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Paijens ST, Vledder A, Loiero D, Duiker EW, Bart J, Hendriks AM, Jalving M, Workel HH, Hollema H, Werner N, Plat A, Wisman GBA, Yigit R, Arts H, Kruse AJ, de Lange N, Koelzer VH, de Bruyn M, Nijman HW. Prognostic image-based quantification of CD8CD103 T cell subsets in high-grade serous ovarian cancer patients. Oncoimmunology 2021; 10:1935104. [PMID: 34123576 PMCID: PMC8183551 DOI: 10.1080/2162402x.2021.1935104] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 05/20/2021] [Indexed: 11/06/2022] Open
Abstract
CD103-positive tissue resident memory-like CD8+ T cells (CD8CD103 TRM) are associated with improved prognosis across malignancies, including high-grade serous ovarian cancer (HGSOC). However, whether quantification of CD8, CD103 or both is required to improve existing survival prediction and whether all HGSOC patients or only specific subgroups of patients benefit from infiltration, remains unclear. To address this question, we applied image-based quantification of CD8 and CD103 multiplex immunohistochemistry in the intratumoral and stromal compartments of 268 advanced-stage HGSOC patients from two independent clinical institutions. Infiltration of CD8CD103 immune cell subsets was independent of clinicopathological factors. Our results suggest CD8CD103 TRM quantification as a superior method for prognostication compared to single CD8 or CD103 quantification. A survival benefit of CD8CD103 TRM was observed only in patients treated with primary cytoreductive surgery. Moreover, survival benefit in this group was limited to patients with no macroscopic tumor lesions after surgery. This approach provides novel insights into prognostic stratification of HGSOC patients and may contribute to personalized treatment strategies in the future.
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Affiliation(s)
- S. T. Paijens
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - A. Vledder
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - D. Loiero
- Department of Pathology and Molecular Pathology, University Hospital and University of Zurich, Zurich, Switzerland
| | - E. W. Duiker
- Department of Pathology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - J. Bart
- Department of Pathology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - A. M. Hendriks
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - M. Jalving
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - H. H. Workel
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - H. Hollema
- Department of Pathology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - N. Werner
- Department of Pathology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - A. Plat
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - G. B. A. Wisman
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - R. Yigit
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - H. Arts
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - A. J. Kruse
- Department of Obstetrics and Gynecology, Isala Hospital Zwolle, Zwolle, The Netherlands
| | - N.M. de Lange
- Department of Obstetrics and Gynecology, Isala Hospital Zwolle, Zwolle, The Netherlands
| | - V. H. Koelzer
- Department of Pathology and Molecular Pathology, University Hospital and University of Zurich, Zurich, Switzerland
| | - M. de Bruyn
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - H. W. Nijman
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Timmermans M, Sonke GS, Van de Vijver KK, Ottevanger PB, Nijman HW, van der Aa MA, Kruitwagen RFPM. Localization of distant metastases defines prognosis and treatment efficacy in patients with FIGO stage IV ovarian cancer. Int J Gynecol Cancer 2019; 29:392-397. [PMID: 30665898 DOI: 10.1136/ijgc-2018-000100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 10/10/2018] [Accepted: 12/27/2018] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Patients with ovarian cancer who are diagnosed with Federation of Gynecology and Obstetrics (FIGO) stage IV disease are a highly heterogeneous group with possible survival differences. The FIGO staging system was therefore updated in 2014. OBJECTIVE To evaluate the 2014 changes to FIGO stage IV ovarian cancer on overall survival. METHODS We identified all patients diagnosed with FIGO stage IV disease between January 2008 and December 2015 from the Netherlands Cancer Registry. We analyzed the prognostic effect of FIGO IVa versus IVb. In addition, patients with extra-abdominal lymph node involvement as the only site of distant disease were analyzed separately. Overall survival was analyzed by Kaplan-Meier curves and multivariable Cox regression models. RESULTS We identified 2436 FIGO IV patients, of whom 35% were diagnosed with FIGO IVa disease. Five-year overall survival of FIGO IVa and IVb patients (including those with no or limited therapy) was 8.9% and 13.0%, respectively (p=0.51). Patients with only extra-abdominal lymph node involvement had a significant better overall survival than all other FIGO IV patients (5-year overall survival 25.9%, hazard ratio 0.77 [95% CI 0.62 to 0.95]). CONCLUSION Our study shows that the FIGO IV sub-classification into FIGO IVa and IVB does not provide additional prognostic information. Patients with extra-abdominal lymph node metastases as the only site of FIGO IV disease, however, have a better prognosis than all other FIGO IV patients. These results warrant a critical appraisal of the current FIGO IV sub-classification.
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Affiliation(s)
- Maite Timmermans
- Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands .,Department of Obstetrics and Gynecology, Maastricht University Medical Centre, Maastricht, The Netherlands.,GROW, School for Oncology and Developmental Biology, Maastricht, The Netherlands
| | - G S Sonke
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - K K Van de Vijver
- Department of Pathology, Ghent University Hospital, Cancer Research Institute Ghent (CRIG), Ghent, Belgium
| | - P B Ottevanger
- Department of Medical Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - H W Nijman
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - M A van der Aa
- Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
| | - R F P M Kruitwagen
- Department of Obstetrics and Gynecology, Maastricht University Medical Centre, Maastricht, The Netherlands.,GROW, School for Oncology and Developmental Biology, Maastricht, The Netherlands
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3
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Wortman BG, Creutzberg CL, Putter H, Jürgenliemk-Schulz IM, Jobsen JJ, Lutgens LCHW, van der Steen-Banasik EM, Mens JWM, Slot A, Kroese MCS, van Triest B, Nijman HW, Stelloo E, Bosse T, de Boer SM, van Putten WLJ, Smit VTHBM, Nout RA. Ten-year results of the PORTEC-2 trial for high-intermediate risk endometrial carcinoma: improving patient selection for adjuvant therapy. Br J Cancer 2018; 119:1067-1074. [PMID: 30356126 PMCID: PMC6219495 DOI: 10.1038/s41416-018-0310-8] [Citation(s) in RCA: 153] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 09/26/2018] [Accepted: 09/28/2018] [Indexed: 01/16/2023] Open
Abstract
Background PORTEC-2 was a randomised trial for women with high-intermediate risk (HIR) endometrial cancer, comparing pelvic external beam radiotherapy (EBRT) with vaginal brachytherapy (VBT). We evaluated long-term outcomes combined with the results of pathology review and molecular analysis. Methods 427 women with HIR endometrial cancer were randomised between 2002–2006 to VBT or EBRT. Primary endpoint was vaginal recurrence (VR). Pathology review was done in 97.4%, combined with molecular analysis. Results Median follow-up was 116 months; 10-year VR was 3.4% versus 2.4% for VBT vs. EBRT (p = 0.55). Ten-year pelvic recurrence (PR) was more frequent in the VBT group (6.3% vs. 0.9%, p = 0.004), mostly combined with distant metastases (DM). Ten-year isolated PR was 2.5% vs. 0.5%, p = 0.10, and DM 10.4 vs. 8.9% (p = 0.45). Overall survival for VBT vs. EBRT was 69.5% vs. 67.6% at 10 years (p = 0.72). L1CAM and p53-mutant expression and substantial lymph-vascular space invasion were risk factors for PR and DM. EBRT reduced PR in cases with these risk factors. Conclusion Long-term results of the PORTEC-2 trial confirm VBT as standard adjuvant treatment for HIR endometrial cancer. Molecular risk assessment has the potential to guide adjuvant therapy. EBRT provided better pelvic control in patients with unfavourable risk factors.
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Affiliation(s)
- B G Wortman
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - C L Creutzberg
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - H Putter
- Department of Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands
| | - I M Jürgenliemk-Schulz
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J J Jobsen
- Department of Radiotherapy, Medisch Spectrum Twente, Enschede, The Netherlands
| | - L C H W Lutgens
- Maastricht Radiation Oncology Clinic, Maastricht, The Netherlands
| | | | - J W M Mens
- Department of Radiation Oncology, Erasmus MC- Cancer Institute, Rotterdam, The Netherlands
| | - A Slot
- Radiotherapy Institute Friesland, Leeuwarden, The Netherlands
| | | | - B van Triest
- Department of Radiotherapy, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - H W Nijman
- Department of Gynaecologic Oncology, University Medical Center Groningen, Groningen, The Netherlands
| | - E Stelloo
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - T Bosse
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - S M de Boer
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - W L J van Putten
- Department of Biostatistics, ErasmusMC Cancer Institute, Rotterdam, The Netherlands
| | - V T H B M Smit
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - R A Nout
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands.
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Versluis M, Plat A, de Bruyn M, Matias-Guiu X, Trovic J, Krakstad C, Nijman HW, Bosse T, de Bock GH, Hollema H. L1CAM expression in uterine carcinosarcoma is limited to the epithelial component and may be involved in epithelial-mesenchymal transition. Virchows Arch 2018; 473:591-598. [PMID: 30140948 DOI: 10.1007/s00428-018-2444-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 07/19/2018] [Revised: 08/14/2018] [Accepted: 08/15/2018] [Indexed: 11/24/2022]
Abstract
Uterine carcinosarcoma (UCS) has been proposed as a model for epithelial-mesenchymal transition (EMT), a process characterized by a functional change facilitating migration and metastasis in many types of cancer. L1CAM is an adhesion molecule that has been involved in EMT as a marker for mesenchymal phenotype. We examined expression of L1CAM in UCS in a cohort of 90 cases from four different centers. Slides were immunohistochemically stained for L1CAM and scored in four categories (0%, < 10%, 10-50%, and > 50%). A score of more than 10% was considered positive for L1CAM. The median age at presentation was 68.6 years, and half of the patients (53.3%) presented with FIGO stage 1 disease. Membranous L1CAM expression was positive in the epithelial component in 65.4% of cases. Remarkably, expression was negative in the mesenchymal component. In cases where both components were intermingled, expression limited to the epithelial component was confirmed by a double stain for L1CAM and keratin. Expression of L1CAM did not relate to overall or disease-free survival. Our findings suggest L1CAM is either not a marker for the mesenchymal phenotype in EMT, or UCS is not a good model for EMT.
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Affiliation(s)
- Mac Versluis
- Department of Gynecology, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands.
| | - A Plat
- Department of Gynecology, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
| | - M de Bruyn
- Department of Gynecology, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
| | - X Matias-Guiu
- Department of Pathology and Molecular Genetics/Oncologic Pathology Group, Arnau de Vilanova University Hospital, IRBLleida, University of Lleida, Lleida, Spain.,Centro de Investigación Biomédica en Red de Oncología (CIBERONC), Madrid, Spain.,Department of Pathology, University Hospital of Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Catalonia, Spain
| | - J Trovic
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, Center for Cancer Biomarkers, University of Bergen, Bergen, Norway
| | - C Krakstad
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, Center for Cancer Biomarkers, University of Bergen, Bergen, Norway
| | - H W Nijman
- Department of Gynecology, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
| | - T Bosse
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - G H de Bock
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - H Hollema
- Department of Pathology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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5
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Versluis MAC, Marchal S, Plat A, de Bock GH, van Hall T, de Bruyn M, Hollema H, Nijman HW. The prognostic benefit of tumour-infiltrating Natural Killer cells in endometrial cancer is dependent on concurrent overexpression of Human Leucocyte Antigen-E in the tumour microenvironment. Eur J Cancer 2017; 86:285-295. [PMID: 29059634 DOI: 10.1016/j.ejca.2017.09.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 09/14/2017] [Indexed: 01/24/2023]
Abstract
BACKGROUND Human Leucocyte Antigen- E (HLA-E) has been reported as both a positive and negative prognostic marker in cancer. This apparent discrepancy may be due to opposing actions of HLA-E on tumour-infiltrating immune cells. Therefore, we evaluated HLA-E expression and survival in relation to the presence of intratumoural natural killer (NK) cells and cytotoxic T cells (CTLs). METHODS Tissue microarrays (TMAs) of endometrial tumours were used for immunohistochemical staining of parameters of interest. The combined impact of clinical, pathological and immune parameters on survival was analysed using log rank testing and Cox regression analyses. RESULTS Upregulation of HLA-E was associated with an improved disease-free and disease-specific survival in univariate analysis (HR 0.58 95% CI 0.37-0.89; HR 0.42 95% CI 0.25-0.73, respectively). In multivariate analysis, the presence of NK cells predicts survival with a hazard ratio (HR) 0.28 (95% confidence interval (CI) 0.09-0.91) when HLA-E expression is upregulated; but it is associated with a worse prognosis when HLA-E expression is normal (HR 13.43, 95% CI 1.70-106.14). By contrast, the prognostic benefit of T cells was not modulated by HLA-E expression. CONCLUSIONS Taken together, we demonstrate that the prognostic benefit of NK cells, but not T-cells, is influenced by HLA-E expression in endometrial cancer (EC) and propose a model to explain our observations.
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Affiliation(s)
- M A C Versluis
- Department of Gynaecology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.
| | - S Marchal
- Department of Gynaecology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - A Plat
- Department of Gynaecology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - G H de Bock
- Department of Epidemiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - T van Hall
- Department of Clinical Oncology, Leiden University Medical Centre, Leiden, The Netherlands
| | - M de Bruyn
- Department of Gynaecology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - H Hollema
- Department of Pathology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - H W Nijman
- Department of Gynaecology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
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Eggink FA, Mom CH, Bouwman K, Boll D, Becker JH, Creutzberg CL, Niemeijer GC, van Driel WJ, Reyners AK, van der Zee AG, Bremer GL, Ezendam NP, Kruitwagen RF, Pijnenborg JM, Hollema H, Nijman HW, van der Aa MA. Corrigendum to "Less-favourable prognosis for low-risk endometrial cancer patients with a discordant pre- versus post-operative risk stratification" [Eur J Cancer 78 (2017) 82-90]. Eur J Cancer 2017; 84:370. [PMID: 28844347 DOI: 10.1016/j.ejca.2017.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- F A Eggink
- University of Groningen, University Medical Center Groningen, Department of Obstetrics and Gynecology, Groningen, The Netherlands
| | - C H Mom
- VU University Medical Center, Center for Gynecologic Oncology Amsterdam, Amsterdam, The Netherlands
| | - K Bouwman
- University of Groningen, University Medical Center Groningen, Department of Obstetrics and Gynecology, Groningen, The Netherlands
| | - D Boll
- Catharina Hospital, Department of Obstetrics and Gynecology, Eindhoven, The Netherlands
| | - J H Becker
- St. Antonius Hospital, Department of Obstetrics and Gynecology, Nieuwegein, The Netherlands
| | - C L Creutzberg
- Leiden University Medical Center, Department of Radiation Oncology, Leiden, The Netherlands
| | - G C Niemeijer
- University Medical Center Groningen, Department of UMC Staff, Groningen, The Netherlands
| | - W J van Driel
- Antoni van Leeuwenhoek Hospital, Center for Gynecologic Oncology Amsterdam, Amsterdam, The Netherlands
| | - A K Reyners
- University of Groningen, University Medical Center Groningen, Department of Medical Oncology, Groningen, The Netherlands
| | - A G van der Zee
- University of Groningen, University Medical Center Groningen, Department of Obstetrics and Gynecology, Groningen, The Netherlands
| | - G L Bremer
- Zuyderland Medical Center, Department of Obstetrics and Gynecology, Heerlen/Sittard, The Netherlands
| | - N P Ezendam
- Netherlands Comprehensive Cancer Organization, Department of Research, Utrecht, The Netherlands
| | - R F Kruitwagen
- Maastricht University Medical Center, Department of Obstetrics and Gynecology, Maastricht, The Netherlands; GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - J M Pijnenborg
- Radboud University Medical Center Nijmegen, Department of Obstetrics and Gynecology, Nijmegen, The Netherlands
| | - H Hollema
- University of Groningen, University Medical Center Groningen, Department of Pathology, Groningen, The Netherlands
| | - H W Nijman
- University of Groningen, University Medical Center Groningen, Department of Obstetrics and Gynecology, Groningen, The Netherlands.
| | - M A van der Aa
- Netherlands Comprehensive Cancer Organization, Department of Research, Utrecht, The Netherlands
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7
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Eggink FA, Vermue MC, Van der Spek C, Arts HJ, Apperloo MJ, Nijman HW, Niemeijer GC. The impact of centralization of services on treatment delay in ovarian cancer: A study on process quality. Int J Qual Health Care 2017; 29:810-816. [DOI: 10.1093/intqhc/mzx107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 08/08/2017] [Indexed: 12/12/2022] Open
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Hartimath SV, Draghiciu O, van de Wall S, Manuelli V, Dierckx RAJO, Nijman HW, Daemen T, de Vries EFJ. Noninvasive monitoring of cancer therapy induced activated T cells using [ 18F]FB-IL-2 PET imaging. Oncoimmunology 2016; 6:e1248014. [PMID: 28197364 DOI: 10.1080/2162402x.2016.1248014] [Citation(s) in RCA: 32] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 09/30/2016] [Accepted: 10/08/2016] [Indexed: 10/20/2022] Open
Abstract
Cancer immunotherapy urgently calls for methods to monitor immune responses at the site of the cancer. Since activated T lymphocytes may serve as a hallmark for anticancer responses, we targeted these cells using the radiotracer N-(4-[18F]fluorobenzoyl)-interleukin-2 ([18F]FB-IL-2) for positron emission tomography (PET) imaging. Thus, we noninvasively monitored the effects of local tumor irradiation and/or immunization on tumor-infiltrating and systemic activated lymphocytes in tumor-bearing mice. A 10- and 27-fold higher [18F]FB-IL-2 uptake was observed in tumors of mice receiving tumor irradiation alone or in combination with immunization, respectively. This increased uptake was extended to several non-target tissues. Administration of the CXCR4 antagonist AMD3100 reduced tracer uptake by 2.8-fold, indicating a CXCR4-dependent infiltration of activated T lymphocytes upon cancer treatment. In conclusion, [18F]FB-IL-2 PET can serve as a clinical biomarker to monitor treatment-induced infiltration of activated T lymphocytes and, on that basis, may guide cancer immunotherapies.
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Affiliation(s)
- S V Hartimath
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, the Netherlands
| | - O Draghiciu
- Department of Medical Microbiology, Tumor Virology and Cancer Immunotherapy, University of Groningen, University Medical Center Groningen, the Netherlands
| | - S van de Wall
- Department of Medical Microbiology, Tumor Virology and Cancer Immunotherapy, University of Groningen, University Medical Center Groningen, the Netherlands
| | - V Manuelli
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, the Netherlands
| | - R A J O Dierckx
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, the Netherlands
| | - H W Nijman
- Department of Gynecological Oncology, University of Groningen, University Medical Center Groningen, the Netherlands
| | - T Daemen
- Department of Medical Microbiology, Tumor Virology and Cancer Immunotherapy, University of Groningen, University Medical Center Groningen, the Netherlands
| | - E F J de Vries
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, the Netherlands
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9
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Eggink FA, Mom CH, Kruitwagen RF, Reyners AK, Van Driel WJ, Massuger LF, Niemeijer GC, Van der Zee AG, Van der Aa MA, Nijman HW. Improved outcomes due to changes in organization of care for patients with ovarian cancer in the Netherlands. Gynecol Oncol 2016; 141:524-530. [PMID: 27090157 DOI: 10.1016/j.ygyno.2016.04.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 04/12/2016] [Accepted: 04/13/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Objectives of this study were to evaluate the effect of changes in patterns of care, for example centralization and treatment sequence, on surgical outcome and survival in patients with epithelial ovarian cancer (EOC). METHODS Patients diagnosed with FIGO stage IIB-IV EOC (2004-2013) were selected from the Netherlands Cancer Registry. Primary outcomes were surgical outcome (extent of macroscopic residual tumor after surgery) and overall survival. Changes in treatment sequence (primary debulking surgery and adjuvant chemotherapy (PDS+ACT) or neo-adjuvant chemotherapy and interval debulking surgery (NACT+IDS)), hospital type and annual hospital volume were also evaluated. RESULTS Patient and tumor characteristics of 7987 patients were retrieved. Most patients were diagnosed with stage III-IV EOC. The average annual case-load per hospital increased from 8 to 28. More patients received an optimal cytoreduction (tumor residue≤1cm) in 2013 (87%) compared to 2004 (55%, p<0.001). Complete cytoreduction (no macroscopic residual tumor), registered since 2010, increased from 42% to 52% (2010 and 2013, respectively, p<0.001). Optimal/complete cytoreduction was achieved in 85% in high volume (≥20 cytoreductive surgeries annually), 80% in medium (10-19 surgeries) and 71% in small hospitals (<10 surgeries, p<0.001). Within a selection of patients with advanced stage disease that underwent surgery the proportion of patients undergoing NACT+IDS increased from 28% (2004) to 71% (2013). Between 2004 and 2013 a 3% annual reduction in risk of death was observed (HR 0.97, p<0.001). CONCLUSION Changes in pattern of care for patients with EOC in the Netherlands have led to improvement in surgical outcome and survival.
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Affiliation(s)
- F A Eggink
- University of Groningen, University Medical Center Groningen, Department of Obstetrics and Gynecology, Groningen, The Netherlands
| | - C H Mom
- University of Groningen, University Medical Center Groningen, Department of Obstetrics and Gynecology, Groningen, The Netherlands
| | - R F Kruitwagen
- Maastricht University Medical Center, Department of Obstetrics and Gynecology, Maastricht, The Netherlands; GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - A K Reyners
- University of Groningen, University Medical Center Groningen, Department of Medical Oncology, Groningen, The Netherlands
| | - W J Van Driel
- Antoni van Leeuwenhoek Hospital, Department of Gynecologic Oncology, Center for Gynecologic Oncology Amsterdam, Amsterdam, The Netherlands
| | - L F Massuger
- Radboud University Medical Center, Department of Obstetrics and Gynecology, Nijmegen, The Netherlands
| | - G C Niemeijer
- University Medical Center Groningen, Department of UMC Staff, Groningen, The Netherlands
| | - A G Van der Zee
- University of Groningen, University Medical Center Groningen, Department of Obstetrics and Gynecology, Groningen, The Netherlands
| | - M A Van der Aa
- Department of Research, Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands
| | - H W Nijman
- University of Groningen, University Medical Center Groningen, Department of Obstetrics and Gynecology, Groningen, The Netherlands.
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10
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Koeneman MM, Kruse AJ, Kooreman LFS, Zur Hausen A, Hopman AHN, Sep SJS, Van Gorp T, Slangen BFM, van Beekhuizen HJ, van de Sande M, Gerestein CG, Nijman HW, Kruitwagen RFPM. TOPical Imiquimod treatment of high-grade Cervical intraepithelial neoplasia (TOPIC trial): study protocol for a randomized controlled trial. BMC Cancer 2016; 16:132. [PMID: 26897518 PMCID: PMC4761416 DOI: 10.1186/s12885-016-2187-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Accepted: 02/16/2016] [Indexed: 11/10/2022] Open
Abstract
Background Cervical intraepithelial neoplasia (CIN) is the premalignant condition of cervical cancer. Whereas not all high grade CIN lesions progress to cervical cancer, the natural history and risk of progression of individual lesions remain unpredictable. Therefore, high-grade CIN is currently treated by surgical excision: large loop excision of the transformation zone (LLETZ). This procedure has potential complications, such as acute haemorrhage, prolonged bleeding, infection and preterm birth in subsequent pregnancies. These complications could be prevented by development of a non-invasive treatment modality, such as topical imiquimod treatment. The primary study objective is to investigate the efficacy of topical imiquimod 5 % cream for the treatment of high-grade CIN and to develop a biomarker profile to predict clinical response to imiquimod treatment. Secondary study objectives are to assess treatment side-effects, disease recurrence and quality of life during and after different treatment modalities. Methods/design The study design is a randomized controlled trial. One hundred forty women with a histological diagnosis of high-grade CIN (CIN 2–3) will be randomized into two arms: imiquimod treatment during 16 weeks (experimental arm) or immediate LLETZ (standard care arm). Treatment efficacy will be evaluated by colposcopy with diagnostic biopsies at 20 weeks for the experimental arm. Successful imiquimod treatment is defined as regression to CIN 1 or less, successful LLETZ treatment is defined as PAP 1 after 6 months. Disease recurrence will be evaluated by cytology at 6, 12 and 24 months after treatment. Side-effects will be evaluated using a standardized report form. Quality of life will be evaluated using validated questionnaires at baseline, 20 weeks and 1 year after treatment. Biomarkers, reflecting both host and viral factors in the pathophysiology of CIN, will be tested at baseline with the aim of developing a predictive biomarker profile for the clinical response to imiquimod treatment. Discussion Treatment of high-grade CIN lesions with imiquimod in a selected patient population may diminish complications as a result of surgical intervention. More knowledge on treatment efficacy, side effects and long-term recurrence rates after treatment is necessary. Trial registration EU Clinical Trials Register EU-CTR2013-001260-34. Registered 18 March 2013. Medical Ethical Committee approval number: NL44336.068.13 (Medical Ethical Committee Maastricht University Hospital, University of Maastricht). Affiliation: Maastricht University Hospital. Registration number ClinicalTrials.gov: NCT02329171.
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Affiliation(s)
- M M Koeneman
- Department of Obstetrics and Gynaecology, Maastricht University Medical Center, Post box 5800, 6202 AZ, Maastricht, The Netherlands. .,GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - A J Kruse
- Department of Obstetrics and Gynaecology, Maastricht University Medical Center, Post box 5800, 6202 AZ, Maastricht, The Netherlands.,GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - L F S Kooreman
- Department of Pathology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - A Zur Hausen
- Department of Pathology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - A H N Hopman
- GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Molecular Cell Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - S J S Sep
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - T Van Gorp
- Department of Obstetrics and Gynaecology, Maastricht University Medical Center, Post box 5800, 6202 AZ, Maastricht, The Netherlands.,GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - B F M Slangen
- Department of Obstetrics and Gynaecology, Maastricht University Medical Center, Post box 5800, 6202 AZ, Maastricht, The Netherlands.,GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - H J van Beekhuizen
- Department of Obstetrics and Gynaecology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - M van de Sande
- Department of Obstetrics and Gynaecology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - C G Gerestein
- Department of Obstetrics and Gynaecology, Meander Medical Center, Amersfoort, The Netherlands
| | - H W Nijman
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, Groningen, The Netherlands
| | - R F P M Kruitwagen
- Department of Obstetrics and Gynaecology, Maastricht University Medical Center, Post box 5800, 6202 AZ, Maastricht, The Netherlands.,GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
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11
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Wouters MCA, Komdeur FL, de Bruyn M, Nijman HW. Size matters: Survival benefit conferred by intratumoral T cells is dependent on surgical outcome, treatment sequence and T cell differentiation. Oncoimmunology 2016; 5:e1122863. [PMID: 27467933 DOI: 10.1080/2162402x.2015.1122863] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 11/16/2015] [Indexed: 10/22/2022] Open
Abstract
Outcome of cytoreductive surgery, treatment sequence and the differentiation status of T cells are key factors to take into account when studying the prognostic value of tumor-infiltrating lymphocytes (TIL) in high grade serous ovarian cancer.
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Affiliation(s)
- M C A Wouters
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Medical Microbiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - F L Komdeur
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen , Groningen, The Netherlands
| | - M de Bruyn
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen , Groningen, The Netherlands
| | - H W Nijman
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen , Groningen, The Netherlands
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12
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Dijkgraaf EM, Santegoets SJAM, Reyners AKL, Goedemans R, Wouters MCA, Kenter GG, van Erkel AR, van Poelgeest MIE, Nijman HW, van der Hoeven JJM, Welters MJP, van der Burg SH, Kroep JR. A phase I trial combining carboplatin/doxorubicin with tocilizumab, an anti-IL-6R monoclonal antibody, and interferon-α2b in patients with recurrent epithelial ovarian cancer. Ann Oncol 2015. [PMID: 26216383 DOI: 10.1093/annonc/mdv309] [Citation(s) in RCA: 132] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
MESH Headings
- Adenocarcinoma, Clear Cell/blood
- Adenocarcinoma, Clear Cell/drug therapy
- Adenocarcinoma, Clear Cell/pathology
- Adenocarcinoma, Mucinous/blood
- Adenocarcinoma, Mucinous/drug therapy
- Adenocarcinoma, Mucinous/pathology
- Adult
- Aged
- Antibodies, Monoclonal, Humanized/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Biomarkers, Tumor/blood
- CA-125 Antigen/blood
- Carboplatin/administration & dosage
- Cystadenocarcinoma, Serous/blood
- Cystadenocarcinoma, Serous/drug therapy
- Cystadenocarcinoma, Serous/pathology
- Dose-Response Relationship, Drug
- Doxorubicin/administration & dosage
- Doxorubicin/analogs & derivatives
- Endometrial Neoplasms/blood
- Endometrial Neoplasms/drug therapy
- Endometrial Neoplasms/pathology
- Enzyme-Linked Immunosorbent Assay
- Female
- Follow-Up Studies
- Humans
- Interferon alpha-2
- Interferon-alpha/administration & dosage
- Interferon-gamma/blood
- Interleukin-6/blood
- Middle Aged
- Neoplasm Invasiveness
- Neoplasm Recurrence, Local/blood
- Neoplasm Recurrence, Local/drug therapy
- Neoplasm Recurrence, Local/pathology
- Neoplasm Staging
- Ovarian Neoplasms/blood
- Ovarian Neoplasms/drug therapy
- Ovarian Neoplasms/pathology
- Polyethylene Glycols/administration & dosage
- Prognosis
- Receptors, Interleukin-6/antagonists & inhibitors
- Recombinant Proteins/administration & dosage
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Affiliation(s)
- E M Dijkgraaf
- Department of Clinical Oncology, Leiden University Medical Center, Leiden
| | - S J A M Santegoets
- Department of Clinical Oncology, Leiden University Medical Center, Leiden
| | | | - R Goedemans
- Department of Clinical Oncology, Leiden University Medical Center, Leiden
| | - M C A Wouters
- Department of Gynecologic Oncology, University Medical Center Groningen, Groningen
| | - G G Kenter
- Department of Gynecologic Oncology, Center for Gynecological Oncology Amsterdam, Amsterdam
| | | | - M I E van Poelgeest
- Department of Gynecology, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | - M J P Welters
- Department of Clinical Oncology, Leiden University Medical Center, Leiden
| | - S H van der Burg
- Department of Clinical Oncology, Leiden University Medical Center, Leiden
| | - J R Kroep
- Department of Clinical Oncology, Leiden University Medical Center, Leiden
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13
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Dijkgraaf EM, Santegoets SJAM, Reyners AKL, Goedemans R, Wouters MCA, Kenter GG, van Erkel AR, van Poelgeest MIE, Nijman HW, van der Hoeven JJM, Welters MJP, van der Burg SH, Kroep JR. A phase I trial combining carboplatin/doxorubicin with tocilizumab, an anti-IL-6R monoclonal antibody, and interferon-α2b in patients with recurrent epithelial ovarian cancer. Ann Oncol 2015. [PMID: 26216383 DOI: 10.1093/annonc/mdv309.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND The immune system is important in epithelial ovarian cancer (EOC). Interleukin-6 is associated with chemoresistance and an immune-suppressive tumor microenvironment. We investigated whether a combination of chemotherapeutics, blockade of interleukin 6 (IL-6) receptor (IL-6R; tocilizumab), and immune enhancer interferon-α (Peg-Intron) is feasible, safe, and able to enhance immunity in patients with recurrent EOC. PATIENTS AND METHODS In this dose-escalation study, patients received tocilizumab 1, 2, 4, or 8 mg/kg i.v., q4 weeks during the first three cycles of carboplatin (AUC5) plus doxorubicin [pegylated liposomal doxorubicin (PLD) 30 mg/m(2) or doxorubicin 50 mg/m(2) i.v., day 1, q4 weeks, for six cycles]. At the highest tocilizumab dose (8 mg/kg), Peg-Intron (1 µg/kg s.c.) was added. Peripheral blood mononuclear cells were collected for immunomonitoring at baseline, after three and six cycles. Dose-limiting toxicity (DLT), CA-125, and radiologic response were evaluated. RESULTS In the 23 patients enrolled, no DLT was established. The most frequent grade 3/4 adverse events (CTCAE v4.03) were neutropenia (23%), febrile neutropenia (19%), and ileus (19%). No treatment-related deaths occurred. Using CT evaluation, 11 of 21 assessable patients responded, 6 had stable disease and 3 progressive disease. Patients receiving highest dose tocilizumab showed a functional blockade of IL-6R with increased levels of serum IL-6 (P = 0.02) and soluble IL-6R (P = 0.008). Consequently, immune cells displayed decreased levels of pSTAT3, myeloid cells produced more IL-12 and IL-1β while T cells were more activated and secreted higher amounts of effector cytokines interferon-γ and tumor necrosis factor-α. An increase in sIL-6R was potentially associated with a survival benefit (P = 0.03). CONCLUSIONS Functional IL-6R blocking is feasible and safe in EOC patients treated with carboplatin/(pegylated liposomal)doxorubicin, using 8 mg/kg tocilizumab. This combination is recommended for phase II evaluation based on immune parameters. CLINICAL TRIAL REGISTER NCT01637532.
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Affiliation(s)
- E M Dijkgraaf
- Department of Clinical Oncology, Leiden University Medical Center, Leiden
| | - S J A M Santegoets
- Department of Clinical Oncology, Leiden University Medical Center, Leiden
| | | | - R Goedemans
- Department of Clinical Oncology, Leiden University Medical Center, Leiden
| | - M C A Wouters
- Department of Gynecologic Oncology, University Medical Center Groningen, Groningen
| | - G G Kenter
- Department of Gynecologic Oncology, Center for Gynecological Oncology Amsterdam, Amsterdam
| | | | - M I E van Poelgeest
- Department of Gynecology, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | - M J P Welters
- Department of Clinical Oncology, Leiden University Medical Center, Leiden
| | - S H van der Burg
- Department of Clinical Oncology, Leiden University Medical Center, Leiden
| | - J R Kroep
- Department of Clinical Oncology, Leiden University Medical Center, Leiden
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14
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Versluis MA, de Jong RA, Plat A, Bosse T, Smit VT, Mackay H, Powell M, Leary A, Mileshkin L, Kitchener HC, Crosbie EJ, Edmondson RJ, Creutzberg CL, Hollema H, Daemen T, de Bock GH, Nijman HW. Prediction model for regional or distant recurrence in endometrial cancer based on classical pathological and immunological parameters. Br J Cancer 2015. [PMID: 26217922 PMCID: PMC4559831 DOI: 10.1038/bjc.2015.268] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background: Adjuvant therapy increases disease-free survival in endometrial cancer (EC), but has no impact on overall survival and negatively influences the quality of life. We investigated the discriminatory power of classical and immunological predictors of recurrence in a cohort of EC patients and confirmed the findings in an independent validation cohort. Methods: We reanalysed the data from 355 EC patients and tested our findings in an independent validation cohort of 72 patients with EC. Predictors were selected and Harrell's C-index for concordance was used to determine discriminatory power for disease-free survival in the total group and stratified for histological subtype. Results: Predictors for recurrence were FIGO stage, lymphovascular space invasion and numbers of cytotoxic and memory T-cells. For high risk cancer, cytotoxic or memory T-cells predicted recurrence as well as a combination of FIGO stage and lymphovascular space invasion (C-index 0.67 and 0.71 vs 0.70). Recurrence was best predicted when FIGO stage, lymphovascular space invasion and numbers of cytotoxic cells were used in combination (C-index 0.82). Findings were confirmed in the validation cohort. Conclusions: In high-risk EC, clinicopathological or immunological variables can predict regional or distant recurrence with equal accuracy, but the use of these variables in combination is more powerful.
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Affiliation(s)
- M A Versluis
- Department of Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - R A de Jong
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - A Plat
- Department of Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - T Bosse
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - V T Smit
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - H Mackay
- Division of Medical Oncology and Hematology, Department of Medicine, University of Toronto, Toronto, Canada
| | - M Powell
- Department of Clinical Oncology, Barts Health NHS trust, London, UK
| | - A Leary
- Department of Medicine, Gynecology Unit, Gustave Roussy, Villejuif, France
| | - L Mileshkin
- Division of Medical Oncology, Peter MacCallum Cancer Center, Victoria, Australia
| | - H C Kitchener
- Department of Gynecology, St Marys Hospital, Manchester, UK
| | - E J Crosbie
- Department of Gynecology, St Marys Hospital, Manchester, UK
| | - R J Edmondson
- Department of Gynecology, St Marys Hospital, Manchester, UK
| | - C L Creutzberg
- Department of Clinical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - H Hollema
- Department of Pathology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - T Daemen
- Department of Medical Microbiology, Molecular Virology Section, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - G H de Bock
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - H W Nijman
- Department of Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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15
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Wouters M, Dijkgraaf EM, Kuijjer ML, Jordanova ES, Hollema H, Welters M, van der Hoeven J, Daemen T, Kroep JR, Nijman HW, van der Burg SH. Interleukin-6 receptor and its ligand interleukin-6 are opposite markers for survival and infiltration with mature myeloid cells in ovarian cancer. Oncoimmunology 2015; 3:e962397. [PMID: 25964862 PMCID: PMC4353164 DOI: 10.4161/21624011.2014.962397] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [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: 08/10/2014] [Accepted: 10/30/2014] [Indexed: 11/19/2022] Open
Abstract
An increased level of interleukin-6 (IL-6) in epithelial ovarian cancer (EOC) is correlated with a worse prognosis. IL-6 stimulates tumor-growth and inflammation. We investigated the intricate interaction between the IL-6 signaling pathway and tumor-infiltrating myeloid cells (TIMs) to determine their prognostic impact in EOC. 160 EOC samples were analyzed for the expression of IL-6, its receptor (IL-6R) and downstream signaling via pSTAT3 by immunohistochemistry. Triple color immunofluorescence confocal microscopy was used to identify myeloid cell populations by CD14, CD33, and CD163. The relationship between these markers, tumor-infiltrating immune cells, clinical-pathological characteristics and survival was investigated. EOC displayed a dense infiltration with myeloid cells, in particular of the CD163+ type. The distribution pattern of all myeloid subtypes was comparable among the different histological subtypes. Analysis of the tumor cells revealed a high expression of IL-6R in 15% and of IL-6 in 23% of patients. Interestingly, tumors expressing IL-6 or IL-6R formed two different groups. Tumors with a high expression of IL-6R displayed low mature myeloid cell infiltration and a longer disease-specific survival (DSS), especially in late stage tumors. High expression of IL-6R was an independent prognostic factor for survival by multivariate analyses (hazard ratio = 0.474, p = 0.011). In contrast, tumors with high epithelial IL-6 expression displayed a dense infiltration of mature myeloid cells and were correlated with a shorter DSS. Furthermore, in densely CD8+ T-cell infiltrated tumors, the ratio between these lymphoid cells and CD163+ myeloid cells was predictive for survival. Thus, IL-6 and IL-6R are opposite markers for myeloid cell infiltration and survival.
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Key Words
- DSS, disease-specific survival
- EOC, epithelial ovarian cancer
- FIGO, International Federation of Gynecology and Obstetrics
- IL-6, interleukin-6; IL-6R, interleukin-6 receptor
- IL-6R, interleukin-6, IL-6, interleukin-6 receptor
- MDSC, myeloid-derived suppressor cell
- T reg, regulatory T cell
- TAM, tumor-associated macrophage
- TIL, tumor-infiltrating lymphocytes
- TIM, tumor-infiltrating myeloid cell
- TMA, tissue microarray
- epithelial ovarian cancer
- pSTAT3
- pSTAT3, phosphorylated signal transducer and activator of transcription 3
- tumor-infiltrating myeloid cells
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Affiliation(s)
- McA Wouters
- Department of Gynecologic Oncology; University of Groningen; University Medical Center Groningen ; Hanzeplein ; Groningen, The Netherlands ; Department of Medical Microbiology; University of Groningen; University Medical Center Groningen ; Hanzeplein , Groningen, The Netherlands
| | - E M Dijkgraaf
- Department of ClinicalOncology; Leiden University Medical Center ; Albinusdreef , Leiden, The Netherlands
| | - M L Kuijjer
- Department of Biostatistics and Computational Biology; Dana-Farber Cancer Institute ; Boston, MA USA ; Department of Biostatistics; Harvard School of Public Health ; Boston, MA USA
| | - E S Jordanova
- Center for Gynaecological Oncology Amsterdam ; VUMC, De Boelelaan , Amsterdam, The Netherlands
| | - H Hollema
- Department of Pathology; University of Groningen; University Medical Center Groningen ; Hanzeplein , Groningen, The Netherlands
| | - Mjp Welters
- Department of ClinicalOncology; Leiden University Medical Center ; Albinusdreef , Leiden, The Netherlands
| | - Jjm van der Hoeven
- Department of ClinicalOncology; Leiden University Medical Center ; Albinusdreef , Leiden, The Netherlands
| | - T Daemen
- Department of Medical Microbiology; University of Groningen; University Medical Center Groningen ; Hanzeplein , Groningen, The Netherlands
| | - J R Kroep
- Department of ClinicalOncology; Leiden University Medical Center ; Albinusdreef , Leiden, The Netherlands
| | - H W Nijman
- Department of Gynecologic Oncology; University of Groningen; University Medical Center Groningen ; Hanzeplein ; Groningen, The Netherlands
| | - S H van der Burg
- Department of ClinicalOncology; Leiden University Medical Center ; Albinusdreef , Leiden, The Netherlands
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16
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Gooden MJM, Wiersma VR, Boerma A, Leffers N, Boezen HM, ten Hoor KA, Hollema H, Walenkamp AME, Daemen T, Nijman HW, Bremer E. Elevated serum CXCL16 is an independent predictor of poor survival in ovarian cancer and may reflect pro-metastatic ADAM protease activity. Br J Cancer 2014; 110:1535-44. [PMID: 24518602 PMCID: PMC3960624 DOI: 10.1038/bjc.2014.55] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Revised: 12/30/2013] [Accepted: 01/08/2014] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND In certain cancers, expression of CXCL16 and its receptor CXCR6 associate with lymphocyte infiltration, possibly aiding anti-tumour immune response. In other cancers, CXCL16 and CXCR6 associate with pro-metastatic activity. In the current study, we aimed to characterise the role of CXCL16, sCXCL16, and CXCR6 in ovarian cancer (OC). METHODS CXCL16/CXCR6 expression was analysed on tissue microarray containing 306 OC patient samples. Pre-treatment serum sCXCL16 was determined in 118 patients using ELISA. In vitro, (primary) OC cells were treated with an ADAM-10/ADAM-17 inhibitor (TAPI-2) and an ADAM-10-specific inhibitor (GI254023x), whereupon CXCL16 levels were evaluated on the cell membrane (immunofluorescent analysis, western blots) and in culture supernatants (ELISA). In addition, cell migration was assessed using scratch assays. RESULTS sCXCL16 independently predicted for poor survival (hazard ratio=2.28, 95% confidence interval=1.29-4.02, P=0.005), whereas neither CXCL16 nor CXCR6 expression correlated with survival. Further, CXCL16/CXCR6 expression and serum sCXCL16 levels did not associate with lymphocyte infiltration. In vitro inhibition of both ADAM-17 and ADAM-10, but especially the latter, decreased CXCL16 membrane shedding and strongly reduced cell migration of A2780 and cultured primary OC-derived malignant cells. CONCLUSIONS High serum sCXCL16 is a prognostic marker for poor survival of OC patients, possibly reflecting ADAM-10 and ADAM-17 pro-metastatic activity. Therefore, serum sCXCL16 levels may be a pseudomarker that identifies patients with highly metastatic tumours.
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Affiliation(s)
- M J M Gooden
- 1] Department of Gynecologic Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands [2] Department of Surgery, Translational Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - V R Wiersma
- Department of Surgery, Translational Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - A Boerma
- 1] Department of Gynecologic Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands [2] Department of Microbiology, Molecular Virology Section, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - N Leffers
- Department of Gynecologic Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - H M Boezen
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - K A ten Hoor
- Department of Gynecologic Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - H Hollema
- Department of Pathology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - A M E Walenkamp
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - T Daemen
- Department of Microbiology, Molecular Virology Section, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - H W Nijman
- Department of Gynecologic Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - E Bremer
- Department of Surgery, Translational Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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17
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Draghiciu O, Hoogeboom BN, Meijerhof T, Nijman HW, Daemen CAHH. P59. Depleting the suppressors for the benefit of immunotherapy against cervical cancer. J Immunother Cancer 2014. [PMCID: PMC4072153 DOI: 10.1186/2051-1426-2-s2-p33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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18
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de Jong RA, Toppen NL, Ten Hoor KA, Boezen HM, Kema IP, Hollema H, Nijman HW. Status of cellular immunity lacks prognostic significance in vulvar squamous carcinoma. Gynecol Oncol 2011; 125:186-93. [PMID: 22155674 DOI: 10.1016/j.ygyno.2011.12.416] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Revised: 11/24/2011] [Accepted: 12/01/2011] [Indexed: 12/15/2022]
Abstract
OBJECTIVE It is generally recognized that the immune system has an important role in regulating cancer development. Evidence indicating a prognostic role of the immune system in vulvar carcinoma is scarce. This study investigated the presence and prognostic significance of several aspects of the immune system in vulvar squamous carcinoma. METHODS The number of intratumoral CD8(+) and Foxp3(+) T-lymphocytes, next to HLA class I (HLA-A, HLA-B/C and β(2)-m) and indoleamine 2,3-dioxygenase (IDO) expression was determined by immunohistochemistry in a consecutively selected cohort of 286 vulvar squamous carcinoma patients, all treated in the University Medical Center Groningen, the Netherlands. Associations between immunohistochemistry expression and the influence on survival were determined. RESULTS The number of tumor-infiltrating CD8(+) T-lymphocytes was significantly lower in tumors with loss of HLA-A (p=0.004), HLA-B/C (p=0.024) or β(2)-m (p=0.025) expression compared with tumors with expression of HLA class I. No association was found between the number of intratumoral CD8(+) T-lymphocytes and Foxp3(+) T-lymphocytes, HLA class I and IDO expression and survival of vulvar squamous carcinoma patients. CONCLUSION Our results indicate that the immune system does not seem to have a major influence on prognosis of patients with vulvar squamous carcinoma.
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Affiliation(s)
- R A de Jong
- Department of Gynecologic Oncology, University of Groningen, Groningen, The Netherlands
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Gooden MJM, de Bock GH, Leffers N, Daemen T, Nijman HW. The prognostic influence of tumour-infiltrating lymphocytes in cancer: a systematic review with meta-analysis. Br J Cancer 2011; 105:93-103. [PMID: 21629244 PMCID: PMC3137407 DOI: 10.1038/bjc.2011.189] [Citation(s) in RCA: 903] [Impact Index Per Article: 69.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background: Tumour-infiltrating lymphocytes (TILs) are often found in tumours, presumably reflecting an immune response against the tumour. We carried out a systematic review and meta-analysis, aiming to establish pooled estimates for survival outcomes based on the presence of TILs in cancer. Methods: A Pubmed and Embase literature search was designed. Studies were included, in which the prognostic significance of intratumoural CD3+, CD4+, CD8+, and FoxP3+ lymphocytes, as well as ratios between these subsets, were determined in solid tumours. Results: In pooled analysis, CD3+ TILs had a positive effect on survival with a hazard ratio (HR) of 0.58 (95% confidence interval (CI) 0.43–0.78) for death, as did CD8+ TILs with a HR of 0.71 (95% CI 0.62–0.82). FoxP3+ regulatory TILs were not linked to overall survival, with a HR of 1.19 (95% CI 0.84–1.67). The CD8/FoxP3 ratio produced a more impressive HR (risk of death: HR 0.48, 95% CI 0.34–0.68), but was used in relatively few studies. Sample size and follow-up time seemed to influence study outcomes. Conclusion: Any future studies should be carefully designed, to prevent overestimating the effect of TILs on prognosis. In this context, ratios between TIL subsets may be more informative.
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Affiliation(s)
- M J M Gooden
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
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Leffers N, Fehrmann RSN, Gooden MJM, Schulze URJ, Ten Hoor KA, Hollema H, Boezen HM, Daemen T, de Jong S, Nijman HW, van der Zee AGJ. Identification of genes and pathways associated with cytotoxic T lymphocyte infiltration of serous ovarian cancer. Br J Cancer 2010; 103:685-92. [PMID: 20664601 PMCID: PMC2938262 DOI: 10.1038/sj.bjc.6605820] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background: Tumour-infiltrating lymphocytes (TILs) are predictors of disease-specific survival (DSS) in ovarian cancer. It is largely unknown what factors contribute to lymphocyte recruitment. Our aim was to evaluate genes and pathways contributing to infiltration of cytotoxic T lymphocytes (CTLs) in advanced-stage serous ovarian cancer. Methods: For this study global gene expression was compared between low TIL (n=25) and high TIL tumours (n=24). The differences in gene expression were evaluated using parametric T-testing. Selectively enriched biological pathways were identified with gene set enrichment analysis. Prognostic influence was validated in 157 late-stage serous ovarian cancer patients. Using immunohistochemistry, association of selected genes from identified pathways with CTL was validated. Results: The presence of CTL was associated with 320 genes and 23 pathways (P<0.05). In addition, 54 genes and 8 pathways were also associated with DSS in our validation cohort. Immunohistochemical evaluation showed strong correlations between MHC class I and II membrane expression, parts of the antigen processing and presentation pathway, and CTL recruitment. Conclusion: Gene expression profiling and pathway analyses are valuable tools to obtain more understanding of tumour characteristics influencing lymphocyte recruitment in advanced-stage serous ovarian cancer. Identified genes and pathways need to be further investigated for suitability as therapeutic targets.
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Affiliation(s)
- N Leffers
- Department of Gynaecologic Oncology (CB22), University Medical Center Groningen, University of Groningen, PO Box 30.001, Groningen 9700 RB, The Netherlands
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Eijsink JJH, de Bock GH, Kuiper JL, Reesink-Peters N, van Hemel BM, Hollema H, Nijman HW, Mourits MJE, van der Zee AGJ. Routine follow-up intervals in patients with high-grade squamous intraepithelial lesions (HSIL) and free excision margins can safely be increased in the first two years after Large Loop Excision of the Transformation Zone (LLETZ). Gynecol Oncol 2009; 113:348-51. [PMID: 19297014 DOI: 10.1016/j.ygyno.2008.11.022] [Citation(s) in RCA: 11] [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] [Received: 09/29/2008] [Revised: 11/07/2008] [Accepted: 11/14/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To assess the compliance of HSIL patients to the national Dutch routine follow-up protocol in the first 2 years after LLETZ and to determine if based on the status of excision margins, follow-up intervals could be modified. METHODS A prospective cohort study was performed in patients, referred because of an abnormal Pap smear between 1996 and 2004 and treated for HSIL with LLETZ. The Dutch national routine follow-up protocol orders a Pap smear after 6, 12 and 24 months, respectively. Follow-up results were completed by using PALGA, the nationwide network and registry of histo- and cytopathology in the Netherlands. To assess compliance to the follow-up protocol, adequate follow-up was defined as three cervical smears taken after 6 (+/-3), 12 (+/-3) and 24 (+/-3) months, respectively. RESULTS Compliance to the first 2 years follow-up protocol declined from 86.2% to 64.8% to 51.2% for first, second and third follow-up cervical smears, respectively. Patients with involved excision margins had a three times higher overall risk of developing a subsequent HSIL after LLETZ as compared to patients with free excision margins (HR: 3.2, 95% CI=1.3-7.9, p=0.01). Risk for diagnosing HSIL during the first 12 months of follow-up for patients with free excision margins was only 1%. CONCLUSIONS Compliance to the Dutch national routine follow-up protocol in HSIL patients after LLETZ is only moderate. For HSIL patients with free excision margins after LLETZ the first cytological follow-up interval can safely be increased to 12 months.
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Affiliation(s)
- J J H Eijsink
- Department of Gynecologic Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Visser J, Nijman HW, Hoogenboom BN, Jager P, van Baarle D, Schuuring E, Abdulahad W, Miedema F, van der Zee AG, Daemen T. Frequencies and role of regulatory T cells in patients with (pre)malignant cervical neoplasia. Clin Exp Immunol 2007; 150:199-209. [PMID: 17937675 DOI: 10.1111/j.1365-2249.2007.03468.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Oncogenic human papillomavirus (HPV)-infection is crucial for developing cervical cancer and its precursor lesions [cervical intraepithelial neoplasia (CIN)]. Regulatory T cells (T(regs)) might be involved in the failure of the immune system to control the development of HPV-induced cancer. We investigated frequencies, phenotype and activity of T(regs) in patients with cervical neoplasia. CIN and cervical cancer patients showed increased CD4(+)/CD25(high) T cell frequencies in peripheral blood and CD4(+) T cell fraction. These CD4(+)/CD25(high) T cells represent T(regs) as demonstrated by their low proliferation rate, low interferon (IFN)-gamma/interleukin (IL)-10 ratio, high expression of CD45RO, GITR, CTLA-4, forkhead box P3 (FoxP3) and low CD45RA expression. Moreover, in HPV16(+) cervical cancer patients, in-vitro depletion of CD25(+) T cells resulted in increased IFN-gamma T cell responses against HPV16 E6- and E7 peptides. Thus, increased frequencies of T(regs) in cervical cancer patients may indeed suppress HPV-specific immunity. Longitudinal analysis of CD4(+)/CD25(high) T cell frequencies in patients showed a modest decline 1 year after curative surgery or chemoradiation. This study demonstrates increased frequencies and suppressive activity of T(regs) in cervical cancer. These results imply that T(regs) may suppress the immune control of cervical neoplasia and furthermore that suppression of immunity by T(regs) will be another hurdle to overcome in therapeutic immunization strategies against cervical neoplasia.
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Affiliation(s)
- J Visser
- Department of Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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de Mare A, Lambeck AJA, Regts J, van Dam GM, Nijman HW, Snippe H, Wilschut J, Daemen T. Viral vector-based prime-boost immunization regimens: a possible involvement of T-cell competition. Gene Ther 2007; 15:393-403. [PMID: 18004406 DOI: 10.1038/sj.gt.3303060] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Vaccination with recombinant viral vectors may be impeded by preexisting vector-specific immunity or by vector-specific immunity induced during the priming immunization. It is assumed that virus-neutralizing antibodies represent the principal effector mechanism of vector-specific immunity, while killing of infected cells by vector-specific cytotoxic T lymphocytes (CTLs) has also been suggested. Using recombinant Semliki Forest virus (rSFV) expressing E6E7 antigen from human papillomavirus, we demonstrate that secondary immune responses against E6E7 are neither affected by vector-specific antibodies nor by CTL-mediated killing of infected cells. Instead, the presence of the antigen during the prime immunization appeared to be the main determinant for the boosting efficacy. After priming with rSFVeE6,7, a homologous booster stimulated the primed E6E7-specific CTL response and induced long-lasting memory. Passively transferred SFV-neutralizing antibodies did not inhibit E6E7-specific CTL responses, although transgene expression was strongly reduced under these conditions. Conversely, in mice primed with irrelevant rSFV, induction of E6E7-specific CTLs was inhibited presumably due to vector-specific responses induced by the priming immunization. When during the priming with irrelevant rSFV, E7-protein was co-administered, the inhibitory effect of vector-specific immunity was abolished. These results suggest that, apart from vector-specific antibodies or killing of infected cells, T-cell competition may be involved in determining the efficacy of viral vector-based prime-boost immunization regimens.
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Affiliation(s)
- A de Mare
- Department of Medical Microbiology, Molecular Virology Section, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Nijhuis ER, Nijman HW, Oien KA, Bell A, ten Hoor KA, Reesink-Peters N, Boezen HM, Hollema H, van der Zee AGJ. Loss of MSH2 protein expression is a risk factor in early stage cervical cancer. J Clin Pathol 2007; 60:824-30. [PMID: 17596548 PMCID: PMC1995775 DOI: 10.1136/jcp.2005.036038] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [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: 11/04/2022]
Abstract
BACKGROUND Loss of mismatch repair (MMR) gene expression has been associated with fewer metastases and improved prognosis in various tumour types. AIMS To evaluate the predictive and prognostic significance of loss of MMR protein MSH2 in early stage cervical cancer. METHODS Specimens from 218 consecutive patients with early stage, surgically treated cervical cancer were analysed. Median age was 42 years (interquartile range 35-53). International Federation of Gynecology and Obstetrics (FIGO) stages were IB1 (57%), IB2 (25%) and IIA (18%). Histology was 70% squamous cell, 6% adenosquamous and 24% adenocarcinoma. Pelvic lymph node metastasis was present in 66 (30%) patients. Median follow-up was 5.2 years (interquartile range 2.5-7.9). Tissue microarrays (TMAs) were constructed containing three cores of paraffin-embedded tumour per case. MSH2 expression was assessed by immunohistochemistry on TMAs and full sections. RESULTS In TMAs MSH2 expression could be analysed in 184/218 (84%) tumours. Loss of MSH2 was observed in 58/184 (32%) tumours, with a moderately strong concordance between TMAs and full sections (kappa = 0.47). In tumours with loss of MSH2, pelvic lymph node metastasis and cancer invasion beyond 10 mm were more frequent (48% vs 25%, and 59% vs 37%, respectively). However, loss of MSH2 expression was not related to recurrence or survival. CONCLUSION TMAs are powerful tools for high throughput screening of biological markers for prognostic value in cervical cancer. Absence of MSH2 expression is associated with a high-risk profile in early stage cervical cancer, but does not predict lymph node status with sufficient accuracy to be used in the clinic.
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Affiliation(s)
- E R Nijhuis
- Department of Gynecological Oncology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
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Nijman HW, Lambeck A, van der Burg SH, van der Zee AGJ, Daemen T. Immunologic aspect of ovarian cancer and p53 as tumor antigen. J Transl Med 2005; 3:34. [PMID: 16164749 PMCID: PMC1243238 DOI: 10.1186/1479-5876-3-34] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2005] [Accepted: 09/15/2005] [Indexed: 01/13/2023] Open
Abstract
Ovarian cancer represents the fifth leading cause of death from all cancers for women. During the last decades overall survival has improved due to the use of new chemotherapy schedules. Still, the majority of patients die of this disease. Research reveals that ovarian cancer patients exhibit significant immune responses against their tumor. In this review the knowledge obtained thus far on the interaction of ovarian cancer tumor cells and the immune system is discussed. Furthermore the role of p53 as tumor antigen and its potential role as target antigen in ovarian cancer is summarized. Based on the increased knowledge on the role of the immune system in ovarian cancer major improvements are to be expected of immunotherapy based treatment of this disease.
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Affiliation(s)
- HW Nijman
- Dept. of Gynaecologic Oncology, Groningen University Medical Center
| | - A Lambeck
- Dept. of Gynaecologic Oncology, Groningen University Medical Center
- Dept. of Medical Microbiology, Molecular Virology Section, Groningen University Medical Center
| | - SH van der Burg
- Dept. of Immunohematology and Blood Transfusion, Leiden University Medical Center
| | - AGJ van der Zee
- Dept. of Gynaecologic Oncology, Groningen University Medical Center
| | - T Daemen
- Dept. of Medical Microbiology, Molecular Virology Section, Groningen University Medical Center
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Nijman HW, Khalifa M, Covens A. What is the number of lymph nodes required for an "adequate" pelvic lymphadenectomy? EUR J GYNAECOL ONCOL 2004; 25:87-9. [PMID: 15053069] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
PURPOSE OF INVESTIGATION To establish a definition of an adequate number of lymph nodes identified at a pelvic lymphadenectomy through statistical methods. METHODS We conducted a retrospective study in cervical and endometrial carcinoma patients who underwent radical or staging surgery. The Student's t-test, Pearson's correlation, analysis of variance, and linear regression analysis were used. RESULTS Five hundred and ninety four-sided pelvic lymphadenectomies were analyzed. The mean (range) number of pelvic lymph nodes identifed was 11.3 (0-42). The 1st, 5th and 10th percentiles were three, five, and six lymph nodes respectively. The number of lymph nodes was higher in the laparoscopic approach compared to laparotomy (11.9 vs 10.6, p < 0.01). CONCLUSIONS The number of lymph nodes identified at a pelvic lymphadencetomy vary with type of surgery. We propose that using the 1st, 5th or 10th percentile is reasonable for the definition of an adequate number of lymph nodes to be identified at a pelvic lymphadenectomy.
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Affiliation(s)
- H W Nijman
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Sunnybrook and Women's College Health Science Center, University of Toronto, Toronto, Ontario, Canada
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Nijman HW, vd Burg SH, Zwaveling S, Melief KM, vd Zee AG, Offringa R. P53, A TARGET ANTIGEN FOR IMMUNOTHERAPY IN OVARIAN CANCER - FROM PRECLINIC TO CLINIC. Int J Gynecol Cancer 2003. [DOI: 10.1136/ijgc-00009577-200303001-00153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Nijman HW, van Diest PJ, Poort-Keesom RJ, von Mensdorff-Pouilly S, Verstraeten RA, Kummer A, Meijer CJ, Melief CJ, Hilgers J, Kenemans P. T cell infiltration and MHC I and II expression in the presence of tumor antigens: An immunohistochemical study in patients with serous epithelial ovarian cancer. Eur J Obstet Gynecol Reprod Biol 2001; 94:114-20. [PMID: 11134836 DOI: 10.1016/s0301-2115(00)00294-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [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: 11/25/2022]
Abstract
OBJECTIVES Ovarian cancer is a frequent cause of death among women with gynaecologic malignancies despite the introduction of combination chemotherapy. There is therefore a need for new therapeutic strategies for patients with ovarian cancer, such as cellular immunotherapy. In this immunohistochemical study we analysed the expression of three tumor antigens, p53, HER-2/neu and MUC-1 in relation to the expression of major histocompatibility complex (MHC) class I and II on tumor cells, and we searched for the presence of (activated) immune effector cells at the tumor site. STUDY DESIGN The study was carried out retrospectively in tumor tissue from 29 patients with serous ovarian cancer. Material used had been formalin fixed and paraffin embedded. Material had been obtained from 15 patients at staging laparotomy and from 14 patients during second look or intervention laparotomy. RESULTS A positive staining for p53 was found in 19/29 (66%) of the tumors, with a high positivity in 13/29 (45%). HER-2/neu and MUC-1 staining was positive in 8/29 (28%) and 21/28 (75%), respectively. Downregulation of MHC class I on tumor cells was found in a minority of the patients, beta-2-microglobin (beta2m) was expressed on tumor cells in all patients. High staining for CD45RO correlated with a high positive staining for granzyme-B (R=0.40, P=0.04) and TIA-1 (R=0.39, P=0.04). A statistically significant better survival in the group with lower stage of disease was found. CONCLUSIONS As only three out of 29 patients were negative for the tumor antigens p53, HER-2/neu and MUC-1, immunotherapy aiming at all three could serve almost all patients with ovarian cancer. We found that granzyme-B, TIA-1 and CD45RO+ T cells are present in the tumor biopsies, increasing this number by immunotherapy may be beneficial. The immune escape mechanism by MHC class I and beta2m downregulation seems to be of minor importance. Our data support the view that immunotherapy may offer new possibilities with high specificity in ovarian cancer.
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Affiliation(s)
- H W Nijman
- Department of Obstetrics and Gynaecology, University Hospital Vrije Universteit, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
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Koelman CA, Coumans AB, Nijman HW, Doxiadis II, Dekker GA, Claas FH. Correlation between oral sex and a low incidence of preeclampsia: a role for soluble HLA in seminal fluid? J Reprod Immunol 2000; 46:155-66. [PMID: 10706945 DOI: 10.1016/s0165-0378(99)00062-5] [Citation(s) in RCA: 129] [Impact Index Per Article: 5.4] [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: 10/17/2022]
Abstract
The involvement of immune mechanisms in the aetiology of preeclampsia is often suggested. Normal pregnancy is thought to be associated with a state of tolerance to the foreign antigens of the fetus, whereas in preeclamptic women this immunological tolerance might be hampered. The present study shows that oral sex and swallowing sperm is correlated with a diminished occurrence of preeclampsia which fits in the existing idea that a paternal factor is involved in the occurrence of preeclampsia. Because pregnancy has many similarities with transplantation, we hypothesize that induction of allogeneic tolerance to the paternal HLA molecules of the fetus may be crucial. Recent data suggest that exposure, and especially oral exposure to soluble HLA (sHLA) or HLA derived peptides can lead to transplantation tolerance. Similarly, sHLA antigens, that are present in the seminal plasma, might cause tolerance in the mother to paternal antigens. In order to test whether this indeed may be the case, we investigated whether sHLA antigens are present in seminal plasma. Using a specific ELISA we detected sHLA class I molecules in seminal plasma. The level varied between individuals and was related to the level in plasma. Further studies showed that these sHLA class I molecules included classical HLA class I alleles, such as sHLA-A2, -B7, -B51, -B35 and sHLA-A9. Preliminary data show lower levels of sHLA in seminal plasma in the preeclampsia group, although not significantly different from the control group. An extension of the present study is necessary to verify this hypothesis.
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Affiliation(s)
- C A Koelman
- Department of Immunohematology and Blood Bank, Leiden University Medical Centre, PO Box 9600, 2300 RC, Leiden, The Netherlands
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Nijman HW, Kenemans P, Poort-Keesom RJ, Verstraeten RA, Mensdorff-Pouilly S, Verheijen RH, Melief CJ, Hilgers J, Meijer CJ. Influence of chemotherapy on the expression of p53, HER-2/neu and proliferation markers in ovarian cancer. Eur J Obstet Gynecol Reprod Biol 1999; 83:201-6. [PMID: 10391533 DOI: 10.1016/s0301-2115(98)00317-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [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: 11/21/2022]
Abstract
OBJECTIVE Mutated p53 and HER-2/neu play a role in the etiology of ovarian cancer. It is important to know whether the expression of these proteins is affected by platinum-containing chemotherapy. STUDY DESIGN Together with the cell proliferation markers Ki-67 and PCNA, the expression of p53 and HER-2/neu was assessed before and after chemotherapy. Paraffin-embedded tumor sections from 20 patients with ovarian cancer and four patients with benign disorders of the ovaries (controls) were analyzed. The expression of p53 was determined by the antibodies DO-1 and BP53-12. In addition to HER-2/neu and PCNA specific antibodies, MIB-1 was used to detect Ki-67. RESULTS The expression of all markers was higher in ovarian cancer patients than in non-malignant controls. MIB-1 showed a significant increase of expression after chemotherapy (P=0.002). HER-2/neu, p53 and PCNA also showed a clear increase after treatment, but this was not statistically significant. HER-2/neu is of prognostic relevance with respect to the response to chemotherapy (P=0.005) and survival (P=0.0002). CONCLUSION The different markers tested all increase after chemotherapy, but the differences are not statistically significant. Low HER-2/neu expression correlates with good outcome at second look.
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Affiliation(s)
- H W Nijman
- Department of Obstetrics and Gynaecology, Vrije Universiteit Amsterdam, Academic Hospital, The Netherlands
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Snijdewint FGM, von Mensdorff-Pouilly S, Karuntu-Wanamarta AH, Verstraeten AA, van Zanten-Przybysz I, Hummel P, Nijman HW, Kenemans P, Hilgers J. Cellular and humoral immune responses to MUC1 mucin and tandem-repeat peptides in ovarian cancer patients and controls. Cancer Immunol Immunother 1999; 48:47-55. [PMID: 10235488 PMCID: PMC11037177 DOI: 10.1007/s002620050547] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The objective of this study was to demonstrate the presence of proliferative T cell responses to human polymorphic epithelial mucin (MUC1) and its tandem-repeat peptides in peripheral blood mononuclear cells (PBMC) from ovarian cancer patients and from controls and to correlate these cellular responses to a humoral response to MUC1. PBMC were obtained from 6 healthy women, from 13 women in the third trimester of pregnancy and from 21 ovarian cancer patients. Only 1 of the 6 healthy women showed a weak primary proliferative response (stimulation index, SI <2) to a 20-mer MUC1 tandem-repeat peptide in the presence of interleukin-2 (IL-2). In PBMC from 5/13 pregnant women (38%) a weak response could be induced by the 20-mer and/or 60-mer tandem-repeat peptides (SI < or =3.0) and in PBMC from 8/15 ovarian cancer patients (53%) 20-mer and/or 60-mer MUC1 tandem-repeat peptides induced primary responses (SI < or =5.4). MUC1 mucin purified from a breast tumor cell line and/or from urine of a healthy donor had a relatively strong stimulating effect (SI < or =19) on PBMC from 4 of 16 ovarian cancer patients (25%). In contrast, in PBMC of 9 ovarian cancer patients stimulated by the addition of a Candida albicans extract, MUC1 mucin strongly inhibited proliferation. This inhibition could partially be abrogated by the addition of IL-2. MUC1 (CA 15.3 assay) and free circulating MUC1 IgG and IgM antibodies (PEM.CIg assay) were determined in the plasma of all subjects. The MUC1 and the free circulating MUC1 IgG antibody plasma levels were significantly higher in the ovarian cancer patients than in the healthy women. Although no significant correlations were found between MUC1 mucin, MUC1 Ab plasma levels and the individual proliferative responses to the MUC1 antigens, an association may exist between them, since all three are significantly higher in the ovarian cancer patients than in the healthy women.
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Affiliation(s)
- F. G. M. Snijdewint
- Department of Obstetrics and Gynaecology, Academic Hospital Vrije Universiteit, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands Tel.: +3120–4444817, Fax: +3120–4444818, , , , NL
| | - S. von Mensdorff-Pouilly
- Department of Obstetrics and Gynaecology, Academic Hospital Vrije Universiteit, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands Tel.: +3120–4444817, Fax: +3120–4444818, , , , NL
| | - A. H. Karuntu-Wanamarta
- Department of Obstetrics and Gynaecology, Academic Hospital Vrije Universiteit, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands Tel.: +3120–4444817, Fax: +3120–4444818, , , , NL
| | - A. A. Verstraeten
- Department of Obstetrics and Gynaecology, Academic Hospital Vrije Universiteit, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands Tel.: +3120–4444817, Fax: +3120–4444818, , , , NL
| | - I. van Zanten-Przybysz
- Department of Obstetrics and Gynaecology, Academic Hospital Vrije Universiteit, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands Tel.: +3120–4444817, Fax: +3120–4444818, , , , NL
| | - P. Hummel
- Department of Obstetrics and Gynaecology, Academic Hospital Vrije Universiteit, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands Tel.: +3120–4444817, Fax: +3120–4444818, , , , NL
| | - H. W. Nijman
- Department of Obstetrics and Gynaecology, Academic Hospital Vrije Universiteit, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands Tel.: +3120–4444817, Fax: +3120–4444818, , , , NL
| | - P. Kenemans
- Department of Obstetrics and Gynaecology, Academic Hospital Vrije Universiteit, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands Tel.: +3120–4444817, Fax: +3120–4444818, , , , NL
| | - J. Hilgers
- Department of Obstetrics and Gynaecology, Academic Hospital Vrije Universiteit, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands Tel.: +3120–4444817, Fax: +3120–4444818, , , , NL
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Vierboom MP, Nijman HW, Offringa R, van der Voort EI, van Hall T, van den Broek L, Fleuren GJ, Kenemans P, Kast WM, Melief CJ. Tumor eradication by wild-type p53-specific cytotoxic T lymphocytes. J Exp Med 1997; 186:695-704. [PMID: 9271585 PMCID: PMC2199025 DOI: 10.1084/jem.186.5.695] [Citation(s) in RCA: 160] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The tumor suppressor protein p53 is overexpressed in close to 50% of all human malignancies. The p53 protein is therefore an attractive target for immunotherapy. Cytotoxic T lymphocytes (CTLs) recognizing a murine wild-type p53 peptide, presented by the major histocompatibility complex class I molecule H-2Kb, were generated by immunizing p53 gene deficient (p53 -/-) C57BL/6 mice with syngeneic p53-overexpressing tumor cells. Adoptive transfer of these CTLs into tumor-bearing p53 +/+ nude mice caused complete and permanent tumor eradication. Importantly, this occurred in the absence of any demonstrable damage to normal tissue. When transferred into p53 +/+ immunocompetent C57BL/6 mice, the CTLs persisted for weeks in the absence of immunopathology and were capable of preventing tumor outgrowth. Wild-type p53-specific CTLs can apparently discriminate between p53-overexpressing tumor cells and normal tissue, indicating that widely expressed autologous molecules such as p53 can serve as a target for CTL-mediated immunotherapy of tumors.
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Affiliation(s)
- M P Vierboom
- Department of Immunohematology and Blood Bank, University Hospital Leiden, 2300 RC Leiden, the Netherlands
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33
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Vennegoor CJ, Nijman HW, Drijfhout JW, Vernie L, Verstraeten RA, von Mensdorff-Pouilly S, Hilgers J, Verheijen RH, Kast WM, Melief CJ, Kenemans P. Autoantibodies to p53 in ovarian cancer patients and healthy women: a comparison between whole p53 protein and 18-mer peptides for screening purposes. Cancer Lett 1997; 116:93-101. [PMID: 9177463 DOI: 10.1016/s0304-3835(97)00168-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Autoantibodies against complete p53 protein and 18-mer peptides of p53 in ovarian cancer patients and healthy women were examined. Sera from 9% (4/46) of ovarian cancer patients but none (0/51) of healthy women recognized complete p53 protein. The antibodies were mainly of the IgG1 isotype. Two patients had also IgG2 antibodies. Sera from 28% (13/46) of cancer patients and 21% (11/52) of healthy women contained either IgM, or IgM plus IgG2 antibodies against 18-mer p53 peptides. Screening against complete p53 protein instead of peptides seems necessary for identifying patients with tumor-related antibodies. IgG2 antibodies against p53 suggest p53-specific CD4+ T helper 1 cell activity in some of the ovarian cancer patients.
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Affiliation(s)
- C J Vennegoor
- Department of Obstetrics and Gynecology, University Hospital Vrije Universiteit, Amsterdam, The Netherlands.
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34
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Röpke M, Hald J, Guldberg P, Zeuthen J, Nørgaard L, Fugger L, Svejgaard A, Van der Burg S, Nijman HW, Melief CJ, Claesson MH. Spontaneous human squamous cell carcinomas are killed by a human cytotoxic T lymphocyte clone recognizing a wild-type p53-derived peptide. Proc Natl Acad Sci U S A 1996; 93:14704-7. [PMID: 8962118 PMCID: PMC26199 DOI: 10.1073/pnas.93.25.14704] [Citation(s) in RCA: 95] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/1996] [Accepted: 09/20/1996] [Indexed: 02/03/2023] Open
Abstract
A cytotoxic T lymphocyte (CTL) clone generated in vitro from the peripheral blood of a healthy HLA-A2-positive individual against a synthetic p53 protein-derived wild-type peptide (L9V) was shown to kill squamous carcinoma cell lines derived from two head and neck carcinomas, which expressed mutant p53 genes, in a L9V/HLA-A2 specific and restricted fashion. Thus, the normal tolerance against endogenously processed p53 protein-derived self-epitopes can be broken by peptide-specific in vitro priming. p53 protein-derived wild-type peptides might thus represent tumor associated target molecules for immunotherapeutical approaches.
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Affiliation(s)
- M Röpke
- Department of Medical Anatomy, Panum Institute, University of Copenhagen, Denmark
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35
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Abstract
Antigen-presenting cells contain a specialized late endocytic compartment, MIIC (major histocompatibility complex [MHC] class II-enriched compartment), that harbors newly synthesized MHC class II molecules in transit to the plasma membrane. MIICs have a limiting membrane enclosing characteristic internal membrane vesicles. Both the limiting membrane and the internal vesicles contain MHC class II. In this study on B lymphoblastoid cells, we demonstrate by immunoelectron microscopy that the limiting membrane of MIICs can fuse directly with the plasma membrane, resulting in release from the cells of internal MHC class II-containing vesicles. These secreted vesicles, named exosomes, were isolated from the cell culture media by differential centrifugation followed by flotation on sucrose density gradients. The overall surface protein composition of exosomes differed significantly from that of the plasma membrane. Exosome-bound MHC class II was in a compact, peptide-bound conformation. Metabolically labeled MHC class II was released into the extracellular medium with relatively slow kinetics, 10 +/- 4% in 24 h, indicating that direct fusion of MIICs with the plasma membrane is not the major pathway by which MHC class II reaches the plasma membrane. Exosomes derived from both human and murine B lymphocytes induced antigen-specific MHC class II-restricted T cell responses. These data suggest a role for exosomes in antigen presentation in vivo.
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Affiliation(s)
- G Raposo
- Department of Cell Biology, Faculty of Medicine and Institute for Biomembranes, Utrecht University, The Netherlands
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36
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Nijman HW, Kleijmeer MJ, Ossevoort MA, Oorschot VM, Vierboom MP, van de Keur M, Kenemans P, Kast WM, Geuze HJ, Melief CJ. Antigen capture and major histocompatibility class II compartments of freshly isolated and cultured human blood dendritic cells. J Exp Med 1995; 182:163-74. [PMID: 7790816 PMCID: PMC2192095 DOI: 10.1084/jem.182.1.163] [Citation(s) in RCA: 145] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Dendritic cells (DC) represent potent antigen-presenting cells for the induction of T cell-dependent immune responses. Previous work on antigen uptake and presentation by human DC is based largely on studies of blood DC that have been cultured for various periods of time before analysis. These cultured cells may therefore have undergone a maturation process from precursors that have different capacities for antigen capture and presentation. We have now used immunoelectron microscopy and antigen presentation assays to compare freshly isolated DC (f-DC) and cultured DC (c-DC). f-DC display a round appearance, whereas c-DC display characteristic long processes. c-DC express much more cell surface major histocompatibility complex (MHC) class II than f-DC. The uptake of colloidal gold-labeled bovine serum albumin (BSA), however, is greater in f-DC, as is the presentation of 65-kD heat shock protein to T cell clones. The most striking discovery is that the majority of MHC class II molecules in both f-DC and c-DC occur in intracellular vacuoles with a complex shape (multivesicular and multilaminar). These MHC class II enriched compartments (MIIC) represent the site to which BSA is transported within 30 min. Although MIIC appear as more dense structures with less MHC class II molecules in f-DC than c-DC, the marker characteristics are very similar. The MIIC in both types of DC are acidic, contain invariant chain, and express the recently described HLA-DM molecule that can contribute to antigen presentation. CD19+ peripheral blood B cells have fewer MIIC and surface MHC class II expression than DCs, while monocytes had low levels of MIIC and surface MHC class II. These results demonstrate in dendritic cells the elaborate development of MIIC expressing several of the components that are required for efficient antigen presentation.
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Affiliation(s)
- H W Nijman
- Department of Immunohematology and Blood Bank, Academic Hospital Leiden, The Netherlands
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37
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Van Elsas A, Nijman HW, Van der Minne CE, Mourer JS, Kast WM, Melief CJ, Schrier PI. Induction and characterization of cytotoxic T-lymphocytes recognizing a mutated p21ras peptide presented by HLA-A*0201. Int J Cancer 1995; 61:389-96. [PMID: 7729952 DOI: 10.1002/ijc.2910610319] [Citation(s) in RCA: 58] [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] [Indexed: 01/26/2023]
Abstract
The ras oncogene is frequently found to be activated in human cancer through point mutations at codons 12, 13 or 61. We explored whether these altered p21ras protein sequences contain peptide sequences that can activate naive CD8+ cytotoxic T lymphocytes (CTL). Several wild-type and mutated p21ras peptides were identified that carry a binding motif for human leukocyte antigen (HLA)-A*0201. Two peptides were found to bind strongly to this allele. CD8+ CTL bulk cultures specifically reacting with one of these peptides could be induced, using processing-defective T2 cells loaded with peptide CLLDILDTAGL as stimulators. The peptide is derived from p21ras, position 51-61, and carries a 61 Gln-->Leu mutation. In contrast, a 9-mer peptide CLLDILDTA corresponding to amino acid sequence 51-59 of wild-type p21ras did not yield reactive CTL cultures. T-cell clones with low affinity for the 11-mer peptide were isolated from CLLDILDTAGL-reactive bulk cultures. These T cells did not lyse melanoma cells transfected with 61-Leu N-ras, although lysis was found when these transfectants were pulsed with the 11-mer peptide. Possibly, T cells of higher affinity may be required to demonstrate processed peptide on the cell surface. The combined experiments suggest that a peptide derived from mutated p21ras can be recognized by HLA class I-restricted CTL, whereas an analogous wild-type p21ras peptide may not be immunogenic.
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Affiliation(s)
- A Van Elsas
- Department of Clinical Oncology, University Hospital, Leiden, The Netherlands
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38
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Ossevoort MA, Kleijmeer MJ, Nijman HW, Geuze HJ, Kast WM, Melief CJ. Functional and ultrastructural aspects of antigen processing by dendritic cells. Adv Exp Med Biol 1995; 378:227-31. [PMID: 8526062 DOI: 10.1007/978-1-4615-1971-3_51] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- M A Ossevoort
- Department of Immunohematology, Academic Hospital Leiden, The Netherlands
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39
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Abstract
Cell lineage-specific cellular proteins, oncogenes from viral or cellular origin and tumor suppressor genes encode tumor-specific/associated antigens. Such antigens can elicit an major compatibility complex (MHC) class I-restricted cytotoxic T lymphocyte (CTL) response, either naturally in cancer patients or following appropriate immunostimulation (in vitro or in vivo). The reported immune responses in humans to the melanoma-associated MAGE gene products, GP100 and tyrosinase, all self-proteins, support the idea to use wild-type p53 products as targets for T cells. An important step towards this goal is identification of potential p53 CTL epitopes. We identified the wild-type p53 peptides with the highest affinity to the HLA-A*0201 molecule using two assays: the previously described MHC peptide-binding assay and the peptide competition assay. We obtained CTL against four p53 peptides with a high affinity for the HLA-A*0201 molecule. These findings are discussed next to a short review concerning the p53 literature.
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Affiliation(s)
- H W Nijman
- Department of Immunohaematology and Blood Bank, University Hospital, Leiden, The Netherlands
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40
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Houbiers JG, Nijman HW, van der Burg SH, Drijfhout JW, Kenemans P, van de Velde CJ, Brand A, Momburg F, Kast WM, Melief CJ. In vitro induction of human cytotoxic T lymphocyte responses against peptides of mutant and wild-type p53. Eur J Immunol 1993; 23:2072-7. [PMID: 8370389 DOI: 10.1002/eji.1830230905] [Citation(s) in RCA: 182] [Impact Index Per Article: 5.9] [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: 01/30/2023]
Abstract
The central role of the p53 tumor suppressor gene product in oncogenesis is gradually being clarified. Point mutations in the p53 tumor suppressor gene are common in most human cancers and are often associated with p53 protein overexpression. Overexpressed wild-type or mutant determinants of the p53 protein thus represent an attractive target for immunotherapy of cancer directed against a structure involved in malignant transformation. An important step towards this goal is identification of epitopes of p53 that can be recognized by human cytotoxic T lymphocytes. We identified peptides of (mutant) p53 capable of binding to HLA-A2.1 in an in vitro assay. These HLA-A2.1-binding peptides were utilized for in vitro induction of primary cytotoxic T lymphocyte responses using a human processing-defective cell line (174CEM.T2) as antigen-presenting cell. These cells display "empty" HLA class I surface molecules, that can efficiently be loaded with a single peptide. We obtained CD8+ cytotoxic T lymphocyte clones capable of specifically lysing target cells loaded with wild-type or tumor-specific mutant p53 peptides. This strategy allows the in vitro initiation of human cytotoxic T lymphocyte responses against target molecules of choice.
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Affiliation(s)
- J G Houbiers
- Department of Immunohaematology and Blood Bank, University Hospital, Leiden, The Netherlands
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41
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Nijman HW, Houbiers JG, van der Burg SH, Vierboom MP, Kenemans P, Kast WM, Melief CJ. Characterization of cytotoxic T lymphocyte epitopes of a self-protein, p53, and a non-self-protein, influenza matrix: relationship between major histocompatibility complex peptide binding affinity and immune responsiveness to peptides. J Immunother Emphasis Tumor Immunol 1993; 14:121-6. [PMID: 7506574] [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] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
We previously described a motif prediction of major histocompatibility complex allele-specific peptides and an in vitro assay for actual measurement of peptide binding to human leukocyte antigen HLA-A2.1 molecules. Using this method we have identified candidate cytotoxic T lymphocyte (CTL) epitopes derived from a non-self-protein (influenza matrix) and self-protein (p53). We now show that results of binding assays performed over a range of peptide concentrations indicate that distinct differences in HLA-A2.1 peptide binding affinities exist between the influenza matrix and p53 protein. The results for the influenza matrix protein indicate that the peptide that shows the highest binding affinity to HLA-A2.1 is identical to the known immunodominant peptide recognized by influenza virus-specific CTLs. The results for p53 indicate that one of the peptides with a low binding affinity is capable of inducing specific CTL responses, but CTLs recognizing the highest affinity binding peptides were not obtained. These findings are discussed in terms of the distinct implications for induction of cellular immune responses directed against peptides with different binding affinities for HLA-A2.1 of proteins that constitute attractive targets for tumor immunotherapy.
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Affiliation(s)
- H W Nijman
- Department of Immunohaematology, University Hospital, Leiden, The Netherlands
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42
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Nijman HW, Houbiers JG, Vierboom MP, van der Burg SH, Drijfhout JW, D'Amaro J, Kenemans P, Melief CJ, Kast WM. Identification of peptide sequences that potentially trigger HLA-A2.1-restricted cytotoxic T lymphocytes. Eur J Immunol 1993; 23:1215-9. [PMID: 7684681 DOI: 10.1002/eji.1830230603] [Citation(s) in RCA: 159] [Impact Index Per Article: 5.1] [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: 01/26/2023]
Abstract
We used the human processing defective cell line 174CEM.T2 (T2) to identify potential cytotoxic T lymphocyte (CTL) epitopes of human proteins. Exogenously added peptides can increase the number of properly folded HLA-A2.1 molecules on the cell surface of T2 cells, as shown by immunofluorescence measurements using the mouse monoclonal antibody BB7.2 (anti-HLA-A2.1) and fluorescein isothiocyanate-labeled goat anti-mouse F(ab')2 antibody. The peptides were selected on the basis of a computer score derived from the recently described HLA-A2.1 specific motif. Analysis of the influenza matrix protein showed that 15 out of 35 high-scoring peptides up-regulate the expression of HLA-A2.1 molecules on the T2 cell surface. The combination of the computer scoring program and an immunofluorescence-based peptide binding assay allows rapid detection of potential CTL target peptides.
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Affiliation(s)
- H W Nijman
- Department of Immunohematology and Blood Bank, University Hospital, Leiden, The Netherlands
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43
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Molthoff CF, Pinedo HM, Schlüper HM, Nijman HW, Boven E. Comparison of the pharmacokinetics, biodistribution and dosimetry of monoclonal antibodies OC125, OV-TL 3, and 139H2 as IgG and F(ab')2 fragments in experimental ovarian cancer. Br J Cancer 1992; 65:677-83. [PMID: 1586596 PMCID: PMC1977382 DOI: 10.1038/bjc.1992.144] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Monoclonal antibody (MAb) 139H2 was previously shown to localise specifically into ovarian cancer xenografts in nude mice. MAb 139H2 was compared with MAbs OC125 and OV-TL 3, all reactive with ovarian carcinomas, for the binding characteristics as IgG and F(ab')2 fragments with the use of the OVCAR-3 cell line grown in vitro and as s.c. xenografts. Immunoperoxidase staining of OVCAR-3 tissue sections with MAbs OC125 and 139H2 was heterogeneous, whereas MAb OV-TL 3 showed homogeneity. No differences in binding were observed between IgG and F(ab')2. The avidity expressed as apparent affinity constants of MAbs OC125, OV-TL 3 and 139H2 for OVAR-3 cells were 1 x 10(9) M-1, 1 x 10(9) M-1, and 1 x 10(8) M-1, while the number of antigenic determinants were 5 x 10(6), 1 x 10(6) and 7 x 10(6), respectively. In OVCAR-3 bearing nude mice the blood half-lives of the MAbs as IgG and F(ab')2 were approximately 50 h and 6 h, respectively. Maximum tumour uptake for the whole MAbs OC125, OV-TL 3, 139H2 and a control MAb 2C7 was 8.5%, 17.7%, 11.1% and 2.5% of the injected dose g-1, reached at 72 h after injection. For the respective F(ab')2 fragments, the maximum values were 5.2%, 10.0%, 5.5% and 1.9% of the injected dose g-1, reached between 6 h and 15 h. Tumour to non-tumour ratios were more favourable for the F(ab')2 fragments as compared to those for MAbs as IgG. Biodistribution in mice bearing a control tumour confirmed the specificity of tumour localisation of MAbs OC125, OV-TL 3 and 139H2. After injection of a tracer dose of 10 microCi of radiolabelled MAbs OC125, OV-TL 3 and 139H2 as IgG, tumours received 38 cGy, and 9 cGy. In our OVCAR-3 model, a ranking in efficiency in tumour localisation would indicate MAb OV-TL 3 as most favourable MAb, but cross-reactivity with subpopulations of human white blood cells might hamper its clinical use. Dosimetric data indicate a 4-fold higher radiation absorbed dose to tumours for IgG compared with F(ab')2 fragments.
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Affiliation(s)
- C F Molthoff
- Department of Oncology, Free University Hospital, Amsterdam, The Netherlands
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Nijman HW, Burger CW, Baak JP, Schats R, Vermorken JB, Kenemans P. Borderline malignancy of the ovary and controlled hyperstimulation, a report of 2 cases. Eur J Cancer 1992; 28A:1971-3. [PMID: 1419292 DOI: 10.1016/0959-8049(92)90240-3] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.5] [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: 12/26/2022]
Abstract
We report 2 patients who developed a borderline malignancy of the ovary after treatment with follicular stimulants in the context of an in vitro fertilisation (IVF) programme. In both cases, conservative surgery for the borderline malignancy was sufficient treatment. Ultimately, both patients became pregnant, 1 after IVF treatment and 1 without treatment, and both delivered healthy babies. In addition to the presentation of both cases, the literature concerning the possible risks of treating patients with high dosage, exogenously administered hormones is reviewed and the possible association between exogenous hormones and the risk of developing ovarian cancer is discussed.
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Affiliation(s)
- H W Nijman
- Department of Obstetrics and Gynaecology, Academic Hospital Free University, Amsterdam
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45
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Baars JW, Wagstaff J, Boven E, Vermorken JB, van Groeningen CJ, Scheper RJ, Fonk JC, Nijman HW, Franks CR, Damsma O. Phase I study on the sequential administration of recombinant human interferon-gamma and recombinant human interleukin-2 in patients with metastatic solid tumors. J Natl Cancer Inst 1991; 83:1408-10. [PMID: 1920484 DOI: 10.1093/jnci/83.19.1408] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- J W Baars
- Department of Medical Oncology, Free University Hospital, Amsterdam, The Netherlands
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