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Marie MA, Sanderlin EJ, Hoffman AP, Cashwell KD, Satturwar S, Hong H, Sun Y, Yang LV. GPR4 Knockout Attenuates Intestinal Inflammation and Forestalls the Development of Colitis-Associated Colorectal Cancer in Murine Models. Cancers (Basel) 2023; 15:4974. [PMID: 37894341 PMCID: PMC10605520 DOI: 10.3390/cancers15204974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 10/09/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023] Open
Abstract
GPR4 is a proton-sensing G protein-coupled receptor highly expressed in vascular endothelial cells and has been shown to potentiate intestinal inflammation in murine colitis models. Herein, we evaluated the proinflammatory role of GPR4 in the development of colitis-associated colorectal cancer (CAC) using the dextran sulfate sodium (DSS) and azoxymethane (AOM) mouse models in wild-type and GPR4 knockout mice. We found that GPR4 contributed to chronic intestinal inflammation and heightened DSS/AOM-induced intestinal tumor burden. Tumor blood vessel density was markedly reduced in mice deficient in GPR4, which correlated with increased tumor necrosis and reduced tumor cell proliferation. These data demonstrate that GPR4 ablation alleviates intestinal inflammation and reduces tumor angiogenesis, development, and progression in the AOM/DSS mouse model.
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Affiliation(s)
- Mona A. Marie
- Department of Internal Medicine, Brody School of Medicine, East Carolina University, Greenville, NC 27834, USA; (M.A.M.)
| | - Edward J. Sanderlin
- Department of Internal Medicine, Brody School of Medicine, East Carolina University, Greenville, NC 27834, USA; (M.A.M.)
| | - Alexander P. Hoffman
- Department of Internal Medicine, Brody School of Medicine, East Carolina University, Greenville, NC 27834, USA; (M.A.M.)
| | - Kylie D. Cashwell
- Department of Internal Medicine, Brody School of Medicine, East Carolina University, Greenville, NC 27834, USA; (M.A.M.)
| | - Swati Satturwar
- Department of Pathology, Brody School of Medicine, East Carolina University, Greenville, NC 27834, USA
| | - Heng Hong
- Department of Pathology, Brody School of Medicine, East Carolina University, Greenville, NC 27834, USA
- Department of Pathology, Wake Forest University, Winston-Salem, NC 27157, USA
| | - Ying Sun
- Department of Pathology, Brody School of Medicine, East Carolina University, Greenville, NC 27834, USA
| | - Li V. Yang
- Department of Internal Medicine, Brody School of Medicine, East Carolina University, Greenville, NC 27834, USA; (M.A.M.)
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Naqash AR, McCallen JD, Mi E, Iivanainen S, Marie MA, Gramenitskaya D, Clark J, Koivunen JP, Macherla S, Jonnalagadda S, Polsani S, Jiwani RA, Hafiz M, Muzaffar M, Brunetti L, Stroud CRG, Walker PR, Wang K, Chung Y, Ruppin E, Lee SH, Yang LV, Pinato DJ, Lee JS, Cortellini A. Increased interleukin-6/C-reactive protein levels are associated with the upregulation of the adenosine pathway and serve as potential markers of therapeutic resistance to immune checkpoint inhibitor-based therapies in non-small cell lung cancer. J Immunother Cancer 2023; 11:e007310. [PMID: 37852738 PMCID: PMC10603340 DOI: 10.1136/jitc-2023-007310] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Systemic immune activation, hallmarked by C-reactive protein (CRP) and interleukin-6 (IL-6), can modulate antitumor immune responses. In this study, we evaluated the role of IL-6 and CRP in the stratification of patients with non-small cell lung cancer (NSCLC) treated with immune checkpoint inhibitors (ICIs). We also interrogated the underlying immunosuppressive mechanisms driven by the IL-6/CRP axis. METHODS In cohort A (n=308), we estimated the association of baseline CRP with objective response rate (ORR), progression-free survival (PFS), and overall survival (OS) in patients with NSCLC treated with ICIs alone or with chemo-immunotherapy (Chemo-ICI). Baseline tumor bulk RNA sequencing (RNA-seq) of lung adenocarcinomas (LUADs) treated with pembrolizumab (cohort B, n=59) was used to evaluate differential expression of purine metabolism, as well as correlate IL-6 expression with PFS. CODEFACS approach was applied to deconvolve cohort B to characterize the tumor microenvironment by reconstructing the cell-type-specific transcriptome from bulk expression. Using the LUAD cohort from The Cancer Genome Atlas (TCGA) we explored the correlation between IL-6 expression and adenosine gene signatures. In a third cohort (cohort C, n=18), plasma concentrations of CRP, adenosine 2a receptor (A2aR), and IL-6 were measured using ELISA. RESULTS In cohort A, 67.2% of patients had a baseline CRP≥10 mg/L (CRP-H). Patients with CRP-H achieved shorter OS (8.6 vs 14.8 months; p=0.006), shorter PFS (3.3 vs 6.6 months; p=0.013), and lower ORR (24.7% vs 46.3%; p=0.015). After adjusting for relevant clinical variables, CRP-H was confirmed as an independent predictor of increased risk of death (HR 1.51, 95% CI: 1.09 to 2.11) and lower probability of achieving disease response (OR 0.34, 95% CI: 0.13 to 0.89). In cohort B, RNA-seq analysis demonstrated higher IL-6 expression on tumor cells of non-responders, along with a shorter PFS (p<0.05) and enrichment of the purinergic pathway. Within the TCGA LUAD cohort, tumor IL-6 expression strongly correlated with the adenosine signature (R=0.65; p<2.2e-16). Plasma analysis in cohort C demonstrated that CRP-H patients had a greater median baseline level of A2aR (6.0 ng/mL vs 1.3 ng/mL; p=0.01). CONCLUSIONS This study demonstrates CRP as a readily available blood-based prognostic biomarker in ICI-treated NSCLC. Additionally, we elucidate a potential link of the CRP/IL-6 axis with the immunosuppressive adenosine signature pathway that could drive inferior outcomes to ICIs in NSCLC and also offer novel therapeutic avenues.
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Affiliation(s)
- Abdul Rafeh Naqash
- Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
- Hematology / Oncology Division, East Carolina University, Greenville, South Carolina, USA
| | - Justin D McCallen
- Department of Internal Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Emma Mi
- Department of Surgery and Cancer, Hammersmith Hospital Campus, Imperial College London, London, UK
| | - Sanna Iivanainen
- Oncology and Radiation Department, Oulu University Hospital, University of Oulu, MRC Oulu, Oulu, Finland
| | - Mona A Marie
- Hematology / Oncology Division, East Carolina University, Greenville, South Carolina, USA
| | - Daria Gramenitskaya
- Department of Surgery and Cancer, Hammersmith Hospital Campus, Imperial College London, London, UK
| | - James Clark
- Department of Surgery and Cancer, Hammersmith Hospital Campus, Imperial College London, London, UK
| | - Jussi Pekka Koivunen
- Oncology and Radiation Department, Oulu University Hospital, University of Oulu, MRC Oulu, Oulu, Finland
| | - Shravanti Macherla
- Hematology / Oncology Division, East Carolina University, Greenville, South Carolina, USA
| | - Sweta Jonnalagadda
- Hematology / Oncology Division, East Carolina University, Greenville, South Carolina, USA
| | - Shanker Polsani
- Hematology / Oncology Division, East Carolina University, Greenville, South Carolina, USA
| | - Rahim Ali Jiwani
- Department of Internal Medicine, East Carolina University, Greenville, NC, USA
| | - Maida Hafiz
- Division of Pulmonary Critical Care, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
- Division of Pulmonary and Critical Care, East Carolina University, Greenville, NC, USA
| | - Mahvish Muzaffar
- Hematology / Oncology Division, East Carolina University, Greenville, South Carolina, USA
| | - Leonardo Brunetti
- Operative Research Unit of Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, Roma, Italy, Italy
| | | | - Paul R Walker
- Hematology / Oncology Division, East Carolina University, Greenville, South Carolina, USA
- Circulogene, Birmingham, Alabama, USA
| | - Kun Wang
- Cancer Data Science Lab, National Cancer Institute, National Institute of Health, Bethesda, Maryland, USA
| | - Youngmin Chung
- Department of Artificial Intelligence, Sungkyunkwan University, Suwon, Reuplic of Korea
| | - Eytan Ruppin
- Cancer Data Science Lab, National Cancer Institute, National Institute of Health, Bethesda, Maryland, USA
| | - Se-Hoon Lee
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center School of Medicine, Sungkyunkwan University, Seoul, Republic of Korea
- Department of Health Sciences and Technology, Samsung Advanced Institute of Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea
| | - Li V Yang
- Hematology / Oncology Division, East Carolina University, Greenville, South Carolina, USA
| | - David J Pinato
- Department of Surgery and Cancer, Hammersmith Hospital Campus, Imperial College London, London, UK
- Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Joo Sang Lee
- Department of Artificial Intelligence, Sungkyunkwan University, Suwon, Reuplic of Korea
- Department of Precision Medicine, School of Medicine, Sungkyunkwan University, Suwon, Republic of Korea
- Department of Digital Health, Samsung Advanced Institute of Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea
| | - Alessio Cortellini
- Department of Surgery and Cancer, Hammersmith Hospital Campus, Imperial College London, London, UK
- Operative Research Unit of Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, Roma, Italy, Italy
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Justus CR, Marie MA, Sanderlin EJ, Yang LV. Transwell In Vitro Cell Migration and Invasion Assays. Methods Mol Biol 2023; 2644:349-359. [PMID: 37142933 PMCID: PMC10335869 DOI: 10.1007/978-1-0716-3052-5_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Cell migration and invasion have essential roles in both normal physiology and disease. As such, methodologies to assess cell migratory and invasive capacities are necessary to elucidate normal cell processes and underlying mechanisms of disease. Here, we describe commonly used transwell in vitro methods for the study of cell migration and invasion. The transwell migration assay involves the chemotaxis of cells through a porous membrane after the establishment of a chemoattractant gradient using two medium-filled compartments. The transwell invasion assay involves the addition of an extracellular matrix on top of the porous membrane which only permits chemotaxis of cells which possess invasive properties such as tumor cells.
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Affiliation(s)
- Calvin R Justus
- Department of Internal Medicine, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Mona A Marie
- Department of Internal Medicine, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Edward J Sanderlin
- Department of Internal Medicine, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Li V Yang
- Department of Internal Medicine, Brody School of Medicine, East Carolina University, Greenville, NC, USA.
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Marie MA, McCallen JD, Hamedi ZS, Naqash AR, Hoffman A, Atwell D, Amara S, Muzaffar M, Walker PR, Yang LV. Case Report: Peripheral blood T cells and inflammatory molecules in lung cancer patients with immune checkpoint inhibitor-induced thyroid dysfunction: Case studies and literature review. Front Oncol 2022; 12:1023545. [PMID: 36568170 PMCID: PMC9768626 DOI: 10.3389/fonc.2022.1023545] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 11/23/2022] [Indexed: 12/13/2022] Open
Abstract
Immunotherapy has changed the paradigm of cancer treatment, yet immune checkpoint inhibitors (ICIs) such as PD-1/PD-L1 monoclonal antibodies may cause immune-related adverse events (irAEs) in some patients. In this report, two non-small cell lung cancer (NSCLC) patients treated with nivolumab presented with checkpoint inhibitor-induced thyroid dysfunction (CITD), followed by a second irAE of pneumonitis and intestinal perforation, respectively. Increases in peripheral CD8+ T cells correlated with the onset of CITD in the patients. Intriguingly, common inflammatory biomarkers, including C-reactive protein (CRP) and neutrophil/lymphocyte ratio (NLR), were not consistently increased during the onset of CITD but were substantially increased during the onset of pneumonitis and intestinal perforation irAEs. The observations suggest that unlike other irAEs such as pneumonitis, CRP levels and NLR were non-contributory in diagnosing CITD, whereas T cell expansion may be associated with immunotherapy-induced thyroiditis.
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Affiliation(s)
- Mona A. Marie
- Department of Internal Medicine, Brody School of Medicine, East Carolina University, Greenville, NC, United States
| | - Justin D. McCallen
- Department of Internal Medicine, Brody School of Medicine, East Carolina University, Greenville, NC, United States
| | - Zahra S. Hamedi
- Department of Internal Medicine, Brody School of Medicine, East Carolina University, Greenville, NC, United States
| | - Abdul Rafeh Naqash
- Department of Internal Medicine, Brody School of Medicine, East Carolina University, Greenville, NC, United States,Department of Internal Medicine, College of Medicine, University of Oklahoma, Oklahoma City, OK, United States
| | - Alexander Hoffman
- Department of Internal Medicine, Brody School of Medicine, East Carolina University, Greenville, NC, United States
| | - Druid Atwell
- Department of Internal Medicine, Brody School of Medicine, East Carolina University, Greenville, NC, United States
| | - Suneetha Amara
- Department of Internal Medicine, Brody School of Medicine, East Carolina University, Greenville, NC, United States
| | - Mahvish Muzaffar
- Department of Internal Medicine, Brody School of Medicine, East Carolina University, Greenville, NC, United States
| | - Paul R. Walker
- Department of Internal Medicine, Brody School of Medicine, East Carolina University, Greenville, NC, United States,Circulogene, Birmingham, AL, United States,*Correspondence: Li V. Yang, ; Paul R. Walker,
| | - Li V. Yang
- Department of Internal Medicine, Brody School of Medicine, East Carolina University, Greenville, NC, United States,*Correspondence: Li V. Yang, ; Paul R. Walker,
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Marie MA. Abstract 6139: GPR4 promotes the development of colitis-associated colorectal cancer in an experimental mouse model. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-6139] [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
GPR4 is a proton-sensing G protein-coupled receptor expressed in endothelial cells as well as other cell types. Endothelial cell adhesion, blood vessel permeability, leukocyte infiltration, and angiogenesis are regulated by the proinflammatory functions of GPR4. Inhibition of GPR4 ameliorates inflammatory bowel disease (IBD) in mouse models. GPR4 expression is upregulated in the intestinal tissues of IBD and colorectal cancer patients and is associated with a worse prognosis. Herein, we studied the role of GPR4 in colitis-associated colorectal cancer (CAC) by inducing CAC in GPR4 knockout (KO) and wild-type (WT) mice using azoxymethane (AOM)/dextran sulfate sodium (DSS). The severity of CAC development was higher in WT mice than GPR4 KO mice when treated with AOM/DSS. Blood vessel density was significantly higher within the tumors of WT mouse colons compared to GPR4 KO mice. GPR4 KO tumors showed a significant increase in tumor necrosis in comparison to WT tumors. Fecal blood/diarrhea score, colon shortening, and mesenteric lymph node size were aggravated in WT mice compared to GPR4 KO mice treated with AOM/DSS. Our data demonstrate that GPR4 increases intestinal inflammation and angiogenesis, enhancing tumor development in the CAC mouse model, suggesting that GPR4 inhibition may reduce the risk of developing colitis-associated colorectal cancer.
Citation Format: Mona A. Marie. GPR4 promotes the development of colitis-associated colorectal cancer in an experimental mouse model [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 6139.
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Affiliation(s)
- Mona A. Marie
- 1The Brody School of Medicine, East Carolina University (ECU), Greenville, NC
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McCallen JD, Naqash AR, Marie MA, Sharma N, Muzaffar M, Walker PR, Yang L. Abstract 1667: A pilot study correlating baseline plasma levels of adenosine 2A receptor (A2aR) with acute phase reactants in advanced non-small cell lung cancer (NSCLC) patients treated with immune-checkpoint inhibitors. Cancer Res 2021. [DOI: 10.1158/1538-7445.am2021-1667] [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
Background: Acute-phase reactants, such as C-reactive protein (CRP) and IL-6, can modulate immune suppression within the tumor microenvironment (TME) and thus potentially result in inferior outcomes to immune checkpoint inhibitors (ICIs). Immunosuppression within the TME is also be mediated by tumoral adenosine production, via hypoxia-induced exonuclease activity of CD39 and CD73 and adenosine 2a receptor (A2aR) signaling. We sought to evaluate whether plasma levels of A2aR correlate with the acute phase reactants (CRP and IL-6) in advanced NSCLC patients treated with ICIs.
Methods: Between December 2016 and April 2019, we enrolled 18 patients with advanced NSCLC treated with single-agent ICIs or in combination with chemotherapy. We isolated plasma samples from patients before ICI initiation and again after each treatment. Plasma concentrations of A2aR and IL-6 were measured using ELISA. The baseline level of CRP was obtained from peripheral blood at ICI initiation (± 3 days). Previous studies correlating CRP and cancer outcomes defined a C-reactive protein (CRP) cutoff of 10 mg/L to define normal (CRP-N) and high CRP (CRP-H) levels. We assessed the relationship between CRP, IL-6, and A2aR plasma levels. Statistical analyses were performed using the Mann-Whitney test and linear regression analysis.
Results: At the initiation of ICI, the median age of the cohort was 63. Two patients had stage III disease and 16 patients had stage IV disease. Four had squamous cell carcinoma, and 14 had non-squamous cell carcinoma. Six patients were treated with concomitant chemotherapy (pembrolizumab with carboplatin and pemetrexed). Patients received a median of 4 ICI cycles (range: 1-8 cycles) in our study. In the cohort, the median baseline levels of CRP, IL-6, and A2aR were 16.9 mg/L, 5.1 pg/mL, and 3.6 ng/mL, respectively. A positive correlation was present between baseline CRP levels and IL-6 plasma levels (R=0.76; p=0.003). Seven patients were CRP-N, and 11 patients were CRP-H. CRP-H patients had a greater median baseline level of A2aR (6.0 ng/mL vs. 1.3 ng/mL; p=0.01). Likewise, patients with baseline IL-6 levels greater than 5 pg/mL had a higher median baseline level of A2aR (6.0 ng/mL vs. 1.3 ng/mL; p=0.02).
Conclusions: In a small, heterogeneous cohort of advanced NSCLC patients treated with ICIs, we demonstrate that elevated baseline levels of acute-phase reactants (CRP and IL-6) potentially act as an indirect surrogate for high plasma A2aR levels. Validation from larger studies is required to understand the biomarker implications of these findings in determining outcomes to ICIs.
J.D.M. and A.R.N contributed equally to this work.
Citation Format: Justin D. McCallen, Abdul R. Naqash, Mona A. Marie, Nitika Sharma, Mahvish Muzaffar, Paul R. Walker, Li Yang. A pilot study correlating baseline plasma levels of adenosine 2A receptor (A2aR) with acute phase reactants in advanced non-small cell lung cancer (NSCLC) patients treated with immune-checkpoint inhibitors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 1667.
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Affiliation(s)
| | | | - Mona A. Marie
- 1Brody School of Medicine at East Carolina University, Greenville, NC
| | - Nitika Sharma
- 1Brody School of Medicine at East Carolina University, Greenville, NC
| | - Mahvish Muzaffar
- 1Brody School of Medicine at East Carolina University, Greenville, NC
| | - Paul R. Walker
- 1Brody School of Medicine at East Carolina University, Greenville, NC
| | - Li Yang
- 1Brody School of Medicine at East Carolina University, Greenville, NC
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McCallen JD, Naqash AR, Marie MA, Atwell DC, Muzaffar M, Sharma N, Amara S, Liles D, Walker PR, Yang LV. Peripheral blood interleukin 6, interleukin 10, and T lymphocyte levels are associated with checkpoint inhibitor induced pneumonitis: a case report. Acta Oncol 2021; 60:813-817. [PMID: 33939588 DOI: 10.1080/0284186x.2021.1917001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Justin D. McCallen
- Brody School of Medicine, East Carolina University, Greenville, NC, USA
- Gastrointestinal Malignancy Section, Thoracic and GI Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Abdul Rafeh Naqash
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD, USA
- Department of Internal Medicine, Hematology/Oncology Division, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Mona A. Marie
- Department of Internal Medicine, Hematology/Oncology Division, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Druid C. Atwell
- Department of Internal Medicine, Hematology/Oncology Division, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Mahvish Muzaffar
- Department of Internal Medicine, Hematology/Oncology Division, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Nitika Sharma
- Department of Internal Medicine, Hematology/Oncology Division, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Suneetha Amara
- Department of Internal Medicine, Hematology/Oncology Division, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Darla Liles
- Department of Internal Medicine, Hematology/Oncology Division, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Paul R. Walker
- Department of Internal Medicine, Hematology/Oncology Division, Brody School of Medicine, East Carolina University, Greenville, NC, USA
- Circulogene, Birmingham, AL, USA
| | - Li V. Yang
- Department of Internal Medicine, Hematology/Oncology Division, Brody School of Medicine, East Carolina University, Greenville, NC, USA
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Yang LV, Oppelt KA, Thomassen MJ, Marie MA, Nik Akhtar S, McCallen JD. Can GPR4 Be a Potential Therapeutic Target for COVID-19? Front Med (Lausanne) 2021; 7:626796. [PMID: 33553219 PMCID: PMC7859652 DOI: 10.3389/fmed.2020.626796] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 11/06/2020] [Accepted: 12/30/2020] [Indexed: 01/08/2023] Open
Abstract
Coronavirus disease 19 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), first emerged in late 2019 and has since rapidly become a global pandemic. SARS-CoV-2 infection causes damages to the lung and other organs. The clinical manifestations of COVID-19 range widely from asymptomatic infection, mild respiratory illness to severe pneumonia with respiratory failure and death. Autopsy studies demonstrate that diffuse alveolar damage, inflammatory cell infiltration, edema, proteinaceous exudates, and vascular thromboembolism in the lung as well as extrapulmonary injuries in other organs represent key pathological findings. Herein, we hypothesize that GPR4 plays an integral role in COVID-19 pathophysiology and is a potential therapeutic target for the treatment of COVID-19. GPR4 is a pro-inflammatory G protein-coupled receptor (GPCR) highly expressed in vascular endothelial cells and serves as a "gatekeeper" to regulate endothelium-blood cell interaction and leukocyte infiltration. GPR4 also regulates vascular permeability and tissue edema under inflammatory conditions. Therefore, we hypothesize that GPR4 antagonism can potentially be exploited to mitigate the hyper-inflammatory response, vessel hyper-permeability, pulmonary edema, exudate formation, vascular thromboembolism and tissue injury associated with COVID-19.
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Affiliation(s)
- Li V. Yang
- Department of Internal Medicine, Brody School of Medicine, East Carolina University, Greenville, NC, United States
- Department of Anatomy and Cell Biology, Brody School of Medicine, East Carolina University, Greenville, NC, United States
| | - Karen A. Oppelt
- Department of Comparative Medicine, Brody School of Medicine, East Carolina University, Greenville, NC, United States
| | - Mary Jane Thomassen
- Department of Internal Medicine, Brody School of Medicine, East Carolina University, Greenville, NC, United States
| | - Mona A. Marie
- Department of Internal Medicine, Brody School of Medicine, East Carolina University, Greenville, NC, United States
| | - Shayan Nik Akhtar
- Department of Anatomy and Cell Biology, Brody School of Medicine, East Carolina University, Greenville, NC, United States
| | - Justin D. McCallen
- Department of Internal Medicine, Brody School of Medicine, East Carolina University, Greenville, NC, United States
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Krewson EA, Sanderlin EJ, Marie MA, Akhtar SN, Velcicky J, Loetscher P, Yang LV. The Proton-Sensing GPR4 Receptor Regulates Paracellular Gap Formation and Permeability of Vascular Endothelial Cells. iScience 2020; 23:100848. [PMID: 32058960 PMCID: PMC6997876 DOI: 10.1016/j.isci.2020.100848] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 11/27/2019] [Accepted: 01/13/2020] [Indexed: 01/31/2023] Open
Abstract
GPR4 is a pH-sensing G protein-coupled receptor highly expressed in vascular endothelial cells and can be activated by protons in the inflamed tissue microenvironment. Herein, we report that acidosis-induced GPR4 activation increases paracellular gap formation and permeability of vascular endothelial cells through the Gα12/13/Rho GTPase signaling pathway. Evaluation of GPR4 in the inflammatory response using the acute hindlimb ischemia-reperfusion mouse model revealed that GPR4 mediates tissue edema, inflammatory exudate formation, endothelial adhesion molecule expression, and leukocyte infiltration in the inflamed tissue. Genetic knockout and pharmacologic inhibition of GPR4 alleviate tissue inflammation. These results suggest GPR4 is a pro-inflammatory receptor and could be targeted for therapeutic intervention. Acidosis/GPR4 regulates endothelial paracellular gap formation and permeability GPR4 exacerbates inflammation by increasing tissue edema and leukocyte infiltration Pharmacological inhibition of GPR4 reduces inflammatory responses
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Affiliation(s)
- Elizabeth A Krewson
- Department of Anatomy and Cell Biology, East Carolina University, Greenville, NC 27834, USA
| | - Edward J Sanderlin
- Department of Internal Medicine, Brody School of Medicine, East Carolina University, Greenville, NC 27834, USA
| | - Mona A Marie
- Department of Internal Medicine, Brody School of Medicine, East Carolina University, Greenville, NC 27834, USA
| | - Shayan Nik Akhtar
- Department of Anatomy and Cell Biology, East Carolina University, Greenville, NC 27834, USA
| | - Juraj Velcicky
- Novartis Institutes for BioMedical Research, 4002 Basel, Switzerland
| | - Pius Loetscher
- Novartis Institutes for BioMedical Research, 4002 Basel, Switzerland
| | - Li V Yang
- Department of Anatomy and Cell Biology, East Carolina University, Greenville, NC 27834, USA; Department of Internal Medicine, Brody School of Medicine, East Carolina University, Greenville, NC 27834, USA.
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Naqash AR, Appah E, Yang LV, Muzaffar M, Marie MA, Mccallen JD, Macherla S, Liles D, Walker PR. Isolated neutropenia as a rare but serious adverse event secondary to immune checkpoint inhibition. J Immunother Cancer 2019; 7:169. [PMID: 31277704 PMCID: PMC6612131 DOI: 10.1186/s40425-019-0648-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 06/21/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Compared to conventional chemotherapy, Immune checkpoint inhibitors (ICI) are known to have a distinct toxicity profile commonly identified as immune-related adverse events (irAEs). These irAEs that are believed to be related to immune dysregulations triggered by ICI can be serious and lead to treatment interruptions and in severe cases, precipitate permanent discontinuation. Isolated neutropenia secondary to ICI has been rarely documented in the literature and needs further description. We report a case of pembrolizumab related severe isolated neutropenia in a patient with metastatic non-small cell lung cancer. We were also able to obtain serial blood and plasma-based biomarkers for this patient during treatment and during neutropenia to understand trends that may correlate with the irAE. In addition we summarize important findings from other studies reporting on ICI related neutropenia. CASE PRESENTATION A 74 years old Caucasian male treated with single-agent pembrolizumab for metastatic non-small cell lung cancer presented with fevers, chills, and an isolated neutrophil count (ANC) of 0 2 weeks after the fourth dose. In addition to antibiotics, due to the strong suspicion of this neutropenia being immune-mediated, he was started on 1 mg/kg of steroids and also received filgrastim to accelerate neutrophil recovery. Serial trends in C-reactive protein and certain other inflammatory cytokines demonstrated a corresponding rise at the time of neutropenia. Post recovery, his pembrolizumab was kept on hold. Eight weeks later he had a second episode of neutropenia which was again managed similar to the first episode. Despite permanent discontinuation of ICI after the first neutropenia, his disease showed an ongoing complete metabolic response on imaging. Our literature review reveals that hematological toxicities constitute < 1% irAEs with isolated neutropenia roughly accounting for one-fourth of the hematological irAEs. Based on the handful of ICI related neutropenia cases reported to date, we identified nivolumab to be the most common offender. The median number of ICI cycles administered before presenting with neutropenia was three, and the median time to recovery was approximately two weeks. All of these neutropenic episodes were ≥ grade 3 and led to permanent ICI discontinuation. Using immunosuppressive therapies in conjunction with granulocyte-colony stimulating factor was the most common strategy described to have favorable results. CONCLUSION Neutropenia as an isolated irAE secondary to ICI is rare but represents a severe toxicity that needs early recognition and can often result in treatment discontinuations. Careful monitoring of these patients with the prompt initiation of immunosuppressive and supportive measures to promote rapid recovery as well as prevent and treat infectious complications should be part of the management algorithms. Serial monitoring of blood and plasma-based biomarkers from more extensive studies may help in identifying patients at risk for irAEs and thus guide patient selection for ICI.
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Affiliation(s)
- Abdul Rafeh Naqash
- Division of Hematology/Oncology, East Carolina University, 600 Moye Boulevard, Greenville, NC, 27834, USA.
| | - Ebenezer Appah
- Division of Hematology/Oncology, East Carolina University, 600 Moye Boulevard, Greenville, NC, 27834, USA
| | - Li V Yang
- Division of Hematology/Oncology, East Carolina University, 600 Moye Boulevard, Greenville, NC, 27834, USA
| | - Mahvish Muzaffar
- Division of Hematology/Oncology, East Carolina University, 600 Moye Boulevard, Greenville, NC, 27834, USA
| | - Mona A Marie
- Division of Hematology/Oncology, East Carolina University, 600 Moye Boulevard, Greenville, NC, 27834, USA
| | - Justin D Mccallen
- Brody School of Medicine, East Carolina University, 600 Moye Boulevard, Greenville, NC, 27834, USA
| | - Shravanti Macherla
- Division of Hematology/Oncology, East Carolina University, 600 Moye Boulevard, Greenville, NC, 27834, USA
| | - Darla Liles
- Division of Hematology/Oncology, East Carolina University, 600 Moye Boulevard, Greenville, NC, 27834, USA
| | - Paul R Walker
- Division of Hematology/Oncology, East Carolina University, 600 Moye Boulevard, Greenville, NC, 27834, USA
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Sultan AS, Marie MA, Sheweita SA. Novel mechanism of cannabidiol-induced apoptosis in breast cancer cell lines. Breast 2018; 41:34-41. [PMID: 30007266 DOI: 10.1016/j.breast.2018.06.009] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 05/20/2018] [Accepted: 06/21/2018] [Indexed: 01/09/2023] Open
Abstract
Studies have emphasized an antineoplastic effect of the non-psychoactive, phyto-cannabinoid, Cannabidiol (CBD). However, the molecular mechanism underlying its antitumor activity is not fully elucidated. Herein, we have examined the effect of CBD on two different human breast cancer cell lines: the ER-positive, well differentiated, T-47D and the triple negative, poor differentiated, MDA-MB-231 cells. In both cell lines, CBD inhibited cell survival and induced apoptosis in a dose dependent manner as observed by MTT assay, morphological changes, DNA fragmentation and ELISA apoptosis assay. CBD-induced apoptosis was accompanied by down-regulation of mTOR, cyclin D1 and up-regulation and localization of PPARγ protein expression in the nuclei and cytoplasmic of the tested cells. The results suggest that CBD treatment induces an interplay among PPARγ, mTOR and cyclin D1 in favor of apoptosis induction in both ER-positive and triple negative breast cancer cells, proposing CBD as a useful treatment for different breast cancer subtypes.
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Affiliation(s)
- Ahmed S Sultan
- Department of Biochemistry, Faculty of Science, Alexandria University, Alexandria, Egypt
| | - Mona A Marie
- Department of Biotechnology, Institute of Graduate Studies and Research, Alexandria University, Alexandria, Egypt
| | - Salah A Sheweita
- Department of Biotechnology, Institute of Graduate Studies and Research, Alexandria University, Alexandria, Egypt.
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Marie MA, Abu Khalil RE, Habib HM. Urinary CXCL10: a marker of nephritis in lupus patients. Reumatismo 2014; 65:292-7. [PMID: 24705033 DOI: 10.4081/reumatismo.2013.719] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Revised: 01/19/2014] [Accepted: 01/28/2014] [Indexed: 11/23/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is a connective tissue disease characterized by the formation of autoantibodies and immune complexes. Lupus nephritis is one of the hallmark features of SLE. CXCL10 is a chemokine secreted by IFNg- stimulated endothelial cells and has been shown to be involved in the pathological processes of autoimmune diseases. The objective was to measure urinary CXCL10 in SLE patients, to compare levels between nephritis and non-nephritis groups and to study its correlation with other variables. Sixty lupus patients were enrolled in our trial. Thirty patients had lupus nephritis and the other 30 were without evidence of lupus nephritis. Thirty healthy subjects were willing to participate as a healthy control group. Renal biopsy was performed for lupus nephritis group. Urinary CXCL10 was measured using the ELISA technique. Serum creatinine, C3, C4 and 24 h urinary proteins were measured. Lupus activity was assessed using systemic lupus erythematosus disease activity index (SLEDAI) scoring system. Renal activity was measured using renal activity scoring system. CXCL10 was significantly higher in lupus nephritis patients than in lupus patients without nephritis. CXCL10 was significantly correlated with renal activity score, 24 hours urinary proteins and the SLEDAI score. It is highly valid predictor of SLE nephritis with high sensitivity and specificity. CXCL 10 a highly sensitive and specific non-invasive diagnostic tool for lupus nephritis patients.
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Affiliation(s)
- M A Marie
- Department of Internal Medicine, Cairo University.
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