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Goel RR, Rook AH. Immunobiology and treatment of cutaneous T-cell lymphoma. Expert Rev Clin Immunol 2024:1-12. [PMID: 38450476 DOI: 10.1080/1744666x.2024.2326035] [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: 12/18/2023] [Accepted: 02/28/2024] [Indexed: 03/08/2024]
Abstract
INTRODUCTION Primary cutaneous T cell lymphomas (CTCL) are a heterogenous group of non-Hodgkin lymphomas derived from skin-homing T cells. These include mycosis fungoides and its leukemic variant Sezary syndrome, as well as the CD30+ lymphoproliferative disorders. AREAS COVERED In this review, we provide a summary of the current literature on CTCL, with a focus on the immunopathogenesis and treatment of mycosis fungoides and Sezary syndrome. EXPERT OPINION Recent advances in immunology have provided new insights into the biology of malignant T cells. This in turn has led to the development of new therapies that modulate the immune system to facilitate tumor clearance or target specific aspects of tumor biology.
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Affiliation(s)
- Rishi R Goel
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Institute for Immunology and Immune Health (I3H), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Alain H Rook
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Warda A, Staniszewski LJP, Sabir Z, Livingston S, Sausedo M, Reshi S, Ron E, Applegate MT, Haddad D, Khamisi M, Marshall PA, Wagner CE, Jurutka PW. Development of Bexarotene Analogs for Treating Cutaneous T-Cell Lymphomas. Cells 2023; 12:2575. [PMID: 37947652 PMCID: PMC10647404 DOI: 10.3390/cells12212575] [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: 10/04/2023] [Revised: 10/21/2023] [Accepted: 11/02/2023] [Indexed: 11/12/2023] Open
Abstract
Bexarotene, a drug approved for treatment of cutaneous T-cell lymphoma (CTCL), is classified as a rexinoid by its ability to act as a retinoid X receptor (RXR) agonist with high specificity. Rexinoids are capable of inducing RXR homodimerization leading to the induction of apoptosis and inhibition of proliferation in human cancers. Numerous studies have shown that bexarotene is effective in reducing viability and proliferation in CTCL cell lines. However, many treated patients present with cutaneous toxicity, hypothyroidism, and hyperlipidemia due to crossover activity with retinoic acid receptor (RAR), thyroid hormone receptor (TR), and liver X receptor (LXR) signaling, respectively. In this study, 10 novel analogs and three standard compounds were evaluated side-by-side with bexarotene for their ability to drive RXR homodimerization and subsequent binding to the RXR response element (RXRE). In addition, these analogs were assessed for proliferation inhibition of CTCL cells, cytotoxicity, and mutagenicity. Furthermore, the most effective analogs were analyzed via qPCR to determine efficacy in modulating expression of two critical tumor suppressor genes, ATF3 and EGR3. Our results suggest that these new compounds may possess similar or enhanced therapeutic potential since they display enhanced RXR activation with equivalent or greater reduction in CTCL cell proliferation, as well as the ability to induce ATF3 and EGR3. This work broadens our understanding of RXR-ligand relationships and permits development of possibly more efficacious pharmaceutical drugs. Modifications of RXR agonists can yield agents with enhanced biological selectivity and potency when compared to the parent compound, potentially leading to improved patient outcomes.
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Affiliation(s)
- Ankedo Warda
- School of Mathematical and Natural Sciences, Arizona State University, Glendale, AZ 85306, USA; (A.W.); (L.J.P.S.); (Z.S.); (S.L.); (M.S.); (S.R.); (M.T.A.); (D.H.); (M.K.); (P.A.M.); (C.E.W.)
- College of Medicine, University of Arizona, Phoenix, AZ 85004, USA;
| | - Lech J. P. Staniszewski
- School of Mathematical and Natural Sciences, Arizona State University, Glendale, AZ 85306, USA; (A.W.); (L.J.P.S.); (Z.S.); (S.L.); (M.S.); (S.R.); (M.T.A.); (D.H.); (M.K.); (P.A.M.); (C.E.W.)
- College of Medicine, University of Arizona, Tucson, AZ 85724, USA
| | - Zhela Sabir
- School of Mathematical and Natural Sciences, Arizona State University, Glendale, AZ 85306, USA; (A.W.); (L.J.P.S.); (Z.S.); (S.L.); (M.S.); (S.R.); (M.T.A.); (D.H.); (M.K.); (P.A.M.); (C.E.W.)
| | - Sarah Livingston
- School of Mathematical and Natural Sciences, Arizona State University, Glendale, AZ 85306, USA; (A.W.); (L.J.P.S.); (Z.S.); (S.L.); (M.S.); (S.R.); (M.T.A.); (D.H.); (M.K.); (P.A.M.); (C.E.W.)
| | - Michael Sausedo
- School of Mathematical and Natural Sciences, Arizona State University, Glendale, AZ 85306, USA; (A.W.); (L.J.P.S.); (Z.S.); (S.L.); (M.S.); (S.R.); (M.T.A.); (D.H.); (M.K.); (P.A.M.); (C.E.W.)
| | - Sabeeha Reshi
- School of Mathematical and Natural Sciences, Arizona State University, Glendale, AZ 85306, USA; (A.W.); (L.J.P.S.); (Z.S.); (S.L.); (M.S.); (S.R.); (M.T.A.); (D.H.); (M.K.); (P.A.M.); (C.E.W.)
| | - Eyal Ron
- College of Medicine, University of Arizona, Phoenix, AZ 85004, USA;
| | - Michael T. Applegate
- School of Mathematical and Natural Sciences, Arizona State University, Glendale, AZ 85306, USA; (A.W.); (L.J.P.S.); (Z.S.); (S.L.); (M.S.); (S.R.); (M.T.A.); (D.H.); (M.K.); (P.A.M.); (C.E.W.)
| | - Dena Haddad
- School of Mathematical and Natural Sciences, Arizona State University, Glendale, AZ 85306, USA; (A.W.); (L.J.P.S.); (Z.S.); (S.L.); (M.S.); (S.R.); (M.T.A.); (D.H.); (M.K.); (P.A.M.); (C.E.W.)
| | - Madleen Khamisi
- School of Mathematical and Natural Sciences, Arizona State University, Glendale, AZ 85306, USA; (A.W.); (L.J.P.S.); (Z.S.); (S.L.); (M.S.); (S.R.); (M.T.A.); (D.H.); (M.K.); (P.A.M.); (C.E.W.)
| | - Pamela A. Marshall
- School of Mathematical and Natural Sciences, Arizona State University, Glendale, AZ 85306, USA; (A.W.); (L.J.P.S.); (Z.S.); (S.L.); (M.S.); (S.R.); (M.T.A.); (D.H.); (M.K.); (P.A.M.); (C.E.W.)
| | - Carl E. Wagner
- School of Mathematical and Natural Sciences, Arizona State University, Glendale, AZ 85306, USA; (A.W.); (L.J.P.S.); (Z.S.); (S.L.); (M.S.); (S.R.); (M.T.A.); (D.H.); (M.K.); (P.A.M.); (C.E.W.)
| | - Peter W. Jurutka
- School of Mathematical and Natural Sciences, Arizona State University, Glendale, AZ 85306, USA; (A.W.); (L.J.P.S.); (Z.S.); (S.L.); (M.S.); (S.R.); (M.T.A.); (D.H.); (M.K.); (P.A.M.); (C.E.W.)
- College of Medicine, University of Arizona, Phoenix, AZ 85004, USA;
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3
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Knaneh J, Hodak E, Fedida-Metula S, Edri A, Eren R, Yoffe Y, Amitay-Laish I, Prag Naveh H, Lubin I, Porgador A, Moyal L. mAb14, a Monoclonal Antibody against Cell Surface PCNA: A Potential Tool for Sezary Syndrome Diagnosis and Targeted Immunotherapy. Cancers (Basel) 2023; 15:4421. [PMID: 37686697 PMCID: PMC10486495 DOI: 10.3390/cancers15174421] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/23/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023] Open
Abstract
Mycosis fungoides (MF) and Sézary syndrome (SS) are the most common types of primary cutaneous T-cell lymphoma (CTCL). Proliferating cell nuclear antigen (PCNA) is expressed on the cell surface of cancer cells (csPCNA), but not on normal cells. It functions as an immune checkpoint ligand by interacting with natural killer (NK) cells through the NK inhibitory receptor NKp44, leading to the inhibition of NK cytotoxicity. A monoclonal antibody (mAb14) was established to detect csPCNA on cancer cells and block their interaction with NKp44. In this study, three CTCL cell lines and peripheral blood mononuclear cells (PBMCs) from patients with SS and healthy donors were analyzed for csPCNA using mAb14, compared to monoclonal antibody PC10, against nuclear PCNA (nPCNA). The following assays were used: immunostaining, imaging flow cytometry, flow cytometry, cell sorting, cell cycle analysis, ELISA, and the NK-cell cytotoxic assay. mAb14 successfully detected PCNA on the membrane and in the cytoplasm of viable CTCL cell lines associated with the G2/M phase. In the Sézary PBMCs, csPCNA was expressed on lymphoma cells that had an atypical morphology and not on normal cells. Furthermore, it was not expressed on PBMCs from healthy donors. In the co-culture of peripheral blood NK (pNK) cells with CTCL lines, mAb14 increased the secretion of IFN-γ, indicating the reactivation of pNK activity. However, mAb14 did not enhance the cytotoxic activity of pNK cells against CTCL cell lines. The unique expression of csPCNA detected by mAb14 suggests that csPCNA and mAb14 may serve as a potential biomarker and tool, respectively, for detecting malignant cells in SS and possibly other CTCL variants.
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Affiliation(s)
- Jamal Knaneh
- Laboratory for Molecular Dermatology, Felsenstein Medical Research Center, Tel Aviv 6997801, Israel; (J.K.); (E.H.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (I.A.-L.); (H.P.N.)
| | - Emmilia Hodak
- Laboratory for Molecular Dermatology, Felsenstein Medical Research Center, Tel Aviv 6997801, Israel; (J.K.); (E.H.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (I.A.-L.); (H.P.N.)
- Davidoff Cancer Center, Rabin Medical Center, Petach Tikva 4941492, Israel
| | | | - Avishay Edri
- The Shraga Segal Department of Microbiology, Immunology and Genetics, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva 8410101, Israel; (A.E.); (A.P.)
| | - Rachel Eren
- PiNK Biopharma Ltd., Ness Ziona 7403648, Israel; (S.F.-M.); (Y.Y.)
| | - Yael Yoffe
- PiNK Biopharma Ltd., Ness Ziona 7403648, Israel; (S.F.-M.); (Y.Y.)
| | - Iris Amitay-Laish
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (I.A.-L.); (H.P.N.)
- Division of Dermatology, Rabin Medical Center, Petach Tikva 4941492, Israel
| | - Hadas Prag Naveh
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (I.A.-L.); (H.P.N.)
- Division of Dermatology, Rabin Medical Center, Petach Tikva 4941492, Israel
| | - Ido Lubin
- Core Facility, Felsenstein Medical Research Center, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
| | - Angel Porgador
- The Shraga Segal Department of Microbiology, Immunology and Genetics, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva 8410101, Israel; (A.E.); (A.P.)
- National Institute for Biotechnology in the Negev, Ben Gurion University of the Negev, Beer Sheva 8410101, Israel
| | - Lilach Moyal
- Laboratory for Molecular Dermatology, Felsenstein Medical Research Center, Tel Aviv 6997801, Israel; (J.K.); (E.H.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (I.A.-L.); (H.P.N.)
- Davidoff Cancer Center, Rabin Medical Center, Petach Tikva 4941492, Israel
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Scheffschick A, Nenonen J, Xiang M, Winther AH, Ehrström M, Wahren-Herlenius M, Eidsmo L, Brauner H. Skin infiltrating NK cells in cutaneous T-cell lymphoma are increased in number and display phenotypic alterations partially driven by the tumor. Front Immunol 2023; 14:1168684. [PMID: 37691935 PMCID: PMC10485839 DOI: 10.3389/fimmu.2023.1168684] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 07/25/2023] [Indexed: 09/12/2023] Open
Abstract
Cutaneous T-cell lymphomas (CTCL) are characterized by focal infiltration of malignant T cell clones in solitary skin lesions. Many CTCL patients experience an indolent disease, but some progress to advanced disease with high fatality. We hypothesized that natural killer (NK) cells participate in local control of tumor growth in CTCL skin. Immunohistochemistry and flow cytometry analysis of the density, localization, phenotype and function of NK cells in twenty-nine fresh or formalin-fixed skin biopsies from twenty-four CTCL patients and twenty-three biopsies from twenty healthy controls highlighted higher numbers of CD56+CD3- NK cells in CTCL skin. A reduced fraction of CTCL skin NK cells expressed the maturation marker CD57, the cytotoxic protein granzyme B and the activation marker CD69, indicating reduced tumor-killing abilities of the NK cells. Retained expression of immune checkpoint proteins or inhibitory proteins including PD1, TIM3, LAG3, CD73 and NKG2A and the activating receptors CD16 and NKp46 indicated maintained effector functions. Indeed, the capacity of NK cells to produce anti-tumor acting IFNγ upon PMA+ionomycin stimulation was similar in cells from CTCL and healthy skin. Co-cultures of primary human NK cells or the NK cell line NKL with CTCL cells resulted in reduced levels of granzyme B and CD69, indicating that close cellular interactions with CTCL cells induced the impaired functional NK cell phenotype. In conclusion, increased numbers of NK cells in CTCL skin exhibit a partially impaired phenotype in terms of activity. Enhancing NK cell activity with NK cell activating cytokines such as IL-15 or immune checkpoint blockade therefore represents a potential immunotherapeutic approach in CTCL.
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Affiliation(s)
- Andrea Scheffschick
- Division of Rheumatology, Department of Medicine, Solna and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Julia Nenonen
- Division of Rheumatology, Department of Medicine, Solna and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Mengmeng Xiang
- Division of Rheumatology, Department of Medicine, Solna and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anna H. Winther
- Division of Rheumatology, Department of Medicine, Solna and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Dermatology, Karolinska University Hospital, Stockholm, Sweden
| | - Marcus Ehrström
- Department of Reconstructive Plastic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Marie Wahren-Herlenius
- Division of Rheumatology, Department of Medicine, Solna and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
- The Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Liv Eidsmo
- Division of Rheumatology, Department of Medicine, Solna and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
- LEO Foundation Skin Immunology Research Center, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Hanna Brauner
- Division of Rheumatology, Department of Medicine, Solna and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Dermatology, Karolinska University Hospital, Stockholm, Sweden
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5
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Imbalanced IL-1B and IL-18 Expression in Sézary Syndrome. Int J Mol Sci 2023; 24:ijms24054674. [PMID: 36902104 PMCID: PMC10003479 DOI: 10.3390/ijms24054674] [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: 01/27/2023] [Revised: 02/20/2023] [Accepted: 02/24/2023] [Indexed: 03/04/2023] Open
Abstract
Sézary syndrome (SS) is a rare and aggressive type of cutaneous T-cell lymphoma, with an abnormal inflammatory response in affected skin. The cytokines IL-1B and IL-18, as key signaling molecules in the immune system, are produced in an inactive form and cleave to the active form by inflammasomes. In this study, we assessed the skin, serum, peripheral mononuclear blood cell (PBMC) and lymph-node samples of SS patients and control groups (healthy donors (HDs) and idiopathic erythroderma (IE) nodes) to investigate the inflammatory markers IL-1B and IL-18 at the protein and transcript expression levels, as potential markers of inflammasome activation. Our findings showed increased IL-1B and decreased IL-18 protein expression in the epidermis of SS patients; however, in the dermis layer, we detected increased IL-18 protein expression. In the lymph nodes of SS patients at advanced stages of the disease (N2/N3), we also detected an enhancement of IL-18 and a downregulation of IL-1B at the protein level. Moreover, the transcriptomic analysis of the SS and IE nodes confirmed the decreased expression of IL1B and NLRP3, whereas the pathway analysis indicated a further downregulation of IL1B-associated genes. Overall, the present findings showed compartmentalized expressions of IL-1B and IL-18 and provided the first evidence of their imbalance in patients with Sézary syndrome.
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Cayrol F, Revuelta MV, Debernardi M, Paulazo A, Phillip JM, Zamponi N, Sterle HA, Díaz Flaqué MC, Magro CM, Marullo R, Mulvey E, Ruan J, Cremaschi GA, Cerchietti L. Inhibition of integrin αVβ3 signaling improves the antineoplastic effect of bexarotene in cutaneous T-cell lymphoma. Mol Cancer Ther 2022; 21:1485-1496. [PMID: 35793463 DOI: 10.1158/1535-7163.mct-22-0093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/18/2022] [Accepted: 06/28/2022] [Indexed: 11/16/2022]
Abstract
Bexarotene is a specific RXR agonist that has been used for the treatment of cutaneous T-cell lymphoma (CTCL). Since bexarotene causes hypothyroidism, it requires the administration of levothyroxine. However, levothyroxine, in addition to its ubiquitous nuclear receptors, can activate the αVβ3 integrin that is overexpressed in CTCL, potentially interfering the antineoplastic effect of bexarotene. We thus investigated the biological effect of levothyroxine in relation to bexarotene treatment. Although in isolated CTCL cells levothyroxine decreased, in an αVβ3 -dependent manner, the antineoplastic effect of bexarotene; levothyroxine supplementation in pre-clinical models was necessary to avoid suppression of lymphoma immunity. Accordingly, selective genetic and pharmacologic inhibition of integrin αVβ3 3 improved the antineoplastic effect of bexarotene plus levothyroxine replacement while maintaining lymphoma immunity. Our results provide a mechanistic rationale for clinical testing of integrin αVβ3 inhibitors as part of CTCL regimens based on bexarotene administration.
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Affiliation(s)
- Florencia Cayrol
- Instituto de Investigaciones Biomédicas (BIOMED)- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET)- Universidad Católica Argentina (UCA), Buenos Aires, Argentina
| | | | - Mercedes Debernardi
- Instituto de Investigaciones Biomédicas (BIOMED)- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET)- Universidad Católica Argentina (UCA), Buenos Aires, CABA, Argentina
| | - Alejandra Paulazo
- Instituto de Investigaciones Biomédicas (BIOMED)- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET)- Universidad Católica Argentina (UCA), Buenos Aires, Argentina
| | - Jude M Phillip
- Johns Hopkins University, Baltimore, Maryland, United States
| | - Nahuel Zamponi
- Weill Cornell Medical College and New York Presbyterian Hospital, New York, New York, United States
| | - Helena A Sterle
- Instituto de Investigaciones Biomédicas (BIOMED)- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET)- Universidad Católica Argentina (UCA), Buenos Aires, Argentina
| | - Maria C Díaz Flaqué
- Instituto de Investigaciones Biomédicas (BIOMED)- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET)- Universidad Católica Argentina (UCA), Buenos Aires, Argentina
| | - Cynthia M Magro
- Weill Medical College of Cornell University, New York, New York, United States
| | | | - Erin Mulvey
- Weill Cornell Medical College and New York Presbyterian Hospital, New York, New York, United States
| | - Jia Ruan
- Weill Cornell Medicine, New York, New York, United States
| | - Graciela A Cremaschi
- Instituto de Investigaciones Biomédicas (BIOMED)- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET)- Universidad Católica Argentina (UCA), Buenos Aires, Argentina
| | - Leandro Cerchietti
- Weill Cornell Medical College and New York Presbyterian Hospital, New York, New York, United States
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The Role of Tumor Microenvironment in the Pathogenesis of Sézary Syndrome. Int J Mol Sci 2022; 23:ijms23020936. [PMID: 35055124 PMCID: PMC8781892 DOI: 10.3390/ijms23020936] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 12/11/2021] [Accepted: 12/19/2021] [Indexed: 02/05/2023] Open
Abstract
Sézary syndrome is an aggressive leukemic variant of cutaneous T-cell lymphomas, characterized by erythroderma, lymphadenopathy, and peripheral blood involvement by CD4+ malignant T-cells. The pathogenesis of Sézary syndrome is not fully understood. However, the course of the disease is strongly influenced by the tumor microenvironment, which is altered by a combination of cytokines, chemokines, and growth factors. The crosstalk between malignant and reactive cells affects the immunologic response against tumor cells causing immune dysregulation. This review focuses on the interaction of malignant Sézary cells and the tumor microenvironment.
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8
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Durgin JS, Weiner DM, Wysocka M, Rook AH. The immunopathogenesis and immunotherapy of cutaneous T cell lymphoma: Pathways and targets for immune restoration and tumor eradication. J Am Acad Dermatol 2020; 84:587-595. [PMID: 33352267 DOI: 10.1016/j.jaad.2020.12.027] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 12/07/2020] [Accepted: 12/09/2020] [Indexed: 11/27/2022]
Abstract
Cutaneous T cell lymphomas (CTCLs) are malignancies of skin-trafficking T cells. Patients with advanced CTCL manifest immune dysfunction that predisposes to infection and suppresses the antitumor immune response. Therapies that stimulate immunity have produced superior progression-free survival compared with conventional chemotherapy, reinforcing the importance of addressing the immune deficient state in the care of patients with CTCL. Recent research has better defined the pathogenesis of these immune deficits, explaining the mechanisms of disease progression and revealing potential therapeutic targets. The features of the malignant cell in mycosis fungoides and Sézary syndrome are now significantly better understood, including the T helper 2 cell phenotype, regulatory T cell cytokine production, immune checkpoint molecule expression, chemokine receptors, and interactions with the microenvironment. The updated model of CTCL immunopathogenesis provides understanding into clinical progression and therapeutic response.
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Affiliation(s)
- Joseph S Durgin
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - David M Weiner
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Maria Wysocka
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alain H Rook
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
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9
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Bobrowicz M, Fassnacht C, Ignatova D, Chang YT, Dimitriou F, Guenova E. Pathogenesis and Therapy of Primary Cutaneous T-Cell Lymphoma: Collegium Internationale Allergologicum (CIA) Update 2020. Int Arch Allergy Immunol 2020; 181:733-745. [PMID: 32690848 DOI: 10.1159/000509281] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 05/29/2020] [Indexed: 11/19/2022] Open
Abstract
Cutaneous T-cell lymphoma (CTCL) is a heterogeneous disease group of unknown etiology with a complex immunological background. As CTCL arises from T cells that have a vital role in the antitumor response, their therapy is largely aimed at reversing the immunological mechanisms leading to or manifesting during this malignancy. Early disease stages can be controlled with skin-directed therapy in most CTCL cases. Still, advanced CTCL has a dismal prognosis and warrants systemic therapy. Despite considerable progress in understanding the pathophysiology of the disease and the numerous systemic treatment options available, long-term remission rates with conventional treatments alone are still low. Allogeneic hematopoietic stem cell transplantation is currently the only curative option for advanced CTCL, including mycosis fungoides and Sézary syndrome. The aims of this review is to summarize the recent findings on the immunology of this heterogeneous disease and to present the advances in its clinical management.
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Affiliation(s)
| | - Christina Fassnacht
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Desislava Ignatova
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Yun-Tsan Chang
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland.,Department of Dermatology, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Florentia Dimitriou
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Emmanuella Guenova
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland, .,Faculty of Medicine, University of Zurich, Zurich, Switzerland, .,Department of Dermatology, Lausanne University Hospital (CHUV), Lausanne, Switzerland, .,Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland,
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10
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Willerslev-Olsen A, Buus TB, Nastasi C, Blümel E, Gluud M, Bonefeld CM, Geisler C, Lindahl LM, Vermeer M, Wasik MA, Iversen L, Becker JC, Andersen MH, Gjerdrum LMR, Litvinov IV, Litman T, Krejsgaard T, Woetmann A, Ødum N. Staphylococcus aureus enterotoxins induce FOXP3 in neoplastic T cells in Sézary syndrome. Blood Cancer J 2020; 10:57. [PMID: 32409671 PMCID: PMC7225173 DOI: 10.1038/s41408-020-0324-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 01/28/2020] [Accepted: 02/04/2020] [Indexed: 12/21/2022] Open
Abstract
Sézary syndrome (SS) is a heterogeneous leukemic subtype of cutaneous T-cell lymphoma (CTCL) with generalized erythroderma, lymphadenopathy, and a poor prognosis. Advanced disease is invariably associated with severe immune dysregulation and the majority of patients die from infectious complications caused by microorganisms such as, Staphylococcus aureus, rather than from the lymphoma per se. Here, we examined if staphylococcal enterotoxins (SE) may shape the phenotype of malignant SS cells, including expression of the regulatory T-cell-associated marker FOXP3. Our studies with primary and cultured malignant cells show that SE induce expression of FOXP3 in malignant cells when exposed to nonmalignant cells. Mutations in the MHC class II binding domain of SE-A (SEA) largely block the effect indicating that the response relies at least in part on the MHC class II-mediated antigen presentation. Transwell experiments show that the effect is induced by soluble factors, partly blocked by anti-IL-2 antibody, and depends on STAT5 activation in malignant cells. Collectively, these findings show that SE stimulate nonmalignant cells to induce FOXP3 expression in malignant cells. Thus, differences in exposure to environmental factors, such as bacterial toxins may explain the heterogeneous FOXP3 expression in malignant cells in SS.
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Affiliation(s)
- Andreas Willerslev-Olsen
- Department of Immunology and Microbiology; LEO Foundation Skin Immunology Research Center, University of Copenhagen, Copenhagen, Denmark
| | - Terkild B Buus
- Department of Immunology and Microbiology; LEO Foundation Skin Immunology Research Center, University of Copenhagen, Copenhagen, Denmark
| | - Claudia Nastasi
- Department of Immunology and Microbiology; LEO Foundation Skin Immunology Research Center, University of Copenhagen, Copenhagen, Denmark
| | - Edda Blümel
- Department of Immunology and Microbiology; LEO Foundation Skin Immunology Research Center, University of Copenhagen, Copenhagen, Denmark
| | - Maria Gluud
- Department of Immunology and Microbiology; LEO Foundation Skin Immunology Research Center, University of Copenhagen, Copenhagen, Denmark
| | - Charlotte M Bonefeld
- Department of Immunology and Microbiology; LEO Foundation Skin Immunology Research Center, University of Copenhagen, Copenhagen, Denmark
| | - Carsten Geisler
- Department of Immunology and Microbiology; LEO Foundation Skin Immunology Research Center, University of Copenhagen, Copenhagen, Denmark
| | - Lise M Lindahl
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - Maarten Vermeer
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Mariusz A Wasik
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Lars Iversen
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - Jürgen C Becker
- Department of Translational Skin Cancer Research, German Cancer Consortium (DKTK), University Hospital of Essen, Essen, Germany.,Deutsches Krebsforschungsinstitut (DKFZ), Heidelberg, Germany
| | - Mads Hald Andersen
- Center for Cancer Immune Therapy, Department of Hematology, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - Lise M R Gjerdrum
- Department of Pathology, Zealand University Hospital, Roskilde, Denmark
| | - Ivan V Litvinov
- Division of Dermatology, McGill University Health Centre, Montreal, QC, Canada
| | - Thomas Litman
- Department of Immunology and Microbiology; LEO Foundation Skin Immunology Research Center, University of Copenhagen, Copenhagen, Denmark
| | - Thorbjørn Krejsgaard
- Department of Immunology and Microbiology; LEO Foundation Skin Immunology Research Center, University of Copenhagen, Copenhagen, Denmark
| | - Anders Woetmann
- Department of Immunology and Microbiology; LEO Foundation Skin Immunology Research Center, University of Copenhagen, Copenhagen, Denmark
| | - Niels Ødum
- Department of Immunology and Microbiology; LEO Foundation Skin Immunology Research Center, University of Copenhagen, Copenhagen, Denmark.
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11
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Sivanand A, Surmanowicz P, Alhusayen R, Hull P, Litvinov IV, Zhou Y, Gniadecki R. Immunotherapy for Cutaneous T-Cell Lymphoma: Current Landscape and Future Developments. J Cutan Med Surg 2019; 23:537-544. [PMID: 31353944 DOI: 10.1177/1203475419867610] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Mycosis fungoides (MF) and Sézary syndrome (SS) are chronic, progressive primary cutaneous T-cell lymphomas (CTCLs) for which there are no curative treatments. Skin-directed therapies, such as phototherapy, radiation therapy, or topical nitrogen mustard, provide only short-term remissions. Numerous attempts with different chemotherapeutic regimes failed to achieve meaningful clinical responses. Immunotherapy seems to be a promising avenue to achieve long-term disease control in CTCL. There is compelling evidence indicating that MF and SS are immunogenic lymphomas, which can be recognized by the patient's immune system. However, CTCL uses different strategies to impair host's immunity, eg, via repolarizing the T-cell differentiation from type I to type II, recruiting immunosuppressive regulatory T-cells, and limiting the repertoire of lymphocytes in the circulation. Many currently used therapies, such as interferon-α, imiquimod, extracorporeal phototherapy, and allogeneic bone marrow transplant, seem to exert their therapeutic effect via activation of the antitumor cytotoxic response and reconstitution of the host's immune system. It is likely that novel immunotherapies such as immune checkpoint inhibitors, cancer vaccines, and chimeric antigen receptor-T cells will help to manage CTCL more efficiently. We also discuss how current genomic techniques, such as estimating the mutational load by whole genome sequencing and neoantigen calling, are likely to provide clinically useful information facilitating personalized immunotherapy of CTCL.
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Affiliation(s)
- Arunima Sivanand
- 1 Division of Dermatology, University of Alberta, Edmonton, AB, Canada
| | | | - Raed Alhusayen
- 2 Division of Dermatology, University of Toronto, ON, Canada
| | - Peter Hull
- 3 Division of Clinical Dermatology and Cutaneous Science, Dalhousie University, Halifax, NS, Canada
| | - Ivan V Litvinov
- 4 Division of Dermatology, McGill University, Montreal, QC, Canada
| | - Youwen Zhou
- 5 Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
| | - Robert Gniadecki
- 1 Division of Dermatology, University of Alberta, Edmonton, AB, Canada
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12
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Highly cytotoxic natural killer cells are associated with poor prognosis in patients with cutaneous T-cell lymphoma. Blood Adv 2019; 2:1818-1827. [PMID: 30054309 DOI: 10.1182/bloodadvances.2018020388] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 06/19/2018] [Indexed: 12/23/2022] Open
Abstract
Key Points
Paradoxically higher NK-cell activity in CTCL patients is associated with increased expression of phosphorylated STAT5. These highly effective NK cells are associated with poor prognosis in patients with leukemic CTCL.
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13
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Lefrançois P, Xie P, Wang L, Tetzlaff MT, Moreau L, Watters AK, Netchiporouk E, Provost N, Gilbert M, Ni X, Sasseville D, Wheeler DA, Duvic M, Litvinov IV. Gene expression profiling and immune cell-type deconvolution highlight robust disease progression and survival markers in multiple cohorts of CTCL patients. Oncoimmunology 2018; 7:e1467856. [PMID: 30221071 DOI: 10.1080/2162402x.2018.1467856] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 04/14/2018] [Accepted: 04/16/2018] [Indexed: 02/01/2023] Open
Abstract
CTCL follows different courses depending on the clinical stage at the time of diagnosis. Patients with early stage Mycosis Fungoides (MF) variant of CTCL may experience an indolent course over decades, whereas patients with advanced MF and Sézary Syndrome (SS) disease at diagnosis, often succumb within 5 years. Even within early stage CTCL/MF, a minority of patients will progress to more advanced stages. We recently generated RNA sequencing data on 284 CTCL-relevant genes for 157 patients and identified differentially expressed genes across stages I-IV. In this study, we aim to validate robust molecular markers linked to disease progression and survival. We performed multiple hypothesis testing-corrected analysis of variance (ANOVA) on the expression of individual genes across all CTCL samples and early stage (≤IIA) CTCL/MF patients. We used in silico immune cell-type deconvolution from gene expression data to estimate immune cell populations. Based on the analysis of all CTCL samples, we identified TOX, FYB, and CD52 as predictors of disease progression and poor survival. Among early stage (≤IIA) CTCL/MF patients, these 3 genes, along with CCR4, were valuable to predict disease progression. We validated these 4 genes in 3 independent, external Sézary Syndrome patient cohorts with RNA-Sequencing data. In silico immune cell-type deconvolution revealed that neutrophil infiltration in early stage MF conveyed a higher risk for disease progression. Also, NK cell infiltration in late stage MF/SS correlated with improved survival. TOX, FYB, CCR4 and CD52 are robust disease progression and decreased survival biomarkers in CTCL.
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Affiliation(s)
- Philippe Lefrançois
- Division of Dermatology, McGill University Health Centre, Montreal, QC, Canada
| | - Pingxing Xie
- Division of Dermatology, McGill University Health Centre, Montreal, QC, Canada
| | - Linghua Wang
- Human Genome Sequencing Center, Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Michael T Tetzlaff
- Department of Pathology, Section of Dermatopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Linda Moreau
- Division of Dermatology, McGill University Health Centre, Montreal, QC, Canada
| | - Andrew K Watters
- Department of Pathology, McGill University Health Centre, Montreal, QC, Canada
| | - Elena Netchiporouk
- Division of Dermatology, McGill University Health Centre, Montreal, QC, Canada
| | - Nathalie Provost
- Division of Dermatology, Université de Montréal, Montréal, QC, Canada
| | - Martin Gilbert
- Division of Dermatology, Université Laval, Québec, QC, Canada
| | - Xiao Ni
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Denis Sasseville
- Division of Dermatology, McGill University Health Centre, Montreal, QC, Canada
| | - David A Wheeler
- Human Genome Sequencing Center, Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Madeleine Duvic
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ivan V Litvinov
- Division of Dermatology, McGill University Health Centre, Montreal, QC, Canada.,Division of Dermatology, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
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14
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Kwatra S, Boozalis E, Kwatra M. Effects of neuroimmune axis modulation by aprepitant on antipruritic and global disease severity in patients with cutaneous T-cell lymphoma. Br J Dermatol 2018; 178:1221-1222. [DOI: 10.1111/bjd.16363] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- S.G. Kwatra
- Department of Dermatology; Johns Hopkins University School of Medicine; 1550 Orleans Street Baltimore MD 21231 U.S.A
| | - E. Boozalis
- Department of Dermatology; Johns Hopkins University School of Medicine; 1550 Orleans Street Baltimore MD 21231 U.S.A
| | - M.M. Kwatra
- Department of Anesthesiology; Duke University Medical Center; Durham NC U.S.A
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15
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Torrealba MP, Manfrere KC, Miyashiro DR, Lima JF, de M Oliveira L, Pereira NZ, Cury-Martins J, Pereira J, Duarte AJS, Sato MN, Sanches JA. Chronic activation profile of circulating CD8+ T cells in Sézary syndrome. Oncotarget 2017; 9:3497-3506. [PMID: 29423061 PMCID: PMC5790478 DOI: 10.18632/oncotarget.23334] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 12/01/2017] [Indexed: 12/13/2022] Open
Abstract
Sézary syndrome (SS) is a leukemic variant of cutaneous T cell lymphoma (CTCL), and the neoplastic CD4+ T cells of SS patients undergo intense clonal proliferation. Although Sézary cells have been studied extensively, studies on adaptive immunity regarding CD8+T cells are scarce. This study aimed to investigate activation marker expression in CD8+ T cells according to the differentiation stages and IL-7/IL7Rα axis responses of patients with SS. Moreover, this study aimed to verify the soluble forms of CD38, sCD127 and IL-7 in serum. Although the SS patients of our cohort had reduced numbers of CD8+ T cells, they exhibited higher percentages of CD8+CD38+ T cells, mainly effector/memory CD8+ T cells, than the control group. In contrast, down-regulated expression of the activation markers CD127/IL-7R and CD26 was found in the CD8+ T cells of SS patients. High serum levels of sCD38 and sCD127 and scarce serum levels of IL-7 were detected, emphasizing the immune activation status of SS patients. Moreover, CD8+ T cells from SS patients exhibited IL-7 unresponsiveness to STAT5 phosphorylation and Bcl-2 expression, and IL-7 priming partially restored IFNγ production. Our findings showed a chronic activation profile of CD8+ T cells, as an attenuated cytotoxic profile and impaired IL-7 responsiveness was observed, suggesting chronic activation status of CD8+ T cells in SS patients.
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Affiliation(s)
- Marina Passos Torrealba
- Medical Investigation Laboratory (LIM-56), Tropical Medicine Institute of São Paulo, Department of Dermatology, University of São Paulo Medical School, São Paulo, Brazil
| | - Kelly Cristina Manfrere
- Medical Investigation Laboratory (LIM-56), Tropical Medicine Institute of São Paulo, Department of Dermatology, University of São Paulo Medical School, São Paulo, Brazil
| | - Denis R Miyashiro
- Cutaneous Lymphoma Clinic, Hospital das Clinicas, Department of Dermatology, University of São Paulo Medical School, São Paulo, Brazil
| | - Josenilson F Lima
- Medical Investigation Laboratory (LIM-56), Tropical Medicine Institute of São Paulo, Department of Dermatology, University of São Paulo Medical School, São Paulo, Brazil
| | - Luana de M Oliveira
- Medical Investigation Laboratory (LIM-56), Tropical Medicine Institute of São Paulo, Department of Dermatology, University of São Paulo Medical School, São Paulo, Brazil
| | - Nátalli Z Pereira
- Medical Investigation Laboratory (LIM-56), Tropical Medicine Institute of São Paulo, Department of Dermatology, University of São Paulo Medical School, São Paulo, Brazil
| | - Jade Cury-Martins
- Cutaneous Lymphoma Clinic, Hospital das Clinicas, Department of Dermatology, University of São Paulo Medical School, São Paulo, Brazil
| | - Juliana Pereira
- Hematology Department, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Alberto J S Duarte
- Medical Investigation Laboratory (LIM-56), Tropical Medicine Institute of São Paulo, Department of Dermatology, University of São Paulo Medical School, São Paulo, Brazil
| | - Maria N Sato
- Medical Investigation Laboratory (LIM-56), Tropical Medicine Institute of São Paulo, Department of Dermatology, University of São Paulo Medical School, São Paulo, Brazil
| | - José A Sanches
- Cutaneous Lymphoma Clinic, Hospital das Clinicas, Department of Dermatology, University of São Paulo Medical School, São Paulo, Brazil
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16
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ManfrereC KCG, Torrealba MP, Miyashiro DR, Pereira NZ, Yoshikawa FSY, de M Oliveira L, Cury-Martins J, Duarte AJS, Sanches JA, Sato MN. Profile of differentially expressed Toll-like receptor signaling genes in the natural killer cells of patients with Sézary syndrome. Oncotarget 2017; 8:92183-92194. [PMID: 29190907 PMCID: PMC5696173 DOI: 10.18632/oncotarget.21006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 08/27/2017] [Indexed: 11/25/2022] Open
Abstract
Sézary syndrome (SS), an aggressive and leukemic form of cutaneous T-cell lymphoma, usually results in shortened survival. Improving innate immunity in SS by targeting natural killer (NK) cells with Toll-like receptor (TLR) agonists could be an interesting modulatory strategy. We evaluated the NK cell populations in SS patients assessing activating and inhibitory receptors expression and profiled the differential expression of TLR signaling pathway genes in unstimulated NK cells and after TLR7/8 stimulation. We observed preserved CD56bright NK cells and a low percentage of CD56dim NK cells in the peripheral blood of SS patients compared to those in the healthy control group. Both NK cell populations showed down-modulation of NKG2C and NKG2D expression, which was associated with high serum levels of the soluble form of NKG2D ligands. In contrast, an expansion of “memory” CD57+ NKG2C+ NK cells and high cytomegalovirus antibody titers were detected in SS patients. Profiling of the TLR signaling genes in NK cells from SS patients showed an abundance of differentially expressed genes (DEGs) in NK cells in the unstimulated condition, with mostly up-regulation of NFκB/JNK p38 pathway genes, but there was down-regulation of type I (IFN-α/β) and II (IFN-γ) interferon and IL-12A. After activation of NK cells with TLR7/8 agonist, the down-regulated genes correlated with the IFN response, and IL-12 became up-regulated, together with other antitumor factors. NK cell activation with a dual agonist for TLR7 and TLR8 is able to induce the expression of IFN-γ and type I IFN, which can improve immunity in SS patients.
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Affiliation(s)
- Kelly C G ManfrereC
- Laboratory of Medical Investigation, LIM-56, Department of Dermatology, Tropical Medicine Institute of São Paulo, University of São Paulo Medical School, São Paulo, Brazil
| | - Marina P Torrealba
- Laboratory of Medical Investigation, LIM-56, Department of Dermatology, Tropical Medicine Institute of São Paulo, University of São Paulo Medical School, São Paulo, Brazil
| | - Denis R Miyashiro
- Cutaneous Lymphoma Clinic, Hospital das Clínicas, Department of Dermatology, University of São Paulo Medical School, São Paulo, Brazil
| | - Nátalli Z Pereira
- Laboratory of Medical Investigation, LIM-56, Department of Dermatology, Tropical Medicine Institute of São Paulo, University of São Paulo Medical School, São Paulo, Brazil
| | - Fabio S Y Yoshikawa
- Laboratory of Medical Investigation, LIM-56, Department of Dermatology, Tropical Medicine Institute of São Paulo, University of São Paulo Medical School, São Paulo, Brazil
| | - Luana de M Oliveira
- Laboratory of Medical Investigation, LIM-56, Department of Dermatology, Tropical Medicine Institute of São Paulo, University of São Paulo Medical School, São Paulo, Brazil
| | - Jade Cury-Martins
- Cutaneous Lymphoma Clinic, Hospital das Clínicas, Department of Dermatology, University of São Paulo Medical School, São Paulo, Brazil
| | - Alberto J S Duarte
- Laboratory of Medical Investigation, LIM-56, Department of Dermatology, Tropical Medicine Institute of São Paulo, University of São Paulo Medical School, São Paulo, Brazil
| | - José A Sanches
- Cutaneous Lymphoma Clinic, Hospital das Clínicas, Department of Dermatology, University of São Paulo Medical School, São Paulo, Brazil
| | - Maria N Sato
- Laboratory of Medical Investigation, LIM-56, Department of Dermatology, Tropical Medicine Institute of São Paulo, University of São Paulo Medical School, São Paulo, Brazil
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17
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Wilcox RA. Cutaneous T-cell lymphoma: 2017 update on diagnosis, risk-stratification, and management. Am J Hematol 2017; 92:1085-1102. [PMID: 28872191 DOI: 10.1002/ajh.24876] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 07/27/2017] [Indexed: 12/12/2022]
Abstract
DISEASE OVERVIEW Cutaneous T-cell lymphomas are a heterogenous group of T-cell lymphoproliferative disorders involving the skin, the majority of which may be classified as Mycosis Fungoides (MF) or Sézary Syndrome (SS). DIAGNOSIS The diagnosis of MF or SS requires the integration of clinical and histopathologic data. RISK-ADAPTED THERAPY TNMB (tumor, node, metastasis, blood) staging remains the most important prognostic factor in MF/SS and forms the basis for a "risk-adapted," multi-disciplinary approach to treatment. For patients with disease limited to the skin, expectant management or skin-directed therapies is preferred, as both disease-specific and overall survival for these patients is favorable. In contrast, patients with advanced-stage disease with significant nodal, visceral or blood involvement are generally approached with biologic-response modifiers or histone deacetylase inhibitors prior to escalating therapy to include systemic, single-agent chemotherapy. In highly-selected patients, allogeneic stem-cell transplantation may be considered, as this may be curative in some patients.
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Affiliation(s)
- Ryan A. Wilcox
- Division of Hematology/Oncology; University of Michigan Comprehensive Cancer Center; Ann Arbor Michigan 48109-5948
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18
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Malignant inflammation in cutaneous T-cell lymphoma-a hostile takeover. Semin Immunopathol 2016; 39:269-282. [PMID: 27717961 PMCID: PMC5368200 DOI: 10.1007/s00281-016-0594-9] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 09/14/2016] [Indexed: 01/05/2023]
Abstract
Cutaneous T-cell lymphomas (CTCL) are characterized by the presence of chronically inflamed skin lesions containing malignant T cells. Early disease presents as limited skin patches or plaques and exhibits an indolent behavior. For many patients, the disease never progresses beyond this stage, but in approximately one third of patients, the disease becomes progressive, and the skin lesions start to expand and evolve. Eventually, overt tumors develop and the malignant T cells may disseminate to the blood, lymph nodes, bone marrow, and visceral organs, often with a fatal outcome. The transition from early indolent to progressive and advanced disease is accompanied by a significant shift in the nature of the tumor-associated inflammation. This shift does not appear to be an epiphenomenon but rather a critical step in disease progression. Emerging evidence supports that the malignant T cells take control of the inflammatory environment, suppressing cellular immunity and anti-tumor responses while promoting a chronic inflammatory milieu that fuels their own expansion. Here, we review the inflammatory changes associated with disease progression in CTCL and point to their wider relevance in other cancer contexts. We further define the term "malignant inflammation" as a pro-tumorigenic inflammatory environment orchestrated by the tumor cells and discuss some of the mechanisms driving the development of malignant inflammation in CTCL.
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20
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Wilcox RA. Cutaneous T-cell lymphoma: 2016 update on diagnosis, risk-stratification, and management. Am J Hematol 2016; 91:151-65. [PMID: 26607183 PMCID: PMC4715621 DOI: 10.1002/ajh.24233] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 11/03/2015] [Indexed: 12/11/2022]
Abstract
DISEASE OVERVIEW Cutaneous T-cell lymphomas are a heterogenous group of T-cell lymphoproliferative disorders involving the skin, the majority of which may be classified as Mycosis Fungoides (MF) or Sézary Syndrome (SS). DIAGNOSIS The diagnosis of MF or SS requires the integration of clinical and histopathologic data. RISK-ADAPTED THERAPY TNMB (tumor, node, metastasis, blood) staging remains the most important prognostic factor in MF/SS and forms the basis for a "risk-adapted," multidisciplinary approach to treatment. For patients with disease limited to the skin, expectant management or skin-directed therapies is preferred, as both disease-specific and overall survival for these patients is favorable. In contrast, patients with advanced-stage disease with significant nodal, visceral, or blood involvement are generally approached with biologic-response modifiers or histone deacetylase inhibitors before escalating therapy to include systemic, single-agent chemotherapy. In highly-selected patients, allogeneic stem-cell transplantation may be considered, as this may be curative in some patients.
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Affiliation(s)
- Ryan A. Wilcox
- Division of Hematology/Oncology, University of Michigan Cancer Center, 1500 E. Medical Center Drive, Room 4310 CC, Ann Arbor, MI 48109-5948
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21
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CD158k Is a Reliable Marker for Diagnosis of Sézary Syndrome and Reveals an Unprecedented Heterogeneity of Circulating Malignant Cells. J Invest Dermatol 2015; 135:247-257. [DOI: 10.1038/jid.2014.356] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 07/28/2014] [Accepted: 08/06/2014] [Indexed: 01/11/2023]
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22
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de Masson A, Guitera P, Brice P, Moulonguet I, Mouly F, Bouaziz JD, Battistella M, Madelaine I, Roux J, Ram-Wolff C, Cayuela JM, Bachelez H, Bensussan A, Michel L, Bagot M. Long-term efficacy and safety of alemtuzumab in advanced primary cutaneous T-cell lymphomas. Br J Dermatol 2014; 170:720-4. [PMID: 24438061 DOI: 10.1111/bjd.12690] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Alemtuzumab has been proposed as salvage therapy for refractory cutaneous T-cell lymphomas (CTCLs). Long-term follow-up data are scarce. OBJECTIVES To assess the efficacy and safety of alemtuzumab in the treatment of advanced CTCL. METHODS A multicentre retrospective analysis was carried out of 39 patients with advanced CTCL treated with alemtuzumab between 2003 and 2013. RESULTS Thirty-nine patients (median age 62 years, range 20-83) with Sézary syndrome (SS, n = 23) or advanced mycosis fungoides (MF, n = 16) received alemtuzumab 30 mg two to three times per week for a median duration of 12 weeks (range 1-35). Fifteen patients received maintenance therapy for a median duration of 24 weeks (range 6-277). Eleven patients (28%) had transformed disease (MF, n = 10; SS, n = 1). After a median follow-up of 24 months (range 0.3-124), eight patients (21%) were still alive. The overall response rate was 51% in the whole study group (partial response, n = 13; complete response, n = 7); 70% in patients with SS and 25% in patients with MF (P = 0.009). The median time to progression was 3.4 months (range 0.4-42). Six patients (15%; SS, n = 5; MF, n = 1) remained progression free for > 2 years (median 56 months, range 28-117). Five patients experienced cutaneous large T-cell transformation during alemtuzumab treatment and one patient developed primary cutaneous large B-cell lymphoma. Twenty-four patients (62%) had a grade three or higher infectious adverse event and 10 (26%) a haematological toxicity, which led to treatment discontinuation in 17 cases (44%) and death in two (5%). CONCLUSIONS Alemtuzumab may induce long-term remission in SS but seems ineffective in MF and transformed CTCL.
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Affiliation(s)
- A de Masson
- Service de Dermatologie, AP-HP, Hôpital Saint-Louis, 1 Avenue Claude Vellefaux, 75010 Paris, France; INSERM UMR-S976, 'Immunologie, Dermatologie, Oncologie', Université Paris VII, 1 Avenue Claude Vellefaux, 75010 Paris, France
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Wilcox RA. Cutaneous T-cell lymphoma: 2014 update on diagnosis, risk-stratification, and management. Am J Hematol 2014; 89:837-51. [PMID: 25042790 DOI: 10.1002/ajh.23756] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 04/29/2014] [Indexed: 12/12/2022]
Abstract
DISEASE OVERVIEW Cutaneous T-cell lymphomas are a heterogenous group of T-cell lymphoproliferative disorders involving the skin, the majority of which may be classified as Mycosis Fungoides (MF) or Sézary Syndrome (SS). DIAGNOSIS The diagnosis of MF or SS requires the integration of clinical and histopathologic data. RISK-ADAPTED THERAPY TNMB (tumor, node, metastasis, and blood) staging remains the most important prognostic factor in MF/SS and forms the basis for a "risk-adapted," multidisciplinary approach to treatment. For patients with disease limited to the skin, expectant management or skin-directed therapies is preferred, as both disease-specific and overall survival for these patients is favorable. In contrast, patients with advanced-stage disease with significant nodal, visceral or blood involvement are generally approached with biologic-response modifiers or histone deacetylase inhibitors prior to escalating therapy to include systemic, single-agent chemotherapy. Multiagent chemotherapy (e.g., CHOP) may be employed for those patients with extensive visceral involvement requiring rapid disease control. In highly selected patients, allogeneic stem-cell transplantation may be considered.
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Affiliation(s)
- Ryan A. Wilcox
- Division of Hematology/Oncology; University of Michigan Cancer Center; Ann Arbor Michigan
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Abstract
Patients with cutaneous T-cell lymphoma (CTCL) are frequently colonized with Staphylococcus aureus (SA). Eradication of SA is, importantly, associated with significant clinical improvement, suggesting that SA promotes the disease activity, but the underlying mechanisms remain poorly characterized. Here, we show that SA isolates from involved skin express staphylococcal enterotoxins (SEs) that induce crosstalk between malignant and benign T cells leading to Stat3-mediated interleukin-10 (IL-10) production by the malignant T cells. The SEs did not stimulate the malignant T cells directly. Instead, SEs triggered a cascade of events involving cell-cell and asymmetric cytokine interactions between malignant and benign T cells, which stimulated the malignant T cells to express high levels of IL-10. Much evidence supports that malignant activation of the Stat3/IL-10 axis plays a key role in driving the immune dysregulation and severe immunodeficiency that characteristically develops in CTCL patients. The present findings thereby establish a novel link between SEs and immune dysregulation in CTCL, strengthening the rationale for antibiotic treatment of colonized patients with severe or progressive disease.
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Wysocka M, Dawany N, Benoit B, Kossenkov AV, Troxel AB, Gelfand JM, Sell MK, Showe LC, Rook AH. Synergistic enhancement of cellular immune responses by the novel Toll receptor 7/8 agonist 3M-007 and interferon-γ: implications for therapy of cutaneous T-cell lymphoma. Leuk Lymphoma 2012; 52:1970-9. [PMID: 21942329 DOI: 10.3109/10428194.2011.582202] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Cutaneous T-cell lymphoma (CTCL) is responsive at all stages to immunotherapy. We determined whether a novel agonist for Toll-like receptor (TLR) 7/8 (3M-007) combined with either interferon-γ (IFN-γ) or interleukin-15 (IL-15) would enhance patients' immune responses in vitro. Our data demonstrate that IFN-γ or IL-15 in combination with 007 significantly increases patients' natural killer (NK) cytolytic activity against CTCL tumor cell lines and synergistically induces dendritic cell cytokines, compared to 007 alone. Microarray studies of gene expression of patients' peripheral blood mononuclear cells (PBMCs) primed with IFN-γ followed by stimulation with 007 identified significant up-regulation of the expression of IL-12 p35 (α-chain), IL-12 p40 (β-chain), and nine IFN-α genes. Importantly, the underlying mechanism of increased levels of IFN-α and IL-12 from combined treatment appears to involve IFN regulatory factor 8 (IRF-8). These results further support our hypothesis that combinations of biological modifiers activating different arms of the immune system may provide significant therapeutic benefits for patients with advanced CTCL.
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Affiliation(s)
- Maria Wysocka
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA 19104, USA.
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Wilcox RA. Cutaneous T-cell lymphoma: 2011 update on diagnosis, risk-stratification, and management. Am J Hematol 2011; 86:928-48. [PMID: 21990092 DOI: 10.1002/ajh.22139] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
DISEASE OVERVIEW Cutaneous T-cell lymphomas are a heterogenous group of T-cell lymphoproliferative disorders involving the skin, the majority of which may be classified as Mycosis fungoides (MF) or Sézary syndrome (SS). DIAGNOSIS The diagnosis of MF or SS requires the integration of clinical and histopathologic data. RISK-ADAPTED THERAPY Tumor, node, metastasis, and blood (TNMB) staging remains the most important prognostic factor in MF/SS and forms the basis for a "risk-adapted," multidisciplinary approach to treatment. For patients with disease limited to the skin, expectant management or skin-directed therapies is preferred, as both disease-specific and overall survival for these patients is favorable. In contrast, patients with advanced-stage disease with significant nodal, visceral, or blood involvement are generally approached with biologic-response modifiers, denileukin diftitox, and histone deacetylase inhibitors before escalating therapy to include systemic, single-agent chemotherapy. Multiagent chemotherapy may be used for those patients with extensive visceral involvement requiring rapid disease control. In highly-selected patients with disease refractory to standard treatments, allogeneic stem-cell transplantation may be considered.
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Affiliation(s)
- Ryan A Wilcox
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan Cancer Center, Ann Arbor, 48109-5948, USA. rywilcox@med. umich.edu
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Krejsgaard T, Odum N, Geisler C, Wasik MA, Woetmann A. Regulatory T cells and immunodeficiency in mycosis fungoides and Sézary syndrome. Leukemia 2011; 26:424-32. [PMID: 21904385 DOI: 10.1038/leu.2011.237] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Cutaneous T-cell lymphoma (CTCL) is the term for diseases characterized by primary accumulation of malignant T cells in the skin. Patients with the two predominant clinical forms of CTCL called mycosis fungoides (MF) and Sézary syndrome (SS) characteristically develop severe immunodeficiency during disease progression and consequently patients with advanced disease frequently die of infections and not from the tumor burden. For decades, it has been suspected that the malignant T cells actively drive the evolving immunodeficiency to avoid antitumor immunity, yet, the underlying mechanisms remain unclear. The identification of a subset of highly immunosuppressive regulatory T cells (Tregs) triggered a variety of studies investigating if MF and SS are malignant proliferations of Tregs but seemingly discordant findings have been reported. Here, we review the literature to clarify the role of Tregs in MF and SS and discuss the potential mechanisms driving the immunodeficiency.
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Affiliation(s)
- T Krejsgaard
- Department of International Health, Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark.
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Krejsgaard T, Kopp K, Ralfkiaer E, Willumsgaard AE, Eriksen KW, Labuda T, Rasmussen S, Mathiesen AM, Geisler C, Lauenborg B, Becker JC, Zhang Q, Wasik MA, Odum N, Woetmann A. A novel xenograft model of cutaneous T-cell lymphoma. Exp Dermatol 2011; 19:1096-102. [PMID: 20629733 DOI: 10.1111/j.1600-0625.2010.01138.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Cutaneous T-cell lymphomas (CTCLs) are characterized by accumulation of malignant T cells in the skin. Early disease resembles benign skin disorders but during disease progression cutaneous tumors develop, and eventually the malignant T cells can spread to lymph nodes and internal organs. However, because of the lack of suitable animal models, little is known about the mechanisms driving CTCL development and progression in vivo. Here, we describe a novel xenograft model of tumor stage CTCL, where malignant T cells (MyLa2059) are transplanted to NOD/SCID-B2m(-/-) (NOD.Cg-Prkdc(scid) B2m(tm1Unc) /J) mice. Subcutaneous transplantation of the malignant T cells led to rapid tumor formation in 43 of 48 transplantations, whereas transplantation of non-malignant T cells isolated from the same donor did not result in tumor development. Importantly, the tumor growth was significantly suppressed in mice treated with vorinostat when compared to mice treated with vehicle. Furthermore, in most mice the tumors displayed subcutaneous and/or lymphatic dissemination. Histological, immunohistochemical and flow cytometric analyses confirmed that both tumors at the inoculation site, as well as distant subcutaneous and lymphatic tumors, originated from the transplanted malignant T cells. In conclusion, we describe a novel mouse model of tumor stage CTCL for future studies of disease dissemination and preclinical evaluations of new therapeutic strategies.
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Sézary syndrome: Immunopathogenesis, literature review of therapeutic options, and recommendations for therapy by the United States Cutaneous Lymphoma Consortium (USCLC). J Am Acad Dermatol 2011; 64:352-404. [DOI: 10.1016/j.jaad.2010.08.037] [Citation(s) in RCA: 129] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2010] [Revised: 08/10/2010] [Accepted: 08/30/2010] [Indexed: 11/19/2022]
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Dulphy N, Berrou J, Campillo JA, Bagot M, Bensussan A, Toubert A. NKG2D Ligands Expression and NKG2D-Mediated NK Activity in Sezary Patients. J Invest Dermatol 2009; 129:359-64. [DOI: 10.1038/jid.2008.256] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Capriotti E, Vonderheid EC, Thoburn CJ, Wasik MA, Bahler DW, Hess AD. Expression of T-plastin, FoxP3 and other tumor-associated markers by leukemic T-cells of cutaneous T-cell lymphoma. Leuk Lymphoma 2008; 49:1190-201. [PMID: 18569641 DOI: 10.1080/10428190802064917] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Peripheral blood cells from 28 patients with leukemic cutaneous T-cell lymphoma including 25 patients with Sezary syndrome were evaluated for expression of regulatory T-cell-associated markers (FoxP3, CD25, CTLA-4, neurophilin-1), T-cell activation markers (CD28 and its ligands B7.1 and B7.2) and NK cell-associated markers (NKG2D and its ligands Mic-A and Mic-B) using real-time quantitative polymerase chain reaction. T-plastin served as a positive genetic marker, and its expression correlated to blood tumor burden. More than 90% of samples had transcripts for CD28 and Mic-B, but less than 30% of samples expressed FoxP3, CTLA-4 and CD25. Expression of Mic-B by neoplastic cells could provide another mechanism to inhibit anti-tumor immune responses. FoxP3 expression correlated with a poor prognosis. Although the underlying mechanisms accounting for this correlation remain unclear, the expression of the Foxp3 and CTLA-4 regulatory elements indicates that a subset of leukemic cases displays a regulatory T-cell phenotype.
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Faguer S, Launay F, Ysebaert L, Mailhol C, Estines-Chartier O, Lamant L, Paul C. Acute cutaneous T-cell lymphoma transformation during treatment with alemtuzumab. Br J Dermatol 2007; 157:841-2. [PMID: 17714563 DOI: 10.1111/j.1365-2133.2007.08130.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Yoon JS, Newton SM, Wysocka M, Troxel AB, Hess SD, Richardson SK, Lin JH, Benoit BM, Kasprzycka M, Wasik MA, Rook AH. IL-21 enhances antitumor responses without stimulating proliferation of malignant T cells of patients with Sézary syndrome. J Invest Dermatol 2007; 128:473-80. [PMID: 17713571 DOI: 10.1038/sj.jid.5701027] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
IL-21, a common gamma-chain cytokine secreted by activated CD4+ T cells, influences both humoral and cell-mediated immune responses through the regulation of T, B, dendritic, and natural killer (NK) cells. Sézary syndrome is an advanced form of cutaneous T-cell lymphoma, a clonally derived malignancy of CD4+ T cells that is characterized by profound defects in host cellular immune function. As a modulator of both innate and adaptive immune responses, IL-21 could play an important role in augmenting cell-mediated immunity in these patients. Normal donor and Sézary syndrome patient peripheral blood mononuclear cells were cultured with IL-21 and tested for CD8+ T- and NK-cell activation, NK-cell cytotoxicity, and tumor cell proliferation and apoptosis. IL-21 resulted in a modest increase in CD8+ T- and NK-cell activation, associated with a marked increase in cytolytic activity against both K562 and malignant CD4+ T-cell targets. Although IL-21 failed to demonstrate pro-apoptotic effects on the malignant CD4+ T cells, it is noteworthy that it had no demonstrable proliferative effects on these cells. Thus, IL-21 may play an important role in enhancing the host immune response of Sézary syndrome patients through the increased cytolytic activity of T and NK cells.
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Affiliation(s)
- Jessica S Yoon
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Querfeld C, Rosen ST, Guitart J, Rademaker A, Foss F, Gupta R, Kuzel TM. Phase II trial of subcutaneous injections of human recombinant interleukin-2 for the treatment of mycosis fungoides and Sézary syndrome. J Am Acad Dermatol 2007; 56:580-3. [PMID: 17367611 DOI: 10.1016/j.jaad.2006.08.067] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2006] [Revised: 08/25/2006] [Accepted: 08/31/2006] [Indexed: 12/30/2022]
Abstract
We conducted a phase II trial to evaluate the efficacy and toxicity of subcutaneous injections of recombinant interleukin (IL)-2 in 22 heavily pretreated patients with advanced cutaneous T-cell lymphoma. We observed modest response rates (18%) with a reasonable toxicity profile. The role of IL-2 in vivo for expansion of cytotoxic CD8(+) T cells, CD4(+) T cells, regulatory CD25(+) T cells, or a combination of these has not been elucidated. There was no evidence of expansion of CD8(+) T cells in peripheral blood of patients during treatment. Immunophenotypic analysis revealed an increase of CD25(+) cells in CD3(+) and CD4(+) populations after treatment in a subset of patients possibly reflecting activation of reactive helper T cells, proliferation of neoplastic T cells, or proliferation of T-regulatory cells. In summary, at this dose and schedule recombinant IL-2 is largely ineffective as therapy in patients with advanced cutaneous T-cell lymphoma. Whether IL-2 has the potential to suppress antitumor activity by stimulation of regulatory T cells needs to be clarified.
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Ortonne N, Bagot M, Bensussan A. KIR3DL2 : une nouvelle étape dans l’histoire du syndrome de Sézary. Med Sci (Paris) 2006; 22:691-3. [PMID: 16962036 DOI: 10.1051/medsci/20062289691] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Affiliation(s)
- Peter Heald
- Department of Dermatology, Yale Comprehensive Cancer Center, Yale University School of Medicine, New Haven, Connecticut, USA
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