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Coukos A, Vionnet J, Obeid M, Bouchaab H, Peters S, Latifyan S, Wicky A, Michielin O, Chtioui H, Moradpour D, Fasquelle F, Sempoux C, Fraga M. Systematic comparison with autoimmune liver disease identifies specific histological features of immune checkpoint inhibitor-related adverse events. J Immunother Cancer 2022; 10:e005635. [PMID: 36283734 PMCID: PMC9608549 DOI: 10.1136/jitc-2022-005635] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Immune checkpoint inhibitors (ICIs) have become a mainstay of cancer treatment. Their immune-boosting quality has one major drawback, their proclivity to induce a broad array of immune-related adverse events (irAEs) affecting, among others, the liver and sharing some similarities with classic autoimmune liver diseases (AILD).We aimed to compare clinical, laboratory and histological features of patients with liver-related irAEs and AILD. METHODS We systematically compared liver irAEs with AILD, namely autoimmune hepatitis (AIH) and primary biliary cholangitis, regarding their clinical, laboratory, and histological features. RESULTS Twenty-seven patients with liver irAEs (ICI group) and 14 patients with AILD were identified. We observed three distinct ICI-induced histological liver injury patterns: hepatitic (52%), cholangitic (19%), and mixed (29%). When comparing the ICI and AILD groups, centrilobular injury as well as granuloma formation were more prevalent in the former (p=0.067 and 0.002, respectively). CD4+/CD8+ T cell ratios were heterogeneous between the two groups, without statistically significant difference but with a trend toward increased CD8+ T cells among hepatitic irAEs as compared with AIH. Pattern of liver function test alteration was predictive for the type of irAEs but did not correlate with histological severity. CONCLUSIONS Liver irAEs have broad clinical, laboratory and histological presentations. Histological features of irAEs and AILD are distinct, likely underpinning their different immunological mechanisms.
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Affiliation(s)
| | - Julien Vionnet
- Gastroenterology and Hepatology, CHUV, Lausanne, Switzerland
- Transplantation Center, CHUV, Lausanne, Switzerland
| | - Michel Obeid
- Immunology Division, CHUV, Lausanne, Switzerland
| | - Hasna Bouchaab
- Department of Medical Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Solange Peters
- Department of Medical Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Sofiya Latifyan
- Department of Medical Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Alexandre Wicky
- Department of Medical Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Olivier Michielin
- Department of Medical Oncology, Lausanne University Hospital, Lausanne, Switzerland
| | - Haithem Chtioui
- Division of Clinical Pharmacology, CHUV, Lausanne, Switzerland
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4
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Coukos A, Daccord C, Lazor R, Blum S, Naveiras O, Unger S, Vionnet J, Gaide O, Koutsokera A, Moschouri E, Sempoux C, Good JM, Moradpour D, Baerlocher GM, Fraga M. [Short telomere syndrome in adults: a rare entity that should be evoked]. Rev Med Suisse 2022; 18:1606-1613. [PMID: 36047552 DOI: 10.53738/revmed.2022.18.793.1606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Short telomere syndrome (STS) is a group of rare, often underrecognized, diseases caused by defects in telomere-maintenance genes, leading to abnormal telomere shortening and associated with diverse multi-organ manifestations. In pediatric patients, STS typically presents with mucocutaneous or gastrointestinal lesions, bone marrow failure and neoplasia. In adulthood, aplastic bone marrow disease, liver disease and pulmonary fibrosis are classic clinical manifestations. At present, medical treatment options for STS remain limited. Danazol, a synthetic androgenic hormone, can slow down telomere shortening and thus limit the progression of the disease. Finally, hematopoietic, hepatic and pulmonary transplantation, sometimes combined, may be discussed in a multidisciplinary setting in certain situations.
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Affiliation(s)
- Alexander Coukos
- Service de gastroentérologie et d'hépatologie, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Cécile Daccord
- Service de pneumologie, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Romain Lazor
- Service de pneumologie, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Sabine Blum
- Service d'hématologie, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Olaia Naveiras
- Service d'hématologie, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
- Département des sciences biomédicales, Faculté de biologie et de médecine, Université de Lausanne, 1011 Lausanne
| | - Sheila Unger
- Service de médecine génétique, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Julien Vionnet
- Service de gastroentérologie et d'hépatologie, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
- Centre de transplantation d'organes, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Olivier Gaide
- Service de dermatologie et vénéréologie, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Angela Koutsokera
- Service de pneumologie, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Eleni Moschouri
- Service de gastroentérologie et d'hépatologie, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Christine Sempoux
- Service de pathologie clinique, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Jean-Marc Good
- Service de médecine génétique, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Darius Moradpour
- Service de gastroentérologie et d'hépatologie, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Gabriela M Baerlocher
- Laboratoire d'hématopoïèse et de génétique moléculaire, Université de Berne, 3012 Berne
| | - Montserrat Fraga
- Service de gastroentérologie et d'hépatologie, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
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5
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Siwicki M, Gort-Freitas NA, Messemaker M, Bill R, Gungabeesoon J, Engblom C, Zilionis R, Garris C, Gerhard GM, Kohl A, Lin Y, Zou AE, Cianciaruso C, Bolli E, Pfirschke C, Lin YJ, Piot C, Mindur JE, Talele N, Kohler RH, Iwamoto Y, Mino-Kenudson M, Pai SI, deVito C, Koessler T, Merkler D, Coukos A, Wicky A, Fraga M, Sempoux C, Jain RK, Dietrich PY, Michielin O, Weissleder R, Klein AM, Pittet MJ. Resident Kupffer cells and neutrophils drive liver toxicity in cancer immunotherapy. Sci Immunol 2021; 6:6/61/eabi7083. [PMID: 34215680 DOI: 10.1126/sciimmunol.abi7083] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 06/03/2021] [Indexed: 12/16/2022]
Abstract
Immunotherapy is revolutionizing cancer treatment but is often restricted by toxicities. What distinguishes adverse events from concomitant antitumor reactions is poorly understood. Here, using anti-CD40 treatment in mice as a model of TH1-promoting immunotherapy, we showed that liver macrophages promoted local immune-related adverse events. Mechanistically, tissue-resident Kupffer cells mediated liver toxicity by sensing lymphocyte-derived IFN-γ and subsequently producing IL-12. Conversely, dendritic cells were dispensable for toxicity but drove tumor control. IL-12 and IFN-γ were not toxic themselves but prompted a neutrophil response that determined the severity of tissue damage. We observed activation of similar inflammatory pathways after anti-PD-1 and anti-CTLA-4 immunotherapies in mice and humans. These findings implicated macrophages and neutrophils as mediators and effectors of aberrant inflammation in TH1-promoting immunotherapy, suggesting distinct mechanisms of toxicity and antitumor immunity.
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Affiliation(s)
- Marie Siwicki
- Center for Systems Biology, Massachusetts General Hospital Research Institute and Harvard Medical School, Boston, MA, USA
| | | | - Marius Messemaker
- Center for Systems Biology, Massachusetts General Hospital Research Institute and Harvard Medical School, Boston, MA, USA
| | - Ruben Bill
- Center for Systems Biology, Massachusetts General Hospital Research Institute and Harvard Medical School, Boston, MA, USA
| | - Jeremy Gungabeesoon
- Center for Systems Biology, Massachusetts General Hospital Research Institute and Harvard Medical School, Boston, MA, USA
| | - Camilla Engblom
- Center for Systems Biology, Massachusetts General Hospital Research Institute and Harvard Medical School, Boston, MA, USA
| | - Rapolas Zilionis
- Department of Systems Biology, Harvard Medical School, Boston, MA, USA.,Institute of Biotechnology, Life Sciences Center, Vilnius University, Vilnius, Lithuania
| | - Christopher Garris
- Center for Systems Biology, Massachusetts General Hospital Research Institute and Harvard Medical School, Boston, MA, USA
| | - Genevieve M Gerhard
- Center for Systems Biology, Massachusetts General Hospital Research Institute and Harvard Medical School, Boston, MA, USA
| | - Anna Kohl
- Center for Systems Biology, Massachusetts General Hospital Research Institute and Harvard Medical School, Boston, MA, USA
| | - Yunkang Lin
- Center for Systems Biology, Massachusetts General Hospital Research Institute and Harvard Medical School, Boston, MA, USA
| | - Angela E Zou
- Center for Systems Biology, Massachusetts General Hospital Research Institute and Harvard Medical School, Boston, MA, USA
| | - Chiara Cianciaruso
- Center for Systems Biology, Massachusetts General Hospital Research Institute and Harvard Medical School, Boston, MA, USA.,Department of Pathology and Immunology, University of Geneva, Geneva, Switzerland
| | - Evangelia Bolli
- Center for Systems Biology, Massachusetts General Hospital Research Institute and Harvard Medical School, Boston, MA, USA.,Department of Pathology and Immunology, University of Geneva, Geneva, Switzerland
| | - Christina Pfirschke
- Center for Systems Biology, Massachusetts General Hospital Research Institute and Harvard Medical School, Boston, MA, USA
| | - Yi-Jang Lin
- Center for Systems Biology, Massachusetts General Hospital Research Institute and Harvard Medical School, Boston, MA, USA
| | - Cecile Piot
- Center for Systems Biology, Massachusetts General Hospital Research Institute and Harvard Medical School, Boston, MA, USA
| | - John E Mindur
- Center for Systems Biology, Massachusetts General Hospital Research Institute and Harvard Medical School, Boston, MA, USA
| | - Nilesh Talele
- Edwin L. Steele Laboratories, Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Rainer H Kohler
- Center for Systems Biology, Massachusetts General Hospital Research Institute and Harvard Medical School, Boston, MA, USA
| | - Yoshiko Iwamoto
- Center for Systems Biology, Massachusetts General Hospital Research Institute and Harvard Medical School, Boston, MA, USA
| | - Mari Mino-Kenudson
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Sara I Pai
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Claudio deVito
- Department of Pathology and Immunology, University of Geneva, Geneva, Switzerland.,Division of Clinical Pathology, Geneva University Hospital, Geneva, Switzerland
| | - Thibaud Koessler
- Department of Oncology, Geneva University Hospitals, Geneva, Switzerland.,Center for Translational Research in Onco-Hematology, University of Geneva, Geneva, Switzerland.,Swiss Cancer Center Leman (SCCL), Lausanne and Geneva, Switzerland
| | - Doron Merkler
- Department of Pathology and Immunology, University of Geneva, Geneva, Switzerland.,Division of Clinical Pathology, Geneva University Hospital, Geneva, Switzerland
| | - Alexander Coukos
- Precision Oncology Center, Department of Oncology, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - Alexandre Wicky
- Precision Oncology Center, Department of Oncology, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - Montserrat Fraga
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.,Service of Gastroenterology and Hepatology, Lausanne University Hospital, Lausanne, Switzerland
| | - Christine Sempoux
- Institute of Pathology, University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Rakesh K Jain
- Edwin L. Steele Laboratories, Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Pierre-Yves Dietrich
- Department of Oncology, Geneva University Hospitals, Geneva, Switzerland.,Center for Translational Research in Onco-Hematology, University of Geneva, Geneva, Switzerland.,Swiss Cancer Center Leman (SCCL), Lausanne and Geneva, Switzerland
| | - Olivier Michielin
- Precision Oncology Center, Department of Oncology, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - Ralph Weissleder
- Center for Systems Biology, Massachusetts General Hospital Research Institute and Harvard Medical School, Boston, MA, USA.,Department of Systems Biology, Harvard Medical School, Boston, MA, USA
| | - Allon M Klein
- Department of Systems Biology, Harvard Medical School, Boston, MA, USA
| | - Mikael J Pittet
- Center for Systems Biology, Massachusetts General Hospital Research Institute and Harvard Medical School, Boston, MA, USA. .,Department of Pathology and Immunology, University of Geneva, Geneva, Switzerland.,Department of Oncology, Geneva University Hospitals, Geneva, Switzerland.,Center for Translational Research in Onco-Hematology, University of Geneva, Geneva, Switzerland.,Swiss Cancer Center Leman (SCCL), Lausanne and Geneva, Switzerland
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