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Elder E, Bangalore Revanna C, Johansson C, Wallin RPA, Sjödahl J, Winqvist O, Mirazimi A. Protective immunity induced by an inhaled SARS-CoV-2 subunit vaccine. Vaccine 2023:S0264-410X(23)00684-9. [PMID: 37353452 PMCID: PMC10242152 DOI: 10.1016/j.vaccine.2023.06.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 10/07/2022] [Revised: 05/31/2023] [Accepted: 06/02/2023] [Indexed: 06/25/2023]
Abstract
Targeting the site of infection is a promising strategy for improving vaccine effectivity. To date, licensed COVID-19 vaccines have been administered intramuscularly despite the fact that SARS-CoV-2 is a respiratory virus. Here, we aim to induce local protective mucosal immune responses with an inhaled subunit vaccine candidate, ISR52, based on the SARS-CoV-2 Spike S1 protein. When tested in a lethal challenge hACE2 transgenic SARS-CoV-2 mouse model, intranasal and intratracheal administration of ISR52 provided superior protection against severe infection, compared to the subcutaneous injection of the vaccine. Interestingly for a protein-based vaccine, inhaled ISR52 elicited both CD4 and CD8 T-cell Spike-specific responses that were maintained for at least 6 months in wild-type mice. Induced IgG and IgA responses cross-reacting with several SARS- CoV-2 variants of concern were detected in the lung and in serum and protected animals displayed neutralizing antibodies. Based on our results, we are developing ISR52 as a dry powder formulation for inhalation, that does not require cold-chain distribution or the use of needle administration, for evaluation in a Phase I/II clinical trial.
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Affiliation(s)
| | | | | | | | | | | | - Ali Mirazimi
- National Veterinary Institute, Uppsala, Sweden; Clinical Microbiology, LABMED, Karolinska Institute, Sweden.
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2
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Hjalmarsson E, Petro M, Georén SK, Winqvist O, Cardell LO. Upregulated expression of Notch1/4 - JAG-1/DLL-1 detected in allergic rhinitis. Allergy Asthma Clin Immunol 2023; 19:41. [PMID: 37183251 PMCID: PMC10183115 DOI: 10.1186/s13223-023-00793-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 04/13/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND Allergic rhinitis (AR) is a chronic disease with high prevalence. There are currently many treatments available. However, despite an often good therapeutic response, many patients still report impairment in quality of life (QoL) during the pollen season. A skewed T helper (Th)2 polarization is a well-acknowledged pathologic feature of AR. In animal models, local notch signaling in peripheral tissue seems crucial for Th2 cell differentiation and the development of AR. However, the involvement of Notch signaling in Th2 cell differentiation and the development of AR in humans remains unknown. Hence, the present study investigated the human expression of Notch receptors on CD4+ T-cells in nasal mucosa and blood. Correspondingly Notch ligand expression was assessed on nasal epithelial cells and neutrophils. METHODOLOGY Nasal brush and blood samples from 18 patients with pollen-induced AR and 22 healthy controls were collected outside the pollen season. Notch 1-4 and Jagged-1,2 and Delta-like ligand 1,3-4 was analyzed using flow cytometry. RESULTS The fraction of CD4+Notch1+ and CD4+Notch4+ T-cells was higher in AR patients than in healthy control patients. Further, the expression levels of the Notch ligands JAG-1 and DLL-1 were increased in nasal epithelial cells from AR patients compared to healthy control patients. In addition, AR patients displayed higher expression of JAG-1 on neutrophils both in the nasal mucosa and in peripheral blood. CONCLUSION The present study is the first to demonstrate increased activity in the Notch1/4 - JAG-1/DLL-1 pathways among allergic individuals. Further propagating the importance of Notch signalling in AR and blocking JAG-1 and DLL-1-induced Notch signalling by nasal epithelial cells and Neutrophils are potential targets to reduce allergic airway inflammation.
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Affiliation(s)
- Eric Hjalmarsson
- Division of ENT Diseases, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Marianne Petro
- Division of ENT Diseases, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Susanna Kumlien Georén
- Division of ENT Diseases, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | | | - Lars Olaf Cardell
- Division of ENT Diseases, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
- Department of Otorhinolaryngology, Karolinska University Hospital, Stockholm, Sweden.
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Krifors A, Freyhult E, Rashid Teljebäck M, Wallin RPA, Winqvist O, Månsson E. Long-lasting T-cell response to SARS-CoV-2 antigens after vaccination-a prospective cohort study of HCWs working with COVID-19 patients. Infect Dis (Lond) 2023; 55:142-148. [PMID: 36369711 DOI: 10.1080/23744235.2022.2142662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Vaccination against SARS-CoV-2 reduces the risk of hospitalisation and death, but vaccine-induced IgG antibodies against the spike protein (IgG S) decline over time. Less is known about the nature of the vaccine-induced T-cell response to SARS-CoV-2 antigens. METHODS IgG antibodies against nucleocapsid protein (IgG N), IgG S, and T-cell response towards SARS-CoV-2 antigens were determined in samples taken between November 2020 and November 2021 from a cohort of healthcare workers at an Infectious Diseases Department. RT-PCR screening for SARS-CoV-2 was encouraged once every four weeks in addition to testing when symptomatic or identified through contact tracing. Vaccination data were collected at the end of the study. RESULTS At inclusion, T-cell response to SARS-CoV-2 antigens was found in 10/15 (66.7%) of participants with a previous/current COVID-19 infection and in 9/54 (16.7%) of participants with no prior/current history of COVID-19 infection. All participants with complete follow-up (n = 59) received two doses of a SARS-CoV-2 vaccine during the study. All participants demonstrated detectable IgG (S) antibodies at the end of the study, in median 278 days (IQR 112) after the second vaccine dose. All but four participants displayed T-cell responses towards SARS-CoV-2 antigens. IgG S antibody levels correlated with time since the second vaccine dose. In addition, previous COVID-19 infection and the strength of the S1 T-cell response correlated with IgG S antibody levels. However, no correlation was demonstrated between the strength of the T-cell response and time since the second vaccine dose. CONCLUSION COVID-19 vaccination induces robust T-cell responses that remain for at least nine months.
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Affiliation(s)
- Anders Krifors
- Department of Infectious Diseases, Västmanlands Hospital, Västerås, Sweden.,Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.,Centre of Clinical Research, Region Västmanland-Uppsala University, Västerås, Sweden
| | - Elisabeth Freyhult
- Department of Laboratory Medicine, Västmanlands Hospital, Västerås, Sweden
| | | | | | | | - Emeli Månsson
- Department of Infectious Diseases, Västmanlands Hospital, Västerås, Sweden.,Centre of Clinical Research, Region Västmanland-Uppsala University, Västerås, Sweden.,Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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4
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Saudi A, Banday V, Zirakzadeh AA, Selinger M, Forsberg J, Holmbom M, Henriksson J, Waldén M, Alamdari F, Aljabery F, Winqvist O, Sherif A. Immune-Activated B Cells Are Dominant in Prostate Cancer. Cancers (Basel) 2023; 15:cancers15030920. [PMID: 36765877 PMCID: PMC9913271 DOI: 10.3390/cancers15030920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 01/22/2023] [Accepted: 01/29/2023] [Indexed: 02/04/2023] Open
Abstract
B cells are multifaceted immune cells responding robustly during immune surveillance against tumor antigens by presentation to T cells and switched immunoglobulin production. However, B cells are unstudied in prostate cancer (PCa). We used flow cytometry to analyze B-cell subpopulations in peripheral blood and lymph nodes from intermediate-high risk PCa patients. B-cell subpopulations were related to clinicopathological factors. B-cell-receptor single-cell sequencing and VDJ analysis identified clonal B-cell expansion in blood and lymph nodes. Pathological staging was pT2 in 16%, pT3a in 48%, and pT3b in 36%. Lymph node metastases occurred in 5/25 patients (20%). Compared to healthy donors, the peripheral blood CD19+ B-cell compartment was significantly decreased in PCa patients and dominated by naïve B cells. The nodal B-cell compartment had significantly increased fractions of CD19+ B cells and switched memory B cells. Plasmablasts were observed in tumor-draining sentinel lymph nodes (SNs). VDJ analysis revealed clonal expansion in lymph nodes. Thus, activated B cells are increased in SNs from PCa patients. The increased fraction of switched memory cells and plasmablasts together with the presence of clonally expanded B cells indicate tumor-specific T-cell-dependent responses from B cells, supporting an important role for B cells in the protection against tumors.
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Affiliation(s)
- Aws Saudi
- Department of Urology, Medical Faculty, Linköping University, 581 85 Linköping, Sweden
- Department of Clinical and Experimental Medicine, Medical Faculty, Linköping University, 581 85 Linköping, Sweden
| | - Viqar Banday
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umea University, 901 85 Umea, Sweden
- Department of Clinical Microbiology, Immunology, Umea University, 901 85 Umeå, Sweden
| | | | - Martin Selinger
- The Laboratory for Molecular Infection Medicine Sweden (MIMS), 901 87 Umeå, Sweden
- Department of Molecular Biology, Umeå Centre for Microbial Research, 6K and 6L, Umeå University, 901 87 Umeå, Sweden
| | - Jon Forsberg
- Department of Urology, Medical Faculty, Linköping University, 581 85 Linköping, Sweden
| | - Martin Holmbom
- Department of Urology, Medical Faculty, Linköping University, 581 85 Linköping, Sweden
| | - Johan Henriksson
- The Laboratory for Molecular Infection Medicine Sweden (MIMS), 901 87 Umeå, Sweden
- Department of Molecular Biology, Umeå Centre for Microbial Research, 6K and 6L, Umeå University, 901 87 Umeå, Sweden
| | - Mauritz Waldén
- Department of Urology, Central Hospital of Karlstad, 652 30 Karlstad, Sweden
| | - Farhood Alamdari
- Department of Urology, Västmanland Hospital, 721 89 Västerås, Sweden
| | - Firas Aljabery
- Department of Urology, Medical Faculty, Linköping University, 581 85 Linköping, Sweden
- Department of Clinical and Experimental Medicine, Medical Faculty, Linköping University, 581 85 Linköping, Sweden
| | - Ola Winqvist
- ABClabs, BioClinicum, Campus Solna, 171 76 Stockholm, Sweden
| | - Amir Sherif
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umea University, 901 85 Umea, Sweden
- Correspondence:
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Lentini A, Pereira A, Winqvist O, Reinius B. Monitoring of the SARS-CoV-2 Omicron BA.1/BA.2 lineage transition in the Swedish population reveals increased viral RNA levels in BA.2 cases. Med (N Y) 2022; 3:636-643.e4. [PMID: 35981541 PMCID: PMC9359497 DOI: 10.1016/j.medj.2022.07.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 04/08/2022] [Revised: 05/31/2022] [Accepted: 07/21/2022] [Indexed: 11/17/2022]
Abstract
Background Throughout the SARS-CoV-2 pandemic, multiple waves of variants of concern have swept across populations, leading to a chain of new and yet more contagious variants dominating COVID-19 cases. Here, we tracked the remarkably rapid shift from Omicron BA.1 to BA.2 sublineage dominance in the Swedish population in early 2022 at a day-by-day basis. Methods Using a custom SARS-CoV-2 Omicron BA.1 lineage-typing RT-PCR assay, we analyzed 174,933 clinical upper airway samples collected during January to March 2022. Findings Our study demonstrates the feasibility and reliability of parallel lineage assignment of select variants at population scale, tracking the dominant sublineage transition from BA.1 to BA.2 at day-to-day resolution and uncovering nearly 2-fold higher levels of viral RNA in cases infected with Omicron BA.2 relative to BA.1. Conclusions Our data provide unique insights into the Omicron BA.1 to BA.2 transition that occurred in Sweden during early 2022, and later, across the world. This may help to understand the increased transmissibility of the BA.2 variant. Early population tracking is critical for informed decision-making and handling of the SARS-CoV-2 pandemic during outbreaks of variant strains of concern. Omicron variant infections emerged during late 2021, but at the time, lineage assignment relied on sequencing or separate genotyping assays in addition to the clinical SARS-CoV-2 RT-PCR, burdening laboratories and restricting the scope of lineage monitoring. Here, researchers at the Karolinska Institute and ABC Labs developed a single RT-PCR assay to simultaneously classify COVID-19 and Omicron BA.1 lineage status and demonstrated the feasibility of parallel lineage assignment of select variants at population scale. The authors show, at day-to-day resolution, the rapid transition from Omicron BA.1 to BA.2 sublineage dominance in the Swedish population, exposing factors that could influence this transition.
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Affiliation(s)
- Antonio Lentini
- Department of Medical Biochemistry and Biophysics, Karolinska Institutet, 171 77 Solna, Sweden
| | | | | | - Björn Reinius
- Department of Medical Biochemistry and Biophysics, Karolinska Institutet, 171 77 Solna, Sweden.
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Melin J, Eriksson Svensson M, Albinsson B, Winqvist O, Pauksens K. MO169: Three Doses of SARS‑COV‑2 BNT162B2 MRNA Vaccine Results in an Enhanced Immunologic B- And T-Cell Response in Haemodialysis Patients. Nephrol Dial Transplant 2022. [PMCID: PMC9383920 DOI: 10.1093/ndt/gfac066.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/18/2022] Open
Abstract
BACKGROUND AND AIMS The immune system is affected by uremia. Haemodialysis (HD) patients have an increased risk of acquiring infections due to many healthcare contacts and have a suboptimal response to vaccination and a high mortality from COVID-19 infection. Accumulating data indicate that two doses of vaccines are not enough, and most HD-patients have now received a third dose. The aim of the study was to describe the antibody and T-cell response to three doses of SARS‑CoV‑2 BNT162b2 mRNA vaccination and change over time. METHOD Initially, 50 patients (mean age 69.4 years and 62% men) with end-stage kidney disease (ESKD) and haemodialysis treatment, at the dialysis outpatient clinic, Uppsala Academic Hospital, Sweden were enrolled into the study. Administration of SARS‑CoV‑2 BNT162b2 mRNA vaccine began on 28 Decemeber 2020. In September 2021, the patients received their third vaccine dose. During the study four patients died, four received a kidney transplant and two did not receive the third vaccine dose. A total of 41 (82%) patients received three doses of vaccine and were followed up until 3 months after the third dose. The antibody response was measured at four timepoints; 7–15 weeks and 6–8 months after the second dose, 3 weeks and 3 months after the third dose, and the T-cell response at three timepoints; 7–15 weeks after the second dose, 3 weeks and 3 months after the third dose. SARS-CoV-2 IgG antibody test (Abbott Architect) was performed against Spike antigen (anti-S) positive both after COVID-19 infection and vaccination (quantitative method used in routine diagnostics at Laboratory of Clinical Microbiology, Uppsala) and T-cell reactivity testing against the Spike protein using ELISPOT technology measuring interferon-gamma activity was performed at ABC-labs, Solna. RESULTS After two doses, IgG antibodies (IgG abs) to anti-S were detected in 37 (74%) of 50 patients, 5 (10%) had a borderline response and 8 (16%) were negative. T-cell response were detected in 29 (58%) of 50 patients and in 21 (42%) no response was detected. Before the third dose IgG abs to anti-S were detected in 24 (52%) of 46 patients, 3 (7%) had a borderline response and 19 (41%) were negative. Three weeks after the third dose IgG abs to anti-S were detected in 39 (95%) of 41 patients, and 2 (5%) were negative. T-cell responses were detected in 35 (85%) of 41 patients and in 6 (15%) no response. Three months after the third dose IgG ab to anti-S were still detected in 38 (95%) of 40 patients, and 2 (5%) were negative. Changes in IgG ab to anti-S and T-cell response over time in patients who received all three doses of vaccine and were followed up until 3 months after the latest dose (n = 40 and 37) are displayed in Figures 1 and 2 (preliminary data). CONCLUSION These results highlight the need for at least three doses of the SARS‑CoV‑2 BNT162b2 mRNA vaccine. It also indicates that the effect of the vaccine decreases slower after dose 3 than after dose 2 since almost all patients had a measurable immune response 3 months after dose 3. However, not all patients develop an immunological response. In a clinical setting, it is justified to measure the antibody response after vaccination to identify patients that are not protected and where one needs to take other measures to protect them from infection and/or to give early treatment in case of symptoms.
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Affiliation(s)
- Jan Melin
- Department of Medical Sciences, Renal Medicine, Uppsala University, Uppsala, Sweden
| | | | - Bo Albinsson
- Department of Medical Biochemistry and Microbiology, Zoonosis Science Centre, Uppsala University, Uppsala, Sweden
| | - Ola Winqvist
- Department of Clinical Immunology, Karolinska University Hospital, Solna, Sweden
| | - Karlis Pauksens
- Department of Medical Sciences, Infectious Medicine, Uppsala University, Uppsala, Sweden
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Gråberg T, Bergman EA, Strömmer L, Sjöholm LK, Wikström AC, Winqvist O, Winerdal M. Genetic variability in exon 1 of the glucocorticoid receptor gene NR3C1 is associated with postoperative complications. Mol Med Rep 2022; 25:198. [PMID: 35445734 PMCID: PMC9052000 DOI: 10.3892/mmr.2022.12714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 05/11/2021] [Accepted: 12/31/2021] [Indexed: 11/06/2022] Open
Abstract
Patients undergoing major surgery experience postoperative inflammation, which may contribute to postoperative morbidity. Endogenous glucocorticoids (GCs) are an essential part of the stress response, but this response varies between individuals, which may in turn affect clinical outcome and specifically postoperative inflammation. Exon 1 of the NR3C1 gene, encoding the GC receptor (GR), contains an established region of differential regulation. DNA methylation patterns in this region have been found to differ between individuals. The present study investigated the methylation status and genotype in the cytosine‑phosphate‑guanine (CpG) island in exon 1 of NR3C1 in 24 patients [Median age 65.5 (range 42‑81) years, 11 male, 13 female] who underwent major abdominal (12 pancreatic, 12 hepatic) surgery and explored its association with postoperative complications. DNA was extracted from peripheral blood leukocytes and underwent targeted bisulfite sequencing of the CpG island. Complications were graded according to the Clavien‑Dindo classification and 14 out of 24 patients had postoperative complications. Multifactorial and partial least square analyses were used to analyse the data. A homogenous demethylated pattern was observed in all patients and no single CpG methylation was associated with postoperative complications. Four SNPs were significantly associated with higher Clavien‑Dindo scores. Genetic variability in the chromosome 5:143,402,505‑143,405,805 region of exon 1 of the GR gene NR3C1, but not DNA methylation, was associated with more severe postoperative complications in patients having major abdominal surgery. These results indicated that the patients' response to GCs may be of clinical importance for inflammatory conditions.
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Affiliation(s)
- Truls Gråberg
- Department of Clinical Science, Intervention and Technology, Division of Surgery, Karolinska Institute, Karolinska University Hospital Huddinge, 14186 Stockholm, Sweden
| | - Emma Ahlén Bergman
- Department of Medicine, Immunology and Allergy Unit, Center for Molecular Medicine, Karolinska Institute, Karolinska University Hospital Solna, 17176 Stockholm, Sweden
| | - Lovisa Strömmer
- Department of Clinical Science, Intervention and Technology, Division of Surgery, Karolinska Institute, Karolinska University Hospital Huddinge, 14186 Stockholm, Sweden
| | - Louise K Sjöholm
- Department of Clinical Neuroscience, Center for Molecular Medicine, Karolinska Institute, Karolinska University Hospital Solna, 17176 Stockholm, Sweden
| | - Ann-Charlotte Wikström
- Department of Clinical Immunology and Transfusion Medicine, Karolinska University Laboratory, Karolinska Institute, Karolinska University Hospital Huddinge, 14186 Stockholm, Sweden
| | | | - Max Winerdal
- Department of Medicine, Immunology and Allergy Unit, Center for Molecular Medicine, Karolinska Institute, Karolinska University Hospital Solna, 17176 Stockholm, Sweden
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8
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Hellkvist L, Hjalmarsson E, Weinfeld D, Dahl Å, Karlsson A, Westman M, Lundkvist K, Winqvist O, Georén SK, Westin U, Cardell LO. High-dose pollen intralymphatic immunotherapy: Two RDBPC trials question the benefit of dose increase. Allergy 2022; 77:883-896. [PMID: 34379802 DOI: 10.1111/all.15042] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [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: 01/19/2021] [Accepted: 07/19/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND The same dosing schedule, 1000 SQ-U times three, with one-month intervals, have been evaluated in most trials of intralymphatic immunotherapy (ILIT) for the treatment of allergic rhinitis (AR). The present studies evaluated if a dose escalation in ILIT can enhance the clinical and immunological effects, without compromising safety. METHODS Two randomized double-blind placebo-controlled trials of ILIT for grass pollen-induced AR were performed. The first included 29 patients that had recently ended 3 years of SCIT and the second contained 39 not previously vaccinated patients. An up-dosage of 1000-3000-10,000 (5000 + 5000 with 30 minutes apart) SQ-U with 1 month in between was evaluated. RESULTS Doses up to 10,000 SQ-U were safe after recent SCIT. The combined symptom-medication scores (CSMS) were reduced by 31% and the grass-specific IgG4 levels in blood were doubled. In ILIT de novo, the two first patients that received active treatment developed serious adverse reactions at 5000 SQ-U. A modified up-dosing schedule; 1000-3000-3000 SQ-U appeared to be safe but failed to improve the CSMS. Flow cytometry analyses showed increased activation of lymph node-derived dendritic but not T cells. Quality of life and nasal provocation response did not improve in any study. CONCLUSION Intralymphatic immunotherapy in high doses after SCIT appears to further reduce grass pollen-induced seasonal symptoms and may be considered as an add-on treatment for patients that do not reach full symptom control after SCIT. Up-dosing schedules de novo with three monthly injections that exceeds 3000 SQ-U should be avoided.
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Affiliation(s)
- Laila Hellkvist
- Division of ENT Diseases Department of Clinical Sciences, Intervention and Technology Karolinska Institutet Stockholm Sweden
- Department of ENT Diseases Karolinska University Hospital Stockholm Sweden
| | - Eric Hjalmarsson
- Division of ENT Diseases Department of Clinical Sciences, Intervention and Technology Karolinska Institutet Stockholm Sweden
| | - Dan Weinfeld
- Asthma and Allergy Clinic Outpatient Unit (adults) Department of Internal Medicine South Alvsborgs Central Hospital Boras Sweden
| | - Åslög Dahl
- Departments of Biological and Environmental Sciences Gothenburg University Gothenburg Sweden
| | - Agneta Karlsson
- Division of ENT Diseases Department of Clinical Sciences, Intervention and Technology Karolinska Institutet Stockholm Sweden
- Department of ENT Diseases Karolinska University Hospital Stockholm Sweden
| | - Marit Westman
- Immunology and Allergy Unit Department of Medicine Solna Karolinska Institutet Stockholm Sweden
| | - Karin Lundkvist
- Division of ENT Diseases Department of Clinical Sciences, Intervention and Technology Karolinska Institutet Stockholm Sweden
| | | | - Susanna Kumlien Georén
- Division of ENT Diseases Department of Clinical Sciences, Intervention and Technology Karolinska Institutet Stockholm Sweden
| | - Ulla Westin
- Laboratory of Clinical and Experimental Allergy Research Department of Otorhinolaryngology Malmö Lund University Skåne University Hospital Malmö Sweden
| | - Lars Olaf Cardell
- Division of ENT Diseases Department of Clinical Sciences, Intervention and Technology Karolinska Institutet Stockholm Sweden
- Department of ENT Diseases Karolinska University Hospital Stockholm Sweden
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Melin J, Svensson MK, Albinsson B, Winqvist O, Pauksens K. A third dose SARS‑CoV‑2 BNT162b2 mRNA vaccine results in improved immune response in hemodialysis patients. Ups J Med Sci 2022; 127:8959. [PMID: 36337280 PMCID: PMC9602199 DOI: 10.48101/ujms.v127.8959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/09/2022] [Accepted: 09/09/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The hemodialysis (HD) population has been a vulnerable group during the coronavirus disease 2019 (COVID-19) pandemic. Advanced chronic kidney disease with uremia is associated with weaker immune response to infections and an attenuated response to vaccines. The aim of this study was to study the humoral and cellular response to the second and third doses of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS‑CoV‑2) BNT162b2 mRNA vaccine in HD patients and to follow the response over time. METHODS The patients received their first two vaccine doses from 28 December 2020 within a 4-week interval and the third dose in September 2021 and were followed-up for humoral and cellular immune response at 1) 7-15 weeks and 2) 6-8 months after dose two (no t-cell reactivity measured), and 3) 3 weeks and 4) 3 months after dose three. Fifty patients were initially enrolled, and 40 patients were followed during the entire study. Levels of COVID-19 (SARS-CoV-2) IgG antibody against the Spike antigen (anti-S) and T-cell reactivity testing against the Spike protein using Enzyme-Linked ImmunoSpot (ELISPOT) technology were evaluated. RESULTS IgG antibodies to anti-S were detected in 35 (88%) of the 40 patients 7-15 weeks after vaccine dose two, 31 (78%) were positive, and 4 (10%) borderline. The median anti-S titer was 606 Abbott Units/milliliter (AU/mL) (interquartile range [IQR] 134-1,712). Three months after the third dose, anti-S was detected in 38 (95%) of 40 patients (P < 0.01 compared to after dose two), and the median anti-S titer was 9,910 AU/mL (IQR 2,325-26,975). Cellular reactivity was detected in 22 (55%), 34 (85%), and 28 (71%) of the 40 patients, and the median T-cell response was 9.5 (IQR 3.5-80), 51.5 (14.8-132), and 19.5 (8.8-54.2) units, respectively, for 6-8 months after dose two, 3 weeks, and 3 months after dose three. CONCLUSIONS Our data show that a third dose of SARS‑CoV‑2 BNT162b2 mRNA vaccine gives a robust and improved immunological response in HD patients, but a few patients did not develop any anti-S response during the entire study, indicating the importance to monitor the vaccine response since those who do not respond could now be given monoclonal antibodies if they contract a COVID-19 infection or in the future antivirals.
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Affiliation(s)
- Jan Melin
- Department of Medical Sciences, Renal Medicine, Uppsala University, Uppsala, Sweden
| | - Maria K Svensson
- Department of Medical Sciences, Renal Medicine, Uppsala University, Uppsala, Sweden
| | - Bo Albinsson
- Department of Medical Biochemistry and Microbiology, Zoonosis Science Centre, Uppsala University, Uppsala, Sweden
- Laboratory of Clinical Microbiology, Uppsala, Sweden
| | - Ola Winqvist
- Department of Clinical Immunology, Karolinska University Hospital, Stockholm, Sweden
- ABC Labs, Solna, Sweden
| | - Karlis Pauksens
- Department of Medical Sciences, Infectious Medicine, Uppsala University, Uppsala, Sweden
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10
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Melin J, Svensson MK, Albinsson B, Winqvist O, Pauksens K. Humoral and cellular response to SARS-CoV-2 BNT162b2 mRNA vaccine in hemodialysis patients. BMC Immunol 2021; 22:70. [PMID: 34666683 PMCID: PMC8524400 DOI: 10.1186/s12865-021-00458-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 08/19/2021] [Accepted: 09/29/2021] [Indexed: 02/06/2023] Open
Abstract
Background Hemodialysis (HD) patients have an increased risk of acquiring infections due to many health care contacts and may, in addition, have a suboptimal response to vaccination and a high mortality from Covid-19 infection. Methods In 50 HD patients (mean age 69.4 years, 62% men) administration of SARS-CoV-2BNT162b2 mRNA vaccine began in Dec 2020 and the immune response was evaluated 7–15 weeks after the last dose. Levels of Covid-19 (SARS-CoV-2) IgG antibody against the nucleocapsid antigen (anti-N) and the Spike antigen (anti-S) and T-cell reactivity testing against the Spike protein using ELISPOT technology were evaluated. Results Out of 50 patients, anti-S IgG antibodies indicating a vaccine effect or previous Covid-19 infection, were detected in 37 (74%), 5 (10%) had a borderline response and 8 (16%) were negative after two doses of vaccine. T-cell responses were detected in 29 (58%). Of the 37 patients with anti-S antibodies, 25 (68%) had a measurable T-cell response. 2 (40%) out of 5 patients with borderline anti-S and 2 (25%) without anti-S had a concomitant T-cell response. Twenty-seven (54%) had both an antibody and T-cell response. IgG antibodies to anti-N indicating a previous Covid-19 disease were detected in 7 (14%) patients. Conclusions Most HD patients develop a B- and/or T-cell response after vaccination against Covid-19 but approx. 20% had a limited immunological response. T-cell reactivity against Covid-19 was only present in a few of the anti-S antibody negative patients.
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Affiliation(s)
- Jan Melin
- Department of Medical Sciences, Renal Medicine, Uppsala University Hospital, Uppsala University, 751 85, Uppsala, Sweden.
| | - Maria K Svensson
- Department of Medical Sciences, Renal Medicine, Uppsala University Hospital, Uppsala University, 751 85, Uppsala, Sweden
| | - Bo Albinsson
- Department of Medical Biochemistry and Microbiology, Zoonosis Science Centre, Uppsala University, Uppsala, Sweden.,Laboratory of Clinical Microbiology, Uppsala, Sweden
| | - Ola Winqvist
- Department of Clinical Immunology, Karolinska University Hospital, Stockholm, Sweden.,ABC Labs, Solna, Sweden
| | - Karlis Pauksens
- Department of Medical Sciences, Infectious Medicine, Uppsala University, Uppsala, Sweden
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11
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Vollmer T, Schlickeiser S, Amini L, Schulenberg S, Wendering DJ, Banday V, Jurisch A, Noster R, Kunkel D, Brindle NR, Savidis I, Akyüz L, Hecht J, Stervbo U, Roch T, Babel N, Reinke P, Winqvist O, Sherif A, Volk HD, Schmueck-Henneresse M. The intratumoral CXCR3 chemokine system is predictive of chemotherapy response in human bladder cancer. Sci Transl Med 2021; 13:13/576/eabb3735. [PMID: 33441425 DOI: 10.1126/scitranslmed.abb3735] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 07/23/2020] [Accepted: 10/14/2020] [Indexed: 12/12/2022]
Abstract
Chemotherapy has direct toxic effects on cancer cells; however, long-term cancer control and complete remission are likely to involve CD8+ T cell immune responses. To study the role of CD8+ T cell infiltration in the success of chemotherapy, we examined patients with muscle invasive bladder cancer (MIBC) who were categorized on the basis of the response to neoadjuvant chemotherapy (NAC). We identified the intratumoral CXCR3 chemokine system (ligands and receptor splice variants) as a critical component for tumor eradication upon NAC in MIBC. Through characterization of CD8+ T cells, we found that stem-like T cell subpopulations with abundant CXCR3alt, a variant form of the CXCL11 receptor, responded to CXCL11 in culture as demonstrated by migration and enhanced effector function. In tumor biopsies of patients with MIBC accessed before treatment, CXCL11 abundance correlated with high numbers of tumor-infiltrating T cells and response to NAC. The presence of CXCR3alt and CXCL11 was associated with improved overall survival in MIBC. Evaluation of both CXCR3alt and CXCL11 enabled discrimination between responder and nonresponder patients with MIBC before treatment. We validated the prognostic role of the CXCR3-CXCL11 chemokine system in an independent cohort of chemotherapy-treated and chemotherapy-naïve patients with MIBC from data in TCGA. In summary, our data revealed stimulatory activity of the CXCR3alt-CXCL11 chemokine system on CD8+ T cells that is predictive of chemotherapy responsiveness in MIBC. This may offer immunotherapeutic options for targeted activation of intratumoral stem-like T cells in solid tumors.
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Affiliation(s)
- Tino Vollmer
- Institute of Medical Immunology, Charité - Universitätsmedizin Berlin, D-13353 Berlin, Germany.,Berlin Institute of Health Center for Regenerative Therapies (BCRT), Charité - Universitätsmedizin Berlin, D-13353 Berlin, Germany.,Berlin Center for Advanced Therapies (BeCAT), Charité - Universitätsmedizin Berlin, D-13353 Berlin, Germany
| | - Stephan Schlickeiser
- Institute of Medical Immunology, Charité - Universitätsmedizin Berlin, D-13353 Berlin, Germany.,Berlin Institute of Health Center for Regenerative Therapies (BCRT), Charité - Universitätsmedizin Berlin, D-13353 Berlin, Germany
| | - Leila Amini
- Institute of Medical Immunology, Charité - Universitätsmedizin Berlin, D-13353 Berlin, Germany.,Berlin Institute of Health Center for Regenerative Therapies (BCRT), Charité - Universitätsmedizin Berlin, D-13353 Berlin, Germany.,Berlin Center for Advanced Therapies (BeCAT), Charité - Universitätsmedizin Berlin, D-13353 Berlin, Germany
| | - Sarah Schulenberg
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Charité - Universitätsmedizin Berlin, D-13353 Berlin, Germany
| | - Desiree J Wendering
- Institute of Medical Immunology, Charité - Universitätsmedizin Berlin, D-13353 Berlin, Germany.,Berlin Institute of Health Center for Regenerative Therapies (BCRT), Charité - Universitätsmedizin Berlin, D-13353 Berlin, Germany.,Berlin Center for Advanced Therapies (BeCAT), Charité - Universitätsmedizin Berlin, D-13353 Berlin, Germany
| | - Viqar Banday
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umea University, 901 85 Umea, Sweden.,Department of Clinical Microbiology, Immunology, Umea University, 901 85 Umea, Sweden
| | - Anke Jurisch
- Institute of Medical Immunology, Charité - Universitätsmedizin Berlin, D-13353 Berlin, Germany.,Berlin Institute of Health Center for Regenerative Therapies (BCRT), Charité - Universitätsmedizin Berlin, D-13353 Berlin, Germany.,Berlin Center for Advanced Therapies (BeCAT), Charité - Universitätsmedizin Berlin, D-13353 Berlin, Germany
| | - Rebecca Noster
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Charité - Universitätsmedizin Berlin, D-13353 Berlin, Germany
| | - Desiree Kunkel
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Charité - Universitätsmedizin Berlin, D-13353 Berlin, Germany
| | - Nicola R Brindle
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Charité - Universitätsmedizin Berlin, D-13353 Berlin, Germany
| | - Ioannis Savidis
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Charité - Universitätsmedizin Berlin, D-13353 Berlin, Germany
| | - Levent Akyüz
- Institute of Medical Immunology, Charité - Universitätsmedizin Berlin, D-13353 Berlin, Germany.,Berlin Institute of Health Center for Regenerative Therapies (BCRT), Charité - Universitätsmedizin Berlin, D-13353 Berlin, Germany
| | - Jochen Hecht
- Centre for Genomic Regulation, Barcelona Institute of Science and Technology, 08003 Barcelona, Spain.,Universitat Pompeu Fabra (UPF), 08002 Barcelona, Spain
| | - Ulrik Stervbo
- Center for Translational Medicine, Medical Clinic I, Marien Hospital Herne, University Hospital of the Ruhr-University Bochum, D-44623 Herne, Germany
| | - Toralf Roch
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Charité - Universitätsmedizin Berlin, D-13353 Berlin, Germany.,Center for Translational Medicine, Medical Clinic I, Marien Hospital Herne, University Hospital of the Ruhr-University Bochum, D-44623 Herne, Germany
| | - Nina Babel
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Charité - Universitätsmedizin Berlin, D-13353 Berlin, Germany.,Center for Translational Medicine, Medical Clinic I, Marien Hospital Herne, University Hospital of the Ruhr-University Bochum, D-44623 Herne, Germany
| | - Petra Reinke
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Charité - Universitätsmedizin Berlin, D-13353 Berlin, Germany.,Berlin Center for Advanced Therapies (BeCAT), Charité - Universitätsmedizin Berlin, D-13353 Berlin, Germany
| | - Ola Winqvist
- Department of Clinical Immunology, Karolinska University Hospital, 17 176 Stockholm, Sweden
| | - Amir Sherif
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umea University, 901 85 Umea, Sweden
| | - Hans-Dieter Volk
- Institute of Medical Immunology, Charité - Universitätsmedizin Berlin, D-13353 Berlin, Germany.,Berlin Institute of Health Center for Regenerative Therapies (BCRT), Charité - Universitätsmedizin Berlin, D-13353 Berlin, Germany
| | - Michael Schmueck-Henneresse
- Institute of Medical Immunology, Charité - Universitätsmedizin Berlin, D-13353 Berlin, Germany. .,Berlin Institute of Health Center for Regenerative Therapies (BCRT), Charité - Universitätsmedizin Berlin, D-13353 Berlin, Germany.,Berlin Center for Advanced Therapies (BeCAT), Charité - Universitätsmedizin Berlin, D-13353 Berlin, Germany
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12
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Stranneheim H, Lagerstedt-Robinson K, Magnusson M, Kvarnung M, Nilsson D, Lesko N, Engvall M, Anderlid BM, Arnell H, Johansson CB, Barbaro M, Björck E, Bruhn H, Eisfeldt J, Freyer C, Grigelioniene G, Gustavsson P, Hammarsjö A, Hellström-Pigg M, Iwarsson E, Jemt A, Laaksonen M, Enoksson SL, Malmgren H, Naess K, Nordenskjöld M, Oscarson M, Pettersson M, Rasi C, Rosenbaum A, Sahlin E, Sardh E, Stödberg T, Tesi B, Tham E, Thonberg H, Töhönen V, von Döbeln U, Vassiliou D, Vonlanthen S, Wikström AC, Wincent J, Winqvist O, Wredenberg A, Ygberg S, Zetterström RH, Marits P, Soller MJ, Nordgren A, Wirta V, Lindstrand A, Wedell A. Integration of whole genome sequencing into a healthcare setting: high diagnostic rates across multiple clinical entities in 3219 rare disease patients. Genome Med 2021; 13:40. [PMID: 33726816 PMCID: PMC7968334 DOI: 10.1186/s13073-021-00855-5] [Citation(s) in RCA: 91] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 02/11/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND We report the findings from 4437 individuals (3219 patients and 1218 relatives) who have been analyzed by whole genome sequencing (WGS) at the Genomic Medicine Center Karolinska-Rare Diseases (GMCK-RD) since mid-2015. GMCK-RD represents a long-term collaborative initiative between Karolinska University Hospital and Science for Life Laboratory to establish advanced, genomics-based diagnostics in the Stockholm healthcare setting. METHODS Our analysis covers detection and interpretation of SNVs, INDELs, uniparental disomy, CNVs, balanced structural variants, and short tandem repeat expansions. Visualization of results for clinical interpretation is carried out in Scout-a custom-developed decision support system. Results from both singleton (84%) and trio/family (16%) analyses are reported. Variant interpretation is done by 15 expert teams at the hospital involving staff from three clinics. For patients with complex phenotypes, data is shared between the teams. RESULTS Overall, 40% of the patients received a molecular diagnosis ranging from 19 to 54% for specific disease groups. There was heterogeneity regarding causative genes (n = 754) with some of the most common ones being COL2A1 (n = 12; skeletal dysplasia), SCN1A (n = 8; epilepsy), and TNFRSF13B (n = 4; inborn errors of immunity). Some causative variants were recurrent, including previously known founder mutations, some novel mutations, and recurrent de novo mutations. Overall, GMCK-RD has resulted in a large number of patients receiving specific molecular diagnoses. Furthermore, negative cases have been included in research studies that have resulted in the discovery of 17 published, novel disease-causing genes. To facilitate the discovery of new disease genes, GMCK-RD has joined international data sharing initiatives, including ClinVar, UDNI, Beacon, and MatchMaker Exchange. CONCLUSIONS Clinical WGS at GMCK-RD has provided molecular diagnoses to over 1200 individuals with a broad range of rare diseases. Consolidation and spread of this clinical-academic partnership will enable large-scale national collaboration.
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Affiliation(s)
- Henrik Stranneheim
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Centre for Inherited Metabolic Diseases, Karolinska University Hospital, Stockholm, Sweden
- Science for Life Laboratory, Department of Microbiology, Tumour and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Kristina Lagerstedt-Robinson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
| | - Måns Magnusson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Science for Life Laboratory, Department of Microbiology, Tumour and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Malin Kvarnung
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
| | - Daniel Nilsson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
| | - Nicole Lesko
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Centre for Inherited Metabolic Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Martin Engvall
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Centre for Inherited Metabolic Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Britt-Marie Anderlid
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
| | - Henrik Arnell
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Michela Barbaro
- Centre for Inherited Metabolic Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Erik Björck
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
| | - Helene Bruhn
- Centre for Inherited Metabolic Diseases, Karolinska University Hospital, Stockholm, Sweden
- Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden
| | - Jesper Eisfeldt
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
| | - Christoph Freyer
- Centre for Inherited Metabolic Diseases, Karolinska University Hospital, Stockholm, Sweden
- Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden
| | - Giedre Grigelioniene
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
| | - Peter Gustavsson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Hammarsjö
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
| | - Maritta Hellström-Pigg
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
| | - Erik Iwarsson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
| | - Anders Jemt
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Mikael Laaksonen
- Science for Life Laboratory, School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH Royal Institutet of Technology, Stockholm, Sweden
| | - Sara Lind Enoksson
- Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Helena Malmgren
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
| | - Karin Naess
- Centre for Inherited Metabolic Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Magnus Nordenskjöld
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
| | - Mikael Oscarson
- Centre for Inherited Metabolic Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Maria Pettersson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
| | - Chiara Rasi
- Science for Life Laboratory, Department of Microbiology, Tumour and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Adam Rosenbaum
- Science for Life Laboratory, School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH Royal Institutet of Technology, Stockholm, Sweden
| | - Ellika Sahlin
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
| | - Eliane Sardh
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Centre for Inherited Metabolic Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Tommy Stödberg
- Centre for Inherited Metabolic Diseases, Karolinska University Hospital, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Bianca Tesi
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
| | - Emma Tham
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
| | - Håkan Thonberg
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
| | - Virpi Töhönen
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Ulrika von Döbeln
- Centre for Inherited Metabolic Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Daphne Vassiliou
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Centre for Inherited Metabolic Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Sofie Vonlanthen
- Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Ann-Charlotte Wikström
- Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Josephine Wincent
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
| | - Ola Winqvist
- Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Wredenberg
- Centre for Inherited Metabolic Diseases, Karolinska University Hospital, Stockholm, Sweden
- Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden
| | - Sofia Ygberg
- Centre for Inherited Metabolic Diseases, Karolinska University Hospital, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Rolf H Zetterström
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Centre for Inherited Metabolic Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Per Marits
- Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Maria Johansson Soller
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
| | - Ann Nordgren
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
| | - Valtteri Wirta
- Science for Life Laboratory, Department of Microbiology, Tumour and Cell Biology, Karolinska Institutet, Stockholm, Sweden
- Science for Life Laboratory, School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH Royal Institutet of Technology, Stockholm, Sweden
| | - Anna Lindstrand
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
- Department of Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden.
| | - Anna Wedell
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
- Centre for Inherited Metabolic Diseases, Karolinska University Hospital, Stockholm, Sweden.
- Science for Life Laboratory, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
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13
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Xia C, Olsen TK, Zirakzadeh AA, Almamoun R, Sjöholm LK, Dahlström J, Sjöberg J, Claesson HE, Johnsen JI, Winqvist O, Xu D, Ekström TJ, Björkholm M, Strååt K. Hodgkin Lymphoma Monozygotic Triplets Reveal Divergences in DNA Methylation Signatures. Front Oncol 2020; 10:598872. [PMID: 33363029 PMCID: PMC7756121 DOI: 10.3389/fonc.2020.598872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 08/25/2020] [Accepted: 11/09/2020] [Indexed: 11/25/2022] Open
Abstract
We studied DNA methylation profiles in four different cell populations from a unique constellation of monozygotic triplets in whom two had developed Hodgkin Lymphoma (HL). We detected shared differences in DNA methylation signatures when comparing the two HL-affected triplets with the non-affected triplet. The differences were observed in naïve B-cells and marginal zone-like B-cells. DNA methylation differences were also detected when comparing each of the HL-affected triplets against each other. Even though we cannot determine whether treatment and/or disease triggered the observed differences, we believe our data are important on behalf of forthcoming studies, and that it might provide important clues for a better understanding of HL pathogenesis.
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Affiliation(s)
- Chuanyou Xia
- Department of Medicine, Division of Hematology, BioClinicum and Centre for Molecular Medicine, Karolinska University Hospital Solna and Karolinska Institutet, Stockholm, Sweden
| | - Thale Kristin Olsen
- Childhood Cancer Research Unit, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - A Ali Zirakzadeh
- Unit of Translational Immunology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Radwa Almamoun
- Department of Clinical Neuroscience, Karolinska Institutet, Center for Molecular Medicine, Stockholm, Sweden
| | - Louise K Sjöholm
- Department of Clinical Neuroscience, Karolinska Institutet, Center for Molecular Medicine, Stockholm, Sweden
| | - Jenny Dahlström
- Department of Medicine, Division of Hematology, BioClinicum and Centre for Molecular Medicine, Karolinska University Hospital Solna and Karolinska Institutet, Stockholm, Sweden
| | - Jan Sjöberg
- Department of Medicine, Division of Hematology, BioClinicum and Centre for Molecular Medicine, Karolinska University Hospital Solna and Karolinska Institutet, Stockholm, Sweden
| | - Hans-Erik Claesson
- Department of Medicine, Division of Hematology, BioClinicum and Centre for Molecular Medicine, Karolinska University Hospital Solna and Karolinska Institutet, Stockholm, Sweden
| | - John Inge Johnsen
- Childhood Cancer Research Unit, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Ola Winqvist
- Unit of Translational Immunology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Dawei Xu
- Department of Medicine, Division of Hematology, BioClinicum and Centre for Molecular Medicine, Karolinska University Hospital Solna and Karolinska Institutet, Stockholm, Sweden
| | - Tomas J Ekström
- Department of Clinical Neuroscience, Karolinska Institutet, Center for Molecular Medicine, Stockholm, Sweden
| | - Magnus Björkholm
- Department of Medicine, Division of Hematology, BioClinicum and Centre for Molecular Medicine, Karolinska University Hospital Solna and Karolinska Institutet, Stockholm, Sweden
| | - Klas Strååt
- Department of Medicine, Division of Hematology, BioClinicum and Centre for Molecular Medicine, Karolinska University Hospital Solna and Karolinska Institutet, Stockholm, Sweden
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14
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Kågedal Å, Hjalmarsson E, Farrajota Neves da Silva P, Piersiala K, Georén SK, Margolin G, Munck-Wikland E, Winqvist O, Häyry V, Cardell LO. Activation of T helper cells in sentinel node predicts poor prognosis in oral squamous cell carcinoma. Sci Rep 2020; 10:22352. [PMID: 33339891 PMCID: PMC7749121 DOI: 10.1038/s41598-020-79273-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 12/03/2020] [Indexed: 01/10/2023] Open
Abstract
Recurrence in oral squamous cell carcinoma (OSCC) significantly reduces overall survival. Improved understanding of the host’s immune status in head and neck cancer may facilitate identification of patients at higher risk of recurrence and improve patients’ selection for ongoing clinical trials assessing the effectiveness of immune checkpoint inhibitors (CPI). We aimed to investigate Sentinel Node-derived T-cells and their impact on survival. We enrolled prospectively 28 OSCC patients treated at Karolinska University Hospital, Stockholm, Sweden with primary tumour excision and elective neck dissection. On top of the standard treatment, the enrolled patients underwent sentinel node procedure. T cells derived from Sentinel nodes, non-sentinel nodes, primary tumour and PBMC were analyzed in flow cytometry. Patients who developed recurrence proved to have significantly lower level of CD4+ CD69+ in their sentinel node (31.38 ± 6.019% vs. 43.44 ± 15.33%, p = 0.0103) and significantly higher level of CD8+ CD HLA-DR+ (38.95 ± 9.479% vs. 24.58 ± 11.36%, p = 0.0116) compared to disease-free individuals. Survival analysis of studied population revealed that patients with low proportion of CD4+ CD69+ had significantly decreased disease-free survival (DFS) of 19.7 months (95% CI 12.6–26.9) compared with 42.6 months (95% CI 40.1–45.1) in those with high CD4+ CD69+ proportion in their Sentinel Nodes (log-rank test, p = 0.033). Our findings demonstrate that characterization of T-cell activation in Sentinel Node serves as a complementary prognostic marker. Flow cytometry of Sentinel Node may be useful in both patients’ surveillance and selection for ongoing CPI clinical trials in head and neck cancer.
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Affiliation(s)
- Åsa Kågedal
- Division of ENT Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.,Department of Otorhinolaryngology, Karolinska University Hospital, Stockholm, Sweden
| | - Eric Hjalmarsson
- Division of ENT Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.,Department of Otorhinolaryngology, Karolinska University Hospital, Stockholm, Sweden
| | | | - Krzysztof Piersiala
- Division of ENT Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.,Department of Otorhinolaryngology, Karolinska University Hospital, Stockholm, Sweden
| | - Susanna Kumlien Georén
- Division of ENT Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.,Department of Otorhinolaryngology, Karolinska University Hospital, Stockholm, Sweden
| | - Gregori Margolin
- Division of ENT Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.,Department of Otorhinolaryngology, Karolinska University Hospital, Stockholm, Sweden
| | - Eva Munck-Wikland
- Division of ENT Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.,Department of Otorhinolaryngology, Karolinska University Hospital, Stockholm, Sweden
| | - Ola Winqvist
- Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Valtteri Häyry
- Division of ENT Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.,Department of Otorhinolaryngology, Karolinska University Hospital, Stockholm, Sweden
| | - Lars Olaf Cardell
- Division of ENT Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden. .,Department of Otorhinolaryngology, Karolinska University Hospital, Stockholm, Sweden.
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15
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Zhang L, Zirakzadeh AA, Rosvall J, Hedlund M, Hu PS, Riklund K, Sherif A, Winqvist O. Immune responses against autologous tumor and human papilloma virus in lymph nodes from patients with penile cancer. Investig Clin Urol 2020; 62:39-46. [PMID: 33314806 PMCID: PMC7801168 DOI: 10.4111/icu.20200116] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 08/03/2020] [Accepted: 08/13/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose Nearly half of penile cancers are related to human papillomavirus (HPV) infection. Investigations of tumor- and HPV-specific T cell reactivity in regional lymph nodes (LNs) from patients with penile cancer are warranted. Materials and Methods In this study, single-cell suspensions from LNs and peripheral blood from 11 patients with penile cancer were stained with antibodies for lymphocyte markers and analyzed by fluorescence-activated cell sorting (FACS). DNA was extracted from the tumor tissue and HPV status was investigated by PCR. Results T-cell reactivity against autologous tumor-extract and against the HPV-vaccine Gardasil® was tested by flow-cytometric assay of specific cell-mediated immune response in activated whole blood (FASCIA). CD4+/CD8+ ratios were significantly lower in HPV positive LNs (p<0.05). Immune responses to tumor extract assessed by blast transformation and expansion in vitro, of either CD4+ or CD8+ T-cells, were found in 9 of 13 LNs (69%). 5 of 6 tested patients demonstrated T cell recognition of tumor-associated antigen(s). In HPV-positive patients, dose-dependent T cell responses against L1 (late) HPV proteins (Gardasil vaccine) were demonstrated. Conclusions LN-derived T cells from patients with penile cancer recognize tumor antigen(s) and in HPV-positive cases, there is a response against L1 (late) HPV proteins, being constituents of the Gardasil vaccine.
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Affiliation(s)
- Lu Zhang
- Department of Medicine, Immunology and Allergy Unit, Karolinska Institutet, Stockholm, Sweden
| | - A Ali Zirakzadeh
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | - Jesper Rosvall
- Department of Urology, Stockholm South General Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Mats Hedlund
- Department of Urology, UroClinic® prostatacenter, Sophiahemmet, Stockholm, Sweden
| | - Ping Sheng Hu
- Cancer Biotherapy Center, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Katrine Riklund
- Department of Radiation Sciences, Umeå University, Umeå, Sweden
| | - Amir Sherif
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden.
| | - Ola Winqvist
- Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden
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16
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Krantz D, Mints M, Winerdal M, Riklund K, Rutishauser D, Zubarev R, Zirakhzadeh AA, Alamdari F, Johansson M, Sherif A, Winqvist O. IL-16 processing in sentinel node regulatory T cells is a factor in bladder cancer immunity. Scand J Immunol 2020; 92:e12926. [PMID: 32862475 DOI: 10.1111/sji.12926] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 11/09/2019] [Revised: 06/18/2020] [Accepted: 06/27/2020] [Indexed: 11/30/2022]
Abstract
In the effort of developing new immunotherapies, the sentinel node (SN) has proven a promising source from which to harness an effective antitumour T cell response. However, tumour immune escape, a process in which regulatory T cells (Tregs) play a central role, remains a major limiting factor. Therefore, there is a clear need to increase the knowledge of Treg function and signalling in sentinel nodes. Here, we set out to explore whether the proteome in SN-resident T cells is altered by the tumour and to identify key proteins in SN T cell signalling, focusing on Tregs. Five patients with muscle-invasive urothelial bladder cancer were prospectively included. Mass spectrometry was performed on two patients, with validation and functional studies being performed on three additional patients and four healthy donors. At cystectomy, SN, non-SN lymph nodes and peripheral blood samples were collected from the patients and T cell subsets isolated through flow cytometry before downstream experiments. Proteomic analysis indicated that growth and immune signalling pathways are upregulated in SN-resident Tregs. Furthermore, centrality analysis identified the cytokine IL-16 to be central in the SN-Treg signalling network. We show that tumour-released factors, through activating caspase-3, increase Treg IL-16 processing into bioactive forms, reinforcing Treg suppressive capacity. In conclusion, we provide evidence that Tregs exposed to secreted factors from bladder tumours show increased immune and growth signalling and altered IL-16 processing which translates to enhanced Treg suppressive function, indicating altered IL-16 signalling as a novel tumour immune escape mechanism.
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Affiliation(s)
- David Krantz
- Department of Haematology, Karolinska University Hospital, Stockholm, Sweden
| | - Michael Mints
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | - Malin Winerdal
- Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Katrine Riklund
- Department of Radiation Sciences, Umeå University, Umeå, Sweden
| | - Dorothea Rutishauser
- Department of Medical Biochemistry and Biophysics, Karolinska Institute and University Hospital, Stockholm, Sweden.,Science for Life Laboratory, Stockholm, Sweden
| | - Roman Zubarev
- Department of Medical Biochemistry and Biophysics, Karolinska Institute and University Hospital, Stockholm, Sweden.,Science for Life Laboratory, Stockholm, Sweden
| | - Amir Ali Zirakhzadeh
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | | | - Markus Johansson
- Department of Surgery and Urology, Sundsvall Hospital, Sundsvall, Sweden
| | - Amir Sherif
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | - Ola Winqvist
- Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden
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17
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Oras A, Quirant-Sanchez B, Popadic D, Thunberg S, Winqvist O, Heck S, Cwikowski M, Riemann D, Seliger B, Martinez Caceres E, Uibo R, Giese T. Comprehensive flow cytometric reference intervals of leukocyte subsets from six study centers across Europe. Clin Exp Immunol 2020; 202:363-378. [PMID: 32654132 PMCID: PMC7670136 DOI: 10.1111/cei.13491] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 03/31/2020] [Revised: 06/30/2020] [Accepted: 07/03/2020] [Indexed: 12/14/2022] Open
Abstract
A group of European FOCIS Centers of Excellence adapted panels of the Human Immunophenotyping Consortium (HIPC) for whole blood analysis. Using four core panels [T/regulatory T cell/B/natural killer (T/Treg/B/NK) and myeloid cells] the main leukocyte populations were analyzed in a clinical–diagnostic setting in a harmonized manner across different platforms. As a first step, the consortium presents here the absolute and relative frequencies of the leukocyte subpopulations in the peripheral blood of more than 300 healthy volunteers across six different European centers.
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Affiliation(s)
- A Oras
- Department of Immunology, Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia
| | - B Quirant-Sanchez
- Immunology Division, LCMN, Germans Trias i Pujol University Hospital and Research Institute, Barcelona, Spain.,Department of Cell Biology, Physiology and Immunology, Universitat Autonoma Barcelona, Barcelona, Spain.,Federation of Clinical Immunology Societies (FOCIS) Center of Excellence
| | - D Popadic
- Institute of Microbiology and Immunology, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - S Thunberg
- Federation of Clinical Immunology Societies (FOCIS) Center of Excellence.,Unit of Immunology and Allergy, Karolinska University Hospital, Stockholm, Sweden
| | - O Winqvist
- Federation of Clinical Immunology Societies (FOCIS) Center of Excellence.,Unit of Immunology and Allergy, Karolinska University Hospital, Stockholm, Sweden
| | - S Heck
- Federation of Clinical Immunology Societies (FOCIS) Center of Excellence.,NIHR GSTT/KCL Comprehensive Biomedical Research Centre, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - M Cwikowski
- Federation of Clinical Immunology Societies (FOCIS) Center of Excellence.,Institute of Medical Immunology, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
| | - D Riemann
- Federation of Clinical Immunology Societies (FOCIS) Center of Excellence.,Institute of Medical Immunology, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
| | - B Seliger
- Federation of Clinical Immunology Societies (FOCIS) Center of Excellence.,Institute of Medical Immunology, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
| | - E Martinez Caceres
- Immunology Division, LCMN, Germans Trias i Pujol University Hospital and Research Institute, Barcelona, Spain.,Department of Cell Biology, Physiology and Immunology, Universitat Autonoma Barcelona, Barcelona, Spain.,Federation of Clinical Immunology Societies (FOCIS) Center of Excellence
| | - R Uibo
- Department of Immunology, Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia
| | - T Giese
- Federation of Clinical Immunology Societies (FOCIS) Center of Excellence.,Institute of Immunology, Heidelberg University Hospital, German Center for Infection Research (DZIF), Partner site, Heidelberg, Germany
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18
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Rosenblatt R, Lorentzi G, Bahar M, Asad D, Forsman R, Johansson M, Shareef M, Alamdari F, Bergh A, Winqvist O, Sherif A. Blood transfusions during neoadjuvant chemotherapy for muscle-invasive urinary bladder cancer may have a negative impact on overall survival. Scand J Urol 2020; 54:46-51. [PMID: 31960752 DOI: 10.1080/21681805.2020.1716067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Objective: To evaluate the extent and plausible effects of blood transfusions given during cisplatin-based neoadjuvant chemotherapy (NAC) on overall survival in patients with muscle-invasive urothelial bladder cancer (MIBC) undergoing NAC and radical cystectomy (RC).Background: Several studies have demonstrated a decreased survival for MIBC patients receiving allogenic peri- and postoperative blood transfusions in conjunction with RC. No studies have previously investigated the effects of blood transfusions during NAC.Materials and methods: 120 patients with MIBC (cT2-T4aN0M0) undergoing NAC and RC between 2008 and 2014 at four Swedish cystectomy centers were retrospectively evaluated. Clinicopathological data were obtained, including data of allogenic blood administration. Survival data was analyzed by Kaplan-Meier plotting and Cox regression.Results: One third of the cohort received blood transfusions during the period of NAC. In univariate analysis, blood transfusions during NAC, nodal stage and advanced tumor stage (pT >2) were negative prognostic factors for survival. In multivariate analysis, only pNx and pT >2 remained significant negative prognostic factors. In a subgroup analysis consisting of patients with localized tumors without dissemination (n = 96), patients that received transfusions during NAC showed an 18.5% absolute risk increase of death at five years of observation, although without statistical significance (p = .197).Conclusions: This is the first time that the extent and plausible effects of allogenic blood transfusions during NAC is examined in MIBC. Data suggest that there may be an association between blood transfusion and poor pathological and oncological outcome. Firm conclusions are difficult to draw due to few study participants and the retrospective nature of the study.
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Affiliation(s)
- Robert Rosenblatt
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden.,Department of Urology, Stockholm South General Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Gabriella Lorentzi
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | - Maryam Bahar
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | - Danna Asad
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | - Ramona Forsman
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | - Markus Johansson
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden.,Department of Urology, Sundsvall Hospital, Sundsvall, Sweden
| | - Marwan Shareef
- Department of Urology, Västmanland Hospital, Västerås, Sweden
| | | | - Anders Bergh
- Department of Medical Biosciences, Pathology, Umeå University, Umeå, Sweden
| | - Ola Winqvist
- Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Amir Sherif
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
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19
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Zirakzadeh AA, Sherif A, Rosenblatt R, Ahlén Bergman E, Winerdal M, Yang D, Cederwall J, Jakobsson V, Hyllienmark M, Winqvist O, Marits P. Tumour-associated B cells in urothelial urinary bladder cancer. Scand J Immunol 2019; 91:e12830. [PMID: 31823416 DOI: 10.1111/sji.12830] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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: 04/24/2019] [Revised: 07/26/2019] [Accepted: 09/15/2019] [Indexed: 12/30/2022]
Abstract
Tumour infiltrating B cells and CD38+ plasma cells have been correlated with survival in different malignancies but their role in urinary bladder cancer is unclear. IL-10 is a multifunctional cytokine with both anti-inflammatory and immunostimulatory properties, that can be released by regulatory B cells (Bregs). We have stained paraffin-embedded tumour sections from 31 patients with invasive urothelial urinary bladder cancer with respect to CD20+ B cells, CD38+ cells, IL-10-expressing cells, IgG, C1q and C3a and analysed the impact of these markers on survival. Interestingly, we observe tumour-associated CD20+ B cells forming follicle-like structures in tumours of some patients. We demonstrate that follicle-like structures, tumour-associated CD38+ cells, IL-10 produced by non-B cells, tumour infiltrating IgG and activation of the complement system, may associate to longer survival of urinary bladder cancer patients. IL-10 expression by tumour-associated Bregs may instead negatively affect prognosis. More research is needed to fully understand the role of B cells and IL-10 in urinary bladder cancer.
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Affiliation(s)
- A Ali Zirakzadeh
- Department of Medicine Solna, Unit of Immunology and Allergy, Karolinska Institutet, Stockholm, Sweden.,Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University Hospital, Umeå, Sweden
| | - Amir Sherif
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University Hospital, Umeå, Sweden
| | - Robert Rosenblatt
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University Hospital, Umeå, Sweden
| | - Emma Ahlén Bergman
- Department of Medicine Solna, Unit of Immunology and Allergy, Karolinska Institutet, Stockholm, Sweden
| | - Max Winerdal
- Department of Medicine Solna, Unit of Immunology and Allergy, Karolinska Institutet, Stockholm, Sweden
| | - David Yang
- Department of Medicine Solna, Unit of Immunology and Allergy, Karolinska Institutet, Stockholm, Sweden
| | - Johanna Cederwall
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University Hospital, Umeå, Sweden
| | - Vivianne Jakobsson
- Department of Medicine Solna, Unit of Immunology and Allergy, Karolinska Institutet, Stockholm, Sweden
| | - Martin Hyllienmark
- Department of Medicine Solna, Unit of Immunology and Allergy, Karolinska Institutet, Stockholm, Sweden
| | - Ola Winqvist
- Department of Clinical Immunology, Karolinska University Hospital, Stockholm, Sweden
| | - Per Marits
- Department of Medicine Solna, Unit of Immunology and Allergy, Karolinska Institutet, Stockholm, Sweden
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20
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Aljadi Z, Kalm F, Nilsson C, Winqvist O, Russom A, Lundahl J, Nopp A. A novel tool for clinical diagnosis of allergy operating a microfluidic immunoaffinity basophil activation test technique. Clin Immunol 2019; 209:108268. [DOI: 10.1016/j.clim.2019.108268] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 08/23/2019] [Accepted: 10/04/2019] [Indexed: 12/25/2022]
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21
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Arebro J, Drakskog C, Winqvist O, Bachert C, Kumlien Georén S, Cardell L. Subsetting reveals CD16 high CD62L dim neutrophils in chronic rhinosinusitis with nasal polyps. Allergy 2019; 74:2499-2501. [PMID: 31116882 DOI: 10.1111/all.13919] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Julia Arebro
- Division of ENT Diseases, Department of Clinical Science, Intervention and Technology Karolinska Institutet Stockholm Sweden
- Department of ENT Diseases Karolinska University Hospital Stockholm Sweden
| | - Cecilia Drakskog
- Division of ENT Diseases, Department of Clinical Science, Intervention and Technology Karolinska Institutet Stockholm Sweden
| | - Ola Winqvist
- Department of Medicine, Immunology and Allergy Unit Karolinska University Hospital Stockholm Sweden
| | - Claus Bachert
- Division of ENT Diseases, Department of Clinical Science, Intervention and Technology Karolinska Institutet Stockholm Sweden
- Department of ENT Diseases Karolinska University Hospital Stockholm Sweden
- Upper Airways Research Laboratory Ghent University Ghent Belgium
| | - Susanna Kumlien Georén
- Division of ENT Diseases, Department of Clinical Science, Intervention and Technology Karolinska Institutet Stockholm Sweden
| | - Lars‐Olaf Cardell
- Division of ENT Diseases, Department of Clinical Science, Intervention and Technology Karolinska Institutet Stockholm Sweden
- Department of ENT Diseases Karolinska University Hospital Stockholm Sweden
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22
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Alvaeus J, Rosenblatt R, Johansson M, Alamdari F, Jakubczyk T, Holmström B, Hemdan T, Huge Y, Aljabery F, Gabrielsson S, Riklund K, Winqvist O, Sherif A. Fewer tumour draining sentinel nodes in patients with progressing muscle invasive bladder cancer, after neoadjuvant chemotherapy and radical cystectomy. World J Urol 2019; 38:2207-2213. [PMID: 31760442 PMCID: PMC7423786 DOI: 10.1007/s00345-019-03025-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 07/08/2019] [Accepted: 11/15/2019] [Indexed: 11/30/2022] Open
Abstract
Purpose To examine the relationship between the number of tumour draining sentinel nodes (SNs) and pathoanatomical outcomes, in muscle-invasive bladder cancer (MIBC), in patients undergoing neoadjuvant chemotherapy (NAC) and radical cystectomy (RC). Materials and Methods In an ongoing prospective multicenter study, we included 230 patients with suspected urothelial MIBC from ten Swedish urological centers. All underwent TURb and clinical staging. From the cohort, 116 patients with urothelial MIBC; cT2-cT4aN0M0, underwent radical cystectomy (RC) and lymphadenectomy with SN-detection (SNd). 83 patients received cisplatin-based NAC and 33 were NAC-naïve. The number and locations of detected SNs and non-SNs were recorded for each patient. The NAC treated patients were categorized by pathoanatomical outcomes post-RC into three groups: complete responders (CR), stable disease (SD) and progressive disease (PD). Selected covariates with possible impact on SN-yield were tested in uni -and multivariate analyses for NAC-treated patients only. Results In NAC treated patients, the mean number of SNs was significantly higher in CR patients (3.3) and SD patients (3.6) compared with PD patients (1.4) (p = 0.034). In a linear multivariate regression model, the number of harvested nodes was the only independent variable that affected the number of SNs (p = 0.0004). Conclusions The number of tumor-draining SNs in NAC-treated patients was significantly lower in patients with progressive disease.
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Affiliation(s)
- Julia Alvaeus
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, 901 85, Umeå, Sweden
| | - Robert Rosenblatt
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, 901 85, Umeå, Sweden.,Department of UrologyKarolinska Institutet, Stockholm South General Hospital, Stockholm, Sweden
| | - Markus Johansson
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, 901 85, Umeå, Sweden.,Department of Urology, Sundsvall Hospital, Sundsvall, Sweden
| | | | | | - Benny Holmström
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Tammer Hemdan
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Ylva Huge
- Division of Urology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Firas Aljabery
- Division of Urology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Susanne Gabrielsson
- Division of Immunology and Allergy, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Katrine Riklund
- Department of Radiation Sciences, Umeå University, Umeå, Sweden
| | - Ola Winqvist
- Department of Clinical Immunology, Karolinska University Hospital, Stockholm, Sweden
| | - Amir Sherif
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, 901 85, Umeå, Sweden.
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23
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Record J, Sendel A, Kritikou JS, Kuznetsov NV, Brauner H, He M, Nagy N, Oliveira MMS, Griseti E, Haase CB, Dahlström J, Boddul S, Wermeling F, Thrasher AJ, Liu C, Andersson J, Claesson HE, Winqvist O, Burns SO, Björkholm M, Westerberg LS. An intronic deletion in megakaryoblastic leukemia 1 is associated with hyperproliferation of B cells in triplets with Hodgkin lymphoma. Haematologica 2019; 105:1339-1350. [PMID: 31582539 PMCID: PMC7193474 DOI: 10.3324/haematol.2019.216317] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 03/07/2019] [Accepted: 09/26/2019] [Indexed: 11/09/2022] Open
Abstract
Megakaryoblastic leukemia 1 (MKL1) is a coactivator of serum response factor and together they regulate transcription of actin cytoskeleton genes. MKL1 is associated with hematologic malignancies and immunodeficiency, but its role in B cells is unexplored. Here we examined B cells from monozygotic triplets with an intronic deletion in MKL1, two of whom had been previously treated for Hodgkin lymphoma (HL). To investigate MKL1 and B-cell responses in the pathogenesis of HL, we generated Epstein-Barr virus-transformed lymphoblastoid cell lines from the triplets and two controls. While cells from the patients with treated HL had a phenotype close to that of the healthy controls, cells from the undiagnosed triplet had increased MKL1 mRNA, increased MKL1 protein, and elevated expression of MKL1-dependent genes. This profile was associated with elevated actin content, increased cell spreading, decreased expression of CD11a integrin molecules, and delayed aggregation. Moreover, cells from the undiagnosed triplet proliferated faster, displayed a higher proportion of cells with hyperploidy, and formed large tumors in vivo This phenotype was reversible by inhibiting MKL1 activity. Interestingly, cells from the triplet treated for HL in 1985 contained two subpopulations: one with high expression of CD11a that behaved like control cells and the other with low expression of CD11a that formed large tumors in vivo similar to cells from the undiagnosed triplet. This implies that pre-malignant cells had re-emerged a long time after treatment. Together, these data suggest that dysregulated MKL1 activity participates in B-cell transformation and the pathogenesis of HL.
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Affiliation(s)
- Julien Record
- Department of Microbiology, Tumor and Cell Biology, Biomedicum, Karolinska Institutet, Stockholm, Sweden
| | - Anton Sendel
- Department of Microbiology, Tumor and Cell Biology, Biomedicum, Karolinska Institutet, Stockholm, Sweden
| | - Joanna S Kritikou
- Department of Microbiology, Tumor and Cell Biology, Biomedicum, Karolinska Institutet, Stockholm, Sweden
| | - Nikolai V Kuznetsov
- Department of Microbiology, Tumor and Cell Biology, Biomedicum, Karolinska Institutet, Stockholm, Sweden
| | - Hanna Brauner
- Department of Microbiology, Tumor and Cell Biology, Biomedicum, Karolinska Institutet, Stockholm, Sweden
| | - Minghui He
- Department of Microbiology, Tumor and Cell Biology, Biomedicum, Karolinska Institutet, Stockholm, Sweden
| | - Noemi Nagy
- Department of Microbiology, Tumor and Cell Biology, Biomedicum, Karolinska Institutet, Stockholm, Sweden
| | - Mariana M S Oliveira
- Department of Microbiology, Tumor and Cell Biology, Biomedicum, Karolinska Institutet, Stockholm, Sweden
| | - Elena Griseti
- Department of Microbiology, Tumor and Cell Biology, Biomedicum, Karolinska Institutet, Stockholm, Sweden
| | - Christoph B Haase
- Department of Microbiology, Tumor and Cell Biology, Biomedicum, Karolinska Institutet, Stockholm, Sweden
| | - Jenny Dahlström
- Department of Medicine Solna, Karolinska University Hospital, Stockholm, Sweden
| | - Sanjaykumar Boddul
- Department of Medicine Solna, Karolinska University Hospital, Stockholm, Sweden
| | - Fredrik Wermeling
- Department of Medicine Solna, Karolinska University Hospital, Stockholm, Sweden
| | | | - Chaohong Liu
- Department of Pathogen Biology, School of Basic Medicine, Huazhong University of Science and Technology, Wuhan, China
| | - John Andersson
- Department of Microbiology, Tumor and Cell Biology, Biomedicum, Karolinska Institutet, Stockholm, Sweden.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Hans-Erik Claesson
- Department of Medicine Solna, Karolinska University Hospital, Stockholm, Sweden
| | - Ola Winqvist
- Department of Medicine Solna, Karolinska University Hospital, Stockholm, Sweden
| | - Siobhan O Burns
- Institute of Immunity and Transplantation, University College London, London, UK.,Department of Immunology, Royal Free London NHS Foundation Trust, London, UK
| | - Magnus Björkholm
- Department of Medicine Solna, Karolinska University Hospital, Stockholm, Sweden
| | - Lisa S Westerberg
- Department of Microbiology, Tumor and Cell Biology, Biomedicum, Karolinska Institutet, Stockholm, Sweden
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24
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Arkestål K, Mints M, Enocson A, Linton L, Marits P, Glise H, Andersson J, Winqvist O. CCR2 upregulated on peripheral T cells in osteoarthritis but not in bone marrow. Scand J Immunol 2018; 88:e12722. [PMID: 30403025 DOI: 10.1111/sji.12722] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 09/11/2018] [Accepted: 09/30/2018] [Indexed: 12/24/2022]
Abstract
Osteoarthritis (OA) is a condition affecting millions of patients around the world, causing pain and disability and often resulting in joint replacement surgery. The aetiology of OA has long been attributed to mechanical wear mainly due to the increased prevalence of OA in load bearing joints among older patients. However, recent studies reveal a complex molecular disease causality in which inflammation, nutritional deficit and angiogenesis lead to the destruction of the joint structure. The aim of this study was to examine chemokine receptor expression in peripheral blood and bone marrow in OA patients. We devised a protocol for extracting healthy bone marrow from patients undergoing hip arthroplasty due to coxarthrosis. Flow cytometry was used to determine the expression of 18 chemokine receptors on CD4 and CD8 T cells from bone marrow and blood from 7 osteoarthritis patients and peripheral blood from 9 healthy controls. We found a significantly increased fraction of CCR2 expressing CD4 and CD8 T cell in peripheral blood compared to healthy controls. Also, there was a significant decrease in CXCR3 (Th1) (P < 0.01) expressing T cells in peripheral blood from OA patients. Finally, multivariate analysis was used to separate T cell profiles from healthy controls and OA patients and demonstrate that the divergence of chemokine receptor expression occurs in the mature T cell subsets. In conclusion, we find increased CCR2 expression in peripheral blood from OA patients that possibly may be targeted in future clinical studies.
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Affiliation(s)
- Kurt Arkestål
- Department of Medicine, Immunology and Allergy Unit, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Michael Mints
- Department of Surgery and Perioperative Science, Urology and Andrology Unit, Umeå University, Umeå, Sweden
| | - Anders Enocson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Ludvig Linton
- Department of Medicine, Immunology and Allergy Unit, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Per Marits
- Department of Medicine, Immunology and Allergy Unit, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Hans Glise
- Department of Medicine, Immunology and Allergy Unit, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - John Andersson
- Department of Medicine, Immunology and Allergy Unit, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Ola Winqvist
- Department of Medicine, Immunology and Allergy Unit, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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25
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Zhang L, Hu J, Ali Zirakzadeh A, Rosvall J, Hedlund M, Hu PS, P A Wallin R, Sherif A, Winqvist O. Detection of micro-metastases by flow cytometry in lymph nodes from patients with penile cancer. BMC Urol 2018; 18:86. [PMID: 30290760 PMCID: PMC6173905 DOI: 10.1186/s12894-018-0399-3] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 09/23/2018] [Indexed: 11/21/2022] Open
Abstract
Background The tumor draining lymph node concept was first described in penile cancer for staging. Immunohistochemistry and histopathology evaluations are routinely used in clinical practice to examine lymph nodes for metastasis. However, these methods are time-consuming with low diagnostic accuracy and micro-metastases might be missed. In this study, we aim to evaluate detection of metastatic cells in draining lymph nodes by flow cytometry. Methods To assess the sensitivity of micro-metastasis detection by FACS (Fluorescence-activated cell sorting), HeLa cells were titrated into Peripheral blood mononuclear cells (PBMCs) and expression of pan-cytokeratin AE1/AE3 was analyzed. Single cell suspensions were separately prepared from 10 regional lymph nodes obtained from 5 patients with invasive penile cancer undergoing radical surgery and lymph node dissection. Lymph node dereived cells were examined for cell surface expression of EpCAM, E-cadherin and intracellular expression of pan-cytokeratin AE1/AE3 by FACS. Results Ten lymph nodes from 5 penile cancer patients were investigated in a head-to-head comparison between FACS and pathology examination of sections. All metastatic lymph nodes verified by pathology examination were also identified by FACS. Two additional lymph nodes with micro-metastases were diagnosed by FACS only. Conclusions FACS analyses of pan-cytokeratin AE1/AE3 stained single cells from tumor draining lymph nodes can be used to detect micro-metastases in patients with penile cancer patients.
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Affiliation(s)
- Lu Zhang
- Department of Medicine, Immunology and Allergy Unit, Karolinska University Hospital, SE-171 76, Stockholm, Sweden
| | - Jin Hu
- Department of Medicine, Immunology and Allergy Unit, Karolinska University Hospital, SE-171 76, Stockholm, Sweden
| | - A Ali Zirakzadeh
- Department of Medicine, Immunology and Allergy Unit, Karolinska University Hospital, SE-171 76, Stockholm, Sweden.,Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | - Jesper Rosvall
- Department of Urology, South General Hospital, Karolinska Institutet, Stockholm, Stockholm, Sweden
| | - Mats Hedlund
- Department of Urology, South General Hospital, Karolinska Institutet, Stockholm, Stockholm, Sweden
| | - Ping Sheng Hu
- Cancer Biotherapy Center, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Robert P A Wallin
- Department of Medicine, Immunology and Allergy Unit, Karolinska University Hospital, SE-171 76, Stockholm, Sweden
| | - Amir Sherif
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | - Ola Winqvist
- Department of Medicine, Immunology and Allergy Unit, Karolinska University Hospital, SE-171 76, Stockholm, Sweden.
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26
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Hartana CA, Ahlén Bergman E, Broomé A, Berglund S, Johansson M, Alamdari F, Jakubczyk T, Huge Y, Aljabery F, Palmqvist K, Holmström B, Glise H, Riklund K, Sherif A, Winqvist O. Tissue-resident memory T cells are epigenetically cytotoxic with signs of exhaustion in human urinary bladder cancer. Clin Exp Immunol 2018; 194:39-53. [PMID: 30009527 PMCID: PMC6156818 DOI: 10.1111/cei.13183] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [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] [Accepted: 05/20/2018] [Indexed: 12/26/2022] Open
Abstract
Tissue‐resident memory T (TRM) cells are CD8+ T lymphocytes that reside in the tissues, including tumours. This T cell subset possesses a magnitude of cytotoxicity, but its epigenetic regulation has not been studied. Here, we investigate the impact of perforin DNA methylation in TRM cells and correlate it with their functional potential. Fifty‐three urothelial urinary bladder cancer (UBC) patients were recruited prospectively. The DNA methylation status of the perforin gene (PRF1) locus in TRM cells was investigated by pyrosequencing. Flow cytometry with ViSNE analysis and in‐vitro stimulation were used to evaluate TRM cell phenotypes. We discovered that tumour TRM cells have low DNA methylation in the PRF1 locus (32·9% methylation), which corresponds to increased numbers of perforin‐expressing TRM cells. Surprisingly, programmed cell death 1 (PD‐1) expression is high in tumour TRM cells, suggesting exhaustion. Following interleukin‐15 and T cell receptor stimulation, perforin and T‐bet expressions are enhanced, indicating that TRM cells from tumours are not terminally exhausted. Moreover, a high number of TRM cells infiltrating the tumours corresponds to lower tumour stage in patients. In conclusion, TRM cells from UBC tumours are epigenetically cytotoxic with signs of exhaustion. This finding identifies TRM cells as potential new targets for cancer immunotherapy.
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Affiliation(s)
- C A Hartana
- Karolinska Institutet, Department of Medicine Solna, Unit of Immunology and Allergy, Stockholm, Sweden
| | - E Ahlén Bergman
- Karolinska Institutet, Department of Medicine Solna, Unit of Immunology and Allergy, Stockholm, Sweden
| | - A Broomé
- Karolinska Institutet, Department of Medicine Solna, Unit of Immunology and Allergy, Stockholm, Sweden
| | - S Berglund
- Karolinska Institutet, Department of Medicine Solna, Unit of Immunology and Allergy, Stockholm, Sweden
| | - M Johansson
- Department of Urology, Sundsvall Hospital, Sundsvall, Sweden
| | - F Alamdari
- Department of Urology, Västmanland Hospital, Västerås, Sweden
| | - T Jakubczyk
- Department of Urology, Länssjukhuset Ryhov, Jönköping, Sweden
| | - Y Huge
- Department of Clinical and Experimental Medicine, Division of Urology, Linköping University, Linköping, Sweden
| | - F Aljabery
- Department of Clinical and Experimental Medicine, Division of Urology, Linköping University, Linköping, Sweden
| | - K Palmqvist
- Department of Surgery, Östersund County Hospital, Urology section, Östersund, Sweden
| | - B Holmström
- Department of Urology, Akademiska University Hospital, Uppsala, Sweden
| | - H Glise
- Karolinska Institutet, Department of Medicine Solna, Unit of Immunology and Allergy, Stockholm, Sweden
| | - K Riklund
- Department of Radiation Sciences, Diagnostic Radiology, Umeå University, Umeå, Sweden
| | - A Sherif
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | - O Winqvist
- Karolinska Institutet, Department of Medicine Solna, Unit of Immunology and Allergy, Stockholm, Sweden
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27
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Ahlén Bergman E, Hartana CA, Johansson M, Linton LB, Berglund S, Hyllienmark M, Lundgren C, Holmström B, Palmqvist K, Hansson J, Alamdari F, Huge Y, Aljabery F, Riklund K, Winerdal ME, Krantz D, Zirakzadeh AA, Marits P, Sjöholm LK, Sherif A, Winqvist O. Increased CD4 + T cell lineage commitment determined by CpG methylation correlates with better prognosis in urinary bladder cancer patients. Clin Epigenetics 2018; 10:102. [PMID: 30075815 PMCID: PMC6076404 DOI: 10.1186/s13148-018-0536-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [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: 03/01/2018] [Accepted: 07/24/2018] [Indexed: 12/24/2022] Open
Abstract
Background Urinary bladder cancer is a common malignancy worldwide. Environmental factors and chronic inflammation are correlated with the disease risk. Diagnosis is performed by transurethral resection of the bladder, and patients with muscle invasive disease preferably proceed to radical cystectomy, with or without neoadjuvant chemotherapy. The anti-tumour immune responses, known to be initiated in the tumour and draining lymph nodes, may play a major role in future treatment strategies. Thus, increasing the knowledge of tumour-associated immunological processes is important. Activated CD4+ T cells differentiate into four main separate lineages: Th1, Th2, Th17 and Treg, and they are recognized by their effector molecules IFN-γ, IL-13, IL-17A, and the transcription factor Foxp3, respectively. We have previously demonstrated signature CpG sites predictive for lineage commitment of these four major CD4+ T cell lineages. Here, we investigate the lineage commitment specifically in tumour, lymph nodes and blood and relate them to the disease stage and response to neoadjuvant chemotherapy. Results Blood, tumour and regional lymph nodes were obtained from patients at time of transurethral resection of the bladder and at radical cystectomy. Tumour-infiltrating CD4+ lymphocytes were significantly hypomethylated in all four investigated lineage loci compared to CD4+ lymphocytes in lymph nodes and blood (lymph nodes vs tumour-infiltrating lymphocytes: IFNG -4229 bp p < 0.0001, IL13 -11 bp p < 0.05, IL17A -122 bp p < 0.01 and FOXP3 -77 bp p > 0.05). Examination of individual lymph nodes displayed different methylation signatures, suggesting possible correlation with future survival. More advanced post-cystectomy tumour stages correlated significantly with increased methylation at the IFNG -4229 bp locus. Patients with complete response to neoadjuvant chemotherapy displayed significant hypomethylation in CD4+ T cells for all four investigated loci, most prominently in IFNG p < 0.0001. Neoadjuvant chemotherapy seemed to result in a relocation of Th1-committed CD4+ T cells from blood, presumably to the tumour, indicated by shifts in the methylation patterns, whereas no such shifts were seen for lineages corresponding to IL13, IL17A and FOXP3. Conclusion Increased lineage commitment in CD4+ T cells, as determined by demethylation in predictive CpG sites, is associated with lower post-cystectomy tumour stage, complete response to neoadjuvant chemotherapy and overall better outcome, suggesting epigenetic profiling of CD4+ T cell lineages as a useful readout for clinical staging. Electronic supplementary material The online version of this article (10.1186/s13148-018-0536-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Emma Ahlén Bergman
- Unit of Immunology and Allergy, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
| | - Ciputra Adijaya Hartana
- Unit of Immunology and Allergy, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Markus Johansson
- Department of Urology, Sundsvall Hospital, Sundsvall, Sweden.,Department of surgical and perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | - Ludvig B Linton
- Unit of Immunology and Allergy, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Sofia Berglund
- Unit of Immunology and Allergy, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | | | - Christian Lundgren
- Unit of Immunology and Allergy, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Benny Holmström
- Department of Urology, Akademiska University Hospital, Uppsala, Sweden
| | - Karin Palmqvist
- Department of surgical and perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden.,Department of Surgery, Urology Section, Östersund County Hospital, Östersund, Sweden
| | - Johan Hansson
- Centre for Research and Development, Faculty of Medicine, Uppsala University, County Council of Gävleborg, Uppsala, Sweden
| | | | - Ylva Huge
- Department of Clinical and Experimental Medicine, Division of Urology, Linköping University, Linköping, Sweden
| | - Firas Aljabery
- Department of Clinical and Experimental Medicine, Division of Urology, Linköping University, Linköping, Sweden
| | - Katrine Riklund
- Department of Radiation Sciences, Diagnostic Radiology, Umeå University, Umeå, Sweden
| | - Malin E Winerdal
- Unit of Immunology and Allergy, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - David Krantz
- Unit of Immunology and Allergy, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - A Ali Zirakzadeh
- Unit of Immunology and Allergy, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.,Department of surgical and perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | - Per Marits
- Unit of Immunology and Allergy, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Louise K Sjöholm
- Center for Molecular Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Amir Sherif
- Department of surgical and perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden.,Department of Radiation Sciences, Diagnostic Radiology, Umeå University, Umeå, Sweden
| | - Ola Winqvist
- Unit of Immunology and Allergy, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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28
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Winerdal ME, Krantz D, Hartana CA, Zirakzadeh AA, Linton L, Bergman EA, Rosenblatt R, Vasko J, Alamdari F, Hansson J, Holmström B, Johansson M, Winerdal M, Marits P, Sherif A, Winqvist O. Urinary Bladder Cancer Tregs Suppress MMP2 and Potentially Regulate Invasiveness. Cancer Immunol Res 2018; 6:528-538. [DOI: 10.1158/2326-6066.cir-17-0466] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 11/13/2017] [Accepted: 03/13/2018] [Indexed: 11/16/2022]
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Abstract
The secondary effects of chemotherapy, with bone marrow depression and risk of leukopenia, has traditionally been considered being detrimental for the immune system. However, growing evidence suggests a main role for chemotherapy in antitumor immunomodulation. With reference to cisplatin, which is the basis of neoadjuvant chemotherapy in muscle invasive bladder cancer, four different aspects of immunomodulation has thus far been described; increased MHC class I expression, recruitment and proliferation of effector cells, enhancement of tumor-lytic activity of cytotoxic effectors and downregulation of immunosuppressive actors in the microenvironment. Consequently, the role of chemotherapy in cancer is changing from a therapy solely aimed at inducing tumor cell death, to a potent inducer of immune responses and a potential future major partaker in cancer immunotherapy. This is a great opportunity for the urological community to broaden research in this field in order to increase knowledge, optimize and improve the neoadjuvant regimens of muscle invasive bladder cancer to ultimately improve patient outcome.
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Affiliation(s)
- Amir Sherif
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | - Malin Winerdal
- Department of Medicine, Immunology and Allergy Unit, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Ola Winqvist
- Department of Medicine, Immunology and Allergy Unit, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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30
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Eriksson D, Dalin F, Eriksson GN, Landegren N, Bianchi M, Hallgren Å, Dahlqvist P, Wahlberg J, Ekwall O, Winqvist O, Catrina SB, Rönnelid J, Hulting AL, Lindblad-Toh K, Alimohammadi M, Husebye ES, Knappskog PM, Rosengren Pielberg G, Bensing S, Kämpe O. Cytokine Autoantibody Screening in the Swedish Addison Registry Identifies Patients With Undiagnosed APS1. J Clin Endocrinol Metab 2018; 103:179-186. [PMID: 29069385 DOI: 10.1210/jc.2017-01957] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Accepted: 10/16/2017] [Indexed: 12/30/2022]
Abstract
CONTEXT Autoimmune polyendocrine syndrome type 1 (APS1) is a monogenic disorder that features autoimmune Addison disease as a major component. Although APS1 accounts for only a small fraction of all patients with Addison disease, early identification of these individuals is vital to prevent the potentially lethal complications of APS1. OBJECTIVE To determine whether available serological and genetic markers are valuable screening tools for the identification of APS1 among patients diagnosed with Addison disease. DESIGN We systematically screened 677 patients with Addison disease enrolled in the Swedish Addison Registry for autoantibodies against interleukin-22 and interferon-α4. Autoantibody-positive patients were investigated for clinical manifestations of APS1, additional APS1-specific autoantibodies, and DNA sequence and copy number variations of AIRE. RESULTS In total, 17 patients (2.5%) displayed autoantibodies against interleukin-22 and/or interferon-α4, of which nine were known APS1 cases. Four patients previously undiagnosed with APS1 fulfilled clinical, genetic, and serological criteria. Hence, we identified four patients with undiagnosed APS1 with this screening procedure. CONCLUSION We propose that patients with Addison disease should be routinely screened for cytokine autoantibodies. Clinical or serological support for APS1 should warrant DNA sequencing and copy number analysis of AIRE to enable early diagnosis and prevention of lethal complications.
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Affiliation(s)
- Daniel Eriksson
- Center for Molecular Medicine, Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden
- Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden
| | - Frida Dalin
- Center for Molecular Medicine, Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden
- Science for Life Laboratory, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | | | - Nils Landegren
- Center for Molecular Medicine, Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden
- Science for Life Laboratory, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Matteo Bianchi
- Science for Life Laboratory, Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
| | - Åsa Hallgren
- Center for Molecular Medicine, Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden
- Science for Life Laboratory, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Per Dahlqvist
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Jeanette Wahlberg
- Department of Endocrinology, Linköping University, Linköping, Sweden
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Olov Ekwall
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ola Winqvist
- Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden
| | - Sergiu-Bogdan Catrina
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Johan Rönnelid
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | | | - Anna-Lena Hulting
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Kerstin Lindblad-Toh
- Science for Life Laboratory, Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
- Broad Institute of Massachusetts Institute of Technology and Harvard University, Cambridge, Massachusetts
| | | | - Eystein S Husebye
- Center for Molecular Medicine, Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Medicine, University of Bergen, Bergen, Norway
- K.G. Jebsen Center for Autoimmune Disorders, Bergen, Norway
| | - Per Morten Knappskog
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Center for Medical Genetics and Molecular Medicine, Haukeland University Hospital, Bergen, Norway
| | - Gerli Rosengren Pielberg
- Science for Life Laboratory, Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
| | - Sophie Bensing
- Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Olle Kämpe
- Center for Molecular Medicine, Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden
- Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden
- Science for Life Laboratory, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
- K.G. Jebsen Center for Autoimmune Disorders, Bergen, Norway
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31
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Eberhardson M, Karlén P, Linton L, Jones P, Lindberg A, Kostalla MJ, Lindh E, Odén A, Glise H, Winqvist O. Randomised, Double-blind, Placebo-controlled Trial of CCR9-targeted Leukapheresis Treatment of Ulcerative Colitis Patients. J Crohns Colitis 2017; 11:534-542. [PMID: 28453759 DOI: 10.1093/ecco-jcc/jjw196] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 10/28/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Ulcerative colitis patients display increased numbers of circulating pro-inflammatory monocyte human leukocyte antigen-DR [HLA-DRhi] monocytes expressing high levels of the gut-homing C-C chemokine receptor 9 [CCR9] and tumour necrosis factor [TNF]-α. The aim of this first-in-human, double-blind, randomised, placebo-controlled trial was to evaluate selective removal of circulating CCR9-expressing monocytes by leukapheresis in patients with moderate to severe ulcerative colitis, with regards to safety, tolerability, and immunological response. METHODS Patients with ulcerative colitis were treated every second day with leukapheresis during five sessions with a C-C chemokine ligand 25 [CCL25; CCR9 ligand] column or a placebo column. RESULTS No major safety concerns were raised and the procedure was well tolerated. Pro-inflammatory HLA-DRhi cells decreased significantly in the active treatment group [p = 0.0391] whereas no statistically significant change was seen in the placebo group [p = 0.4688]. There was a significant decrease of HLA-DRhi monocytes in the active group compared with the placebo group when corrected for the imbalance in weight between the groups [p = 0.0105]. Mayo score decreased in the active group [p = 0.0156] whereas the change in the placebo group was not significant [p = 0.1250]. Mayo score ≤ 3 was observed in five out of 14 patients [35.7%] in the active group compared with one out of eight [12.5%] receiving placebo. The number of responders in the active treatment group was eight out of 14 patients [57.1%], whereas in the corresponding placebo group three out of eight patients [37.5%] responded to placebo. A dose-response correlation was observed between the blood volume processed and clinical outcome. CONCLUSION This clinical induction trial using CCL25-tailored leukapheresis demonstrates a safe and effective removal of activated monocytes with a clinical effect in patients with ulcerative colitis.
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Affiliation(s)
- Michael Eberhardson
- Department of Gastroenterology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Per Karlén
- Department of Gastroenterology, Karolinska Institutet, Danderyd Hospital, Sweden
| | - Ludvig Linton
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Petra Jones
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Annelie Lindberg
- Department of Gastroenterology, Karolinska Institutet, Danderyd Hospital, Sweden
| | | | - Emma Lindh
- ITH, Karolinska University Hospital, Stockholm, Sweden
| | - Anders Odén
- Mathematical Sciences, Chalmers University of Technology, Gothenburg, Sweden
| | - Hans Glise
- ITH, Karolinska University Hospital, Stockholm, Sweden
| | - Ola Winqvist
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
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32
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Millrud CR, Kågedal Å, Kumlien Georén S, Winqvist O, Uddman R, Razavi R, Munck-Wikland E, Cardell LO. NET-producing CD16 high CD62L dim neutrophils migrate to tumor sites and predict improved survival in patients with HNSCC. Int J Cancer 2017; 140:2557-2567. [PMID: 28247912 DOI: 10.1002/ijc.30671] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [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: 09/09/2016] [Revised: 11/24/2016] [Accepted: 02/21/2017] [Indexed: 01/13/2023]
Abstract
The concept of functional neutrophil subsets is new and their clinical significance in malignancies is unknown. Our study investigated the role of CD16dim CD62Lhigh , CD16high CD62Lhigh and CD16high CD62Ldim neutrophil subsets in head and neck squamous cell carcinoma (HNSCC) patients. These neutrophil subsets may play different roles in immune-related activity in cancer, based on their profile, activation state and migration ability within a tumor site, which may be important in predicting cancer prognoses. Tumor biopsies and blood were obtained from newly diagnosed untreated HNSCC patients and healthy controls. Neutrophil subsets and their phenotype were characterized using flow cytometry. Isolated granulocytes were assessed for anti-tumor immune functions. Compared to controls HNSCC patients exhibited increased CD16high CD62Ldim neutrophils in blood; this subset displayed a distinct phenotypes with high expression of CD11b and CD18. This subset was prone to migrate into the tumor facilitated by tumor-derived IL-8. Furthermore, IL-8 was also found to activate neutrophils and thereby promoting subset transition. Various assays demonstrated that activated CD16high CD62Ldim neutrophils inhibited migration, proliferation and induced apoptosis of FaDu cancer cells. Neutrophil elastase detected in activated CD16high CD62Ldim neutrophils and tumor biopsies suggested that CD16high CD62Ldim neutrophils impart anti-tumoral activity via neutrophil extracellular traps. Furthermore, increased fraction of CD16high CD62Ldim neutrophils was shown to correlate with an increased survival rate. Our study demonstrates the clinical relevance of the CD16high CD62Ldim neutrophil subset, providing evidence for its increased migration capacity, its anti-tumor activity including increased NET formation and finally its correlation with increased survival in HNSCC patients.
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Affiliation(s)
- Camilla Rydberg Millrud
- Division of ENT Diseases, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Åsa Kågedal
- Division of ENT Diseases, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Susanna Kumlien Georén
- Division of ENT Diseases, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Ola Winqvist
- Department of Medicine, Translational Immunology Unit, Karolinska Institutet, Stockholm, Sweden
| | - Rolf Uddman
- Department of Otorhinolaryngology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Ronia Razavi
- Division of ENT Diseases, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Eva Munck-Wikland
- Division of ENT Diseases, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Lars Olaf Cardell
- Division of ENT Diseases, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
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Arebro J, Ekstedt S, Hjalmarsson E, Winqvist O, Kumlien Georén S, Cardell LO. A possible role for neutrophils in allergic rhinitis revealed after cellular subclassification. Sci Rep 2017; 7:43568. [PMID: 28272395 PMCID: PMC5341103 DOI: 10.1038/srep43568] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [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: 10/14/2016] [Accepted: 01/25/2017] [Indexed: 12/13/2022] Open
Abstract
A re-examination of former concepts is required to meet today’s medical challenges in allergic rhinitis. Previously, neutrophils have been treated as a relatively homogenous cell population found in the nose both when the patient is suffering at the height of the allergic season as well as when the patient report no symptoms. However, new data indicates that neutrophils can be divided into different subsets with diverse roles in inflammation. We showed increased levels of neutrophils in peripheral blood, nasal biopsies and nasal lavage fluid (NAL) from allergic patients during the pollen season compared to healthy controls. A closer examination revealed that the activated subset of neutrophils, CD16high CD62Ldim, outweighed the normal form CD16high CD62Lhigh in nasal tissue among these patients. This skewed distribution was not seen in controls. The normal subset prevailed in peripheral blood from patients as well as controls, whereas CD16high CD62Ldim and CD16dim CD62Ldim subsets, the latter considered “end state” neutrophils before apoptosis, were elevated in NAL. Functional in vitro experiments revealed that activated neutrophils exhibit a T cell priming capacity and an ability to enhance eosinophil migration. Activated neutrophils may thus contribute to allergic inflammation seen in allergic rhinitis by priming T cells and attracting eosinophils.
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Affiliation(s)
- Julia Arebro
- Division of ENT Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.,Department of ENT Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Sandra Ekstedt
- Division of ENT Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Eric Hjalmarsson
- Division of ENT Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Ola Winqvist
- Department of Medicine, Unit of Translational Immunology, Karolinska Institutet, Stockholm, Sweden
| | - Susanna Kumlien Georén
- Division of ENT Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Lars-Olaf Cardell
- Division of ENT Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.,Department of ENT Diseases, Karolinska University Hospital, Stockholm, Sweden
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Dalin F, Nordling Eriksson G, Dahlqvist P, Hallgren Å, Wahlberg J, Ekwall O, Söderberg S, Rönnelid J, Olcén P, Winqvist O, Catrina SB, Kriström B, Laudius M, Isaksson M, Halldin Stenlid M, Gustafsson J, Gebre-Medhin G, Björnsdottir S, Janson A, Åkerman AK, Åman J, Duchen K, Bergthorsdottir R, Johannsson G, Lindskog E, Landin-Olsson M, Elfving M, Waldenström E, Hulting AL, Kämpe O, Bensing S. Clinical and Immunological Characteristics of Autoimmune Addison Disease: A Nationwide Swedish Multicenter Study. J Clin Endocrinol Metab 2017; 102:379-389. [PMID: 27870550 DOI: 10.1210/jc.2016-2522] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 10/07/2016] [Indexed: 11/19/2022]
Abstract
CONTEXT Studies of the clinical and immunological features of autoimmune Addison disease (AAD) are needed to understand the disease burden and increased mortality. OBJECTIVE To provide upgraded data on autoimmune comorbidities, replacement therapy, autoantibody profiles, and cardiovascular risk factors. DESIGN, SETTING, AND PARTICIPANTS A cross-sectional, population-based study that included 660 AAD patients from the Swedish Addison Registry (2008-2014). When analyzing the cardiovascular risk factors, 3594 individuals from the population-based survey in Northern Sweden, MONICA (monitoring of trends and determinants of cardiovascular disease), served as controls. MAIN OUTCOME MEASURES The endpoints were the prevalence of autoimmune comorbidities and cardiovascular risk factors. Autoantibodies against 13 autoantigens were determined. RESULTS The proportion of 21-hydroxylase autoantibody-positive patients was 83%, and 62% of patients had ≥1 associated autoimmune diseases, more frequently coexisting in females (P < 0.0001). AAD patients had a lower body mass index (P < 0.0001) and prevalence of hypertension (P = 0.027) compared with controls. Conventional hydrocortisone tablets were used by 89% of the patients, with a mean dose of 28.1 ± 8.5 mg/d. The mean hydrocortisone equivalent dose normalized to the body surface was 14.8 ± 4.4 mg/m2/d. A greater hydrocortisone equivalent dose was associated with a greater incidence of hypertension (P = 0.046). CONCLUSIONS Careful monitoring of AAD patients is warranted to detect associated autoimmune diseases. Contemporary Swedish AAD patients did not have an increased prevalence of overweight, hypertension, type 2 diabetes mellitus, or hyperlipidemia. However, high glucocorticoid replacement doses could be a risk factor for hypertension.
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Affiliation(s)
- Frida Dalin
- Centre for Molecular Medicine, Department of Medicine (Solna)
- Science for Life Laboratory, Department of Medical Sciences, and
| | | | - Per Dahlqvist
- Department of Public Health and Clinical Medicine and
| | - Åsa Hallgren
- Centre for Molecular Medicine, Department of Medicine (Solna)
| | - Jeanette Wahlberg
- Division of Endocrinology, Department of Medical and Health Sciences, Faculty of Health Sciences, and
| | - Olov Ekwall
- Department of Pediatrics, Institute of Clinical Sciences
| | | | | | - Per Olcén
- Department of Laboratory Medicine and
| | - Ola Winqvist
- Translational Immunology, Department of Medicine (Solna), and
| | - Sergiu-Bogdan Catrina
- Department of Molecular Medicine and Surgery, and
- Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Karolinska Institutet, Stockholm SE-17176, Sweden
| | - Berit Kriström
- Institution of Clinical Science, Pediatrics, Umeå University, Umeå SE-90736, Sweden
| | - Maria Laudius
- Department of Public Health and Clinical Medicine and
| | | | | | - Jan Gustafsson
- Women's and Children's Health, Uppsala University, Uppsala SE-75236, Sweden
| | | | - Sigridur Björnsdottir
- Department of Molecular Medicine and Surgery, and
- Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Karolinska Institutet, Stockholm SE-17176, Sweden
| | - Annika Janson
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm SE-17176, Sweden
| | | | - Jan Åman
- Department of Pediatrics, Faculty of Medicine and Health, Örebro University, Örebro SE-70281, Sweden
| | - Karel Duchen
- Division of Pediatrics, Department of Clinical and Experimental Medicine, Linköping University, Linköping SE-58183, Sweden
| | - Ragnhildur Bergthorsdottir
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, and
- Department of Endocrinology, Sahlgrenska University Hospital, Sahlgrenska Academy, University of Gothenburg, Gothenburg SE-40530, Sweden
| | - Gudmundur Johannsson
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, and
- Department of Endocrinology, Sahlgrenska University Hospital, Sahlgrenska Academy, University of Gothenburg, Gothenburg SE-40530, Sweden
| | - Emma Lindskog
- Department of Pediatrics, Institute of Clinical Sciences
| | - Mona Landin-Olsson
- Department of Endocrinology, Skåne University Hospital, Lund SE-22362, Sweden; and
| | - Maria Elfving
- Department of Pediatrics, Pediatric Endocrinology, Clinical Sciences, Lund University, Lund SE-22362, Sweden
| | - Erik Waldenström
- Department of Endocrinology, Skåne University Hospital, Lund SE-22362, Sweden; and
| | | | - Olle Kämpe
- Centre for Molecular Medicine, Department of Medicine (Solna)
- Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Karolinska Institutet, Stockholm SE-17176, Sweden
| | - Sophie Bensing
- Department of Molecular Medicine and Surgery, and
- Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Karolinska Institutet, Stockholm SE-17176, Sweden
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Winerdal M, Urmaliya V, Winerdal ME, Fredholm BB, Winqvist O, Ådén U. Single Dose Caffeine Protects the Neonatal Mouse Brain against Hypoxia Ischemia. PLoS One 2017; 12:e0170545. [PMID: 28129361 PMCID: PMC5271335 DOI: 10.1371/journal.pone.0170545] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 12/13/2016] [Indexed: 11/27/2022] Open
Abstract
In this randomized blinded study, we investigated caffeine 5 mg/kg treatment given directly after neonatal brain hypoxia ischemia. Brain morphology, behavior and key brain infiltrating immune populations were examined. Caffeine treatment significantly improves outcome when compared to phosphate buffered saline. Flow cytometric analysis of immune responses revealed no persistent immunological alterations. Given its safety caffeine emerges as a candidate for neuroprotective intervention after neonatal brain injury.
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Affiliation(s)
- Max Winerdal
- Department of Women´s and Children´s Health, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | - Vijay Urmaliya
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | | | - Bertil B. Fredholm
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Ola Winqvist
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Ulrika Ådén
- Department of Women´s and Children´s Health, Karolinska Institutet, Stockholm, Sweden
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36
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Kindlund B, Sjöling Å, Yakkala C, Adamsson J, Janzon A, Hansson LE, Hermansson M, Janson P, Winqvist O, Lundin SB. CD4 + regulatory T cells in gastric cancer mucosa are proliferating and express high levels of IL-10 but little TGF-β. Gastric Cancer 2017; 20:116-125. [PMID: 26782287 DOI: 10.1007/s10120-015-0591-z] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 12/21/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND An increase of regulatory T cells, defined as CD25high- and/or FOXP3+-expressing CD4+ T cells, within tumors has been reported in several studies. Tregs promote tumor growth by modulating the antitumor immune response, mainly through inhibition of T-cell-mediated tumor cell killing: this has been suggested to be dependent on IL-10 and/or TGF-β. In stomach cancer, the mechanisms behind the accumulation of Tregs in tumor tissue has not been fully elucidated, and neither has Treg gene expression in situ. MATERIALS AND METHODS Stomach tissue from gastric cancer patients undergoing gastric resection was analyzed using flow cytometry and cell sorting, followed by RT-PCR. RESULTS We observed that stomach CD4+ FOXP3+ T cells proliferated to a higher degree than CD4+ FOXP3- T cells, which may contribute to Treg accumulation in the mucosa. By analyzing DNA methylation, we demonstrated that both proliferating and nonproliferating FOXP3+ T cells exhibited complete demethylation of the FOXP3 gene, indicating a stable FOXP3 expression in both cell populations. Furthermore, analysis of T-cell populations isolated directly from the tumor and tumor-free mucosa demonstrated that CD4+ CD25high T cells have a higher IL-10/IFN-γ gene expression ratio but express lower levels of TGF-β than CD4+ CD25low/- T cells. CONCLUSION We demonstrate strong proliferation among regulatory CD4+ FOXP3+ CD25high T cells in the gastric cancer mucosa. These local Treg express a suppressive cytokine profile characterized by high IL-10 and low TGF-β and IFN-γ production.
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Affiliation(s)
- Bert Kindlund
- Department of Microbiology and Immunology, Institute of Biomedicine, University of Gothenburg, Box 435, 40530, Gothenburg, Sweden
| | - Åsa Sjöling
- Department of Microbiology and Immunology, Institute of Biomedicine, University of Gothenburg, Box 435, 40530, Gothenburg, Sweden
| | - Chakradhar Yakkala
- Department of Microbiology and Immunology, Institute of Biomedicine, University of Gothenburg, Box 435, 40530, Gothenburg, Sweden
| | - Jenni Adamsson
- Department of Microbiology and Immunology, Institute of Biomedicine, University of Gothenburg, Box 435, 40530, Gothenburg, Sweden
| | - Anders Janzon
- Department of Microbiology and Immunology, Institute of Biomedicine, University of Gothenburg, Box 435, 40530, Gothenburg, Sweden
| | - Lars-Erik Hansson
- Department of Gastro-Research, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Michael Hermansson
- Department of Gastro-Research, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Peter Janson
- Clinical Allergy Research Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Ola Winqvist
- Clinical Allergy Research Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Samuel B Lundin
- Department of Microbiology and Immunology, Institute of Biomedicine, University of Gothenburg, Box 435, 40530, Gothenburg, Sweden.
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Aljadi Z, Nopp A, Winqvist O, Hylander B, Jacobson S, Lundahl J. P08 BASOPHIL DYSFUNCTION IN CHRONIC KIDNEY DISEASE PATIENTS. Kidney Int Rep 2016. [DOI: 10.1016/j.ekir.2016.09.014] [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: 10/20/2022] Open
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Rosenblatt R, Johansson M, Alamdari F, Sidiki A, Holmström B, Hansson J, Vasko J, Marits P, Gabrielsson S, Riklund K, Winqvist O, Sherif A. Sentinel node detection in muscle-invasive urothelial bladder cancer is feasible after neoadjuvant chemotherapy in all pT stages, a prospective multicenter report. World J Urol 2016; 35:921-927. [PMID: 27738804 PMCID: PMC5486537 DOI: 10.1007/s00345-016-1952-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 05/25/2016] [Accepted: 10/06/2016] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To determine whether sentinel node detection (SNd) in muscle-invasive urothelial bladder cancer (MIBC) can be performed in patients undergoing neoadjuvant chemotherapy (NAC) and determine whether SNd is feasible in all pT stages, including pT0. BACKGROUND Previous published series of SNd in MIBC have not included patients undergoing NAC, and systematic reports of pT0 patients w/wo NAC were absent. Translational immunological tumor research on MIBC focusing on SNd, in the era of NAC, requires technical feasibility. Additionally, SNd in MIBC requests further evaluations as a method for nodal staging. MATERIALS AND METHODS Ninety-nine patients with suspected urothelial MIBC were prospectively selected from six urological centers. After TUR-B and primary staging, 65 MIBC patients qualified for radical cystectomy. Precystectomy staging was cT2a-T4aN0M0, including 47 NAC patients and 18 chemo-naïve patients. All 65 patients underwent intraoperative SNd by peritumoral injection of 80 Mbq Technetium and Geiger probe detection. Postcystectomy staging was pT0-T4aN0-N2M0. SNs were defined by two calculations, SNdef1 and SNdef2. RESULTS Totally 1063 lymph nodes were removed (total SNs; 222-227). NAC patients with pT0 (n = 24) displayed a true positive detection in 91.7 % by either SNdef, with a median of 3.0 SNs. NACpT >0 patients had a true positive detection in 87 % (SNdef1) and 91.3 % (SNdef2). In a univariate analysis, patient group neither NAC nor tumor downstaging influenced detection rates, regardless of SN definition. In total eight patients, 4/22 metastatic nodes were SNs while 18/22 were non-SNs. CONCLUSIONS Sentinel node detection in MIBC is feasible also in NAC patients, regardless of pT stage. SNd played no role in nodal staging.
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Affiliation(s)
- Robert Rosenblatt
- Department of Urology, Stockholm South General Hospital, Karolinska Institutet, Stockholm, Sweden.,Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, 901 85, Umeå, Sweden
| | | | | | | | - Benny Holmström
- Department of Urology, Akademiska University Hospital, Uppsala, Sweden
| | - Johan Hansson
- Centre for Research and Development, Faculty of Medicine, Uppsala University, County Council of Gävleborg, Uppsala, Sweden
| | - Janos Vasko
- Department of Medical Biosciences, Pathology, Umeå University, Umeå, Sweden
| | - Per Marits
- Department of Medicine, Unit for Immunology and Allergy, Karolinska Institutet, Stockholm, Sweden
| | - Susanne Gabrielsson
- Department of Medicine, Unit for Immunology and Allergy, Karolinska Institutet, Stockholm, Sweden
| | - Katrine Riklund
- Department of Radiation Sciences, Umeå University, Umeå, Sweden
| | - Ola Winqvist
- Department of Medicine, Unit for Immunology and Allergy, Karolinska Institutet, Stockholm, Sweden
| | - Amir Sherif
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, 901 85, Umeå, Sweden.
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Duhlin A, Chen Y, Wermeling F, Sedimbi SK, Lindh E, Shinde R, Halaby MJ, Kaiser Y, Winqvist O, McGaha TL, Karlsson MCI. Selective Memory to Apoptotic Cell-Derived Self-Antigens with Implications for Systemic Lupus Erythematosus Development. J Immunol 2016; 197:2618-26. [PMID: 27559051 DOI: 10.4049/jimmunol.1401129] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 07/27/2016] [Indexed: 11/19/2022]
Abstract
Autoimmune diseases are characterized by pathogenic immune responses to self-antigens. In systemic lupus erythematosus (SLE), many self-antigens are found in apoptotic cells (ACs), and defects in removal of ACs from the body are linked to a risk for developing SLE. This includes pathological memory that gives rise to disease flares. In this study, we investigated how memory to AC-derived self-antigens develops and the contribution of self-memory to the development of lupus-related pathology. Multiple injections of ACs without adjuvant into wild-type mice induce a transient primary autoimmune response without apparent anti-nuclear Ab reactivity or kidney pathology. Interestingly, as the transient Ab response reached baseline, a single boost injection fully recalled the immune response to ACs, and this memory response was furthermore transferable into naive mice. Additionally, the memory response contains elements of pathogenicity, accompanied by selective memory to selective Ags. Thus, we provide evidence for a selective self-memory that underlies progression of the response to self-antigens with implications for SLE development therapy.
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Affiliation(s)
- Amanda Duhlin
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Yunying Chen
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Fredrik Wermeling
- Department of Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden; and
| | - Saikiran K Sedimbi
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Emma Lindh
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Rahul Shinde
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario M5G 2M9, Canada
| | - Marie Jo Halaby
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario M5G 2M9, Canada
| | - Ylva Kaiser
- Department of Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden; and
| | - Ola Winqvist
- Department of Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden; and
| | - Tracy L McGaha
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario M5G 2M9, Canada
| | - Mikael C I Karlsson
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, 171 77 Stockholm, Sweden;
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Yang T, Zollbrecht C, Winerdal ME, Zhuge Z, Zhang XM, Terrando N, Checa A, Sällström J, Wheelock CE, Winqvist O, Harris RA, Larsson E, Persson AEG, Fredholm BB, Carlström M. Genetic Abrogation of Adenosine A3 Receptor Prevents Uninephrectomy and High Salt-Induced Hypertension. J Am Heart Assoc 2016; 5:JAHA.116.003868. [PMID: 27431647 PMCID: PMC5015411 DOI: 10.1161/jaha.116.003868] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background Early‐life reduction in nephron number (uninephrectomy [UNX]) and chronic high salt (HS) intake increase the risk of hypertension and chronic kidney disease. Adenosine signaling via its different receptors has been implicated in modulating renal, cardiovascular, and metabolic functions as well as inflammatory processes; however, the specific role of the A3 receptor in cardiovascular diseases is not clear. In this study, gene‐modified mice were used to investigate the hypothesis that lack of A3 signaling prevents the development of hypertension and attenuates renal and cardiovascular injuries following UNX in combination with HS (UNX‐HS) in mice. Methods and Results Wild‐type (A3+/+) mice subjected to UNX‐HS developed hypertension compared with controls (mean arterial pressure 106±3 versus 82±3 mm Hg; P<0.05) and displayed an impaired metabolic phenotype (eg, increased adiposity, reduced glucose tolerance, hyperinsulinemia). These changes were associated with both cardiac hypertrophy and fibrosis together with renal injuries and proteinuria. All of these pathological hallmarks were significantly attenuated in the A3−/− mice. Mechanistically, absence of A3 receptors protected from UNX‐HS–associated increase in renal NADPH oxidase activity and Nox2 expression. In addition, circulating cytokines including interleukins 1β, 6, 12, and 10 were increased in A3+/+ following UNX‐HS, but these cytokines were already elevated in naïve A3−/− mice and did not change following UNX‐HS. Conclusions Reduction in nephron number combined with chronic HS intake is associated with oxidative stress, chronic inflammation, and development of hypertension in mice. Absence of adenosine A3 receptor signaling was strongly protective in this novel mouse model of renal and cardiovascular disease.
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Affiliation(s)
- Ting Yang
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Christa Zollbrecht
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Malin E Winerdal
- Unit of Translational Immunology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Zhengbing Zhuge
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Xing-Mei Zhang
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Niccolo Terrando
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Antonio Checa
- Division of Physiological Chemistry 2, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden
| | - Johan Sällström
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Craig E Wheelock
- Division of Physiological Chemistry 2, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden
| | - Ola Winqvist
- Unit of Translational Immunology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Robert A Harris
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Erik Larsson
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - A Erik G Persson
- Department of Medical Cell Biology, Uppsala University, Uppsala, Sweden
| | - Bertil B Fredholm
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Mattias Carlström
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
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Friman V, Winqvist O, Blimark C, Langerbeins P, Chapel H, Dhalla F. Secondary immunodeficiency in lymphoproliferative malignancies. Hematol Oncol 2016; 34:121-32. [PMID: 27402426 DOI: 10.1002/hon.2323] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [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: 05/03/2016] [Revised: 05/18/2016] [Accepted: 05/27/2016] [Indexed: 11/10/2022]
Abstract
Secondary immunodeficiencies occur as a consequence of various diseases, including hematological malignancies, and the use of pharmacological therapies, such as immunosuppressive, anti-inflammatory, and biological drugs. Infections are the main cause of morbidity and mortality in multiple myeloma (MM) and chronic lymphocytic leukemia (CLL) patients. Recent advances in treatment have prolonged the duration of remission and the time between relapse phases in MM and CLL patients. However, managing multiple relapses and the use of salvage therapies can lead to cumulative immunosuppression and a higher risk of infections. The pathogenesis of immune deficiency secondary to lymphoproliferative malignancy is multifactorial including disease- and treatment-related factors. Supportive treatment, including early vaccination, anti-infective prophylaxis, and replacement immunoglobulin, plays a key role in preventing infections in MM and CLL. This article provides an overview of the basic immunology necessary to understand the pathogenesis of secondary immunodeficiency and the infectious complications in MM and CLL. We also discuss the evidence supporting the role of prophylactic replacement immunoglobulin treatment in patients with antibody failure secondary to MM and CLL and the indications for its use. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Vanda Friman
- Department of Infectious Diseases, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ola Winqvist
- Translational Immunology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Cecilie Blimark
- Department of Internal Medicine, Hematology Section, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Petra Langerbeins
- German CLL Study Group, Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Helen Chapel
- Department of Clinical Immunology, University of Oxford, Oxford, UK
| | - Fatima Dhalla
- Department of Clinical Immunology, University of Oxford, Oxford, UK
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42
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Hylander T, Larsson O, Petersson-Westin U, Eriksson M, Kumlien Georén S, Winqvist O, Cardell LO. Intralymphatic immunotherapy of pollen-induced rhinoconjunctivitis: a double-blind placebo-controlled trial. Respir Res 2016; 17:10. [PMID: 26817454 PMCID: PMC4728811 DOI: 10.1186/s12931-016-0324-9] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [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: 09/09/2015] [Accepted: 01/13/2016] [Indexed: 01/08/2023] Open
Abstract
Background Allergen-specific immunotherapy represents the only disease-modifying treatment for allergic diseases. We and others have previously demonstrated that intralymphatic immunotherapy (ILIT), a less time-consuming alternative to conventional subcutaneous immunotherapy (SCIT), is safe and effective. However, this has recently been disputed. The aim of this study was therefore to expand our previous trial, further assessing the safety and efficacy of ILIT. Methods Thirty-six patients with pollen-induced rhinoconjunctivitis were randomised to receive three intralymphatic inguinal injections of active allergen (1000 SQ-U birch- or grass-pollen) or placebo. Clinical effects, safety and circulating immunological markers were assessed before, 4 weeks after treatment and at the end of the consecutive pollen season. Results No moderate or severe reactions were recorded following ILIT. Patients receiving active ILIT experienced a significant improvement in self-recorded seasonal allergic symptoms, as compared to placebo (p = 0.05). In a subgroup of these patients (“improved”), a reduction in nasal symptoms following nasal allergen provocation was also demonstrated. No changes in total IgE or IgG4 were found. However, the affinity of allergen specific IgG4 following active treatment was significantly increased, as compared to non-improved patients (p = 0.04). This could be correlated with clinical improvement, on an individual level. Conclusions This double-blinded placebo-controlled study confirms that ILIT is a safe and effective treatment for pollen-induced rhinoconjunctivitis, markedly reducing seasonal allergic symptoms. Trial registration EudraCT: 2009-016815-39 Electronic supplementary material The online version of this article (doi:10.1186/s12931-016-0324-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Terese Hylander
- Division of ENT Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
| | - Olivia Larsson
- Division of ENT Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
| | - Ulla Petersson-Westin
- Laboratoy of Clinical Experimental Allergy Research, Department of Otorhinolaryngology Malmö, Lund University, Skåne University Hospital, Malmö, Sweden.
| | - Mia Eriksson
- Division of ENT Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
| | - Susanna Kumlien Georén
- Division of ENT Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
| | - Ola Winqvist
- Department of Medicine Solna, Translational Immunology Unit, Karolinska University Hospital Solna, Stockholm, Sweden.
| | - Lars-Olaf Cardell
- Division of ENT Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden. .,Laboratoy of Clinical Experimental Allergy Research, Department of Otorhinolaryngology Malmö, Lund University, Skåne University Hospital, Malmö, Sweden. .,Department of ENT Diseases, Karolinska University Hospital, Stockholm, Sweden.
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Zirakzadeh AA, Krantz D, Winerdal M, Lundgren C, Hartana CA, Bergman EA, Hansson J, Holmström B, Sidiki A, Vasko J, Johansson M, Marits P, Sherif A, Winqvist O. B cells in tumor draining lymph nodes act as efficient antigen presenting cells in cancer patients. J Immunother Cancer 2015. [PMCID: PMC4645294 DOI: 10.1186/2051-1426-3-s2-p65] [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: 11/21/2022] Open
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Jungebluth P, Holzgraefe B, Lim ML, Duru AD, Lundin V, Heldring N, Wiklander OPB, Nordin JZ, Chrobok M, Roderburg C, Sjöqvist S, Anderstam B, Beltrán Rodríguez A, Haag JC, Gustafsson Y, Roddewig KG, Jones P, Wood MJA, Luedde T, Teixeira AI, Hermanson O, Winqvist O, Kalzén H, El Andaloussi S, Alici E, Macchiarini P. Autologous Peripheral Blood Mononuclear Cells as Treatment in Refractory Acute Respiratory Distress Syndrome. Respiration 2015; 90:481-492. [PMID: 26613253 DOI: 10.1159/000441799] [Citation(s) in RCA: 8] [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] [Received: 04/30/2015] [Accepted: 10/12/2015] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Acute respiratory distress syndrome (ARDS) is a devastating disorder. Despite enormous efforts in clinical research, effective treatment options are lacking, and mortality rates remain unacceptably high. OBJECTIVES A male patient with severe ARDS showed no clinical improvement with conventional therapies. Hence, an emergent experimental intervention was performed. METHODS We performed intratracheal administration of autologous peripheral blood-derived mononuclear cells (PBMCs) and erythropoietin (EPO). RESULTS We found that after 2 days of initial PBMC/EPO application, lung function improved and extracorporeal membrane oxygenation (ECMO) support was reduced. Bronchoscopy and serum inflammatory markers revealed reduced inflammation. Additionally, serum concentration of miR-449a, b, c and miR-34a, a transient upregulation of E-cadherin and associated chromatin marks in PBMCs indicated airway epithelial differentiation. Extracellular vesicles from PBMCs demonstrated anti-inflammatory capacity in a TNF-α-mediated nuclear factor-x03BA;B in vitro assay. Despite improving respiratory function, the patient died of multisystem organ failure on day 38 of ECMO treatment. CONCLUSIONS This case report provides initial encouraging evidence to use locally instilled PBMC/EPO for treatment of severe refractory ARDS. The observed clinical improvement may partially be due to the anti-inflammatory effects of PBMC/EPO to promote tissue regeneration. Further studies are needed for more in-depth understanding of the underlying mechanisms of in vivo regeneration.
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Affiliation(s)
- Philipp Jungebluth
- Division of Ear, Nose and Throat, Advanced Center for Translational Regenerative Medicine, Department for Clinical Science, Intervention and Technology, Karolinska Institutet, Huddinge, Stockholm, Sweden
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Arebro J, Tengroth L, Razavi R, Kumlien Georén S, Winqvist O, Cardell LO. Antigen-presenting epithelial cells can play a pivotal role in airway allergy. J Allergy Clin Immunol 2015; 137:957-60.e7. [PMID: 26560042 PMCID: PMC7112366 DOI: 10.1016/j.jaci.2015.08.053] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 07/25/2015] [Accepted: 08/17/2015] [Indexed: 01/22/2023]
Affiliation(s)
- Julia Arebro
- Division of ENT Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Department of ENT Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Lotta Tengroth
- Division of ENT Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Ronia Razavi
- Division of ENT Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Susanna Kumlien Georén
- Division of ENT Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Ola Winqvist
- Department of Medicine, Unit of Translational Immunology, Karolinska Institutet, Stockholm, Sweden
| | - Lars-Olaf Cardell
- Division of ENT Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Department of ENT Diseases, Karolinska University Hospital, Stockholm, Sweden.
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Sandblad KG, Jones P, Kostalla MJ, Linton L, Glise H, Winqvist O. Chemokine receptor expression on monocytes from healthy individuals. Clin Immunol 2015; 161:348-53. [PMID: 26496147 DOI: 10.1016/j.clim.2015.09.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [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: 02/17/2015] [Revised: 09/14/2015] [Accepted: 09/16/2015] [Indexed: 01/02/2023]
Abstract
Chronic immune mediated inflammation is characterized by continuous chemokine mediated recruitment and activation of pro-inflammatory cells, monocytes in particular. We believe that an evaluation of the recruitment profile of monocytes during healthy condition is essential for the understanding of cellular response in disease. For this, we have established normal reference values and 95% confidence intervals for receptor expression of 20 chemokine receptors on monocyte subsets; classical (CD14+ CD16−), non-classical (CD14+ CD16+) and HLA-DRhi monocytes from 20 healthy controls using flow cytometry. We demonstrate significant differences in the chemokine receptor expression profiles and high correlation between fraction of cells and level of expression. This is the first global approach to provide a platform for comparable evaluation of cell recruitment during normal and under inflammatory conditions. This will be useful when exploring chemokine–chemokine receptor interactions, inhibition of chemokine signaling and selective removal of migrating cells, which are new treatment strategies in immune mediated diseases.
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Affiliation(s)
- Katarina Glise Sandblad
- Department of Medicine, Translational Immunology Unit, Karolinska Institutet, Stockholm, Sweden
| | - Petra Jones
- Department of Medicine, Translational Immunology Unit, Karolinska Institutet, Stockholm, Sweden; ITH, Karolinska University Hospital, Stockholm, Sweden
| | | | - Ludvig Linton
- Department of Medicine, Translational Immunology Unit, Karolinska Institutet, Stockholm, Sweden
| | - Hans Glise
- Department of Medicine, Translational Immunology Unit, Karolinska Institutet, Stockholm, Sweden; ITH, Karolinska University Hospital, Stockholm, Sweden
| | - Ola Winqvist
- Department of Medicine, Translational Immunology Unit, Karolinska Institutet, Stockholm, Sweden.
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Jungebluth P, Holzgraefe B, Lim ML, Duru A, Lundin V, Sjöqvist S, Jones P, Wood M, Luedde T, Teixeira A, Hermanson O, Winqvist O, Kalzén H, Nordin J, Wiklander O, EL Andaloussi S, Alici E, Dienemann H. Intratracheale Anwendung von autologen Stammzellen in Patienten mit ARDS. Zentralbl Chir 2015. [DOI: 10.1055/s-0035-1559948] [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: 10/23/2022]
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48
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Sherif A, Hasan MN, Radecka E, Rodriguez AL, Shabo S, Karlsson M, Schumacher MC, Marits P, Winqvist O. Pilot study of adoptive immunotherapy with sentinel node-derived T cells in muscle-invasive urinary bladder cancer. Scand J Urol 2015; 49:453-462. [PMID: 26144252 DOI: 10.3109/21681805.2015.1059880] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of this study was to determine by computed tomography (CT) whether treatment with tumor-draining lymph-node-derived expanded autologous T lymphocytes results in objective responses and/or improved survival in patients with metastatic urinary bladder cancer (UBC) and to record the toxicity of the treatment. MATERIALS AND METHODS Eighteen patients with metastatic UBC were prospectively selected from two centers. The preoperative staging was T2-T4bN1-2 and/or M0-M1 or MX. Tumor-draining lymph nodes were harvested at intended cystectomy for the extraction of T lymphocytes. This was followed by expansion of the T lymphocytes in a cell culture, and subsequent reinfusion of these autologous tumor-specific T lymphocytes. Responses to therapy were evaluated by CT scans according to Response Evaluation Criteria In Solid Tumors (RECIST) and clinical follow-up, according to the research protocol. RESULTS Nine out of 18 patients were treated. Treatment was feasible and safe. In two out of nine immunologically treated patients, objective responses were detected in terms of diminished or obliterated nodal metastases. When excluding three patients with disseminated osseous metastases plus one with a T4b tumor left in situ, a success rate of two out of six treated patients was seen. The two responders had survival times of 35 and 11 months, respectively. No toxicity was recorded. CONCLUSIONS Infusion of expanded autologous tumor-specific T lymphocytes is feasible and safe, and objective responses according to RECIST were recorded. One objective responder to immunotherapy displayed notably long overall survival.
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Affiliation(s)
- Amir Sherif
- a 1 Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University , Umeå, Sweden
| | - Mudhar N Hasan
- b 2 Department of Clinical Sciences, Surgery and Urology, Danderyd Hospital, Karolinska Institutet , Sweden
| | - Eva Radecka
- c 3 Department of Diagnostic Radiology, Karolinska University Hospital, Karolinska Institutet , Stockholm, Sweden
| | - Alvaro Lozano Rodriguez
- d 4 Servicio de Radiología, Hospital Universitario Insular de Gran Canaria , Las Palmas, Spain
| | - Sarab Shabo
- e 5 Department of Surgery and Urology, Mälarsjukhuset , Eskilstuna, Sweden
| | - Mona Karlsson
- f 6 Translational Immunology Unit, Department of Medicine, Karolinska University Hospital, Karolinska Institutet , Stockholm, Sweden
| | | | - Per Marits
- f 6 Translational Immunology Unit, Department of Medicine, Karolinska University Hospital, Karolinska Institutet , Stockholm, Sweden
| | - Ola Winqvist
- f 6 Translational Immunology Unit, Department of Medicine, Karolinska University Hospital, Karolinska Institutet , Stockholm, Sweden
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Hellkvist L, Hjalmarsson E, Kumlien SG, Winqvist O, Westin UP, Cardell LO. Intralymphatic Immunotherapy (ILIT) with both grass and birch allergen‐ a randomized controlled trial. Clin Transl Allergy 2015. [PMCID: PMC4493501 DOI: 10.1186/2045-7022-5-s4-p29] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
| | - Eric Hjalmarsson
- Karolinska InstitutetClinical SciencesIntervention and TechnologyStockholmSweden
| | | | - Ola Winqvist
- Karolinska InstitutetDepartment of MedicineStockholmSweden
| | - Ulla Petersson Westin
- Department of OtorhinolaryngologyLund UniversitySkåne University HospitalMalmöMalmöSweden
| | - Lars Olaf Cardell
- Karolinska InstitutetClinical SciencesIntervention and TechnologyStockholmSweden
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50
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Arebro J, Tengroth L, Georén SK, Winqvist O, Cardell L. Antigen presenting epithelial cells play a pivotal role in airway allergy. Clin Transl Allergy 2015. [PMCID: PMC4493605 DOI: 10.1186/2045-7022-5-s4-o8] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Affiliation(s)
- Julia Arebro
- Karolinska InstitutetENT‐departmentStockholmSweden
| | | | | | - Ola Winqvist
- Karolinska InstitutetDep. of MedicineUnit of Translational ImmunologyStockholmSweden
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