1
|
Hänel G, Angerer C, Petry K, Lichtenegger FS, Subklewe M. Blood DCs activated with R848 and poly(I:C) induce antigen-specific immune responses against viral and tumor-associated antigens. Cancer Immunol Immunother 2021; 71:1705-1718. [PMID: 34821951 PMCID: PMC8614222 DOI: 10.1007/s00262-021-03109-w] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 11/09/2021] [Indexed: 01/11/2023]
Abstract
Monocyte-derived Dendritic cells (DCs) have successfully been employed to induce immune responses against tumor-associated antigens in patients with various cancer entities. However, objective clinical responses have only been achieved in a minority of patients. Additionally, generation of GMP-compliant DCs requires time- and labor-intensive cell differentiation. In contrast, Blood DCs (BDCs) require only minimal ex vivo handling, as differentiation occurs in vivo resulting in potentially better functional capacities and survival. We aimed to identify a protocol for optimal in vitro activation of BDCs including the three subsets pDCs, cDC1s, and cDC2s. We evaluated several TLR ligand combinations and demonstrated that polyinosinic:polycytidylic acid [poly(I:C)] and R848, ligands for TLR3 and TLR7/8, respectively, constituted the optimal combination for inducing a positive co-stimulatory profile in all BDC subsets. In addition, TLR3 and TLR7/8 activation led to high secretion of IFN-α and IL-12p70. Simultaneous as opposed to separate tailored activation of pDCs and cDCs increased immunostimulatory capacities, suggesting that BDC subsets engage in synergistic cross-talk during activation. Stimulation of BDCs with this protocol resulted in enhanced migration, high NK-cell activation, and potent antigen-specific T-cell induction. We conclude that simultaneous activation of all BDC subsets with a combination of R848 + poly(I:C) generates highly immunostimulatory DCs. These results support further investigation and clinical testing, as standalone or in conjunction with other immunotherapeutic strategies including adoptive T-cell transfer and checkpoint inhibition.
Collapse
Affiliation(s)
- Gerulf Hänel
- Department of Medicine III, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
- Laboratory for Translational Cancer Immunology, Gene Center, LMU Munich, Munich, Germany
| | | | - Katja Petry
- Miltenyi Biotec B.V. & Co. KG, Bergisch Gladbach, Germany
| | - Felix S Lichtenegger
- Department of Medicine III, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
- Laboratory for Translational Cancer Immunology, Gene Center, LMU Munich, Munich, Germany
- Roche Innovation Center Munich, Penzberg, Germany
| | - Marion Subklewe
- Department of Medicine III, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
- Laboratory for Translational Cancer Immunology, Gene Center, LMU Munich, Munich, Germany.
- German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany.
| |
Collapse
|
2
|
Schwaab J, Naumann N, Luebke J, Jawhar M, Somervaille TCP, Williams MS, Frewin R, Jost PJ, Lichtenegger FS, La Rosée P, Storch N, Haferlach T, Horny HP, Fabarius A, Haferlach C, Burchert A, Hofmann WK, Cross NCP, Hochhaus A, Reiter A, Metzgeroth G. Response to tyrosine kinase inhibitors in myeloid neoplasms associated with PCM1-JAK2, BCR-JAK2 and ETV6-ABL1 fusion genes. Am J Hematol 2020; 95:824-833. [PMID: 32279331 DOI: 10.1002/ajh.25825] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [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: 02/05/2020] [Revised: 04/03/2020] [Accepted: 04/05/2020] [Indexed: 12/16/2022]
Abstract
We report on 18 patients with myeloid neoplasms and associated tyrosine kinase (TK) fusion genes on treatment with the TK inhibitors (TKI) ruxolitinib (PCM1-JAK2, n = 8; BCR-JAK2, n = 1) and imatinib, nilotinib or dasatinib (ETV6-ABL1, n = 9). On ruxolitinib (median 24 months, range 2-36 months), a complete hematologic response (CHR) and complete cytogenetic response (CCR) was achieved by five of nine and two of nine patients, respectively. However, ruxolitinib was stopped in eight of nine patients because of primary resistance (n = 3), progression (n = 3) or planned allogeneic stem cell transplantation (allo SCT, n = 2). At a median of 36 months (range 4-78 months) from diagnosis, five of nine patients are alive: four of six patients after allo SCT and one patient who remains on ruxolitinib. In ETV6-ABL1 positive patients, a durable CHR was achieved by four of nine patients (imatinib with one of five, nilotinib with two of three, dasatinib with one of one). Because of inadequate efficacy (lack of hematological and/or cytogenetic/molecular response), six of nine patients (imatinib, n = 5; nilotinib, n = 1) were switched to nilotinib or dasatinib. At a median of 23 months (range 3-60 months) from diagnosis, five of nine patients are in CCR or complete molecular response (nilotinib, n = 2; dasatinib, n = 2; allo SCT, n = 1) while two of nine patients have died. We conclude that (a) responses on ruxolitinib may only be transient in the majority of JAK2 fusion gene positive patients with allo SCT being an important early treatment option, and (b) nilotinib or dasatinib may be more effective than imatinib to induce durable complete remissions in ETV6-ABL1 positive patients.
Collapse
Affiliation(s)
- Juliana Schwaab
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Nicole Naumann
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Johannes Luebke
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Mohamad Jawhar
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Tim C P Somervaille
- Department of Haematology, The Christie NHS Foundation Trust, Manchester, UK
- Cancer Research UK Manchester Institute, Manchester, UK
| | - Mark S Williams
- Department of Haematology, The Christie NHS Foundation Trust, Manchester, UK
- Cancer Research UK Manchester Institute, Manchester, UK
| | - Rebecca Frewin
- Department of Pathology, Gloucester Royal Hospital, Gloucester, UK
| | - Philipp J Jost
- III. Medical Department, Hematology and Oncology, Klinikum rechts der Isar, Technical University Munich, Munchen, Bayern, Germany
| | | | - Paul La Rosée
- Klinik für Innere Medizin II, Schwarzwald-Baar-Klinikum, Villingen-Schwenningen, Germany
| | - Nicola Storch
- Department of Hematology and Oncology, St. Vincenz Medical Centre, Limburg, Germany
| | | | | | - Alice Fabarius
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | | | - Andreas Burchert
- Department of Hematology, Oncology and Immunology, Philipps University Marburg, and University Medical Center Giessen and Marburg, Marburg, Germany
| | - Wolf-Karsten Hofmann
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Nicholas C P Cross
- Faculty of Medicine, University of Southampton, Southampton, UK
- Wessex Regional Genetics Laboratory, Salisbury, UK
| | - Andreas Hochhaus
- Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Germany
| | - Andreas Reiter
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Georgia Metzgeroth
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| |
Collapse
|
3
|
Lichtenegger FS, Schnorfeil FM, Rothe M, Deiser K, Altmann T, Bücklein VL, Köhnke T, Augsberger C, Konstandin NP, Spiekermann K, Moosmann A, Boehm S, Boxberg M, Heemskerk MH, Goerlich D, Wittmann G, Wagner B, Hiddemann W, Schendel DJ, Kvalheim G, Bigalke I, Subklewe M. Toll-like receptor 7/8-matured RNA-transduced dendritic cells as post-remission therapy in acute myeloid leukaemia: results of a phase I trial. Clin Transl Immunology 2020; 9:e1117. [PMID: 32153780 PMCID: PMC7053229 DOI: 10.1002/cti2.1117] [Citation(s) in RCA: 13] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 02/10/2020] [Accepted: 02/10/2020] [Indexed: 12/19/2022] Open
Abstract
Objectives Innovative post‐remission therapies are needed to eliminate residual AML cells. DC vaccination is a promising strategy to induce anti‐leukaemic immune responses. Methods We conducted a first‐in‐human phase I study using TLR7/8‐matured DCs transfected with RNA encoding the two AML‐associated antigens WT1 and PRAME as well as CMVpp65. AML patients in CR at high risk of relapse were vaccinated 10× over 26 weeks. Results Despite heavy pretreatment, DCs of sufficient number and quality were generated from a single leukapheresis in 11/12 cases, and 10 patients were vaccinated. Administration was safe and resulted in local inflammatory responses with dense T‐cell infiltration. In peripheral blood, increased antigen‐specific CD8+ T cells were seen for WT1 (2/10), PRAME (4/10) and CMVpp65 (9/10). For CMVpp65, increased CD4+ T cells were detected in 4/7 patients, and an antibody response was induced in 3/7 initially seronegative patients. Median OS was not reached after 1057 days; median RFS was 1084 days. A positive correlation was observed between clinical benefit and younger age as well as mounting of antigen‐specific immune responses. Conclusions Administration of TLR7/8‐matured DCs to AML patients in CR at high risk of relapse was feasible and safe and resulted in induction of antigen‐specific immune responses. Clinical benefit appeared to occur more likely in patients <65 and in patients mounting an immune response. Our observations need to be validated in a larger patient cohort. We hypothesise that TLR7/8 DC vaccination strategies should be combined with hypomethylating agents or checkpoint inhibition to augment immune responses. Trial registration The study was registered at https://clinicaltrials.gov on 17 October 2012 (NCT01734304) and at https://www.clinicaltrialsregister.eu (EudraCT‐Number 2010‐022446‐24) on 10 October 2013.
Collapse
Affiliation(s)
- Felix S Lichtenegger
- Department of Medicine III University Hospital, LMU Munich Munich Germany.,Laboratory for Translational Cancer Immunology Gene Center LMU Munich Munich Germany.,Present address: Roche Innovation Center Munich Penzberg Germany
| | - Frauke M Schnorfeil
- Department of Medicine III University Hospital, LMU Munich Munich Germany.,Laboratory for Translational Cancer Immunology Gene Center LMU Munich Munich Germany.,German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ) Heidelberg Germany.,Present address: Medigene AG Planegg Germany
| | - Maurine Rothe
- Department of Medicine III University Hospital, LMU Munich Munich Germany.,Laboratory for Translational Cancer Immunology Gene Center LMU Munich Munich Germany
| | - Katrin Deiser
- Department of Medicine III University Hospital, LMU Munich Munich Germany.,Laboratory for Translational Cancer Immunology Gene Center LMU Munich Munich Germany
| | - Torben Altmann
- Department of Medicine III University Hospital, LMU Munich Munich Germany.,Laboratory for Translational Cancer Immunology Gene Center LMU Munich Munich Germany
| | - Veit L Bücklein
- Department of Medicine III University Hospital, LMU Munich Munich Germany.,Laboratory for Translational Cancer Immunology Gene Center LMU Munich Munich Germany
| | - Thomas Köhnke
- Department of Medicine III University Hospital, LMU Munich Munich Germany.,Laboratory for Translational Cancer Immunology Gene Center LMU Munich Munich Germany
| | - Christian Augsberger
- Department of Medicine III University Hospital, LMU Munich Munich Germany.,Laboratory for Translational Cancer Immunology Gene Center LMU Munich Munich Germany
| | | | | | - Andreas Moosmann
- DZIF Research Group "Host Control of Viral Latency and Reactivation" (HOCOVLAR) Helmholtz Zentrum München Munich Germany
| | - Stephan Boehm
- Max von Pettenkofer Institute LMU Munich Munich Germany
| | - Melanie Boxberg
- Institute of Pathology Technical University of Munich Munich Germany
| | - Mirjam Hm Heemskerk
- Department of Hematology Leiden University Medical Center Leiden The Netherlands
| | - Dennis Goerlich
- Institute of Biostatistics and Clinical Research University of Muenster Muenster Germany
| | - Georg Wittmann
- Department of Transfusion Medicine, Cellular Therapeutics and Hemostaseology University Hospital LMU Munich Munich Germany
| | - Beate Wagner
- Department of Transfusion Medicine, Cellular Therapeutics and Hemostaseology University Hospital LMU Munich Munich Germany
| | - Wolfgang Hiddemann
- Department of Medicine III University Hospital, LMU Munich Munich Germany.,German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ) Heidelberg Germany
| | | | - Gunnar Kvalheim
- Department of Cellular Therapy The Norwegian Radium Hospital Oslo University Hospital Oslo Norway
| | - Iris Bigalke
- Department of Cellular Therapy The Norwegian Radium Hospital Oslo University Hospital Oslo Norway.,Present address: BioNTech IMFS Idar-Oberstein Germany
| | - Marion Subklewe
- Department of Medicine III University Hospital, LMU Munich Munich Germany.,Laboratory for Translational Cancer Immunology Gene Center LMU Munich Munich Germany.,German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ) Heidelberg Germany
| |
Collapse
|
4
|
Van Acker HH, Versteven M, Lichtenegger FS, Roex G, Campillo-Davo D, Lion E, Subklewe M, Van Tendeloo VF, Berneman ZN, Anguille S. Dendritic Cell-Based Immunotherapy of Acute Myeloid Leukemia. J Clin Med 2019; 8:E579. [PMID: 31035598 PMCID: PMC6572115 DOI: 10.3390/jcm8050579] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [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: 03/21/2019] [Revised: 04/16/2019] [Accepted: 04/24/2019] [Indexed: 12/20/2022] Open
Abstract
Acute myeloid leukemia (AML) is a type of blood cancer characterized by the uncontrolled clonal proliferation of myeloid hematopoietic progenitor cells in the bone marrow. The outcome of AML is poor, with five-year overall survival rates of less than 10% for the predominant group of patients older than 65 years. One of the main reasons for this poor outcome is that the majority of AML patients will relapse, even after they have attained complete remission by chemotherapy. Chemotherapy, supplemented with allogeneic hematopoietic stem cell transplantation in patients at high risk of relapse, is still the cornerstone of current AML treatment. Both therapies are, however, associated with significant morbidity and mortality. These observations illustrate the need for more effective and less toxic treatment options, especially in elderly AML and have fostered the development of novel immune-based strategies to treat AML. One of these strategies involves the use of a special type of immune cells, the dendritic cells (DCs). As central orchestrators of the immune system, DCs are key to the induction of anti-leukemia immunity. In this review, we provide an update of the clinical experience that has been obtained so far with this form of immunotherapy in patients with AML.
Collapse
Affiliation(s)
- Heleen H Van Acker
- Laboratory of Experimental Hematology, Vaccine & Infectious Disease Institute, Faculty of Medicine & Health Sciences, University of Antwerp, 2610 Wilrijk, Antwerp, Belgium.
| | - Maarten Versteven
- Laboratory of Experimental Hematology, Vaccine & Infectious Disease Institute, Faculty of Medicine & Health Sciences, University of Antwerp, 2610 Wilrijk, Antwerp, Belgium.
| | - Felix S Lichtenegger
- Department of Medicine III, LMU Munich, University Hospital, 80799 Munich, Germany.
| | - Gils Roex
- Laboratory of Experimental Hematology, Vaccine & Infectious Disease Institute, Faculty of Medicine & Health Sciences, University of Antwerp, 2610 Wilrijk, Antwerp, Belgium.
| | - Diana Campillo-Davo
- Laboratory of Experimental Hematology, Vaccine & Infectious Disease Institute, Faculty of Medicine & Health Sciences, University of Antwerp, 2610 Wilrijk, Antwerp, Belgium.
| | - Eva Lion
- Laboratory of Experimental Hematology, Vaccine & Infectious Disease Institute, Faculty of Medicine & Health Sciences, University of Antwerp, 2610 Wilrijk, Antwerp, Belgium.
| | - Marion Subklewe
- Department of Medicine III, LMU Munich, University Hospital, 80799 Munich, Germany.
| | - Viggo F Van Tendeloo
- Laboratory of Experimental Hematology, Vaccine & Infectious Disease Institute, Faculty of Medicine & Health Sciences, University of Antwerp, 2610 Wilrijk, Antwerp, Belgium.
| | - Zwi N Berneman
- Laboratory of Experimental Hematology, Vaccine & Infectious Disease Institute, Faculty of Medicine & Health Sciences, University of Antwerp, 2610 Wilrijk, Antwerp, Belgium.
- Division of Hematology and Center for Cell Therapy & Regenerative Medicine, Antwerp University Hospital, 2650 Edegem, Antwerp, Belgium.
| | - Sébastien Anguille
- Laboratory of Experimental Hematology, Vaccine & Infectious Disease Institute, Faculty of Medicine & Health Sciences, University of Antwerp, 2610 Wilrijk, Antwerp, Belgium.
- Division of Hematology and Center for Cell Therapy & Regenerative Medicine, Antwerp University Hospital, 2650 Edegem, Antwerp, Belgium.
| |
Collapse
|
5
|
Krupka C, Lichtenegger FS, Köhnke T, Bögeholz J, Bücklein V, Roiss M, Altmann T, Do TU, Dusek R, Wilson K, Bisht A, Terrett J, Aud D, Pombo-Villar E, Rohlff C, Hiddemann W, Subklewe M. Targeting CD157 in AML using a novel, Fc-engineered antibody construct. Oncotarget 2018; 8:35707-35717. [PMID: 28415689 PMCID: PMC5482610 DOI: 10.18632/oncotarget.16060] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 02/27/2017] [Indexed: 12/28/2022] Open
Abstract
Antibody-based immunotherapy represents a promising strategy to eliminate chemorefractory leukemic cells in acute myeloid leukemia (AML). In this study, we evaluated a novel Fc-engineered antibody against CD157 (MEN1112) for its suitability as immunotherapy in AML. CD157 was expressed in 97% of primary AML patient samples. A significant, albeit lower expression level of CD157 was observed within the compartment of leukemia-initiating cells, which are supposed to be the major source of relapse. In healthy donor bone marrow, CD157 was expressed on CD34+ cells. In ex vivo assays, MEN1112 triggered natural killer (NK) cell-mediated cytotoxicity against AML cell lines and primary AML cells. Compared to its parental analogue, the Fc-engineered antibody exhibited higher antibody dependent cellular cytotoxicity responses. Using NK cells from AML patients, we observed heterogeneous MEN1112-mediated cytotoxicity against AML cells, most likely due to well-documented defects in AML-NK cells and corresponding inter-patient variations in NK cell function. Cytotoxicity could not be correlated to the time after completion of chemotherapy. In summary, we could demonstrate that CD157 is strongly expressed in AML. MEN1112 is a promising antibody construct that showed high cytotoxicity against AML cells and warrants further clinical testing. Due to variability in NK-cell function of AML patients, the time of application during the course of the disease as well as combinatorial strategies might influence treatment results.
Collapse
Affiliation(s)
- Christina Krupka
- Department of Internal Medicine III, Klinikum of The LMU Munich, Munich, Germany.,Clinical Cooperation Group Immunotherapy at The Helmholtz Institute Munich, Munich, Germany.,Laboratory of Translational Cancer Immunology, Gene Center Munich, Ludwig-Maximilians-University Munich, Germany
| | - Felix S Lichtenegger
- Department of Internal Medicine III, Klinikum of The LMU Munich, Munich, Germany.,Clinical Cooperation Group Immunotherapy at The Helmholtz Institute Munich, Munich, Germany.,Laboratory of Translational Cancer Immunology, Gene Center Munich, Ludwig-Maximilians-University Munich, Germany
| | - Thomas Köhnke
- Department of Internal Medicine III, Klinikum of The LMU Munich, Munich, Germany.,Clinical Cooperation Group Immunotherapy at The Helmholtz Institute Munich, Munich, Germany.,Laboratory of Translational Cancer Immunology, Gene Center Munich, Ludwig-Maximilians-University Munich, Germany
| | - Jan Bögeholz
- Department of Hematology, University Hospital Zurich, Zurich, Switzerland
| | - Veit Bücklein
- Department of Internal Medicine III, Klinikum of The LMU Munich, Munich, Germany.,Clinical Cooperation Group Immunotherapy at The Helmholtz Institute Munich, Munich, Germany.,Laboratory of Translational Cancer Immunology, Gene Center Munich, Ludwig-Maximilians-University Munich, Germany
| | - Michael Roiss
- Department of Internal Medicine III, Klinikum of The LMU Munich, Munich, Germany.,Clinical Cooperation Group Immunotherapy at The Helmholtz Institute Munich, Munich, Germany.,Laboratory of Translational Cancer Immunology, Gene Center Munich, Ludwig-Maximilians-University Munich, Germany
| | - Torben Altmann
- Department of Internal Medicine III, Klinikum of The LMU Munich, Munich, Germany.,Clinical Cooperation Group Immunotherapy at The Helmholtz Institute Munich, Munich, Germany.,Laboratory of Translational Cancer Immunology, Gene Center Munich, Ludwig-Maximilians-University Munich, Germany
| | - To Uyen Do
- Independent consultant Oxford BioTherapeutics Ltd, Abingdon, United Kingdom and San Jose, CA, USA
| | - Rachel Dusek
- Independent consultant Oxford BioTherapeutics Ltd, Abingdon, United Kingdom and San Jose, CA, USA
| | - Keith Wilson
- Independent consultant Oxford BioTherapeutics Ltd, Abingdon, United Kingdom and San Jose, CA, USA
| | - Arnima Bisht
- Independent consultant Oxford BioTherapeutics Ltd, Abingdon, United Kingdom and San Jose, CA, USA
| | | | - Dee Aud
- CRISPR Therapeutics, Cambridge, MA, USA
| | - Esteban Pombo-Villar
- Independent consultant Oxford BioTherapeutics Ltd, Abingdon, United Kingdom and San Jose, CA, USA
| | - Christian Rohlff
- Independent consultant Oxford BioTherapeutics Ltd, Abingdon, United Kingdom and San Jose, CA, USA
| | - Wolfgang Hiddemann
- Department of Internal Medicine III, Klinikum of The LMU Munich, Munich, Germany
| | - Marion Subklewe
- Department of Internal Medicine III, Klinikum of The LMU Munich, Munich, Germany.,Clinical Cooperation Group Immunotherapy at The Helmholtz Institute Munich, Munich, Germany.,Laboratory of Translational Cancer Immunology, Gene Center Munich, Ludwig-Maximilians-University Munich, Germany
| |
Collapse
|
6
|
Lichtenegger FS, Rothe M, Schnorfeil FM, Deiser K, Krupka C, Augsberger C, Schlüter M, Neitz J, Subklewe M. Targeting LAG-3 and PD-1 to Enhance T Cell Activation by Antigen-Presenting Cells. Front Immunol 2018; 9:385. [PMID: 29535740 PMCID: PMC5835137 DOI: 10.3389/fimmu.2018.00385] [Citation(s) in RCA: 115] [Impact Index Per Article: 19.2] [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: 10/08/2017] [Accepted: 02/12/2018] [Indexed: 12/14/2022] Open
Abstract
Immune checkpoint inhibition has been shown to successfully reactivate endogenous T cell responses directed against tumor-associated antigens, resulting in significantly prolonged overall survival in patients with various tumor entities. For malignancies with low endogenous immune responses, this approach has not shown a clear clinical benefit so far. Therapeutic vaccination, particularly dendritic cell (DC) vaccination, is a strategy to induce T cell responses. Interaction of DCs and T cells is dependent on receptor-ligand interactions of various immune checkpoints. In this study, we analyzed the influence of blocking antibodies targeting programmed cell death protein 1 (PD-1), HVEM, CD244, TIM-3, and lymphocyte activation gene 3 (LAG-3) on the proliferation and cytokine secretion of T cells after stimulation with autologous TLR-matured DCs. In this context, we found that LAG-3 blockade resulted in superior T cell activation compared to inhibition of other pathways, including PD-1/PD-L1. This result was consistent across different methods to measure T cell stimulation (proliferation, IFN-γ secretion), various stimulatory antigens (viral and bacterial peptide pool, specific viral antigen, specific tumor antigen), and seen for both CD4+ and CD8+ T cells. Only under conditions with a weak antigenic stimulus, particularly when combining antigen presentation by peripheral blood mononuclear cells with low concentrations of peptides, we observed the highest T cell stimulation with dual blockade of LAG-3 and PD-1 blockade. We conclude that priming of novel immune responses can be strongly enhanced by blockade of LAG-3 or dual blockade of LAG-3 and PD-1, depending on the strength of the antigenic stimulus.
Collapse
Affiliation(s)
- Felix S. Lichtenegger
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany,Laboratory for Translational Cancer Immunology, Gene Center, LMU Munich, Munich, Germany
| | - Maurine Rothe
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany,Laboratory for Translational Cancer Immunology, Gene Center, LMU Munich, Munich, Germany
| | - Frauke M. Schnorfeil
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany,Laboratory for Translational Cancer Immunology, Gene Center, LMU Munich, Munich, Germany,German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Katrin Deiser
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany,Laboratory for Translational Cancer Immunology, Gene Center, LMU Munich, Munich, Germany
| | - Christina Krupka
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany,Laboratory for Translational Cancer Immunology, Gene Center, LMU Munich, Munich, Germany
| | - Christian Augsberger
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany,Laboratory for Translational Cancer Immunology, Gene Center, LMU Munich, Munich, Germany
| | - Miriam Schlüter
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany,Laboratory for Translational Cancer Immunology, Gene Center, LMU Munich, Munich, Germany
| | - Julia Neitz
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany,Laboratory for Translational Cancer Immunology, Gene Center, LMU Munich, Munich, Germany
| | - Marion Subklewe
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany,Laboratory for Translational Cancer Immunology, Gene Center, LMU Munich, Munich, Germany,German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany,*Correspondence: Marion Subklewe,
| |
Collapse
|
7
|
Abstract
The advent of new immunotherapeutic agents in clinical practice has revolutionized cancer treatment in the past decade, both in oncology and hematology. The transfer of the immunotherapeutic concepts to the treatment of acute myeloid leukemia (AML) is hampered by various characteristics of the disease, including non-leukemia-restricted target antigen expression profile, low endogenous immune responses, and intrinsic resistance mechanisms of the leukemic blasts against immune responses. However, considerable progress has been made in this field in the past few years.Within this manuscript, we review the recent developments and the current status of the five currently most prominent immunotherapeutic concepts: (1) antibody-drug conjugates, (2) T cell-recruiting antibody constructs, (3) chimeric antigen receptor (CAR) T cells, (4) checkpoint inhibitors, and (5) dendritic cell vaccination. We focus on the clinical data that has been published so far, both for newly diagnosed and refractory/relapsed AML, but omitting immunotherapeutic concepts in conjunction with hematopoietic stem cell transplantation. Besides, we have included important clinical trials that are currently running or have recently been completed but are still lacking full publication of their results.While each of the concepts has its particular merits and inherent problems, the field of immunotherapy of AML seems to have taken some significant steps forward. Results of currently running trials will reveal the direction of further development including approaches combining two or more of these concepts.
Collapse
Affiliation(s)
- Felix S Lichtenegger
- Department of Medicine III, University Hospital, LMU Munich, Germany
- Laboratory of Translational Cancer Immunology, Gene Center, Munich, Germany
| | - Christina Krupka
- Department of Medicine III, University Hospital, LMU Munich, Germany
- Laboratory of Translational Cancer Immunology, Gene Center, Munich, Germany
| | - Sascha Haubner
- Department of Medicine III, University Hospital, LMU Munich, Germany
- Laboratory of Translational Cancer Immunology, Gene Center, Munich, Germany
| | - Thomas Köhnke
- Department of Medicine III, University Hospital, LMU Munich, Germany
- Laboratory of Translational Cancer Immunology, Gene Center, Munich, Germany
| | - Marion Subklewe
- Department of Medicine III, University Hospital, LMU Munich, Germany.
- Laboratory of Translational Cancer Immunology, Gene Center, Munich, Germany.
- German Cancer Consortium (DKTK), Partner Site, Munich, Germany.
- German Cancer Research Center (DKFZ), Heidelberg, Germany.
| |
Collapse
|
8
|
Deiser K, Lichtenegger FS, Schnorfeil FM, Köhnke T, Altmann T, Bücklein V, Augsberger C, Moosmann A, Brüggemann M, Heemskerk MHM, Wagner B, Hiddemann W, Bigalke I, Kvalheim G, Subklewe M. Abstract B002: TLR7/8-matured dendritic cells for therapeutic vaccination in AML: Results of a clinical Phase I/II trial. Cancer Immunol Res 2016. [DOI: 10.1158/2326-6066.imm2016-b002] [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: 11/16/2022]
Abstract
Abstract
Postremission therapy for acute myeloid leukemia (AML) is critical for elimination of minimal residual disease (MRD). In patients not eligible for allogeneic stem cell transplantation, alternative treatment options are needed. Therapeutic vaccination with autologous dendritic cells (DCs) loaded with leukemia-associated antigens (LAAs) is a promising treatment strategy to induce anti-leukemic immune responses and to eradicate chemorefractory cells. Using a TLR7/8 agonist, we have developed a GMP-compliant 3-day protocol to differentiate monocytes of intensively pretreated AML patients into highly functional, therapeutic DCs.
A phase I/II proof-of-concept study has been initiated using TLR7/8-matured DCs as postremission therapy of AML patients with a non-favorable risk profile in CR or CRi after intensive induction therapy (NCT01734304). DCs have been loaded with in vitro transcribed RNA encoding the LAAs WT1 and PRAME as well as CMVpp65 as adjuvant and surrogate antigen. Patients have been vaccinated intradermally with 5×106 DCs of each antigen species up to 10 times within 26 weeks. The primary endpoint of the phase I/II trial is feasibility and safety of the vaccination. Secondary endpoints are immunological responses and disease control.
In total, 13 patients have been enrolled into the study. The first 6 patients were analysed in phase I for safety and toxicity of the DC vaccine. No higher grade toxicities were observed during their treatment and hence phase II has been initiated. DCs of sufficient number and quality were generated from leukapheresis in 10/11 cases. DCs exhibited an immune-stimulatory profile based on high surface expression of positive costimulatory molecules, the capacity to secrete IL-12p70, the migration towards a chemokine gradient and processing and presentation of antigen. In 9/9 vaccinated patients, we observed delayed-type hypersensitivity (DTH) responses at the vaccination site, accompanied by slight erythema and indurations at the injection site, but no grade III/IV toxicities. TCR repertoire analysis by NGS revealed an enrichment of particular clonotypes at DTH sites. In addition, we detected vaccine-specific T-cell responses by multimer staining and by Interferon-gamma-ELISPOT analysis: 7/7 patients showed responses to CMVpp65 and 2/7 exhibited responses to PRAME and WT1, respectively. In an individual treatment attempt, an enrolled patient with impending relapse was treated with a combination of DC vaccination and 5-azacytidine, resulting in MRD conversion. Long-term disease control and immunological responses are studied in the ongoing phase II trial.
We conclude that vaccination with TLR7/8-matured, LAA-expressing DCs in AML is feasible, safe and induces anti-leukemia-specific immune responses in vivo.
Citation Format: Katrin Deiser, Felix S. Lichtenegger, Frauke M. Schnorfeil, Thomas Köhnke, Torben Altmann, Veit Bücklein, Christian Augsberger, Andreas Moosmann, Monika Brüggemann, Mirjam HM Heemskerk, Beate Wagner, Wolfgang Hiddemann, Iris Bigalke, Gunnar Kvalheim, Marion Subklewe. TLR7/8-matured dendritic cells for therapeutic vaccination in AML: Results of a clinical Phase I/II trial [abstract]. In: Proceedings of the Second CRI-CIMT-EATI-AACR International Cancer Immunotherapy Conference: Translating Science into Survival; 2016 Sept 25-28; New York, NY. Philadelphia (PA): AACR; Cancer Immunol Res 2016;4(11 Suppl):Abstract nr B002.
Collapse
Affiliation(s)
- Katrin Deiser
- 1Klinikum der Universität München, LMU Munich, Munich, Germany
| | | | | | - Thomas Köhnke
- 1Klinikum der Universität München, LMU Munich, Munich, Germany
| | - Torben Altmann
- 1Klinikum der Universität München, LMU Munich, Munich, Germany
| | - Veit Bücklein
- 1Klinikum der Universität München, LMU Munich, Munich, Germany
| | | | - Andreas Moosmann
- 2Clinical Cooperation Group Immunotherapy at the Helmholtz Zentrum München, Munich, Germany
| | - Monika Brüggemann
- 3Department of Hematology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Mirjam HM Heemskerk
- 4Department of Hematology, Leiden University Medical Center, Leiden, Netherlands
| | - Beate Wagner
- 5Department of Transfusion Medicine, Cellular Therapeutics and Hemostaseology, Klinikum der Universität München, LMU Munich, Munich, Germany
| | | | - Iris Bigalke
- 6Department of Cellular Therapy, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Gunnar Kvalheim
- 6Department of Cellular Therapy, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Marion Subklewe
- 1Klinikum der Universität München, LMU Munich, Munich, Germany
| |
Collapse
|
9
|
Lichtenegger FS, Schnorfeil FM, Köhnke T, Altmann T, Bücklein V, Moosmann A, Brüggemann M, Wagner B, Hiddemann W, Bigalke I, Kvalheim G, Subklewe M. Abstract B146: Next-generation dendritic cell vaccination in postremission therapy of AML: Results of a clinical phase I trial. Cancer Immunol Res 2016. [DOI: 10.1158/2326-6074.cricimteatiaacr15-b146] [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: 11/16/2022]
Abstract
Abstract
Postremission therapy for acute myeloid leukemia (AML) is critical for elimination of minimal residual disease (MRD). In patients not eligible for allogeneic stem cell transplantation, alternative treatment options are needed. Therapeutic vaccination with autologous dendritic cells (DCs) loaded with leukemia-associated antigens (LAAs) is a promising treatment strategy to induce anti-leukemic immune responses and to eradicate chemorefractory cells. We have developed a GMP-compliant 3-day protocol including a TLR7/8 agonist to differentiate monocytes of intensively pretreated AML patients into next-generation DCs.
A phase I proof-of-concept study (n=6) was completed using next-generation DCs as postremission therapy of AML patients with a non-favorable genetic risk profile in CR after intensive induction therapy (NCT01734304), and we have already started enrollment into a phase II trial building on these results. DCs are loaded with ivt-RNA encoding the LAAs WT1 and PRAME as well as CMVpp65 as adjuvant and surrogate antigen. Patients are vaccinated intradermally with 5x106 DCs of each antigen species up to 10 times within 26 weeks. The primary endpoint of the phase I trial is feasibility and safety of the vaccination. Secondary endpoints are immunological responses and disease control.
In total, 10 patients have been enrolled into the phase I/II trial. With two screening failures, DCs of sufficient number and quality were generated from leukapheresis in 7/8 cases. DC analysis demonstrated a positive costimulatory profile, secretion of IL-12p70, migration towards a chemokine gradient, antigen processing and presentation and activation of specific T cells in vitro. 5 patients have completed the vaccination schedule; the 6th patient has received 4/10 vaccinations. We observed delayed-type hypersensitivity (DTH) responses at the vaccination site in 5/5 patients, accompanied by slight erythema and indurations at the injection site, but no grade III/IV toxicities. Multimer analysis revealed the induction of antigen-specific T cell responses in 3/3 patients tested. We detected an increase of WT1-specific T cells in one patient and strong inductions of CMVpp65-specific T cells in two CMV-seronegative patients. TCR repertoire analysis by next-generation sequencing revealed an enrichment of particular clonotypes at DTH sites. In an individual treatment attempt, we treated one patient with impending relapse with a combination of DC vaccination and 5-azacytidine, resulting in MRD conversion.
From the results of our phase I trial, we conclude that vaccination with next-generation DCs in AML is feasible and safe and induces leukemia-specific immune responses in vivo. The protocol is continued to be studied in an ongoing phase II trial.
Citation Format: Felix S. Lichtenegger, Frauke M. Schnorfeil, Thomas Köhnke, Torben Altmann, Veit Bücklein, Andreas Moosmann, Monika Brüggemann, Beate Wagner, Wolfgang Hiddemann, Iris Bigalke, Gunnar Kvalheim, Marion Subklewe. Next-generation dendritic cell vaccination in postremission therapy of AML: Results of a clinical phase I trial. [abstract]. In: Proceedings of the CRI-CIMT-EATI-AACR Inaugural International Cancer Immunotherapy Conference: Translating Science into Survival; September 16-19, 2015; New York, NY. Philadelphia (PA): AACR; Cancer Immunol Res 2016;4(1 Suppl):Abstract nr B146.
Collapse
Affiliation(s)
- Felix S. Lichtenegger
- 1Department of Internal Medicine III, Klinikum der Universität München, Munich, Germany,
| | - Frauke M. Schnorfeil
- 1Department of Internal Medicine III, Klinikum der Universität München, Munich, Germany,
| | - Thomas Köhnke
- 1Department of Internal Medicine III, Klinikum der Universität München, Munich, Germany,
| | - Torben Altmann
- 1Department of Internal Medicine III, Klinikum der Universität München, Munich, Germany,
| | - Veit Bücklein
- 1Department of Internal Medicine III, Klinikum der Universität München, Munich, Germany,
| | - Andreas Moosmann
- 2Clinical Cooperation Group Immunooncology at the Helmholtz Zentrum München, Munich, Germany,
| | - Monika Brüggemann
- 3Department of Hematology, University Hospital Schleswig-Holstein, Kiel, Germany,
| | - Beate Wagner
- 4Department of Transfusion Medicine, Cellular Therapeutics and Hemostaseology, Klinikum der Universit, Munich, Germany,
| | - Wolfgang Hiddemann
- 1Department of Internal Medicine III, Klinikum der Universität München, Munich, Germany,
| | - Iris Bigalke
- 5Department of Cellular Therapy, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Gunnar Kvalheim
- 5Department of Cellular Therapy, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Marion Subklewe
- 1Department of Internal Medicine III, Klinikum der Universität München, Munich, Germany,
| |
Collapse
|
10
|
Lichtenegger FS, Kondla I, Krempasky M, Weber AL, Herold T, Krupka C, Spiekermann K, Schneider S, Büchner T, Berdel WE, Wörmann BJ, Hiddemann W, Subklewe M. RNA and protein expression of herpesvirus entry mediator (HVEM) is associated with molecular markers, immunity-related pathways and relapse-free survival of patients with AML. Cancer Immunol Immunother 2015; 64:1505-15. [PMID: 26377688 PMCID: PMC11028999 DOI: 10.1007/s00262-015-1755-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 10/29/2014] [Accepted: 09/04/2015] [Indexed: 01/20/2023]
Abstract
Immune checkpoint molecules are highly relevant as potential prognostic markers and therapeutic targets in malignant diseases. HVEM belongs to the TNF receptor family and provides stimulatory as well as inhibitory signals depending on the ligand. Abnormal HVEM expression has been described in various malignancies, but the role in AML is unknown. Here we report extensive data on HVEM surface protein expression analyzed by flow cytometry on bone marrow leukemic cells of 169 AML patients at diagnosis. An independent cohort of 512 AML patients was analyzed for HVEM mRNA expression in bone marrow samples by Affymetrix microarrays. Consistently for both cohorts and methods, we show that HVEM was differentially expressed and that expression levels were associated with defined genetic markers. HVEM expression was lower in cases with FLT3-ITD (p = 0.001, p < 0.001), with mutations in NPM1 (p = 0.001, p < 0.001) or with the combination of NPM1 mutation and FLT3 wild type (p = 0.049, p = 0.050), while a biallelic mutation in CEBPA correlated positively with higher HVEM expression (p = 0.015, p < 0.001). In a differential gene expression analysis, we found 13 genes including HOXA9, MEIS1 and MN1 that were closely associated with HVEM expression. Besides, four gene sets closely linked to immunity were enriched in HVEM (high) samples. Finally, high expression of HVEM was associated with a trend toward longer relapse-free survival. The results of this study provide new information on the potential significance of HVEM in AML.
Collapse
MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Biomarkers, Tumor/genetics
- Bone Marrow/metabolism
- Disease-Free Survival
- Female
- Flow Cytometry
- Gene Expression Regulation, Neoplastic
- Humans
- Leukemia, Myeloid, Acute/diagnosis
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myeloid, Acute/immunology
- Leukemia, Myeloid, Acute/mortality
- Male
- Middle Aged
- Nucleophosmin
- RNA/genetics
- Receptors, Tumor Necrosis Factor, Member 14/genetics
- Receptors, Tumor Necrosis Factor, Member 14/immunology
Collapse
Affiliation(s)
- Felix S Lichtenegger
- Department of Internal Medicine III, Klinikum der Universität München, Marchioninistraße 15, 81377, Munich, Germany.
- Clinical Cooperation Group Immunotherapy, Helmholtz Zentrum München, Munich, Germany.
- Division of Clinical Pharmacology, Department of Internal Medicine IV, Klinikum der Universität München, Munich, Germany.
| | - Isabell Kondla
- Department of Internal Medicine III, Klinikum der Universität München, Marchioninistraße 15, 81377, Munich, Germany
- Clinical Cooperation Group Immunotherapy, Helmholtz Zentrum München, Munich, Germany
| | - Michael Krempasky
- Department of Internal Medicine III, Klinikum der Universität München, Marchioninistraße 15, 81377, Munich, Germany
- Clinical Cooperation Group Immunotherapy, Helmholtz Zentrum München, Munich, Germany
| | - Anna L Weber
- Department of Internal Medicine III, Klinikum der Universität München, Marchioninistraße 15, 81377, Munich, Germany
- Clinical Cooperation Group Immunotherapy, Helmholtz Zentrum München, Munich, Germany
| | - Tobias Herold
- Department of Internal Medicine III, Klinikum der Universität München, Marchioninistraße 15, 81377, Munich, Germany
- Clinical Cooperation Group Pathogenesis of Acute Leukemia, Helmholtz Zentrum München, Munich, Germany
| | - Christina Krupka
- Department of Internal Medicine III, Klinikum der Universität München, Marchioninistraße 15, 81377, Munich, Germany
- Clinical Cooperation Group Immunotherapy, Helmholtz Zentrum München, Munich, Germany
| | - Karsten Spiekermann
- Department of Internal Medicine III, Klinikum der Universität München, Marchioninistraße 15, 81377, Munich, Germany
- Clinical Cooperation Group Pathogenesis of Acute Leukemia, Helmholtz Zentrum München, Munich, Germany
| | - Stephanie Schneider
- Department of Internal Medicine III, Klinikum der Universität München, Marchioninistraße 15, 81377, Munich, Germany
| | - Thomas Büchner
- Department of Medicine A, Westfälische Wilhelms-Universität Münster, Münster, Germany
| | - Wolfgang E Berdel
- Department of Medicine A, Westfälische Wilhelms-Universität Münster, Münster, Germany
| | | | - Wolfgang Hiddemann
- Department of Internal Medicine III, Klinikum der Universität München, Marchioninistraße 15, 81377, Munich, Germany
- Clinical Cooperation Group Pathogenesis of Acute Leukemia, Helmholtz Zentrum München, Munich, Germany
| | - Marion Subklewe
- Department of Internal Medicine III, Klinikum der Universität München, Marchioninistraße 15, 81377, Munich, Germany
- Clinical Cooperation Group Immunotherapy, Helmholtz Zentrum München, Munich, Germany
| |
Collapse
|
11
|
Krupka C, Kufer P, Kischel R, Zugmaier G, Lichtenegger FS, Köhnke T, Vick B, Jeremias I, Metzeler KH, Altmann T, Schneider S, Fiegl M, Spiekermann K, Bauerle PA, Hiddemann W, Riethmüller G, Subklewe M. Blockade of the PD-1/PD-L1 axis augments lysis of AML cells by the CD33/CD3 BiTE antibody construct AMG 330: reversing a T-cell-induced immune escape mechanism. Leukemia 2015; 30:484-91. [PMID: 26239198 DOI: 10.1038/leu.2015.214] [Citation(s) in RCA: 185] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 07/06/2015] [Accepted: 07/10/2015] [Indexed: 12/13/2022]
Abstract
Bispecific T-cell engagers (BiTEs) are very effective in recruiting and activating T cells. We tested the cytotoxicity of the CD33/CD3 BiTE antibody construct AMG 330 on primary acute myeloid leukemia (AML) cells ex vivo and characterized parameters contributing to antileukemic cytolytic activity. The E:T ratio and the CD33 expression level significantly influenced lysis kinetics in long-term cultures of primary AML cells (n=38). AMG 330 induced T-cell-mediated proinflammatory conditions, favoring the upregulation of immune checkpoints on target and effector cells. Although not constitutively expressed at the time of primary diagnosis (n=123), PD-L1 was strongly upregulated on primary AML cells upon AMG 330 addition to ex vivo cultures (n=27, P<0.0001). This phenomenon was cytokine-driven as the sole addition of interferon (IFN)-γ and tumor necrosis factor-α also induced expression. Through blockade of the PD-1/PD-L1 interaction, AMG 330-mediated lysis (n=9, P=0.03), T-cell proliferation (n=9, P=0.01) and IFN-γ secretion (n=8, P=0.008) were significantly enhanced. The combinatorial approach was most beneficial in settings of protracted AML cell lysis. Taken together, we have characterized a critical resistance mechanism employed by primary AML cells under AMG 330-mediated proinflammatory conditions. Our results support the evaluation of checkpoint molecules in upcoming clinical trials with AMG 330 to enhance BiTE antibody construct-mediated cytotoxicity.
Collapse
Affiliation(s)
- C Krupka
- Department of Internal Medicine III, LMU-Klinikum der Universität München, Munich, Germany.,Clinical Co-operation Group Immunotherapy at the Helmholtz Zentrum München, Munich, Germany
| | - P Kufer
- AMGEN Research (Munich) GmbH, Munich, Germany
| | - R Kischel
- AMGEN Research (Munich) GmbH, Munich, Germany
| | - G Zugmaier
- AMGEN Research (Munich) GmbH, Munich, Germany
| | - F S Lichtenegger
- Department of Internal Medicine III, LMU-Klinikum der Universität München, Munich, Germany.,Clinical Co-operation Group Immunotherapy at the Helmholtz Zentrum München, Munich, Germany
| | - T Köhnke
- Department of Internal Medicine III, LMU-Klinikum der Universität München, Munich, Germany.,Clinical Co-operation Group Immunotherapy at the Helmholtz Zentrum München, Munich, Germany
| | - B Vick
- Department of Gene Vectors, Helmholtz Zentrum München, German Research Center for Environmental Health, Munich, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - I Jeremias
- Department of Gene Vectors, Helmholtz Zentrum München, German Research Center for Environmental Health, Munich, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Oncology, Dr von Haunersches Kinderspital, Ludwig Maximilians-Universität (LMU), Munich, Germany
| | - K H Metzeler
- Department of Internal Medicine III, LMU-Klinikum der Universität München, Munich, Germany
| | - T Altmann
- Department of Internal Medicine III, LMU-Klinikum der Universität München, Munich, Germany.,Clinical Co-operation Group Immunotherapy at the Helmholtz Zentrum München, Munich, Germany
| | - S Schneider
- Department of Internal Medicine III, LMU-Klinikum der Universität München, Munich, Germany
| | - M Fiegl
- Department of Internal Medicine III, LMU-Klinikum der Universität München, Munich, Germany
| | - K Spiekermann
- Department of Internal Medicine III, LMU-Klinikum der Universität München, Munich, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - P A Bauerle
- AMGEN Research (Munich) GmbH, Munich, Germany
| | - W Hiddemann
- Department of Internal Medicine III, LMU-Klinikum der Universität München, Munich, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - G Riethmüller
- Institute for Immunology, Ludwig-Maximilians-Universität, Munich, Germany
| | - M Subklewe
- Department of Internal Medicine III, LMU-Klinikum der Universität München, Munich, Germany.,Clinical Co-operation Group Immunotherapy at the Helmholtz Zentrum München, Munich, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| |
Collapse
|
12
|
Schnorfeil FM, Lichtenegger FS, Emmerig K, Schlueter M, Neitz JS, Draenert R, Hiddemann W, Subklewe M. T cells are functionally not impaired in AML: increased PD-1 expression is only seen at time of relapse and correlates with a shift towards the memory T cell compartment. J Hematol Oncol 2015. [PMID: 26219463 PMCID: PMC4518596 DOI: 10.1186/s13045-015-0189-2] [Citation(s) in RCA: 110] [Impact Index Per Article: 12.2] [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: 01/02/2023] Open
Abstract
Background T cell function is crucial for the success of several novel immunotherapeutic strategies for the treatment of acute myeloid leukemia (AML). However, changes in phenotype and function of T cells have been described in various hematologic malignancies, mimicking T cell exhaustion known from chronic viral infections. Detailed knowledge about phenotype and function of T cells in AML patients at different stages of the disease is indispensable for optimal development and application of immunotherapeutic strategies for this disease. Methods We used flow cytometry-based assays to characterize T cell phenotype and function in peripheral blood and bone marrow of AML patients at diagnosis, at relapse after intensive chemotherapy, and at relapse after allogeneic stem cell transplantation (SCT). Surface expression of CD244, PD-1, CD160, and TIM-3 was determined, and proliferation and production of IFN-γ, TNF-α, and IL-2 were measured. Results We detected similar expression of inhibitory molecules on T cells from patients at diagnosis and from age-matched healthy controls. At relapse after SCT, however, PD-1 expression was significantly increased compared to diagnosis, both on CD4+ and CD8+ T cells. This pattern was not associated with age and cytomegalovirus (CMV) status but with a shift towards effector memory cells in relapsed AML patients. Proliferation and cytokine production assays did not reveal functional defects in T cells of AML patients, neither at diagnosis nor at relapse. Conclusion We thus conclude that T cell exhaustion does not play a major role in AML. Immunotherapeutic strategies targeting autologous T cells thus have particularly good prospects in the setting of AML. Electronic supplementary material The online version of this article (doi:10.1186/s13045-015-0189-2) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Frauke M Schnorfeil
- Department of Internal Medicine III, Klinikum der Universität München, Munich, Germany. .,Clinical Cooperation Group Immunotherapy, Helmholtz Institute Munich, Munich, Germany.
| | - Felix S Lichtenegger
- Department of Internal Medicine III, Klinikum der Universität München, Munich, Germany. .,Clinical Cooperation Group Immunotherapy, Helmholtz Institute Munich, Munich, Germany. .,Division of Clinical Pharmacology, Department of Internal Medicine IV, Klinikum der Universität München, Munich, Germany.
| | - Katharina Emmerig
- Department of Internal Medicine III, Klinikum der Universität München, Munich, Germany. .,Clinical Cooperation Group Immunotherapy, Helmholtz Institute Munich, Munich, Germany.
| | - Miriam Schlueter
- Department of Internal Medicine III, Klinikum der Universität München, Munich, Germany. .,Clinical Cooperation Group Immunotherapy, Helmholtz Institute Munich, Munich, Germany.
| | - Julia S Neitz
- Department of Internal Medicine III, Klinikum der Universität München, Munich, Germany. .,Clinical Cooperation Group Immunotherapy, Helmholtz Institute Munich, Munich, Germany.
| | - Rika Draenert
- Division of Clinical Infectiology, Department of Internal Medicine IV, Klinikum der Universität München, Munich, Germany.
| | - Wolfgang Hiddemann
- Department of Internal Medicine III, Klinikum der Universität München, Munich, Germany. .,Clinical Cooperation Group Pathogenesis of Acute Myeloid Leukemia, Helmholtz Institute Munich, Munich, Germany.
| | - Marion Subklewe
- Department of Internal Medicine III, Klinikum der Universität München, Munich, Germany. .,Clinical Cooperation Group Immunotherapy, Helmholtz Institute Munich, Munich, Germany.
| |
Collapse
|
13
|
Abstract
Despite longstanding efforts in basic research and clinical studies, the prognosis for patients with acute myeloid leukemia (AML) remains poor. About half of the patients are not medically fit for intensive induction therapy to induce a complete remission and are treated with palliative treatment concepts. The patients medically fit for intensive induction therapy have a high complete remission rate but the majority suffers from relapse due to chemo-refractory leukemic cells. Allogeneic stem cell transplantation as post-remission therapy can significantly reduce the likelihood of relapse, but it is associated with a high rate of morbidity and mortality. Novel therapeutic concepts are therefore urgently sought after. During recent years, the focus has shifted towards the development of novel immunotherapeutic strategies. Some of the most promising are drug-conjugated monoclonal antibodies, T-cell engaging antibody constructs, adoptive transfer with chimeric antigen receptor (CAR) T cells, and dendritic cell vaccination. Here, we review recent progress in these four fields and speculate about the optimal time points during the course of AML treatment for their application.
Collapse
Affiliation(s)
- Felix S Lichtenegger
- Department of Internal Medicine III, Klinikum der Universität München, Munich, Germany; Clinical Cooperation Group Immunotherapy at the Helmholtz Institute Munich, Munich, Germany
| | - Christina Krupka
- Department of Internal Medicine III, Klinikum der Universität München, Munich, Germany; Clinical Cooperation Group Immunotherapy at the Helmholtz Institute Munich, Munich, Germany
| | - Thomas Köhnke
- Department of Internal Medicine III, Klinikum der Universität München, Munich, Germany; Clinical Cooperation Group Immunotherapy at the Helmholtz Institute Munich, Munich, Germany
| | - Marion Subklewe
- Department of Internal Medicine III, Klinikum der Universität München, Munich, Germany; Clinical Cooperation Group Immunotherapy at the Helmholtz Institute Munich, Munich, Germany.
| |
Collapse
|
14
|
Subklewe M, Geiger C, Lichtenegger FS, Javorovic M, Kvalheim G, Schendel DJ, Bigalke I. New generation dendritic cell vaccine for immunotherapy of acute myeloid leukemia. Cancer Immunol Immunother 2014; 63:1093-103. [PMID: 25186611 PMCID: PMC11028838 DOI: 10.1007/s00262-014-1600-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [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: 03/02/2014] [Accepted: 08/11/2014] [Indexed: 01/22/2023]
Abstract
Dendritic cell (DC)-based immunotherapy is a promising strategy for the elimination of minimal residual disease in patients with acute myeloid leukemia (AML). Particularly, patients with a high risk of relapse who are not eligible for hematopoietic stem cell transplantation could benefit from such a therapeutic approach. Here, we review our extensive studies on the development of a protocol for the generation of DCs with improved immunogenicity and optimized for the use in cell-based immunotherapy. This new generation DC vaccine combines the production of DCs in only 3 days with Toll-like receptor-signaling-induced cell maturation. These mature DCs are then loaded with RNA encoding the leukemia-associated antigens Wilm's tumor protein 1 and preferentially expressed antigen in melanoma in order to stimulate an AML-specific T-cell-based immune response. In vitro as well as in vivo studies demonstrated the enhanced capacity of these improved DCs for the induction of tumor-specific immune responses. Finally, a proof-of-concept Phase I/II clinical trial is discussed for post-remission AML patients with high risk for disease relapse.
Collapse
Affiliation(s)
- Marion Subklewe
- Department of Internal Medicine III, Klinikum der Universität München, Munich, Germany
| | - Christiane Geiger
- Institute of Molecular Immunology, Helmholtz Zentrum München, Munich, Germany
- Trianta Immunotherapies GmbH, A subsidiary of Medigene AG, Lochhamer Str. 11, 82152 Planegg-Martinsried, Germany
| | - Felix S. Lichtenegger
- Department of Internal Medicine III, Klinikum der Universität München, Munich, Germany
| | - Miran Javorovic
- Institute of Molecular Immunology, Helmholtz Zentrum München, Munich, Germany
| | - Gunnar Kvalheim
- Department of Cellular Therapy, Oslo University Hospital, Oslo, Norway
| | - Dolores J. Schendel
- Institute of Molecular Immunology, Helmholtz Zentrum München, Munich, Germany
- Trianta Immunotherapies GmbH, A subsidiary of Medigene AG, Lochhamer Str. 11, 82152 Planegg-Martinsried, Germany
| | - Iris Bigalke
- Institute of Molecular Immunology, Helmholtz Zentrum München, Munich, Germany
- Department of Cellular Therapy, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
15
|
Schnorfeil FM, Lichtenegger FS, Emmerig K, Schlüter M, Draenert R, Hiddemann W, Subklewe M. P20. Lack of T cell exhaustion in acute myeloid leukaemia. J Immunother Cancer 2014. [PMCID: PMC4072134 DOI: 10.1186/2051-1426-2-s2-p11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
16
|
Lichtenegger FS, Beck B, Bigalke I, Geiger C, Hiddemann W, Henschler R, Kvalheim G, Schendel DJ, Subklewe M. P55. Dendritic cell vaccination for postremission therapy in AML. J Immunother Cancer 2014. [PMCID: PMC4072282 DOI: 10.1186/2051-1426-2-s2-p29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
|
17
|
Abstract
The prognosis of acute myeloid leukemia, particularly when associated with adverse chromosomal or molecular aberrations, is poor due to a high relapse rate after induction chemotherapy. Postremission therapy for elimination of minimal residual disease remains a major challenge. Allogeneic hematopoietic stem cell transplantation has proven to provide a potent antileukemic effect. Novel strategies are needed for patients ineligible for this treatment. Here current immunotherapeutic concepts in acute myeloid leukemia in a nonallogeneic hematopoietic stem cell transplantation setting are reviewed. Data gathered with different monoclonal antibodies are discussed. Adoptive transfer of NK and T cells is reviewed, including evolving data on T-cell engineering. Results of systemic cytokine administration and of therapeutic vaccinations with peptides, modified leukemic cells and dendritic cells are presented. One particular focus of this review is the integration of currently running clinical trials. Recent immunotherapeutic studies have been encouraging and further interesting results are to be expected.
Collapse
Affiliation(s)
- Felix S Lichtenegger
- Department of Internal Medicine III, Klinikum der Universität München, Marchioninistrasse 15, 81377 Munich, Germany
| | | | | | | |
Collapse
|
18
|
Beck B, Dörfel D, Lichtenegger FS, Geiger C, Lindner L, Merk M, Schendel DJ, Subklewe M. Effects of TLR agonists on maturation and function of 3-day dendritic cells from AML patients in complete remission. J Transl Med 2011; 9:151. [PMID: 21910911 PMCID: PMC3182913 DOI: 10.1186/1479-5876-9-151] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [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: 05/19/2011] [Accepted: 09/13/2011] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Active dendritic cell (DC) immunization protocols are rapidly gaining interest as therapeutic options in patients with acute myeloid leukemia (AML). Here we present for the first time a GMP-compliant 3-day protocol for generation of monocyte-derived DCs using different synthetic Toll-like receptor (TLR) agonists in intensively pretreated patients with AML. METHODS Four different maturation cocktails were compared for their impact on cell recovery, phenotype, cytokine secretion, migration, and lymphocyte activation in 20 AML patients and 25 healthy controls. RESULTS Maturation cocktails containing the TLR7/8 agonists R848 or CL075, with and without the addition of the TLR3 agonist poly(I:C), induced DCs that had a positive costimulatory profile, secreted high levels of IL-12(p70), showed chemotaxis to CCR7 ligands, had the ability to activate NK cells, and efficiently stimulated antigen-specific CD8+ T cells. CONCLUSIONS Our results demonstrate that this approach translates into biologically improved DCs, not only in healthy controls but also in AML patients. This data supports the clinical application of TLR-matured DCs in patients with AML for activation of innate and adaptive immune responses.
Collapse
Affiliation(s)
- Barbara Beck
- Department of Internal Medicine III, University of Munich, Campus Grosshadern, Munich, Germany
| | | | | | | | | | | | | | | |
Collapse
|
19
|
Lichtenegger FS, Kuerten S, Faas S, Boehm BO, Tary-Lehmann M, Lehmann PV. Dissociation of Experimental Allergic Encephalomyelitis Protective Effect and Allergic Side Reactions in Tolerization with Neuroantigen. J Immunol 2007; 178:4749-56. [PMID: 17404254 DOI: 10.4049/jimmunol.178.8.4749] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Administration of autoantigens under conditions that induce type 2 immunity frequently leads to protection from T cell-mediated autoimmune diseases. Such treatments, however, are inherently linked to the induction of IgG1 Abs and to the risk of triggering anaphylactic reactions. We studied the therapeutic benefit vs risk of immune deviation in experimental allergic encephalomyelitis of SJL mice induced by MP4, a myelin basic protein-proteolipid protein (PLP) fusion protein. MP4 administration in IFA induced type 2 T cell immunity, IgG1 Abs, and experimental allergic encephalomyelitis protection, and all three were enhanced by repeat injections. Despite high Ab titers, anaphylactic side reactions were not observed when MP4 was repeatedly injected in IFA or as soluble Ag s.c. In contrast, lethal anaphylaxis was seen after s.c. injection of soluble PLP:139-151 peptide, but not when the peptide was reinjected in IFA. Therefore, the Ab response accompanying the immune therapy constituted an anaphylactic risk factor only when the autoantigen was not retained in an adjuvant and when it was small enough to be readily disseminated within the body. Taken together, our data show that treatment regimens can be designed to boost the protective type 2 T cell response while avoiding the risk of Ab-mediated allergic side effects.
Collapse
Affiliation(s)
- Felix S Lichtenegger
- Department of Pathology, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | | | | | | | | | | |
Collapse
|
20
|
Kuerten S, Lichtenegger FS, Faas S, Angelov DN, Tary-Lehmann M, Lehmann PV. MBP-PLP fusion protein-induced EAE in C57BL/6 mice. J Neuroimmunol 2006; 177:99-111. [PMID: 16781782 DOI: 10.1016/j.jneuroim.2006.03.021] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [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: 12/20/2005] [Revised: 03/18/2006] [Accepted: 03/20/2006] [Indexed: 01/06/2023]
Abstract
Gene knock-out and knock-in mice are becoming increasingly indispensable for mechanism-oriented studies of EAE. Most gene-modified mice are on the C57BL/6 background, for which presently there are only two EAE models available, the MOG peptide 35-55 and the PLP 178-191 peptide induced disease. However, because MS is not a single pathogenic entity, different EAE models are required to reproduce and study its various features. Here we are introducing MBP-PLP fusion protein (MP4)-induced EAE for C57BL/6 mice. B cell- and CD8+ T cell-dependence, as well as multi-determinant recognition are among the unique features of this demyelinating EAE.
Collapse
Affiliation(s)
- Stefanie Kuerten
- Department of Pathology, Case Western Reserve University, School of Medicine, Cleveland OH, 44106, USA
| | | | | | | | | | | |
Collapse
|