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Pena J, Cull D, Strowd LC, Vaidya R, Seegars MB, Ahn C, Winkfield KM, Hughes RT. Response and local control in patients treated with low-dose radiotherapy for tumoral mycosis fungoides. Leuk Lymphoma 2023; 64:2202-2207. [PMID: 37671707 PMCID: PMC10873100 DOI: 10.1080/10428194.2023.2254435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 08/23/2023] [Accepted: 08/26/2023] [Indexed: 09/07/2023]
Abstract
Low-dose radiotherapy (LDRT), defined in this study as 2 fractions of 4 Gy delivered on consecutive days, is an effective option for local palliation of mycosis fungoides (MF), but its efficacy for tumoral lesions (TL) needs investigation. We assessed response and local control (LC) rates for patients treated with LDRT for MF and compared these outcomes between TL and non-TL. A total of 73 lesions in 18 patients treated with LDRT between 2013-2020 were analyzed. Response was defined as complete response (CR), partial response (PR), or no response (NR). In the non-TL versus TL groups, CR was observed in 16.7% v. 4.0%, PR in 81.2% v. 80.0%, NR in 2.1% v. 16.0%, respectively. 2-year LC was 100% for non-TL and 61% for TLs (p < 0.01). LDRT yields excellent response and lesion control for non-TLs and is associated with lower response rates and LC for TLs.
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Affiliation(s)
- Joseph Pena
- Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Deborah Cull
- Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Lindsay C. Strowd
- Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Rakhee Vaidya
- Department of Radiation Oncology, Wake Forest University School of Medicine, Winston Salem, NC, USA
| | - Mary Beth Seegars
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Christine Ahn
- Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Karen M. Winkfield
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ryan T. Hughes
- Department of Radiation Oncology, Wake Forest University School of Medicine, Winston Salem, NC, USA
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Di Raimondo C, Lombardo P, Tesei C, Esposito F, Meconi F, Secchi R, Lozzi F, Monopoli A, Narducci MG, Scala E, Angeloni C, De Stefano A, Rahimi S, Bianchi L, Cantonetti M. Role of Neutrophil-to-Lymphocyte Ratio (NLR) in Patients with Mycosis Fungoides. Diagnostics (Basel) 2023; 13:diagnostics13111979. [PMID: 37296831 DOI: 10.3390/diagnostics13111979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 05/28/2023] [Accepted: 06/02/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND The neutrophil/lymphocyte ratio (NLR) at baseline has been demonstrated to correlate with higher stages of disease and to be a prognostic factor in numerous cancers. However, its function as a prognostic factor for mycosis fungoides (MF) has not been yet clarified. OBJECTIVE Our work aimed to assess the association of the NLR with different stages of MF and to outline whether higher values of this marker are related to a more aggressive MF. METHODS We retrospectively calculated the NLRs in 302 MF patients at the moment of diagnosis. The NLR was obtained using the complete blood count values. RESULTS The median NLR among patients with early stage disease (low-grade IA-IB-IIA) was 1.88, while the median NLR for patients with high-grade MF (IIB-IIIA-IIIB) was 2.64. Statistical analysis showed positive associations of advanced MF stages with NLRs higher than 2.3. CONCLUSIONS Our analysis demonstrates that the NLR represents a cheap and easily available parameter functioning as a marker for advanced MF. This might guide physicians in recognizing patients with advanced stages of disease requiring a strict follow-up or an early treatment.
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Affiliation(s)
- Cosimo Di Raimondo
- Department of Dermatology, University of Roma Tor Vergata, 00133 Rome, Italy
| | - Paolo Lombardo
- Istituto Dermopatico dell'Immacolata, IDI-IRCCS, 00167 Rome, Italy
| | - Cristiano Tesei
- Department of Hematology, University of Roma Tor Vergata, 00133 Rome, Italy
| | - Fabiana Esposito
- Department of Hematology, University of Roma Tor Vergata, 00133 Rome, Italy
| | - Federico Meconi
- Department of Hematology, University of Roma Tor Vergata, 00133 Rome, Italy
| | - Roberto Secchi
- Department of Hematology, University of Roma Tor Vergata, 00133 Rome, Italy
| | - Flavia Lozzi
- Department of Dermatology, University of Roma Tor Vergata, 00133 Rome, Italy
| | | | | | - Enrico Scala
- Istituto Dermopatico dell'Immacolata, IDI-IRCCS, 00167 Rome, Italy
| | - Cecilia Angeloni
- Department of Diagnostic Imaging and Interventional Radiology, University of Roma Tor Vergata, 00133 Rome, Italy
| | - Alberto De Stefano
- Volunteers Association of Fondazione Policlinico "Tor Vergata", 00133 Rome, Italy
| | - Siavash Rahimi
- Istituto Dermopatico dell'Immacolata, IDI-IRCCS, 00167 Rome, Italy
| | - Luca Bianchi
- Department of Dermatology, University of Roma Tor Vergata, 00133 Rome, Italy
| | - Maria Cantonetti
- Istituto Dermopatico dell'Immacolata, IDI-IRCCS, 00167 Rome, Italy
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Some New Aspects of Genetic Variability in Patients with Cutaneous T-Cell Lymphoma. Genes (Basel) 2022; 13:genes13122401. [PMID: 36553668 PMCID: PMC9778129 DOI: 10.3390/genes13122401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/10/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022] Open
Abstract
AIM Cutaneous T-cell lymphoma (CTCL) is a group of T-cell malignancies that develop in the skin. Though studied intensively, the etiology and pathogenesis of CTCL remain elusive. This study evaluated the survival of CTCL patients in the 1st Department of Dermatovenereology of St. Anne's University Hospital Brno. It included analysis of 19 polymorphic gene variants based on their expected involvement in CTCL severity. MATERIAL AND METHODS 75 patients with CTCL, evaluated and treated at the 1st Department of Dermatovenereology of St. Anne´s University Hospital Brno, Faculty of Medicine, Masaryk University, were recruited for the study over the last 28 years (44 men and 31 women, average age 58 years, range 20-82 years). All patients were genotyped for 19 chosen gene polymorphisms by the conventional PCR method with restriction analysis. A multivariate Cox regression model was calculated to reveal genetic polymorphisms and other risk factors for survival. RESULTS The model identified MDR Ex21 2677 (rs2032582) as a significant genetic factor influencing the survival of the patients, with the T-allele playing a protective role. A multivariate stepwise Cox regression model confirmed the following as significant independent risk factors for overall survival: increased age at admission, clinical staging of the tumor, and male sex. CONCLUSION We showed that the TT genotype at position 2677 of the MDR1 gene exhibited statistically significant longer survival in CTCL patients. As such, the TT genotype of MDR1 confers a significant advantage for the CTCL patients who respond to treatment.
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Epidemiologic Trends of Cutaneous T-Cell Lymphoma in Arkansas Reveals Demographic Disparities. Cancers (Basel) 2022; 14:cancers14174329. [PMID: 36077864 PMCID: PMC9454538 DOI: 10.3390/cancers14174329] [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: 05/18/2022] [Revised: 07/14/2022] [Accepted: 08/20/2022] [Indexed: 11/17/2022] Open
Abstract
Accurate demographic data are critical for comprehending and treating cutaneous T-cell lymphoma (CTCL). Our research aimed to determine the demographics and incidence trends of CTCL patients in Arkansas compared to those of the national CTCL population to recognize the underlying disparities. We collected data from 143 CTCL patients at the University of Arkansas for Medical Sciences (UAMS) and national CTCL patient data from the Surveillance, Epidemiology, and End Results (SEER) database. Our analysis revealed that males are affected more than females across all ages and races. CTCL incidence and mortality data show that CTCL has a steady increase at the national level and in Arkansas while disproportionately affecting the young black male population. In Arkansas, more than one-third of black patients presented at an advanced stage (IIB+) compared to one-fifth in the white population, and the mean age of death was more than a decade younger for black (60 years) than for white patients (74.6 years). Nationally, black male patients had the greatest mortality rate (0.5) compared to 0.32 for white males. CTCL is 2.23 and 2.38 times more prevalent in urban versus rural areas in Arkansas and nationally, respectively. Most Arkansas patients reside near major interstates and chemical-emitting sites. In conclusion, our demographic analysis of Arkansas and national CTCL patients verifies recent trends toward more aggressive presentations in young black male patients, and our geographic findings suggest possible environmental risk factors.
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Kondratjeva J, Julien F, Coutelier C, Humeau L, Moog F, Combarros D, Fourquaux I, Pressanti C, Delverdier M, Moore PF, Cadiergues MC. Cutaneous epitheliotropic T-cell lymphoma in a donkey - a case report. BMC Vet Res 2022; 18:267. [PMID: 35821128 PMCID: PMC9275177 DOI: 10.1186/s12917-022-03365-7] [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: 12/15/2021] [Accepted: 06/28/2022] [Indexed: 05/31/2023] Open
Abstract
Background Cutaneous epitheliotropic T-cell lymphoma is a malignant tumour of the skin already reported in humans, dogs, cats, horses, and other species, but not previously in donkeys. The standard diagnosis is based on clinical, morphological and immunophenotypic data. Differentiation of malignant versus benign proliferation of lymphocytes is crucial; in ambiguous cases T-cell receptor gamma (TRG) molecular clonality should be tested. In the present paper, we report a case of mycosis fungoides diagnosed in a donkey whose diagnosis was based on clinical, histological and immunohistochemical aspects and a positive TRG clonality test. Case presentation A twenty-five-year-old donkey gelding was referred with a mildly pruritic, generalised and severe exfoliative dermatosis. Otherwise, the animal was clinically healthy, though mildly underweight. Dermatological examination revealed severe generalised alopecic and exfoliative dermatitis, occasionally eroded, with high number of large, thin, greyish scales. All mucocutaneous junctions except the hoofs were affected. Ectoparasites and dermatophytes were ruled out. The complete blood count and blood smear evaluation revealed mild normocytic normochromic anemia. The biochemistry panel showed mild hyperproteinemia with albumin within the normal range. Protein electrophoresis showed moderate polyclonal hypergammaglobulinemia. Histological findings were characterised by interface dermatitis with massive exocytosis in the epidermis of a homogenous population of lymphoid cells showing atypia. Clusters of neoplastic cells were present within the epidermis forming Pautrier “microabscesses”. These findings are consistent with cutaneous epitheliotropic lymphoma. Immunohistochemical staining revealed uniform labelling of the neoplastic cells for CD3, and lack of expression of CD20 (a B cell lineage associated marker). Molecular clonality PCR (PARR) was performed using equine TRG primers; this revealed a clonal rearrangement in a heavy polyclonal background. Transmission electronic microscopy showed multiple lymphocytes with convoluted or cerebriform nuclei. Conclusions This case report provides the first evidence of clinical, histopathological, immunophenotypic features, electron microscopy findings and molecular analysis of a cutaneous epitheliotropic T-cell lymphoma (mycosis fungoides) in a donkey. Our observations suggest that cutaneous T-cell lymphoma should be included in the differential diagnoses of exfoliative dermatitis, even those progressing in a chronic pattern and/or with few or no pruritus.
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Affiliation(s)
| | | | - Céline Coutelier
- Small Animal and Equine Hospital, ENVT, Université de Toulouse, Toulouse, France
| | - Louis Humeau
- Small Animal and Equine Hospital, ENVT, Université de Toulouse, Toulouse, France
| | - Fabien Moog
- Small Animal and Equine Hospital, ENVT, Université de Toulouse, Toulouse, France
| | - Daniel Combarros
- Small Animal and Equine Hospital, ENVT, Université de Toulouse, Toulouse, France.,INFINITy, Université de Toulouse, CNRS, UPS, InsermToulouse, France
| | - Isabelle Fourquaux
- Centre de Microscopie Electronique Appliquée À La Biologie, Université de Toulouse, Toulouse, France
| | - Charline Pressanti
- Small Animal and Equine Hospital, ENVT, Université de Toulouse, Toulouse, France.,INFINITy, Université de Toulouse, CNRS, UPS, InsermToulouse, France
| | - Maxence Delverdier
- Basic Sciences Department, Université de Toulouse, ENVT, Toulouse, France.,IHAP, Université de Toulouse, INRAE, ENVT, Toulouse, France
| | - Peter F Moore
- Leukocyte Antigen Biology Laboratory, UC Davis, VM PMI, Davis, CA, USA
| | - Marie Christine Cadiergues
- Small Animal and Equine Hospital, ENVT, Université de Toulouse, Toulouse, France. .,INFINITy, Université de Toulouse, CNRS, UPS, InsermToulouse, France.
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Assaf C, Dobos G, Zech IM, Doess A, Hibbe T, Jadasz JJ. Versorgungsstruktur der Patienten mit Mycosis fungoides und Sézary-Syndrom in Deutschland - Versorgungsforschung auf Basis von GKV-Routinedaten. J Dtsch Dermatol Ges 2022; 20:643-652. [PMID: 35578415 DOI: 10.1111/ddg.14725_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 12/20/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Chalid Assaf
- Helios Klinikum Krefeld.,Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin
| | - Gabor Dobos
- Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin.,Hopital Saint-Louis, AP-HP, Paris, Frankreich
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Assaf C, Dobos G, Zech IM, Doess A, Hibbe T, Jadasz JJ. Care structure of patients with mycosis fungoides and Sézary syndrome in Germany - Care research based on SHI claims data. J Dtsch Dermatol Ges 2022; 20:643-651. [PMID: 35499207 DOI: 10.1111/ddg.14725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 12/20/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Cutaneous T-cell lymphomas (CTCLs) are rare forms of non-Hodgkin's lymphoma of T-cell origin that occur mainly in the skin. The most common form is mycosis fungoides (MF), but Sézary syndrome (SS), a more aggressive form of CTCL, is another relevant subgroup. Due to the rare nature of the disease, population-based studies of the epidemiology and disease burden and insights into care delivery are limited. PATIENTS AND METHODS Based on an anonymized, age and sex-adjusted routine dataset comprising approximately five million people with statutory health insurance, a retrospective, longitudinal healthcare research study was conducted over a six-year period (2012-2017). RESULTS In 55 % of patients with MF and SS, the initial diagnosis was documented in an outpatient setting; in 59 % of cases by a dermatologist. Immunophenotyping by flow cytometry is considered an important investigative tool for the detection and follow-up surveillance of blood involvement of cutaneous lymphomas, as the disease stage is the most important prognostic factor in MF and SS; this was performed in only 10 % of patients. The first-line treatment was topical (76 %), in particular with corticosteroids (66 %). CONCLUSIONS The findings from this healthcare research point to the need for increased guideline-based care.
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Affiliation(s)
- Chalid Assaf
- Helios Klinikum Krefeld.,Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin [Department of dermatology, venereology and allergology, Charité University Hospital Berlin]
| | - Gabor Dobos
- Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin [Department of dermatology, venereology and allergology, Charité University Hospital Berlin].,Hopital Saint-Louis, AP-HP, Paris, France
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Cheng M, Zain J, Rosen ST, Querfeld C. Emerging drugs for the treatment of cutaneous T-cell lymphoma. Expert Opin Emerg Drugs 2022; 27:45-54. [PMID: 35235473 DOI: 10.1080/14728214.2022.2049233] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Cutaneous T cell lymphoma (CTCL) is a rare and incurable group of non-Hodgkin lymphomas that manifests as patches, plaques, tumors, and/or erythroderma in the skin. Standard skin-directed therapies for CTCL are effective in patients with indolent early-stage disease but more advanced/refractory stage patients require systemic therapies. However, none of the treatments are considered curative and most patients suffer from relapses. Biologic therapies and immunotherapy provide novel treatment options for patients with advanced or refractory disease. AREAS COVERED This review provides a discussion of recently approved biological and novel therapeutics that are actively developed for the management of the heterogenous group of CTCL. EXPERT OPINION Mogamulizumab and brentuximab vedotin have reached the market and are approved for the treatment of CTCL, providing valuable options. Additionally, therapies utilizing immune checkpoint inhibitors, miRNA inhibitors, and peptide inhibitors show promising results in clinical trials. Durvalumab, pembrolizumab, TTI-621, BNZ-1, and MRG-106 are several of the emerging treatments still in trials. Further combinatorial studies are needed as none of the treatments have demonstrated long term remissions.
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Affiliation(s)
- Melissa Cheng
- Division of Dermatology, City of Hope National Medical Center, Duarte, CA, USA.,Western University of Health Sciences College of Osteopathic Medicine of the Pacific, Pomona, CA, USA
| | - Jasmine Zain
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
| | - Steven T Rosen
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA.,Beckman Research Institute, Duarte, CA, USA
| | - Christiane Querfeld
- Division of Dermatology, City of Hope National Medical Center, Duarte, CA, USA.,Department of Pathology, City of Hope National Medical Center, Duarte, CA, USA.,Beckman Research Institute, Duarte, CA, USA
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9
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Di Raimondo C, Rubio-Gonzalez B, Palmer J, Weisenburger DD, Zain J, Wu X, Han Z, Rosen ST, Song JY, Querfeld C. Expression of Immune Checkpoint Molecules PD1, PD-L1 and ICOS in Mycosis Fungoides and Sézary Syndrome: Association with Disease Stage and Clinical Outcome. Br J Dermatol 2022; 187:234-243. [PMID: 35194801 PMCID: PMC9357001 DOI: 10.1111/bjd.21063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 01/11/2022] [Accepted: 02/18/2022] [Indexed: 12/01/2022]
Abstract
Background The relationship between immune checkpoint status and disease outcome is a major focus of research in cutaneous T‐cell lymphoma (CTCL), a disfiguring neoplastic dermatological disorder. Mycosis fungoides (MF) and Sézary syndrome (SS) are the two most common types of CTCL. Objectives The aim was to evaluate the immune checkpoint markers programmed death protein 1 (PD1), inducible T‐cell co‐stimulator (ICOS) and programmed death‐ligand 1 (PD‐L1) in skin biopsies from patients with CTCL relative to disease stage and overall survival. Methods This consecutive case series enrolled 47 patients: 57% had stage IA–IIA disease and 43% had stage IIB–IVA2 disease (including seven with SS). Results PD1, PD‐L1 and ICOS expression was seen in all biopsies. Notably, PD‐L1 was predominantly expressed on histiocytes/macrophages, but focal expression on CTCL cells was seen. High expression of either ICOS or PD‐L1 was associated with advanced‐stage disease (P = 0·007 for both) and with the appearance of large‐cell transformation (LCT), a histopathological feature associated with a poor prognosis (ICOS: P = 0·02; PD‐L1: P = 0·002). PD1 expression was not significantly associated with disease stage (P = 0·12) or LCT (P = 0·49), but expression was high in SS biopsies. A high combined checkpoint marker score (PD1, PD‐L1 and ICOS) was associated with advanced‐stage disease (P = 0·001), LCT (P = 0·021) and lower overall survival (P = 0·014). Conclusions These findings demonstrate the existence of a complex immunoregulatory microenvironment in CTCL and support the development of immunotherapies targeting ICOS and PD‐L1 in advanced disease.
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Affiliation(s)
| | | | - Joycelynne Palmer
- Department of Computational and Quantitative Medicine, Division of Biostatistics
| | | | - Jasmine Zain
- Department of Hematology/Hematopoietic Cell Transplantation
| | - Xiwei Wu
- Integrative and Genomics Core.,Beckman Research Institute, City of Hope, Duarte, CA, USA
| | - Zhen Han
- Division of Dermatology.,Beckman Research Institute, City of Hope, Duarte, CA, USA
| | - Steve T Rosen
- Department of Hematology/Hematopoietic Cell Transplantation.,Beckman Research Institute, City of Hope, Duarte, CA, USA
| | | | - Christiane Querfeld
- Division of Dermatology.,Department of Pathology.,Department of Hematology/Hematopoietic Cell Transplantation.,Beckman Research Institute, City of Hope, Duarte, CA, USA
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10
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Wen P, Xie Y, Wang L. The Role of microRNA in Pathogenesis, Diagnosis, Different Variants, Treatment and Prognosis of Mycosis Fungoides. Front Oncol 2021; 11:752817. [PMID: 34966672 PMCID: PMC8710607 DOI: 10.3389/fonc.2021.752817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 11/12/2021] [Indexed: 02/05/2023] Open
Abstract
Mycosis fungoides (MF) is the most common type of cutaneous T-cell lymphoma (CTCL), accounting for approximately 50% of all CTCLs. Although various molecular changes in MF have been described in existing studies, no obvious disease-specific changes have been found thus far. microRNAs (miRs) are short, noncoding RNA molecules that play roles in the post-transcriptional regulation of oncogenes and tumor suppressor genes in various diseases. Recently, there has been rapidly expanding experimental evidence for the role of miRs in the progression, early diagnosis, prognosis prediction for MF. Efforts to improve early diagnosis and develop personalized therapy options have become more important in recent years. Here, we provide an overview and update of recent advances regarding miRs associated with MF. Furthermore, we provide insights into future opportunities for miR-based therapies.
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Affiliation(s)
- Pengfei Wen
- Department of Dermatovenerology, West China Hospital, Sichuan University, Chengdu, China
| | - Yao Xie
- Department of Dermatovenerology, West China Hospital, Sichuan University, Chengdu, China
| | - Lin Wang
- Department of Dermatovenerology, West China Hospital, Sichuan University, Chengdu, China
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Alberti Violetti S, Alaibac M, Ardigò M, Baldo A, DI Meo N, Massone C, Onida F, Simontacchi G, Zalaudek I, Pimpinelli N, Quaglino P, Berti E. An expert consensus report on Mycosis fungoides in Italy: epidemiological impact and diagnostic-therapeutic pathway. Ital J Dermatol Venerol 2021; 156:413-421. [PMID: 34037370 DOI: 10.23736/s2784-8671.20.06668-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Mycosis fungoides (MF) is a rare neoplasm representing the most frequent form of primary cutaneous T-cell lymphoma (CTCL). Diagnosis of MF is generally complex, often requiring integration of clinical, histological, immunophenotypic and molecular data. Currently, there are no epidemiological data supported by registries or local studies on MF in Italy. Moreover, the clinical management of MF in Italy is heterogeneous, and differs according to the geographical area and experience of the physician who manages the disease. Considering the uncertainties in the current scenario for MF in Italy, a consensus project involving experts on CTCL was initiated to define the epidemiological impact of MF and obtain information about the current diagnostic and therapeutic pathway of this disease in Italy. The prevalence of MF in Italy was estimated to be 6,800 patients, 4,900 of whom with early stage of disease; the estimated incidence ranged between 270 and 330 new cases per year. Among the clinical figures involved in the multidisciplinary management of MF, dermatologists were recognised as a reference point for both diagnosis and therapeutic decisions. These findings suggest the importance of monitoring both the disease and its management; it is, therefore, interesting to set up regional registries for monitoring and recognition of rare tumor status for MF. The results further indicate the need to train physicians to favour more rapid diagnosis and simplify the pathway for referring patients to reference centres with adequate diagnostic and treatment standards. In light of the forthcoming introduction of new therapies, the development of a nationwide PDTA (Path of Diagnostic Therapeutic Care, in Italian defined as Percorso Diagnostico-Terapeutico Assistenziale) is also of substantial importance.
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Affiliation(s)
- Silvia Alberti Violetti
- UOC Dermatologia, Dipartimento di Medicina Interna Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy -
| | - Mauro Alaibac
- UOC Clinica Dermatologica, Dipartimento di Medicina Azienda Ospedaliera di Padova, Padova, Italy
| | - Marco Ardigò
- UOC di Dermatologia Clinica, Istituto San Gallicano-IRCCS, Rome, Italy
| | - Antonello Baldo
- Azienda Ospedaliera Universitaria Federico II, Naples, Italy
| | - Nicola DI Meo
- Clinica Dermatologica, Università degli Studi di Trieste ASUITS, Trieste, Italy
| | | | - Francesco Onida
- Centro Trapianti Midollo Osseo, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Gabriele Simontacchi
- U.O. Radioterapia, Dipartimento di Oncologia, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Iris Zalaudek
- Clinica Dermatologica, Università degli Studi di Trieste ASUITS, Trieste, Italy
| | - Nicola Pimpinelli
- Dipartimento di Scienze della Salute, Sezione Dermatologia, Università degli Studi di Firenze, Florence, Italy
| | - Pietro Quaglino
- Clinica Dermatologica, Dipartimento di Scienze Mediche, Università degli Studi di Torino, Turin, Italy
| | - Emilio Berti
- UOC Dermatologia, Dipartimento di Medicina Interna Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
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12
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Mehdi SJ, Moerman-Herzog A, Wong HK. Normal and cancer fibroblasts differentially regulate TWIST1, TOX and cytokine gene expression in cutaneous T-cell lymphoma. BMC Cancer 2021; 21:492. [PMID: 33941102 PMCID: PMC8091512 DOI: 10.1186/s12885-021-08142-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 04/02/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Mycosis fungoides (MF) is a primary cutaneous T-cell lymphoma (CTCL) that transforms from mature, skin-homing T cells and progresses during the early stages in the skin. The role of the skin microenvironment in MF development is unclear, but recent findings in a variety of cancers have highlighted the role of stromal fibroblasts in promoting or inhibiting tumorigenesis. Stromal fibroblasts are an important part of the cutaneous tumor microenvironment (TME) in MF. Here we describe studies into the interaction of TME-fibroblasts and malignant T cells to gain insight into their role in CTCL. METHODS Skin from normal (n = 3) and MF patients (n = 3) were analyzed for FAPα by immunohistochemistry. MyLa is a CTCL cell line that retains expression of biomarkers TWIST1 and TOX that are frequently detected in CTCL patients. MyLa cells were cultured in the presence or absence of normal or MF skin derived fibroblasts for 5 days, trypsinized to detached MyL a cells, and gene expression analyzed by RT-PCR for MF biomarkers (TWIST1 and TOX), Th1 markers (IFNG, TBX21), Th2 markers (GATA3, IL16), and proliferation marker (MKI67). Purified fibroblasts were assayed for VIM and ACTA2 gene expression. Cellular senescence assay was performed to assess senescence. RESULTS MF skin fibroblast showed increased expression of FAP-α with increasing stage compared to normal. Normal fibroblasts co-cultured with MyLa cells suppressed expression of TWIST1 (p < 0.0006), and TOX (p < 0.03), GATA3 (p < 0.02) and IL16 (p < 0.03), and increased expression of IFNG (p < 0.03) and TBX21 (p < 0.03) in MyLa cells. In contrast, MyLa cells cultured with MF fibroblasts retained high expression of TWIST1, TOX and GATA3. MF fibroblasts co-culture with MyLa cells increased expression of IL16 (p < 0.01) and IL4 (p < 0.02), and suppressed IFNG and TBX21 in MyLa cells. Furthermore, expression of MKI67 in MyLa cells was suppressed by normal fibroblasts compared to MF fibroblasts. CONCLUSION Skin fibroblasts represent important components of the TME in MF. In co-culture model, normal and MF fibroblasts have differential influence on T-cell phenotype in modulating expression of Th1 cytokine and CTCL biomarker genes to reveal distinct roles with implications in MF progression.
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Affiliation(s)
- Syed Jafar Mehdi
- Department of Dermatology, University of Arkansas for Medical Sciences, 4301 West Markham St, #576, Little Rock, AR, 72205, USA
| | - Andrea Moerman-Herzog
- Department of Dermatology, University of Arkansas for Medical Sciences, 4301 West Markham St, #576, Little Rock, AR, 72205, USA
| | - Henry K Wong
- Department of Dermatology, University of Arkansas for Medical Sciences, 4301 West Markham St, #576, Little Rock, AR, 72205, USA.
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Tomasini C, Michelerio A, Quaglino P. Spiky/keratosis-pilaris-like early follicular mycosis fungoides: A clinicopathologic study of 20 cases with extended follow-up. J Cutan Pathol 2021; 48:1124-1132. [PMID: 33675561 DOI: 10.1111/cup.14002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/21/2020] [Accepted: 03/01/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUNDS Follicular mycosis fungoides (FMFs) is a distinct form of T-cell lymphoma whose course is considered aggressive. METHODS A retrospective study with long-term follow-up of 20 patients diagnosed with spiky/keratosis-pilaris-like FMF between 2008 and 2017 was conducted. RESULTS Twelve males and eight females were identified, with a mean age at first diagnosis of 59 years (range 42-86). Hyperkeratotic follicular papules were the sole clinical finding in 16 of 20 patients. A diagnostic delay between first symptom development and initial diagnosis was frequent (mean 42 months). The head/neck region was concurrently affected only in two patients. Disease stage at diagnosis was IA in two patients (10%) and IB in 18 (90%). Five patients had almost complete lesion regression, whilst there was only a slight improvement, without regression in 14. Two patients developed infiltrated papules, comedones, and small cysts during follow-up. Only one patient progressed to tumor stage (IIB) five years after the first diagnosis. The mean follow-up was seven years (range: 12-180 months). None of them died of cutaneous lymphoma. CONCLUSIONS FMF presenting with only spiky/keratosis-pilaris-like lesions have an excellent prognosis at medium-term follow-up. Early recognition of patients with this peculiar FMF presentation might lead to identifying prognostic factors.
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Affiliation(s)
- Carlo Tomasini
- Dermatology Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Andrea Michelerio
- Dermatology Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Pietro Quaglino
- Department of Medical Sciences, Dermatologic Clinic, University of Turin, Turin, Italy
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14
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Aronovich A, Moyal L, Gorovitz B, Amitay-Laish I, Naveh HP, Forer Y, Maron L, Knaneh J, Ad-El D, Yaacobi D, Barel E, Erez N, Hodak E. Cancer-Associated Fibroblasts in Mycosis Fungoides Promote Tumor Cell Migration and Drug Resistance through CXCL12/CXCR4. J Invest Dermatol 2021; 141:619-627.e2. [DOI: 10.1016/j.jid.2020.06.034] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 06/16/2020] [Accepted: 06/17/2020] [Indexed: 12/12/2022]
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15
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Papathemeli D, Patsatsi A, Papanastassiou D, Koletsa T, Papathemelis T, Avgeros C, Pikou O, Lazaridou E, Georgiou E. Protein and mRNA Expression Levels of Interleukin-17A, -17F and -22 in Blood and Skin Samples of Patients with Mycosis Fungoides. Acta Derm Venereol 2020; 100:adv00326. [PMID: 33170303 PMCID: PMC9309846 DOI: 10.2340/00015555-3688] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2020] [Indexed: 11/16/2022] Open
Abstract
This study investigated the expression of interleukin (IL)-17A, -17F and -22 in mycosis fungoides. Blood samples were collected from 50 patients with mycosis fungoides and 50 healthy controls. Skin samples were obtained from 26 patients with mycosis fungoides and 5 healthy controls. Protein levels of IL-17A, -17F and -22 were measured in serum by multiplex enzyme-linked immunosorbent assay, and mRNA expression levels were measured in blood and skin samples by real-time quantitative reverse transcription PCR. Both IL-17A and IL-17F mRNA expression levels were significantly lower in blood of patients with mycosis fungoides in comparison with healthy controls. IL-22 serum levels and expression levels of IL-22 mRNA in skin tissue, were significantly increased in patients with mycosis fungoides in comparison with healthy controls. These results suggest that low levels of IL-17A and IL-17F in mycosis fungoides may be connected to impaired immune surveillance contributing to tumourigenesis. Upregulation of IL-22 may play a role in the establishment of the tumour microenvironment in mycosis fungoides.
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Affiliation(s)
- Despoina Papathemeli
- 2nd Department of Dermatology and Venereology, Cutaneous Lymphoma Outpatient Clinic, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Lee H, Mauceri TC, Bhagwat MS, Patel CG. Water Bath Radiation for Extensive, Extremity-Based Cutaneous Disease of Mycosis Fungoides. Adv Radiat Oncol 2020; 5:1370-1374. [PMID: 33305101 PMCID: PMC7718509 DOI: 10.1016/j.adro.2020.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 06/14/2020] [Accepted: 07/10/2020] [Indexed: 11/19/2022] Open
Affiliation(s)
- Hyeri Lee
- Corresponding author: Hyeri Lee, PhD
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17
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Beiser I, Yim J, Robles-Sherman E, Mirkin GS, Hao X. Mycosis Fungoides Palmaris et Plantaris on the Plantar Aspect of the Foot: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e923361. [PMID: 32943601 PMCID: PMC7521462 DOI: 10.12659/ajcr.923361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Patient: Male, 54-year-old Final Diagnosis: Mycosis fungoides Symptoms: Pain • patch Medication: — Clinical Procedure: Topical psoralen plus ultraviolet A (PUVA) photochemotherapy Specialty: Dermatology • Oncology • Pathology • Podiatry
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Affiliation(s)
- Ian Beiser
- Department of Podiatry, Foot and Ankle Specialists of The Mid-Atlantic, LLC, Rockville, MD, USA
| | - Joon Yim
- Department of Pathology, Foot and Ankle Specialists of The Mid-Atlantic, LLC, Rockville, MD, USA
| | - Erin Robles-Sherman
- Department of Podiatry, Foot and Ankle Specialists of The Mid-Atlantic, LLC, Rockville, MD, USA
| | - Gene S Mirkin
- Department of Podiatry, Foot and Ankle Specialists of The Mid-Atlantic, LLC, Rockville, MD, USA
| | - Xingpei Hao
- Department of Pathology, Foot and Ankle Specialists of The Mid-Atlantic, LLC, Rockville, MD, USA
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18
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Gene Expression Comparison between Sézary Syndrome and Lymphocytic-Variant Hypereosinophilic Syndrome Refines Biomarkers for Sézary Syndrome. Cells 2020; 9:cells9091992. [PMID: 32872487 PMCID: PMC7563155 DOI: 10.3390/cells9091992] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 08/26/2020] [Accepted: 08/27/2020] [Indexed: 02/07/2023] Open
Abstract
Sézary syndrome (SS), an aggressive cutaneous T-cell lymphoma (CTCL) with poor prognosis, is characterized by the clinical hallmarks of circulating malignant T cells, erythroderma and lymphadenopathy. However, highly variable clinical skin manifestations and similarities with benign mimickers can lead to significant diagnostic delay and inappropriate therapy that can lead to disease progression and mortality. SS has been the focus of numerous transcriptomic-profiling studies to identify sensitive and specific diagnostic and prognostic biomarkers. Benign inflammatory disease controls (e.g., psoriasis, atopic dermatitis) have served to identify chronic inflammatory phenotypes in gene expression profiles, but provide limited insight into the lymphoproliferative and oncogenic roles of abnormal gene expression in SS. This perspective was recently clarified by a transcriptome meta-analysis comparing SS and lymphocytic-variant hypereosinophilic syndrome, a benign yet often clonal T-cell lymphoproliferation, with clinical features similar to SS. Here we review the rationale for selecting lymphocytic-variant hypereosinophilic syndrome (L-HES) as a disease control for SS, and discuss differentially expressed genes that may distinguish benign from malignant lymphoproliferative phenotypes, including additional context from prior gene expression studies to improve understanding of genes important in SS.
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19
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Single-Cell Heterogeneity of Cutaneous T-Cell Lymphomas Revealed Using RNA-Seq Technologies. Cancers (Basel) 2020; 12:cancers12082129. [PMID: 32751918 PMCID: PMC7464763 DOI: 10.3390/cancers12082129] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/16/2020] [Accepted: 07/29/2020] [Indexed: 01/04/2023] Open
Abstract
Cutaneous T-cell lymphomas (CTCLs) represent a large, heterogeneous group of non-Hodgkin lymphomas that primarily affect the skin. Among multiple CTCL variants, the most prevalent types are mycosis fungoides (MF) and Sézary syndrome (SS). In the past decade, the molecular genetics of CTCL have been the target of intense study, increasing the knowledge of CTCL genomic alterations, discovering novel biomarkers, and potential targets for patient-specific therapy. However, the detailed pathogenesis of CTCL development still needs to be discovered. This review aims to summarize the novel insights into molecular heterogeneity of malignant cells using high-throughput technologies, such as RNA sequencing and single-cell RNA sequencing, which might be useful to identify tumour-specific molecular signatures and, therefore, offer guidance for therapy, diagnosis, and prognosis of CTCL.
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20
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Hypopigmented Mycosis Fungoides: Loss of Pigmentation Reflects Antitumor Immune Response in Young Patients. Cancers (Basel) 2020; 12:cancers12082007. [PMID: 32707930 PMCID: PMC7465783 DOI: 10.3390/cancers12082007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 07/14/2020] [Accepted: 07/16/2020] [Indexed: 12/15/2022] Open
Abstract
Hypopigmented mycosis fungoides (HMF) is a form of cutaneous T-cell lymphoma (CTCL), a heterogeneous group of extranodal non-Hodgkin's lymphomas. HMF has a unique set of defining features that include light colored to achromic lesions, a predilection for darker skin phototypes, an early onset of disease, and predominance of CD8+ T-cells, among others. In the current review, we detail the known pathways of molecular pathogenesis for this lymphoma and posit that an active Th1/cytotoxic antitumor immune response in part explains why this variant is primarily seen in children/adolescents and young adults, who do not exhibit signs of immunosenescence. As a result of this potent cytotoxic response, HMF patients experience mostly favorable overall prognosis, while hypopigmentation may in fact represent a useful surrogate marker of cytotoxic immunity targeting the malignant cells. Understanding the molecular processes behind the specific features that define HMF may lead to improved diagnostic accuracy, personalized prognosis by risk stratification, and improved management of HMF. Moreover, improving our knowledge of HMF may aid our further understanding of other cutaneous lymphomas.
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21
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Dotimas J, Das M, Martin D. Cutaneous T-cell lymphoma in the setting of anti-tumor necrosis factor and immunomodulator therapy: A case report and literature review. SAGE Open Med Case Rep 2020; 8:2050313X20937223. [PMID: 32655868 PMCID: PMC7328350 DOI: 10.1177/2050313x20937223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 05/31/2020] [Indexed: 01/23/2023] Open
Abstract
Immunosuppressive therapy is well recognized as increasing the risk of lymphoma. Mycosis fungoides is a rare cutaneous form of T-cell lymphoma with a largely unknown etiology and not typically associated with immunosuppression. In this article, we describe our encounter with a 24-year-old male with Crohn’s disease in remission on immunotherapy, specifically dual therapy with azathioprine and infliximab, presenting with a facial rash found to be consistent with mycosis fungoides on biopsy. The patient’s rash resolved with treatment of topical steroids. In addition, the decision was made to discontinue his azathioprine to minimize his risks of developing future malignancies.
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Affiliation(s)
- James Dotimas
- The University of Illinois College of Medicine at Peoria, Peoria, IL, USA
| | - Manjusha Das
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, The University of Illinois College of Medicine at Peoria, Peoria, IL, USA
| | - Daniel Martin
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, The University of Illinois College of Medicine at Peoria, Peoria, IL, USA
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The polymorphisms of IL-6/STAT3 signaling pathway may contribute to cutaneous T-cell lymphomas susceptibility. Arch Dermatol Res 2020; 313:25-31. [PMID: 32270320 PMCID: PMC7806529 DOI: 10.1007/s00403-020-02062-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 01/26/2020] [Accepted: 03/28/2020] [Indexed: 12/15/2022]
Abstract
IL-6/STAT3 signaling pathway has been suggested to play a role in CTCL pathogenesis. Polymorphisms in STAT3 signaling pathway-related genes might be a risk factor for CTCL. However, the exact role of inherited gene polymorphisms of IL-6 and STAT3 in the pathogenesis of CTCL is still not fully understood. The aim was to examine whether IL-6 cytokine and polymorphisms of IL-6 and STAT3 gene are associated with CTCL susceptibility, stage of disease and pruritus intensity. We compared the IL-6 serum level and the frequency of selected single nucleotide polymorphisms of IL-6 and STAT3 in 106 CTCL and 198 control group using polymerase chain reaction with sequence-specific primers method and ELISA. We have found that serum IL-6 level in CTCL patients was significantly higher than in healthy controls (p < 0.05). We also demonstrated that two genotypes, CC of IL-6 and GG of STAT3, were overexpressed in CTCL patients compared to healthy controls, and that they increase the risk of malignancy development (OR = 1.8, p = 0.04 for IL-6 and OR 2.53, p = 0.0064 for STAT3). Moreover, the GG genotype of STAT3 polymorphism seems to be associated with lack of pruritus or mild pruritus in CTCL patients. Our results indicate that IL-6 is involved in pathogenesis of CTCL but not pruritus. Moreover, CC of IL-6 and GG genotype of STAT3 genes might be considered as the risk factor for development of CTCL.
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23
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Expression Profiles of Genes Encoding Cornified Envelope Proteins in Atopic Dermatitis and Cutaneous T-Cell Lymphomas. Nutrients 2020; 12:nu12030862. [PMID: 32213830 PMCID: PMC7146369 DOI: 10.3390/nu12030862] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 03/20/2020] [Accepted: 03/22/2020] [Indexed: 11/17/2022] Open
Abstract
The skin barrier defect in cutaneous T-cell lymphomas (CTCL) was recently confirmed to be similar to the one observed in atopic dermatitis (AD). We have examined the expression level of cornified envelope (CE) proteins in CTCL, AD and healthy skin, to search for the differences and their relation to the courses of both diseases. The levels of FLG, FLG2, RPTN, HRNR, SPRR1A, SPRR1B, SPRR3 and LELP-1 mRNA were determined by qRT-PCR, while protein levels were examined using the ELISA method in skin samples. We have found that mRNA levels of FLG, FLG2, LOR, CRNN and SPRR3v1 were decreased (p ≤ 0.04), whereas mRNA levels of RPTN, HRNR and SPRR1Av1 were increased in lesional and nonlesional AD skin compared to the healthy control group (p ≤ 0.04). The levels of FLG, FLG2, CRNN, SPRR3v1 mRNA increased (p ≤ 0.02) and RPTN, HRNR and SPRR1Av1 mRNA decreased (p ≤ 0.005) in CTCL skin compared to the lesional AD skin. There was a strong correlation between the stage of CTCL and increased SPRR1Av1 gene expression at both mRNA (R = 0.89; p ≤ 0.05) and protein levels (R = 0.94; p ≤ 0.05). FLG, FLG2, RPTN, HRNR and SPRR1A seem to play a key role in skin barrier dysfunction in CTCL and could be considered a biomarker for differential diagnosis of AD and CTCL. SPRR1Av1 transcript levels seem to be a possible marker of CTCL stage, however, further studies on a larger study group are needed to confirm our findings.
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Sayed KS, Mohammed FN, Abdel Hay RM, Amr KS, AlOrbani AM. Cyclooxygenase-2 Gene Polymorphisms -765G>C and -1195A>G and Mycosis Fungoides Risk. Dermatology 2019; 237:17-21. [PMID: 31846957 DOI: 10.1159/000504840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 11/18/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Cyclooxygenase-2 (COX-2) is an inducible modulator of inflammation that acts through increasing prostaglandin levels and has been described as a major mediator linking inflammation to cancer. Previous studies supported that COX-2-765G>C and -1195A>G polymorphisms were associated with increased risk of several solid tissue cancers as well as some hematological malignancies. OBJECTIVE The aim of the study was to elucidate the association between functional COX-2 genotypes (-765G>C and -1195A>G) polymorphisms and the risk of developing mycosis fungoides (MF). METHODS This was a hospital-based, case-control study of 70 MF patients and 100 MF-free controls. We genotyped COX-2 -1195A>G, -765G>C, and -8473T>C polymorphisms by using the PCR-restriction fragment length polymorphism method. RESULTS The AA genotype in the COX-2 -1195A>G gene polymorphism and the GC genotype in the COX-2 -765G>C gene were significantly more frequent among MF patients compared to controls (p< 0.001 and p = 0.002, respectively). CONCLUSION The -results indicate a possible role of COX-2 genes in the pathogenesis of MF. These novel findings may allow for notable future advances, as it will enable the identification of the -individuals most susceptible to MF.
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Affiliation(s)
- Khadiga Sayed Sayed
- Department of Dermatology, Faculty of Medicine, Cairo University, Giza, Egypt
| | | | | | - Khalda Sayed Amr
- Medical Molecular Genetics Department, National Research Centre, Giza, Egypt
| | - Aya M AlOrbani
- Department of Dermatology, Faculty of Medicine, Cairo University, Giza, Egypt,
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Menter T, Tzankov A. Lymphomas and Their Microenvironment: A Multifaceted Relationship. Pathobiology 2019; 86:225-236. [PMID: 31574515 DOI: 10.1159/000502912] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 08/24/2019] [Indexed: 11/19/2022] Open
Abstract
It has become evident that the microenvironment - lymphocytes, macrophages, fibroblasts as well as the extracellular matrix, cytokines, chemokines, and a plethora of other cells, structures and substances residing in the vicinity of tumor cells - plays an important part in the maintenance of cancer growth and survival. This is also relevant in lymphomas. In this review, we give an outline on the importance of the microenvironment for tumors in general and lymphomas in particular, by highlighting certain basic principles of tumor-microenvironment interaction. The relationship of lymphomas and their microenvironment is multifaceted: lymphoma cells need growth factors and cytokines derived from microenvironmental cells for their sustenance and growth. On the contrary, many lymphomas silence or at least deregulate the immune system to escape recognition and subsequent elimination by immune cells, while giving advantage to suppressive microenvironmental compounds such as M2 polarized macrophages, regulatory T-cells, mast cells, and immunosuppressive fibroblasts. We also give a detailed insight across different lymphoma types to show the variety of tumor-microenvironment interactions. Due to its tremendous importance, the microenvironment has also become a new target for oncologic therapy. The most important finding concerning lymphomas with a focus on immunomodulatory substances is also, therefore, highlighted.
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Affiliation(s)
- Thomas Menter
- Institute of Medical Genetics and Pathology, University of Basel Hospital, Basel, Switzerland
| | - Alexandar Tzankov
- Institute of Medical Genetics and Pathology, University of Basel Hospital, Basel, Switzerland,
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Martinez XU, Di Raimondo C, Abdulla FR, Zain J, Rosen ST, Querfeld C. Leukaemic variants of cutaneous T-cell lymphoma: Erythrodermic mycosis fungoides and Sézary syndrome. Best Pract Res Clin Haematol 2019; 32:239-252. [PMID: 31585624 PMCID: PMC9056079 DOI: 10.1016/j.beha.2019.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 06/05/2019] [Indexed: 01/22/2023]
Abstract
Mycosis fungoides (MF) and Sézary syndrome (SS) are the most common types of cutaneous lymphoma, accounting for approximately 60% of cutaneous T-cell lymphomas. Diagnosis requires correlation of clinical, histologic, and molecular features. A multitude of factors have been linked to the aetiopathogenesis, however, none have been definitively proven. Erythrodermic MF (E-MF) and SS share overlapping clinical features, such as erythroderma, but are differentiated on the degree of malignant blood involvement. While related, they are considered to be two distinct entities originating from different memory T cell subsets. Differential expression of PD-1 and KIR3DL2 may represent a tool for distinguishing MF and SS, as well as a means of monitoring treatment response. Treatment of E-MF/SS is guided by disease burden, patients' ages and comorbidities, and effect on quality of life. Current treatment options include biologic, targeted, immunologic, and investigational therapies that can provide long term response with minimal side effects. Currently, allogeneic stem cell transplantation is the only potential curative treatment.
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Affiliation(s)
| | - Cosimo Di Raimondo
- City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA 91010, USA; Policlinico Tor Vergata, Viale Oxford 81, 00133, Rome, Italy.
| | - Farah R Abdulla
- City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA 91010, USA.
| | - Jasmine Zain
- City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA 91010, USA.
| | - Steven T Rosen
- City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA 91010, USA; Beckman Research Institute, 1500 E. Duarte Road, Duarte, CA, 91010, United States.
| | - Christiane Querfeld
- City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA 91010, USA; Beckman Research Institute, 1500 E. Duarte Road, Duarte, CA, 91010, United States.
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27
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Moerman-Herzog AM, Acheampong DA, Brooks AG, Blair SM, Hsu PC, Wong HK. Transcriptome analysis of Sézary syndrome and lymphocytic-variant hypereosinophilic syndrome T cells reveals common and divergent genes. Oncotarget 2019; 10:5052-5069. [PMID: 31489115 PMCID: PMC6707948 DOI: 10.18632/oncotarget.27120] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 07/15/2019] [Indexed: 11/25/2022] Open
Abstract
Sézary syndrome (SS) is an aggressive cutaneous T cell lymphoma with pruritic skin inflammation and immune dysfunction, driven by neoplastic, clonal memory T cells in both peripheral blood and skin. To gain insight into abnormal gene expression promoting T cell dysfunction, lymphoproliferation and transformation in SS, we first compared functional transcriptomic profiles of both resting and activated CD4+CD45RO+ T cells from SS patients and normal donors to identified differential expressed genes. Next, a meta-analysis was performed to compare our SS data to public microarray data from a novel benign disease control, lymphocytic-variant hypereosinophilic syndrome (L-HES). L-HES is a rare, clonal lymphoproliferation of abnormal memory T cells that produces similar clinical symptoms as SS, including severe pruritus and eosinophilia. Comparison revealed gene sets specific for either SS (370 genes) or L-HES (519 genes), and a subset of 163 genes that were dysregulated in both SS and L-HES T cells compared to normal donor T cells. Genes confirmed by RT-qPCR included elevated expression of PLS3, TWIST1 and TOX only in SS, while IL17RB mRNA was increased only in L-HES. CDCA7 was increased in both diseases. In an L-HES patient who progressed to peripheral T cell lymphoma, the malignant transformation identified increases in the expression of CDCA7, TIGIT, and TOX, which are highly expressed in SS, suggesting that these genes contribute to neoplastic transformation. In summary, we have identified gene expression biomarkers that implicate a common transformative mechanism and others that are unique to differentiate SS from L-HES.
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Affiliation(s)
- Andrea M Moerman-Herzog
- Department of Dermatology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Daniel A Acheampong
- Department of Dermatology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.,Joint Graduate Program in Bioinformatics, University of Arkansas at Little Rock and University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Amanda G Brooks
- Department of Dermatology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Suzan M Blair
- Department of Dermatology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Ping-Ching Hsu
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Henry K Wong
- Department of Dermatology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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28
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Highly cytotoxic natural killer cells are associated with poor prognosis in patients with cutaneous T-cell lymphoma. Blood Adv 2019; 2:1818-1827. [PMID: 30054309 DOI: 10.1182/bloodadvances.2018020388] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 06/19/2018] [Indexed: 12/23/2022] Open
Abstract
Key Points
Paradoxically higher NK-cell activity in CTCL patients is associated with increased expression of phosphorylated STAT5. These highly effective NK cells are associated with poor prognosis in patients with leukemic CTCL.
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29
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Gug G, Huang Q, Chiticariu E, Solovan C, Baudis M. DNA copy number imbalances in primary cutaneous lymphomas. J Eur Acad Dermatol Venereol 2019; 33:1062-1075. [PMID: 30659659 DOI: 10.1111/jdv.15442] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 12/14/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Cutaneous lymphomas (CL) represent a clinically defined group of extranodal non-Hodgkin lymphomas harbouring heterogeneous and incompletely delineated molecular aberrations. Over the past decades, molecular studies have identified several chromosomal aberrations, but the interpretation of individual genomic studies can be challenging. OBJECTIVE With a comprehensive meta-analysis, we aim to delineate genomic alterations for different types of CL and propose a more accurate classification in line with their various pathogenicity. METHODS We searched PubMed and ISI Web of Knowledge for publications from 1996 to 2016 reporting the investigation of CL for genome-wide copy number alterations, by means of comparative genomic hybridization techniques and whole-genome sequencing and whole-exome sequencing. We then extracted and remapped the available copy number variation (CNV) data from these publications with the same pipeline and performed clustering and visualisation to aggregate samples of similar CNV profiles. RESULTS For 449 samples from 22 publications, CNV data were accessible for sample based meta-analysis. Our findings illustrate structural and numerical chromosomal imbalance patterns. Most frequent CNAs were linked to oncogenes or tumour suppressor genes with important roles in the course of the disease. CONCLUSION Summary profiles for genomic imbalances, generated from case-specific data, identified complex genomic imbalances, which could discriminate between different subtypes of CL and promise a more accurate classification. The collected data presented in this study are publicly available through the 'Progenetix' online repository.
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Affiliation(s)
- G Gug
- University of Medicine and Pharmacy "Victor Babeș", Timișoara, România
| | - Q Huang
- Institute of Molecular Life Sciences, University of Zurich, Zurich, Switzerland.,Swiss Institute of Bioinformatics, Zurich, Switzerland
| | - E Chiticariu
- University of Medicine and Pharmacy "Victor Babeș", Timișoara, România
| | - C Solovan
- University of Medicine and Pharmacy "Victor Babeș", Timișoara, România.,Emergency City Hospital, University Clinic of Dermatology and Venereology, Timișoara, România
| | - M Baudis
- Institute of Molecular Life Sciences, University of Zurich, Zurich, Switzerland.,Swiss Institute of Bioinformatics, Zurich, Switzerland
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30
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Kohnken R, McNeil B, Wen J, McConnell K, Grinshpun L, Keiter A, Chen L, William B, Porcu P, Mishra A. Preclinical Targeting of MicroRNA-214 in Cutaneous T-Cell Lymphoma. J Invest Dermatol 2019; 139:1966-1974.e3. [PMID: 30876800 DOI: 10.1016/j.jid.2019.01.033] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 01/11/2019] [Accepted: 01/22/2019] [Indexed: 12/19/2022]
Abstract
Cutaneous T-cell lymphomas (CTCLs) are a family of primary extranodal lymphomas of mature CD4+, skin-homing or skin-resident T cells. In a significant fraction of patients with CTCL, the neoplastic CD4+ lymphocytes acquire extracutaneous tropism, and with disease progression, they disseminate to the lymph nodes, peripheral blood, and visceral organs. MicroRNA (miR)-based therapies are a newly emerging strategy for many types of diseases, including cancers. CTCL represents one of the disease indications for a clinical trial of miR inhibitor therapy, supporting further investigation of epigenetic dysregulation and miR-driven oncogenesis in this disease. In this study, we interrogated an aberrant miR-based regulatory network that operates in malignant CD4+ T cells and identified potential targets of therapy. We show that miR-214 levels are significantly higher in purified CD4+ neoplastic T cells from patients with CTCL than from healthy donors. We then show that antagomiR-214 treatment of IL-15 transgenic mice with spontaneous, miR-214-overexpressing CTCL leads to significant decrease in disease severity using multiple validated clinical and histological endpoints, compared with scrambled control-treated IL-15 transgenic CTCL mice. Mechanistically, we show that aberrantly expressed TWIST1 and BET protein BRD4 cooperate to drive miR-214 expression in CTCL cell lines and in samples from patients with CTCL and that treatment with BRD4 inhibitor JQ1 leads to down-regulation of miR-214. Based on both in vitro and in vivo data, we propose that the TWIST1/BRD4/miR-214 regulatory loop is an important, targetable, oncogenic pathway in CTCL.
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Affiliation(s)
- Rebecca Kohnken
- Department of Veterinary Biosciences, Ohio State University, Columbus, Ohio, USA
| | - Betina McNeil
- Comprehensive Cancer Center, Ohio State University, Columbus, Ohio, USA
| | - Jing Wen
- Comprehensive Cancer Center, Ohio State University, Columbus, Ohio, USA
| | | | - Leah Grinshpun
- Comprehensive Cancer Center, Ohio State University, Columbus, Ohio, USA
| | - Ashleigh Keiter
- Comprehensive Cancer Center, Ohio State University, Columbus, Ohio, USA
| | - Luxi Chen
- Comprehensive Cancer Center, Ohio State University, Columbus, Ohio, USA
| | - Basem William
- Comprehensive Cancer Center, Ohio State University, Columbus, Ohio, USA
| | - Pierluigi Porcu
- Division of Hematologic Malignancies and Hematopoietic Stem Cell Transplantation, Department of Medical Oncology, Sidney Kimmel Cancer Center, Philadelphia, Pennsylvania, USA
| | - Anjali Mishra
- Comprehensive Cancer Center, Ohio State University, Columbus, Ohio, USA; Division of Hematologic Malignancies and Hematopoietic Stem Cell Transplantation, Department of Medical Oncology, Sidney Kimmel Cancer Center, Philadelphia, Pennsylvania, USA; Division of Dermatology, Department of Internal Medicine, Ohio State University, Columbus, Ohio, USA.
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31
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αEβ7 Expression Increases With the Extent of Cutaneous Involvement in Mycosis Fungoides. Am J Dermatopathol 2019; 41:630-636. [PMID: 30839339 DOI: 10.1097/dad.0000000000001397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cell adhesion molecules are essential to lymphocyte migration in neoplastic and inflammatory skin diseases. Our aim was to investigate possible differences in cell adhesion molecule expression between mycosis fungoides (MF) and inflammatory skin diseases (drug reactions and allergic contact dermatitis). METHODS We selected 33 biopsies from patients with MF and 10 biopsies of patients with inflammatory skin diseases from Department of Pathology-Universidade Federal de São Paulo (UNIFESP) from January 1997 to December 2013. Expression of α4β1 integrin and αEβ7 integrin was assessed by immunohistochemistry in intraepidermal lymphocytes by counting 4 microscopic epidermal fields (×400) and comparing those between the 2 groups. RESULTS We observed increased expression of integrin αEβ7 in intraepidermal lymphocytes in advanced stages of MF (T3 and T4). αEβ7 expression was detected in intraepidermal dendritic cells of MF and inflammatory diseases samples. The expression of E-cadherin in epidermal cells in MF outlined Pautrier microabscesses, whereas in inflammatory diseases, spongiosis reduced its expression in keratinocytes. CONCLUSIONS The findings presented here support the idea that the lymphocyte migratory mechanism observed in neoplasms is similar to that of inflammatory processes of the skin.
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32
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Wong HK. Developing BET-ter treatments for cutaneous T-cell lymphoma. Oncotarget 2019; 10:1267-1268. [PMID: 30863486 PMCID: PMC6407685 DOI: 10.18632/oncotarget.26662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 01/30/2019] [Indexed: 11/25/2022] Open
Affiliation(s)
- Henry K Wong
- Henry K. Wong: Department of Dermatology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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33
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Tsang M, Gantchev J, Netchiporouk E, Moreau L, Ghazawi FM, Glassman S, Sasseville D, Litvinov IV. A study of meiomitosis and novel pathways of genomic instability in cutaneous T-cell lymphomas (CTCL). Oncotarget 2018; 9:37647-37661. [PMID: 30701021 PMCID: PMC6340880 DOI: 10.18632/oncotarget.26479] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 12/04/2018] [Indexed: 12/31/2022] Open
Abstract
Genomic instability is a hallmark of cancer and an enabling factor for genetic alterations that drive cancer development and progression. The clashing of mitosis and aberrantly expressed meiosis machineries, which may contribute to genomic instability, has been coined cancer “meiomitosis”. LINE-1 retrotransposition, a process active in germ cells, acts outside of the meiotic machinery to create DNA double strand breaks (DNA DSBs) and has played an important role in the evolution of the human genome. We have previously demonstrated that in CTCL several cancer testis/meiotic genes are expressed. Furthermore, this cancer exhibits extensive and ongoing chromosomal/microsatellite instability. In this study we analyzed immortalized patient-derived cells and primary CTCL patient samples using RT-PCR, western blotting and confocal microscopy and found that proteins critically involved in meiosis and LINE-1 retrotransposition are expressed and are associated with chromosomal instability and DNA DSB formation. Using cell cycle synchronization, we show G1/S phase-transition-specific expression of meiosis proteins. Using the Alu retrotransposition assay, we demonstrate the functional activity of LINE-1 retrotransposon in CTCL. Histone acetyltransferase inhibition results in downregulation of the ectopic germ cell programs and concomitant decrease in DNA DSBs foci formation. Notably, LINE-1 and meiosis genes were expressed across a panel of other solid tumor cell lines. Taken together, our results indicate that malignant cells in culture undergo “cancer meiomitosis” rather than the classic mitosis division. The ectopic expression of meiosis genes and reactivation of LINE-1 may be contributing to genomic instability and represent novel targets for immunotherapy in this and other cancers.
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Affiliation(s)
- Matthew Tsang
- Division of Dermatology, University of Ottawa, Ottawa, Ontario K1H 8L6, Canada
| | - Jennifer Gantchev
- Division of Dermatology, McGill University, Montréal, Québec H4A 3J1, Canada
| | - Elena Netchiporouk
- Division of Dermatology, McGill University, Montréal, Québec H4A 3J1, Canada
| | - Linda Moreau
- Division of Dermatology, McGill University, Montréal, Québec H4A 3J1, Canada
| | - Feras M Ghazawi
- Division of Dermatology, University of Ottawa, Ottawa, Ontario K1H 8L6, Canada
| | - Steven Glassman
- Division of Dermatology, University of Ottawa, Ottawa, Ontario K1H 8L6, Canada
| | - Denis Sasseville
- Division of Dermatology, McGill University, Montréal, Québec H4A 3J1, Canada
| | - Ivan V Litvinov
- Division of Dermatology, University of Ottawa, Ottawa, Ontario K1H 8L6, Canada.,Division of Dermatology, McGill University, Montréal, Québec H4A 3J1, Canada
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34
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Fanok MH, Sun A, Fogli LK, Narendran V, Eckstein M, Kannan K, Dolgalev I, Lazaris C, Heguy A, Laird ME, Sundrud MS, Liu C, Kutok J, Lacruz RS, Latkowski JA, Aifantis I, Ødum N, Hymes KB, Goel S, Koralov SB. Role of Dysregulated Cytokine Signaling and Bacterial Triggers in the Pathogenesis of Cutaneous T-Cell Lymphoma. J Invest Dermatol 2018; 138:1116-1125. [PMID: 29128259 PMCID: PMC5912980 DOI: 10.1016/j.jid.2017.10.028] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 10/02/2017] [Accepted: 10/23/2017] [Indexed: 12/26/2022]
Abstract
Cutaneous T-cell lymphoma is a heterogeneous group of lymphomas characterized by the accumulation of malignant T cells in the skin. The molecular and cellular etiology of this malignancy remains enigmatic, and what role antigenic stimulation plays in the initiation and/or progression of the disease remains to be elucidated. Deep sequencing of the tumor genome showed a highly heterogeneous landscape of genetic perturbations, and transcriptome analysis of transformed T cells further highlighted the heterogeneity of this disease. Nonetheless, using data harvested from high-throughput transcriptional profiling allowed us to develop a reliable signature of this malignancy. Focusing on a key cytokine signaling pathway previously implicated in cutaneous T-cell lymphoma pathogenesis, JAK/STAT signaling, we used conditional gene targeting to develop a fully penetrant small animal model of this disease that recapitulates many key features of mycosis fungoides, a common variant of cutaneous T-cell lymphoma. Using this mouse model, we show that T-cell receptor engagement is critical for malignant transformation of the T lymphocytes and that progression of the disease is dependent on microbiota.
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Affiliation(s)
- Melania H Fanok
- Department of Pathology, New York University School of Medicine, New York, New York, USA
| | - Amy Sun
- Department of Pathology, New York University School of Medicine, New York, New York, USA
| | - Laura K Fogli
- Department of Pathology, New York University School of Medicine, New York, New York, USA
| | - Vijay Narendran
- Department of Medicine, Division of Hematology-Oncology, New York University School of Medicine, New York, New York, USA
| | - Miriam Eckstein
- Department of Basic Science and Craniofacial Biology, NYU College of Dentistry, New York, New York, USA
| | - Kasthuri Kannan
- Department of Pathology, New York University School of Medicine, New York, New York, USA; Office of Collaborative Science, New York University School of Medicine, New York, New York, USA
| | - Igor Dolgalev
- Department of Pathology, New York University School of Medicine, New York, New York, USA; Office of Collaborative Science, New York University School of Medicine, New York, New York, USA
| | - Charalampos Lazaris
- Department of Pathology, New York University School of Medicine, New York, New York, USA; Laura and Isaac Perlmutter Cancer Institute, New York University School of Medicine, New York, New York, USA
| | - Adriana Heguy
- Department of Pathology, New York University School of Medicine, New York, New York, USA; Office of Collaborative Science, New York University School of Medicine, New York, New York, USA
| | - Mary E Laird
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York, USA
| | - Mark S Sundrud
- Department of Immunology and Microbiology, The Scripps Research Institute, Jupiter, Florida, USA
| | - Cynthia Liu
- Department of Pathology, New York University School of Medicine, New York, New York, USA
| | - Jeff Kutok
- Department of Pathology, Brigham and Women's Hospital; Boston, Massachusetts, USA
| | - Rodrigo S Lacruz
- Department of Basic Science and Craniofacial Biology, NYU College of Dentistry, New York, New York, USA
| | - Jo-Ann Latkowski
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York, USA
| | - Iannis Aifantis
- Department of Pathology, New York University School of Medicine, New York, New York, USA; Laura and Isaac Perlmutter Cancer Institute, New York University School of Medicine, New York, New York, USA
| | - Niels Ødum
- Department of International Health, Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Kenneth B Hymes
- Department of Medicine, Division of Hematology-Oncology, New York University School of Medicine, New York, New York, USA; Department of Pathology, Brigham and Women's Hospital; Boston, Massachusetts, USA
| | - Swati Goel
- Department of Medicine, Division of Hematology-Oncology, New York University School of Medicine, New York, New York, USA
| | - Sergei B Koralov
- Department of Pathology, New York University School of Medicine, New York, New York, USA; Laura and Isaac Perlmutter Cancer Institute, New York University School of Medicine, New York, New York, USA.
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35
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What Is New in CTCL—Pathogenesis, Diagnosis, and Treatments. CURRENT DERMATOLOGY REPORTS 2018. [DOI: 10.1007/s13671-018-0214-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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36
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Wei T, Biskup E, Gjerdrum LMR, Niazi O, Ødum N, Gniadecki R. Ubiquitin-specific protease 2 decreases p53-dependent apoptosis in cutaneous T-cell lymphoma. Oncotarget 2018; 7:48391-48400. [PMID: 27351221 PMCID: PMC5217025 DOI: 10.18632/oncotarget.10268] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 06/09/2016] [Indexed: 11/25/2022] Open
Abstract
Treatment of advanced cutaneous T-cell lymphomas (CTCL) is challenging because they are resistant to conventional chemotherapy. USP2 has been shown to promote resistance to chemotherapeutic agents in several cancer models.We show here USP2 is expressed in quiescent and activated T-cells and its expression is 50% lower in CTCL cell lines (MyLa2000, SeAx and Hut-78) than in normal T-cells. USP2 is expressed in neoplastic cells in early, plaque-stage mycosis fungoides (MF) and is downregulated in advanced tumor stages. Upon treatment with psoralen with UVA (PUVA) or a p53 activator, nutlin3a, USP2 expression is significantly increased in MyLa2000 (p53wt/wt), but not in SeAx (p53mut) or Hut-78 (p53-/-). USP2 knockdown decreases MyLa2000 cell viability after PUVA by 50% but not Hut-78, suggesting that the function of USP2 in CTCL cells is p53-dependent. Furthermore, USP2 knockdown results in a decreased Mdm2 expression and upregulation of p53. Taken together, our findings suggest that USP2 stabilizes Mdm2 which antagonizes pro-apoptotic activity of p53 and possibly contributes to therapeutic resistance in CTCL.
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Affiliation(s)
- Tianling Wei
- Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark
| | - Edyta Biskup
- Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark
| | | | - Omid Niazi
- Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark
| | - Niels Ødum
- Institute of Medical Microbiology and Immunology, University of Copenhagen, Copenhagen, Denmark.,Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Robert Gniadecki
- Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark.,Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
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37
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Lindahl LM, Schmidt M, Farkas DK, Sørensen HT, Iversen L. Risk of venous thromboembolism in patients with mycosis fungoides and parapsoriasis: A Danish nationwide population-based cohort study. J Am Acad Dermatol 2017; 78:1077-1083.e4. [PMID: 29203438 DOI: 10.1016/j.jaad.2017.11.043] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 11/22/2017] [Accepted: 11/24/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Mycosis fungoides (MF) and parapsoriasis are characterized by malignant proliferation and chronic inflammation, which may affect the risk for venous thromboembolism (VTE). OBJECTIVES To examine the risk for VTE in patients with MF and parapsoriasis. METHODS We conducted a nationwide population-based cohort study in Denmark to examine the relative risk (RR) of VTE in 525 patients with MF and 634 patients with parapsoriasis compared with that in sex- and age-matched controls from the general population. RESULTS In patients with MF, the 10-year absolute risk for VTE was 3.4% (95% confidence interval [CI], 2.0-5.4). The adjusted RRs were 2.41 (95% CI, 1.49-3.90) for VTE and 4.01 (95% CI, 2.16-7.46) for pulmonary embolism. Notably, within the first 5 years after diagnosis with MF, the RR of pulmonary embolism was increased 6.7-fold (to 6.71 [95% CI, 2.86-15.72]). Patients with parapsoriasis had a 2.7-fold increased RR of VTE (to 2.67 [95% CI, 1.32-5.40]) in the absence of other established VTE risk factors. LIMITATIONS We had no information regarding disease stage of MF and prescribed drugs. CONCLUSION Patients with MF and parapsoriasis had an increased RR of VTE, although the absolute risk remained low. These findings should increase awareness of comorbidities in patients with MF and parapsoriasis.
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Affiliation(s)
- Lise M Lindahl
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
| | - Morten Schmidt
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; Department of Cardiology, Regional Hospital West Jutland, Herning
| | - Dora K Farkas
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik T Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Lars Iversen
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
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38
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Diminished microRNA-29b level is associated with BRD4-mediated activation of oncogenes in cutaneous T-cell lymphoma. Blood 2017; 131:771-781. [PMID: 29180399 DOI: 10.1182/blood-2017-09-805663] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 11/15/2017] [Indexed: 02/07/2023] Open
Abstract
MicroRNA (miRNA) dysregulation is a hallmark of cutaneous T-cell lymphoma (CTCL), an often-fatal malignancy of skin-homing CD4+ T cells for which there are few effective therapies. The role of microRNAs (miRs) in controlling epigenetic modifier-dependent transcriptional regulation in CTCL is unknown. In this study, we characterize a novel miR dysregulation that contributes to overexpression of the epigenetic reader bromodomain-containing protein 4 (BRD4). We used patient CD4+ T cells to show diminished levels of miR-29b compared with healthy donor cells. Patient cells and miR-29b-/- mouse cells revealed an inverse relationship between miR-29b and BRD4, the latter of which is overexpressed in these cells. Chromatin immunoprecipitation and sequencing analysis revealed increased genome-wide BRD4 occupancy at promoter and enhancer regions in CD4+ T cells from CTCL patients. The cumulative result of BRD4 binding was increased expression of tumor-associated genes such as NOTCH1 and RBPJ, as well as the interleukin-15 (IL-15) receptor complex, the latter enhancing IL-15 autocrine signaling. Furthermore, we confirm the in vivo relevance of this pathway in our IL-15 transgenic mouse model of CTCL by showing that interference with BRD4-mediated pathogenesis, either by restoring miR-29b levels via bortezomib treatment or by directly inhibiting BRD4 binding via JQ1 treatment, prevents progression of CTCL. We describe a novel oncogenic pathway featuring IL-15, miR-29b, and BRD4 in CTCL and suggest targeting of these components as a potentially effective therapy for CTCL patients.
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39
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Mascolo M, Romano MF, Ilardi G, Romano S, Baldo A, Scalvenzi M, Argenziano G, Merolla F, Russo D, Varricchio S, Pagliuca F, Russo M, Ciancia G, De Rosa G, Staibano S. Expression of FK506-binding protein 51 (FKBP51) in Mycosis fungoides. J Eur Acad Dermatol Venereol 2017; 32:735-744. [PMID: 28977697 DOI: 10.1111/jdv.14614] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 09/19/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND Mycosis fungoides (MF) is the major subtype of cutaneous T-cell lymphomas (CTCL). It usually has a prolonged indolent clinical course with a minority of cases acquiring a more aggressive biological profile and resistance to conventional therapies, partially attributed to the persistent activation of nuclear factor-kappa B (NF-κB) pathway. In the last decade, several papers suggested an important role for the FK506-binding protein 51 (FKBP51), an immunophilin initially cloned in lymphocytes, in the control of NF-κB pathway in different types of human malignancies. OBJECTIVES We aimed to investigate the possible value of FKBP51 expression as a new reliable marker of outcome in patients with MF. METHODS We assessed by immunohistochemistry (IHC) FKBP51 expression in 44 patients with MF, representative of different stages of the disease. Immunohistochemical results were subsequently confirmed at mRNA level with quantitative PCR (qPCR) in a subset of enrolled patients. In addition, IHC and qPCR served to study the expression of some NF-κB-target genes, including the tumour necrosis factor receptor-associated factor 2 (TRAF2). RESULTS Our results show that FKBP51 was expressed in all evaluated cases, with the highest level of expression characterizing MFs with the worst prognosis. Moreover, a significant correlation subsisted between FKBP51 and TRAF2 IHC expression scores. CONCLUSIONS We hypothesize a role for FKBP51 as a prognostic marker for MF and suggest an involvement of this immunophilin in deregulated NF-κB pathway of this CTCL.
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Affiliation(s)
- M Mascolo
- Pathology Section, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - M F Romano
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, Naples, Italy
| | - G Ilardi
- Pathology Section, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - S Romano
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, Naples, Italy
| | - A Baldo
- Department of Dermatology, University of Naples Federico II, Naples, Italy
| | - M Scalvenzi
- Department of Dermatology, University of Naples Federico II, Naples, Italy
| | - G Argenziano
- Dermatology Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | - F Merolla
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Campobasso, Italy
| | - D Russo
- Pathology Section, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - S Varricchio
- Pathology Section, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - F Pagliuca
- Pathology Section, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - M Russo
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, Naples, Italy
| | - G Ciancia
- Pathology Section, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - G De Rosa
- Pathology Section, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - S Staibano
- Pathology Section, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
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40
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Haverkos BM, Gru AA, Geyer SM, Bingman AK, Hemminger JA, Mishra A, Wong HK, Pancholi P, Freud AG, Caligiuri MA, Baiocchi RA, Porcu P. Increased Levels of Plasma Epstein Barr Virus DNA Identify a Poor-Risk Subset of Patients With Advanced Stage Cutaneous T-Cell Lymphoma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2017; 16 Suppl:S181-S190.e4. [PMID: 27521316 DOI: 10.1016/j.clml.2016.02.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 02/09/2016] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Outcomes in advanced stage (AS) cutaneous T-cell lymphomas (CTCL) are poor but with great variability. Epstein-Barr virus (EBV) is associated with a subset of non-Hodgkin lymphomas. Frequency of plasma EBV-DNA (pEBVd) detection, concordance with EBV RNA (EBER) in tumor tissue, codetection of plasma cytomegalovirus DNA (pCMVd), and prognostic effect in AS CTCL are unknown. PATIENTS AND METHODS Patients (n = 46; 2006-2013) with AS CTCL (≥IIB) were retrospectively studied. pEBVd and pCMVd were longitudinally measured using quantitative real-time polymerase chain reaction. EBER in situ hybridization (ISH) was performed on tumor samples. Survival from time of diagnosis (ToD) and time of progression to AS was assessed. RESULTS Plasma EBV-DNA and pCMVd were detected in 37% (17 of 46) and 17% (8 of 46) of AS CTCL patients, respectively. pCMVd detection was significantly more frequent in pEBVd-positive (pEBVd(+)) than pEBVd(-) patients (35% vs. 7%; P = .038). Tumor tissue for EBER-ISH was available in 14 of 17 pEBVd(+) and 22 of 29 pEBVd(-) patients; 12 of 14 (85.7%) pEBVd(+) patients were EBER(+) versus 0 of 22 pEBVd(-) patients. Frequency of large cell transformation (LCT) tended to be greater in pEBVd(+) patients, but was not significant (10 of 14 pEBVd(+) vs. 10 of 23 pEBVd(-); P = .17). No notable differences in rates of increased levels of serum lactate dehydrogenase (LDH) were observed (17 of 17 pEBVd(+) vs. 27 of 29 pEBVd(-)). pEBVd detection was associated with significantly worse survival from ToD (P = .021) and time of progression to AS (P = .0098). CONCLUSION Detection of cell-free plasma EBV-DNA was highly concordant with the presence of EBERs in tumor tissue, predicted survival independent of LDH and LCT, and should be further studied as a biomarker in AS CTCL.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antineoplastic Agents/administration & dosage
- Antineoplastic Agents/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Biomarkers
- Biopsy
- DNA, Viral
- Epstein-Barr Virus Infections/complications
- Epstein-Barr Virus Infections/virology
- Female
- Follow-Up Studies
- Herpesvirus 4, Human/genetics
- Humans
- Lymphoma, T-Cell, Cutaneous/diagnosis
- Lymphoma, T-Cell, Cutaneous/etiology
- Lymphoma, T-Cell, Cutaneous/mortality
- Lymphoma, T-Cell, Cutaneous/therapy
- Male
- Middle Aged
- Neoplasm Staging
- Prognosis
- Retrospective Studies
- Skin/pathology
- Survival Analysis
- Treatment Outcome
- Viral Load
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Affiliation(s)
| | - Alejandro A Gru
- Department of Pathology, University of Virginia, Charlottesville, VA
| | - Susan M Geyer
- Department of Pediatrics Health Informatics Institute, University of South Florida, Tampa, FL
| | - Anissa K Bingman
- Center for Biostatistics, The Ohio State University, Columbus, OH
| | | | - Anjali Mishra
- The Comprehensive Cancer Center and The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, OH; Division of Dermatology, The Ohio State University, Columbus, OH
| | - Henry K Wong
- Department of Dermatology, University of Arkansas for Medical Sciences, College of Medicine, Little Rock, AR
| | - Preeti Pancholi
- Department of Pathology, The Ohio State University, Columbus, OH
| | - Aharon G Freud
- The Comprehensive Cancer Center and The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, OH
| | - Michael A Caligiuri
- The Comprehensive Cancer Center and The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, OH; Division of Hematology, The Ohio State University, Columbus, OH
| | - Robert A Baiocchi
- The Comprehensive Cancer Center and The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, OH; Division of Hematology, The Ohio State University, Columbus, OH
| | - Pierluigi Porcu
- The Comprehensive Cancer Center and The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, OH; Division of Hematology, The Ohio State University, Columbus, OH.
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41
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Quaglino P, Maule M, Prince HM, Porcu P, Horwitz S, Duvic M, Talpur R, Vermeer M, Bagot M, Guitart J, Papadavid E, Sanches JA, Hodak E, Sugaya M, Berti E, Ortiz-Romero P, Pimpinelli N, Servitje O, Pileri A, Zinzani PL, Estrach T, Knobler R, Stadler R, Fierro MT, Alberti Violetti S, Amitay-Laish I, Antoniou C, Astrua C, Chaganti S, Child F, Combalia A, Fabbro S, Fava P, Grandi V, Jonak C, Martinez-Escala E, Kheterpal M, Kim EJ, McCormack C, Miyagaki T, Miyashiro D, Morris S, Muniesa C, Nikolaou V, Ognibene G, Onida F, Osella-Abate S, Porkert S, Postigo-Llorente C, Ram-Wolff C, Ribero S, Rogers K, Sanlorenzo M, Stranzenbach R, Spaccarelli N, Stevens A, Zugna D, Rook AH, Geskin LJ, Willemze R, Whittaker S, Hoppe R, Scarisbrick J, Kim Y. Global patterns of care in advanced stage mycosis fungoides/Sezary syndrome: a multicenter retrospective follow-up study from the Cutaneous Lymphoma International Consortium. Ann Oncol 2017; 28:2517-2525. [PMID: 28961843 DOI: 10.1093/annonc/mdx352] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Advanced-stage mycosis fungoides (MF)/Sézary syndrome (SS) patients are weighted by an unfavorable prognosis and share an unmet clinical need of effective treatments. International guidelines are available detailing treatment options for the different stages but without recommending treatments in any particular order due to lack of comparative trials. The aims of this second CLIC study were to retrospectively analyze the pattern of care worldwide for advanced-stage MF/SS patients, the distribution of treatments according to geographical areas (USA versus non-USA), and whether the heterogeneity of approaches has potential impact on survival. PATIENTS AND METHODS This study included 853 patients from 21 specialist centers (14 European, 4 USA, 1 each Australian, Brazilian, and Japanese). RESULTS Heterogeneity of treatment approaches was found, with up to 24 different modalities or combinations used as first-line and 36% of patients receiving four or more treatments. Stage IIB disease was most frequently treated by total-skin-electron-beam radiotherapy, bexarotene and gemcitabine; erythrodermic and SS patients by extracorporeal photochemotherapy, and stage IVA2 by polychemotherapy. Significant differences were found between USA and non-USA centers, with bexarotene, photopheresis and histone deacetylase inhibitors most frequently prescribed for first-line treatment in USA while phototherapy, interferon, chlorambucil and gemcitabine in non-USA centers. These differences did not significantly impact on survival. However, when considering death and therapy change as competing risk events and the impact of first treatment line on both events, both monochemotherapy (SHR = 2.07) and polychemotherapy (SHR = 1.69) showed elevated relative risks. CONCLUSION This large multicenter retrospective study shows that there exist a large treatment heterogeneity in advanced MF/SS and differences between USA and non-USA centers but these were not related to survival, while our data reveal that chemotherapy as first treatment is associated with a higher risk of death and/or change of therapy and thus other therapeutic options should be preferable as first treatment approach.
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Affiliation(s)
- P Quaglino
- Dermatologic Clinic, Department of Medical Sciences;.
| | - M Maule
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Torino, Torino, Italy
| | - H M Prince
- Division of Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne;; University of Melbourne, Melbourne, Australia
| | - P Porcu
- Division of Hematologic Malignancies, Ohio State University
| | - S Horwitz
- Department of Medicine, Memorial Sloan-Kettering Cancer Centre, New York
| | - M Duvic
- Department of Dermatology and Pathology, MD Anderson Cancer Centre, Houston, USA
| | - R Talpur
- Department of Dermatology and Pathology, MD Anderson Cancer Centre, Houston, USA
| | - M Vermeer
- Department of Dermatology, Leiden University Medical Centre, Leiden, The Netherlands
| | - M Bagot
- Dermatology Department, Hospital St Louis, Paris, France
| | - J Guitart
- Department of Dermatology and Pathology, Northwestern University, Chicago, USA
| | - E Papadavid
- 2nd Department of Dermatology and Venereology, Attikon General Hospital, University of Athens, Chaidari, Greece
| | - J A Sanches
- Department of Dermatology, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - E Hodak
- Beilinson Hospital, Petach Tikva;; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - M Sugaya
- Department of Dermatology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - E Berti
- Dermatologic Clinic, University of Milano, Milano, Italy
| | - P Ortiz-Romero
- Department of Dermatology, Hospital 12 de Octubre, Madrid, Spain
| | - N Pimpinelli
- Dermatologic Clinic, University of Florence, Florence, Italy
| | - O Servitje
- Department of Dermatology, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - A Pileri
- Dermatologic Clinic, University of Bologna, Bologna
| | - P L Zinzani
- Seragnoli Institute of Haematology, Bologna, Italy
| | - T Estrach
- Department of Dermatology, Hospital Clinico, University of Barcelona, Barcelona, Spain
| | - R Knobler
- Dermatologic Clinic, University of Vienna Medical School, Vienna, Austria
| | - R Stadler
- University Clinic for Dermatology, Venereology, Allergology and Phlebology, Minden, Germany
| | - M T Fierro
- Dermatologic Clinic, Department of Medical Sciences
| | | | - I Amitay-Laish
- Beilinson Hospital, Petach Tikva;; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - C Antoniou
- 2nd Department of Dermatology and Venereology, Attikon General Hospital, University of Athens, Chaidari, Greece
| | - C Astrua
- Dermatologic Clinic, Department of Medical Sciences
| | - S Chaganti
- Cutaneous Lymphoma Service, University Hospital Birmingham, Birmingham
| | - F Child
- Kings College London, Guys and St Thomas NHS Foundation Trust, London, UK
| | - A Combalia
- Department of Dermatology, Hospital Clinico, University of Barcelona, Barcelona, Spain
| | - S Fabbro
- Division of Hematologic Malignancies, Ohio State University
| | - P Fava
- Dermatologic Clinic, Department of Medical Sciences
| | - V Grandi
- Dermatologic Clinic, University of Florence, Florence, Italy
| | - C Jonak
- Dermatologic Clinic, University of Vienna Medical School, Vienna, Austria
| | - E Martinez-Escala
- Department of Dermatology and Pathology, Northwestern University, Chicago, USA
| | - M Kheterpal
- Department of Medicine, Memorial Sloan-Kettering Cancer Centre, New York
| | - E J Kim
- Department of Dermatology and Pathology, University of Pennsylvania, Philadelphia
| | - C McCormack
- Division of Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne;; University of Melbourne, Melbourne, Australia
| | - T Miyagaki
- Department of Dermatology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - D Miyashiro
- Department of Dermatology, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - S Morris
- Kings College London, Guys and St Thomas NHS Foundation Trust, London, UK
| | - C Muniesa
- Department of Dermatology, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - V Nikolaou
- 2nd Department of Dermatology and Venereology, Attikon General Hospital, University of Athens, Chaidari, Greece
| | - G Ognibene
- Comprehensive Skin Cancer Center, Columbia University Medical Center
| | - F Onida
- Dermatologic Clinic, University of Milano, Milano, Italy
| | | | - S Porkert
- Dermatologic Clinic, University of Vienna Medical School, Vienna, Austria
| | | | - C Ram-Wolff
- Dermatology Department, Hospital St Louis, Paris, France
| | - S Ribero
- Dermatologic Clinic, Department of Medical Sciences
| | - K Rogers
- Comprehensive Skin Cancer Center, Columbia University Medical Center
| | - M Sanlorenzo
- Dermatologic Clinic, Department of Medical Sciences
| | - R Stranzenbach
- University Clinic for Dermatology, Venereology, Allergology and Phlebology, Minden, Germany
| | - N Spaccarelli
- Department of Dermatology and Pathology, University of Pennsylvania, Philadelphia
| | - A Stevens
- Cutaneous Lymphoma Service, University Hospital Birmingham, Birmingham
| | - D Zugna
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Torino, Torino, Italy
| | - A H Rook
- Department of Dermatology and Pathology, University of Pennsylvania, Philadelphia
| | - L J Geskin
- Comprehensive Skin Cancer Center, Columbia University Medical Center
| | - R Willemze
- Department of Dermatology, Leiden University Medical Centre, Leiden, The Netherlands
| | - S Whittaker
- Kings College London, Guys and St Thomas NHS Foundation Trust, London, UK
| | - R Hoppe
- Department of Dermatology, Stanford University Medical Centre, USA
| | - J Scarisbrick
- Cutaneous Lymphoma Service, University Hospital Birmingham, Birmingham
| | - Y Kim
- Department of Dermatology, Stanford University Medical Centre, USA
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42
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Abstract
T-cell lymphoma, a collection of subtypes of Non-Hodgkin lymphoma, is a rare malignancy. The low prevalence of this disease has made it challenging to identify subtype-specific risk factors. Potential risk factors could enable us to identify high-risk patients and predict patient outcomes. Here, we report on the current epidemiologic and prognostic factors data associated with the individual subtypes both of peripheral T-cell lymphoma (PTCL) and cutaneous T-cell lymphoma (CTCL) found in large cohort and case studies. Additionally, with recent findings, as well as updates in the new World Health Organization (WHO) classification of lymphoid neoplasms, we consider what this could do to change our approach to this group of diseases.
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43
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Magro CM, Davis TL, Kurtzman DJ. Epidermotropic marginal zone lymphoma: An uncommon cutaneous B-cell lymphoma responsive to rituximab. JAAD Case Rep 2017; 3:474-476. [PMID: 28971136 PMCID: PMC5614640 DOI: 10.1016/j.jdcr.2017.06.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Cynthia M. Magro
- Department of Pathology and Laboratory Medicine, Weill Medical College of Cornell University, New York, New York
| | | | - Drew J.B. Kurtzman
- Division of Dermatology, the University of Arizona, Tucson, Arizona
- Correspondence to: Drew J. B. Kurtzman, MD, Assistant Professor of Medicine (Dermatology), Director, Connective Tissue Disease Clinic, 1515 N Campbell Ave, PO Box 245024, Tucson, Arizona 85724.Assistant Professor of Medicine (Dermatology)Director, Connective Tissue Disease Clinic1515 N Campbell AvePO Box 245024TucsonArizona85724
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44
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Duvic M, Bates SE, Piekarz R, Eisch R, Kim YH, Lerner A, Robak T, Samtsov A, Becker JC, McCulloch W, Waksman J, Whittaker S. Responses to romidepsin in patients with cutaneous T-cell lymphoma and prior treatment with systemic chemotherapy. Leuk Lymphoma 2017; 59:880-887. [PMID: 28853310 DOI: 10.1080/10428194.2017.1361022] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Cutaneous T-cell lymphomas (CTCL) are a group of non-Hodgkin lymphomas that typically present in the skin but can progress to systemic involvement. The optimal treatment for patients who relapse from or are refractory to systemic chemotherapy remains unclear. Romidepsin is a potent, class-I selective histone deacetylase inhibitor approved for the treatment of patients with CTCL who have had ≥1 prior systemic therapy. Here, we present a subanalysis of two phase-2 trials (NCT00106431, NCT00007345) of romidepsin in patients with CTCL who had prior treatment with systemic chemotherapy. Patients with prior chemotherapy were able to achieve durable responses to romidepsin, and response rates were similar to those in patients who were chemotherapy naïve. Overall, no new safety signals emerged in patients who had received prior chemotherapy. The data presented here suggest that romidepsin is safe and effective in patients with CTCL who received prior systemic chemotherapy.
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Affiliation(s)
- Madeleine Duvic
- a The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Susan E Bates
- b Department of Hematology/Oncology , Columbia University , New York , NY , USA
| | - Richard Piekarz
- c Cancer Therapy Evaluation Program, Division of Cancer Treatment and Diagnosis , National Cancer Institute , Bethesda , MD , USA
| | - Robin Eisch
- d National Cancer Institute , Bethesda , MD , USA
| | - Youn H Kim
- e Department of Dermatology , Stanford University , Stanford , CA , USA
| | | | - Tadeusz Robak
- g Department of Hematology , Medical University of Lodz, Copernicus Memorial Hospital , Lodz , Poland
| | - Alexey Samtsov
- h State Educational Institution of Military Medicine , St. Petersburg , Russia
| | - Jürgen C Becker
- i Translational Skin Cancer Research, German Cancer Consortium (DKTK) , University Clinic Essen , Germany
| | | | - Joel Waksman
- k Brightech International LLC , Somerset , NJ , USA
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45
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Abstract
From the application of Coley's toxin in the early 1900s to the present clinical trials using immune checkpoint regulatory inhibitors, the history of cancer immunotherapy has consisted of extremely high levels of enthusiasm after anecdotal case reports of enormous success, followed by decreasing levels of enthusiasm as the results of controlled clinical trials are available. In this review, this pattern will be documented for the various immunotherapeutic approaches over the years. The sole exception being vaccination against cancer causing viruses, which have already prevented thousands of cancers. We can only hope that the present high level of enthusiasm for the use of immune stimulation by removal of blocks to cancer immunity will be more productive than the incremental improvements using previous immunotherapies.
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Affiliation(s)
- Stewart Sell
- Wadsworth Center, New York State Department of Health and Albany College of Pharmacy and Health Sciences, Albany, NY, USA
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46
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TCR-CXCR4 signaling stabilizes cytokine mRNA transcripts via a PREX1-Rac1 pathway: implications for CTCL. Blood 2017; 130:982-994. [PMID: 28694325 DOI: 10.1182/blood-2017-03-770982] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 07/05/2017] [Indexed: 02/06/2023] Open
Abstract
As with many immunopathologically driven diseases, the malignant T cells of cutaneous T-cell lymphomas (CTCLs), such as Sézary syndrome, display aberrant cytokine secretion patterns that contribute to pathology and disease progression. Targeting this disordered release of cytokines is complicated by the changing cytokine milieu that drives the phenotypic changes of CTCLs. Here, we characterize a novel signaling pathway that can be targeted to inhibit the secretion of cytokines by modulating either CXCR4 or CXCR4-mediated signaling. We demonstrate that upon ligation of the T-cell antigen receptor (TCR), the TCR associates with and transactivates CXCR4 via phosphorylation of S339-CXCR4 in order to activate a PREX1-Rac1-signaling pathway that stabilizes interleukin-2(IL-2), IL-4, and IL-10 messenger RNA (mRNA) transcripts. Pharmacologic inhibition of either TCR-CXCR4 complex formation or PREX1-Rac1 signaling in primary human T cells decreased mRNA stability and inhibited secretion of IL-2, IL-4, and IL-10. Applying this knowledge to Sézary syndrome, we demonstrate that targeting various aspects of this signaling pathway blocks both TCR-dependent and TCR-independent cytokine secretion from a Sézary syndrome-derived cell line and patient isolates. Together, these results identify multiple aspects of a novel TCR-CXCR4-signaling pathway that could be targeted to inhibit the aberrant cytokine secretion that drives the immunopathogenesis of Sézary syndrome and other immunopathological diseases.
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47
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48
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Langerhans, plasmacytoid dendritic and myeloid-derived suppressor cell levels in mycosis fungoides vary according to the stage of the disease. Virchows Arch 2017; 470:575-582. [DOI: 10.1007/s00428-017-2107-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 01/14/2017] [Accepted: 03/09/2017] [Indexed: 01/28/2023]
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49
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Virmani P, Hwang SH, Hastings JG, Haverkos BM, Kohnken B, Gru AA, Mishra A, Fabbro SK, Horwitz SM, Porcu P. Systemic therapy for cutaneous T-cell lymphoma: who, when, what, and why? Expert Rev Hematol 2016; 10:111-121. [DOI: 10.1080/17474086.2017.1270201] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Pooja Virmani
- Department of Medicine, Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Susan H. Hwang
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Justin G. Hastings
- Department of Internal Medicine, Division of Dermatology, The Ohio State University, Columbus, OH, USA
| | | | - Becca Kohnken
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
- Department of Veterinary Biosciences, Ohio State University, Columbus, OH, USA
| | - Alejandro A Gru
- Department of Pathology, University of Virginia, Charlottesville, VA, USA
| | - Anjali Mishra
- Department of Internal Medicine, Division of Dermatology, The Ohio State University, Columbus, OH, USA
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Stephanie K. Fabbro
- Department of Internal Medicine, Division of Dermatology, The Ohio State University, Columbus, OH, USA
| | - Steve M. Horwitz
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Pierluigi Porcu
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, OH, USA
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
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50
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Kodigepalli KM, Li M, Liu SL, Wu L. Exogenous expression of SAMHD1 inhibits proliferation and induces apoptosis in cutaneous T-cell lymphoma-derived HuT78 cells. Cell Cycle 2016; 16:179-188. [PMID: 27929746 DOI: 10.1080/15384101.2016.1261226] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Sterile α motif and HD domain-containing protein 1 (SAMHD1) is a mammalian dNTP hydrolase (dNTPase) that regulates intracellular dNTP balance. We have previously reported that SAMHD1 mRNA and protein levels are significantly downregulated in CD4+ T-cells of patients with cutaneous T-cell lymphoma (CTCL), a disease characterized by infiltration of neoplastic CD4+ T-lymphocytes into the skin. However, functional significance of SAMHD1 in CTCL development and progression remains unknown. Here we investigate the mechanism by which SAMHD1 induces apoptosis in CTCL-derived CD4+ T-cells. We stably expressed exogenous SAMHD1 in the CTCL-derived HuT78 T-cell line containing a very low level of endogenous SAMHD1 protein. We found that low-level exogenous expression of SAMHD1 led to a significant reduction in HuT78 cell growth, proliferation, and colony formation. Exogenous SAMHD1 expression in HuT78 cells also resulted in increased spontaneous and Fas ligand (Fas-L)-induced apoptosis levels via activation of the extrinsic pathway, including caspase-8, -3 and -7. Additionally, increased SAMHD1 significantly reduced the protein and mRNA expression of the short isoform of cFLIP (cFLIPS), an important negative regulator of Fas-L-mediated apoptotic signaling. Our results indicate that exogenous SAMHD1 expression inhibits HuT78 cell growth and proliferation in part by increasing apoptosis. These findings implicate that SAMHD1 acts as an inhibitor in CTCL cell growth, suggesting that downregulation of SAMHD1 expression in neoplastic T-cells can facilitate uncontrolled cell proliferation.
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Affiliation(s)
- Karthik M Kodigepalli
- a Center of Retrovirus Research, Department of Veterinary Biosciences ; The Ohio State University , Columbus , OH , USA
| | - Minghua Li
- a Center of Retrovirus Research, Department of Veterinary Biosciences ; The Ohio State University , Columbus , OH , USA
| | - Shan-Lu Liu
- a Center of Retrovirus Research, Department of Veterinary Biosciences ; The Ohio State University , Columbus , OH , USA
| | - Li Wu
- a Center of Retrovirus Research, Department of Veterinary Biosciences ; The Ohio State University , Columbus , OH , USA.,b Comprehensive Cancer Center, The Ohio State University , Columbus , OH , USA.,c Department of Microbial Infection and Immunity , The Ohio State University , Columbus , OH , USA
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