1
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Rabin EE, Huang J, Kim M, Mozny A, Lauing KL, Penco-Campillo M, Zhai L, Bommi P, Mi X, Power EA, Prabhu VC, Anderson DE, Barton KP, Walunas TL, Schiltz GE, Amidei C, Sanchez-Gomez P, Thakkar JP, Lukas RV, Wainwright DA. Age-stratified comorbid and pharmacologic analysis of patients with glioblastoma. Brain Behav Immun Health 2024; 38:100753. [PMID: 38600951 PMCID: PMC11004500 DOI: 10.1016/j.bbih.2024.100753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 02/13/2024] [Accepted: 03/08/2024] [Indexed: 04/12/2024] Open
Abstract
Background Increased age is a strong and unfavorable prognostic factor for patients with glioblastoma (GBM). However, the relationships between stratified patient age, comorbidities, and medications have yet to be explored in GBM patient survival analyses. Objective To evaluate co-morbid conditions, tumor-related symptoms, medication prescriptions, and subject age for patients with GBM and to establish potential targets for prospective studies. Methods Electronic health records for 565 patients with IDHwt GBM were evaluated at a single center between January 1, 2000 and August 9, 2021 were retrospectively assessed. Data were stratified by MGMT promoter methylation status when available and were used to construct multivariable time-dependent cox models and intra-cohort hazards. Results Younger (<65 years of age) but not older (≥65 years) GBM patients demonstrated a worse prognosis with movement related disabilities (P < 0.0001), gait/balance difficulty (P = 0.04) and weakness (P = 0.007), as well as psychiatric conditions, mental health disorders (P = 0.002) and anxiety (P = 0.001). In contrast, older but not younger GBM patients demonstrated a worse prognosis with epilepsy (P = 0.039). Both groups had worse survival with confusion/altered mental status (P = 0.023 vs < 0.000) and an improved survival with a Temozolomide prescription. Older but not younger GBM patients experienced an improved hazard with a prescription of ace-inhibitor medications (P = 0.048). Conclusion Age-dependent novel associations between clinical symptoms and medications prescribed for co-morbid conditions were demonstrated in patients with GBM. The results of the current work support future mechanistic studies that investigate the negative relationship(s) between increased age, comorbidities, and drug therapies for differential clinical decision-making across the lifespan of patients with GBM.
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Affiliation(s)
- Erik E. Rabin
- Department of Neurological Surgery at Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jonathan Huang
- Department of Neurological Surgery at Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Miri Kim
- Department of Neurological Surgery at Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA
| | - Andreas Mozny
- Department of Neurological Surgery at Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Kristen L. Lauing
- Department of Cancer Biology, Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA
| | - Manon Penco-Campillo
- Department of Cancer Biology, Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA
| | - Lijie Zhai
- Department of Cancer Biology, Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA
| | - Prashant Bommi
- Department of Cancer Biology, Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA
| | - Xinlei Mi
- Department of Preventive Medicine-Division of Biostatistics at Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Erica A. Power
- Department of Cancer Biology, Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA
| | - Vikram C. Prabhu
- Department of Neurological Surgery at Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA
| | - Douglas E. Anderson
- Department of Neurological Surgery at Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA
| | - Kevin P. Barton
- Department of Medicine - Hematology/Oncology at Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA
| | - Theresa L. Walunas
- Department of Medicine - Division of General Internal Medicine and Geriatrics at Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Preventive Medicine-Division of Health and Biomedical Informatics at Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Gary E. Schiltz
- Department of Chemistry at Northwestern University, Evanston, IL, USA
| | - Christina Amidei
- Department of Neurological Surgery at Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Pilar Sanchez-Gomez
- Neurooncology Unit, Unidad Funcional de Investigación en Enfermedades Crónicas (UFIEC), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Jigisha P. Thakkar
- Department of Neurology at Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA
| | - Rimas V. Lukas
- Department of Neurology at Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Derek A. Wainwright
- Department of Neurological Surgery at Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA
- Department of Cancer Biology, Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA
- Cardinal Bernardin Cancer Center, Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA
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2
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Johnson M, Bell A, Lauing KL, Ladomersky E, Zhai L, Penco-Campillo M, Shah Y, Mauer E, Xiu J, Nicolaides T, Drumm M, McCortney K, Elemento O, Kim M, Bommi P, Low JT, Memon R, Wu J, Zhao J, Mi X, Glantz MJ, Sengupta S, Castro B, Yamini B, Horbinski C, Baker DJ, Walunas TL, Schiltz GE, Lukas RV, Wainwright DA. Advanced Age in Humans and Mouse Models of Glioblastoma Show Decreased Survival from Extratumoral Influence. Clin Cancer Res 2023; 29:4973-4989. [PMID: 37725593 PMCID: PMC10690140 DOI: 10.1158/1078-0432.ccr-23-0834] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 08/03/2023] [Accepted: 09/14/2023] [Indexed: 09/21/2023]
Abstract
PURPOSE Glioblastoma (GBM) is the most common aggressive primary malignant brain tumor in adults with a median age of onset of 68 to 70 years old. Although advanced age is often associated with poorer GBM patient survival, the predominant source(s) of maladaptive aging effects remains to be established. Here, we studied intratumoral and extratumoral relationships between adult patients with GBM and mice with brain tumors across the lifespan. EXPERIMENTAL DESIGN Electronic health records at Northwestern Medicine and the NCI SEER databases were evaluated for GBM patient age and overall survival. The commercial Tempus and Caris databases, as well as The Cancer Genome Atlas were profiled for gene expression, DNA methylation, and mutational changes with varying GBM patient age. In addition, gene expression analysis was performed on the extratumoral brain of younger and older adult mice with or without a brain tumor. The survival of young and old wild-type or transgenic (INK-ATTAC) mice with a brain tumor was evaluated after treatment with or without senolytics and/or immunotherapy. RESULTS Human patients with GBM ≥65 years of age had a significantly decreased survival compared with their younger counterparts. While the intra-GBM molecular profiles were similar between younger and older patients with GBM, non-tumor brain tissue had a significantly different gene expression profile between young and old mice with a brain tumor and the eradication of senescent cells improved immunotherapy-dependent survival of old but not young mice. CONCLUSIONS This work suggests a potential benefit for combining senolytics with immunotherapy in older patients with GBM.
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Affiliation(s)
- Margaret Johnson
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina
| | - April Bell
- Department of Cancer Biology, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
| | - Kristen L. Lauing
- Department of Cancer Biology, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
- Department of Neurological Surgery at Loyola University Medical Center, Maywood, Illinois
| | | | - Lijie Zhai
- Department of Cancer Biology, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
- Department of Neurological Surgery at Loyola University Medical Center, Maywood, Illinois
| | - Manon Penco-Campillo
- Department of Cancer Biology, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
- Department of Neurological Surgery at Loyola University Medical Center, Maywood, Illinois
| | - Yajas Shah
- Institute of Computational Biomedicine, Weill Cornell Medicine, New York, New York
| | | | | | | | - Michael Drumm
- Department of Neurological Surgery, Feinberg School of Medicine, Chicago, Illinois
| | - Kathleen McCortney
- Department of Neurological Surgery, Feinberg School of Medicine, Chicago, Illinois
| | - Olivier Elemento
- Institute of Computational Biomedicine, Weill Cornell Medicine, New York, New York
| | - Miri Kim
- Department of Neurological Surgery at Loyola University Medical Center, Maywood, Illinois
| | - Prashant Bommi
- Department of Cancer Biology, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
- Department of Neurological Surgery at Loyola University Medical Center, Maywood, Illinois
| | - Justin T. Low
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina
| | - Ruba Memon
- Department of Cancer Biology, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
| | - Jennifer Wu
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Microbiology-Immunology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Junfei Zhao
- Department of Systems Biology, Herbert Irving Comprehensive Center, Columbia University, New York, New York
- Department of Biomedical Informatics, Columbia University, New York, New York
| | - Xinlei Mi
- Department of Preventive Medicine-Division of Biostatistics at Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Michael J. Glantz
- Department of Neurosurgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Soma Sengupta
- Departments of Neurology, Neurosurgery, and the Lineberger Cancer Center, University of North Carolina Chapel Hill, Chapel Hill, North Carolina
| | - Brandyn Castro
- Department of Neurological Surgery, University of Chicago, Chicago, Illinois
| | - Bakhtiar Yamini
- Department of Neurological Surgery, University of Chicago, Chicago, Illinois
| | - Craig Horbinski
- Department of Neurological Surgery, Feinberg School of Medicine, Chicago, Illinois
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Darren J. Baker
- Robert and Arlene Kogod Center on Aging, Mayo Clinic, Rochester, Minnesota
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
- Paul F. Glenn Center for the Biology of Aging at Mayo Clinic, Rochester, Minnesota
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, Minnesota
| | - Theresa L. Walunas
- Department of Medicine-Division of General Internal Medicine and Geriatrics at Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Gary E. Schiltz
- Department of Chemistry, Northwestern University, Evanston, Illinois
| | - Rimas V. Lukas
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Derek A. Wainwright
- Department of Cancer Biology, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
- Department of Neurological Surgery at Loyola University Medical Center, Maywood, Illinois
- Cardinal Bernardin Cancer Center, Loyola University Chicago, Maywood, Illinois
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3
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Bollu L, Bommi PV, Monsen PJ, Zhai L, Lauing KL, Bell A, Kim M, Ladomersky E, Yang X, Platanias LC, Matei DE, Bonini MG, Munshi HG, Hashizume R, Wu JD, Zhang B, James CD, Chen P, Kocherginsky M, Horbinski C, Cameron MD, Grigorescu AA, Yamini B, Lukas RV, Schiltz GE, Wainwright DA. Identification and Characterization of a Novel Indoleamine 2,3-Dioxygenase 1 Protein Degrader for Glioblastoma. J Med Chem 2022; 65:15642-15662. [PMID: 36410047 PMCID: PMC9743093 DOI: 10.1021/acs.jmedchem.2c00771] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Indexed: 11/22/2022]
Abstract
Indoleamine 2,3-dioxygenase 1 (IDO1) is a potent immunosuppressive enzyme that inhibits the antitumor immune response through both tryptophan metabolism and non-enzymatic functions. To date, most IDO1-targeted approaches have focused on inhibiting tryptophan metabolism. However, this class of drugs has failed to improve the overall survival of patients with cancer. Here, we developed and characterized proteolysis targeting chimeras (PROTACs) that degrade the IDO1 protein. IDO1-PROTACs were tested for their effects on IDO1 enzyme and non-enzyme activities. After screening a library of IDO1-PROTAC derivatives, a compound was identified that potently degraded the IDO1 protein through cereblon-mediated proteasomal degradation. The IDO1-PROTAC: (i) inhibited IDO1 enzyme activity and IDO1-mediated NF-κB phosphorylation in cultured human glioblastoma (GBM) cells, (ii) degraded the IDO1 protein within intracranial brain tumors in vivo, and (iii) mediated a survival benefit in mice with well-established brain tumors. This study identified and characterized a new IDO1 protein degrader with therapeutic potential for patients with glioblastoma.
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Affiliation(s)
- Lakshmi
R. Bollu
- Department
of Neurological Surgery, Northwestern University
Feinberg School of Medicine, Chicago, Illinois 60611, United States
| | - Prashant V. Bommi
- Department
of Neurological Surgery, Northwestern University
Feinberg School of Medicine, Chicago, Illinois 60611, United States
| | - Paige J. Monsen
- Department
of Chemistry, Northwestern University, Evanston, Illinois 60208, United States
| | - Lijie Zhai
- Department
of Neurological Surgery, Northwestern University
Feinberg School of Medicine, Chicago, Illinois 60611, United States
| | - Kristen L. Lauing
- Department
of Neurological Surgery, Northwestern University
Feinberg School of Medicine, Chicago, Illinois 60611, United States
| | - April Bell
- Department
of Neurological Surgery, Northwestern University
Feinberg School of Medicine, Chicago, Illinois 60611, United States
| | - Miri Kim
- Department
of Neurological Surgery, Loyola University
Medical Center, Maywood, Illinois 60153, United
States
| | - Erik Ladomersky
- Department
of Neurological Surgery, Northwestern University
Feinberg School of Medicine, Chicago, Illinois 60611, United States
| | - Xinyu Yang
- WuXi
AppTec, Shanghai 200131, People’s Republic of China
| | - Leonidas C. Platanias
- Department
of Medicine—Division of Hematology and Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, United States
- Robert
H.
Lurie Comprehensive Cancer Center, Chicago, Illinois 60611, United States
| | - Daniela E. Matei
- Robert
H.
Lurie Comprehensive Cancer Center, Chicago, Illinois 60611, United States
- Department
of Obstetrics and Gynecology, Northwestern
University Feinberg School of Medicine, Chicago, Illinois 60611, United States
| | - Marcelo G. Bonini
- Department
of Medicine—Division of Hematology and Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, United States
- Robert
H.
Lurie Comprehensive Cancer Center, Chicago, Illinois 60611, United States
| | - Hidayatullah G. Munshi
- Department
of Medicine—Division of Hematology and Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, United States
- Robert
H.
Lurie Comprehensive Cancer Center, Chicago, Illinois 60611, United States
| | - Rintaro Hashizume
- Robert
H.
Lurie Comprehensive Cancer Center, Chicago, Illinois 60611, United States
- Department
of Pediatrics − Division of Hematology, Oncology, and Stem
Cell Transplantation, Northwestern University
Feinberg School of Medicine, Chicago, Illinois 60611, United States
| | - Jennifer D. Wu
- Robert
H.
Lurie Comprehensive Cancer Center, Chicago, Illinois 60611, United States
- Department
of Urology, Northwestern University Feinberg
School of Medicine, Chicago, Illinois 60611, United States
- Department
of Microbiology-Immunology, Northwestern
University Feinberg School of Medicine, Chicago, Illinois 60611, United States
| | - Bin Zhang
- Department
of Medicine—Division of Hematology and Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, United States
- Department
of Microbiology-Immunology, Northwestern
University Feinberg School of Medicine, Chicago, Illinois 60611, United States
| | - Charles David James
- Department
of Neurological Surgery, Northwestern University
Feinberg School of Medicine, Chicago, Illinois 60611, United States
| | - Peiwen Chen
- Department
of Neurological Surgery, Northwestern University
Feinberg School of Medicine, Chicago, Illinois 60611, United States
| | - Masha Kocherginsky
- Robert
H.
Lurie Comprehensive Cancer Center, Chicago, Illinois 60611, United States
- Department
of Obstetrics and Gynecology, Northwestern
University Feinberg School of Medicine, Chicago, Illinois 60611, United States
- Department of Preventive Medicine, Northwestern
University Feinberg School of Medicine, Chicago, Illinois 60611, United States
| | - Craig Horbinski
- Department
of Neurological Surgery, Northwestern University
Feinberg School of Medicine, Chicago, Illinois 60611, United States
- Robert
H.
Lurie Comprehensive Cancer Center, Chicago, Illinois 60611, United States
- Department of Pathology, Northwestern University
Feinberg School of Medicine, Chicago, Illinois 60611, United States
| | - Michael D. Cameron
- Department of Molecular Therapeutics, The
Scripps Research Institute, Scripps Florida, Jupiter, Florida 33458, United States
| | - Arabela A. Grigorescu
- Department of Molecular Biosciences, Northwestern
University Weinberg College of Arts and Sciences, Evanston, Illinois 60208, United States
| | - Bakhtiar Yamini
- Department of Neurological Surgery, Division of the Biological Sciences, The University of Chicago, Chicago, Illinois 60637, United States
| | - Rimas V. Lukas
- Robert
H.
Lurie Comprehensive Cancer Center, Chicago, Illinois 60611, United States
- Department
of Neurology, Northwestern University Feinberg
School of Medicine, Chicago, Illinois 60611, United States
| | - Gary E. Schiltz
- Department
of Chemistry, Northwestern University, Evanston, Illinois 60208, United States
- Robert
H.
Lurie Comprehensive Cancer Center, Chicago, Illinois 60611, United States
- Department of Pharmacology, Northwestern
University Feinberg School of Medicine, Chicago, Illinois 60611, United States
| | - Derek A. Wainwright
- Department
of Neurological Surgery, Northwestern University
Feinberg School of Medicine, Chicago, Illinois 60611, United States
- Department
of Medicine—Division of Hematology and Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, United States
- Robert
H.
Lurie Comprehensive Cancer Center, Chicago, Illinois 60611, United States
- Department
of Microbiology-Immunology, Northwestern
University Feinberg School of Medicine, Chicago, Illinois 60611, United States
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4
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Nguyen TT, Shin DH, Sohoni S, Singh SK, Rivera-Molina Y, Jiang H, Fan X, Gumin J, Lang FF, Alvarez-Breckenridge C, Godoy-Vitorino F, Zhu L, Zheng WJ, Zhai L, Ladomersky E, Lauing KL, Alonso MM, Wainwright DA, Gomez-Manzano C, Fueyo J. Reshaping the tumor microenvironment with oncolytic viruses, positive regulation of the immune synapse, and blockade of the immunosuppressive oncometabolic circuitry. J Immunother Cancer 2022; 10:e004935. [PMID: 35902132 PMCID: PMC9341188 DOI: 10.1136/jitc-2022-004935] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [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] [Accepted: 06/27/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Oncolytic viruses are considered part of immunotherapy and have shown promise in preclinical experiments and clinical trials. Results from these studies have suggested that tumor microenvironment remodeling is required to achieve an effective response in solid tumors. Here, we assess the extent to which targeting specific mechanisms underlying the immunosuppressive tumor microenvironment optimizes viroimmunotherapy. METHODS We used RNA-seq analyses to analyze the transcriptome, and validated the results using Q-PCR, flow cytometry, and immunofluorescence. Viral activity was analyzed by replication assays and viral titration. Kyn and Trp metabolite levels were quantified using liquid chromatography-mass spectrometry. Aryl hydrocarbon receptor (AhR) activation was analyzed by examination of promoter activity. Therapeutic efficacy was assessed by tumor histopathology and survival in syngeneic murine models of gliomas, including Indoleamine 2,3-dioxygenase (IDO)-/- mice. Flow cytometry was used for immunophenotyping and quantification of cell populations. Immune activation was examined in co-cultures of immune and cancer cells. T-cell depletion was used to identify the role played by specific cell populations. Rechallenge experiments were performed to identify the development of anti-tumor memory. RESULTS Bulk RNA-seq analyses showed the activation of the immunosuppressive IDO-kynurenine-AhR circuitry in response to Delta-24-RGDOX infection of tumors. To overcome the effect of this pivotal pathway, we combined Delta-24-RGDOX with clinically relevant IDO inhibitors. The combination therapy increased the frequency of CD8+ T cells and decreased the rate of myeloid-derived suppressor cell and immunosupressive Treg tumor populations in animal models of solid tumors. Functional studies demonstrated that IDO-blockade-dependent activation of immune cells against tumor antigens could be reversed by the oncometabolite kynurenine. The concurrent targeting of the effectors and suppressors of the tumor immune landscape significantly prolonged the survival in animal models of orthotopic gliomas. CONCLUSIONS Our data identified for the first time the in vivo role of IDO-dependent immunosuppressive pathways in the resistance of solid tumors to oncolytic adenoviruses. Specifically, the IDO-Kyn-AhR activity was responsible for the resurface of local immunosuppression and resistance to therapy, which was ablated through IDO inhibition. Our data indicate that combined molecular and immune therapy may improve outcomes in human gliomas and other cancers treated with virotherapy.
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Affiliation(s)
- Teresa T Nguyen
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, Texas, USA
| | - Dong Ho Shin
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, Texas, USA
| | - Sagar Sohoni
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sanjay K Singh
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Yisel Rivera-Molina
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Hong Jiang
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Xuejun Fan
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Joy Gumin
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Frederick F Lang
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Filipa Godoy-Vitorino
- Department of Microbiology and Medical Zoology, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
| | - Lisha Zhu
- The University of Texas Health Science Center at Houston School of Biomedical Informatics, Houston, Texas, USA
| | - W Jim Zheng
- The University of Texas Health Science Center at Houston School of Biomedical Informatics, Houston, Texas, USA
| | - Lijie Zhai
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Erik Ladomersky
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kristen L Lauing
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Marta M Alonso
- Pediatrics, Clínica Universidad de Navarra, Pamplona, Spain
- Program of Solid Tumors, CIMA, Pamplona, Spain
| | - Derek A Wainwright
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Medicine-Hematology/Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Candelaria Gomez-Manzano
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, Texas, USA
| | - Juan Fueyo
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, Texas, USA
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5
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Nguyen TT, Shin DH, Sohoni S, Singh SK, Rivera-Molina Y, Jiang H, Fan X, Gumin J, Lang FF, Alvarez-Breckenridge C, Alonso MM, Godoy-Vitorino F, Zhai L, Ladomersky E, Lauing KL, Wainwright DA, Fueyo J, Gomez-Manzano C. Abstract 4184: RNA-seq analyses reveal remodeling of tumor microenvironment and reversal of glioma resistance to oncolytic viruses by targeting immunometabolism. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-4184] [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
Viroimmunotherapy aims to infect cancer cells to elicit anti-tumor immune responses. In clinical trials, glioma treatment with oncolytic viruses induced durable clinical responses in a small fraction of patients. To improve the percentage of responders, it is necessary to reshape the tumor microenvironment that shields the tumor from the immune system of the patient. Thus, we engineered Delta-24-RGDOX (DNX-2440), an oncolytic adenovirus that carries the cDNA of the T-cell activator, OX40L. In this work, we observed that Delta-24-RGDOX triggered a dramatic reshaping of the tumor microenvironment dominated by strong changes in immune processes as indicated by RNA-sequencing via ingenuity pathway analyses in a murine glioblastoma model. Paradoxically, network analyses revealed that Delta-24-RGDOX also induced robust activation of the cytokine-driven immunosuppressive IDO-Kynurenine-AhR circuitry, indicating a potential mechanism of resistance of the cancer cells to oncolytic virotherapy. To reverse this immunosuppression, we combined Delta-24-RGDOX with clinically relevant IDO inhibitors to treat glioma bearing mice. Importantly, addition of the IDO inhibitor to Delta-24-RGDOX decreased the activation of the IDO network. IDO inhibition did not affect virus infection or replication in human or murine glioma cells. Flow cytometry assays revealed that the combination therapy increased the frequency of activated CD8+ T cells and decreased the presence of the immunosuppressive cell populations, MDSCs and Tregs. Gene set enrichment analyses confirmed the decrease of MDSCs and Tregs in the combination treated glioma-bearing mice compared to the virus alone. Functional co-culture studies showed that the combined therapy activated splenocytes against tumor antigens, and that this activation was reversed by kynurenine. Importantly, the combination treatment eradicated the tumors in a CD4-dependent manner and significantly prolonged the survival of glioma-bearing mice. Altogether, these studies indicate that the combination treatment promotes an adaptive immune response while decreasing immunosuppression caused by virus-induced IDO activation. Furthermore, our data identified the striking role of immunosuppressive pathways in the resistance of gliomas to oncolytic virotherapy. Specifically, the activity of the tumor microenvironment IDO circuitry was responsible, at least partially, for the remodeling of local immunosuppression after tumor infection. Combining molecular and immune-related therapies may improve outcomes in human gliomas treated with virotherapy.
Citation Format: Teresa T. Nguyen, Dong Ho Shin, Sagar Sohoni, Sanjay K. Singh, Yisel Rivera-Molina, Hong Jiang, Xuejun Fan, Joy Gumin, Frederick F. Lang, Christopher Alvarez-Breckenridge, Marta M. Alonso, Filipa Godoy-Vitorino, Lijie Zhai, Erik Ladomersky, Kristen L. Lauing, Derek A. Wainwright, Juan Fueyo, Candelaria Gomez-Manzano. RNA-seq analyses reveal remodeling of tumor microenvironment and reversal of glioma resistance to oncolytic viruses by targeting immunometabolism [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 4184.
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Affiliation(s)
| | | | | | | | | | | | | | - Joy Gumin
- 1MD Anderson Cancer Center, Houston, TX
| | | | | | | | | | - Lijie Zhai
- 5Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Erik Ladomersky
- 5Northwestern University Feinberg School of Medicine, Chicago, IL
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6
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Rabin EE, Kim M, Mozny A, Cardoza K, Bell AC, Zhai L, Bommi P, Lauing KL, King AL, Armstrong TS, Walunas TL, Fang D, Roy I, Peipert JD, Sieg E, Mi X, Amidei C, Lukas RV, Wainwright DA. A systematic review of pharmacologic treatment efficacy for depression in older patients with cancer. Brain Behav Immun Health 2022; 21:100449. [PMID: 35368609 PMCID: PMC8968450 DOI: 10.1016/j.bbih.2022.100449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 03/03/2022] [Accepted: 03/12/2022] [Indexed: 12/19/2022] Open
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7
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Zhai L, Bell A, Ladomersky E, Lauing KL, Bollu L, Nguyen B, Genet M, Kim M, Chen P, Mi X, Wu JD, Schipma MJ, Wray B, Griffiths J, Unwin RD, Clark SJ, Acharya R, Bao R, Horbinski C, Lukas RV, Schiltz GE, Wainwright DA. Tumor Cell IDO Enhances Immune Suppression and Decreases Survival Independent of Tryptophan Metabolism in Glioblastoma. Clin Cancer Res 2021; 27:6514-6528. [PMID: 34479957 PMCID: PMC8639612 DOI: 10.1158/1078-0432.ccr-21-1392] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 08/06/2021] [Accepted: 08/31/2021] [Indexed: 01/09/2023]
Abstract
PURPOSE Glioblastoma (GBM) is an incurable primary brain tumor that has not benefited from immunotherapy to date. More than 90% of GBM expresses the tryptophan (Trp) metabolic enzyme, indoleamine 2,3-dioxygenase 1 (IDO). This observation supported the historical hypothesis that IDO suppresses the antitumor immune response solely through a mechanism that requires intratumoral Trp depletion. However, recent findings led us to investigate the alternative hypothesis that IDO suppresses the anti-GBM immune response independent of its association with Trp metabolism. EXPERIMENTAL DESIGN IDO-deficient GBM cell lines reconstituted with IDO wild-type or IDO enzyme-null cDNA were created and validated in vitro and in vivo. Microarray analysis was conducted to search for genes that IDO regulates, followed by the analysis of human GBM cell lines, patient GBM and plasma, and The Cancer Genome Atlas (TCGA) database. Ex vivo cell coculture assays, syngeneic and humanized mouse GBM models, were used to test the alternative hypothesis. RESULTS Nonenzymic tumor cell IDO activity decreased the survival of experimental animals and increased the expression of complement factor H (CFH) and its isoform, factor H like protein 1 (FHL-1) in human GBM. Tumor cell IDO increased CFH and FHL-1 expression independent of Trp metabolism. Increased intratumoral CFH and FHL-1 levels were associated with poorer survival among patients with glioma. Similar to IDO effects, GBM cell FHL-1 expression increased intratumoral regulatory T cells (Treg) and myeloid-derived suppressor cells while it decreased overall survival in mice with GBM. CONCLUSIONS Our study reveals a nonmetabolic IDO-mediated enhancement of CFH expression and provides a new therapeutic target for patients with GBM.
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Affiliation(s)
- Lijie Zhai
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - April Bell
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Erik Ladomersky
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kristen L Lauing
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lakshmi Bollu
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Brenda Nguyen
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Matthew Genet
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Miri Kim
- Department of Neurological Surgery, Loyola University Medical Center, Loyola University Chicago, Maywood, Illinois
| | - Peiwen Chen
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Xinlei Mi
- Department of Preventive Medicine at Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jennifer D Wu
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Microbiology-Immunology at Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Matthew J Schipma
- Department of Biochemistry and Molecular Genetics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Brian Wray
- Department of Biochemistry and Molecular Genetics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - John Griffiths
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Richard D Unwin
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Simon J Clark
- University Eye Clinic, Institute for Ophthalmic Research, Eberhard Karls University of Tübingen, Tübingen, Baden-Württemberg, Germany
- Institute for Ophthalmic Research, Eberhard Karls University of Tübingen, Tübingen, Germany
- Lydia Becker Institute of Immunology and Inflammation, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Rajesh Acharya
- University of Pittsburgh Hillman Cancer Center, Pittsburgh, Pennsylvania
| | - Riyue Bao
- University of Pittsburgh Hillman Cancer Center, Pittsburgh, Pennsylvania
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Craig Horbinski
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Rimas V Lukas
- The Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Gary E Schiltz
- Department of Chemistry, Weinberg College of Arts and Sciences, Northwestern University, Evanston, Illinois
- Department of Pharmacology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Derek A Wainwright
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
- Department of Microbiology-Immunology at Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Division of Hematology and Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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8
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Kim M, Ladomersky E, Mozny A, Kocherginsky M, O'Shea K, Reinstein ZZ, Zhai L, Bell A, Lauing KL, Bollu L, Rabin E, Dixit K, Kumthekar P, Platanias LC, Hou L, Zheng Y, Wu J, Zhang B, Hrachova M, Merrill SA, Mrugala MM, Prabhu VC, Horbinski C, James CD, Yamini B, Ostrom QT, Johnson MO, Reardon DA, Lukas RV, Wainwright DA. Glioblastoma as an age-related neurological disorder in adults. Neurooncol Adv 2021; 3:vdab125. [PMID: 34647022 PMCID: PMC8500689 DOI: 10.1093/noajnl/vdab125] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [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: 12/25/2022] Open
Abstract
Background Advanced age is a major risk factor for the development of many diseases including those affecting the central nervous system. Wild-type isocitrate dehydrogenase glioblastoma (IDHwt GBM) is the most common primary malignant brain cancer and accounts for ≥90% of all adult GBM diagnoses. Patients with IDHwt GBM have a median age of diagnosis at 68–70 years of age, and increasing age is associated with an increasingly worse prognosis for patients with this type of GBM. Methods The Surveillance, Epidemiology, and End Results, The Cancer Genome Atlas, and the Chinese Glioma Genome Atlas databases were analyzed for mortality indices. Meta-analysis of 80 clinical trials was evaluated for log hazard ratio for aging to tumor survivorship. Results Despite significant advances in the understanding of intratumoral genetic alterations, molecular characteristics of tumor microenvironments, and relationships between tumor molecular characteristics and the use of targeted therapeutics, life expectancy for older adults with GBM has yet to improve. Conclusions Based upon the results of our analysis, we propose that age-dependent factors that are yet to be fully elucidated, contribute to IDHwt GBM patient outcomes.
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Affiliation(s)
- Miri Kim
- Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois, USA.,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Erik Ladomersky
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Andreas Mozny
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Masha Kocherginsky
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kaitlyn O'Shea
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Zachary Z Reinstein
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Lijie Zhai
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - April Bell
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kristen L Lauing
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Lakshmi Bollu
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Erik Rabin
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Karan Dixit
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Priya Kumthekar
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Leonidas C Platanias
- Department of Medicine, Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Lifang Hou
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Yinan Zheng
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jennifer Wu
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Bin Zhang
- Department of Medicine, Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Maya Hrachova
- Division of Neuro-Oncology, Department of Neurology, Mayo Clinic, Phoenix, Arizona, USA
| | - Sarah A Merrill
- Division of Neuro-Oncology, Department of Neurology, Mayo Clinic, Phoenix, Arizona, USA
| | - Maciej M Mrugala
- Division of Neuro-Oncology, Department of Neurology, Mayo Clinic, Phoenix, Arizona, USA
| | - Vikram C Prabhu
- Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois, USA
| | - Craig Horbinski
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Charles David James
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Bakhtiar Yamini
- Department of Neurological Surgery, University of Chicago Medical Center & Biological Sciences, Chicago, Illinois, USA
| | - Quinn T Ostrom
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Margaret O Johnson
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - David A Reardon
- Dana-Farber/Harvard Cancer Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Rimas V Lukas
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Derek A Wainwright
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Department of Medicine, Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Department of Microbiology and Immunology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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9
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Zhai L, Bell A, Ladomersky E, Lauing KL, Bollu L, Sosman JA, Zhang B, Wu JD, Miller SD, Meeks JJ, Lukas RV, Wyatt E, Doglio L, Schiltz GE, McCusker RH, Wainwright DA. Immunosuppressive IDO in Cancer: Mechanisms of Action, Animal Models, and Targeting Strategies. Front Immunol 2020; 11:1185. [PMID: 32612606 PMCID: PMC7308527 DOI: 10.3389/fimmu.2020.01185] [Citation(s) in RCA: 110] [Impact Index Per Article: 27.5] [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: 02/01/2020] [Accepted: 05/13/2020] [Indexed: 12/24/2022] Open
Abstract
Indoleamine 2, 3-dioxygenase 1 (IDO; IDO1; INDO) is a rate-limiting enzyme that metabolizes the essential amino acid, tryptophan, into downstream kynurenines. Canonically, the metabolic depletion of tryptophan and/or the accumulation of kynurenine is the mechanism that defines how immunosuppressive IDO inhibits immune cell effector functions and/or facilitates T cell death. Non-canonically, IDO also suppresses immunity through non-enzymic effects. Since IDO targeting compounds predominantly aim to inhibit metabolic activity as evidenced across the numerous clinical trials currently evaluating safety/efficacy in patients with cancer, in addition to the recent disappointment of IDO enzyme inhibitor therapy during the phase III ECHO-301 trial, the issue of IDO non-enzyme effects have come to the forefront of mechanistic and therapeutic consideration(s). Here, we review enzyme-dependent and -independent IDO-mediated immunosuppression as it primarily relates to glioblastoma (GBM); the most common and aggressive primary brain tumor in adults. Our group's recent discovery that IDO levels increase in the brain parenchyma during advanced age and regardless of whether GBM is present, highlights an immunosuppressive synergy between aging-increased IDO activity in cells of the central nervous system that reside outside of the brain tumor but collaborate with GBM cell IDO activity inside of the tumor. Because of their potential value for the in vivo study of IDO, we also review current transgenic animal modeling systems while highlighting three new constructs recently created by our group. This work converges on the central premise that maximal immunotherapeutic efficacy in subjects with advanced cancer requires both IDO enzyme- and non-enzyme-neutralization, which is not adequately addressed by available IDO-targeting pharmacologic approaches at this time.
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Affiliation(s)
- Lijie Zhai
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - April Bell
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Erik Ladomersky
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Kristen L. Lauing
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Lakshmi Bollu
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Jeffrey A. Sosman
- Division of Hematology and Oncology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, United States
| | - Bin Zhang
- Division of Hematology and Oncology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, United States
- Department of Microbiology-Immunology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Jennifer D. Wu
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, United States
- Department of Microbiology-Immunology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Stephen D. Miller
- Department of Microbiology-Immunology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Joshua J. Meeks
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, United States
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Department of Biochemistry and Molecular Genetics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Rimas V. Lukas
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, United States
- Division of Neuro-Oncology, Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Eugene Wyatt
- Department of Pharmacology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Transgenic and Targeted Mutagenesis Laboratory, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Lynn Doglio
- Department of Pharmacology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Transgenic and Targeted Mutagenesis Laboratory, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Gary E. Schiltz
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, United States
- Department of Pharmacology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Center for Molecular Innovation and Drug Discovery, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Robert H. McCusker
- Department of Animal Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, United States
| | - Derek A. Wainwright
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Division of Hematology and Oncology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, United States
- Department of Microbiology-Immunology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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10
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Ladomersky E, Zhai L, Lauing KL, Bell A, Xu J, Kocherginsky M, Zhang B, Wu JD, Podojil JR, Platanias LC, Mochizuki AY, Prins RM, Kumthekar P, Raizer JJ, Dixit K, Lukas RV, Horbinski C, Wei M, Zhou C, Pawelec G, Campisi J, Grohmann U, Prendergast GC, Munn DH, Wainwright DA. Advanced Age Increases Immunosuppression in the Brain and Decreases Immunotherapeutic Efficacy in Subjects with Glioblastoma. Clin Cancer Res 2020; 26:5232-5245. [PMID: 32546647 DOI: 10.1158/1078-0432.ccr-19-3874] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 05/04/2020] [Accepted: 06/11/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE Wild-type isocitrate dehydrogenase-expressing glioblastoma (GBM) is the most common and aggressive primary brain tumor with a median age at diagnosis of ≥65 years. It accounts for approximately 90% of all GBMs and has a median overall survival (OS) of <15 months. Although immune checkpoint blockade (ICB) therapy has achieved remarkable survival benefits in a variety of aggressive malignancies, similar success has yet to be achieved for GBM among phase III clinical trials to date. Our study aimed to understand the relationship between subject age and immunotherapeutic efficacy as it relates to survival from glioma. EXPERIMENTAL DESIGN (i) Clinical data: GBM patient datasets from The Cancer Genome Atlas, Northwestern Medicine Enterprise Data Warehouse, and clinical studies evaluating ICB were stratified by age and compared for OS. (ii) Animal models: young, middle-aged, and older adult wild-type and indoleamine 2,3 dioxygenase (IDO)-knockout syngeneic mice were intracranially engrafted with CT-2A or GL261 glioma cell lines and treated with or without CTLA-4/PD-L1 mAbs, or radiation, anti-PD-1 mAb, and/or a pharmacologic IDO enzyme inhibitor. RESULTS Advanced age was associated with decreased GBM patient survival regardless of treatment with ICB. The advanced age-associated increase of brain IDO expression was linked to the suppression of immunotherapeutic efficacy and was not reversed by IDO enzyme inhibitor treatment. CONCLUSIONS Immunosuppression increases in the brain during advanced age and inhibits antiglioma immunity in older adults. Going forward, it will be important to fully understand the factors and mechanisms in the elderly brain that contribute to the decreased survival of older patients with GBM during treatment with ICB.
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Affiliation(s)
- Erik Ladomersky
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lijie Zhai
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kristen L Lauing
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - April Bell
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jiahui Xu
- Department of Preventive Medicine-Biostatistics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Masha Kocherginsky
- Department of Preventive Medicine-Biostatistics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Bin Zhang
- Department of Medicine-Hematology/Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Department of Microbiology-Immunology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jennifer D Wu
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Joseph R Podojil
- Department of Microbiology-Immunology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Leonidas C Platanias
- Department of Medicine-Hematology/Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Department of Biochemistry and Molecular Genetics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Aaron Y Mochizuki
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, California
| | - Robert M Prins
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Priya Kumthekar
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jeffrey J Raizer
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Karan Dixit
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Rimas V Lukas
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Craig Horbinski
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Min Wei
- BeiGene, Zhong-Guan-Cun Life Science Park, Changping District, Beijing, China
| | - Changyou Zhou
- BeiGene, Zhong-Guan-Cun Life Science Park, Changping District, Beijing, China
| | - Graham Pawelec
- Department of Immunology, University of Tübingen, Tübingen, Germany
| | - Judith Campisi
- Buck Institute for Research on Aging, Novato, California.,Lawrence Berkeley National Laboratory, Berkeley, California
| | - Ursula Grohmann
- Department of Experimental Medicine, University of Perugia, Perugia, Italy
| | | | | | - Derek A Wainwright
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois. .,Department of Medicine-Hematology/Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Department of Microbiology-Immunology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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11
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Otto-Meyer S, DeFaccio R, Dussold C, Ladomersky E, Zhai L, Lauing KL, Bollu LR, Amidei C, Lukas RV, Scholtens DM, Wainwright DA. A retrospective survival analysis of Glioblastoma patients treated with selective serotonin reuptake inhibitors. Brain Behav Immun Health 2019; 2. [PMID: 32190845 PMCID: PMC7079579 DOI: 10.1016/j.bbih.2019.100025] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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] [Indexed: 12/11/2022] Open
Abstract
Glioblastoma (GBM) is the most common and aggressive form of malignant glioma in adults with a median overall survival (OS) time of 16–18 months and a median age of diagnosis at 64 years old. Recent work has suggested that depression and psychosocial distress are associated with worse outcomes in patients with GBM. We therefore hypothesized that the targeted neutralization of psychosocial distress with selective serotonin reuptake inhibitor (SSRI) antidepressant treatment would be associated with a longer OS among patients with GBM. To address this hypothesis, we retrospectively studied the association between adjuvant SSRI usage and OS in GBM patients treated by Northwestern Medicine-affiliated providers. The medical records of 497 GBM patients were analyzed after extraction from the Northwestern Medicine Enterprise Data Warehouse. Data were retrospectively studied using a multivariable Cox model with SSRI use defined as a time-dependent variable for estimating the association with OS. Of the 497 patients, 315 individuals died, while 182 were censored due to the loss of follow-up or were alive at the end of our study. Of the 497 patients, 151 had a recorded use of SSRI treatment during the disease course. Unexpectedly, SSRI usage was not associated with an OS effect in both naïve (HR = 0.81, 95% CI = 0.64–1.03) and adjusted time-dependent (HR = 1.26, 95% CI = 0.97–1.63) Cox models. Ultimately, we failed to find an association between SSRI treatment and an improved OS of patients with GBM. Additional work is necessary for understanding the potential therapeutic effects of SSRIs when combined with other treatment approaches, and immunotherapies in particular, for subjects with GBM. SSRI use was not associated with improved overall survival in GBM patients. Analysis included fluoxetine, citalopram, escitalopram, sertraline, paroxetine, vilazodone. Multiple statistical models were used to verify the findings. Time-dependent modeling of SSRI use was critical to avoid immortal time bias. Future work in animal models or prospective studies is critical.
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Affiliation(s)
| | - Rian DeFaccio
- Department of Preventative Medicine-Biostatistics, Chicago, IL, 60611, USA
| | - Corey Dussold
- Department of Neurological Surgery, Chicago, IL, 60611, USA
| | | | - Lijie Zhai
- Department of Neurological Surgery, Chicago, IL, 60611, USA
| | | | | | | | - Rimas V Lukas
- Department of Neurology, Chicago, IL, 60611, USA.,Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, 60611, USA
| | - Denise M Scholtens
- Department of Preventative Medicine-Biostatistics, Chicago, IL, 60611, USA.,Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, 60611, USA
| | - Derek A Wainwright
- Department of Neurological Surgery, Chicago, IL, 60611, USA.,Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, 60611, USA.,Department of Medicine-Division of Hematology and Oncology, Chicago, IL, 60611, USA.,Department of Microbiology-Immunology, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
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12
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Zhai L, Bell A, Qian J, Ladomersky E, Lauing KL, Wainwright DA. Tumor cell IDO1 increases intratumoral immunosuppressive Tregs independent of enzyme activity. The Journal of Immunology 2019. [DOI: 10.4049/jimmunol.202.supp.137.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Abstract
Objective
Indoleamine 2, 3 dioxygenase 1 (IDO1) is a rate limiting enzyme that converts tryptophan (Trp) into kynurenine (Kyn). IDO1 knockdown in murine glioblastoma (GBM) cells suppresses intratumoral regulatory T cell (Treg) recruitment and increases survival, but unexpectedly, has no effect on intratumoral Trp levels. Moreover, while GBM cell IDO1 overexpression increases intratumoral Treg levels, treatment with a pharmacological IDO1 enzyme inhibitor fails to reverse this effect. These novel data led us to question whether GBM cell IDO1 recruits Tregs independent of enzyme activity, in vivo.
Methods
Ido1−/− mouse GBM cells reconstituted with wild-type or enzyme-null (H350A) murine Ido1 cDNA, and IDO1−/− human GBM cells were created. HPLC for Trp/Kyn levels, cell proliferation, cell viability, and splenic macrophage-GBM cell co-cultures, were studied in vitro. Syngeneic or humanized mice intracranially-engrafted with modified mouse or human GBM cells, respectively, were studied for the effect(s) on Treg accumulation and/or survival.
Results
As compared with IDO1 WT GBM cells, IDO1 H350A GBM cells show a significant decrease of Trp metabolism without affecting cell proliferation and viability. As compared with vector control GBM cells, co-culture for both IDO1 WT and H350A GBM cells induces greater numbers of mature macrophages. Independent of enzyme activity, GBM cell IDO1 expression increases intratumoral Tregs and decreases animal survival.
Conclusions
We created novel GBM models for elucidating the mechanism of metabolism-independent, IDO1-mediated intratumoral Treg accumulation. Given the majority of cancers with IDO1 expression, we suspect that our work may be generalizable to many types of malignancies.
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Affiliation(s)
- Lijie Zhai
- 1Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University
| | - April Bell
- 1Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University
| | - Jun Qian
- 1Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University
| | - Erik Ladomersky
- 1Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University
| | - Kristen L Lauing
- 1Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University
| | - Derek A Wainwright
- 2Departments of Neurological Surgery, Microbiology-Immunology, and Medicine-Hematology/Oncology, Feinberg School of Medicine, Northwestern University
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13
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Lenzen A, Lauing KL, Zhai L, Ladomersky E, Raman P, Rathi K, Lulla RR, Hashizume R, Wainwright DA. IMMU-01. NOVEL RNA-TARGETING STRATEGY FOR TREATING T CELL-DRIVEN IMMUNOSUPPRESSION IN HUMAN DIFFUSE INTRINSIC PONTINE GLIOMA. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz036.122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Alicia Lenzen
- Ann & Robert H. Lurie Children’s Hospital, Chicago, IL, USA
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Kristen L Lauing
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lijie Zhai
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Erik Ladomersky
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Pichai Raman
- Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Komal Rathi
- Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Rishi R Lulla
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Rintaro Hashizume
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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14
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Ladomersky E, Scholtens DM, Kocherginsky M, Hibler EA, Bartom ET, Otto-Meyer S, Zhai L, Lauing KL, Choi J, Sosman JA, Wu JD, Zhang B, Lukas RV, Wainwright DA. The Coincidence Between Increasing Age, Immunosuppression, and the Incidence of Patients With Glioblastoma. Front Pharmacol 2019; 10:200. [PMID: 30971917 PMCID: PMC6446059 DOI: 10.3389/fphar.2019.00200] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 02/18/2019] [Indexed: 12/12/2022] Open
Abstract
Background: Glioblastoma (GBM) is the most aggressive primary brain tumor in adults and is associated with a median overall survival (mOS) of 16-21 months. Our previous work found a negative association between advanced aging and the survival benefit after treatment with immunotherapy in an experimental brain tumor model. Given the recent phase III clinical success of immunotherapy in patients with many types of cancer, but not for patients with GBM, we hypothesize that aging enhances immunosuppression in the brain and contributes to the lack of efficacy for immunotherapy to improve mOS in patients with malignant glioma. Herein, we compare epidemiological data for the incidence and mortality of patients with central nervous system (CNS) cancers, in addition to immune-related gene expression in the normal human brain, as well as peripheral blood immunological changes across the adult lifespan. Methods: Data were extracted from the National Cancer Institute's surveillance, epidemiology, and end results (SEER)-, the Broad Institute's Genotype Tissue Expression project (GTEx)-, and the University of California San Francisco's 10k Immunomes-databases and analyzed for associations with aging. Results: The proportion of elderly individuals, defined as ≥65 years of age, has predominantly increased for more than 100 years in the United States. Over time, the rise in elderly United States citizens has correlated with an increased incidence and mortality rate associated with primary brain and other CNS cancer. With advanced aging, human mRNA expression for factors associated with immunoregulation including immunosuppressive indoleamine 2,3 dioxygenase 1 (IDO) and programmed death-ligand 1 (PD-L1), as well as the dendritic cell surface marker, CD11c, increase in the brain of normal human subjects, coincident with increased circulating immunosuppressive Tregs and decreased cytolytic CD8+ T cells in the peripheral blood. Strikingly, these changes are maximally pronounced in the 60-69 year old group; consistent with the median age of a diagnosis for GBM. Conclusion: These data demonstrate a significant association between normal human aging and increased immunosuppression in the circulation and CNS; particularly late in life. Our data raise several hypotheses including that, aging: (i) progressively suppresses normal immunosurveillance and thereby contributes to GBM cell initiation and/or outgrowth; (ii) decreases immunotherapeutic efficacy against malignant glioma.
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Affiliation(s)
- Erik Ladomersky
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Denise M Scholtens
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Masha Kocherginsky
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Elizabeth A Hibler
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Elizabeth T Bartom
- Department of Biochemistry and Molecular Genetics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Sebastian Otto-Meyer
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Lijie Zhai
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Kristen L Lauing
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Jaehyuk Choi
- Department of Biochemistry and Molecular Genetics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Jeffrey A Sosman
- Department of Medicine-Hematology and Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Jennifer D Wu
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Department of Microbiology-Immunology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Bin Zhang
- Department of Medicine-Hematology and Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Department of Microbiology-Immunology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Rimas V Lukas
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Derek A Wainwright
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Department of Medicine-Hematology and Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Department of Microbiology-Immunology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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15
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Zhai L, Ladomersky E, Lauing KL, Wu M, Scholtens DM, Savoor R, Zhang B, Wu JD, Horbinski C, Lukas RV, Binder DC, Wainwright DA. Commentary: preclinical efficacy of immune-checkpoint monotherapy does not recapitulate corresponding biomarkers-based clinical predictions in glioblastoma by Garg et al. (2017). Oncoimmunology 2018; 8:1548242. [PMID: 30723577 DOI: 10.1080/2162402x.2018.1548242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 10/29/2018] [Accepted: 11/09/2018] [Indexed: 10/27/2022] Open
Abstract
Preclinical modeling and gene expression analyses have yielded distinct observations for the role of immune checkpoint, IDO1, in glioblastoma (GBM). Accordingly, our recent work differs with Garg et al. (2017) with respect to IDO1 among preclinical and bioinformatic GBM datasets. Here, we discuss the methodological differences that affected study interpretation, and potentially, future clinical decision-making for IDO1-targeting approaches against GBM.
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Affiliation(s)
- Lijie Zhai
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Erik Ladomersky
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Kristen L Lauing
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Meijing Wu
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Denise M Scholtens
- Department of Preventive Medicine-Biostatistics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Rohan Savoor
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Bin Zhang
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Microbiology-Immunology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jennifer D Wu
- Department of Microbiology-Immunology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Craig Horbinski
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Rimas V Lukas
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - David C Binder
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Derek A Wainwright
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Microbiology-Immunology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Medicine-Division of Hematology and Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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16
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Zhai L, Qian J, Ladomersky E, Lenzen A, Lauing KL, Wainwright DA. Abstract LB-285: Non-enzyme IDO1 activity and its immunosuppressive effects in glioblastoma. Cancer Res 2018. [DOI: 10.1158/1538-7445.am2018-lb-285] [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
Purpose: Adult glioblastoma (GBM) is the most common primary malignant brain tumor of the central nervous system (CNS) with a median patient survival of 15-20 months. A consistent feature of GBM is the presence of indoleamine 2,3 dioxygenase 1 (IDO1) expressed by tumor cells. IDO1 is canonically characterized as an enzyme that metabolizes tryptophan (Trp) into kynurenines (Kyns). Tryptophan metabolism is the primary feature associated with IDO1-mediated immune suppression - primarily derived from in vitro study. Less appreciated is the recent find that, plasmacytoid dendritic cells (pDCs) utilize IDO1 to activate the non-canonical NFκB pathway, independent of Trp metabolism, resulting in greater levels of immunosuppression. The scientific premise of our study was therefore to determine whether GBM cell IDO1 is capable of mediating immunosuppression without associated enzyme activity.
Experimental methods: IDO1-deficient (IDO1-/-) glioma cells isolated from mice that spontaneously develop GBM [GFAP(ERT2)→Cre+/-;pTENfl/fl;Rbfl/fl;p53fl/fl;IDO1-/-] were transduced with lentiviral particles expressing wild-type or modified mouse IDO1 cDNA fused to a mGFP tag. Stably expressing cells were enriched for high IDO1/GFP expression by fluorescence-activated cell sorting and confirmed with RT-PCR and Western blotting. The effects of IDO1 modification on Trp/Kyn was quantified by HPLC. IDO1-/- syngeneic mice were intracranially-engrafted with modified GBM cells and studied for regulatory T cell (Treg; CD4+CD25+FoxP3+)/MDSC accumulation.
Results: (i) Viral transduction yielded stable expression of murine IDO1 mRNA and protein; (ii) the mGFP tag did not interfere with IDO1 enzyme activity in unmodified GBM cells; (iii) the histidine 350 to alanine (H350A), as well as aspartic acid 278 to alanine (D278A) mutations cause decreased or ablated IDO1 enzyme activity, respectively; (iv) ITIM mutation of tyrosine into glutamate (YE), as well as tyrosine into phenylalanine (YF), had a minimal effect on IDO1 enzyme activity.
Conclusions: We established new, novel, GFP-tagged mouse GBM cell lines to dissect the immunosuppressive contributions of Trp metabolism vs. non-enzyme functions as mediated by IDO1. Some GBM cell lines expressed high IDO1 with no Trp catabolic activity. GBM with IDO1-associated ITIM mutations showed marginal effects on enzyme activity. The analysis of in vitro GBM cell growth/cell death rate, invasion, and effects on co-cultured Tregs, as well as the in vivo analysis of GBM-infiltrating Treg/MDSC levels and impact on overall survival, will be presented.
Citation Format: Lijie Zhai, Jun Qian, Erik Ladomersky, Alicia Lenzen, Kristen L. Lauing, Derek A. Wainwright. Non-enzyme IDO1 activity and its immunosuppressive effects in glioblastoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr LB-285.
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Affiliation(s)
| | - Jun Qian
- Northwestern University, Chicago, IL
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17
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Lenzen A, Cole L, Lauing KL, Zhai L, Ladomersky E, Lulla RR, Hashizume R, Stegh A, Wainwright DA. IMMU-24. IMMUNOTHERAPEUTIC NANOTECHNOLOGY TARGETING IDO1 FOR PEDIATRIC DIFFUSE INTRINSIC PONTINE GLIOMA. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy059.340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Alicia Lenzen
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lisa Cole
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Kristen L Lauing
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lijie Zhai
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Erik Ladomersky
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Rishi R Lulla
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | - Rintaro Hashizume
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Alexander Stegh
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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18
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Rosenberg AJ, Wainwright DA, Rademaker A, Galvez C, Genet M, Zhai L, Lauing KL, Mulcahy MF, Hayes JP, Odell DD, Horbinski C, Komanduri S, Tetreault MP, Kim KYA, Villaflor VM. Indoleamine 2,3-dioxygenase 1 and overall survival of patients diagnosed with esophageal cancer. Oncotarget 2018; 9:23482-23493. [PMID: 29805749 PMCID: PMC5955099 DOI: 10.18632/oncotarget.25235] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 04/04/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Indoleamine 2,3-dioxygenase 1 (IDO1) is an enzyme with immunomodulatory properties that has emerged as a potential immunotherapeutic target in human cancer. However, the role, expression pattern, and relevance of IDO1 in esophageal cancer (EC) are poorly understood. Here, we utilize gene expression analysis of the cancer genome atlas (TCGA) and immunohistochemistry (IHC) to better understand the role and prognostic significance of IDO1 in EC. RESULTS High IDO1 mRNA levels were associated with worse overall survival (OS) in both esophageal squamous cell carcinoma (SCC) (P = 0.02) and adenocarcinoma (AC) (P = 0.036). High co-expression of IDO1 and programmed death ligand 1 (PD-L1) was associated with worse OS in SCC (P = 0.0031) and AC (P = 0.0186). IHC for IDO1 in SCC showed a significant correlation with PD-L1 (P < 0.0001) and CD3ε (P < 0.0001). CONCLUSIONS EC with high IDO1 and PD-L1 expression is significantly correlated with decreased patient survival, and may correlate with increased T-cells. These data suggest that simultaneous inhibition of IDO1 and PD-(L)1 may overcome important barriers to T-cell mediated immune rejection of EC. MATERIALS AND METHODS mRNA expression data from TCGA (SCC N = 87; AC N = 97). IHC in a second cohort of EC (N = 93) were stained for IDO1, PD-L1, and CD3ε, followed by light microscopic analysis.
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Affiliation(s)
- Ari J. Rosenberg
- Department of Medicine, Feinberg School of Medicine of Northwestern University, Chicago, 60611 IL, USA
- Division of Hematology and Oncology, Northwestern University, Chicago, 60611 IL, USA
| | - Derek A. Wainwright
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, 60611 IL, USA
- Department of Neurological Surgery, Feinberg School of Medicine of Northwestern University, Chicago, 60611 IL, USA
| | - Alfred Rademaker
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, 60611 IL, USA
- Department of Preventive Medicine, Feinberg School of Medicine of Northwestern University, Chicago, 60611 IL, USA
| | - Carlos Galvez
- Department of Medicine, Feinberg School of Medicine of Northwestern University, Chicago, 60611 IL, USA
| | - Matthew Genet
- Department of Medicine, Feinberg School of Medicine of Northwestern University, Chicago, 60611 IL, USA
| | - Lijie Zhai
- Department of Neurological Surgery, Feinberg School of Medicine of Northwestern University, Chicago, 60611 IL, USA
| | - Kristen L. Lauing
- Department of Neurological Surgery, Feinberg School of Medicine of Northwestern University, Chicago, 60611 IL, USA
| | - Mary F. Mulcahy
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, 60611 IL, USA
- Department of Medicine, Feinberg School of Medicine of Northwestern University, Chicago, 60611 IL, USA
- Division of Hematology and Oncology, Northwestern University, Chicago, 60611 IL, USA
- Northwestern Medicine Developmental Therapeutics Institute, Chicago, 60611 IL, USA
| | - John P. Hayes
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, 60611 IL, USA
- Department of Radiation Oncology, Northwestern University, Chicago, 60611 IL, USA
| | - David D. Odell
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, 60611 IL, USA
- Department of Thoracic Surgery, Northwestern University, Chicago, 60611 IL, USA
| | - Craig Horbinski
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, 60611 IL, USA
- Department of Pathology, Northwestern University, Chicago, 60611 IL, USA
| | - Srinadh Komanduri
- Department of Gastroenterology, Northwestern University, Chicago, 60611 IL, USA
| | | | - Kwang-Youn A. Kim
- Department of Preventive Medicine, Feinberg School of Medicine of Northwestern University, Chicago, 60611 IL, USA
| | - Victoria M. Villaflor
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, 60611 IL, USA
- Department of Medicine, Feinberg School of Medicine of Northwestern University, Chicago, 60611 IL, USA
- Division of Hematology and Oncology, Northwestern University, Chicago, 60611 IL, USA
- Northwestern Medicine Developmental Therapeutics Institute, Chicago, 60611 IL, USA
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19
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Zhai L, Ladomersky E, Lenzen A, Nguyen B, Patel R, Lauing KL, Wu M, Wainwright DA. IDO1 in cancer: a Gemini of immune checkpoints. Cell Mol Immunol 2018; 15:447-457. [PMID: 29375124 PMCID: PMC6068130 DOI: 10.1038/cmi.2017.143] [Citation(s) in RCA: 233] [Impact Index Per Article: 38.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 10/30/2017] [Accepted: 11/05/2017] [Indexed: 12/18/2022] Open
Abstract
Indoleamine 2, 3-dioxygenase 1 (IDO1) is a rate-limiting metabolic enzyme that converts the essential amino acid tryptophan (Trp) into downstream catabolites known as kynurenines. Coincidently, numerous studies have demonstrated that IDO1 is highly expressed in multiple types of human cancer. Preclinical studies have further introduced an interesting paradox: while single-agent treatment with IDO1 enzyme inhibitor has a negligible effect on decreasing the established cancer burden, approaches combining select therapies with IDO1 blockade tend to yield a synergistic benefit against tumor growth and/or animal subject survival. Given the high expression of IDO1 among multiple cancer types along with the lack of monotherapeutic efficacy, these data suggest that there is a more complex mechanism of action than previously appreciated. Similar to the dual faces of the astrological Gemini, we highlight the multiple roles of IDO1 and review its canonical association with IDO1-dependent tryptophan metabolism, as well as documented evidence confirming the dispensability of enzyme activity for its immunosuppressive effects. The gene transcript levels for IDO1 highlight its strong association with T-cell infiltration, but the lack of a universal prognostic significance among all cancer subtypes. Finally, ongoing clinical trials are discussed with consideration of IDO1-targeting strategies that enhance the efficacy of immunotherapy for cancer patients.
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Affiliation(s)
- Lijie Zhai
- Department of Neurological Surgery, Northwestern University, Chicago, USA
| | - Erik Ladomersky
- Department of Neurological Surgery, Northwestern University, Chicago, USA
| | - Alicia Lenzen
- Department of Pediatrics, Northwestern University, Chicago, USA
- Division of Hematology, Oncology and Stem Cell Transplantation, Northwestern University, Chicago, USA
- Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, USA
| | - Brenda Nguyen
- Department of Neurological Surgery, Northwestern University, Chicago, USA
| | - Ricky Patel
- Department of Neurological Surgery, Northwestern University, Chicago, USA
| | - Kristen L Lauing
- Department of Neurological Surgery, Northwestern University, Chicago, USA
| | - Meijing Wu
- Department of Neurological Surgery, Northwestern University, Chicago, USA
| | - Derek A Wainwright
- Department of Neurological Surgery, Northwestern University, Chicago, USA.
- Department of Medicine-Hematology/Oncology, Northwestern University, Chicago, USA.
- Department of Microbiology-Immunology, Northwestern University, Chicago, USA.
- Department of Medicine-Division of Hematology and Oncology, Northwestern University; Brain Tumor Institute, Northwestern University, Chicago, USA.
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Northwestern University, 60611, Chicago, IL, USA.
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20
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Binder DC, Ladomersky E, Lenzen A, Zhai L, Lauing KL, Otto-Meyer SD, Lukas RV, Wainwright DA. Lessons learned from rindopepimut treatment in patients with EGFRvIII-expressing glioblastoma. Transl Cancer Res 2018. [DOI: 10.21037/tcr.2018.03.36] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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21
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Binder DC, Ladomersky E, Lenzen A, Zhai L, Lauing KL, Otto-Meyer SD, Lukas RV, Wainwright DA. Lessons learned from rindopepimut treatment in patients with EGFRvIII-expressing glioblastoma. Transl Cancer Res 2018; 7:S510-S513. [PMID: 30283731 PMCID: PMC6166880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- David C. Binder
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Erik Ladomersky
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Alicia Lenzen
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lijie Zhai
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Kristen L. Lauing
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sebastian D. Otto-Meyer
- Department of Medicine-Hematology/Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Rimas V. Lukas
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
- Lou and Jean Malnati Brain Tumor Institute, Northwestern University, Chicago, IL, USA
| | - Derek A. Wainwright
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Medicine-Hematology/Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
- Lou and Jean Malnati Brain Tumor Institute, Northwestern University, Chicago, IL, USA
- Department of Microbiology-Immunology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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22
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Ladomersky E, Zhai L, Lenzen A, Lauing KL, Qian J, Scholtens DM, Gritsina G, Sun X, Liu Y, Yu F, Gong W, Liu Y, Jiang B, Tang T, Patel R, Platanias LC, James CD, Stupp R, Lukas RV, Binder DC, Wainwright DA. IDO1 Inhibition Synergizes with Radiation and PD-1 Blockade to Durably Increase Survival Against Advanced Glioblastoma. Clin Cancer Res 2018; 24:2559-2573. [PMID: 29500275 DOI: 10.1158/1078-0432.ccr-17-3573] [Citation(s) in RCA: 127] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 01/21/2018] [Accepted: 02/27/2018] [Indexed: 01/05/2023]
Abstract
Purpose: Glioblastoma is the most aggressive primary brain tumor in adults with a median survival of 15-20 months. Numerous approaches and novel therapeutics for treating glioblastoma have been investigated in the setting of phase III clinical trials, including a recent analysis of the immune checkpoint inhibitor, nivolumab (anti-PD-1), which failed to improve recurrent glioblastoma patient survival. However, rather than abandoning immune checkpoint inhibitor treatment for glioblastoma, which has shown promise in other types of cancer, ongoing studies are currently evaluating this therapeutic class when combined with other agents.Experimental Design: Here, we investigated immunocompetent orthotopic mouse models of glioblastoma treated with the potent CNS-penetrating IDO1 enzyme inhibitor, BGB-5777, combined with anti-PD1 mAb, as well as radiotherapy, based on our recent observation that tumor-infiltrating T cells directly increase immunosuppressive IDO1 levels in human glioblastoma, the previously described reinvigoration of immune cell functions after PD-1 blockade, as well as the proinflammatory effects of radiation.Results: Our results demonstrate a durable survival benefit from this novel three-agent treatment, but not for any single- or dual-agent combination. Unexpectedly, treatment efficacy required IDO1 enzyme inhibition in non-glioblastoma cells, rather than tumor cells. Timing of effector T-cell infiltration, animal subject age, and usage of systemic chemotherapy, all directly impacted therapy-mediated survival benefit.Conclusions: These data highlight a novel and clinically relevant immunotherapeutic approach with associated mechanistic considerations that have formed the basis of a newly initiated phase I/II trial for glioblastoma patients. Clin Cancer Res; 24(11); 2559-73. ©2018 AACR.
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Affiliation(s)
- Erik Ladomersky
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lijie Zhai
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Alicia Lenzen
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kristen L Lauing
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jun Qian
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Denise M Scholtens
- Department of Preventive Medicine-Biostatistics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Galina Gritsina
- Department of Molecular Genetics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Xuebing Sun
- BeiGene, Zhong-Guan-Cun Life Science Park, Changping District, Beijing, China
| | - Ye Liu
- BeiGene, Zhong-Guan-Cun Life Science Park, Changping District, Beijing, China
| | - Fenglong Yu
- BeiGene, Zhong-Guan-Cun Life Science Park, Changping District, Beijing, China
| | - Wenfeng Gong
- BeiGene, Zhong-Guan-Cun Life Science Park, Changping District, Beijing, China
| | - Yong Liu
- BeiGene, Zhong-Guan-Cun Life Science Park, Changping District, Beijing, China
| | - Beibei Jiang
- BeiGene, Zhong-Guan-Cun Life Science Park, Changping District, Beijing, China
| | - Tristin Tang
- BeiGene, Zhong-Guan-Cun Life Science Park, Changping District, Beijing, China
| | - Ricky Patel
- Rosalind Franklin University of Medicine and Science, North Chicago, Illinois
| | - Leonidas C Platanias
- Department of Medicine-Division of Hematology and Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois
| | - C David James
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois.,Department of Biochemistry and Molecular Genetics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Roger Stupp
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Department of Medicine-Division of Hematology and Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois.,Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Rimas V Lukas
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois.,Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - David C Binder
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Derek A Wainwright
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois. .,Department of Medicine-Division of Hematology and Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois.,Department of Microbiology-Immunology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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23
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Zhai L, Ladomersky E, Lauing KL, Wu M, Genet M, Gritsina G, Győrffy B, Brastianos PK, Binder DC, Sosman JA, Giles FJ, James CD, Horbinski C, Stupp R, Wainwright DA. Infiltrating T Cells Increase IDO1 Expression in Glioblastoma and Contribute to Decreased Patient Survival. Clin Cancer Res 2017; 23:6650-6660. [PMID: 28751450 DOI: 10.1158/1078-0432.ccr-17-0120] [Citation(s) in RCA: 120] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 04/28/2017] [Accepted: 07/24/2017] [Indexed: 12/15/2022]
Abstract
Purpose: Indoleamine 2,3 dioxygenase 1 (IDO1) mediates potent immunosuppression in multiple preclinical models of cancer. However, the basis for elevated IDO1 expression in human cancer, including the most common primary malignant brain tumor in adults, glioblastoma (GBM), is poorly understood. The major objective of this study is to address this gap in our understanding of how IDO1 expression contributes to the biology of GBM, and whether its level of expression is a determinant of GBM patient outcome.Experimental Design: Patient-resected GBM, The Cancer Genome Atlas, human T-cell:GBM cocultures, as well as nu/nu, NOD-scid, and humanized (NSG-SGM3-BLT) mice-engrafted human GBM form the basis of our investigation.Results:In situ hybridization for IDO1 revealed transcript expression throughout patient-resected GBM, whereas immunohistochemical IDO1 positivity was highly variable. Multivariate statistical analysis revealed that higher levels of IDO1 transcript predict a poor patient prognosis (P = 0.0076). GBM IDO1 mRNA levels positively correlated with increased gene expression for markers of cytolytic and regulatory T cells, in addition to decreased patient survival. Humanized mice intracranially engrafted human GBM revealed an IFNγ-associated T-cell-mediated increase of intratumoral IDO1Conclusions: Our data demonstrate that high intratumoral IDO1 mRNA levels correlate with a poor GBM patient prognosis. It also confirms the positive correlation between increased GBM IDO1 levels and human-infiltrating T cells. Collectively, this study suggests that future efforts aimed at increasing T-cell-mediated effects against GBM should consider combinatorial approaches that coinhibit potential T-cell-mediated IDO1 enhancement during therapy. Clin Cancer Res; 23(21); 6650-60. ©2017 AACR.
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Affiliation(s)
- Lijie Zhai
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Erik Ladomersky
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kristen L Lauing
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Meijing Wu
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Matthew Genet
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Galina Gritsina
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Balázs Győrffy
- MTA TTK Lendület Cancer Biomarker Research Group, Institute of Enzymology, Budapest, Hungary.,2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Priscilla K Brastianos
- Department of Medicine, Harvard Medical School, Boston, Massachusetts.,Divisions of Hematology/Oncology and Neuro-Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - David C Binder
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Jeffrey A Sosman
- Division of Hematology and Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois
| | - Francis J Giles
- Division of Hematology and Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois
| | - Charles D James
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois.,Department of Biochemistry and Molecular Genetics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Craig Horbinski
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois.,Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Roger Stupp
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Division of Hematology and Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois
| | - Derek A Wainwright
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois. .,Division of Hematology and Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois.,Department of Microbiology-Immunology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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24
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Lauing KL, Lulla RR, Zhai L, Hashizume R, Fangusaro J, Wainwright DA. IMMU-21. CHARACTERIZING IDO1 AND ITS THERAPEUTIC POTENTIAL IN PEDIATRIC CENTRAL NERVOUS SYSTEM TUMORS. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox083.131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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25
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Lenzen A, Genet M, Lauing KL, Zhai L, Lulla R, Hashizume R, Stegh A, Wainwright DA. DIPG-35. A SIRNA APPROACH FOR TARGETING IMMUNOSUPPRESSIVE IDO1 IN PEDIATRIC DIFFUSE INTRINSIC PONTINE GLIOMA. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox083.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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26
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Ladomersky E, Zhai L, Gritsina G, Lauing KL, Genet M, James CD, Wainwright DA. Abstract B018: A novel IDO1 inhibitor combined with targeted immunotherapy durably increases survival in a mouse model of glioblastoma. Cancer Immunol Res 2016. [DOI: 10.1158/2326-6066.imm2016-b018] [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
Glioblastoma (GBM) is the most common primary brain tumor, accounting for 54% of malignant glioma diagnoses. Over the course of the past 30 years, a diagnosis of GBM has remained fatal even after maximum surgical resection, radiotherapy (RT), and chemotherapy, with a median overall survival of 14.6 months. The immunosuppressive microenvironment of GBM is a major contributor to the poor patient outcome. Expression of IDO1, as well as the accumulation of tumor-infiltrating regulatory T cells contribute to the avoidance of immune surveillance. Although current immunotherapies have had some success in extending patient survival, combinatorial treatment approaches addressing both tumor growth and the potent immunosuppression may prove to be more effective. This work aimed to determine the efficacy of a novel, pharmaceutical-grade, blood brain barrier-penetrating small molecule IDO1 inhibitor, BGB-5777, in combination with PD-1 blockade and/or whole brain radiation in an immunocompetent mouse GBM model. METHODS/RESULTS: All mice were intracranially-engrafted 2×105 GL261 (syngeneic to B6 background) cells to recapitulate brain tumors. At 14 days post-intracranial injection (dp-ic.), mice were treated with IgG alone as a control (n = 7), 2Gy RT for 5 days (n = 8), 500 ug (loading dose), followed by three 200 ug maintenance doses given every 3 days, of PD-1 mAb (J43) (n = 8), or 100mg/kg BGB-5777 for 4 weeks (n = 10), with a median overall survival (OS) of 25, 25, 32, and 26.5 days, respectively. Mice treated with dual therapies including RT and PD-1 mAb (n = 10), RT and BGB-5777 (n = 8), or PD-1 mAb and BGB-5777 (n = 9), had a median OS of 30, 39, and 32 days, respectively. All mice treated with mono- or dual-therapy succumbed to tumor burden. In contrast, mice treated with concurrent RT, PD-1 mAb and BGB-5777 (n = 9) showed a significant increase in median OS to 53 days (P<0.0001) with 33% of mice demonstrating a durable survival benefit of more than 150 days. Importantly, mice treated with the triple therapy and co-administered CD4 (n = 9)-, but not CD8 (n = 9)- or NK1.1 (n = 9)-depleting mAb, significantly decreased median OS to 29 days (P<0.001) confirming the requirement of CD4+ T cells for efficacy of this immunotherapeutic approach. CONCLUSION: The data indicate that combining the standard of care agent, RT, with PD-1 blockade and the novel IDO1 inhibitor, BGB-5777, synergistically increases OS in a mouse GBM model. Unexpectedly, CD4+, rather than CD8+ T cells, are required for immunotherapeutic efficacy. Understanding how CD4+ T cells coordinate anti-GBM immunity, the kinetics of PD-1 and IDO1 expression after RT, and determining why CD8+ T cells are dispensable under these conditions, are current areas of active investigation in our laboratory. Ultimately, these data suggest that using radiation to induce potential immunogenicity and/or inflammation in GBM, while co-inhibiting immunosuppression, is a rational and potentially clinically-beneficial pursuit.
Citation Format: Erik Ladomersky, Lijie Zhai, Galina Gritsina, Kristen L. Lauing, Matthew Genet, C. David James, Derek A. Wainwright. A novel IDO1 inhibitor combined with targeted immunotherapy durably increases survival in a mouse model of glioblastoma [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 B018.
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Affiliation(s)
- Erik Ladomersky
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Lijie Zhai
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Galina Gritsina
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Matthew Genet
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - C. David James
- Northwestern University Feinberg School of Medicine, Chicago, IL
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27
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Lenzen A, Zhai L, Lauing KL, Gritsina G, Ladomersky E, Genet M, James CD, Bloch O, Wainwright DA. The Kynurenine/Tryptophan Ratio and Glioblastoma Patients Treated with Hsppc-96 Vaccine. ACTA ACUST UNITED AC 2016; 2. [PMID: 27819068 DOI: 10.4172/2471-9552.1000125] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The discovery that immunotherapy is a clinically-relevant approach for the treatment of malignant tumors is revolutionizing patient care. In adults diagnosed with glioblastoma (GBM), an aggressive and incurable primary brain tumor, autologous HSPPC-96 vaccination provides a significant increase in overall survival. However, all GBM patients eventually succumb to their disease, providing rationale for discovering new methods that proactively identify individuals that will respond, optimally. Of the immunosuppressive mediators that contribute to the inhibition of productive tumor immunity, indoleamine 2,3 dioxygenase 1 (IDO1), a rate-limiting enzyme that catabolizes tryptophan (Trp) into kynurenine (Kyn), has been demonstrated to be expressed at elevated levels in patients with malignant glioma. Recently, our group determined that a correlation exists between peripheral blood Trp and Kyn levels in GBM patients and the association with overall survival after HSPPC-96 treatment. Our findings indicate that the Kyn/Trp ratio may be a useful benchmark for identifying GBM patients with a higher likelihood to survive longer after vaccination. The relevance to future clinical trials, the limitations of brain tumor models to address these findings and the role of IDO1 versus tryptophan dioxygenase (TDO) in the maintenance of peripheral Trp and Kyn levels, is discussed.
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Affiliation(s)
- Alicia Lenzen
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, USA; Department of Pediatrics, Northwestern University Feinberg School of Medicine, USA; Division of Hematology, Oncology and Stem Cell Transplantation, Northwestern University Feinberg School of Medicine, USA; Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, USA
| | - Lijie Zhai
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, USA
| | - Kristen L Lauing
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, USA
| | - Galina Gritsina
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, USA
| | - Erik Ladomersky
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, USA
| | - Matthew Genet
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, USA
| | - C David James
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, USA; Department of Biochemistry and Molecular Genetics, Northwestern University Feinberg School of Medicine, USA; Brain Tumor Institute, Northwestern University Feinberg School of Medicine, USA; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL 60611, USA
| | - Orin Bloch
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, USA; Department of Neurology, Northwestern University Feinberg School of Medicine, USA; Brain Tumor Institute, Northwestern University Feinberg School of Medicine, USA; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL 60611, USA
| | - Derek A Wainwright
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, USA; Department of Medicine-Hematology/Oncology, Northwestern University Feinberg School of Medicine, USA; Department of Microbiology-Immunology, Northwestern University Feinberg School of Medicine, USA; Brain Tumor Institute, Northwestern University Feinberg School of Medicine, USA; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL 60611, USA
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28
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Ladomersky E, Zhai L, Gritsina G, Genet M, Lauing KL, Wu M, James CD, Wainwright DA. Advanced age negatively impacts survival in an experimental brain tumor model. Neurosci Lett 2016; 630:203-208. [PMID: 27493076 DOI: 10.1016/j.neulet.2016.08.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 07/28/2016] [Accepted: 08/01/2016] [Indexed: 12/23/2022]
Abstract
Glioblastoma (GBM) is the most common primary malignant brain tumor in adults, with an average age of 64 years at the time of diagnosis. To study GBM, a number of mouse brain tumor models have been utilized. In these animal models, subjects tend to range from 6 to 12 weeks of age, which is analogous to that of a human teenager. Here, we examined the impact of age on host immunity and the gene expression associated with immune evasion in immunocompetent mice engrafted with syngeneic intracranial GL261. The data indicate that, in mice with brain tumors, youth conveys an advantage to survival. While age did not affect the tumor-infiltrating T cell phenotype or quantity, we discovered that old mice express higher levels of the immunoevasion enzyme, IDO1, which was decreased by the presence of brain tumor. Interestingly, other genes associated with promoting immunosuppression including CTLA-4, PD-L1 and FoxP3, were unaffected by age. These data highlight the possibility that IDO1 contributes to faster GBM outgrowth with advanced age, providing rationale for future investigation into immunotherapeutic targeting in the future.
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Affiliation(s)
| | | | | | | | | | | | - C David James
- Department of Neurological Surgery, USA; Department of Biochemistry and Molecular Genetics, USA; Northwestern Brain Tumor Institute,USA; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL 60611, USA
| | - Derek A Wainwright
- Department of Neurological Surgery, USA; Department of Microbiology-Immunology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA; Northwestern Brain Tumor Institute,USA; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL 60611, USA.
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29
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Ladomersky E, Genet M, Zhai L, Gritsina G, Lauing KL, Lulla RR, Fangusaro J, Lenzen A, Kumthekar P, Raizer JJ, Binder DC, James CD, Wainwright DA. Improving vaccine efficacy against malignant glioma. Oncoimmunology 2016; 5:e1196311. [PMID: 27622066 DOI: 10.1080/2162402x.2016.1196311] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 04/27/2016] [Revised: 05/26/2016] [Accepted: 05/27/2016] [Indexed: 12/19/2022] Open
Abstract
The effective treatment of adult and pediatric malignant glioma is a significant clinical challenge. In adults, glioblastoma (GBM) accounts for the majority of malignant glioma diagnoses with a median survival of 14.6 mo. In children, malignant glioma accounts for 20% of primary CNS tumors with a median survival of less than 1 y. Here, we discuss vaccine treatment for children diagnosed with malignant glioma, through targeting EphA2, IL-13Rα2 and/or histone H3 K27M, while in adults, treatments with RINTEGA, Prophage Series G-100 and dendritic cells are explored. We conclude by proposing new strategies that are built on current vaccine technologies and improved upon with novel combinatorial approaches.
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Affiliation(s)
- Erik Ladomersky
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine , Chicago, IL, USA
| | - Matthew Genet
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine , Chicago, IL, USA
| | - Lijie Zhai
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine , Chicago, IL, USA
| | - Galina Gritsina
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine , Chicago, IL, USA
| | - Kristen L Lauing
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine , Chicago, IL, USA
| | - Rishi R Lulla
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Division of Hematology, Oncology and Stem Cell Transplantation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Northwestern Brain Tumor Institute, Northwestern University, Chicago, IL, USA; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA; Ann & Robert Lurie Children's Hospital of Northwestern University, Chicago, IL, USA
| | - Jason Fangusaro
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Division of Hematology, Oncology and Stem Cell Transplantation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Northwestern Brain Tumor Institute, Northwestern University, Chicago, IL, USA; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA; Ann & Robert Lurie Children's Hospital of Northwestern University, Chicago, IL, USA
| | - Alicia Lenzen
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Division of Hematology, Oncology and Stem Cell Transplantation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Ann & Robert Lurie Children's Hospital of Northwestern University, Chicago, IL, USA
| | - Priya Kumthekar
- Northwestern Brain Tumor Institute, Northwestern University, Chicago, IL, USA; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA; Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jeffrey J Raizer
- Northwestern Brain Tumor Institute, Northwestern University, Chicago, IL, USA; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA; Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - David C Binder
- Committee on Cancer Biology, University of Chicago, Chicago, IL, USA; Department of Pathology, The University of Chicago, Chicago, IL, USA
| | - C David James
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Northwestern Brain Tumor Institute, Northwestern University, Chicago, IL, USA; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA; Department of Biochemistry and Molecular Genetics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Derek A Wainwright
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Northwestern Brain Tumor Institute, Northwestern University, Chicago, IL, USA; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA
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30
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Lauing KL, Lulla RR, Hashizume R, Wainwright DA. TB-28IMMUNOSUPPRESSIVE IDO1 AND TDO ARE EXPRESSED IN PEDIATRIC CENTRAL NERVOUS SYSTEM TUMORS. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now084.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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31
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Zhai L, Spranger S, Binder DC, Gritsina G, Lauing KL, Giles FJ, Wainwright DA. Molecular Pathways: Targeting IDO1 and Other Tryptophan Dioxygenases for Cancer Immunotherapy. Clin Cancer Res 2015; 21:5427-33. [PMID: 26519060 DOI: 10.1158/1078-0432.ccr-15-0420] [Citation(s) in RCA: 219] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 10/15/2015] [Indexed: 01/12/2023]
Abstract
Indoleamine 2, 3-dioxygenase 1 (IDO1), IDO2, and tryptophan 2, 3-dioxygenase (TDO) comprise a family of enzymes that catalyze the first- and rate-limiting step associated with the catabolic conversion of tryptophan (Trp) into kynurenine (Kyn). Through subsequent enzymatic and spontaneous reactions, Kyn is further converted into the energetic substrates, NAD(+) and ATP, to fuel cellular metabolic functions. Coincidently, the depletion of Trp and accumulation of Kyn has been demonstrated to induce effector T-cell apoptosis/dysfunction and immunosuppressive regulatory T-cell induction, respectively. Similar to other immune checkpoints, IDO1 and TDO are suggested to be important targets for immunotherapeutic intervention. This is represented by the recent growth of efforts to inhibit the Trp-to-Kyn pathway as a means to control immunosuppression. Inhibitors currently in clinical trials, INCB024360, GDC-0919, indoximod, and an IDO1 peptide-based vaccine, are being evaluated for their efficacy against a wide range of cancers including melanoma, glioblastoma, non-small cell lung, pancreatic, and/or breast cancer, as well as metastatic disease. Despite the rapid development of potent clinical grade inhibitors, strategic questions remain. Here, we review the state of the literature with respect to current therapeutic inhibitors of tryptophan catabolism, evaluation of those efforts preclinically and clinically, compensatory changes that occur with therapeutic targeting, as well as newly recognized signaling features that raise critical questions to the field. Given the rapidly evolving interest in determining how IDO1/TDO, and to an unknown extent, IDO2, can be targeted for increasing cancer immunotherapeutic efficacy, we present a brief but comprehensive analysis that addresses critical questions, while highlighting the mechanics that remain to be explored.
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Affiliation(s)
- Lijie Zhai
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Stefani Spranger
- Department of Pathology, The University of Chicago, Chicago, Illinois
| | - David C Binder
- Department of Pathology, The University of Chicago, Chicago, Illinois. Committee on Cancer Biology, The University of Chicago, Chicago, Illinois
| | - Galina Gritsina
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kristen L Lauing
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Francis J Giles
- Northwestern Medicine Developmental Therapeutics Institute, Northwestern University, Chicago, Illinois. Division of Hematology and Oncology, Northwestern University, Chicago, Illinois. Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois
| | - Derek A Wainwright
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois. Northwestern Brain Tumor Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
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32
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Zhai L, Dey M, Lauing KL, Gritsina G, Kaur R, Lukas RV, Nicholas MK, Rademaker AW, Dostal CR, McCusker RH, Raizer JJ, Parsa AT, Bloch O, Wainwright DA. The kynurenine to tryptophan ratio as a prognostic tool for glioblastoma patients enrolling in immunotherapy. J Clin Neurosci 2015; 22:1964-8. [PMID: 26279502 DOI: 10.1016/j.jocn.2015.06.018] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 06/24/2015] [Indexed: 12/12/2022]
Abstract
We hypothesized that peripheral tryptophan (Trp) and/or kynurenine (Kyn) levels would provide prognostic value for physicians planning to enroll glioblastoma multiforme (GBM) patients in immunotherapy. GBM is the most common form of malignant glioma in adults. Despite aggressive surgical resection, irradiation and chemotherapy, patients with GBM have a median survival of only 14.6 months after diagnosis. This poor outcome has led to the search for more effective treatments, including immunotherapy. However, the identification of parameters that proactively stratify GBM patients who have the potential for therapeutic benefit has been challenging. Given recent observations demonstrating high indoleamine 2,3 dioxygenase 1 (IDO1) expression in GBM, the immunosuppressive impact of IDO1-mediated Trp catabolism, as well as active transport of Trp and the IDO1-downstream Trp catabolite, Kyn, across the blood brain barrier, we hypothesized that peripheral blood analysis of this pathway would provide diagnostic utility. When comparing individuals without tumors to GBM patients prior to surgical resection, or at the 48 hour (48 h) and ⩾10 week (10 w+) postoperative time points, Trp levels were significantly decreased (p<0.0002). Similarly, Kyn levels were decreased in the pre- and 48 h postoperative GBM patients (p<0.0001), while there was no difference between individuals without tumors and 10 w+ GBM patients. Interestingly, those 10 w+ patients with a high Kyn/Trp ratio (⩾9.5) had a mean overall survival (OS) of 23.6 ± a standard error of 6.8 months, compared to an OS of 38.7 ± 4.9 months for patients with lower Kyn/Trp values. Since the 10 w+ blood draw and analyses occurred prior to patient enrollment in the heat shock protein peptide complex-96 clinical trial, these novel data suggest that the late Kyn/Trp index may be a relevant clinical benchmark, providing prognostic value for GBM patients who are enrolled in immunotherapeutic regimens.
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Affiliation(s)
- Lijie Zhai
- Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Tarry Bldg 2-703, 300 East Superior Street, Chicago, IL 60611, USA
| | - Mahua Dey
- Department of Surgery, Section of Neurosurgery, University of Chicago, Chicago, IL, USA
| | - Kristen L Lauing
- Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Tarry Bldg 2-703, 300 East Superior Street, Chicago, IL 60611, USA
| | - Galina Gritsina
- Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Tarry Bldg 2-703, 300 East Superior Street, Chicago, IL 60611, USA
| | - Rajwant Kaur
- Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Tarry Bldg 2-703, 300 East Superior Street, Chicago, IL 60611, USA
| | - Rimas V Lukas
- Department of Neurology, University of Chicago, Chicago, IL, USA
| | - M Kelly Nicholas
- Department of Neurology and Rehabilitation, The University of Illinois at Chicago, Chicago, IL, USA
| | - Alfred W Rademaker
- Department of Preventative Medicine, Biostatistics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Carlos R Dostal
- Neuroscience Program, The University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Robert H McCusker
- Neuroscience Program, The University of Illinois at Urbana-Champaign, Urbana, IL, USA; Department of Animal Sciences, The University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Jeffrey J Raizer
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Andrew T Parsa
- Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Tarry Bldg 2-703, 300 East Superior Street, Chicago, IL 60611, USA; Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Orin Bloch
- Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Tarry Bldg 2-703, 300 East Superior Street, Chicago, IL 60611, USA; Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Derek A Wainwright
- Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Tarry Bldg 2-703, 300 East Superior Street, Chicago, IL 60611, USA.
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Zhai L, Lauing KL, Chang AL, Dey M, Qian J, Cheng Y, Lesniak MS, Wainwright DA. The role of IDO in brain tumor immunotherapy. J Neurooncol 2014; 123:395-403. [PMID: 25519303 DOI: 10.1007/s11060-014-1687-8] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Accepted: 12/14/2014] [Indexed: 01/23/2023]
Abstract
Malignant glioma comprises the majority of primary brain tumors. Coincidently, most of those malignancies express an inducible tryptophan catabolic enzyme, indoleamine 2,3 dioxygenase 1 (IDO1). While IDO1 is not normally expressed at appreciable levels in the adult central nervous system, it's rapidly induced and/or upregulated upon inflammatory stimulus. The primary function of IDO1 is associated with conversion of the essential amino acid, tryptophan, into downstream catabolites known as kynurenines. The depletion of tryptophan and/or accumulation of kynurenine has been shown to induce T cell deactivation, apoptosis and/or the induction of immunosuppressive programming via the expression of FoxP3. This understanding has informed immunotherapeutic design for the strategic development of targeted molecular therapeutics that inhibit IDO1 activity. Here, we review the current knowledge of IDO1 in brain tumors, pre-clinical studies targeting this enzymatic pathway, alternative tryptophan catabolic mediators that compensate for IDO1 loss and/or inhibition, as well as proposed clinical strategies and questions that are critical to address for increasing future immunotherapeutic effectiveness in patients with incurable brain cancer.
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Affiliation(s)
- Lijie Zhai
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, 300 East Superior Street, Tarry Building 2-703, Chicago, IL, 60611, USA
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Lauing KL, Cortes M, Domowicz MS, Henry JG, Baria AT, Schwartz NB. Aggrecan is required for growth plate cytoarchitecture and differentiation. Dev Biol 2014; 396:224-36. [PMID: 25446537 DOI: 10.1016/j.ydbio.2014.10.005] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 10/10/2014] [Accepted: 10/12/2014] [Indexed: 01/28/2023]
Abstract
The proteoglycan aggrecan is a prominent component of the extracellular matrix in growth plate cartilage. A naturally occurring, recessive, perinatally lethal mutation in the aggrecan core protein gene, cmd(bc) (Acan(cmd-Bc)), that deletes the entire protein-coding sequence provided a model in which to characterize the phenotypic and morphologic effects of aggrecan deletion on skeletal development. We also generated a novel transgenic mouse, Tg(COL2A1-ACAN), that has the chick ACAN coding sequence driven by the mouse COL2A1 promoter to enable the production of cmd(bc)/cmd(bc); Tg(COL2A1-ACAN) rescue embryos. These were used to assess the impact of aggrecan on growth plate organization, chondrocyte survival and proliferation, and the expression of mRNAs encoding chondrocyte differentiation markers and growth factors. Homozygous mutant (cmd(bc)/cmd(bc)) embryos exhibited severe defects in all skeletal elements with deformed and shortened (50%) limb elements. Expression of aggrecan in rescue embryos reversed the skeletal defects to varying degrees with a 20% increase in limb element length and near-full reversal (80%) of size and diameter of the ribcage and vertebrae. Aggrecan-null growth plates were devoid of matrix and lacked chondrocyte organization and differentiation, while those of the rescue embryos exhibited matrix production concomitant with partial zonation of chondrocytes having proliferative and hypertrophic morphologies. Deformation of the trachea, likely the cause of the mutation's lethality, was reduced in the rescue embryos. Aggrecan-null embryos also had abnormal patterns of COL10A1, SOX9, IHH, PTCH1, and FGFR3 mRNA expression in the growth plate. Expression of chick aggrecan in the rescue embryos notably increased COLX expression, accompanied by the reappearance of a hypertrophic zone and IHH expression. Significantly, in transgenic rescue embryos, the cell death and decreased proliferation phenotypes exhibited by the mutants were reversed; both were restored to wild-type levels. These findings suggest that aggrecan has a major role in regulating the expression of key growth factors and signaling molecules during development of cartilaginous tissue and is essential for proper chondrocyte organization, morphology, and survival during embryonic limb development.
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Affiliation(s)
- Kristen L Lauing
- Department of Pediatrics, The University of Chicago, Chicago IL 60637, USA
| | - Mauricio Cortes
- Department of Biochemistry and Molecular Biology, The University of Chicago, Chicago, IL 60637, USA
| | - Miriam S Domowicz
- Department of Pediatrics, The University of Chicago, Chicago IL 60637, USA
| | - Judith G Henry
- Department of Pediatrics, The University of Chicago, Chicago IL 60637, USA
| | - Alexis T Baria
- Department of Pediatrics, The University of Chicago, Chicago IL 60637, USA
| | - Nancy B Schwartz
- Department of Pediatrics, The University of Chicago, Chicago IL 60637, USA; Department of Biochemistry and Molecular Biology, The University of Chicago, Chicago, IL 60637, USA.
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Lauing KL, Sundaramurthy S, Nauer RK, Callaci JJ. Exogenous activation of Wnt/β-catenin signaling attenuates binge alcohol-induced deficient bone fracture healing. Alcohol Alcohol 2014; 49:399-408. [PMID: 24627571 DOI: 10.1093/alcalc/agu006] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS Excessive alcohol consumption is associated with fracture non-union. Canonical Wnt pathway signaling activity regulates normal fracture healing. We previously demonstrated that binge alcohol exposure modulates β-catenin levels in the fracture callus of mice. Here, we sought to determine whether exogenous enhancement β-catenin signaling activity could restore normal fracture healing to binge-exposed mice. METHODS C57BL/6 male mice were exposed to episodic alcohol or saline for 6 total days of alcohol exposure over a 2-week period. Following alcohol exposure, mice were subjected to a stabilized mid-shaft tibia fracture. Beginning 4 days post-injury, mice received daily injections of either lithium chloride or saline subcutaneously. Protein levels of activated, inactivated, and total β-catenin and GSK-3β in fracture calluses were measured at post-injury day 9. Biomechanical strength testing and histology of callus tissue was assessed at post fracture day 14. RESULTS Binge alcohol was associated with decreased callus biomechanical strength, and reduced cartilaginous callus formation. Alcohol decreased levels of callus-associated activated β-catenin while concomitantly increasing the levels of inactive β-catenin at post-injury day 9. Alcohol also increased callus associated activated GSK-3β at post-injury day 9. Lithium chloride (an inhibitor of GSK-3β) treatment increased activated β-catenin protein levels, significantly decreased activated GSK-3β and restored cartilaginous callus formation and endochondral ossification. CONCLUSION These data link alcohol-impaired fracture healing with deregulation of Canonical Wnt signaling activity in the fracture callus. Exogenous activation of the Wnt pathway using LiCl attenuated the damaging effects of binge alcohol exposure on the fracture healing process by modulating canonical Wnt signaling activity.
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Affiliation(s)
- Kristen L Lauing
- Alcohol Research Program, Loyola University Stritch School of Medicine, 2160 S. 1st Ave, Maywood, IL 60546, USA Burn and Shock Trauma Institute, Loyola University Stritch School of Medicine, 2160 S. 1st Ave, Maywood, IL 60546, USA
| | - Sumana Sundaramurthy
- Alcohol Research Program, Loyola University Stritch School of Medicine, 2160 S. 1st Ave, Maywood, IL 60546, USA Department of Orthopaedic Surgery and Rehabilitation, Loyola University Stritch School of Medicine, 2160 S. 1st Ave, Maywood, IL 60546, USA
| | - Rachel K Nauer
- Burn and Shock Trauma Institute, Loyola University Stritch School of Medicine, 2160 S. 1st Ave, Maywood, IL 60546, USA
| | - John J Callaci
- Alcohol Research Program, Loyola University Stritch School of Medicine, 2160 S. 1st Ave, Maywood, IL 60546, USA Burn and Shock Trauma Institute, Loyola University Stritch School of Medicine, 2160 S. 1st Ave, Maywood, IL 60546, USA Department of Orthopaedic Surgery and Rehabilitation, Loyola University Stritch School of Medicine, 2160 S. 1st Ave, Maywood, IL 60546, USA
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Lauing KL, Roper PM, Nauer RK, Callaci JJ. Acute alcohol exposure impairs fracture healing and deregulates β-catenin signaling in the fracture callus. Alcohol Clin Exp Res 2012; 36:2095-103. [PMID: 22691115 DOI: 10.1111/j.1530-0277.2012.01830.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Accepted: 03/11/2012] [Indexed: 01/02/2023]
Abstract
BACKGROUND Alcohol abuse is a risk factor for bone damage and fracture-related complications. Through precise β-catenin signaling, canonical Wnt signaling plays a key role in fracture repair by promoting the differentiation of new bone and cartilage cells. In this study, we examined the effects of alcohol on the Wnt pathway in injured bone using a murine model of alcohol-induced impaired fracture healing. METHODS Male C57Bl/6 or T cell factor (TCF)-transgenic mice were administered 3 daily intraperitoneal doses of alcohol or saline. One hour following the final injection, mice were subjected to a stabilized, mid-shaft tibial fracture. Injured and contralateral tibias were harvested at 6, 9, or 14 days post-fracture for the analysis of biomechanical strength, callus tissue composition, and Wnt/β-catenin signaling. RESULTS Acute alcohol treatment was associated with a significant decrease in fracture callus volume, diameter, and biomechanical strength at day 14 post-fracture. Histology revealed an alcohol-related reduction in cartilage and bone formation at the fracture site, and that alcohol inhibited normal cartilage maturation. Acute alcohol exposure caused a significant 2.3-fold increase in total β-catenin protein at day 6 and a significant decrease of 53 and 56% at days 9 and 14, respectively. lacZ staining in β-galactosidase-expressing TCF-transgenic mice revealed spatial and quantitative differences in Wnt-specific transcriptional activation at day 6 in the alcohol group. Days 9 and 14 post-fracture showed that acute alcohol exposure decreased Wnt transcriptional activation, which correlates with the modulation of total β-catenin protein levels observed at these time points. CONCLUSIONS Acute alcohol exposure resulted in significant impairment of fracture callus tissue formation, perturbation of the key Wnt pathway protein β-catenin, and disruption of normal Wnt-mediated transcription. These data suggest that the canonical Wnt pathway is a target for alcohol in bone and may partially explain why impaired fracture healing is observed in alcohol-abusing individuals.
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Affiliation(s)
- Kristen L Lauing
- Burn and Shock Trauma Institute, Loyola University Stritch School of Medicine, Maywood, Illinois 60153, USA.
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Abstract
Tissue injury owing to acute and chronic alcohol consumption has extensive medical consequences, with the level and duration of alcohol exposure affecting both the magnitude of injury and the time frame to recovery. While the understanding of many of the molecular processes disrupted by alcohol has advanced, mechanisms of alcohol-induced tissue injury remain a subject of intensive research. Alcohol has multiple targets, as it affects diverse cellular and molecular processes. Some mechanisms of tissue damage as a result of alcohol may be common to many tissue types, while others are likely to be tissue specific. Here, we present a discussion of the alcohol-induced molecular and cellular disruptions associated with injury or recovery from injury in bone, muscle, skin, and gastric mucosa. In every case, the goal of characterizing the sites of alcohol action is to devise potential measures for protection, prevention, or therapeutic intervention.
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Affiliation(s)
- M Katherine Jung
- Division of Metabolism and Health Effects, National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland 20892-9304, USA.
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