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Wescott EC, Sun X, Gonzalez-Ericsson P, Hanna A, Taylor BC, Sanchez V, Bronzini J, Opalenik SR, Sanders ME, Wulfkuhle J, Gallagher RI, Gomez H, Isaacs C, Bharti V, Wilson JT, Ballinger TJ, Santa-Maria CA, Shah PD, Dees EC, Lehmann BD, Abramson VG, Hirst GL, Brown Swigart L, van ˈt Veer LJ, Esserman LJ, Petricoin EF, Pietenpol JA, Balko JM. Epithelial Expressed B7-H4 Drives Differential Immunotherapy Response in Murine and Human Breast Cancer. Cancer Res Commun 2024; 4:1120-1134. [PMID: 38687247 PMCID: PMC11041871 DOI: 10.1158/2767-9764.crc-23-0468] [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] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 01/30/2024] [Accepted: 03/29/2024] [Indexed: 05/02/2024]
Abstract
Combinations of immune checkpoint inhibitors (ICI, including anti-PD-1/PD-L1) and chemotherapy have been FDA approved for metastatic and early-stage triple-negative breast cancer (TNBC), but most patients do not benefit. B7-H4 is a B7 family ligand with proposed immunosuppressive functions being explored as a cancer immunotherapy target and may be associated with anti-PD-L1 resistance. However, little is known about its regulation and effect on immune cell function in breast cancers. We assessed murine and human breast cancer cells to identify regulation mechanisms of B7-H4 in vitro. We used an immunocompetent anti-PD-L1-sensitive orthotopic mammary cancer model and induced ectopic expression of B7-H4. We assessed therapy response and transcriptional changes at baseline and under treatment with anti-PD-L1. We observed B7-H4 was highly associated with epithelial cell status and transcription factors and found to be regulated by PI3K activity. EMT6 tumors with cell-surface B7-H4 expression were more resistant to immunotherapy. In addition, tumor-infiltrating immune cells had reduced immune activation signaling based on transcriptomic analysis. Paradoxically, in human breast cancer, B7-H4 expression was associated with survival benefit for patients with metastatic TNBC treated with carboplatin plus anti-PD-L1 and was associated with no change in response or survival for patients with early breast cancer receiving chemotherapy plus anti-PD-1. While B7-H4 induces tumor resistance to anti-PD-L1 in murine models, there are alternative mechanisms of signaling and function in human cancers. In addition, the strong correlation of B7-H4 to epithelial cell markers suggests a potential regulatory mechanism of B7-H4 independent of PD-L1. SIGNIFICANCE This translational study confirms the association of B7-H4 expression with a cold immune microenvironment in breast cancer and offers preclinical studies demonstrating a potential role for B7-H4 in suppressing response to checkpoint therapy. However, analysis of two clinical trials with checkpoint inhibitors in the early and metastatic settings argue against B7-H4 as being a mechanism of clinical resistance to checkpoints, with clear implications for its candidacy as a therapeutic target.
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Affiliation(s)
- Elizabeth C. Wescott
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Xiaopeng Sun
- Breast Cancer Research Program, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Paula Gonzalez-Ericsson
- Breast Cancer Research Program, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ann Hanna
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Brandie C. Taylor
- Breast Cancer Research Program, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Violeta Sanchez
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Juliana Bronzini
- Department of Biological Sciences, Vanderbilt University, Nashville, Tennessee
| | - Susan R. Opalenik
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Melinda E. Sanders
- Breast Cancer Research Program, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Julia Wulfkuhle
- Center for Applied Proteomics and Molecular Medicine, George Mason University, Manassas, Virginia
| | - Rosa I. Gallagher
- Center for Applied Proteomics and Molecular Medicine, George Mason University, Manassas, Virginia
| | - Henry Gomez
- Department of Medical Oncology, Instituto Nacional de Enfermedades Neoplásicas, Lima, Perú
| | - Claudine Isaacs
- Division of Hematology-Oncology, Department of Medicine, Georgetown University, Washington, District of Columbia
| | - Vijaya Bharti
- Department of Chemical and Biomolecular Engineering, Vanderbilt University, Nashville, Tennessee
| | - John T. Wilson
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Chemical and Biomolecular Engineering, Vanderbilt University, Nashville, Tennessee
| | - Tarah J. Ballinger
- Division of Hematology and Oncology, Indiana University School of Medicine, Indianapolis, Indiana
| | | | - Payal D. Shah
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Elizabeth C. Dees
- Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Brian D. Lehmann
- Breast Cancer Research Program, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Vandana G. Abramson
- Breast Cancer Research Program, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Gillian L. Hirst
- Department of Surgery, University of California San Francisco, San Francisco, California
| | - Lamorna Brown Swigart
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, California
| | - Laura J. van ˈt Veer
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, California
| | - Laura J. Esserman
- Department of Surgery, University of California San Francisco, San Francisco, California
| | - Emanuel F. Petricoin
- Center for Applied Proteomics and Molecular Medicine, George Mason University, Manassas, Virginia
| | - Jennifer A. Pietenpol
- Breast Cancer Research Program, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
- Department of Biochemistry, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Justin M. Balko
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
- Breast Cancer Research Program, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Cancer Biology Program, Vanderbilt University, Nashville, Tennessee
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Taylor BC, Sun X, Gonzalez-Ericsson PI, Sanchez V, Sanders ME, Wescott EC, Opalenik SR, Hanna A, Chou ST, Van Kaer L, Gomez H, Isaacs C, Ballinger TJ, Santa-Maria CA, Shah PD, Dees EC, Lehmann BD, Abramson VG, Pietenpol JA, Balko JM. NKG2A Is a Therapeutic Vulnerability in Immunotherapy Resistant MHC-I Heterogeneous Triple-Negative Breast Cancer. Cancer Discov 2024; 14:290-307. [PMID: 37791898 PMCID: PMC10850946 DOI: 10.1158/2159-8290.cd-23-0519] [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: 05/05/2023] [Revised: 08/21/2023] [Accepted: 09/25/2023] [Indexed: 10/05/2023]
Abstract
Despite the success of immune checkpoint inhibition (ICI) in treating cancer, patients with triple-negative breast cancer (TNBC) often develop resistance to therapy, and the underlying mechanisms are unclear. MHC-I expression is essential for antigen presentation and T-cell-directed immunotherapy responses. This study demonstrates that TNBC patients display intratumor heterogeneity in regional MHC-I expression. In murine models, loss of MHC-I negates antitumor immunity and ICI response, whereas intratumor MHC-I heterogeneity leads to increased infiltration of natural killer (NK) cells in an IFNγ-dependent manner. Using spatial technologies, MHC-I heterogeneity is associated with clinical resistance to anti-programmed death (PD) L1 therapy and increased NK:T-cell ratios in human breast tumors. MHC-I heterogeneous tumors require NKG2A to suppress NK-cell function. Combining anti-NKG2A and anti-PD-L1 therapies restores complete response in heterogeneous MHC-I murine models, dependent on the presence of activated, tumor-infiltrating NK and CD8+ T cells. These results suggest that similar strategies may enhance patient benefit in clinical trials. SIGNIFICANCE Clinical resistance to immunotherapy is common in breast cancer, and many patients will likely require combination therapy to maximize immunotherapeutic benefit. This study demonstrates that heterogeneous MHC-I expression drives resistance to anti-PD-L1 therapy and exposes NKG2A on NK cells as a target to overcome resistance. This article is featured in Selected Articles from This Issue, p. 201.
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Affiliation(s)
| | - Xiaopeng Sun
- Cancer Biology Program, Vanderbilt University, Nashville, Tennessee
| | - Paula I. Gonzalez-Ericsson
- Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
- Breast Cancer Research Program, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Violeta Sanchez
- Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Melinda E. Sanders
- Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
- Breast Cancer Research Program, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Elizabeth C. Wescott
- Department of Pathology, Microbiology, and Immunology, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Susan R. Opalenik
- Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ann Hanna
- Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Shu-Ting Chou
- Cancer Biology Program, Vanderbilt University, Nashville, Tennessee
| | - Luc Van Kaer
- Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Pathology, Microbiology, and Immunology, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Henry Gomez
- Department of Medical Oncology, Instituto Nacional de Enfermedades Neoplásicas, Lima, Perú
| | - Claudine Isaacs
- Division of Hematology-Oncology, Department of Medicine, Georgetown University, Washington, District of Columbia
| | - Tarah J. Ballinger
- Division of Hematology and Oncology, Indiana University School of Medicine, Indianapolis, Indiana
| | | | - Payal D. Shah
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Elizabeth C. Dees
- Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Brian D. Lehmann
- Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
- Breast Cancer Research Program, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Vandana G. Abramson
- Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
- Breast Cancer Research Program, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jennifer A. Pietenpol
- Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
- Breast Cancer Research Program, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Biochemistry, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Justin M. Balko
- Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
- Breast Cancer Research Program, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Pathology, Microbiology, and Immunology, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
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James JL, Taylor BC, Axelrod ML, Sun X, Guerin LN, Gonzalez-Ericsson PI, Wang Y, Sanchez V, Fahey CC, Sanders ME, Xu Y, Hodges E, Johnson DB, Balko JM. Polycomb repressor complex 2 suppresses interferon-responsive MHC-II expression in melanoma cells and is associated with anti-PD-1 resistance. J Immunother Cancer 2023; 11:e007736. [PMID: 38315170 PMCID: PMC10660662 DOI: 10.1136/jitc-2023-007736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2023] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Despite the remarkable success of immunotherapy in treating melanoma, understanding of the underlying mechanisms of resistance remains limited. Emerging evidence suggests that upregulation of tumor-specific major histocompatibility complex-II (tsMHC-II) serves as a predictive marker for the response to anti-programmed death-1 (PD-1)/programmed death ligand 1 (PD-L1) therapy in various cancer types. The genetic and epigenetic pathways modulating tsMHC-II expression remain incompletely characterized. Here, we provide evidence that polycomb repressive complex 2 (PRC2)/EZH2 signaling and resulting H3K27 hypermethylation suppresses tsMHC-II. METHODS RNA sequencing data from tumor biopsies from patients with cutaneous melanoma treated with or without anti-PD-1, targeted inhibition assays, and assays for transposase-accessible chromatin with sequencing were used to observe the relationship between EZH2 inhibition and interferon (IFN)-γ inducibility within the MHC-II pathway. RESULTS We find that increased EZH2 pathway messenger RNA (mRNA) expression correlates with reduced mRNA expression of both presentation and T-cell genes. Notably, targeted inhibition assays revealed that inhibition of EZH2 influences the expression dynamics and inducibility of the MHC-II pathway following IFN-γ stimulation. Additionally, our analysis of patients with metastatic melanoma revealed a significant inverse association between PRC2-related gene expression and response to anti-PD-1 therapy. CONCLUSIONS Collectively, our findings demonstrate that EZH2 inhibition leads to enhanced MHC-II expression potentially resulting from improved chromatin accessibility at CIITA, the master regulator of MHC-II. These insights shed light on the molecular mechanisms involved in tsMHC-II suppression and highlight the potential of targeting EZH2 as a therapeutic strategy to improve immunotherapy efficacy.
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Affiliation(s)
- Jamaal L James
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Brandie C Taylor
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Margaret L Axelrod
- Department of Medicine, Washington University in St Louis, St Louis, Missouri, USA
| | - Xiaopeng Sun
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Lindsey N Guerin
- Department of Biochemistry, Vanderbilt University, Nashville, Tennessee, USA
| | - Paula I Gonzalez-Ericsson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Breast Cancer Research Program, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Yu Wang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Violeta Sanchez
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Catherine C Fahey
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Hematology/Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Melinda E Sanders
- Breast Cancer Research Program, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Yaomin Xu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Emily Hodges
- Department of Biochemistry, Vanderbilt University, Nashville, Tennessee, USA
- Genetics Institute, Vanderbilt University, Nashville, Tennessee, USA
| | - Douglas B Johnson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Justin M Balko
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Breast Cancer Research Program, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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4
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Brugel M, Dupont M, Carlier C, Botsen D, Essi DE, Sanchez V, Slimano F, Perrier M, Bouché O. Association of palliative care management and survival after chemotherapy discontinuation in patients with advanced pancreatic adenocarcinoma: A retrospective single-centre observational study. Pancreatology 2023:S1424-3903(23)00069-8. [PMID: 37037682 DOI: 10.1016/j.pan.2023.03.005] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 02/20/2023] [Accepted: 03/16/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND Palliative care (PC) is integrated into standard oncology care. However, its clinical impact at the end of life remains unclear in pancreatic adenocarcinoma (PA). We aimed to describe the end-of-life care pathway and to assess whether PC referral influences survival after chemotherapy discontinuation (CD) among advanced PA patients. METHODS This retrospective single-centre observational study was conducted among deceased patients with advanced PA who had received chemotherapy between January 1, 2016, and December 31, 2021. Baseline characteristics, the timing of PC referral and events after CD were collected. The primary outcome was time from CD to death. RESULTS Among the 148 included patients, 53.4% (n = 79) received PC, mostly late after the CD (n = 133, 89.9%), 16.9% (n = 25) received chemotherapy in the last 14 days of life and 75.6% died at the hospital. None received PC in the 8 weeks following the diagnosis. PC referral significantly increased PC department admissions (p < 0.001) and decreased medical unit admissions (p < 0.001). The median survival after the CD was 35 days (IQR: 19-64.5). PC referral was associated with increased survival after CD (HR: 0.65 [0.47-0.90], p = 0.010, Cox) and after adjusting (HR: 0.65 [0.42-0.99], p = 0.045, Cox). CONCLUSION The study suggests that PC may be associated with longer survival after CD in advanced PA patients. However, PC is underused, and patients are referred late in their care pathway.
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Affiliation(s)
- M Brugel
- Université de Reims Champagne-Ardenne, Department of Ambulatory Oncology Care Unit, CHU Reims, Reims, France.
| | - M Dupont
- Department of Medical Oncology, Institut Jean Godinot, Reims, France
| | - C Carlier
- Université de Reims Champagne-Ardenne, Department of Ambulatory Oncology Care Unit, CHU Reims, Reims, France; Department of Medical Oncology, Institut Jean Godinot, Reims, France
| | - D Botsen
- Université de Reims Champagne-Ardenne, Department of Ambulatory Oncology Care Unit, CHU Reims, Reims, France; Department of Medical Oncology, Institut Jean Godinot, Reims, France
| | - D Edoh Essi
- Department of Medical Oncology, Institut Jean Godinot, Reims, France
| | - V Sanchez
- Department of Palliative Care, CHU Reims, Reims, France
| | - F Slimano
- Université de Reims Champagne-Ardenne, Department of Pharmacy, CHU Reims, Reims, France
| | - M Perrier
- Université de Reims Champagne-Ardenne, Department of Ambulatory Oncology Care Unit, CHU Reims, Reims, France
| | - O Bouché
- Université de Reims Champagne-Ardenne, Department of Ambulatory Oncology Care Unit, CHU Reims, Reims, France
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Bergman R, Berko YA, Sanchez V, Sanders ME, Gonzalez-Ericsson PI, Arteaga CL, Rexer BN. Obesity and metabolic syndrome are associated with short-term endocrine therapy resistance in early ER + breast cancer. Breast Cancer Res Treat 2023; 197:307-317. [PMID: 36396775 PMCID: PMC10603601 DOI: 10.1007/s10549-022-06794-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 10/30/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE Increased body mass index (BMI) and metabolic syndrome (MS) are associated with increased breast cancer recurrence risk. Whether this is due to intrinsic tumor biology or modifiable factors of the obese state remains incompletely understood. METHODS Oncotype DX Recurrence Scores of 751 patients were stratified by BMI to assess association with tumor-intrinsic recurrence risk. Cellular proliferation by Ki67 after 10-21 days of presurgical letrozole treatment was used to stratify endocrine therapy response (sensitive-ln(Ki67) < 1; intermediate-ln(Ki67)1-2; resistant-ln(Ki67) > = 2). BMI at the time of surgery and MS variables were collected retrospectively for 143 patients to analyze association between therapy response and BMI/MS. Additionally, PI3K pathway signaling was evaluated by immunohistochemistry of phosphorylated Akt and S6. RESULTS There was no significant association between BMI and recurrence score (p = 0.99), and risk score distribution was similar across BMI groups. However, BMI was associated with short-term endocrine therapy resistance, with a significant enrichment of intermediate and resistant tumors in patients with obesity (55%, p = 0.0392). Similarly, the relative risk of an endocrine therapy-resistant tumor was 1.4-fold greater for patients with MS (p = 0.0197). In evaluating PI3K pathway mediators, we found patients with 3 or more MS criteria had more tumors with pAkt scores above the median (p = 0.0436). There were no significant differences in S6 activation. CONCLUSION Our findings suggest the association between obesity/metabolic syndrome and breast cancer recurrence is better reflected by response to treatment than tumor-intrinsic properties, suggesting interventions to reverse obesity and/or MS may improve outcomes for breast cancer recurrence.
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Affiliation(s)
- Riley Bergman
- Vanderbilt University Medical Center, Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
| | - Yvonne A Berko
- Meharry Medical College, Nashville, TN, USA
- Currently Piedmont Newnan Hospital, Newnan, Georgia
| | - Violeta Sanchez
- Vanderbilt University Medical Center, Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
| | - Melinda E Sanders
- Vanderbilt University Medical Center, Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
| | | | - Carlos L Arteaga
- Vanderbilt University Medical Center, Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
- UTSW Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA
| | - Brent N Rexer
- Vanderbilt University Medical Center, Vanderbilt-Ingram Cancer Center, Nashville, TN, USA.
- Division of Hematology/Oncology, Vanderbilt University Medical Center, 2220 Pierce Ave, Nashville, TN 777 PRB 37232-6307, USA.
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6
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Ye Z, Lane C, Beachey J, Medina-Inojosa J, Galian L, Dentamaro I, Calvo-Iglesias F, Alegret J, Sanchez V, Moral S, Bellino M, Enriquez-Sarano M, Bagnati R, Evangelista A, Michelena H. Clinical outcomes in patients with bicuspid aortic valves and ascending aorta dilatation equal or above 50mm. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1951] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Little is known about clinical outcomes in patients with bicuspid aortic valve (BAV) and ascending aortic diameters ≥50 mm where the elective surgical-indication zone begins.
Purpose
To assess incident aortic dissection (AoD), post-surgical survival and guideline implementation.
Methods
Multi-center retrospective study of BAV patients (≥18 years) with maximal root or tubular-ascending aortic diameters ≥50mm detected by transthoracic echocardiography at baseline. Ascertainment of aortic surgery, AoD and death was carried-out at their respective institutions. The primary outcome was AoD: “confirmed” AoD by surgery or death certificate, or “possible” AoD defined as sudden cardiac death of unknown cause by death certificate. Secondary outcomes were aortic surgery, post-surgical survival and guideline implementation.
Results
We included 506 consecutive BAV patients, mean age 61±14 years, 83% men, mean maximal aortic diameter 52±2 mm at baseline, ascending aorta was the most common segment ≥50mm (85%). During a median follow-up of 7.7 years, 356 (71%) underwent elective surgery (89% of class 1 patients). Early-surgery (≤6 months from baseline) occurred in 195 patients and 311 patients remained “under-surveillance”. Surgery under-surveillance (>6 months from baseline) occurred in 161/311 (52%) patients at 2.6 [IQR: 1.5–4.7] years of follow-up. Surgical mortality was 1.4%. Ten-year post-surgical survival was >90% and similar between early-surgery and surgery under-surveillance (p=0.8). Of 8 AoD events, 3 confirmed and 5 possible (all occurring in unoperated patients under-surveillance), 5 events occurred with maximal aortic baseline diameter ≥55 mm and/or >1 year without clinical follow-up; therefore, under guideline non-compliance. Incidence of confirmed plus possible aortic dissection was 0.37% per year with size 50–54mm, 1.13% per year between 55–59mm, and 10.41% per year with size ≥60mm. Aortic stenosis was associated with AoD (p=0.04) and all-cause death in unoperated patients (p=0.001).
Conclusions
Our results suggest that BAV patients can be safely followed as per guidelines after aortic diameters enter the elective surgical zone (≥50mm), with excellent post-surgical survival regardless of whether surgery is early- or under-surveillance. Appropriate guideline implementation for surgical thresholds and interval clinical follow-up could have prevented most AoD events. Valvular disease guideline should also be followed to prevent AoD and improve survival in these patients.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- Z Ye
- Mayo Clinic , Rochester , United States of America
| | - C Lane
- Mayo Clinic , Rochester , United States of America
| | - J Beachey
- Mayo Clinic , Rochester , United States of America
| | | | - L Galian
- University Hospital Vall d'Hebron , Barcelona , Spain
| | - I Dentamaro
- University Hospital Vall d'Hebron , Barcelona , Spain
| | | | - J Alegret
- University Hospital Sant Joan de Reus, Cardiology , Reus , Spain
| | - V Sanchez
- University Hospital 12 de Octubre, Cardiology , Madrid , Spain
| | - S Moral
- University Hospital de Girona Dr. Josep Trueta, Cardiology , Girona , Spain
| | - M Bellino
- University Hospital San Giovanni di Dio e Ruggi dAragona, Cardiovascular and Thoracic , Salerno , Italy
| | | | - R Bagnati
- Hospital Italiano de Buenos Aires, Cardiology , Buenos Aires , Argentina
| | - A Evangelista
- University Hospital Vall d'Hebron , Barcelona , Spain
| | - H Michelena
- Mayo Clinic , Rochester , United States of America
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7
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Hanna A, Nixon MJ, Estrada MV, Sanchez V, Sheng Q, Opalenik SR, Toren AL, Bauer J, Owens P, Mason FM, Cook RS, Sanders ME, Arteaga CL, Balko JM. Combined Dusp4 and p53 loss with Dbf4 amplification drives tumorigenesis via cell cycle restriction and replication stress escape in breast cancer. Breast Cancer Res 2022; 24:51. [PMID: 35850776 PMCID: PMC9290202 DOI: 10.1186/s13058-022-01542-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 06/28/2022] [Indexed: 11/10/2022] Open
Abstract
AIM Deregulated signaling pathways are a hallmark feature of oncogenesis and driver of tumor progression. Dual specificity protein phosphatase 4 (DUSP4) is a critical negative regulator of the mitogen-activated protein kinase (MAPK) pathway and is often deleted or epigenetically silenced in tumors. DUSP4 alterations lead to hyperactivation of MAPK signaling in many cancers, including breast cancer, which often harbor mutations in cell cycle checkpoint genes, particularly in TP53. METHODS Using a genetically engineered mouse model, we generated mammary-specific Dusp4-deleted primary epithelial cells to investigate the necessary conditions in which DUSP4 loss may drive breast cancer oncogenesis. RESULTS We found that Dusp4 loss alone is insufficient in mediating tumorigenesis, but alternatively converges with loss in Trp53 and MYC amplification to induce tumorigenesis primarily through chromosome 5 amplification, which specifically upregulates Dbf4, a cell cycle gene that promotes cellular replication by mediating cell cycle checkpoint escape. CONCLUSIONS This study identifies a novel mechanism for breast tumorigenesis implicating Dusp4 loss and p53 mutations in cellular acquisition of Dbf4 upregulation as a driver of cellular replication and cell cycle checkpoint escape.
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Affiliation(s)
- Ann Hanna
- Departments of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, 2200 Pierce Ave, 777 PRB, Nashville, TN, 37232, USA
| | - Mellissa J Nixon
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
- Department of Early Discovery Oncology, Merck & Co., Boston, MA, USA
| | - M Valeria Estrada
- Department of Pathology, Microbiology & Immunology, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, 2200 Pierce Ave, 777 PRB, Nashville, TN, 37232, USA
- Breast Cancer Research Program, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, 2200 Pierce Ave, 777 PRB, Nashville, TN, 37232, USA
| | - Violeta Sanchez
- Department of Pathology, Microbiology & Immunology, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, 2200 Pierce Ave, 777 PRB, Nashville, TN, 37232, USA
| | - Quanhu Sheng
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Susan R Opalenik
- Departments of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, 2200 Pierce Ave, 777 PRB, Nashville, TN, 37232, USA
| | - Abigail L Toren
- Departments of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, 2200 Pierce Ave, 777 PRB, Nashville, TN, 37232, USA
| | - Joshua Bauer
- Vanderbilt Institute of Chemical Biology, Nashville, TN, USA
| | - Phillip Owens
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Frank M Mason
- Departments of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, 2200 Pierce Ave, 777 PRB, Nashville, TN, 37232, USA
| | - Rebecca S Cook
- Biomedical Engineering, Vanderbilt University School of Engineering, Nashville, TN, USA
| | - Melinda E Sanders
- Department of Pathology, Microbiology & Immunology, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, 2200 Pierce Ave, 777 PRB, Nashville, TN, 37232, USA
- Breast Cancer Research Program, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, 2200 Pierce Ave, 777 PRB, Nashville, TN, 37232, USA
| | - Carlos L Arteaga
- Simmons Comprehensive Cancer Center, University of Texas Southwester, Dallas, TX, USA
| | - Justin M Balko
- Departments of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, 2200 Pierce Ave, 777 PRB, Nashville, TN, 37232, USA.
- Department of Pathology, Microbiology & Immunology, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, 2200 Pierce Ave, 777 PRB, Nashville, TN, 37232, USA.
- Breast Cancer Research Program, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, 2200 Pierce Ave, 777 PRB, Nashville, TN, 37232, USA.
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8
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Hanna A, Sun X, Gonzalez-Ericsson PI, Sanchez V, Balko JM. Abstract 2726: Host myeloid response drives anti-PD-L1 resistance in murine models of triple negative breast cancer. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-2726] [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
Immune checkpoint inhibitors (ICI) have improved patient overall and progression-free survival in some cancer types with limited success in breast cancer. Clinical trials in triple negative breast cancer (TNBC) patients, who harbor extensive tumor-infiltrating lymphocytes within tumor stroma, have demonstrated increased progression-free survival (IMpassion130) and pathologic complete response (KEYNOTE-522). Thus, combinations of ICI and chemotherapy have been FDA-approved for metastatic TNBC. However, the therapeutic benefit of ICI alone is poorly characterized. We sought to model ICI response in vivo to ascertain the immune repertoire responsible for ICI efficacy in breast cancer and identify the therapeutic benefit of ICI alone or in combination with approved chemotherapeutics.
We used an immunocompetent EMT6 orthotopic mammary tumor model to investigate the efficacy of single-agent ICI (anti-PD-L1) or in combination with standard-of-care chemotherapy (paclitaxel or doxorubicin). Analysis of the primary tumor immune landscape was performed by flow cytometry and single-cell RNA sequencing. Peripheral blood from mice was serially sampled by bulk and T-cell receptor (TCR) sequencing to identify systemic genomic alterations and T-cell expansion, respectively.
Single-agent ICI robustly suppressed primary tumor growth (p =0.0046) and extended survival (p<0.0001) beyond the control group. While chemotherapy demonstrated moderate therapeutic efficacy, it did not enhance ICI benefit. Transcriptomic and phenotypic profiling of the tumor microenvironment (TME) revealed increased T cells, dendritic cells, and NK cells in the combination groups versus chemotherapy alone, but this did not translate into improved benefit. Interestingly, despite using a genetically identical tumor model and murine host, ICI induced heterogeneous responses, ranging from complete response to intrinsic resistance. The longitudinal analysis of peripheral blood from heterogeneously responding mice uncovered enriched myeloid signatures and clonal T cell expansion corresponding to ICI resistance and response, respectively.
In conclusion, we identify a heterogeneously ICI-responsive in vivo model that emulates TNBC patient response to combinatorial ICI approaches. We report the efficacy of single-agent ICI in upregulating cytotoxic immune cell infiltration and expansion within the primary tumor, thereby diminishing tumor growth and enhancing survival. We describe host-specific signatures, specifically myeloid cells, that correlate with differential responses to immunotherapy, which models heterogeneous patient response to ICI. Ongoing characterization of matched peripheral blood and TME samples may identify systemic biomarkers and tumor antigen-specific T cell clones to accurately predict ICI response in patients and uncover mechanisms for sensitizing tumors refractory to ICI.
Citation Format: Ann Hanna, Xiaopeng Sun, Paula I. Gonzalez-Ericsson, Violeta Sanchez, Justin M. Balko. Host myeloid response drives anti-PD-L1 resistance in murine models of triple negative breast cancer [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 2726.
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Affiliation(s)
- Ann Hanna
- 1Vanderbilt University Medical Center, Nashville, TN
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9
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Romero Castro M, Fernandez Galindo M, Garcia Robles JA, Musa LA, Fernandez Herrero I, Priego Rodenas MA, Sanchez V, Jimenez Lopez-Guarch C, Corros-Vicente C, Carbonell San-Roman AS, Arribas Ysaurriaga F, Solis J. Regadenoson stress echocardiography: a road ahead. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.117] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Drugs use in stress echocardiography (SE) have important limitations due to side effect and contraindications. Regadenoson (R) is emerging as a selective coronary vasodilator for pharmacological stress tests. Several studies have analyzed its diagnostic accuracy, but its prognostic value has not yet been studied.
Purpose
The objective is to assess safety and short-medium term prognosis in patients (p) who underwent SE with R.
Methods
Retrospective observational study. 126 patients were included from 2017 to 2020 and SE to study the detection of myocardial ischemia with R were performed. A positive SE test were consider if presented at least one of the follow: segmental changes in myocardial contractility, electrocardiography ischaemic changes or ischaemic symtomps. Adverse events (AE) were collected. To assess prognosis, we evaluated cardiovascular events (CV) with a median follow-up of 23 months, considering heart failure, angina, myocardial infarction (AMI) o cardiovascular death. We compare negative result SE test group (NG) with group of positive results (PG).
Results
Sixteen (13%) patients, presented AE, generally mild, with nausea in 4 patients. Two patients (1.6%) required the use of aminophylline for severe AE type bronchospasm.
Nineteen studies (15%) were positive: 17 (89%) showed echocardiographically positive results, 5 of them also had clinical or electrocardiographic positivity, one (5%) was considered positive only by electrocardiographic criteria and another by clinical criteria.
There were no CV deaths at follow-up. In the NG, 6 events were observed versus 2 in the PG (6 vs 11%). Time to event of the NG was a median of 90 [3-600] days versus 110 [40-180] days in the PG. The most frequent event was HF (4 NG vs 1 PG), coronary angiography was performed in only 2 patients with HF of the NG and did not show significant lesions. In the NG there were 2 IAM (2 vs 0), one had severe stenosis in the right coronary artery and the other several moderate diffuse stenosis. There was no events for angina in the NG (0 vs 1). The annual cumulative incidence was 11% in the PG compared to 4% in the NG.
Conclusions
Stress echocardiography with regadenoson is a safe test with a low serious adverse events rate. As concern as prognosis, In our sample, NG presented a lower proportion of events with a lower annual cumulative incidence than PG and also in a 23-month follow-up. Abstract Figure.
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Affiliation(s)
- M Romero Castro
- UNIVERSITY HOSPITAL 12 DE OCTUBRE - MADRID HEALTH SERVICE, Madrid, Spain
| | | | - JA Garcia Robles
- UNIVERSITY HOSPITAL 12 DE OCTUBRE - MADRID HEALTH SERVICE, Madrid, Spain
| | - LA Musa
- UNIVERSITY HOSPITAL 12 DE OCTUBRE - MADRID HEALTH SERVICE, Madrid, Spain
| | | | - MA Priego Rodenas
- UNIVERSITY HOSPITAL 12 DE OCTUBRE - MADRID HEALTH SERVICE, Madrid, Spain
| | - V Sanchez
- UNIVERSITY HOSPITAL 12 DE OCTUBRE - MADRID HEALTH SERVICE, Madrid, Spain
| | | | - C Corros-Vicente
- UNIVERSITY HOSPITAL 12 DE OCTUBRE - MADRID HEALTH SERVICE, Madrid, Spain
| | | | | | - J Solis
- UNIVERSITY HOSPITAL 12 DE OCTUBRE - MADRID HEALTH SERVICE, Madrid, Spain
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10
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Lopez A, Dentamaro I, Galian L, Calvo F, Alegret JM, Sanchez V, Citro R, Moreo A, Chirillo F, Colonna P, Carrero MC, Bossone E, Moral S, Sao-Aviles A, Gutiérrez L, Teixido-Tura G, Rodríguez-Palomares J, Evangelista A. Predictors of Ascending Aorta Enlargement and Valvular Dysfunction Progression in Patients with Bicuspid Aortic Valve. J Clin Med 2021; 10:jcm10225264. [PMID: 34830546 PMCID: PMC8621265 DOI: 10.3390/jcm10225264] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/05/2021] [Accepted: 11/09/2021] [Indexed: 12/01/2022] Open
Abstract
Bicuspid aortic valve (BAV) patients are at high risk of developing progressive aortic valve dysfunction and ascending aorta dilation. However, the progression of the disease is not well defined. We aimed to assess mid-long-term aorta dilation and valve dysfunction progression and their predictors. Patients were referred from cardiac outpatient clinics to the echocardiographic laboratories of 10 tertiary hospitals and followed clinically and by echocardiography for >5 years. Seven hundred and eighteen patients with BAV (median age 47.8 years [IQR 33–62], 69.2% male) were recruited. BAV without raphe was observed in 11.3%. After a median follow-up of 7.2 years [IQR5–8], mean aortic root growth rate was 0.23 ± 0.15 mm/year. On multivariate analysis, rapid aortic root dilation (>0.35 mm/year) was associated with male sex, hypertension, presence of raphe and aortic regurgitation. Annual ascending aorta growth rate was 0.43 ± 0.32 mm/year. Rapid ascending aorta dilation was related only to hypertension. Variables associated with aortic stenosis and regurgitation progression, adjusted by follow-up time, were presence of raphe, hypertension and dyslipidemia and basal valvular dysfunction, respectively. Intrinsic BAV characteristics and cardiovascular risk factors were associated with aorta dilation and valvular dysfunction progression, taking into account the inherent limitations of our study-design. Strict and early control of cardiovascular risk factors is mandatory in BAV patients.
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Affiliation(s)
- Angela Lopez
- Department of Cardiology, University Hospital Vall d’Hebron, CIBERCV, 08035 Barcelona, Spain; (A.L.); (I.D.); (L.G.); (A.S.-A.); (L.G.); (G.T.-T.); (J.R.-P.)
| | - Ilaria Dentamaro
- Department of Cardiology, University Hospital Vall d’Hebron, CIBERCV, 08035 Barcelona, Spain; (A.L.); (I.D.); (L.G.); (A.S.-A.); (L.G.); (G.T.-T.); (J.R.-P.)
| | - Laura Galian
- Department of Cardiology, University Hospital Vall d’Hebron, CIBERCV, 08035 Barcelona, Spain; (A.L.); (I.D.); (L.G.); (A.S.-A.); (L.G.); (G.T.-T.); (J.R.-P.)
| | - Francisco Calvo
- Cardiology Department, Hospital Alvaro Cunqueiro, 36213 Vigo, Spain;
| | - Josep M. Alegret
- Cardiology Department, Hospital Universitari Sant Joan de Reus, IISPV, Universitat Rovira i Virgili, 43204 Reus, Spain;
| | - Violeta Sanchez
- Cardiology Department, University Hospital 12 de Octubre, 28041 Madrid, Spain;
| | - Rodolfo Citro
- Cardiology Department, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, 84125 Salerno, Italy;
| | - Antonella Moreo
- Cardiology Department, Niguarda Ca’ Granda Hospital, 20162 Milan, Italy;
| | - Fabio Chirillo
- Cardiology Department, Bassano del Grappa General Hospital, 36061 Bassano Del Grappa, Italy;
| | - Paolo Colonna
- Cardiology Department, Polyclinic Hospital of Bari, 70124 Bari, Italy;
| | - María Celeste Carrero
- Instituto Cardiovascular San Isidro, Sanatorio Las Lomas, Buenos Aires 3031, Argentina;
| | - Eduardo Bossone
- Cardiology Department, Azienda Ospedaliera di Rilievo Nazionale Antonio Cardarelli, 80131 Napoli, Italy;
| | - Sergio Moral
- Servei de Cardiologia, Hospital Josep Trueta, 17007 Girona, Spain;
| | - Augusto Sao-Aviles
- Department of Cardiology, University Hospital Vall d’Hebron, CIBERCV, 08035 Barcelona, Spain; (A.L.); (I.D.); (L.G.); (A.S.-A.); (L.G.); (G.T.-T.); (J.R.-P.)
| | - Laura Gutiérrez
- Department of Cardiology, University Hospital Vall d’Hebron, CIBERCV, 08035 Barcelona, Spain; (A.L.); (I.D.); (L.G.); (A.S.-A.); (L.G.); (G.T.-T.); (J.R.-P.)
| | - Gisela Teixido-Tura
- Department of Cardiology, University Hospital Vall d’Hebron, CIBERCV, 08035 Barcelona, Spain; (A.L.); (I.D.); (L.G.); (A.S.-A.); (L.G.); (G.T.-T.); (J.R.-P.)
| | - Jose Rodríguez-Palomares
- Department of Cardiology, University Hospital Vall d’Hebron, CIBERCV, 08035 Barcelona, Spain; (A.L.); (I.D.); (L.G.); (A.S.-A.); (L.G.); (G.T.-T.); (J.R.-P.)
| | - Arturo Evangelista
- Department of Cardiology, University Hospital Vall d’Hebron, CIBERCV, 08035 Barcelona, Spain; (A.L.); (I.D.); (L.G.); (A.S.-A.); (L.G.); (G.T.-T.); (J.R.-P.)
- Heart Institute, Teknon Medical Center-Quirón Salud, 08022 Barcelona, Spain
- Correspondence:
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11
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Hanna A, Sun X, Gonzalez-Ericsson P, Sanchez V, Sanders M, Balko J. 245 Host myeloid response to tumor and immunotherapy is associated with heterogeneity in outcomes to anti-PDL1. J Immunother Cancer 2021. [DOI: 10.1136/jitc-2021-sitc2021.245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BackgroundImmune checkpoint inhibitors (ICI) improve patient survival in some cancer types but yield limited success in breast cancer. Phase-III clinical trials in triple-negative breast cancer (TNBC) patients, who harbor extensive tumor-infiltrating lymphocytes, demonstrate increased progression-free survival (IMpassion130) and pathologic complete response (KEYNOTE-522). Consequently, combinations of ICI and chemotherapy have been FDA-approved for metastatic TNBC patients. However, the therapeutic benefit of ICI alone and the most efficacious chemotherapy combinations are poorly characterized. We sought to model ICI response in vivo to elucidate the mechanisms of immunotherapy efficacy in breast cancer and ascertain the therapeutic benefits of different chemotherapeutic combinations with ICI.MethodsUsing an immunocompetent EMT6 orthotopic mammary tumor model, we investigated the efficacy of single-agent immunotherapy and in combination with standard-of-care chemotherapy (paclitaxel [PAC] or doxorubicin [DOX]). We used single-cell RNA sequencing and bulk RNA and T-cell receptor (TCR) sequencingto assess the cellular landscape of the primary tumor in response to combinatorial therapeutic strategies and identify systemic genetic alterations and T-cell expansion, respectively.ResultsSingle-agent anti-PD-L1 robustly suppressed primary tumor growth (p =0.0046) and extended survival (p<0.0001) beyond the isotype control. Chemotherapy demonstrated moderate therapeutic efficacy without potentiating the benefit of single-agent anti-PD-L1. Interestingly, despite using a genetically identical murine tumor model/host, anti-PD-L1 induced heterogeneous responses, from complete response to intrinsic resistance. Longitudinal analysis of peripheral blood from heterogeneously responding mice uncovered myeloid cell recruitment signatures corresponding to transient responses ultimately converting to resistance. We identified specific clonal T cell expansion present only in responders. Single-cell transcriptomic profiling of the tumor microenvironment revealed increased T cells and natural killer cells and reduced regulatory T cells in the combination groups versus chemotherapy alone, although this did not translate into improved benefit. Gene-set enrichment analysis on infiltrating T cells identified a robust signature of cytotoxic T cell activation characterized by a significant enrichment in inflammatory pathways in both single-agent anti-PD-L1 and in combination with chemotherapy.ConclusionsWe identify a heterogeneously ICI-responsive in vivo model that emulates TNBC patient response to combinatorial ICI approaches. We describe single-agent ICI efficacy in upregulating cytotoxic immune cell infiltration and expansion within the primary tumor that diminishes tumor growth and enhances survival. Moreover, this study describes differential responses in a genetically similar host, which reflects heterogeneous patient response to ICI. Further characterization may identify systemic biomarkers and tumor antigen-specific T cell clones to accurately predict immunotherapy response in patients and uncover mechanisms for sensitizing refractory tumors to ICI
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12
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Wescott E, Gonzalez-Ericcson P, Sanchez V, Sanders M, Balko J. 756 Identifying the role of B7-H4 as a suppressor of tumor infiltrating lymphocytes and a target for immunotherapy in breast cancer. J Immunother Cancer 2021. [DOI: 10.1136/jitc-2021-sitc2021.756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BackgroundImmune checkpoint inhibitors (ICI) have improved patient survival in some cancer types but yielded limited success in breast cancer. Combinations of ICI (αPD-L1/PD-1) and chemotherapy have been FDA-approved for metastatic TNBC patients, and potentially in the early breast cancer setting, but many patients remain non-responsive to ICI. B7-H4 is a B7 family ligand with proposed immunosuppressive functions being explored as a cancer immunotherapy target and may be associated with resistance to αPD-L1. We confirmed an inverse expression pattern between B7-H4 and PD-L1 in breast tumor cells, which has previously been noted by others. B7-H4 was expressed in immune-excluded tumors, while PD-L1 was expressed in immune-infiltrated tumors. Based on these findings, we hypothesized ectopic B7-H4 expression would induce αPD-L1 resistance through immune cell suppression in vivo.MethodsUsing an immunocompetent and αPD-L1-sensitive EMT6 orthotopic mammary cancer model, we induced ectopic expression of B7-H4 and performed animal survival studies to assess therapy response, and RNA analysis to assess changes to cell signaling among tumor infiltrating immune cells. Finally, we performed transcriptomic correlation analyses from the cancer cell line encyclopedia dataset to identify potential regulators of B7-H4 in breast cancer.ResultsIn the αPD-L1-sensitive EMT6 mammary cancer model, tumors with cell-surface B7-H4 expression were more resistant to immunotherapy. Additionally, tumor infiltrating immune cells had reduced immune activation signaling based on transcriptomic analysis. We also observed strong correlation with B7-H4 mRNA and epithelial cell markers, in contrast to gene expression markers of mesenchymal cells.ConclusionsOur data support the hypothesis that B7-H4 induces tumor resistance to αPD-L1 ICI through an immunosuppressive function. Additionally, the strong correlation of B7-H4 to epithelial cell markers suggests a potential regulatory mechanism of B7-H4 expression independent of PD-L1 regulation.
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13
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Taylor B, Balko J, Sanders M, Gonzalez-Ericsson P, Sanchez V. 318 Enforced tumor specific MHC-I heterogeneity in triple negative breast cancer drives immunotherapy resistance. J Immunother Cancer 2021. [DOI: 10.1136/jitc-2021-sitc2021.318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BackgroundDespite the broad success of immune checkpoint inhibition (ICI e.g. anti-Programmed Death Ligand-1 [PD-L1]) in cancer treatment, tumor-intrinsic factors leading to intrinsic and acquired resistance are poorly understood. Tumor specific MHC-I expression is indispensable for anti-PD-1/L1 response as complete loss of MHC-I via B2M deletion results in inability of CD8+ T cells to recognize tumor-associated antigens. However, MHC-I is heterogeneously downregulated or lost in many tumor types. Tumor cell destruction can also occur through non-synaptic mechanisms, in a so-called ‘field effect’. Therefore, we modeled heterogeneous loss of MHC-I expression in breast cancer and experimentally evaluated how heterogeneous MHC-I loss affects response to anti-PD-L1 therapy.MethodsWe performed quantitative immunofluorescence for MHC-I and Pan-CK on breast cancer tumors (n=410). To determine the functional effect of MHC-I heterogeneity on anti-PD-L1 response, we used an immunocompetent EMT6 orthotopic mammary tumor model which ubiquitously expresses MHC-I at baseline. Using CRISPR/Cas9, we engineered EMT6 cells with B2m loci excision resulting in complete knockout of MHC-I on the cell surface. We then orthotopically implanted B2m-comtetent and B2m-KO cells at varying inoculum ratios (100:0, 90:10, 50:50, 10:90, 0:100) into syngeneic Balb/C mice and assessed immune responsiveness and efficacy of checkpoint inhibition. Additionally, to look at how loss of MHC-I affects the tumor microenvironment we will use the PanCancer Immune NanoString panel (n=770 genes) to evaluate gene expression patterns in tumor cells and infiltrating immune cells.ResultsIn patient samples, we identified high diversity in MHC-I expression across all clinical subtypes, with triple negative breast cancer (TNBC) having the highest MHC-I expression. Chemotherapy-treated tumors had higher MHC-I levels than untreated tumors. In mice when 10% of cells were B2m-KO, we observed a 50% reduction in complete eradication of EMT6 tumors with aPD-L1 treatment and reduced disease-stabilization and no complete responses when a 50% mixture of MHC-I deficient cells. An increasing percentage of B2m KO leads to worse outcomes overall and a decrease in infiltrating T cells.ConclusionsOur work suggests that there is an ICI-responsive phenotype that is driven by heterogeneity in MHC-I expression levels. As little as 10% of tumor specific MHC-I loss can lead to therapeutic resistance and a decrease in complete responders. This represents that early TNBC may be less responsive to single-agent PD-L1 due to specific percentages of MHC-I loss. MHC-I expression can influence therapy outcomes and potentially lead to novel observations of how to overcome lack of, or limited, MHC-I expression.
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14
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Gonzalez-Ericsson PI, Wulfkhule JD, Gallagher RI, Sun X, Axelrod ML, Sheng Q, Luo N, Gomez H, Sanchez V, Sanders M, Pusztai L, Petricoin E, Blenman KRM, Balko JM. Tumor-Specific Major Histocompatibility-II Expression Predicts Benefit to Anti-PD-1/L1 Therapy in Patients With HER2-Negative Primary Breast Cancer. Clin Cancer Res 2021; 27:5299-5306. [PMID: 34315723 DOI: 10.1158/1078-0432.ccr-21-0607] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/15/2021] [Accepted: 07/15/2021] [Indexed: 12/16/2022]
Abstract
PURPOSE Immunotherapies targeting PD-1/L1 enhance pathologic complete response (pCR) rates when added to standard neoadjuvant chemotherapy (NAC) regimens in early-stage triple-negative, and possibly high-risk estrogen receptor-positive breast cancer. However, immunotherapy has been associated with significant toxicity, and most patients treated with NAC do not require immunotherapy to achieve pCR. Biomarkers discerning patients benefitting from the addition of immunotherapy from those who would achieve pCR to NAC alone are clearly needed. In this study, we tested the ability of MHC-II expression on tumor cells, to predict immunotherapy-specific benefit in the neoadjuvant breast cancer setting. PATIENTS AND METHODS This was a retrospective tissue-based analysis of 3 cohorts of patients with breast cancer: (i) primary nonimmunotherapy-treated breast cancers (n = 381), (ii) triple-negative breast cancers (TNBC) treated with durvalumab and standard NAC (n = 48), and (iii) HER2-negative patients treated with standard NAC (n = 87) or NAC and pembrolizumab (n = 66). RESULTS HLA-DR positivity on ≥5% of tumor cells, defined a priori, was observed in 10% and 15% of primary non-immunotherapy-treated hormone receptor-positive and triple-negative breast cancers, respectively. Quantitative assessment of MHC-II on tumor cells was predictive of durvalumab + NAC and pembrolizumab + NAC (ROC AUC, 0.71; P = 0.01 and AUC, 0.73; P = 0.001, respectively), but not NAC alone (AUC, 0.5; P = 0.99). CONCLUSIONS Tumor-specific MHC-II has a strong candidacy as a specific biomarker of anti-PD-1/L1 immunotherapy benefit when added to standard NAC in HER2-negative breast cancer. Combined with previous studies in melanoma, MHC-II has the potential to be a pan-cancer biomarker. Validation is warranted in existing and future phase II/III clinical trials in this setting.
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Affiliation(s)
- Paula I Gonzalez-Ericsson
- Breast Cancer Research Program, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Julia D Wulfkhule
- Center for Applied Proteomics and Molecular Medicine, George Mason University, Manassas, Virginia
| | - Rosa I Gallagher
- Center for Applied Proteomics and Molecular Medicine, George Mason University, Manassas, Virginia
| | - Xiaopeng Sun
- Program in Cancer Biology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Margaret L Axelrod
- Program in Cancer Biology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Quanhu Sheng
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Na Luo
- Anatomy and Histology, School of Medicine, Nankai University, Tianjin, China
| | - Henry Gomez
- Department of Medical Oncology, Instituto Nacional de Enfermedades Neoplásicas, Lima, Perú
| | - Violeta Sanchez
- Breast Cancer Research Program, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Melinda Sanders
- Breast Cancer Research Program, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee.,Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Lajos Pusztai
- Department of Internal Medicine Section of Medical Oncology and Yale Cancer Center, School of Medicine, Yale University, New Haven, Connecticut
| | - Emanuel Petricoin
- Center for Applied Proteomics and Molecular Medicine, George Mason University, Manassas, Virginia
| | - Kim R M Blenman
- Department of Internal Medicine Section of Medical Oncology and Yale Cancer Center, School of Medicine, Yale University, New Haven, Connecticut. .,Department of Computer Science, School of Engineering and Applied Science, Yale University, New Haven, Connecticut
| | - Justin M Balko
- Breast Cancer Research Program, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee. .,Program in Cancer Biology, Vanderbilt University School of Medicine, Nashville, Tennessee.,Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
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15
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Schafer JM, Lehmann BD, Gonzalez-Ericsson PI, Marshall CB, Beeler JS, Redman LN, Jin H, Sanchez V, Stubbs MC, Scherle P, Johnson KN, Sheng Q, Roland JT, Bauer JA, Shyr Y, Chakravarthy B, Mobley BC, Hiebert SW, Balko JM, Sanders ME, Liu PCC, Pietenpol JA. Targeting MYCN-expressing triple-negative breast cancer with BET and MEK inhibitors. Sci Transl Med 2021; 12:12/534/eaaw8275. [PMID: 32161105 DOI: 10.1126/scitranslmed.aaw8275] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 10/14/2019] [Accepted: 01/28/2020] [Indexed: 12/12/2022]
Abstract
Triple-negative breast cancer (TNBC) is an aggressive form of breast cancer that does not respond to endocrine therapy or human epidermal growth factor receptor 2 (HER2)-targeted therapies. Individuals with TNBC experience higher rates of relapse and shorter overall survival compared to patients with receptor-positive breast cancer subtypes. Preclinical discoveries are needed to identify, develop, and advance new drug targets to improve outcomes for patients with TNBC. Here, we report that MYCN, an oncogene typically overexpressed in tumors of the nervous system or with neuroendocrine features, is heterogeneously expressed within a substantial fraction of primary and recurrent TNBC and is expressed in an even higher fraction of TNBCs that do not display a pathological complete response after neoadjuvant chemotherapy. We performed high-throughput chemical screens on TNBC cell lines with varying amounts of MYCN expression and determined that cells with higher expression of MYCN were more sensitive to bromodomain and extraterminal motif (BET) inhibitors. Combined BET and MEK inhibition resulted in a synergistic decrease in viability, both in vitro and in vivo, using cell lines and patient-derived xenograft (PDX) models. Our preclinical data provide a rationale to advance a combination of BET and MEK inhibitors to clinical investigation for patients with advanced MYCN-expressing TNBC.
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Affiliation(s)
- Johanna M Schafer
- Department of Biochemistry, Vanderbilt University, Nashville, TN 37232, USA
| | - Brian D Lehmann
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA.,Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | | | - Clayton B Marshall
- Department of Biochemistry, Vanderbilt University, Nashville, TN 37232, USA.,Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - J Scott Beeler
- Department of Biochemistry, Vanderbilt University, Nashville, TN 37232, USA
| | - Lindsay N Redman
- Department of Biochemistry, Vanderbilt University, Nashville, TN 37232, USA
| | - Hailing Jin
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Violeta Sanchez
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | | | | | - Kimberly N Johnson
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Quanhu Sheng
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Joseph T Roland
- Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Joshua A Bauer
- Department of Biochemistry, Vanderbilt University, Nashville, TN 37232, USA.,Vanderbilt Institute of Chemical Biology, Vanderbilt University, Nashville, TN 37232, USA
| | - Yu Shyr
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Bapsi Chakravarthy
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN 37232, USA.,Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Bret C Mobley
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Scott W Hiebert
- Department of Biochemistry, Vanderbilt University, Nashville, TN 37232, USA.,Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Justin M Balko
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA.,Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Melinda E Sanders
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN 37232, USA.,Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | | | - Jennifer A Pietenpol
- Department of Biochemistry, Vanderbilt University, Nashville, TN 37232, USA. .,Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN 37232, USA
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16
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Karthikeyan S, Waters IG, Dennison L, Chu D, Donaldson J, Shin DH, Rosen DM, Gonzalez-Ericsson PI, Sanchez V, Sanders ME, Pantone MV, Bergman RE, Davidson BA, Reed SC, Zabransky DJ, Cravero K, Kyker-Snowman K, Button B, Wong HY, Hurley PJ, Croessmann S, Park BH. Hierarchical tumor heterogeneity mediated by cell contact between distinct genetic subclones. J Clin Invest 2021; 131:143557. [PMID: 33529175 PMCID: PMC7954606 DOI: 10.1172/jci143557] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 01/27/2021] [Indexed: 12/16/2022] Open
Abstract
Intratumor heterogeneity is an important mediator of poor outcomes in many cancers, including breast cancer. Genetic subclones frequently contribute to this heterogeneity; however, their growth dynamics and interactions remain poorly understood. PIK3CA and HER2 alterations are known to coexist in breast and other cancers. Herein, we present data that describe the ability of oncogenic PIK3CA mutant cells to induce the proliferation of quiescent HER2 mutant cells through a cell contact-mediated mechanism. Interestingly, the HER2 cells proliferated to become the major subclone over PIK3CA counterparts both in vitro and in vivo. Furthermore, this phenotype was observed in both hormone receptor-positive and -negative cell lines, and was dependent on the expression of fibronectin from mutant PIK3CA cells. Analysis of human tumors demonstrated similar HER2:PIK3CA clonal dynamics and fibronectin expression. Our study provides insight into nonrandom subclonal architecture of heterogenous tumors, which may aid the understanding of tumor evolution and inform future strategies for personalized medicine.
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Affiliation(s)
- Swathi Karthikeyan
- The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ian G. Waters
- The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Lauren Dennison
- The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - David Chu
- The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Joshua Donaldson
- Division of Hematology, Oncology, Department of Medicine, Vanderbilt Ingram Cancer Center
| | - Dong Ho Shin
- Division of Hematology, Oncology, Department of Medicine, Vanderbilt Ingram Cancer Center
| | - D. Marc Rosen
- The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Paula I. Gonzalez-Ericsson
- Department of Pathology, Microbiology, and Immunology, and,Breast Cancer Research Program, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Violeta Sanchez
- Division of Hematology, Oncology, Department of Medicine, Vanderbilt Ingram Cancer Center,,Breast Cancer Research Program, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Melinda E. Sanders
- Department of Pathology, Microbiology, and Immunology, and,Breast Cancer Research Program, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Morgan V. Pantone
- Division of Hematology, Oncology, Department of Medicine, Vanderbilt Ingram Cancer Center
| | - Riley E. Bergman
- Division of Hematology, Oncology, Department of Medicine, Vanderbilt Ingram Cancer Center
| | - Brad A. Davidson
- Division of Hematology, Oncology, Department of Medicine, Vanderbilt Ingram Cancer Center
| | - Sarah C. Reed
- Division of Hematology, Oncology, Department of Medicine, Vanderbilt Ingram Cancer Center
| | - Daniel J. Zabransky
- The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Karen Cravero
- The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kelly Kyker-Snowman
- The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Berry Button
- The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Hong Yuen Wong
- Division of Hematology, Oncology, Department of Medicine, Vanderbilt Ingram Cancer Center
| | - Paula J. Hurley
- Division of Hematology, Oncology, Department of Medicine, Vanderbilt Ingram Cancer Center
| | - Sarah Croessmann
- Division of Hematology, Oncology, Department of Medicine, Vanderbilt Ingram Cancer Center
| | - Ben Ho Park
- The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Division of Hematology, Oncology, Department of Medicine, Vanderbilt Ingram Cancer Center
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17
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Hanna A, Gonzalez-Ericsson PI, Sanchez V, Sanders ME, Balko JM. Abstract PS17-14: Evaluating the efficacy of immunotherapy in triple negative breast cancer. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ps17-14] [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
The breast cancer microenvironment comprises a complex stroma including tumor-infiltrating lymphocytes (TILs), which can either stimulate tumor progression or promote anti-tumor immunity in response to tumor-derived cues. In general, of all clinical subtypes, triple-negative breast cancer (TNBC) is characterized by the most extensive infiltration of TILs within tumor stroma, which is consistent with the observation that TNBC seems to clinically respond to immunotherapies at the highest rates. Immune checkpoint blockade (ICB), an immunotherapy that promotes prolonged activation of cytotoxic immune cells to mount robust anti-tumorigenic responses, has yielded limited success in treating breast cancer. IMpassion130 was the first clinical trial to indicate that combining anti-PD-L1 with standard-of-care chemotherapy (nab-paclitaxel) to treat TNBC increases progression-free survival in patients exclusively those with PD-L1 positive tumors. Furthermore, the KEYSTONE-522 trial showed that administering anti-PD-1 in addition to various neoadjuvant chemotherapies increased the pathologic complete response in early stage TNBC patients. Despite promising evidence for immunotherapy success, both clinical trials lacked an experimental ICB-only group, and thus cannot address the therapeutic benefit of ICB alone, or which chemotherapy combination would maximize this benefit. Finally, mechanisms of resistance to ICB in breast cancer remain unexplored. We sought to model ICB response in vivo to elucidate the mechanisms responsible for immunotherapy efficacy in breast cancer, explore the synergistic effects of ICB with chemotherapies, and model ICB resistance.In this study, we investigated the efficacy of anti-PD-L1 as single-agent or in combination with paclitaxel or doxorubicin in the EMT6 (Balb/c) orthotopic mammary tumor model. In this model, single-agent immunotherapy was efficacious in reducing primary tumor growth compared to combination treatment, with a small proportion of complete responses, whereas modest benefit was observed with either chemotherapy alone. Following two rounds of treatment, we analyzed the tumor-immune microenvironment by flow cytometry and gene expression analysis. Anti-PD-L1 alone or in combination with either chemotherapy enhanced infiltration of cytotoxic and effector T cell as well as natural killer cells into the tumor microenvironment. Using gene expression analysis, we observed elevated expression of myeloid recruitment and activation markers in combination-treated tumors, supporting a known role of chemotherapy-induced cell death in myeloid recruitment; however as chemotherapy did not add benefit to tumor response or survival, it is unclear if this effect is detrimental or supportive. Interestingly, completely responsive anti-PD-L1 treated tumors that eventually recurred retained resistance to ICB upon re-implantation in naïve recipient mice, suggesting that tumor-intrinsic factors may contribute to resistance.Herein, we explore an in vivo model that corroborates clinical response to combinatorial immunotherapy approaches in breast cancer patients. We report the immunogenic efficacy of single-agent ICB that upregulates tumoricidal immune cell infiltration into the primary tumor, thereby controlling tumor growth, albeit without achieving complete response in all mice. Additionally, post-therapy recurrent tumors retain resistance upon transplantation, indicating tumor-specific adaptive resistance. This study has potentially significant clinical implications for re-evaluating the contributions of chemotherapy in combination with ICB in TNBC patients.
Citation Format: Ann Hanna, Paula I. Gonzalez-Ericsson, Violeta Sanchez, Melinda E. Sanders, Justin M. Balko. Evaluating the efficacy of immunotherapy in triple negative breast cancer [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS17-14.
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Affiliation(s)
- Ann Hanna
- Vanderbilt University Medical Center, Nashville, TN
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18
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Ericsson PIG, Balko JM, Sanchez V, Sanders M. Abstract PS4-19: Evaluation of tumor-specific MHC-II expression as a biomarker. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ps4-19] [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
Recently MHC-II protein expression levels in breast cancer tumor cells were shown to predict response to the PD-1 inhibitor pembrolizumab on a neoadjuvant clinical trial for ER+ and TNBC (ISPY-2). To better understand this biomarker and avoid post-market issues, we aimed to investigate possible pitfalls of MHC-II/HLA-DR quantification, prevalence of HLA-DR expression in breast cancer (BC) cells and its association with clinical data in a cohort of 372 BC patents. We assessed tumor and non-tumor HLA-DR expression by multiplex fluorescence immunohistochemistry on 8 TMAs containing 372 surgical BC samples, comprised of 239 ER+ and 123 TNBCs. Patient characteristics are shown in table 1. PanCK was used to define the tumor area and HLA-DR quantification was performed by training an object classifier on QuPath. Upon visual examination, 23 samples showed patchy panCK expression. We excluded normal breast epithelium and in situ components, which showed varying degrees of HLA-DR. 44.4% of breast cancers expressed HLA-DR, with 8.3% showing high tumor expression (HLA-DRHI; ≥20% of tumor cells). TNBC showed higher prevalence of HLA-DRHI cases (35% HLADR+, 14.6% HLA-DRHI, mean tumor HLA-DR expression (% of tumor cells) 10.3%, range 0-84%) than ER+ BC (51% HLADR+, 5.4% HLA-DRHI, mean 7.4%, range 0-66.5%). In some cases, HLA-DR and panCK expression were mutually exclusive. In other cases the lack of panCK expression highlighted the presence of stromal cells within the tumor area that were not evident on H&E. Tumoral MHC-II expression correlated with the presence of TILs for ER+ BC (r=0.18, p=0.0158) and TNBC (r=0.20, p= 0.0450), specifically CD3 (r=0.49 p<0.0001) and CD4 (r=0.48 p<0.0001), and to a lesser extent CD8 (r=0.28, p= 0.013) in a subset of TNBCs on which these stains where performed (n=81). We found no correlation between tumoral MHC-II expression and clinical characteristics (ER and PR within ER+ BC, age, presence of lymph node metastasis, stage, neoadjuvant treatment) in ER+ or TNBC. High tumor HLA-DR expression correlated with poorer recurrence-free survival (RFS) in ER+ BC (p=0.038) but showed no correlation in TNBC. Cox proportional hazard model including clinical data determined that only stage was an independent predictor of survival in ER+. Non-tumoral HLA-DR expression was associated with better RFS (p=0.007) and overall survival (p=0.01) in TNBC; however, only stage was an independent predictor in multivariant analyses. Tumor MHC-II expression in BC has been reported to range from 22% to 48.5% in TNBC or unselected BC, and high tumoral MHC-II expression was reported to be 6.9% in unselected BC and 36.3% in TNBC. Specific rates of HLA-DR expression in ER+ breast cancer have not been extensively investigated. Here we report a similar overall prevalence, but lower number of tumors presenting high HLA-DR expression and an association with poorer survival in ER+ BC. HLA-DR IHC is a robust assay that can be easily used to identify MCH-II high expressing tumors and scoring percentage of tumoral cells should be more reproducible than PD-L1 scoring on immune cells when assessed by a trained pathologist.
Table 1: Patient characteristicsTNBCER+Total number of cases239123Median age48,563Treatmenttreatment naïve26%45%neoadjuvant chemotherapy74%4%pre-surgical letrozole-51%Positive lymph node58%14%StageI27%82%II20%27%III67%8%IV0%1%
Citation Format: Paula Ines Gonzalez Ericsson, Justin M Balko, Violeta Sanchez, Melinda Sanders. Evaluation of tumor-specific MHC-II expression as a biomarker [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS4-19.
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19
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Guala A, Teixidó-Tura G, Rodríguez-Palomares J, Ruiz-Muñoz A, Dux-Santoy L, Villalva N, Granato C, Galian L, Gutiérrez L, González-Alujas T, Sanchez V, Forteza A, García-Dorado D, Evangelista A. Proximal aorta longitudinal strain predicts aortic root dilation rate and aortic events in Marfan syndrome. Eur Heart J 2020; 40:2047-2055. [PMID: 30977783 DOI: 10.1093/eurheartj/ehz191] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 10/15/2018] [Accepted: 03/22/2019] [Indexed: 12/31/2022] Open
Abstract
AIMS Life expectancy in Marfan syndrome patients has improved thanks to the early detection of aortic dilation and prophylactic aortic root surgery. Current international clinical guidelines support the use of aortic root diameter as a predictor of complications. However, other imaging markers are needed to improve risk stratification. This study aim to ascertain whether proximal aorta longitudinal and circumferential strain and distensibility assessed by cardiac magnetic resonance (CMR) predict the aortic root dilation rate and aortic events in Marfan syndrome. METHODS AND RESULTS One hundred and seventeen Marfan patients with no previous aortic dissection, cardiac/aortic surgery, or moderate/severe aortic regurgitation were prospectively included in a multicentre protocol of clinical and imaging follow-up. At baseline, CMR was performed and proximal aorta longitudinal strain and ascending aorta circumferential strain and distensibility were obtained. During follow-up (85.7 [75.0-93.2] months), the annual growth rate of aortic root diameter was 0.62 ± 0.65 mm/year. Fifteen patients underwent elective surgical aortic root replacement and four presented aortic dissection. Once corrected for baseline clinical and demographic characteristics and aortic root diameter, proximal aorta longitudinal strain, but not circumferential strain and distensibility, was an independent predictor of the aortic root diameter growth rate (P = 0.001, P = 0.823, and P = 0.997, respectively), z-score growth rate (P = 0.013, P = 0.672, and P = 0.680, respectively), and aortic events (P = 0.023, P = 0.096, and P = 0.237, respectively). CONCLUSION Proximal aorta longitudinal strain is independently related to the aortic root dilation rate and aortic events in addition to aortic root diameter, clinical risk factors, and demographic characteristics in Marfan syndrome patients.
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Affiliation(s)
- Andrea Guala
- Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Vall d'Hebron institut de Recerca, Universitat Autònoma de Barcelona, Paseo Vall d'Hebron 119-129, Barcelona, Spain
| | - Gisela Teixidó-Tura
- Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Vall d'Hebron institut de Recerca, Universitat Autònoma de Barcelona, Paseo Vall d'Hebron 119-129, Barcelona, Spain
| | - Jose Rodríguez-Palomares
- Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Vall d'Hebron institut de Recerca, Universitat Autònoma de Barcelona, Paseo Vall d'Hebron 119-129, Barcelona, Spain
| | - Aroa Ruiz-Muñoz
- Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Vall d'Hebron institut de Recerca, Universitat Autònoma de Barcelona, Paseo Vall d'Hebron 119-129, Barcelona, Spain
| | - Lydia Dux-Santoy
- Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Vall d'Hebron institut de Recerca, Universitat Autònoma de Barcelona, Paseo Vall d'Hebron 119-129, Barcelona, Spain
| | - Nicolas Villalva
- Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Vall d'Hebron institut de Recerca, Universitat Autònoma de Barcelona, Paseo Vall d'Hebron 119-129, Barcelona, Spain
| | - Chiara Granato
- Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Vall d'Hebron institut de Recerca, Universitat Autònoma de Barcelona, Paseo Vall d'Hebron 119-129, Barcelona, Spain
| | - Laura Galian
- Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Vall d'Hebron institut de Recerca, Universitat Autònoma de Barcelona, Paseo Vall d'Hebron 119-129, Barcelona, Spain
| | - Laura Gutiérrez
- Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Vall d'Hebron institut de Recerca, Universitat Autònoma de Barcelona, Paseo Vall d'Hebron 119-129, Barcelona, Spain
| | - Teresa González-Alujas
- Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Vall d'Hebron institut de Recerca, Universitat Autònoma de Barcelona, Paseo Vall d'Hebron 119-129, Barcelona, Spain
| | - Violeta Sanchez
- Department of Cardiology, Hospital doce de Octubre, Avenida Cordoba, Madrid, Spain
| | - Alberto Forteza
- Department of Cardiac Surgery, Hospital Puerta de Hierro. Calle Manuel de Falla, 1, Majadahonda, Spain
| | - David García-Dorado
- Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Vall d'Hebron institut de Recerca, Universitat Autònoma de Barcelona, Paseo Vall d'Hebron 119-129, Barcelona, Spain
| | - Artur Evangelista
- Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Vall d'Hebron institut de Recerca, Universitat Autònoma de Barcelona, Paseo Vall d'Hebron 119-129, Barcelona, Spain
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20
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Axelrod ML, Nixon MJ, Gonzalez-Ericsson PI, Bergman RE, Pilkinton MA, McDonnell WJ, Sanchez V, Opalenik SR, Loi S, Zhou J, Mackay S, Rexer BN, Abramson VG, Jansen VM, Mallal S, Donaldson J, Tolaney SM, Krop IE, Garrido-Castro AC, Marotti JD, Shee K, Miller TW, Sanders ME, Mayer IA, Salgado R, Balko JM. Changes in Peripheral and Local Tumor Immunity after Neoadjuvant Chemotherapy Reshape Clinical Outcomes in Patients with Breast Cancer. Clin Cancer Res 2020; 26:5668-5681. [PMID: 32826327 DOI: 10.1158/1078-0432.ccr-19-3685] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 05/21/2020] [Accepted: 08/18/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE The recent approval of anti-programmed death-ligand 1 immunotherapy in combination with nab-paclitaxel for metastatic triple-negative breast cancer (TNBC) highlights the need to understand the role of chemotherapy in modulating the tumor immune microenvironment (TIME). EXPERIMENTAL DESIGN We examined immune-related gene expression patterns before and after neoadjuvant chemotherapy (NAC) in a series of 83 breast tumors, including 44 TNBCs, from patients with residual disease (RD). Changes in gene expression patterns in the TIME were tested for association with recurrence-free (RFS) and overall survival (OS). In addition, we sought to characterize the systemic effects of NAC through single-cell analysis (RNAseq and cytokine secretion) of programmed death-1-high (PD-1HI) CD8+ peripheral T cells and examination of a cytolytic gene signature in whole blood. RESULTS In non-TNBC, no change in expression of any single gene was associated with RFS or OS, while in TNBC upregulation of multiple immune-related genes and gene sets were associated with improved long-term outcome. High cytotoxic T-cell signatures present in the peripheral blood of patients with breast cancer at surgery were associated with persistent disease and recurrence, suggesting active antitumor immunity that may indicate ongoing disease burden. CONCLUSIONS We have characterized the effects of NAC on the TIME, finding that TNBC is uniquely sensitive to the immunologic effects of NAC, and local increases in immune genes/sets are associated with improved outcomes. However, expression of cytotoxic genes in the peripheral blood, as opposed to the TIME, may be a minimally invasive biomarker of persistent micrometastatic disease ultimately leading to recurrence.
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Affiliation(s)
- Margaret L Axelrod
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mellissa J Nixon
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Riley E Bergman
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mark A Pilkinton
- Department of Infectious Disease, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Wyatt J McDonnell
- Department of Infectious Disease, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Violeta Sanchez
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.,Breast Cancer Research Program, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Susan R Opalenik
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sherene Loi
- Department of Oncology, University of Melbourne and Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Jing Zhou
- IsoPlexis Corporation, Branford, Connecticut
| | - Sean Mackay
- IsoPlexis Corporation, Branford, Connecticut
| | - Brent N Rexer
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Vandana G Abramson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Valerie M Jansen
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Simon Mallal
- Department of Infectious Disease, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Joshua Donaldson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sara M Tolaney
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
| | - Ian E Krop
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
| | - Ana C Garrido-Castro
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
| | - Jonathan D Marotti
- Department of Pathology & Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.,Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Kevin Shee
- Department of Molecular & Systems Biology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Todd W Miller
- Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.,Department of Molecular & Systems Biology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Melinda E Sanders
- Breast Cancer Research Program, Vanderbilt University Medical Center, Nashville, Tennessee.,Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ingrid A Mayer
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.,Breast Cancer Research Program, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Roberto Salgado
- Department of Oncology, University of Melbourne and Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Pathology, GZA-ZNA Hospitals, Antwerp, Belgium
| | - Justin M Balko
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee. .,Breast Cancer Research Program, Vanderbilt University Medical Center, Nashville, Tennessee
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21
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Franklin DA, Sharick JT, Ericsson-Gonzalez PI, Sanchez V, Dean PT, Opalenik SR, Cairo S, Judde JG, Lewis MT, Chang JC, Sanders ME, Cook RS, Skala MC, Bordeaux J, Orozco Bender J, Vaupel C, Geiss G, Hinerfeld D, Balko JM. MEK activation modulates glycolysis and supports suppressive myeloid cells in TNBC. JCI Insight 2020; 5:134290. [PMID: 32634121 PMCID: PMC7455066 DOI: 10.1172/jci.insight.134290] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 07/01/2020] [Indexed: 12/11/2022] Open
Abstract
Triple-negative breast cancers (TNBCs) are heterogeneous and aggressive, with high mortality rates. TNBCs frequently respond to chemotherapy, yet many patients develop chemoresistance. The molecular basis and roles for tumor cell-stromal crosstalk in establishing chemoresistance are complex and largely unclear. Here we report molecular studies of paired TNBC patient-derived xenografts (PDXs) established before and after the development of chemoresistance. Interestingly, the chemoresistant model acquired a distinct KRASQ61R mutation that activates K-Ras. The chemoresistant KRAS-mutant model showed gene expression and proteomic changes indicative of altered tumor cell metabolism. Specifically, KRAS-mutant PDXs exhibited increased redox ratios and decreased activation of AMPK, a protein involved in responding to metabolic homeostasis. Additionally, the chemoresistant model exhibited increased immunosuppression, including expression of CXCL1 and CXCL2, cytokines responsible for recruiting immunosuppressive leukocytes to tumors. Notably, chemoresistant KRAS-mutant tumors harbored increased numbers of granulocytic myeloid-derived suppressor cells (gMDSCs). Interestingly, previously established Ras/MAPK-associated gene expression signatures correlated with myeloid/neutrophil-recruiting CXCL1/2 expression and negatively with T cell-recruiting chemokines (CXCL9/10/11) across patients with TNBC, even in the absence of KRAS mutations. MEK inhibition induced tumor suppression in mice while reversing metabolic and immunosuppressive phenotypes, including chemokine production and gMDSC tumor recruitment in the chemoresistant KRAS-mutant tumors. These results suggest that Ras/MAPK pathway inhibitors may be effective in some breast cancer patients to reverse Ras/MAPK-driven tumor metabolism and immunosuppression, particularly in the setting of chemoresistance.
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Affiliation(s)
- Derek A Franklin
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Joe T Sharick
- Department of Biomedical Engineering, School of Engineering, Vanderbilt University, Nashville, Tennessee, USA.,Morgridge Institute for Research, University of Wisconsin-Madison, Wisconsin, USA
| | | | - Violeta Sanchez
- Breast Cancer Research Program, Vanderbilt-Ingram Cancer Center, Nashville, Tennessee, USA
| | - Phillip T Dean
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Susan R Opalenik
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | | | | | - Jenny C Chang
- Department of Radiation Oncology, Houston Methodist Research Institute, Houston, Texas, USA
| | - Melinda E Sanders
- Breast Cancer Research Program, Vanderbilt-Ingram Cancer Center, Nashville, Tennessee, USA.,Department of Pathology, Microbiology and Immunology and
| | - Rebecca S Cook
- Department of Cell and Developmental Biology, Vanderbilt University Medical Center, Nashville Tennessee, USA
| | - Melissa C Skala
- Morgridge Institute for Research, University of Wisconsin-Madison, Wisconsin, USA.,Department of Biomedical Engineering, College of Engineering, University of Wisconsin-Madison, Wisconsin, USA
| | | | | | | | - Gary Geiss
- NanoString Technologies, Seattle, Washington, USA
| | | | - Justin M Balko
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Breast Cancer Research Program, Vanderbilt-Ingram Cancer Center, Nashville, Tennessee, USA
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Martín C, Evangelista A, Serrano-Fiz S, Villar S, Ospina V, Martínez D, De Villarreal J, Sanchez V, Moñivas V, Mingo S, Forteza A. Aortic Complications in Marfan Syndrome: Should We Anticipate Preventive Aortic Root Surgery? Ann Thorac Surg 2020; 109:1850-1857. [DOI: 10.1016/j.athoracsur.2019.08.096] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 07/27/2019] [Accepted: 08/26/2019] [Indexed: 01/09/2023]
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23
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Lehmann BD, Abramson VG, Sanders ME, Mayer EL, Haddad TC, Nanda R, Van Poznak C, Storniolo AM, Nangia J, Gonzalez-Ericsson PI, Sanchez V, Johnson KN, Abramson RG, Chen SC, Shyr Y, Arteaga CL, Wolff AC, Pietenpol JA. TBCRC 032 IB/II Multicenter Study: Molecular Insights to AR Antagonist and PI3K Inhibitor Efficacy in Patients with AR + Metastatic Triple-Negative Breast Cancer. Clin Cancer Res 2020; 26:2111-2123. [PMID: 31822498 PMCID: PMC7196503 DOI: 10.1158/1078-0432.ccr-19-2170] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/23/2019] [Accepted: 12/04/2019] [Indexed: 02/01/2023]
Abstract
PURPOSE Preclinical data demonstrating androgen receptor (AR)-positive (AR+) triple-negative breast cancer (TNBC) cells are sensitive to AR antagonists, and PI3K inhibition catalyzed an investigator-initiated, multi-institutional phase Ib/II study TBCRC032. The trial investigated the safety and efficacy of the AR-antagonist enzalutamide alone or in combination with the PI3K inhibitor taselisib in patients with metastatic AR+ (≥10%) breast cancer. PATIENTS AND METHODS Phase Ib patients [estrogen receptor positive (ER+) or TNBC] with AR+ breast cancer received 160 mg enzalutamide in combination with taselisib to determine dose-limiting toxicities and the maximum tolerated dose (MTD). Phase II TNBC patients were randomized to receive either enzalutamide alone or in combination with 4 mg taselisib until disease progression. Primary endpoint was clinical benefit rate (CBR) at 16 weeks. RESULTS The combination was tolerated, and the MTD was not reached. The adverse events were hyperglycemia and skin rash. Overall, CBR for evaluable patients receiving the combination was 35.7%, and median progression-free survival (PFS) was 3.4 months. Luminal AR (LAR) TNBC subtype patients trended toward better response compared with non-LAR (75.0% vs. 12.5%, P = 0.06), and increased PFS (4.6 vs. 2.0 months, P = 0.082). Genomic analyses revealed subtype-specific treatment response, and novel FGFR2 fusions and AR splice variants. CONCLUSIONS The combination of enzalutamide and taselisib increased CBR in TNBC patients with AR+ tumors. Correlative analyses suggest AR protein expression alone is insufficient for identifying patients with AR-dependent tumors and knowledge of tumor LAR subtype and AR splice variants may identify patients more or less likely to benefit from AR antagonists.
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Affiliation(s)
- Brian D. Lehmann
- Department of Medicine, Vanderbilt University, Nashville, Tennessee, USA
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Vandana G. Abramson
- Department of Medicine, Vanderbilt University, Nashville, Tennessee, USA
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Melinda E. Sanders
- Department of Pathology, Microbiology and Immunology, Nashville, Tennessee, Vanderbilt University, USA
- Breast Cancer Research Program, Vanderbilt University Medical Center, Nashville TN, USA
| | | | | | - Rita Nanda
- Department of Medicine, University of Chicago, Chicago, IL
| | | | | | | | - Paula I. Gonzalez-Ericsson
- Department of Pathology, Microbiology and Immunology, Nashville, Tennessee, Vanderbilt University, USA
- Breast Cancer Research Program, Vanderbilt University Medical Center, Nashville TN, USA
| | - Violeta Sanchez
- Department of Medicine, Vanderbilt University, Nashville, Tennessee, USA
| | - Kimberly N. Johnson
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Richard G. Abramson
- Department of Radiology and Radiological Sciences, Vanderbilt-Ingram Cancer Center, Nashville, Tennessee, USA
| | - Sheau-Chiann Chen
- Center for Quantitative Sciences, Division of Cancer Biostatistics, Department of Biostatistics, Vanderbilt University, Nashville, Tennessee, USA
| | - Yu Shyr
- Center for Quantitative Sciences, Division of Cancer Biostatistics, Department of Biostatistics, Vanderbilt University, Nashville, Tennessee, USA
| | - Carlos L. Arteaga
- Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Antonio C. Wolff
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - Jennifer A. Pietenpol
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Biochemistry, Vanderbilt University, Nashville, Tennessee, USA
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24
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Gonzalez-Ericsson PI, Sanchez V, Salgado R, Bordeaux J, Kim JY, Vaupel C, Gomez H, Sanders ME, Balko JM. Abstract PD5-07: The immune landscape of residual triple-negative breast cancers after neoadjuvant chemotherapy. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-pd5-07] [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: Although neoadjuvant chemotherapy (NAC) induces complete response in 30-40% of triple-negative breast cancers (TNBC), patients with residual disease at surgery have poor prognosis and limited treatment options until recurrence. Tumor-infiltrating lymphocytes (TILs) in the residual disease are a positive prognostic factor, but how specific immune composition of the tumor guides outcome is unclear, resulting in a lack of understanding of how to employ immunotherapies in the adjuvant setting.
Methods: We assessed multiple immunologic biomarkers in a series of 99 residual TNBCs after NAC. Immune markers were assessed by multiple methods, including H&E-based TILs analysis, standard immunohistochemistry (IHC; CD8, CD20, CD56, FOXP3, LAG-3, B7-H4, HLA-A) and multiplexed immunofluorescence (mIF; HLA-DR, GZMB, CD4, CD8, PD-L1, pan-CK, PD1, CD3). Association among parameters were assessed (up to n=98) including clinical outcome after surgery (n=94).
Results: As previously demonstrated, TILs in residual tumors after NAC predicted both RFS and OS (p=0.0093 and p=0.0376, respectively). H&E-scored TILs were highly correlated to CD3, CD4 and CD8 positive T cells (Spearman r range 0.34-0.4850; all p<0.001), while CD20 and CD56 positive cells only make up a small and non-significant proportion of the TILs composition. Likewise, infiltration by overall T cell populations were associated with significantly improved recurrence free survival (RFS; HR range 0.34-0.54) and overall survival (OS; HR range 0.38-0.43), whereas CD20+ B cells were not. Additionally, infiltration by cells expressing LAG3 (HR 0.49) and CD56 (HR 0.44), were each associated with significantly improved OS. Interestingly, colocalizing GZMB+ and CD8+ T cells by mIF yielded a paradoxical finding that cytotoxic CD8+ T cells (CD8+GZMB+ T cells) were associated with worse RFS and OS (HR 1.8 p=0.0338 and HR=2.8 p=0.0013, respectively). In a multivariate model, only CD8+GZMB+ T cell infiltration remained significant for OS (p=0.0224), suggesting independence. CD8+GZMB+ T cell infiltration inversely correlated with TILs (p=0.0293) and CD8/mm2 counts in the tumor core (p=0.0020) and showed a positive correlation with B7H4 tumor expression (p=0.0183). Additionally, high CD8+GZMB+ cases showed low HLA-A (p=0.0189) expression in tumor cells. In accordance, high CD8+GZMB+ tumors mainly correspond to stroma-restricted, margin-restricted and immune-desert tumor immune microenvironment landscapes.
Conclusions: We have found a paradoxical association of GZMB+ CD8+ T cells with a negative prognosis in NAC-treated TNBC. We hypothesize that while these T cells are poised for cytotoxic activity, they remain restricted through sub-localization outside the tumor core, downregulation of HLA-A on tumor cells preventing interaction with the T cell receptor, and upregulation of B7H4 expression, which has been shown to inhibit cytotoxic T cell activity. Patients with high CD8+GZMB+ tumors in the post-NAC setting may benefit from adjuvant immunotherapy, particularly in combination with therapies that enhance MHC-I (e.g. HLA-A) antigen presentation.
Citation Format: Paula I Gonzalez-Ericsson, Violeta Sanchez, Roberto Salgado, Jennifer Bordeaux, Ju Y Kim, Christine Vaupel, Henry Gomez, Melinda E Sanders, Justin M Balko. The immune landscape of residual triple-negative breast cancers after neoadjuvant chemotherapy [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr PD5-07.
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Affiliation(s)
| | | | | | | | - Ju Y Kim
- 3Navigate Biopharma Services, Inc., Carlsbad, CA
| | | | - Henry Gomez
- 4Instituto Nacional de Enfermedades Neoplásicas (INEN), Lima, Peru
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25
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Balko JM, Nixon M, Gonzalez-Ericsson PI, Pilkinton MA, McDonnell WJ, Sanchez V, Opalenik SR, Loi S, Rexer B, Abramson V, Jansen V, Mallal S, Marotti JD, Shee K, Miller TW, Sanders ME, Mayer IA, Salgado R. Abstract P3-08-15: Immunologic correlates of long-term outcome in the residual disease of triple-negative breast cancer after neoadjuvant chemotherapy. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p3-08-15] [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
The recent approval of anti-PD-L1 immunotherapy in combination with nAB-paclitaxel for metastatic triple-negative breast cancer (TNBC) highlights the need to understand the role of chemotherapy in modulating the tumor-immune microenvironment (TIME). Patients with TNBC are routinely treated with neoadjuvant chemotherapy (NAC). Stromal tumor-infiltrating lymphocytes (sTILs) in the pre-treatment diagnostic biopsy are predictive of pathologic complete response (pCR). In patients with residual disease (RD) at surgery, sTILs confer good prognosis. However, the effect of chemotherapy on sTILs and how it influences the TIME are poorly understood. We examined immune-gene expression patterns before and after NAC in a series of 83 breast tumors, including 44 TNBCs, from patients with RD. sTILs were enumerated by standardized guidelines. Gene expression patterns were tested for association with recurrence-free (RFS) and overall survival (OS). T cell receptor sequencing (TCRseq) was performed on a subset (n=15) of tumors. In 4 patients undergoing NAC, PD-1-high and -negative CD8+ peripheral blood mononuclear cells (PBMCs) were profiled using single-cell RNAseq and multiplexed cytokine secretion assays. Post-NAC sTILs (≥30%) were only predictive of outcome (RFS p=0.019; OS p=0.05) in TNBC patients, but not in non-TNBC patients (RFS p=0.28; OS p=0.78) confirming that the prognostic capacity of sTILs is confined to TNBC. Pre-NAC sTILs were not predictive of outcome in either group, likely due to exclusion of patients experiencing pCR. The change in sTILs during NAC did not prognosticate outcome in TNBC, suggesting that in the post-NAC setting, only the most proximal measurement of sTILs is meaningful. However, these results did suggest that NAC alters the TIME. To examine the interplay among NAC, the TIME, and clinical outcomes, we tested the change in expression of 770 immune-related genes during NAC in univariate cox-proportional hazards models. In non-TNBC, no change in expression of any single gene was associated with RFS or OS at a false-discovery rate (FDR) of 10%. In TNBC, individual changes in 12 genes and 204 genes were identified as associated with RFS and OS, respectively (FDR<10%). Interestingly, in nearly all cases, upregulation of these genes during NAC was associated with improved outcome, with only 1 and 15 genes being associated with poor RFS and OS, respectively. Collapsing genes to functional and cell-type specific signatures gave similar insights: T cell, NK cell, TNF-superfamily, and toll-like receptor signatures were highly prognostic. Surprisingly, NAC did not alter T cell clonality in TNBC. Thus, the immunologic impact of chemotherapy appears to be specific to TNBC and is primarily a beneficial effect but does not appear to appreciably expand the clonality of tumor-infiltrating T cells. Using fresh PD-1HI CD8+ T cells isolated from PBMCs of patients undergoing NAC, we detected a significant increase in cytolytic and inflammatory cytokines secreted in 2 TNBC patients after chemotherapy, but not in 2 non-TNBC patients, which was particularly dramatic in one TNBC patient who experienced a pCR. A further characterization of PD-1HI CD8+ cells by single-cell RNAseq identified a sizeable expansion of cytolytic gene (granulysin, Ksp37, granzyme) expressing cells in the TNBC patient with pCR compared to the TNBC patient with RD. In conclusion, we have characterized the effects of NAC on the TIME. TNBC appears to be uniquely sensitive to the immunologic effects of NAC, and most of these effects are primarily stimulatory, rather than repressive. Finally, these changes can be observed in the PD-1HI CD8+ peripheral T cell compartment and appeared to co-occur with pCR.
Citation Format: Justin M Balko, Mellissa Nixon, Paula I Gonzalez-Ericsson, Mark A Pilkinton, Wyatt J McDonnell, Violeta Sanchez, Susan R Opalenik, Sherene Loi, Brent Rexer, Vandana Abramson, Valerie Jansen, Simon Mallal, Jonathan D Marotti, Kevin Shee, Todd W Miller, Melinda E Sanders, Ingrid A Mayer, Roberto Salgado. Immunologic correlates of long-term outcome in the residual disease of triple-negative breast cancer after neoadjuvant chemotherapy [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P3-08-15.
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Affiliation(s)
| | | | | | | | | | | | | | - Sherene Loi
- 2Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Brent Rexer
- 1Vanderbilt University Medical Center, Nashville, TN
| | | | | | - Simon Mallal
- 1Vanderbilt University Medical Center, Nashville, TN
| | | | - Kevin Shee
- 4Dartmouth College Norris Cotton Cancer Center, Hanover, NH
| | - Todd W Miller
- 4Dartmouth College Norris Cotton Cancer Center, Hanover, NH
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26
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Williams MM, Elion DL, Rahman B, Hicks DJ, Sanchez V, Cook RS. Therapeutic inhibition of Mcl-1 blocks cell survival in estrogen receptor-positive breast cancers. Oncotarget 2019; 10:5389-5402. [PMID: 31595181 PMCID: PMC6739218 DOI: 10.18632/oncotarget.27070] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 06/14/2019] [Indexed: 12/17/2022] Open
Abstract
Cancers often overexpress anti-apoptotic Bcl-2 proteins for cell death evasion, a recognized hallmark of cancer progression. While estrogen receptor (ER)-α+ breast cancers express high levels of three anti-apoptotic Bcl-2 family members (Bcl-2, Bcl-xL, and Mcl-1), pharmacological inhibition of Bcl-2 and/or Bcl-xL fails to induce cell death in ERα+ breast cancer cell lines, due to rapid and robust Mcl-1 upregulation. The mechanisms of acute Mcl-1 upregulation in response to Bcl-2/Bcl-xL inhibition remain undefined in in ERα+ breast cancers. We report here that blockade of Bcl-2 or Bcl-xL, alone or together, rapidly induced mTOR signaling in ERα+ breast cancer cells, rapidly increasing cap-dependent Mcl-1 translation. Cells treated with a pharmacological inhibitor of cap-dependent translation, or with the mTORC1 inhibitor RAD001/everolimus, displayed reduced protein levels of Mcl-1 under basal conditions, and failed to upregulate Mcl-1 protein expression following treatment with ABT-263, a pharmacological inhibitor of Bcl-2 and Bcl-xL. Although treatment with ABT-263 alone did not sustain apoptosis in tumor cells in culture or in vivo, ABT-263 plus RAD001 increased apoptosis to a greater extent than either agent used alone. Similarly, combined use of the selective Mcl-1 inhibitor VU661013 with ABT-263 resulted in tumor cell apoptosis and diminished tumor growth in vivo. These findings suggest that rapid Mcl-1 translation drives ABT-263 resistance, but can be combated directly using emerging Mcl-1 inhibitors, or indirectly through existing and approved mTOR inhibitors.
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Affiliation(s)
| | - David L Elion
- Program in Cancer Biology, Vanderbilt University, Nashville, TN 37232, USA
| | - Bushra Rahman
- Department of Cell and Developmental Biology, Vanderbilt University, Nashville, TN 37232, USA
| | - Donna J Hicks
- Department of Cell and Developmental Biology, Vanderbilt University, Nashville, TN 37232, USA
| | - Violeta Sanchez
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Rebecca S Cook
- Program in Cancer Biology, Vanderbilt University, Nashville, TN 37232, USA.,Department of Cell and Developmental Biology, Vanderbilt University, Nashville, TN 37232, USA.,Department of Biomedical Engineering, Vanderbilt University, Nashville TN 37232, USA.,The Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN 37232, USA
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27
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Guala A, Teixido Tura G, Rodriguez-Palomares JF, Ruiz Munoz A, Granato C, Galian L, Valente F, Servato L, Villalva N, Gutierrez L, Lopez Sainz A, Gonzalez-Alujas T, Sanchez V, Forteza A, Evangelista A. P1821Proximal aorta longitudinal but not circumferential strain predicts aortic events and aortic root dilation rate in marfan syndrome patients. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0573] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The most common cardiovascular complications in Marfan syndrome (MFS) are aortic root dilation and type A aortic dissections. Elective aortic root surgery is indicated when maximum aortic diameter is larger than a defined threshold or in the case of fast-progressing dilation. However, maximum aortic diameter is limited for the prediction of aortic events. Indeed, a large international registry of acute aortic syndromes reported that as much as 40% of aortic dissections happen with maximum aortic diameter lower than 50 mm. Consequently, there is a need for new, non-invasive biomarkers to improve the prediction of aortic complications.
Purpose
The aim of the present study was to assess if proximal aorta circumferential and longitudinal strain and ascending aorta distensibility were associated with progressive aortic dilation and incidence of aortic events in Marfan syndrome patients.
Methods
Eighty seven Marfan syndrome patients free from previous cardiac/aortic surgery or dissection, were prospectively included in a multicenter follow-up. Patients were diagnosed by original Ghent criteria. Proximal aorta longitudinal and circumferential strain and distensibility were computed from baseline cine CMR images by means of feature-tracking. The predictive capacity of each stiffness biomarkers was separately tested with multivariable linear regression analysis (aortic growth) and with Cox logistic regression analysis (aortic events), both corrected for clinical and demographic variables, including baseline maximum aortic diameter.
Results
During a follow-up of 81.6±17 months, mean diameter growth-rate was 0.65±0.67 mm/year and z-score growth rate was 0.07±0.13 / year. Elective aortic root replacement was performed in 11 patients while two patients presented type A aortic dissection.Baseline proximal aorta longitudinal strain was independently related to diameter growth-rate (p=0.001), z-score growth-rate (p=0.018) and aortic events (p=0.018). Conversely, neither circumferential strain nor distensibility were independent predictors of diameter growth-rate (p=0.385 and p=0.381, respectively), z-score growth-rate (p=0.515 and p=0.484, respectively) and aortic events (p=0.064 and p=0.205, respectively).
Conclusions
Proximal aorta longitudinal strain predicts aortic root dilation and major aortic events in Marfan syndrome patients beyond aortic root diameter and clinical and demographic characteristics.
Acknowledgement/Funding
ISCIII PI14/0106, La Maratό de TV3 (20151330) and CIBERCV. Guala A. FP7/People n° 267128
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Affiliation(s)
- A Guala
- University Hospital Vall d'Hebron, Barcelona, Spain
| | | | | | - A Ruiz Munoz
- University Hospital Vall d'Hebron, Barcelona, Spain
| | - C Granato
- University Hospital Vall d'Hebron, Barcelona, Spain
| | - L Galian
- University Hospital Vall d'Hebron, Barcelona, Spain
| | - F Valente
- University Hospital Vall d'Hebron, Barcelona, Spain
| | - L Servato
- University Hospital Vall d'Hebron, Barcelona, Spain
| | - N Villalva
- University Hospital Vall d'Hebron, Barcelona, Spain
| | - L Gutierrez
- University Hospital Vall d'Hebron, Barcelona, Spain
| | | | | | - V Sanchez
- University Hospital 12 de Octubre, Madrid, Spain
| | - A Forteza
- University Hospital Puerta de Hierro Majadahonda, Madrid, Spain
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28
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Dentamaro I, Sao-Aviles A, Teixido G, Galian L, Gutierrez L, Gonzalez-Alujas MT, Calvo F, Sanchez V, Alegret J, Colonna P, Moreo A, Citro R, Chirillo F, Rodriguez-Palomares JF, Evangelista A. P3373Predictors of dilatation of ascending aorta in patients with bicuspid aortic valve, a longitudinal multicenter study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0249] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
The bicuspid aortic valve (BAV) is frequently associated to dilation of the ascending aorta. Some cross-sectional studies have related the aortic dilation with morphotype and valvular dysfunction. The aim of this longitudinal multicenter study was to analyze the progression of the aortic dilation and to identify its predictors.
Methods
We included 459 patients (mean age 52±17; 325 men 70.8%) with BAV, without aortic coarctation. The BAV morphotype, significant valvular dysfunction and dilation of the aortic root and ascending aorta were established by echocardiography. The patients were followed annually, with an average of 7.5±3.2 years.
Results
77% of the patients had BAV with a fusion between left and right cusps, 21% between right and non coronary cusps and 2% between left and non coronary cusps, with a raphe in 77% of these patients. Risk factors included: 35% hypertension, 20% smoking, 5% diabetes and 18% dyslipidemia. The baseline study showed a maximum root diameter of 36±6.2 mm and ascending aorta of 39±8.1 mm. In 7% the aortic root was>45 mm, while in 32% the ascending aorta>45 mm. There was no valvular dysfunction in 17% of patients, while the 8% had significant aortic stenosis and 35% significant aortic regurgitation. The annual growth of the aortic root was 0.33±0.2 mm and for the ascending aorta was 0.38±0.3 mm. At the end of follow-up, 16% of the patients had a root>45 mm and 41% an ascending aorta>45 mm. The annual progression of aortic diameters was not related to valvular morphotype, valvular dysfunction or cardiovascular risk factors. The univariate analysis showed a significant relationship between the annual growth of the aortic root and arterial hypertension (p=0.028) and the annual growth of the ascending aorta with the male sex (p=0.019), smoking (p=0.046) and significant (moderate or severe) aortic stenosis (p=0.013). Diabetes mellitus and the presence of raphe were found to be slightly protective (p=0.049 and p=0.031, respectively). In the multivariate analysis, only the male sex and significant aortic stenosis were independent predictors of dilation of the ascending aorta.
Conclusions
In patients with bicuspid aortic valve, the progression of the dilation of the aortic root is related to hypertension and the growth of the ascending aorta with the male sex and the presence of significant aortic stenosis. Both bicuspid valve morphotype, basal aortic diameter or age were not related to the progression of aortic dilation.
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Affiliation(s)
- I Dentamaro
- University Hospital Vall d'Hebron, Barcelona, Spain
| | - A Sao-Aviles
- University Hospital Vall d'Hebron, Barcelona, Spain
| | - G Teixido
- University Hospital Vall d'Hebron, Barcelona, Spain
| | - L Galian
- University Hospital Vall d'Hebron, Barcelona, Spain
| | - L Gutierrez
- University Hospital Vall d'Hebron, Barcelona, Spain
| | | | - F Calvo
- Hospital of Meixoeiro, Cardiology Department, Vigo, Spain
| | - V Sanchez
- University Hospital 12 de Octubre, Cardiology Department, Madrid, Spain
| | - J Alegret
- Hospital Universitario Joan XXIII, Cardiology Department, Tarragona, Spain
| | - P Colonna
- Polyclinic Hospital of Bari, Cardiology Department, Bari, Italy
| | - A Moreo
- Niguarda Ca' Granda Hospital, Milan, Italy
| | - R Citro
- AOU S. Giovanni e Ruggi, Cardiology Department, Salerno, Italy
| | - F Chirillo
- Bassano del Grappa General Hospital, Cardiology Department, Bassano Del Grappa, Italy
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Johnson DB, McDonnell WJ, Gonzalez-Ericsson PI, Al-Rohil RN, Mobley BC, Salem JE, Wang DY, Sanchez V, Wang Y, Chastain CA, Barker K, Liang Y, Warren S, Beechem JM, Menzies AM, Tio M, Long GV, Cohen JV, Guidon AC, O'Hare M, Chandra S, Chowdhary A, Lebrun-Vignes B, Goldinger SM, Rushing EJ, Buchbinder EI, Mallal SA, Shi C, Xu Y, Moslehi JJ, Sanders ME, Sosman JA, Balko JM. A case report of clonal EBV-like memory CD4 + T cell activation in fatal checkpoint inhibitor-induced encephalitis. Nat Med 2019; 25:1243-1250. [PMID: 31332390 PMCID: PMC6689251 DOI: 10.1038/s41591-019-0523-2] [Citation(s) in RCA: 118] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 06/12/2019] [Indexed: 12/18/2022]
Abstract
Checkpoint inhibitors produce durable responses in numerous metastatic cancers, but immune-related adverse events (irAEs) complicate and limit their benefit. IrAEs can affect organ systems idiosyncratically; presentations range from mild and self-limited to fulminant and fatal. The molecular mechanisms underlying irAEs are poorly understood. Here, we report a fatal case of encephalitis arising during anti-programmed cell death receptor 1 therapy in a patient with metastatic melanoma. Histologic analyses revealed robust T cell infiltration and prominent programmed death ligand 1 expression. We identified 209 reported cases in global pharmacovigilance databases (across multiple cancer types) of encephalitis associated with checkpoint inhibitor regimens, with a 19% fatality rate. We performed further analyses from the index case and two additional cases to shed light on this recurrent and fulminant irAE. Spatial and multi-omic analyses pinpointed activated memory CD4+ T cells as highly enriched in the inflamed, affected region. We identified a highly oligoclonal T cell receptor repertoire, which we localized to activated memory cytotoxic (CD45RO+GZMB+Ki67+) CD4 cells. We also identified Epstein-Barr virus-specific T cell receptors and EBV+ lymphocytes in the affected region, which we speculate contributed to neural inflammation in the index case. Collectively, the three cases studied here identify CD4+ and CD8+ T cells as culprits of checkpoint inhibitor-associated immune encephalitis.
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Affiliation(s)
- Douglas B Johnson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA. .,Vanderbilt Institute for Infection, Immunology and Inflammation, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Wyatt J McDonnell
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.,Vanderbilt Institute for Infection, Immunology and Inflammation, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA.,Center for Translational Immunology and Infectious Disease, Vanderbilt University Medical Center, Nashville, TN, USA.,Vanderbilt Vaccine Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Rami N Al-Rohil
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Pathology and Dermatology, Duke University Medical Center, Durham, NC, USA
| | - Bret C Mobley
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Joe-Elie Salem
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.,Sorbonne Université, INSERM CIC Paris-Est, AP-HP, ICAN, Regional Pharmacovigilance Centre, Pitié-Salpêtrière Hospital, Department of Pharmacology, Paris, France
| | - Daniel Y Wang
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Violeta Sanchez
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Yu Wang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Cody A Chastain
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Yan Liang
- NanoString Technologies, Seattle, WA, USA
| | | | | | - Alexander M Menzies
- Melanoma Institute Australia, Sydney, Australia.,The University of Sydney, Sydney, New South Wales, Australia.,Royal North Shore Hospital, Sydney, New South Wales, Australia.,Mater Hospital, Sydney, New South Wales, Australia
| | - Martin Tio
- Melanoma Institute Australia, Sydney, Australia
| | - Georgina V Long
- Melanoma Institute Australia, Sydney, Australia.,The University of Sydney, Sydney, New South Wales, Australia.,Royal North Shore Hospital, Sydney, New South Wales, Australia.,Mater Hospital, Sydney, New South Wales, Australia
| | | | | | | | - Sunandana Chandra
- Feinberg School of Medicine, Northwestern University, Evanston, IL, USA
| | - Akansha Chowdhary
- Feinberg School of Medicine, Northwestern University, Evanston, IL, USA
| | - Bénédicte Lebrun-Vignes
- Sorbonne Université, INSERM CIC Paris-Est, AP-HP, ICAN, Regional Pharmacovigilance Centre, Pitié-Salpêtrière Hospital, Department of Pharmacology, Paris, France
| | | | | | | | - Simon A Mallal
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.,Vanderbilt Institute for Infection, Immunology and Inflammation, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA.,Center for Translational Immunology and Infectious Disease, Vanderbilt University Medical Center, Nashville, TN, USA.,Institute for Immunology and Infectious Diseases, Perth, Australia
| | - Chanjuan Shi
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Yaomin Xu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Javid J Moslehi
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Melinda E Sanders
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Justin M Balko
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA. .,Vanderbilt Institute for Infection, Immunology and Inflammation, Vanderbilt University Medical Center, Nashville, TN, USA. .,Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA. .,Breast Cancer Research Program, Vanderbilt University Medical Center, Nashville, TN, USA.
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Wilson JT, Shae D, Gonzalez-Ericsson PI, Sanchez V, Gong J, Liang Y, Hinerfeld D, Beechem JM, Balko JM. Abstract 4978: Digital spatial profiling of molecular responses to nanoparticle STING agonists identify S100A9 and B7-H3 as possible escape mechanisms. Cancer Res 2019. [DOI: 10.1158/1538-7445.am2019-4978] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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
Cyclic dinucleotide (CDN) agonists of stimulator of interferon genes (STING) activate innate immunity to increase tumor immunogenicity. However, the efficacy of CDNs is limited by drug delivery barriers, including inefficient transport to the cytosol where STING is localized. We recently developed STING-activating nanoparticles (STING-NPs), polymer vesicles designed for enhanced cytosolic delivery of the endogenous CDN ligand for STING, 2’3’ cyclic guanosine monophosphate-adenosine monophosphate (cGAMP). Intratumorally-administered (IT) STING-NPs significantly enhance the therapeutic efficacy of cGAMP and improve response to immune checkpoint inhibition (ICI) in established murine B16 melanoma tumors. However, the immunologic effects of STING-NPs have not been well characterized in tumors or lymphatic tissue.
We utilized Digital Spatial Profiling (DSP) to identify immunologic responses in the injected tumor, a distal tumor, and both tumor draining lymph nodes (TDLN) 48 hours after a single IT injection of STING-NP or three injections of STING-NP co-administered with systemic ICI (anti-PD-1/CTLA-4). DSP analysis permits simultaneous detection of over 30 protein markers in distinct spatial regions of interest (ROI; n=2-4 per tumor/TDLN) or cell types in tissue sections.
After a single STING-NP injection of B16 tumors, B7-H3, an immunosuppressive T cell checkpoint, was significantly induced in tumors compared to PBS or free cGAMP. More strikingly, in T cell-rich regions of the TDLN, STING-NP dramatically increased B7-H3, GZMB, and S100A9 while suppressing VISTA and CD73 expression. After multiple injections of STING-NP, B7-H3, S100A9, CD73, Foxp3, and beta-catenin were substantially upregulated in the injected tumor, with more modest fold changes in distal tumors. Co-treatment with systemic ICI in part abrogated this effect. In contrast, STING-NP-induced changes in GZMB, CD4, and CD8a expression were observed regardless of ICI treatment, and were generally equivalent in both treated and distal tumors, suggesting an abscopal effect. Both the treated and distal TDLN showed striking S100A9 increases which was preferential, but not exclusive, to T cell-rich vs. B cell regions. This effect was exacerbated with the combination of STING-NP and ICI therapy. B7-H3 upregulation in response to STING-NP (regardless of ICI) was exclusive to treated TLDNs vs. distal TDLNs. B7-H3 was expressed in both B and T cell regions, but was nearly two-fold higher in B cell-rich regions. Upregulation of GZMB (5-10 fold over free cGAMP alone) was observed in both treated and distal TDLNs.
Markers of T cell activation were observed after STING-NP treatment, including moderate abscopal effects in synchronous distal tumors. In TDLNs, STING-NP robustly induced S100A9 and B7-H3, which may be immunosuppressive escape mechanisms that could be targeted to enhance responses.
Citation Format: John T. Wilson, Daniel Shae, Paula I. Gonzalez-Ericsson, Violeta Sanchez, JingJing Gong, Yan Liang, Douglas Hinerfeld, Joseph M. Beechem, Justin M. Balko. Digital spatial profiling of molecular responses to nanoparticle STING agonists identify S100A9 and B7-H3 as possible escape mechanisms [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 4978.
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Affiliation(s)
| | | | | | | | | | - Yan Liang
- 3NanoString Technologies, Seattle, WA
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31
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Guala A, Teixidó-Tura G, Rodríguez-Palomares J, Ruiz-Muñoz A, Dux-Santoy L, Villalva N, Granato C, Galian L, Gutiérrez L, González-Alujas T, Sanchez V, Forteza A, García-Dorado D, Evangelista A. Proximal aorta longitudinal strain predicts aortic root dilation rate and aortic events in Marfan syndrome. Eur Heart J 2019. [PMID: 30977783 DOI: 10.1093/eurheart/ehz191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
AIMS Life expectancy in Marfan syndrome patients has improved thanks to the early detection of aortic dilation and prophylactic aortic root surgery. Current international clinical guidelines support the use of aortic root diameter as a predictor of complications. However, other imaging markers are needed to improve risk stratification. This study aim to ascertain whether proximal aorta longitudinal and circumferential strain and distensibility assessed by cardiac magnetic resonance (CMR) predict the aortic root dilation rate and aortic events in Marfan syndrome. METHODS AND RESULTS One hundred and seventeen Marfan patients with no previous aortic dissection, cardiac/aortic surgery, or moderate/severe aortic regurgitation were prospectively included in a multicentre protocol of clinical and imaging follow-up. At baseline, CMR was performed and proximal aorta longitudinal strain and ascending aorta circumferential strain and distensibility were obtained. During follow-up (85.7 [75.0-93.2] months), the annual growth rate of aortic root diameter was 0.62 ± 0.65 mm/year. Fifteen patients underwent elective surgical aortic root replacement and four presented aortic dissection. Once corrected for baseline clinical and demographic characteristics and aortic root diameter, proximal aorta longitudinal strain, but not circumferential strain and distensibility, was an independent predictor of the aortic root diameter growth rate (P = 0.001, P = 0.823, and P = 0.997, respectively), z-score growth rate (P = 0.013, P = 0.672, and P = 0.680, respectively), and aortic events (P = 0.023, P = 0.096, and P = 0.237, respectively). CONCLUSION Proximal aorta longitudinal strain is independently related to the aortic root dilation rate and aortic events in addition to aortic root diameter, clinical risk factors, and demographic characteristics in Marfan syndrome patients.
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Affiliation(s)
- Andrea Guala
- Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Vall d'Hebron institut de Recerca, Universitat Autònoma de Barcelona, Paseo Vall d'Hebron 119-129, Barcelona, Spain
| | - Gisela Teixidó-Tura
- Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Vall d'Hebron institut de Recerca, Universitat Autònoma de Barcelona, Paseo Vall d'Hebron 119-129, Barcelona, Spain
| | - Jose Rodríguez-Palomares
- Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Vall d'Hebron institut de Recerca, Universitat Autònoma de Barcelona, Paseo Vall d'Hebron 119-129, Barcelona, Spain
| | - Aroa Ruiz-Muñoz
- Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Vall d'Hebron institut de Recerca, Universitat Autònoma de Barcelona, Paseo Vall d'Hebron 119-129, Barcelona, Spain
| | - Lydia Dux-Santoy
- Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Vall d'Hebron institut de Recerca, Universitat Autònoma de Barcelona, Paseo Vall d'Hebron 119-129, Barcelona, Spain
| | - Nicolas Villalva
- Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Vall d'Hebron institut de Recerca, Universitat Autònoma de Barcelona, Paseo Vall d'Hebron 119-129, Barcelona, Spain
| | - Chiara Granato
- Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Vall d'Hebron institut de Recerca, Universitat Autònoma de Barcelona, Paseo Vall d'Hebron 119-129, Barcelona, Spain
| | - Laura Galian
- Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Vall d'Hebron institut de Recerca, Universitat Autònoma de Barcelona, Paseo Vall d'Hebron 119-129, Barcelona, Spain
| | - Laura Gutiérrez
- Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Vall d'Hebron institut de Recerca, Universitat Autònoma de Barcelona, Paseo Vall d'Hebron 119-129, Barcelona, Spain
| | - Teresa González-Alujas
- Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Vall d'Hebron institut de Recerca, Universitat Autònoma de Barcelona, Paseo Vall d'Hebron 119-129, Barcelona, Spain
| | - Violeta Sanchez
- Department of Cardiology, Hospital doce de Octubre, Avenida Cordoba, Madrid, Spain
| | - Alberto Forteza
- Department of Cardiac Surgery, Hospital Puerta de Hierro. Calle Manuel de Falla, 1, Majadahonda, Spain
| | - David García-Dorado
- Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Vall d'Hebron institut de Recerca, Universitat Autònoma de Barcelona, Paseo Vall d'Hebron 119-129, Barcelona, Spain
| | - Artur Evangelista
- Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Vall d'Hebron institut de Recerca, Universitat Autònoma de Barcelona, Paseo Vall d'Hebron 119-129, Barcelona, Spain
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Franklin DA, Sharick JT, Ericsson-Gonzalez PI, Sanchez V, Dean PT, Opalenik SR, Cairo S, Judde JG, Lewis MT, Chang JC, Sanders ME, Cook RS, Skala MC, Bordeaux J, Bender JO, Vaupel C, Geiss G, Hinerfeld D, Balko JM. Abstract 1511: MEK activation modulates immunosuppressive MDSCs and metabolic phenotypes in TNBC. Cancer Res 2019. [DOI: 10.1158/1538-7445.am2019-1511] [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
Triple-negative breast cancers (TNBCs) are highly heterogeneous and aggressive, with high mortality rates. Although TNBC is typically more responsive to chemotherapy than other breast cancer subtypes, many patients develop chemo-resistance. The molecular processes between tumor and stromal cells involved in developing chemo-resistance are under-explored. Here we report studies of paired TNBC patient-derived xenografts (PDX) established before and after chemo-resistance. Despite significant genetic similarities, the chemo-resistant PDX model harbored a rare constitutively-active KRASQ61R mutation which was not present in the chemo-naive PDX. Further analysis demonstrated that the chemo-resistant KRAS-mutant model exhibited altered gene expression changes including increased expression of CXCR2-ligands CXCL1 and CXCL2, which are responsible for recruiting immune cells to tumors. These expression patterns were largely inhibited in vivo by MEK inhibitor (MEKi) treatment. Moreover, in breast cancer cell lines, CXCL1, CXCL2, and granulocyte macrophage-colony stimulating factor (CSF2, stimulates granulocyte and macrophage differentiation from hematopoietic precursor cells, including immunosuppressive myeloid cells) transcripts were also downregulated by MEKi. Notably, chemo-resistant KRAS-mutant tumors harbored increased Gr1+ and Arginase-1+ cells, consistent with recruitment of immunosuppressive M2-like macrophages and/or myeloid-derived suppressor cells (MDSCs), which was inhibited by MEKi. Further experiments demonstrate that CD45+CD11b+Ly6G+ MDSC accumulation in tumors can be inhibited by MEKi treatment alone, or by CXCR2 inhibition, suggesting that the effects of MEK inhibition on MDSC recruitment are CXCL1/2-dependent. Confirming the translational relevance of these findings, in >200 murine and >1000 human breast tumors, Ras/MAPK transcriptional activity correlated with myeloid-recruiting CXCL1/2 expression and negatively with T-cell recruiting chemokines (CXCL9/10/11), even in the absence of activating KRAS mutations. The association with Ras/MAPK activity was also confirmed using immunofluorescence to quantify MHC-II-low myeloid cells in 80 post-chemotherapy TNBC tumors. Importantly, MEKi and chemotherapy combination treatment reversed immunosuppressive cell accumulation and metabolic phenotypes exemplified by altered optical redox ratios (NAD(P)H/FAD) in the chemo-resistant KRAS mutant tumors, resulting in tumor growth suppression in mice. MEKi treatment also reduced redox ratios in 3D cultures of breast cancer cell lines further suggesting that MEK inhibition targets multiple oncogenic processes in breast cancer. These results suggest that Ras/MAPK pathway inhibitors may be effective in some breast cancer patients to reverse Ras/MAPK-driven tumor metabolism and immunosuppression, particularly in the setting of chemo-resistant disease.
Citation Format: Derek A. Franklin, Joe T. Sharick, Paula I. Ericsson-Gonzalez, Violeta Sanchez, Phillip T. Dean, Susan R. Opalenik, Stefano Cairo, Jean-Gabriel Judde, Michael T. Lewis, Jenny C. Chang, Melinda E. Sanders, Rebecca S. Cook, Melissa C. Skala, Jennifer Bordeaux, Jehovana Orozco Bender, Christine Vaupel, Gary Geiss, Douglas Hinerfeld, Justin M. Balko. MEK activation modulates immunosuppressive MDSCs and metabolic phenotypes in TNBC [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 1511.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Melissa C. Skala
- 5Morgridge Institute for Research, University of Wisconsin, Madison, WI
| | - Jennifer Bordeaux
- 6Navigate Biopharma Services, Inc. a Novartis subsidiary, Carlsbad, CA
| | | | - Christine Vaupel
- 6Navigate Biopharma Services, Inc. a Novartis subsidiary, Carlsbad, CA
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33
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Guala A, Rodriguez-Palomares JF, Ruiz Munoz A, Dux-Santoy L, Villalva N, Granato C, Galian L, Gutierrez L, Gonzalez-Alujas T, Gandara M, Sanchez V, Forteza A, Garcia-Dorado D, Evangelista A, Teixido Tura G. P412Prognostic value of proximal aorta longitudinal strain for aortic events and dilation in Marfan syndrome patients. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez118.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Guala
- University Hospital Vall d"Hebron, Department of Cardiology, Barcelona, Spain
| | | | - A Ruiz Munoz
- University Hospital Vall d"Hebron, Department of Cardiology, Barcelona, Spain
| | - L Dux-Santoy
- University Hospital Vall d"Hebron, Department of Cardiology, Barcelona, Spain
| | - N Villalva
- University Hospital Vall d"Hebron, Department of Cardiology, Barcelona, Spain
| | - C Granato
- University Hospital Vall d"Hebron, Department of Cardiology, Barcelona, Spain
| | - L Galian
- University Hospital Vall d"Hebron, Department of Cardiology, Barcelona, Spain
| | - L Gutierrez
- University Hospital Vall d"Hebron, Department of Cardiology, Barcelona, Spain
| | - T Gonzalez-Alujas
- University Hospital Vall d"Hebron, Department of Cardiology, Barcelona, Spain
| | - M Gandara
- University Hospital Vall d"Hebron, Department of Cardiology, Barcelona, Spain
| | - V Sanchez
- University Hospital 12 de Octubre, Madrid, Spain
| | - A Forteza
- University Hospital Puerta de Hierro Majadahonda, Madrid, Spain
| | - D Garcia-Dorado
- University Hospital Vall d"Hebron, Department of Cardiology, Barcelona, Spain
| | - A Evangelista
- University Hospital Vall d"Hebron, Department of Cardiology, Barcelona, Spain
| | - G Teixido Tura
- University Hospital Vall d"Hebron, Department of Cardiology, Barcelona, Spain
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Elion DL, Jacobson ME, Hicks DJ, Rahman B, Sanchez V, Gonzales-Ericsson PI, Fedorova O, Pyle AM, Wilson JT, Cook RS. Abstract A187: RIG-I agonists reinforce antitumor adaptive immunity and decrease Treg activity in breast cancer. Cancer Immunol Res 2019. [DOI: 10.1158/2326-6074.cricimteatiaacr18-a187] [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
RIG-I like receptors, RNA helicases that sense viral oligonucleotide motifs and activate innate immunity, are gaining interest in cancer therapy, given their ability to redirect immune responses within the tumor microenvironment (TME), and increase efficacy of experimental cancer vaccines. RIG-I agonists are not well studied in breast cancers, a type of cancer that is often considered immunologically “silent.” We recently reported that therapeutic delivery of RIG-I agonists increase tumor-infiltrating leukocytes (TILs) and expression of proinflammatory Th1 cytokines in the 4T1 mouse model of aggressive, metastatic breast cancer through tumor cell-intrinsic mechanisms. However, these studies do not rule out the importance of myeloid immune responders (e.g., macrophages and dendritic cells) in propagating the effects of RIG-I agonists against tumor cells in vivo, nor do they rule out the impact of RIG-I agonists on adaptive antitumor immunity, a subject that is relatively understudied. We assessed the effects of the RIG-I agonist SLR20 on the the activity of effector T-lymphocytes (TEff) and regulatory T-lymphocytes (TReg) in the TME. Interestingly, SLR20 treatment of mouse and human breast tumor cells increased expression of FAS and MHC-I on tumor cells, and caused tumor cells to express T-cell chemoattractants (e.g., CXCL10, RANTES), potentially increasing T-cells recruitment to tumors, and increasing tumor cell susceptibility to TEff recognition and killing. Using an ex vivo co-culture assay in which 4T1 mouse mammary tumor cells were co-cultured with CD8+ T-cells harvested from mice pre-inoculated with SLR20-treated 4T1 tumor cells, we measured the rate of CD8+-mediated tumor cell killing. This approach revealed that T-cells harvested from mice inoculated with SLR20-treated cells caused greater tumor cell killing than what was seen by CD8+ T-cells harvested from untreated mice. We also found that conditioned media harvested from 4T1 cells treated with SLR20 increased clonal expansion of CD3/CD28-activated T-cells above what was seen with conditioned media harvested from 4T1 cells treated with a control oligonucleotide or from untreated 4T1 cells. TGFβ-mediated differentiation of CD4+ T-cells into tolerogenic and immunosuppressive TRegs was measured in cultures of CD4+ T-cells treated with cultured media derived from SLR20-treated 4T1 cells. These studies showed that cultured media harvested from 4T1 cells treated with SLR20, but not from untreated 4T1 cells or 4T1 cells treated with a control ligand, diminished TReg differentiation, and decreased CD4+ T-cells surface expression of PD-1, CTLA4, and CCR8. Importantly, in vivo experiments assessing therapeutic treatment of 4T1 tumors with SLR20 revealed greater tumor growth inhibition when SLR20 was combined with PD-L1 targeting antibodies. Taken together, these findings indicate that therapeutic activation of RIG-I signaling operates at the interface of innate and adaptive immunity within breast tumors to redirect the TME from an immunosuppressed state to one that is immunogenic and receptive to clinically relevant checkpoint inhibitors.
Citation Format: David L. Elion, Max E. Jacobson, Donna J. Hicks, Bushra Rahman, Violeta Sanchez, Paula I Gonzales-Ericsson, Olga Fedorova, Anna M. Pyle, John T. Wilson, Rebecca S. Cook. RIG-I agonists reinforce antitumor adaptive immunity and decrease Treg activity in breast cancer [abstract]. In: Proceedings of the Fourth CRI-CIMT-EATI-AACR International Cancer Immunotherapy Conference: Translating Science into Survival; Sept 30-Oct 3, 2018; New York, NY. Philadelphia (PA): AACR; Cancer Immunol Res 2019;7(2 Suppl):Abstract nr A187.
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Affiliation(s)
- David L. Elion
- Vanderbilt University School of Medicine, Nashville, TN; Vanderbilt Ingram Cancer Center, Nashville, TN; Yale University, New Haven, CT; Vanderbilt University School of Engineering, Nashville, TN
| | - Max E. Jacobson
- Vanderbilt University School of Medicine, Nashville, TN; Vanderbilt Ingram Cancer Center, Nashville, TN; Yale University, New Haven, CT; Vanderbilt University School of Engineering, Nashville, TN
| | - Donna J. Hicks
- Vanderbilt University School of Medicine, Nashville, TN; Vanderbilt Ingram Cancer Center, Nashville, TN; Yale University, New Haven, CT; Vanderbilt University School of Engineering, Nashville, TN
| | - Bushra Rahman
- Vanderbilt University School of Medicine, Nashville, TN; Vanderbilt Ingram Cancer Center, Nashville, TN; Yale University, New Haven, CT; Vanderbilt University School of Engineering, Nashville, TN
| | - Violeta Sanchez
- Vanderbilt University School of Medicine, Nashville, TN; Vanderbilt Ingram Cancer Center, Nashville, TN; Yale University, New Haven, CT; Vanderbilt University School of Engineering, Nashville, TN
| | - Paula I Gonzales-Ericsson
- Vanderbilt University School of Medicine, Nashville, TN; Vanderbilt Ingram Cancer Center, Nashville, TN; Yale University, New Haven, CT; Vanderbilt University School of Engineering, Nashville, TN
| | - Olga Fedorova
- Vanderbilt University School of Medicine, Nashville, TN; Vanderbilt Ingram Cancer Center, Nashville, TN; Yale University, New Haven, CT; Vanderbilt University School of Engineering, Nashville, TN
| | - Anna M. Pyle
- Vanderbilt University School of Medicine, Nashville, TN; Vanderbilt Ingram Cancer Center, Nashville, TN; Yale University, New Haven, CT; Vanderbilt University School of Engineering, Nashville, TN
| | - John T. Wilson
- Vanderbilt University School of Medicine, Nashville, TN; Vanderbilt Ingram Cancer Center, Nashville, TN; Yale University, New Haven, CT; Vanderbilt University School of Engineering, Nashville, TN
| | - Rebecca S. Cook
- Vanderbilt University School of Medicine, Nashville, TN; Vanderbilt Ingram Cancer Center, Nashville, TN; Yale University, New Haven, CT; Vanderbilt University School of Engineering, Nashville, TN
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Johnson DB, Nixon MJ, Wang Y, Wang DY, Castellanos E, Estrada MV, Ericsson-Gonzalez PI, Cote CH, Salgado R, Sanchez V, Dean PT, Opalenik SR, Schreeder DM, Rimm DL, Kim JY, Bordeaux J, Loi S, Horn L, Sanders ME, Ferrell PB, Xu Y, Sosman JA, Davis RS, Balko JM. Tumor-specific MHC-II expression drives a unique pattern of resistance to immunotherapy via LAG-3/FCRL6 engagement. JCI Insight 2018; 3:120360. [PMID: 30568030 PMCID: PMC6338319 DOI: 10.1172/jci.insight.120360] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [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: 02/05/2018] [Accepted: 11/06/2018] [Indexed: 12/12/2022] Open
Abstract
Immunotherapies targeting the PD-1 pathway produce durable responses in many cancers, but the tumor-intrinsic factors governing response and resistance are largely unknown. MHC-II expression on tumor cells can predict response to anti-PD-1 therapy. We therefore sought to determine how MHC-II expression by tumor cells promotes PD-1 dependency. Using transcriptional profiling of anti-PD-1-treated patients, we identified unique patterns of immune activation in MHC-II+ tumors. In patients and preclinical models, MHC-II+ tumors recruited CD4+ T cells and developed dependency on PD-1 as well as Lag-3 (an MHC-II inhibitory receptor), which was upregulated in MHC-II+ tumors at acquired resistance to anti-PD-1. Finally, we identify enhanced expression of FCRL6, another MHC-II receptor expressed on NK and T cells, in the microenvironment of MHC-II+ tumors. We ascribe this to what we believe to be a novel inhibitory function of FCRL6 engagement, identifying it as an immunotherapy target. These data suggest a MHC-II-mediated context-dependent mechanism of adaptive resistance to PD-1-targeting immunotherapy.
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Affiliation(s)
| | | | - Yu Wang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | | | - Monica V. Estrada
- Department of Pathology, University of California, San Diego, San Diego, California, USA
| | - Paula I. Ericsson-Gonzalez
- Department of Pathology Microbiology, and Immunology, and,Breast Cancer Research Program, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Roberto Salgado
- Department of Pathology, GZA-ZNA Hospitals, Antwerp, Belgium.,Department of Oncology, University of Melbourne and Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | | | | | | | | | - David L. Rimm
- Departments of Pathology and Medicine, Yale University, New Haven, Connecticut, USA
| | - Ju Young Kim
- Navigate BioPharma Services Inc., a Novartis Company, Carlsbad, California, USA
| | - Jennifer Bordeaux
- Navigate BioPharma Services Inc., a Novartis Company, Carlsbad, California, USA
| | - Sherene Loi
- Department of Oncology, University of Melbourne and Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | | | - Melinda E. Sanders
- Department of Pathology Microbiology, and Immunology, and,Breast Cancer Research Program, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Yaomin Xu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jeffrey A. Sosman
- Department of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Randall S. Davis
- Departments of Medicine, Microbiology, and Biochemistry and Molecular Genetics, University of Alabama, Birmingham, Alabama, USA
| | - Justin M. Balko
- Department of Medicine and,Breast Cancer Research Program, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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36
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Johnson DB, Nixon MJ, Wang Y, Wang DY, Castellanos E, Estrada MV, Ericsson-Gonzalez PI, Cote CH, Salgado R, Sanchez V, Dean PT, Opalenik SR, Schreeder DM, Rimm DL, Kim JY, Bordeaux J, Loi S, Horn L, Sanders ME, Ferrell PB, Xu Y, Sosman JA, Davis RS, Balko JM. Tumor-specific MHC-II expression drives a unique pattern of resistance to immunotherapy via LAG-3/FCRL6 engagement. JCI Insight 2018. [PMID: 30568030 DOI: 10.1172/jci.insight.120360.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Immunotherapies targeting the PD-1 pathway produce durable responses in many cancers, but the tumor-intrinsic factors governing response and resistance are largely unknown. MHC-II expression on tumor cells can predict response to anti-PD-1 therapy. We therefore sought to determine how MHC-II expression by tumor cells promotes PD-1 dependency. Using transcriptional profiling of anti-PD-1-treated patients, we identified unique patterns of immune activation in MHC-II+ tumors. In patients and preclinical models, MHC-II+ tumors recruited CD4+ T cells and developed dependency on PD-1 as well as Lag-3 (an MHC-II inhibitory receptor), which was upregulated in MHC-II+ tumors at acquired resistance to anti-PD-1. Finally, we identify enhanced expression of FCRL6, another MHC-II receptor expressed on NK and T cells, in the microenvironment of MHC-II+ tumors. We ascribe this to what we believe to be a novel inhibitory function of FCRL6 engagement, identifying it as an immunotherapy target. These data suggest a MHC-II-mediated context-dependent mechanism of adaptive resistance to PD-1-targeting immunotherapy.
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Affiliation(s)
| | | | - Yu Wang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | | | - Monica V Estrada
- Department of Pathology, University of California, San Diego, San Diego, California, USA
| | - Paula I Ericsson-Gonzalez
- Department of Pathology Microbiology, and Immunology, and.,Breast Cancer Research Program, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Roberto Salgado
- Department of Pathology, GZA-ZNA Hospitals, Antwerp, Belgium.,Department of Oncology, University of Melbourne and Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | | | | | | | | | - David L Rimm
- Departments of Pathology and Medicine, Yale University, New Haven, Connecticut, USA
| | - Ju Young Kim
- Navigate BioPharma Services Inc., a Novartis Company, Carlsbad, California, USA
| | - Jennifer Bordeaux
- Navigate BioPharma Services Inc., a Novartis Company, Carlsbad, California, USA
| | - Sherene Loi
- Department of Oncology, University of Melbourne and Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | | | - Melinda E Sanders
- Department of Pathology Microbiology, and Immunology, and.,Breast Cancer Research Program, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Yaomin Xu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jeffrey A Sosman
- Department of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Randall S Davis
- Departments of Medicine, Microbiology, and Biochemistry and Molecular Genetics, University of Alabama, Birmingham, Alabama, USA
| | - Justin M Balko
- Department of Medicine and.,Breast Cancer Research Program, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Werfel TA, Elion DL, Rahman B, Hicks DJ, Sanchez V, Gonzales-Ericsson PI, Nixon MJ, James JL, Balko JM, Scherle PA, Koblish HK, Cook RS. Treatment-Induced Tumor Cell Apoptosis and Secondary Necrosis Drive Tumor Progression in the Residual Tumor Microenvironment through MerTK and IDO1. Cancer Res 2018; 79:171-182. [PMID: 30413412 DOI: 10.1158/0008-5472.can-18-1106] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 08/31/2018] [Accepted: 11/06/2018] [Indexed: 11/16/2022]
Abstract
Efferocytosis is the process by which apoptotic cells are cleared from tissue by phagocytic cells. The removal of apoptotic cells prevents them from undergoing secondary necrosis and releasing their inflammation-inducing intracellular contents. Efferocytosis also limits tissue damage by increasing immunosuppressive cytokines and leukocytes and maintains tissue homeostasis by promoting tolerance to antigens derived from apoptotic cells. Thus, tumor cell efferocytosis following cytotoxic cancer treatment could impart tolerance to tumor cells evading treatment-induced apoptosis with deleterious consequences in tumor residual disease. We report here that efferocytosis cleared apoptotic tumor cells in residual disease of lapatinib-treated HER2+ mammary tumors in MMTV-Neu mice, increased immunosuppressive cytokines, myeloid-derived suppressor cells (MDSC), and regulatory T cells (Treg). Blockade of efferocytosis induced secondary necrosis of apoptotic cells, but failed to prevent increased tumor MDSCs, Treg, and immunosuppressive cytokines. We found that efferocytosis stimulated expression of IFN-γ, which stimulated the expression of indoleamine-2,3-dioxegenase (IDO) 1, an immune regulator known for driving maternal-fetal antigen tolerance. Combined inhibition of efferocytosis and IDO1 in tumor residual disease decreased apoptotic cell- and necrotic cell-induced immunosuppressive phenotypes, blocked tumor metastasis, and caused tumor regression in 60% of MMTV-Neu mice. This suggests that apoptotic and necrotic tumor cells, via efferocytosis and IDO1, respectively, promote tumor 'homeostasis' and progression. SIGNIFICANCE: These findings show in a model of HER2+ breast cancer that necrosis secondary to impaired efferocytosis activates IDO1 to drive immunosuppression and tumor progression.
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Affiliation(s)
- Thomas A Werfel
- Department of Cell & Developmental Biology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - David L Elion
- Program in Cancer Biology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Bushra Rahman
- Department of Cell & Developmental Biology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Donna J Hicks
- Department of Cell & Developmental Biology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Violeta Sanchez
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Mellissa J Nixon
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jamaal L James
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Justin M Balko
- Program in Cancer Biology, Vanderbilt University School of Medicine, Nashville, Tennessee.,Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.,Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Peggy A Scherle
- Preclinical Biology, Incyte Corporation, Experimental Station, Wilmington, Delaware
| | - Holly K Koblish
- Preclinical Biology, Incyte Corporation, Experimental Station, Wilmington, Delaware
| | - Rebecca S Cook
- Department of Cell & Developmental Biology, Vanderbilt University School of Medicine, Nashville, Tennessee. .,Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee.,Department of Biomedical Engineering, Vanderbilt University School of Engineering, Nashville, Tennessee
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38
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Elion DL, Jacobson ME, Hicks DJ, Rahman B, Sanchez V, Gonzales-Ericsson PI, Fedorova O, Pyle AM, Wilson JT, Cook RS. Therapeutically Active RIG-I Agonist Induces Immunogenic Tumor Cell Killing in Breast Cancers. Cancer Res 2018; 78:6183-6195. [PMID: 30224377 DOI: 10.1158/0008-5472.can-18-0730] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [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: 03/13/2018] [Revised: 06/29/2018] [Accepted: 09/04/2018] [Indexed: 11/16/2022]
Abstract
Cancer immunotherapies that remove checkpoint restraints on adaptive immunity are gaining clinical momentum but have not achieved widespread success in breast cancers, a tumor type considered poorly immunogenic and which harbors a decreased presence of tumor-infiltrating lymphocytes. Approaches that activate innate immunity in breast cancer cells and the tumor microenvironment are of increasing interest, based on their ability to induce immunogenic tumor cell death, type I IFNs, and lymphocyte-recruiting chemokines. In agreement with reports in other cancers, we observe loss, downregulation, or mutation of the innate viral nucleotide sensor retinoic acid-inducible gene I (RIG-I/DDX58) in only 1% of clinical breast cancers, suggesting potentially widespread applicability for therapeutic RIG-I agonists that activate innate immunity. This was tested using an engineered RIG-I agonist in a breast cancer cell panel representing each of three major clinical breast cancer subtypes. Treatment with RIG-I agonist resulted in upregulation and mitochondrial localization of RIG-I and activation of proinflammatory transcription factors STAT1 and NF-κB. RIG-I agonist triggered the extrinsic apoptosis pathway and pyroptosis, a highly immunogenic form of cell death in breast cancer cells. RIG-I agonist also induced expression of lymphocyte-recruiting chemokines and type I IFN, confirming that cell death and cytokine modulation occur in a tumor cell-intrinsic manner. Importantly, RIG-I activation in breast tumors increased tumor lymphocytes and decreased tumor growth and metastasis. Overall, these findings demonstrate successful therapeutic delivery of a synthetic RIG-I agonist to induce tumor cell killing and to modulate the tumor microenvironment in vivo Significance: These findings describe the first in vivo delivery of RIG-I mimetics to tumors, demonstrating a potent immunogenic and therapeutic effect in the context of otherwise poorly immunogenic breast cancers. Cancer Res; 78(21); 6183-95. ©2018 AACR.
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Affiliation(s)
- David L Elion
- Cancer Biology Graduate Program, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Max E Jacobson
- Department of Chemical and Biomolecular Engineering, Vanderbilt University School of Engineering, Nashville, Tennessee
| | - Donna J Hicks
- Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Bushra Rahman
- Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Violeta Sanchez
- Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Paula I Gonzales-Ericsson
- Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Olga Fedorova
- Department of Molecular, Cellular, and Developmental Biology, Yale University, New Haven, Connecticut
- Howard Hughes Medical Institute, Chevy Chase, Maryland
| | - Anna M Pyle
- Department of Molecular, Cellular, and Developmental Biology, Yale University, New Haven, Connecticut
- Howard Hughes Medical Institute, Chevy Chase, Maryland
- Department of Chemistry, Yale University, New Haven, Connecticut
| | - John T Wilson
- Cancer Biology Graduate Program, Vanderbilt University School of Medicine, Nashville, Tennessee
- Department of Chemical and Biomolecular Engineering, Vanderbilt University School of Engineering, Nashville, Tennessee
- Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Biomedical Engineering, Vanderbilt University School of Engineering, Nashville, Tennessee
| | - Rebecca S Cook
- Cancer Biology Graduate Program, Vanderbilt University School of Medicine, Nashville, Tennessee.
- Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, Tennessee
- Department of Biomedical Engineering, Vanderbilt University School of Engineering, Nashville, Tennessee
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Redondo MJ, Geyer S, Steck AK, Sharp S, Wentworth JM, Weedon MN, Antinozzi P, Sosenko J, Atkinson M, Pugliese A, Oram RA, Antinozzi P, Atkinson M, Battaglia M, Becker D, Bingley P, Bosi E, Buckner J, Colman P, Gottlieb P, Herold K, Insel R, Kay T, Knip M, Marks J, Moran A, Palmer J, Peakman M, Philipson L, Pugliese A, Raskin P, Rodriguez H, Roep B, Russell W, Schatz D, Wherrett D, Wilson D, Winter W, Ziegler A, Benoist C, Blum J, Chase P, Clare-Salzler M, Clynes R, Eisenbarth G, Fathman C, Grave G, Hering B, Kaufman F, Leschek E, Mahon J, Nanto-Salonen K, Nepom G, Orban T, Parkman R, Pescovitz M, Peyman J, Roncarolo M, Simell O, Sherwin R, Siegelman M, Steck A, Thomas J, Trucco M, Wagner J, Greenbaum ,CJ, Bourcier K, Insel R, Krischer JP, Leschek E, Rafkin L, Spain L, Cowie C, Foulkes M, Krause-Steinrauf H, Lachin JM, Malozowski S, Peyman J, Ridge J, Savage P, Skyler JS, Zafonte SJ, Kenyon NS, Santiago I, Sosenko JM, Bundy B, Abbondondolo M, Adams T, Amado D, Asif I, Boonstra M, Bundy B, Burroughs C, Cuthbertson D, Deemer M, Eberhard C, Fiske S, Ford J, Garmeson J, Guillette H, Browning G, Coughenour T, Sulk M, Tsalikan E, Tansey M, Cabbage J, Dixit N, Pasha S, King M, Adcock K, Geyer S, Atterberry H, Fox L, Englert K, Mauras N, Permuy J, Sikes K, Berhe T, Guendling B, McLennan L, Paganessi L, Hays B, Murphy C, Draznin M, Kamboj M, Sheppard S, Lewis V, Coates L, Moore W, Babar G, Bedard J, Brenson-Hughes D, Henderson C, Cernich J, Clements M, Duprau R, Goodman S, Hester L, Huerta-Saenz L, Karmazin A, Letjen T, Raman S, Morin D, Henry M, Bestermann W, Morawski E, White J, Brockmyer A, Bays R, Campbell S, Stapleton A, Stone N, Donoho A, Everett H, Heyman K, Hensley H, Johnson M, Marshall C, Skirvin N, Taylor P, Williams R, Ray L, Wolverton C, Nickels D, Dothard C, Hsiao B, Speiser P, Pellizzari M, Bokor L, Izuora K, Abdelnour S, Cummings P, Paynor S, Leahy M, Riedl M, Shockley S, Karges C, Saad R, Briones T, Casella S, Herz C, Walsh K, Greening J, Hay F, Hunt S, Sikotra N, Simons L, Keaton N, Karounos D, Oremus R, Dye L, Myers L, Ballard D, Miers W, Sparks R, Thraikill K, Edwards K, Fowlkes J, Kinderman A, Kemp S, Morales A, Holland L, Johnson L, Paul P, Ghatak A, Phelen K, Leyland H, Henderson T, Brenner D, Law P, Oppenheimer E, Mamkin I, Moniz C, Clarson C, Lovell M, Peters A, Ruelas V, Borut D, Burt D, Jordan M, Leinbach A, Castilla S, Flores P, Ruiz M, Hanson L, Green-Blair J, Sheridan R, Wintergerst K, Pierce G, Omoruyi A, Foster M, Linton C, Kingery S, Lunsford A, Cervantes I, Parker T, Price P, Urben J, Doughty I, Haydock H, Parker V, Bergman P, Liu S, Duncum S, Rodda C, Thomas A, Ferry R, McCommon D, Cockroft J, Perelman A, Calendo R, Barrera C, Arce-Nunez E, Lloyd J, Martinez Y, De la Portilla M, Cardenas I, Garrido L, Villar M, Lorini R, Calandra E, D’Annuzio G, Perri K, Minuto N, Malloy J, Rebora C, Callegari R, Ali O, Kramer J, Auble B, Cabrera S, Donohoue P, Fiallo-Scharer R, Hessner M, Wolfgram P, Maddox K, Kansra A, Bettin N, McCuller R, Miller A, Accacha S, Corrigan J, Fiore E, Levine R, Mahoney T, Polychronakos C, Martin J, Gagne V, Starkman H, Fox M, Chin D, Melchionne F, Silverman L, Marshall I, Cerracchio L, Cruz J, Viswanathan A, Miller J, Wilson J, Chalew S, Valley S, Layburn S, Lala A, Clesi P, Genet M, Uwaifo G, Charron A, Allerton T, Milliot E, Cefalu W, Melendez-Ramirez L, Richards R, Alleyn C, Gustafson E, Lizanna M, Wahlen J, Aleiwe S, Hansen M, Wahlen H, Moore M, Levy C, Bonaccorso A, Rapaport R, Tomer Y, Chia D, Goldis M, Iazzetti L, Klein M, Levister C, Waldman L, Muller S, Wallach E, Regelmann M, Antal Z, Aranda M, Reynholds C, Leech N, Wake D, Owens C, Burns M, Wotherspoon J, Nguyen T, Murray A, Short K, Curry G, Kelsey S, Lawson J, Porter J, Stevens S, Thomson E, Winship S, Wynn L, O’Donnell R, Wiltshire E, Krebs J, Cresswell P, Faherty H, Ross C, Vinik A, Barlow P, Bourcier M, Nevoret M, Couper J, Oduah V, Beresford S, Thalagne N, Roper H, Gibbons J, Hill J, Balleaut S, Brennan C, Ellis-Gage J, Fear L, Gray T, Pilger J, Jones L, McNerney C, Pointer L, Price N, Few K, Tomlinson D, Denvir L, Drew J, Randell T, Mansell P, Roberts A, Bell S, Butler S, Hooton Y, Navarra H, Roper A, Babington G, Crate L, Cripps H, Ledlie A, Moulds C, Sadler K, Norton R, Petrova B, Silkstone O, Smith C, Ghai K, Murray M, Viswanathan V, Henegan M, Kawadry O, Olson J, Stavros T, Patterson L, Ahmad T, Flores B, Domek D, Domek S, Copeland K, George M, Less J, Davis T, Short M, Tamura R, Dwarakanathan A, O’Donnell P, Boerner B, Larson L, Phillips M, Rendell M, Larson K, Smith C, Zebrowski K, Kuechenmeister L, Wood K, Thevarayapillai M, Daniels M, Speer H, Forghani N, Quintana R, Reh C, Bhangoo A, Desrosiers P, Ireland L, Misla T, Xu P, Torres C, Wells S, Villar J, Yu M, Berry D, Cook D, Soder J, Powell A, Ng M, Morrison M, Young K, Haslam Z, Lawson M, Bradley B, Courtney J, Richardson C, Watson C, Keely E, DeCurtis D, Vaccarcello-Cruz M, Torres Z, Alies P, Sandberg K, Hsiang H, Joy B, McCormick D, Powell A, Jones H, Bell J, Hargadon S, Hudson S, Kummer M, Badias F, Sauder S, Sutton E, Gensel K, Aguirre-Castaneda R, Benavides Lopez V, Hemp D, Allen S, Stear J, Davis E, Jones T, Baker A, Roberts A, Dart J, Paramalingam N, Levitt Katz L, Chaudhary N, Murphy K, Willi S, Schwartzman B, Kapadia C, Larson D, Bassi M, McClellan D, Shaibai G, Kelley L, Villa G, Kelley C, Diamond R, Kabbani M, Dajani T, Hoekstra F, Magorno M, Beam C, Holst J, Chauhan V, Wilson N, Bononi P, Sperl M, Millward A, Eaton M, Dean L, Olshan J, Renna H, Boulware D, Milliard C, Snyder D, Beaman S, Burch K, Chester J, Ahmann A, Wollam B, DeFrang D, Fitch R, Jahnke K, Bounmananh L, Hanavan K, Klopfenstein B, Nicol L, Bergstrom R, Noland T, Brodksy J, Bacon L, Quintos J, Topor L, Bialo S, Bream S, Bancroft B, Soto A, Lagarde W, Lockemer H, Vanderploeg T, Ibrahim M, Huie M, Sanchez V, Edelen R, Marchiando R, Freeman D, Palmer J, Repas T, Wasson M, Auker P, Culbertson J, Kieffer T, Voorhees D, Borgwardt T, DeRaad L, Eckert K, Gough J, Isaacson E, Kuhn H, Carroll A, Schubert M, Francis G, Hagan S, Le T, Penn M, Wickham E, Leyva C, Ginem J, Rivera K, Padilla J, Rodriguez I, Jospe N, Czyzyk J, Johnson B, Nadgir U, Marlen N, Prakasam G, Rieger C, Granger M, Glaser N, Heiser E, Harris B, Foster C, Slater H, Wheeler K, Donaldson D, Murray M, Hale D, Tragus R, Holloway M, Word D, Lynch J, Pankratz L, Rogers W, Newfield R, Holland S, Hashiguchi M, Gottschalk M, Philis-Tsimikas A, Rosal R, Kieffer M, Franklin S, Guardado S, Bohannon N, Garcia M, Aguinaldo T, Phan J, Barraza V, Cohen D, Pinsker J, Khan U, Lane P, Wiley J, Jovanovic L, Misra P, Wright M, Cohen D, Huang K, Skiles M, Maxcy S, Pihoker C, Cochrane K, Nallamshetty L, Fosse J, Kearns S, Klingsheim M, Wright N, Viles L, Smith H, Heller S, Cunningham M, Daniels A, Zeiden L, Parrimon Y, Field J, Walker R, Griffin K, Bartholow L, Erickson C, Howard J, Krabbenhoft B, Sandman C, Vanveldhuizen A, Wurlger J, Paulus K, Zimmerman A, Hanisch K, Davis-Keppen L, Cotterill A, Kirby J, Harris M, Schmidt A, Kishiyama C, Flores C, Milton J, Ramiro J, Martin W, Whysham C, Yerka A, Freels T, Hassing J, Webster J, Green R, Carter P, Galloway J, Hoelzer D, Ritzie AQL, Roberts S, Said S, Sullivan P, Allen H, Reiter E, Feinberg E, Johnson C, Newhook L, Hagerty D, White N, Sharma A, Levandoski L, Kyllo J, Johnson M, Benoit C, Iyer P, Diamond F, Hosono H, Jackman S, Barette L, Jones P, Shor A, Sills I, Bzdick S, Bulger J, Weinstock R, Douek I, Andrews R, Modgill G, Gyorffy G, Robin L, Vaidya N, Song X, Crouch S, O’Brien K, Thompson C, Thorne N, Blumer J, Kalic J, Klepek L, Paulett J, Rosolowski B, Horner J, Terry A, Watkins M, Casey J, Carpenter K, Burns C, Horton J, Pritchard C, Soetaert D, Wynne A, Kaiserman K, Halvorson M, Weinberger J, Chin C, Molina O, Patel C, Senguttuvan R, Wheeler M, Furet O, Steuhm C, Jelley D, Goudeau S, Chalmers L, Wootten M, Greer D, Panagiotopoulos C, Metzger D, Nguyen D, Horowitz M, Christiansen M, Glades E, 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Hefty D, Klein J, Kuhns K, Letlau M, Lord S, McCulloch-Olson M, Miller L, Nepom G, Odegard J, Ramey M, Sachter E, St. Marie M, Stickney K, VanBuecken D, Vellek B, Webber C, Allen L, Bollyk J, Hilderman N, Ismail H, Lamola S, Sanda S, Vendettuoli H, Tridgell D, Monzavi R, Bock M, Fisher L, Halvorson M, Jeandron D, Kim M, Wood J, Geffner M, Kaufman F, Parkman R, Salazar C, Goland R, Clynes R, Cook S, Freeby M, Gallagher MP, Gandica R, Greenberg E, Kurland A, Pollak S, Wolk A, Chan M, Koplimae L, Levine E, Smith K, Trast J, DiMeglio L, Blum J, Evans-Molina C, Hufferd R, Jagielo B, Kruse C, Patrick V, Rigby M, Spall M, Swinney K, Terrell J, Christner L, Ford L, Lynch S, Menendez M, Merrill P, Pescovitz M, Rodriguez H, Alleyn C, Baidal D, Fay S, Gaglia J, Resnick B, Szubowicz S, Weir G, Benjamin R, Conboy D, deManbey A, Jackson R, Jalahej H, Orban T, Ricker A, Wolfsdorf J, Zhang HH, Wilson D, Aye T, Baker B, Barahona K, Buckingham B, Esrey K, Esrey T, Fathman G, Snyder R, Aneja B, Chatav M, 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Toledo F, Rodriguez H, Bollepalli S, Diamond F, Eyth E, Henson D, Lenz A, Shulman D, Raskin P, Adhikari S, Dickson B, Dunnigan E, Lingvay I, Pruneda L, Ramos-Roman M, Raskin P, Rhee C, Richard J, Siegelman M, Sturges D, Sumpter K, White P, Alford M, Arthur J, Aviles-Santa ML, Cordova E, Davis R, Fernandez S, Fordan S, Hardin T, Jacobs A, Kaloyanova P, Lukacova-Zib I, Mirfakhraee S, Mohan A, Noto H, Smith O, Torres N, Wherrett D, Balmer D, Eisel L, Kovalakovska R, Mehan M, Sultan F, Ahenkorah B, Cevallos J, Razack N, Ricci MJ, Rhode A, Srikandarajah M, Steger R, Russell WE, Black M, Brendle F, Brown A, Moore D, Pittel E, Robertson A, Shannon A, Thomas JW, Herold K, Feldman L, Sherwin R, Tamborlane W, Weinzimer S, Toppari J, Kallio T, Kärkkäinen M, Mäntymäki E, Niininen T, Nurmi B, Rajala P, Romo M, Suomenrinne S, Näntö-Salonen K, Simell O, Simell T, Bosi E, Battaglia M, Bianconi E, Bonfanti R, Grogan P, Laurenzi A, Martinenghi S, Meschi F, Pastore M, Falqui L, Muscato MT, Viscardi M, Castleden H, Farthing N, Loud S, Matthews C, McGhee J, Morgan A, Pollitt J, Elliot-Jones R, Wheaton C, Knip M, Siljander H, Suomalainen H, Colman P, Healy F, Mesfin S, Redl L, Wentworth J, Willis J, Farley M, Harrison L, Perry C, Williams F, Mayo A, Paxton J, Thompson V, Volin L, Fenton C, Carr L, Lemon E, Swank M, Luidens M, Salgam M, Sharma V, Schade D, King C, Carano R, Heiden J, Means N, Holman L, Thomas I, Madrigal D, Muth T, Martin C, Plunkett C, Ramm C, Auchus R, Lane W, Avots E, Buford M, Hale C, Hoyle J, Lane B, Muir A, Shuler S, Raviele N, Ivie E, Jenkins M, Lindsley K, Hansen I, Fadoju D, Felner E, Bode B, Hosey R, Sax J, Jefferies C, Mannering S, Prentis R, She J, Stachura M, Hopkins D, Williams J, Steed L, Asatapova E, Nunez S, Knight S, Dixon P, Ching J, Donner T, Longnecker S, Abel K, Arcara K, Blackman S, Clark L, Cooke D, Plotnick L, Levin P, Bromberger L, Klein K, Sadurska K, Allen C, Michaud D, Snodgrass H, Burghen G, Chatha S, Clark C, Silverberg J, Wittmer C, Gardner J, LeBoeuf C, Bell P, McGlore O, Tennet H, Alba N, Carroll M, Baert L, Beaton H, Cordell E, Haynes A, Reed C, Lichter K, McCarthy P, McCarthy S, Monchamp T, Roach J, Manies S, Gunville F, Marosok L, Nelson T, Ackerman K, Rudolph J, Stewart M, McCormick K, May S, Falls T, Barrett T, Dale K, Makusha L, McTernana C, Penny-Thomas K, Sullivan K, Narendran P, Robbie J, Smith D, Christensen R, Koehler B, Royal C, Arthur T, Houser H, Renaldi J, Watsen S, Wu P, Lyons L, House B, Yu J, Holt H, Nation M, Vickers C, Watling R, Heptulla R, Trast J, Agarwal C, Newell D, Katikaneni R, Gardner C, Del Rio A, Logan A, Collier H, Rishton C, Whalley G, Ali A, Ramtoola S, Quattrin T, Mastrandea L, House A, Ecker M, Huang C, Gougeon C, Ho J, Pacuad D, Dunger D, May J, O’Brien C, Acerini C, Salgin B, Thankamony A, Williams R, Buse J, Fuller G, Duclos M, Tricome J, Brown H, Pittard D, Bowlby D, Blue A, Headley T, Bendre S, Lewis K, Sutphin K, Soloranzo C, Puskaric J, Madison H, Rincon M, Carlucci M, Shridharani R, Rusk B, Tessman E, Huffman D, Abrams H, Biederman B, Jones M, Leathers V, Brickman W, Petrie P, Zimmerman D, Howard J, Miller L, Alemzadeh R, Mihailescu D, Melgozza-Walker R, Abdulla N, Boucher-Berry C, Ize-Ludlow D, Levy R, Swenson Brousell C, Scott R, Heenan H, Lunt H, Kendall D, Willis J, Darlow B, Crimmins N, Edler D, Weis T, Schultz C, Rogers D, Latham D, Mawhorter C, Switzer C, Spencer W, Konstantnopoulus P, Broder S, Klein J, Bachrach B, Gardner M, Eichelberger D, Knight L, Szadek L, Welnick G, Thompson B, Hoffman R, Revell A, Cherko J, Carter K, Gilson E, Haines J, Arthur G, Bowen B, Zipf W, Graves P, Lozano R, Seiple D, Spicer K, Chang A, Fregosi J, Harbinson J, Paulson C, Stalters S, Wright P, Zlock D, Freeth A, Victory J, Maheshwari H, Maheshwari A, Holmstrom T, Bueno J, Arguello R, Ahern J, Noreika L, Watson V, Hourse S, Breyer P, Kissel C, Nicholson Y, Pfeifer M, Almazan S, Bajaj J, Quinn M, Funk K, McCance J, Moreno E, Veintimilla R, Wells A, Cook J, Trunnel S, Transue D, Surhigh J, Bezzaire D, Moltz K, Zacharski E, Henske J, Desai S, Frizelis K, Khan F, Sjoberg R, Allen K, Manning P, Hendry G, Taylor B, Jones S, Couch R, Danchak R, Lieberman D, Strader W, Bencomo M, Bailey T, Bedolla L, Roldan C, Moudiotis C, Vaidya B, Anning C, Bunce S, Estcourt S, Folland E, Gordon E, Harrill C, Ireland J, Piper J, Scaife L, Sutton K, Wilkins S, Costelloe M, Palmer J, Casas L, Miller C, Burgard M, Erickson C, Hallanger-Johnson J, Clark P, Taylor W, Galgani J, Banerjee S, Banda C, McEowen D, Kinman R, Lafferty A, Gillett S, Nolan C, Pathak M, Sondrol L, Hjelle T, Hafner S, Kotrba J, Hendrickson R, Cemeroglu A, Symington T, Daniel M, Appiagyei-Dankah Y, Postellon D, Racine M, Kleis L, Barnes K, Godwin S, McCullough H, Shaheen K, Buck G, Noel L, Warren M, Weber S, Parker S, Gillespie I, Nelson B, Frost C, Amrhein J, Moreland E, Hayes A, Peggram J, Aisenberg J, Riordan M, Zasa J, Cummings E, Scott K, Pinto T, Mokashi A, McAssey K, Helden E, Hammond P, Dinning L, Rahman S, Ray S, Dimicri C, Guppy S, Nielsen H, Vogel C, Ariza C, Morales L, Chang Y, Gabbay R, Ambrocio L, Manley L, Nemery R, Charlton W, Smith P, Kerr L, Steindel-Kopp B, Alamaguer M, Tabisola-Nuesca E, Pendersen A, Larson N, Cooper-Olviver H, Chan D, Fitz-Patrick D, Carreira T, Park Y, Ruhaak R, Liljenquist D. A Type 1 Diabetes Genetic Risk Score Predicts Progression of Islet Autoimmunity and Development of Type 1 Diabetes in Individuals at Risk. Diabetes Care 2018; 41:1887-1894. [PMID: 30002199 PMCID: PMC6105323 DOI: 10.2337/dc18-0087] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 06/06/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We tested the ability of a type 1 diabetes (T1D) genetic risk score (GRS) to predict progression of islet autoimmunity and T1D in at-risk individuals. RESEARCH DESIGN AND METHODS We studied the 1,244 TrialNet Pathway to Prevention study participants (T1D patients' relatives without diabetes and with one or more positive autoantibodies) who were genotyped with Illumina ImmunoChip (median [range] age at initial autoantibody determination 11.1 years [1.2-51.8], 48% male, 80.5% non-Hispanic white, median follow-up 5.4 years). Of 291 participants with a single positive autoantibody at screening, 157 converted to multiple autoantibody positivity and 55 developed diabetes. Of 953 participants with multiple positive autoantibodies at screening, 419 developed diabetes. We calculated the T1D GRS from 30 T1D-associated single nucleotide polymorphisms. We used multivariable Cox regression models, time-dependent receiver operating characteristic curves, and area under the curve (AUC) measures to evaluate prognostic utility of T1D GRS, age, sex, Diabetes Prevention Trial-Type 1 (DPT-1) Risk Score, positive autoantibody number or type, HLA DR3/DR4-DQ8 status, and race/ethnicity. We used recursive partitioning analyses to identify cut points in continuous variables. RESULTS Higher T1D GRS significantly increased the rate of progression to T1D adjusting for DPT-1 Risk Score, age, number of positive autoantibodies, sex, and ethnicity (hazard ratio [HR] 1.29 for a 0.05 increase, 95% CI 1.06-1.6; P = 0.011). Progression to T1D was best predicted by a combined model with GRS, number of positive autoantibodies, DPT-1 Risk Score, and age (7-year time-integrated AUC = 0.79, 5-year AUC = 0.73). Higher GRS was significantly associated with increased progression rate from single to multiple positive autoantibodies after adjusting for age, autoantibody type, ethnicity, and sex (HR 2.27 for GRS >0.295, 95% CI 1.47-3.51; P = 0.0002). CONCLUSIONS The T1D GRS independently predicts progression to T1D and improves prediction along T1D stages in autoantibody-positive relatives.
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Affiliation(s)
- Maria J. Redondo
- Texas Children’s Hospital, Baylor College of Medicine, Houston, TX
| | | | - Andrea K. Steck
- Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine, Aurora, CO
| | - Seth Sharp
- Institute of Biomedical and Clinical Science, University of Exeter, Exeter, U.K
| | - John M. Wentworth
- Walter and Eliza Hall Institute of Medical Research and Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Michael N. Weedon
- Institute of Biomedical and Clinical Science, University of Exeter, Exeter, U.K
| | | | | | | | | | - Richard A. Oram
- Institute of Biomedical and Clinical Science, University of Exeter, Exeter, U.K
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Teixido Tura G, Rodriguez-Palomares J, Gonzalez Mirelis J, Gutierrez L, Sanchez V, Galian L, Fernandez R, Gonzalez-Alujas T, Huguet F, Sao Aviles A, Ibanez B, Forteza A, Garcia-Dorado D, Evangelista A. P723Long-term efficacy of losartan vs atenolol for the prevention of aortic dilation and clinical complications in Marfan syndrome. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p723] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- G Teixido Tura
- University Hospital Vall d'Hebron, Cardiology, Barcelona, Spain
| | | | - J Gonzalez Mirelis
- University Hospital Puerta de Hierro Majadahonda, Cardiology, Madrid, Spain
| | - L Gutierrez
- University Hospital Vall d'Hebron, Cardiology, Barcelona, Spain
| | - V Sanchez
- University Hospital 12 de Octubre, Department of Cardiology, Madrid, Spain
| | - L Galian
- University Hospital Vall d'Hebron, Cardiology, Barcelona, Spain
| | - R Fernandez
- University Hospital Vall d'Hebron, Cardiology, Barcelona, Spain
| | | | - F Huguet
- University Hospital Vall d'Hebron, Cardiology, Barcelona, Spain
| | - A Sao Aviles
- University Hospital Vall d'Hebron, Cardiology, Barcelona, Spain
| | - B Ibanez
- National Centre for Cardiovascular Research (CNIC), Madrid, Spain
| | - A Forteza
- University Hospital Puerta de Hierro Majadahonda, Cardiac surgery, Madrid, Spain
| | - D Garcia-Dorado
- University Hospital Vall d'Hebron, Cardiology, Barcelona, Spain
| | - A Evangelista
- University Hospital Vall d'Hebron, Cardiology, Barcelona, Spain
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Dentamaro I, Galian L, Calvo F, Moral S, Robledo-Carmona J, Sanchez V, Saura D, Arnold R, Citro R, Moreo A, Chirillo F, Colonna P, Teixido G, Rdriguez-Palomares J, Evangelista A. P674Evaluation of sex differences in aortic valve dysfunction and aorta dilation in patients with bicuspid aortic valve. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p674] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- I Dentamaro
- University Hospital Vall d'Hebron, Department of Cardiology, Barcelona, Spain
| | - L Galian
- University Hospital Vall d'Hebron, Department of Cardiology, Barcelona, Spain
| | - F Calvo
- University Hospital Gregorio Maranon, Madrid, Spain
| | - S Moral
- University Hospital de Girona Dr. Josep Trueta, Girona, Spain
| | | | - V Sanchez
- University Hospital 12 de Octubre, Madrid, Spain
| | - D Saura
- Hospital Clínico Univeristario Virgen de la Arrixaca, Murcia, Spain
| | - R Arnold
- Institute of Heart Sciences (ICICOR), Valladolid, Spain
| | - R Citro
- AOU S. Giovanni e Ruggi, Salerno, Italy
| | - A Moreo
- Niguarda Ca' Granda Hospital, Milan, Italy
| | - F Chirillo
- Bassano del Grappa General Hospital, Bassano Del Grappa, Italy
| | - P Colonna
- Polyclinic Hospital of Bari, Bari, Italy
| | - G Teixido
- University Hospital Vall d'Hebron, Department of Cardiology, Barcelona, Spain
| | | | - A Evangelista
- University Hospital Vall d'Hebron, Department of Cardiology, Barcelona, Spain
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Keddie S, Bharambe V, Jayakumar A, Shah A, Sanchez V, Adams A, Gnanapavan S. Clinical perspectives into the use of thalidomide for central nervous system tuberculosis. Eur J Neurol 2018; 25:1345-1351. [PMID: 29935038 DOI: 10.1111/ene.13732] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 06/19/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Central nervous system (CNS) tuberculosis (TB) accounts for over 4% of all TB notifications in the UK and causes death or significant disability in over half of those affected. Tumour necrosis factor alpha is a critical cytokine involved in the neuropathogenesis of CNS TB. Thalidomide has been trialled in CNS TB due to its immunomodulatory and immune reconstitution effects through the inhibition of tumour necrosis factor alpha. Despite animal models demonstrating dramatic improvement in survival, studies in paediatric patients have been associated with higher levels of mortality. The effects of thalidomide have not yet been studied in adults with CNS TB. This narrative case series guides clinicians through a range of CNS TB clinical cases seen in a large London teaching hospital, serving a region with a high incidence of TB (32 per 100 000) with 55% of TB cases manifesting as extrapulmonary disease. We aimed to illustrate our experiences of using thalidomide to treat a range of severe CNS TB complications. METHODS Five inpatients at The Royal London Hospital, London, UK treated with thalidomide in addition to standard TB treatment are described in detail. The rationale for treatment initiation with thalidomide is explained. RESULTS The case examples are used to guide our reflections and lessons learnt regarding the use of thalidomide. Responses to treatment and functional outcomes suggest that thalidomide may be a useful adjunct to standard TB therapy in selected adult cases. CONCLUSIONS The experience gained from using thalidomide in this small case series may provide evidence leading to more research into using thalidomide to treat severe CNS TB.
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Affiliation(s)
- S Keddie
- Emergency Care and Acute Medicine Clinical Academic Group, Neuroscience, The Royal London Hospital, Barts Health NHS Trust, London.,National Hospital for Neurology and Neurosurgery, MRC Centre for Neuromuscular Diseases and Department of Molecular Neuroscience, University College London Hospitals NHS Foundation Trust, London
| | - V Bharambe
- The Walton Centre NHS Foundation Trust, Liverpool
| | - A Jayakumar
- Division of Infection, The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - A Shah
- Emergency Care and Acute Medicine Clinical Academic Group, Neuroscience, The Royal London Hospital, Barts Health NHS Trust, London
| | - V Sanchez
- Emergency Care and Acute Medicine Clinical Academic Group, Neuroscience, The Royal London Hospital, Barts Health NHS Trust, London
| | - A Adams
- Emergency Care and Acute Medicine Clinical Academic Group, Neuroscience, The Royal London Hospital, Barts Health NHS Trust, London
| | - S Gnanapavan
- Emergency Care and Acute Medicine Clinical Academic Group, Neuroscience, The Royal London Hospital, Barts Health NHS Trust, London.,The Walton Centre NHS Foundation Trust, Liverpool
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Nowack H, Chatelard P, Chailan L, Hermsmeyer S, Sanchez V, Herranz L. CESAM – Code for European severe accident management, EURATOM project on ASTEC improvement. ANN NUCL ENERGY 2018. [DOI: 10.1016/j.anucene.2018.02.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Giltnane JM, Hutchinson KE, Stricker TP, Formisano L, Young CD, Estrada MV, Nixon MJ, Du L, Sanchez V, Ericsson PG, Kuba MG, Sanders ME, Mu XJ, Van Allen EM, Wagle N, Mayer IA, Abramson V, Gόmez H, Rizzo M, Toy W, Chandarlapaty S, Mayer EL, Christiansen J, Murphy D, Fitzgerald K, Wang K, Ross JS, Miller VA, Stephens PJ, Yelensky R, Garraway L, Shyr Y, Meszoely I, Balko JM, Arteaga CL. Genomic profiling of ER + breast cancers after short-term estrogen suppression reveals alterations associated with endocrine resistance. Sci Transl Med 2018; 9:9/402/eaai7993. [PMID: 28794284 DOI: 10.1126/scitranslmed.aai7993] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Revised: 03/30/2017] [Accepted: 06/29/2017] [Indexed: 12/11/2022]
Abstract
Inhibition of proliferation in estrogen receptor-positive (ER+) breast cancers after short-term antiestrogen therapy correlates with long-term patient outcome. We profiled 155 ER+/human epidermal growth factor receptor 2-negative (HER2-) early breast cancers from 143 patients treated with the aromatase inhibitor letrozole for 10 to 21 days before surgery. Twenty-one percent of tumors remained highly proliferative, suggesting that these tumors harbor alterations associated with intrinsic endocrine therapy resistance. Whole-exome sequencing revealed a correlation between 8p11-12 and 11q13 gene amplifications, including FGFR1 and CCND1, respectively, and high Ki67. We corroborated these findings in a separate cohort of serial pretreatment, postneoadjuvant chemotherapy, and recurrent ER+ tumors. Combined inhibition of FGFR1 and CDK4/6 reversed antiestrogen resistance in ER+FGFR1/CCND1 coamplified CAMA1 breast cancer cells. RNA sequencing of letrozole-treated tumors revealed the existence of intrachromosomal ESR1 fusion transcripts and increased expression of gene signatures indicative of enhanced E2F-mediated transcription and cell cycle processes in cancers with high Ki67. These data suggest that short-term preoperative estrogen deprivation followed by genomic profiling can be used to identify druggable alterations that may cause intrinsic endocrine therapy resistance.
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Affiliation(s)
- Jennifer M Giltnane
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN 37232, USA.,Breast Cancer Research Program, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | | | - Thomas P Stricker
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN 37232, USA.,Breast Cancer Research Program, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Luigi Formisano
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Christian D Young
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Monica V Estrada
- Breast Cancer Research Program, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Mellissa J Nixon
- Department of Cancer Biology, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Liping Du
- Vanderbilt Center for Quantitative Sciences, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Violeta Sanchez
- Breast Cancer Research Program, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Paula Gonzalez Ericsson
- Breast Cancer Research Program, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Maria G Kuba
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Melinda E Sanders
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN 37232, USA.,Breast Cancer Research Program, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Xinmeng J Mu
- Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Eliezer M Van Allen
- Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Nikhil Wagle
- Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Ingrid A Mayer
- Breast Cancer Research Program, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN 37232, USA.,Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Vandana Abramson
- Breast Cancer Research Program, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN 37232, USA.,Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Henry Gόmez
- Instituto Nacional de Enfermedades Neoplásicas, Surquillo 15038, Peru
| | - Monica Rizzo
- Department of Surgery, Emory University, Atlanta, GA 30322, USA
| | - Weiyi Toy
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY 10022, USA
| | - Sarat Chandarlapaty
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY 10022, USA
| | - Erica L Mayer
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | | | | | | | - Kai Wang
- Foundation Medicine Inc., Cambridge, MA 02141, USA
| | - Jeffrey S Ross
- Foundation Medicine Inc., Cambridge, MA 02141, USA.,Department of Pathology, Albany Medical College, Albany, NY 12208, USA
| | | | | | | | - Levi Garraway
- Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA.,Joint Center for Cancer Precision Medicine, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Yu Shyr
- Vanderbilt Center for Quantitative Sciences, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Ingrid Meszoely
- Breast Cancer Research Program, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN 37232, USA.,Department of Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Justin M Balko
- Breast Cancer Research Program, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN 37232, USA.,Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA.,Department of Cancer Biology, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Carlos L Arteaga
- Breast Cancer Research Program, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN 37232, USA. .,Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA.,Department of Cancer Biology, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
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Luo N, Formisano L, Gonzalez-Ericsson PI, Sanchez V, Dean PT, Opalenik SR, Sanders ME, Cook RS, Arteaga CL, Johnson DB, Balko JM. Melanoma response to anti-PD-L1 immunotherapy requires JAK1 signaling, but not JAK2. Oncoimmunology 2018; 7:e1438106. [PMID: 29872580 PMCID: PMC5975601 DOI: 10.1080/2162402x.2018.1438106] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [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: 09/15/2017] [Revised: 01/31/2018] [Accepted: 02/02/2018] [Indexed: 12/14/2022] Open
Abstract
Immunotherapies targeting programmed cell death protein 1 (PD-1) or its ligand, programmed cell death ligand 1 (PD-L1), dramatically improve the survival of melanoma patients. However, only ∼40% of treated patients demonstrate a clinical response to single-agent anti-PD-1 therapy. An intact tumor response to type-II interferon (i.e. IFN-γ) correlates with response to anti-PD-1, and patients with de novo or acquired resistance may harbor loss-of-function alterations in the JAK/STAT pathway, which lies downstream of the interferon gamma receptor (IFNGR1/2). In this study, we dissected the specific roles of individual JAK/STAT pathway members on the IFN-γ response, and identified JAK1 as the primary mediator of JAK/STAT signaling associated with IFN-γ-induced expression of antigen-presenting molecules MHC-I and MHC-II, as well as PD-L1 and the cytostatic response to IFN-γ. In contrast to the crucial role of JAK1, JAK2 was largely dispensable in mediating most IFN-γ effects. In a mouse melanoma model, inhibition of JAK1/2 in combination with anti-PD-L1 therapy partially blocked anti-tumor immunologic responses, while selective JAK2 inhibition appeared to augment therapy. Amplification of JAK/STAT signaling in tumor cells through genetic inhibition of the negative regulator PTPN2 potentiated IFN-γ response in vitro and in vivo, and may be a target to enhance immunotherapy efficacy.
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Affiliation(s)
- Na Luo
- Department of Anatomy and Histology, School of Medicine, Nankai University, Tianjin, China
- Departments of Medicine, Vanderbilt University Medical Center, Nashville TN, USA
| | - Luigi Formisano
- Departments of Medicine, Vanderbilt University Medical Center, Nashville TN, USA
| | | | - Violeta Sanchez
- Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville TN, USA
| | - Phillip T. Dean
- Departments of Medicine, Vanderbilt University Medical Center, Nashville TN, USA
| | - Susan R. Opalenik
- Departments of Medicine, Vanderbilt University Medical Center, Nashville TN, USA
| | - Melinda E. Sanders
- Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville TN, USA
| | - Rebecca S. Cook
- Cell and Developmental Biology, Vanderbilt University Medical Center, Nashville TN, USA
- Cancer Biology Program, Vanderbilt University Medical Center, Nashville TN, USA
- Breast Cancer Research Program, Vanderbilt University Medical Center, Nashville TN, USA
- Department of Biomedical Engineering, Vanderbilt University Medical Center, Nashville TN
| | - Carlos L. Arteaga
- Departments of Medicine, Vanderbilt University Medical Center, Nashville TN, USA
- Department of Biomedical Engineering, Vanderbilt University Medical Center, Nashville TN
| | - Douglas B. Johnson
- Departments of Medicine, Vanderbilt University Medical Center, Nashville TN, USA
| | - Justin M. Balko
- Departments of Medicine, Vanderbilt University Medical Center, Nashville TN, USA
- Cancer Biology Program, Vanderbilt University Medical Center, Nashville TN, USA
- Breast Cancer Research Program, Vanderbilt University Medical Center, Nashville TN, USA
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Panariti A, Baglole CJ, Sanchez V, Eidelman DH, Hussain S, Olivenstein R, Martin JG, Hamid Q. Interleukin-17A and vascular remodelling in severe asthma; lack of evidence for a direct role. Clin Exp Allergy 2018; 48:365-378. [PMID: 29337379 DOI: 10.1111/cea.13093] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 11/10/2017] [Accepted: 12/11/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Bronchial vascular remodelling may contribute to the severity of airway narrowing through mucosal congestion. Interleukin (IL)-17A is associated with the most severe asthmatic phenotype but whether it might contribute to vascular remodelling is uncertain. OBJECTIVE To assess vascular remodelling in severe asthma and whether IL-17A directly or indirectly may cause endothelial cell activation and angiogenesis. METHODS Bronchial vascularization was quantified in asthmatic subjects, COPD and healthy subjects together with the number of IL-17A+ cells as well as the concentration of angiogenic factors in the sputum. The effect of IL-17A on in vitro angiogenesis, cell migration and endothelial permeability was assessed directly on primary human lung microvascular endothelial cells (HMVEC-L) or indirectly with conditioned medium derived from normal bronchial epithelial cells (NHBEC), fibroblasts (NHBF) and airway smooth muscle cells (ASMC) after IL-17A stimulation. RESULTS Severe asthmatics have increased vascularity compared to the other groups, which correlates positively with the concentrations of angiogenic factors in sputum. Interestingly, we demonstrated that increased bronchial vascularity correlates positively with the number of subepithelial IL-17A+ cells. However IL-17A had no direct effect on HMVEC-L function but it enhanced endothelial tube formation and cell migration through the production of angiogenic factors by NHBE and ASMC. CONCLUSIONS & CLINICAL RELEVANCE Our results shed light on the role of IL-17A in vascular remodelling, most likely through stimulating the synthesis of other angiogenic factors. Knowledge of these pathways may aid in the identification of new therapeutic targets.
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Affiliation(s)
- A Panariti
- Research Institute of the McGill University Health Centre, Meakins-Christie Laboratories, Montreal, QC, Canada
| | - C J Baglole
- Research Institute of the McGill University Health Centre, Meakins-Christie Laboratories, Montreal, QC, Canada
| | - V Sanchez
- Research Institute of the McGill University Health Centre, Meakins-Christie Laboratories, Montreal, QC, Canada
| | - D H Eidelman
- Research Institute of the McGill University Health Centre, Meakins-Christie Laboratories, Montreal, QC, Canada
| | - S Hussain
- Research Institute of the McGill University Health Centre, Meakins-Christie Laboratories, Montreal, QC, Canada
| | - R Olivenstein
- Research Institute of the McGill University Health Centre, Meakins-Christie Laboratories, Montreal, QC, Canada
| | - J G Martin
- Research Institute of the McGill University Health Centre, Meakins-Christie Laboratories, Montreal, QC, Canada
| | - Q Hamid
- Research Institute of the McGill University Health Centre, Meakins-Christie Laboratories, Montreal, QC, Canada
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Balko JM, Johnson DB, Ericsson-Gonzalez P, Nixon MJ, Salgado R, Sanchez V, Shreeder DM, Rimm DL, Loi S, Kim JY, Bordeaux J, Sanders ME, Davis RS. Abstract P1-08-02: Breast tumor-specific MHC-II expression drives a unique pattern of adaptive resistance to antitumor immunity through MHC-II receptor checkpoint engagement. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p1-08-02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: We have previously shown that some breast cancers express major histocompatibility complex II (MHC-II), correlating with enhanced immune infiltration. In other tumor types, we have shown that MHC-II expression on tumor cells predicts clinical response to checkpoint inhibition. We sought to determine the direct effects of MHC-II on anti-tumor immunity and characterize mechanisms of immune escape in this breast cancer subset.
Methods: To determine the functional effects of MHC-II on tumor cells, we generated isogenic mouse breast tumor cells with enforced MHC-II expression and determined their ability to generate tumors in syngeneic mice, the impact on immunity, and their response to checkpoint inhibition. In a series of molecularly-characterized HER2+ (n=8) and triple-negative breast cancers (TNBC; n=103), we performed immunohistochemistry (IHC) and quantitative immunofluorescence (QIF) for Lag-3, PD-L1, CD4, CD8, FCRL6, and granzyme B.
Results: Following injection in syngeneic immunocompetent mice, MHC-II+ mouse breast tumors were more frequently rejected (p=0.04) and recruited greater numbers of CD4+ TILs. When MHC-II+ tumors escaped rejection, they expressed higher degrees of PD-1 and Lag-3 in the tumor and in the draining lymph node. Since Lag-3 is a checkpoint that specifically targets MHC-II, we hypothesized that MHC-II+ breast cancers escape anti-tumor immunity through suppressing MHC-II-mediated antigen presentation. Combinations of anti-Lag-3 and anti-Pd-1 antibodies inhibited growth of MHC-II+ tumors. These findings led us to also explore Fc receptor-like 6 (FCRL6), a previously reported MHC-II receptor expressed on NK and cytotoxic T cells. Residual MHC-II+ TNBC post-neoadjuvant chemotherapy (NAC) recruited greater numbers of CD4+ and CD8+ TILs (p=0.0001 and p=0.0002), suggesting enhanced immune recognition. However, MHC-II+ TNBCs also demonstrated a greater frequency of Lag-3+ and FCRL6+ TILs (p<0.001 and p=0.01, respectively) which frequently co-occurred (p=0.003). Thus, our data suggest that MHC-II expression in breast tumors supports recruitment of MHC-II-specific checkpoint-positive TILs. In line with this concept, QIF analysis demonstrated that the presence of Lag3+ and/or FCRL6+ TILs was strongly associated with suppression of T cell cytotoxicity as assessed by granzyme-B+ CD8+ T cells (p=0.0001 and p=0.002, respectively). Functional analyses of FCRL6 on human NK cell lines and peripheral blood mononuclear cells (PBMCs) demonstrated that like Lag3, FCRL6 is a checkpoint which engages MHC-II and suppresses cytotoxic NK and T cell activity.
Conclusions: These data suggest that MHC-II+ breast tumors are immunologically active and circumvent anti-tumor immunity by targeting MHC-II antigen presentation through recruitment of Lag-3+ and FCRL6+ TILs. We describe herein FCRL6 as a novel bona fide immune checkpoint which targets MHC-II, which may impact a variety of cancers. MHC-II expression status may be a useful biomarker for patient stratification on anti-PD-1/anti-Lag-3 combination, and eventually, anti-PD-1/anti-FCRL6 combinations in patients with breast cancer.
Citation Format: Balko JM, Johnson DB, Ericsson-Gonzalez P, Nixon MJ, Salgado R, Sanchez V, Shreeder DM, Rimm DL, Loi S, Kim JY, Bordeaux J, Sanders ME, Davis RS. Breast tumor-specific MHC-II expression drives a unique pattern of adaptive resistance to antitumor immunity through MHC-II receptor checkpoint engagement [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P1-08-02.
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Affiliation(s)
- JM Balko
- Vanderbilt University Medical Center; GZA and Jules Bordet Institute; University of Pennsylvania; Yale University; Peter MacCallum Cancer Center; Navigate BioPharma Services, Inc., a Novartis Company; University of Alabama
| | - DB Johnson
- Vanderbilt University Medical Center; GZA and Jules Bordet Institute; University of Pennsylvania; Yale University; Peter MacCallum Cancer Center; Navigate BioPharma Services, Inc., a Novartis Company; University of Alabama
| | - P Ericsson-Gonzalez
- Vanderbilt University Medical Center; GZA and Jules Bordet Institute; University of Pennsylvania; Yale University; Peter MacCallum Cancer Center; Navigate BioPharma Services, Inc., a Novartis Company; University of Alabama
| | - MJ Nixon
- Vanderbilt University Medical Center; GZA and Jules Bordet Institute; University of Pennsylvania; Yale University; Peter MacCallum Cancer Center; Navigate BioPharma Services, Inc., a Novartis Company; University of Alabama
| | - R Salgado
- Vanderbilt University Medical Center; GZA and Jules Bordet Institute; University of Pennsylvania; Yale University; Peter MacCallum Cancer Center; Navigate BioPharma Services, Inc., a Novartis Company; University of Alabama
| | - V Sanchez
- Vanderbilt University Medical Center; GZA and Jules Bordet Institute; University of Pennsylvania; Yale University; Peter MacCallum Cancer Center; Navigate BioPharma Services, Inc., a Novartis Company; University of Alabama
| | - DM Shreeder
- Vanderbilt University Medical Center; GZA and Jules Bordet Institute; University of Pennsylvania; Yale University; Peter MacCallum Cancer Center; Navigate BioPharma Services, Inc., a Novartis Company; University of Alabama
| | - DL Rimm
- Vanderbilt University Medical Center; GZA and Jules Bordet Institute; University of Pennsylvania; Yale University; Peter MacCallum Cancer Center; Navigate BioPharma Services, Inc., a Novartis Company; University of Alabama
| | - S Loi
- Vanderbilt University Medical Center; GZA and Jules Bordet Institute; University of Pennsylvania; Yale University; Peter MacCallum Cancer Center; Navigate BioPharma Services, Inc., a Novartis Company; University of Alabama
| | - JY Kim
- Vanderbilt University Medical Center; GZA and Jules Bordet Institute; University of Pennsylvania; Yale University; Peter MacCallum Cancer Center; Navigate BioPharma Services, Inc., a Novartis Company; University of Alabama
| | - J Bordeaux
- Vanderbilt University Medical Center; GZA and Jules Bordet Institute; University of Pennsylvania; Yale University; Peter MacCallum Cancer Center; Navigate BioPharma Services, Inc., a Novartis Company; University of Alabama
| | - ME Sanders
- Vanderbilt University Medical Center; GZA and Jules Bordet Institute; University of Pennsylvania; Yale University; Peter MacCallum Cancer Center; Navigate BioPharma Services, Inc., a Novartis Company; University of Alabama
| | - RS Davis
- Vanderbilt University Medical Center; GZA and Jules Bordet Institute; University of Pennsylvania; Yale University; Peter MacCallum Cancer Center; Navigate BioPharma Services, Inc., a Novartis Company; University of Alabama
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Balko JM, Johnson DB, Wang DY, Ericsson-Gonzalez P, Nixon M, Salgado R, Sanchez V, Schreeder D, Kim JY, Bordeaux J, Sanders M, Davis RS. MHC-II expression to drive a unique pattern of adaptive resistance to antitumor immunity through receptor checkpoint engagement. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.5_suppl.180] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
180 Background: Anti-PD-1 therapy is effective in many cancers, but tumor-intrinsic factors governing response and resistance are largely unknown. MHC-II (HLA-DR) expression on tumor cells can predict response to anti-PD-1. Thus, we sought to determine the molecular features of MHC-II+ tumors in the evolution of anti-PD-1 response. Methods: We performed RNA-seq on 58 anti-PD-1 treated melanoma and lung tumors, including a subset of matched specimens prior to treatment and at acquired resistance. We performed immunohistochemistry (IHC) for immunologic markers, including HLA-DR on tumor cells. In triple-negative breast cancers (TNBC; n = 103), we performed IHC and/or quantitative immunofluorescence (QIF) for LAG3, PD-L1, CD4, CD8, Fc-receptor-like 6 (FCRL6), and granzyme B (GZMB). QIF images were assessed by Automated Quantitative Analysis (AQUA). To determine the functional effect of MHC-II on tumor cells, we generated isogenic MHC-II+ mouse tumors and assessed immune responsiveness and efficacy of checkpoint inhibition. Results: We identified unique inflammatory signatures in HLA-DR+ tumors, correlating with enhanced pre-treatment CD4+ and CD8+ tumor-infiltrating lymphocytes (TILs) and response to anti-PD-1. LAG3+ and FCRL6+ TILs were enriched in HLA-DR+ tumors. LAG3 and FCRL6, known inhibitory receptors which bind MHC-II, were elevated at anti-PD-1 resistance. Similarly, in > 100 TNBCs, HLA-DR+ tumor cells associated with increased CD4+ and CD8+ TILs and enhanced LAG3+ and FCRL6+ TILs. Further, presence of MHC-II-suppressing (LAG3+/FCRL6+) TILs associated with decreased GZMB+ CD8+ T cells, suggesting suppressed cytotoxicity. In mice, enforced expression of MHC-II on tumor cells enhanced CD4-enhanced anti-tumor immunity but was thwarted by LAG3+ TIL recruitment. Combined anti-LAG3 and anti-PD-1 therapy was selectively effective in MHC-II+ tumors. Conclusions: MHC-II+ tumors are immunologically active and may circumvent anti-tumor immunity by targeting MHC-II antigen presentation via recruitment of MHC-II-suppressing TILs. MHC-II expression may be useful to stratify patients to anti-PD-1/anti-LAG3 and eventually, anti-PD-1/anti-FCRL6 combinations.
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Affiliation(s)
| | | | | | | | | | - Roberto Salgado
- Breast Cancer Translational Research Laboratory/Breast International Group, Institut Jules Bordet, Brussels, Belgium
| | | | | | - Ju Young Kim
- Navigate BioPharma Services, Inc., a Novartis subsidiary, Carlsbad, CA
| | - Jennifer Bordeaux
- Navigate BioPharma Services, Inc., a Novartis subsidiary, Carlsbad, CA
| | | | - Randall S. Davis
- University of Alabama at Birmingham, Division of Hematology and Oncology, Birmingham, AL
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Werfel TA, Wang S, Jackson MA, Kavanaugh TE, Joly MM, Lee LH, Hicks DJ, Sanchez V, Ericsson PG, Kilchrist KV, Dimobi SC, Sarett SM, Brantley-Sieders DM, Cook RS, Duvall CL. Selective mTORC2 Inhibitor Therapeutically Blocks Breast Cancer Cell Growth and Survival. Cancer Res 2018; 78:1845-1858. [PMID: 29358172 DOI: 10.1158/0008-5472.can-17-2388] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 10/11/2017] [Accepted: 01/17/2018] [Indexed: 12/12/2022]
Abstract
Small-molecule inhibitors of the mTORC2 kinase (torkinibs) have shown efficacy in early clinical trials. However, the torkinibs under study also inhibit the other mTOR-containing complex mTORC1. While mTORC1/mTORC2 combined inhibition may be beneficial in cancer cells, recent reports describe compensatory cell survival upon mTORC1 inhibition due to loss of negative feedback on PI3K, increased autophagy, and increased macropinocytosis. Genetic models suggest that selective mTORC2 inhibition would be effective in breast cancers, but the lack of selective small-molecule inhibitors of mTORC2 have precluded testing of this hypothesis to date. Here we report the engineering of a nanoparticle-based RNAi therapeutic that can effectively silence the mTORC2 obligate cofactor Rictor. Nanoparticle-based Rictor ablation in HER2-amplified breast tumors was achieved following intratumoral and intravenous delivery, decreasing Akt phosphorylation and increasing tumor cell killing. Selective mTORC2 inhibition in vivo, combined with the HER2 inhibitor lapatinib, decreased the growth of HER2-amplified breast cancers to a greater extent than either agent alone, suggesting that mTORC2 promotes lapatinib resistance, but is overcome by mTORC2 inhibition. Importantly, selective mTORC2 inhibition was effective in a triple-negative breast cancer (TNBC) model, decreasing Akt phosphorylation and tumor growth, consistent with our findings that RICTOR mRNA correlates with worse outcome in patients with basal-like TNBC. Together, our results offer preclinical validation of a novel RNAi delivery platform for therapeutic gene ablation in breast cancer, and they show that mTORC2-selective targeting is feasible and efficacious in this disease setting.Significance: This study describes a nanomedicine to effectively inhibit the growth regulatory kinase mTORC2 in a preclinical model of breast cancer, targeting an important pathogenic enzyme in that setting that has been undruggable to date. Cancer Res; 78(7); 1845-58. ©2018 AACR.
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Affiliation(s)
- Thomas A Werfel
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee.,Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Shan Wang
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Meredith A Jackson
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee
| | - Taylor E Kavanaugh
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee
| | - Meghan Morrison Joly
- Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Linus H Lee
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee
| | - Donna J Hicks
- Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Violeta Sanchez
- Breast Cancer Research Program, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Paula Gonzalez Ericsson
- Breast Cancer Research Program, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kameron V Kilchrist
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee
| | - Somtochukwu C Dimobi
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee
| | - Samantha M Sarett
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee
| | - Dana M Brantley-Sieders
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.,Breast Cancer Research Program, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Rebecca S Cook
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee. .,Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, Tennessee.,Breast Cancer Research Program, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Craig L Duvall
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee.
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50
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Williams MM, Lee L, Werfel T, Joly MMM, Hicks DJ, Rahman B, Elion D, McKernan C, Sanchez V, Estrada MV, Massarweh S, Elledge R, Duvall C, Cook RS. Intrinsic apoptotic pathway activation increases response to anti-estrogens in luminal breast cancers. Cell Death Dis 2018; 9:21. [PMID: 29343814 PMCID: PMC5833697 DOI: 10.1038/s41419-017-0072-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Revised: 08/10/2017] [Accepted: 08/17/2017] [Indexed: 01/26/2023]
Abstract
Estrogen receptor-α positive (ERα+) breast cancer accounts for approximately 70–80% of the nearly 25,0000 new cases of breast cancer diagnosed in the US each year. Endocrine-targeted therapies (those that block ERα activity) serve as the first line of treatment in most cases. Despite the proven benefit of endocrine therapies, however, ERα+ breast tumors can develop resistance to endocrine therapy, causing disease progression or relapse, particularly in the metastatic setting. Anti-apoptotic Bcl-2 family proteins enhance breast tumor cell survival, often promoting resistance to targeted therapies, including endocrine therapies. Herein, we investigated whether blockade of anti-apoptotic Bcl-2 family proteins could sensitize luminal breast cancers to anti-estrogen treatment. We used long-term estrogen deprivation (LTED) of human ERα+ breast cancer cell lines, an established model of sustained treatment with and acquired resistance to aromatase inhibitors (AIs), in combination with Bcl-2/Bcl-xL inhibition (ABT-263), finding that ABT-263 induced only limited tumor cell killing in LTED-selected cells in culture and in vivo. Interestingly, expression and activity of the Bcl-2-related factor Mcl-1 was increased in LTED cells. Genetic Mcl-1 ablation induced apoptosis in LTED-selected cells, and potently increased their sensitivity to ABT-263. Increased expression and activity of Mcl-1 was similarly seen in clinical breast tumor specimens treated with AI + the selective estrogen receptor downregulator fulvestrant. Delivery of Mcl-1 siRNA loaded into polymeric nanoparticles (MCL1 si-NPs) decreased Mcl-1 expression in LTED-selected and fulvestrant-treated cells, increasing tumor cell death and blocking tumor cell growth. These findings suggest that Mcl-1 upregulation in response to anti-estrogen treatment enhances tumor cell survival, decreasing response to therapeutic treatments. Therefore, strategies blocking Mcl-1 expression or activity used in combination with endocrine therapies would enhance tumor cell death.
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Affiliation(s)
- Michelle M Williams
- Department of Cancer Biology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Linus Lee
- Department of Biomedical Engineering, Vanderbilt University School of Engineering, Nashville, TN, USA
| | - Thomas Werfel
- Department of Biomedical Engineering, Vanderbilt University School of Engineering, Nashville, TN, USA
| | - Meghan M Morrison Joly
- Department of Cancer Biology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Donna J Hicks
- Department of Cancer Biology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Bushra Rahman
- Department of Cancer Biology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - David Elion
- Department of Cancer Biology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Courtney McKernan
- Department of Cancer Biology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Violeta Sanchez
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Monica V Estrada
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Suleiman Massarweh
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Richard Elledge
- Cancer Therapy and Research Center, University of Texas Health Science Center, San Antonio, TX, USA
| | - Craig Duvall
- Department of Biomedical Engineering, Vanderbilt University School of Engineering, Nashville, TN, USA
| | - Rebecca S Cook
- Department of Cancer Biology, Vanderbilt University School of Medicine, Nashville, TN, USA. .,Department of Biomedical Engineering, Vanderbilt University School of Engineering, Nashville, TN, USA. .,The Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, 37232, USA.
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