1
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Vargas-Blanco DA, Hepworth OW, Basham KJ, Simaku P, Crossen AJ, Timmer KD, Hopke A, Brown Harding H, Vandal SR, Jensen KN, Floyd DJ, Reedy JL, Reardon C, Mansour MK, Ward RA, Irimia D, Abramson JS, Vyas JM. BTK inhibitor-induced defects in human neutrophil effector activity against Aspergillus fumigatus are restored by TNF-α. JCI Insight 2024; 9:e176162. [PMID: 38713531 DOI: 10.1172/jci.insight.176162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 04/23/2024] [Indexed: 05/09/2024] Open
Abstract
Inhibition of Bruton's tyrosine kinase (BTK) through covalent modifications of its active site (e.g., ibrutinib [IBT]) is a preferred treatment for multiple B cell malignancies. However, IBT-treated patients are more susceptible to invasive fungal infections, although the mechanism is poorly understood. Neutrophils are the primary line of defense against these infections; therefore, we examined the effect of IBT on primary human neutrophil effector activity against Aspergillus fumigatus. IBT significantly impaired the ability of neutrophils to kill A. fumigatus and potently inhibited reactive oxygen species (ROS) production, chemotaxis, and phagocytosis. Importantly, exogenous TNF-α fully compensated for defects imposed by IBT and newer-generation BTK inhibitors and restored the ability of neutrophils to contain A. fumigatus hyphal growth. Blocking TNF-α did not affect ROS production in healthy neutrophils but prevented exogenous TNF-α from rescuing the phenotype of IBT-treated neutrophils. The restorative capacity of TNF-α was independent of transcription. Moreover, the addition of TNF-α immediately rescued ROS production in IBT-treated neutrophils, indicating that TNF-α worked through a BTK-independent signaling pathway. Finally, TNF-α restored effector activity of primary neutrophils from patients on IBT therapy. Altogether, our data indicate that TNF-α rescued the antifungal immunity block imposed by inhibition of BTK in primary human neutrophils.
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Affiliation(s)
- Diego A Vargas-Blanco
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Olivia W Hepworth
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Kyle J Basham
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Patricia Simaku
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Arianne J Crossen
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kyle D Timmer
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Alex Hopke
- Harvard Medical School, Boston, Massachusetts, USA
- BioMEMS Resource Center, Massachusetts General Hospital, Boston, Massachusetts, USA
- Shriners Hospital for Children, Boston, Massachusetts, USA
| | - Hannah Brown Harding
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Steven R Vandal
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Kirstine N Jensen
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel J Floyd
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jennifer L Reedy
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher Reardon
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Michael K Mansour
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Rebecca A Ward
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Daniel Irimia
- Harvard Medical School, Boston, Massachusetts, USA
- BioMEMS Resource Center, Massachusetts General Hospital, Boston, Massachusetts, USA
- Shriners Hospital for Children, Boston, Massachusetts, USA
| | - Jeremy S Abramson
- Center for Lymphoma, Mass General Cancer Center, Boston, Massachusetts, USA
| | - Jatin M Vyas
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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2
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Desai JV, Zarakas MA, Wishart AL, Roschewski M, Aufiero MA, Donkó Á, Wigerblad G, Shlezinger N, Plate M, James MR, Lim JK, Uzel G, Bergerson JR, Fuss I, Cramer RA, Franco LM, Clark ES, Khan WN, Yamanaka D, Chamilos G, El-Benna J, Kaplan MJ, Staudt LM, Leto TL, Holland SM, Wilson WH, Hohl TM, Lionakis MS. BTK drives neutrophil activation for sterilizing antifungal immunity. J Clin Invest 2024; 134:e176142. [PMID: 38696257 PMCID: PMC11178547 DOI: 10.1172/jci176142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 04/22/2024] [Indexed: 05/04/2024] Open
Abstract
We describe a previously-unappreciated role for Bruton's tyrosine kinase (BTK) in fungal immune surveillance against aspergillosis, an unforeseen complication of BTK inhibitors (BTKi) used for treating B-cell lymphoid malignancies. We studied BTK-dependent fungal responses in neutrophils from diverse populations, including healthy donors, BTKi-treated patients, and X-linked agammaglobulinemia patients. Upon fungal exposure, BTK was activated in human neutrophils in a TLR2-, Dectin-1-, and FcγR-dependent manner, triggering the oxidative burst. BTK inhibition selectively impeded neutrophil-mediated damage to Aspergillus hyphae, primary granule release, and the fungus-induced oxidative burst by abrogating NADPH oxidase subunit p40phox and GTPase RAC2 activation. Moreover, neutrophil-specific Btk deletion in mice enhanced aspergillosis susceptibility by impairing neutrophil function, not recruitment or lifespan. Conversely, GM-CSF partially mitigated these deficits by enhancing p47phox activation. Our findings underline the crucial role of BTK signaling in neutrophils for antifungal immunity and provide a rationale for GM-CSF use to offset these deficits in susceptible patients.
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Affiliation(s)
- Jigar V Desai
- Fungal Pathogenesis Section, LCIM, NIAID, NIH, Bethesda, United States of America
| | - Marissa A Zarakas
- Fungal Pathogenesis Section, LCIM, NIAID, NIH, Bethesda, United States of America
| | - Andrew L Wishart
- Fungal Pathogenesis Section, LCIM, NIAID, NIH, Bethesda, United States of America
| | - Mark Roschewski
- Lymphoid Malignancies Branch, National Cancer Institute, NIH, Bethesda, United States of America
| | - Mariano A Aufiero
- Louis V. Gerstner Jr. Graduate School of Biomedical Sciences, Memorial Sloan Kettering Cancer Center, New York, United States of America
| | - Ágnes Donkó
- Molecular Defenses Section, LCIM, NIAID, NIH, Bethesda, United States of America
| | - Gustaf Wigerblad
- Systemic Autoimmunity Branch, NIAMS, NIH, Bethesda, United States of America
| | - Neta Shlezinger
- Infectious Diseases, Memorial Sloan Kettering Cancer Center, New York, United States of America
| | - Markus Plate
- Infectious Diseases, Memorial Sloan Kettering Cancer Center, New York, United States of America
| | - Matthew R James
- Microbiology and Immunology, Geisel School of Medicine at Dartmouth, Hanover, United States of America
| | - Jean K Lim
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - Gulbu Uzel
- Immunopathogenesis Section, LCIM, NIAID, NIH, Bethesda, United States of America
| | - Jenna Re Bergerson
- Primary Immune Deficiency Clinic, LCIM, NIAID, NIH, Bethesda, United States of America
| | - Ivan Fuss
- Mucosal Immunity Section, LCIM, NIAID, NIH, Bethesda, United States of America
| | - Robert A Cramer
- Microbiology and Immunology, Geisel School of Medicine at Dartmouth, Hanover, United States of America
| | - Luis M Franco
- Functional Immunogenomics Section, NIAMS, NIH, Bethesda, United States of America
| | - Emily S Clark
- Microbiology and Immunology, Miller School of Medicine, University of Miami, Miami, United States of America
| | - Wasif N Khan
- Microbiology and Immunology, Miller School of Medicine, University of Miami, Miami, United States of America
| | - Daisuke Yamanaka
- Laboratory for Immunopharmacology of Microbial Products, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan
| | - Georgios Chamilos
- Clinical Microbiology and Microbial Pathogenesis, University Hospital of Heraklion, Heraklion, Greece
| | - Jamel El-Benna
- Center for Research on Inflammation, City University of Paris, INSERM-U1149, CNRS-ERL8252, Paris, France
| | - Mariana J Kaplan
- Systemic Autoimmunity Branch, NIAMS, NIH, Bethesda, United States of America
| | - Louis M Staudt
- Lymphoid Malignancies Branch, National Cancer Institute, NIH, Bethesda, United States of America
| | - Thomas L Leto
- Molecular Defenses Section, LCIM, NIAID, NIH, Bethesda, United States of America
| | - Steven M Holland
- Immunopathogenesis Section, LCIM, NIAID, NIH, Bethesda, United States of America
| | - Wyndham H Wilson
- Lymphoid Malignancies Branch, National Cancer Institute, NIH, Bethesda, United States of America
| | - Tobias M Hohl
- Infectious Diseases, Memorial Sloan Kettering Cancer Center, New York, United States of America
| | - Michail S Lionakis
- Fungal Pathogenesis Section, LCIM, NIAID, NIH, Bethesda, United States of America
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3
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Davis MJ, Rypka KJ, Perron AK, Keilty J, Wils B, Levine J, Rezcallah AT, Solomon R, Goldfarb N, Kaka A. Angioinvasive Trichophyton rubrum associated necrotizing fasciitis in an immunocompromised patient. Clin Case Rep 2023; 11:e7718. [PMID: 37786455 PMCID: PMC10541569 DOI: 10.1002/ccr3.7718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/28/2023] [Accepted: 07/07/2023] [Indexed: 10/04/2023] Open
Abstract
Angioinvasive dermatophytosis with necrotizing fasciitis can be a rare complication in immunocompromised patients with early surgical debridement, 12 weeks of oral terbinafine, and reduction in immunosuppression being a viable management strategy.
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Affiliation(s)
- Michael J. Davis
- Minneapolis VA Health Care System – Department of Infectious Diseases and University of Minnesota – Department of Infectious DiseasesMinneapolisMinnesotaUSA
| | - Katelyn J. Rypka
- Minneapolis VA Health Care System – Department of Dermatology and University of Minnesota – Department of DermatologyMinneapolisMinnesotaUSA
| | | | - John Keilty
- University of Minnesota Medical SchoolMinneapolisMinnesotaUSA
| | - Benjamin Wils
- University of Minnesota Medical SchoolMinneapolisMinnesotaUSA
| | - Joshua Levine
- University of Minnesota Medical SchoolMinneapolisMinnesotaUSA
| | - Anthony T. Rezcallah
- Minneapolis VA Health Care System – Department of Surgery and University of Minnesota – Department of SurgeryMinneapolisMinnesotaUSA
| | - Robin Solomon
- Department of PathologyMinneapolis VA Health Care SystemMinneapolisMinnesotaUSA
| | - Noah Goldfarb
- Minneapolis VA Health Care System – Department of Dermatology and University of Minnesota – Department of DermatologyMinneapolisMinnesotaUSA
| | - Anjum Kaka
- Department of Infectious DiseasesMinneapolis VA Health Care SystemMinneapolisMinnesotaUSA
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4
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Xiao Z, Murakhovskaya I. Rituximab resistance in ITP and beyond. Front Immunol 2023; 14:1215216. [PMID: 37575230 PMCID: PMC10422042 DOI: 10.3389/fimmu.2023.1215216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 07/10/2023] [Indexed: 08/15/2023] Open
Abstract
The pathophysiology of immune thrombocytopenia (ITP) is complex and encompasses innate and adaptive immune responses, as well as megakaryocyte dysfunction. Rituximab is administered in relapsed cases and has the added benefit of inducing treatment-free remission in over 50% of patients. Nevertheless, the responses to this therapy are not long-lasting, and resistance development is frequent. B cells, T cells, and plasma cells play a role in developing resistance. To overcome this resistance, targeting these pathways through splenectomy and novel therapies that target FcγR pathway, FcRn, complement, B cells, plasma cells, and T cells can be useful. This review will summarize the pathogenetic mechanisms implicated in rituximab resistance and examine the potential therapeutic interventions to overcome it. This review will explore the efficacy of established therapies, as well as novel therapeutic approaches and agents currently in development.
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Affiliation(s)
| | - Irina Murakhovskaya
- Division of Hematology, Department of Hematology-Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, New York City, NY, United States
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5
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D'Sa S, Matous JV, Advani R, Buske C, Castillo JJ, Gatt M, Kapoor P, Kersten MJ, Leblond V, Leiba M, Palomba ML, Paludo J, Qiu L, Sarosiek S, Shadman M, Talaulikar D, Tam CS, Tedeschi A, Thomas SK, Tohidi-Esfahani I, Trotman J, Varettoni M, Vos J, Garcia-Sanz R, San-Miguel J, Dimopoulos MA, Treon SP, Kastritis E. Report of consensus panel 2 from the 11th international workshop on Waldenström's macroglobulinemia on the management of relapsed or refractory WM patients. Semin Hematol 2023; 60:80-89. [PMID: 37147252 DOI: 10.1053/j.seminhematol.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 03/09/2023] [Indexed: 03/29/2023]
Abstract
The consensus panel 2 (CP2) of the 11th International Workshop on Waldenström's macroglobulinemia (IWWM-11) has reviewed and incorporated current data to update the recommendations for treatment approaches in patients with relapsed or refractory WM (RRWM). The key recommendations from IWWM-11 CP2 include: (1) Chemoimmunotherapy (CIT) and/or a covalent Bruton tyrosine kinase (cBTKi) strategies are important options; their use should reflect the prior upfront strategy and are subject to their availability. (2) In selecting treatment, biological age, co-morbidities and fitness are important; nature of relapse, disease phenotype and WM-related complications, patient preferences and hematopoietic reserve are also critical factors while the composition of the BM disease and mutational status (MYD88, CXCR4, TP53) should also be noted. (3) The trigger for initiating treatment in RRWM should utilize knowledge of patients' prior disease characteristics to avoid unnecessary delays. (4) Risk factors for cBTKi related toxicities (cardiovascular dysfunction, bleeding risk and concurrent medication) should be addressed when choosing cBTKi. Mutational status (MYD88, CXCR4) may influence the cBTKi efficacy, and the role of TP53 disruptions requires further study) in the event of cBTKi failure dose intensity could be up titrated subject to toxicities. Options after BTKi failure include CIT with a non-cross-reactive regimen to one previously used CIT, addition of anti-CD20 antibody to BTKi, switching to a newer cBTKi or non-covalent BTKi, proteasome inhibitors, BCL-2 inhibitors, and new anti-CD20 combinations are additional options. Clinical trial participation should be encouraged for all patients with RRWM.
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Affiliation(s)
- S D'Sa
- UCLH Centre for Waldenström Macroglobulinaemia and Related Conditions, University College London Hospitals NHS Foundation Trust, London, UK.
| | - J V Matous
- Colorado Blood Cancer Institute, Sarah Cannon Research Institute, Denver, CO
| | - R Advani
- Stanford University Medical Center, Stanford, CA
| | - C Buske
- University Hospital Ulm, Ulm, Germany
| | - J J Castillo
- Dana Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - M Gatt
- Hadassah University Medical Center, Jerusalem, Israel
| | | | - M J Kersten
- Amsterdam UMC, University of Amsterdam, Department of Hematology, Cancer Center Amsterdam/LYMMCARE, Amsterdam, Netherlands
| | - V Leblond
- Groupe Hospitalier Pitié-Salpêtrière, Sorbonne University, Paris, France
| | - M Leiba
- Assuta Ashdod University Hospital; Faculty of Health Science, Ben-Gurion University of the Negev, Negev, Israel Memorial Sloan Kettering Cancer Center, New York, NY
| | - M L Palomba
- Memorial Sloan Kettering Cancer Center, New York NY US
| | | | - L Qiu
- National Clinical Medical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - S Sarosiek
- Dana Farber Cancer Institute, Harvard Medical School, Boston, MA
| | | | - D Talaulikar
- ANU College of Health and Medicine, Canberra, Australia
| | - C S Tam
- Alfred Health, Monash University, Melbourne, Australia
| | - A Tedeschi
- A. O. Ospedale Niguarda Ca' Granda, Milan, Italy
| | - S K Thomas
- University of Texas, MD Anderson Cancer Center, Houston TX USA
| | - I Tohidi-Esfahani
- Concord Repatriation General Hospital, University of Sydney, Sydney, Australia
| | - J Trotman
- Concord Repatriation General Hospital, University of Sydney, Sydney, Australia
| | - M Varettoni
- Division of Hematology, Fondazione iRCCS Policlinico, San Matteo, Italy
| | - Jmi Vos
- Amsterdam UMC, University of Amsterdam, Department of Hematology, Cancer Center Amsterdam/LYMMCARE, Amsterdam, Netherlands
| | - R Garcia-Sanz
- Hematology Department, University Hospital of Salamanca, Research Biomedical Institute of Salamanca, CIBERONC and Center for Cancer Research-IBMCC (University of Salamanca-CSIC), Salamanca, Spain
| | - J San-Miguel
- Clínica Universidad de Navarra, Centro de Investigación Médica Aplicada, Instituto de Investigación Sanitaria de Navarra, Centro de Investigación Biomédica en Red Cáncer, Pamplona, Spain
| | - M A Dimopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - S P Treon
- Dana Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - E Kastritis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
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6
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Alu A, Lei H, Han X, Wei Y, Wei X. BTK inhibitors in the treatment of hematological malignancies and inflammatory diseases: mechanisms and clinical studies. J Hematol Oncol 2022; 15:138. [PMID: 36183125 PMCID: PMC9526392 DOI: 10.1186/s13045-022-01353-w] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 09/07/2022] [Indexed: 11/28/2022] Open
Abstract
Bruton's tyrosine kinase (BTK) is an essential component of multiple signaling pathways that regulate B cell and myeloid cell proliferation, survival, and functions, making it a promising therapeutic target for various B cell malignancies and inflammatory diseases. Five small molecule inhibitors have shown remarkable efficacy and have been approved to treat different types of hematological cancers, including ibrutinib, acalabrutinib, zanubrutinib, tirabrutinib, and orelabrutinib. The first-in-class agent, ibrutinib, has created a new era of chemotherapy-free treatment of B cell malignancies. Ibrutinib is so popular and became the fourth top-selling cancer drug worldwide in 2021. To reduce the off-target effects and overcome the acquired resistance of ibrutinib, significant efforts have been made in developing highly selective second- and third-generation BTK inhibitors and various combination approaches. Over the past few years, BTK inhibitors have also been repurposed for the treatment of inflammatory diseases. Promising data have been obtained from preclinical and early-phase clinical studies. In this review, we summarized current progress in applying BTK inhibitors in the treatment of hematological malignancies and inflammatory disorders, highlighting available results from clinical studies.
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Affiliation(s)
- Aqu Alu
- Laboratory of Aging Research and Cancer Drug Target, State Key Laboratory of Biotherapy and Cancer Center, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Hong Lei
- Laboratory of Aging Research and Cancer Drug Target, State Key Laboratory of Biotherapy and Cancer Center, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Xuejiao Han
- Laboratory of Aging Research and Cancer Drug Target, State Key Laboratory of Biotherapy and Cancer Center, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yuquan Wei
- Laboratory of Aging Research and Cancer Drug Target, State Key Laboratory of Biotherapy and Cancer Center, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Xiawei Wei
- Laboratory of Aging Research and Cancer Drug Target, State Key Laboratory of Biotherapy and Cancer Center, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, China.
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7
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Wang H, Guo H, Yang J, Liu Y, Liu X, Zhang Q, Zhou K. Bruton tyrosine kinase inhibitors in B-cell lymphoma: beyond the antitumour effect. Exp Hematol Oncol 2022; 11:60. [PMID: 36138486 PMCID: PMC9493169 DOI: 10.1186/s40164-022-00315-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 09/11/2022] [Indexed: 01/08/2023] Open
Abstract
Targeting B-cell receptor signalling using Bruton tyrosine kinase (BTK) inhibitors (BTKis) has become a highly successful treatment modality for B-cell malignancies, especially for chronic lymphocytic leukaemia. However, long-term administration of BTKis can be complicated by adverse on- and/or off-target effects in particular cell types. BTK is widely expressed in cells of haematopoietic origin, which are pivotal components of the tumour microenvironment. BTKis, thus, show broad immunomodulatory effects on various non-B immune cell subsets by inhibiting specific immune receptors, including T-cell receptor and Toll-like receptors. Furthermore, due to the off-target inhibition of other kinases, such as IL-2-inducible T-cell kinase, epidermal growth factor receptor, and the TEC and SRC family kinases, BTKis have additional distinct effects on T cells, natural killer cells, platelets, cardiomyocytes, and other cell types. Such mechanisms of action might contribute to the exceptionally high clinical efficacy as well as the unique profiles of adverse effects, including infections, bleeding, and atrial fibrillation, observed during BTKi administration. However, the immune defects and related infections caused by BTKis have not received sufficient attention in clinical studies till date. The broad involvement of BTK in immunological pathways provides a rationale to combine BTKis with specific immunotherapies, such as immune checkpoint inhibitor or chimeric antigen receptor-T-cell therapy, for the treatment of relapsed or refractory diseases. This review discusses and summarises the above-mentioned issues as a reference for clinicians and researchers.
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Affiliation(s)
- Haoran Wang
- Department of Hematology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, No. 127 Dongming Road, Jinshui District, Zhengzhou, 450003, China
| | - Hao Guo
- Department of Hematology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, No. 127 Dongming Road, Jinshui District, Zhengzhou, 450003, China
| | - Jingyi Yang
- Department of Hematology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, No. 127 Dongming Road, Jinshui District, Zhengzhou, 450003, China
| | - Yanyan Liu
- Department of Hematology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, No. 127 Dongming Road, Jinshui District, Zhengzhou, 450003, China
| | - Xingchen Liu
- Department of Hematology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, No. 127 Dongming Road, Jinshui District, Zhengzhou, 450003, China
| | - Qing Zhang
- Department of Hematology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, No. 127 Dongming Road, Jinshui District, Zhengzhou, 450003, China
| | - Keshu Zhou
- Department of Hematology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, No. 127 Dongming Road, Jinshui District, Zhengzhou, 450003, China.
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8
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Cai L, Gao P, Wang Z, Dai C, Ning Y, Ilkit M, Xue X, Xiao J, Chen C. Lung and gut microbiomes in pulmonary aspergillosis: Exploring adjunctive therapies to combat the disease. Front Immunol 2022; 13:988708. [PMID: 36032147 PMCID: PMC9411651 DOI: 10.3389/fimmu.2022.988708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 07/25/2022] [Indexed: 11/13/2022] Open
Abstract
Species within the Aspergillus spp. cause a wide range of infections in humans, including invasive pulmonary aspergillosis, chronic pulmonary aspergillosis, and allergic bronchopulmonary aspergillosis, and are associated with high mortality rates. The incidence of pulmonary aspergillosis (PA) is on the rise, and the emergence of triazole-resistant Aspergillus spp. isolates, especially Aspergillus fumigatus, limits the efficacy of mold-active triazoles. Therefore, host-directed and novel adjunctive therapies are required to more effectively combat PA. In this review, we focus on PA from a microbiome perspective. We provide a general overview of the effects of the lung and gut microbiomes on the growth of Aspergillus spp. and host immunity. We highlight the potential of the microbiome as a therapeutic target for PA.
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Affiliation(s)
- Liuyang Cai
- Shanghai Engineering Research Center of Lung Transplantation, Shanghai, China
- Basic School of Medicine, Second Military Medical University (Naval Medical University), Shanghai, China
| | - Peigen Gao
- Shanghai Engineering Research Center of Lung Transplantation, Shanghai, China
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zeyu Wang
- Shanghai Engineering Research Center of Lung Transplantation, Shanghai, China
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Chenyang Dai
- Shanghai Engineering Research Center of Lung Transplantation, Shanghai, China
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ye Ning
- Shanghai Engineering Research Center of Lung Transplantation, Shanghai, China
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Macit Ilkit
- Division of Mycology, Department of Microbiology, Faculty of Medicine, University of Çukurova, Adana, Turkey
| | - Xiaochun Xue
- Department of Pharmacy, 905th Hospital of People’s Liberation Army of China (PLA) Navy, Shanghai, China
- *Correspondence: Xiaochun Xue, ; Jinzhou Xiao, ; Chang Chen,
| | - Jinzhou Xiao
- Shanghai Engineering Research Center of Hadal Science and Technology, College of Marine Sciences, Shanghai Ocean University, Shanghai, China
- *Correspondence: Xiaochun Xue, ; Jinzhou Xiao, ; Chang Chen,
| | - Chang Chen
- Shanghai Engineering Research Center of Lung Transplantation, Shanghai, China
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
- *Correspondence: Xiaochun Xue, ; Jinzhou Xiao, ; Chang Chen,
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