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Su C, Kim SK, Wang CX, Kirsch DG, Monjazeb AM. Radiotherapy Combined with Intralesional Immunostimulatory Agents for Soft Tissue Sarcomas. Semin Radiat Oncol 2024; 34:243-257. [PMID: 38508788 DOI: 10.1016/j.semradonc.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
Immunotherapy has shifted the treatment paradigm for many types of cancer. Unfortunately, the most commonly used immunotherapies, such as immune checkpoint inhibitors (ICI), have yielded limited benefit for most types of soft tissue sarcoma (STS). Radiotherapy (RT) is a mainstay of sarcoma therapy and can induce immune modulatory effects. Combining immunotherapy and RT in STS may be a promising strategy to improve sarcoma response to RT and increase the efficacy of immunotherapy. Most combination strategies have employed immunotherapies, such as ICI, that derepress immune suppressive networks. These have yielded only modest results, possibly due to the limited immune stimulatory effects of RT. Combining RT with immune stimulatory agents has yielded promising preclinical and clinical results but can be limited by the toxic nature of systemic administration of immune stimulants. Using intralesional immune stimulants may generate stronger RT immune modulation and less systemic toxicity, which may be a feasible strategy in accessible tumors such as STS. In this review, we summarize the immune modulatory effects of RT, the mechanism of action of various immune stimulants, including toll-like receptor agonists, and data for combinatorial strategies utilizing these agents.
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Affiliation(s)
- Chang Su
- Department of Radiation Oncology, Duke University, Durham, NC
| | - Soo Kyoung Kim
- Department of Radiation Oncology, UC Davis Comprehensive Cancer Center, UC Davis Health, Davis, CA
| | - Charles X Wang
- Department of Radiation Oncology, UC Davis Comprehensive Cancer Center, UC Davis Health, Davis, CA
| | - David G Kirsch
- Department of Radiation Oncology, Duke University, Durham, NC; Department of Radiation Oncology, Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Arta M Monjazeb
- Department of Radiation Oncology, UC Davis Comprehensive Cancer Center, UC Davis Health, Davis, CA.
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Xie B, Fan M, Wang CX, Zhang Y, Xu S, Mizenko R, Lin TY, Duan Y, Zhang Y, Huang J, Berg JI, Wu D, Li A, Hao D, Gao K, Sun Y, Tepper CG, Carney R, Li Y, Wang A, Gong Q, Daly M, Jao LE, Monjazeb AM, Fierro FA, Li JJ. Post-death Vesicles of Senescent Bone Marrow Mesenchymal Stromal Polyploids Promote Macrophage Aging and Breast Cancer. bioRxiv 2024:2024.03.06.583755. [PMID: 38496556 PMCID: PMC10942423 DOI: 10.1101/2024.03.06.583755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Potential systemic factors contributing to aging-associated breast cancer (BC) remain elusive. Here, we reveal that the polyploid giant cells (PGCs) that contain more than two sets of genomes prevailing in aging and cancerous tissues constitute 5-10% of healthy female bone marrow mesenchymal stromal cells (fBMSCs). The PGCs can repair DNA damage and stimulate neighboring cells for clonal expansion. However, dying PGCs in advanced-senescent fBMSCs can form "spikings" which are then separated into membraned mtDNA-containing vesicles (Senescent PGC-Spiking Bodies; SPSBs). SPSB-phagocytosed macrophages accelerate aging with diminished clearance on BC cells and protumor M2 polarization. SPSB-carried mitochondrial OXPHOS components are enriched in BC of elder patients and associated with poor prognosis. SPSB-incorporated breast epithelial cells develop aggressive characteristics and PGCs resembling the polyploid giant cancer cells (PGCCs) in clonogenic BC cells and cancer tissues. These findings highlight an aging BMSC-induced BC risk mediated by SPSB-induced macrophage dysfunction and epithelial cell precancerous transition. SIGNIFICANCE Mechanisms underlying aging-associated cancer risk remain unelucidated. This work demonstrates that polyploid giant cells (PGCs) in bone marrow mesenchymal stromal cells (BMSCs) from healthy female bone marrow donors can boost neighboring cell proliferation for clonal expansion. However, the dying-senescent PGCs in the advanced-senescent fBMSCs can form "spikings" which are separated into mitochondrial DNA (mtDNA)-containing spiking bodies (senescent PGC-spiking bodies; SPSBs). The SPSBs promote macrophage aging and breast epithelial cell protumorigenic transition and form polyploid giant cancer cells. These results demonstrate a new form of ghost message from dying-senescent BMSCs, that may serve as a systemic factor contributing to aging-associated immunosuppression and breast cancer risk. Graphic Abstract
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Priester JI, Simister SK, Sario M, Choi J, Pina D, Theriault R, Bateni C, Ghasemiesfe A, Carr-Ascher J, Monjazeb AM, Canter RJ, Randall RL, Thorpe SW. Scrutinizing the use of contrasted chest CTs in extremity sarcoma staging and surveillance. J Surg Oncol 2024; 129:523-530. [PMID: 37997294 DOI: 10.1002/jso.27510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 10/18/2023] [Accepted: 10/31/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Since 2015, the American College of Radiology (ACR) has recommended staging for lung metastasis via chest computed tomography (CT) without contrast for extremity sarcoma staging and surveillance. The purpose of this study was to determine our institutional compliance with this recommendation. METHODS This was a retrospective chart review of patients diagnosed with sarcoma in the extremities who received CT imaging of the chest for pulmonary staging and surveillance at our institution from 2005 to 2023. A total of 1916 CT studies were included for analysis. We scrutinized ordering patterns before and after 2015 based on the ACR-published metastasis staging and screening guidelines. An institutional and patient cost analysis was performed between CT modalities. RESULTS The prevalence of CT scans ordered and performed with contrast was greater than those without contrast both prior and post-ACR 2015 guidelines. Furthermore, 79.2% of patient's final surveillance CTs after 2015 were performed with contrast. A cost analysis was performed and demonstrated an additional $297 704 in patient and institutional costs. CONCLUSIONS At our institution, upon review of CT chest imaging for pulmonary staging and surveillance in patients with extremity sarcoma the use of contrast has been routinely utilized despite a lack of evidence for its necessity and contrary to ACR guidelines.
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Affiliation(s)
- Jacob I Priester
- Department of Orthopaedic Surgery, University of California, Davis, Sacramento, California, USA
| | - Samuel K Simister
- Department of Orthopaedic Surgery, University of California, Davis, Sacramento, California, USA
| | - Matthew Sario
- Department of Orthopaedic Surgery, University of California, Davis, Sacramento, California, USA
| | - Justin Choi
- Department of Radiology, Cardiothoracic Imaging, University of California, Davis, Sacramento, California, USA
| | - Dagoberto Pina
- Department of Orthopaedic Surgery, University of California, Davis, Sacramento, California, USA
| | - Raminta Theriault
- Department of Orthopaedic Surgery, Ochsner Medical Center, New Orleans, Louisiana, USA
| | - Cyrus Bateni
- Department of Radiology, Musculoskeletal Radiology, University of California, Davis, Sacramento, California, USA
| | - Ahmadreza Ghasemiesfe
- Department of Radiology, Cardiothoracic Imaging, University of California, Davis, Sacramento, California, USA
| | - Janai Carr-Ascher
- Department of Orthopaedic Surgery, University of California, Davis, Sacramento, California, USA
- Department of Internal Medicine, Hematology and Oncology, University of California, Davis, Sacramento, California, USA
| | - Arta M Monjazeb
- Department of Orthopaedic Surgery, University of California, Davis, Sacramento, California, USA
- Department of Radiation Oncology, University of California, Davis, Sacramento, California, USA
| | - Robert J Canter
- Department of Surgery, Surgical Oncology, University of California, Davis, Sacramento, California, USA
| | - R L Randall
- Department of Orthopaedic Surgery, University of California, Davis, Sacramento, California, USA
| | - Steven W Thorpe
- Department of Orthopaedic Surgery, University of California, Davis, Sacramento, California, USA
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Vick LV, Yoon D, Perks JR, Li JJ, Murphy WJ, Monjazeb AM. Tumor Resistance to Fractionated Radiotherapy in Obese Mice. Int J Radiat Oncol Biol Phys 2023; 117:S139. [PMID: 37784355 DOI: 10.1016/j.ijrobp.2023.06.546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Obesity has reached pandemic levels in the United States and will soon surpass smoking as the number one cause of preventable cancer. Clinical data demonstrate that obese cancer patients are more resistant to radiotherapy and have higher rates of recurrence. Although a growing number of cancer patients are obese, and obesity is linked to poor outcomes with radiotherapy, little is understood about how obesity impacts the efficacy of radiotherapy. Understanding if and how obesity induces radio-resistance and how to best treat obese cancer patients is a critical unmet need. In this study we test the hypothesis that tumors in obese mice have increased resistance to fractionated radiotherapy. MATERIALS/METHODS Control and diet induce obese (DIO) mice were generated by feeding 4-6-week-old, genetically identical, inbred C57BL/6 mice with a high-fat diet consisting of 60% kcal from fat (DIO) or a control diet consisting of 10% fat (control) until 6 months of age. Mice were then implanted with syngeneic B16F0 tumors in the hind leg. When tumors reached 5mm in diameter mice were treated with fractionated radiotherapy (12 Gy delivered in daily 4 Gy fractions X 3 days) using a 2cm electron cutout to treat the tumor + margin only. RESULTS DIO mice had significantly increased body weight (control 30-40 g; DIO 50-65 g), significantly increased visceral and subcutaneous fat deposits, and elevated leptin levels. Blood glucose levels and HgbA1c in DIO mice, although slighter higher than controls, were within normal limits and did not indicate insulin resistance. Mice were divided into four groups of 8 mice (control, control + RT, DIO, DIO + RT). Fractionated radiotherapy (4 Gy x 3) significantly reduced the growth of B16F0 tumors by about three-fold in control mice compared to untreated controls. Radiotherapy failed to significantly reduce tumor size in DIO mice (compared to unirradiated DIO), although the treated tumors trended towards being modestly smaller. Additionally, tumors in the DIO + RT group were significantly larger than the tumors in the control + RT group. Initial mechanistic studies suggest increased tumor proliferation and immune dysfunction in DIO mice may induce the observed radio-resistance. CONCLUSION Using genetically identical mice with genetically identical tumors we demonstrate, for the first time, that diet and obesity can drastically alter the anti-tumor effects of radiotherapy. Mechanistic studies and studies in other tumor models are underway. Understanding how obesity impacts radiotherapy response and developing strategies to address these issues will improve outcomes in obese patients. Thus, these studies can have a major clinical impact and represent a step towards personalized medicine by tailoring radiotherapy treatment strategies to a patient's metabolic parameters.
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Affiliation(s)
| | | | - J R Perks
- University of California Davis, Sacramento, CA
| | - J J Li
- Department of Radiation Oncology, University of California Davis, Sacramento, CA
| | - W J Murphy
- University of California Davis, Sacramento, CA
| | - A M Monjazeb
- University of California Davis Comprehensive Cancer Center, Sacramento, CA
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Vick LV, Canter RJ, Monjazeb AM, Murphy WJ. Multifaceted effects of obesity on cancer immunotherapies: Bridging preclinical models and clinical data. Semin Cancer Biol 2023; 95:88-102. [PMID: 37499846 PMCID: PMC10836337 DOI: 10.1016/j.semcancer.2023.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/04/2023] [Accepted: 07/24/2023] [Indexed: 07/29/2023]
Abstract
Obesity, defined by excessive body fat, is a highly complex condition affecting numerous physiological processes, such as metabolism, proliferation, and cellular homeostasis. These multifaceted effects impact cells and tissues throughout the host, including immune cells as well as cancer biology. Because of the multifaceted nature of obesity, common parameters used to define it (such as body mass index in humans) can be problematic, and more nuanced methods are needed to characterize the pleiotropic metabolic effects of obesity. Obesity is well-accepted as an overall negative prognostic factor for cancer incidence, progression, and outcome. This is in part due to the meta-inflammatory and immunosuppressive effects of obesity. Immunotherapy is increasingly used in cancer therapy, and there are many different types of immunotherapy approaches. The effects of obesity on immunotherapy have only recently been studied with the demonstration of an "obesity paradox", in which some immune therapies have been demonstrated to result in greater efficacy in obese subjects despite the direct adverse effects of obesity and excess body fat acting on the cancer itself. The multifactorial characteristics that influence the effects of obesity (age, sex, lean muscle mass, underlying metabolic conditions and drugs) further confound interpretation of clinical data and necessitate the use of more relevant preclinical models mirroring these variables in the human scenario. Such models will allow for more nuanced mechanistic assessment of how obesity can impact, both positively and negatively, cancer biology, host metabolism, immune regulation, and how these intersecting processes impact the delivery and outcome of cancer immunotherapy.
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Affiliation(s)
- Logan V Vick
- Department of Dermatology, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Robert J Canter
- Department of Surgery, Division of Surgical Oncology, University of California Davis Comprehensive Cancer Center, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Arta M Monjazeb
- Department of Radiation Oncology, University of California Davis Comprehensive Cancer Center, University of California School of Medicine, Sacramento, CA, USA
| | - William J Murphy
- Department of Dermatology, University of California Davis School of Medicine, Sacramento, CA, USA; Department of Internal Medicine, Division of Malignant Hematology, Cellular Therapy and Transplantation, University of California Davis School of Medicine, Sacramento, CA, USA.
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Cordero T, Beagen PL, Daly ME, Monjazeb AM, Zhao X. 3D Surface Imaging in Reducing Setup Error for Prone Whole Breast Radiotherapy. Int J Radiat Oncol Biol Phys 2023; 117:e172. [PMID: 37784782 DOI: 10.1016/j.ijrobp.2023.06.1014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) For patients undergoing whole breast radiotherapy, treatment in the prone position allows for reduced dose to critical organs such as the heart and lungs. However, this treatment position comes with greater challenges in reproducibility and setup error given the unstable position. Our objective was to investigate the benefit of using 3D surface imaging to reduce daily setup errors for these patients. MATERIALS/METHODS We performed a retrospective review of consecutive breast patients receiving prone breast radiotherapy at our institution. All patients were positioned initially using setup tattoos and twice a week, the positioning was adjusted using the aid of a motion tracking system. Then, a daily kilovoltage (kV) cone beam computed tomography (CBCT) image was acquired and positioning was adjusted to setup the breast and chest wall. Shifts in each translational direction were recorded and the three-dimensional vector displacement was calculated. For each patient the average displacements on days where a motion tracking system was used were compared to days whereas motion tracking system was not used. Patients were classified into significant benefit (more than 4 mm improvement), small benefit (0-4 mm improvement) or increased error (increased shifts on days a motion tracking system was used). Patient demographics were collected including stage, BMI, weight, heigh, age, ethnicity. Comparisons were made using t-tests. RESULTS A total of 40 patients with stage T0-2N0 breast cancer were included. The median age was 64 and 60% of patients had left sided breast cancer. A total of 665 daily CBCT scans were analyzed, and the median daily vector displacement was 7.2 mm (1-21 mm). The median displacement on treatments where a motion tracking system was used (41% of treatments) was 6.1 mm versus 8.1 mm when not used (p<.0001). The use of a motion tracking system significantly reduced the occurrence of shifts more than 1 cm (12% vs. 33%, p < .0001) and 5 mm (65% vs. 83% p < .0001). For individual patients, 28% showed a significant improvement, 55% showed small improvement, 17% showed increased error. The median BMI was 27, weight was 71 kg, and neither was associated with an improvement in the use of Align RT (p > .05). However, patients in the small improvement group had a higher BMI than patients in the other two groups 29 vs. 25 (p = .01). A similar association was seen for weight (p < .05). No association was found for the benefit of a motion tracking system for height, age, stage or ethnicity. CONCLUSION The use of 3D surface imaging for breast cancer patients receiving prone whole breast radiotherapy on average significantly reduced setup errors. For patients with higher BMI there was a consistent small reduction in setup error when compared to using setup marks alone. For patients with lower BMI, caution should be exercised as there was more variation with some patients demonstrating a large benefit and other patients having an increased setup error with the use of surface imaging. Further research is needed to investigate on the optimal use of this technology.
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Affiliation(s)
- T Cordero
- University of California Los Angeles, Los Angeles, CA
| | - P L Beagen
- UC Davis Comprehensive Cancer Center, Sacramento, CA, United States
| | - M E Daly
- University of California Davis Comprehensive Cancer Center, Sacramento, CA
| | - A M Monjazeb
- University of California Davis Comprehensive Cancer Center, Sacramento, CA
| | - X Zhao
- University of California Davis Comprehensive Cancer Center, Sacramento, CA
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Le CT, Vick LV, Collins C, Dunai C, Sheng MK, Khuat LT, Barao I, Judge SJ, Aguilar EG, Curti B, Dave M, Longo DL, Blazar BR, Canter RJ, Monjazeb AM, Murphy WJ. Regulation of human and mouse bystander T cell activation responses by PD-1. JCI Insight 2023; 8:e173287. [PMID: 37737264 PMCID: PMC10561715 DOI: 10.1172/jci.insight.173287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/15/2023] [Indexed: 09/23/2023] Open
Abstract
Bystander activation of memory T cells occurs via cytokine signaling alone in the absence of T cell receptor (TCR) signaling and provides a means of amplifying T cell effector responses in an antigen-nonspecific manner. While the role of Programmed Cell Death Protein 1 (PD-1) on antigen-specific T cell responses is extensively characterized, its role in bystander T cell responses is less clear. We examined the role of the PD-1 pathway during human and mouse non-antigen-specific memory T cell bystander activation and observed that PD-1+ T cells demonstrated less activation and proliferation than activated PD-1- populations in vitro. Higher activation and proliferative responses were also observed in the PD-1- memory population in both mice and patients with cancer receiving high-dose IL-2, mirroring the in vitro phenotypes. This inhibitory effect of PD-1 could be reversed by PD-1 blockade in vivo or observed using memory T cells from PD-1-/- mice. Interestingly, increased activation through abrogation of PD-1 signaling in bystander-activated T cells also resulted in increased apoptosis due to activation-induced cell death (AICD) and eventual T cell loss in vivo. These results demonstrate that the PD-1/PD-Ligand 1 (PD-L1) pathway inhibited bystander-activated memory T cell responses but also protected cells from AICD.
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Affiliation(s)
| | | | | | | | | | - Lam T. Khuat
- Department of Dermatology, School of Medicine, and
| | - Isabel Barao
- Department of Dermatology, School of Medicine, and
| | - Sean J. Judge
- Department of Surgery, University of California, Davis, Sacramento, California, USA
| | - Ethan G. Aguilar
- Masonic Cancer Center, and Division of Blood and Marrow Transplantation, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Brendan Curti
- Earle A. Chiles Research Institute at the Robert W. Franz Cancer Center, Portland, Oregon, USA
| | - Maneesh Dave
- Department of Internal Medicine, Division of Gastroenterology, School of Medicine, University of California, Davis, Sacramento, California, USA
| | - Dan L. Longo
- Department of Medicine, Division of Hematology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Bruce R. Blazar
- Masonic Cancer Center, and Division of Blood and Marrow Transplantation, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Robert J. Canter
- Department of Surgery, University of California, Davis, Sacramento, California, USA
| | | | - William J. Murphy
- Department of Dermatology, School of Medicine, and
- Department of Internal Medicine, Division of Hematology and Oncology, University of California, Davis School of Medicine, Sacramento, California, USA
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Monjazeb AM, Daly ME, Luxardi G, Maverakis E, Merleev AA, Marusina AI, Borowsky A, Mirhadi A, Shiao SL, Beckett L, Chen S, Eastham D, Li T, Vick LV, McGee HM, Lara F, Garcia L, Morris LA, Canter RJ, Riess JW, Schalper KA, Murphy WJ, Kelly K. Atezolizumab plus stereotactic ablative radiotherapy for medically inoperable patients with early-stage non-small cell lung cancer: a multi-institutional phase I trial. Nat Commun 2023; 14:5332. [PMID: 37658083 PMCID: PMC10474145 DOI: 10.1038/s41467-023-40813-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 08/11/2023] [Indexed: 09/03/2023] Open
Abstract
Stereotactic ablative radiotherapy (SABR) is a standard-of-care for medically-inoperable-early-stage non-small cell lung cancer (NSCLC). One third of patients progress and chemotherapy is rarely used in this population. We questioned if addition of the immune-checkpoint-inhibitor (ICI) atezolizumab to standard-of-care SABR can improve outcomes. We initiated a multi-institutional single-arm phase I study (NCT02599454) enrolling twenty patients with the primary endpoint of maximum tolerated dose (MTD); secondary endpoints of safety and efficacy; and exploratory mechanistic correlatives. Treatment is well tolerated and full dose atezolizumab (1200 mg) is the MTD. Efficacy signals include early responses (after 2 cycles of ICI, before initiation of SABR) in 17% of patients. Biomarkers of functional adaptive immunity, including T cell activation in the tumor and response to ex-vivo stimulation by circulating T cells, are highly predictive of benefit. These results require validation and are being tested in a phase III randomized trial.
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Affiliation(s)
| | | | | | | | | | | | | | - Amin Mirhadi
- Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
| | | | | | - Shuai Chen
- UC Davis Health, Sacramento, CA, 95817, USA
| | - David Eastham
- David Grant USAF Medical Center, Travis AFB, Fairfield, CA, 93405, USA
| | | | | | | | | | | | | | | | | | | | | | - Karen Kelly
- UC Davis Health, Sacramento, CA, 95817, USA
- International Association for the Study of Lung Cancer, Denver, CO, 80202, USA
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Cruz SM, Sholevar CJ, Judge SJ, Darrow MA, Iranpur KR, Farley LE, Lammers M, Razmara AM, Dunai C, Gingrich AA, Persky J, Mori H, Thorpe SW, Monjazeb AM, Murphy WJ, Canter RJ. Intratumoral NKp46 + natural killer cells are spatially distanced from T and MHC-I + cells with prognostic implications in soft tissue sarcoma. Front Immunol 2023; 14:1230534. [PMID: 37545516 PMCID: PMC10401426 DOI: 10.3389/fimmu.2023.1230534] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 07/04/2023] [Indexed: 08/08/2023] Open
Abstract
Introduction Soft tissue sarcomas (STS) are rare, heterogenous malignancies with an unmet need for novel immunotherapies. Tumor infiltrating lymphocytes (TILs) have been linked with favorable outcomes in STS patients, though the contribution of natural killer (NK) cells and spatial relationships of TILs with MHC-I expressing cells lacks detailed characterization. Experimental design Using archived and prospectively collected specimens, we evaluated intratumoral NK cells by immunohistochemistry (IHC), flow cytometry, and immunofluorescence (IF). We assessed spatial localization of NK and T cells by multiplex IF, analyzing the effects of MHC-I expression status on NK and T cell clustering. Results Both intratumoral NKp46 and CD56dim expression were associated with significantly improved overall survival (P=0.05), while higher infiltrates of CD56bright NK cells predicted a worse prognosis (P=0.05). The presence of intratumoral NK cells was inversely proportional to CD3+ T cells. Spatial analyses showed NK cells preferentially clustering close to other NK cells with sparse CD3+ T and CD8+ T cells in range (P<0.0001). Additionally, CD3+ T and CD8+ T cells showed significantly greater co-localization with MHC-I+ cells, compared to NK cells (P<0.0001). After neoadjuvant radiotherapy, there was greater CD8 clustering, while after neoadjuvant chemotherapy, there was overall lower TIL clustering. Conclusion Intratumoral NK cells are prognostic in STS and localize closer to MHC-I- cells than T cells. Although both NK and T cells are associated with improved survival in STS, their differential distribution in the TME based on MHC-I expression status may serve as a biomarker for improved immunotherapy treatment selection.
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Affiliation(s)
- Sylvia M. Cruz
- Division of Surgical Oncology, Department of Surgery, University of California, Davis, Sacramento, CA, United States
| | - Cyrus J. Sholevar
- Division of Surgical Oncology, Department of Surgery, University of California, Davis, Sacramento, CA, United States
| | - Sean J. Judge
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Morgan A. Darrow
- Pathology and Laboratory Medicine, University of California, Davis, Sacramento, CA, United States
| | - Khurshid R. Iranpur
- Division of Surgical Oncology, Department of Surgery, University of California, Davis, Sacramento, CA, United States
| | - Lauren E. Farley
- Division of Surgical Oncology, Department of Surgery, University of California, Davis, Sacramento, CA, United States
| | - Marshall Lammers
- Division of Surgical Oncology, Department of Surgery, University of California, Davis, Sacramento, CA, United States
| | - Aryana M. Razmara
- Division of Surgical Oncology, Department of Surgery, University of California, Davis, Sacramento, CA, United States
| | - Cordelia Dunai
- Department of Dermatology, University of California, Davis, Sacramento, CA, United States
| | - Alicia A. Gingrich
- Department of Surgical Oncology, MD Anderson Cancer Center, Houston, TX, United States
| | - Julia Persky
- Division of Surgical Oncology, Department of Surgery, University of California, Davis, Sacramento, CA, United States
| | - Hidetoshi Mori
- Center for Immunology and Infectious Diseases, University of California, Davis, Sacramento, CA, United States
| | - Steven W. Thorpe
- Orthopedic Surgery, University of California, Davis, Sacramento, CA, United States
| | - Arta M. Monjazeb
- Radiation Oncology, University of California, Davis, Sacramento, CA, United States
| | - William J. Murphy
- Department of Dermatology, University of California, Davis, Sacramento, CA, United States
| | - Robert J. Canter
- Division of Surgical Oncology, Department of Surgery, University of California, Davis, Sacramento, CA, United States
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10
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Wang CX, Hunt J, Feinstein S, Kim SK, Monjazeb AM. Advances in Radiotherapy Immune Modulation: From Bench-to-Bedside and Back Again. Surg Oncol Clin N Am 2023; 32:617-629. [PMID: 37182996 DOI: 10.1016/j.soc.2023.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Pre-clinical and clinical data clearly demonstrate the immune modulatory effects of radiotherapy (RT) but clinical trials testing RT + immunotherapy have been equivocal. An improved understanding of the immune modulatory effects of RT and how practical parameters of RT delivery (site and number of lesions, dose, fractionation, timing) influence these effects are needed to optimally combine RT with immunotherapy. Additionally, increased exploration of immunotherapy combinations with RT, beyond immune checkpoint inhibitors, are needed. A "bench-to-bedside and back again" approach will improve our understanding of RT immune modulation and allow for the implementation of more effective RT + immunotherapy strategies.
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Affiliation(s)
- Charles X Wang
- UC Davis Health, Department of Radiation Oncology, 4501 X-Street, Sacramento, CA 95817, USA
| | - Jared Hunt
- UC Davis Health, Department of Radiation Oncology, 4501 X-Street, Sacramento, CA 95817, USA
| | - Shera Feinstein
- UC Davis Health, Department of Radiation Oncology, 4501 X-Street, Sacramento, CA 95817, USA
| | - Soo Kyoung Kim
- UC Davis Health, Department of Radiation Oncology, 4501 X-Street, Sacramento, CA 95817, USA
| | - Arta M Monjazeb
- UC Davis Health, Department of Radiation Oncology, 4501 X-Street, Sacramento, CA 95817, USA.
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11
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Rosario SR, Dong B, Zhang Y, Hsiao HH, Isenhart E, Wang J, Siegel EM, Monjazeb AM, Owen DH, Dey P, Tabung FK, Spakowicz DJ, Murphy WJ, Edge S, Yendamuri S, Ibrahimi S, Kolesar JM, McDonald PH, Vadehra D, Churchman M, Liu S, Kalinski P, Mukherjee S. Metabolic Dysregulation Explains the Diverse Impacts of Obesity in Males and Females with Gastrointestinal Cancers. Int J Mol Sci 2023; 24:10847. [PMID: 37446025 PMCID: PMC10342094 DOI: 10.3390/ijms241310847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/09/2023] [Accepted: 06/24/2023] [Indexed: 07/15/2023] Open
Abstract
The prevalence of obesity, defined as the body mass index (BMI) ≥ 30 kg/m2, has reached epidemic levels. Obesity is associated with an increased risk of various cancers, including gastrointestinal ones. Recent evidence has suggested that obesity disproportionately impacts males and females with cancer, resulting in varied transcriptional and metabolic dysregulation. This study aimed to elucidate the differences in the metabolic milieu of adenocarcinomas of the gastrointestinal (GI) tract both related and unrelated to sex in obesity. To demonstrate these obesity and sex-related effects, we utilized three primary data sources: serum metabolomics from obese and non-obese patients assessed via the Biocrates MxP Quant 500 mass spectrometry-based kit, the ORIEN tumor RNA-sequencing data for all adenocarcinoma cases to assess the impacts of obesity, and publicly available TCGA transcriptional analysis to assess GI cancers and sex-related differences in GI cancers specifically. We applied and integrated our unique transcriptional metabolic pipeline in combination with our metabolomics data to reveal how obesity and sex can dictate differential metabolism in patients. Differentially expressed genes (DEG) analysis of ORIEN obese adenocarcinoma as compared to normal-weight adenocarcinoma patients resulted in large-scale transcriptional reprogramming (4029 DEGs, adj. p < 0.05 and |logFC| > 0.58). Gene Set Enrichment and metabolic pipeline analysis showed genes enriched for pathways relating to immunity (inflammation, and CD40 signaling, among others) and metabolism. Specifically, we found alterations to steroid metabolism and tryptophan/kynurenine metabolism in obese patients, both of which are highly associated with disease severity and immune cell dysfunction. These findings were further confirmed using the TCGA colorectal adenocarcinoma (CRC) and esophageal adenocarcinoma (ESCA) data, which showed similar patterns of increased tryptophan catabolism for kynurenine production in obese patients. These patients further showed disparate alterations between males and females when comparing obese to non-obese patient populations. Alterations to immune and metabolic pathways were validated in six patients (two obese and four normal weight) via CD8+/CD4+ peripheral blood mononuclear cell RNA-sequencing and paired serum metabolomics, which showed differential kynurenine and lipid metabolism, which corresponded with altered T-cell transcriptome in obese populations. Overall, obesity is associated with differential transcriptional and metabolic programs in various disease sites. Further, these alterations, such as kynurenine and tryptophan metabolism, which impact both metabolism and immune phenotype, vary with sex and obesity together. This study warrants further in-depth investigation into obesity and sex-related alterations in cancers that may better define biomarkers of response to immunotherapy.
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Affiliation(s)
- Spencer R. Rosario
- Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (S.R.R.); (Y.Z.); (H.-H.H.); (E.I.); (J.W.); (S.L.)
- Department of Pharmacology and Therapeutics, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA
| | - Bowen Dong
- Department of Immunology, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (B.D.); (P.D.); (P.K.)
| | - Yali Zhang
- Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (S.R.R.); (Y.Z.); (H.-H.H.); (E.I.); (J.W.); (S.L.)
| | - Hua-Hsin Hsiao
- Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (S.R.R.); (Y.Z.); (H.-H.H.); (E.I.); (J.W.); (S.L.)
| | - Emily Isenhart
- Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (S.R.R.); (Y.Z.); (H.-H.H.); (E.I.); (J.W.); (S.L.)
| | - Jianmin Wang
- Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (S.R.R.); (Y.Z.); (H.-H.H.); (E.I.); (J.W.); (S.L.)
| | - Erin M. Siegel
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA;
| | - Arta M. Monjazeb
- Department of Radiation Oncology, University of California Davis, Sacramento, CA 95616, USA;
| | - Dwight H. Owen
- Department of Medical Oncology, Ohio State University Comprehensive Cancer Center, Columbus, OH 43210, USA; (D.H.O.); (D.J.S.)
| | - Prasenjit Dey
- Department of Immunology, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (B.D.); (P.D.); (P.K.)
| | - Fred K. Tabung
- Department of Epidemiology, Ohio State University Comprehensive Cancer Center, Columbus, OH 43210, USA;
| | - Daniel J. Spakowicz
- Department of Medical Oncology, Ohio State University Comprehensive Cancer Center, Columbus, OH 43210, USA; (D.H.O.); (D.J.S.)
| | - William J. Murphy
- Department of Immunology, University of California Davis, Sacramento, CA 95616, USA;
| | - Stephen Edge
- Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA;
| | - Sai Yendamuri
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA;
| | - Sami Ibrahimi
- Department of Medicine, Oklahoma University Health Stephenson Cancer Center, Oklahoma City, OK 73104, USA;
| | - Jill M. Kolesar
- Department of Pharmacy, University of Kentucky College of Pharmacy, Lexington, KY 40506, USA;
| | - Patsy H. McDonald
- Department of Cancer Biology, Moffitt Cancer Center, Tampa, FL 33612, USA;
| | - Deepak Vadehra
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA;
| | - Michelle Churchman
- Precision Therapy and Diagnostics, Aster Insights, Hudson, FL 34667, USA;
| | - Song Liu
- Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (S.R.R.); (Y.Z.); (H.-H.H.); (E.I.); (J.W.); (S.L.)
| | - Pawel Kalinski
- Department of Immunology, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (B.D.); (P.D.); (P.K.)
| | - Sarbajit Mukherjee
- Department of Immunology, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (B.D.); (P.D.); (P.K.)
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA;
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12
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Vick LV, Collins CP, Khuat LT, Wang Z, Dunai C, Aguilar EG, Stoffel K, Yendamuri S, Smith R, Mukherjee S, Barbi J, Canter RJ, Monjazeb AM, Murphy WJ. Aging augments obesity-induced thymic involution and peripheral T cell exhaustion altering the "obesity paradox". Front Immunol 2023; 13:1012016. [PMID: 36776393 PMCID: PMC9910174 DOI: 10.3389/fimmu.2022.1012016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 12/07/2022] [Indexed: 01/28/2023] Open
Abstract
Introduction The incidence of obesity, a condition characterized by systemic chronic inflammation, has reached pandemic proportions and is a poor prognostic factor in many pathologic states. However, its role on immune parameters has been diverse and at times contradictory. We have previously demonstrated that obesity can result in what has been called the "obesity paradox" which results in increased T cell exhaustion, but also greater efficacy of immune checkpoint blockade in cancer treatment. Methods The role of obesity, particularly in the context of aging, has not been robustly explored using preclinical models. We therefore evaluated how age impacts the immune environment on T cell development and function using diet-induced obese (DIO) mice. Results We observed that DIO mice initially displayed greater thymopoiesis but then developed greater thymic involution over time compared to their lean counterparts. Both aging and obesity resulted in increased T cell memory conversion combined with increased expression of T cell exhaustion markers and Treg expansion. This increased T cell immunosuppression with age then resulted in a loss of anti-tumor efficacy by immune checkpoint inhibitors (ICIs) in older DIO mice compared to the younger DIO counterparts. Discussion These results suggest that both aging and obesity contribute to T cell dysfunction resulting in increased thymic involution. This combined with increased T cell exhaustion and immunosuppressive parameters affects immunotherapy efficacy reducing the advantage of obesity in cancer immunotherapy responses.
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Affiliation(s)
- Logan V. Vick
- Department of Dermatology, University of California Davis School of Medicine, Sacramento, CA, United States
| | - Craig P. Collins
- Department of Dermatology, University of California Davis School of Medicine, Sacramento, CA, United States
| | - Lam T. Khuat
- Department of Dermatology, University of California Davis School of Medicine, Sacramento, CA, United States
| | - Ziming Wang
- Department of Dermatology, University of California Davis School of Medicine, Sacramento, CA, United States
| | - Cordelia Dunai
- Department of Dermatology, University of California Davis School of Medicine, Sacramento, CA, United States
| | - Ethan G. Aguilar
- Department of Dermatology, University of California Davis School of Medicine, Sacramento, CA, United States
| | - Kevin Stoffel
- Department of Dermatology, University of California Davis School of Medicine, Sacramento, CA, United States
| | - Sai Yendamuri
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Randall Smith
- Department of Immunology Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Sarbajit Mukherjee
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Joseph Barbi
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
- Department of Immunology Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Robert J. Canter
- Division of Surgical Oncology, Department of Surgery, University of California Davis Comprehensive Cancer Center, University of California Davis School of Medicine, Sacramento, CA, United States
| | - Arta M. Monjazeb
- Department of Radiation Oncology, University of California Davis Comprehensive Cancer Center, University of California School of Medicine, Sacramento, CA, United States
| | - William J. Murphy
- Department of Dermatology, University of California Davis School of Medicine, Sacramento, CA, United States
- Department of Internal Medicine, Division of Hematology and Oncology, University of California Davis School of Medicine, Sacramento, CA, United States
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13
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Le ST, Ji-Xu A, Liakos W, Toussi AM, Cheng MY, Ma C, Wang EA, Wilken R, Boddu S, Downing L, Kao J, Davis JR, Monjazeb AM, Fung MA, Konia TH, Maverakis E, Kirane AR. Intralesional Interleukin-2 Augmentation Therapy in Treatment-Refractory Melanoma. Dermatol Ther 2022; 35:e15853. [PMID: 36151592 DOI: 10.1111/dth.15853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 09/20/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Stephanie T Le
- Department of Dermatology, UC Davis School of Medicine, Sacramento, CA
| | - Antonio Ji-Xu
- Department of Dermatology, UC Davis School of Medicine, Sacramento, CA
| | - William Liakos
- Department of Dermatology, UC Davis School of Medicine, Sacramento, CA
| | - Atrin M Toussi
- Department of Dermatology, UC Davis School of Medicine, Sacramento, CA
| | - Michelle Y Cheng
- Department of Dermatology, UC Davis School of Medicine, Sacramento, CA
| | - Chelsea Ma
- Department of Dermatology, Stanford University School of Medicine, Palo Alto, CA
| | - Elizabeth A Wang
- Department of Dermatology, Stanford University School of Medicine, Palo Alto, CA
| | - Reason Wilken
- Department of Dermatology, Northwell Health, New York, NY
| | | | - Lauren Downing
- Department of Dermatology, UC Davis School of Medicine, Sacramento, CA
| | - Jason Kao
- Department of Hematology/Oncology, Stanford University School of Medicine, Palo Alto, CA
| | - Julian R Davis
- Department of Internal Medicine, UC Davis School of Medicine, Sacramento, CA
| | - Arta M Monjazeb
- Department of Radiation Oncology, UC Davis School of Medicine, Sacramento, CA
| | - Maxwell A Fung
- Department of Dermatology, UC Davis School of Medicine, Sacramento, CA
| | - Thomas H Konia
- Department of Dermatology, UC Davis School of Medicine, Sacramento, CA
| | - Emanual Maverakis
- Department of Dermatology, UC Davis School of Medicine, Sacramento, CA
| | - Amanda R Kirane
- Department of Surgery, Stanford University School of Medicine, Palo Alto, CA
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14
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Jawad MU, Zeitlinger LN, Bewley AF, O’Donnell EF, Traven SA, Carr-Ascher JR, Monjazeb AM, Canter RJ, Thorpe SW, Randall RL. Head and Neck Cutaneous Soft-Tissue Sarcoma Demonstrate Sex and Racial/Ethnic Disparities in Incidence and Socioeconomic Disparities in Survival. J Clin Med 2022; 11:jcm11185475. [PMID: 36143122 PMCID: PMC9501210 DOI: 10.3390/jcm11185475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/15/2022] [Accepted: 09/16/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Cutaneous soft-tissue sarcoma (CSTS) of the head and neck are rare and are known to have aggressive clinical course. The current study utilizes a population-based registry in the U.S. to characterize these malignancies and explore disparities. Methods: National Cancer Institute’s (NCI) Surveillance, Epidemiology and End Result (SEER) database from 2000 to 2018 was queried to report incidence and survival data in 4253 cases in the U.S. Results: Males were 5.37 times more likely and Non-Hispanic-White people (NHW) were 4.62 times more likely than females and Non-Hispanic-Black people (NHB) to develop CSTS of the head and neck. The overall incidence was 0.27 per 100,000 persons in 2018, with a significant increase since 2000. Advanced age and stage, histologic group other than ‘fibromatous sarcoma’ and lower SES groups were independent factors for worse overall survival. Conclusions: CSTS of the head and neck demonstrate sex and racial/ethnic disparities in incidence and socioeconomic disparities in overall survival. Level of evidence: II.
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Affiliation(s)
- Muhammad Umar Jawad
- Department of Orthopaedic Surgery, Good Samaritan Regional Medical Center, Corvallis, OR 97333, USA
| | - Lauren N. Zeitlinger
- Department of Orthopaedic Surgery, University of California-Davis, Sacramento, CA 95817, USA
| | - Arnaud F. Bewley
- Department of Otolaryngology, University of California-Davis, Sacramento, CA 95817, USA
| | - Edmond F. O’Donnell
- Department of Orthopaedic Surgery, University of California-Davis, Sacramento, CA 95817, USA
| | - Sophia A. Traven
- Department of Orthopaedic Surgery, University of California-Davis, Sacramento, CA 95817, USA
| | - Janai R. Carr-Ascher
- Department of Orthopaedic Surgery, University of California-Davis, Sacramento, CA 95817, USA
- Department of Medicine, University of California-Davis, Sacramento, CA 95817, USA
| | - Arta M. Monjazeb
- Department of Radiation Oncology, University of California-Davis, Sacramento, CA 95817, USA
| | - Robert J. Canter
- Department of Surgery-General, University of California-Davis, Sacramento, CA 95817, USA
| | - Steven W. Thorpe
- Department of Orthopaedic Surgery, University of California-Davis, Sacramento, CA 95817, USA
| | - R. Lor Randall
- Department of Orthopaedic Surgery, University of California-Davis, Sacramento, CA 95817, USA
- Correspondence:
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15
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Judge SJ, Bloomstein JD, Sholevar CJ, Darrow MA, Stoffel KM, Vick LV, Dunai C, Cruz SM, Razmara AM, Monjazeb AM, Rebhun RB, Murphy WJ, Canter RJ. Transcriptome Analysis of Tumor-Infiltrating Lymphocytes Identifies NK Cell Gene Signatures Associated With Lymphocyte Infiltration and Survival in Soft Tissue Sarcomas. Front Immunol 2022; 13:893177. [PMID: 35874727 PMCID: PMC9300876 DOI: 10.3389/fimmu.2022.893177] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 06/16/2022] [Indexed: 01/26/2023] Open
Abstract
Purpose Clinical successes using current T-cell based immunotherapies have been limited in soft tissue sarcomas (STS), while pre-clinical studies have shown evidence of natural killer (NK) cell activity. Since tumor immune infiltration, especially tumor-infiltrating lymphocytes, is associated with improved survival in most solid tumors, we sought to evaluate the gene expression profile of tumor and blood NK and T cells, as well as tumor cells, with the goal of identifying potential novel immune targets in STS. Experimental Design Using fluorescence-activated cell sorting, we isolated blood and tumor-infiltrating CD3-CD56+ NK and CD3+ T cells and CD45- viable tumor cells from STS patients undergoing surgery. We then evaluated differential gene expression (DGE) of these purified populations with RNA sequencing analysis. To evaluate survival differences and validate primary DGE results, we also queried The Cancer Genome Atlas (TCGA) database to compare outcomes stratified by bulk gene expression. Results Sorted intra-tumoral CD3+ T cells showed significant upregulation of established activating (CD137) and inhibitory genes (TIM-3) compared to circulating T cells. In contrast, intra-tumoral NK cells did not exhibit upregulation of canonical cytotoxic genes (IFNG, GZMB), but rather significant DGE in mitogen signaling (DUSP4) and metabolic function (SMPD3, SLC7A5). Tumors with higher NK and T cell infiltration exhibited significantly increased expression of the pro-inflammatory receptor TLR4 in sorted CD45- tumor cells. TCGA analysis revealed that tumors with high TLR4 expression (P = 0.03) and low expression of STMN1 involved in microtubule polymerization (P < 0.001) were associated with significantly improved survival. Conclusions Unlike T cells, which demonstrate significant DGE consistent with upregulation of both activating and inhibiting receptors in tumor-infiltrating subsets, NK cells appear to have more stable gene expression between blood and tumor subsets, with alterations restricted primarily to metabolic pathways. Increased immune cell infiltration and improved survival were positively correlated with TLR4 expression and inversely correlated with STMN1 expression within tumors, suggesting possible novel therapeutic targets for immunotherapy in STS.
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Affiliation(s)
- Sean J. Judge
- Division of Surgical Oncology, Department of Surgery, University of California, Davis, Sacramento, CA, United States
| | - Joshua D. Bloomstein
- Division of Surgical Oncology, Department of Surgery, University of California, Davis, Sacramento, CA, United States
| | - Cyrus J. Sholevar
- Division of Surgical Oncology, Department of Surgery, University of California, Davis, Sacramento, CA, United States
| | - Morgan A. Darrow
- Department of Pathology and Laboratory Medicine, University of California, Davis, Sacramento, CA, United States
| | - Kevin M. Stoffel
- Department of Dermatology, University of California, Davis, Sacramento, CA, United States
| | - Logan V. Vick
- Department of Dermatology, University of California, Davis, Sacramento, CA, United States
| | - Cordelia Dunai
- Department of Dermatology, University of California, Davis, Sacramento, CA, United States
| | - Sylvia M. Cruz
- Division of Surgical Oncology, Department of Surgery, University of California, Davis, Sacramento, CA, United States
| | - Aryana M. Razmara
- Division of Surgical Oncology, Department of Surgery, University of California, Davis, Sacramento, CA, United States
| | - Arta M. Monjazeb
- Department of Radiation Oncology, University of California, Davis, Sacramento, CA, United States
| | - Robert B. Rebhun
- Center for Companion Animal Health, Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - William J. Murphy
- Department of Dermatology, University of California, Davis, Sacramento, CA, United States,Division of Hematology and Oncology, Department of Medicine, University of California, Davis, Sacramento, CA, United States
| | - Robert J. Canter
- Division of Surgical Oncology, Department of Surgery, University of California, Davis, Sacramento, CA, United States,*Correspondence: Robert J. Canter,
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16
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Jiang N, Xie B, Xiao W, Fan M, Xu S, Duan Y, Hamsafar Y, Evans AC, Huang J, Zhou W, Lin X, Ye N, Wanggou S, Chen W, Jing D, Fragoso RC, Dugger BN, Wilson PF, Coleman MA, Xia S, Li X, Sun LQ, Monjazeb AM, Wang A, Murphy WJ, Kung HJ, Lam KS, Chen HW, Li JJ. Fatty acid oxidation fuels glioblastoma radioresistance with CD47-mediated immune evasion. Nat Commun 2022; 13:1511. [PMID: 35314680 PMCID: PMC8938495 DOI: 10.1038/s41467-022-29137-3] [Citation(s) in RCA: 69] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 02/25/2022] [Indexed: 02/07/2023] Open
Abstract
Glioblastoma multiforme (GBM) remains the top challenge to radiotherapy with only 25% one-year survival after diagnosis. Here, we reveal that co-enhancement of mitochondrial fatty acid oxidation (FAO) enzymes (CPT1A, CPT2 and ACAD9) and immune checkpoint CD47 is dominant in recurrent GBM patients with poor prognosis. A glycolysis-to-FAO metabolic rewiring is associated with CD47 anti-phagocytosis in radioresistant GBM cells and regrown GBM after radiation in syngeneic mice. Inhibition of FAO by CPT1 inhibitor etomoxir or CRISPR-generated CPT1A-/-, CPT2-/-, ACAD9-/- cells demonstrate that FAO-derived acetyl-CoA upregulates CD47 transcription via NF-κB/RelA acetylation. Blocking FAO impairs tumor growth and reduces CD47 anti-phagocytosis. Etomoxir combined with anti-CD47 antibody synergizes radiation control of regrown tumors with boosted macrophage phagocytosis. These results demonstrate that enhanced fat acid metabolism promotes aggressive growth of GBM with CD47-mediated immune evasion. The FAO-CD47 axis may be targeted to improve GBM control by eliminating the radioresistant phagocytosis-proofing tumor cells in GBM radioimmunotherapy.
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Affiliation(s)
- Nian Jiang
- grid.27860.3b0000 0004 1936 9684Department of Radiation Oncology, University of California Davis School of Medicine, Sacramento, CA 95817 USA ,grid.216417.70000 0001 0379 7164Department of Neurosurgery, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan 410008 PR China
| | - Bowen Xie
- grid.27860.3b0000 0004 1936 9684Department of Radiation Oncology, University of California Davis School of Medicine, Sacramento, CA 95817 USA ,grid.12527.330000 0001 0662 3178Institute for Immunology and School of Medicine, Tsinghua University, Beijing, 100084 PR China
| | - Wenwu Xiao
- grid.27860.3b0000 0004 1936 9684Department of Biochemistry and Molecular Medicine, University of California Davis, Sacramento, CA 95817 USA
| | - Ming Fan
- grid.27860.3b0000 0004 1936 9684Department of Radiation Oncology, University of California Davis School of Medicine, Sacramento, CA 95817 USA
| | - Shanxiu Xu
- grid.27860.3b0000 0004 1936 9684Department of Surgery, School of Medicine, University of California Davis, Sacramento, CA 95817 USA
| | - Yixin Duan
- grid.27860.3b0000 0004 1936 9684Department of Radiation Oncology, University of California Davis School of Medicine, Sacramento, CA 95817 USA
| | - Yamah Hamsafar
- grid.27860.3b0000 0004 1936 9684Department of Pathology and Laboratory Medicine, University of California Davis, Sacramento, CA 95817 USA
| | - Angela C. Evans
- grid.27860.3b0000 0004 1936 9684Department of Radiation Oncology, University of California Davis School of Medicine, Sacramento, CA 95817 USA
| | - Jie Huang
- grid.27860.3b0000 0004 1936 9684Department of Radiation Oncology, University of California Davis School of Medicine, Sacramento, CA 95817 USA
| | - Weibing Zhou
- grid.27860.3b0000 0004 1936 9684Department of Radiation Oncology, University of California Davis School of Medicine, Sacramento, CA 95817 USA ,grid.216417.70000 0001 0379 7164Department of Radiation Oncology, Xiangya Hospital, Central South University, Changsha, Hunan 410008 PR China
| | - Xuelei Lin
- grid.216417.70000 0001 0379 7164Department of Neurosurgery, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan 410008 PR China
| | - Ningrong Ye
- grid.216417.70000 0001 0379 7164Department of Neurosurgery, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan 410008 PR China
| | - Siyi Wanggou
- grid.216417.70000 0001 0379 7164Department of Neurosurgery, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan 410008 PR China
| | - Wen Chen
- grid.27860.3b0000 0004 1936 9684Department of Radiation Oncology, University of California Davis School of Medicine, Sacramento, CA 95817 USA ,grid.216417.70000 0001 0379 7164Department of Radiation Oncology, Xiangya Hospital, Central South University, Changsha, Hunan 410008 PR China
| | - Di Jing
- grid.27860.3b0000 0004 1936 9684Department of Biochemistry and Molecular Medicine, University of California Davis, Sacramento, CA 95817 USA ,grid.216417.70000 0001 0379 7164Department of Radiation Oncology, Xiangya Hospital, Central South University, Changsha, Hunan 410008 PR China
| | - Ruben C. Fragoso
- grid.27860.3b0000 0004 1936 9684Department of Radiation Oncology, University of California Davis School of Medicine, Sacramento, CA 95817 USA ,grid.27860.3b0000 0004 1936 9684NCI-Designated Comprehensive Cancer Center, University of California Davis, Sacramento, CA 95817 USA
| | - Brittany N. Dugger
- grid.27860.3b0000 0004 1936 9684Department of Pathology and Laboratory Medicine, University of California Davis, Sacramento, CA 95817 USA
| | - Paul F. Wilson
- grid.27860.3b0000 0004 1936 9684Department of Radiation Oncology, University of California Davis School of Medicine, Sacramento, CA 95817 USA ,grid.27860.3b0000 0004 1936 9684NCI-Designated Comprehensive Cancer Center, University of California Davis, Sacramento, CA 95817 USA
| | - Matthew A. Coleman
- grid.27860.3b0000 0004 1936 9684Department of Radiation Oncology, University of California Davis School of Medicine, Sacramento, CA 95817 USA ,grid.27860.3b0000 0004 1936 9684NCI-Designated Comprehensive Cancer Center, University of California Davis, Sacramento, CA 95817 USA
| | - Shuli Xia
- grid.21107.350000 0001 2171 9311Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD 21205 USA
| | - Xuejun Li
- grid.216417.70000 0001 0379 7164Department of Neurosurgery, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan 410008 PR China ,grid.216417.70000 0001 0379 7164Hunan International Scientific and Technological Cooperation Base of Brain Tumor Research, Xiangya Hospital, Central South University, Changsha, Hunan 410008 PR China
| | - Lun-Quan Sun
- grid.216417.70000 0001 0379 7164Center for Molecular Medicine, Xiangya Hospital, Central South University, Changsha, Hunan 410008 PR China
| | - Arta M. Monjazeb
- grid.27860.3b0000 0004 1936 9684Department of Radiation Oncology, University of California Davis School of Medicine, Sacramento, CA 95817 USA ,grid.27860.3b0000 0004 1936 9684NCI-Designated Comprehensive Cancer Center, University of California Davis, Sacramento, CA 95817 USA
| | - Aijun Wang
- grid.27860.3b0000 0004 1936 9684Department of Surgery, School of Medicine, University of California Davis, Sacramento, CA 95817 USA
| | - William J. Murphy
- grid.27860.3b0000 0004 1936 9684NCI-Designated Comprehensive Cancer Center, University of California Davis, Sacramento, CA 95817 USA ,grid.27860.3b0000 0004 1936 9684Departments of Dermatology and Internal Medicine, UC Davis School of Medicine, Sacramento, CA 95817 USA
| | - Hsing-Jien Kung
- grid.27860.3b0000 0004 1936 9684Department of Biochemistry and Molecular Medicine, University of California Davis, Sacramento, CA 95817 USA ,grid.412896.00000 0000 9337 0481TMU Research Center of Cancer Translational Medicine, Taipei Medical University, Taipei, 110 Taiwan
| | - Kit S. Lam
- grid.27860.3b0000 0004 1936 9684Department of Biochemistry and Molecular Medicine, University of California Davis, Sacramento, CA 95817 USA ,grid.27860.3b0000 0004 1936 9684NCI-Designated Comprehensive Cancer Center, University of California Davis, Sacramento, CA 95817 USA
| | - Hong-Wu Chen
- grid.27860.3b0000 0004 1936 9684Department of Biochemistry and Molecular Medicine, University of California Davis, Sacramento, CA 95817 USA ,grid.27860.3b0000 0004 1936 9684NCI-Designated Comprehensive Cancer Center, University of California Davis, Sacramento, CA 95817 USA ,grid.413933.f0000 0004 0419 2847Veterans Affairs Northern California Health Care System, Mather, CA95655 USA
| | - Jian Jian Li
- Department of Radiation Oncology, University of California Davis School of Medicine, Sacramento, CA, 95817, USA. .,NCI-Designated Comprehensive Cancer Center, University of California Davis, Sacramento, CA, 95817, USA.
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Schoenfeld JD, Giobbie-Hurder A, Ranasinghe S, Kao KZ, Lako A, Tsuji J, Liu Y, Brennick RC, Gentzler RD, Lee C, Hubbard J, Arnold SM, Abbruzzese JL, Jabbour SK, Uboha NV, Stephans KL, Johnson JM, Park H, Villaruz LC, Sharon E, Streicher H, Ahmed MM, Lyon H, Cibuskis C, Lennon N, Jhaveri A, Yang L, Altreuter J, Gunasti L, Weirather JL, Mak RH, Awad MM, Rodig SJ, Chen HX, Wu CJ, Monjazeb AM, Hodi FS. Durvalumab plus tremelimumab alone or in combination with low-dose or hypofractionated radiotherapy in metastatic non-small-cell lung cancer refractory to previous PD(L)-1 therapy: an open-label, multicentre, randomised, phase 2 trial. Lancet Oncol 2022; 23:279-291. [PMID: 35033226 PMCID: PMC8813905 DOI: 10.1016/s1470-2045(21)00658-6] [Citation(s) in RCA: 113] [Impact Index Per Article: 56.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 11/03/2021] [Accepted: 11/04/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Patients with non-small-cell lung cancer (NSCLC) that is resistant to PD-1 and PD-L1 (PD[L]-1)-targeted therapy have poor outcomes. Studies suggest that radiotherapy could enhance antitumour immunity. Therefore, we investigated the potential benefit of PD-L1 (durvalumab) and CTLA-4 (tremelimumab) inhibition alone or combined with radiotherapy. METHODS This open-label, multicentre, randomised, phase 2 trial was done by the National Cancer Institute Experimental Therapeutics Clinical Trials Network at 18 US sites. Patients aged 18 years or older with metastatic NSCLC, an Eastern Cooperative Oncology Group performance status of 0 or 1, and progression during previous PD(L)-1 therapy were eligible. They were randomly assigned (1:1:1) in a web-based system by the study statistician using a permuted block scheme (block sizes of three or six) without stratification to receive either durvalumab (1500 mg intravenously every 4 weeks for a maximum of 13 cycles) plus tremelimumab (75 mg intravenously every 4 weeks for a maximum of four cycles) alone or with low-dose (0·5 Gy delivered twice per day, repeated for 2 days during each of the first four cycles of therapy) or hypofractionated radiotherapy (24 Gy total delivered over three 8-Gy fractions during the first cycle only), 1 week after initial durvalumab-tremelimumab administration. Study treatment was continued until 1 year or until progression. The primary endpoint was overall response rate (best locally assessed confirmed response of a partial or complete response) and, along with safety, was analysed in patients who received at least one dose of study therapy. The trial is registered with ClinicalTrials.gov, NCT02888743, and is now complete. FINDINGS Between Aug 24, 2017, and March 29, 2019, 90 patients were enrolled and randomly assigned, of whom 78 (26 per group) were treated. This trial was stopped due to futility assessed in an interim analysis. At a median follow-up of 12·4 months (IQR 7·8-15·1), there were no differences in overall response rates between the durvalumab-tremelimumab alone group (three [11·5%, 90% CI 1·2-21·8] of 26 patients) and the low-dose radiotherapy group (two [7·7%, 0·0-16·3] of 26 patients; p=0·64) or the hypofractionated radiotherapy group (three [11·5%, 1·2-21·8] of 26 patients; p=0·99). The most common grade 3-4 adverse events were dyspnoea (two [8%] in the durvalumab-tremelimumab alone group; three [12%] in the low-dose radiotherapy group; and three [12%] in the hypofractionated radiotherapy group) and hyponatraemia (one [4%] in the durvalumab-tremelimumab alone group vs two [8%] in the low-dose radiotherapy group vs three [12%] in the hypofractionated radiotherapy group). Treatment-related serious adverse events occurred in one (4%) patient in the durvalumab-tremelimumab alone group (maculopapular rash), five (19%) patients in the low-dose radiotherapy group (abdominal pain, diarrhoea, dyspnoea, hypokalemia, and respiratory failure), and four (15%) patients in the hypofractionated group (adrenal insufficiency, colitis, diarrhoea, and hyponatremia). In the low-dose radiotherapy group, there was one death from respiratory failure potentially related to study therapy. INTERPRETATION Radiotherapy did not increase responses to combined PD-L1 plus CTLA-4 inhibition in patients with NSCLC resistant to PD(L)-1 therapy. However, PD-L1 plus CTLA-4 therapy could be a treatment option for some patients. Future studies should refine predictive biomarkers in this setting. FUNDING The US National Institutes of Health and the Dana-Farber Cancer Institute.
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Affiliation(s)
- Jonathan D Schoenfeld
- Department of Radiation Oncology, Brigham and Women's Hospital, Boston, MA, USA; Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
| | | | - Srinika Ranasinghe
- Center for Immuno-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Katrina Z Kao
- Center for Immuno-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Ana Lako
- Center for Immuno-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Junko Tsuji
- Genomics Platform, Broad Institute, Cambridge, MA, USA
| | - Yang Liu
- Department of Data Science, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Ryan C Brennick
- Center for Immuno-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Ryan D Gentzler
- Division of Hematology/Oncology, University of Virginia Cancer Center, Charlottesville, VA, USA
| | - Carrie Lee
- Division of Hematology/Oncology, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Joleen Hubbard
- Department of Medical Oncology, Mayo Clinic, Rochester, MN, USA
| | - Susanne M Arnold
- Division of Medical Oncology, University of Kentucky Markey Cancer Center, Lexington, KY, USA
| | | | - Salma K Jabbour
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Nataliya V Uboha
- Department of Medicine, University of Wisconsin Carbone Cancer Center, University of Wisconsin School of Medicine, Madison, WI, USA
| | - Kevin L Stephans
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, OH, USA
| | - Jennifer M Johnson
- Department of Medical Oncology, Sidney Kimmel Cancer Center-Jefferson Health, Philadelphia, PA, USA
| | - Haeseong Park
- Division of Oncology, Siteman Cancer Center, Washington University, Saint Louis, MO, USA
| | - Liza C Villaruz
- Division of Hematology/Oncology, University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh, PA, USA
| | - Elad Sharon
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD, USA
| | - Howard Streicher
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD, USA
| | - Mansoor M Ahmed
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD, USA
| | - Hayley Lyon
- Genomics Platform, Broad Institute, Cambridge, MA, USA
| | | | - Niall Lennon
- Genomics Platform, Broad Institute, Cambridge, MA, USA
| | - Aashna Jhaveri
- Department of Data Science, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Lin Yang
- Department of Data Science, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Jennifer Altreuter
- Department of Data Science, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Lauren Gunasti
- Department of Radiation Oncology, Brigham and Women's Hospital, Boston, MA, USA; Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Jason L Weirather
- Department of Data Science, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Raymond H Mak
- Department of Radiation Oncology, Brigham and Women's Hospital, Boston, MA, USA; Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Mark M Awad
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Scott J Rodig
- Center for Immuno-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Helen X Chen
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD, USA
| | - Catherine J Wu
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Arta M Monjazeb
- Department of Radiation Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, CA, USA
| | - F Stephen Hodi
- Center for Immuno-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
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Sparger EE, Chang H, Chin N, Rebhun RB, Withers SS, Kieu H, Canter RJ, Monjazeb AM, Kent MS. T Cell Immune Profiles of Blood and Tumor in Dogs Diagnosed With Malignant Melanoma. Front Vet Sci 2021; 8:772932. [PMID: 34926643 PMCID: PMC8674490 DOI: 10.3389/fvets.2021.772932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 11/05/2021] [Indexed: 11/29/2022] Open
Abstract
Investigation of canine T cell immunophenotypes in canine melanomas as prognostic biomarkers for disease progression or predictive biomarkers for targeted immunotherapeutics remains in preliminary stages. We aimed to examine T cell phenotypes and function in peripheral blood mononuclear cells (PBMC) and baseline tumor samples by flow cytometry, and to compare patient (n = 11–20) T cell phenotypes with healthy controls dogs (n = 10–20). CD3, CD4, CD8, CD25, FoxP3, Ki67, granzyme B, and interferon-γ (IFN-γ) were used to classify T cell subsets in resting and mitogen stimulated PBMCs. In a separate patient cohort (n = 11), T cells were classified using CD3, CD4, CD8, FoxP3, and granzyme B in paired PBMC and single cell suspensions of tumor samples. Analysis of flow cytometric data of individual T cell phenotypes in PBMC revealed specific T cell phenotypes including FoxP3+ and CD25+FoxP3- populations that distinguished patients from healthy controls. Frequencies of IFN-γ+ cells after ConA stimulation identified two different patient phenotypic responses, including a normal/exaggerated IFN-γ response and a lower response suggesting dysfunction. Principle component analysis of selected T cell immunophenotypes also distinguished patients and controls for T cell phenotype and revealed a clustering of patients based on metastasis detected at diagnosis. Findings supported the overall hypothesis that canine melanoma patients display a T cell immunophenotype profile that is unique from healthy pet dogs and will guide future studies designed with larger patient cohorts necessary to further characterize prognostic T cell immunophenotypes.
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Affiliation(s)
- Ellen E Sparger
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Hong Chang
- Center for Companion Animal Health, Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Ning Chin
- California National Primate Research Center, Department of Medical Microbiology and Immunology, University of California, Davis, Davis, CA, United States
| | - Robert B Rebhun
- Center for Companion Animal Health, Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Sita S Withers
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, United States
| | - Hung Kieu
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Robert J Canter
- Surgical Oncology, School of Medicine, University of California, Davis, Sacramento, CA, United States
| | - Arta M Monjazeb
- Radiation Oncology, School of Medicine, University of California, Davis, Sacramento, CA, United States
| | - Michael S Kent
- Center for Companion Animal Health, Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
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19
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Khuat LT, Vick LV, Dunai C, Collins CP, More SK, Le CT, Pai CCS, Stoffel KM, Maverakis E, Canter RJ, Monjazeb AM, Longo DL, Abedi M, Choi E, Blazar BR, Dave M, Murphy WJ. Increased efficacy of dual proinflammatory cytokine blockade on acute GVHD while maintaining GVT effects. Blood 2021; 138:2583-2588. [PMID: 34424962 PMCID: PMC8678998 DOI: 10.1182/blood.2021011216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 08/14/2021] [Indexed: 11/20/2022] Open
Abstract
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains a potential curative option for treating a variety of hematologic diseases, but acute and chronic graft-versus-host disease (GVHD) remain major barriers limiting efficacy. Acute gut GVHD occurs with marked increases in proinflammatory cytokines (including TNF and IL-6), which we recently demonstrated was exacerbated in obesity resulting in severe gastrointestinal pathology. Given the pleiotropic and overlapping effects of these 2 cytokines, we assessed the impact of dual TNF and IL-6R blockade on GVHD as well as graft-versus tumor (GVT) effects in different mouse GVHD models. Early administration of combined blockade resulted in greater protection and survival from acute gut GVHD compared with single blockade regimens and even development of later chronic skin GVHD. Importantly, double cytokine blockade preserved GVT effects reinforcing that GVT and GVHD can be delineated and may result in greater efficacy in allo-HSCT.
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Affiliation(s)
| | | | | | | | - Shyam K More
- Division of Gastroenterology, Department of Internal Medicine
| | | | | | | | | | | | - Arta M Monjazeb
- Department of Radiation Oncology, School of Medicine, University of California, Davis, Sacramento, CA
| | - Dan L Longo
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Mehrdad Abedi
- Department of Internal Medicine, School of Medicine, University of California, Davis, Sacramento, CA
| | - Eunju Choi
- Department of Pathology, Microbiology, and Immunology, University of California, Davis, Davis, CA; and
| | - Bruce R Blazar
- Masonic Cancer Center and Division of Blood and Marrow Transplantation and Cellular Therapy, Department of Pediatrics, University of Minnesota, Minneapolis, MN
| | - Maneesh Dave
- Division of Gastroenterology, Department of Internal Medicine
| | - William J Murphy
- Department of Dermatology
- Department of Internal Medicine, School of Medicine, University of California, Davis, Sacramento, CA
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20
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Khuat LT, Vick LV, Choi E, Dunai C, Merleev AA, Maverakis E, Blazar BR, Monjazeb AM, Murphy WJ. Mechanisms by Which Obesity Promotes Acute Graft- Versus-Host Disease in Mice. Front Immunol 2021; 12:752484. [PMID: 34707616 PMCID: PMC8542879 DOI: 10.3389/fimmu.2021.752484] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 09/17/2021] [Indexed: 02/02/2023] Open
Abstract
The efficacy of allogeneic hematopoietic stem cell transplantation (allo-HSCT) is limited by the occurrence of acute and chronic graft-versus-host disease (GVHD). We have recently demonstrated that obesity results in exacerbated acute gastrointestinal GVHD in both mouse models and clinical outcomes due to increased pro-inflammatory cytokine responses and microbiota alterations. We therefore wanted to delineate the role of the various parameters in obesity, adiposity, effects of high-fat (HF) diet, and the role of microbiome on GVHD pathogenesis, by taking advantage of a mouse strain resistant to diet-induced obesity (DIO). Female BALB/c mice are resistant to DIO phenotype with approximately 50% becoming DIO under HF diets. The DIO-susceptible recipients rapidly succumb to acute gut GVHD, whereas the DIO-resistant recipient littermates, which do not become obese, are partially protected from GVHD, indicating that being on HF diet alone contributes to but is not the primary driver of GVHD. Microbiome assessment revealed restricted diversity in both cohorts of mice, but coprophagy normalizes the microbiota in mice housed together. We then individually housed DIO-resistant, DIO-susceptible, and lean control mice. Notably, each of the individually housed groups demonstrates marked restricted diversity that has been shown to occur from the stress of single housing. Despite the restricted microbiome diversity, the GVHD pathogenesis profile remains consistent in the group-housed mice, with the lean control single-housed mice exhibiting no acute GVHD and DIO-resistant recipients showing again partial protection. These results demonstrate that the deleterious effects of obesity on acute gut GVHD are critically dependent on adiposity with the HF diet also playing a lesser role, and the microbiome alterations with obesity instead appear to fuel ongoing acute GVHD processes.
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Affiliation(s)
- Lam T Khuat
- Department of Dermatology, School of Medicine, University of California, Davis, Sacramento, CA, United States
| | - Logan V Vick
- Department of Dermatology, School of Medicine, University of California, Davis, Sacramento, CA, United States
| | - Eunju Choi
- Department of Pathology, Microbiology and Immunology, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Cordelia Dunai
- Department of Dermatology, School of Medicine, University of California, Davis, Sacramento, CA, United States
| | - Alexander A Merleev
- Department of Dermatology, School of Medicine, University of California, Davis, Sacramento, CA, United States
| | - Emanual Maverakis
- Department of Dermatology, School of Medicine, University of California, Davis, Sacramento, CA, United States
| | - Bruce R Blazar
- Masonic Cancer Center and Division of Blood & Marrow Transplant & Cellular Therapy, Department of Pediatrics, University of Minnesota, Minneapolis, MN, United States
| | - Arta M Monjazeb
- Department of Radiation Oncology, School of Medicine, University of California, Davis, Sacramento, CA, United States
| | - William J Murphy
- Department of Dermatology, School of Medicine, University of California, Davis, Sacramento, CA, United States.,Department of Internal Medicine, School of Medicine, University of California, Davis, Sacramento, CA, United States
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21
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Cruz SM, Basmaci UN, Bateni CP, Darrow MA, Judge SJ, Monjazeb AM, Thorpe SW, Humphries MD, Canter RJ. Surgical and oncologic outcomes following arterial resection and reconstruction for advanced solid tumors. J Surg Oncol 2021; 124:1251-1260. [PMID: 34495553 DOI: 10.1002/jso.26665] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 08/16/2021] [Accepted: 08/28/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND OBJECTIVES Although arterial involvement for advanced tumors is rare, vascular resection may be indicated to achieve complete tumor resection. Given the potential morbidity of this approach, we sought to evaluate perioperative outcomes, vascular graft patency, and survival among patients undergoing tumor excision with en bloc arterial resection and reconstruction. METHODS From 2010 to 2020, we identified nine patients with tumors encasing or extensively abutting major arterial structures for whom en bloc arterial resection and reconstruction was performed. RESULTS Mean age was 53 ± 20 years, and 89% were females. Diagnoses were primary sarcomas (5), recurrent gynecologic carcinomas (3), and benign retroperitoneal fibrosis (1). Tumors involved the infrarenal aorta (2), iliac arteries (6), and superficial femoral artery (1). Three patients (33%) had severe perioperative morbidity (Grade III + ) with no mortality. At a median follow-up of 23 months, eight patients (89%) had primary graft patency, and five patients (56%) had no evidence of disease. CONCLUSIONS Arterial resection and reconstruction as part of the multimodality treatment of regionally advanced tumors is associated with acceptable short- and long-term outcomes, including excellent graft patency. In appropriately selected patients, involvement of major arterial structures should not be viewed as a contraindication to attempted curative surgery.
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Affiliation(s)
- Sylvia M Cruz
- Department of Surgery, UC Davis School of Medicine, Sacramento, California, USA
| | - Ugur N Basmaci
- Department of Surgery, UC Davis School of Medicine, Sacramento, California, USA
| | - Cyrus P Bateni
- Division of Musculoskeletal Radiology, UC Davis Comprehensive Cancer Center, Sacramento, California, USA
| | - Morgan A Darrow
- Department of Pathology and Laboratory Medicine, UC Davis Medical Center, Sacramento, California, USA
| | - Sean J Judge
- Division of Surgical Oncology, UC Davis Comprehensive Cancer Center, Sacramento, California, USA
| | - Arta M Monjazeb
- Department of Radiation Oncology, UC Davis Medical Center, Sacramento, California, USA
| | - Steven W Thorpe
- Department of Orthopedic Surgery, UC Davis Medical Center, Sacramento, California, USA
| | - Misty D Humphries
- Division of Vascular and Endovascular Surgery, UC Davis Medical Center, Sacramento, California, USA
| | - Robert J Canter
- Division of Surgical Oncology, UC Davis Comprehensive Cancer Center, Sacramento, California, USA
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22
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Abstract
A malignant tumor consists of malignant cells as well as a wide array of normal host tissues including stroma, vasculature, and immune infiltrate. The interaction between cancer and these host tissues is critical as these host tissues play a variety of roles in supporting or resisting disease progression. Radiotherapy (RT) has direct effects on malignant cells, but, also, critically important effects on these other components of the tumor microenvironment (TME). Given the growing role of immune checkpoint inhibitors and other immunotherapy strategies, understanding how RT affects the TME, particularly the immune compartment, is essential to advance RT in this new era of cancer therapy. The interactions between RT and the TME are complex, affecting the innate and adaptive arms of the immune system. RT can induce both proinflammatory effects and immune suppressive effects that can either promote or impede antitumor immunity. It is likely that the initial proinflammatory effects of RT eventually lead to rebound immune-suppression as chronic inflammation sets in. The exact kinetics and nature of how RT changes the TME likely depends on timing, dose, fractionation, site irradiated, and tumor type. With increased understanding of the effects of RT on the TME, in the future it is likely that we will be able to personalize RT by varying the dose, site, and timing of intervention to generate the desired response to partner with immunotherapy strategies.
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Affiliation(s)
- Arta M Monjazeb
- UC Davis Comprehensive Cancer Center, Department of Radiation Oncology, Sacramento, CA.
| | - Kurt A Schalper
- Yale University School of Medicine, Department of Pathology, New Haven, CT
| | | | - Anthony Nguyen
- Cedars-Sinai Medical Center, Department of Radiation Oncology, Los Angeles, CA
| | - Stephen L Shiao
- Cedars-Sinai Medical Center, Department of Radiation Oncology, Los Angeles, CA
| | - Kristina Young
- Earle A. Chiles Research Institute, Providence Cancer Institute, Portland, OR; Radiation Oncology Division, The Oregon Clinic, Portland, OR
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23
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Monjazeb AM, Giobbie-Hurder A, Lako A, Thrash EM, Brennick RC, Kao KZ, Manuszak C, Gentzler RD, Tesfaye A, Jabbour SK, Alese OB, Rahma OE, Cleary JM, Sharon E, Mamon HJ, Cho M, Streicher H, Chen HX, Ahmed MM, Mariño-Enríquez A, Kim-Schulze S, Gnjatic S, Maverakis E, Marusina AI, Merleev AA, Severgnini M, Pfaff KL, Lindsay J, Weirather JL, Ranasinghe S, Spektor A, Rodig SJ, Hodi FS, Schoenfeld JD. Correction: A Randomized Trial of Combined PD-L1 and CTLA-4 Inhibition with Targeted Low-dose or Hypofractionated Radiation for Patients with Metastatic Colorectal Cancer. Clin Cancer Res 2021; 27:4940. [PMID: 34470811 DOI: 10.1158/1078-0432.ccr-21-2698] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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24
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Khuat LT, Le CT, Pai CCS, Shields-Cutler RR, Holtan SG, Rashidi A, Parker SL, Knights D, Luna JI, Dunai C, Wang Z, Sturgill IR, Stoffel KM, Merleev AA, More SK, Maverakis E, Raybould HE, Chen M, Canter RJ, Monjazeb AM, Dave M, Ferrara JLM, Levine JE, Longo DL, Abedi M, Blazar BR, Murphy WJ. Obesity induces gut microbiota alterations and augments acute graft-versus-host disease after allogeneic stem cell transplantation. Sci Transl Med 2021; 12:12/571/eaay7713. [PMID: 33239390 DOI: 10.1126/scitranslmed.aay7713] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 01/22/2020] [Accepted: 06/02/2020] [Indexed: 12/22/2022]
Abstract
The efficacy of allogeneic hematopoietic stem cell transplantation (allo-HSCT) is limited by acute and chronic graft-versus-host disease (GVHD). The impact of obesity on allo-HSCT outcomes is poorly understood. Here, we report that obesity had a negative and selective impact on acute gut GVHD after allo-HSCT in mice with diet-induced obesity (DIO). These animals exhibited increased gut permeability, endotoxin translocation across the gut, and radiation-induced gastrointestinal damage after allo-HSCT. After allo-HSCT, both male and female DIO mouse recipients showed increased proinflammatory cytokine production and expression of the GVHD marker ST2 (IL-33R) and MHC class II molecules; they also exhibited decreased survival associated with acute severe gut GVHD. This rapid-onset, obesity-associated gut GVHD depended on donor CD4+ T cells and occurred even with a minor MHC mismatch between donor and recipient animals. Retrospective analysis of clinical cohorts receiving allo-HSCT transplants from unrelated donors revealed that recipients with a high body mass index (BMI, >30) had reduced survival and higher serum ST2 concentrations compared with nonobese transplant recipients. Assessment of both DIO mice and allo-HSCT recipients with a high BMI revealed reduced gut microbiota diversity and decreased Clostridiaceae abundance. Prophylactic antibiotic treatment protected DIO mouse recipients from endotoxin translocation across the gut and increased inflammatory cytokine production, as well as gut pathology and mortality, but did not protect against later development of chronic skin GVHD. These results suggest that obesity-induced alterations of the gut microbiota may affect GVHD after allo-HSCT in DIO mice, which could be ameliorated by prophylactic antibiotic treatment.
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Affiliation(s)
- Lam T Khuat
- Department of Dermatology, School of Medicine, University of California, Davis, Sacramento, CA 95817, USA
| | - Catherine T Le
- Department of Dermatology, School of Medicine, University of California, Davis, Sacramento, CA 95817, USA
| | - Chien-Chun Steven Pai
- Department of Dermatology, School of Medicine, University of California, Davis, Sacramento, CA 95817, USA
| | | | - Shernan G Holtan
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, MN 55455, USA
| | - Armin Rashidi
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, MN 55455, USA
| | - Sarah L Parker
- Department of Internal Medicine, University of Minnesota, Minneapolis, MN 55455, USA
| | - Dan Knights
- Department of Computer Science and Engineering, Biotechnology Institute, University of Minnesota, Minneapolis, MN 55455, USA
| | - Jesus I Luna
- Department of Dermatology, School of Medicine, University of California, Davis, Sacramento, CA 95817, USA
| | - Cordelia Dunai
- Department of Dermatology, School of Medicine, University of California, Davis, Sacramento, CA 95817, USA
| | - Ziming Wang
- Department of Dermatology, School of Medicine, University of California, Davis, Sacramento, CA 95817, USA
| | - Ian R Sturgill
- Department of Dermatology, School of Medicine, University of California, Davis, Sacramento, CA 95817, USA
| | - Kevin M Stoffel
- Department of Dermatology, School of Medicine, University of California, Davis, Sacramento, CA 95817, USA
| | - Alexander A Merleev
- Department of Dermatology, School of Medicine, University of California, Davis, Sacramento, CA 95817, USA
| | - Shyam K More
- Division of Gastroenterology, Department of Internal Medicine, School of Medicine, University of California, Davis, Sacramento, CA 95817, USA
| | - Emanual Maverakis
- Department of Dermatology, School of Medicine, University of California, Davis, Sacramento, CA 95817, USA
| | - Helen E Raybould
- Department of Anatomy, Physiology, and Cell Biology, School of Veterinary Medicine, University of California, Davis, Davis, CA 95616, USA
| | - Mingyi Chen
- Department of Pathology and Laboratory Medicine, UT Southwestern Medical Center, Dallas, TX 75390, USA
| | - Robert J Canter
- Division of Surgical Oncology, Department of Surgery, School of Medicine, University of California, Davis, Sacramento, CA 95817, USA
| | - Arta M Monjazeb
- Department of Radiation Oncology, School of Medicine, University of California, Davis, Sacramento, CA 95817, USA
| | - Maneesh Dave
- Division of Gastroenterology, Department of Internal Medicine, School of Medicine, University of California, Davis, Sacramento, CA 95817, USA
| | - James L M Ferrara
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - John E Levine
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Dan L Longo
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Mehrdad Abedi
- Department of Internal Medicine, School of Medicine, University of California, Davis, Sacramento, CA 95817, USA
| | - Bruce R Blazar
- Masonic Cancer Center and Division of Blood and Marrow Transplantation, Department of Pediatrics, University of Minnesota, Minneapolis, MN 55455, USA
| | - William J Murphy
- Department of Dermatology, School of Medicine, University of California, Davis, Sacramento, CA 95817, USA. .,Department of Internal Medicine, School of Medicine, University of California, Davis, Sacramento, CA 95817, USA
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25
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Monjazeb AM, Giobbie-Hurder A, Lako A, Thrash EM, Brennick RC, Kao KZ, Manuszak C, Gentzler RD, Tesfaye A, Jabbour SK, Alese OB, Rahma OE, Cleary JM, Sharon E, Mamon HJ, Cho M, Streicher H, Chen HX, Ahmed MM, Mariño-Enríquez A, Kim-Schulze S, Gnjatic S, Maverakis E, Marusina AI, Merleev AA, Severgnini M, Pfaff KL, Lindsay J, Weirather JL, Ranasinghe S, Spektor A, Rodig SJ, Hodi SF, Schoenfeld JD. A Randomized Trial of Combined PD-L1 and CTLA-4 Inhibition with Targeted Low-Dose or Hypofractionated Radiation for Patients with Metastatic Colorectal Cancer. Clin Cancer Res 2021; 27:2470-2480. [PMID: 33568343 DOI: 10.1158/1078-0432.ccr-20-4632] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/14/2021] [Accepted: 02/05/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE Prospective human data are lacking regarding safety, efficacy, and immunologic impacts of different radiation doses administered with combined PD-L1/CTLA-4 blockade. PATIENTS AND METHODS We performed a multicenter phase II study randomly assigning patients with metastatic microsatellite stable colorectal cancer to repeated low-dose fractionated radiation (LDFRT) or hypofractionated radiation (HFRT) with PD-L1/CTLA-4 inhibition. The primary endpoint was response outside the radiation field. Correlative samples were analyzed using multiplex immunofluorescence (IF), IHC, RNA/T-cell receptor (TCR) sequencing, cytometry by time-of-flight (CyTOF), and Olink. RESULTS Eighteen patients were evaluable for response. Median lines of prior therapy were four (range, 1-7). Sixteen patients demonstrated toxicity potentially related to treatment (84%), and 8 patients had grade 3-4 toxicity (42%). Best response was stable disease in 1 patient with out-of-field tumor shrinkage. Median overall survival was 3.8 months (90% confidence interval, 2.3-5.7 months). Correlative IF and RNA sequencing (RNA-seq) revealed increased infiltration of CD8+ and CD8+/PD-1+/Ki-67+ T cells in the radiation field after HFRT. LDFRT increased foci of micronuclei/primary nuclear rupture in two subjects. CyTOF and RNA-seq demonstrated significant declines in multiple circulating immune populations, particularly in patients receiving HFRT. TCR sequencing revealed treatment-associated changes in T-cell repertoire in the tumor and peripheral blood. CONCLUSIONS We demonstrate the feasibility and safety of adding LDFRT and HFRT to PD-L1/CTLA-4 blockade. Although the best response of stable disease does not support the use of concurrent PD-L1/CTLA-4 inhibition with HFRT or LDFRT in this population, biomarkers provide support that both LDFRT and HFRT impact the local immune microenvironment and systemic immunogenicity that can help guide future studies.
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Affiliation(s)
- Arta M Monjazeb
- Department of Radiation Oncology, University of California Davis, Comprehensive Cancer Center, Sacramento, California
| | | | - Ana Lako
- Brigham and Women's Hospital, Boston, Massachusetts
| | | | | | | | | | | | - Anteneh Tesfaye
- Karmanos Cancer Institute/Wayne State University, Detroit, Michigan
| | - Salma K Jabbour
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | | | - Osama E Rahma
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Brigham and Women's Hospital, Boston, Massachusetts
| | - James M Cleary
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Brigham and Women's Hospital, Boston, Massachusetts
| | - Elad Sharon
- Cancer Therapy Evaluation Program, NCI, Bethesda, Maryland
| | - Harvey J Mamon
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Brigham and Women's Hospital, Boston, Massachusetts
| | - May Cho
- Department of Radiation Oncology, University of California Davis, Comprehensive Cancer Center, Sacramento, California
| | | | - Helen X Chen
- Cancer Therapy Evaluation Program, NCI, Bethesda, Maryland
| | | | - Adrian Mariño-Enríquez
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Brigham and Women's Hospital, Boston, Massachusetts
| | | | | | - Emanual Maverakis
- Department of Dermatology, University of California Davis, School of Medicine, Sacramento, California
| | - Alina I Marusina
- Department of Dermatology, University of California Davis, School of Medicine, Sacramento, California
| | - Alexander A Merleev
- Department of Dermatology, University of California Davis, School of Medicine, Sacramento, California
| | | | | | | | | | | | - Alexander Spektor
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Brigham and Women's Hospital, Boston, Massachusetts
| | - Scott J Rodig
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Brigham and Women's Hospital, Boston, Massachusetts
| | - Stephen F Hodi
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Brigham and Women's Hospital, Boston, Massachusetts
| | - Jonathan D Schoenfeld
- Dana-Farber Cancer Institute, Boston, Massachusetts. .,Brigham and Women's Hospital, Boston, Massachusetts
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26
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Monjazeb AM, Wang Z, Vick LV, Dunai C, Minnar C, Khuat LT, Murphy WJ. Mouse Preclinical Cancer Immunotherapy Modeling Involving Anti-PD-1 Therapies Reveals the Need to Use Mouse Reagents to Mirror Clinical Paradigms. Cancers (Basel) 2021; 13:cancers13040729. [PMID: 33578798 PMCID: PMC7916633 DOI: 10.3390/cancers13040729] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/27/2021] [Accepted: 02/04/2021] [Indexed: 11/16/2022] Open
Abstract
Immune checkpoint inhibition (ICI) has emerged as one of the most powerful tools to reverse cancer induced immune suppression. Monoclonal antibodies (mAbs) targeting programmed cell death 1/programmed cell death ligand 1(PD-1/PD-L1) are FDA-approved and their clinical use is rapidly expanding. As opposed to the clinical paradigm, which can result in significant responses and toxicities, it has been difficult to reproduce these effects preclinically using mouse models. In large part, this is due to models, which employ rapidly growing ex vivo cultured transplantable tumor cell lines engrafted into young naïve inbred laboratory mice. However, another issue concerns the use and repeated application of xenogeneic reagents in mice (i.e., rat or hamster mAbs directed against mouse antigens at variance with clinical use of human or humanized mAbs). Building on our previous studies demonstrating that repeated administration of commonly used xenogeneic anti-PD-1 mAbs derived from both rat and hamster can induce fatal hypersensitivity in some tumor-bearing mice, we sought to compare these result with the effects of a mouse anti-mouse PD-1 mAb. Application of a murine anti-mouse PD-1 (clone: MuDX400) did not result in lethal anaphylaxis in the 4T1 tumor model. It also displayed superior antitumor effects in this and other tumor models, as it did not induce neutralizing antibody responses against the anti-PD-1 mAb, such as were observed when using xenogeneic anti-PD1 mAbs. These results demonstrate that more accurate preclinical modeling necessitates the use of mouse reagents mirroring the clinical scenario to ascertain long-term effects or toxicities, while avoiding xenogeneic responses, which do not occur clinically. Furthermore, these studies suggest a direct mechanism, whereby preclinical murine studies have often failed to recapitulate the clinical efficacy and toxicity of single agent checkpoint inhibition.
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Affiliation(s)
- Arta M. Monjazeb
- Department of Radiation Oncology, Comprehensive Cancer Center, University of California Davis School of Medicine, Sacramento, CA 95817, USA; (A.M.M.); (L.V.V.)
| | - Ziming Wang
- Department of Dermatology, University of California Davis School of Medicine, Sacramento, CA 95817, USA; (Z.W.); (C.D.); (L.T.K.)
| | - Logan V. Vick
- Department of Radiation Oncology, Comprehensive Cancer Center, University of California Davis School of Medicine, Sacramento, CA 95817, USA; (A.M.M.); (L.V.V.)
| | - Cordelia Dunai
- Department of Dermatology, University of California Davis School of Medicine, Sacramento, CA 95817, USA; (Z.W.); (C.D.); (L.T.K.)
| | - Christine Minnar
- Laboratory of Tumor Immunology and Biology, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA;
| | - Lam T. Khuat
- Department of Dermatology, University of California Davis School of Medicine, Sacramento, CA 95817, USA; (Z.W.); (C.D.); (L.T.K.)
| | - William J. Murphy
- Department of Dermatology, University of California Davis School of Medicine, Sacramento, CA 95817, USA; (Z.W.); (C.D.); (L.T.K.)
- Department of Internal Medicine, Division of Hematology and Oncology, University of California Davis School of Medicine, Sacramento, CA 95817, USA
- Correspondence:
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27
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McGee HM, Marciscano AE, Campbell AM, Monjazeb AM, Kaech SM, Teijaro JR. Parallels Between the Antiviral State and the Irradiated State. J Natl Cancer Inst 2020; 113:969-979. [PMID: 33252657 PMCID: PMC8502484 DOI: 10.1093/jnci/djaa190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/07/2020] [Accepted: 11/16/2020] [Indexed: 01/12/2023] Open
Abstract
Improved understanding of host antiviral defense and antitumor immunity have elucidated molecular pathways important to both processes. During viral infection, RNA or DNA in the host cell serves as a danger signal that initiates the antiviral response. Recent studies have elucidated similarities in the signaling pathways activated by viruses and the signaling pathways induced by tumor DNA that is released into the cytoplasm of irradiated tumor cells. Both the host defense to viral infection and the sterile inflammation provoked by radiotherapy induce a type I interferon response that is necessary for pathogen control and immune-mediated tumor control, respectively. These findings have led to the hypothesis that radiotherapy employs a form of viral mimicry.
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Affiliation(s)
- Heather M McGee
- NOMIS Center for Immunobiology and Microbial Pathogenesis, The Salk Institute for Biological Studies, La Jolla, CA, USA,Correspondence to: Heather M. McGee, M.D. Ph.D. The Salk Institute for Biological Studies 10010 N. Torrey Pines Road La Jolla, CA 92037 (e-mail: ) and John R. Teijaro, PhD The Scripps Research Institute 10550 N. Torrey Pines Road, La Jolla, CA, 92037 (e-mail: )
| | - Ariel E Marciscano
- Department of Radiation Oncology, Weill Cornell Medical College, New York, NY, USA
| | - Allison M Campbell
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT, USA
| | - Arta M Monjazeb
- Department of Radiation Oncology, UC Davis Comprehensive Cancer Center, Sacramento, CA, USA
| | - Susan M Kaech
- NOMIS Center for Immunobiology and Microbial Pathogenesis, The Salk Institute for Biological Studies, La Jolla, CA, USA
| | - John R Teijaro
- Department of Immunology and Microbiology, Scripps Research Institute, La Jolla, CA, USA,Correspondence to: Heather M. McGee, M.D. Ph.D. The Salk Institute for Biological Studies 10010 N. Torrey Pines Road La Jolla, CA 92037 (e-mail: ) and John R. Teijaro, PhD The Scripps Research Institute 10550 N. Torrey Pines Road, La Jolla, CA, 92037 (e-mail: )
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28
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Le CT, Khuat LT, Caryotakis SE, Wang M, Dunai C, Nguyen AV, Vick LV, Stoffel KM, Blazar BR, Monjazeb AM, Murphy WJ, Soulika AM. PD-1 Blockade Reverses Obesity-Mediated T Cell Priming Impairment. Front Immunol 2020; 11:590568. [PMID: 33193426 PMCID: PMC7658608 DOI: 10.3389/fimmu.2020.590568] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 09/22/2020] [Indexed: 01/22/2023] Open
Abstract
Despite obesity reaching pandemic proportions, its impact on antigen-specific T cell responses is still unclear. We have recently demonstrated that obesity results in increased expression of PD-1 on T cells, and checkpoint blockade targeting PD-1/PD-L1 surprisingly resulted in greater clinical efficacy in cancer therapy. Adverse events associated with this therapy center around autoimmune reactions. In this study, we examined the impact of obesity on T cell priming and on autoimmune pathogenesis using the mouse model experimental autoimmune encephalomyelitis (EAE), which is mediated by autoreactive myelin-specific T cells generated after immunization. We observed that diet-induced obese (DIO) mice had a markedly delayed EAE onset and developed milder clinical symptoms compared to mice on control diet (CD). This delay was associated with impaired generation of myelin-specific T cell numbers and concurrently correlated with increased PD-L1 upregulation on antigen-presenting cells in secondary lymphoid organs. PD-1 blockade during the priming stage of EAE restored disease onset and severity and increased numbers of pathogenic CD4+ T cells in the central nervous system (CNS) of DIO mice to similar levels to those of CD mice. Administration of anti-PD-1 after onset of clinical symptoms did not increase EAE pathogenesis demonstrating that initial priming is the critical juncture affected by obesity. These findings demonstrate that obesity impairs antigen-specific T cell priming, but this can be reversed with PD-1 blockade. Our results further suggest that PD-1 blockade may increase the risk of autoimmune toxicities, particularly in obesity.
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Affiliation(s)
- Catherine T Le
- Department of Dermatology, School of Medicine, University of California, Davis, Sacramento, CA, United States
| | - Lam T Khuat
- Department of Dermatology, School of Medicine, University of California, Davis, Sacramento, CA, United States
| | - Sofia E Caryotakis
- Institute for Pediatric Regenerative Medicine, Shriners Hospitals for Children Northern California, Sacramento, CA, United States
| | - Marilyn Wang
- Department of Dermatology, School of Medicine, University of California, Davis, Sacramento, CA, United States.,Institute for Pediatric Regenerative Medicine, Shriners Hospitals for Children Northern California, Sacramento, CA, United States
| | - Cordelia Dunai
- Department of Dermatology, School of Medicine, University of California, Davis, Sacramento, CA, United States
| | - Alan V Nguyen
- Department of Dermatology, School of Medicine, University of California, Davis, Sacramento, CA, United States.,Institute for Pediatric Regenerative Medicine, Shriners Hospitals for Children Northern California, Sacramento, CA, United States
| | - Logan V Vick
- Department of Radiation-Oncology, School of Medicine, Comprehensive Cancer Center, University of California, Davis, Sacramento, CA, United States
| | - Kevin M Stoffel
- Department of Dermatology, School of Medicine, University of California, Davis, Sacramento, CA, United States
| | - Bruce R Blazar
- Masonic Cancer Center, and Division of Blood and Marrow Transplantation, Department of Pediatrics, University of Minnesota, Minneapolis, MN, United States
| | - Arta M Monjazeb
- Department of Radiation-Oncology, School of Medicine, Comprehensive Cancer Center, University of California, Davis, Sacramento, CA, United States
| | - William J Murphy
- Department of Dermatology, School of Medicine, University of California, Davis, Sacramento, CA, United States.,Department of Internal Medicine, Division of Hematology and Oncology, School of Medicine, University of California, Davis, Sacramento, CA, United States
| | - Athena M Soulika
- Department of Dermatology, School of Medicine, University of California, Davis, Sacramento, CA, United States.,Institute for Pediatric Regenerative Medicine, Shriners Hospitals for Children Northern California, Sacramento, CA, United States
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29
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Judge SJ, Darrow MA, Thorpe SW, Gingrich AA, O'Donnell EF, Bellini AR, Sturgill IR, Vick LV, Dunai C, Stoffel KM, Lyu Y, Chen S, Cho M, Rebhun RB, Monjazeb AM, Murphy WJ, Canter RJ. Analysis of tumor-infiltrating NK and T cells highlights IL-15 stimulation and TIGIT blockade as a combination immunotherapy strategy for soft tissue sarcomas. J Immunother Cancer 2020; 8:jitc-2020-001355. [PMID: 33158916 PMCID: PMC7651745 DOI: 10.1136/jitc-2020-001355] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2020] [Indexed: 12/13/2022] Open
Abstract
Purpose Given the unmet need for novel immunotherapy in soft tissue sarcoma (STS), we sought to characterize the phenotype and function of intratumoral natural killer (NK) and T cells to identify novel strategies to augment tumor-infiltrating lymphocyte (TIL) function. Experimental design Using prospectively collected specimens from dogs and humans with sarcomas, archived specimens, and The Cancer Genome Atlas (TCGA) data, we evaluated blood and tumor NK and T cell phenotype and function and correlated those with outcome. We then assessed the effects of interleukin 15 (IL-15) stimulation on both NK and T cell activation and TIGIT upregulation. Finally, we evaluated cytotoxic effects of IL-15 combined with TIGIT blockade using a novel anti-TIGIT antibody. Results TILs were strongly associated with survival outcome in both archived tissue and TCGA, but higher TIL content was also associated with higher TIGIT expression. Compared with blood, intratumoral NK and T cells showed significantly higher expression of both activation and exhaustion markers, in particular TIGIT. Ex vivo stimulation of blood and tumor NK and T cells from patients with STS with IL-15 further increased both activation and exhaustion markers, including TIGIT. Dogs with metastatic osteosarcoma receiving inhaled IL-15 also exhibited upregulation of activation markers and TIGIT. Ex vivo, combined IL-15 and TIGIT blockade using STS blood and tumor specimens significantly increased cytotoxicity against STS targets. Conclusion Intratumoral NK and T cells are prognostic in STS, but their activation is marked by significant upregulation of TIGIT. Our data suggest that combined IL-15 and TIGIT blockade may be a promising clinical strategy in STS.
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Affiliation(s)
- Sean J Judge
- Surgery, University of California Davis School of Medicine, Sacramento, California, USA
| | - Morgan A Darrow
- Pathology and Laboratory Medicine, University of California Davis School of Medicine, Sacramento, California, USA
| | - Steve W Thorpe
- Orthopedic Surgery, University of California Davis School of Medicine, Sacramento, California, USA
| | - Alicia A Gingrich
- Surgery, University of California Davis School of Medicine, Sacramento, California, USA
| | - Edmond F O'Donnell
- Orthopedic Surgery, University of California Davis School of Medicine, Sacramento, California, USA
| | - Alyssa R Bellini
- Surgery, University of California Davis School of Medicine, Sacramento, California, USA
| | - Ian R Sturgill
- Dermatology, University of California Davis School of Medicine, Sacramento, California, USA
| | - Logan V Vick
- Dermatology, University of California Davis School of Medicine, Sacramento, California, USA
| | - Cordelia Dunai
- Dermatology, University of California Davis School of Medicine, Sacramento, California, USA
| | - Kevin M Stoffel
- Dermatology, University of California Davis School of Medicine, Sacramento, California, USA
| | - Yue Lyu
- Statistics, University of California Davis, Davis, California, USA
| | - Shuai Chen
- Public Health Sciences, University of California Davis School of Medicine, Sacramento, California, USA
| | - May Cho
- Internal Medicine, University of California Davis School of Medicine, Sacramento, California, USA
| | - Robert B Rebhun
- Center for Companion Animal Health, Department of Surgical and Radiological Sciences, University of California Davis School of Veterinary Medicine, Davis, California, USA
| | - Arta M Monjazeb
- Radiation Oncology, University of California Davis School of Medicine, Sacramento, California, USA
| | - William J Murphy
- Dermatology, University of California Davis School of Medicine, Sacramento, California, USA
| | - Robert J Canter
- Surgery, University of California Davis School of Medicine, Sacramento, California, USA
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30
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Candas-Green D, Xie B, Huang J, Fan M, Wang A, Menaa C, Zhang Y, Zhang L, Jing D, Azghadi S, Zhou W, Liu L, Jiang N, Li T, Gao T, Sweeney C, Shen R, Lin TY, Pan CX, Ozpiskin OM, Woloschak G, Grdina DJ, Vaughan AT, Wang JM, Xia S, Monjazeb AM, Murphy WJ, Sun LQ, Chen HW, Lam KS, Weichselbaum RR, Li JJ. Dual blockade of CD47 and HER2 eliminates radioresistant breast cancer cells. Nat Commun 2020; 11:4591. [PMID: 32929084 PMCID: PMC7490264 DOI: 10.1038/s41467-020-18245-7] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 08/11/2020] [Indexed: 12/19/2022] Open
Abstract
Although the efficacy of cancer radiotherapy (RT) can be enhanced by targeted immunotherapy, the immunosuppressive factors induced by radiation on tumor cells remain to be identified. Here, we report that CD47-mediated anti-phagocytosis is concurrently upregulated with HER2 in radioresistant breast cancer (BC) cells and RT-treated mouse syngeneic BC. Co-expression of both receptors is more frequently detected in recurrent BC patients with poor prognosis. CD47 is upregulated preferentially in HER2-expressing cells, and blocking CD47 or HER2 reduces both receptors with diminished clonogenicity and augmented phagocytosis. CRISPR-mediated CD47 and HER2 dual knockouts not only inhibit clonogenicity but also enhance macrophage-mediated attack. Dual antibody of both receptors synergizes with RT in control of syngeneic mouse breast tumor. These results provide the evidence that aggressive behavior of radioresistant BC is caused by CD47-mediated anti-phagocytosis conjugated with HER2-prompted proliferation. Dual blockade of CD47 and HER2 is suggested to eliminate resistant cancer cells in BC radiotherapy.
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Affiliation(s)
- Demet Candas-Green
- Department of Radiation Oncology, University of California Davis, Sacramento, CA, USA
| | - Bowen Xie
- Department of Radiation Oncology, University of California Davis, Sacramento, CA, USA
- Center for Molecular Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jie Huang
- Department of Radiation Oncology, University of California Davis, Sacramento, CA, USA
| | - Ming Fan
- Department of Radiation Oncology, University of California Davis, Sacramento, CA, USA
| | - Aijun Wang
- Department of Surgery, School of Medicine, University of California Davis, Sacramento, CA, 95817, USA
| | - Cheikh Menaa
- Department of Radiation Oncology, University of California Davis, Sacramento, CA, USA
| | - Yanhong Zhang
- Department of Pathology, Kaiser Permanente Medical Center Vallejo and Vacaville, Vallejo, CA, USA
| | - Lu Zhang
- Department of Radiation Oncology, University of California Davis, Sacramento, CA, USA
- Center for Molecular Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Di Jing
- Department of Radiation Oncology, University of California Davis, Sacramento, CA, USA
- Center for Molecular Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Soheila Azghadi
- Department of Radiation Oncology, University of California Davis, Sacramento, CA, USA
| | - Weibing Zhou
- Department of Radiation Oncology, University of California Davis, Sacramento, CA, USA
- Center for Molecular Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Lin Liu
- Department of Radiation Oncology, University of California Davis, Sacramento, CA, USA
| | - Nian Jiang
- Department of Radiation Oncology, University of California Davis, Sacramento, CA, USA
| | - Tao Li
- Department of Radiation Oncology, University of California Davis, Sacramento, CA, USA
| | - Tianyi Gao
- Department of Radiation Oncology, University of California Davis, Sacramento, CA, USA
| | - Colleen Sweeney
- Department of Biochemistry and Molecular Medicine, University of California Davis, Sacramento, CA, USA
- NCI-Designated Comprehensive Cancer Center, University of California Davis, Sacramento, CA, USA
| | - Rulong Shen
- Department of Pathology, Ohio State University, Columbus, OH, USA
| | - Tzu-Yin Lin
- Department of Biochemistry and Molecular Medicine, University of California Davis, Sacramento, CA, USA
| | - Chong-Xian Pan
- NCI-Designated Comprehensive Cancer Center, University of California Davis, Sacramento, CA, USA
- Department of Internal Medicine, University of California Davis, Sacramento, CA, USA
| | - Omer M Ozpiskin
- Department of Radiation Oncology, University of California Davis, Sacramento, CA, USA
| | - Gayle Woloschak
- Department of Radiation Oncology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - David J Grdina
- Department of Radiation and Cellular Oncology and the Ludwig Center for Metastasis Research, The University of Chicago, Chicago, IL, USA
| | - Andrew T Vaughan
- Department of Radiation Oncology, University of California Davis, Sacramento, CA, USA
- NCI-Designated Comprehensive Cancer Center, University of California Davis, Sacramento, CA, USA
| | - Ji Ming Wang
- Chemoattractant Receptor and Signal Section, Cancer and Inflammation Program, Center for Cancer Research, National Cancer Institute, Frederick, MD, USA
| | - Shuli Xia
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, 21205, USA
| | - Arta M Monjazeb
- Department of Radiation Oncology, University of California Davis, Sacramento, CA, USA
- NCI-Designated Comprehensive Cancer Center, University of California Davis, Sacramento, CA, USA
| | - William J Murphy
- NCI-Designated Comprehensive Cancer Center, University of California Davis, Sacramento, CA, USA
- Department of Dermatology, University of California Davis, Sacramento, CA, USA
| | - Lun-Quan Sun
- Center for Molecular Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Hong-Wu Chen
- Department of Biochemistry and Molecular Medicine, University of California Davis, Sacramento, CA, USA
- NCI-Designated Comprehensive Cancer Center, University of California Davis, Sacramento, CA, USA
| | - Kit S Lam
- Department of Biochemistry and Molecular Medicine, University of California Davis, Sacramento, CA, USA
- NCI-Designated Comprehensive Cancer Center, University of California Davis, Sacramento, CA, USA
| | - Ralph R Weichselbaum
- Department of Radiation and Cellular Oncology and the Ludwig Center for Metastasis Research, The University of Chicago, Chicago, IL, USA
| | - Jian Jian Li
- Department of Radiation Oncology, University of California Davis, Sacramento, CA, USA.
- NCI-Designated Comprehensive Cancer Center, University of California Davis, Sacramento, CA, USA.
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31
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Chen H, Nguyen KNB, Huang H, Feng C, Zhao X, Daly ME, Rao S, Fragoso R, Valicenti R, Sekhon S, Navarro SM, Kim EJ, Cho M, Tam K, Farkas L, Halabi WJ, Monjazeb AM, Rong Y. Effect and Safety of Radiation Therapy Boost to Extramesorectal Lymph Nodes in Rectal Cancer. Pract Radiat Oncol 2020; 10:e372-e377. [DOI: 10.1016/j.prro.2019.12.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 10/28/2019] [Accepted: 12/04/2019] [Indexed: 12/20/2022]
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Gingrich AA, Marrufo AS, Liu Y, Li CS, Darrow MA, Monjazeb AM, Thorpe SW, Canter RJ. Radiotherapy is Associated With Improved Survival in Patients With Synovial Sarcoma Undergoing Surgery: A National Cancer Database Analysis. J Surg Res 2020; 255:378-387. [PMID: 32599458 DOI: 10.1016/j.jss.2020.05.075] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 05/20/2020] [Accepted: 05/27/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Previous studies have demonstrated an association of perioperative radiotherapy (RT) with improved survival in patients with synovial sarcoma (SS) undergoing surgery, but the mechanism for this is unknown. In this study, we sought to further analyze this association using a hospital-based data set where data on chemotherapy administration and surgical margin status are available. METHODS Using the National Cancer Database, we identified 1216 patients with SS (aged ≥18 y) from 2004-2012 undergoing surgery. Cox proportional hazards analysis was used to study the effect of clinicopathologic variables on overall survival (OS). RESULTS Mean age at diagnosis was 41.5 y (range 18-90), and 71.3% of tumors were high grade; 22.9% underwent surgery alone, 59.6% received RT with surgery, 44.2% received chemotherapy with surgery, and 26.3% received trimodality therapy. Age, sex, grade, Charlson-Deyo score, and RT (hazard ratio, 0.676; 95% confidence interval, 0.519-0.880; P = 0.004) were associated with improved OS, whereas chemotherapy (hazard ratio, 1.20; 95% confidence interval, 0.899-1.60; P = 0.217) and surgical margin status were not. Trimodality therapy with surgery, RT, and chemotherapy was associated with improved OS when compared with therapy with surgery and chemotherapy alone. CONCLUSIONS In patients with SS undergoing surgery, we observed a significant improved association of OS with the addition of RT when adjusting for comorbidity score, margin status, and receipt of chemotherapy. These data further support routine implementation of RT in the treatment of patients with SS, including those receiving aggressive multimodality and trimodality care.
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Affiliation(s)
- Alicia A Gingrich
- Department of Surgery, University of California Davis, Sacramento, California
| | - Angelica S Marrufo
- Department of Surgery, University of California Davis, Sacramento, California
| | - Yu Liu
- Department of Public Health Sciences, University of California Davis, Davis, California
| | - Chin-Shang Li
- Department of Public Health Sciences, University of California Davis, Davis, California
| | - Morgan A Darrow
- Department of Pathology, University of California Davis, Sacramento, California
| | - Arta M Monjazeb
- Department of Radiation Oncology, University of California Davis, Sacramento, California
| | - Steven W Thorpe
- Department of Orthopedic Surgery, University of California Davis, Sacramento, California
| | - Robert J Canter
- Department of Surgery, University of California Davis, Sacramento, California.
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Judge SJ, Dunai C, Aguilar EG, Vick SC, Sturgill IR, Khuat LT, Stoffel KM, Van Dyke J, Longo DL, Darrow MA, Anderson SK, Blazar BR, Monjazeb AM, Serody JS, Canter RJ, Murphy WJ. Minimal PD-1 expression in mouse and human NK cells under diverse conditions. J Clin Invest 2020; 130:3051-3068. [PMID: 32134744 PMCID: PMC7260004 DOI: 10.1172/jci133353] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 02/26/2020] [Indexed: 12/13/2022] Open
Abstract
PD-1 expression is a hallmark of both early antigen-specific T cell activation and later chronic stimulation, suggesting key roles in both naive T cell priming and memory T cell responses. Although significant similarities exist between T cells and NK cells, there are critical differences in their biology and functions reflecting their respective adaptive and innate immune effector functions. Expression of PD-1 on NK cells is controversial despite rapid incorporation into clinical cancer trials. Our objective was to stringently and comprehensively assess expression of PD-1 on both mouse and human NK cells under multiple conditions and using a variety of readouts. We evaluated NK cells from primary human tumor samples, after ex vivo culturing, and from multiple mouse tumor and viral models using flow cytometry, quantitative reverse-transcriptase PCR (qRT-PCR), and RNA-Seq for PD-1 expression. We demonstrate that, under multiple conditions, human and mouse NK cells consistently lack PD-1 expression despite the marked upregulation of other activation/regulatory markers, such as TIGIT. This was in marked contrast to T cells, which were far more prominent within all tumors and expressed PD-1. These data have important implications when attempting to discern NK from T cell effects and to determine whether PD-1 targeting can be expected to have direct effects on NK cell functions.
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Affiliation(s)
| | - Cordelia Dunai
- Department of Dermatology, UCD, Sacramento, California, USA
| | | | - Sarah C. Vick
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Lam T. Khuat
- Department of Dermatology, UCD, Sacramento, California, USA
| | | | | | - Dan L. Longo
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Morgan A. Darrow
- Department of Pathology and Laboratory Medicine, UCD, Sacramento, California, USA
| | - Stephen K. Anderson
- Molecular Immunology Section, Leidos Biomedical Research Inc., Frederick National Laboratory for Cancer Research, Frederick, Maryland, USA
| | - Bruce R. Blazar
- Masonic Cancer Center and
- Division of Blood and Bone Marrow Transplantation, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Arta M. Monjazeb
- Department of Radiation Oncology, UCD, Sacramento, California, USA
| | - Jonathan S. Serody
- Lineberger Comprehensive Cancer Center and
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - William J. Murphy
- Department of Dermatology, UCD, Sacramento, California, USA
- Department of Medicine, UCD, Sacramento, California, USA
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34
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Chen H, Shi L, Nguyen KNB, Monjazeb AM, Matsukuma KE, Loehfelm TW, Huang H, Qiu J, Rong Y. MRI Radiomics for Prediction of Tumor Response and Downstaging in Rectal Cancer Patients after Preoperative Chemoradiation. Adv Radiat Oncol 2020; 5:1286-1295. [PMID: 33305090 PMCID: PMC7718560 DOI: 10.1016/j.adro.2020.04.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 04/07/2020] [Accepted: 04/13/2020] [Indexed: 12/13/2022] Open
Abstract
Purpose This study aimed to investigate radiomic features extracted from magnetic resonance imaging (MRI) scans performed before and after neoadjuvant chemoradiotherapy (nCRT) in predicting response of locally advanced rectal cancer (LARC). Methods and Materials Thirty-nine patients who underwent nCRT for LARC were included, with 294 radiomic features extracted from MRI that was performed before (pre-CRT) and 6 to 8 weeks after completing nCRT (post-CRT). Based on tumor regression grade (TRG), 26 patients were classified as having a histopathologic good response (GR; TRG 0-1) and 13 as non-GR (TRG 2-3). Tumor downstaging (T-downstaging) occurred in 25 patients. Univariate analyses were performed to assess potential radiomic and delta-radiomic predictors for TRG in pathologic complete response (pCR) versus non-pCR, GR versus non-GR, and T-downstaging. The support vector machine-based multivariate model was used to select the best predictors for TRG and T-downstaging. Results We identified 13 predictive features for pCR versus non-pCR, 14 for GR versus non-GR, and 16 for T-downstaging. Pre-CRT gray-level run length matrix nonuniformity, pre-CRT neighborhood intensity difference matrix (NIDM) texture strength, and post-CRT NIDM busyness predicted all 3 treatment responses. The best predictor for GR versus non-GR was pre-CRT global minimum combined with clinical N stage in the multivariate analysis. The best predictor for T-downstaging was the combination of pre-CRT gray-level co-occurrence matrix correlation, NIDM-texture strength, and gray-level co-occurrence matrix variance. The pre-CRT, post-CRT, and delta radiomic-based models had no significant difference in predicting all 3 responses. Conclusions Pre-CRT MRI, post-CRT MRI, and delta radiomic-based models have the potential to predict tumor response after nCRT in LARC. These data, if validated in larger cohorts, can provide important predictive information to aid in clinical decision making.
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Affiliation(s)
- Haihui Chen
- Department of Medical Oncology, the Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, China.,Department of Radiation Oncology, University of California Davis School of Medicine, Sacramento, California
| | - Liting Shi
- Department of Radiation Oncology, University of California Davis School of Medicine, Sacramento, California.,Medical Engineering and Technology Research Center, Imaging-X Joint Laboratory, Department of Radiology, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, China
| | - Ky Nam Bao Nguyen
- Department of Radiation Oncology, University of California Davis School of Medicine, Sacramento, California
| | - Arta M Monjazeb
- Department of Radiation Oncology, University of California Davis School of Medicine, Sacramento, California
| | - Karen E Matsukuma
- Department of Pathology and Laboratory Medicine, University of California Davis School of Medicine, Sacramento, California
| | - Thomas W Loehfelm
- Department of Radiology, University of California Davis School of Medicine, Sacramento, California
| | - Haixin Huang
- Department of Medical Oncology, the Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, China
| | - Jianfeng Qiu
- Medical Engineering and Technology Research Center, Imaging-X Joint Laboratory, Department of Radiology, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, China
| | - Yi Rong
- Department of Radiation Oncology, University of California Davis School of Medicine, Sacramento, California
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Judge SJ, Dunai C, Le CT, Khuat LT, Vick LV, Stoffel KM, Monjazeb AM, Canter RJ, Murphy WJ. Differences in NK and Memory CD8 T cell responses to antigen-nonspecific stimulation by interleukin-15. The Journal of Immunology 2020. [DOI: 10.4049/jimmunol.204.supp.148.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Abstract
Natural killer (NK) cells are innate lymphoid cells that exert immediate functions which can be further augmented and sustained with immunostimulatory cytokines. Memory CD8 T cells, due to expression of CD132 and CD122, can be activated by similar cytokines in the absence of TCR engagement (termed “bystander” activation). This results in activation and proliferation but necessitates high amounts of cytokine as high-affinity IL2R complexes (CD25) are not induced. Interestingly, both cell types can then elicit similar effector functions via NKG2D-mediated target cell recognition. As these cell types can fill a similar immunologic niche, we set out to compare NK and memory CD8 T cell responses following IL-15 exposure in vitro from healthy human donors. Cell analysis was performed by flow cytometry and qRT-PCR. At baseline, CD25 expression is negligible at <5% on both human NK and memory CD8 T cells. Surprisingly, culture with rhIL-15 (10 ng/mL) for 4–6 days resulted in marked CD25 upregulation on CD56+CD3− NK cells but not bystander-activated CD45RA-CD95+ CD8 T cells (72±9.2% vs 11±3.8%, P=0.003) despite comparable expansion. Additionally, cytokine-activated NK cells expressed higher levels of inhibitory receptor TIGIT (85±4% vs 57±2%, P=0.01) and activation marker CD69 (99±1% vs 27±9%, P=0.008). Functionally, NK cells had increased expression of granzyme B compared to bystander-activated CD8 T cells. Thus, although NK and bystander CD8 T cells can fill a similar immunologic niche regarding target cell killing, there are significant differences in expression of critical markers following activation. These differences may have consequences in the regulation of these cell types and impact anti-viral and anti-tumor responses.
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Affiliation(s)
- Sean J Judge
- 1Department of Surgery, University of California, Davis
| | - Cordelia Dunai
- 2Department of Dermatology, University of California, Davis
| | | | - Lam T. Khuat
- 2Department of Dermatology, University of California, Davis
| | - Logan V. Vick
- 3Department of Radiation Oncology, University of California, Davis
| | | | - Arta M. Monjazeb
- 3Department of Radiation Oncology, University of California, Davis
| | | | - William J. Murphy
- 2Department of Dermatology, University of California, Davis
- 4Department of Internal Medicine, University of California, Davis
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Gingrich AA, Reiter T, Judge SJ, Sturgill I, Monjazeb AM, Murphy WJ, Brown CT, Canter RJ. Cross-species gene expression analysis of human, canine and murine natural killer cells suggests convergence of activated dog and human transcriptomic profiles. The Journal of Immunology 2020. [DOI: 10.4049/jimmunol.204.supp.92.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Abstract
Key species differences exist between human and murine natural killer (NK) cells. Although outbred dogs are a link for translational NK studies, better characterization of dog NK cells is needed. We used RNAseq to profile resting and activated NK cells from mice, dogs and humans. Cells were isolated based on putative NK cell populations from healthy humans (CD56+CD3−), beagles (CD5dim) and C57BL/6J mice (NK1.1+CD3−) and sequenced from steady-state or following exposure to irradiated human feeder cells (K562 clone 9) with 100 IU/mL rhIL-2 × 14 days (human and dog) or 1000 IU/mL rhIL-2 × 7 days. Purity of expanded human and dog NK cells was ~ 90%, while for mouse it was ~ 70%. We performed differential gene expression (DGE) across species and conditions using ~7000 1:1 orthologous genes. DGE revealed distinct transcriptional profiles for each species (FDR <0.05). Hierarchical clustering demonstrated mouse NK cells as an outgroup compared to dog and human. PCA showed within-species spatial clustering of resting NK cells. After activation, variance between dog and human NK cells decreased, variance between human and mouse NK cells increased (PC1 40%, PC2 28%). Species differed in expression of key genes after activation, including PRF1, GZMA, SPP1, IL2RB, CTSD and FCER1G, which showed greater increases in abundance counts in mice than dogs and humans. In this first transcriptomic sequencing of dog NK cells, we show distinct gene profiles of resting cells across the most commonly used mouse, dog, and human NK populations, with convergence of dog and human NK cells upon stimulation under these standard conditions. By defining the cross-species comparative transcriptional profiles of putative NK cells, these data fill a gap in translational NK studies.
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Affiliation(s)
| | | | - Sean J Judge
- 3Department of Surgery, University of California, Davis
| | | | - Arta M. Monjazeb
- 4Department of Radiation Oncology, University of California, Davis
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37
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Judge SJ, Yanagisawa M, Sturgill IR, Bateni SB, Gingrich AA, Foltz JA, Lee DA, Modiano JF, Monjazeb AM, Culp WTN, Rebhun RB, Murphy WJ, Kent MS, Canter RJ. Blood and tissue biomarker analysis in dogs with osteosarcoma treated with palliative radiation and intra-tumoral autologous natural killer cell transfer. PLoS One 2020; 15:e0224775. [PMID: 32084139 PMCID: PMC7034869 DOI: 10.1371/journal.pone.0224775] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 02/04/2020] [Indexed: 01/01/2023] Open
Abstract
We have previously reported radiation-induced sensitization of canine osteosarcoma (OSA) to natural killer (NK) therapy, including results from a first-in-dog clinical trial. Here, we report correlative analyses of blood and tissue specimens for signals of immune activation in trial subjects. Among 10 dogs treated with palliative radiotherapy (RT) and intra-tumoral adoptive NK transfer, we performed ELISA on serum cytokines, flow cytometry for immune phenotype of PBMCs, and PCR on tumor tissue for immune-related gene expression. We then queried The Cancer Genome Atlas (TCGA) to evaluate the association of cytotoxic/immune-related gene expression with human sarcoma survival. Updated survival analysis revealed five 6-month survivors, including one dog who lived 17.9 months. Using feeder line co-culture for NK expansion, we observed maximal activation of dog NK cells on day 17-19 post isolation with near 100% expression of granzyme B and NKp46 and high cytotoxic function in the injected NK product. Among dogs on trial, we observed a trend for higher baseline serum IL-6 to predict worse lung metastasis-free and overall survival (P = 0.08). PCR analysis revealed low absolute gene expression of CD3, CD8, and NKG2D in untreated OSA. Among treated dogs, there was marked heterogeneity in the expression of immune-related genes pre- and post-treatment, but increases in CD3 and CD8 gene expression were higher among dogs that lived > 6 months compared to those who did not. Analysis of the TCGA confirmed significant differences in survival among human sarcoma patients with high and low expression of genes associated with greater immune activation and cytotoxicity (CD3e, CD8a, IFN-γ, perforin, and CD122/IL-2 receptor beta). Updated results from a first-in-dog clinical trial of palliative RT and autologous NK cell immunotherapy for OSA illustrate the translational relevance of companion dogs for novel cancer therapies. Similar to human studies, analyses of immune markers from canine serum, PBMCs, and tumor tissue are feasible and provide insight into potential biomarkers of response and resistance.
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Affiliation(s)
- Sean J. Judge
- Department of Surgery, University of California Davis Medical Center, Sacramento, California, United States of America
| | - Mio Yanagisawa
- Department of Surgery, University of California Davis Medical Center, Sacramento, California, United States of America
| | - Ian R. Sturgill
- Department of Surgery, University of California Davis Medical Center, Sacramento, California, United States of America
| | - Sarah B. Bateni
- Department of Surgery, University of California Davis Medical Center, Sacramento, California, United States of America
| | - Alicia A. Gingrich
- Department of Surgery, University of California Davis Medical Center, Sacramento, California, United States of America
| | - Jennifer A. Foltz
- Nationwide Children’s Hospital, Center for Childhood Cancer & Blood Diseases, Columbus, Ohio, United States of America
| | - Dean A. Lee
- Nationwide Children’s Hospital, Center for Childhood Cancer & Blood Diseases, Columbus, Ohio, United States of America
| | - Jaime F. Modiano
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Animal Cancer Care and Research Center, Center for Immunology, Masonic Cancer Center, and Stem Cell Institute, University of Minnesota, St. Paul, Minneapolis, United States of America
| | - Arta M. Monjazeb
- Department of Radiation Oncology, University of California Davis Medical Center, Sacramento, California, United States of America
| | - William T. N. Culp
- The Center for Companion Animal Health, Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California Davis, Davis, California, United States of America
| | - Robert B. Rebhun
- The Center for Companion Animal Health, Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California Davis, Davis, California, United States of America
| | - William J. Murphy
- Distinguished Professor of Dermatology and Internal Medicine, Vice Chair of Dermatology, University of California Davis Medical Center, Sacramento, California, United States of America
| | - Michael S. Kent
- The Center for Companion Animal Health, Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California Davis, Davis, California, United States of America
| | - Robert J. Canter
- Department of Surgery, Division of Surgical Oncology, University of California Davis Medical Center, Sacramento, California, United States of America
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38
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Affiliation(s)
- Ziming Wang
- Department of Dermatology, UC Davis School of Medicine, Sacramento, CA 95816, USA
| | - Arta M Monjazeb
- Department of Radiation Oncology, UC Davis Comprehensive Cancer Center, UC School of Medicine, Sacramento, CA 95817, USA
| | - William J Murphy
- Department of Dermatology, UC Davis School of Medicine, Sacramento, CA 95816, USA.,Department of Internal Medicine, Division of Hematology & Oncology, UC Davis School of Medicine, Sacramento, CA 95817, USA
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Dyer BA, Li CS, Daly ME, Monjazeb AM, Mayadev JS. Prospective, Randomized Control Trial Investigating the Impact of a Physician-Communicated Radiation Therapy Plan Review on Breast Cancer Patient-Reported Satisfaction. Pract Radiat Oncol 2019; 9:e487-e496. [DOI: 10.1016/j.prro.2019.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 05/22/2019] [Accepted: 06/11/2019] [Indexed: 10/26/2022]
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40
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Gong J, Robertson MD, Kim E, Fakih M, Schrock AB, Tam KW, Burugapalli B, Monjazeb AM, Hendifar AE, Hitchins M, Klempner SJ, Cho M. Efficacy of PD-1 Blockade in Refractory Microsatellite-Stable Colorectal Cancer With High Tumor Mutation Burden. Clin Colorectal Cancer 2019; 18:307-309. [PMID: 31563511 DOI: 10.1016/j.clcc.2019.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 07/10/2019] [Accepted: 08/27/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Jun Gong
- Division of Medical Oncology, Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | | | - Edward Kim
- Division of Hematology and Oncology, Department of Internal Medicine, UC Davis Comprehensive Cancer Center, Sacramento, CA
| | - Marwan Fakih
- Department of Medical Oncology, City of Hope National Medical Center, Duarte, CA
| | | | - Kit W Tam
- Division of Hematology and Oncology, Department of Internal Medicine, UC Davis Comprehensive Cancer Center, Sacramento, CA
| | - Bhuvaneswari Burugapalli
- Division of Hematology and Oncology, Department of Internal Medicine, UC Davis Comprehensive Cancer Center, Sacramento, CA
| | - Arta M Monjazeb
- Department of Radiation Oncology, UC Davis Medical Center, University of California, Sacramento, CA
| | - Andrew E Hendifar
- Division of Medical Oncology, Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Megan Hitchins
- Division of Medical Oncology, Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Samuel J Klempner
- Division of Medical Oncology, Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA; The Angeles Clinic and Research Institute, Los Angeles, CA
| | - May Cho
- Division of Hematology and Oncology, Department of Internal Medicine, UC Davis Comprehensive Cancer Center, Sacramento, CA.
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Withers SS, York D, Choi JW, Woolard KD, Laufer-Amorim R, Sparger EE, Burton JH, McSorley SJ, Monjazeb AM, Murphy WJ, Canter RJ, Rebhun RB. Metastatic immune infiltrates correlate with those of the primary tumour in canine osteosarcoma. Vet Comp Oncol 2019; 17:242-252. [PMID: 30684301 PMCID: PMC6658355 DOI: 10.1111/vco.12459] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 11/09/2018] [Accepted: 11/21/2018] [Indexed: 12/21/2022]
Abstract
Our lack of understanding of the immune microenvironment in canine osteosarcoma (cOSA) has limited the identification of potential immunotherapeutic targets. In particular, our ability to utilize readily available tissue from a dog's primary tumour to predict the type and extent of immune response in their pulmonary metastatic lesions is unknown. We, therefore, collected 21 matched pairs of primary tumours and pulmonary metastatic lesions from dogs with OSA and performed immunohistochemistry to quantify T-lymphocyte (CD3), FOXP3+ cell, B-lymphocyte (Pax-5), and CD204+ macrophage infiltration. We found that T-lymphocytes and FOXP3+ infiltrates in primary tumours positively correlated with that of metastatic lesions (ρ = 0.512, P = 0.038 and ρ = 0.698, P = 0.007, respectively), while a strong trend existed for CD204+ infiltrates (ρ = 0.404, P = 0.087). We also observed T- and B-lymphocytes, and CD204+ macrophages to be significantly higher in a dog's pulmonary metastasis compared to their primary tumour (P = 0.018, P = 0.018, P = 0.016, respectively), while FOXP3+ cells were only significantly higher in metastases when all primary tumour and metastasis lesions were compared without pairing (P = 0.036). Together, these findings suggest that the metastatic immune microenvironment may be influenced by that of the primary cOSA, and that primary tumour immune biomarkers could potentially be applied to predict immunotherapeutic responses in gross metastatic disease. We, therefore, provide a rationale for the treatment of cOSA pulmonary metastases with immunotherapeutics that enhance the anti-tumour activity of these immune cells, particularly in dogs with moderate to high immune cell infiltration in their primary tumours.
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Affiliation(s)
- Sita S Withers
- The Comparative Oncology Laboratory and Center for Companion Animal Health, Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, California
| | - Daniel York
- The Comparative Oncology Laboratory and Center for Companion Animal Health, Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, California
| | - Jin W Choi
- Center for Comparative Medicine, Department of Anatomy, Physiology and Cell Biology, School of Veterinary Medicine, University of California-Davis, Davis, California
| | - Kevin D Woolard
- Department of Pathology, Microbiology, and Immunology, School of Veterinary Medicine, University of California-Davis, Davis, California
| | - Renee Laufer-Amorim
- Department of Veterinary Clinics, School of Veterinary Medicine and Animal Science, Sao Paulo State University (UNESP), Botucatu, Brazil
| | - Ellen E Sparger
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California-Davis, Davis, California
| | - Jenna H Burton
- The Comparative Oncology Laboratory and Center for Companion Animal Health, Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, California
| | - Stephen J McSorley
- Center for Comparative Medicine, Department of Anatomy, Physiology and Cell Biology, School of Veterinary Medicine, University of California-Davis, Davis, California
| | - Arta M Monjazeb
- Comprehensive Cancer Center, Department of Radiation Oncology, School of Medicine, University of California-Davis, Sacramento, California
| | - William J Murphy
- Department of Dermatology, School of Medicine, University of California-Davis, Sacramento, California
| | - Robert J Canter
- Comprehensive Cancer Center, Department of Surgery, School of Medicine, University of California-Davis, Sacramento, California
| | - Robert B Rebhun
- The Comparative Oncology Laboratory and Center for Companion Animal Health, Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, California
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George TJ, Franke AJ, Chakravarthy AB, Das P, Dasari A, El-Rayes BF, Hong TS, Kinsella TJ, Landry JC, Lee JJ, Monjazeb AM, Jacobs SA, Raben D, Rahma OE, Williams TM, Wu C, Coleman CN, Vikram B, Ahmed MM. National Cancer Institute (NCI) state of the science: Targeted radiosensitizers in colorectal cancer. Cancer 2019; 125:2732-2746. [PMID: 31017664 PMCID: PMC6663584 DOI: 10.1002/cncr.32150] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 03/03/2019] [Accepted: 03/07/2019] [Indexed: 12/13/2022]
Abstract
Colorectal cancer (CRC) represents a major public health problem as the second leading cause of cancer-related mortality in the United States. Of an estimated 140,000 newly diagnosed CRC cases in 2018, roughly one-third of these patients will have a primary tumor located in the distal large bowel or rectum. The current standard-of-care approach includes curative-intent surgery, often after preoperative (neoadjuvant) radiotherapy (RT), to increase rates of tumor down-staging, clinical and pathologic response, as well as improving surgical resection quality. However, despite advancements in surgical techniques, as well as sharpened precision of dosimetry offered by contemporary RT delivery platforms, the oncology community continues to face challenges related to disease relapse. Ongoing investigations are aimed at testing novel radiosensitizing agents and treatments that might exploit the systemic antitumor effects of RT using immunotherapies. If successful, these treatments may usher in a new curative paradigm for rectal cancers, such that surgical interventions may be avoided. Importantly, this disease offers an opportunity to correlate matched paired biopsies, radiographic response, and molecular mechanisms of treatment sensitivity and resistance with clinical outcomes. Herein, the authors highlight the available evidence from preclinical models and early-phase studies, with an emphasis on promising developmental therapeutics undergoing prospective validation in larger scale clinical trials. This review by the National Cancer Institute's Radiation Research Program Colorectal Cancer Working Group provides an updated, comprehensive examination of the continuously evolving state of the science regarding radiosensitizer drug development in the curative treatment of CRC.
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Affiliation(s)
- Thomas J George
- Division of Hematology and Oncology, Department of Medicine, University of Florida, Gainesville, Florida
| | - Aaron J Franke
- Division of Hematology and Oncology, Department of Medicine, University of Florida, Gainesville, Florida
| | - A Bapsi Chakravarthy
- Department of Radiation Oncology, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Prajnan Das
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Arvind Dasari
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Bassel F El-Rayes
- Department of Hematology and Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Theodore S Hong
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard, Boston, Massachusetts
| | - Timothy J Kinsella
- Department of Radiation Oncology, Rhode Island Hospital-Brown University Alpert Medical School, Providence, Rhode Island
| | - Jerome C Landry
- Department of Hematology and Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - James J Lee
- Division of Hematology-Oncology, Department of Medicine, University of Pittsburgh Medical Center, Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Arta M Monjazeb
- Division of Radiation Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, California
| | - Samuel A Jacobs
- National Adjuvant Surgical and Bowel Project Foundation/NRG Oncology, Pittsburg, Pennsylvania
| | - David Raben
- Department of Radiation Oncology, University of Colorado Denver School of Medicine, Aurora, Colorado
| | - Osama E Rahma
- Center for Immuno-Oncology, Department of Medical Oncology, Dana Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
| | - Terence M Williams
- Department of Radiation Oncology, The Ohio State University, Columbus, Ohio
| | - Christina Wu
- Department of Hematology and Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - C Norman Coleman
- Clinical Radiation Oncology Branch, Radiation Research Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Bhadrasain Vikram
- Clinical Radiation Oncology Branch, Radiation Research Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Mansoor M Ahmed
- Clinical Radiation Oncology Branch, Radiation Research Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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Judge SJ, Lata‐Arias K, Yanagisawa M, Darrow MA, Monjazeb AM, Kirane AR, Bold RJ, Canter RJ, Canter DJ. Morbidity, mortality and temporal trends in the surgical management of retroperitoneal sarcoma: An ACS‐NSQIP follow up analysis. J Surg Oncol 2019; 120:753-760. [DOI: 10.1002/jso.25649] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 07/18/2019] [Indexed: 01/05/2023]
Affiliation(s)
- Sean J. Judge
- Department of SurgeryUniversity of California Davis Medical CenterSacramento California
| | | | - Mio Yanagisawa
- Department of SurgeryUniversity of California Davis Medical CenterSacramento California
| | - Morgan A. Darrow
- Department of PathologyUniversity of California Davis Medical CenterSacramento California
| | - Arta M. Monjazeb
- Department of Radiation OncologyUniversity of California Davis Medical CenterSacramento California
| | - Amanda R. Kirane
- Department of SurgeryUniversity of California Davis Medical CenterSacramento California
| | - Richard J. Bold
- Department of SurgeryUniversity of California Davis Medical CenterSacramento California
| | - Robert J. Canter
- Department of SurgeryUniversity of California Davis Medical CenterSacramento California
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Nguyen KNB, Hause DJ, Novak J, Monjazeb AM, Daly ME. Tumor Control and Toxicity after SBRT for Ultracentral, Central, and Paramediastinal Lung Tumors. Pract Radiat Oncol 2018; 9:e196-e202. [PMID: 30496842 DOI: 10.1016/j.prro.2018.11.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 11/02/2018] [Accepted: 11/14/2018] [Indexed: 12/25/2022]
Abstract
PURPOSE Increased rates of toxicity have been described after stereotactic body radiation therapy (SBRT) for central lung tumors within 2 cm of the proximal bronchial tree (PBT). Recent studies have defined a new class of ultracentral tumors. We report our experience treating ultracentral, central, and paramediastinal tumors with SBRT and compare toxicity, disease control, and survival rates. METHODS AND MATERIALS We reviewed the records of patients with central lung tumors treated with SBRT between September 2009 and July 2017. Tumors were classified as central if within 2 cm of the PBT, ultracentral if the planning target volume touched the PBT or esophagus, and paramediastinal if touching mediastinal pleura. Actuarial rates of grades 2+ and 3+ toxicity, local control (LC), and overall survival were assessed using the Kaplan-Meier method and compared using a log-rank test. Toxicity was scored with the Common Terminology Criteria for Adverse Events, version 4.03. RESULTS We identified 68 patients with 69 central lung tumors, including 14 ultracentral, 15 paramediastinal, and 39 central tumors. Fifty-three patients were treated for early stage lung cancer and 15 for lung metastases. The prescribed dose ranged from 40 Gy to 60 Gy over 3 to 8 fractions. Most patients were treated using 5 fractions (83%), followed by 8 fractions (10%). Median follow-up was 19.7 months (range, 3.3-78.3 months). The 2-year estimates of LC (89%, 85%, and 93%, respectively; P = .72) and overall survival (76%, 73%, and 72%, respectively; P = .75) for ultracentral, central, and paramediastinal tumors were similar. Ultracentral tumors had an increased risk of grade 2+ toxicity (57.6% vs 14.2% vs 7.1%; P = .007) at 2 years. One patient with an ultracentral tumor developed grade 5 respiratory failure. CONCLUSIONS The oncologic outcomes after SBRT for ultracentral, central, and paramediastinal lung tumors were similar, with LC exceeding 85% at 2 years using predominantly 5-fraction schedules. Ultracentral lung tumors were associated with an increased risk of toxicity in our patient cohort. Additional studies are needed to minimize toxicity for ultracentral tumors.
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Affiliation(s)
- Ky Nam B Nguyen
- Department of Radiation Oncology, University of California Davis, Comprehensive Cancer Center, Sacramento, California
| | - Destiny J Hause
- Department of Radiation Oncology, University of California Davis, Comprehensive Cancer Center, Sacramento, California
| | - Jennifer Novak
- Department of Radiation Oncology, University of California Davis, Comprehensive Cancer Center, Sacramento, California
| | - Arta M Monjazeb
- Department of Radiation Oncology, University of California Davis, Comprehensive Cancer Center, Sacramento, California
| | - Megan E Daly
- Department of Radiation Oncology, University of California Davis, Comprehensive Cancer Center, Sacramento, California.
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Withers SS, Moore PF, Chang H, Choi JW, McSorley SJ, Kent MS, Monjazeb AM, Canter RJ, Murphy WJ, Sparger EE, Rebhun RB. Multi-color flow cytometry for evaluating age-related changes in memory lymphocyte subsets in dogs. Dev Comp Immunol 2018; 87:64-74. [PMID: 29859828 PMCID: PMC6197816 DOI: 10.1016/j.dci.2018.05.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 05/29/2018] [Accepted: 05/30/2018] [Indexed: 06/08/2023]
Abstract
While dogs are increasingly being utilized as large-animal models of disease, important features of age-related immunosenescence in the dog have yet to be evaluated due to the lack of defined naïve vs. memory T lymphocyte phenotypes. We therefore performed multi-color flow cytometry on peripheral blood mononuclear cells from young and aged beagles, and determined the differential cytokine production by proposed memory subsets. CD4+ and CD8+ T lymphocytes in aged dogs displayed increased cytokine production, and decreased proliferative capacity. Antibodies targeting CD45RA and CD62L, but less so CD28 or CD44, defined canine cells that consistently exhibited properties of naïve-, central memory-, effector memory-, and terminal effector-like CD4+ and CD8+ T lymphocyte subsets. Older dogs demonstrated decreased frequencies of naïve-like CD4+ and CD8+ T lymphocytes, and an increased frequency of terminal effector-like CD8+ T lymphocytes. Overall findings revealed that aged dogs displayed features of immunosenescence similar to those reported in other species.
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Affiliation(s)
- Sita S Withers
- Center for Companion Animal Health, Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, One Shields Avenue, Davis, CA 95616, USA
| | - Peter F Moore
- Department of Pathology, Microbiology, and Immunology, School of Veterinary Medicine, University of California-Davis, One Shields Avenue, Davis, CA 95616, USA
| | - Hong Chang
- Center for Companion Animal Health, Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, One Shields Avenue, Davis, CA 95616, USA
| | - Jin W Choi
- Center for Comparative Medicine, Department of Anatomy, Physiology and Cell Biology, School of Veterinary Medicine, University of California-Davis, County Road 98 & Hutchison Drive, Davis, CA 95616, USA
| | - Stephen J McSorley
- Center for Comparative Medicine, Department of Anatomy, Physiology and Cell Biology, School of Veterinary Medicine, University of California-Davis, County Road 98 & Hutchison Drive, Davis, CA 95616, USA
| | - Michael S Kent
- Center for Companion Animal Health, Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, One Shields Avenue, Davis, CA 95616, USA
| | - Arta M Monjazeb
- Comprehensive Cancer Center, Department of Radiation Oncology, School of Medicine, University of California-Davis, 4501 X Street, G-140, Sacramento, CA 95817, USA
| | - Robert J Canter
- Comprehensive Cancer Center, Department of Surgery, School of Medicine, University of California-Davis, 4501 X Street, G-140, Sacramento, CA 95817, USA
| | - William J Murphy
- Department of Dermatology, School of Medicine, University of California-Davis, 2921 Stockton Blvd, Sacramento, CA 95716, USA
| | - Ellen E Sparger
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California-Davis, One Shields Avenue, Davis, CA 95616, USA.
| | - Robert B Rebhun
- Center for Companion Animal Health, Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, One Shields Avenue, Davis, CA 95616, USA.
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Withers SS, Skorupski KA, York D, Choi JW, Woolard KD, Laufer-Amorim R, Sparger EE, Rodriguez CO, McSorley SJ, Monjazeb AM, Murphy WJ, Canter RJ, Rebhun RB. Association of macrophage and lymphocyte infiltration with outcome in canine osteosarcoma. Vet Comp Oncol 2018; 17:49-60. [PMID: 30156029 DOI: 10.1111/vco.12444] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 08/20/2018] [Accepted: 08/21/2018] [Indexed: 12/29/2022]
Abstract
Immunotherapeutic strategies have shown promise for the treatment of canine osteosarcoma (cOSA). Very little is known about the immune microenvironment within cOSA, however, limiting our ability to identify potential immune targets and biomarkers of therapeutic response. We therefore prospectively assessed the disease-free interval (DFI) and overall survival time (ST) of 30 dogs with cOSA treated with amputation and six doses of adjuvant carboplatin. We then quantified lymphocytic (CD3+, FOXP3+) and macrophage (CD204+) infiltrates within the primary tumours of this cohort using immunohistochemistry, and evaluated their association with outcome. Overall, the median DFI and ST were 392 and 455 days, respectively. The median number of CD3+ and FOXP3+ infiltrates were 45.8 cells/mm2 (4.6-607.6 cells/mm2 ) and 8.5 mm2 (0-163.1 cells/mm2 ), respectively. The median area of CD204+ macrophages was 4.7% (1.3%-23.3%), and dogs with tumours containing greater than 4.7% CD204+ macrophages experienced a significantly longer DFI (P = 0.016). Interestingly, a significantly lower percentage of CD204+ macrophages was detected in cOSA arising from the proximal humerus compared to other appendicular bone locations (P = 0.016). Lymphocytic infiltrates did not appear to correlate with outcome in cOSA. Overall, our findings suggest that macrophages may play a role in inhibiting cOSA progression, as has been suggested in human osteosarcoma.
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Affiliation(s)
- Sita S Withers
- The Comparative Oncology Laboratory and Center for Companion Animal Health, Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, California
| | - Katherine A Skorupski
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, California
| | - Daniel York
- The Comparative Oncology Laboratory and Center for Companion Animal Health, Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, California
| | - Jin W Choi
- Center for Comparative Medicine, Department of Anatomy, Physiology and Cell Biology, School of Veterinary Medicine, University of California-Davis, Davis, California
| | - Kevin D Woolard
- Department of Pathology, Microbiology, and Immunology, School of Veterinary Medicine, University of California-Davis, Davis, California
| | - Renee Laufer-Amorim
- Department of Veterinary Clinics, School of Veterinary Medicine and Animal Science, Sao Paulo State University (UNESP), Botucatu, Brazil
| | - Ellen E Sparger
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California-Davis, Davis, California
| | | | - Stephen J McSorley
- Center for Comparative Medicine, Department of Anatomy, Physiology and Cell Biology, School of Veterinary Medicine, University of California-Davis, Davis, California
| | - Arta M Monjazeb
- Comprehensive Cancer Center, Department of Radiation Oncology, School of Medicine, University of California-Davis, Sacramento, California
| | - William J Murphy
- Department of Dermatology, School of Medicine, University of California-Davis, Sacramento, California
| | - Robert J Canter
- Comprehensive Cancer Center, Department of Surgery, School of Medicine, University of California-Davis, Sacramento, California
| | - Robert B Rebhun
- The Comparative Oncology Laboratory and Center for Companion Animal Health, Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, California
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Chavez M, Silvestrini MT, Ingham ES, Fite BZ, Mahakian LM, Tam SM, Ilovitsh A, Monjazeb AM, Murphy WJ, Hubbard NE, Davis RR, Tepper CG, Borowsky AD, Ferrara KW. Distinct immune signatures in directly treated and distant tumors result from TLR adjuvants and focal ablation. Am J Cancer Res 2018; 8:3611-3628. [PMID: 30026870 PMCID: PMC6037035 DOI: 10.7150/thno.25613] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 05/15/2018] [Indexed: 11/05/2022] Open
Abstract
Both adjuvants and focal ablation can alter the local innate immune system and trigger a highly effective systemic response. Our goal is to determine the impact of these treatments on directly treated and distant disease and the mechanisms for the enhanced response obtained by combinatorial treatments. Methods: We combined RNA-sequencing, flow cytometry and TCR-sequencing to dissect the impact of immunotherapy and of immunotherapy combined with ablation on local and systemic immune components. Results: With administration of a toll-like receptor agonist agonist (CpG) alone or CpG combined with same-site ablation, we found dramatic differences between the local and distant tumor environments, where the directly treated tumors were skewed to high expression of F4/80, Cd11b and Tnf and the distant tumors to enhanced Cd11c, Cd3 and Ifng. When ablation was added to immunotherapy, 100% (n=20/20) of directly treated tumors and 90% (n=18/20) of distant tumors were responsive. Comparing the combined ablation-immunotherapy treatment to immunotherapy alone, we find three major mechanistic differences. First, while ablation alone enhanced intratumoral antigen cross-presentation (up to ~8% of CD45+ cells), systemic cross-presentation of tumor antigen remained low. Combining same-site ablation with CpG amplified cross-presentation in the draining lymph node (~16% of CD45+ cells) compared to the ablation-only (~0.1% of CD45+ cells) and immunotherapy-only cohorts (~10% of CD45+ cells). Macrophages and DCs process and present this antigen to CD8+ T-cells, increasing the number of unique T-cell receptor rearrangements in distant tumors. Second, type I interferon (IFN) release from tumor cells increased with the ablation-immunotherapy treatment as compared with ablation or immunotherapy alone. Type I IFN release is synergistic with toll-like receptor activation in enhancing cytokine and chemokine expression. Expression of genes associated with T-cell activation and stimulation (Eomes, Prf1 and Icos) was 27, 56 and 89-fold higher with ablation-immunotherapy treatment as compared to the no-treatment controls (and 12, 32 and 60-fold higher for immunotherapy-only treatment as compared to the no-treatment controls). Third, we found that the ablation-immunotherapy treatment polarized macrophages and dendritic cells towards a CD169 subset systemically, where CD169+ macrophages are an IFN-enhanced subpopulation associated with dead-cell antigen presentation. Conclusion: While the local and distant responses are distinct, CpG combined with ablative focal therapy drives a highly effective systemic immune response.
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Yanagisawa M, Gingrich AA, Judge S, Li CS, Wang N, Thorpe SW, Kirane AR, Bold RJ, Monjazeb AM, Canter RJ. Serum C-reactive Protein and Neutrophil/Lymphocyte Ratio After Neoadjuvant Radiotherapy in Soft Tissue Sarcoma. Anticancer Res 2018; 38:1491-1497. [PMID: 29491077 DOI: 10.21873/anticanres.12376] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 01/31/2018] [Accepted: 02/01/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND/AIM The predictive value of serum C-reactive protein (CRP) and neutrophil/lymphocyte (N/L) ratio in soft tissue sarcoma (STS) patients receiving neoadjuvant radiotherapy (RT) has not been analyzed. PATIENTS AND METHODS From 2007 to 2015, we identified 98 STS patients from a prospective database. Using multivariate analysis, we analyzed CRP and N/L ratios as predictors of overall survival (OS). RESULTS Mean age of patients was 59 years, 46% were female, and 55% of tumors were located at the extremity. A total of 15 histologies were represented. Fifty percent received preoperative RT. Except for extremity location, characteristics were similar between the preoperative RT and upfront surgery cohorts, including baseline CRP levels and N/L ratios. Multivariate analysis of upfront surgery revealed histological grade, tumor size, and baseline N/L ratio to be predictors of OS, while for preoperative RT, baseline CRP and N/L ratio were not predictive. CONCLUSION Baseline CRP and N/L ratio did not predict poor clinical outcome in STS patients receiving neoadjuvant RT.
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Affiliation(s)
- Mio Yanagisawa
- Division of Surgical Oncology, Department of Surgery, UC Davis School of Medicine, Sacramento, CA, U.S.A
| | - Alicia A Gingrich
- Division of Surgical Oncology, Department of Surgery, UC Davis School of Medicine, Sacramento, CA, U.S.A
| | - Sean Judge
- Division of Surgical Oncology, Department of Surgery, UC Davis School of Medicine, Sacramento, CA, U.S.A
| | - Chin-Shang Li
- Department of Public Health Sciences, Division of Biostatistics, University of California, Davis, CA, U.S.A
| | - Nana Wang
- Department of Statistics, University of California, Davis, CA, U.S.A
| | - Steven W Thorpe
- Department of Orthopedic Surgery, UC Davis School of Medicine, Sacramento, CA, U.S.A
| | - Amanda R Kirane
- Division of Surgical Oncology, Department of Surgery, UC Davis School of Medicine, Sacramento, CA, U.S.A
| | - Richard J Bold
- Division of Surgical Oncology, Department of Surgery, UC Davis School of Medicine, Sacramento, CA, U.S.A
| | - Arta M Monjazeb
- Department of Radiation Oncology, UC Davis School of Medicine, Sacramento, CA, U.S.A
| | - Robert J Canter
- Division of Surgical Oncology, Department of Surgery, UC Davis School of Medicine, Sacramento, CA, U.S.A.
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Marciscano AE, Walker JM, McGee HM, Kim MM, Kunos CA, Monjazeb AM, Shiao SL, Tran PT, Ahmed MM. Incorporating Radiation Oncology into Immunotherapy: proceedings from the ASTRO-SITC-NCI immunotherapy workshop. J Immunother Cancer 2018; 6:6. [PMID: 29375032 PMCID: PMC5787916 DOI: 10.1186/s40425-018-0317-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 01/09/2018] [Indexed: 12/11/2022] Open
Abstract
Radiotherapy (RT) has been a fundamental component of the anti-cancer armamentarium for over a century. Approximately half of all cancer patients are treated with radiotherapy during their disease course. Over the two past decades, there has been a growing body of preclinical evidence supporting the immunomodulatory effects of radiotherapy, particularly when combined with immunotherapy, but only anecdotal clinical examples existed until recently. The renaissance of immunotherapy and the recent U.S. Food and Drug Administration (FDA) approval of several immune checkpoint inhibitors (ICIs) and other immuno-oncology (IO) agents in multiple cancers provides the opportunity to investigate how localized radiotherapy can induce systemic immune responses. Early clinical experiences have demonstrated feasibility of this approach but additional preclinical and clinical investigation is needed to understand how RT and immunotherapy can be optimally combined. To address questions that are critical to successful incorporation of radiation oncology into immunotherapy, the American Society for Radiation Oncology (ASTRO), the Society for Immunotherapy of Cancer (SITC) and the National Cancer Institute (NCI) organized a collaborative scientific workshop, Incorporating Radiation Oncology into Immunotherapy, that convened on June 15 and 16 of 2017 at the Natcher Building, NIH Campus in Bethesda, Maryland. This report summarizes key data and highlights from each session.
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Affiliation(s)
- Ariel E Marciscano
- Department of Radiation Oncology & Molecular Radiation Sciences, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, 1550 Orleans Street CRB2, RM 406, Baltimore, MD, 21231, USA
| | - Joshua M Walker
- Department of Radiation Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Heather M McGee
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michelle M Kim
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Charles A Kunos
- Investigational Drug Branch, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD, USA
| | - Arta M Monjazeb
- Department of Radiation Oncology, UC Davis Comprehensive Cancer Center, Sacramento, CA, USA
| | - Stephen L Shiao
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Phuoc T Tran
- Department of Radiation Oncology & Molecular Radiation Sciences, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, 1550 Orleans Street CRB2, RM 406, Baltimore, MD, 21231, USA.
| | - Mansoor M Ahmed
- Radiation Research Program, National Cancer Institute, Bethesda, MD, USA. .,Molecular Radiation Therapeutics, Radiation Research Program, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Rockville, MD, 20892-9760, USA.
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50
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Ogawa H, Luxardi G, Kirane A, Kulkarni R, Monjazeb AM, Cheng MY, Ma C, Maverakis E. T Cells Dominate the Local Immune Response Induced by Intralesional IL-2 in Combination with Imiquimod and Retinoid for In-Transit Metastatic Melanoma. J Invest Dermatol 2017; 138:1442-1445. [PMID: 29291382 DOI: 10.1016/j.jid.2017.12.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 12/07/2017] [Accepted: 12/07/2017] [Indexed: 11/18/2022]
Affiliation(s)
- Hiromi Ogawa
- Department of Dermatology, University of California, Davis, School of Medicine, Sacramento, California, USA; Department of Dermatology, University of California, Los Angeles, School of Medicine, Los Angeles, California, USA
| | - Guillaume Luxardi
- Department of Dermatology, University of California, Davis, School of Medicine, Sacramento, California, USA
| | - Amanda Kirane
- Department of Surgery, University of California, Davis, School of Medicine, Los Angeles, California, USA
| | - Rajan Kulkarni
- Department of Dermatology, University of California, Los Angeles, School of Medicine, Los Angeles, California, USA
| | - Arta M Monjazeb
- Department of Dermatology, University of California, Davis, School of Medicine, Sacramento, California, USA
| | - Michelle Y Cheng
- Department of Dermatology, University of California, Davis, School of Medicine, Sacramento, California, USA
| | - Chelsea Ma
- Department of Dermatology, University of California, Davis, School of Medicine, Sacramento, California, USA
| | - Emanual Maverakis
- Department of Dermatology, University of California, Davis, School of Medicine, Sacramento, California, USA.
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