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Lacunza E, Ahuja A, Coso OA, Abba M, Ramos JC, Cesarman E, Mesri EA, Naipauer J. Unveiling the role of KSHV-infected human mesenchymal stem cells in Kaposi's sarcoma initiation. J Med Virol 2024; 96:e29684. [PMID: 38773828 DOI: 10.1002/jmv.29684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 05/08/2024] [Accepted: 05/09/2024] [Indexed: 05/24/2024]
Abstract
Kaposi's sarcoma (KS) may derive from Kaposi's sarcoma herpesvirus (KSHV)-infected human mesenchymal stem cells (hMSCs) that migrate to sites characterized by inflammation and angiogenesis, promoting the initiation of KS. By analyzing the RNA sequences of KSHV-infected primary hMSCs, we have identified specific cell subpopulations, mechanisms, and conditions involved in the initial stages of KSHV-induced transformation and reprogramming of hMSCs into KS progenitor cells. Under proangiogenic environmental conditions, KSHV can reprogram hMSCs to exhibit gene expression profiles more similar to KS tumors, activating cell cycle progression, cytokine signaling pathways, endothelial differentiation, and upregulating KSHV oncogenes indicating the involvement of KSHV infection in inducing the mesenchymal-to-endothelial (MEndT) transition of hMSCs. This finding underscores the significance of this condition in facilitating KSHV-induced proliferation and reprogramming of hMSCs towards MEndT and closer to KS gene expression profiles, providing further evidence of these cell subpopulations as precursors of KS cells that thrive in a proangiogenic environment.
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Affiliation(s)
- Ezequiel Lacunza
- Centro de Investigaciones Inmunologicas Basicas y Aplicadas, Facultad de Ciencias Medicas, Universidad Nacional de La Plata, La Plata, Argentina
- University of Miami-Centre for AIDS Research/Sylvester Cancer Comprehensive Center Argentina Consortium for Research and Training in Virally Induced AIDS-Malignancies, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Anuj Ahuja
- Tumor Biology Program, Sylvester Comprehensive Cancer Center and Miami Center for AIDS Research, Department of Microbiology and Immunology, University of Miami Miller School of Medicine, Miami, Florida, USA
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Omar A Coso
- University of Miami-Centre for AIDS Research/Sylvester Cancer Comprehensive Center Argentina Consortium for Research and Training in Virally Induced AIDS-Malignancies, University of Miami Miller School of Medicine, Miami, Florida, USA
- Instituto de Fisiología, Biología Molecular y Neurociencias (IFIBYNE), CONICET-Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Martin Abba
- Centro de Investigaciones Inmunologicas Basicas y Aplicadas, Facultad de Ciencias Medicas, Universidad Nacional de La Plata, La Plata, Argentina
- University of Miami-Centre for AIDS Research/Sylvester Cancer Comprehensive Center Argentina Consortium for Research and Training in Virally Induced AIDS-Malignancies, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Juan Carlos Ramos
- University of Miami-Centre for AIDS Research/Sylvester Cancer Comprehensive Center Argentina Consortium for Research and Training in Virally Induced AIDS-Malignancies, University of Miami Miller School of Medicine, Miami, Florida, USA
- Department of Medicine, Division of Hematology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, USA
- Center for AIDS Research, University of Miami Miller School of Medicine, Miami, Florida, USA
- Department of Microbiology and Immunology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ethel Cesarman
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Enrique A Mesri
- University of Miami-Centre for AIDS Research/Sylvester Cancer Comprehensive Center Argentina Consortium for Research and Training in Virally Induced AIDS-Malignancies, University of Miami Miller School of Medicine, Miami, Florida, USA
- Tumor Biology Program, Sylvester Comprehensive Cancer Center and Miami Center for AIDS Research, Department of Microbiology and Immunology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Julian Naipauer
- University of Miami-Centre for AIDS Research/Sylvester Cancer Comprehensive Center Argentina Consortium for Research and Training in Virally Induced AIDS-Malignancies, University of Miami Miller School of Medicine, Miami, Florida, USA
- Instituto de Fisiología, Biología Molecular y Neurociencias (IFIBYNE), CONICET-Universidad de Buenos Aires, Buenos Aires, Argentina
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Wang X, Chen W, Yuan Y. KSHV enhances mesenchymal stem cell homing and promotes KS-like pathogenesis. Virology 2020; 549:5-12. [PMID: 32777727 DOI: 10.1016/j.virol.2020.07.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 06/21/2020] [Accepted: 07/17/2020] [Indexed: 12/13/2022]
Abstract
Kaposi's sarcoma (KS) tends to occur in injured or inflamed sites of the body, which is described as the "Koebner phenomenon". KS is also unique in its extraordinary angio-hyperplastic inflammatory phenotype. Recently, evidence has accrued indicating that KS may derive from KSHV-infected mesenchymal stem cells (MSCs), which possess enhanced migration and homing ability. Inspired by these findings, we hypothesized that KS may arise from KSHV-infected MSCs that chemotactically migrate to preexisting inflammatory or injured sites. Here we report that KSHV infection of human MSCs significantly up-regulated expression of several chemokine receptors and enhanced cell migration ability in vitro. Furthermore, using a wound mouse model, we demonstrated that KSHV infection dramatically promotes MSCs migrating and settling in the wound sites. In addition, two mice in the KSHV-infected group showed purpura and tumors with KS-like features. Taken together, KSHV-enhanced MSC migration ability and inflammatory microenvironment play crucial roles in KS development.
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MESH Headings
- Animals
- Cell Movement
- Disease Models, Animal
- Ear
- Gene Expression Regulation
- Genes, Reporter
- Green Fluorescent Proteins/genetics
- Green Fluorescent Proteins/metabolism
- Herpesvirus 8, Human/growth & development
- Herpesvirus 8, Human/pathogenicity
- Host-Pathogen Interactions/genetics
- Humans
- Luminescent Proteins/genetics
- Luminescent Proteins/metabolism
- Male
- Mice
- Mice, Inbred BALB C
- Periodontal Ligament/cytology
- Primary Cell Culture
- RNA, Small Interfering/genetics
- RNA, Small Interfering/metabolism
- Receptors, CCR1/antagonists & inhibitors
- Receptors, CCR1/genetics
- Receptors, CCR1/metabolism
- Receptors, CCR3/antagonists & inhibitors
- Receptors, CCR3/genetics
- Receptors, CCR3/metabolism
- Receptors, CCR4/antagonists & inhibitors
- Receptors, CCR4/genetics
- Receptors, CCR4/metabolism
- Sarcoma, Kaposi/genetics
- Sarcoma, Kaposi/metabolism
- Sarcoma, Kaposi/pathology
- Sarcoma, Kaposi/virology
- Signal Transduction
- Stem Cells/metabolism
- Stem Cells/pathology
- Stem Cells/virology
- Wounds, Nonpenetrating/pathology
- Wounds, Nonpenetrating/virology
- Red Fluorescent Protein
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Affiliation(s)
- Xiaoqian Wang
- Institute of Human Virology, Key Laboratory of Tropical Disease Control of Ministry of Education, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Weikang Chen
- Institute of Human Virology, Key Laboratory of Tropical Disease Control of Ministry of Education, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Yan Yuan
- Institute of Human Virology, Key Laboratory of Tropical Disease Control of Ministry of Education, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, Guangdong, China; Department of Microbiology, University of Pennsylvania School of Dental Medicine, Philadelphia, PA, USA.
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3
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Desnoyer A, Dupin N, Assoumou L, Carlotti A, Gaudin F, Deback C, Peytavin G, Marcelin A, Boué F, Balabanian K, Pourcher V. Expression pattern of the CXCL12/CXCR4-CXCR7 trio in Kaposi sarcoma skin lesions. Br J Dermatol 2016; 175:1251-1262. [DOI: 10.1111/bjd.14748] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2016] [Indexed: 01/08/2023]
Affiliation(s)
- A. Desnoyer
- Assistance Publique-Hôpitaux de Paris; Hôpital Bichat-Claude Bernard; Département de Pharmaco-Toxicologie Clinique; Paris France
- UMR996 - Inflammation, Chemokines and Immunopathology; INSERM; Université Paris-Sud; Université Paris-Saclay; 92140 Clamart France
| | - N. Dupin
- Service de Dermatologie; Assistance Publique-Hôpitaux de Paris; Groupe Hospitalier Cochin; Paris France
- Université Paris Descartes; UMR1016; Paris France
- INSERM; UMR1016; Institut Cochin; Université Paris Descartes; Paris France
| | - L. Assoumou
- Université Sorbonne UPMC; Université Paris 06; UMRS1136; Institut Pierre Louis d'Epidémiologie et de Santé Publique; Paris France
- INSERM; UMRS1136; Institut Pierre Louis d'Epidémiologie et de Santé Publique; Paris France
| | - A. Carlotti
- Service d'Anatomopathologie; Assistance Publique-Hôpitaux de Paris; Groupe Hospitalier Cochin; Paris France
| | - F. Gaudin
- UMR996 - Inflammation, Chemokines and Immunopathology; INSERM; Université Paris-Sud; Université Paris-Saclay; 92140 Clamart France
| | - C. Deback
- UMR996 - Inflammation, Chemokines and Immunopathology; INSERM; Université Paris-Sud; Université Paris-Saclay; 92140 Clamart France
- Assistance Publique-Hôpitaux de Paris; Hôpital Paul Brousse; Service de Virologie; Villejuif France
| | - G. Peytavin
- Assistance Publique-Hôpitaux de Paris; Hôpital Bichat-Claude Bernard; Département de Pharmaco-Toxicologie Clinique; Paris France
- Université Paris Diderot; INSERM; IAME; UMR1137; Paris France
- INSERM; IAME; UMR1137; Paris France
| | - A.G. Marcelin
- Université Sorbonne UPMC; Université Paris 06; UMRS1136; Institut Pierre Louis d'Epidémiologie et de Santé Publique; Paris France
- INSERM; UMRS1136; Institut Pierre Louis d'Epidémiologie et de Santé Publique; Paris France
- Assistance Publique-Hôpitaux de Paris; Groupe Hospitalier Pitié-Salpêtrière; Laboratoire de Virologie; Paris France
| | - F. Boué
- UMR996 - Inflammation, Chemokines and Immunopathology; INSERM; Université Paris-Sud; Université Paris-Saclay; 92140 Clamart France
- Assistance Publique-Hôpitaux de Paris; Hôpital Antoine Béclère; Service de Médecine Interne; Clamart France
| | - K. Balabanian
- UMR996 - Inflammation, Chemokines and Immunopathology; INSERM; Université Paris-Sud; Université Paris-Saclay; 92140 Clamart France
| | - V. Pourcher
- UMR996 - Inflammation, Chemokines and Immunopathology; INSERM; Université Paris-Sud; Université Paris-Saclay; 92140 Clamart France
- Assistance Publique-Hôpitaux de Paris; Groupe Hospitalier Pitié-Salpêtrière; Service de Maladies Infectieuses et Tropicales; France Sorbonne Universités; UPMC; Université Paris 06; Paris France
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HIV-1 Evolutionary Patterns Associated with Metastatic Kaposi's Sarcoma during AIDS. Sarcoma 2016; 2016:4510483. [PMID: 27651732 PMCID: PMC5019946 DOI: 10.1155/2016/4510483] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 08/07/2016] [Indexed: 12/19/2022] Open
Abstract
Kaposi's sarcoma (KS) in HIV-infected individuals can have a wide range of clinical outcomes, from indolent skin tumors to a life-threatening visceral cancer. KS tumors contain endothelial-related cells and inflammatory cells that may be HIV-infected. In this study we tested if HIV evolutionary patterns distinguish KS tumor relatedness and progression. Multisite autopsies from participants who died from HIV-AIDS with KS prior to the availability of antiretroviral therapy were identified at the AIDS and Cancer Specimen Resource (ACSR). Two patients (KS1 and KS2) died predominantly from non-KS-associated disease and KS3 died due to aggressive and metastatic KS within one month of diagnosis. Skin and visceral tumor and nontumor autopsy tissues were obtained (n = 12). Single genome sequencing was used to amplify HIV RNA and DNA, which was present in all tumors. Independent HIV tumor clades in phylogenies differentiated KS1 and KS2 from KS3, whose sequences were interrelated by both phylogeny and selection. HIV compartmentalization was confirmed in KS1 and KS2 tumors; however, in KS3, no compartmentalization was observed among sampled tissues. While the sample size is small, the HIV evolutionary patterns observed in all patients suggest an interplay between tumor cells and HIV-infected cells which provides a selective advantage and could promote KS progression.
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Hessol NA, Napolitano LA, Smith D, Lie Y, Levine A, Young M, Cohen M, Minkoff H, Anastos K, D'Souza G, Greenblatt RM, Goedert JJ. HIV tropism and decreased risk of breast cancer. PLoS One 2010; 5:e14349. [PMID: 21179547 PMCID: PMC3002931 DOI: 10.1371/journal.pone.0014349] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2010] [Accepted: 11/19/2010] [Indexed: 11/21/2022] Open
Abstract
Background During the first two decades of the U.S. AIDS epidemic, and unlike some malignancies, breast cancer risk was significantly lower for women with human immunodeficiency virus (HIV) infection compared to the general population. This deficit in HIV-associated breast cancer could not be attributed to differences in survival, immune deficiency, childbearing or other breast cancer risk factors. HIV infects mononuclear immune cells by binding to the CD4 molecule and to CCR5 or CXCR4 chemokine coreceptors. Neoplastic breast cells commonly express CXCR4 but not CCR5. In vitro, binding HIV envelope protein to CXCR4 has been shown to induce apoptosis of neoplastic breast cells. Based on these observations, we hypothesized that breast cancer risk would be lower among women with CXCR4-tropic HIV infection. Methods and Findings We conducted a breast cancer nested case-control study among women who participated in the WIHS and HERS HIV cohort studies with longitudinally collected risk factor data and plasma. Cases were HIV-infected women (mean age 46 years) who had stored plasma collected within 24 months of breast cancer diagnosis and an HIV viral load ≥500 copies/mL. Three HIV-infected control women, without breast cancer, were matched to each case based on age and plasma collection date. CXCR4-tropism was determined by a phenotypic tropism assay. Odds ratios (OR) and 95% confidence intervals (CI) for breast cancer were estimated by exact conditional logistic regression. Two (9%) of 23 breast cancer cases had CXCR4-tropic HIV, compared to 19 (28%) of 69 matched controls. Breast cancer risk was significantly and independently reduced with CXCR4 tropism (adjusted odds ratio, 0.10, 95% CI 0.002–0.84) and with menopause (adjusted odds ratio, 0.08, 95% CI 0.001–0.83). Adjustment for CD4+ cell count, HIV viral load, and use of antiretroviral therapy did not attenuate the association between infection with CXCR4-tropic HIV and breast cancer. Conclusions Low breast cancer risk with HIV is specifically linked to CXCR4-using variants of HIV. These variants are thought to exclusively bind to and signal through a receptor that is commonly expressed on hyperplastic and neoplastic breast duct cells. Additional studies are needed to confirm these observations and to understand how CXCR4 might reduce breast cancer risk.
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Affiliation(s)
- Nancy A. Hessol
- Department of Clinical Pharmacy, University of California San Francisco, San Francisco, California, United States of America
| | - Laura A. Napolitano
- Monogram Biosciences, South San Francisco, California, United States of America
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Dawn Smith
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Yolanda Lie
- Monogram Biosciences, South San Francisco, California, United States of America
| | - Alexandra Levine
- City of Hope National Medical Center, Duarte, California, United States of America
- Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
| | - Mary Young
- Georgetown University School of Medicine, Washington D.C., United States of America
| | - Mardge Cohen
- Departments of Medicine, Stroger Hospital and Rush University, Chicago, Illinois, United States of America
| | - Howard Minkoff
- Maimonides Medical Center and State University of New York, Health Sciences Center at Brooklyn, Brooklyn, New York, United States of America
| | - Kathryn Anastos
- Montefiore Medical Center, Bronx, New York, United States of America
| | - Gypsyamber D'Souza
- Johns Hopkins School of Public Health, Baltimore, Maryland, United States of America
| | - Ruth M. Greenblatt
- Department of Clinical Pharmacy, University of California San Francisco, San Francisco, California, United States of America
| | - James J. Goedert
- Infections & Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health (NIH), Bethesda, Maryland, United States of America
- * E-mail:
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6
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Choi YB, Nicholas J. Induction of angiogenic chemokine CCL2 by human herpesvirus 8 chemokine receptor. Virology 2010; 397:369-78. [PMID: 20004457 PMCID: PMC3024549 DOI: 10.1016/j.virol.2009.11.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2009] [Revised: 08/21/2009] [Accepted: 11/14/2009] [Indexed: 12/16/2022]
Abstract
Human herpesvirus 8 (HHV-8) is associated with Kaposi's sarcoma (KS), an endothelial cell lesion believed to be initiated and driven primarily by cytokine dysregulation. Among the viral proteins suspected as contributing to viral pathogenesis is the lytically expressed viral G protein-coupled receptor (vGPCR), which can induce various cellular cytokines. CC ligand-2 (CCL2/MCP-1) is a vGPCR-regulated angiogenic chemokine found at elevated levels in KS lesions and induced by HHV-8 infection of endothelial cells. Here we show that vGPCR induces CCL2 in endothelial cells via activation of C/EBPbeta and that vGPCR and C/EBPbeta are critical components of CCL2 induction by HHV-8 infection of endothelial cultures. To our knowledge, this is the first report of vGPCR-mediated cytokine induction, and its characterization, in the context of virus infection. Our results identify a mechanism by which vGPCR can contribute, in a host cell shutoff-independent manner, to viral pathogenesis.
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Affiliation(s)
| | - John Nicholas
- Corresponding author. Phone: 410 502 6801; Fax: 410 502 6802;
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Hensler HR, Rappocciolo G, Rinaldo CR, Jenkins FJ. Cytokine production by human herpesvirus 8-infected dendritic cells. J Gen Virol 2009; 90:79-83. [PMID: 19088276 DOI: 10.1099/vir.0.006239-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
We have shown previously that human herpesvirus 8 (HHV-8)-infected dendritic cells (DCs) undergo incomplete maturation and have a defective antigen-presenting function. Here, we examined the effects of HHV-8 infection on cytokine production, which is critical to the function of DCs. We detected expression of interleukin (IL)-6, tumour necrosis factor (TNF)-alpha, macrophage inflammatory protein (MIP)-1alpha, MIP-1beta, RANTES and IL-12p40 from 2 to 6 h post-infection, and these peaked by 15-24 h. Expression of these factors decreased 24-48 h post-infection, with the exception of TNF-alpha which remained high throughout the entire 72 h. Interestingly, while IL-12p40 expression increased post-infection, bioactive IL-12p70 was not detected in the supernatants. These results suggest an intentional skewing of cytokine production in HHV-8-infected DCs towards induction of a Th2 response.
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Affiliation(s)
- Heather R Hensler
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, USA
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Abstract
Among individuals with HIV-infection, coinfection with oncogenic viruses including EBV, HHV-8, and HPV cause significant cancer-related morbidity and mortality. It is clear that these viruses interact with HIV in unique ways that predispose HIV-infected individuals to malignant diseases. In general, treatment directed specifically against these viruses does not appear to change the natural history of the malignant disease, and once the malignancy develops, if their health permits, HIV-infected patients should be treated using similar treatment protocols to HIV-negative patients. However, for the less frequent HIV-related malignancies, such as PEL, or MCD, optimal treatments are still emerging. For certain AIDS-defining malignancies, it is clear that the widespread access to HAART has significantly decreased the incidence, and improved outcomes. However, for other cancers, such as the HPV-related tumors, the role of HAART is much less clear. Further research into prevention and treatment of these oncogenic virally mediated AIDS-related malignancies is necessary.
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Affiliation(s)
- Anita Arora
- Center for Clinical Studies, Houston, TX, USA
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Cheung MC, Pantanowitz L, Dezube BJ. AIDS-related malignancies: emerging challenges in the era of highly active antiretroviral therapy. Oncologist 2005; 10:412-26. [PMID: 15967835 DOI: 10.1634/theoncologist.10-6-412] [Citation(s) in RCA: 121] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Human immunodeficiency virus (HIV)-infected patients are at increased risk of developing cancer, particularly in the later stages of acquired immune deficiency syndrome (AIDS). Despite the advent of highly active anti-retroviral therapy (HAART), malignancy in this population is a leading cause of morbidity and mortality. Kaposi's sarcoma (KS) and AIDS-related non-Hodgkin's lymphoma (ARL) are the most common AIDS-defining malignancies. AIDS-related KS varies from minimal to fulminant disease. Treatment decisions for AIDS-related KS are guided largely by the presence and extent of symptomatic disease. In addition to HAART, excellent treatments exist for both localized disease (topical gel, radiotherapy, and intralesional therapy) and advanced disease (liposomal anthracyclines, paclitaxel). Novel therapies that have become available to treat AIDS-related KS include angiogenesis inhibitors and antiviral agents. ARL comprises a heterogeneous group of malignancies. With the immune restoration afforded by HAART, standard-dose chemotherapies now can be safely administered to treat ARL with curative intent. The role of analogous treatments used in HIV-negative patients, including monoclonal antibodies and autologous stem cell transplantation, requires further clarification in HIV-positive patients. HIV-infected patients also appear to be at increased risk for developing certain non-AIDS-defining cancers, such as Hodgkin's lymphoma and multiple myeloma. Although the optimal treatment of these neoplasms is at present uncertain, recent advances in chemotherapy, antiretroviral drugs, and supportive care protocols are allowing for more aggressive management of many of the AIDS-related cancers. This article provides an up-to-date review of the epidemiology, pathogenesis, clinical features, and treatment of various AIDS-related malignancies that are likely to be encountered by an oncologist practicing in the current HAART era.
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MESH Headings
- Acquired Immunodeficiency Syndrome/complications
- Antiretroviral Therapy, Highly Active
- Education, Medical, Continuing
- Hodgkin Disease/drug therapy
- Hodgkin Disease/etiology
- Hodgkin Disease/pathology
- Humans
- Lymphoma, AIDS-Related/drug therapy
- Lymphoma, AIDS-Related/etiology
- Lymphoma, AIDS-Related/pathology
- Lymphoma, Non-Hodgkin/drug therapy
- Lymphoma, Non-Hodgkin/etiology
- Lymphoma, Non-Hodgkin/pathology
- Medical Oncology/trends
- Prognosis
- Risk Factors
- Sarcoma, Kaposi/drug therapy
- Sarcoma, Kaposi/etiology
- Sarcoma, Kaposi/pathology
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Affiliation(s)
- Matthew C Cheung
- Sunnybrook and Women's College Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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Affiliation(s)
- Thomas T Murooka
- University of Toronto, Department of Immunology & Toronto General Research Institute, University of Health Network, Toronto, ON
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11
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Abstract
PURPOSE OF REVIEW Kaposi sarcoma, which has reached epidemic proportions in parts of Africa and in the Western world, continues to pose a problem in patients with AIDS receiving highly active antiretroviral therapy (HAART). This article reviews the new and important information regarding the epidemiology, biology, and management of Kaposi sarcoma that was published in the last year. RECENT FINDINGS Worldwide Kaposi sarcoma herpesvirus/human herpesvirus 8 (HHV8) seropositivity has been found to exceed the incidence of Kaposi sarcoma. Therefore, investigators have justifiably implicated other cofactors (eg, blood-sucking arthropods, angiotensin converting enzyme inhibitors, hemodialysis, and iron) in the development of Kaposi sarcoma. In the transplant setting, Kaposi sarcoma lesions have been shown to originate from the engraftment of donor tumor cells. The detection of HHV8 in Kaposi sarcoma lesions has provided a new diagnostic tool to help differentiate Kaposi sarcoma from its mimics. Kaposi sarcoma lesional cells, now confirmed to be of lymphatic origin, have been shown to express several chemokine receptors, some of which may help explain the predilection for skin. Regression of Kaposi sarcoma has been characterized histologically for the first time. The finding that some tumor cells can remain in an atrophic state even in completely regressed lesions suggests that they have the potential to recur. Protease inhibitor-based and nonnucleoside reverse transcriptase inhibitor-based HAART regimens have been verified to be similarly effective. Although antiretrovirals have been noted to favorably alter the clinical characteristics of Kaposi sarcoma favorably, they seem not to alter the natural history of this disease. In the HAART era, because CD4 cell count was shown no longer to provide prognostic information about AIDS-related Kaposi sarcoma, the traditional classification system for staging AIDS-related Kaposi sarcoma has been refined. Also, a new staging system for classic Kaposi sarcoma has been proposed. SUMMARY Numerous advances have emerged regarding Kaposi sarcoma during the last year, many of which still need to be translated into clinically useful information. The results of new clinical trials involving antivirals purposely directed against HHV8 and antiretrovirals for HIV-uninfected people are anticipated. Finally, although investigators during this period did provide us with additional potential therapeutic targets, more novel approaches such as RNA interference and gene therapy have been also proposed as options in the future management of Kaposi sarcoma.
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Affiliation(s)
- Liron Pantanowitz
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215, USA
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