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Ma P, Liu J, Qin J, Lai L, Heo GS, Luehmann H, Sultan D, Bredemeyer A, Bajapa G, Feng G, Jimenez J, He R, Parks A, Amrute J, Villanueva A, Liu Y, Lin CY, Mack M, Amancherla K, Moslehi J, Lavine KJ. Expansion of Pathogenic Cardiac Macrophages in Immune Checkpoint Inhibitor Myocarditis. Circulation 2024; 149:48-66. [PMID: 37746718 DOI: 10.1161/circulationaha.122.062551] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 08/28/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Immune checkpoint inhibitors (ICIs), antibodies targeting PD-1 (programmed cell death protein 1)/PD-L1 (programmed death-ligand 1) or CTLA4 (cytotoxic T-lymphocyte-associated protein 4), have revolutionized cancer management but are associated with devastating immune-related adverse events including myocarditis. The main risk factor for ICI myocarditis is the use of combination PD-1 and CTLA4 inhibition. ICI myocarditis is often fulminant and is pathologically characterized by myocardial infiltration of T lymphocytes and macrophages. Although much has been learned about the role of T-cells in ICI myocarditis, little is understood about the identity, transcriptional diversity, and functions of infiltrating macrophages. METHODS We used an established murine ICI myocarditis model (Ctla4+/-Pdcd1-/- mice) to explore the cardiac immune landscape using single-cell RNA-sequencing, immunostaining, flow cytometry, in situ RNA hybridization, molecular imaging, and antibody neutralization studies. RESULTS We observed marked increases in CCR2 (C-C chemokine receptor type 2)+ monocyte-derived macrophages and CD8+ T-cells in this model. The macrophage compartment was heterogeneous and displayed marked enrichment in an inflammatory CCR2+ subpopulation highly expressing Cxcl9 (chemokine [C-X-C motif] ligand 9), Cxcl10 (chemokine [C-X-C motif] ligand 10), Gbp2b (interferon-induced guanylate-binding protein 2b), and Fcgr4 (Fc receptor, IgG, low affinity IV) that originated from CCR2+ monocytes. It is important that a similar macrophage population expressing CXCL9, CXCL10, and CD16α (human homologue of mouse FcgR4) was expanded in patients with ICI myocarditis. In silico prediction of cell-cell communication suggested interactions between T-cells and Cxcl9+Cxcl10+ macrophages via IFN-γ (interferon gamma) and CXCR3 (CXC chemokine receptor 3) signaling pathways. Depleting CD8+ T-cells or macrophages and blockade of IFN-γ signaling blunted the expansion of Cxcl9+Cxcl10+ macrophages in the heart and attenuated myocarditis, suggesting that this interaction was necessary for disease pathogenesis. CONCLUSIONS These data demonstrate that ICI myocarditis is associated with the expansion of a specific population of IFN-γ-induced inflammatory macrophages and suggest the possibility that IFN-γ blockade may be considered as a treatment option for this devastating condition.
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Affiliation(s)
- Pan Ma
- Cardiovascular Division, Department of Medicine (P.M., J.L., A.B., G.B., G.F., J.J., R.H., A.P., J.A., K.J.L.), Washington University School of Medicine, St Louis, MO
| | - Jing Liu
- Cardiovascular Division, Department of Medicine (P.M., J.L., A.B., G.B., G.F., J.J., R.H., A.P., J.A., K.J.L.), Washington University School of Medicine, St Louis, MO
| | - Juan Qin
- Division of Cardiology, Department of Medicine, University of California San Francisco (J.Q., J.M.)
| | - Lulu Lai
- Department of Pathology and Immunology (L.L., A.V., C.-Y.L., K.J.L.), Washington University School of Medicine, St Louis, MO
| | - Gyu Seong Heo
- Mallinckrodt Institute of Radiology (G.S.H., H.L., D.S., Y.L.), Washington University School of Medicine, St Louis, MO
| | - Hannah Luehmann
- Department of Pathology and Immunology (L.L., A.V., C.-Y.L., K.J.L.), Washington University School of Medicine, St Louis, MO
| | - Deborah Sultan
- Mallinckrodt Institute of Radiology (G.S.H., H.L., D.S., Y.L.), Washington University School of Medicine, St Louis, MO
| | - Andrea Bredemeyer
- Cardiovascular Division, Department of Medicine (P.M., J.L., A.B., G.B., G.F., J.J., R.H., A.P., J.A., K.J.L.), Washington University School of Medicine, St Louis, MO
| | - Geetika Bajapa
- Cardiovascular Division, Department of Medicine (P.M., J.L., A.B., G.B., G.F., J.J., R.H., A.P., J.A., K.J.L.), Washington University School of Medicine, St Louis, MO
| | - Guoshuai Feng
- Cardiovascular Division, Department of Medicine (P.M., J.L., A.B., G.B., G.F., J.J., R.H., A.P., J.A., K.J.L.), Washington University School of Medicine, St Louis, MO
| | - Jesus Jimenez
- Cardiovascular Division, Department of Medicine (P.M., J.L., A.B., G.B., G.F., J.J., R.H., A.P., J.A., K.J.L.), Washington University School of Medicine, St Louis, MO
| | - Ruijun He
- Cardiovascular Division, Department of Medicine (P.M., J.L., A.B., G.B., G.F., J.J., R.H., A.P., J.A., K.J.L.), Washington University School of Medicine, St Louis, MO
| | - Antanisha Parks
- Cardiovascular Division, Department of Medicine (P.M., J.L., A.B., G.B., G.F., J.J., R.H., A.P., J.A., K.J.L.), Washington University School of Medicine, St Louis, MO
| | - Junedh Amrute
- Cardiovascular Division, Department of Medicine (P.M., J.L., A.B., G.B., G.F., J.J., R.H., A.P., J.A., K.J.L.), Washington University School of Medicine, St Louis, MO
| | - Ana Villanueva
- Department of Pathology and Immunology (L.L., A.V., C.-Y.L., K.J.L.), Washington University School of Medicine, St Louis, MO
| | - Yongjian Liu
- Mallinckrodt Institute of Radiology (G.S.H., H.L., D.S., Y.L.), Washington University School of Medicine, St Louis, MO
| | - Chieh-Yu Lin
- Department of Pathology and Immunology (L.L., A.V., C.-Y.L., K.J.L.), Washington University School of Medicine, St Louis, MO
| | - Matthias Mack
- Department of Internal Medicine II - Nephrology, Universitatsklinikum Regensburg Klinik und Poliklinik Innere Medizin II, Regensburg, Germany (M.M.)
| | - Kaushik Amancherla
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN (K.A.)
| | - Javid Moslehi
- Division of Cardiology, Department of Medicine, University of California San Francisco (J.Q., J.M.)
| | - Kory J Lavine
- Cardiovascular Division, Department of Medicine (P.M., J.L., A.B., G.B., G.F., J.J., R.H., A.P., J.A., K.J.L.), Washington University School of Medicine, St Louis, MO
- Department of Pathology and Immunology (L.L., A.V., C.-Y.L., K.J.L.), Washington University School of Medicine, St Louis, MO
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Lin X, Li F, Guan J, Wang X, Yao C, Zeng Y, Liu X. Janus Silica Nanoparticle-Based Tumor Microenvironment Modulator for Restoring Tumor Sensitivity to Programmed Cell Death Ligand 1 Immune Checkpoint Blockade Therapy. ACS Nano 2023; 17:14494-14507. [PMID: 37485850 DOI: 10.1021/acsnano.3c01019] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
An immunosuppressive tumor microenvironment (TME) with inadequate and exhausted tumor-infiltrating cytotoxic lymphocytes and abundant cellular immunosuppressors is the major obstacle responsible for the poor efficacy of PD-1/PD-L1 (programmed cell death 1 and its ligand 1) immune checkpoint blockade (ICB) therapy. Herein, a Janus silica nanoparticle (JSNP)-based immunomodulator is explored to reshape the TME for boosting the therapeutic outcomes of αPD-L1 therapy. The designed JSNP has two distinct domains, namely, an ultra pH-responsive side (UPS), which could encapsulate PI3Kγ inhibitor IPI549 in the pore structure, and a polycation-grafted intra-glutathione (GSH)-sensitive side (IGS), which could absorb CXCL9 cDNA on the surface. The final IPI549@UPS-IGS-PDMAEMA@CXCL9 cDNA (IUIPC) could release IPI549 in weak acid TME to target myeloid-derived suppressor cells (MDSCs) to reverse negative immunoregulation and then release CXCL9 cDNA in tumor cells with abundant GSH for sustained CXCL9 chemokine expression and secretion to improve cytotoxic lymphocyte recruitment signals, thereby jointly restoring tumor sensitivity to PD-1/PD-L1 ICB therapy. As expected, the IUIPC-mediated TME remodeling during αPD-L1 therapy significantly ameliorated TME immunosuppression, as well as induced potent systemic antitumor immune responses, which ultimately achieved a robustly boosted antitumor efficacy proven by remarkable suppression of primary tumor growth, obvious prevention of tumor recurrence, and significant regression of abscopal tumors. Hence, the IUIPC-mediated TME-regulating strategy provides an enormous perspective for the improvement of PD-1/PD-L1 ICB therapy.
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Affiliation(s)
- Xinyi Lin
- The United Innovation of Mengchao Hepatobiliary Technology Key Laboratory of Fujian Province, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou 350025, P. R. China
- Fujian Provincial Clinical Research Center for Hepatobiliary and Pancreatic Tumors, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou 350025, P. R. China
- Key Laboratory of Biomedical Information Engineering of Ministry of Education, Institute of Biomedical Photonics and Sensing, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an 710049, P. R. China
| | - Feida Li
- The United Innovation of Mengchao Hepatobiliary Technology Key Laboratory of Fujian Province, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou 350025, P. R. China
- School of Life Sciences, Fujian Agriculture and Forestry University, Fuzhou 350002, P. R. China
| | - Jianhua Guan
- The United Innovation of Mengchao Hepatobiliary Technology Key Laboratory of Fujian Province, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou 350025, P. R. China
- College of Biological Science and Engineering, Fuzhou University, Fuzhou 350116, P. R. China
| | - Xiaoyan Wang
- The United Innovation of Mengchao Hepatobiliary Technology Key Laboratory of Fujian Province, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou 350025, P. R. China
- School of Life Sciences, Fujian Agriculture and Forestry University, Fuzhou 350002, P. R. China
| | - Cuiping Yao
- Key Laboratory of Biomedical Information Engineering of Ministry of Education, Institute of Biomedical Photonics and Sensing, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an 710049, P. R. China
| | - Yongyi Zeng
- The United Innovation of Mengchao Hepatobiliary Technology Key Laboratory of Fujian Province, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou 350025, P. R. China
- Fujian Provincial Clinical Research Center for Hepatobiliary and Pancreatic Tumors, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou 350025, P. R. China
| | - Xiaolong Liu
- The United Innovation of Mengchao Hepatobiliary Technology Key Laboratory of Fujian Province, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou 350025, P. R. China
- Fujian Provincial Clinical Research Center for Hepatobiliary and Pancreatic Tumors, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou 350025, P. R. China
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