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Chua KLM, Fehlings M, Yeo ELL, Nardin A, Sumatoh H, Chu PL, Nei WL, Ong EHW, Woo WY, Low KP, Wang H, Poon DJJ, Liang ZG, Yao K, Huang L, Toh CK, Ang MK, Farid M, Cheng XM, Kanesvaran R, Dent R, Wee JTS, Lim TKH, Iyer NG, Tan DSW, Soo KC, Newell EW, Chua MLK. High-Dimensional Characterization of the Systemic Immune Landscape Informs on Synergism Between Radiation Therapy and Immune Checkpoint Blockade. Int J Radiat Oncol Biol Phys 2020; 108:70-80. [PMID: 32544576 DOI: 10.1016/j.ijrobp.2020.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 04/01/2020] [Accepted: 06/08/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE Improved antitumor responses have been observed in patients after combination radiation therapy (RT) and immune checkpoint blockade (ICB). Whether these clinical responses are linked to the host systemic immune system has not been elucidated. METHODS AND MATERIALS In this single-institution prospective observational study, peripheral blood was longitudinally collected from 10 patients with metastatic disease who had responded to anti-PD-1/anti-PD-L1 ICB and received RT (8-50 Gy in 1-5 fractions) upon disease progression at the following timepoints: baseline (pre-RT), 1 to 2 weeks post-RT, and post-ICB (cycle 1) on reintroduction post-RT. To thoroughly characterize the interaction between combined RT-ICB and the host immune system, we performed high-dimensional, mass cytometry-based immunophenotyping of circulating lymphocytes using a 40-marker panel addressing lineage, differentiation, activation, trafficking, cytotoxicity, and costimulatory and inhibitory functions. Phenotypic expression of circulating lymphocytes was compared across patients and time points and correlated with post-RT tumor responses. RESULTS Foremost, we demonstrated excellent posttreatment clinical responses, including 4 local responses with >50% reduction in radiated tumor size, 1 out-of-field response, and 4 patients who resumed ICB for >1 year. Baseline and post-RT immune states were highly heterogeneous among patients. Despite this interindividual heterogeneity in baseline immune states, we observed a systemic immune reaction to RT-ICB common across patients, histology, and radiation sites; a subset of pre-existing Ki-67+ CD8+ T cells were increased post-RT and further expanded upon reintroduction of ICB post-RT (2.3-fold increase, P = .02). Importantly, RT did not alter the phenotypic profile of these Ki-67+ CD8+ T cells, which was characterized by a distinct activated and differentiated effector phenotype. CONCLUSIONS Collectively, these findings point toward a sustained reinvigoration of host antitumor immunity after RT-ICB and suggest an expansion in activated Ki-67+ CD8+ T cells as a possible demonstration of this synergy, thereby providing new insights that may support the development of optimal sequencing strategies.
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Affiliation(s)
- Kevin L M Chua
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore; Oncology Academic Programme, Duke-NUS Medical School, Singapore
| | | | - Eugenia L L Yeo
- Division of Medical Sciences, National Cancer Centre Singapore, Singapore
| | | | | | - Pek Lim Chu
- Oncology Academic Programme, Duke-NUS Medical School, Singapore; Division of Medical Sciences, National Cancer Centre Singapore, Singapore
| | - Wen-Long Nei
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore; Oncology Academic Programme, Duke-NUS Medical School, Singapore
| | - Enya H W Ong
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | - Wai Yee Woo
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | - Kar Perng Low
- Division of Medical Sciences, National Cancer Centre Singapore, Singapore
| | - Haitao Wang
- Division of Medical Sciences, National Cancer Centre Singapore, Singapore
| | - Dennis J J Poon
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | - Zhong-Guo Liang
- Division of Medical Sciences, National Cancer Centre Singapore, Singapore; Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, People's Republic of China
| | - Kai Yao
- Division of Medical Sciences, National Cancer Centre Singapore, Singapore; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China
| | - Luo Huang
- Division of Medical Sciences, National Cancer Centre Singapore, Singapore; Department of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing Cancer Hospital & Institute, Chongqing, People's Republic of China
| | - Chee Keong Toh
- Oncology Academic Programme, Duke-NUS Medical School, Singapore; Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Mei-Kim Ang
- Oncology Academic Programme, Duke-NUS Medical School, Singapore; Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Mohamad Farid
- Oncology Academic Programme, Duke-NUS Medical School, Singapore; Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Xin Min Cheng
- Department of Anatomical Pathology, Singapore General Hospital, Singapore
| | - Ravindran Kanesvaran
- Oncology Academic Programme, Duke-NUS Medical School, Singapore; Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Rebecca Dent
- Oncology Academic Programme, Duke-NUS Medical School, Singapore; Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Joseph T S Wee
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore; Oncology Academic Programme, Duke-NUS Medical School, Singapore
| | - Tony K H Lim
- Department of Anatomical Pathology, Singapore General Hospital, Singapore
| | - N Gopalakrishna Iyer
- Oncology Academic Programme, Duke-NUS Medical School, Singapore; Division of Medical Sciences, National Cancer Centre Singapore, Singapore; Division of Surgical Oncology, National Cancer Centre Singapore, Singapore
| | - Daniel S W Tan
- Oncology Academic Programme, Duke-NUS Medical School, Singapore; Division of Medical Sciences, National Cancer Centre Singapore, Singapore; Division of Medical Oncology, National Cancer Centre Singapore, Singapore; Genome Institute of Singapore, Agency for Science, Technology and Research (A∗STAR), Singapore
| | - Khee Chee Soo
- Division of Medical Sciences, National Cancer Centre Singapore, Singapore; Division of Surgical Oncology, National Cancer Centre Singapore, Singapore
| | - Evan W Newell
- immunoSCAPE Pte Ltd; Singapore Immunology Network (SIgN), Agency for Science, Technology and Research (A∗STAR), Singapore; Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Melvin L K Chua
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore; Oncology Academic Programme, Duke-NUS Medical School, Singapore; Division of Medical Sciences, National Cancer Centre Singapore, Singapore.
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Zhang Z, Jayakumar MKG, Zheng X, Shikha S, Zhang Y, Bansal A, Poon DJJ, Chu PL, Yeo ELL, Chua MLK, Chee SK, Zhang Y. Upconversion superballs for programmable photoactivation of therapeutics. Nat Commun 2019; 10:4586. [PMID: 31594932 PMCID: PMC6783568 DOI: 10.1038/s41467-019-12506-w] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [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: 01/13/2019] [Accepted: 09/09/2019] [Indexed: 12/31/2022] Open
Abstract
Upconversion nanoparticles (UCNPs) are the preferred choice for deep-tissue photoactivation, owing to their unique capability of converting deep tissue-penetrating near-infrared light to UV/visible light for photoactivation. Programmed photoactivation of multiple molecules is critical for controlling many biological processes. However, syntheses of such UCNPs require epitaxial growth of multiple shells on the core nanocrystals and are highly complex/time-consuming. To overcome this bottleneck, we have modularly assembled two distinct UCNPs which can individually be excited by 980/808 nm light, but not both. These orthogonal photoactivable UCNPs superballs are used for programmed photoactivation of multiple therapeutic processes for enhanced efficacy. These include sequential activation of endosomal escape through photochemical-internalization for enhanced cellular uptake, followed by photocontrolled gene knockdown of superoxide dismutase-1 to increase sensitivity to reactive oxygen species and finally, photodynamic therapy under these favorable conditions. Such programmed activation translated to significantly higher therapeutic efficacy in vitro and in vivo in comparison to conventional, non-programmed activation.
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Affiliation(s)
- Zhen Zhang
- Faculty of Engineering, Department of Biomedical Engineering, National University of Singapore, Singapore, 117583, Singapore
| | | | - Xiang Zheng
- Faculty of Engineering, Department of Biomedical Engineering, National University of Singapore, Singapore, 117583, Singapore
- NUS Graduate School for Integrative Sciences and Engineering, National University of Singapore, Singapore, 117456, Singapore
| | - Swati Shikha
- Faculty of Engineering, Department of Biomedical Engineering, National University of Singapore, Singapore, 117583, Singapore
| | - Yi Zhang
- Faculty of Engineering, Department of Biomedical Engineering, National University of Singapore, Singapore, 117583, Singapore
| | - Akshaya Bansal
- Faculty of Engineering, Department of Biomedical Engineering, National University of Singapore, Singapore, 117583, Singapore
| | - Dennis J J Poon
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore, 169610, Singapore
| | - Pek Lim Chu
- Oncology Academic Program, Duke-NUS Medical School, Singapore, 169857, Singapore
| | - Eugenia L L Yeo
- Division of Medical Sciences, National Cancer Centre Singapore, Singapore, 169610, Singapore
| | - Melvin L K Chua
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore, 169610, Singapore
- Oncology Academic Program, Duke-NUS Medical School, Singapore, 169857, Singapore
- Division of Medical Sciences, National Cancer Centre Singapore, Singapore, 169610, Singapore
| | - Soo Khee Chee
- Oncology Academic Program, Duke-NUS Medical School, Singapore, 169857, Singapore
- Division of Medical Sciences, National Cancer Centre Singapore, Singapore, 169610, Singapore
- Division of Surgical Oncology, National Cancer Centre Singapore, Singapore, 169610, Singapore
| | - Yong Zhang
- Faculty of Engineering, Department of Biomedical Engineering, National University of Singapore, Singapore, 117583, Singapore.
- NUS Graduate School for Integrative Sciences and Engineering, National University of Singapore, Singapore, 117456, Singapore.
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