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Zidan M, Zidan AAA, Attia Saad M, El-Shanshory M, Bakry U, Sobh A, Mohammed Abdou S, Labib Salem M. Altered microRNA expression profile is linked to T-cell exhaustion-related pathways in pediatric patients with acute lymphoblastic leukemia. Hum Immunol 2023; 84:113-122. [PMID: 36347735 DOI: 10.1016/j.humimm.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 10/05/2022] [Accepted: 10/21/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Although the phenotype and functions of exhausted T cells in several cancers have been identified, the involved molecular mechanisms remain to be further elucidated. In this regard, we have recently reported that the immunoregulatory cells, including myeloid-derived suppressor cells (MDSCs) and regulatory T cells (Tregs), share common dysregulated miRNAs that target specific immunosuppressive pathways in patients with in acute lymphoblastic leukemia (ALL). AIM In this study, we aimed to further explore whether similar dysregulation in miRNA expression is linked to T cell exhaustion and dysfunctionality in B cell ALL patients. METHODS Peripheral blood samples from pediatric patients with ALL were recruited before and after induction chemotherapy as well as from healthy donors. Affymetrix microarray platform was used for miRNA profiling, and qRT-PCR was used to validate the expression of certain miRNAs that are related to T cell exhaustion. Bioinformatics analysis was performed to explore whether the dysregulated miRNAs were linked to T-cell exhaustion related pathways. RESULTS A total of 516 miRNAs were dysregulated in ALL patients as compared to the healthy donor. Furthermore, among the total analyzed miRNAs, 10 were found to be linked to the key genes implicated in three exhaustion-related pathways; TGF-β, FOXO, and MAPK, as revealed by miR-pathway analysis. Moreover, qRT-PCR analysis showed similar expression pattern to those obtained by microarray analysis. CONCLUSION Our pilot study suggests the implication of certain miRNAs in T cell exhaustion pathways via targeting the specific key genes in those pathways.
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Affiliation(s)
- Mona Zidan
- Microbiology and Immunology Research Program, 57357 Children Cancer Hospital, Cairo, Egypt
| | - Abdel-Aziz A Zidan
- Department of Zoology, Faculty of Science, Damanhur University, Damanhur, Egypt; Center of Excellence in Cancer Research, Tanta University Educational Hospital, Tanta University, Tanta, Egypt
| | - Mohamed Attia Saad
- Center of Excellence in Cancer Research, Tanta University Educational Hospital, Tanta University, Tanta, Egypt; Department of Clinical Pathology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Mohamed El-Shanshory
- Center of Excellence in Cancer Research, Tanta University Educational Hospital, Tanta University, Tanta, Egypt; Department of Pediatric, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Usama Bakry
- Egypt Center for Research and Regenerative Medicine, Cairo, Egypt
| | - Ashraf Sobh
- Department of Biology, Faculty of Science, Jazan University, Jazan, Kingdom of Saudi Arabia
| | | | - Mohamed Labib Salem
- Center of Excellence in Cancer Research, Tanta University Educational Hospital, Tanta University, Tanta, Egypt; Immunology and Biotechnology Unit, Department of Zoology, Faculty of Science, Tanta University, Tanta, Egypt.
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Abdallah MS, Mosalam EM, Zidan AAA, Elattar KS, Zaki SA, Ramadan AN, Ebeid AM. Retraction Note: The Antidiabetic Metformin as an Adjunct to Antidepressants in Patients with Major Depressive Disorder: A Proof-of-Concept, Randomized, Double-Blind, Placebo-Controlled Trial. Neurotherapeutics 2022; 19:1687. [PMID: 36071262 PMCID: PMC9606185 DOI: 10.1007/s13311-022-01291-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Affiliation(s)
- Mahmoud S Abdallah
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Sadat City (USC), Sadat City, 32897, Menoufia, Egypt.
| | - Esraa M Mosalam
- Department of Biochemistry, Faculty of Pharmacy, Menoufia University, Menoufia, Egypt
| | - Abdel-Aziz A Zidan
- Zoology Department, Faculty of Science, Damanhour University, Damanhour & Center of Excellence in Cancer Research (CECR), Tanta University, Tanta, Egypt
| | - Khaled S Elattar
- Consultant of Psychiatry & Private Psychiatric Hospital Manager, 10th of Ramadan, Egypt
| | - Shimaa A Zaki
- National Liver Institute, Menoufia University, Menoufia, Egypt
| | - Ahmed N Ramadan
- Department of Neuropsychiatry, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Abla M Ebeid
- Department of Clinical Pharmacy, Faculty of Pharmacy, Delta University for Science and Technology, Gamasaa, Egypt
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Elsawy AA, Abol-Enein H, Laymon M, Ahmed AE, Essam A, Hamam ET, Zidan AAA, Zahran MH, Shokeir AA, Awadalla A. Predictive value of immunological markers after bacille Calmette-Guérin induction in bladder cancer. BJU Int 2021; 130:444-453. [PMID: 34448522 DOI: 10.1111/bju.15582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/09/2021] [Accepted: 08/23/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To investigate the predictive value of different immunological markers on treatment outcomes after bacille Calmette-Guérin (BCG) induction in high-risk non-muscle-invasive bladder cancer (NMIBC). PATIENTS AND METHODS Patients who underwent transurethral resection of bladder tumour for NMIBC were assessed for study eligibility. Urine and blood samples were taken from patients at baseline (immediately before first dose of induction) and after induction (4 h after last [sixth] dose). Urine samples were evaluated for interleukin (IL)-2 and IL-10 by solid-phase enzyme-linked immunosorbent assay. Blood samples were evaluated for tumour necrosis factor α (TNF-α), cytotoxic T-lymphocyte antigen 4 (CTLA-4) and transcription factors (TFs) (GATA-binding protein 3 [GATA3], T-box expressed in T cells [T-bet], and forkhead box protein 3 [FoxP3]) using quantitative reverse transcriptase-polymerase chain reaction analysis. Change pattern and fold change of each evaluable marker was assessed in relation to different treatment outcomes (initial complete response [ICR]/recurrence/progression). RESULTS Between July 2013 and May 2019, 204 patients were included. Among evaluable markers, urinary IL-2 and serum TNF-α increased in all patients, serum CTLA-4 and FoxP3+ showed a predominant decreased pattern in 188 (92.2%) and 192 (94.1%) patients, respectively. An ICR was achieved in 186 (91.2%) patients. Serum TNF-α fold change and urinary IL-10 change pattern were significantly associated with an ICR (P = 0.001 and P = 0.03, respectively). At a median (range) follow-up of 37 (20-88) months, 104 (56%) patients developed recurrence. Urinary IL-10, serum CTLA-4, T-bet+ , FoxP3+ change patterns and GATA3+ /T-bet+ ratio were significantly associated with tumour recurrence (P = 0.001, P = 0.001, P = 0.02, P = 0.009 and P = 0.001, respectively). Tumour progression occurred in 34 (18.3%) patients. Urinary IL-10, serum CTLA-4, serum T-bet+ change patterns and GATA3+ /T-bet+ ratio were independent predictors of tumour progression (P = 0.001, P = 0.001, P = 0.02 and P = 0.001, respectively). CONCLUSIONS Urinary IL-10 and serum TNF-α can significantly predict ICR. Moreover, change pattern of urinary IL-10, serum CTLA-4, TFs (GATA3, T-bet and FoxP3) and GATA3+ /T-bet+ ratio after BCG induction can independently predict further BCG response. These markers could be implemented in clinical practice when management options are discussed or in systems with severe BCG shortage.
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Affiliation(s)
- Amr A Elsawy
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | | | - Mahmoud Laymon
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Asmaa E Ahmed
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Ahmed Essam
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Eman T Hamam
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Abdel-Aziz A Zidan
- Department of Zoology, Faculty of Science, Damanhour University, Damanhour, Egypt
| | - Mohamed H Zahran
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Ahmed A Shokeir
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Amira Awadalla
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
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Labib Salem M, Zidan AAA, Ezz El-Din El-Naggar R, Attia Saad M, El-Shanshory M, Bakry U, Zidan M. Myeloid-derived suppressor cells and regulatory T cells share common immunoregulatory pathways-related microRNAs that are dysregulated by acute lymphoblastic leukemia and chemotherapy. Hum Immunol 2021; 82:36-45. [PMID: 33162185 DOI: 10.1016/j.humimm.2020.10.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 09/27/2020] [Accepted: 10/22/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Relapse remains a critical challenge in children with acute lymphoblastic leukemia (ALL). The emergence of immunoregulatory cells, including myeloid-derived suppressor cells (MDSCs), and T regulatory (Treg) cells, has been considered one potential mechanism of relapse in children with ALL. AIM This study aimed to address the microRNAs (miRNAs) related to MDSCs and Treg cells and to explore their targeted immunoregulatory pathways. METHODS Affymetrix microarray was used for global miRNA profiling in B-ALL pediatric patients before, during, and after induction of chemotherapy. Bioinformatics analysis was performed on MDSCs and Treg cells-related dysregulated miRNAs, and miR-Pathway analysis was performed to explore their targeted immunoregulatory pathways. RESULTS 516 miRNAs were dysregulated in ALL patients as compared to the healthy donor. Among them, 13 miRNAs and 8 miRNAs related to MDSCs and Treg cells, respectively, were common in all patients. Besides, 12 miRNAs were shared between MDSCs and Treg cells; 4 of them were common in all patients. Four immune-related pathways; TNF, TGF-β, FoxO, and Hippo were found implicated. CONCLUSION Our pilot study concluded certain miRNAs related to MDSCs and Treg cells, these miRNAs were linked to immunoregulatory pathways. Our results open avenues for testing those miRNA as molecular biomarkers for the immunosuppressive tumor microenvironment.
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Affiliation(s)
- Mohamed Labib Salem
- Immunology and Biotechnology Unit, Department of Zoology, Faculty of Science, Tanta University, Tanta, Egypt; Center of Excellence in Cancer Research, Tanta University Teaching Hospital, Tanta University, Tanta, Egypt.
| | - Abdel-Aziz A Zidan
- Center of Excellence in Cancer Research, Tanta University Teaching Hospital, Tanta University, Tanta, Egypt; Department of Zoology, Faculty of Science, Damanhur University, Damanhur, Egypt
| | - Randa Ezz El-Din El-Naggar
- Immunology and Biotechnology Unit, Department of Zoology, Faculty of Science, Tanta University, Tanta, Egypt
| | - Mohamed Attia Saad
- Center of Excellence in Cancer Research, Tanta University Teaching Hospital, Tanta University, Tanta, Egypt; Department of Clinical Pathology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Mohamed El-Shanshory
- Center of Excellence in Cancer Research, Tanta University Teaching Hospital, Tanta University, Tanta, Egypt; Department of Pediatric, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Usama Bakry
- Genomics Research Program, 57357 Children Cancer Hospital, Cairo, Egypt
| | - Mona Zidan
- Immunology and Biotechnology Unit, Department of Zoology, Faculty of Science, Tanta University, Tanta, Egypt; Immunology Research Program, 57357 Children Cancer Hospital, Cairo, Egypt
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Abdallah MS, Mosalam EM, Zidan AAA, Elattar KS, Zaki SA, Ramadan AN, Ebeid AM. The Antidiabetic Metformin as an Adjunct to Antidepressants in Patients with Major Depressive Disorder: A Proof-of-Concept, Randomized, Double-Blind, Placebo-Controlled Trial. Neurotherapeutics 2020; 17:1897-1906. [PMID: 32500486 PMCID: PMC7851215 DOI: 10.1007/s13311-020-00878-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Metformin (MET) has been reported to have antidepressant effects in animal models and in diabetic patients with depression, owing to its anti-inflammatory, antioxidant, and neuroprotective activity. Accordingly, we proposed that MET would show antidepressant effects in patients with major depressive disorder (MDD) without other comorbidities. In this double-blind placebo-controlled study, 80 adult outpatients with MDD (DSM-IV criteria) and a Hamilton Depression Rating Scale (HAM-D) score >18 were randomized to receive fluoxetine 20 mg once daily plus placebo (n = 40) or fluoxetine 20 mg once daily plus MET 1000 mg once daily for 12 weeks. Patients were assessed by HAM-D score (weeks 0, 4, 8, and 12). The serum levels of TNF-α, IL-1β, IL-6, IGF-1, MDA, CRP, BDNF, and serotonin were measured before and after therapy. Mixed-effects model repeated-measures analysis of covariance was used to compare the HAM-D scores and the biological markers between the two groups. After 4, 8 and 12 weeks, patients in the MET group showed a statistically significant decline in HAM-D score relative to the placebo group (least squares mean difference [LSMD] -2.347, p = 0.000, LSMD -3.369, p = 0.000, and LSMD -3.454, p = 0.000, respectively). Response and remission rates were significantly higher in the MET group (89% and 81%, respectively) than in the placebo group (59% and 46%, respectively). Moreover, the MET group was superior in conserving the measured biological markers compared with the placebo group. Our findings suggest MET as a promising, effective, and safe short-term adjunctive approach in nondiabetic MDD patients. Trial registration ID: NCT04088448.
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Affiliation(s)
- Mahmoud S Abdallah
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Sadat City (USC), Sadat City, Menoufia, 32897, Egypt.
| | - Esraa M Mosalam
- Department of Biochemistry, Faculty of Pharmacy, Menoufia University, Menoufia, Egypt
| | - Abdel-Aziz A Zidan
- Zoology Department, Faculty of Science, Damanhour University, Damanhour & Center of Excellence in Cancer Research (CECR), Tanta University, Tanta, Egypt
| | - Khaled S Elattar
- Consultant of Psychiatry & Private Psychiatric Hospital Manager, 10th of Ramadan, Egypt
| | - Shimaa A Zaki
- Department of Clinical Biochemistry and Molecular Diagnostics, National Liver Institute, Menoufia University, Menoufia, Egypt
| | - Ahmed N Ramadan
- Department of Neuropsychiatry, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Abla M Ebeid
- Department of Clinical Pharmacy, Faculty of Pharmacy, Delta University for Science and Technology, Gamasaa, Egypt
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Salman S, Attar YAE, Salem ML, Kashef SM, Zidan AAA, Abdel-Latif AM. WITHDRAWN: The effect of anti IL-2/IL-2 complex versus stand-alone low dose of IL-2 on imiquimod induced psoriasis like skin inflammation model. Immunol Lett 2020:S0165-2478(20)30382-5. [PMID: 32949628 DOI: 10.1016/j.imlet.2020.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/17/2020] [Accepted: 09/13/2020] [Indexed: 02/07/2023]
Abstract
This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.
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Affiliation(s)
- Samar Salman
- Department of Dermatology and Venereology, Tanta University Hospital, Faculty of Medicine, Tanta University, Tanta, Egypt.
| | - Yasmina Ahmed El Attar
- Department of Dermatology and Venereology, Tanta University Hospital, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Mohamed Labib Salem
- Department of Zoology, Faculty of Science, Immunology and Biotechnology Unit, Center of Excellence in Cancer Research, Tanta University Teaching Hospital, Tanta University, Tanta, Egypt
| | | | - Abdel-Aziz A Zidan
- Center of Excellence in Cancer Research, Tanta University, Tanta, Egypt; Zoology Department, Faculty of Science, Damanhur University, Damanhur, Egypt
| | - Amany Mohammad Abdel-Latif
- Department of Dermatology and Venereology, Tanta University Hospital, Faculty of Medicine, Tanta University, Tanta, Egypt
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L. Salem M, A. Abdul B E, A. Zidan AA, M. Elghara R. Stem Cell Mobilization with G-CSF and Cyclophosphamide Ameliorated Collagen-Induced Arthritis in Wistar Rats. INT J PHARMACOL 2020. [DOI: 10.3923/ijp.2020.223.235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Salem ML, Attia M, Abdou S, Zidan AAA, Zidan MF. Abstract A106: Higher numbers of cancer stem cells in the peripheral blood of children with B-ALL after chemotherapy. Cancer Immunol Res 2019. [DOI: 10.1158/2326-6074.cricimteatiaacr18-a106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Acute lymphocytic leukemia (ALL) is biologically and clinically considered as a heterogeneous neoplasm of lymphoid progenitor cells in the bone marrow (BM). 15- 20 % of children with ALL who achieve an initial remission, will show relapse. One potential mechanism behind this relapse could be the emergence of cancer stem cells (CSCs), which are considered the driving force of tumorigenesis due to their ability of self-renewal as well as the emergence of immune regulatory cells including myeloid-derived suppressor cells (MDSCs) and regulatory T-cells (Treg). Aim: The main aim of this study was to analyze the numbers of CSCs and correlate these numbers with the numbers of blasT-cells, MDSCs and Treg cells in children with B-ALL before and after induction of chemotherapy. Materials and Methods: CSCs were defined as CD45dimCD19+CD10+CD34+CD38-, MDSCs were defined as Lin-HLA-DR-CD33+CD11b+ and Treg cells were defined as CD4+CD25+CD127-. The frequencies of these cells were analyzed in the peripheral blood of B-ALL patients before (n= 10) and after (n= 10) induction of chemotherapy using flow cytometry. Results: Significant increases in the numbers of CSCs were shown in B-ALL patients after induction of chemotherapy as compared to newly diagnosed patients (7.6± 8.3 vs. 2.7± 2.4, P<0.05). The numbers of CSCs in ALL patents before and after induction of chemotherapy inversely correlated with the numbers of the blasT-cells. Additionally, the numbers of MDSCs and Treg cells were higher and lower, respectively, in patients after induction of chemotherapy as compared to before chemotherapy. Conclusion: Our results indicate that chemotherapy of B-ALL patients results in emergence of high numbers of CSCs and MDSCs, which might be contributing, respectively, to tumor relapse and creation of systemic immune suppression. This pilot study opens a new avenue to investigate the mechanism mediating the emergence of these cells on larger population of B-ALL patients at different treatment stages.
Citation Format: Mohamed Labib Salem, Mohamed Attia, Said Abdou, Abdel-Aziz A. Zidan, Mona F. Zidan. Higher numbers of cancer stem cells in the peripheral blood of children with B-ALL after chemotherapy [abstract]. In: Proceedings of the Fourth CRI-CIMT-EATI-AACR International Cancer Immunotherapy Conference: Translating Science into Survival; Sept 30-Oct 3, 2018; New York, NY. Philadelphia (PA): AACR; Cancer Immunol Res 2019;7(2 Suppl):Abstract nr A106.
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Zidan AAA, El-Ashmawy NE, Khedr EG, Ebeid EZM, Salem ML, Mosalam EM. Loading of doxorubicin and thymoquinone with F2 gel nanofibers improves the antitumor activity and ameliorates doxorubicin-associated nephrotoxicity. Life Sci 2018; 207:461-470. [PMID: 29885348 DOI: 10.1016/j.lfs.2018.06.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 06/05/2018] [Indexed: 02/07/2023]
Abstract
AIMS This study aimed to elucidate the benefits of nanoformulation of doxorubicin (DOX) and thymoquinone (TQ) loaded with nanofibers of poly-N-acetyl glucosamine (pGlcNAc), which is known as F2 gel, over their conventional free forms. Moreover, evaluate the role of TQ in improving chemotherapeutic effect and ameliorating nephrotoxicity of DOX. MAIN METHODS The drugs were loaded into F2 gel followed by measurement of physicochemical characterization. Next, MCF-7 and HEPG2 cells were treated with the prepared formulations and assessed for apoptosis alongside with cellular proliferation. Furthermore, we experimentally induced Heps liver carcinoma in mice and at the end of the treatment, mice were sacrificed and serum samples were used to assess nephrotoxicity markers; blood urea nitrogen (BUN) and creatinine. Additionally, renal tissue was used for determination of oxidative markers and antioxidant enzymes; whereas, tumor tissue was utilized to measure nuclear factor kappa B (NF-κB) and caspase 3. KEY FINDINGS Nanoformulation showed dramatic increase in apoptosis, caspase 3, and antioxidant enzymes; in contrast to, dramatic fall in cell viability, tumor volume, oxidative and nephrotoxicity markers, and NF-κB compared to corresponding free therapies. Combined therapy was superior in conserving the measured parameters compared to other treated groups. SIGNIFICANCE F2 gel loaded with DOX and TQ revealed enhanced antitumor activity with minimal toxicity. Moreover, using TQ as an adjuvant with DOX could augment its cytotoxicity and ameliorate nephrotoxicity.
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Affiliation(s)
- Abdel-Aziz A Zidan
- Zoology Department, Faculty of Science, Damanhour University, Egypt; Center of Excellence in cancer Research (CECR), Tanta University, Tanta, Egypt.
| | | | - Eman G Khedr
- Biochemistry Department, Faculty of Pharmacy, Tanta University, Egypt
| | - El-Zeiny M Ebeid
- Physical Chemistry Department, Faculty of Science, Tanta University, Egypt
| | - Mohamed L Salem
- Immunology and Biotechnology Unit, Zoology Department, Faculty of Science, Tanta University, Egypt
| | - Esraa M Mosalam
- Biochemistry Department, Faculty of Pharmacy, Menoufia University, Egypt
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Salem ML, El-Shanshory MR, Abdou SH, Attia MS, Sobhy SM, Zidan MF, Zidan AAA. Chemotherapy alters the increased numbers of myeloid-derived suppressor and regulatory T cells in children with acute lymphoblastic leukemia. Immunopharmacol Immunotoxicol 2018; 40:158-167. [PMID: 29388481 DOI: 10.1080/08923973.2018.1424897] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Acute lymphoblastic leukemia (ALL) is the most common cancer diagnosed in children. The precise mechanism behind the relapse in this disease is not clearly known. One possible mechanism could be the accumulation of immunosuppressive cells, including myeloid-derived suppressor cells (MDSCs) and T regulatory cells (Tregs) which we and others have reported to mediate suppression of anti-tumor immune responses. AIM In this study, we aimed to analyze the numbers of these cells in a population of B-ALL pediatric patients. METHODS Peripheral blood samples withdrawn from B-ALL pediatric patients (n = 45 before, during and after the induction phase of chemotherapy. Using multi parametric flow cytometric analysis. MDSCs were identified as Lin-HLA-DR-CD33+CD11b+; and Treg cells were defined as CD4+CD25+CD127-/low. RESULTS Early diagnosed B-ALL patients showed significant increases in the numbers of MDSCs and Tregs as compared to healthy volunteers. During induction of chemotherapy, however, the patients showed higher and lower numbers of MDSCs and Treg cells, respectively as compared to early diagnosed patients (i.e., before chemotherapy). After induction of chemotherapy, the numbers of MDSCs and Treg cells showed higher increases and decreases, respectively as compared to the numbers in patients during chemotherapy. CONCLUSION Our results indicate that B-ALL patients harbor high numbers of both MDSCs and Tregs cells. This pilot study opens a new avenue to investigate the mechanism mediating the emergence of these cells on larger number of B-ALL patients at different treatment stages.
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Affiliation(s)
- Mohamed Labib Salem
- a Center of Excellence in Cancer Research (CECR), Tanta University , Tanta , Egypt
- b Department of Zoology, Faculty of Science , Tanta University , Tanta , Egypt
| | - Mohamed R El-Shanshory
- a Center of Excellence in Cancer Research (CECR), Tanta University , Tanta , Egypt
- c Pediatric Oncology, Faculty of Medicine , Tanta University , Tanta , Egypt
| | - Said H Abdou
- a Center of Excellence in Cancer Research (CECR), Tanta University , Tanta , Egypt
- d Clinical Pathology, Faculty of Medicine , Tanta University , Tanta , Egypt
| | - Mohamed S Attia
- a Center of Excellence in Cancer Research (CECR), Tanta University , Tanta , Egypt
- d Clinical Pathology, Faculty of Medicine , Tanta University , Tanta , Egypt
| | - Shymaa M Sobhy
- a Center of Excellence in Cancer Research (CECR), Tanta University , Tanta , Egypt
- b Department of Zoology, Faculty of Science , Tanta University , Tanta , Egypt
| | - Mona F Zidan
- a Center of Excellence in Cancer Research (CECR), Tanta University , Tanta , Egypt
- b Department of Zoology, Faculty of Science , Tanta University , Tanta , Egypt
| | - Abdel-Aziz A Zidan
- a Center of Excellence in Cancer Research (CECR), Tanta University , Tanta , Egypt
- e Department of Zoology , Damanhour University , Damanhour , Egypt
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Elwan N, Salem ML, Kobtan A, El-Kalla F, Mansour L, Yousef M, Al-Sabbagh A, Zidan AAA, Abd-Elsalam S. High numbers of myeloid derived suppressor cells in peripheral blood and ascitic fluid of cirrhotic and HCC patients. Immunol Invest 2018; 47:169-180. [PMID: 29182438 DOI: 10.1080/08820139.2017.1407787] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is the 3rd most common cause of cancer-related death worldwide. It has evolved different immune escape mechanisms, which might include emergence of lymphoid and myeloid regulatory cells. Aim of this work: To determine the numbers of Myeloid-derived suppressor cells (MDSCs) in peripheral blood and ascitic fluid in cirrhosis and HCC and their relation to IFN-γ and α-fetoprotein (α-FP). PATIENTS AND METHODS Sixty individuals were enrolled in this study; forty cirrhotic patients with ascites; twenty without HCC (Group I), and twenty with HCC (group II) as well as twenty healthy individuals as a control group (group III). The phenotype and numbers of MDSCs were analyzed in peripheral blood of all the individuals and ascitic fluid of the patients using flow cytometry. Intracellular IFN-γ and serum alfa-fetoprotein were measured. RESULTS Significant increases in the relative and the mean number of peripheral blood MDSCs were found in the cirrhosis and HCC groups than in the control group, with the HCC group showing the highest number. MDSC count was negatively correlated with IFN-γ levels, while α-FP was positively correlated with MDSC% in the HCC group. MDSC count was low in ascitic fluid of both HCC and cirrhosis groups with no significant difference between the 2 groups. CONCLUSION A high frequency of MDSCs was detected in the peripheral blood of cirrhotic and HCC patients, indicating presence of immunosuppressive arms. These cells could be targeted to develop a new effective immunotherapy or an adjuvant to current therapies.
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Affiliation(s)
- Nadia Elwan
- a Faculty of Medicine, Department of Tropical Medicine , Tanta University , Tanta , Egypt
| | - Mohamed Labib Salem
- b Faculty of science, Zoology Department, Immunology and Biotechnology Unit , Tanta University , Tanta , Egypt
| | - Abdelrahman Kobtan
- a Faculty of Medicine, Department of Tropical Medicine , Tanta University , Tanta , Egypt
| | - Ferial El-Kalla
- a Faculty of Medicine, Department of Tropical Medicine , Tanta University , Tanta , Egypt
| | - Loai Mansour
- a Faculty of Medicine, Department of Tropical Medicine , Tanta University , Tanta , Egypt
| | - Mohamed Yousef
- a Faculty of Medicine, Department of Tropical Medicine , Tanta University , Tanta , Egypt
| | - Ashraf Al-Sabbagh
- c Department of General Medicine , Almehalla Hospital , Elmehalla , Egypt
| | - Abdel-Aziz A Zidan
- d Faculty of science, Zoology Department , Damanhour University , Tanta , Egypt
| | - Sherief Abd-Elsalam
- a Faculty of Medicine, Department of Tropical Medicine , Tanta University , Tanta , Egypt
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El-Ashmawy NE, Khedr EG, Ebeid EZM, Salem ML, Zidan AAA, Mosalam EM. Enhanced anticancer effect and reduced toxicity of doxorubicin in combination with thymoquinone released from poly-N-acetyl glucosamine nanomatrix in mice bearing solid Ehrlish carcinoma. Eur J Pharm Sci 2017; 109:525-532. [PMID: 28890201 DOI: 10.1016/j.ejps.2017.09.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 08/04/2017] [Accepted: 09/06/2017] [Indexed: 02/07/2023]
Abstract
The incidence of breast cancer remarkably increases all over the world. Therefore, there is a great demand to introduce new approaches into cancer treatment field. The current study was designated to evaluate the role of doxorubicin (DOX) and/or thymoquinone (TQ) nanomatrix in potentiating the cytotoxicity of either drug, and to investigate the ability of TQ to reduce cardiotoxicity of DOX in solid Ehrlich carcinoma (SEC)-bearing mice. DOX and TQ were loaded into F2 gel, which is a fully-acetylated poly-N-acetyl glucosamine nanofiber. SEC was induced in female albino mice as a model for experimentally induced breast cancer. Mice were randomly divided into eight groups (n=10): normal control, tumor control, F2 gel, free DOX, DOX+F2 gel, free TQ, TQ+F2 gel, and DOX+TQ+F2 gel. On day 28th from tumor inoculation, mice were sacrificed and blood samples were collected for measurement of the cardiac markers; lactate dehydrogenase (LDH) and creatine kinase (CK-MB). In addition, cardiac tissue was utilized for determination of lipid peroxide, and tumor tissue was used for measurement of anti-apoptotic protein Bcl-2 as well as gene expression of the tumor suppressor gene P53. DOX and/or TQ showed a significant reduction in tumor volume, cardiac markers, tumor Bcl-2, and P53 upregulation compared to free conventional therapies. Co-treatment with DOX+TQ+F2 gel was superior to all other groups in exerting beneficial effects. Use of TQ as an adjuvant therapy with DOX could improve its cytotoxic effects and limit its cardiac toxicity. Furthermore, loading of DOX and/or TQ into F2 gel showed a remarkable anti-cancer activity.
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MESH Headings
- Acetylglucosamine/administration & dosage
- Animals
- Antibiotics, Antineoplastic/administration & dosage
- Benzoquinones/administration & dosage
- Carcinoma, Ehrlich Tumor/drug therapy
- Carcinoma, Ehrlich Tumor/metabolism
- Carcinoma, Ehrlich Tumor/pathology
- Chemotherapy, Adjuvant
- Creatine Kinase/blood
- Creatine Kinase, MB Form/blood
- Doxorubicin/administration & dosage
- Female
- Gene Expression Regulation, Neoplastic/drug effects
- Genes, p53
- L-Lactate Dehydrogenase/blood
- Malondialdehyde/metabolism
- Mice
- Microscopy, Electron, Transmission
- Myocardium/metabolism
- Nanostructures/administration & dosage
- Nanostructures/ultrastructure
- Proto-Oncogene Proteins c-bcl-2/metabolism
- Tumor Burden/drug effects
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Affiliation(s)
| | - Eman G Khedr
- Biochemistry Department, Faculty of Pharmacy, Tanta University, Egypt
| | - El-Zeiny M Ebeid
- Physical Chemistry Department, Faculty of Science, Tanta University, Egypt
| | - Mohamed L Salem
- Immunology and Biotechnology Unit, Zoology Department, Faculty of Science Tanta University, Egypt
| | | | - Esraa M Mosalam
- Biochemistry Department, Faculty of Pharmacy, Menoufia University, Egypt.
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Salem ML, Zidan AAA, Attia M, El-Naggar RE, Nassef M, Abou El-Azm AR, El-Bate H, Yussif M, Galal S, Abo Senna M, El Demellawy M. IFN-α-based treatment of patients with chronic HCV show increased levels of cells with myeloid-derived suppressor cell phenotype and of IDO and NOS. Immunopharmacol Immunotoxicol 2017; 39:188-198. [PMID: 28472907 DOI: 10.1080/08923973.2017.1320670] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Hepatitis C virus (HCV) infection causes chronic hepatitis, which is often associated with suppressed anti-HCV immune responses. We have recently reported accumulation of myeloid-derived suppressor cells (MDSCs) and suppressed immunity in cancer patients. AIM The main aim of this study was to determine whether chronic HCV patients harbor high of MDSCs in general and in nonresponders to IFN-based therapy in particular as well as to analyze the immune suppressive molecules. METHODS Peripheral blood samples withdrawn from 154 patients with chronic HCV infection and were categorized into responders and nonresponders based on viral titer upon IFN-α treatment. RESULTS The relative and absolute numbers of MDSCs defined as Lin-/HLA-DR-/CD33+/CD11b+ increased in all HCV patients, where they were higher in nonresponders than in responders. Additionally, the levels of MDSCs after 4-6 months of treatment in responders were lower than during the course of treatment. The responders also showed higher levels of IL-2 coincided with increased numbers of dendritic cells (DCs), CD4+ and CD8+ T cells. The levels of total NOS and IDO were also higher in nonresponders as compared to responders and healthy controls, while the expression levels of CD3ζ was lower in responders as compared to nonresponders and healthy volunteers. CONCLUSION Chronic HCV patients harbor high numbers of MDSCs, which are higher in nonresponders than in responders. The higher numbers of MDSCs associated with increases in the suppressing factors.
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Affiliation(s)
- Mohamed Labib Salem
- a Zoology Department, Immunology and Biotechnology Unit, Faculty of Science , Tanta University , Tanta , Egypt
| | - Abdel-Aziz A Zidan
- b Zoology Department, Faculty of Science , Damanhour University , Damanhour , Egypt
| | - Mohamed Attia
- c Department of Clinical Pathology, Faculty of Medicine , Tanta University , Tanta , Egypt
| | - Randa E El-Naggar
- a Zoology Department, Immunology and Biotechnology Unit, Faculty of Science , Tanta University , Tanta , Egypt
| | - Mohamed Nassef
- a Zoology Department, Immunology and Biotechnology Unit, Faculty of Science , Tanta University , Tanta , Egypt
| | - Abdel Raouf Abou El-Azm
- d Department of Tropical Medicine and Infectious Diseases, Faculty of Medicine , Tanta University , Tanta , Egypt
| | - Hasan El-Bate
- e Department of Tropical Medicine and Infectious Diseases, Faculty of Medicine , Kafrelshheikh University , Kafr Elshheikh , Egypt
| | - Mohamed Yussif
- d Department of Tropical Medicine and Infectious Diseases, Faculty of Medicine , Tanta University , Tanta , Egypt
| | - Sohaila Galal
- a Zoology Department, Immunology and Biotechnology Unit, Faculty of Science , Tanta University , Tanta , Egypt
| | - Mohamed Abo Senna
- a Zoology Department, Immunology and Biotechnology Unit, Faculty of Science , Tanta University , Tanta , Egypt
| | - Maha El Demellawy
- f City of Scientific Research and Technological Applications , Pharmaceutical and Fermentation Industries Development Center , New Burg El Arab , Egypt
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Salem ML, Shoukry NM, Zidan AAA, Vournakis J. Immunomodulatory effects of IL-12 released from poly-N-acetyl glucosamine gel matrix during schistosomiasis infection. Cytotechnology 2014; 66:667-75. [PMID: 23884721 PMCID: PMC4082772 DOI: 10.1007/s10616-013-9620-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2013] [Accepted: 07/15/2013] [Indexed: 02/07/2023] Open
Abstract
We have reported recently that Interleukin-12 (IL-12) released from poly-N-acetyl glucosamine gel matrix (F2 gel/IL-12) is more effective than free IL-12 to enhance vaccination of mice with Schistosoma soluble worm antigen preparation. The aim of this study is to evaluate the effect of F2 gel/IL-12 on the inflammatory responses in mice undergoing schistosomiasis infection in absence of vaccination. To achieve this, mice undergoing Schistosoma mansoni infection or cured from this infection, after treatment with praziquantil (PZQ), were treated with subcutaneous injection of IL-12 for 3 consecutive days or once with F2 gel loaded with IL-12 (F2 gel/IL-12). The treatment was started on day 35 days after infection. For infection, mice were infected with 100 cercariae of S. mansoni using tail immersion method. We found that treatment with F2 gel/IL-12 induced significant decreases in the egg burden with a moderate reduction in the size of granuloma and decrease in the cellular granulomatous reaction in the lung as compared to infected mice treated with IL-12. These effects of F2 gel/IL-12 were more pronounced in infected mice previously treated with the anti-schistosomal drug PZQ. The total numbers of white blood cells in all treated mice showed similar profile. Treatment with IL-12 or F2 gel/IL-12, however, showed significant reduction in the number of mononuclear cells when compared with non-treated infected mice. In conclusion, this study showed the ability of IL-12 released from F2 gel to lower the inflammatory response to Schistosoma infection even in absence of vaccination.
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Affiliation(s)
- Mohamed L Salem
- Immunology and Biotechnology Division, Department of Zoology, Faculty of Science, Tanta University, Tanta, Egypt,
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Tuorkey MJ, Abdul-Aziz KK, Zidan AAA. Active immunization against tumor necrosis factor-alpha decreases proinflammatory cytokines, oxidative stress mediators and adhesion molecules risk factors in streptozotocin-induced diabetic rats. Endocr Metab Immune Disord Drug Targets 2014; 13:269-74. [PMID: 23859636 DOI: 10.2174/18715303113139990039] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 07/09/2013] [Indexed: 11/22/2022]
Abstract
UNLABELLED Diabetes is now one of the most common un-communicable diseases worldwide. Few studies have dealt specifically with the potential therapeutic effect of TNF-α suppressor to decrease oxidative stress markers in patients with diabetes. The aim of this study was to investigate the potential therapeutic and toxic effect of the direct injection of the anti-TNF-α on oxidative stress mediators, proinflammatory cytokines and vascular risk factors associated with diabetes on diabetic rats. METHODS diabetes was induced by streptozotocin, three weeks after the - induction of diabetes, a polyclonal anti-mouse/rat TNF-α rabbit serum was injected in the treated group and sacrificed after 4 weeks. The expression of TNF-α mRNA was measured by RT-PCR. The levels of TNF-α, VEGF, IL-2, IL- 6, HSP-70, troponin-t, 8-OHdG, ICAM-1 and VCAM-1 were evaluated using ELISA. Myeloperoxiase (MPO) and total peroxides (TPs) levels were estimated by biochemical reactions. RESULTS the treatment of diabetic rats with the anti-TNF-α caused a significant decrease in the TNF-α mRNA expression, which were paralleled with the decreased levels of TNF-α, IL-6, MOP, HSP-70, ICAM-1, VCAM-1, troponin-t and 8-OHdG in the blood serum. On the contrary, all were highly expressed in the diabetic group that may be the leading reasons for the DNA damage and cell loss. Data revealed that TNF-α, HSP-70, IL-6, MPO and adhesion molecules when expressed in diabetic rats, collectively induce dramatic changes. CONCLUSION these new findings suggested that targeting TNF-α could effectively reduce expressions of MCP-1, HSP-70, troponin-t, 8-OHdG and VCAM- 1, along with prominent reduction in MPO and IL-6 levels.
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Affiliation(s)
- Muobarak J Tuorkey
- Department of Zoology, Faculty of Science, Damanhour University, Damanhour, Egypt.
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Salem ML, Zidan AAA, Abou Senna M, Abou Al-Azm AR, Albatei H, Aldemelaawy M, Attia M. Frequencies of circulating myeloid derived suppressor cells and dendritic cells in Egyptian patients with chronic Hepatitis C Virus infection undergoing treatment with IFN-α-based therapy. J Immunother Cancer 2013. [PMCID: PMC3991173 DOI: 10.1186/2051-1426-1-s1-p248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Salem ML, Al-Khami AA, El-Nagaar SA, Zidan AAA, Al-Sharkawi IM, Marcela Díaz-Montero C, Cole DJ. Kinetics of rebounding of lymphoid and myeloid cells in mouse peripheral blood, spleen and bone marrow after treatment with cyclophosphamide. Cell Immunol 2012; 276:67-74. [PMID: 22560674 PMCID: PMC3787597 DOI: 10.1016/j.cellimm.2012.03.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Revised: 03/06/2012] [Accepted: 03/21/2012] [Indexed: 02/07/2023]
Abstract
Recently, we showed that post cyclophosphamide (CTX) microenvironment benefits the function of transferred T cells. Analysis of the kinetics of cellular recovery after CTX treatment showed that a single 4 mg/mouse CTX treatment decreased the absolute number of leukocytes in the peripheral blood (PBL) at days 3-15, and in the spleen and bone marrow (BM) at days 3-6. The absolute numbers of CD11c(+)CD11b(-) and CD11c(+)CD11b(+) dendritic cells (DCs), CD11b(+) and Ly6G(+) myeloid cells, T and B cells, CD4(+)CD25(+) T regulatory (T(reg)) cells, and NK1.1(+) cells also decreased. The cell numbers returned to control levels during the recovery phase. The absolute numbers of B cells remained low for 3 weeks. The numbers of DCs increased in PBL and spleen at day 9 but returned to control levels at day 15. These data indicate that CTX alters the cellular microenvironment in kinetics that might be precisely targeted to benefit the host.
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Affiliation(s)
- Mohamed L Salem
- Zoology Department, Faculty of Science, Tanta University, Tanta, Egypt.
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Díaz-Montero CM, Naga O, Zidan AAA, Salem ML, Pallin M, Parmigiani A, Walker G, Wieder E, Komanduri K, Cole DJ, Montero AJ, Lichtenheld MG. Synergy of brief activation of CD8 T-cells in the presence of IL-12 and adoptive transfer into lymphopenic hosts promotes tumor clearance and anti-tumor memory. Am J Cancer Res 2011; 1:882-96. [PMID: 21915391 PMCID: PMC3170749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2011] [Accepted: 08/16/2011] [Indexed: 05/31/2023] Open
Abstract
Adoptive T-cell therapy holds great promise for the treatment of metastatic melanoma. However, prohibitive costs associated with current technology required for culture and expansion of tumor-reactive T-cells, the need for intense preconditioning regimens to induce lymphopenia, and the unpredictable anti-tumor effect of adoptively transferred T-cells remain significant impediments for its clinical implementation. Here we report a simplified combinatorial approach that involves short activation of CD8(+) T cells in the presence of IL-12 followed by adoptive transfer into tumor bearing animals after a single injection of cyclophosphamide. This approach resulted in complete eradication of B16 melanoma, and the establishment of long term immunological memory capable of fully protecting mice after a second B16 melanoma challenge. The activated donor cells were unique because they simultaneously exhibited traits for cytotoxic effector function, central memory-like, homing, and senescence. After tumor eradication and within three months after transfer, CD8+ cells exhibited a conventional memory CTL phenotype. Moreover, these memory CTLs acquired functional attributes characteristic of memory stem cells, including the ability to resist chemotherapy-induced toxicity. Our results suggest that short-term T-cell receptor signaling in the presence of IL-12 promotes promiscuous qualities in naïve CTL which - upon transfer into lymphopenic hosts- are sufficient to eradicate tumors and generate life-long tumor-specific memory.
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Affiliation(s)
- C Marcela Díaz-Montero
- Department of Medicine, Division of Hematology/Oncology, Sylvester Cancer Center, University of Miami, Miami, FL33136, USA
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