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Shen J, Liu P, Zhang B, Ye B, Xu S, Su W, Chu X. Expanding the application of tyrosine: engineering microbes for the production of tyrosine and its derivatives. Front Bioeng Biotechnol 2025; 13:1519764. [PMID: 40343203 PMCID: PMC12058496 DOI: 10.3389/fbioe.2025.1519764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2024] [Accepted: 04/09/2025] [Indexed: 05/11/2025] Open
Abstract
Aromatic compounds are widely used in the fields of medicine, chemical industry, and food, with a considerable market size. Tyrosine, an aromatic amino acid, boasts not only a wide range of applications but also serves as a valuable precursor for synthesizing a diverse array of high-value aromatic compounds. Amid growing concerns over environmental and resource challenges, the adoption of green, clean, and sustainable biotechnology for producing aromatic compounds is gaining increasing recognition as a viable alternative to traditional chemical synthesis and plant extraction methods. This article provides an overview of the current status of tyrosine biomanufacturing and explores the methods for generating derivatives, including resveratrol, levodopa, p-coumaric acid, caffeic acid, zosteric acid, tyrosol, hydroxytyrosol, tanshinol, naringenin, eriodictyol, and salidroside, using tyrosine as a primary raw material. Furthermore, this review examines the current challenges and outlines future directions for microbial fermentation for the production of tyrosine and its derivatives.
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Affiliation(s)
- Jian Shen
- Collaborative Innovation Center of Yangtze River Delta Region Green Pharmaceuticals, Zhejiang University of Technology, Hangzhou, Zhejiang, China
| | - Pengfu Liu
- Collaborative Innovation Center of Yangtze River Delta Region Green Pharmaceuticals, Zhejiang University of Technology, Hangzhou, Zhejiang, China
| | - Bin Zhang
- College of Bioscience and Bioengineering, Jiangxi Agricultural University, Nanchang, Jiangxi, China
| | - Bangce Ye
- East China University of Science and Technology, Shanghai, China
| | - Shunqing Xu
- Collaborative Innovation Center of Yangtze River Delta Region Green Pharmaceuticals, Zhejiang University of Technology, Hangzhou, Zhejiang, China
| | - Weike Su
- Collaborative Innovation Center of Yangtze River Delta Region Green Pharmaceuticals, Zhejiang University of Technology, Hangzhou, Zhejiang, China
| | - Xiaohe Chu
- Collaborative Innovation Center of Yangtze River Delta Region Green Pharmaceuticals, Zhejiang University of Technology, Hangzhou, Zhejiang, China
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Titov A, Kaminskiy Y, Ganeeva I, Zmievskaya E, Valiullina A, Rakhmatullina A, Petukhov A, Miftakhova R, Rizvanov A, Bulatov E. Knowns and Unknowns about CAR-T Cell Dysfunction. Cancers (Basel) 2022; 14:1078. [PMID: 35205827 PMCID: PMC8870103 DOI: 10.3390/cancers14041078] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/29/2022] [Accepted: 02/11/2022] [Indexed: 02/01/2023] Open
Abstract
Immunotherapy using chimeric antigen receptor (CAR) T cells is a promising option for cancer treatment. However, T cells and CAR-T cells frequently become dysfunctional in cancer, where numerous evasion mechanisms impair antitumor immunity. Cancer frequently exploits intrinsic T cell dysfunction mechanisms that evolved for the purpose of defending against autoimmunity. T cell exhaustion is the most studied type of T cell dysfunction. It is characterized by impaired proliferation and cytokine secretion and is often misdefined solely by the expression of the inhibitory receptors. Another type of dysfunction is T cell senescence, which occurs when T cells permanently arrest their cell cycle and proliferation while retaining cytotoxic capability. The first section of this review provides a broad overview of T cell dysfunctional states, including exhaustion and senescence; the second section is focused on the impact of T cell dysfunction on the CAR-T therapeutic potential. Finally, we discuss the recent efforts to mitigate CAR-T cell exhaustion, with an emphasis on epigenetic and transcriptional modulation.
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Affiliation(s)
- Aleksei Titov
- Institute of Fundamental Medicine and Biology, Kazan Federal University, 420008 Kazan, Russia
- Laboratory of Transplantation Immunology, National Research Centre for Hematology, 125167 Moscow, Russia
| | - Yaroslav Kaminskiy
- Laboratory of Transplantation Immunology, National Research Centre for Hematology, 125167 Moscow, Russia
| | - Irina Ganeeva
- Institute of Fundamental Medicine and Biology, Kazan Federal University, 420008 Kazan, Russia
| | - Ekaterina Zmievskaya
- Institute of Fundamental Medicine and Biology, Kazan Federal University, 420008 Kazan, Russia
| | - Aygul Valiullina
- Institute of Fundamental Medicine and Biology, Kazan Federal University, 420008 Kazan, Russia
| | - Aygul Rakhmatullina
- Institute of Fundamental Medicine and Biology, Kazan Federal University, 420008 Kazan, Russia
| | - Alexey Petukhov
- Institute of Fundamental Medicine and Biology, Kazan Federal University, 420008 Kazan, Russia
- Institute of Hematology, Almazov National Medical Research Center, 197341 Saint Petersburg, Russia
| | - Regina Miftakhova
- Institute of Fundamental Medicine and Biology, Kazan Federal University, 420008 Kazan, Russia
| | - Albert Rizvanov
- Institute of Fundamental Medicine and Biology, Kazan Federal University, 420008 Kazan, Russia
| | - Emil Bulatov
- Institute of Fundamental Medicine and Biology, Kazan Federal University, 420008 Kazan, Russia
- Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences, 117997 Moscow, Russia
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Pich C, Teiti I, Sarrabayrouse G, Gallardo F, Gence R, Tilkin-Mariamé AF. Melanoma Expressed-CD70 Is Regulated by RhoA and MAPK Pathways without Affecting Vemurafenib Treatment Activity. PLoS One 2016; 11:e0148095. [PMID: 26828592 PMCID: PMC4734704 DOI: 10.1371/journal.pone.0148095] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 01/13/2016] [Indexed: 11/19/2022] Open
Abstract
CD70 is a costimulatory molecule member of the Tumor Necrosis Factor family that is expressed on activated immune cells. Its ectopic expression has been described in several types of cancer cells including lymphomas, renal cell carcinomas and glioblastomas. We have recently described its expression in a part of tumor cells from the vast majority of melanoma biopsies and human melanoma cell lines, and found that CD70 expression decreased over time as the disease progressed. Here, we show that RhoA, BRAF and Mitogen Activating Protein Kinase pathways are involved in the positive transcriptional regulation of CD70 expression in melanomas. Interestingly, the clinical inhibitor of the common BRAF V600E/D variants, Vemurafenib (PLX-4032), which is currently used to treat melanoma patients with BRAF V600E/D-mutated metastatic melanomas, decreased CD70 expression in human CD70+ melanoma cell lines. This decrease was seen in melanoma cells both with and without the BRAFV600E/D mutation, although was less efficient in those lacking the mutation. But interestingly, by silencing CD70 in CD70+ melanoma cell lines we show that PLX-4032-induced melanoma cell killing and its inhibitory effect on MAPK pathway activation are unaffected by CD70 expression. Consequently, our work demonstrates that CD70 ectopic expression in melanomas is not a valuable biomarker to predict tumor cells sensitivity to BRAF V600 inhibitors.
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Affiliation(s)
- Christine Pich
- INSERM UMR 1037, CRCT, Toulouse FR-31037, France
- Université Paul Sabatier, Toulouse FR-31062, France
| | - Iotefa Teiti
- INSERM UMR 1037, CRCT, Toulouse FR-31037, France
- Université Paul Sabatier, Toulouse FR-31062, France
| | - Guillaume Sarrabayrouse
- INSERM UMR 1037, CRCT, Toulouse FR-31037, France
- Université Paul Sabatier, Toulouse FR-31062, France
| | - Franck Gallardo
- NeoVirTech, Institut des Sciences du vivant, Toulouse FR-31106, France
| | - Rémi Gence
- INSERM UMR 1037, CRCT, Toulouse FR-31037, France
- Université Paul Sabatier, Toulouse FR-31062, France
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Pich C, Sarrabayrouse G, Teiti I, Mariamé B, Rochaix P, Lamant L, Favre G, Maisongrosse V, Tilkin-Mariamé AF. Melanoma-expressed CD70 is involved in invasion and metastasis. Br J Cancer 2015; 114:63-70. [PMID: 26671750 PMCID: PMC4716537 DOI: 10.1038/bjc.2015.412] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 08/20/2015] [Accepted: 10/23/2015] [Indexed: 01/10/2023] Open
Abstract
Background: CD70 is a costimulatory molecule of the tumour necrosis factor family expressed in activated immune cells and some solid tumours. In lymphocytes CD70 triggers T cell-mediated cytotoxicity and mitogen-activated protein kinase phosphorylation. Methods: We evaluated the expression of CD70 in biopsies and melanoma cell lines. Using melanoma cell lines positive or not for CD70, we analysed CD70 function on melanoma progression. Results: We report CD70 expression in human melanoma cell lines and tumour cells from melanoma biopsies. This expression was observed in 95% of primary melanomas but only 37% of metastases. Both monomeric and trimeric forms of CD70 were detected in tumour cell membrane fractions, whereas cytoplasmic fractions contained almost exclusively monomeric CD70. In vitro and in vivo experiments demonstrated that CD70 expression inhibited melanoma cell migration, invasion and pulmonary metastasis implantation independently of the tumour immune microenvironment. Increasing the levels of the trimeric form of CD70 through monoclonal antibody binding led to an increase in CD70+ melanoma cell invasiveness through MAPK pathway activation, RhoE overexpression, ROCK1 and MYPT1 phosphorylation decrease, and stress fibres and focal adhesions disappearance. Conclusions: Our results describe a new non-immunological function of melanoma-expressed CD70, which involves melanoma invasiveness through MAPK pathway, RhoE and cytoskeletal modulation.
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Affiliation(s)
- Christine Pich
- Unité INSERM UMR 1037, CRCT, F-31037 Toulouse, France.,Université Paul Sabatier, F-31062 Toulouse, France
| | - Guillaume Sarrabayrouse
- Unité INSERM UMR 1037, CRCT, F-31037 Toulouse, France.,Université Paul Sabatier, F-31062 Toulouse, France
| | - Iotefa Teiti
- Unité INSERM UMR 1037, CRCT, F-31037 Toulouse, France.,Université Paul Sabatier, F-31062 Toulouse, France
| | - Bernard Mariamé
- Université Paul Sabatier, F-31062 Toulouse, France.,ITAV, USR 3505, 1 Place Potier, F-31106 Toulouse, France
| | - Philippe Rochaix
- Service d'anatomo-Pathologie, Institut Universitaire du Cancer - IUCT, F-31059 Toulouse, France
| | - Laurence Lamant
- Unité INSERM UMR 1037, CRCT, F-31037 Toulouse, France.,Service d'anatomo-Pathologie, Institut Universitaire du Cancer - IUCT, F-31059 Toulouse, France
| | - Gilles Favre
- Unité INSERM UMR 1037, CRCT, F-31037 Toulouse, France.,Université Paul Sabatier, F-31062 Toulouse, France.,Service d'anatomo-Pathologie, Institut Universitaire du Cancer - IUCT, F-31059 Toulouse, France
| | - Véronique Maisongrosse
- Service d'anatomo-Pathologie, Institut Universitaire du Cancer - IUCT, F-31059 Toulouse, France
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Opposing effects of CD70 costimulation during acute and chronic lymphocytic choriomeningitis virus infection of mice. J Virol 2011; 85:6168-74. [PMID: 21507976 DOI: 10.1128/jvi.02205-10] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
T cell costimulation is important for T cell activation. The CD27/CD70 pathway contributes to effector and memory T cell development and is involved in T cell and B cell activation. CD27/CD70 is known for having opposing roles during different models of antigenic challenges. During primary T cell responses to influenza virus infection or during tumor challenges, CD27/CD70 costimulation has a positive role on T cell responses. However, during some chronic infections, constitutive triggering of this signaling pathway has a negative role on T cell responses. It is currently unclear what specific characteristic of an antigen determines the outcome of CD27/CD70 costimulation. We investigated the effect of a transient CD70 blockade during an acute or a chronic lymphocytic choriomeningitis virus (LCMV) infection in mice. Blockade of this pathway during acute LCMV infection (Armstrong strain) resulted in delayed T cell responses and decreased CD127 (interleukin-7 receptor α [IL-7Rα] chain) conversion. Upregulation of CD127 is an important event in T cell differentiation that heralds the passage of an effector T cell to a long-lived memory T cell. In contrast to the reduced CD8 T cell responses after CD70 blockade during acute infection, CD70 blockade during chronic LCMV infection resulted in increased CD8 T cell responses. Our data show the dual roles of this costimulatory pathway in acute versus persistent antigen challenge. Our findings suggest that antigen persistence may determine the effect of CD27/CD70 signaling on CD8 T cell responses. Tailored triggering or blockade of this costimulatory pathway may be important in vaccination regimens against acute or chronic pathogens.
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Stimulation of the endosomal TLR pathway enhances autophagy-induced cell death in radiotherapy of breast cancer. Genes Genomics 2010. [DOI: 10.1007/s13258-010-0139-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Miller J, Eisele G, Tabatabai G, Aulwurm S, von Kürthy G, Stitz L, Roth P, Weller M. Soluble CD70: a novel immunotherapeutic agent for experimental glioblastoma. J Neurosurg 2010; 113:280-5. [PMID: 19961309 DOI: 10.3171/2009.11.jns09901] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECT Given the overall poor outcome with current treatment strategies in malignant gliomas, immunotherapy has been considered a promising experimental approach to glioblastoma for more than 2 decades. A cell surface molecule, CD70, may induce potent antitumor immune responses via activation of the costimulatory receptor CD27 expressed on immune effector cells. There is evidence that a soluble form of CD70 (sCD70) may exhibit biological activity, too. A soluble costimulatory ligand is attractive because it may facilitate immune activation and may achieve a superior tissue distribution. METHODS To test the antiglioma effect of sCD70, the authors genetically modified SMA-560 mouse glioma cells to secrete the extracellular domain of CD70. They assessed the immunogenicity of the transfected cells in cocultures with immune effector cells by the determination of immune cell proliferation and the release of interferon-gamma. Syngeneic VM/Dk mice were implanted orthotopically with control or sCD70-releasing glioma cells to determine a survival benefit mediated by sCD70. Depletion studies were performed to identify the cellular mediators of prolonged survival of sCD70-releasing glioma-bearing mice. RESULTS The authors found that ectopic expression of sCD70 enhanced the proliferation and interferon-gamma release of syngeneic splenocytes in vitro. More importantly, sCD70 prolonged the survival of syngeneic VM/Dk mice bearing intracranial SMA-560 gliomas. The survival rate at 60 days increased from 5 to 45%. Antibody-mediated depletion of CD8-positive T cells abrogates the survival advantage conferred by sCD70. CONCLUSIONS These data suggest that sCD70 is a potent stimulator of antiglioma immune responses that depend critically on CD8-positive T cells. Soluble CD70 could be a powerful adjuvant for future immunotherapy trials for glioblastoma.
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Affiliation(s)
- James Miller
- Department of Neurosurgery, Indiana University, Indianapolis, Indiana, USA
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Sirikanjanapong S, Lanson B, Amin M, Martiniuk F, Kamino H, Wang BY. Collision tumor of primary laryngeal mucosal melanoma and invasive squamous cell carcinoma with IL-17A and CD70 gene over-expression. Head Neck Pathol 2010; 4:295-9. [PMID: 20697851 PMCID: PMC2996505 DOI: 10.1007/s12105-010-0200-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2010] [Accepted: 07/20/2010] [Indexed: 02/06/2023]
Abstract
The most common primary malignancy of the larynx is the squamous cell carcinoma (SCC). The primary malignant melanoma is quite rare in this location. Less than 60 cases of laryngeal melanomas have been reported to date. To our knowledge, collision primary malignant melanoma and invasive squamous cell carcinoma in the vocal cords has not been reported. We report a 53-year-old male patient who was diagnosed with a collision tumor of laryngeal melanoma and invasive SCC. Multiple Th17 pathway related genes including CTLA-4, IL-17A-F, PLZF, FoxP3, RorγT, CD27, and CD70 were analyzed by reverse transcriptase-polymerase chain reaction (Rt-PCR) in this case. Both IL-17A and CD70 genes were detected in this case of collision tumor. The results may define useful biomarkers for early diagnosis of mucosal melanoma and open an immunotherapeutic field for clinical management with the potential benefit from the immunomodulators that enhance both genes.
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Affiliation(s)
- Sasis Sirikanjanapong
- Department of Pathology, New York University School of Medicine, 550 First Avenue, TCH-461, New York, NY 10016 USA
| | - Biana Lanson
- Department of Otolaryngology, New York University School of Medicine, New York, USA
| | - Milan Amin
- Department of Otolaryngology, New York University School of Medicine, New York, USA
| | - Frank Martiniuk
- Department of Medicine, New York University School of Medicine, New York, USA
| | - Hideko Kamino
- Department of Dermatopathology, New York University School of Medicine, New York, USA
| | - Beverly Y. Wang
- Department of Pathology, New York University School of Medicine, 550 First Avenue, TCH-461, New York, NY 10016 USA ,Department of Otolaryngology, New York University School of Medicine, New York, USA
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Sarrabayrouse G, Pich C, Moriez R, Armand-Labit V, Rochaix P, Favre G, Tilkin-Mariamé AF. Melanoma cells treated with GGTI and IFN-gamma allow murine vaccination and enhance cytotoxic response against human melanoma cells. PLoS One 2010; 5:e9043. [PMID: 20140259 PMCID: PMC2815789 DOI: 10.1371/journal.pone.0009043] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2009] [Accepted: 01/14/2010] [Indexed: 11/28/2022] Open
Abstract
Background Suboptimal activation of T lymphocytes by melanoma cells is often due to the defective expression of class I major histocompatibility antigens (MHC-I) and costimulatory molecules. We have previously shown that geranylgeranyl transferase inhibition (done with GGTI-298) stimulates anti-melanoma immune response through MHC-I and costimulatory molecule expression in the B16F10 murine model [1]. Methodology/Principal Findings In this study, it is shown that vaccination with mIFN-gand GGTI-298 pretreated B16F10 cells induces a protection against untreated tumor growth and pulmonary metastases implantation. Furthermore, using a human melanoma model (LB1319-MEL), we demonstrated that in vitro treatment with hIFN-γ and GGTI-298 led to the up regulation of MHC-I and a costimulatory molecule CD86 and down regulation of an inhibitory molecule PD-1L. Co-culture experiments with peripheral blood mononuclear cells (PBMC) revealed that modifications induced by hIFN-γ and GGTI-298 on the selected melanoma cells, enables the stimulation of lymphocytes from HLA compatible healthy donors. Indeed, as compared with untreated melanoma cells, pretreatment with hIFN-γ and GGTI-298 together rendered the melanoma cells more efficient at inducing the: i) activation of CD8 T lymphocytes (CD8+/CD69+); ii) proliferation of tumor-specific CD8 T cells (MelanA-MART1/TCR+); iii) secretion of hIFN-γ; and iv) anti-melanoma specific cytotoxic cells. Conclusions/Significance These data indicate that pharmacological treatment of melanoma cell lines with IFN-γ and GGTI-298 stimulates their immunogenicity and could be a novel approach to produce tumor cells suitable for vaccination and for stimulation of anti-melanoma effector cells.
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Affiliation(s)
- Guillaume Sarrabayrouse
- Département «Innovation thérapeutique et Oncologie Moléculaire», INSERM U563 CPTP, Toulouse, France
- Institut Claudius Regaud, Toulouse, France
- Université Paul Sabatier, Toulouse, France
| | - Christine Pich
- Département «Innovation thérapeutique et Oncologie Moléculaire», INSERM U563 CPTP, Toulouse, France
- Institut Claudius Regaud, Toulouse, France
- Université Paul Sabatier, Toulouse, France
| | - Raphaël Moriez
- Neuro-Gastroenterology and Nutrition Unit, INRA, Toulouse, France
| | - Virginie Armand-Labit
- Département «Innovation thérapeutique et Oncologie Moléculaire», INSERM U563 CPTP, Toulouse, France
- Institut Claudius Regaud, Toulouse, France
- Université Paul Sabatier, Toulouse, France
| | | | - Gilles Favre
- Département «Innovation thérapeutique et Oncologie Moléculaire», INSERM U563 CPTP, Toulouse, France
- Institut Claudius Regaud, Toulouse, France
- Université Paul Sabatier, Toulouse, France
| | - Anne-Françoise Tilkin-Mariamé
- Département «Innovation thérapeutique et Oncologie Moléculaire», INSERM U563 CPTP, Toulouse, France
- Institut Claudius Regaud, Toulouse, France
- * E-mail:
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Glouchkova L, Ackermann B, Zibert A, Meisel R, Siepermann M, Janka-Schaub GE, Goebel U, Troeger A, Dilloo D. The CD70/CD27 pathway is critical for stimulation of an effective cytotoxic T cell response against B cell precursor acute lymphoblastic leukemia. THE JOURNAL OF IMMUNOLOGY 2009; 182:718-25. [PMID: 19109206 DOI: 10.4049/jimmunol.182.1.718] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
For effective immunotherapy, maintaining the frequency and cytotoxic potential of effector cells is critical. In this context costimulation via the CD70/CD27 pathway has been proven essential. CD70 has been reported to be expressed to varying degrees on malignant B cells. However, in B cell precursor acute lymphoblastic leukemia, the most common childhood malignancy, the role of CD70 in stimulation of antileukemic T cell responses has so far not been delineated. Herein we demonstrate that in B cell precursor acute lymphoblastic leukemia expression of CD70 is low but can be induced upon blast activation via CD40. Both CD70 and CD80/CD86 up-regulated on CD40-stimulated blasts contribute to primary stimulation of T cell proliferation and cytokine production in an additive manner. These two signals also cooperate in the prevention of T cell anergy. In contrast to blockade of CD70 during the effector phase, inhibition of CD70-mediated costimulation during generation of antileukemic T cells prevents effector cell proliferation and reduces their cytotoxic capacity. Modulation of the CD70/CD27 pathway may thus represent a novel therapeutic approach for augmenting magnitude and quality of the antileukemic response in B cell precursor acute lymphoblastic leukemia.
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Affiliation(s)
- Ludmila Glouchkova
- Clinic for Pediatric Oncology, Hematology, and Clinical Immunology, Heinrich Heine University of Duesseldorf, Duesseldorf, Germany
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