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van den Brand FF, Masrati H, Jordanova ES, Bloemena E, Lissenberg-Witte BI, de Boer YS, Bontkes HJ, Mebius R, Bouma G. MAdCAM-1 does not play a central role in the early pathophysiology of autoimmune hepatitis. Clin Res Hepatol Gastroenterol 2023; 47:102099. [PMID: 36841352 DOI: 10.1016/j.clinre.2023.102099] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/13/2023] [Accepted: 02/21/2023] [Indexed: 02/27/2023]
Abstract
INTRODUCTION CD4+ T cells are thought to have a central role in the pathogenesis of autoimmune hepatitis (AIH). Mucosal addressin cell adhesion molecule-1 (MAdCAM-1) directs homing of CD4+ T cells in the alimentary tract and is a therapeutic target in inflammatory bowel diseases. Here we assessed MAdCAM-1 expression in AIH and viral hepatitis and related its expression with immune infiltrate analysis and histopathological key features. METHODS Hepatic portal areas of pretreatment biopsies (n=10) and follow-up biopsies (n=9) of patients with a confirmed diagnosis of AIH were assessed for MAdCAM-1 expression and infiltrate composition using immunohistochemistry and multispectral imaging (Vectra® Polaris™). Controls consisted of biopsies of patients with untreated chronic viral hepatitis B or C (n=22). RESULTS MAdCAM-1 expression on endothelium was sparsely present in portal fields of two treatment-naïve AIH patients. Three patients showed MAdCAM-1 expression within lymphoid aggregates. No expression of significance (including single-cell expression) was observed in the remaining 6 patients. In contrast, viral hepatitis C biopsies showed endothelial MAdCAM-1 expression in 8 of 13 untreated patients. Densities of both B-cells (CD20+) and CD4+ T-cells (CD3+ CD8-) were increased in AIH and viral hepatitis patients with MAdCAM-1 expression. CONCLUSION MAdCAM-1 was detected in liver biopsies in a minority of patients with AIH at the time of diagnosis suggesting no central role in its pathophysiology. Lymphoid or reticular MAdCAM-1 pattern expression was associated with more dense infiltrates of both B-cells and CD4+ T-cells, and may be related to the formation of secondary lymphoid follicles.
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Affiliation(s)
- F F van den Brand
- Department of Gastroenterology and Hepatology, Amsterdam UMC, location VU University Medical Center, PK 2×136, Boelelaan 1117, Amsterdam 1081HV, The Netherlands; Amsterdam Gastroenterology Endocrinology and Metabolism Research Institute, Amsterdam, The Netherlands.
| | - H Masrati
- Department of Gastroenterology and Hepatology, Amsterdam UMC, location VU University Medical Center, PK 2×136, Boelelaan 1117, Amsterdam 1081HV, The Netherlands
| | - E S Jordanova
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - E Bloemena
- Amsterdam Gastroenterology Endocrinology and Metabolism Research Institute, Amsterdam, The Netherlands; Department of Pathology, Amsterdam UMC, location VU University Medical Center, The Netherlands
| | - B I Lissenberg-Witte
- Department of Epidemiology and Data Science, Amsterdam UMC, location VU University Medical Center, The Netherlands
| | - Y S de Boer
- Department of Gastroenterology and Hepatology, Amsterdam UMC, location VU University Medical Center, PK 2×136, Boelelaan 1117, Amsterdam 1081HV, The Netherlands; Amsterdam Gastroenterology Endocrinology and Metabolism Research Institute, Amsterdam, The Netherlands
| | - H J Bontkes
- Department of Clinical Chemistry, Laboratory Medical Immunology, Amsterdam UMC, location VU University Medical Center, The Netherlands; Department of Molecular Cell Biology and Immunology, Amsterdam UMC, location VU University Medical Center, The Netherlands; Amsterdam Institute for Infection and Immunity, Amsterdam, The Netherlands
| | - R Mebius
- Department of Molecular Cell Biology and Immunology, Amsterdam UMC, location VU University Medical Center, The Netherlands; Amsterdam Institute for Infection and Immunity, Amsterdam, The Netherlands; Cancer Center Amsterdam Research Institute, Amsterdam, location VU University medical center, The Netherlands
| | - G Bouma
- Department of Gastroenterology and Hepatology, Amsterdam UMC, location VU University Medical Center, PK 2×136, Boelelaan 1117, Amsterdam 1081HV, The Netherlands; Amsterdam Gastroenterology Endocrinology and Metabolism Research Institute, Amsterdam, The Netherlands
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2
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Goedegebuure RSA, Harrasser M, de Klerk LK, van Schooten TS, van Grieken NCT, Eken M, Grifhorst MS, Pocorni N, Jordanova ES, van Berge Henegouwen MI, Pouw RE, Verheul HMW, van der Vliet JJ, van Laarhoven HWM, Thijssen VLJL, Bass AJ, De Gruijl TD, Derks S. Pre-treatment tumor-infiltrating T cells influence response to neoadjuvant chemoradiotherapy in esophageal adenocarcinoma. Oncoimmunology 2021; 10:1954807. [PMID: 34377591 PMCID: PMC8344794 DOI: 10.1080/2162402x.2021.1954807] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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] [Indexed: 12/12/2022] Open
Abstract
Esophageal adenocarcinoma (EAC) is a disease with dismal treatment outcomes. Response to neoadjuvant chemoradiation (CRT) varies greatly. Although the underlying mechanisms of CRT resistance are not identified, accumulating evidence indicates an important role for local antitumor immunity. To explore the immune microenvironment in relation to response to CRT we performed an in-depth analysis using multiplex immunohistochemistry, flow cytometry and mRNA expression analysis (NanoString) to generate a detailed map of the immunological landscape of pretreatment biopsies as well as peripheral blood mononuclear cells (PBMCs) of EAC patients. Response to CRT was assessed by Mandard’s tumor regression grade (TRG), disease-free- and overall survival. Tumors with a complete pathological response (TRG 1) to neoadjuvant CRT had significantly higher tumor-infiltrating T cell levels compared to all other response groups (TRG 2–5). These T cells were also in closer proximity to tumor cells in complete responders compared to other response groups. Notably, immune profiles of near-complete responders (TRG 2) showed more resemblance to non-responders (TRG 3–5) than to complete responders. A high CD8:CD163 ratio in the tumor was associated with an improved disease-free survival. Gene expression analyses revealed that T cells in non-responders were Th2-skewed, while complete responders were enriched in cytotoxic immune cells. Finally, complete responders were enriched in circulating memory T cells. preexisting immune activation enhances the chance for a complete pathological response to neoadjuvant CRT. This information can potentially be used for future patient selection, but also fuels the development of immunomodulatory strategies to enhance CRT efficacy.
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Affiliation(s)
- R S A Goedegebuure
- Amsterdam UMC, Location VUMC, Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam, The Netherlands.,Oncode Institute, Utrecht, The Nederlands
| | - M Harrasser
- Amsterdam UMC, Location VUMC, Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam, The Netherlands.,Oncode Institute, Utrecht, The Nederlands
| | - L K de Klerk
- Amsterdam UMC, Location VUMC, Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam, The Netherlands.,Oncode Institute, Utrecht, The Nederlands.,Dana-Farber Cancer Institute, Department of Medical Oncology, Boston, MA, USA
| | - T S van Schooten
- Amsterdam UMC, Location VUMC, Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam, The Netherlands.,Oncode Institute, Utrecht, The Nederlands
| | - N C T van Grieken
- Amsterdam UMC, Location VUMC, Department of Pathology, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - M Eken
- Amsterdam UMC, Location VUMC, Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - M S Grifhorst
- Amsterdam UMC, Location VUMC, Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - N Pocorni
- Amsterdam UMC, Location VUMC, Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - E S Jordanova
- Amsterdam UMC, Location VUMC, Department of Obstetrics and Gynecology, Center for Gynecologic Oncology Amsterdam, Amsterdam, The Netherlands
| | - M I van Berge Henegouwen
- Amsterdam UMC, Location VUMC, Department of Surgery, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - R E Pouw
- Amsterdam UMC, Location VUMC, Department of Gastroenterology, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - H M W Verheul
- Radboud UMC, Department of Medical Oncology, Nijmegen, The Netherlands
| | - J J van der Vliet
- Amsterdam UMC, Location VUMC, Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam, The Netherlands.,LAVA Therapeutics, Utrecht, The Netherlands
| | - H W M van Laarhoven
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - V L J L Thijssen
- Amsterdam UMC, Location VUMC, Department of Radiation Oncology, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - A J Bass
- Dana-Farber Cancer Institute, Department of Medical Oncology, Boston, MA, USA.,Cancer Program, the Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - T D De Gruijl
- Amsterdam UMC, Location VUMC, Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - S Derks
- Amsterdam UMC, Location VUMC, Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam, The Netherlands.,Oncode Institute, Utrecht, The Nederlands
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3
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Santegoets SJ, Duurland CL, Jordanova ES, van Ham JJ, Ehsan I, van Egmond SL, Welters MJP, van der Burg SH. Tbet-positive regulatory T cells accumulate in oropharyngeal cancers with ongoing tumor-specific type 1 T cell responses. J Immunother Cancer 2019; 7:14. [PMID: 30658697 PMCID: PMC6339415 DOI: 10.1186/s40425-019-0497-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [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: 10/11/2018] [Accepted: 01/01/2019] [Indexed: 01/13/2023] Open
Abstract
Regulatory T cells (Tregs) may comprise different subsets allowing them to efficiently suppress different types of effector T cells. In this study, we show that high numbers of both conventional and Tbet co-expressing Foxp3hi Tregs accumulate in human papilloma virus (HPV)-driven oropharyngeal squamous cell carcinoma (OPSCC). The infiltration of Tbet+ Foxp3+ Tregs was strongly correlated with a concomitant tumor-specific and conventional type 1-oriented intratumoral T cell infiltrate. Both conventional CD4+CD25+CD127–Foxp3hi Tregs and their Tbethi counterparts exhibited an activated phenotype, co-expressed high levels of CTLA4 and Helios and exhibited a maximally demethylated Foxp3 gene locus TSDR, indicating their full capacity to impede a type 1 effector T cell response. Interestingly, while the prognostic value of conventional Tregs was neutral, a high intratumoral frequency of Tbet+ Tregs was associated with prolonged disease-specific survival, most likely because their presence reflected high numbers of effector T cells. The presence of these Tbet+ Tregs may in part explain why a dense type 1-oriented immune infiltrate in OPSCC is not enough to fully control tumor growth.
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Affiliation(s)
- S J Santegoets
- Departments of Medical Oncology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
| | - C L Duurland
- Departments of Medical Oncology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
| | - E S Jordanova
- Department of Obstetrics and Gynecology, Center for Gynecological Oncology Amsterdam (CGOA) Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - J J van Ham
- Departments of Medical Oncology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
| | - I Ehsan
- Departments of Medical Oncology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
| | - S L van Egmond
- Departments of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - M J P Welters
- Departments of Medical Oncology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
| | - S H van der Burg
- Departments of Medical Oncology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands.
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Rotman J, Mom CH, Jordanova ES, de Gruijl TD, Kenter GG. 'DURVIT': a phase-I trial of single low-dose durvalumab (Medi4736) IntraTumourally injected in cervical cancer: safety, toxicity and effect on the primary tumour- and lymph node microenvironment. BMC Cancer 2018; 18:888. [PMID: 30208866 PMCID: PMC6134598 DOI: 10.1186/s12885-018-4764-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [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: 11/21/2017] [Accepted: 08/20/2018] [Indexed: 12/29/2022] Open
Abstract
Background Treatment with programmed cell death receptor (PD-1) and programmed cell death ligand 1 (PD-L1) inhibitors is a promising strategy to lift tumour-induced immune response suppression. However, the current systemic treatment often causes autoimmune side effects. In more than 50% of squamous cell cervical cancer, PD-L1 expression is detected. Moreover, we observed high and interrelated rates of PD-L1 positive macrophages and regulatory T cells in metastatic lymph nodes of cervical cancer patients. As cervical cancer in general initially metastasizes to regional lymph nodes, local administration of durvalumab (a PD-L1 checkpoint inhibitor) at an early stage will deliver these antibodies exactly where they are needed, facilitating immune protection. This may result in a clinical benefit while reducing undesirable side effects. Methods DURVIT is a non-randomized, single-arm, open-label, phase I study. Three escalating dose levels of intratumourally (i.t.) injected durvalumab will be tested, i.e. 5, 10 and 20 mg (three patients per dose level, with an additional three at the highest tolerated dose). The primary endpoint of this phase-I study is safety. Immune monitoring will consist of flow cytometric, immunohistochemical and functional T cell reactivity testing. The first patient has been included in this trial in November 2017. Discussion Evidence of safety and biological efficacy of this locally administered checkpoint blockade may expand adjuvant therapy options for cervical cancer patients. Early metastatic spread of cervical cancer cells may thus be controlled in the draining lymph node basin, and beyond, and hopefully delay or even prevent the onset of disease recurrence. Trial registration NTR6119, 1-nov-2016. Electronic supplementary material The online version of this article (10.1186/s12885-018-4764-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- J Rotman
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Obstetrics and Gynaecology, Cancer Center Amsterdam, Center for Gynaecologic Oncology Amsterdam (CGOA), CCA 2.48, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands
| | - C H Mom
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Obstetrics and Gynaecology, Cancer Center Amsterdam, Center for Gynaecologic Oncology Amsterdam (CGOA), CCA 2.48, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands. .,Amsterdam UMC, Univ(ersity) of Amsterdam, Department of Obstetrics and Gynaecology, Center for Gynaecologic Oncology Amsterdam (CGOA), H4-222, Postbus 22660, 1100 DD, Amsterdam, the Netherlands.
| | - E S Jordanova
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Obstetrics and Gynaecology, Cancer Center Amsterdam, Center for Gynaecologic Oncology Amsterdam (CGOA), CCA 2.48, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands
| | - T D de Gruijl
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Medical Oncology, Cancer Center Amsterdam, CCA 2.44, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands
| | - G G Kenter
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Obstetrics and Gynaecology, Cancer Center Amsterdam, Center for Gynaecologic Oncology Amsterdam (CGOA), CCA 2.48, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands.,Amsterdam UMC, Univ(ersity) of Amsterdam, Department of Obstetrics and Gynaecology, Center for Gynaecologic Oncology Amsterdam (CGOA), H4-222, Postbus 22660, 1100 DD, Amsterdam, the Netherlands.,The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Department of Gynaecology, Center for Gynaecologic Oncology Amsterdam (CGOA), Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands
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5
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Ottenhof SR, Djajadiningrat RS, Thygesen HH, Jakobs PJ, Jóźwiak K, Heeren AM, de Jong J, Sanders J, Horenblas S, Jordanova ES. The Prognostic Value of Immune Factors in the Tumor Microenvironment of Penile Squamous Cell Carcinoma. Front Immunol 2018; 9:1253. [PMID: 29942303 PMCID: PMC6004546 DOI: 10.3389/fimmu.2018.01253] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 05/18/2018] [Indexed: 12/26/2022] Open
Abstract
The host's immune system plays a pivotal role in many tumor types, including squamous cell carcinomas (SCCs). We aim to identify immunological prognosticators for lymph node metastases (LNM) and disease-specific survival (DSS) in penile SCC. For this retrospective observational cohort study, penile SCC patients (n = 213) treated in the Netherlands Cancer Institute, were selected if sufficient formalin-fixed, paraffin-embedded tumor material was available. Analysis included previously described high-risk human papilloma virus (hrHPV) status, immunohistochemical scores for classical and non-classical human leukocyte antigen (HLA) class I, programmed death ligand-1 (PD-L1) expression, and novel data on tumor-infiltrating macrophages and cytotoxic an regulatory T-cells. Clinicopathological characteristics and extended follow-up were also included. Regression analyses investigated relationships of the immune parameters with LNM and DSS. In the total cohort, diffuse PD-L1 tumor-cell expression, CD163+ macrophage infiltration, non-classical HLA class I upregulation, and low stromal CD8+ T-cell infiltration were all associated with LNM. In the multivariable model, only tumor PD-L1 expression remained a significant predictor for LNM (odds ratio (OR) 2.8, p = 0.05). hrHPV negativity and diffuse PD-L1 tumor-cell expression were significantly associated with poor DSS and remained so upon correction for clinical parameters [hazard ratio (HR) 9.7, p < 0.01 and HR 2.8, p = 0.03]. The only immune factor with different expression in HPV+ and HPV- tumors was PD-L1, with higher PD-L1 expression in the latter (p = 0.03). In the HPV- cohort (n = 158), LNM were associated with diffuse PD-L1 tumor-cell expression, high intratumoral CD163+ macrophage infiltration, and low number of stromal CD8+ T-cells. The first two parameters were also linked to DSS. In the multivariable regression model, diffuse PD-L1 expression remained significantly unfavorable for DSS (HR 5.0, p < 0.01). These results emphasize the complexity of the tumor microenvironment in penile cancer and point toward several possible immunotherapy targets. Here described immune factors can aid risk-stratification and should be evaluated in clinical immunotherapy studies to ultimately lead to patient tailored treatment.
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Affiliation(s)
| | - Rosa Sanne Djajadiningrat
- Department of Urology, Netherlands Cancer Institute, Amsterdam, Netherlands
- Department of Urology, HagaZiekenhuis, Hague, Netherlands
| | - Helene Hoegsbro Thygesen
- Department of Biometrics, Netherlands Cancer Institute, Amsterdam, Netherlands
- Statistics, Department of Conservation, Hamilton, New Zealand
| | | | - Katarzyna Jóźwiak
- Department of Epidemiology and Biostatistics, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Anne Marijne Heeren
- Center for Gynecologic Oncology Amsterdam (CGOA), VU University Medical Center, Amsterdam, Netherlands
| | - Jeroen de Jong
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Joyce Sanders
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Simon Horenblas
- Department of Urology, Netherlands Cancer Institute, Amsterdam, Netherlands
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6
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Samuels S, Ferns DM, Meijer D, van Straalen JP, Buist MR, Zijlmans HJ, Kenter GG, Jordanova ES. High levels of soluble MICA are significantly related to increased disease-free and disease-specific survival in patients with cervical adenocarcinoma. ACTA ACUST UNITED AC 2015; 85:476-83. [PMID: 25871737 DOI: 10.1111/tan.12562] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [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: 10/24/2014] [Revised: 02/11/2015] [Accepted: 03/17/2015] [Indexed: 12/31/2022]
Abstract
Downregulation of major histocompatibility complex class I chain-related molecule A (MICA) and upregulation of human leukocyte antigen G (HLA-G) on the tumor cells are important immune escape mechanisms for different epithelial tumors. In addition, upregulation of the soluble forms of the latter molecules in serum leads to peripheral T-cell and natural killer (NK)-cell tolerance. As for cervical cancer, it remains unknown whether soluble MICA (sMICA) and soluble HLA-G (sHLA-G) concentrations are related to tumor characteristics or patient survival rates. We measured sMICA and sHLA-G in pre-treatment sera of a large cohort of cervical cancer patients (n = 366) by enzyme-linked immunosorbent assay (ELISA). We detected a median sMICA of 174.73 pg/ml and a median sHLA-G of 5.35 U/ml. We did not find an association between sHLA-G levels and clinicopathological characteristics. In adenocarcinoma, low sMICA concentration was positively related to recurrent disease, a higher International Federation of Gynecology and Obstetrics (FIGO) stage and vaginal involvement (Mann-Whitney U-test; P = 0.018, P = 0.042 and P = 0.013, respectively). In the latter patient group, high sMICA levels were associated with better disease-free survival (DFS) and disease-specific survival (DSS) (P = 0.011 and P = 0.047). After adjusting for confounding factors, high sMICA proved to be an independent predictor for a better DFS and DSS [HR 0.16; 95% confidence interval (CI) 0.04-0.64; P = 0.009 and HR 0.12; 95% CI 0.03-0.50; P = 0.004]. sHLA-G did not influence survival in cervical cancer patients, regardless of histology. We conclude that cervical adenocarcinoma patients with high sMICA levels have an increased DFS and DSS. This data warrants a prospective trial to study the functional role of sMICA in cervical adenocarcinoma.
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Affiliation(s)
- S Samuels
- Department of Gynecology, Netherlands Cancer Institute - Antoni van Leeuwenhoek (in collaboratation within the Centre for Gynecologic Oncology Amsterdam (CGOA)), Amsterdam, the Netherlands
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7
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Wouters M, Dijkgraaf EM, Kuijjer ML, Jordanova ES, Hollema H, Welters M, van der Hoeven J, Daemen T, Kroep JR, Nijman HW, van der Burg SH. Interleukin-6 receptor and its ligand interleukin-6 are opposite markers for survival and infiltration with mature myeloid cells in ovarian cancer. Oncoimmunology 2015; 3:e962397. [PMID: 25964862 PMCID: PMC4353164 DOI: 10.4161/21624011.2014.962397] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [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: 08/10/2014] [Accepted: 10/30/2014] [Indexed: 11/19/2022] Open
Abstract
An increased level of interleukin-6 (IL-6) in epithelial ovarian cancer (EOC) is correlated with a worse prognosis. IL-6 stimulates tumor-growth and inflammation. We investigated the intricate interaction between the IL-6 signaling pathway and tumor-infiltrating myeloid cells (TIMs) to determine their prognostic impact in EOC. 160 EOC samples were analyzed for the expression of IL-6, its receptor (IL-6R) and downstream signaling via pSTAT3 by immunohistochemistry. Triple color immunofluorescence confocal microscopy was used to identify myeloid cell populations by CD14, CD33, and CD163. The relationship between these markers, tumor-infiltrating immune cells, clinical-pathological characteristics and survival was investigated. EOC displayed a dense infiltration with myeloid cells, in particular of the CD163+ type. The distribution pattern of all myeloid subtypes was comparable among the different histological subtypes. Analysis of the tumor cells revealed a high expression of IL-6R in 15% and of IL-6 in 23% of patients. Interestingly, tumors expressing IL-6 or IL-6R formed two different groups. Tumors with a high expression of IL-6R displayed low mature myeloid cell infiltration and a longer disease-specific survival (DSS), especially in late stage tumors. High expression of IL-6R was an independent prognostic factor for survival by multivariate analyses (hazard ratio = 0.474, p = 0.011). In contrast, tumors with high epithelial IL-6 expression displayed a dense infiltration of mature myeloid cells and were correlated with a shorter DSS. Furthermore, in densely CD8+ T-cell infiltrated tumors, the ratio between these lymphoid cells and CD163+ myeloid cells was predictive for survival. Thus, IL-6 and IL-6R are opposite markers for myeloid cell infiltration and survival.
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Key Words
- DSS, disease-specific survival
- EOC, epithelial ovarian cancer
- FIGO, International Federation of Gynecology and Obstetrics
- IL-6, interleukin-6; IL-6R, interleukin-6 receptor
- IL-6R, interleukin-6, IL-6, interleukin-6 receptor
- MDSC, myeloid-derived suppressor cell
- T reg, regulatory T cell
- TAM, tumor-associated macrophage
- TIL, tumor-infiltrating lymphocytes
- TIM, tumor-infiltrating myeloid cell
- TMA, tissue microarray
- epithelial ovarian cancer
- pSTAT3
- pSTAT3, phosphorylated signal transducer and activator of transcription 3
- tumor-infiltrating myeloid cells
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Affiliation(s)
- McA Wouters
- Department of Gynecologic Oncology; University of Groningen; University Medical Center Groningen ; Hanzeplein ; Groningen, The Netherlands ; Department of Medical Microbiology; University of Groningen; University Medical Center Groningen ; Hanzeplein , Groningen, The Netherlands
| | - E M Dijkgraaf
- Department of ClinicalOncology; Leiden University Medical Center ; Albinusdreef , Leiden, The Netherlands
| | - M L Kuijjer
- Department of Biostatistics and Computational Biology; Dana-Farber Cancer Institute ; Boston, MA USA ; Department of Biostatistics; Harvard School of Public Health ; Boston, MA USA
| | - E S Jordanova
- Center for Gynaecological Oncology Amsterdam ; VUMC, De Boelelaan , Amsterdam, The Netherlands
| | - H Hollema
- Department of Pathology; University of Groningen; University Medical Center Groningen ; Hanzeplein , Groningen, The Netherlands
| | - Mjp Welters
- Department of ClinicalOncology; Leiden University Medical Center ; Albinusdreef , Leiden, The Netherlands
| | - Jjm van der Hoeven
- Department of ClinicalOncology; Leiden University Medical Center ; Albinusdreef , Leiden, The Netherlands
| | - T Daemen
- Department of Medical Microbiology; University of Groningen; University Medical Center Groningen ; Hanzeplein , Groningen, The Netherlands
| | - J R Kroep
- Department of ClinicalOncology; Leiden University Medical Center ; Albinusdreef , Leiden, The Netherlands
| | - H W Nijman
- Department of Gynecologic Oncology; University of Groningen; University Medical Center Groningen ; Hanzeplein ; Groningen, The Netherlands
| | - S H van der Burg
- Department of ClinicalOncology; Leiden University Medical Center ; Albinusdreef , Leiden, The Netherlands
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8
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van Esch EMG, Tummers B, Baartmans V, Osse EM, Ter Haar N, Trietsch MD, Hellebrekers BWJ, Holleboom CAG, Nagel HTC, Tan LT, Fleuren GJ, van Poelgeest MIE, van der Burg SH, Jordanova ES. Alterations in classical and nonclassical HLA expression in recurrent and progressive HPV-induced usual vulvar intraepithelial neoplasia and implications for immunotherapy. Int J Cancer 2014; 135:830-42. [PMID: 24415578 DOI: 10.1002/ijc.28713] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [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: 09/18/2013] [Accepted: 12/17/2013] [Indexed: 01/23/2023]
Abstract
Immunotherapy of usual vulvar intraepithelial neoplasia (uVIN) is promising; however, many patients still fail to show clinical responses, which could be explained by an immune escape through alterations in human leukocyte antigen (HLA) expression. Therefore, we analyzed a cohort of patients with a primary (n = 43) and subsequent recurrent uVIN lesion (n = 20), vaccine-treated uVIN patients (n = 12), patients with human papillomavirus (HPV)-induced vulvar carcinoma (n = 21) and healthy controls (n = 26) for the expression of classical HLA-class I/II and nonclassical HLA-E/-G and MHC class I chain-related molecule A (MICA). HLA-class I was downregulated in 70% of uVIN patients, including patients with a clinical response to immunotherapy. Downregulation of HLA-class I is probably reversible, as only 15% of the uVIN cases displayed loss of heterozygosity (LOH) and HLA-class I could be upregulated in uVIN keratinocyte cultures by interferon γ. HLA-class I downregulation is more frequently associated with LOH in vulvar carcinomas (25-55.5%). HLA-class II was found to be focally expressed in 65% of uVIN patients. Of the nonclassical molecules, MICA was downregulated in 80% of uVIN whereas HLA-E and -G were expressed in a minority of cases. Their expression was more prominent in vulvar carcinoma. No differences were found between the alterations observed in paired primary and recurrent uVIN. Importantly, downregulation of HLA-B/C in primary uVIN lesions was associated with the development of recurrences and progression to cancer. We conclude that downregulation of HLA is frequently observed in premalignant HPV-induced lesions, including clinical responders to immunotherapy, and is associated with worse clinical outcome. However, in the majority of cases downregulation may still be reversible.
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Affiliation(s)
- E M G van Esch
- Department of Gynaecology, Leiden University Medical Center, Leiden, The Netherlands; Department of Clinical Oncology, Leiden University Medical Center, Leiden, The Netherlands
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9
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de Vos van Steenwijk PJ, Ramwadhdoebe TH, Goedemans R, Doorduijn EM, van Ham JJ, Gorter A, van Hall T, Kuijjer ML, van Poelgeest MIE, van der Burg SH, Jordanova ES. Tumor-infiltrating CD14-positive myeloid cells and CD8-positive T-cells prolong survival in patients with cervical carcinoma. Int J Cancer 2013; 133:2884-94. [PMID: 23740735 DOI: 10.1002/ijc.28309] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [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: 03/15/2013] [Accepted: 05/17/2013] [Indexed: 01/10/2023]
Abstract
One of the hallmarks of cancer is the influx of myeloid cells. In our study, we investigated the constitution of tumor-infiltrating myeloid cells and their relationship to other tumor-infiltrating immune cells, tumor characteristics and the disease-specific survival of patients with cervical cancer (CxCa). Triple-color immunofluorescence confocal microscopy was used to locate, identify and quantify macrophages (CD14), their maturation status (CD33) and their polarization (CD163) in a cohort of 86 patients with cervical carcinoma. Quantification of the numbers of myeloid cells revealed that a strong intraepithelial infiltration of CD14+ cells, and more specifically the population of CD14+CD33-CD163- matured M1 macrophages, is associated with a large influx of intraepithelial T lymphocytes (p = 0.008), improved disease-specific survival (p = 0.007) and forms an independent prognostic factor for survival (p = 0.033). The intraepithelial CD8+ T-cell and regulatory T-cell (Treg) ratio also forms an independent prognostic factor (p = 0.010) and combination of these two factors reveals a further increased benefit in survival for patients whose tumor displays a dense infiltration with intraepithelial matured M1 macrophages and a high CD8 T-cell/Treg ratio, indicating that both populations of immune cells simultaneously improve survival. Subsequently, we made a heatmap including all known immune parameters for these patients, whereby we were able to identify different immune signatures in CxCa. These results indicate that reinforcement and activation of the intratumoral M1 macrophages may form an attractive immunotherapeutic option in CxCa.
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Schrevel M, Karim R, ter Haar NT, van der Burg SH, Trimbos JBMZ, Fleuren GJ, Gorter A, Jordanova ES. CXCR7 expression is associated with disease-free and disease-specific survival in cervical cancer patients. Br J Cancer 2012; 106:1520-5. [PMID: 22531719 PMCID: PMC3341866 DOI: 10.1038/bjc.2012.110] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [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] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The CXC chemokine receptor (CXCR)7 is involved in tumour development and metastases formation. The aim of the present study was to determine protein expression of CXCR7, its putative co-receptors epidermal growth factor receptor (EGFR) and CXCR4, its predominant ligand CXCL12, their co-dependency and their association with survival in cervical cancer patients. METHODS CXC chemokine receptor 7, EGFR, CXCR4 and CXCL12 expression were determined immunohistochemically in 103 paraffin-embedded, cervical cancers. Subsequently, associations with patient characteristics were assessed and survival analyses were performed. RESULTS CXC chemokine receptor 7 was expressed by 43% of tumour specimens, in a large majority of cases together with either EGFR or CXCR4 (double positive), or both (triple positive). The CXCR7 expression was associated with tumour size (P=0.013), lymph node metastasis (P=0.001) and EGFR expression (P=0.009). CXC chemokine receptor 7 was independently associated with disease-free survival (hazard ratio (HR)=4.3, 95% confidence intervals (CI) 1.7-11.0, P=0.002), and strongly associated with disease-specific survival (HR=3.9, 95% CI 1.5-10.2, P=0.005). CONCLUSION CXC chemokine receptor 7 expression predicts poor disease-free and disease-specific survival in cervical cancer patients, and might be a promising new therapeutic marker. In a large majority of cases, CXCR7 is co-expressed with CXCR4 and/or EGFR, supporting the hypothesis that these receptors assist in CXCR7 signal transduction.
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Affiliation(s)
- M Schrevel
- Department of Pathology, Leiden University Medical Center, RC Leiden, The Netherlands
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11
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Middeldorp A, van Puijenbroek M, Nielsen M, Corver WE, Jordanova ES, ter Haar N, Tops CMJ, Vasen HFA, Lips EH, van Eijk R, Hes FJ, Oosting J, Wijnen J, van Wezel T, Morreau H. High frequency of copy-neutral LOH in MUTYH-associated polyposis carcinomas. J Pathol 2008; 216:25-31. [PMID: 18506705 DOI: 10.1002/path.2375] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Genetic instability is known to drive colorectal carcinogenesis. Generally, a distinction is made between two types of genetic instability: chromosomal instability (CIN) and microsatellite instability (MIN or MSI). Most CIN tumours are aneuploid, whereas MSI tumours are considered near-diploid. However, for MUTYH-associated polyposis (MAP) the genetic instability involved in the carcinogenesis remains unclear, as near-diploid adenomas, aneuploid adenomas and near-diploid carcinomas have been reported. Remarkably, our analysis of 26 MAP carcinomas, using SNP arrays and flow sorting, showed that these tumours are often near-diploid (52%) and mainly contain chromosomal regions of copy-neutral loss of heterozygosity (LOH) (71%). This is in contrast to sporadic colon cancer, where physical loss is the main characteristic. The percentage of chromosomal gains (24%) is comparable to sporadic colorectal cancers with CIN. Furthermore, we verified our scoring of copy-neutral LOH versus physical loss in MAP carcinomas by two methods: fluorescence in situ hybridization, and LOH analysis using polymorphic markers on carcinoma fractions purified by flow sorting. The results presented in this study suggest that copy-neutral LOH is an important mechanism in the tumorigenesis of MAP.
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Affiliation(s)
- A Middeldorp
- Department of Pathology, Leiden University Medical Centre, Leiden, The Netherlands
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12
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Kloth JN, Gorter A, Fleuren GJ, Oosting J, Uljee S, Haar NT, Dreef EJ, Kenter GG, Jordanova ES. Elevated expression of SerpinA1 and SerpinA3 in HLA-positive cervical carcinoma. J Pathol 2008; 215:222-30. [DOI: 10.1002/path.2347] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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13
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Riemersma SA, Jordanova ES, Haasnoot GW, Drabbels J, Schuuring E, Schreuder GMT, Kluin PM. The Relationship Between HLA Class II Polymorphisms and Somatic Deletions in Testicular B Cell Lymphomas of Dutch Patients. Hum Immunol 2006; 67:303-10. [PMID: 16720210 DOI: 10.1016/j.humimm.2006.03.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2005] [Indexed: 11/21/2022]
Abstract
Several risk factors including immune deficiencies, infections, and autoimmune diseases have been established for non-Hodgkin's lymphoma (NHL). For diffuse large B cell lymphoma (DLBCL), the most common type of lymphoma, no risk factors have been described, which may be due to the intrinsic heterogeneity of this disorder. Previously we reported that, in contrast to nodal DLBCLs, the majority of testicular DLBCLs manifested complete loss of HLA-DR and -DQ expression associated with homozygous deletions of the corresponding genes. To determine the correlation between HLA class II polymorphisms and these lymphomas, we applied DNA typing for HLA-DRB1 and HLA-DQB1 on 50 Dutch patients with testicular and 48 with nodal DLBCL and compared the frequencies with a cohort of healthy Dutch controls. Both the patients with nodal and those with testicular DLBCL manifested significantly higher frequencies of HLA-DRB1*15 than the controls (p < 0.018, odds ratio 2.09 and p < 0.013, odds ratio 2.12, respectively). Moreover, a positive association was seen with HLA-DRB1*12 (p = 0.043, odds ratio 4.17) in the patients with testicular DLBCL, and a negative association was seen with HLA-DRB1*07 (p = 0.022, odds ratio 0.13) in the patients with nodal DLBCL. Homozygous deletions of the HLA-DR/DQ region, evaluated by interphase fluorescence in situ hybridization were seen in 20 of 48 testicular tumors. No preferential loss or retention of a particular HLA-DR or -DQ allele was seen because all alleles were at least once retained or involved in a homozygous deletion.
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Affiliation(s)
- S A Riemersma
- Laboratorium Pathologie Oost Nederland, Enschede, The Netherlands.
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Hughes-Davies L, Huntsman D, Ruas M, Fuks F, Bye J, Chin SF, Milner J, Brown LA, Hsu F, Gilks B, Nielsen T, Schulzer M, Chia S, Ragaz J, Cahn A, Linger L, Ozdag H, Cattaneo E, Jordanova ES, Schuuring E, Yu DS, Venkitaraman A, Ponder B, Doherty A, Aparicio S, Bentley D, Theillet C, Ponting CP, Caldas C, Kouzarides T. EMSY links the BRCA2 pathway to sporadic breast and ovarian cancer. Cell 2004; 115:523-35. [PMID: 14651845 DOI: 10.1016/s0092-8674(03)00930-9] [Citation(s) in RCA: 346] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The BRCA2 gene is mutated in familial breast and ovarian cancer, and its product is implicated in DNA repair and transcriptional regulation. Here we identify a protein, EMSY, which binds BRCA2 within a region (exon 3) deleted in cancer. EMSY is capable of silencing the activation potential of BRCA2 exon 3, associates with chromatin regulators HP1beta and BS69, and localizes to sites of repair following DNA damage. EMSY maps to chromosome 11q13.5, a region known to be involved in breast and ovarian cancer. We show that the EMSY gene is amplified almost exclusively in sporadic breast cancer (13%) and higher-grade ovarian cancer (17%). In addition, EMSY amplification is associated with worse survival, particularly in node-negative breast cancer, suggesting that it may be of prognostic value. The remarkable clinical overlap between sporadic EMSY amplification and familial BRCA2 deletion implicates a BRCA2 pathway in sporadic breast and ovarian cancer.
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Affiliation(s)
- Luke Hughes-Davies
- Cancer Research UK/Wellcome Trust Institute and Department of Pathology, Tennis Court Road, Cambridge CB2 1QR, United Kingdom.
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Riemersma SA, Jordanova ES, Schop RF, Philippo K, Looijenga LH, Schuuring E, Kluin PM. Extensive genetic alterations of the HLA region, including homozygous deletions of HLA class II genes in B-cell lymphomas arising in immune-privileged sites. Blood 2000; 96:3569-77. [PMID: 11071656] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
In B-cell lymphomas, loss of human leukocyte antigen (HLA) class I and II molecules might contribute to immune escape from CD8(+) and CD4(+) cytotoxic T cells, especially because B cells can present their own idiotype. Loss of HLA expression and the possible underlying genomic alterations were studied in 28 testicular, 11 central nervous system, and 21 nodal diffuse large B-cell lymphomas (DLCLs), the first two sites are considered as immune-privileged sites. The analysis included immunohistochemistry, loss of heterozygosity analysis, and fluorescent in situ hybridization (FISH) on interphase cells and isolated DNA fibers. Total loss of HLA-A expression was found in 60% of the extranodal cases and in 10% of the nodal cases (P <.01), whereas loss of HLA-DR expression was found in 56% and 5%, respectively (P <.01). This was accompanied by extensive loss of heterozygosity within the HLA region in the extranodal DLCLs. In 3 cases, retention of heterozygosity for D6S1666 in the class II region suggested a homozygous deletion. This finding was confirmed by interphase FISH that showed homozygous deletions in the class II genes in 11 of the 18 extranodal lymphomas but in none of the 7 nodal DLCLs (P <.001). Mapping by fiber FISH showed variable deletions that always included HLA-DQ and HLA-DR genes. Hemizygous deletions and mitotic recombinations often involving all HLA genes were found in 13 of 18 extranodal and 2 of 7 nodal lymphomas. In conclusion, a structural loss of HLA class I and II expression might help the B-cell lymphoma cells to escape from immune attack.
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MESH Headings
- Adolescent
- Adult
- Aged
- Central Nervous System Neoplasms/genetics
- Central Nervous System Neoplasms/immunology
- Central Nervous System Neoplasms/metabolism
- Chromosome Mapping
- Chromosomes, Human, Pair 6/genetics
- Cytogenetic Analysis
- Female
- Gene Deletion
- Genes, MHC Class II/genetics
- Genes, MHC Class II/immunology
- HLA-A Antigens/genetics
- HLA-A Antigens/metabolism
- HLA-DQ Antigens/genetics
- HLA-DQ Antigens/metabolism
- HLA-DR Antigens/genetics
- HLA-DR Antigens/metabolism
- Homozygote
- Humans
- Immunohistochemistry
- In Situ Hybridization, Fluorescence
- Loss of Heterozygosity
- Lymph Nodes/pathology
- Lymphoma, B-Cell/genetics
- Lymphoma, B-Cell/immunology
- Lymphoma, Large B-Cell, Diffuse/genetics
- Lymphoma, Large B-Cell, Diffuse/immunology
- Lymphoma, Large B-Cell, Diffuse/metabolism
- Major Histocompatibility Complex/genetics
- Major Histocompatibility Complex/immunology
- Male
- Middle Aged
- Testicular Neoplasms/genetics
- Testicular Neoplasms/immunology
- Testicular Neoplasms/metabolism
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Affiliation(s)
- S A Riemersma
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands.
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