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Cluxton C, Naidoo J. Prospective Clinical Trials to Advance the Study of Immune Checkpoint Inhibitor Toxicity. Curr Oncol 2023; 30:6862-6871. [PMID: 37504362 PMCID: PMC10378048 DOI: 10.3390/curroncol30070502] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/10/2023] [Accepted: 07/15/2023] [Indexed: 07/29/2023] Open
Abstract
Immune checkpoint inhibitors (ICIs) are a class of drug that produces durable and sustained anti-tumour responses in a wide variety of malignancies. The exponential rise in their use has been mirrored by a rise in immune-related adverse events (IrAEs). Knowledge of such toxicities, as well as effective management algorithms for these toxicities, is essential to optimize clinical efficacy and safety. Currently, the guidelines for management of the IrAEs are based largely on retrospective studies and case series. In this article, we review the current landscape of clinical trials investigating the management of IrAEs with an aim to develop standardised, randomised controlled trial-based management algorithms for ICI-related toxicities.
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Affiliation(s)
- Christopher Cluxton
- Beaumont Hospital, RCSI Cancer Centre, D09 V2N0 Dublin, Ireland
- Department of Medicine, RCSI University of Medicine and Health Sciences, D02 YN77 Dublin, Ireland
| | - Jarushka Naidoo
- Beaumont Hospital, RCSI Cancer Centre, D09 V2N0 Dublin, Ireland
- Department of Medicine, RCSI University of Medicine and Health Sciences, D02 YN77 Dublin, Ireland
- Sidney Kimmel Comprehensive Cancer Center at John Hopkins University, Baltimore, MD 21218, USA
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2
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Targeting TRMT5 suppresses hepatocellular carcinoma progression via inhibiting the HIF-1α pathways. J Zhejiang Univ Sci B 2023; 24:50-63. [PMID: 36632750 PMCID: PMC9837375 DOI: 10.1631/jzus.b2200224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Accumulating evidence has confirmed the links between transfer RNA (tRNA) modifications and tumor progression. The present study is the first to explore the role of tRNA methyltransferase 5 (TRMT5), which catalyzes the m1G37 modification of mitochondrial tRNAs in hepatocellular carcinoma (HCC) progression. Here, based on bioinformatics and clinical analyses, we identified that TRMT5 expression was upregulated in HCC, which correlated with poor prognosis. Silencing TRMT5 attenuated HCC proliferation and metastasis both in vivo and in vitro, which may be partially explained by declined extracellular acidification rate (ECAR) and oxygen consumption rate (OCR). Mechanistically, we discovered that knockdown of TRMT5 inactivated the hypoxia-inducible factor-1 (HIF-1) signaling pathway by preventing HIF-1α stability through the enhancement of cellular oxygen content. Moreover, our data indicated that inhibition of TRMT5 sensitized HCC to doxorubicin by adjusting HIF-1α. In conclusion, our study revealed that targeting TRMT5 could inhibit HCC progression and increase the susceptibility of tumor cells to chemotherapy drugs. Thus, TRMT5 might be a carcinogenesis candidate gene that could serve as a potential target for HCC therapy.
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3
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Chen W, Qie C, Hu X, Wang L, Jiang J, Liu W, Liu J. A small molecule inhibitor of VSIG-8 prevents its binding to VISTA. Invest New Drugs 2022; 40:690-699. [DOI: 10.1007/s10637-022-01244-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 03/31/2022] [Indexed: 12/19/2022]
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4
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Siu DHW, O'Neill RS, Harris CA, Wang J, Ardolino L, Downton T, Tong M, Hong JH, Chin V, Clingan PR, Aghmesheh M, Soudy H. Immune checkpoint inhibitor-induced myocarditis, myositis, myasthenia gravis and transaminitis: a case series and review. Immunotherapy 2022; 14:511-520. [PMID: 35321560 DOI: 10.2217/imt-2021-0225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Immune checkpoint inhibitors have been incorporated into the treatment of various malignancies. An increasing body of literature is reporting rare but potentially fatal adverse events associated with these agents. In this case series, the authors report the clinical features and outcomes of seven patients who received immune checkpoint inhibitors for different solid organ malignancies and developed a tetrad of immune-related myocarditis, myositis, myasthenia gravis and transaminitis. Herein the authors review the literature and describe the current diagnostic and management approach for this overlapping syndrome. The authors' series highlights the importance of a high index of clinical suspicion, prompt comprehensive investigations, early multidisciplinary team involvement and initiation of immunosuppressive therapy when immune-related adverse events are suspected.
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Affiliation(s)
- Derrick Ho Wai Siu
- Department of Medical Oncology, St George Hospital, Kogarah, New South Wales, 2217, Australia.,National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Camperdown, New South Wales, 2050, Australia.,Faculty of Medicine, The University of New South Wales, New South Wales, Australia
| | - Robert Sean O'Neill
- Faculty of Medicine, The University of New South Wales, New South Wales, Australia.,Department of Medical Oncology, Sutherland Hospital, Caringbah, New South Wales, 2229, Australia
| | - Carole A Harris
- Department of Medical Oncology, St George Hospital, Kogarah, New South Wales, 2217, Australia.,Faculty of Medicine, The University of New South Wales, New South Wales, Australia.,Department of Medical Oncology, Sutherland Hospital, Caringbah, New South Wales, 2229, Australia
| | - Justine Wang
- Faculty of Medicine, The University of New South Wales, New South Wales, Australia.,Department of Neurology, St George Hospital, Kogarah, New South Wales, 2217, Australia.,Institute of Neurological Sciences, Prince of Wales Hospital, Randwick, New South Wales, 2031, Australia
| | - Luke Ardolino
- Faculty of Medicine, The University of New South Wales, New South Wales, Australia.,Department of Medical Oncology, The Kinghorn Centre, St Vincent's Hospital, Darlinghurst, New South Wales, 2010, Australia
| | - Teesha Downton
- Department of Medical Oncology, The Wollongong Hospital, Wollongong, New South Wales, 2500, Australia
| | - Matthew Tong
- Department of Medical Oncology, Sutherland Hospital, Caringbah, New South Wales, 2229, Australia
| | - Jun Hee Hong
- Department of Medical Oncology, St George Hospital, Kogarah, New South Wales, 2217, Australia
| | - Venessa Chin
- Department of Medical Oncology, The Kinghorn Centre, St Vincent's Hospital, Darlinghurst, New South Wales, 2010, Australia.,Single Cell and Computational Genomics Lab, The Garvan Institute of Medical Research, Darlinghurst, New South Wales, 2010, Australia
| | - Philip R Clingan
- Department of Medical Oncology, The Wollongong Hospital, Wollongong, New South Wales, 2500, Australia.,University of Wollongong, New South Wales, Australia
| | - Morteza Aghmesheh
- Department of Medical Oncology, The Wollongong Hospital, Wollongong, New South Wales, 2500, Australia.,University of Wollongong, New South Wales, Australia
| | - Hussein Soudy
- Department of Medical Oncology, St George Hospital, Kogarah, New South Wales, 2217, Australia.,Faculty of Medicine, The University of New South Wales, New South Wales, Australia.,Department of Medical Oncology, Sutherland Hospital, Caringbah, New South Wales, 2229, Australia
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5
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Anti-PD-1 induced collagenous colitis in metastatic melanoma: a rare severe adverse event. Melanoma Res 2021; 30:603-605. [PMID: 32404733 DOI: 10.1097/cmr.0000000000000665] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Immunotherapy has improved the overall survival of patients with metastatic melanoma. Inflammatory bowel disease-like colitis is the most frequent gastrointestinal serious adverse event in patients treated with immune-checkpoint inhibitors. Collagenous colitis is microscopic colitis. Only two cases of immune-checkpoint inhibitors induced collagenous colitis have been reported. A man in his early 70s was referred for a metastatic melanoma treated with nivolumab as the fourth line of treatment. During the 21st cycle, the patient complained of watery, nonbloody diarrhea (around six times per day). Rectosigmoidoscopy showed no mucosal lesion. A thickened subepithelial collagen band was evidenced by trichrome staining, which was suggestive of collagenous colitis. Nivolumab was stopped and the patient was treated with budesonide 9 mg/day in combination with loperamide and cholestyramine, leading to improvement of diarrhea. However, worsening of digestive symptoms during tapering of corticosteroid dose required the permanent discontinuation of nivolumab. Due to the very low number of cases reported to date and their different evolution under corticosteroids, it is not clear whether or not immune checkpoint inhibitors can be restarted in these patients.
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Lentz RW, Colton MD, Mitra SS, Messersmith WA. Innate Immune Checkpoint Inhibitors: The Next Breakthrough in Medical Oncology? Mol Cancer Ther 2021; 20:961-974. [PMID: 33850005 PMCID: PMC9028741 DOI: 10.1158/1535-7163.mct-21-0041] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/01/2021] [Accepted: 03/29/2021] [Indexed: 11/16/2022]
Abstract
While immunotherapy has revolutionized the treatment of many types of advanced cancer, most patients still do not derive benefit. The currently available immune checkpoint inhibitors target the adaptive immune system, generating a T-cell antitumor response. However, an antitumor immune response depends on a complex interplay of both innate and adaptive immune cells. The innate immune system is a promising new target, and innate immune checkpoint inhibitors can disrupt inhibitory interactions ("don't eat me" signals) between tumor and both phagocytes and natural killer cells. The checkpoint inhibitor may also provide a stimulatory interaction ("eat me" signal), or this can be achieved through use of combination therapy. This generates antitumor effector functions including phagocytosis, natural cytotoxicity, antibody-dependent effects, and synergistic activation of the adaptive immune system via antigen presentation. This is a rapidly expanding area of drug development, either alone or in combination (with anticancer antibodies or adaptive immune checkpoint inhibitors). Here, we comprehensively review the mechanism of action and up-to-date solid tumor clinical trial data of the drugs targeting phagocytosis checkpoints (SIRPα/CD47, LILRB1/MHC-I, and LILRB2/MHC-I) and natural killer-cell checkpoints (TIGIT/CD112 + CD155, PVRIG/CD112, KIRs/MHC-I, and NKG2A-CD94/HLA-E). Innate immune checkpoint inhibitors could once again revolutionize immune-based cancer therapies.
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Affiliation(s)
- Robert W Lentz
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Meryl D Colton
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Siddhartha S Mitra
- Division of Hematology, Oncology, and Bone Marrow Transplant, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Wells A Messersmith
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado.
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Autio KA, Boni V, Humphrey RW, Naing A. Probody Therapeutics: An Emerging Class of Therapies Designed to Enhance On-Target Effects with Reduced Off-Tumor Toxicity for Use in Immuno-Oncology. Clin Cancer Res 2020; 26:984-989. [PMID: 31601568 PMCID: PMC8436251 DOI: 10.1158/1078-0432.ccr-19-1457] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 08/12/2019] [Accepted: 10/04/2019] [Indexed: 12/17/2022]
Abstract
The deep and durable antitumor effects of antibody-based immunotherapies such as immune checkpoint inhibitors (ICIs) have revolutionized oncology and transformed the therapeutic landscape for many cancers. Several anti-programmed death receptor 1 and anti-programmed death receptor ligand 1 antibodies have been approved for use in advanced solid tumors, including melanoma, non-small cell lung cancer, bladder cancer, and other cancers. ICIs are under development across many tumor types and preliminary results are compelling. However, ICIs have been associated with severe immune-related adverse events (irAEs), including rash, diarrhea, colitis, hypophysitis, hepatotoxicity, and hypothyroidism, which in some cases lead to high morbidity, are potentially life-threatening, and limit the duration of treatment. The incidence of severe irAEs increases further when programmed cell death-1 and programmed cell death ligand-1 inhibitors are combined with anti-CTLA-4 and/or other multidrug regimens. Probody therapeutics, a new class of recombinant, proteolytically activated antibody prodrugs are in early development and are designed to exploit the hallmark of dysregulation of tumor protease activity to deliver their therapeutic effects within the tumor microenvironment (TME) rather than peripheral tissue. TME targeting, rather than systemic targeting, may reduce irAEs in tissues distant from the tumor. Probody therapeutic technology has been applied to multiple antibody formats, including immunotherapies, Probody drug conjugates, and T-cell-redirecting bispecific Probody therapeutics. In preclinical models, Probody therapeutics have consistently maintained anticancer activity with improved safety in animals compared with the non-Probody parent antibody. In the clinical setting, Probody therapeutics may expand or create therapeutic windows for anticancer therapies.
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Affiliation(s)
- Karen A Autio
- Genitourinary Oncology Service/Early Drug Development Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Valentina Boni
- START Madrid-CIOCC HM University Hospital Sanchinarro, Madrid, Spain
| | | | - Aung Naing
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Gorospe L, Pacios-Blanco RE, Garrido-López P. The Importance of Imaging Studies in the Assessment of Response to Immunotherapy in Lung Cancer. Arch Bronconeumol 2020; 56:380-389. [PMID: 31898993 DOI: 10.1016/j.arbres.2019.10.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 10/30/2019] [Accepted: 10/31/2019] [Indexed: 12/17/2022]
Abstract
Immunotherapy (particularly immune checkpoint inhibitors) in the treatment of patients with lung cancer has aroused great interest in recent years, revolutionized the management of patients with locally advanced/metastatic disease, and given hope to both patients and treating physicians. These drugs, in combination or in monotherapy, have become the standard treatment for many patients with lung cancer, and their use is expected to increase significantly in the near future. In this article, we will review the growing importance of imaging techniques in the evaluation of therapeutic response to immunotherapy in lung cancer patients, with emphasis on the new specific radiological criteria on response to immunotherapy, atypical radiological responses (pseudoprogresion, dissociative responses, hyperprogresion), and the main radiological manifestations of adverse events associated with immunotherapy (sarcoid reactions, pulmonary toxicities, etc.). Pulmonologists must be familiar not only with atypical radiological responses to immunotherapy and their prognostic implications, but also with their effects and the new radiological criteria of response to assess treatment response. In this study, we will address key concepts such as "pseudoprogresion", "paradoxical response", "hyperprogresion", or "unconfirmed progression", and their significance in the management of patients with lung cancer treated with immunotherapy.
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Affiliation(s)
- Luis Gorospe
- Servicio de Radiodiagnóstico, Hospital Universitario Ramón y Cajal, Madrid, España.
| | | | - Pilar Garrido-López
- Servicio de Oncología Médica, Hospital Universitario Ramón y Cajal, Madrid, España
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9
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Czaja AJ. Examining pathogenic concepts of autoimmune hepatitis for cues to future investigations and interventions. World J Gastroenterol 2019; 25:6579-6606. [PMID: 31832000 PMCID: PMC6906207 DOI: 10.3748/wjg.v25.i45.6579] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 11/25/2019] [Accepted: 11/29/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Multiple pathogenic mechanisms have been implicated in autoimmune hepatitis, but they have not fully explained susceptibility, triggering events, and maintenance or escalation of the disease. Furthermore, they have not identified a critical defect that can be targeted. The goals of this review are to examine the diverse pathogenic mechanisms that have been considered in autoimmune hepatitis, indicate investigational opportunities to validate their contribution, and suggest interventions that might evolve to modify their impact. English abstracts were identified in PubMed by multiple search terms. Full length articles were selected for review, and secondary and tertiary bibliographies were developed. Genetic and epigenetic factors can affect susceptibility by influencing the expression of immune regulatory genes. Thymic dysfunction, possibly related to deficient production of programmed cell death protein-1, can allow autoreactive T cells to escape deletion, and alterations in the intestinal microbiome may help overcome immune tolerance and affect gender bias. Environmental factors may trigger the disease or induce epigenetic changes in gene function. Molecular mimicry, epitope spread, bystander activation, neo-antigen production, lymphocytic polyspecificity, and disturbances in immune inhibitory mechanisms may maintain or escalate the disease. Interventions that modify epigenetic effects on gene expression, alter intestinal dysbiosis, eliminate deleterious environmental factors, and target critical pathogenic mechanisms are therapeutic possibilities that might reduce risk, individualize management, and improve outcome. In conclusion, diverse pathogenic mechanisms have been implicated in autoimmune hepatitis, and they may identify a critical factor or sequence that can be validated and used to direct future management and preventive strategies.
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Affiliation(s)
- Albert J Czaja
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, MN 55905, United States
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10
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Czaja AJ. Immune inhibitory proteins and their pathogenic and therapeutic implications in autoimmunity and autoimmune hepatitis. Autoimmunity 2019; 52:144-160. [PMID: 31298041 DOI: 10.1080/08916934.2019.1641200] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Key inhibitory proteins can blunt immune responses to self-antigens, and deficiencies in this repertoire may promote autoimmunity. The goals of this review are to describe the key immune inhibitory proteins, indicate their possible impact on the development of autoimmune disease, especially autoimmune hepatitis, and encourage studies to clarify their pathogenic role and candidacy as therapeutic targets. English abstracts were identified in PubMed by multiple search terms. Full length articles were selected for review, and secondary and tertiary bibliographies were developed. Cytotoxic T lymphocyte antigen-4 impairs ligation of CD28 to B7 ligands on antigen presenting cells and inhibits the adaptive immune response by increasing anti-inflammatory cytokines, generating regulatory T cells, and reducing T cell activation and proliferation. Programed cell death antigen-1 inhibits T cell selection, activation, and proliferation by binding with two ligands at different phases and locations of the immune response. A soluble alternatively spliced variant of this protein can dampen the inhibitory signal. Autoimmune hepatitis has been associated with polymorphisms of the cytotoxic T lymphocyte antigen-4 gene, reduced hepatic expression of a ligand of programed cell death antigen-1, an interfering soluble variant of this key inhibitory protein, and antibodies against it. Findings have been associated with laboratory indices of liver injury and suboptimal treatment response. Abatacept, belatacept, CD28 blockade, and induction of T cell exhaustion are management considerations that require scrutiny. In conclusion, deficiencies in key immune inhibitory proteins may promote the occurrence of autoimmune diseases, such as autoimmune hepatitis, and emerging interventions may overcome these deficiencies. Investigations should define the nature, impact and management of these inhibitory disturbances in autoimmune hepatitis.
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Affiliation(s)
- Albert J Czaja
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science , Rochester , MN , USA
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Calvani M, Bruno G, Dal Monte M, Nassini R, Fontani F, Casini A, Cavallini L, Becatti M, Bianchini F, De Logu F, Forni G, la Marca G, Calorini L, Bagnoli P, Chiarugi P, Pupi A, Azzari C, Geppetti P, Favre C, Filippi L. β 3 -Adrenoceptor as a potential immuno-suppressor agent in melanoma. Br J Pharmacol 2019; 176:2509-2524. [PMID: 30874296 DOI: 10.1111/bph.14660] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 02/02/2019] [Accepted: 02/22/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND AND PURPOSE Stress-related catecholamines have a role in cancer and β-adrenoceptors; specifically, β2 -adrenoceptors have been identified as new targets in treating melanoma. Recently, β3 -adrenoceptors have shown a pleiotropic effect on melanoma micro-environment leading to cancer progression. However, the mechanisms by which β3 -adrenoceptors promote this progression remain poorly understood. Catecholamines affect the immune system by modulating several factors that can alter immune cell sub-population homeostasis. Understanding the mechanisms of cancer immune-tolerance is one of the most intriguing challenges in modern research. This study investigates the potential role of β3 -adrenoceptors in immune-tolerance regulation. EXPERIMENTAL APPROACH A mouse model of melanoma in which syngeneic B16-F10 cells were injected in C57BL-6 mice was used to evaluate the effect of β-adrenoceptor blockade on the number and activity of immune cell sub-populations (Treg, NK, CD8, MDSC, macrophages, and neutrophils). Pharmacological and molecular approaches with β-blockers (propranolol and SR59230A) and specific β-adrenoceptor siRNAs targeting β2 - or β3 -adrenoceptors were used. KEY RESULTS Only β3 -, but not β2 -adrenoceptors, were up-regulated under hypoxia in peripheral blood mononuclear cells and selectively expressed in immune cell sub-populations including Treg, MDSC, and NK. SR59230A and β3 -adrenoceptor siRNAs increased NK and CD8 number and cytotoxicity, while they attenuated Treg and MDSC sub-populations in the tumour mass, blood, and spleen. SR59230A and β3 -adrenoceptor siRNAs increased the ratio of M1/M2 macrophages and N1 granulocytes. CONCLUSIONS AND IMPLICATIONS Our data suggest that β3 -adrenoceptors are involved in immune-tolerance, which opens the way for new strategic therapies to overcome melanoma growth. LINKED ARTICLES This article is part of a themed section on Adrenoceptors-New Roles for Old Players. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v176.14/issuetoc.
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Affiliation(s)
- Maura Calvani
- Oncohematology Unit, Department of Pediatric Oncology, Meyer University Children's University Hospital, Florence, Italy
| | - Gennaro Bruno
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Massimo Dal Monte
- Department of Biology, Unit of General Physiology, University of Pisa, Pisa, Italy
| | - Romina Nassini
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Filippo Fontani
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Arianna Casini
- Division of Immunology, Section of Pediatrics, Meyer University Children's Hospital, Florence, Italy
| | - Lorenzo Cavallini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Matteo Becatti
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Francesca Bianchini
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Francesco De Logu
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Giulia Forni
- Metabolic and Newborn Screening Clinical Unit, Department of Neurosciences, Meyer University Children's University Hospital, Florence, Italy
| | - Giancarlo la Marca
- Metabolic and Newborn Screening Clinical Unit, Department of Neurosciences, Meyer University Children's University Hospital, Florence, Italy
| | - Lido Calorini
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Paola Bagnoli
- Department of Biology, Unit of General Physiology, University of Pisa, Pisa, Italy
| | - Paola Chiarugi
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Alberto Pupi
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Chiara Azzari
- Department of Health Sciences, University of Florence, Florence, Italy
| | | | - Claudio Favre
- Oncohematology Unit, Department of Pediatric Oncology, Meyer University Children's University Hospital, Florence, Italy
| | - Luca Filippi
- Neonatal Intensive Care Unit, Medical Surgical Fetal-Neonatal Department, Meyer University Children's Hospital, Florence, Italy
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Wirsdörfer F, de Leve S, Jendrossek V. Combining Radiotherapy and Immunotherapy in Lung Cancer: Can We Expect Limitations Due to Altered Normal Tissue Toxicity? Int J Mol Sci 2018; 20:ijms20010024. [PMID: 30577587 PMCID: PMC6337556 DOI: 10.3390/ijms20010024] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 12/18/2018] [Accepted: 12/19/2018] [Indexed: 02/08/2023] Open
Abstract
In recent decades, technical advances in surgery and radiotherapy, as well as breakthroughs in the knowledge on cancer biology, have helped to substantially improve the standard of cancer care with respect to overall response rates, progression-free survival, and the quality of life of cancer patients. In this context, immunotherapy is thought to have revolutionized the standard of care for cancer patients in the long term. For example, immunotherapy approaches such as immune checkpoint blockade are currently increasingly being used in cancer treatment, either alone or in combination with chemotherapy or radiotherapy, and there is hope from the first clinical trials that the appropriate integration of immunotherapy into standard care will raise the success rates of cancer therapy to a new level. Nevertheless, successful cancer therapy remains a major challenge, particularly in tumors with either pronounced resistance to chemotherapy and radiation treatment, a high risk of normal tissue complications, or both, as in lung cancer. Chemotherapy, radiotherapy and immunotherapy have the capacity to evoke adverse effects in normal tissues when administered alone. However, therapy concepts are usually highly complex, and it is still not clear if combining immunotherapy with radio(chemo)therapy will increase the risk of normal tissue complications, in particular since normal tissue toxicity induced by chemotherapy and radiotherapy can involve immunologic processes. Unfortunately, no reliable biomarkers are available so far that are suited to predict the unique normal tissue sensitivity of a given patient to a given treatment. Consequently, clinical trials combining radiotherapy and immunotherapy are attracting major attention, not only regarding efficacy, but also with regard to safety. In the present review, we summarize the current knowledge of radiation-induced and immunotherapy-induced effects in tumor and normal tissue of the lung, and discuss the potential limitations of combined radio-immunotherapy in lung cancer with a focus on the suspected risk for enhanced acute and chronic normal tissue toxicity.
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Affiliation(s)
- Florian Wirsdörfer
- Institute of Cell Biology (Cancer Research), University Hospital Essen, 45147 Essen, Germany.
| | - Simone de Leve
- Institute of Cell Biology (Cancer Research), University Hospital Essen, 45147 Essen, Germany.
| | - Verena Jendrossek
- Institute of Cell Biology (Cancer Research), University Hospital Essen, 45147 Essen, Germany.
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