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Gilje EA, Abbott JK. The Pulmonary Effects of STAT3 Deficiency. J Allergy Clin Immunol 2023:S0091-6749(23)00757-1. [PMID: 37331431 DOI: 10.1016/j.jaci.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 06/05/2023] [Accepted: 06/09/2023] [Indexed: 06/20/2023]
Affiliation(s)
- Elizabeth A Gilje
- Department of Allergy and Immunology, Children's Hospital Colorado, 13132 E 16(th) Ave, Aurora, CO, 80045, USA
| | - Jordan K Abbott
- Department of Allergy and Immunology, Children's Hospital Colorado, 13132 E 16(th) Ave, Aurora, CO, 80045, USA.
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2
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Shen M. A case report of T-LGL leukemia-associated pure red cell aplasia harboring STAT3, TNFAIP3, and KMT2D mutation. Transl Cancer Res 2023; 12:1054-1059. [PMID: 37180665 PMCID: PMC10174971 DOI: 10.21037/tcr-23-326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 03/30/2023] [Indexed: 05/16/2023]
Abstract
Background T-large granular lymphocyte (T-LGL) leukemia is a rare clonal lymphoproliferative disorder, which has a favorable prognosis. There are different complications between Asian and Western patients diagnosed with LGL leukemia. In Asians, pure red cell aplasia (PRCA) is the most common hematological compatible clinical feature of LGL leukemia, whereas in Western patients, rheumatoid arthritis and neutropenia are more commonly seen. Herein, a rare case of T-LGL leukemia associated PRCA was reported. Case Description A 72-year-old man, presenting with anemia and leukopenia, was admitted to hospital. The bone marrow (BM) smear revealed that erythroid series were suppressed with only 4%, mature lymphocytes constituting up to 23% of the marrow cells. The results of T-cell receptor (TCR) arrangement revealed mutations in the TCR-β and TCR-γ genes. Further, STAT3 mutation (p. [D661Y; N664T] and p.N647I), TNFAIP3 mutation (p.L48fs), and KMT2D mutation (p.E5291K) were confirmed. The patient was diagnosed with CD8+ TCRαβ T-LGL leukemia-associated PRCA, harboring STAT3, TNFAIP3 and KMT2D mutation. The BM smear, immunophenotype, gene rearrangement and karyotype were consistent with those of the first diagnosis. Cyclosporine A (CyA) based regimens were effective, even in a cessation of discontinued treatment. The patient refused BM-related examinations and has remained in hematological complete remission (CR) until the time of writing (at least 3 years). Conclusions The administration of CyA yielded a CR in this case. However, the standard therapy for T-LGL leukemia-associated PRCA is not clear, and more prospective studies are needed to ascertain the underlying mechanism of pathogenesis.
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Affiliation(s)
- Meixiao Shen
- Department of Hematology, Affiliated Haikou Hospital of Xiangya Medical College, Central South University, Haikou, China
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Mochida K, Nakahata S, Suzuki Y, Inoue K, Moriguchi S, Yamashita A, Amano M, Morishita K. Prognostic analysis of smoldering ATLL with skin eruptions based on genomic aberrations. J Dermatol Sci 2023:S0923-1811(23)00057-9. [PMID: 36842846 DOI: 10.1016/j.jdermsci.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 01/30/2023] [Accepted: 02/12/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUND Patients with smoldering ATLL often present with a skin eruption due to skin infiltration of ATLL cells. Although skin eruption type is known to be associated with prognosis based on its pattern, it is unknown why different types of skin eruptions are associated with different prognoses. OBJECTIVE Genomic analysis of patients with skin eruptions of smoldering ATLL will be performed to determine the mechanism of ATLL development and its association with prognosis. METHODS DNA from skin biopsy specimens was used for targeted sequencing of 280 genes to examine the association between genomic variation and prognosis. RESULTS Due to the small number of smoldering ATLL patients (27 cases), we could not find a clear relationship between skin eruption and prognosis in this study. Genomic analysis identified 247 genomic variants (108 genes), with an average of 9.2 variants and 3.2 variants as driver genes. Pathway analysis of the driver genes showed activation of the pathway associated with HTLV-1 infection, as well as activation of the signaling pathway observed throughout ATLL. Furthermore, multivariate analysis identified age>70 years and STAT3 mutation as prognostic risk factors and TBL1XR1 mutation as a risk factor for progression-free survival. CONCLUSION Although the small number of patient samples did not allow us to determine a prognostic association with skin eruption, STAT3 mutation was identified as a prognostic risk factor for smoldering ATLL with skin eruption. Further studies are needed to increase the number of patients with this disease.
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Gorodetskiy V, Vasilyev V, Sidorova Y, Biderman B, Kupryshina N, Vagida M, Ryzhikova N, Sudarikov A. Clinical Study of the Relationship between Sjögren Syndrome and T-Cell Large Granular Lymphocytic Leukemia: Single-Center Experience. Int J Mol Sci 2022; 23:13345. [PMID: 36362126 PMCID: PMC9656665 DOI: 10.3390/ijms232113345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 10/29/2022] [Accepted: 10/30/2022] [Indexed: 08/30/2023] Open
Abstract
The relationship between Sjögren syndrome (SS) and T-cell large granular lymphocytic (T-LGL) leukemia remains unclear. In this paper, we report for the first time a large case series of 21 patients with primary and secondary SS associated with T-LGL leukemia. Our results suggest the importance of considering T-LGL leukemia in the diagnostic evaluation of SS patients, particularly when neutropenia occurs. We also postulate that elevated antinuclear antibody titers in patients with T-LGL leukemia indicate the need for the clinical assessment of SS. To assess whether SS affects the frequency of the signal transducer and activator of transcription 3 (STAT3) gene mutations in T-LGL leukemia, we examined STAT3 mutations by next-generation sequencing in two cohorts of patients: with SS-associated T-LGL leukemia and T-LGL leukemia in the setting of rheumatic diseases but without SS. While our results suggest that SS, per se, is not associated with an increased frequency of STAT3 mutations in T-LGL leukemia, further studies are needed to better assess the role of the STAT pathway in the development of concomitant SS and T-LGL leukemia.
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Affiliation(s)
- Vadim Gorodetskiy
- Department of Intensive Methods of Therapy, V.A. Nasonova Research Institute of Rheumatology, 115522 Moscow, Russia
| | | | - Yulia Sidorova
- Laboratory of Molecular Hematology, National Medical Research Center for Hematology, 125167 Moscow, Russia
| | - Bella Biderman
- Laboratory of Molecular Hematology, National Medical Research Center for Hematology, 125167 Moscow, Russia
| | - Natalia Kupryshina
- Hematopoiesis Immunology Laboratory, Russian Cancer Research Center N.N. Blokhin, 115478 Moscow, Russia
| | - Murad Vagida
- Laboratory of Transplantation Immunology, National Medical Research Center for Hematology, 125167 Moscow, Russia
| | - Natalya Ryzhikova
- Laboratory of Molecular Hematology, National Medical Research Center for Hematology, 125167 Moscow, Russia
| | - Andrey Sudarikov
- Laboratory of Molecular Hematology, National Medical Research Center for Hematology, 125167 Moscow, Russia
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Fang J, Yang Q, Pi B. Delayed diagnosis of hyperimmunoglobulin E syndrome with STAT3 mutation in mainland China: a case report and literature review. J Int Med Res 2021; 49:3000605211008073. [PMID: 33900869 PMCID: PMC8755649 DOI: 10.1177/03000605211008073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Hyperimmunoglobulin E syndrome (HIES) is a rare immunologic disorder. Typical clinical features of HIES include recurrent bacterial pneumonia, lung cysts, characteristic facial features, and newborn dermatitis. The varied clinical presentation can lead to a delayed diagnosis. We herein present a sporadic case of HIES in a man who initially presented with a longstanding history of intractable skin abscesses.
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Affiliation(s)
- Jiazhui Fang
- Department of Liver and Infectious Diseases, Sir Run Run Shaw Hospital, Hangzhou, China
| | - Qiao Yang
- Department of Liver and Infectious Diseases, Sir Run Run Shaw Hospital, Hangzhou, China
| | - Borui Pi
- Department of Liver and Infectious Diseases, Sir Run Run Shaw Hospital, Hangzhou, China
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6
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Yoshida Y, Nagamori T, Takahashi H, Ishibazawa E, Shimada S, Kawai T, Azuma H. A novel STAT3 mutation associated with hyper immunoglobulin E syndrome with a paucity of connective tissue signs. Pediatr Int 2021; 63:510-515. [PMID: 32920916 DOI: 10.1111/ped.14463] [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: 11/20/2019] [Revised: 08/20/2020] [Accepted: 08/31/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND A heterozygous mutation of STAT3 causes autosomal dominant hyper immunoglobulin E (IgE) syndrome; however, there are still many unclear points regarding the clinical spectrum of this syndrome. METHODS In addition to a clinical description of patients in terms of pedigree, a genetic analysis, quantitation of peripheral blood Th17 and ex vivo IL-17 production were carried out. RESULTS The proband, a 2-year-old boy (Patient 1) with early onset atopic dermatitis-like eczema and recurrent bacterial infections, was suspected of autosomal dominant hyper immunoglobulin E syndrome on the basis of his symptoms and family history. His mother (Patient 2) also had skin eczema and recurrent bacterial infections, and his sister (Patient 3) had skin eczema. A novel STAT3 mutation (p.S476F) was detected in all three patients, but not in the father, who had no such symptoms. A significant decrease in peripheral blood Th17 subsets and IL-17 production was found in all the patients. Curiously, all three patients carrying the p.S476F mutation in STAT3 lacked connective tissue signs such as distinctive facial features, retention of primary teeth, and joint hyperextensibility. CONCLUSIONS Autosomal dominant hyper IgE syndrome should, perhaps, be considered even if patients lack connective tissue signs, as long as hypersensitivity to infection and skin manifestations with hyper IgE are present.
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Affiliation(s)
- Yoichiro Yoshida
- Department of Pediatrics, Asahikawa Medical University, Hokkaido, Japan
| | | | | | - Emi Ishibazawa
- Department of Pediatrics, Asahikawa Medical University, Hokkaido, Japan
| | - Sorachi Shimada
- Department of Pediatrics, Asahikawa Medical University, Hokkaido, Japan
| | - Toshinao Kawai
- Division of Immunology, National Center for Child Health and Development, Tokyo, Japan
| | - Hiroshi Azuma
- Department of Pediatrics, Asahikawa Medical University, Hokkaido, Japan
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7
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Adachi M, Yoshida K, Shiraishi Y, Chiba K, Miyano S, Ogawa S. [Successful treatment of pure red cell aplasia with cyclosporin in a patient with T-cell large granular lymphocytic leukemia harboring the STAT3 D661V mutation]. Rinsho Ketsueki 2019; 60:39-45. [PMID: 30726823 DOI: 10.11406/rinketsu.60.39] [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] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
T-cell large granular lymphocyte (T-LGL) leukemia is a chronic T-cell monoclonal disease that is occasionally associated with pure red cell aplasia (PRCA). A 71-year-old previously healthy man complained of physical fatigue and exhibited anemia (hemoglobin, 10.5 g/dl) with lymphocytosis (76%) showing LGL. The LGL cells expressed CD3, CD7, CD8, and T-cell receptor (TCR) -α/β. TCR-β/γ gene rearrangement was positive. He was thus diagnosed with CD8+ T-LGL leukemia. Anemia progressed with low reticulocyte count (0.11%), and the patient became blood transfusion-dependent, but no distinct abnormality caused the anemia. Bone marrow aspiration revealed an increase in lymphocytes (33.6%) and a decrease in erythroblasts (M/E ratio, 6.1). He was thus diagnosed with T-LGL-associated PRCA. Oral cyclosporin A administration resulted in prompt improvement of anemia, suggesting its high sensitivity. Whole-exome sequencing of his peripheral blood DNA revealed somatic mutations in 33 genes, including the STAT3 gene, implying their roles in T-LGL leukemia.
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Affiliation(s)
| | - Kenichi Yoshida
- Pathology and Tumor Biology, Graduate School of Medicine, Kyoto University
| | - Yuichi Shiraishi
- Human Genome Center, Institute of Medical Science, The University of Tokyo
| | - Kenichi Chiba
- Human Genome Center, Institute of Medical Science, The University of Tokyo
| | - Satoru Miyano
- Human Genome Center, Institute of Medical Science, The University of Tokyo
| | - Seishi Ogawa
- Pathology and Tumor Biology, Graduate School of Medicine, Kyoto University
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Morichika K, Karube K, Kayo H, Uchino S, Nishi Y, Nakachi S, Okamoto S, Morishima S, Ohshiro K, Nakazato I, Fukushima T, Masuzaki H. Phosphorylated STAT3 expression predicts better prognosis in smoldering type of adult T-cell leukemia/lymphoma. Cancer Sci 2019; 110:2982-2991. [PMID: 31237072 PMCID: PMC6726676 DOI: 10.1111/cas.14114] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 05/27/2019] [Accepted: 06/21/2019] [Indexed: 12/21/2022] Open
Abstract
Adult T‐cell leukemia/lymphoma (ATLL) is a mature T‐cell neoplasm, and is divided into 2 indolent (smoldering and chronic) and 2 aggressive (acute and lymphoma) clinical subtypes. Based on previous integrated molecular analyses suggesting the importance of the JAK‐STAT pathway in ATLL, we attempted to clarify the clinicopathological significance of this pathway. Clinical and morphological findings were reviewed in 116 cases with ATLL. The nuclear localizations of phosphorylated STAT3 (pSTAT3), pSTAT5, and pSTAT6 were analyzed by immunohistochemistry. Targeted sequencing was undertaken on the portion of STAT3 encoding the Src homology 2 domain. Expression of pSTAT3 was observed in 43% (50/116) of ATLL cases, whereas pSTAT5 and pSTAT6 were largely undetected. Cases with the lymphoma type showed significantly less frequent pSTAT3 expression (8/45, 18%) than those with the other subtypes (41/66, 62%; P < .001). STAT3 mutations were detected in 36% (10/28) and 19% (12/64) of cases with the smoldering and aggressive types of ATLL, respectively. The correlation between STAT3 mutation and pSTAT3 expression was not significant (P = .07). Both univariate and multivariate analysis revealed that pSTAT3 expression was significantly associated with better overall survival and progression‐free survival in the smoldering type of ATLL, whereas STAT3 mutation was not related to a line of clinical outcome. Collectively, our data show that only the lymphoma type showed a low prevalence of tumor cells positive for pSTAT3 expression, and raises the possibility that pSTAT3 expression is a novel biomarker to predict better prognosis in the smoldering type of ATLL.
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Affiliation(s)
- Kazuho Morichika
- Division of Endocrinology, Diabetes and Metabolism, Hematology, Rheumatology (Second Department of Internal Medicine), Graduate School of Medicine, University of the Ryukyus, Nishihara, Japan
| | - Kennosuke Karube
- Department of Pathology and Cell Biology, Graduate School of Medicine, University of the Ryukyus, Nishihara, Japan
| | - Hirona Kayo
- Faculty of Medicine, University of the Ryukyus, Nishihara, Japan
| | - Shuta Uchino
- Faculty of Medicine, University of the Ryukyus, Nishihara, Japan
| | - Yukiko Nishi
- Division of Endocrinology, Diabetes and Metabolism, Hematology, Rheumatology (Second Department of Internal Medicine), Graduate School of Medicine, University of the Ryukyus, Nishihara, Japan
| | - Sawako Nakachi
- Division of Endocrinology, Diabetes and Metabolism, Hematology, Rheumatology (Second Department of Internal Medicine), Graduate School of Medicine, University of the Ryukyus, Nishihara, Japan
| | - Shiki Okamoto
- Division of Endocrinology, Diabetes and Metabolism, Hematology, Rheumatology (Second Department of Internal Medicine), Graduate School of Medicine, University of the Ryukyus, Nishihara, Japan
| | - Satoko Morishima
- Division of Endocrinology, Diabetes and Metabolism, Hematology, Rheumatology (Second Department of Internal Medicine), Graduate School of Medicine, University of the Ryukyus, Nishihara, Japan
| | - Kazuiku Ohshiro
- Department of Hematology, Okinawa Prefectural Nanbu Medical Center and Children's Medical Center, Haebaru, Japan
| | - Iwao Nakazato
- Department of Pathology, Okinawa Prefectural Nanbu Medical Center and Children's Medical Center, Haebaru, Japan
| | - Takuya Fukushima
- Laboratory of Hematoimmunology, School of Health Sciences, Faculty of Medicine, University of the Ryukyus, Nishihara, Japan
| | - Hiroaki Masuzaki
- Division of Endocrinology, Diabetes and Metabolism, Hematology, Rheumatology (Second Department of Internal Medicine), Graduate School of Medicine, University of the Ryukyus, Nishihara, Japan
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9
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de Silva R, Dasanayake D, Senanayake M, Ediriweera R, Dias S, Karunatilleke C, Brocas K, Tahami F, Seneviratne S. Hyper IgE recurrent infection syndrome in South Asia: is there a different outcome? Allergy Asthma Clin Immunol 2018; 14:70. [PMID: 30410549 PMCID: PMC6214173 DOI: 10.1186/s13223-018-0292-3] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 08/10/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND Hyper IgE recurrent infection syndrome (HIES) is a rare immune deficiency, characterized by recurrent staphylococcal skin and lung abscesses, pneumonia and increased IgE levels. The majority of autosomal dominant HIES (AD HIGE) is due to hypomorphic mutations in the signal transducer and the activator of transcription 3 (STAT3) gene. CASE PRESENTATION Five patients were diagnosed with HIES, based on the clinical criteria and scoring system developed at the National Institutes of Health (NIH), USA. The STAT3 gene was sequenced and previously described mutations were identified in all five patients. We compare the clinical features of our patients with those from Asia, Europe and the US. CONCLUSION Even though the number of patients is limited, there are some clinical differences in patients from South Asia compared to European and even East Asian patients. However, the mutations detected are located at hot spots seen in western and Asian patients with AD HIGE.
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Affiliation(s)
| | | | | | | | | | | | - Karen Brocas
- Institute of Infection and Immunity, Royal Free Hospital, London, UK
| | - Fariba Tahami
- Institute of Infection and Immunity, Royal Free Hospital, London, UK
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10
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Kuusanmäki H, Dufva O, Parri E, van Adrichem AJ, Rajala H, Majumder MM, Yadav B, Parsons A, Chan WC, Wennerberg K, Mustjoki S, Heckman CA. Drug sensitivity profiling identifies potential therapies for lymphoproliferative disorders with overactive JAK/STAT3 signaling. Oncotarget 2017; 8:97516-97527. [PMID: 29228628 PMCID: PMC5722580 DOI: 10.18632/oncotarget.22178] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 08/27/2017] [Indexed: 12/31/2022] Open
Abstract
Constitutive JAK/STAT3 signaling contributes to disease progression in many lymphoproliferative disorders. Recent genetic analyses have revealed gain-of-function STAT3 mutations in lymphoid cancers leading to hyperactivation of STAT3, which may represent a potential therapeutic target. Using a functional reporter assay, we screened 306 compounds with selective activity against various target molecules to identify drugs capable of inhibiting the cellular activity of STAT3. Top hits were further validated with additional models including STAT3-mutated natural killer (NK)-cell leukemia/lymphoma cell lines and primary large granular lymphocytic (LGL) leukemia cells to assess their ability to inhibit STAT3 phosphorylation and STAT3 dependent cell viability. We identified JAK, mTOR, Hsp90 and CDK inhibitors as potent inhibitors of both WT and mutant STAT3 activity. The Hsp90 inhibitor luminespib was highly effective at reducing the viability of mutant STAT3 NK cell lines and LGL leukemia patient samples. Luminespib decreased the phosphorylation of mutant STAT3 at Y705, whereas JAK1/JAK2 inhibitor ruxolitinib had reduced efficacy on mutant STAT3 phosphorylation. Additionally, combinations involving Hsp90, JAK and mTOR inhibitors were more effective at reducing cell viability than single agents. Our findings show alternative approaches to inhibit STAT3 activity and suggest Hsp90 as a therapeutic target in lymphoproliferative disorders with constitutively active STAT3.
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Affiliation(s)
- Heikki Kuusanmäki
- Institute for Molecular Medicine Finland, Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland.,Hematology Research Unit, Helsinki University Hospital Comprehensive Cancer Center, Helsinki, Finland
| | - Olli Dufva
- Hematology Research Unit, Helsinki University Hospital Comprehensive Cancer Center, Helsinki, Finland
| | - Elina Parri
- Institute for Molecular Medicine Finland, Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
| | - Arjan J van Adrichem
- Institute for Molecular Medicine Finland, Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
| | - Hanna Rajala
- Hematology Research Unit, Helsinki University Hospital Comprehensive Cancer Center, Helsinki, Finland
| | - Muntasir M Majumder
- Institute for Molecular Medicine Finland, Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
| | - Bhagwan Yadav
- Institute for Molecular Medicine Finland, Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
| | - Alun Parsons
- Institute for Molecular Medicine Finland, Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
| | - Wing C Chan
- Department of Pathology, City of Hope National Medical Center, Duarte, CA, USA
| | - Krister Wennerberg
- Institute for Molecular Medicine Finland, Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
| | - Satu Mustjoki
- Hematology Research Unit, Helsinki University Hospital Comprehensive Cancer Center, Helsinki, Finland.,Department of Clinical Chemistry and Hematology, University of Helsinki, Helsinki, Finland
| | - Caroline A Heckman
- Institute for Molecular Medicine Finland, Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
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11
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Teramo A, Barilà G, Calabretto G, Ercolin C, Lamy T, Moignet A, Roussel M, Pastoret C, Leoncin M, Gattazzo C, Cabrelle A, Boscaro E, Teolato S, Pagnin E, Berno T, De March E, Facco M, Piazza F, Trentin L, Semenzato G, Zambello R. STAT3 mutation impacts biological and clinical features of T-LGL leukemia. Oncotarget 2017; 8:61876-61889. [PMID: 28977911 PMCID: PMC5617471 DOI: 10.18632/oncotarget.18711] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 05/22/2017] [Indexed: 11/25/2022] Open
Abstract
STAT3 mutations have been described in 30-40% of T-large granular lymphocyte (T-LGL) leukemia patients, leading to STAT3 pathway activation. Considering the heterogeneity of the disease and the several immunophenotypes that LGL clone may express, the aim of this work was to evaluate whether STAT3 mutations might be associated with a distinctive LGL immunophenotype and/or might be indicative for specific clinical features. Our series of cases included a pilot cohort of 101 T-LGL leukemia patients (68 CD8+/CD4- and 33 CD4+/CD8±) from Padua Hematology Unit (Italy) and a validation cohort of additional 20 patients from Rennes Hematology Unit (France). Our results indicate that i) CD8+ T-LGL leukemia patients with CD16+/CD56- immunophenotype identify a subset of patients characterized by the presence of STAT3 mutations and neutropenia, ii) CD4+/CD8± T-LGL leukemia are devoid of STAT3 mutations but characterized by STAT5b mutations, and iii) a correlation exists between STAT3 activation and presence of Fas ligand, this molecule resulting highly expressed in CD8+/CD16+/CD56- patients. Experiments with stimulation and inhibition of STAT3 phosphorylation confirmed this relationship. In conclusion, our data show that T-LGL leukemia with specific molecular and phenotypic patterns is associated with discrete clinical features contributing to get insights into molecular bases accounting for the development of Fas ligand-mediated neutropenia.
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Affiliation(s)
- Antonella Teramo
- Padua University School of Medicine, Department of Medicine, Hematology and Clinical Immunology Branch, Padua, Italy.,Venetian Institute of Molecular Medicine (VIMM), Padua, Italy
| | - Gregorio Barilà
- Padua University School of Medicine, Department of Medicine, Hematology and Clinical Immunology Branch, Padua, Italy.,Venetian Institute of Molecular Medicine (VIMM), Padua, Italy
| | - Giulia Calabretto
- Padua University School of Medicine, Department of Medicine, Hematology and Clinical Immunology Branch, Padua, Italy.,Venetian Institute of Molecular Medicine (VIMM), Padua, Italy
| | - Chiara Ercolin
- Padua University School of Medicine, Department of Medicine, Hematology and Clinical Immunology Branch, Padua, Italy.,Venetian Institute of Molecular Medicine (VIMM), Padua, Italy
| | - Thierry Lamy
- Department of Clinical Hematology, University Hospital of Rennes, Rennes, France
| | - Aline Moignet
- Department of Clinical Hematology, University Hospital of Rennes, Rennes, France
| | - Mikael Roussel
- Biology Department, University Hospital of Rennes, Rennes, France
| | - Cédric Pastoret
- Biology Department, University Hospital of Rennes, Rennes, France
| | - Matteo Leoncin
- Padua University School of Medicine, Department of Medicine, Hematology and Clinical Immunology Branch, Padua, Italy
| | - Cristina Gattazzo
- Padua University School of Medicine, Department of Medicine, Hematology and Clinical Immunology Branch, Padua, Italy.,Venetian Institute of Molecular Medicine (VIMM), Padua, Italy
| | - Anna Cabrelle
- Venetian Institute of Molecular Medicine (VIMM), Padua, Italy
| | - Elisa Boscaro
- Padua University School of Medicine, Department of Medicine, Hematology and Clinical Immunology Branch, Padua, Italy
| | - Sara Teolato
- Padua University School of Medicine, Department of Medicine, Hematology and Clinical Immunology Branch, Padua, Italy
| | - Elisa Pagnin
- Padua University School of Medicine, Department of Medicine, Hematology and Clinical Immunology Branch, Padua, Italy
| | - Tamara Berno
- Padua University School of Medicine, Department of Medicine, Hematology and Clinical Immunology Branch, Padua, Italy
| | - Elena De March
- Padua University School of Medicine, Department of Medicine, Hematology and Clinical Immunology Branch, Padua, Italy
| | - Monica Facco
- Padua University School of Medicine, Department of Medicine, Hematology and Clinical Immunology Branch, Padua, Italy.,Venetian Institute of Molecular Medicine (VIMM), Padua, Italy
| | - Francesco Piazza
- Padua University School of Medicine, Department of Medicine, Hematology and Clinical Immunology Branch, Padua, Italy.,Venetian Institute of Molecular Medicine (VIMM), Padua, Italy
| | - Livio Trentin
- Padua University School of Medicine, Department of Medicine, Hematology and Clinical Immunology Branch, Padua, Italy.,Venetian Institute of Molecular Medicine (VIMM), Padua, Italy
| | - Gianpietro Semenzato
- Padua University School of Medicine, Department of Medicine, Hematology and Clinical Immunology Branch, Padua, Italy.,Venetian Institute of Molecular Medicine (VIMM), Padua, Italy
| | - Renato Zambello
- Padua University School of Medicine, Department of Medicine, Hematology and Clinical Immunology Branch, Padua, Italy.,Venetian Institute of Molecular Medicine (VIMM), Padua, Italy
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Sanikommu SR, Clemente MJ, Chomczynski P, Afable MG, Jerez A, Thota S, Patel B, Hirsch C, Nazha A, Desamito J, Lichtin A, Pohlman B, Sekeres MA, Radivoyevitch T, Maciejewski JP. Clinical features and treatment outcomes in large granular lymphocytic leukemia (LGLL). Leuk Lymphoma 2017. [PMID: 28633612 DOI: 10.1080/10428194.2017.1339880] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Large granular lymphocytic leukemia (LGLL) represents a clonal/oligoclonal lymphoproliferation of cytotoxic T and natural killer cells often associated with STAT3 mutations. When symptomatic, due to mostly anemia and neutropenia, therapy choices are often empirically-based, because only few clinical trials and systematic studies have been performed. Incorporating new molecular and flow cytometry parameters, we identified 204 patients fulfilling uniform criteria for LGLL diagnoses and analyzed clinical course with median follow-up of 36 months, including responses to treatments. While selection of initial treatment was dictated by clinical features, the initial responses, as well as overall responses to methotrexate (MTX), cyclosporine (CsA), and cyclophosphamide (CTX), were similar at 40-50% across drugs. Sequential use of these drugs resulted in responses in most cases: only 10-20% required salvage therapies such as ATG, Campath, tofacitinib, splenectomy or abatacept. MTX yielded the most durable responses. STAT3-mutated patients required therapy more frequently and had better overall survival.
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Affiliation(s)
- Srinivasa R Sanikommu
- a Department of Translational Hematology and Oncology Research , Taussig Cancer Institute, Cleveland Clinic , Cleveland , OH , USA
| | - Michael J Clemente
- a Department of Translational Hematology and Oncology Research , Taussig Cancer Institute, Cleveland Clinic , Cleveland , OH , USA
| | - Peter Chomczynski
- a Department of Translational Hematology and Oncology Research , Taussig Cancer Institute, Cleveland Clinic , Cleveland , OH , USA
| | - Manuel G Afable
- a Department of Translational Hematology and Oncology Research , Taussig Cancer Institute, Cleveland Clinic , Cleveland , OH , USA
| | - Andres Jerez
- a Department of Translational Hematology and Oncology Research , Taussig Cancer Institute, Cleveland Clinic , Cleveland , OH , USA
| | - Swapna Thota
- b Department of Hematologic Oncology and Blood Disorders , Taussig Cancer Institute, Cleveland Clinic , Cleveland , OH , USA
| | - Bhumika Patel
- a Department of Translational Hematology and Oncology Research , Taussig Cancer Institute, Cleveland Clinic , Cleveland , OH , USA
| | - Cassandra Hirsch
- a Department of Translational Hematology and Oncology Research , Taussig Cancer Institute, Cleveland Clinic , Cleveland , OH , USA
| | - Aziz Nazha
- b Department of Hematologic Oncology and Blood Disorders , Taussig Cancer Institute, Cleveland Clinic , Cleveland , OH , USA
| | - John Desamito
- b Department of Hematologic Oncology and Blood Disorders , Taussig Cancer Institute, Cleveland Clinic , Cleveland , OH , USA
| | - Alan Lichtin
- b Department of Hematologic Oncology and Blood Disorders , Taussig Cancer Institute, Cleveland Clinic , Cleveland , OH , USA
| | - Brad Pohlman
- b Department of Hematologic Oncology and Blood Disorders , Taussig Cancer Institute, Cleveland Clinic , Cleveland , OH , USA
| | - Mikkael A Sekeres
- a Department of Translational Hematology and Oncology Research , Taussig Cancer Institute, Cleveland Clinic , Cleveland , OH , USA.,b Department of Hematologic Oncology and Blood Disorders , Taussig Cancer Institute, Cleveland Clinic , Cleveland , OH , USA
| | - Tomas Radivoyevitch
- c Department of Quantitative Health Sciences , Cleveland Clinic , Cleveland , OH , USA
| | - Jaroslaw P Maciejewski
- a Department of Translational Hematology and Oncology Research , Taussig Cancer Institute, Cleveland Clinic , Cleveland , OH , USA.,b Department of Hematologic Oncology and Blood Disorders , Taussig Cancer Institute, Cleveland Clinic , Cleveland , OH , USA
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Tanahashi T, Sekiguchi N, Matsuda K, Takezawa Y, Ito T, Kobayashi H, Ichikawa N, Nishina S, Senoo N, Sakai H, Nakazawa H, Ishida F. Cell size variations of large granular lymphocyte leukemia: Implication of a small cell subtype of granular lymphocyte leukemia with STAT3 mutations. Leuk Res 2016; 45:8-13. [PMID: 27064362 DOI: 10.1016/j.leukres.2016.04.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 03/22/2016] [Accepted: 04/01/2016] [Indexed: 11/20/2022]
Abstract
Large granular lymphocyte leukemia (LGL-L) has been morphologically defined as a group of lymphoproliferative disorders, including T-cell large granular lymphocytic leukemia (T-LGL-L), chronic lymphoproliferative disorders of NK cells (CLPD-NK) and aggressive NK cell leukemia. We investigated the morphological features of LGL leukemic cells in 26 LGL-L patients in order to elucidate relationships with current classifications and molecular backgrounds. LGL-L cells were mostly indistinguishable from normal LGL. Patients with STAT3 SH2 domain mutations showed significantly smaller cells compared with patients without STAT3 mutations. Four patients with T-LGL-L showed smaller granular lymphocytes with a median diameter of less than 13μm, which were rarely seen in normal subjects. This small subtype of T-LGL-L was recognized among rather young patients and was associated with D661Y mutations in the STAT3 gene SH2 domain. In addition, all of them showed anemia including two cases with pure red cell aplasia. These results suggest the heterogeneity of T-LGL-L and a specific subtype with small variants of T-LGL-L.
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