1
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Tsai YC, Schlaepfer T, Ignatova D, Chang YT, Valaperti A, Amarov B, Blanchard G, Pehr K, Vonow-Eisenring M, Urosevic-Maiwald M, Hoetzenecker W, Pascolo S, Iselin C, Fassnacht C, Dimitriou F, Bobrowicz M, Guenova E. Boost of innate immunity cytokines as biomarkers of response to extracorporeal photopheresis in patients with leukaemic cutaneous T-cell lymphoma. Br J Dermatol 2023; 189:603-611. [PMID: 37409661 DOI: 10.1093/bjd/ljad220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/28/2023] [Accepted: 06/30/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND Extracorporeal photopheresis (ECP) has emerged as a systemic first-line immunomodulatory therapy in leukaemic cutaneous T-cell lymphoma (L-CTCL) and is now beginning to be utilized in other T-cell-mediated diseases. Although ECP has been used for nearly 30 years, its mechanisms of action are not sufficiently understood, and biomarkers for response are scarce. OBJECTIVES We aimed to investigate the immunomodulatory effects of ECP on cytokine secretion patterns in patients with L-CTCL, to help elucidate its mechanism of action. METHODS A total of 25 patients with L-CTCL and 15 healthy donors (HDs) were enrolled in this retrospective cohort study. Concentrations of 22 cytokines were simultaneously quantified by using multiplex bead-based immunoassays. Neoplastic cells in patients' blood were evaluated by flow cytometry. RESULTS Firstly, we observed a distinct cytokine profile pattern difference between L-CTCLs and HDs. There was a significant loss of tumour necrosis factor (TNF)-α, and significant increase of interleukins (IL)-9, IL-12 and IL-13 in the sera of patients with L-CTCL compared with HDs. Secondly, patients with L-CTCL who received ECP were classified as treatment responders and nonresponders according to the quantitative reduction of malignant burden in their blood. We evaluated cytokine levels in culture supernatants from patients' peripheral blood mononuclear cells (PBMCs) at baseline and 27 weeks after ECP initiation. Strikingly, PBMCs purified from ECP responders released statistically higher concentrations of innate immune cytokines IL-1α, IL-1β, granulocyte-macrophage colony-stimulating factor (GM-CSF) and TNF-α in comparison with ECP nonresponders. In parallel, responders showed clearance of erythema, reduction of malignant clonal T cells in the blood, and a potent boost of relevant innate immune cytokines in individual patients with L-CTCL. CONCLUSIONS Taken together, our results demonstrate that ECP stimulates the innate immune network, and facilitates redirection of the tumour-biased immunosuppressive microenvironment towards proactive antitumour immune responses. The alterations of IL-1α, IL-1β, GM-CSF and TNF-α can be used as biomarkers of response to ECP in patients with L-CTCL.
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Affiliation(s)
- Yi-Chien Tsai
- Department of Dermatology, Lausanne University Hospital (CHUV), and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | | | | | - Yun-Tsan Chang
- Department of Dermatology, Lausanne University Hospital (CHUV), and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | | | - Boyko Amarov
- Institute of Statistics and Econometrics, Faculty of Economics and Business Administration, Sofia University 'St Kliment Ohridski', Sofia, Bulgaria
| | - Gabriela Blanchard
- Department of Dermatology, Lausanne University Hospital (CHUV), and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Kevin Pehr
- Division of Dermatology, McGill University, Jewish General Hospital, and Lady Davis Institute for Medical Research, Montreal, Canada
| | | | | | | | | | - Christoph Iselin
- Department of Dermatology, Lausanne University Hospital (CHUV), and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | | | | | | | - Emmanuella Guenova
- Department of Dermatology, Lausanne University Hospital (CHUV), and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Departments of Dermatology
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2
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Mayer W, Mayr J, Koch F, Rechberger U, Gasser W, Hermann M, Kempel A, Edlinger M, Schennach H. Increasing the collection flow rate to 2 mL/min is effective and reduces the procedure time in off-line photopheresis. Transfusion 2023; 63:1546-1553. [PMID: 37422880 DOI: 10.1111/trf.17469] [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: 03/25/2023] [Revised: 06/03/2023] [Accepted: 06/04/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Extracorporeal photopheresis (ECP) treatment, mostly based on apheresis technology, is used for immunomodulation in various diseases such as cutaneous T-cell lymphoma, graft versus host disease and other (auto)immune disorders. The aim of this study was to collect high cell counts and purity in shorter procedure times using an ECP off-line system with an increased collection flow rate of 2 mL/min to a target volume of 200 mL buffy coat. STUDY DESIGN AND METHODS In this prospective study, data of routinely performed off-line photopheresis treatments were collected and analyzed at the Central Institute for Blood Transfusion & Department of Immunology (ZIB) of the Tirol Kliniken, to assess absolute cell counts and procedure times and to calculate collection efficiencies (CE2). RESULTS A total of 22 patients participated in this study. The processed blood volume was 4312 mL, the collection time 120 min, overall procedure time 157 min and the absolute cell counts of treated white blood cells (WBC) and mononuclear cells (MNC) were 5.0 and 4.3 × 109 respectively (median values). The calculated CE2 for WBC and MNC was 21.1% and 58.5%, the proportion of treated MNCs of the total number of MNCs present was 55.0%. CONCLUSION The data presented in this study show high therapeutically effective cell counts collected with a high MNC purity within a shorter overall collection/procedure time due to an increased collection flow rate.
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Affiliation(s)
- Wolfgang Mayer
- Central Institute for Blood Transfusion & Department of Immunology (ZIB), Tirol Kliniken GmbH, Innsbruck, Austria
| | - Jonas Mayr
- Central Institute for Blood Transfusion & Department of Immunology (ZIB), Tirol Kliniken GmbH, Innsbruck, Austria
| | - Felix Koch
- Central Institute for Blood Transfusion & Department of Immunology (ZIB), Tirol Kliniken GmbH, Innsbruck, Austria
| | - Ulrike Rechberger
- Central Institute for Blood Transfusion & Department of Immunology (ZIB), Tirol Kliniken GmbH, Innsbruck, Austria
| | - Werner Gasser
- Central Institute for Blood Transfusion & Department of Immunology (ZIB), Tirol Kliniken GmbH, Innsbruck, Austria
| | - Martin Hermann
- Department of Anesthesia and Intensive Care Medicine at the Medical University Innsbruck, Innsbruck, Austria
| | - Angela Kempel
- Pharmametrics GmbH, Institute for Health Economics & Epidemiology, Freiburg, Germany
| | - Michael Edlinger
- Institute of Medical Statistics and Informatics, Medical University Innsbruck, Innsbruck, Austria
| | - Harald Schennach
- Central Institute for Blood Transfusion & Department of Immunology (ZIB), Tirol Kliniken GmbH, Innsbruck, Austria
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3
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Maeda A, Yamamoto R, Mizuno S, Miki S, Sakamoto Y, Kogata S, Toyama C, Sato K, Okamatsu C, Ando T, Iida M, Watsuji T, Sato T, Miyagawa S, Okuyama H, Takami A, Kodera Y. Efficacy of a 365 nm Ultraviolet A1 light Emitting Diode (UVA1-LED) in in vitro Extracorporeal Photopheresis. Photochem Photobiol 2022; 98:1229-1235. [PMID: 35238039 DOI: 10.1111/php.13613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/24/2022] [Accepted: 02/25/2022] [Indexed: 11/29/2022]
Abstract
Extracorporeal photochemotherapy (ECP) is one of the more effective cell therapies for graft-versus-host disease (GvHD). ECP is a widely recommended therapeutic approach for the treatment of chronic GvHD, particularly steroid-refractory GVHD. In recent years, the use of a light emitting diode (LED) in the clinic has attracted considerable interest. In this study, we examined the issue of whether an ultraviolet A1-light emitting diode (UVA1-LED) can be used as a light source in ECP. To compare the efficacy of ECP with conventional UVA lamp and a UVA1-LED, we established an in vitro ECP model. Treatment efficacy was evaluated by measuring the % apoptosis and the inhibition of T-cell proliferation. To investigate the effect of ECP on the innate immune reaction, THP-1 cells with a luciferase reporter gene driven by a NF-kB response element (THP-1 luc NF-kB) were treated with ECP. The LED-ECP induced apoptosis and inhibition of T-cell proliferation as efficiently as a conventional ECP. However, LED-ECP induced less innate immunity in THP-1. Since LED devices are more compact compared with conventional UVA irradiation devices, the use of a UVA1-LED in the treatment of ECP may be a better alternative to conventional ECP therapy.
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Affiliation(s)
- Akira Maeda
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Japan
- Department of Promotion for Blood and Marrow Transplantation, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Riho Yamamoto
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Japan
- Air Water Incorporated, Osaka, Japan
| | - Shohei Mizuno
- Division of Hematology, Department of Internal Medicine, Aichi Medical University School of Medicine, Nagakute, Japan
| | | | | | - Shuhei Kogata
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Chiyoshi Toyama
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kazuki Sato
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Chizu Okamatsu
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Takanori Ando
- Department of Promotion for Blood and Marrow Transplantation, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Minako Iida
- Department of Promotion for Blood and Marrow Transplantation, Aichi Medical University School of Medicine, Nagakute, Japan
| | | | - Toshinobu Sato
- Molecular Genetics, Institute of Life Science, Kurume University, Kurume, Japan
| | - Shuji Miyagawa
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Japan
- Meiji University International Institute for Bio-Resource Research, Kawasaki, Japan
| | - Hiroomi Okuyama
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Akiyoshi Takami
- Division of Hematology, Department of Internal Medicine, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Yoshitaka Kodera
- Department of Promotion for Blood and Marrow Transplantation, Aichi Medical University School of Medicine, Nagakute, Japan
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4
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Buchele V, Hackstein H. A simplified extracorporeal photopheresis procedure based on single high-dose ultraviolet A light irradiation shows similar in vitro efficacy. Transfusion 2020; 61:883-893. [PMID: 33300629 DOI: 10.1111/trf.16209] [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: 06/04/2020] [Revised: 11/06/2020] [Accepted: 11/06/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Extracorporeal photopheresis (ECP) is one of the most widely used and effective cell-based therapies for the treatment of T-cell-mediated diseases. The patients' white blood cells (WBCs) are collected by apheresis and exposed to the photosensitizer 8-methoxypsoralen (8-MOP) and ultraviolet A (UVA) light before retransfusion. The UVA/8-MOP combination has been in use in ECP for more than 4 decades; however, whether ECP can be simplified by UVA light irradiation only has never been analyzed. STUDY DESIGN AND METHODS Peripheral blood mononuclear cells were treated with classical ECP or different UVA light doses only (UVAonly ). Treatment efficacy was investigated by apoptosis induction in WBC subsets, inhibition of T-cell proliferation, and the ability of monocytes to induce allogeneic T-cell expansion and to respond to lipopolysaccharide and interferon-γ stimulation in vitro. RESULTS High-dose UVAonly treatment (5 J/cm2 ) was as efficient as ECP to induce apoptosis within 48 hours. UVAonly treatment modulated the composition of the surviving cells by improving monocyte survival and promoting CD8+ T-cell apoptosis. Both ECP and UVAonly treatment inhibited anti-CD3/anti-CD28 triggered T-cell proliferation. Interestingly, whereas ECP-treated monocytes exhibited a markedly reduced capacity to respond to stimulation and to induce allogeneic T-cell proliferation, UVAonly treatment preserved monocyte functionality to some degree. CONCLUSIONS High-dose UVAonly and standard ECP showed comparable efficacy in inducing apoptosis and inhibiting direct T-cell proliferation. Hence, UVAonly treatment can be a simplified alternative to ECP therapy. Furthermore, increased monocyte survival with partially preserved functionality after UVAonly treatment may provide a novel method for immunoregulation.
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Affiliation(s)
- Vera Buchele
- Department of Transfusion Medicine and Hemostaseology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Holger Hackstein
- Department of Transfusion Medicine and Hemostaseology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
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5
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Hackstein H, Kalina A, Dorn B, Keil IS, Baal N, Michel G, Brendel C, Neubauer A, Jakob T, Bein G. CD11c + dendritic cells mediate antigen-specific suppression in extracorporeal photopheresis. Clin Exp Immunol 2020; 203:329-339. [PMID: 33073358 PMCID: PMC7806418 DOI: 10.1111/cei.13539] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 10/07/2020] [Accepted: 10/11/2020] [Indexed: 01/05/2023] Open
Abstract
Extracorporeal photopheresis (ECP) represents one of the most widespread and effective cell therapies for graft‐versus‐host disease and other T cell‐mediated disorders. However, the key factors affecting the therapeutic efficacy of ECP remain unclear. We hypothesized that therapeutic effects are mediated by ECP‐treated antigen‐presenting dendritic cells (DC). To test this hypothesis, we used the experimental model of contact hypersensitivity (CHS). The ECP’s therapeutic activity improved when the total cell dose of the ECP‐treated cells was increased. We used different haptens during sensitization to demonstrate that the anti‐inflammatory activity of ECP is antigen‐specific. This confirmed the hypothesis that professional antigen‐presenting cells are involved in the mode of action. Also, the ECP’s therapeutic activity was abrogated by the depletion of CD11c+ DC, which represents fewer than 1% of all the ECP‐exposed cells. Finally, we confirm the critical importance of CD11c+ DC for ECP activity by showing that only a few purified CD11c+ DC are sufficient to mediate its therapeutic effect. The finding that ECP‐treated, physiological antigen‐presenting DC alone mediate antigen‐specific modulation of a pathological immune response may result in better‐targeted interventions when treating patients.
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Affiliation(s)
- H Hackstein
- Department of Transfusion Medicine and Hemostaseology, University Hospital Erlangen, Erlangen, Germany
| | - A Kalina
- Institute for Clinical Immunology and Transfusion Medicine, Justus-Liebig-University, Giessen, Germany
| | - B Dorn
- Department of Dermatology and Allergology, Experimental Dermatology and Allergy Research Group, Justus-Liebig-University, Giessen, Germany
| | - I S Keil
- Institute for Clinical Immunology and Transfusion Medicine, Justus-Liebig-University, Giessen, Germany
| | - N Baal
- Institute for Clinical Immunology and Transfusion Medicine, Justus-Liebig-University, Giessen, Germany
| | - G Michel
- Institute for Clinical Immunology and Transfusion Medicine, Justus-Liebig-University, Giessen, Germany
| | - C Brendel
- Department of Hematology, Oncology, Immunology, Philipps-University, Marburg, Germany
| | - A Neubauer
- Department of Hematology, Oncology, Immunology, Philipps-University, Marburg, Germany
| | - T Jakob
- Department of Dermatology and Allergology, Experimental Dermatology and Allergy Research Group, Justus-Liebig-University, Giessen, Germany
| | - G Bein
- Institute for Clinical Immunology and Transfusion Medicine, Justus-Liebig-University, Giessen, Germany
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6
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Vieyra-Garcia PA, Wolf P. Extracorporeal Photopheresis: A Case of Immunotherapy Ahead of Its Time. Transfus Med Hemother 2020; 47:226-235. [PMID: 32595427 DOI: 10.1159/000508479] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 05/05/2020] [Indexed: 12/18/2022] Open
Abstract
Extracorporeal photopheresis (ECP) is a cell-based immunotherapy that involves the reinfusion of autologous leukocytes after exposure to psoralen and UVA. The treatment has been used for over 30 years, at first on patients with cutaneous T-cell lymphoma (CTCL) and later for the management of patients with graft-versus-host disease (GvHD), sclerosing disorders, atopic dermatitis, and other diseases that may share the common driving factor of a pathogenic T-cell clone or clones in blood circulation. Patients with clinical improvement mount an antigen-specific immune response that may have tolerance traits in the case of GvHD or anticlonal cytotoxic characteristics in the case of CTCL. The exact mechanisms that dictate one response or the other are not fully understood, but the evidence accumulated so far indicates that multiple events occur simultaneously and consequentially contribute to the end result. These include contact of cells with the outside (plastics and tubing of the ECP apparatus), exposure to psoralen and UVA that activates platelets, monocytes, and other myeloid cells, the release of damage-associated molecular patterns, differentiation of monocytes into dendritic cells, and generation and successive presentation of numerous antigens after the phagocytosis of apoptotic cells. Once reintroduced, the ECP product increases the frequency and activity of regulatory T cells (Tregs), shifts the systemic cytokine balance, and promotes extravasation of immune cells that together shape the effects of this treatment. In this review, we summarize the seminal work and most recent literature of the therapeutic mechanisms and reflect on future avenues of improvements and applications of ECP.
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Affiliation(s)
| | - Peter Wolf
- Department of Dermatology and Venerology, Medical University of Graz, Graz, Austria
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7
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Ploetz E, Zimpel A, Cauda V, Bauer D, Lamb DC, Haisch C, Zahler S, Vollmar AM, Wuttke S, Engelke H. Metal-Organic Framework Nanoparticles Induce Pyroptosis in Cells Controlled by the Extracellular pH. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2020; 32:e1907267. [PMID: 32182391 DOI: 10.1002/adma.201907267] [Citation(s) in RCA: 96] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 03/01/2020] [Accepted: 03/02/2020] [Indexed: 05/21/2023]
Abstract
Ion homeostasis is essential for cellular survival, and elevated concentrations of specific ions are used to start distinct forms of programmed cell death. However, investigating the influence of certain ions on cells in a controlled way has been hampered due to the tight regulation of ion import by cells. Here, it is shown that lipid-coated iron-based metal-organic framework nanoparticles are able to deliver and release high amounts of iron ions into cells. While high concentrations of iron often trigger ferroptosis, here, the released iron induces pyroptosis, a form of cell death involving the immune system. The iron release occurs only in slightly acidic extracellular environments restricting cell death to cells in acidic microenvironments and allowing for external control. The release mechanism is based on endocytosis facilitated by the lipid-coating followed by degradation of the nanoparticle in the lysosome via cysteine-mediated reduction, which is enhanced in slightly acidic extracellular environment. Thus, a new functionality of hybrid nanoparticles is demonstrated, which uses their nanoarchitecture to facilitate controlled ion delivery into cells. Based on the selectivity for acidic microenvironments, the described nanoparticles may also be used for immunotherapy: the nanoparticles may directly affect the primary tumor and the induced pyroptosis activates the immune system.
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Affiliation(s)
- Evelyn Ploetz
- Department of Chemistry and Center for NanoScience (CeNS), LMU Munich, Munich, 81377, Germany
- Nanosystems Initiative Munich (NIM), LMU Munich, Munich, 81377, Germany
- Center for Integrated Protein Science Munich (CiPSM), LMU Munich, Munich, 81377, Germany
| | - Andreas Zimpel
- Department of Chemistry and Center for NanoScience (CeNS), LMU Munich, Munich, 81377, Germany
| | - Valentina Cauda
- Department of Applied Science and Technology, Politecnico di Torino, Torino, 10129, Italy
| | - David Bauer
- Department of Chemistry, TU Munich, Munich, 81377, Germany
| | - Don C Lamb
- Department of Chemistry and Center for NanoScience (CeNS), LMU Munich, Munich, 81377, Germany
- Nanosystems Initiative Munich (NIM), LMU Munich, Munich, 81377, Germany
- Center for Integrated Protein Science Munich (CiPSM), LMU Munich, Munich, 81377, Germany
| | | | - Stefan Zahler
- Department of Pharmacy, LMU Munich, Munich, 81377, Germany
| | | | - Stefan Wuttke
- BCMaterials, Basque Center for Materials, UPV/EHU Science Park, Leioa, 48940, Spain
- Ikerbasque, Basque Foundation for Science, Bilbao, 48013, Spain
| | - Hanna Engelke
- Department of Chemistry and Center for NanoScience (CeNS), LMU Munich, Munich, 81377, Germany
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8
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Mankarious M, Matthews NC, Snowden JA, Alfred A. Extracorporeal Photopheresis (ECP) and the Potential of Novel Biomarkers in Optimizing Management of Acute and Chronic Graft vs. Host Disease (GvHD). Front Immunol 2020; 11:81. [PMID: 32082329 PMCID: PMC7005102 DOI: 10.3389/fimmu.2020.00081] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 01/13/2020] [Indexed: 12/14/2022] Open
Abstract
As the use of hematopoietic stem cell transplantation (HSCT) has become a more widespread and effective treatment for hematological malignant and non-malignant conditions, the need to minimize the harmful effects of graft- vs.-host disease (GvHD) has become more important in achieving good outcomes. With diagnosis of GvHD reliant on its clinical manifestations, research into biomarkers for the diagnosis, progression, and even for the prediction of disease, is imperative to combating the high levels of morbidity and mortality post-HSCT. Despite the development of novel treatment approaches to GvHD, corticosteroids remain the standard first-line treatment, with immunosuppressant therapies as second-line options. These strategies however have significant limitations and associated complications. Extracorporeal Photopheresis (ECP) has shown to be effective and safe in treating patients with symptomatic GvHD. ECP has been shown to have varied effects on multiple parts of the immune system and does not appear to increase the risk of relapse or infection in the post HSCT setting. Even so, ECP can be logistically more complex to organize and requires patients to be sufficiently stable. This review aims to summarize the potential role of biomarkers to help guide individualized treatment decisions in patients with acute and chronic GvHD. In relation to ECP, robust biomarkers of GvHD will be highly useful in informing patient selection, intensity and duration of the ECP schedule, monitoring of response and other treatment decisions alongside the concurrent administration of other GvHD therapies. Further research is warranted to establish how GvHD biomarkers are best incorporated into ECP treatment pathways with the goal of tailoring ECP to the needs of individual patients and maximizing benefit.
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Affiliation(s)
- Matthew Mankarious
- Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Nick C Matthews
- Department of Photopheresis, The Rotherham NHS Foundation Trust, Rotherham, United Kingdom
| | - John A Snowden
- Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Arun Alfred
- Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, United Kingdom.,Department of Photopheresis, The Rotherham NHS Foundation Trust, Rotherham, United Kingdom
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9
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Worel N, Mansouri Taleghani B, Strasser E. Recommendations for Therapeutic Apheresis by the Section "Preparative and Therapeutic Hemapheresis" of the German Society for Transfusion Medicine and Immunohematology. Transfus Med Hemother 2020; 46:394-406. [PMID: 31933569 DOI: 10.1159/000503937] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 10/07/2019] [Indexed: 01/18/2023] Open
Abstract
The section "Preparative and Therapeutic Hemapheresis" of the German Society for Transfusion Medicine and Immunohematology (DGTI) has reviewed the actual literature and updated techniques and indications for evidence-based use of therapeutic apheresis in human disease. The recommendations are mostly in line with the "Guidelines on the Use of Therapeutic Apheresis in Clinical Practice" published by the Writing Committee of the American Society for Apheresis (ASFA) and have been conducted by experts from the DACH (Germany, Austria, Switzerland) region.
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Affiliation(s)
- Nina Worel
- Department for Blood Group Serology and Transfusion Medicine, Medical University Vienna, Vienna, Austria
| | - Behrouz Mansouri Taleghani
- University Clinic of Hematology and Central Hematology Laboratory, Division of Transfusion Medicine, Bern University Hospital, Inselspital, Bern, Switzerland
| | - Erwin Strasser
- Department of Transfusion Medicine and Hemostasis, University Hospital Erlangen, Erlangen, Germany
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10
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Pilon C, Stehlé T, Beldi-Ferchiou A, Matignon M, Thiolat A, Burlion A, Grondin C, Birebent B, Pirenne F, Rouard H, Lang P, Marodon G, Grimbert P, Cohen JL. Human Apoptotic Cells, Generated by Extracorporeal Photopheresis, Modulate Allogeneic Immune Response. Front Immunol 2019; 10:2908. [PMID: 31921167 PMCID: PMC6930166 DOI: 10.3389/fimmu.2019.02908] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 11/26/2019] [Indexed: 01/05/2023] Open
Abstract
The induction of specific and sustainable tolerance is a challenging issue in organ transplantation. The discovery of the immunosuppressive properties of apoptotic cells in animal models has paved the way for their use in human transplantation. In this work, we aimed to define a stable, reproducible, and clinically compatible production procedure of human apoptotic cells (Apo-cells). Using a clinically approved extracorporeal photopheresis technique, we have produced and characterized phenotypically and functionally human apoptotic cells. These Apo-cells have immunosuppressive properties proved in vitro and in vivo in NOD/SCID/γC mice by their capacity to modulate an allogeneic response following both a direct and an indirect antigen presentation. These results brought the rationale for the use of Apo-cells in tolerance induction protocol for organ transplantation.
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Affiliation(s)
- Caroline Pilon
- Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalo-Universitaire Chenevier Mondor, Centre d'Investigation Clinique Biothérapie, Créteil, France.,Institut Mondor de recherche biomédicale, Université Paris-Est, UMR_S955, UPEC, Créteil, France.,Inserm, U955, Equipe 21, Créteil, France
| | - Thomas Stehlé
- Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalo-Universitaire Chenevier Mondor, Centre d'Investigation Clinique Biothérapie, Créteil, France.,Institut Mondor de recherche biomédicale, Université Paris-Est, UMR_S955, UPEC, Créteil, France.,AP-HP, Groupe Hospitalo-Universitaire Chenevier Mondor, Service de Néphrologie-Transplantation, Créteil, France
| | - Asma Beldi-Ferchiou
- Institut Mondor de recherche biomédicale, Université Paris-Est, UMR_S955, UPEC, Créteil, France.,Inserm, U955, Equipe 21, Créteil, France
| | - Marie Matignon
- Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalo-Universitaire Chenevier Mondor, Centre d'Investigation Clinique Biothérapie, Créteil, France.,Institut Mondor de recherche biomédicale, Université Paris-Est, UMR_S955, UPEC, Créteil, France.,Inserm, U955, Equipe 21, Créteil, France.,AP-HP, Groupe Hospitalo-Universitaire Chenevier Mondor, Service de Néphrologie-Transplantation, Créteil, France
| | - Allan Thiolat
- Institut Mondor de recherche biomédicale, Université Paris-Est, UMR_S955, UPEC, Créteil, France.,Inserm, U955, Equipe 21, Créteil, France
| | - Aude Burlion
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, CNRS, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France
| | - Cynthia Grondin
- Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalo-Universitaire Chenevier Mondor, Centre d'Investigation Clinique Biothérapie, Créteil, France.,Institut Mondor de recherche biomédicale, Université Paris-Est, UMR_S955, UPEC, Créteil, France.,Inserm, U955, Equipe 21, Créteil, France
| | - Brigitte Birebent
- Etablissement Français du Sang (EFS) - Ile de France, Créteil, France
| | - France Pirenne
- Etablissement Français du Sang (EFS) - Ile de France, Créteil, France.,Inserm, U955, Equipe 2, Créteil, France
| | - Hélène Rouard
- Etablissement Français du Sang (EFS) - Ile de France, Créteil, France
| | - Philippe Lang
- Institut Mondor de recherche biomédicale, Université Paris-Est, UMR_S955, UPEC, Créteil, France.,Inserm, U955, Equipe 21, Créteil, France.,AP-HP, Groupe Hospitalo-Universitaire Chenevier Mondor, Service de Néphrologie-Transplantation, Créteil, France
| | - Gilles Marodon
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, CNRS, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France
| | - Philippe Grimbert
- Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalo-Universitaire Chenevier Mondor, Centre d'Investigation Clinique Biothérapie, Créteil, France.,Institut Mondor de recherche biomédicale, Université Paris-Est, UMR_S955, UPEC, Créteil, France.,Inserm, U955, Equipe 21, Créteil, France.,AP-HP, Groupe Hospitalo-Universitaire Chenevier Mondor, Service de Néphrologie-Transplantation, Créteil, France
| | - José L Cohen
- Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalo-Universitaire Chenevier Mondor, Centre d'Investigation Clinique Biothérapie, Créteil, France.,Institut Mondor de recherche biomédicale, Université Paris-Est, UMR_S955, UPEC, Créteil, France.,Inserm, U955, Equipe 21, Créteil, France
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11
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Schwab L, Michel G, Bein G, Hackstein H. CD71 surface analysis of T cells: a simple alternative for extracorporeal photopheresis quality control. Vox Sang 2019; 115:81-93. [PMID: 31680273 DOI: 10.1111/vox.12850] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 08/02/2019] [Accepted: 09/05/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Extracorporeal photopheresis (ECP) is a leukapheresis-based cellular therapy that is used with increasing frequency worldwide to treat various T-cell-mediated diseases. Currently, the inhibition of T-cell proliferation after photopheresis is analysed frequently using time-consuming assays including radioactive thymidine assays or carboxyfluorescein succinimidyl ester (CFSE) staining. We investigated whether simple surface T-cell staining using surrogate markers of T-cell proliferation can replace time-consuming measurement of T-cell proliferation in ECP quality control. STUDY DESIGN AND METHODS T-cell activation markers were investigated by flow cytometry after ECP. Candidates were validated by direct comparison with the classical CFSE T-cell proliferation inhibition test and apoptosis staining. Finally, surface T-cell staining was performed in patient samples in comparison with classical methods. RESULTS CD71 expression exhibited the fastest and most robust upregulation, which was detectable as early as 6-8 h after T-cell stimulation and almost completely abrogated by ECP. In a direct comparison with the CFSE T-cell proliferation assay, suppression of CD71 expression after ECP was almost identical and detectable as early as 16 h after stimulation in peripheral blood mononuclear cells of healthy donors. Furthermore, in direct comparison with classical apoptosis staining, the inhibition delta of CD71 after ECP was significantly higher. Moreover, in patients under T-cell suppressive therapy, T-cell-dependent CFSE and CD71 assays exhibited decreased sensitivity to detect ECP treatment and were inferior in comparison to apoptosis staining. CONCLUSION Surface CD71 analysis represents a very simple quality control alternative to detect ECP-mediated T-cell proliferation inhibition in normal PBMC samples devoid of T-cell suppressive drugs.
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Affiliation(s)
- Laura Schwab
- Institute for Clinical Immunology and Transfusion Medicine, Justus-Liebig-University Giessen, Giessen, Germany
| | - Gabriela Michel
- Institute for Clinical Immunology and Transfusion Medicine, Justus-Liebig-University Giessen, Giessen, Germany
| | - Gregor Bein
- Institute for Clinical Immunology and Transfusion Medicine, Justus-Liebig-University Giessen, Giessen, Germany
| | - Holger Hackstein
- Department of Transfusion Medicine and Haemostaseology, University Hospital Erlangen, Erlangen, Germany
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12
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Extracorporeal photopheresis for the treatment of graft rejection in 33 adult kidney transplant recipients. Transfus Apher Sci 2019; 58:515-524. [PMID: 31383541 DOI: 10.1016/j.transci.2019.06.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 05/06/2019] [Accepted: 06/03/2019] [Indexed: 01/02/2023]
Abstract
Background - Extracorporeal photopheresis (ECP) has shown encouraging results in the prevention of allograft rejection in heart transplantation. However, the role of ECP in kidney transplant (KT) rejection needs to be determined. Methods - This multicentre retrospective study included 33 KT recipients who were treated with ECP for allograft rejection (23 acute antibody-mediated rejections (AMRs), 2 chronic AMRs and 8 acute cellular rejections (ACRs)). The ECP indications were KT rejection in patients who were resistant to standard therapies (n = 18) or in patients for whom standard therapies were contraindicated because of concomitant infections or cancers (n = 15). Results - At 12 months (M12) post-ECP, 11 patients (33%) had a stabilization of kidney function with a graft survival rate of 61%. The Banff AMR score (g + ptc + v) was a risk factor for graft loss at M12 (HR 1.44 [1.01-2.05], p < 0.05). The factorial mixed data analysis identified 2 clusters. Patients with a functional graft at M12 tended to have cellular and/or chronic rejections. Patients with graft loss at M12 tended to have acute rejections and/or AMR; higher serum creatinine levels; DSA levels and histologic scores of AMR; and a longer delay between the rejection and ECP start than those of patients with functional grafts. Conclusions - ECP may be helpful to control ACR or moderate AMR in KT recipients presenting concomitant opportunistic infections or malignancies when it is initiated early.
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13
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Yu Y, Zhang Y, Hu C, Zou X, Lin Y, Xia Y, You L. Chemistry and immunostimulatory activity of a polysaccharide from Undaria pinnatifida. Food Chem Toxicol 2019; 128:119-128. [PMID: 30926436 DOI: 10.1016/j.fct.2019.03.042] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 03/12/2019] [Accepted: 03/21/2019] [Indexed: 01/20/2023]
Abstract
An immunologically active polysaccharide named as UPP-2 (1035.52 kDa) was isolated from Undaria pinnatifida using traditional water extraction followed by DEAE Sepharose fast flow chromatography. UPP-2 was proven to be a low sulfated polysaccharide with relatively abundant uronic acid (13.08 ± 0.67%). UPP-2 mainly consisted of xylose (64.55%), glucose (23.81%), arabinose (5.90%) and mannose (4.26%), and its main glycosidic linkage types included →2)-α-D-Xylp-(1→, →4)-α-D-Glcp-(1→, α-D-Xylp-(1→ and →2,4)-β-D-Xylp-(1 → . Results indicated that UPP-2 significantly promoted the proliferation and pinocytic capacity of RAW264.7 cells, and upregulated the mRNA expressions of iNOS, TNF-α, IL-6 and IL-1β at 100-600 μg/mL with a maximum of 195, 42, 768 and 539 times of those of the negative control, respectively. Moreover, UPP-2 significantly increased the secretions of nitric oxide, TNF-α and IL-6 at 100-600 μg/mL (8.0, 73.1 and 188.7 times compared to those of the negative control, respectively), as well as promoted the production of IL-1β obviously at 600 μg/mL. Overall, UPP-2 could be served as a potential dietary supplement or functional food based on its immunostimulatory activity.
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Affiliation(s)
- Yongyi Yu
- School of Food Science and Engineering, South China University of Technology, Guangzhou, Guangdong, 510640, People's Republic of China; Overseas Expertise Introduction Center for Food Nutrition and Human Health (111 Center), Guangzhou, 510640, People's Republic of China
| | - Yajun Zhang
- School of Food Science and Engineering, South China University of Technology, Guangzhou, Guangdong, 510640, People's Republic of China; Overseas Expertise Introduction Center for Food Nutrition and Human Health (111 Center), Guangzhou, 510640, People's Republic of China
| | - Cebin Hu
- School of Food Science and Engineering, South China University of Technology, Guangzhou, Guangdong, 510640, People's Republic of China; Overseas Expertise Introduction Center for Food Nutrition and Human Health (111 Center), Guangzhou, 510640, People's Republic of China
| | - Xinyuan Zou
- School of Food Science and Engineering, South China University of Technology, Guangzhou, Guangdong, 510640, People's Republic of China; Overseas Expertise Introduction Center for Food Nutrition and Human Health (111 Center), Guangzhou, 510640, People's Republic of China
| | - Yang Lin
- School of Food Science and Engineering, South China University of Technology, Guangzhou, Guangdong, 510640, People's Republic of China; Overseas Expertise Introduction Center for Food Nutrition and Human Health (111 Center), Guangzhou, 510640, People's Republic of China
| | - Yangyuan Xia
- School of Food Science and Engineering, South China University of Technology, Guangzhou, Guangdong, 510640, People's Republic of China; Overseas Expertise Introduction Center for Food Nutrition and Human Health (111 Center), Guangzhou, 510640, People's Republic of China
| | - Lijun You
- School of Food Science and Engineering, South China University of Technology, Guangzhou, Guangdong, 510640, People's Republic of China; Overseas Expertise Introduction Center for Food Nutrition and Human Health (111 Center), Guangzhou, 510640, People's Republic of China.
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14
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Wiese F, Reinhardt-Heller K, Volz M, Gille C, Köstlin N, Billing H, Handgretinger R, Holzer U. Monocytes show immunoregulatory capacity on CD4 + T cells in a human in-vitro model of extracorporeal photopheresis. Clin Exp Immunol 2018; 195:369-380. [PMID: 30411330 DOI: 10.1111/cei.13232] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2018] [Indexed: 01/02/2023] Open
Abstract
Extracorporeal photopheresis (ECP) is a widely used immunomodulatory therapy for the treatment of various T cell-mediated disorders such as cutaneous T cell lymphoma (CTCL), graft-versus-host disease (GvHD) or systemic sclerosis. Although clinical benefits of ECP are already well described, the underlying mechanism of action of ECP is not yet fully understood. Knowledge on the fate of CD14+ monocytes in the context of ECP is particularly limited and controversial. Here, we investigated the immunoregulatory function of ECP treated monocytes on T cells in an in-vitro ECP model. We show that ECP-treated monocytes significantly induce proinflammatory T cell types in co-cultured T cells, while anti-inflammatory T cells remain unaffected. Furthermore, we found significantly reduced proliferation rates of T cells after co-culture with ECP-treated monocytes. Both changes in interleukin secretion and proliferation were dependent on cell-contact between monocytes and T cells. Interestingly, blocking interactions of programmed death ligand 1 (PD-L1) to programmed death 1 (PD-1) in the in-vitro model led to a significant recovery of T cell proliferation. These results set the base for further studies on the mechanism of ECP, especially the regulatory role of ECP-treated monocytes.
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Affiliation(s)
- F Wiese
- Tuebingen University Children's Hospital, Department of Hematology and Oncology, Tuebingen, Germany
| | - K Reinhardt-Heller
- Tuebingen University Children's Hospital, Department of Hematology and Oncology, Tuebingen, Germany
| | - M Volz
- Tuebingen University Children's Hospital, Department of Hematology and Oncology, Tuebingen, Germany
| | - C Gille
- Tuebingen University Children's Hospital, Department of Neonatology, Tuebingen, Germany
| | - N Köstlin
- Tuebingen University Children's Hospital, Department of Neonatology, Tuebingen, Germany
| | - H Billing
- Tuebingen University Children's Hospital, Department of Hematology and Oncology, Tuebingen, Germany
| | - R Handgretinger
- Tuebingen University Children's Hospital, Department of Hematology and Oncology, Tuebingen, Germany
| | - U Holzer
- Tuebingen University Children's Hospital, Department of Hematology and Oncology, Tuebingen, Germany
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15
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Raval JS, Ratcliffe NR. Extracorporeal photopheresis and personalized medicine in the 21st century: The future's so bright! J Clin Apher 2018; 33:461-463. [PMID: 29736969 DOI: 10.1002/jca.21633] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 04/20/2018] [Indexed: 02/01/2023]
Affiliation(s)
- Jay S Raval
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Nora R Ratcliffe
- Department of Pathology and Laboratory Medicine, Department of Veterans Affairs, White River Junction, Vermont.,Transfusion Medicine, Department of Pathology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
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16
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Choe HK, van Besien K. Earlier may be better: the role of extracorporeal photopheresis (ECP) as prevention of GVHD after allogeneic transplant. Leuk Lymphoma 2017; 59:272-273. [PMID: 28812411 DOI: 10.1080/10428194.2017.1361034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Hannah K Choe
- a Division of Hematology and Medical Oncology , Weill Cornell Medicine , New York , NY , USA
| | - Koen van Besien
- a Division of Hematology and Medical Oncology , Weill Cornell Medicine , New York , NY , USA
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17
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Li L, Li H, Qian J, He Y, Zheng J, Lu Z, Xu Z, Shi J. Structural and Immunological Activity Characterization of a Polysaccharide Isolated from Meretrix meretrix Linnaeus. Mar Drugs 2015; 14:6. [PMID: 26729136 PMCID: PMC4728503 DOI: 10.3390/md14010006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 12/13/2015] [Accepted: 12/21/2015] [Indexed: 12/30/2022] Open
Abstract
Polysaccharides from marine clams perform various biological activities, whereas information on structure is scarce. Here, a water-soluble polysaccharide MMPX-B2 was isolated from Meretrix meretrix Linnaeus. The proposed structure was deduced through characterization and its immunological activity was investigated. MMPX-B2 consisted of d-glucose and d-galctose residues at a molar ratio of 3.51:1.00. The average molecular weight of MMPX-B2 was 510 kDa. This polysaccharide possessed a main chain of (1→4)-linked-α-d-glucopyranosyl residues, partially substituted at the C-6 position by a few terminal β-d-galactose residues or branched chains consisting of (1→3)-linked β-d-galactose residues. Preliminary immunological tests in vitro showed that MMPX-B2 could stimulate the murine macrophages to release various cytokines, and the structure-activity relationship was then established. The present study demonstrated the potential immunological activity of MMPX-B2, and provided references for studying the active ingredients in M. meretrix.
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Affiliation(s)
- Li Li
- School of Pharmaceutical Science, Jiangnan University, Wuxi 214122, China.
| | - Heng Li
- School of Pharmaceutical Science, Jiangnan University, Wuxi 214122, China.
| | - Jianying Qian
- School of Pharmaceutical Science, Jiangnan University, Wuxi 214122, China.
| | - Yongfeng He
- School of Pharmaceutical Science, Jiangnan University, Wuxi 214122, China.
| | - Jialin Zheng
- School of Pharmaceutical Science, Jiangnan University, Wuxi 214122, China.
| | - Zhenming Lu
- School of Pharmaceutical Science, Jiangnan University, Wuxi 214122, China.
| | - Zhenghong Xu
- School of Pharmaceutical Science, Jiangnan University, Wuxi 214122, China.
| | - Jinsong Shi
- School of Pharmaceutical Science, Jiangnan University, Wuxi 214122, China.
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