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Eltahir M, Fletcher E, Dynesius L, Jarblad JL, Lord M, Laurén I, Zekarias M, Yu X, Cragg MS, Hammarström C, Levedahl KH, Höglund M, Ullenhag G, Mattsson M, Mangsbo SM. Profiling of donor-specific immune effector signatures in response to rituximab in a human whole blood loop assay using blood from CLL patients. Int Immunopharmacol 2021; 90:107226. [PMID: 33316742 DOI: 10.1016/j.intimp.2020.107226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 11/04/2020] [Accepted: 11/18/2020] [Indexed: 12/27/2022]
Abstract
Rituximab is widely used in the treatment of haematological malignancies, including chronic lymphocytic leukaemia (CLL), the most common leukaemia in adults. However, some patients, especially those with high tumour burden, develop cytokine release syndrome (CRS). It is likely that more patients will develop therapy-linked CRS in the future due to the implementation of other immunotherapies, such as CAR T-cell, for many malignancies. Current methods for CRS risk assessment are limited, hence there is a need to develop new methods. To better recapitulate an in vivo setting, we implemented a unique human whole blood "loop" system to study patient-specific immune responses to rituximab in blood derived from CLL patients. Upon rituximab infusion, both complement-dependent cytotoxicity (CDC) and antibody-dependent cellular cytotoxicity (ADCC) profiles were evident in CLL patient blood, coincident with CLL cell depletion. Whereas B cell depletion is induced in healthy persons in the blood loop, only patients display B cell depletion coupled with CRS. With the exception of one donor who lacked NK cells, all other five patients displayed variable B cell depletion along with CRS profile. Additionally, inhibition of CDC or ADCC via either inhibitors or antibody Fc modification resulted in skewing of the immune killing mechanism consistent with published literature. Herein we have shown that the human whole blood loop model can be applied using blood from a specific indication to build a disease-specific CRS and immune activation profiling ex vivo system. Other therapeutic antibodies used for other indications may benefit from antibody characterization in a similar setting.
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MESH Headings
- Aged
- Aged, 80 and over
- Antineoplastic Agents, Immunological/therapeutic use
- Antirheumatic Agents
- B-Lymphocytes/immunology
- Blood Cell Count
- Complement Activation
- Cytokine Release Syndrome/etiology
- Cytokine Release Syndrome/immunology
- Cytokines/blood
- Cytotoxicity, Immunologic
- Female
- Humans
- Immunoglobulin Fc Fragments/immunology
- Killer Cells, Natural
- Leukemia, Lymphocytic, Chronic, B-Cell/complications
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/immunology
- Leukocyte Count
- Male
- Rituximab/therapeutic use
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Affiliation(s)
- M Eltahir
- Department of Pharmaceutical Biosciences, Science for Life Laboratory, Uppsala University, Uppsala, Sweden; Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | | | | | | | - M Lord
- Department of Pharmaceutical Biosciences, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - I Laurén
- Department of Pharmaceutical Biosciences, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - M Zekarias
- Department of Pharmaceutical Biosciences, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - X Yu
- Antibody and Vaccine Group, Centre for Cancer Immunology, School of Cancer Sciences, University of Southampton, Faculty of Medicine, Southampton, UK
| | - M S Cragg
- Antibody and Vaccine Group, Centre for Cancer Immunology, School of Cancer Sciences, University of Southampton, Faculty of Medicine, Southampton, UK
| | | | - K H Levedahl
- Department of Haematology, Uppsala University Hospital; Department of Public Health and Caring Sciences, Uppsala University, Sweden
| | - M Höglund
- Department of Haematology, Uppsala University Hospital
| | - G Ullenhag
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden; Department of Oncology, Uppsala University Hospital, Uppsala, Sweden
| | - M Mattsson
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden; Department of Haematology, Uppsala University Hospital
| | - S M Mangsbo
- Department of Pharmaceutical Biosciences, Science for Life Laboratory, Uppsala University, Uppsala, Sweden.
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