1
|
Asgari MM, Arron S, Warton EM, Quesenberry CP, Weisshaar D. Response to "Comments on sirolimus use and risk of cutaneous squamous cell carcinoma (SCC) in solid organ transplant recipients" (SOTRs). J Am Acad Dermatol 2022; 86:e205-e206. [PMID: 35430053 PMCID: PMC9904155 DOI: 10.1016/j.jaad.2016.01.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 01/30/2016] [Indexed: 11/15/2022]
Affiliation(s)
- Maryam M. Asgari
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston;,Division of Research, Kaiser Permanente Northern California, Oakland
| | - Sarah Arron
- Department of Dermatology, University of California at San Francisco
| | | | | | - Dana Weisshaar
- Department of Cardiology, Santa Clara, Kaiser Permanente Northern California
| |
Collapse
|
2
|
Piselli P, Taborelli M, Cimaglia C, Serraino D. Decreased incidence of Kaposi sarcoma after kidney transplant in Italy and role of mTOR-inhibitors: 1997-2016. Int J Cancer 2019; 145:597-598. [PMID: 30613958 DOI: 10.1002/ijc.32098] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 12/14/2018] [Indexed: 01/11/2023]
Affiliation(s)
- Pierluca Piselli
- Clinical Epidemiology Unit, Istituto Nazionale per le Malattie Infettive "Lazzaro Spallanzani" IRCCS, Rome, Italy
| | - Martina Taborelli
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano (PN), Italy
| | - Claudia Cimaglia
- Clinical Epidemiology Unit, Istituto Nazionale per le Malattie Infettive "Lazzaro Spallanzani" IRCCS, Rome, Italy
| | - Diego Serraino
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano (PN), Italy
| | | |
Collapse
|
3
|
Jung JW, Veitch M, Bridge JA, Overgaard NH, Cruz JL, Linedale R, Franklin ME, Saunders NA, Simpson F, Frazer IH, Steptoe RJ, Wells JW. Clinically-Relevant Rapamycin Treatment Regimens Enhance CD8 + Effector Memory T Cell Function In The Skin and Allow their Infiltration into Cutaneous Squamous Cell Carcinoma. Oncoimmunology 2018; 7:e1479627. [PMID: 30228949 DOI: 10.1080/2162402x.2018.1479627] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 05/15/2018] [Accepted: 05/16/2018] [Indexed: 10/28/2022] Open
Abstract
Patients receiving immunosuppressive drugs to prevent organ transplant rejection exhibit a greatly increased risk of developing cutaneous squamous cell carcinoma (SCC). However, not all immunosuppressive drugs confer the same risk. Randomised, controlled trials demonstrate that switching renal transplant recipients receiving calcineurin inhibitor-based therapies to mammalian target of rapamycin (mTOR) inhibitors results in a reduced incidence of de novo SSC formation, and can even result in the regression of pre-existing premalignant lesions. However, the contribution played by residual immune function in this setting is unclear. We examined the hypotheses that mTOR inhibitors promote the enhanced differentiation and function of CD8+ memory T cells in the skin. Here, we demonstrate that the long-term oral administration of rapamycin to achieve clinically-relevant whole blood drug target thresholds, creates a "low rapamycin dose" environment in the skin. While both rapamycin and the calcineurin inhibitor tacrolimus elongated the survival of OVA-expressing skin grafts, and inhibited short-term antigen-specific CD8+ T cell responses, rapamycin but not tacrolimus permitted the statistically significant infiltration of CD8+ effector memory T cells into UV-induced SCC lesions. Furthermore, rapamycin uniquely enhanced the number and function of CD8+ effector and central memory T cells in a model of long-term contact hypersensitivity provided that rapamycin was present during the antigen sensitization phase. Thus, our findings suggest that patients switched to mTOR inhibitor regimens likely experience enhanced CD8+ memory T cell function to new antigen-challenges in their skin, which could contribute to their lower risk of de novo SSC formation and regression of pre-existing premalignant lesions.
Collapse
Affiliation(s)
- Ji-Won Jung
- The University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, QLD Australia
| | - Margaret Veitch
- The University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, QLD Australia
| | - Jennifer A Bridge
- The University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, QLD Australia
| | - Nana H Overgaard
- The University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, QLD Australia.,Division of Immunology & Vaccinology, National Veterinary Institute, Technical University of Denmark, Lyngby, Denmark
| | - Jazmina L Cruz
- The University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, QLD Australia
| | - Richard Linedale
- The University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, QLD Australia
| | - Michael E Franklin
- Department of Clinical Pharmacology, Princess Alexandra Hospital, Queensland Health, Brisbane, QLD, Australia
| | - Nicholas A Saunders
- The University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, QLD Australia
| | - Fiona Simpson
- The University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, QLD Australia
| | - Ian H Frazer
- The University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, QLD Australia
| | - Raymond J Steptoe
- The University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, QLD Australia
| | - James W Wells
- The University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, QLD Australia
| |
Collapse
|
4
|
Imko-Walczuk B, Kielbowicz M, Malyszko J, Malyszko J, Barczyk M, Debska-Slizien A, Mysliwiec M, Rutkowski B. Kaposi Sarcoma in the Genital Area in a Kidney Transplant Patient: A Case Report and Literature Review. Transplant Proc 2017; 48:1843-8. [PMID: 27496505 DOI: 10.1016/j.transproceed.2016.01.070] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Accepted: 01/21/2016] [Indexed: 12/28/2022]
Abstract
BACKGROUND Kaposi sarcoma (KS) is a cancer with an incidence in patients after transplantation (Tx) that is 500 times greater than that in the healthy population. The risk of KS increases significantly during therapy, especially when immunosuppressive therapy with cyclosporine A (CsA) is used. Most cases of KS develop during the first 2 years after transplantation. After a KS diagnosis, it is recommended to reduce the doses of immunosuppressive medications. Conversion of immunosuppressive treatment into mammalian target of rapamycin (m-TOR) inhibitors is strongly suggested. PATIENTS AND METHODS We present the case of a 65-year-old man with end-stage renal disease (ESRD) of unknown etiology, who had kidney transplantation in 2008. Immunosuppressive protocol was based on CsA, mycophenolate mofetil (MMF) and prednisolone (PRE). In 2011, during the dermatological consultation, on the penis glans a purple stain of uneven surface was noted. Histology study revealed the presence of KS. The treatment was modified. The patient was converted from CsA to everolimus. Before converting, the creatinine concentration was 1.79 mg/dl and proteinuria less than 0.3 g/day. RESULTS The change in the scheme of immunosuppresion from CsA to everolimus was performed to treat the Kaposi sarcoma. Gradually, within a year, the KS was cured. However, the graft function deteriorated, and the graft was lost in one-years' time. CONCLUSION We present the first documented case of KS in the genital area of a kidney patient. The reduction in the strength of immunosuppression, and the introduction of an m-TOR inhibitor, may have contributed to the deterioration of kidney function, however it was substantial in the treatment of KS.
Collapse
Affiliation(s)
- B Imko-Walczuk
- Copernicus-Independent Public Healthcare Centre, Dermatology & Venereology Clinic, Gdansk, Poland; College of Health, Beauty and Education in Poznan, Poland.
| | - M Kielbowicz
- College of Health, Beauty and Education in Poznan, Poland
| | - J Malyszko
- 1st Department of Nephrology and Transplantology with Dialysis Unit, Medical University, Bialystok, Poland
| | - J Malyszko
- 2nd Department of Nephrology Medical University, Bialystok, Poland
| | - M Barczyk
- 1st Department of Nephrology and Transplantology with Dialysis Unit, Medical University, Bialystok, Poland
| | - A Debska-Slizien
- Chair & Clinic of Nephrology, Transplantology and Internal Medicine, Gdansk University of Medical Sciences, Gdansk, Poland
| | - M Mysliwiec
- 1st Department of Nephrology and Transplantology with Dialysis Unit, Medical University, Bialystok, Poland
| | - B Rutkowski
- Chair & Clinic of Nephrology, Transplantology and Internal Medicine, Gdansk University of Medical Sciences, Gdansk, Poland
| |
Collapse
|
5
|
Balcan B, Simsek E, Ugurlu AO, Demiralay E, Sahin S. Sirolimus-Induced Diffuse Alveolar Hemorrhage: A Case Report. Am J Ther 2017; 23:e1938-e1941. [PMID: 26849007 DOI: 10.1097/mjt.0000000000000427] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Sirolimus is a mammalian target of the rapamycin, a protein kinase, which is responsible for inhibition of T cell and B cell proliferation. Sirolimus has side effects on lugs, and may cause cryptogenic organizing pneumonia, diffuse alveolar hemorrhage, lymphocytic pneumonitis, hypersensitivity pneumonitis, desquamative interstitial pneumonia, and pulmonary alveolar proteinosis. Diagnosis is based on the combination of clinical, radiological, histological, and pathological investigation. We report a case of diffuse alveolar hemorrhage in a 33-year-old, female renal transplant recipient. After discontinuation of sirolimus, radiological images and clinical condition of the patient got better. We also planned steroid therapy for 6 months by tapering the dosage slowly. After steroid therapy, full recovery of pulmonary functions achieved, and the patient is observed in our outpatient clinic with lack of any pulmonary symptoms.
Collapse
Affiliation(s)
- Baran Balcan
- Departments of 1Pulmonary Medicine, 2Nephrology, and 3Pathology, Faculty of Medicine, Baskent University, Istanbul, Turkey
| | | | | | | | | |
Collapse
|
6
|
Longo MI, Wen X, Womer KL. Comment on "Sirolimus use and risk of cutaneous squamous cell carcinoma (SCC) in solid organ transplant recipients (SOTRs)". J Am Acad Dermatol 2016; 74:e105-6. [PMID: 27085243 DOI: 10.1016/j.jaad.2015.11.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 11/28/2015] [Accepted: 11/30/2015] [Indexed: 11/30/2022]
Affiliation(s)
| | - Xuerong Wen
- Division of Nephrology, Hypertension and Renal Transplantation, University of Florida, Gainesville
| | - Karl L Womer
- Division of Nephrology, Hypertension and Renal Transplantation, University of Florida, Gainesville
| |
Collapse
|
7
|
Jung JW, Overgaard NH, Burke MT, Isbel N, Frazer IH, Simpson F, Wells JW. Does the nature of residual immune function explain the differential risk of non-melanoma skin cancer development in immunosuppressed organ transplant recipients? Int J Cancer 2015; 138:281-92. [DOI: 10.1002/ijc.29450] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 01/08/2015] [Indexed: 12/12/2022]
Affiliation(s)
- Ji-Won Jung
- The University of Queensland Diamantina Institute, The University of Queensland, Translational Research Institute; Brisbane QLD
| | - Nana H. Overgaard
- The University of Queensland Diamantina Institute, The University of Queensland, Translational Research Institute; Brisbane QLD
- Center for Cancer Immune Therapy (CCIT), Department of Hematology; Copenhagen University Hospital; Herlev Denmark
| | - Michael T. Burke
- Department of Renal Medicine; The University of Queensland, Princess Alexandra Hospital; Brisbane QLD
| | - Nicole Isbel
- Department of Renal Medicine; The University of Queensland, Princess Alexandra Hospital; Brisbane QLD
| | - Ian H. Frazer
- The University of Queensland Diamantina Institute, The University of Queensland, Translational Research Institute; Brisbane QLD
| | - Fiona Simpson
- The University of Queensland Diamantina Institute, The University of Queensland, Translational Research Institute; Brisbane QLD
| | - James W. Wells
- The University of Queensland Diamantina Institute, The University of Queensland, Translational Research Institute; Brisbane QLD
| |
Collapse
|
8
|
Díaz-Ley B, Grillo E, Ríos-Buceta L, Paoli J, Moreno C, Vano-Galván S, Jaén-Olasolo P. Classic Kaposi's sarcoma treated with topical rapamycin. Dermatol Ther 2014; 28:40-3. [DOI: 10.1111/dth.12182] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Blanca Díaz-Ley
- Department of Dermatology, Ramon y Cajal University Hospital; University of Alcalá; Madrid Spain
| | - Emiliano Grillo
- Department of Dermatology, Ramon y Cajal University Hospital; University of Alcalá; Madrid Spain
| | - Luis Ríos-Buceta
- Department of Dermatology, Ramon y Cajal University Hospital; University of Alcalá; Madrid Spain
| | - John Paoli
- Department of Dermatology, Ramon y Cajal University Hospital; University of Alcalá; Madrid Spain
| | - Carmen Moreno
- Department of Dermatology, Ramon y Cajal University Hospital; University of Alcalá; Madrid Spain
| | - Sergio Vano-Galván
- Department of Dermatology, Ramon y Cajal University Hospital; University of Alcalá; Madrid Spain
| | - Pedro Jaén-Olasolo
- Department of Dermatology, Ramon y Cajal University Hospital; University of Alcalá; Madrid Spain
| |
Collapse
|
9
|
|
10
|
Wall D, McMenamin M, O'Mahony D, Irvine AD. Kaposi sarcoma in an patient with atopic dermatitis treated with ciclosporin. BMJ Case Rep 2013. [PMID: 24265347 DOI: 10.1136/bcr‐2013‐202171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
There are four clinical subtypes of Kaposi sarcoma (KS): classic, endemic, epidemic and iatrogenic. The geographical prevalence of the endemic variant matches areas of human herpes virus type 8 (HHV8) seroprevalence. The iatrogenic variant, seen in immunosuppressed patients, can be associated with significant morbidity and mortality. This is the first report of KS described in the context of atopic dermatitis (AD) treated with ciclosporin (CSA). We report a case of KS in an HHV8 seropositive Congolese patient following immunosuppression with CSA for AD. Treatment has been challenging, protracted and associated with significant morbidity. Immunosuppressive therapies are increasingly used for inflammatory dermatological conditions, including AD. This case highlights the importance of HHV8 screening of patients from endemic regions or those with other risk factors. It also highlights the importance of early recognition of a condition associated with significant morbidity and even mortality to facilitate appropriate treatment.
Collapse
Affiliation(s)
- Dmitri Wall
- Department of Dermatology, St James's Hospital, Dublin, Ireland
| | | | | | | |
Collapse
|
11
|
Roy D, Sin SH, Lucas A, Venkataramanan R, Wang L, Eason A, Chavakula V, Hilton IB, Tamburro KM, Damania B, Dittmer DP. mTOR inhibitors block Kaposi sarcoma growth by inhibiting essential autocrine growth factors and tumor angiogenesis. Cancer Res 2013; 73:2235-46. [PMID: 23382046 DOI: 10.1158/0008-5472.can-12-1851] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Kaposi sarcoma originates from endothelial cells and it is one of the most overt angiogenic tumors. In Sub-Saharan Africa, where HIV and the Kaposi sarcoma-associated herpesvirus (KSHV) are endemic, Kaposi sarcoma is the most common cancer overall, but model systems for disease study are insufficient. Here, we report the development of a novel mouse model of Kaposi sarcoma, where KSHV is retained stably and tumors are elicited rapidly. Tumor growth was sensitive to specific allosteric inhibitors (rapamycin, CCI-779, and RAD001) of the pivotal cell growth regulator mTOR. Inhibition of tumor growth was durable up to 130 days and reversible. mTOR blockade reduced VEGF secretion and formation of tumor vasculature. Together, the results show that mTOR inhibitors exert a direct anti-Kaposi sarcoma effect by inhibiting angiogenesis and paracrine effectors, suggesting their application as a new treatment modality for Kaposi sarcoma and other cancers of endothelial origin.
Collapse
Affiliation(s)
- Debasmita Roy
- Curriculum in Genetics and Molecular Biology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Krengel S, Satzger I, Alter M, Kapp A, Gutzmer R. [Remission of an iatrogenic Kaposi sarcoma in a patient with myasthenia gravis after switching immunosuppressive therapy to the mTOR inhibitor everolimus]. Hautarzt 2012; 63:573-6. [PMID: 22751858 DOI: 10.1007/s00105-011-2274-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Iatrogenic Kaposi sarcomas (KS) in organ transplant recipients are often treated by switching immunosuppressive therapy to an mTOR inhibitor, such as sirolimus or everolimus, as these have immunosuppressive as well as anti-tumor effects. We report on an 80-year-old male patient who developed a disseminated cutaneous KS during therapy with prednisone and azathioprine for myasthenia gravis. After discontinuation of azathioprine therapy and despite continuing therapy with cortisone, the KS progressed and autoantibody levels against the nicotinic acetylcholine receptor increased. During the administration of everolimus, a long-term near-complete remission of KS and a decrease in autoantibodies took place. This case study illustrates that even in non-organ transplant patients with iatrogenic KS, switching to immunosuppressive therapy using an mTOR inhibitor can be beneficial.
Collapse
Affiliation(s)
- S Krengel
- Klinik für Dermatologie, Allergologie und Venerologie, Hauttumorzentrum Hannover, Medizinische Hochschule Hannover, Deutschland.
| | | | | | | | | |
Collapse
|
13
|
Kirby S, Satoskar A, Brodsky S, Pope-Harman A, Nunley D, Hitchcock C, Pelletier R, Ross P, Nadasdy T, Shilo K. Histological spectrum of pulmonary manifestations in kidney transplant recipients on sirolimus inclusive immunosuppressive regimens. Diagn Pathol 2012; 7:25. [PMID: 22416975 PMCID: PMC3344684 DOI: 10.1186/1746-1596-7-25] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2012] [Accepted: 03/14/2012] [Indexed: 12/16/2022] Open
Abstract
Background After the introduction of novel effective immunosuppressive therapies, kidney transplantation became the treatment of choice for end stage renal disease. While these new therapies lead to better graft survival, they can also cause a variety of complications. Only small series or case reports describe pulmonary pathology in renal allograft recipients on mTOR inhibitor inclusive therapies. The goal of this study was to provide a systematic review of thoracic biopsies in kidney transplant recipients for possible association between a type of immunosuppressive regimen and pulmonary complications. Methods A laboratory database search revealed 28 of 2140 renal allograft recipients (18 males and 10 females, 25 to 77 years old, mean age 53 years) who required a biopsy for respiratory symptoms. The histological features were correlated with clinical findings including immunosuppressive medications. Results The incidence of neoplasia on lung biopsy was 0.4% (9 cases), which included 3 squamous cell carcinomas, 2 adenocarcinomas, 1 diffuse large B-cell lymphoma, 1 lymphomatoid granulomatosis, and 2 post transplant B-cell lymphoproliferative disorders. Diffuse parenchymal lung disease was identified in 0.4% (9 cases), and included 5 cases of pulmonary hemorrhage, 3 cases of organizing pneumonia and 1 case of pulmonary alveolar proteinosis. Five (0.2%) cases showed histological features indicative of a localized infectious process. Patients on sirolimus had neoplasia less frequently than patients on other immunosuppressive combinations (12.5% vs. 58.3%, p = 0.03). Lung biopsies in 4 of 5 patients with clinically suspected sirolimus toxicity revealed pulmonary hemorrhage as the sole histological finding or in combination with other patterns. Conclusions Our study documents a spectrum of neoplastic and non-neoplastic lesions in renal allograft recipients on current immunosuppressive therapies. Sirolimus inclusive regimens are associated with increased risk of pulmonary toxicity but may be beneficial in cases of posttransplant neoplasia. Virtual Slides The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/3320012126569395.
Collapse
Affiliation(s)
- Sean Kirby
- Department of Pathology, The Ohio State University Medical Center, Columbus, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Roy D, Dittmer DP. Phosphatase and tensin homolog on chromosome 10 is phosphorylated in primary effusion lymphoma and Kaposi's sarcoma. THE AMERICAN JOURNAL OF PATHOLOGY 2011; 179:2108-19. [PMID: 21819957 DOI: 10.1016/j.ajpath.2011.06.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Revised: 06/18/2011] [Accepted: 06/28/2011] [Indexed: 12/23/2022]
Abstract
Primary effusion lymphoma (PEL) is a non-Hodgkin's B-cell lymphoma driven by Kaposi's sarcoma-associated herpesvirus. It is uniquely sensitive to mTOR, PI3K, and Akt inhibitors; however, the basis of this requirement for the mTOR pathway remains to be elucidated. The phosphatase and tensin homolog gene (PTEN) on chromosome 10 controls the first step in the phosphatidylinositol 3 kinase (PI3K)-Akt-mammalian target of rapamycin (mTOR) pathway and is genetically inactivated in many solid tumors. We find an absence of PTEN deletions, mutations, or protein mislocalization in PEL. However, we find consistent hyperphosphorylation at serine 380 of PTEN, which is an inactivating modification, in PEL cell lines and in tumor xenografts. We also evaluated a large tissue microarray of Kaposi's sarcoma biopsies and observed concordant high levels of phospho-PTEN, phospho-Akt, and phospho-S6 ribosomal protein. Reintroduction of PTEN into PEL inhibited colony formation in soft agar, verifying the functional dependence of PEL on PI3K signaling. This was also true for PEL cell lines that carried mutant p53 and for KS-like cell lines. Activating PTEN in these cancers may yield a new treatment strategy for PEL, KS, and similar PTEN wild-type lymphomas.
Collapse
Affiliation(s)
- Debasmita Roy
- Curriculum in Genetics and Molecular Biology, Lineberger Comprehensive Cancer Center, Center for AIDS Research, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7290, USA
| | | |
Collapse
|
15
|
Hofbauer G. [Immunosuppressive therapy after transplantation. Dermatologic relevance and pathomechanisms]. Hautarzt 2010; 61:214-9. [PMID: 20145903 DOI: 10.1007/s00105-009-1861-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Immunosuppressive therapy keeps rejection in check following solid organ transplantation. Drug reactions, inflammatory and infectious skin conditions frequently follow. Specific side effects can be avoided by switching individual agents. In addition to UV light, immunosuppressants are the most important driver for squamous cell carcinoma of the skin (SCC). Beyond immunosuppression, cyclosporine A promotes carcinogenesis by TGF beta and VEGF, while mTOR inhibitors are antiproliferative. Azathioprine photosensitizes to UVA and enables UVA to damage DNA directly. To fight skin cancer, global reduction of immunosuppression is the most effective measure. Switching calcineurin inhibitors to mTOR inhibitors is probably to be recommended, while omitting azathioprine may potentially be advisable in recurrent SCC.
Collapse
Affiliation(s)
- G Hofbauer
- Dermatologische Klinik, Universitätsspital Zürich, Gloriastr. 31, 8091, Zürich, Schweiz.
| |
Collapse
|
16
|
Hofbauer GFL, Bouwes Bavinck JN, Euvrard S. Organ transplantation and skin cancer: basic problems and new perspectives. Exp Dermatol 2010; 19:473-82. [PMID: 20482618 DOI: 10.1111/j.1600-0625.2010.01086.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Solid organ transplant and subsequent graft survival have increased worldwide, while immunosuppression has prevented rejection with increasing success. Side effects of cutaneous infection and neoplasm, however, affect the majority of solid organ transplant recipients (OTRs). Squamous cell carcinoma of the skin (SCC) is the most common neoplasm overall following organ transplant with a risk that is 60-100 times greater than for the immunocompetent population. This review focuses on questions of ongoing debate about SCC formation in OTRs such as viral carcinogenesis, systemic photoprotection, photosensitization by drugs, the impact of immunosuppressive drugs and inflammation as a driver of carcinogenesis.
Collapse
|
17
|
Results of the Conversion to Everolimus in Renal Transplant Recipients With Posttransplantation Malignancies. Transplant Proc 2010; 42:277-9. [DOI: 10.1016/j.transproceed.2009.11.017] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
18
|
Ho CM, Huang SF, Hu RH, Ho MC, Wu YM, Lee PH. Sirolimus-induced signaling modifications in Kaposi's sarcoma with resolution in a liver transplant recipient. Clin Transplant 2009; 24:127-32. [PMID: 19919613 DOI: 10.1111/j.1399-0012.2009.01132.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Sirolimus is one treatment option in transplant recipients with Kaposi's sarcoma (KS), which involves dysregulation of Akt-mammalian target of rapamycin (mTOR) signaling pathway. Signal modifications after sirolimus therapy in organ recipients with KS are largely unknown and not verified. We reported a case of KS found two yr after liver transplantation in which the immunosuppression was changed from tacrolimus, MMF, and steroid to sirolimus alone. In skin, which was found to have persistent KS after a two-month treatment of sirolimus and was removed completely one yr later, KS was no longer present. The patient went well without graft rejection. Tumor biopsies were performed before, two months, and one yr after the start of sirolimus. Immunohistochemical staining of vascular endothelial growth factor (VEGF), p-Akt, p-mTOR, p-p70 S6 kinase, and Western blot for p-tuberin/ tuberous sclerosis complex (TSC)2 was performed. VEGF was suppressed thoroughly in two-month use of sirolimus. In addition, p-Akt and p-mTOR, which were decreased at two months, could not be detected after one yr of treatment. Moreover, p-p70 S6 kinase, expressed strongly in overlying epidermis initially, was suppressed completely after two months of treatment. However, p-tuberin/TSC2, contrary to suggested theoretically, was not detected through all specimens, implying not to be a significant event. Suppressed expression of VEGF, p-Akt, and p-mTOR was the major event of signaling modification through the long-term use of sirolimus.
Collapse
Affiliation(s)
- Cheng-Maw Ho
- Department of Surgery, National Taiwan UniversityHospital, Taipei
| | | | | | | | | | | |
Collapse
|
19
|
Abstract
Organ transplant recipients given mammalian target of rapamycin inhibitor (mTORi) have reduced incidence of de novo posttransplant malignancies (dNPTMs). Posttransplant Kaposi's sarcoma and nonmelanotic skin malignancies (NMSC) frequently undergo remission/regression after conversion to mTORi immunosuppression (IS), especially early, small, and low-grade lesions, whereas larger, aggressive, and metastatic skin tumors are less likely to respond. mTORi-based IS is effective and well tolerated in orthotopic liver transplant patients with hepatocellular carcinoma (HCC) achieving excellent survival and disease-free intervals, particularly with extended criteria tumors, although the evidence that mTORi prevents HCC recurrence after orthotopic liver transplantation is only suggestive. Regression of metastatic HCC and other tumors and various forms of posttransplant lymphoproliferative disease have occurred after mTOR conversion. Documentation of regression/remission of other solid-organ dNPTM (colon, stomach, breast, etc.) after mTORi conversion is essentially absent with only anecdotal reports lacking follow-up data. Unfortunately, there is not a single reported prospective clinical trial powered for looking at the effect of mTORi IS in transplant recipients. Nevertheless, reduced incidence of all of dNPTMs and remission/regression of the commonest posttransplant tumors with mTOR therapy are strong reasons to expand the use of mTORi.
Collapse
|
20
|
Affiliation(s)
- Camille Francès
- Department of Dermatology, APHP Hospital Tenon Paris, Paris, France
| | | |
Collapse
|
21
|
Chaisuparat R, Hu J, Jham BC, Knight ZA, Shokat KM, Montaner S. Dual inhibition of PI3Kalpha and mTOR as an alternative treatment for Kaposi's sarcoma. Cancer Res 2008; 68:8361-8. [PMID: 18922908 DOI: 10.1158/0008-5472.can-08-0878] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Rapamycin (or sirolimus), the prototypical inhibitor of the mammalian target of rapamycin (mTOR) and an immunosuppressant used for the prevention of renal transplant rejection, has recently emerged as an effective treatment for Kaposi's sarcoma (KS), an enigmatic vascular tumor and a model for pathologic angiogenesis. Indeed, recent work supports a role for mTOR as a central player in the transformation of endothelial cells by the KS-associated herpesvirus-encoded G protein-coupled receptor (vGPCR), the viral oncogene believed to be responsible for causing KS. However, emerging evidence that rapamycin may transiently promote the activation of Akt may limit its use as an anti-KS therapy. Here, we show that activation of Akt in endothelial cells expressing vGPCR is augmented by treatment with rapamycin, resulting in the up-regulation of several Akt proliferative and survival pathways. However, use of a novel dual phosphatidylinositol 3-kinase alpha (PI3Kalpha)/mTOR inhibitor, PI-103, effectively and independently blocked activation of both PI3K and mTOR in vGPCR-expressing endothelial cells. This resulted in more effective inhibition of endothelial cell proliferation and survival in vitro and tumor growth in vivo. Our results suggest that PI-103 may be an effective therapeutic option for the treatment of patients with KS. Moreover, as KS may serve as a model for pathologic angiogenesis, our results further provide the basis for the early assessment of PI-103 as an antiangiogenic chemotherapeutic.
Collapse
Affiliation(s)
- Risa Chaisuparat
- Department of Oncology and Diagnostic Sciences and Greenebaum Cancer Center, University of Maryland, Baltimore, Maryland 21201, USA
| | | | | | | | | | | |
Collapse
|
22
|
Maintenance immunosuppressive therapy in adult renal transplantation: A single center analysis. Transpl Immunol 2008; 20:14-20. [DOI: 10.1016/j.trim.2008.08.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2008] [Accepted: 08/07/2008] [Indexed: 11/18/2022]
|
23
|
|
24
|
Schwartz RA, Micali G, Nasca MR, Scuderi L. Kaposi sarcoma: a continuing conundrum. J Am Acad Dermatol 2008; 59:179-206; quiz 207-8. [PMID: 18638627 DOI: 10.1016/j.jaad.2008.05.001] [Citation(s) in RCA: 163] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2007] [Revised: 04/20/2008] [Accepted: 05/05/2008] [Indexed: 12/11/2022]
Abstract
UNLABELLED Kaposi sarcoma (KS) remains a challenge. Its classic or Mediterranean form tends to be benign. In transplant recipients it may be less so. As part of the AIDS pandemic, of which it was an original defining component, it may be life-threatening. It is due to human herpesvirus-8, which is necessary but not sufficient to produce the disease. KS has a low prevalence in the general population of the United States and United Kingdom, with an intermediate rate in Italy and Greece, and a high one in parts of Africa. In Italy, hot spots include its southern regions, the Po River Valley, and Sardinia, possibly related to a high density of blood-sucking insects. An important challenge is to treat KS patients without immunocompromising them. The potential of effective anti-herpes virus therapy and the use of sirolimus in transplantation recipients have added new opportunities for KS prevention. LEARNING OBJECTIVES At the conclusion of this learning activity, participants should be able to provide the most recent information about Kaposi sarcoma in the context in which it occurs. Its classic or Mediterranean form, its pattern in transplant recipients and others iatrogenically immunosuppressed, and its occurrence as a potentially life-threatening part of the AIDS pandemic will be stressed. Its etiology and transmission will be discussed in detail to facilitate understanding of Kaposi sarcoma and of human herpesvirus-8 infection in the general population of the United States and United Kingdom, in Italy and Greece, and in certain parts of Africa. Its therapy, including the concept of doing it without immunocompromising the patient, will be stressed. New opportunities for Kaposi sarcoma prevention will also be discussed.
Collapse
Affiliation(s)
- Robert A Schwartz
- Department of Dermatology, New Jersey Medical School, Newark, New Jersey 07103-2714, USA.
| | | | | | | |
Collapse
|
25
|
Johansson G, Mahller YY, Collins MH, Kim MO, Nobukuni T, Perentesis J, Cripe TP, Lane HA, Kozma SC, Thomas G, Ratner N. Effective in vivo targeting of the mammalian target of rapamycin pathway in malignant peripheral nerve sheath tumors. Mol Cancer Ther 2008; 7:1237-45. [PMID: 18483311 DOI: 10.1158/1535-7163.mct-07-2335] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Malignant peripheral nerve sheath tumors (MPNST) are chemoresistant sarcomas with poor 5-year survival that arise in patients with neurofibromatosis type 1 (NF1) or sporadically. We tested three drugs for single and combinatorial effects on collected MPNST cell lines and in MPNST xenografts. The mammalian target of rapamycin complex 1 inhibitor RAD001 (Everolimus) decreased growth 19% to 60% after 4 days of treatment in NF1 and sporadic-derived MPNST cell lines. Treatment of subcutaneous sporadic MPNST cell xenografts with RAD001 significantly, but transiently, delayed tumor growth, and decreased vessel permeability within xenografts. RAD001 combined with the epidermal growth factor receptor tyrosine kinase inhibitor erlotinib caused additional inhibitory effects on growth and apoptosis in vitro, and a small but significant additional inhibitory effect on MPNST growth in vivo that were larger than the effects of RAD001 with doxorubicin. RAD001 plus erlotinib, in vitro and in vivo, reduced phosphorylation of AKT and total AKT levels, possibly accounting for their additive effect. The results support the consideration of RAD001 therapy in NF1 patient and sporadic MPNST. The preclinical tests described allow rapid screening strata for drugs that block MPNST growth, prior to tests in more complex models, and should be useful to identify drugs that synergize with RAD001.
Collapse
Affiliation(s)
- Gunnar Johansson
- Division of Experimental Hematology, University of Cincinnati, Cincinnati, OH, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Pranteda G, Feliziani G, Grimaldi M, Paleologo G, Pranteda G, Melotti F, Camplone G. Sirolimus and regression of Kaposi's sarcoma in immunosuppressed transplant patient. J Eur Acad Dermatol Venereol 2008; 22:1022-3. [DOI: 10.1111/j.1468-3083.2007.02536.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
|
27
|
Stallone G, Infante B, Grandaliano G, Schena FP, Gesualdo L. Kaposi's sarcoma and mTOR: a crossroad between viral infection neoangiogenesis and immunosuppression. Transpl Int 2008; 21:825-32. [PMID: 18498314 DOI: 10.1111/j.1432-2277.2008.00697.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The incidence of Kaposi's sarcoma (KS) among the recipients of solid organ transplants is about 500 times the rate in the general population, suggesting a role for immunosuppression in the development of the disease. The drugs used for the induction and maintenance of immunosuppression and the length of treatment with these agents influence both the incidence and the type of cancer development. The clinical presentation of KS in transplant recipients is often limited to the skin. The risk of death from KS is related to the form and extent of the lesions. The main approach to managing transplant-associated KS is to reduce or even discontinue immunosuppressive therapy; this strategy carries a risk of acute rejection of the graft. KS is a multicentric tumor composed of endothelium-lined vascular spaces and spindle-shaped cells. Its pathogenesis is unclear. Recent evidence suggests that vascular endothelial growth factor (VEGF) is likely to be a growth factor for KS cells: blocking the interaction between VEGF and Flk-1/KDR can abolish VEGF-induced growth of the tumor. Recently, Sirolimus, a drug used in kidney-transplant recipients, has been suggested to reduce KS progression in transplant recipients. This unexpected effect of the drug confirms previous experimental information on KS pathogenesis and may shed light on an array of molecular mechanisms, modulated by Sirolimus, of potential clinical interest in the transplantation scenario.
Collapse
Affiliation(s)
- Giovanni Stallone
- Section of Nephrology, Dialysis and Transplant, Department of Biomedical Sciences, University of Foggia, Foggia, Italy.
| | | | | | | | | |
Collapse
|
28
|
Hansen A, Boshoff C, Lagos D. Kaposi sarcoma as a model of oncogenesis and cancer treatment. Expert Rev Anticancer Ther 2007; 7:211-20. [PMID: 17288530 DOI: 10.1586/14737140.7.2.211] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Kaposi sarcoma is the most common cancer among HIV-infected individuals and one of the most common cancers in sub-Saharan Africa. Kaposi sarcoma lesions are highly vascularized, and comprised of spindle-shaped tumor cells. Kaposi sarcoma herpesvirus is etiologically linked to Kaposi sarcoma development and encodes genes that contribute to cellular transformation, evasion of apoptosis, aberrant angiogenesis and an inflammatory tumor microenvironment. The study of Kaposi sarcoma herpesvirus-driven malignancies has provided a model of oncogenesis and identified some of the key steps and, therefore, therapeutic targets of Kaposi sarcoma development. However, current Kaposi sarcoma treatments are not specific and rely on reconstitution of the immune system and systemic administration of cytotoxic agents. Recent studies have demonstrated that mechanism-based therapeutics, such as vascular endothelial growth factor A or mammalian target of rapamycin inhibitors, are promising therapeutic approaches bridging basic research with clinical practice.
Collapse
Affiliation(s)
- Amy Hansen
- Cancer Research UK Viral Oncology Group, Wolfson Institute for Biomedical Research, UCL, London, UK.
| | | | | |
Collapse
|