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Zhuang L, Tian J, Lai B, Zhang G, Li H. Single-Cell RNA Sequencing Reveals Cellular Heterogeneity in an Acral Amelanotic Melanoma After Immunotherapy Treatment. Clin Cosmet Investig Dermatol 2023; 16:1009-1018. [PMID: 37077860 PMCID: PMC10108909 DOI: 10.2147/ccid.s404381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 03/20/2023] [Indexed: 04/21/2023]
Abstract
Background Anti-programmed cell death ligand-1 (anti-PD-L1) immunotherapy is often used for advanced urothelial carcinoma and melanoma, including amelanotic melanoma, a relatively rare subtype with little to no pigment in the tumor cells. However, cellular heterogeneity of amelanotic melanoma during or after anti-PD-L1 immunotherapy treatments has not been described. Purpose To investigate cellular heterogeneity in acral amelanotic melanoma after immunotherapy exposure. Methods We evaluated subtle visual changes of the melanoma by dermoscopy and performed a pathological examination to analyze the heterogeneity of microscopic morphological and immunohistochemistry changes. The cellular transcriptional heterogeneity and corresponding biological function profiles of the melanoma were determined by single-cell RNA sequencing (scRNA-seq). Results The dermoscopic examination revealed black globules and scar-like depigmentation areas against a homogeneous red background. Pigmented and amelanotic melanoma cells were observed microscopically. The pigmented cells were large and contained melanin granules expressing Melan-A and HMB45; the amelanotic cells were small and did not express HMB45. Ki-67 immunohistochemical staining revealed that the pigmented melanoma cells had a higher proliferative ability than the amelanotic cells. scRNA-seq identified three cell clusters: amelanotic cell cluster 1, amelanotic cell cluster 2, and pigmented cell cluster. Furthermore, a pseudo-time trajectory analysis showed that amelanotic cell cluster 2 originated from amelanotic cell cluster 1 and transformed into the pigmented melanoma cell cluster. The expression pattern of melanin synthesis-related and lysosome-endosome-related genes in different cell clusters supported the cell cluster transformation results. Also, upregulated expression of cell cycle genes indicated that the pigmented melanoma cells had a high proliferative ability. Conclusion Coexisting amelanotic and pigmented melanoma cells indicated cellular heterogeneity in an acral amelanotic melanoma from a patient who underwent immunotherapy treatment. Additionally, the pigmented melanoma cells acquired a higher proliferative ability than the amelanotic melanoma cells.
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Affiliation(s)
- Le Zhuang
- Department of Dermatology, Peking University First Hospital, Beijing, People’s Republic of China
- National Clinical Research Center for Skin and Immune Diseases, Peking University First Hospital, Beijing, People’s Republic of China
- Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Peking University First Hospital, Beijing, People’s Republic of China
- NMPA Key Laboratory for Quality Control and Evaluation of Cosmetics, Peking University First Hospital, Beijing, People’s Republic of China
- Dermatology Hospital, Southern Medical University, Guangzhou, People’s Republic of China
- Central Hospital Affiliated to Shandong First Medical University, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong Province, People's Republic of China
| | - Jie Tian
- Department of Dermatology, Peking University First Hospital, Beijing, People’s Republic of China
- National Clinical Research Center for Skin and Immune Diseases, Peking University First Hospital, Beijing, People’s Republic of China
- Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Peking University First Hospital, Beijing, People’s Republic of China
- NMPA Key Laboratory for Quality Control and Evaluation of Cosmetics, Peking University First Hospital, Beijing, People’s Republic of China
- Institute of Medical Technology, Peking University Health Science Center, Beijing, People’s Republic of China
| | - Binbin Lai
- Department of Dermatology, Peking University First Hospital, Beijing, People’s Republic of China
- National Clinical Research Center for Skin and Immune Diseases, Peking University First Hospital, Beijing, People’s Republic of China
- Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Peking University First Hospital, Beijing, People’s Republic of China
- NMPA Key Laboratory for Quality Control and Evaluation of Cosmetics, Peking University First Hospital, Beijing, People’s Republic of China
- Institute of Medical Technology, Peking University Health Science Center, Beijing, People’s Republic of China
| | - Guohong Zhang
- Department of Dermatology, Peking University First Hospital, Beijing, People’s Republic of China
- National Clinical Research Center for Skin and Immune Diseases, Peking University First Hospital, Beijing, People’s Republic of China
- Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Peking University First Hospital, Beijing, People’s Republic of China
- NMPA Key Laboratory for Quality Control and Evaluation of Cosmetics, Peking University First Hospital, Beijing, People’s Republic of China
| | - Hang Li
- Department of Dermatology, Peking University First Hospital, Beijing, People’s Republic of China
- National Clinical Research Center for Skin and Immune Diseases, Peking University First Hospital, Beijing, People’s Republic of China
- Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Peking University First Hospital, Beijing, People’s Republic of China
- NMPA Key Laboratory for Quality Control and Evaluation of Cosmetics, Peking University First Hospital, Beijing, People’s Republic of China
- Correspondence: Hang Li, Peking University First Hospital, No. 8, Xishiku Street, Xicheng District, Beijing, 100034, People’s Republic of China, Tel +8613693058190, Fax +861083572350, Email
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Wu JH, Cohen DN, Rady PL, Tyring SK. BRAF inhibitor-associated cutaneous squamous cell carcinoma: new mechanistic insight, emerging evidence for viral involvement and perspectives on clinical management. Br J Dermatol 2017; 177:914-923. [PMID: 28129674 DOI: 10.1111/bjd.15348] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2017] [Indexed: 12/18/2022]
Abstract
Mutations in the BRAF proto-oncogene occur in the majority of cutaneous melanomas. The commonly detected valine (V) to glutamate (E) mutation (V600E) is known to drive melanomagenesis and has thus been the target of two highly selective chemotherapeutic agents: vemurafenib and dabrafenib. While BRAF inhibitor therapy has revolutionized the treatment of metastatic melanoma, unanticipated cutaneous toxicities, including the development of cutaneous squamous cell carcinomas (cSCCs), are frequently reported and hinder therapeutic durability. However, the mechanisms by which BRAF inhibitors induce cutaneous neoplasms are poorly understood, thus posing a challenge for specific therapies. In this review, we summarize the clinical and molecular profiles of BRAF inhibitor-associated cSCCs, with a focus on factors that may contribute to disease pathogenesis. In particular, we discuss the emerging evidence pointing towards viral involvement in BRAF inhibitor-induced cutaneous neoplasms and offer new perspectives on future therapeutic interventions. Continued clinical and mechanistic studies along this line will not only allow for better understanding of the pathogenic progression of BRAF inhibitor-induced cSCCs, but will also lead to development of new therapeutic and preventative options for patients receiving targeted cancer therapy.
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Affiliation(s)
- J H Wu
- Baylor College of Medicine, Houston, TX, U.S.A.,Department of Dermatology, University of Texas Health Science Center at Houston, Houston, TX, U.S.A
| | - D N Cohen
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX, U.S.A
| | - P L Rady
- Department of Dermatology, University of Texas Health Science Center at Houston, Houston, TX, U.S.A
| | - S K Tyring
- Department of Dermatology, University of Texas Health Science Center at Houston, Houston, TX, U.S.A
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Wu JH, Simonette RA, Nguyen HP, Rady PL, Tyring SK. Molecular mechanisms supporting a pathogenic role for human polyomavirus 6 small T antigen: Protein phosphatase 2A targeting and MAPK cascade activation. J Med Virol 2016; 89:742-747. [PMID: 27632801 DOI: 10.1002/jmv.24688] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2016] [Indexed: 02/04/2023]
Abstract
BRAF inhibitors are highly effective therapies in treating a subset of melanomas but are associated with induction of secondary cutaneous squamous cell carcinoma (cSCC). Recently, Human Polyomavirus 6 (HPyV6) was found to actively express viral proteins in BRAF inhibitor-induced cSCCs; however, the specific cellular mechanisms by which HPyV6 may facilitate neoplastic cell growth require further investigation. The current study describes a novel pathogenic mechanism of action for HPyV6 small tumor (sT) antigen which involves binding to protein phosphatase 2A (PP2A) via its WFG motif and zinc binding sites. Our findings demonstrate an important role of HPyV6 sT for activation of PP2A's downstream oncogenic pathways (MEK/ERK/c-Jun), which may underlie the pathogenesis of BRAF inhibitor-induced neoplasms. J. Med. Virol. 89:742-747, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Julie H Wu
- Department of Dermatology, University of Texas Health Science Center, Houston, Texas.,Baylor College of Medicine, Houston, Texas
| | - Rebecca A Simonette
- Department of Dermatology, University of Texas Health Science Center, Houston, Texas
| | - Harrison P Nguyen
- Department of Dermatology, University of Texas Health Science Center, Houston, Texas.,Baylor College of Medicine, Houston, Texas
| | - Peter L Rady
- Department of Dermatology, University of Texas Health Science Center, Houston, Texas
| | - Stephen K Tyring
- Department of Dermatology, University of Texas Health Science Center, Houston, Texas
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Cohen DN, Lawson SK, Shaver AC, Du L, Nguyen HP, He Q, Johnson DB, Lumbang WA, Moody BR, Prescott JL, Chandra PK, Boyd AS, Zwerner JP, Robbins JB, Tyring SK, Rady PL, Chappell JD, Shyr Y, Infante JR, Sosman JA. Contribution of Beta-HPV Infection and UV Damage to Rapid-Onset Cutaneous Squamous Cell Carcinoma during BRAF-Inhibition Therapy. Clin Cancer Res 2015; 21:2624-34. [PMID: 25724524 PMCID: PMC4452444 DOI: 10.1158/1078-0432.ccr-14-2667] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 02/06/2015] [Indexed: 12/21/2022]
Abstract
PURPOSE BRAF-inhibition (BRAFi) therapy for advanced melanoma carries a high rate of secondary cutaneous squamous cell carcinoma (cSCC) and risk of other cancers. UV radiation and α-genus human papillomavirus (HPV) are highly associated with SCC, but a novel role for β-genus HPV is suspected in BRAFi-cSCC. Cutaneous β-HPV may act in concert with host and environmental factors in BRAFi-cSCC. EXPERIMENTAL DESIGN Primary BRAFi-cSCC tissue DNA isolated from patients receiving vemurafenib or dabrafenib from two cancer centers was analyzed for the presence of cutaneous oncogenic viruses and host genetic mutations. Diagnostic specimens underwent consensus dermatopathology review. Clinical parameters for UV exposure and disease course were statistically analyzed in conjunction with histopathology. RESULTS Twenty-nine patients contributed 69 BRAFi-cSCC lesions. BRAFi-cSCC had wart-like features (BRAFi-cSCC-WF) in 22% of specimens. During vemurafenib therapy, BRAFi-cSCC-WF arose 11.6 weeks more rapidly than conventional cSCC when controlled for gender and UV exposure (P value = 0.03). Among all BRAFi-cSCC, β-genus HPV-17, HPV-38, HPV-111 were most frequently isolated, and novel β-HPV genotypes were discovered (CTR, CRT-11, CRT-22). Sequencing revealed 63% of evaluated BRAFi-cSCCs harbored RAS mutations with PIK3CA, CKIT, ALK, and EGFR mutations also detected. CONCLUSIONS We examined clinical, histopathologic, viral, and genetic parameters in BRAFi-cSCC demonstrating rapid onset; wart-like histomorphology; β-HPV-17, HPV-38, and HPV-111 infection; UV damage; and novel ALK and CKIT mutations. Discovered β-HPV genotypes expand the spectrum of tumor-associated viruses. These findings enhance our understanding of factors cooperating with BRAF inhibition that accelerate keratinocyte oncogenesis as well as broaden the knowledge base of multifactorial mediators of cancer in general.
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Affiliation(s)
- Daniel N Cohen
- Departments of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, Tennessee.
| | - Steven K Lawson
- Departments of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Aaron C Shaver
- Departments of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Liping Du
- Department of Medicine, Division of Hematology and Oncology, Vanderbilt University Medical Center and Vanderbilt Ingram Cancer Center, Nashville, Tennessee
| | | | - Qin He
- University of Texas, Department of Dermatology, Houston, Texas
| | - Douglas B Johnson
- Department of Medicine, Division of Hematology and Oncology, Vanderbilt University Medical Center and Vanderbilt Ingram Cancer Center, Nashville, Tennessee
| | - Wilfred A Lumbang
- Department of Medicine, Division of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | | | | | - Alan S Boyd
- Departments of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, Tennessee. Department of Medicine, Division of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee. Pathology Consultants of America, Columbia, Tennessee
| | - Jeffrey P Zwerner
- Departments of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, Tennessee. Department of Medicine, Division of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jason B Robbins
- Departments of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, Tennessee. Department of Medicine, Division of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee. Pathology Associates of St. Thomas, Nashville, Tennessee
| | | | - Peter L Rady
- University of Texas, Department of Dermatology, Houston, Texas
| | - James D Chappell
- Departments of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Yu Shyr
- Department of Medicine, Division of Hematology and Oncology, Vanderbilt University Medical Center and Vanderbilt Ingram Cancer Center, Nashville, Tennessee
| | | | - Jeffrey A Sosman
- Department of Medicine, Division of Hematology and Oncology, Vanderbilt University Medical Center and Vanderbilt Ingram Cancer Center, Nashville, Tennessee
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