Trans-arterial chemoembolization as a loco-regional inducer of immunogenic cell death in hepatocellular carcinoma: implications for immunotherapy
BackgroundModulation of adaptive immunity may underscore the efficacy of trans-arterial chemoembolization (TACE). We evaluated the influence of TACE on T-cell function by phenotypic lymphocyte characterization in samples of patients undergoing surgery with (T+) or without (T-) prior-TACE treatment.M...
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| Vydané v: | Journal for immunotherapy of cancer Ročník 9; číslo 9; s. e003311 |
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| Hlavní autori: | , , , , , , , , , , , , , , , , , , , , |
| Médium: | Journal Article |
| Jazyk: | English |
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England
BMJ Publishing Group Ltd
01.09.2021
BMJ Publishing Group LTD BMJ Publishing Group |
| Edícia: | Original research |
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| ISSN: | 2051-1426, 2051-1426 |
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| Abstract | BackgroundModulation of adaptive immunity may underscore the efficacy of trans-arterial chemoembolization (TACE). We evaluated the influence of TACE on T-cell function by phenotypic lymphocyte characterization in samples of patients undergoing surgery with (T+) or without (T-) prior-TACE treatment.MethodsWe profiled intratumoral (IT), peritumoral (PT) and non-tumoral (NT) background tissue to evaluate regulatory CD4+/FOXP3+ (T-reg) and immune-exhausted CD8+/PD-1+ T-cells across T+ (n=58) and T− (n=61). We performed targeted transcriptomics and T-cell receptor sequencing in a restricted subset of samples (n=24) evaluated in relationship with the expression of actionable drivers of anti-cancer immunity including PD-L1, indoleamine 2,3 dehydrogenase (IDO-1), cytotoxic T-lymphocyte associated protein 4 (CTLA-4), Lag-3, Tim-3 and CD163.ResultsWe analyzed 119 patients resected (n=25, 21%) or transplanted (n=94, 79%) for Child-Pugh A (n=65, 55%) and Barcelona Clinic Liver Cancer stage A (n=92, 77%) hepatocellular carcinoma. T+ samples displayed lower IT CD4+/FOXP3+ (p=0.006), CD8+ (p=0.002) and CD8+/PD-1+ and NT CD8+/PD-1+ (p<0.001) compared with T−. Lower IT (p=0.005) and NT CD4+/FOXP3+ (p=0.03) predicted for improved recurrence-free survival. In a subset of samples (n=24), transcriptomic analysis revealed upregulation of a pro-inflammatory response in T+. T+ samples were enriched for IRF2 expression (p=0.01), an interferon-regulated transcription factor implicated in cancer immune-evasion. T-cell clonality and expression of PD-L1, IDO-1, CTLA-4, Lag-3, Tim-3 and CD163 was similar in T+ versus T−.ConclusionsTACE is associated with lower IT density of immune-exhausted effector cytotoxic and T-regs, with significant upregulation of pro-inflammatory pathways. This highlights the pleiotropic effects of TACE in modulating the tumor microenvironment and strengthens the rationale for developing immunotherapy alongside TACE. |
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| AbstractList | BackgroundModulation of adaptive immunity may underscore the efficacy of trans-arterial chemoembolization (TACE). We evaluated the influence of TACE on T-cell function by phenotypic lymphocyte characterization in samples of patients undergoing surgery with (T+) or without (T-) prior-TACE treatment.MethodsWe profiled intratumoral (IT), peritumoral (PT) and non-tumoral (NT) background tissue to evaluate regulatory CD4+/FOXP3+ (T-reg) and immune-exhausted CD8+/PD-1+ T-cells across T+ (n=58) and T− (n=61). We performed targeted transcriptomics and T-cell receptor sequencing in a restricted subset of samples (n=24) evaluated in relationship with the expression of actionable drivers of anti-cancer immunity including PD-L1, indoleamine 2,3 dehydrogenase (IDO-1), cytotoxic T-lymphocyte associated protein 4 (CTLA-4), Lag-3, Tim-3 and CD163.ResultsWe analyzed 119 patients resected (n=25, 21%) or transplanted (n=94, 79%) for Child-Pugh A (n=65, 55%) and Barcelona Clinic Liver Cancer stage A (n=92, 77%) hepatocellular carcinoma. T+ samples displayed lower IT CD4+/FOXP3+ (p=0.006), CD8+ (p=0.002) and CD8+/PD-1+ and NT CD8+/PD-1+ (p<0.001) compared with T−. Lower IT (p=0.005) and NT CD4+/FOXP3+ (p=0.03) predicted for improved recurrence-free survival. In a subset of samples (n=24), transcriptomic analysis revealed upregulation of a pro-inflammatory response in T+. T+ samples were enriched for IRF2 expression (p=0.01), an interferon-regulated transcription factor implicated in cancer immune-evasion. T-cell clonality and expression of PD-L1, IDO-1, CTLA-4, Lag-3, Tim-3 and CD163 was similar in T+ versus T−.ConclusionsTACE is associated with lower IT density of immune-exhausted effector cytotoxic and T-regs, with significant upregulation of pro-inflammatory pathways. This highlights the pleiotropic effects of TACE in modulating the tumor microenvironment and strengthens the rationale for developing immunotherapy alongside TACE. Modulation of adaptive immunity may underscore the efficacy of trans-arterial chemoembolization (TACE). We evaluated the influence of TACE on T-cell function by phenotypic lymphocyte characterization in samples of patients undergoing surgery with (T+) or without (T-) prior-TACE treatment. We profiled intratumoral (IT), peritumoral (PT) and non-tumoral (NT) background tissue to evaluate regulatory CD4+/FOXP3+ (T-reg) and immune-exhausted CD8+/PD-1+ T-cells across T+ (n=58) and T- (n=61). We performed targeted transcriptomics and T-cell receptor sequencing in a restricted subset of samples (n=24) evaluated in relationship with the expression of actionable drivers of anti-cancer immunity including PD-L1, indoleamine 2,3 dehydrogenase (IDO-1), cytotoxic T-lymphocyte associated protein 4 (CTLA-4), Lag-3, Tim-3 and CD163. We analyzed 119 patients resected (n=25, 21%) or transplanted (n=94, 79%) for Child-Pugh A (n=65, 55%) and Barcelona Clinic Liver Cancer stage A (n=92, 77%) hepatocellular carcinoma. T+ samples displayed lower IT CD4+/FOXP3+ (p=0.006), CD8+ (p=0.002) and CD8+/PD-1+ and NT CD8+/PD-1+ (p<0.001) compared with T-. Lower IT (p=0.005) and NT CD4+/FOXP3+ (p=0.03) predicted for improved recurrence-free survival. In a subset of samples (n=24), transcriptomic analysis revealed upregulation of a pro-inflammatory response in T+. T+ samples were enriched for IRF2 expression (p=0.01), an interferon-regulated transcription factor implicated in cancer immune-evasion. T-cell clonality and expression of PD-L1, IDO-1, CTLA-4, Lag-3, Tim-3 and CD163 was similar in T+ versus T-. TACE is associated with lower IT density of immune-exhausted effector cytotoxic and T-regs, with significant upregulation of pro-inflammatory pathways. This highlights the pleiotropic effects of TACE in modulating the tumor microenvironment and strengthens the rationale for developing immunotherapy alongside TACE. Modulation of adaptive immunity may underscore the efficacy of trans-arterial chemoembolization (TACE). We evaluated the influence of TACE on T-cell function by phenotypic lymphocyte characterization in samples of patients undergoing surgery with (T+) or without (T-) prior-TACE treatment.BACKGROUNDModulation of adaptive immunity may underscore the efficacy of trans-arterial chemoembolization (TACE). We evaluated the influence of TACE on T-cell function by phenotypic lymphocyte characterization in samples of patients undergoing surgery with (T+) or without (T-) prior-TACE treatment.We profiled intratumoral (IT), peritumoral (PT) and non-tumoral (NT) background tissue to evaluate regulatory CD4+/FOXP3+ (T-reg) and immune-exhausted CD8+/PD-1+ T-cells across T+ (n=58) and T- (n=61). We performed targeted transcriptomics and T-cell receptor sequencing in a restricted subset of samples (n=24) evaluated in relationship with the expression of actionable drivers of anti-cancer immunity including PD-L1, indoleamine 2,3 dehydrogenase (IDO-1), cytotoxic T-lymphocyte associated protein 4 (CTLA-4), Lag-3, Tim-3 and CD163.METHODSWe profiled intratumoral (IT), peritumoral (PT) and non-tumoral (NT) background tissue to evaluate regulatory CD4+/FOXP3+ (T-reg) and immune-exhausted CD8+/PD-1+ T-cells across T+ (n=58) and T- (n=61). We performed targeted transcriptomics and T-cell receptor sequencing in a restricted subset of samples (n=24) evaluated in relationship with the expression of actionable drivers of anti-cancer immunity including PD-L1, indoleamine 2,3 dehydrogenase (IDO-1), cytotoxic T-lymphocyte associated protein 4 (CTLA-4), Lag-3, Tim-3 and CD163.We analyzed 119 patients resected (n=25, 21%) or transplanted (n=94, 79%) for Child-Pugh A (n=65, 55%) and Barcelona Clinic Liver Cancer stage A (n=92, 77%) hepatocellular carcinoma. T+ samples displayed lower IT CD4+/FOXP3+ (p=0.006), CD8+ (p=0.002) and CD8+/PD-1+ and NT CD8+/PD-1+ (p<0.001) compared with T-. Lower IT (p=0.005) and NT CD4+/FOXP3+ (p=0.03) predicted for improved recurrence-free survival. In a subset of samples (n=24), transcriptomic analysis revealed upregulation of a pro-inflammatory response in T+. T+ samples were enriched for IRF2 expression (p=0.01), an interferon-regulated transcription factor implicated in cancer immune-evasion. T-cell clonality and expression of PD-L1, IDO-1, CTLA-4, Lag-3, Tim-3 and CD163 was similar in T+ versus T-.RESULTSWe analyzed 119 patients resected (n=25, 21%) or transplanted (n=94, 79%) for Child-Pugh A (n=65, 55%) and Barcelona Clinic Liver Cancer stage A (n=92, 77%) hepatocellular carcinoma. T+ samples displayed lower IT CD4+/FOXP3+ (p=0.006), CD8+ (p=0.002) and CD8+/PD-1+ and NT CD8+/PD-1+ (p<0.001) compared with T-. Lower IT (p=0.005) and NT CD4+/FOXP3+ (p=0.03) predicted for improved recurrence-free survival. In a subset of samples (n=24), transcriptomic analysis revealed upregulation of a pro-inflammatory response in T+. T+ samples were enriched for IRF2 expression (p=0.01), an interferon-regulated transcription factor implicated in cancer immune-evasion. T-cell clonality and expression of PD-L1, IDO-1, CTLA-4, Lag-3, Tim-3 and CD163 was similar in T+ versus T-.TACE is associated with lower IT density of immune-exhausted effector cytotoxic and T-regs, with significant upregulation of pro-inflammatory pathways. This highlights the pleiotropic effects of TACE in modulating the tumor microenvironment and strengthens the rationale for developing immunotherapy alongside TACE.CONCLUSIONSTACE is associated with lower IT density of immune-exhausted effector cytotoxic and T-regs, with significant upregulation of pro-inflammatory pathways. This highlights the pleiotropic effects of TACE in modulating the tumor microenvironment and strengthens the rationale for developing immunotherapy alongside TACE. |
| Author | Forner, Alejandro Giannini, Edoardo Marafioti, Teresa Mazzaferro, Vincenzo Goldin, Robert D Diaz, Alba Fessas, Petros Altmann, Daniel M. Boyton, Rosemary J. Avellini, Claudio Toniutto, Pierluigi Pinato, David J. Mínguez, Beatriz Murray, Sam M Kaneko, Takahiro Akarca, Ayse U Mauri, Francesco A Bhoori, Sherrie Grillo, Federica Cacciato, Valentina Casagrande, Edoardo |
| AuthorAffiliation | 14 Department of Surgery and Cancer , Imperial College London , London , UK 3 Department of Infectious Diseases, Faculty of Medicine , Imperial College London, Hammersmith Hospital Campus , London , UK 11 Pathology Department, Barcelona Clinic Liver Cancer (BCLC) Group, Hospital Clínic , University of Barcelona , Barcelona , Spain 8 Liver Unit, Hospital Universitari Vall d’Hebron , Universitat Autonoma de Barcelona , Barcelona , Spain 16 Department of Oncology , University of Milan , Milano , Italy 10 Institute of Histopathology , Azienda Ospedaliero-Universitaria "Santa Maria della Misericordia" , Udine , Italy 13 Department of Histopathology , University College London Cancer Institute , London , UK 15 Department of Surgical Sciences , IRCCS-Ospedale Policlinico San Martino , Genoa , Italy 1 Department of Surgery & Cancer, Faculty of Medicine , Imperial College London, Hammersmith Hospital Campus , London , UK 7 Hepatology and Liver Transplantation Unit, Department of Medical Area (DAME) , Un |
| AuthorAffiliation_xml | – name: 7 Hepatology and Liver Transplantation Unit, Department of Medical Area (DAME) , University of Udine , Udine , Italy – name: 15 Department of Surgical Sciences , IRCCS-Ospedale Policlinico San Martino , Genoa , Italy – name: 2 Division of Oncology, Department of Translational Medicine , Universita del Piemonte Orientale "A. Avogadro" , Novara , Italy – name: 9 Gastroenterology Unit, Department of Internal Medicine , IRCCS-Ospedale Policlinico San Martino , Genoa , Italy – name: 10 Institute of Histopathology , Azienda Ospedaliero-Universitaria "Santa Maria della Misericordia" , Udine , Italy – name: 11 Pathology Department, Barcelona Clinic Liver Cancer (BCLC) Group, Hospital Clínic , University of Barcelona , Barcelona , Spain – name: 14 Department of Surgery and Cancer , Imperial College London , London , UK – name: 3 Department of Infectious Diseases, Faculty of Medicine , Imperial College London, Hammersmith Hospital Campus , London , UK – name: 12 Centre for Pathology , Imperial College London , London , UK – name: 4 Liver Unit, Barcelona Clinic Liver Cancer (BCLC) Group , University of Barcelona, Hospital Clinic , Barcelona , Spain – name: 16 Department of Oncology , University of Milan , Milano , Italy – name: 8 Liver Unit, Hospital Universitari Vall d’Hebron , Universitat Autonoma de Barcelona , Barcelona , Spain – name: 13 Department of Histopathology , University College London Cancer Institute , London , UK – name: 1 Department of Surgery & Cancer, Faculty of Medicine , Imperial College London, Hammersmith Hospital Campus , London , UK – name: 5 Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD) , Instituto de Salud Carlos III , Madrid , Spain – name: 6 Tokyo Medical and Dental University , Bunkyo-ku , Japan – name: 17 Hepato-Pancreatic-Biliary Surgery and Liver Transplantation , Fondazione IRCCS Istituto Nazionale Tumori , Milan , Italy |
| Author_xml | – sequence: 1 givenname: David J. orcidid: 0000-0002-3529-0103 surname: Pinato fullname: Pinato, David J. email: david.pinato@imperial.ac.uk organization: Division of Oncology, Department of Translational Medicine, Universita del Piemonte Orientale "A. Avogadro", Novara, Italy – sequence: 2 givenname: Sam M surname: Murray fullname: Murray, Sam M organization: Department of Infectious Diseases, Faculty of Medicine, Imperial College London, Hammersmith Hospital Campus, London, UK – sequence: 3 givenname: Alejandro surname: Forner fullname: Forner, Alejandro organization: Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III, Madrid, Spain – sequence: 4 givenname: Takahiro surname: Kaneko fullname: Kaneko, Takahiro organization: Tokyo Medical and Dental University, Bunkyo-ku, Japan – sequence: 5 givenname: Petros orcidid: 0000-0002-7472-8913 surname: Fessas fullname: Fessas, Petros organization: Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, Hammersmith Hospital Campus, London, UK – sequence: 6 givenname: Pierluigi surname: Toniutto fullname: Toniutto, Pierluigi organization: Hepatology and Liver Transplantation Unit, Department of Medical Area (DAME), University of Udine, Udine, Italy – sequence: 7 givenname: Beatriz surname: Mínguez fullname: Mínguez, Beatriz organization: Liver Unit, Hospital Universitari Vall d’Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain – sequence: 8 givenname: Valentina surname: Cacciato fullname: Cacciato, Valentina organization: Gastroenterology Unit, Department of Internal Medicine, IRCCS-Ospedale Policlinico San Martino, Genoa, Italy – sequence: 9 givenname: Claudio surname: Avellini fullname: Avellini, Claudio organization: Institute of Histopathology, Azienda Ospedaliero-Universitaria "Santa Maria della Misericordia", Udine, Italy – sequence: 10 givenname: Alba surname: Diaz fullname: Diaz, Alba organization: Pathology Department, Barcelona Clinic Liver Cancer (BCLC) Group, Hospital Clínic, University of Barcelona, Barcelona, Spain – sequence: 11 givenname: Rosemary J. surname: Boyton fullname: Boyton, Rosemary J. organization: Department of Infectious Diseases, Faculty of Medicine, Imperial College London, Hammersmith Hospital Campus, London, UK – sequence: 12 givenname: Daniel M. surname: Altmann fullname: Altmann, Daniel M. organization: Department of Infectious Diseases, Faculty of Medicine, Imperial College London, Hammersmith Hospital Campus, London, UK – sequence: 13 givenname: Robert D surname: Goldin fullname: Goldin, Robert D organization: Centre for Pathology, Imperial College London, London, UK – sequence: 14 givenname: Ayse U surname: Akarca fullname: Akarca, Ayse U organization: Department of Histopathology, University College London Cancer Institute, London, UK – sequence: 15 givenname: Teresa surname: Marafioti fullname: Marafioti, Teresa organization: Department of Histopathology, University College London Cancer Institute, London, UK – sequence: 16 givenname: Francesco A surname: Mauri fullname: Mauri, Francesco A organization: Department of Surgery and Cancer, Imperial College London, London, UK – sequence: 17 givenname: Edoardo surname: Casagrande fullname: Casagrande, Edoardo organization: Gastroenterology Unit, Department of Internal Medicine, IRCCS-Ospedale Policlinico San Martino, Genoa, Italy – sequence: 18 givenname: Federica surname: Grillo fullname: Grillo, Federica organization: Department of Surgical Sciences, IRCCS-Ospedale Policlinico San Martino, Genoa, Italy – sequence: 19 givenname: Edoardo surname: Giannini fullname: Giannini, Edoardo organization: Gastroenterology Unit, Department of Internal Medicine, IRCCS-Ospedale Policlinico San Martino, Genoa, Italy – sequence: 20 givenname: Sherrie surname: Bhoori fullname: Bhoori, Sherrie organization: Hepato-Pancreatic-Biliary Surgery and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy – sequence: 21 givenname: Vincenzo surname: Mazzaferro fullname: Mazzaferro, Vincenzo organization: Hepato-Pancreatic-Biliary Surgery and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/34593621$$D View this record in MEDLINE/PubMed |
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| ContentType | Journal Article |
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| Keywords | liver neoplasms immunotherapy |
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| Snippet | BackgroundModulation of adaptive immunity may underscore the efficacy of trans-arterial chemoembolization (TACE). We evaluated the influence of TACE on T-cell... Modulation of adaptive immunity may underscore the efficacy of trans-arterial chemoembolization (TACE). We evaluated the influence of TACE on T-cell function... |
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| SubjectTerms | Adult Aged Apoptosis Cancer Cancer therapies Carcinoma, Hepatocellular - drug therapy Carcinoma, Hepatocellular - pathology Cell death Chemoembolization Chemoembolization, Therapeutic - methods Chemotherapy Clinical trials Clinical/Translational Cancer Immunotherapy Cytotoxicity Embolization Female Gene expression Humans Immunogenic Cell Death - drug effects Immunotherapy Immunotherapy - methods Ligands Liver cancer liver neoplasms Liver Neoplasms - drug therapy Liver Neoplasms - pathology Male Middle Aged Patients Surgery Tumors |
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| Title | Trans-arterial chemoembolization as a loco-regional inducer of immunogenic cell death in hepatocellular carcinoma: implications for immunotherapy |
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