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Akahoshi Y, Spyrou N, Hoepting M, Aguayo-Hiraldo P, Ayuk F, Chanswangphuwana C, Choe HK, Eder M, Etra AM, Grupp SA, Hexner EO, Hogan WJ, Kitko CL, Kraus S, Al Malki MM, Merli P, Qayed M, Reshef R, Schechter T, Ullrich E, Vasova I, Wölfl M, Zeiser R, Baez J, Beheshti R, Eng G, Gleich S, Kasikis S, Katsivelos N, Kowalyk S, Morales G, Young R, DeFilipp Z, Ferrara JLM, Levine JE, Nakamura R. Flares of acute graft-versus-host disease: a Mount Sinai Acute GVHD International Consortium analysis. Blood Adv 2024; 8:2047-2057. [PMID: 38324721 PMCID: PMC11103178 DOI: 10.1182/bloodadvances.2023012091] [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: 11/01/2023] [Revised: 01/19/2024] [Accepted: 01/19/2024] [Indexed: 02/09/2024] Open
Abstract
ABSTRACT The absence of a standardized definition for graft-versus-host disease (GVHD) flares and data on its clinical course are significant concerns. We retrospectively evaluated 968 patients across 23 Mount Sinai Acute GVHD International Consortium (MAGIC) transplant centers who achieved complete response (CR) or very good partial response (VGPR) within 4 weeks of treatment. The cumulative incidence of flares within 6 months was 22%, and flares were associated with a higher risk of nonrelapse mortality (NRM; adjusted hazard ratio [aHR], 4.84; 95% confidence interval [CI], 3.19-7.36; P < .001). Flares were more severe (grades 3/4, 41% vs 16%; P < .001) and had more frequent lower gastrointestinal (LGI) involvement (55% vs 32%; P < .001) than the initial GVHD. At CR/VGPR, elevated MAGIC biomarkers predicted the future occurrence of a flare, along with its severity and LGI involvement. In multivariate analyses, higher Ann Arbor (AA) biomarker scores at CR/VGPR were significant risk factors for flares (AA2 vs AA1: aHR, 1.81 [95% CI, 1.32-2.48; P = .001]; AA3 vs AA1: aHR, 3.14 [95% CI, 1.98-4.98; P < .001]), as were early response to initial treatment (aHR, 1.84; 95% CI, 1.21-2.80; P = .004) and HLA-mismatched unrelated donor (aHR, 1.74; 95% CI, 1.00-3.02; P = .049). MAGIC biomarkers also stratified the risk of NRM both at CR/VGPR and at the time of flare. We conclude that GVHD flares are common and carry a significant mortality risk. The occurrence of future flares can be predicted by serum biomarkers that may serve to guide adjustment and discontinuation of immunosuppression.
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Affiliation(s)
- Yu Akahoshi
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Nikolaos Spyrou
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Matthias Hoepting
- Department of Hematology and Oncology, Internal Medicine III, University of Regensburg, Regensburg, Germany
| | - Paibel Aguayo-Hiraldo
- Cancer and Blood Disease Institute, Children's Hospital Los Angeles, University of Southern California, Los Angeles, CA
| | - Francis Ayuk
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Chantiya Chanswangphuwana
- Division of Hematology and Center of Excellence in Translational Hematology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Hannah K. Choe
- Blood and Marrow Transplantation Program, The Ohio State University, Columbus, OH
| | - Matthias Eder
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Aaron M. Etra
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Stephan A. Grupp
- Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, PA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Elizabeth O. Hexner
- Department of Medicine and Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | - Carrie L. Kitko
- Pediatric Stem Cell Transplant Program, Vanderbilt University Medical Center, Nashville, TN
| | - Sabrina Kraus
- Department of Internal Medicine II, University Hospital of Würzburg, Würzburg, Germany
| | - Monzr M. Al Malki
- Department of Hematology/Hematopoietic Cell Transplantation, City of Hope, Duarte, CA
| | - Pietro Merli
- Department of Pediatric Hematology/Oncology and of Cell and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Muna Qayed
- Division of Pediatric Hematology/Oncology and Bone Marrow Transplantation, Aflac Cancer and Blood Disorders Center, Emory University and Children's Healthcare of Atlanta, Atlanta, GA
| | - Ran Reshef
- Blood and Marrow Transplantation Program and Columbia Center for Translational Immunology, Columbia University Irving Medical Center, New York, NY
| | - Tal Schechter
- Division of Hematology/Oncology/BMT, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Evelyn Ullrich
- Department of Pediatrics, Experimental Immunology and Cell Therapy, Goethe University Frankfurt, Frankfurt, Germany
| | - Ingrid Vasova
- Department of Internal Medicine 5, Hematology and Oncology, Friedrich-Alexander-Universität Erlangen-Nürnberg and University Hospital Erlangen, Erlangen, Germany
| | - Matthias Wölfl
- Pediatric Blood and Marrow Transplantation Program, Children's Hospital, University Hospital of Würzburg, Würzburg, Germany
| | - Robert Zeiser
- Department of Medicine I, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Janna Baez
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Rahnuma Beheshti
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Gilbert Eng
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Sigrun Gleich
- Department of Hematology and Oncology, Internal Medicine III, University of Regensburg, Regensburg, Germany
| | - Stelios Kasikis
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Nikolaos Katsivelos
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Steven Kowalyk
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - George Morales
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Rachel Young
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Zachariah DeFilipp
- Hematopoietic Cell Transplant and Cellular Therapy Program, Massachusetts General Hospital, Boston, MA
| | - James L. M. Ferrara
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - John E. Levine
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ryotaro Nakamura
- Department of Hematology/Hematopoietic Cell Transplantation, City of Hope, Duarte, CA
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Etra AM, El Jurdi N, Katsivelos N, Kwon D, Gergoudis SC, Morales G, Spyrou N, Kowalyk S, Aguayo-Hiraldo P, Akahoshi Y, Ayuk FA, Baez J, Betts BC, Chanswangphuwana C, Chen YB, Choe HK, DeFilipp Z, Gleich S, Hexner EO, Hogan WJ, Holler E, Kitko CL, Kraus S, Al Malki MM, MacMillan ML, Pawarode A, Quagliarella F, Qayed M, Reshef R, Schechter-Finkelstein T, Vasova I, Weisdorf DJ, Wölfl M, Young R, Nakamura R, Ferrara JLM, Levine JE, Holtan SG. Amphiregulin, ST2,and REG3α Biomarker Risk Algorithms as Predictors of Non-Relapse Mortality in Patients with Acute GVHD. Blood Adv 2024:bloodadvances.2023011049. [PMID: 38640195 DOI: 10.1182/bloodadvances.2023011049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 03/29/2024] [Accepted: 03/29/2024] [Indexed: 04/21/2024] Open
Abstract
Graft-vs-host disease (GVHD) is a major cause of non-relapse mortality (NRM) following allogeneic hematopoietic cell transplant (HCT). Algorithms containing either the GI GVHD biomarker amphiregulin (AREG) or a combination of two GI GVHD biomarkers, (ST2+REG3α) when measured at GVHD diagnosis are validated predictors of NRM risk, but have never been assessed in the same patients using identical statistical methods. We measured serum concentrations of ST2, REG3, and AREG by ELISA at the time of GVHD diagnosis in 715 patients divided by date of transplant into training (2004-2015) and validation (2015-2017) cohorts. The training cohort (n=341) was used to develop algorithms for predicting probability of 12 month NRM that contained all possible combinations of 1-3 biomarkers and a threshold corresponding to the concordance probability was used to stratify patients for risk of NRM. Algorithms were compared to each other based on several metrics including the area under the receiver operating characteristics curve (AUC), proportion of patients correctly classified, sensitivity, and specificity using only the validation cohort (n=374). All algorithms were strong discriminators of 12 month NRM, whether or not patients were systemically treated (n=321). An algorithm containing only ST2+REG3α had the highest AUC (0.757), correctly classified the most patients (75%), and more accurately risk stratified those who developed Minnesota standard risk GVHD and for patients who received post-transplant cyclophosphamide-based prophylaxis. An algorithm containing only AREG more accurately risk stratified patients with Minnesota high risk GVHD. Combining ST2, REG3α, and AREG into a single algorithm did not improve performance.
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Affiliation(s)
- Aaron M Etra
- Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Najla El Jurdi
- University of Minnesota, Minneapolis, Minnesota, United States
| | | | - Deukwoo Kwon
- Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | | | - George Morales
- Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Nikolaos Spyrou
- Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Steven Kowalyk
- Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Paibel Aguayo-Hiraldo
- Children's Hospital Los Angeles, University of Southern California, Los Angeles, California, United States
| | - Yu Akahoshi
- Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | | | - Janna Baez
- Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Brian C Betts
- University of Minnesota, Buffalo, New York, United States
| | - Chantiya Chanswangphuwana
- Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Yi-Bin Chen
- Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Hannah K Choe
- The Ohio State University, Columbus, Ohio, United States
| | | | | | - Elizabeth O Hexner
- University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, United States
| | | | - Ernst Holler
- University Hospital Regensburg, Regensburg, Germany
| | - Carrie L Kitko
- Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | | | - Monzr M Al Malki
- City of Hope National Medical Center, Duarte, California, United States
| | | | | | | | - Muna Qayed
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, and Emory University, Atlanta, Georgia, United States
| | - Ran Reshef
- Columbia University Medical Center, New York, New York, United States
| | | | - Ingrid Vasova
- University Hospital Erlangen, Erlangen, Germany, Erlangen, Germany
| | | | | | - Rachel Young
- Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Ryotaro Nakamura
- City of Hope National Medical Center, Duarte, California, United States
| | - James L M Ferrara
- Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - John E Levine
- Icahn School of Medicine at Mount Sinai, New York, New York, United States
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DeFilipp Z, Kim HT, Spyrou N, Katsivelos N, Kowalyk S, Eng GW, Kasikis S, Beheshti R, Baez J, Akahoshi Y, Ayuk FA, Choe HK, Etra AM, Grupp SA, Hexner EO, Hogan WJ, Kitko CL, Qayed M, Reshef R, Vasova I, Zeiser R, Young R, Holler E, Ferrara JLM, Nakamura R, Levine JE, Chen YB. The MAGIC algorithm probability predicts treatment response and long-term outcomes to second-line therapy for acute GVHD. Blood Adv 2024:bloodadvances.2024012561. [PMID: 38640197 DOI: 10.1182/bloodadvances.2024012561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 04/02/2024] [Accepted: 04/02/2024] [Indexed: 04/21/2024] Open
Abstract
The significance of biomarkers at second-line treatment for acute graft-versus-host disease (GVHD) is not well characterized. We analyzed clinical data and serum samples at initiation of second-line systemic treatment of acute GVHD from 167 patients from 17 centers of the Mount Sinai Acute GVHD International Consortium (MAGIC) between 2016 and 2021. Sixty-two patients received ruxolitinib-based therapy while 102 received other systemic agents. In agreement with prospective trials, ruxolitinib resulted in higher day 28 (D28) ORR compared to non-ruxolitinib therapies (55% vs 31%, P=0.003) and patients who received ruxolitinib had significantly lower non-relapse mortality (NRM) than those who received non-ruxolitinib therapies (point estimates at 2-year: 35% vs 61%, p=0.002). Biomarker analyses demonstrated that the benefit from ruxolitinib was observed only in patients with low MAGIC algorithm probabilities (MAPs) at the start of second-line treatment. Among patients with a low MAP, those who received ruxolitinib experienced significantly lower NRM than those who received non-ruxolitinib therapies (point estimates at 2-year: 12% vs 41%, p=0.016). However, patients with a high MAP experienced high NRM regardless of treatment with ruxolitinib or non-ruxolitinib therapies (point estimates at 2-year: 67% vs 80%, p=0.65). A landmark analysis demonstrated that the relationship between D28 response and NRM largely depends on the MAP level at initiation of second-line therapy. In conclusion, the MAP measured at second-line systemic treatment for acute GVHD predicts treatment response and NRM. Outcomes of patients with high MAP are poor, regardless of treatment choice, and ruxolitinib appears to primarily benefit patients with low MAP.
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Affiliation(s)
| | - Haesook T Kim
- Dana-Farber Cancer Inst., Boston, Massachusetts, United States
| | - Nikolaos Spyrou
- Icahn School of Medicine at Mount Sinai, NEW YORK, New York, Japan
| | | | - Steven Kowalyk
- Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Gilbert W Eng
- Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Stelios Kasikis
- Icahn School of Medicine at Mount Sinai, New York City, New York, United States
| | - Rahnuma Beheshti
- Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Janna Baez
- Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Yu Akahoshi
- Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | | | - Hannah K Choe
- The Ohio State University, Columbus, Ohio, United States
| | - Aaron M Etra
- Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Stephan A Grupp
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
| | - Elizabeth O Hexner
- University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, United States
| | | | - Carrie L Kitko
- Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Muna Qayed
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, and Emory University, Atlanta, Georgia, United States
| | - Ran Reshef
- Columbia University Medical Center, New York, New York, United States
| | - Ingrid Vasova
- University Hospital Erlangen, Erlangen, Germany, Erlangen, Germany
| | - Robert Zeiser
- University Medical Center Freiburg, Freiburg, Germany
| | - Rachel Young
- Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Ernst Holler
- University Hospital Regensburg, Regensburg, Germany
| | - James L M Ferrara
- Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Ryotaro Nakamura
- City of Hope National Medical Center, Duarte, California, United States
| | - John E Levine
- Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Yi-Bin Chen
- Massachusetts General Hospital, Boston, Massachusetts, United States
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Neidemire-Colley L, Khanal S, Braunreiter KM, Gao Y, Kumar R, Snyder KJ, Weber MA, Surana S, Toirov O, Karunasiri M, Duszynski ME, Chi M, Malik P, Kalyan S, Chan WK, Naeimi Kararoudi M, Choe HK, Garzon R, Ranganathan P. CRISPR/Cas9 deletion of MIR155HG in human T cells reduces incidence and severity of acute GVHD in a xenogeneic model. Blood Adv 2024; 8:947-958. [PMID: 38181781 PMCID: PMC10877121 DOI: 10.1182/bloodadvances.2023010570] [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: 04/27/2023] [Revised: 12/19/2023] [Accepted: 12/19/2023] [Indexed: 01/07/2024] Open
Abstract
ABSTRACT Acute graft-versus-host disease (GVHD) is a major complication of allogeneic hematopoietic cell transplantation (allo-HCT). Using preclinical mouse models of disease, previous work in our laboratory has linked microRNA-155 (miR-155) to the development of acute GVHD. Transplantation of donor T cells from miR-155 host gene (MIR155HG) knockout mice prevented acute GVHD in multiple murine models of disease while maintaining critical graft-versus-leukemia (GVL) response, necessary for relapse prevention. In this study, we used clustered, regularly interspaced, short palindromic repeats (CRISPR)/Cas9 genome editing to delete miR-155 in primary T cells (MIR155HGΔexon3) from human donors, resulting in stable and sustained reduction in expression of miR-155. Using the xenogeneic model of acute GVHD, we show that NOD/SCID/IL2rγnull (NSG) mice receiving MIR155HGΔexon3 human T cells provide protection from lethal acute GVHD compared with mice that received human T cells with intact miR-155. MIR155HGΔexon3 human T cells persist in the recipients displaying decreased proliferation potential, reduced pathogenic T helper-1 cell population, and infiltration into GVHD target organs, such as the liver and skin. Importantly, MIR155HGΔexon3 human T cells retain GVL response significantly improving survival in an in vivo model of xeno-GVL. Altogether, we show that CRISPR/Cas9-mediated deletion of MIR155HG in primary human donor T cells is an innovative approach to generate allogeneic donor T cells that provide protection from lethal GVHD while maintaining robust antileukemic response.
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Affiliation(s)
- Lotus Neidemire-Colley
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH
- Biological Sciences Graduate Program, The Ohio State University, Columbus, OH
| | - Shrijan Khanal
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH
- Molecular, Cellular and Developmental Biology Graduate Program, The Ohio State University, Columbus, OH
| | - Kara M. Braunreiter
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH
- Pelotonia Institute for Immuno-Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Yandi Gao
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH
- Pelotonia Institute for Immuno-Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Rathan Kumar
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH
- Biological Sciences Graduate Program, The Ohio State University, Columbus, OH
| | - Katiri J. Snyder
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH
- Biological Sciences Graduate Program, The Ohio State University, Columbus, OH
| | - Margot A. Weber
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Simran Surana
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Olimjon Toirov
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Malith Karunasiri
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Molly E. Duszynski
- Division of Experimental Hematology and Cancer Biology, Cancer and Blood Disease Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Mengna Chi
- Division of Experimental Hematology and Cancer Biology, Cancer and Blood Disease Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Punam Malik
- Division of Experimental Hematology and Cancer Biology, Cancer and Blood Disease Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Sonu Kalyan
- Department of Pathology, New York University Langone Health, Long Island, NY
| | - Wing K. Chan
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Meisam Naeimi Kararoudi
- Center for Childhood Cancer and Blood Diseases, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH
- Department of Pediatrics, The Ohio State University, Columbus, OH
| | - Hannah K. Choe
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH
- Pelotonia Institute for Immuno-Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Ramiro Garzon
- Division of Hematology and Hematological Malignancies, Huntsman Cancer Institute, The University of Utah, Salt Lake City, UT
| | - Parvathi Ranganathan
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH
- Pelotonia Institute for Immuno-Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH
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Mital R, Penza SL, Choe HK, Chung CG, Kaffenberger BH. Dupilumab for refractory sclerotic-type cutaneous graft-versus-host disease. J Eur Acad Dermatol Venereol 2023; 37:e1323-e1324. [PMID: 37416952 DOI: 10.1111/jdv.19311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 06/27/2023] [Indexed: 07/08/2023]
Affiliation(s)
- Rohan Mital
- Department of Dermatology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Sam L Penza
- Division of Hematology, The Ohio State University James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Hannah K Choe
- Division of Hematology, The Ohio State University James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Catherine G Chung
- Department of Dermatology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Benjamin H Kaffenberger
- Department of Dermatology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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6
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Akahoshi Y, Spyrou N, Hogan WJ, Ayuk F, DeFilipp Z, Weber D, Choe HK, Hexner EO, Rösler W, Etra AM, Sandhu K, Yanik GA, Chanswangphuwana C, Kitko CL, Reshef R, Kraus S, Wölfl M, Eder M, Bertrand H, Qayed M, Merli P, Grupp SA, Aguayo-Hiraldo P, Schechter T, Ullrich E, Baez J, Beheshti R, Gleich S, Kowalyk S, Morales G, Young R, Kwon D, Nakamura R, Levine JE, Ferrara JLM, Chen YB. Incidence, clinical presentation, risk factors, outcomes, and biomarkers in de novo late acute GVHD. Blood Adv 2023; 7:4479-4491. [PMID: 37315175 PMCID: PMC10440469 DOI: 10.1182/bloodadvances.2023009885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 05/24/2023] [Accepted: 05/31/2023] [Indexed: 06/16/2023] Open
Abstract
Late acute graft-versus-host disease (GVHD) is defined as de novo acute GVHD presenting beyond 100 days after allogeneic hematopoietic cell transplantation (HCT) without manifestations of chronic GVHD. Data are limited regarding its characteristics, clinical course, and risk factors because of underrecognition and changes in classification. We evaluated 3542 consecutive adult recipients of first HCTs at 24 Mount Sinai Acute GVHD International Consortium (MAGIC) centers between January 2014 and August 2021 to better describe the clinical evolution and outcomes of late acute GVHD. The cumulative incidence of classic acute GVHD that required systemic treatment was 35.2%, and an additional 5.7% of patients required treatment for late acute GVHD. At the onset of symptoms, late acute GVHD was more severe than classic acute GVHD based on both clinical and MAGIC algorithm probability biomarker parameters and showed a lower overall response rate on day 28. Both clinical and biomarker grading at the time of treatment stratified the risk of nonrelapse mortality (NRM) in patients with classic and late acute GVHD, respectively, but long-term NRM and overall survival did not differ between patients with classic and late acute GVHD. Advanced age, female-to-male sex mismatch, and the use of reduced intensity conditioning were associated with the development of late acute GVHD, whereas the use of posttransplant cyclophosphamide-based GVHD prevention was protective mainly because of shifts in GVHD timing. Because overall outcomes were comparable, our findings, although not definitive, suggest that similar treatment strategies, including eligibility for clinical trials, based solely on clinical presentation at onset are appropriate.
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Affiliation(s)
- Yu Akahoshi
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Nikolaos Spyrou
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Francis Ayuk
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Zachariah DeFilipp
- Hematopoietic Cell Transplant and Cellular Therapy Program, Massachusetts General Hospital, Boston, MA
| | - Daniela Weber
- Department of Hematology and Oncology, Internal Medicine III, University of Regensburg, Regensburg, Germany
| | - Hannah K. Choe
- Blood and Marrow Transplantation Program, The Ohio State University, Columbus, OH
| | - Elizabeth O. Hexner
- Department of Medicine, Division of Hematology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Wolf Rösler
- Department of Internal Medicine 5, Hematology and Oncology, Friedrich-Alexander-Universität Erlangen-Nürnberg and University Hospital Erlangen, Erlangen, Germany
| | - Aaron M. Etra
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Karamjeet Sandhu
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - Gregory A. Yanik
- Blood and Marrow Transplantation Program, University of Michigan, Ann Arbor, MI
| | - Chantiya Chanswangphuwana
- Department of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Carrie L. Kitko
- Pediatric Stem Cell Transplant Program, Vanderbilt University Medical Center, Nashville, TN
| | - Ran Reshef
- Blood and Marrow Transplantation Program and Columbia Center for Translational Immunology, Columbia University Medical Center, New York, NY
| | - Sabrina Kraus
- Department of Internal Medicine II, University Hospital of Würzburg, Würzburg, Germany
| | - Matthias Wölfl
- Pediatric Blood and Marrow Transplantation Program, Children's Hospital, University Hospital of Würzburg, Würzburg, Germany
| | - Matthias Eder
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Hannah Bertrand
- Department of Medicine I, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Muna Qayed
- Emory University School of Medicine, Atlanta, GA
| | - Pietro Merli
- Department of Haematology-Oncology and Cell and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Stephan A. Grupp
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Paibel Aguayo-Hiraldo
- Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Los Angeles, CA
| | - Tal Schechter
- Division of Hematology/Oncology/BMT, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Evelyn Ullrich
- Frankfurt Cancer Institute, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Janna Baez
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Rahnuma Beheshti
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Sigrun Gleich
- Department of Hematology and Oncology, Internal Medicine III, University of Regensburg, Regensburg, Germany
| | - Steven Kowalyk
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - George Morales
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Rachel Young
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Deukwoo Kwon
- Department of Population Health Science and Policy, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ryotaro Nakamura
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - John E. Levine
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - James L. M. Ferrara
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Yi-Bin Chen
- Hematopoietic Cell Transplant and Cellular Therapy Program, Massachusetts General Hospital, Boston, MA
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7
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Holtan SG, Yu J, Choe HK, Paranagama D, Tang J, Naim A, Galvin J, Joachim Deeg H. Correction to: Disease progression, treatments, hospitalization, and clinical outcomes in acute GVHD: a multicenter chart review. Bone Marrow Transplant 2023; 58:237. [PMID: 36369478 PMCID: PMC9902270 DOI: 10.1038/s41409-022-01857-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Shernan G. Holtan
- grid.437349.e0000 0004 0519 9645Univeristy of Minnesota, Minneapolis, MN USA
| | - Jingbo Yu
- grid.417921.80000 0004 0451 3241Incyte Corporation, Wilmington, DE USA
| | - Hannah K. Choe
- grid.261331.40000 0001 2285 7943The Ohio State University, Columbus, OH USA
| | - Dilan Paranagama
- grid.417921.80000 0004 0451 3241Incyte Corporation, Wilmington, DE USA
| | | | - Ahmad Naim
- grid.417921.80000 0004 0451 3241Incyte Corporation, Wilmington, DE USA
| | - John Galvin
- grid.417921.80000 0004 0451 3241Incyte Corporation, Wilmington, DE USA ,grid.185648.60000 0001 2175 0319University of Illinois Cancer Center, Chicago, IL USA
| | - H. Joachim Deeg
- grid.270240.30000 0001 2180 1622Fred Hutchinson Cancer Research Center, Seattle, WA USA
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8
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Holtan SG, Yu J, Choe HK, Paranagama D, Tang J, Naim A, Galvin J, Joachim Deeg H. Disease progression, treatments, hospitalization, and clinical outcomes in acute GVHD: a multicenter chart review. Bone Marrow Transplant 2022; 57:1581-1585. [PMID: 35908108 PMCID: PMC9576589 DOI: 10.1038/s41409-022-01764-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 07/08/2022] [Accepted: 07/13/2022] [Indexed: 11/24/2022]
Abstract
Acute graft-versus-host disease (GVHD) remains a barrier to successful allogeneic hematopoietic cell transplantation (HCT) outcomes. This multicenter, retrospective chart review describes disease progression, treatment patterns, hospitalizations, and clinical outcomes among 475 patients (≥12 years old) who developed grades II–IV acute GVHD after their first HCT (January 2014–June 2016). Median (interquartile range) age at HCT was 55 (44–63) years. From the date of acute GVHD diagnosis, 190 patients (40.0%) experienced progression to more severe disease and/or developed new organ involvement. Among 431 patients with grades II–IV acute GVHD at diagnosis, 73.1% received first-line systemic corticosteroids. During follow-up (median 524 days since acute GVHD diagnosis), 23.4% of patients had an increase in steroid dose and 44.4% were unable to taper below 10 mg/day. Over half of patients (54.9%) required ≥1 hospital readmission within 100 days post-HCT (≥2 readmissions in 22.3%); mean inpatient length of stay upon readmission was 27.5 days. Approximately half of patients (52.8%) died during follow-up; 1-year overall mortality from date of acute GVHD diagnosis and nonrelapse mortality rates were 35.2% and 25.5%, respectively. Overall, patients who developed acute GVHD following HCT had poor clinical outcomes, highlighting the unmet need for early and effective treatment strategies.
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Affiliation(s)
| | - Jingbo Yu
- Incyte Corporation, Wilmington, DE, USA
| | | | | | | | | | - John Galvin
- Incyte Corporation, Wilmington, DE, USA.,University of Illinois Cancer Center, Chicago, IL, USA
| | - H Joachim Deeg
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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9
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Holtan SG, Yu J, Paranagama D, Tang J, Choe HK, Naim A, Joachim Deeg H, Galvin J. Disease progression, hospital readmissions, and clinical outcomes for patients with steroid-refractory acute graft-versus-host disease: A multicenter, retrospective study. Bone Marrow Transplant 2022; 57:1399-1404. [PMID: 35739326 PMCID: PMC9439948 DOI: 10.1038/s41409-022-01736-0] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 05/23/2022] [Accepted: 05/31/2022] [Indexed: 11/15/2022]
Abstract
Acute graft-versus-host disease (GVHD) is a significant cause of morbidity and mortality following allogeneic hematopoietic cell transplantation (HCT). This analysis of 168 patients (mean age, 54.8 years) from a multicenter, retrospective chart review describes the clinical course, treatment patterns, hospitalizations, and clinical outcomes of patients aged ≥12 years who developed grades II–IV acute GVHD after their first allogeneic HCT (January 1, 2014, to June 30, 2016) and were refractory to or dependent on corticosteroids. Between diagnosis and maximum grade (median, 6.0 days), 53.6% of patients had new organ involvement, particularly lower gastrointestinal tract acute GVHD, or an increase in acute GVHD grade. Eighty-nine patients (53.0%) received additional systemic GVHD therapy (after systemic corticosteroids) within a median of 21.0 days. Hospital readmission(s) was required for 56.5% of patients within 100 days post-HCT (mean inpatient length of readmission stay, 49.5 days); 24.4% had ≥2 readmissions within 100 days post-HCT. From the date of acute GVHD diagnosis, 70.2% of patients died at a median (interquartile range) of 117.5 (49–258) days. In summary, steroid-refractory and steroid-dependent acute GVHD is associated with a rapidly worsening clinical course that leads to high readmission and mortality rates, emphasizing the need for effective and tolerable therapies.
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Affiliation(s)
| | - Jingbo Yu
- Incyte Corporation, Wilmington, DE, USA
| | | | | | | | | | - H Joachim Deeg
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - John Galvin
- Incyte Corporation, Wilmington, DE, USA.,University of Illinois Cancer Center, Chicago, IL, USA
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10
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Snyder KJ, Choe HK, Gao Y, Sell NE, Braunreiter KM, Zitzer NC, Neidemire-Colley L, Kalyan S, Dorrance AM, Keller A, Mihaylova MM, Singh S, Sehgal L, Bollag G, Ma Y, Powell B, Devine SM, Ranganathan P. Inhibition of Bromodomain and Extra Terminal (BET) Domain Activity Modulates the IL-23R/IL-17 Axis and Suppresses Acute Graft- Versus-Host Disease. Front Oncol 2021; 11:760789. [PMID: 34722316 PMCID: PMC8554203 DOI: 10.3389/fonc.2021.760789] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 08/18/2021] [Accepted: 09/20/2021] [Indexed: 01/04/2023] Open
Abstract
Acute graft-versus-host disease (GVHD) is the leading cause of non-relapse mortality following allogeneic hematopoietic cell transplantation. The majority of patients non-responsive to front line treatment with steroids have an estimated overall 2-year survival rate of only 10%. Bromodomain and extra-terminal domain (BET) proteins influence inflammatory gene transcription, and therefore represent a potential target to mitigate inflammation central to acute GVHD pathogenesis. Using potent and selective BET inhibitors Plexxikon-51107 and -2853 (PLX51107 and PLX2853), we show that BET inhibition significantly improves survival and reduces disease progression in murine models of acute GVHD without sacrificing the beneficial graft-versus-leukemia response. BET inhibition reduces T cell alloreactive proliferation, decreases inflammatory cytokine production, and impairs dendritic cell maturation both in vitro and in vivo. RNA sequencing studies in human T cells revealed that BET inhibition impacts inflammatory IL-17 and IL-12 gene expression signatures, and Chromatin Immunoprecipitation (ChIP)-sequencing revealed that BRD4 binds directly to the IL-23R gene locus. BET inhibition results in decreased IL-23R expression and function as demonstrated by decreased phosphorylation of STAT3 in response to IL-23 stimulation in human T cells in vitro as well as in mouse donor T cells in vivo. Furthermore, PLX2853 significantly reduced IL-23R+ and pathogenic CD4+ IFNγ+ IL-17+ double positive T cell infiltration in gastrointestinal tissues in an acute GVHD murine model. Our findings identify a role for BET proteins in regulating the IL-23R/STAT3/IL-17 pathway. Based on our preclinical data presented here, PLX51107 will enter clinical trial for refractory acute GVHD in a Phase 1 safety, biological efficacy trial.
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Affiliation(s)
- Katiri J Snyder
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, United States
| | - Hannah K Choe
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, United States
| | - Yandi Gao
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, United States
| | - Natalie E Sell
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, United States
| | - Kara M Braunreiter
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, United States
| | - Nina C Zitzer
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, United States
| | - Lotus Neidemire-Colley
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, United States
| | - Sonu Kalyan
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, United States
| | - Adrienne M Dorrance
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, United States
| | - Andrea Keller
- Department of Biological Chemistry and Pharmacology, Comprehensive Cancer Center, The Ohio State University Columbus, Columbus, OH, United States
| | - Maria M Mihaylova
- Department of Biological Chemistry and Pharmacology, Comprehensive Cancer Center, The Ohio State University Columbus, Columbus, OH, United States
| | - Satishkumar Singh
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, United States
| | - Lalit Sehgal
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, United States
| | - Gideon Bollag
- Plexxikon Inc, South San Francisco, CA, United States
| | - Yan Ma
- Plexxikon Inc, South San Francisco, CA, United States
| | - Ben Powell
- Plexxikon Inc, South San Francisco, CA, United States
| | - Steven M Devine
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, United States
| | - Parvathi Ranganathan
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, United States
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11
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Snyder KJ, Zitzer NC, Gao Y, Choe HK, Sell NE, Neidemire-Colley L, Devine R, Behbehani G, Pietrzak M, Vaddi K, Baiocchi R, Ranganathan P. PRMT5 promotes STAT-1 mediated T cell inflammatory response and is a therapeutic target for acute graft-versus-host disease. The Journal of Immunology 2020. [DOI: 10.4049/jimmunol.204.supp.87.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Abstract
Introduction
T cell mediated acute graft-versus-host disease (aGVHD) is the main cause of non-relapse mortality in allogeneic hematopoietic cell transplant recipients. Protein arginine methyltransferase 5 (PRMT5) is a post-translational modifier and promotes activation of memory TH cells. We investigate mechanisms by which PRMT5 regulates T cell function and propose PRMT5 inhibition as a therapeutic strategy for aGVHD.
Materials and Methods
PRMT5 expression and function was evaluated in T cells of healthy and aGVHD mice and humans. We assessed T cell proliferation and effector function, using C220, a novel PRMT5 inhibitor. We tested effects of PRMT5 inhibition using in vivo mouse models of aGVHD, where mice received T cell depleted bone marrow + allogeneic splenocytes. In graft-versus-leukemia (GVL) experiments, P815 tumor cells were administered. Mice were treated with C220 or vehicle and monitored for survival and clinical aGVHD scores.
Results
PRMT5 expression and function is upregulated in T cells of mice and humans with aGVHD. Inhibition of PRMT5 reduces T cell proliferation, perturbs cell cycle and downregulates STAT-1 mediated interferon response. Administration of C220 improved survival in aGVHD mouse models and maintained tumor specific CTL response contributing to retention of Graft versus leukemia (GVL) effect.
Conclusions
Inhibition of PRMT5 using C220, down-regulates T cell proliferative and effector response, induces cell-cycle arrest, reduces interferon response and perturbs signaling pathways. C220 shows potent biological activity in vivo by reducing aGVHD clinical severity and prolonging survival in mouse models without compromising GVL. Therefore, PRMT5 is a novel and druggable target for aGVHD.
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Affiliation(s)
- Katiri Jenna Snyder
- 1Div. of Hematology, Dept. of Internal Medicine, Comprehensive Cancer Center, The Ohio State University
| | - Nina C. Zitzer
- 1Div. of Hematology, Dept. of Internal Medicine, Comprehensive Cancer Center, The Ohio State University
| | - Yandi Gao
- 1Div. of Hematology, Dept. of Internal Medicine, Comprehensive Cancer Center, The Ohio State University
| | - Hannah K. Choe
- 1Div. of Hematology, Dept. of Internal Medicine, Comprehensive Cancer Center, The Ohio State University
| | - Natalie E. Sell
- 1Div. of Hematology, Dept. of Internal Medicine, Comprehensive Cancer Center, The Ohio State University
| | - Lotus Neidemire-Colley
- 1Div. of Hematology, Dept. of Internal Medicine, Comprehensive Cancer Center, The Ohio State University
| | - Raymond Devine
- 1Div. of Hematology, Dept. of Internal Medicine, Comprehensive Cancer Center, The Ohio State University
| | - Gregory Behbehani
- 1Div. of Hematology, Dept. of Internal Medicine, Comprehensive Cancer Center, The Ohio State University
| | | | | | - Robert Baiocchi
- 1Div. of Hematology, Dept. of Internal Medicine, Comprehensive Cancer Center, The Ohio State University
| | - Parvathi Ranganathan
- 1Div. of Hematology, Dept. of Internal Medicine, Comprehensive Cancer Center, The Ohio State University
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12
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Snyder KJ, Zitzer NC, Gao Y, Choe HK, Sell NE, Neidemire-Colley L, Ignaci A, Kale C, Devine RD, Abad MG, Pietrzak M, Wang M, Lin H, Zhang YW, Behbehani GK, Jackman JE, Garzon R, Vaddi K, Baiocchi RA, Ranganathan P. PRMT5 regulates T cell interferon response and is a target for acute graft-versus-host disease. JCI Insight 2020; 5:131099. [PMID: 32191634 DOI: 10.1172/jci.insight.131099] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [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: 06/18/2019] [Accepted: 03/16/2020] [Indexed: 01/09/2023] Open
Abstract
Acute graft-versus-host disease (aGVHD) is a T cell-mediated immunological disorder and the leading cause of nonrelapse mortality in patients who receive allogeneic hematopoietic cell transplants. Based on recent observations that protein arginine methyltransferase 5 (PRMT5) and arginine methylation are upregulated in activated memory T cells, we hypothesized that PRMT5 is involved in the pathogenesis of aGVHD. Here, we show that PRMT5 expression and enzymatic activity were upregulated in activated T cells in vitro and in T cells from mice developing aGVHD after allogeneic transplant. PRMT5 expression was also upregulated in T cells of patients who developed aGVHD after allogeneic hematopoietic cell transplant compared with those who did not develop aGVHD. PRMT5 inhibition using a selective small-molecule inhibitor (C220) substantially reduced mouse and human allogeneic T cell proliferation and inflammatory IFN-γ and IL-17 cytokine production. Administration of PRMT5 small-molecule inhibitors substantially improves survival, reducing disease incidence and clinical severity in mouse models of aGVHD without adversely affecting engraftment. Importantly, we show that PRMT5 inhibition retained the beneficial graft-versus-leukemia effect by maintaining cytotoxic CD8+ T cell responses. Mechanistically, we show that PRMT5 inhibition potently reduced STAT1 phosphorylation as well as transcription of proinflammatory genes, including interferon-stimulated genes and IL-17. Additionally, PRMT5 inhibition deregulates the cell cycle in activated T cells and disrupts signaling by affecting ERK1/2 phosphorylation. Thus, we have identified PRMT5 as a regulator of T cell responses and as a therapeutic target in aGVHD.
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Affiliation(s)
- Katiri J Snyder
- Division of Hematology, Department of Internal Medicine, Comprehensive Cancer Center
| | - Nina C Zitzer
- Division of Hematology, Department of Internal Medicine, Comprehensive Cancer Center
| | - Yandi Gao
- Division of Hematology, Department of Internal Medicine, Comprehensive Cancer Center
| | - Hannah K Choe
- Division of Hematology, Department of Internal Medicine, Comprehensive Cancer Center
| | - Natalie E Sell
- Division of Hematology, Department of Internal Medicine, Comprehensive Cancer Center
| | | | - Anora Ignaci
- Division of Hematology, Department of Internal Medicine, Comprehensive Cancer Center
| | - Charuta Kale
- Division of Hematology, Department of Internal Medicine, Comprehensive Cancer Center
| | - Raymond D Devine
- Division of Hematology, Department of Internal Medicine, Comprehensive Cancer Center
| | | | - Maciej Pietrzak
- Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio, USA
| | - Min Wang
- Prelude Therapeutics, Wilmington, Delaware, USA
| | - Hong Lin
- Prelude Therapeutics, Wilmington, Delaware, USA
| | | | - Gregory K Behbehani
- Division of Hematology, Department of Internal Medicine, Comprehensive Cancer Center
| | | | - Ramiro Garzon
- Division of Hematology, Department of Internal Medicine, Comprehensive Cancer Center
| | - Kris Vaddi
- Prelude Therapeutics, Wilmington, Delaware, USA
| | - Robert A Baiocchi
- Division of Hematology, Department of Internal Medicine, Comprehensive Cancer Center
| | - Parvathi Ranganathan
- Division of Hematology, Department of Internal Medicine, Comprehensive Cancer Center
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13
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Choe HK, van Besien K. Donor graft genotypes versus leukemia. Leuk Lymphoma 2019; 60:1606-1607. [PMID: 31238818 DOI: 10.1080/10428194.2019.1613542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Hannah K Choe
- a Division of Hematology , The Ohio State University Comprehensive Cancer Center , Columbus , OH , USA
| | - Koen van Besien
- b Department of Hematology/Oncology , Weill Cornell Medicine , New York , NY , USA
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14
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Choe HK, van Besien K. Earlier may be better: the role of extracorporeal photopheresis (ECP) as prevention of GVHD after allogeneic transplant. Leuk Lymphoma 2017; 59:272-273. [PMID: 28812411 DOI: 10.1080/10428194.2017.1361034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Hannah K Choe
- a Division of Hematology and Medical Oncology , Weill Cornell Medicine , New York , NY , USA
| | - Koen van Besien
- a Division of Hematology and Medical Oncology , Weill Cornell Medicine , New York , NY , USA
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15
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Affiliation(s)
- H K Choe
- Department of Hematology and Medical Oncology, Weill Cornell Medicine, 520 East 70th Street, New York, NY, USA
| | - K van Besien
- Department of Hematology and Medical Oncology, Weill Cornell Medicine, 520 East 70th Street, New York, NY, USA
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