary hypertension therapies (anti-endothelin receptors, inhibitors of phosphodiesterases) may be used with caution in specialized centres for patients with severe pulmonary hypertension, and seem to be well tolerated. The recent identification of the V600E mutation of the BRAF oncogene in approximately half of the Langerhans cell histiocytosis lesions, including pulmonary granulomas, represents an important step forward in the understanding of the pathogenesis of Langerhans cell histiocytosis. Potentially it opens the way to targeted therapies.
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Affiliation(s)
- J Obert
- Service de pneumologie, Centre national de référence de l'histiocytose langerhansienne, hôpital Saint-Louis, Assistance publique-Hôpitaux de Paris, 1, avenue Claude-Vellefaux, 75475 Paris cedex 10, France
| | - A Tazi
- Service de pneumologie, Centre national de référence de l'histiocytose langerhansienne, hôpital Saint-Louis, Assistance publique-Hôpitaux de Paris, 1, avenue Claude-Vellefaux, 75475 Paris cedex 10, France; U1153 CRESS, équipe de recherche en biostatistiques et épidémiologie clinique, université Paris Diderot, Sorbonne Paris Cité, 75013 Paris, France.
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30
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Bi L, Sun B, Lu Z, Shi Z, Wang D, Zhu Z. Langerhans cell histiocytosis with multisystem involvement in an infant: A case report. Exp Ther Med 2015; 9:2137-2140. [PMID: 26136948 DOI: 10.3892/etm.2015.2396] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 02/03/2015] [Indexed: 12/11/2022] Open
Abstract
Langerhans cell histiocytosis (LCH) is a proliferative disease of histiocyte-like cells, with a wide range of clinical presentations that vary from a solitary lesion to more severe multifocal or disseminated lesions. The disease can affect any age group; however, the peak incidence rate is in infants aged between 1 and 3 years-old. Diagnosis of LCH should be based on the synthetical analysis of clinical presentations, in addition to features of imaging and histopathology. Although certain cases regress spontaneously, other patients require systemic chemotherapy together with the administration of steroids. The present study reports the case of an infant with LDH with multisystem involvement, including that of the bone, skin, orbit, spleen and lungs. The patient received chemotherapy and obtained rapid improvement in the involved systems. A total of 2.5 years after completion of the therapy, the patient still remains in follow-up and no evidence of active disease has been noted.
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Affiliation(s)
- Lintao Bi
- Department of Hematology and Oncology, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, P.R. China
| | - Butong Sun
- Department of Hematology and Oncology, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, P.R. China
| | - Zhenxia Lu
- Department of Hematology and Oncology, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, P.R. China
| | - Zhangzhen Shi
- Department of Hematology and Oncology, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, P.R. China
| | - Dan Wang
- Department of Hematology and Oncology, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, P.R. China
| | - Zhenxing Zhu
- Department of Hematology and Oncology, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, P.R. China
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31
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Morimoto A, Oh Y, Shioda Y, Kudo K, Imamura T. Recent advances in Langerhans cell histiocytosis. Pediatr Int 2014; 56:451-61. [PMID: 24840547 DOI: 10.1111/ped.12380] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Revised: 03/27/2014] [Accepted: 05/01/2014] [Indexed: 12/12/2022]
Abstract
The purpose of this review is to provide an updated overview of the pathogenesis and treatment of Langerhans cell histiocytosis (LCH). The pathogenesis of LCH remains obscure and the optimal treatment for LCH has not been established, although incremental progress has been made. Proinflammatory cytokines and chemokines are known to play a role in LCH, which suggests that LCH is an immune disorder. However, the oncogenic BRAF mutation is also detected in more than half of LCH patients, which suggests that LCH is a neoplastic disorder. Remaining major issues in the treatment of LCH are how to rescue patients who have risk-organ involvement but do not respond to first-line therapy, the optimal treatment for the orphan disease of multifocal adult LCH, and how to reduce and treat central nervous system-related consequences, such as central diabetes insipidus and neurodegeneration. More research is needed to better understand the pathogenesis of this disease and to resolve the treatment issues.
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Affiliation(s)
- Akira Morimoto
- Department of Pediatrics, Jichi Medical University of Medicine, Shimotsuke, Japan
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32
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Oh Y, Morimoto A, Shioda Y, Imamura T, Kudo K, Imashuku S. High serum osteopontin levels in pediatric patients with high risk Langerhans cell histiocytosis. Cytokine 2014; 70:194-7. [PMID: 25086462 DOI: 10.1016/j.cyto.2014.07.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Revised: 06/18/2014] [Accepted: 07/07/2014] [Indexed: 11/17/2022]
Abstract
Osteopontin (OPN) acts as an osteoclast activator, a proinflammatory cytokine, and a chemokine attracting histiocytes/monocytes and is abundantly expressed in Langerhans cell histiocytosis (LCH). We investigated whether serum OPN levels are related to disease types in LCH. Fifty-eight newly diagnosed LCH patients were studied; eight with risk organ (liver, spleen and/or hematopoietic) involvements positive multisystem (MS+) disease, 27 with risk organ involvement negative multisystem (MS-) disease and 23 with single system (SS) disease. Pediatric patients with non-inflammatory disease (n=27) were used as controls. All of patients with MS+ disease were younger than 3 years. Serum OPN levels and 44 kinds of humoral factors were measured by ELISA and Bio-Plex suspension array system, respectively. In the patients younger than 3 years, the median serum OPN level (interquartile range) was 240.3 ng/ml (137.6-456.0) in MS+ (n=8); 92.7 ng/ml (62.0-213.8) in MS- (n=14) and 72.5 ng/ml (55.6-94.0) in SS (n=9) and 74.4 ng/ml (42.2-100.0) in control (n=12). The OPN values were significantly higher in the MS+ group than the MS-, SS and control groups (p=0.044, p=0.001 and p=0.002, respectively), but not different between the MS-, SS and control groups. In the patients older than 3 years, the median level of serum OPN (IQR) was 56.2 ng/ml (22.9-77.5) in MS- (n=13), 58.9 ng/ml (31.0-78.7) in SS (n=14) and 41.9 (28.9-54.1) in control (n=15). These values did not differ significantly between each group. The serum OPN levels were positively correlated with the serum IL-6, CCL2, IL-18, IL-8 and IL-2 receptor concentration. OPN may be involved in risk organ dissemination and poor prognosis of LCH through the function as inflammatory cytokine/chemokine.
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Affiliation(s)
- Yukiko Oh
- Department of Pediatrics, Jichi Medical University School of Medicine, Shimotsuke, Japan
| | - Akira Morimoto
- Department of Pediatrics, Jichi Medical University School of Medicine, Shimotsuke, Japan.
| | - Yoko Shioda
- Division of Pediatric Oncology, National Center for Child Health and Development, Tokyo, Japan
| | - Toshihiko Imamura
- Department of Pediatrics, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kazuko Kudo
- Division of Hematology and Oncology, Shizuoka Children's Hospital, Shizuoka, Japan
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Chilosi M, Facchetti F, Caliò A, Zamò A, Brunelli M, Martignoni G, Rossi A, Montagna L, Piccoli P, Dubini A, Tironi A, Tomassetti S, Poletti V, Doglioni C. Oncogene-induced senescence distinguishes indolent from aggressive forms of pulmonary and non-pulmonary Langerhans cell histiocytosis. Leuk Lymphoma 2014; 55:2620-6. [DOI: 10.3109/10428194.2014.887713] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Marco Chilosi
- Department of Pathology and Diagnostics, University of Verona,
Verona, Italy
| | - Fabio Facchetti
- Department of Pathology and Diagnostics, University of Brescia,
Brescia, Italy
| | - Anna Caliò
- Department of Pathology and Diagnostics, University of Verona,
Verona, Italy
| | - Alberto Zamò
- Department of Pathology and Diagnostics, University of Verona,
Verona, Italy
| | - Matteo Brunelli
- Department of Pathology and Diagnostics, University of Verona,
Verona, Italy
| | - Guido Martignoni
- Department of Pathology and Diagnostics, University of Verona,
Verona, Italy
| | - Andrea Rossi
- Pulmonary Division, Verona General Hospital,
Verona, Italy
| | - Licia Montagna
- Department of Pathology and Diagnostics, University of Verona,
Verona, Italy
| | - Paola Piccoli
- Department of Pathology and Diagnostics, University of Verona,
Verona, Italy
| | - Alessandra Dubini
- Department of Anatomic Pathology, GB Morgagni Hospital,
Forlì, Italy
| | - Andrea Tironi
- Department of Pathology and Diagnostics, University of Brescia,
Brescia, Italy
| | - Sara Tomassetti
- Department of Diseases of the Thorax, GB Morgagni Hospital,
Forlì, Italy
| | - Venerino Poletti
- Department of Diseases of the Thorax, GB Morgagni Hospital,
Forlì, Italy
| | - Claudio Doglioni
- Department of Histopathology, San Raffaele Hospital,
Milan, Italy
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34
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Rizzo FM, Cives M, Simone V, Silvestris F. New insights into the molecular pathogenesis of langerhans cell histiocytosis. Oncologist 2014; 19:151-63. [PMID: 24436311 DOI: 10.1634/theoncologist.2013-0341] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Langerhans cell histiocytosis (LCH) is a rare proliferative disorder characterized by an accumulation of cells sharing the major phenotypic features of cutaneous Langerhans cells. Given its variable clinical evolution, ranging from self-limiting lesions to multisystemic forms with a poor prognosis, in the last decades it has been debated whether LCH might not have a neoplastic rather than an inflammatory nature. However, although the fundamental events underlying the pathogenesis of LCH are still elusive, recent advances have strikingly improved our understanding of the disease. In particular, the identification of multiple interplays between LCH cells and their tumor microenvironment, along with the recognition of the lesional cytokine storm as a key determinant of LCH progression, has substantiated new opportunities for devising targeted therapeutic approaches. Strikingly, the detection of the rapidly accelerated fibrosarcoma isoform B(V600E) gain-of-function mutation as a genetic alteration recurring in more than 50% of patients has fueled the paradoxical picture of LCH as a tumor of the antigen-presenting cells that can evade rejection by the immune system. Thus, new evidence regarding the ontogeny of LCH cells, as well as a better understanding of the putative immune system frustrating strategy in LCH, may help to define the precise pathogenesis.
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Affiliation(s)
- Francesca M Rizzo
- Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, Bari, Italy
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Arceci RJ. Biological and therapeutic implications of the BRAF pathway in histiocytic disorders. Am Soc Clin Oncol Educ Book 2014:e441-e445. [PMID: 24857137 DOI: 10.14694/edbook_am.2014.34.e441] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Langerhans cell histiocytosis (LCH) has historically evolved in its classification from a primary immune dysregulatory disorder to what current evidence supports as a dendritic cell neoplasm with an immune-inflammatory component. A key part of the classification of LCH as a neoplasm has been the identification of BRAF V600E mutations in 35% to 60% of cases. Tumor protein p53 (TP53) and RAS mutations have also been identified, albeit in less than 2% of reported cases. Of note, over 50% of patients with another dendritic cell disease, Erdheim-Chester Disease, have also been shown to have BRAF V600E mutations. Although the BRAF mutations have not been shown to be associated with extent of disease, they may still provide a target for a molecularly guided approach to therapy. In cases of LCH in which no BRAF mutations were identified, there was evidence for activation of the RAS-RAF-MEK-extracellular signal-regulated kinases (ERK) pathway, suggesting that similar to other tumors, this pathway may be therapeutically exploitable. Anecdotal responses have been reported in a few patients with LCH and Erdheim-Chester Disease to vemurafenib, a BRAF V600E inhibitor. Although these results pave the way for careful, prospective clinical testing, selection of the optimal groups in which to test such inhibitors, alone or in combination, will be critical based on the toxicity profile thus far observed in adults with melanoma and other BRAF mutated tumors.
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Affiliation(s)
- Robert J Arceci
- From the Children's Center for Cancer and Blood Disorders, Hematology/Oncology, Ron Matricaria Institute of Molecular Medicine, Phoenix Children's Hospital, University of Arizona, College of Medicine, Phoenix, AZ
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Cho YA, Yoon HJ, Hong SD, Lee JI, Hong SP. Hypothetical pathogenesis of eosinophilic infiltration in Langerhans cell histiocytosis of the jaw. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 116:734-42. [PMID: 23773614 DOI: 10.1016/j.oooo.2013.04.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Revised: 04/16/2013] [Accepted: 04/21/2013] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The present study investigated the densities of mast cells and CCL-11/eotaxin-1 expression of tumor cells in Langerhans cell histiocytosis (LCH) of the jaw. STUDY DESIGN Eleven LCH cases arising in the jaws were selected. We evaluated eotaxin-1 expression in LCH cells via immunohistochemical staining. Toluidine blue was used to stain mast cells, with 20 periapical granuloma specimens serving as the control group. RESULTS In all 7 patients with multifocal LCH, jaw lesions were the earliest manifestation. Toluidine blue staining revealed that most of the mast cells involved in LCH were degranulated, and the number of mast cells in LCH lesions was not significantly higher than in periapical granulomas. Upon immunohistochemical examination, all patients but one showed positivity for eotaxin-1 in LCH cells. CONCLUSION This preliminary study suggests that eotaxin-1 expression in LCH cells may contribute to eosinophilic infiltration. Further studies of chemokine-receptor interactions will be needed to confirm this.
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Affiliation(s)
- Young-Ah Cho
- Lecturer, Department of Oral Pathology, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Republic of Korea
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Herwig MC, Wojno T, Zhang Q, Grossniklaus HE. Langerhans cell histiocytosis of the orbit: five clinicopathologic cases and review of the literature. Surv Ophthalmol 2012; 58:330-40. [PMID: 23246282 DOI: 10.1016/j.survophthal.2012.09.004] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2012] [Revised: 09/14/2012] [Accepted: 09/18/2012] [Indexed: 01/01/2023]
Abstract
Langerhans cell histiocytosis (LCH) is a proliferation of Langerhans cells intermixed with inflammatory cells, in particular eosinophils, that may manifest as unisystem (unifocal or multifocal) or multisystem disease. Orbital involvement typically manifests as a solitary lesion that carries a favorable prognosis. We describe the clinical and histologic spectrum of LCH of the orbit in our five cases. One patient exhibited multifocal unisystem disease; the other four had a localized process. Typical histologic features included numerous histiocytes with varying degrees of giant cell formation and scattered eosinophilic granulocytes. The presence of Langerhans cells was confirmed by CD1a and S100 immunohistochemistry. Transmission electron microscopy demonstrated characteristic intracytoplasmic Birbeck granules. We review the different ophthalmic manifestations of LCH and treatment strategies. As LCH may solely involve the orbit, treatment is based on the degree of organ involvement. LCH should included in the differential diagnosis in tumors of the ocular adnexae, especially in young children.
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Affiliation(s)
- Martina C Herwig
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia 30322, USA
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van der Waart AB, van der Velden WJFM, van Halteren AGS, Leenders MJLG, Feuth T, Blijlevens NMA, van der Voort R, Dolstra H. Decreased levels of circulating IL17-producing CD161+CCR6+ T cells are associated with graft-versus-host disease after allogeneic stem cell transplantation. PLoS One 2012; 7:e50896. [PMID: 23226545 PMCID: PMC3514180 DOI: 10.1371/journal.pone.0050896] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Accepted: 10/26/2012] [Indexed: 12/23/2022] Open
Abstract
The C-type lectin-like receptor CD161 is a well-established marker for human IL17-producing T cells, which have been implicated to contribute to the development of graft-versus-host disease (GVHD) after allogeneic stem cell transplantation (allo-SCT). In this study, we analyzed CD161+ T cell recovery, their functional properties and association with GVHD occurrence in allo-SCT recipients. While CD161+CD4+ T cells steadily recovered, CD161hiCD8+ T cell numbers declined during tapering of Cyclosporine A (CsA), which can be explained by their initial growth advantage over CD161neg/lowCD8+ T cells due to ABCB1-mediated CsA efflux. Interestingly, occurrence of acute and chronic GVHD was significantly correlated with decreased levels of circulating CD161+CD4+ as well as CD161hiCD8+ T cells. In addition, these subsets from transplanted patients secreted high levels of IFNγ and IL17. Moreover, we found that CCR6 co-expression by CD161+ T cells mediated specific migration towards CCL20, which was expressed in GVHD biopsies. Finally, we demonstrated that CCR6+ T cells indeed were present in these CCL20+ GVHD-affected tissues. In conclusion, we showed that functional CD161+CCR6+ co-expressing T cells disappear from the circulation and home to GVHD-affected tissue sites. These findings support the hypothesis that CCR6+CD161-expressing T cells may be involved in the immune pathology of GVHD following their CCL20-dependent recruitment into affected tissues.
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Affiliation(s)
- Anniek B. van der Waart
- Department of Laboratory Medicine - Laboratory of Hematology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | | | - Astrid G. S. van Halteren
- Immunology Laboratory, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Marij J. L. G. Leenders
- Department of Laboratory Medicine - Laboratory of Hematology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Ton Feuth
- Department of Epidemiology, Biostatistics and Health Technology Assessment, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Nicole M. A. Blijlevens
- Department of Hematology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Robbert van der Voort
- Department of Laboratory Medicine - Laboratory of Hematology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Harry Dolstra
- Department of Laboratory Medicine - Laboratory of Hematology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
- * E-mail:
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Badalian-Very G, Vergilio JA, Fleming M, Rollins BJ. Pathogenesis of Langerhans cell histiocytosis. ANNUAL REVIEW OF PATHOLOGY-MECHANISMS OF DISEASE 2012; 8:1-20. [PMID: 22906202 DOI: 10.1146/annurev-pathol-020712-163959] [Citation(s) in RCA: 122] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Langerhans cell histiocytosis (LCH) combines in one nosological category a group of diseases that have widely disparate clinical manifestations but are all characterized by accumulation of proliferating cells with surface markers and ultrastructural features similar to cutaneous Langerhans cells (LCs). Despite this unified nosology, important questions about LCH remain unanswered. First, despite having phenotypic features of LCs, LCH cell gene-expression patterns differ from those in LCs. Although this observation suggests that LCH may arise from an earlier precursor, it is not necessarily inconsistent with the hypothesis that LCs are the cell of origin for LCH. Second, LCH's prominent inflammatory component and occasional benign clinical course suggest that LCH may not be a neoplasm. However, the demonstration that LCH cells are clonal, along with the recent discovery of activating BRAF mutations in LCH cells, strongly suggests that LCH is a neoplastic disease. These new observations point the way to rationally targeted therapies.
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Affiliation(s)
- Gayane Badalian-Very
- Department of Medical Oncology, Dana-Farber Cancer Institute, and Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02215, USA.
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Lajolo C, Campisi G, Deli G, Littarru C, Guiglia R, Giuliani M. Langerhans's cell histiocytosis in old subjects: two rare case reports and review of the literature. Gerodontology 2012; 29:e1207-e1214. [PMID: 22612839 DOI: 10.1111/j.1741-2358.2012.00629.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
BACKGROUND Langerhans cell histiocytosis (LCH) is a proliferative disease of histiocyte-like cells that generally affects children; LCH onset is rare in adults; immunohistochemistry is essential to obtain the correct diagnosis, and treatment protocols are controversial. OBJECTIVE To describe two new cases of adult onset oral LCH. CASE REPORTS Case 1: a 71-year-old woman, complaining of diffuse oral pain, presented with erythematous mucosal lesions; the panoramic radiograph and CT scan showed multiple mandible radiolucent areas. Immunohistochemical assay for S-100, CD1a and langerin test was essential in reaching the correct diagnosis. Case 2: a 77-year-old female patient presented with a non-painful, non-bleeding, slightly elevated erythematous palatal lesion of 6 months duration, together with a genital vulvar lesion of uncertain nature. The pathology confirmed the diagnosis of LCH. Many therapies (etoposid, radiotherapy) could induce only a clinical partial remission; Cladribine induced a complete recovery. CONCLUSION The first case was difficult to diagnose: the clinical presentation and course of the disease (LCH) in the elderly are multiple and unpredictable. An immunohistochemistry study is often essential to obtain the correct diagnosis. The second case required several therapeutic interventions: even though some cases regress spontaneously, others require systemic chemotherapy.
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Affiliation(s)
- Carlo Lajolo
- School of Dentistry, Catholic University, Largo A. Gemelli, Rome, Italy.
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Satoh T, Smith A, Sarde A, Lu HC, Mian S, Trouillet C, Mufti G, Emile JF, Fraternali F, Donadieu J, Geissmann F. B-RAF mutant alleles associated with Langerhans cell histiocytosis, a granulomatous pediatric disease. PLoS One 2012; 7:e33891. [PMID: 22506009 PMCID: PMC3323620 DOI: 10.1371/journal.pone.0033891] [Citation(s) in RCA: 118] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Accepted: 02/19/2012] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Langerhans cell histiocytosis (LCH) features inflammatory granuloma characterised by the presence of CD1a+ dendritic cells or 'LCH cells'. Badalian-Very et al. recently reported the presence of a canonical (V600E)B-RAF mutation in 57% of paraffin-embedded biopsies from LCH granuloma. Here we confirm their findings and report the identification of two novel B-RAF mutations detected in LCH patients. METHODS AND RESULTS Mutations of B-RAF were observed in granuloma samples from 11 out of 16 patients using 'next generation' pyrosequencing. In 9 cases the mutation identified was (V600E)B-RAF. In 2 cases novel polymorphisms were identified. A somatic (600DLAT)B-RAF insertion mimicked the structural and functional consequences of the (V600E)B-RAF mutant. It destabilized the inactive conformation of the B-RAF kinase and resulted in increased ERK activation in 293 T cells. The (600DLAT)B-RAF and (V600E)B-RAF mutations were found enriched in DNA and mRNA from the CD1a+ fraction of granuloma. They were absent from the blood and monocytes of 58 LCH patients, with a lower threshold of sequencing sensitivity of 1%-2% relative mutation abundance. A novel germ line (T599A)B-RAF mutant allele was detected in one patient, at a relative mutation abundance close to 50% in the LCH granuloma, blood monocytes and lymphocytes. However, (T599A)B-RAF did not destabilize the inactive conformation of the B-RAF kinase, and did not induce increased ERK phosphorylation or C-RAF transactivation. CONCLUSIONS Our data confirmed presence of the (V600E)B-RAF mutation in LCH granuloma of some patients, and identify two novel B-RAF mutations. They indicate that (V600E)B-RAF and (600DLAT)B-RAF mutations are somatic mutants enriched in LCH CD1a(+) cells and absent from the patient blood. Further studies are needed to assess the functional consequences of the germ-line (T599A)B-RAF allele.
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Affiliation(s)
- Takeshi Satoh
- School of Medicine, Centre for Molecular and Cellular Biology of Inflammation (CMCBI), King's College London, London, United Kingdom
| | - Alexander Smith
- Haematology Department, King's College London, London, United Kingdom
| | - Aurelien Sarde
- School of Medicine, Centre for Molecular and Cellular Biology of Inflammation (CMCBI), King's College London, London, United Kingdom
| | - Hui-chun Lu
- Randall Division of Molecular Biophysics, King's College London, London, United Kingdom
| | - Sophie Mian
- Haematology Department, King's College London, London, United Kingdom
| | - Celine Trouillet
- School of Medicine, Centre for Molecular and Cellular Biology of Inflammation (CMCBI), King's College London, London, United Kingdom
| | - Ghulam Mufti
- Haematology Department, King's College London, London, United Kingdom
| | | | - Franca Fraternali
- Randall Division of Molecular Biophysics, King's College London, London, United Kingdom
| | - Jean Donadieu
- Centre de Référence de l'Histiocytose, Hopital d'Enfants Armand Trousseau, Pediatric Hematology Unit, AP-HP, Paris, France
| | - Frederic Geissmann
- School of Medicine, Centre for Molecular and Cellular Biology of Inflammation (CMCBI), King's College London, London, United Kingdom
- * E-mail:
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Abstract
Cigarette smoke, a toxic collection of thousands of chemicals generated from combustion of tobacco, is recognized as the primary causative agent of certain diffuse interstitial and bronchiolar lung diseases. Most patients afflicted with these disorders are cigarette smokers, and smoking cessation has been shown to be capable of inducing disease remission and should occupy a pivotal role in the management of all smokers with these diffuse lung diseases. The role of pharmacotherapy with corticosteroids or other immunomodulating agents is not well established but may be considered in patients with progressive forms of smoking-related interstitial lung diseases.
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Affiliation(s)
- Robert Vassallo
- Division of Pulmonary and Critical Care and Internal Medicine, Mayo Clinic and Foundation, 200 First Street Southwest, Rochester, MN, 55905, USA
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Badalian-Very G, Vergilio JA, Degar BA, Rodriguez-Galindo C, Rollins BJ. Recent advances in the understanding of Langerhans cell histiocytosis. Br J Haematol 2011; 156:163-72. [PMID: 22017623 DOI: 10.1111/j.1365-2141.2011.08915.x] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Langerhans cell histiocytosis (LCH) is a proliferative disease of cells that share phenotypic characteristics with the primary antigen presenting cells of the epidermis. Its clinical manifestations are highly variable, extending from very benign forms to a disseminated, aggressive disease that causes significant mortality. Although many of the fundamental pathogenetic features of LCH have been enigmatic, recent advances have led to a much clearer understanding of the disease. In particular, careful molecular analyses of mouse models and human LCH samples suggest that LCH's cell of origin may not be the epidermal LC itself but a myeloid-derived precursor. Advanced genomic technologies have revealed the presence of activating, somatic BRAF mutations in the majority of patient specimens. Together, these observations have produced a new picture of LCH as a myeloid neoplasm. These advances are likely to have profound implications for the use of targeted therapeutics in LCH.
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Affiliation(s)
- Gayane Badalian-Very
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
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Choi WI, Jeong YC, Kim SY, Kim SD, Pribis JP, Kim HJ, Koh KN, Im HJ, Lee YH, Seo JJ. New clinical score for disease activity at diagnosis in Langerhans cell histiocytosis. THE KOREAN JOURNAL OF HEMATOLOGY 2011; 46:186-91. [PMID: 22065974 PMCID: PMC3208202 DOI: 10.5045/kjh.2011.46.3.186] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Revised: 09/06/2011] [Accepted: 09/07/2011] [Indexed: 11/17/2022]
Abstract
BACKGROUND The clinical presentation and course of Langerhans cell histiocytosis (LCH) are variable, ranging from an isolated, spontaneously remitting bone lesion to multisystem disease with risk organ involvement. Treatment of LCH ranges from a wait-and-see attitude to intensive multidrug therapy and, in some cases, bone marrow transplantation. It is necessary to develop an objective score for assessing disease activity in patients with LCH. We propose a new clinical scoring system to evaluate disease activity at diagnosis that can predict the clinical outcomes of LCH and correlate it with clinical courses. METHODS Clinical data, obtained from children diagnosed with LCH at Asan Medical Center and Hanyang University Hospital between March 1998 and February 2009, were studied retrospectively. The scoring system was developed according to the basic biological data, radiological findings, and physical findings and applied to a database containing information on 133 patients. RESULTS The median age of the 133 patients (74 male, 59 female) was 52 months (range, 0.6-178 months), and LCH was diagnosed based on CD1a positivity. At diagnosis, the score distributions were highly asymmetrical: the score was between 1 and 2 in 75.9% of cases, 3-6 in 15.8%, and greater than 6 in 8.3%. Initial scores above 6 were highly predictive of reactivation and late complications. CONCLUSION This new LCH disease activity score provides an objective tool for assessing disease severity, both at diagnosis and during follow-up.
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Affiliation(s)
- Won-Ik Choi
- Department of Pediatrics, College of Medicine, Hanyang University Hospital, Seoul, Korea
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Abstract
Irrespective of the immune status, the vast majority of all lymphocytes reside in peripheral tissues whereas those present in blood only amount to a small fraction of the total. It has been estimated that T cells in healthy human skin outnumber those present in blood by at least a factor of two. How lymphocytes within these two compartments relate to each other is not well understood. However, mounting evidence suggest that the study of T cell subsets present in peripheral blood does not reflect the function of their counterparts at peripheral sites. This is especially true under steady-state conditions whereby long-lived memory T cells in healthy tissues, notably those in epithelial tissues at body surfaces, are thought to fulfill a critical immune surveillance function by contributing to the first line of defense against a series of local threats, including microbes, tumors, and toxins, and by participating in wound healing. The relative scarcity of information regarding peripheral T cells and the factors regulating their localization is primarily due to inherent difficulties in obtaining healthy tissue for the extraction and study of immune cells on a routine basis. This is most certainly true for humans. Here, we review our current understanding of T cell homing to human skin and compare it when possible with gut-selective homing. We also discuss candidate chemokines that may account for the tissue selectivity in this process and present a model whereby CCR8, and its ligand CCL1, selectively regulate the homeostatic migration of memory lymphocytes to skin tissue.
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Affiliation(s)
- Michelle L McCully
- Department of Infection, Immunity and Biochemistry, School of Medicine, Cardiff University Cardiff, UK
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46
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Abstract
Langerhans cell histiocytosis (LCH) is a rare (about 3-5 cases per million children aged 0-14 years), non-malignant disease characterized by proliferation and accumulation of clonal dendritic cells, extreme clinical heterogeneity, and an unpredictable course. Three large-scale, international, prospective therapeutic studies (LCH-I to III) for multisystem LCH (MS-LCH) have been conducted by the Histiocyte Society since 1991. The cumulative lessons from these studies are summarized in this review. Patients with MS-LCH represent a heterogeneous group with respect to disease severity and outcome, therefore treatment stratification and risk-tailored treatment are mandatory. The risk for mortality can be predicted based on involvement of 'risk organs' (e.g. hematopoietic system, liver, and/or spleen) at diagnosis and on response to initial therapy (assessed after 6-12 weeks of treatment). Thus, patients without involvement of risk organs (low-risk group) are not at risk for mortality but need systemic therapy in order to control the disease activity and avoid reactivations and permanent consequences. Patients with risk organ involvement (risk group) are at risk for mortality, and lack of therapy response defines a subgroup with a particularly dismal prognosis (high-risk group). Those patients in the risk group who respond to therapy and survive are at risk for reactivations and permanent consequences. The LCH-I study compared the efficacy of vinblastine and etoposide, and concluded that they are equivalent single-agent treatments for children with MS-LCH. However, the results of this trial were inferior with respect to response rate at week 6, disease reactivation rate, and sequelae, when compared with historical trials using more intensive regimens. The combination of prednisolone and vinblastine was established as a standard first-line treatment through the LCH-II and LCH-III studies. The regimen consists of one to two 6-week courses (continuous oral corticosteroids 40 mg/m2/day for 4 weeks, tapered over 2 weeks plus weekly vinblastine intravenous push) of initial therapy, followed by a continuation phase (three weekly pulses of oral prednisolone 40 mg/m2/day for 5 days plus a vinblastine injection). The addition of a third drug to the standard combination (etoposide in LCH-II and methotrexate in LCH-III) failed to significantly improve survival in the risk group. The remaining mortality in the risk group is about 20%, and up to 40% in the high-risk group. Concerning low-risk MS-LCH, comparison of results of the LCH-II study with historical data suggested that the remaining reactivation rate of about 50% (and possibly permanent consequences) could be reduced by prolongation of the total treatment duration. To study this hypothesis, in the low-risk group of the LCH-III study standard maintenance therapy was randomly given for a total treatment duration of 6 and 12 months. Unpublished preliminary data from this recently closed trial suggested that prolongation of the treatment duration may significantly improve reactivation-free survival. In summary, several studies have shown that systemic therapy is indicated for all patients with MS-LCH. A standard two-drug regimen consisting of an initial 'intensive' phase for 6-12 weeks, followed by a less intensive 'maintenance phase' for a total treatment duration of at least 12 months is recommended for patients treated outside of clinical trials. Non-responders, particularly those with progressive disease in risk organs, are eligible for experimental salvage approaches. Remaining questions will be addressed in the upcoming LCH-IV trial, which is in the process of intensive preparation.
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Affiliation(s)
- Milen Minkov
- Department of Outpatient Hematology/Oncology, St Anna Children's Hospital, Kinderspitalgasse 6, Vienna, Austria.
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Pimentel A, Haupt R, Sihelnik SA, Kimmel WB, Swierczynski SL. Focal Langerhans Cell Histiocytosis (LCH) Coexisting With Renal Cell Carcinoma. J Clin Oncol 2011; 29:e107-9. [PMID: 21098320 DOI: 10.1200/jco.2010.30.9344] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
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Decoster L, De Braekeleer K, Bourgain C, Schallier D. Langerhans cell histiocytosis: two case reports in adults and review of the literature. Acta Clin Belg 2010; 65:345-9. [PMID: 21128563 DOI: 10.1179/acb.2010.074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Langerhans Cell histiocytosis is a rare proliferative histiocytic disorder in which pathologic Langerhans cells accumulate in a variety of organs. The clinical presentation, evolution and therapeutic options are highly variable. Because of its relative rarity and the broad clinical spectrum, the diagnosis of Langerhans cell histiocytosis is often delayed or missed. At present, many questions with respect to aetiology, pathogenesis and treatment remain unanswered. In the present article we want to raise the awareness of this rare disease in adults and its diversity by the means of two case reports. In addition, the clinical manifestations, diagnosis and the current management are reviewed.
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Affiliation(s)
- L Decoster
- Department of Medical Oncology, UZ Brussel - Vrije Universiteit Brussel, Brussels, Belgium.
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Combined Erdheim-Chester disease and Langerhans cell histiocytosis of skin are both monoclonal: A rare case with human androgen-receptor gene analysis. J Am Acad Dermatol 2010; 63:284-91. [DOI: 10.1016/j.jaad.2009.08.013] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2009] [Revised: 08/07/2009] [Accepted: 08/07/2009] [Indexed: 11/21/2022]
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50
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Faaij CMJM, Willemze AJ, Révész T, Balzarolo M, Tensen CP, Hoogeboom M, Vermeer MH, van Wering E, Zwaan CM, Kaspers GJL, Story C, van Halteren AGS, Vossen JM, Egeler RM, van Tol MJD, Annels NE. Chemokine/chemokine receptor interactions in extramedullary leukaemia of the skin in childhood AML: differential roles for CCR2, CCR5, CXCR4 and CXCR7. Pediatr Blood Cancer 2010; 55:344-8. [PMID: 20582977 DOI: 10.1002/pbc.22500] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Chemokine receptor/ligand interactions orchestrate the migration of cells to peripheral tissues such as the skin. We analysed chemokine receptor expression by acute myeloid leukaemic (AML) cells present in peripheral blood (n = 7), bone marrow (n = 6), or skin (n = 11) obtained from 15 paediatric AML patients with skin involvement and in 10 AML patients without skin involvement. High percentages of circulating CCR2(pos) AML cells were only detected in patients with extramedullary disease. Skin-residing AML cells displayed a different set of receptors in situ, namely: CCR5, CXCR4, CXCR7 and CX3CR1. These results suggest the involvement of different chemokine/chemokine receptor interactions in homing and retention of AML blasts in the skin.
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Affiliation(s)
- Claudia M J M Faaij
- Division of Immunology, Haematology, Oncology, Bone Marrow Transplantation and Autoimmune Diseases, Department of Paediatrics, Leiden University Medical Centre, Leiden, The Netherlands
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