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McIlroy G, Lax S, Gaskell C, Jackson A, Rhodes M, Seale T, Fox S, Hopkins L, Okosun J, Barrington SF, Ringshausen I, Ramsay AG, Calaminici M, Linton K, Bishton M. Investigator choice of standard therapy versus sequential novel therapy arms in the treatment of relapsed follicular lymphoma (REFRACT): study protocol for a multi-centre, open-label, randomised, phase II platform trial. BMC Cancer 2024; 24:370. [PMID: 38528445 PMCID: PMC10962099 DOI: 10.1186/s12885-024-12112-0] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 03/12/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND Relapsed or refractory follicular lymphoma (rrFL) is an incurable disease associated with shorter remissions and survival after each line of standard therapy. Many promising novel, chemotherapy-free therapies are in development, but few are licensed as their role in current treatment pathways is poorly defined. METHODS The REFRACT trial is an investigator-initiated, UK National Cancer Research Institute, open-label, multi-centre, randomised phase II platform trial aimed at accelerating clinical development of novel therapies by addressing evidence gaps. The first of the three sequential novel therapy arms is epcoritamab plus lenalidomide, to be compared with investigator choice standard therapy (ICT). Patients aged 18 years or older with biopsy proven relapsed or refractory CD20 positive, grade 1-3a follicular lymphoma and assessable disease by PET-CT are eligible. The primary outcome is complete metabolic response by PET-CT at 24 weeks using the Deauville 5-point scale and Lugano 2014 criteria. Secondary outcomes include overall metabolic response, progression-free survival, overall survival, duration of response, and quality of life assessed by EQ-5D-5 L and FACT-Lym. The trial employs an innovative Bayesian design with a target sample size of 284 patients: 95 in the ICT arm and 189 in the novel therapy arms. DISCUSSION Whilst there are many promising novel drugs in early clinical development for rrFL, understanding the relative efficacy and safety of these agents, and their place in modern treatment pathways, is limited by a lack of randomised trials and dearth of published outcomes for standard regimens to act as historic controls. Therefore, the aim of REFRACT is to provide an efficient platform to evaluate novel agents against standard therapies for rrFL. The adaptive Bayesian power prior methodology design will minimise patient numbers and accelerate trial delivery. TRIAL REGISTRATION ClinicalTrials.gov: NCT05848765; 08-May-2023. EUDRACT 2022-000677-75; 10-Feb-2022.
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Affiliation(s)
- Graham McIlroy
- Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Birmingham, UK.
| | - Siân Lax
- Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Birmingham, UK
| | - Charlotte Gaskell
- Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Birmingham, UK
| | - Aimee Jackson
- Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Birmingham, UK
| | | | - Tania Seale
- Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - Sonia Fox
- Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Birmingham, UK
| | - Lousie Hopkins
- Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Birmingham, UK
| | - Jessica Okosun
- Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Sally F Barrington
- King's College London and Guy's and St Thomas' PET Centre, School of Biomedical Engineering and Imaging Sciences, King's College London, King's Health Partners, London, UK
| | | | - Alan G Ramsay
- School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Maria Calaminici
- Department of Cellular Pathology Barts Health and Centre for Haemato-Oncology, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Kim Linton
- Division of Cancer Sciences, University of Manchester, Manchester, UK
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Mark Bishton
- Translational Medical Sciences, University of Nottingham, Nottingham, UK
- Department of Haematology, Nottingham University Hospitals NHS Trust, Nottingham, UK
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2
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Papazoglou D, Wang XV, Shanafelt TD, Lesnick CE, Ioannou N, De Rossi G, Herter S, Bacac M, Klein C, Tallman MS, Kay NE, Ramsay AG. Ibrutinib-based therapy reinvigorates CD8+ T cells compared to chemoimmunotherapy: immune monitoring from the E1912 trial. Blood 2024; 143:57-63. [PMID: 37824808 PMCID: PMC10797553 DOI: 10.1182/blood.2023020554] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 07/21/2023] [Accepted: 08/14/2023] [Indexed: 10/14/2023] Open
Abstract
ABSTRACT Bruton tyrosine kinase inhibitors (BTKis) that target B-cell receptor signaling have led to a paradigm shift in chronic lymphocytic leukemia (CLL) treatment. BTKis have been shown to reduce abnormally high CLL-associated T-cell counts and the expression of immune checkpoint receptors concomitantly with tumor reduction. However, the impact of BTKi therapy on T-cell function has not been fully characterized. Here, we performed longitudinal immunophenotypic and functional analysis of pretreatment and on-treatment (6 and 12 months) peripheral blood samples from patients in the phase 3 E1912 trial comparing ibrutinib-rituximab with fludarabine, cyclophosphamide, and rituximab (FCR). Intriguingly, we report that despite reduced overall T-cell counts; higher numbers of T cells, including effector CD8+ subsets at baseline and at the 6-month time point, associated with no infections; and favorable progression-free survival in the ibrutinib-rituximab arm. Assays demonstrated enhanced anti-CLL T-cell killing function during ibrutinib-rituximab treatment, including a switch from predominantly CD4+ T-cell:CLL immune synapses at baseline to increased CD8+ lytic synapses on-therapy. Conversely, in the FCR arm, higher T-cell numbers correlated with adverse clinical responses and showed no functional improvement. We further demonstrate the potential of exploiting rejuvenated T-cell cytotoxicity during ibrutinib-rituximab treatment, using the bispecific antibody glofitamab, supporting combination immunotherapy approaches.
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Affiliation(s)
- Despoina Papazoglou
- School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - Xin Victoria Wang
- Department of Data Science, Dana-Farber Cancer Institute, Boston, MA
- Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, MA
| | | | | | - Nikolaos Ioannou
- School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - Giulia De Rossi
- Institute of Ophthalmology, University College London, London, United Kingdom
| | - Sylvia Herter
- Discovery Oncology, Roche Innovation Center Zürich, Schlieren, Switzerland
| | - Marina Bacac
- Discovery Oncology, Roche Innovation Center Zürich, Schlieren, Switzerland
| | - Christian Klein
- Discovery Oncology, Roche Innovation Center Zürich, Schlieren, Switzerland
| | - Martin S. Tallman
- Leukemia Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Neil E. Kay
- Department of Immunology, Mayo Clinic, Rochester, MN
| | - Alan G. Ramsay
- School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
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3
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Pagano G, Botana IF, Wierz M, Roessner PM, Ioannou N, Zhou X, Al-Hity G, Borne C, Gargiulo E, Gonder S, Qu B, Stamatopoulos B, Ramsay AG, Seiffert M, Largeot A, Moussay E, Paggetti J. Interleukin-27 potentiates CD8+ T-cell-mediated antitumor immunity in chronic lymphocytic leukemia. Haematologica 2023; 108:3011-3024. [PMID: 37345470 PMCID: PMC10620579 DOI: 10.3324/haematol.2022.282474] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 06/15/2023] [Indexed: 06/23/2023] Open
Abstract
Chronic lymphocytic leukemia (CLL) cells are highly dependent on interactions with the immunosuppressive tumor microenvironment (TME) for survival and proliferation. In the search for novel treatments, pro-inflammatory cytokines have emerged as candidates to reactivate the immune system. Among those, interleukin 27 (IL-27) has recently gained attention, but its effects differ among malignancies. Here, we utilized the Eμ-TCL1 and EBI3 knock-out mouse models as well as clinical samples from patients to investigate the role of IL-27 in CLL. Characterization of murine leukemic spleens revealed that the absence of IL-27 leads to enhanced CLL development and a more immunosuppressive TME in transgenic mice. Gene-profiling of T-cell subsets from EBI3 knock-out highlighted transcriptional changes in the CD8+ T-cell population associated with T-cell activation, proliferation, and cytotoxicity. We also observed an increased anti-tumor activity of CD8+ T cells in the presence of IL-27 ex vivo with murine and clinical samples. Notably, IL-27 treatment led to the reactivation of autologous T cells from CLL patients. Finally, we detected a decrease in IL-27 serum levels during CLL development in both pre-clinical and patient samples. Altogether, we demonstrated that IL-27 has a strong anti-tumorigenic role in CLL and postulate this cytokine as a promising treatment or adjuvant for this malignancy.
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Affiliation(s)
- Giulia Pagano
- Tumor Stroma Interactions, Department of Cancer Research, Luxembourg Institute of Health, Luxembourg, Luxembourg; Faculty of Science, Technology and Medicine, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Iria Fernandez Botana
- Tumor Stroma Interactions, Department of Cancer Research, Luxembourg Institute of Health, Luxembourg, Luxembourg; Faculty of Science, Technology and Medicine, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Marina Wierz
- Tumor Stroma Interactions, Department of Cancer Research, Luxembourg Institute of Health, Luxembourg, Luxembourg
| | | | - Nikolaos Ioannou
- School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King's College London, London
| | - Xiangda Zhou
- Biophysics, Center for Integrative Physiology and Molecular Medicine, School of Medicine, Saarland University, Homburg
| | - Gheed Al-Hity
- School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King's College London, London
| | - Coralie Borne
- Tumor Stroma Interactions, Department of Cancer Research, Luxembourg Institute of Health, Luxembourg, Luxembourg
| | - Ernesto Gargiulo
- Tumor Stroma Interactions, Department of Cancer Research, Luxembourg Institute of Health, Luxembourg, Luxembourg
| | - Susanne Gonder
- Tumor Stroma Interactions, Department of Cancer Research, Luxembourg Institute of Health, Luxembourg, Luxembourg; Faculty of Science, Technology and Medicine, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Bin Qu
- Biophysics, Center for Integrative Physiology and Molecular Medicine, School of Medicine, Saarland University, Homburg
| | | | - Alan G Ramsay
- School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King's College London, London
| | - Martina Seiffert
- Molecular Genetics, German Cancer Research Center (DKFZ), Heidelberg
| | - Anne Largeot
- Tumor Stroma Interactions, Department of Cancer Research, Luxembourg Institute of Health, Luxembourg, Luxembourg
| | - Etienne Moussay
- Tumor Stroma Interactions, Department of Cancer Research, Luxembourg Institute of Health, Luxembourg, Luxembourg.
| | - Jerome Paggetti
- Tumor Stroma Interactions, Department of Cancer Research, Luxembourg Institute of Health, Luxembourg, Luxembourg.
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4
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Apollonio B, Spada F, Petrov N, Cozzetto D, Papazoglou D, Jarvis P, Kannambath S, Terranova-Barberio M, Amini RM, Enblad G, Graham C, Benjamin R, Phillips E, Ellis R, Nuamah R, Saqi M, Calado DP, Rosenquist R, Sutton LA, Salisbury J, Zacharioudakis G, Vardi A, Hagner PR, Gandhi AK, Bacac M, Claus C, Umana P, Jarrett RF, Klein C, Deutsch A, Ramsay AG. Tumor-activated lymph node fibroblasts suppress T cell function in diffuse large B cell lymphoma. J Clin Invest 2023; 133:e166070. [PMID: 37219943 PMCID: PMC10313378 DOI: 10.1172/jci166070] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [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: 11/08/2022] [Accepted: 05/09/2023] [Indexed: 05/24/2023] Open
Abstract
Recent transcriptomic-based analysis of diffuse large B cell lymphoma (DLBCL) has highlighted the clinical relevance of LN fibroblast and tumor-infiltrating lymphocyte (TIL) signatures within the tumor microenvironment (TME). However, the immunomodulatory role of fibroblasts in lymphoma remains unclear. Here, by studying human and mouse DLBCL-LNs, we identified the presence of an aberrantly remodeled fibroblastic reticular cell (FRC) network expressing elevated fibroblast-activated protein (FAP). RNA-Seq analyses revealed that exposure to DLBCL reprogrammed key immunoregulatory pathways in FRCs, including a switch from homeostatic to inflammatory chemokine expression and elevated antigen-presentation molecules. Functional assays showed that DLBCL-activated FRCs (DLBCL-FRCs) hindered optimal TIL and chimeric antigen receptor (CAR) T cell migration. Moreover, DLBCL-FRCs inhibited CD8+ TIL cytotoxicity in an antigen-specific manner. Notably, the interrogation of patient LNs with imaging mass cytometry identified distinct environments differing in their CD8+ TIL-FRC composition and spatial organization that associated with survival outcomes. We further demonstrated the potential to target inhibitory FRCs to rejuvenate interacting TILs. Cotreating organotypic cultures with FAP-targeted immunostimulatory drugs and a bispecific antibody (glofitamab) augmented antilymphoma TIL cytotoxicity. Our study reveals an immunosuppressive role of FRCs in DLBCL, with implications for immune evasion, disease pathogenesis, and optimizing immunotherapy for patients.
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Affiliation(s)
- Benedetta Apollonio
- School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
| | | | | | - Domenico Cozzetto
- BRC Translational Bioinformatics at Guy’s and St. Thomas’s NHS Foundation Trust and King’s College London, London, United Kingdom
- Division of Digestive Diseases, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Despoina Papazoglou
- School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
| | - Peter Jarvis
- 5th Surgical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Shichina Kannambath
- BRC Genomics Research Platform at Guy’s and St. Thomas’s NHS Foundation Trust and King’s College London, London, United Kingdom
| | | | - Rose-Marie Amini
- Department of Immunology, Genetics and Pathology, Uppsala University and Hospital, Uppsala, Sweden
| | - Gunilla Enblad
- Department of Immunology, Genetics and Pathology, Uppsala University and Hospital, Uppsala, Sweden
| | - Charlotte Graham
- School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
| | - Reuben Benjamin
- School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
| | - Elisabeth Phillips
- School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
| | | | - Rosamond Nuamah
- BRC Genomics Research Platform at Guy’s and St. Thomas’s NHS Foundation Trust and King’s College London, London, United Kingdom
| | - Mansoor Saqi
- BRC Translational Bioinformatics at Guy’s and St. Thomas’s NHS Foundation Trust and King’s College London, London, United Kingdom
| | - Dinis P. Calado
- Immunity & Cancer Laboratory, Francis Crick Institute, London, United Kingdom
| | - Richard Rosenquist
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Lesley A. Sutton
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Jon Salisbury
- Department of Haematology, King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | | | - Anna Vardi
- Hematology Department and HCT Unit, G. Papanikolaou Hospital, Thessaloniki, Greece
| | | | | | - Marina Bacac
- Roche Innovation Center Zurich, Schlieren, Switzerland
| | | | - Pablo Umana
- Roche Innovation Center Zurich, Schlieren, Switzerland
| | - Ruth F. Jarrett
- MRC–University of Glasgow Centre for Virus Research, Glasgow, United Kingdom
| | | | | | - Alan G. Ramsay
- School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
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5
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Arruga F, Rubin M, Papazoglou D, Iannello A, Ioannou N, Moia R, Rossi D, Gaidano G, Coscia M, Laurenti L, D'Arena G, Allan JN, Furman RR, Vaisitti T, Ramsay AG, Deaglio S. The immunomodulatory molecule TIGIT is expressed by chronic lymphocytic leukemia cells and contributes to anergy. Haematologica 2023. [PMID: 36655432 PMCID: PMC10388274 DOI: 10.3324/haematol.2022.282177] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Indexed: 01/20/2023] Open
Abstract
T-cell immunoreceptor with Ig and ITIM domains (TIGIT) is an inhibitory checkpoint receptor that negatively regulates T cell responses. CD226 competes with TIGIT for binding to the CD155 ligand, delivering a positive signal to the T cell. Here we studied expression of TIGIT and CD226 in a cohort of 115 chronic lymphocytic leukemia (CLL) patients and report expression of TIGIT and CD226 by leukemic cells. By devising a TIGIT/CD226 ratio, we showed that CLL cells favoring TIGIT over CD226 are typical of a more indolent disease, while those favoring CD226 are characterized by a shorter time-to-first-treatment and shorter progression-fee survival after first treatment. TIGIT expression was inversely correlated to the B cell receptor (BCR) signaling capacity, as determined by studying BTK phosphorylation, cell proliferation and IL-10 production. In CLL cells treated with ibrutinib, where surface IgM and BCR signaling capacity are temporarily increased, TIGIT expression was downmodulated, in line with data indicating transient recovery from anergy. Lastly, cells from Richter syndrome patients were characterized by high levels of CD226, with low to undetectable TIGIT, in keeping with their high proliferative drive. Together, these data suggest that TIGIT contributes to CLL anergy by downregulating BCR signaling, identifying novel and actionable molecular circuits regulating anergy and modulating CLL cell functions.
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Affiliation(s)
- Francesca Arruga
- Laboratory of Functional Genomics, Department of Medical Sciences, University of Turin, Turin
| | - Marta Rubin
- Laboratory of Functional Genomics, Department of Medical Sciences, University of Turin, Turin
| | | | - Andrea Iannello
- Laboratory of Functional Genomics, Department of Medical Sciences, University of Turin, Turin
| | - Nikolaos Ioannou
- School of Cancer and Pharmaceutical Sciences, King's College London, London
| | - Riccardo Moia
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, Novara
| | - Davide Rossi
- Laboratory of Experimental Hematology, Institute of Oncology Research; Faculty of Biomedical Sciences, Universita della Svizzera Italiana
| | - Gianluca Gaidano
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, Novara
| | - Marta Coscia
- Department of Molecular Biotechnology and Health Sciences, University of Turin and Division of Hematology, A.O.U. Citta della Salute e della Scienza di Torino, Turin
| | - Luca Laurenti
- Hematology Unit, IRCCS Fondazione Policlinico Gemelli, Catholic University of "Sacred Heart", Rome
| | | | - John N Allan
- Department of Hematology, Weill Cornell Medicine, New York, NY
| | | | - Tiziana Vaisitti
- Laboratory of Functional Genomics, Department of Medical Sciences, University of Turin, Turin
| | - Alan G Ramsay
- School of Cancer and Pharmaceutical Sciences, King's College London, London
| | - Silvia Deaglio
- Laboratory of Functional Genomics, Department of Medical Sciences, University of Turin, Turin.
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6
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Gargiulo E, Viry E, Morande PE, Largeot A, Gonder S, Xian F, Ioannou N, Benzarti M, Kleine Borgmann FB, Mittelbronn M, Dittmar G, Nazarov PV, Meiser J, Stamatopoulos B, Ramsay AG, Moussay E, Paggetti J. Extracellular Vesicle Secretion by Leukemia Cells In Vivo Promotes CLL Progression by Hampering Antitumor T-cell Responses. Blood Cancer Discov 2023; 4:54-77. [PMID: 36108149 PMCID: PMC9816815 DOI: 10.1158/2643-3230.bcd-22-0029] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 07/04/2022] [Accepted: 09/07/2022] [Indexed: 01/11/2023] Open
Abstract
Small extracellular vesicle (sEV, or exosome) communication among cells in the tumor microenvironment has been modeled mainly in cell culture, whereas their relevance in cancer pathogenesis and progression in vivo is less characterized. Here we investigated cancer-microenvironment interactions in vivo using mouse models of chronic lymphocytic leukemia (CLL). sEVs isolated directly from CLL tissue were enriched in specific miRNA and immune-checkpoint ligands. Distinct molecular components of tumor-derived sEVs altered CD8+ T-cell transcriptome, proteome, and metabolome, leading to decreased functions and cell exhaustion ex vivo and in vivo. Using antagomiRs and blocking antibodies, we defined specific cargo-mediated alterations on CD8+ T cells. Abrogating sEV biogenesis by Rab27a/b knockout dramatically delayed CLL pathogenesis. This phenotype was rescued by exogenous leukemic sEV or CD8+ T-cell depletion. Finally, high expression of sEV-related genes correlated with poor outcomes in CLL patients, suggesting sEV profiling as a prognostic tool. In conclusion, sEVs shape the immune microenvironment during CLL progression. SIGNIFICANCE sEVs produced in the leukemia microenvironment impair CD8+ T-cell mediated antitumor immune response and are indispensable for leukemia progression in vivo in murine preclinical models. In addition, high expression of sEV-related genes correlated with poor survival and unfavorable clinical parameters in CLL patients. See related commentary by Zhong and Guo, p. 5. This article is highlighted in the In This Issue feature, p. 1.
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Affiliation(s)
- Ernesto Gargiulo
- Tumor–Stroma Interactions Group, Department of Cancer Research, Luxembourg Institute of Health, Luxembourg City, Luxembourg
| | - Elodie Viry
- Tumor–Stroma Interactions Group, Department of Cancer Research, Luxembourg Institute of Health, Luxembourg City, Luxembourg
| | - Pablo Elías Morande
- Tumor–Stroma Interactions Group, Department of Cancer Research, Luxembourg Institute of Health, Luxembourg City, Luxembourg.,Instituto de Medicina Experimental (IMEX)-CONICET-Academia Nacional de Medicina, Buenos Aires, Argentina
| | - Anne Largeot
- Tumor–Stroma Interactions Group, Department of Cancer Research, Luxembourg Institute of Health, Luxembourg City, Luxembourg
| | - Susanne Gonder
- Tumor–Stroma Interactions Group, Department of Cancer Research, Luxembourg Institute of Health, Luxembourg City, Luxembourg.,Faculty of Science, Technology and Medicine, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Feng Xian
- Proteomics of Cellular Signaling, Department of Infection and Immunity, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Nikolaos Ioannou
- School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Mohaned Benzarti
- Faculty of Science, Technology and Medicine, University of Luxembourg, Esch-sur-Alzette, Luxembourg.,Cancer Metabolism Group, Department of Cancer Research, Luxembourg Institute of Health, Luxembourg City, Luxembourg
| | - Felix Bruno Kleine Borgmann
- Faculty of Science, Technology and Medicine, University of Luxembourg, Esch-sur-Alzette, Luxembourg.,Department of Neurosurgery, Centre Hospitalier de Luxembourg, Luxembourg City, Luxembourg.,Luxembourg Centre of Neuropathology, Department of Cancer Research, Luxembourg Institute of Health, Luxembourg City, Luxembourg
| | - Michel Mittelbronn
- Faculty of Science, Technology and Medicine, University of Luxembourg, Esch-sur-Alzette, Luxembourg.,Luxembourg Centre of Neuropathology, Department of Cancer Research, Luxembourg Institute of Health, Luxembourg City, Luxembourg.,Luxembourg Centre of Neuropathology, University of Luxembourg, Esch-sur-Alzette, Luxembourg.,Department of Life Sciences and Medicine, University of Luxembourg, Esch-sur-Alzette, Luxembourg.,National Center of Pathology, Laboratoire national de santé (LNS), Dudelange, Luxembourg.,Luxembourg Centre for Systems Biomedicine, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Gunnar Dittmar
- Faculty of Science, Technology and Medicine, University of Luxembourg, Esch-sur-Alzette, Luxembourg.,Proteomics of Cellular Signaling, Department of Infection and Immunity, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Petr V. Nazarov
- Multiomics Data Science Group, Department of Cancer Research, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Johannes Meiser
- Cancer Metabolism Group, Department of Cancer Research, Luxembourg Institute of Health, Luxembourg City, Luxembourg
| | - Basile Stamatopoulos
- Laboratory of Clinical Cell Therapy, Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium
| | - Alan G. Ramsay
- School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Etienne Moussay
- Tumor–Stroma Interactions Group, Department of Cancer Research, Luxembourg Institute of Health, Luxembourg City, Luxembourg.,Corresponding Authors: Jérôme Paggetti, Department of Cancer Research, Luxembourg Institute of Health, 6, Rue Nicolas-Ernest Barblé, Luxembourg, L-1210, Luxembourg. Phone: 352-26970-344; E-mail: ; and Etienne Moussay. Phone: 352-26970-232; E-mail:
| | - Jérôme Paggetti
- Tumor–Stroma Interactions Group, Department of Cancer Research, Luxembourg Institute of Health, Luxembourg City, Luxembourg.,Corresponding Authors: Jérôme Paggetti, Department of Cancer Research, Luxembourg Institute of Health, 6, Rue Nicolas-Ernest Barblé, Luxembourg, L-1210, Luxembourg. Phone: 352-26970-344; E-mail: ; and Etienne Moussay. Phone: 352-26970-232; E-mail:
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7
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Uhl B, Prochazka KT, Pansy K, Wenzl K, Strobl J, Baumgartner C, Szmyra MM, Waha JE, Wolf A, Tomazic PV, Steinbauer E, Steinwender M, Friedl S, Weniger M, Küppers R, Pichler M, Greinix HT, Stary G, Ramsay AG, Apollonio B, Feichtinger J, Beham-Schmid C, Neumeister P, Deutsch AJ. Distinct Chemokine Receptor Expression Profiles in De Novo DLBCL, Transformed Follicular Lymphoma, Richter's Trans-Formed DLBCL and Germinal Center B-Cells. Int J Mol Sci 2022; 23:7874. [PMID: 35887224 PMCID: PMC9316992 DOI: 10.3390/ijms23147874] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 07/12/2022] [Accepted: 07/13/2022] [Indexed: 11/17/2022] Open
Abstract
Chemokine receptors and their ligands have been identified as playing an important role in the development of diffuse large B-cell lymphoma (DLBCL), follicular lymphoma, and Richter syndrome (RS). Our aim was to investigate the different expression profiles in de novo DLBCL, transformed follicular lymphoma (tFL), and RS. Here, we profiled the mRNA expression levels of 18 chemokine receptors (CCR1-CCR9, CXCR1-CXCR7, CX3CR1 and XCR1) using RQ-PCR, as well as immunohistochemistry of seven chemokine receptors (CCR1, CCR4-CCR8 and CXCR2) in RS, de novo DLBCL, and tFL biopsy-derived tissues. Tonsil-derived germinal center B-cells (GC-B) served as non-neoplastic controls. The chemokine receptor expression profiles of de novo DLBCL and tFL substantially differed from those of GC-B, with at least 5-fold higher expression of 15 out of the 18 investigated chemokine receptors (CCR1-CCR9, CXCR1, CXCR2, CXCR6, CXCR7, CX3CR1 and XCR1) in these lymphoma subtypes. Interestingly, the de novo DLBCL and tFL exhibited at least 22-fold higher expression of CCR1, CCR5, CCR8, and CXCR6 compared with RS, whereas no significant difference in chemokine receptor expression profile was detected when comparing de novo DLBCL with tFL. Furthermore, in de novo DLBCL and tFLs, a high expression of CCR7 was associated with a poor overall survival in our study cohort, as well as in an independent patient cohort. Our data indicate that the chemokine receptor expression profile of RS differs substantially from that of de novo DLBCL and tFL. Thus, these multiple dysregulated chemokine receptors could represent novel clinical markers as diagnostic and prognostic tools. Moreover, this study highlights the relevance of chemokine signaling crosstalk in the tumor microenvironment of aggressive lymphomas.
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Affiliation(s)
- Barbara Uhl
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria; (B.U.); (K.T.P.); (K.P.); (K.W.); (M.M.S.); (H.T.G.)
| | - Katharina T. Prochazka
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria; (B.U.); (K.T.P.); (K.P.); (K.W.); (M.M.S.); (H.T.G.)
| | - Katrin Pansy
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria; (B.U.); (K.T.P.); (K.P.); (K.W.); (M.M.S.); (H.T.G.)
| | - Kerstin Wenzl
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria; (B.U.); (K.T.P.); (K.P.); (K.W.); (M.M.S.); (H.T.G.)
- Division of Hematology, Mayo Clinic, Rochester, MN 55902, USA
| | - Johanna Strobl
- Department of Dermatology, Medical University of Vienna, 1090 Vienna, Austria; (J.S.); (G.S.)
| | - Claudia Baumgartner
- Division of Cell Biology, Histology and Embryology, Gottfried Schatz Research Center, Medical University of Graz, 8036 Graz, Austria; (C.B.); (J.F.)
| | - Marta M. Szmyra
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria; (B.U.); (K.T.P.); (K.P.); (K.W.); (M.M.S.); (H.T.G.)
| | - James E. Waha
- General, Visceral and Transplant Surgery, Medical University of Graz, 8036 Graz, Austria;
| | - Axel Wolf
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Graz, 8036 Graz, Austria; (A.W.); (P.V.T.)
| | - Peter V. Tomazic
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Graz, 8036 Graz, Austria; (A.W.); (P.V.T.)
| | - Elisabeth Steinbauer
- Institute of Pathology, Medical University of Graz, 8036 Graz, Austria; (E.S.); (M.S.); (S.F.); (C.B.-S.)
| | - Maria Steinwender
- Institute of Pathology, Medical University of Graz, 8036 Graz, Austria; (E.S.); (M.S.); (S.F.); (C.B.-S.)
| | - Sabine Friedl
- Institute of Pathology, Medical University of Graz, 8036 Graz, Austria; (E.S.); (M.S.); (S.F.); (C.B.-S.)
| | - Marc Weniger
- Institute of Cell Biology (Cancer Research), University of Duisburg-Essen, 45122 Essen, Germany; (M.W.); (R.K.)
| | - Ralf Küppers
- Institute of Cell Biology (Cancer Research), University of Duisburg-Essen, 45122 Essen, Germany; (M.W.); (R.K.)
- German Cancer Consortium (DKTK), 69120 Heidelberg, Germany
| | - Martin Pichler
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria;
| | - Hildegard T. Greinix
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria; (B.U.); (K.T.P.); (K.P.); (K.W.); (M.M.S.); (H.T.G.)
| | - Georg Stary
- Department of Dermatology, Medical University of Vienna, 1090 Vienna, Austria; (J.S.); (G.S.)
- Ludwig Boltzmann Institute for Rare and Undiagnosed Diseases, 1090 Vienna, Austria
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, 1090 Vienna, Austria
| | - Alan G. Ramsay
- Faculty of Life Sciences & Medicine, School of Cancer & Pharmaceutical Sciences, King’s College London, London WC2R 2LS, UK; (A.G.R.); (B.A.)
| | - Benedetta Apollonio
- Faculty of Life Sciences & Medicine, School of Cancer & Pharmaceutical Sciences, King’s College London, London WC2R 2LS, UK; (A.G.R.); (B.A.)
| | - Julia Feichtinger
- Division of Cell Biology, Histology and Embryology, Gottfried Schatz Research Center, Medical University of Graz, 8036 Graz, Austria; (C.B.); (J.F.)
| | - Christine Beham-Schmid
- Institute of Pathology, Medical University of Graz, 8036 Graz, Austria; (E.S.); (M.S.); (S.F.); (C.B.-S.)
| | - Peter Neumeister
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria; (B.U.); (K.T.P.); (K.P.); (K.W.); (M.M.S.); (H.T.G.)
| | - Alexander J. Deutsch
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria; (B.U.); (K.T.P.); (K.P.); (K.W.); (M.M.S.); (H.T.G.)
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8
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Vaca AM, Ioannou N, Sivina M, Vlachonikola E, Clise-Dwyer K, Kim E, Li D, Ma Q, Ferrajoli A, Estrov Z, Wierda WG, Patten PEM, Ramsay AG, Burger JA. Activation and expansion of T-follicular helper cells in chronic lymphocytic leukemia nurselike cell co-cultures. Leukemia 2022; 36:1324-1335. [PMID: 35149845 DOI: 10.1038/s41375-022-01519-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 01/20/2022] [Accepted: 01/31/2022] [Indexed: 12/16/2022]
Abstract
Interactions between chronic lymphocytic leukemia (CLL) cells and T-cell subsets in the lymph node microenvironment are thought to play a central role in disease biology. To study these interactions in a model of the CLL lymph node microenvironment, we characterized T-cell subsets in CLL nurselike cell (NLC) co-cultures. We focused on T-follicular helper (Tfh) cells, which are characterized by CXCR5 expression and localization to B-cell follicles. In co-cultures from 28 different CLL patients, we detected an expansion of Tfh cells based on PD-1, BCL6, and ICOS expression, with increased IL-21 and downmodulated CD40L surface expression. Regulatory T cells (Treg), which promote immune tolerance, also expanded in NLC co-cultures. T-cell receptor (TR) gene repertoire analyses confirmed the clonal expansion of CD4+ T cells, with an enrichment of TR clonotypes commonly expanded also in primary CLL samples. Multicolor confocal microscopy revealed that Tfh, but not Treg co-localize with proliferating CLL cells in CLL lymph node sections. Collectively, these data provide new insight into the cellular and molecular cross-talk between CLL and T-cell subsets, resulting in clonal expansion of T-helper cells and interaction of Tfh cells with proliferating CLL cells which may open new avenues for therapeutic targeting.
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Affiliation(s)
- Alicia M Vaca
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nikolaos Ioannou
- School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Mariela Sivina
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Elisavet Vlachonikola
- Institute of Applied Biosciences, Center for Research and Technology Hellas, Thessaloniki, Greece
| | - Karen Clise-Dwyer
- Department of Stem Cell Transplantation and Hematopoietic Biology & Malignancy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ekaterina Kim
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Dan Li
- Department of Stem Cell Transplantation and Hematopoietic Biology & Malignancy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Qing Ma
- Department of Stem Cell Transplantation and Hematopoietic Biology & Malignancy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Alessandra Ferrajoli
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Zeev Estrov
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - William G Wierda
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Piers E M Patten
- School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Alan G Ramsay
- School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Jan A Burger
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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9
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Svanberg R, Janum S, Patten PEM, Ramsay AG, Niemann CU. Targeting the tumor microenvironment in chronic lymphocytic leukemia. Haematologica 2021; 106:2312-2324. [PMID: 33882636 PMCID: PMC8409023 DOI: 10.3324/haematol.2020.268037] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 03/31/2021] [Indexed: 11/24/2022] Open
Abstract
The tumor microenvironment (TME) plays an essential role in the development, growth, and survival of the malignant B-cell clone in chronic lymphocytic leukemia (CLL). Within the proliferation niches of lymph nodes, bone marrow, and secondary lymphoid organs, a variety of phenotypically and functionally altered cell types, including T cells, natural killer cells, monocytes/macrophages, endothelial and mesenchymal stroma cells, provide crucial survival signals, along with CLL-cellinduced suppression of antitumor immune responses. The B-cell receptor pathway plays a pivotal role in mediating the interaction between CLL cells and the TME. However, an increasing number of additional components of the multifactorial TME are being discovered. Although the majority of therapeutic strategies employed in CLL hitherto have focused on targeting the leukemic cells, emerging evidence implies that modulation of microenvironmental cells and CLL-TME interactions by novel therapeutic agents significantly affect their clinical efficacy. Thus, improving our understanding of CLL-TME interactions and how they are affected by current therapeutic agents may improve and guide treatment strategies. Identification of novel TME interactions may also pave the road for the development of novel therapeutic strategies targeting the TME. In this review, we summarize current evidence on the effects of therapeutic agents on cells and interactions within the TME. With a growing demand for improved and personalized treatment options in CLL, this review aims at inspiring future exploration of smart drug combination strategies, translational studies, and novel therapeutic targets in clinical trials.
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Affiliation(s)
| | - Sine Janum
- Department of Clinical Haemato-oncology, Bartholomew's Hospital, Barts Health Trust, London
| | - Piers E M Patten
- School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King's College London, London
| | - Alan G Ramsay
- School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King's College London, London
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10
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Ioannou N, Jain K, Ramsay AG. Immunomodulatory Drugs for the Treatment of B Cell Malignancies. Int J Mol Sci 2021; 22:8572. [PMID: 34445275 PMCID: PMC8395307 DOI: 10.3390/ijms22168572] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 07/25/2021] [Accepted: 07/26/2021] [Indexed: 12/23/2022] Open
Abstract
Accumulating evidence suggests that the tumor microenvironment (TME) is involved in disease progression and drug resistance in B cell malignancies, by supporting tumor growth and facilitating the ability of malignant cells to avoid immune recognition. Immunomodulatory drugs (IMiDs) such as lenalidomide have some direct anti-tumor activity, but critically also target various cellular compartments of the TME including T cells, NK cells, and stromal cells, which interfere with pro-tumor signaling while activating anti-tumor immune responses. Lenalidomide has delivered favorable clinical outcomes as a single-agent, and in combination therapy leads to durable responses in chronic lymphocytic leukemia (CLL) and several non-Hodgkin lymphomas (NHLs) including follicular lymphoma (FL), diffuse large B cell lymphoma (DLBCL), and mantle cell lymphoma (MCL). Recently, avadomide, a next generation cereblon E3 ligase modulator (CELMoD), has shown potent anti-tumor and TME immunomodulatory effects, as well as promising clinical efficacy in DLBCL. This review describes how the pleiotropic effects of IMiDs and CELMoDs could make them excellent candidates for combination therapy in the immuno-oncology era-a concept supported by preclinical data, as well as the recent approval of lenalidomide in combination with rituximab for the treatment of relapsed/refractory (R/R) FL.
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MESH Headings
- Adaptor Proteins, Signal Transducing/antagonists & inhibitors
- Adaptor Proteins, Signal Transducing/immunology
- Antineoplastic Agents/therapeutic use
- Enzyme Inhibitors/therapeutic use
- Humans
- Immunologic Factors/therapeutic use
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/immunology
- Lymphoma, B-Cell/drug therapy
- Lymphoma, B-Cell/immunology
- Neoplasm Proteins/antagonists & inhibitors
- Neoplasm Proteins/immunology
- Ubiquitin-Protein Ligases/antagonists & inhibitors
- Ubiquitin-Protein Ligases/immunology
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Affiliation(s)
| | | | - Alan G. Ramsay
- Faculty of Life Sciences & Medicine, School of Cancer & Pharmaceutical Sciences, King’s College London, London SE1 9RT, UK; (N.I.); (K.J.)
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11
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Apollonio B, Petrov N, Spada F, Jarvis P, Cozzetto D, Kannambath S, Kuo D, Saqui M, Amini RM, Enblad G, Charlotte G, Benjamin R, Vardi A, Phillips E, Salisbury J, Olson EN, Fox B, Hagner P, Gandhi A, Jarrett RF, Herter S, Bacac M, Klaus C, Klein C, Deutsch A, Ramsay AG. Abstract 3165: Stroma-immune landscape in lymphoma: new mechanisms of immunosuppression and therapeutic targeting. Cancer Res 2021. [DOI: 10.1158/1538-7445.am2021-3165] [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
Tumor cells engage in bidirectional interactions with stroma and immune cells to promote disease progression and immune evasion. Stroma-specific gene signatures have been associated with outcome in diffuse large B-cell lymphoma (DLBCL), but their immunobiology has been understudied.
To characterize the stromal landscape in lymphoma, we performed high-dimensional imaging mass cytometry analysis of the major stroma subsets and revealed a marked expansion and remodeling of the immuno-specialized fibroblastic reticular cells (FRCs) in human DLBCL biopsies (n=53). The FRC network was similarly remodeled in tumors from the IμBcl6 transgenic model of lymphoma, and aberrant fibroblasts were in close proximity to cancer cells.
Modelling the interactions between murine and patient FRCs and tumor cells, using 2D and 3D cultures, showed that lymphoma drives the acquisition of an inflammatory-like, pro-tumoral (upregulation of fibroblast activating protein-α, FAP) phenotype and associated functional capabilities. Comparative bulk transcriptomic analysis revealed that lymphoma-FRCs undergo transcriptional reprogramming and activate gene pathways associated with inflammatory responses. Moreover, single-cell RNA-seq revealed an expansion of activated FRC clusters expressing B cell supporting genes, while T cell-associated FRCs were contracted. Altered chemokine signaling pathways in DLBCL-FRCs were functionally linked to reduced attraction of T cells and impeded migration along the lymphoma-reticular network. Moreover, lymphoma-FRCs upregulated expression of inhibitory PD-1 ligands that reduced the anti-tumor cytolytic activity of CD8+ T cells, a T cell bispecific antibody (CD20-TCB, glofitamab) and anti-CD19 CAR T cells in our coculture models.
To overcome the immunosuppressive activity of DLBCL-FRCs, we investigated the use of CD20-TCB in combination with stroma-targeting immunocytokine fusion protein drug (FAP-IL2v, RG7461) or costimulatory fusion protein (FAP-4-1BBL, RG7827). Functional cytotoxicity assays using human and murine primary DLBCL patient samples revealed that both stroma-targeting drugs paired effectively with the CD20-TCB to enhance the cytotoxic activity of autologous CD8+ T cells. In addition, the ability of immune-/stroma- targeted combination immunotherapy to trigger anti-tumor activity and CD8+ T cell retention within the FRC-TME was demonstrated using 3D precision-cut lymph node slice-based organotypic cultures of DLBCL and other B cell malignancies.
In conclusion our data reveal that lymphoma cells actively reprogram FRCs that acquire altered immunoregulatory function which prevents effective T cell motility and suppresses the anti-tumor function of cytolytic T cells. Importantly, we demonstrate that combination immunotherapy incorporating fibroblast-targeting fusion proteins could effectively recover anti-tumor T cell activity.
Citation Format: Benedetta Apollonio, Nedyalko Petrov, Filomena Spada, Peter Jarvis, Domenico Cozzetto, Shichina Kannambath, David Kuo, Mansoor Saqui, Rose-Marie Amini, Gunilla Enblad, Graham Charlotte, Reuben Benjamin, Anna Vardi, Elisabeth Phillips, Jon Salisbury, Eric N. Olson, Brian Fox, Patrick Hagner, Anita Gandhi, Ruth F. Jarrett, Sylvia Herter, Marina Bacac, Christina Klaus, Christian Klein, Alexander Deutsch, Alan G. Ramsay. Stroma-immune landscape in lymphoma: new mechanisms of immunosuppression and therapeutic targeting [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 3165.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Anna Vardi
- 4G. Papanikolaou Hospital, Thessaloniki, Greece
| | | | - Jon Salisbury
- 5King's College Hospital NHS Foundation Trust, London, United Kingdom
| | | | | | | | | | - Ruth F. Jarrett
- 6MRC University of Glasgow Centre for Virus Research, Glasgow, United Kingdom
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12
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Graham CE, Jozwik A, Quartey-Papafio R, Ioannou N, Metelo AM, Scala C, Dickson G, Stewart O, Almena-Carrasco M, Peranzoni E, Ramsay AG, Patten PEM, Pertel T, Farzaneh F, Dupouy S, Pepper A, Benjamin R. Gene-edited healthy donor CAR T cells show superior anti-tumour activity compared to CAR T cells derived from patients with lymphoma in an in vivo model of high-grade lymphoma. Leukemia 2021; 35:3581-3584. [PMID: 34145373 PMCID: PMC8632681 DOI: 10.1038/s41375-021-01324-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 05/31/2021] [Accepted: 06/04/2021] [Indexed: 01/06/2023]
Affiliation(s)
- Charlotte Elizabeth Graham
- Faculty of Life Sciences and Medicine, School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom. .,King's College Hospital NHS Foundation Trust, London, United Kingdom.
| | - Agnieszka Jozwik
- Faculty of Life Sciences and Medicine, School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Ruby Quartey-Papafio
- Faculty of Life Sciences and Medicine, School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Nikolaos Ioannou
- Faculty of Life Sciences and Medicine, School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Ana M Metelo
- Faculty of Life Sciences and Medicine, School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Carlo Scala
- Faculty of Life Sciences and Medicine, School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Glenda Dickson
- Faculty of Life Sciences and Medicine, School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Orla Stewart
- King's College Hospital NHS Foundation Trust, London, United Kingdom
| | | | - Elisa Peranzoni
- Institut de Recherches Internationales Servier, Paris, France
| | - Alan G Ramsay
- Faculty of Life Sciences and Medicine, School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Piers E M Patten
- Faculty of Life Sciences and Medicine, School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom.,King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Thomas Pertel
- Allogene Therapeutics, San Francisco, CA, United States
| | - Farzin Farzaneh
- Faculty of Life Sciences and Medicine, School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Sandra Dupouy
- Institut de Recherches Internationales Servier, Paris, France
| | - Andrea Pepper
- Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom
| | - Reuben Benjamin
- Faculty of Life Sciences and Medicine, School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom.,King's College Hospital NHS Foundation Trust, London, United Kingdom
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13
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Opzoomer JW, Timms JA, Blighe K, Mourikis TP, Chapuis N, Bekoe R, Kareemaghay S, Nocerino P, Apollonio B, Ramsay AG, Tavassoli M, Harrison C, Ciccarelli F, Parker P, Fontenay M, Barber PR, Arnold JN, Kordasti S. ImmunoCluster provides a computational framework for the nonspecialist to profile high-dimensional cytometry data. eLife 2021; 10:e62915. [PMID: 33929322 PMCID: PMC8112868 DOI: 10.7554/elife.62915] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 04/22/2021] [Indexed: 01/04/2023] Open
Abstract
High-dimensional cytometry is an innovative tool for immune monitoring in health and disease, and it has provided novel insight into the underlying biology as well as biomarkers for a variety of diseases. However, the analysis of large multiparametric datasets usually requires specialist computational knowledge. Here, we describe ImmunoCluster (https://github.com/kordastilab/ImmunoCluster), an R package for immune profiling cellular heterogeneity in high-dimensional liquid and imaging mass cytometry, and flow cytometry data, designed to facilitate computational analysis by a nonspecialist. The analysis framework implemented within ImmunoCluster is readily scalable to millions of cells and provides a variety of visualization and analytical approaches, as well as a rich array of plotting tools that can be tailored to users' needs. The protocol consists of three core computational stages: (1) data import and quality control; (2) dimensionality reduction and unsupervised clustering; and (3) annotation and differential testing, all contained within an R-based open-source framework.
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Affiliation(s)
- James W Opzoomer
- School of Cancer and Pharmaceutical Sciences, King’s College London, Faculty of Life Sciences and Medicine, Guy’s HospitalLondonUnited Kingdom
| | - Jessica A Timms
- School of Cancer and Pharmaceutical Sciences, King’s College London, Faculty of Life Sciences and Medicine, Guy’s HospitalLondonUnited Kingdom
| | - Kevin Blighe
- School of Cancer and Pharmaceutical Sciences, King’s College London, Faculty of Life Sciences and Medicine, Guy’s HospitalLondonUnited Kingdom
| | - Thanos P Mourikis
- School of Cancer and Pharmaceutical Sciences, King’s College London, Faculty of Life Sciences and Medicine, Guy’s HospitalLondonUnited Kingdom
| | - Nicolas Chapuis
- Institut Cochin, Institut National de la Santé et de la Recherche Médicale U1016, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 8104, Université Paris DescartesParisFrance
| | - Richard Bekoe
- UCL Cancer Institute, Paul O'Gorman Building, University College LondonLondonUnited Kingdom
| | - Sedigeh Kareemaghay
- Centre for Host Microbiome Interaction, FoDOCS, King’s College, Guy’s HospitalLondonUnited Kingdom
| | - Paola Nocerino
- School of Cancer and Pharmaceutical Sciences, King’s College London, Faculty of Life Sciences and Medicine, Guy’s HospitalLondonUnited Kingdom
| | - Benedetta Apollonio
- School of Cancer and Pharmaceutical Sciences, King’s College London, Faculty of Life Sciences and Medicine, Guy’s HospitalLondonUnited Kingdom
| | - Alan G Ramsay
- School of Cancer and Pharmaceutical Sciences, King’s College London, Faculty of Life Sciences and Medicine, Guy’s HospitalLondonUnited Kingdom
| | - Mahvash Tavassoli
- Centre for Host Microbiome Interaction, FoDOCS, King’s College, Guy’s HospitalLondonUnited Kingdom
| | - Claire Harrison
- School of Cancer and Pharmaceutical Sciences, King’s College London, Faculty of Life Sciences and Medicine, Guy’s HospitalLondonUnited Kingdom
- Haematology Department, Guy’s HospitalLondonUnited Kingdom
| | - Francesca Ciccarelli
- School of Cancer and Pharmaceutical Sciences, King’s College London, Faculty of Life Sciences and Medicine, Guy’s HospitalLondonUnited Kingdom
- Cancer Systems Biology Laboratory, The Francis Crick InstituteLondonUnited Kingdom
| | - Peter Parker
- School of Cancer and Pharmaceutical Sciences, King’s College London, Faculty of Life Sciences and Medicine, Guy’s HospitalLondonUnited Kingdom
- Francis Crick InstituteLondonUnited Kingdom
| | - Michaela Fontenay
- Institut Cochin, Institut National de la Santé et de la Recherche Médicale U1016, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 8104, Université Paris DescartesParisFrance
| | - Paul R Barber
- School of Cancer and Pharmaceutical Sciences, King’s College London, Faculty of Life Sciences and Medicine, Guy’s HospitalLondonUnited Kingdom
- UCL Cancer Institute, Paul O'Gorman Building, University College LondonLondonUnited Kingdom
| | - James N Arnold
- School of Cancer and Pharmaceutical Sciences, King’s College London, Faculty of Life Sciences and Medicine, Guy’s HospitalLondonUnited Kingdom
| | - Shahram Kordasti
- School of Cancer and Pharmaceutical Sciences, King’s College London, Faculty of Life Sciences and Medicine, Guy’s HospitalLondonUnited Kingdom
- Haematology Department, Guy’s HospitalLondonUnited Kingdom
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14
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Apollonio B, Ioannou N, Papazoglou D, Ramsay AG. Understanding the Immune-Stroma Microenvironment in B Cell Malignancies for Effective Immunotherapy. Front Oncol 2021; 11:626818. [PMID: 33842331 PMCID: PMC8027510 DOI: 10.3389/fonc.2021.626818] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 01/04/2021] [Indexed: 12/28/2022] Open
Abstract
Cancers, including lymphomas, develop in complex tissue environments where malignant cells actively promote the creation of a pro-tumoral niche that suppresses effective anti-tumor effector T cell responses. Research is revealing that the tumor microenvironment (TME) differs between different types of lymphoma, covering inflamed environments, as exemplified by Hodgkin lymphoma, to non-inflamed TMEs as seen in chronic lymphocytic leukemia (CLL) or diffuse-large B-cell lymphoma (DLBCL). In this review we consider how T cells and interferon-driven inflammatory signaling contribute to the regulation of anti-tumor immune responses, as well as sensitivity to anti-PD-1 immune checkpoint blockade immunotherapy. We discuss tumor intrinsic and extrinsic mechanisms critical to anti-tumor immune responses, as well as sensitivity to immunotherapies, before adding an additional layer of complexity within the TME: the immunoregulatory role of non-hematopoietic stromal cells that co-evolve with tumors. Studying the intricate interactions between the immune-stroma lymphoma TME should help to design next-generation immunotherapies and combination treatment strategies to overcome complex TME-driven immune suppression.
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Affiliation(s)
- Benedetta Apollonio
- Faculty of Life Sciences & Medicine, School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Nikolaos Ioannou
- Faculty of Life Sciences & Medicine, School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Despoina Papazoglou
- Faculty of Life Sciences & Medicine, School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Alan G Ramsay
- Faculty of Life Sciences & Medicine, School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
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15
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Patten PEM, Ferrer G, Chen SS, Kolitz JE, Rai KR, Allen SL, Barrientos JC, Ioannou N, Ramsay AG, Chiorazzi N. A Detailed Analysis of Parameters Supporting the Engraftment and Growth of Chronic Lymphocytic Leukemia Cells in Immune-Deficient Mice. Front Immunol 2021; 12:627020. [PMID: 33767698 PMCID: PMC7985329 DOI: 10.3389/fimmu.2021.627020] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 01/11/2021] [Indexed: 01/19/2023] Open
Abstract
Patient-derived xenograft models of chronic lymphocytic leukemia (CLL) can be created using highly immunodeficient animals, allowing analysis of primary tumor cells in an in vivo setting. However, unlike many other tumors, CLL B lymphocytes do not reproducibly grow in xenografts without manipulation, proliferating only when there is concomitant expansion of T cells. Here we show that in vitro pre-activation of CLL-derived T lymphocytes allows for a reliable and robust system for primary CLL cell growth within a fully autologous system that uses small numbers of cells and does not require pre-conditioning. In this system, growth of normal T and leukemic B cells follows four distinct temporal phases, each with characteristic blood and tissue findings. Phase 1 constitutes a period during which resting CLL B cells predominate, with cells aggregating at perivascular areas most often in the spleen. In Phase 2, T cells expand and provide T-cell help to promote B-cell division and expansion. Growth of CLL B and T cells persists in Phase 3, although some leukemic B cells undergo differentiation to more mature B-lineage cells (plasmablasts and plasma cells). By Phase 4, CLL B cells are for the most part lost with only T cells remaining. The required B-T cell interactions are not dependent on other human hematopoietic cells nor on murine macrophages or follicular dendritic cells, which appear to be relatively excluded from the perivascular lymphoid aggregates. Notably, the growth kinetics and degree of anatomic localization of CLL B and T cells is significantly influenced by intravenous versus intraperitoneal administration. Importantly, B cells delivered intraperitoneally either remain within the peritoneal cavity in a quiescent state, despite the presence of dividing T cells, or migrate to lymphoid tissues where they actively divide; this dichotomy mimics the human condition in that cells in primary lymphoid tissues and the blood are predominately resting, whereas those in secondary lymphoid tissues proliferate. Finally, the utility of this approach is illustrated by documenting the effects of a bispecific antibody reactive with B and T cells. Collectively, this model represents a powerful tool to evaluate CLL biology and novel therapeutics in vivo.
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Affiliation(s)
- Piers E M Patten
- Institute of Molecular Medicine, Karches Center for Oncology Research, The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States.,Faculty of Life Sciences & Medicine, School of Cancer & Pharmaceutical Sciences, Comprehensive Cancer Centre, Institute of Haematology, King's College London, London, United Kingdom
| | - Gerardo Ferrer
- Institute of Molecular Medicine, Karches Center for Oncology Research, The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
| | - Shih-Shih Chen
- Institute of Molecular Medicine, Karches Center for Oncology Research, The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
| | - Jonathan E Kolitz
- Institute of Molecular Medicine, Karches Center for Oncology Research, The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States.,Department of Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| | - Kanti R Rai
- Institute of Molecular Medicine, Karches Center for Oncology Research, The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States.,Department of Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| | - Steven L Allen
- Institute of Molecular Medicine, Karches Center for Oncology Research, The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States.,Department of Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| | - Jacqueline C Barrientos
- Institute of Molecular Medicine, Karches Center for Oncology Research, The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States.,Department of Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| | - Nikolaos Ioannou
- Faculty of Life Sciences & Medicine, School of Cancer & Pharmaceutical Sciences, Comprehensive Cancer Centre, Institute of Haematology, King's College London, London, United Kingdom
| | - Alan G Ramsay
- Faculty of Life Sciences & Medicine, School of Cancer & Pharmaceutical Sciences, Comprehensive Cancer Centre, Institute of Haematology, King's College London, London, United Kingdom
| | - Nicholas Chiorazzi
- Institute of Molecular Medicine, Karches Center for Oncology Research, The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States.,Department of Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States.,Department of Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
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16
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Ioannou N, Hagner PR, Stokes M, Gandhi AK, Apollonio B, Fanous M, Papazoglou D, Sutton LA, Rosenquist R, Amini RM, Chiu H, Lopez-Girona A, Janardhanan P, Awan FT, Jones J, Kay NE, Shanafelt TD, Tallman MS, Stamatopoulos K, Patten PEM, Vardi A, Ramsay AG. Triggering interferon signaling in T cells with avadomide sensitizes CLL to anti-PD-L1/PD-1 immunotherapy. Blood 2021; 137:216-231. [PMID: 33024998 PMCID: PMC7820876 DOI: 10.1182/blood.2020006073] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 09/26/2020] [Indexed: 12/14/2022] Open
Abstract
Cancer treatment has been transformed by checkpoint blockade therapies, with the highest anti-tumor activity of anti-programmed death 1 (PD-1) antibody therapy seen in Hodgkin lymphoma. Disappointingly, response rates have been low in the non-Hodgkin lymphomas, with no activity seen in relapsed/refractory chronic lymphocytic leukemia (CLL) with PD-1 blockade. Thus, identifying more powerful combination therapy is required for these patients. Here, we preclinically demonstrate enhanced anti-CLL activity following combinational therapy with anti-PD-1 or anti-PD-1 ligand (PD-L1) and avadomide, a cereblon E3 ligase modulator (CELMoD). Avadomide induced type I and II interferon (IFN) signaling in patient T cells, triggering a feedforward cascade of reinvigorated T-cell responses. Immune modeling assays demonstrated that avadomide stimulated T-cell activation, chemokine expression, motility and lytic synapses with CLL cells, as well as IFN-inducible feedback inhibition through upregulation of PD-L1. Patient-derived xenograft tumors treated with avadomide were converted to CD8+ T cell-inflamed tumor microenvironments that responded to anti-PD-L1/PD-1-based combination therapy. Notably, clinical analyses showed increased PD-L1 expression on T cells, as well as intratumoral expression of chemokine signaling genes in B-cell malignancy patients receiving avadomide-based therapy. These data illustrate the importance of overcoming a low inflammatory T-cell state to successfully sensitize CLL to checkpoint blockade-based combination therapy.
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Affiliation(s)
- Nikolaos Ioannou
- School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | | | | | | | - Benedetta Apollonio
- School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - Mariam Fanous
- School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - Despoina Papazoglou
- School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - Lesley-Ann Sutton
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Richard Rosenquist
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Clinical Genetics, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Rose-Marie Amini
- Department of Immunology, Genetics and Pathology, Uppsala University and University Hospital, Uppsala, Sweden
| | | | | | | | - Farrukh T Awan
- Division of Hematology, The Ohio State University Cancer Center, Columbus, OH
| | | | - Neil E Kay
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | | | - Kostas Stamatopoulos
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece
| | - Piers E M Patten
- School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
- Department of Haematology, King's College Hospital NHS Foundation Trust, London, United Kingdom; and
| | - Anna Vardi
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece
- Hematology Department and HCT Unit, G. Papanikolaou Hospital, Thessaloniki, Greece
| | - Alan G Ramsay
- School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
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17
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Vardi A, Vlachonikola E, Papazoglou D, Psomopoulos F, Kotta K, Ioannou N, Galigalidou C, Gemenetzi K, Pasentsis K, Kotouza M, Koravou E, Scarfó L, Iskas M, Stavroyianni N, Ghia P, Anagnostopoulos A, Kouvatsi A, Ramsay AG, Stamatopoulos K, Chatzidimitriou A. T-Cell Dynamics in Chronic Lymphocytic Leukemia under Different Treatment Modalities. Clin Cancer Res 2020; 26:4958-4969. [PMID: 32616500 DOI: 10.1158/1078-0432.ccr-19-3827] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 04/01/2020] [Accepted: 06/25/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE Using next-generation sequencing (NGS), we recently documented T-cell oligoclonality in treatment-naïve chronic lymphocytic leukemia (CLL), with evidence indicating T-cell selection by restricted antigens. EXPERIMENTAL DESIGN Here, we sought to comprehensively assess T-cell repertoire changes during treatment in relation to (i) treatment type [fludarabine-cyclophosphamide-rituximab (FCR) versus ibrutinib (IB) versus rituximab-idelalisib (R-ID)], and (ii) clinical response, by combining NGS immunoprofiling, flow cytometry, and functional bioassays. RESULTS T-cell clonality significantly increased at (i) 3 months in the FCR and R-ID treatment groups, and (ii) over deepening clinical response in the R-ID group, with a similar trend detected in the IB group. Notably, in constrast to FCR that induced T-cell repertoire reconstitution, B-cell receptor signaling inhibitors (BcRi) preserved pretreatment clones. Extensive comparisons both within CLL as well as against T-cell receptor sequence databases showed little similarity with other entities, but instead revealed major clonotypes shared exclusively by patients with CLL, alluding to selection by conserved CLL-associated antigens. We then evaluated the functional effect of treatments on T cells and found that (i) R-ID upregulated the expression of activation markers in effector memory T cells, and (ii) both BcRi improved antitumor T-cell immune synapse formation, in marked contrast to FCR. CONCLUSIONS Taken together, our NGS immunoprofiling data suggest that BcRi retain T-cell clones that may have developed against CLL-associated antigens. Phenotypic and immune synapse bioassays support a concurrent restoration of functionality, mostly evident for R-ID, arguably contributing to clinical response.
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Affiliation(s)
- Anna Vardi
- Institute of Applied Biosciences, CERTH, Thessaloniki, Greece.,Hematology Department and HCT Unit, G. Papanicolaou Hospital, Thessaloniki, Greece.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Elisavet Vlachonikola
- Institute of Applied Biosciences, CERTH, Thessaloniki, Greece.,Faculty of Sciences, Department of Genetics, Development and Molecular Biology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Despoina Papazoglou
- Lymphoma Immunology Group, School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - Fotis Psomopoulos
- Institute of Applied Biosciences, CERTH, Thessaloniki, Greece.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Kostantia Kotta
- Institute of Applied Biosciences, CERTH, Thessaloniki, Greece
| | - Nikolaos Ioannou
- Lymphoma Immunology Group, School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - Chrysi Galigalidou
- Institute of Applied Biosciences, CERTH, Thessaloniki, Greece.,Democritus University of Thrace, Department of Molecular Biology and Genetics, Alexandroupolis, Greece
| | - Katerina Gemenetzi
- Institute of Applied Biosciences, CERTH, Thessaloniki, Greece.,Democritus University of Thrace, Department of Molecular Biology and Genetics, Alexandroupolis, Greece
| | | | - Maria Kotouza
- Institute of Applied Biosciences, CERTH, Thessaloniki, Greece
| | - Evdoxia Koravou
- Hematology Department and HCT Unit, G. Papanicolaou Hospital, Thessaloniki, Greece
| | - Lydia Scarfó
- Division of Experimental Oncology, Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan, Italy
| | - Michail Iskas
- Hematology Department and HCT Unit, G. Papanicolaou Hospital, Thessaloniki, Greece
| | - Niki Stavroyianni
- Hematology Department and HCT Unit, G. Papanicolaou Hospital, Thessaloniki, Greece
| | - Paolo Ghia
- Division of Experimental Oncology, Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - Anastasia Kouvatsi
- Faculty of Sciences, Department of Genetics, Development and Molecular Biology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Alan G Ramsay
- Lymphoma Immunology Group, School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - Kostas Stamatopoulos
- Institute of Applied Biosciences, CERTH, Thessaloniki, Greece.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Anastasia Chatzidimitriou
- Institute of Applied Biosciences, CERTH, Thessaloniki, Greece. .,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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18
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Chiu H, Trisal P, Bjorklund C, Carrancio S, Toraño EG, Guarinos C, Papazoglou D, Hagner PR, Beldi-Ferchiou A, Tarte K, Delfau-Larue MH, Morschhauser F, Ramsay AG, Gandhi AK. Combination lenalidomide-rituximab immunotherapy activates anti-tumour immunity and induces tumour cell death by complementary mechanisms of action in follicular lymphoma. Br J Haematol 2019; 185:240-253. [PMID: 30767211 PMCID: PMC6594227 DOI: 10.1111/bjh.15797] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 12/14/2018] [Indexed: 12/22/2022]
Abstract
Chemotherapy plus rituximab has been the mainstay of treatment for follicular lymphoma (FL) for two decades but is associated with immunosuppression and relapse. In phase 2 studies, lenalidomide combined with rituximab (R2) has shown clinical synergy in front‐line and relapsed/refractory FL. Here, we show that lenalidomide reactivated dysfunctional T and Natural Killer (NK) cells ex vivo from FL patients by enhancing proliferative capacity and T‐helper cell type 1 (Th1) cytokine release. In combination with rituximab, lenalidomide improved antibody‐dependent cellular cytotoxicity in sensitive and chemo‐resistant FL cells, via a cereblon‐dependent mechanism. While single‐agent lenalidomide and rituximab increased formation of lytic NK cell immunological synapses with primary FL tumour cells, the combination was superior and correlated with enhanced cytotoxicity. Immunophenotyping of FL patient samples from a phase 3 trial revealed that R2 treatment increased circulating T‐ and NK‐cell counts, while R‐chemotherapy was associated with reduced cell numbers. Finally, using an in vitro model of myeloid differentiation, we demonstrated that lenalidomide caused a reversible arrest in neutrophil maturation that was distinct from a cytotoxic chemotherapeutic agent, which may help explain the lower rates of neutropenia observed with R2versus R‐chemotherapy. Taken together, we believe these data support a paradigm shift in the treatment of FL – moving from combination immunochemotherapy to chemotherapy‐free immunotherapy.
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Affiliation(s)
| | | | | | | | - Estela G Toraño
- Celgene Institute for Translational Research Europe, Seville, Spain
| | - Carla Guarinos
- Celgene Institute for Translational Research Europe, Seville, Spain
| | - Despoina Papazoglou
- School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | | | - Asma Beldi-Ferchiou
- Department of Immunobiology and Haematobiology, CHU Henri Mondor, Créteil, France
| | - Karin Tarte
- SITI laboratory, CHU Rennes, UMR, U1236 University of Rennes, INSERM, EFS, Rennes, France
| | | | | | - Alan G Ramsay
- School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
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19
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Ioannou N, Ramsay AG. Combination targeted therapy in chronic lymphocytic leukaemia - can pre-clinical studies translate to the clinic? Br J Haematol 2018; 182:315-316. [PMID: 29767410 DOI: 10.1111/bjh.15279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Nikolaos Ioannou
- Lymphoma Immunology Group, School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Alan G Ramsay
- Lymphoma Immunology Group, School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
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20
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Lim SP, Ioannou N, Ramsay AG, Darling D, Gäken J, Mufti GJ. miR-181c-BRK1 axis plays a key role in actin cytoskeleton-dependent T cell function. J Leukoc Biol 2018; 103:855-866. [PMID: 29656550 DOI: 10.1002/jlb.1a0817-325rr] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 08/15/2017] [Revised: 02/07/2018] [Accepted: 02/15/2018] [Indexed: 01/23/2023] Open
Abstract
MicroRNAs are short endogenous noncoding RNAs that play pivotal roles in a diverse range of cellular processes. The miR-181 family is important in T cell development, proliferation, and activation. In this study, we have identified BRK1 as a potential target of miR-181c using a dual selection functional assay and have showed that miR-181c regulates BRK1 by translational inhibition. Given the importance of miR-181 in T cell function and the potential role of BRK1 in the involvement of WAVE2 complex and actin polymerization in T cells, we therefore investigated the influence of miR-181c-BRK1 axis in T cell function. Stimulation of PBMC derived CD3+ T cells resulted in reduced miR-181c expression and up-regulation of BRK1 protein expression, suggesting that miR-181c-BRK1 axis is important in T cell activation. We further showed that overexpression of miR-181c or suppression of BRK1 resulted in inhibition of T cell activation and actin polymerization coupled with defective lamellipodia generation and immunological synapse formation. Additionally, we found that BRK1 silencing led to reduced expressions of other proteins in the WAVE2 complex, suggesting that the impairment of T cell actin dynamics was a result of the instability of the WAVE2 complex following BRK1 depletion. Collectively, we demonstrated that miR-181c reduces BRK1 protein expression level and highlighted the important role of miR-181c-BRK1 axis in T cell activation and actin polymerization-mediated T cell functions.
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Affiliation(s)
- Shok Ping Lim
- Department of Haemato-Oncology, Division of Cancer Studies, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - Nikolaos Ioannou
- Department of Haemato-Oncology, Division of Cancer Studies, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - Alan G Ramsay
- Department of Haemato-Oncology, Division of Cancer Studies, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - David Darling
- Department of Haemato-Oncology, Division of Cancer Studies, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - Joop Gäken
- Department of Haemato-Oncology, Division of Cancer Studies, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - Ghulam J Mufti
- Department of Haemato-Oncology, Division of Cancer Studies, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom.,Department of Haemato-Oncology, King's College Hospital, London, United Kingdom
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21
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Hagner PR, Chiu H, Ortiz M, Apollonio B, Wang M, Couto S, Waldman MF, Flynt E, Ramsay AG, Trotter M, Gandhi AK, Chopra R, Thakurta A. Activity of lenalidomide in mantle cell lymphoma can be explained by NK cell-mediated cytotoxicity. Br J Haematol 2017; 179:399-409. [DOI: 10.1111/bjh.14866] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 06/05/2017] [Indexed: 01/13/2023]
Affiliation(s)
| | | | | | - Benedetta Apollonio
- School of Cancer Sciences; Faculty of Life Sciences & Medicine; King's College London; London UK
| | | | | | | | | | - Alan G. Ramsay
- School of Cancer Sciences; Faculty of Life Sciences & Medicine; King's College London; London UK
| | | | | | - Rajesh Chopra
- Celgene Corporation; Summit NJ USA
- Division of Cancer Therapeutics; Institute of Cancer Research; London UK
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22
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Boissard F, Laurent C, Ramsay AG, Quillet-Mary A, Fournié JJ, Poupot M, Ysebaert L. Nurse-like cells impact on disease progression in chronic lymphocytic leukemia. Blood Cancer J 2016; 6:e381. [PMID: 26771807 PMCID: PMC4742625 DOI: 10.1038/bcj.2015.108] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- F Boissard
- CRCT, UMR1037, Inserm-Univ. Toulouse III Paul Sabatier-ERL5294 CNRS, Toulouse, France
| | - C Laurent
- CRCT, UMR1037, Inserm-Univ. Toulouse III Paul Sabatier-ERL5294 CNRS, Toulouse, France.,Department of Haematology, Institut Universitaire du Cancer de Toulouse - Oncopôle, Toulouse, France
| | - A G Ramsay
- Department of Haemato-Oncology, Division of Cancer Studies, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - A Quillet-Mary
- CRCT, UMR1037, Inserm-Univ. Toulouse III Paul Sabatier-ERL5294 CNRS, Toulouse, France
| | - J-J Fournié
- CRCT, UMR1037, Inserm-Univ. Toulouse III Paul Sabatier-ERL5294 CNRS, Toulouse, France
| | - M Poupot
- CRCT, UMR1037, Inserm-Univ. Toulouse III Paul Sabatier-ERL5294 CNRS, Toulouse, France
| | - L Ysebaert
- CRCT, UMR1037, Inserm-Univ. Toulouse III Paul Sabatier-ERL5294 CNRS, Toulouse, France.,Department of Haematology, Institut Universitaire du Cancer de Toulouse - Oncopôle, Toulouse, France
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23
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Apollonio B, Ramsay AG. Subclonal heterogeneity in chronic lymphocytic leukaemia: revealing the importance of the lymphoid tumour microenvironment. Br J Haematol 2015; 172:7-8. [PMID: 26597651 DOI: 10.1111/bjh.13856] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
| | - Alan G Ramsay
- Department of Haemato-Oncology, King's College London, London, UK
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24
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Nakagawa R, Vukovic M, Tarafdar A, Cosimo E, Dunn K, McCaig AM, Holroyd A, McClanahan F, Ramsay AG, Gribben JG, Michie AM. Generation of a poor prognostic chronic lymphocytic leukemia-like disease model: PKCα subversion induces up-regulation of PKCβII expression in B lymphocytes. Haematologica 2015; 100:499-510. [PMID: 25616575 DOI: 10.3324/haematol.2014.112276] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Overwhelming evidence identifies the microenvironment as a critical factor in the development and progression of chronic lymphocytic leukemia, underlining the importance of developing suitable translational models to study the pathogenesis of the disease. We previously established that stable expression of kinase dead protein kinase C alpha in hematopoietic progenitor cells resulted in the development of a chronic lymphocytic leukemia-like disease in mice. Here we demonstrate that this chronic lymphocytic leukemia model resembles the more aggressive subset of chronic lymphocytic leukemia, expressing predominantly unmutated immunoglobulin heavy chain genes, with upregulated tyrosine kinase ZAP-70 expression and elevated ERK-MAPK-mTor signaling, resulting in enhanced proliferation and increased tumor load in lymphoid organs. Reduced function of PKCα leads to an up-regulation of PKCβII expression, which is also associated with a poor prognostic subset of human chronic lymphocytic leukemia samples. Treatment of chronic lymphocytic leukemia-like cells with the selective PKCβ inhibitor enzastaurin caused cell cycle arrest and apoptosis both in vitro and in vivo, and a reduction in the leukemic burden in vivo. These results demonstrate the importance of PKCβII in chronic lymphocytic leukemia-like disease progression and suggest a role for PKCα subversion in creating permissive conditions for leukemogenesis.
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Affiliation(s)
- Rinako Nakagawa
- Institute of Cancer Sciences, College of Medical, Veterinary & Life Sciences, University of Glasgow The Babraham Institute, Cambridge
| | - Milica Vukovic
- Institute of Cancer Sciences, College of Medical, Veterinary & Life Sciences, University of Glasgow MRC Centre for Regenerative Medicine, University of Edinburgh
| | - Anuradha Tarafdar
- Institute of Cancer Sciences, College of Medical, Veterinary & Life Sciences, University of Glasgow
| | - Emilio Cosimo
- Institute of Cancer Sciences, College of Medical, Veterinary & Life Sciences, University of Glasgow
| | - Karen Dunn
- Institute of Cancer Sciences, College of Medical, Veterinary & Life Sciences, University of Glasgow
| | - Alison M McCaig
- Institute of Cancer Sciences, College of Medical, Veterinary & Life Sciences, University of Glasgow
| | - Ailsa Holroyd
- Institute of Cancer Sciences, College of Medical, Veterinary & Life Sciences, University of Glasgow
| | - Fabienne McClanahan
- Centre for Haemato-Oncology, Barts Cancer Institute, Queen Mary University of London
| | - Alan G Ramsay
- Department of Haemato-Oncology, King's College London, UK
| | - John G Gribben
- Centre for Haemato-Oncology, Barts Cancer Institute, Queen Mary University of London
| | - Alison M Michie
- Institute of Cancer Sciences, College of Medical, Veterinary & Life Sciences, University of Glasgow
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25
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Ene-Obong A, Clear AJ, Watt J, Wang J, Fatah R, Riches JC, Marshall JF, Chin-Aleong J, Chelala C, Gribben JG, Ramsay AG, Kocher HM. Activated pancreatic stellate cells sequester CD8+ T cells to reduce their infiltration of the juxtatumoral compartment of pancreatic ductal adenocarcinoma. Gastroenterology 2013; 145:1121-32. [PMID: 23891972 PMCID: PMC3896919 DOI: 10.1053/j.gastro.2013.07.025] [Citation(s) in RCA: 384] [Impact Index Per Article: 34.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Revised: 06/24/2013] [Accepted: 07/17/2013] [Indexed: 12/15/2022]
Abstract
BACKGROUND & AIMS Pancreatic ductal adenocarcinoma (PDAC) is characterized by a prominent desmoplastic microenvironment that contains many different immune cells. Activated pancreatic stellate cells (PSCs) contribute to the desmoplasia. We investigated whether distinct stromal compartments are differentially infiltrated by different types of immune cells. METHODS We used tissue microarray analysis to compare immune cell infiltration of different pancreaticobiliary diseased tissues (PDAC, ampullary carcinoma, cholangiocarcinoma, mucinous cystic neoplasm, chronic inflammation, and chronic pancreatitis) and juxtatumoral stromal (<100 μm from tumor) and panstromal compartments. We investigated the association between immune infiltrate and patient survival times. We also analyzed T-cell migration and tumor infiltration in LSL-KrasG12D/+; LSL-Trp53R172H/+; Pdx-1-Cre (KPC) mice and the effects of all-trans retinoic acid (ATRA) on these processes. RESULTS Juxtatumoral compartments in PDAC samples from 2 independent groups of patients contained increased numbers of myeloperoxidase(+) and CD68(+) cells compared with panstromal compartments. However, juxtatumoral compartments of PDACs contained fewer CD8(+), FoxP3(+), CD56(+), or CD20(+) cells than panstromal compartments, a distinction absent in ampullary carcinomas and cholangiocarcinomas. Patients with PDACs that had high densities of CD8(+) T cells in the juxtatumoral compartment had longer survival times than patients with lower densities. In KPC mice, administration of ATRA, which renders PSCs quiescent, increased numbers of CD8(+) T cells in juxtatumoral compartments. We found that activated PSCs express cytokines, chemokines, and adhesion molecules that regulate T-cell migration. In vitro migration assays showed that CD8(+) T cells, from patients with PDAC, had increased chemotaxis toward activated PSCs, which secrete CXCL12, compared with quiescent PSCs or tumor cells. These effects could be reversed by knockdown of CXCL12 or treatment of PSCs with ATRA. CONCLUSIONS Based on studies of human PDAC samples and KPC mice, activated PSCs appear to reduce migration of CD8(+) T cells to juxtatumoral stromal compartments, preventing their access to cancer cells. Deregulated signaling by activated PSCs could prevent an effective antitumor immune response.
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Affiliation(s)
- Abasi Ene-Obong
- Centre for Tumour Biology, Barts Cancer Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London EC1M 6BQ, UK
| | - Andrew J. Clear
- Centre for Hemato-Oncology, Barts Cancer Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London EC1M 6BQ, UK
| | - Jennifer Watt
- Centre for Tumour Biology, Barts Cancer Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London EC1M 6BQ, UK
,Department of Surgery, Barts and the London HPB Centre, The Royal London Hospital, Barts Health NHS Trust, London, E1 1BB, UK.
| | - Jun Wang
- Centre for Molecular Oncology, Barts Cancer Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London EC1M 6BQ, UK
| | - Rewas Fatah
- Centre for Hemato-Oncology, Barts Cancer Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London EC1M 6BQ, UK
| | - John C. Riches
- Centre for Hemato-Oncology, Barts Cancer Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London EC1M 6BQ, UK
| | - John F. Marshall
- Centre for Tumour Biology, Barts Cancer Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London EC1M 6BQ, UK
| | - Joanne Chin-Aleong
- Department of Pathology, Barts and the London HPB Centre, The Royal London Hospital, Barts Health NHS Trust, London, E1 1BB, UK.
| | - Claude Chelala
- Centre for Molecular Oncology, Barts Cancer Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London EC1M 6BQ, UK
| | - John G. Gribben
- Centre for Hemato-Oncology, Barts Cancer Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London EC1M 6BQ, UK
| | - Alan G. Ramsay
- Centre for Hemato-Oncology, Barts Cancer Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London EC1M 6BQ, UK
| | - Hemant M. Kocher
- Centre for Tumour Biology, Barts Cancer Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London EC1M 6BQ, UK
,Department of Surgery, Barts and the London HPB Centre, The Royal London Hospital, Barts Health NHS Trust, London, E1 1BB, UK.
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Kiaii S, Clear AJ, Ramsay AG, Davies D, Sangaralingam A, Lee A, Calaminici M, Neuberg DS, Gribben JG. Follicular lymphoma cells induce changes in T-cell gene expression and function: potential impact on survival and risk of transformation. J Clin Oncol 2013; 31:2654-61. [PMID: 23775959 DOI: 10.1200/jco.2012.44.2137] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
PURPOSE Previous studies have demonstrated the prognostic importance of the immune microenvironment in follicular lymphoma (FL). To investigate the molecular mechanisms during which tumor-infiltrating T cells (TILs) are altered in the FL microenvironment, we studied highly purified CD4 and CD8 TILs from lymph node biopsies at diagnosis in treatment-naive patients with FL compared with reactive tonsils and the peripheral blood of healthy donors. PATIENTS AND METHODS Gene expression profiling of highly purified CD4 and CD8 TILs was performed on the Affymetrix platform. Diagnostic tissue microarrays from an independent patient set (n = 172) were used to verify protein expression and analyze any impact of TIL-expressed genes on outcome. Time-lapse imaging was used to assess T-cell motility. RESULTS The most upregulated genes in both CD4 and CD8 TILs were PMCH, ETV1, and TNFRSF9. PMCH is not expressed in peripheral blood T cells, but expression is highly induced on culture with FL. Both CD4 and CD8 TILs from patients with FL have significantly impaired motility compared with those of healthy TILs from reactive tonsils and this can be induced on healthy T cells by FL cells. During multivariate analysis, a model incorporating the number and location of T cells expressing PMCH, NAMPT, and ETV1 showed prognostic significance for overall survival and for time to transformation. CONCLUSION We showed altered gene expression in TILs in FL and demonstrated that altering the immune microenvironment in FL affects overall survival and time to transformation in this disease.
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Affiliation(s)
- Shahryar Kiaii
- Barts Cancer Institute, The London School of Medicine, Queen Mary, University of London, United Kingdom
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Ramsay AG. Immune checkpoint blockade immunotherapy to activate anti-tumour T-cell immunity. Br J Haematol 2013; 162:313-25. [PMID: 23691926 DOI: 10.1111/bjh.12380] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [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: 02/04/2013] [Accepted: 04/03/2013] [Indexed: 01/21/2023]
Abstract
The tumour microenvironment plays a dual role in cancer: it can promote tumour progression by establishing pro-tumour survival conditions but can also suppress tumour progression by killing cancer cells or inhibiting their outgrowth. These dynamically interconnected processes are under intense investigation to better understand cancer pathophysiology and allow identification of new therapeutic approaches. The ability of cancer cells to evade anti-tumour T-cell activity in the microenvironment has recently been accepted as a hallmark of cancer progression. This review will highlight the most promising therapeutic approach aimed at activating anti-tumour T-cell immunity in the cancer microenvironment: blocking inhibitory immune regulatory proteins (immune checkpoint ligands and receptors). There is emerging evidence that haematological tumours co-opt immune checkpoints as a major immune resistance mechanism. Pre-clinical findings indicate that targeted therapies and blockade of immune checkpoints could be combined to promote therapeutic synergy and long-term anti-tumour immunity to improve clinical outcomes for cancer patients.
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Affiliation(s)
- Alan G Ramsay
- Centre for Haemato-Oncology, Barts Cancer Institute, Queen Mary University of London, London, UK.
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C. Riches J, G. Ramsay A, G. Gribben J. Immune Dysfunction in Chronic Lymphocytic Leukemia: The Role for Immunotherapy. Curr Pharm Des 2012; 18:3389-98. [DOI: 10.2174/138161212801227023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Accepted: 02/27/2012] [Indexed: 11/22/2022]
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Abstract
Chronic lymphocytic leukemia (CLL) is associated with a profound immune defect, which results in increased susceptibility to recurrent infections as well as a failure to mount effective antitumor immune responses. Current chemotherapy-based regimens are not curative and often worsen this immune suppression, so their usefulness is limited, particularly in the frail and elderly. This article reviews the immune defect in CLL and discusses strategies aimed at repairing or circumventing this defect. In particular, it focuses on recent developments in the areas of CD40 ligand (CD40L/CD154) gene therapy, immunomodulatory agents such as lenalidomide, and adoptive transfer of T cells bearing chimeric antigen receptors.
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Affiliation(s)
- John C Riches
- Barts Cancer Institute, Queen Mary University of London, Charterhouse Square, London, UK.
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Riches JC, Ramsay AG, Gribben JG. T-cell function in chronic lymphocytic leukaemia. Semin Cancer Biol 2010; 20:431-8. [DOI: 10.1016/j.semcancer.2010.09.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Revised: 09/22/2010] [Accepted: 09/27/2010] [Indexed: 10/19/2022]
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Ramsay AG, Gribben JG. Immune dysfunction in chronic lymphocytic leukemia T cells and lenalidomide as an immunomodulatory drug. Haematologica 2009; 94:1198-202. [PMID: 19734414 DOI: 10.3324/haematol.2009.009274] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Abstract
B-cell chronic lymphocytic leukaemia (CLL) should be an ideal target for immune-mediated responses. CLL arises from B cells that can act as antigen-presenting cells (APCs), expresses unique tumour antigens, and has been shown to be a target of the allogeneic T cells which mediate a graft-versus-leukaemia effect. Despite these potential benefits, immune responses against CLL cells have been difficult to elicit. CLL induces immune defects in the host, the tumour cells are inefficient APCs, and therapies given to patients with CLL are themselves immunosuppressive. Successful vaccination approaches in this disease will require steps to overcome these difficulties, including identification of the targets of immune responses in this disease to enable monitoring of the immune response after vaccination, improved presentation of antigens, and steps to improve the immune defects that accompany this disease.
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Affiliation(s)
- Alan G Ramsay
- Institute of Cancer, Barts and The London School of Medicine, University of London, Charterhouse Square, London EC1M 6BQ, UK
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Ramsay AG, Johnson AJ, Lee AM, Gorgün G, Le Dieu R, Blum W, Byrd JC, Gribben JG. Chronic lymphocytic leukemia T cells show impaired immunological synapse formation that can be reversed with an immunomodulating drug. J Clin Invest 2008; 118:2427-37. [PMID: 18551193 DOI: 10.1172/jci35017] [Citation(s) in RCA: 261] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2008] [Accepted: 05/07/2008] [Indexed: 01/18/2023] Open
Abstract
Cancer is associated with immune deficiency, but the biologic basis of this is poorly defined. Here we demonstrate that impaired actin polymerization results in CD4+ and CD8+ T cells from patients with chronic lymphocytic leukemia (CLL) exhibiting defective immunological synapse formation with APCs. Although this synapse dysfunction was in part a result of the CLL cells having poor APC function, defective actin polymerization was also identified in T cells from patients with CLL. We further demonstrate that, following contact with CLL cells, defects in immune synapse formation were induced in healthy allogeneic T cells. This required direct contact and was inhibited by blocking adhesion molecules on CLL B cells. In T cells from patients with CLL and in T cells from healthy individuals that had been in contact with CLL cells, recruitment of key regulatory proteins to the immune synapse was inhibited. Treatment of autologous T cells and CLL cells with the immunomodulating drug lenalidomide resulted in improved synapse formation. These results define what we believe to be a novel immune dysfunction in T cells from patients with CLL that has implications for both autologous and allogeneic immunotherapy approaches and identifies repair of immune synapse defects as an essential step in improving cancer immunotherapy approaches.
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Affiliation(s)
- Alan G Ramsay
- Institute of Cancer, Centre for Medical Oncology, Barts and The London School of Medicine, University of London, London, United Kingdom
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Abstract
Enhanced levels of expression of certain integrins, and a consequent increase in specific integrin signals, have been linked to cancer cell progression. Dysfunctional integrin signaling is thought to be involved, at least in part, in mediating the detachment of tumor cells from neighboring cells while providing enhanced survival and proliferative capabilities which allow such disseminating tumor cells to grow in new, foreign, microenvironments. Cell biologists have known for some time that integrin heterodimers are endocytosed from the plasma membrane in to the cytoplasm with some of this receptor later being exocytosed back to the cell surface; a cellular mechanism referred to as 'trafficking'. Although extensive research within the integrin field has elucidated key signal transduction pathways as being involved in integrin-mediated cellular behavior, both in normal and transformed cells, it is only relatively recently that the importance of integrin trafficking in modulating cellular function has been demonstrated. This review aims to identify the major trafficking molecules found to play a functional role in cancer cell behavior with special emphasis on the importance of integrin trafficking during neoplastic cell migration and invasion; vital components of the metastatic process.
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Affiliation(s)
- Alan G Ramsay
- Centre for Tumor Biology, Institute of Cancer and CR-UK Clinical Centre, Barts and The London, Queen Mary's School of Medicine and Dentistry, John Vane Science Centre, Charterhouse Square, London, EC1M 6BQ, UK
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Ramsay AG, Keppler MD, Jazayeri M, Thomas GJ, Parsons M, Violette S, Weinreb P, Hart IR, Marshall JF. HS1-associated protein X-1 regulates carcinoma cell migration and invasion via clathrin-mediated endocytosis of integrin alphavbeta6. Cancer Res 2007; 67:5275-84. [PMID: 17545607 DOI: 10.1158/0008-5472.can-07-0318] [Citation(s) in RCA: 108] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Enhanced expression levels of integrin alphavbeta6 have been linked to more aggressive invasive carcinoma cell behavior and poorer clinical prognosis. However, how alphavbeta6 determines invasion and the dynamics of integrin alphavbeta6 regulation in tumor cells are poorly understood. We have identified the 35-kDa HS1-associated protein X-1 (HAX-1) protein as a novel binding partner of the beta6 cytoplasmic tail using a yeast two-hybrid screen. We show that alphavbeta6-dependent migration is blocked following small interfering RNA (siRNA)-mediated depletion of HAX-1 in oral squamous cell carcinoma cell lines. Using both siRNA and membrane-permeable peptides, we show that alphavbeta6-dependent migration and invasion require HAX-1 to bind directly to beta6 and thereby regulate clathrin-mediated endocytosis of alphavbeta6 integrins. Progression of oral cancer is associated with enhanced expression of alphavbeta6 and HAX-1 proteins in patient tissue. This report establishes that integrin endocytosis is required for alphavbeta6-dependent carcinoma cell motility and invasion and suggests that this process is an important mechanism in cancer progression.
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Affiliation(s)
- Alan G Ramsay
- Centre for Tumour Biology, Institute of Cancer and Cancer Research UK Clinical Centre, London, United Kingdom
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Ramsay AG, Scott KP, Martin JC, Rincon MT, Flint HJ. Cell-associated alpha-amylases of butyrate-producing Firmicute bacteria from the human colon. Microbiology (Reading) 2007; 152:3281-3290. [PMID: 17074899 DOI: 10.1099/mic.0.29233-0] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Selected butyrate-producing bacteria from the human colon that are related to Roseburia spp. and Butyrivibrio fibrisolvens showed a good ability to utilize a variety of starches for growth when compared with the Gram-negative amylolytic anaerobe Bacteroides thetaiotaomicron. A major cell-associated amylase of high molecular mass (140-210 kDa) was detected in each strain by SDS-PAGE zymogram analysis, and genes corresponding to these enzymes were analysed for two representative strains. Amy13B from But. fibrisolvens 16/4 is a multi-domain enzyme of 144.6 kDa that includes a family 13 glycoside hydrolase domain, and duplicated family 26 carbohydrate-binding modules. Amy13A (182.4 kDa), from Roseburia inulinivorans A2-194, also includes a family 13 domain, which is preceded by two repeat units of approximately 116 aa rich in aromatic residues, an isoamylase N-terminal domain, a pullulanase-associated domain, and an additional unidentified domain. Both Amy13A and Amy13B have N-terminal signal peptides and C-terminal cell-wall sorting signals, including a modified LPXTG motif similar to that involved in interactions with the cell surface in other Gram-positive bacteria, a hydrophobic transmembrane segment, and a basic C terminus. The overexpressed family 13 domains showed an absolute requirement for Mg2+ or Ca2+ for activity, and functioned as 1,4-alpha-glucanohydrolases (alpha-amylases; EC 3.2.1.1). These major starch-degrading enzymes thus appear to be anchored to the cell wall in this important group of human gut bacteria.
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Affiliation(s)
- Alan G Ramsay
- Rowett Research Institute, Greenburn Road, Bucksburn, Aberdeen AB21 9SB, UK
| | - Karen P Scott
- Rowett Research Institute, Greenburn Road, Bucksburn, Aberdeen AB21 9SB, UK
| | - Jenny C Martin
- Rowett Research Institute, Greenburn Road, Bucksburn, Aberdeen AB21 9SB, UK
| | - Marco T Rincon
- Rowett Research Institute, Greenburn Road, Bucksburn, Aberdeen AB21 9SB, UK
| | - Harry J Flint
- Rowett Research Institute, Greenburn Road, Bucksburn, Aberdeen AB21 9SB, UK
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Duncan SH, Scott KP, Ramsay AG, Harmsen HJM, Welling GW, Stewart CS, Flint HJ. Effects of alternative dietary substrates on competition between human colonic bacteria in an anaerobic fermentor system. Appl Environ Microbiol 2003; 69:1136-42. [PMID: 12571040 PMCID: PMC143671 DOI: 10.1128/aem.69.2.1136-1142.2003] [Citation(s) in RCA: 134] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Duplicate anaerobic fermentor systems were used to examine changes in a community of human fecal bacteria supplied with different carbohydrate energy sources. A panel of group-specific fluorescent in situ hybridization probes targeting 16S rRNA sequences revealed that the fermentors supported growth of a greater proportion of Bacteroides and a lower proportion of gram-positive anaerobes related to Faecalibacterium prausnitzii, Ruminococcus flavefaciens-Ruminococcus bromii, Eubacterium rectale-Clostridium coccoides, and Eubacterium cylindroides than the proportions in the starting fecal inoculum. Nevertheless, certain substrates, such as dahlia inulin, caused a pronounced increase in the number of bacteria related to R. flavefaciens-R. bromii and E. cylindroides. The ability of three strictly anaerobic, gram-positive bacteria to compete with the complete human fecal flora was tested in the same experiment by using selective plating to enumerate the introduced strains. The Roseburia-related strain A2-183(F) was able to grow on all substrates despite the fact that it was unable to utilize complex carbohydrates in pure culture, and it was assumed that this organism survived by cross-feeding. In contrast, Roseburia intestinalis L1-82(R) and Eubacterium sp. strain A2-194(R) survived less well despite the fact that they were able to utilize polysaccharides in pure culture, except that A2-194(R) was stimulated 100-fold by inulin. These results suggest that many low-G+C-content gram-positive obligate anaerobes may be selected against during in vitro incubation, although several groups were stimulated by inulin. Thus, considerable caution is necessary when workers attempt to predict the in vivo effects of probiotics and prebiotics from their effects in vitro.
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Affiliation(s)
- Sylvia H Duncan
- Gut Microbiology and Immunology Division, Rowett Research Institute, Bucksburn, Aberdeen AB21 9SB, United Kingdom
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Ramsay AG, Olesnicky L, Pirani CL. Acute tubulo-interstitial nephritis from candida albicans with oliguric renal failure. Clin Nephrol 1985; 24:310-4. [PMID: 4075600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
A patient developed candidemia after receiving steroids and antibiotics. Subsequently, acute oliguric renal failure occurred. Renal biopsy showed multiple cortical microabscesses. These contained encapsulated ovoid Candida, budding organisms, short hyphae, and polymorphs. Adjacent tubules showed disruption of the basement membrane, infiltration by polymorphs and necrosis. There was no evidence of pelvic-calyceal obstruction by bezoar. The acute renal failure was attributed to acute candidal tubulo-interstitial nephritis, and was successfully reversed with Amphotericin.
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Abstract
Because of mounting evidence of precipitation of calcium oxalate in the soft tissues of patients with end-stage renal disease (ESRD) on maintenance hemodialysis, the plasma oxalate concentrations and calculated dialysis removal of oxalate were studied in seven patients without evidence of either primary or absorption hyperoxaluria prior to ESRD. A reversed-phase high-pressure liquid chromatographic method was developed to quantitate serum oxalate. Mean value +/- SE in four healthy controls was 28 +/- 5 mumol/L, and in the seven patients it was 187 +/- 15 mumol/L predialysis and 89 +/- 11 mumol/L postdialysis. Oxalate deposition in the soft tissues of ESRD patients is the consequence of sustained hyperoxalemia. Oxalate removal by dialysis was calculated from the four-hour oxalate clearance. Since the ionic radii of phosphate and oxalate are similar, total oxalate clearance was calculated midpoint of dialysis. Mean oxalate removal/dialysis was 3.01 +/- 0.283 mmol. On a daily basis this value was 1.645 +/- 0.155 mmol, which is about threefold the normal oxalate excretion rate. It is not significantly different from the excretion rate in absorption oxalurias but is less than that in primary hyperoxaluria. Therefore, it is concluded that hyperoxalemia in ESRD results from loss of renal excretion, failure of hemodialysis to remove enough oxalate to maintain a normal serum concentration, and increased intestinal absorption of oxalate and/or increased endogenous production.
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Abstract
A patient with a single kidney and oliguric renal failure for 47 days experienced dramatic restoration of glomerular filtration and renal function following graft bypass of an occluded renal artery. There was very little evidence of acute tubular necrosis. The case emphasizes the importance of the renal collateral circulation in the maintenance of tissue viability, even when the hydrostatic pressure of collateral flow is inadequate for glomerular ultrafiltrate formation. The differentiation of oliguric renal failure due to renal arterial occlusion from that due to acute tubular necrosis following arterial injection of radiocontrast material is imperative because of the dramatic response to reconstructive vascular surgery.
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Hoffman GS, Schumacher HR, Paul H, Cherian V, Reed R, Ramsay AG, Franck WA. Calcium oxalate microcrystalline-associated arthritis in end-stage renal disease. Ann Intern Med 1982; 97:36-42. [PMID: 7092004 DOI: 10.7326/0003-4819-97-1-36] [Citation(s) in RCA: 96] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Chronic renal failure is known to be associated with secondary hyperoxalemia and the deposition of calcium oxalate in visceral organs, bones, and cartilage. We report the identification of calcium oxalate crystals in the synovial fluid of three patients with chronic renal failure. In one patient, calcium oxalate crystals were also identified within synovium and cartilage. Crystals were pleomorphic and bipyramidal. Some crystals were rod-like and had positive birefringence, thus tending to be confused with calcium pyrophosphate dihydrate when observed with only compensated polarized light microscopy. In one patients asymptomatic effusions were associated with joint capsule calcification, but otherwise normal knee radiographs. The other two patients had bilateral knee pain, one having coexistent features of osteoarthritis and the other chondrocalcinosis. Samples of proliferative synovium, joint capsule, and cartilage from the patient with chondrocalcinosis showed abundant calcium oxalate crystals, and not calcium pyrophosphate dihydrate or calcium hydroxyapatite. Thus, radiographically typical chondrocalcinosis may be due to calcium oxalate. Joint disease in chronic renal failure may be associated with calcium oxalate as well as the previously recognized apatite deposition.
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Ramsay AG. Membrane potentials, resistances, and conductances of toad bladder during Na+ - H+ transport and H+ transport. Proc Soc Exp Biol Med 1982; 170:94-102. [PMID: 6281798 DOI: 10.3181/00379727-170-41404] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Ramsay AG, Gallagher DL. Influence of mucosal sodium concentration on electrical resistances and potentials of toad bladder. Proc Soc Exp Biol Med 1980; 164:57-62. [PMID: 6769130 DOI: 10.3181/00379727-164-40824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Abstract
The effect of Ba2+ on Na+ transport and electrical characteristics of toad bladder was determined from change produced in short circuit current (Isc), epithelial, apical and basal-lateral potentials (psit, psia, psib), epithelial and membrane resistances (Rt, Ra, Rb) and shunt resistance (Rs). Mucosal Ba2+ had no effect. Serosal Ba2+ reduced Isc, psit, psia, and psib, but had no effect on Rt, Ra, Rb and Rs. Minimal effective Ba2+ concentration was 5-10(-5) M. The phenomenon was reversed by Ba2+ removal, but not by 86 mM serosal K+. Ba2+ inhibition of Isc did not impair the response to vasopressin which was quantitatively the same as controls. Psia with Ba2+ equalled psib. After Ba2+ inhibition, ouabain produced no further decrease in psit and Isc. Ba2+ exposure after ouabain did not decrease psit and Isc. The results suggest that Ba2+ inhibits the basal-lateral electrogenic Na+ pump.
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Ramsay AG, Elliott HC, Haynes AM. The effect of methyl acetylsalicylate on renal tubular ionic reabsorption. Proc Soc Exp Biol Med 1969; 132:307-13. [PMID: 5344852 DOI: 10.3181/00379727-132-34203] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Ramsay AG. Clinical application of the Henderson-Hasselbalch equation. Appl Ther 1965; 7:730-6. [PMID: 5318252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Ramsay AG. Renal Lesions and Analgesic Abuse. Can Med Assoc J 1965; 92:579. [PMID: 20328155 PMCID: PMC1928189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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