Colloquio tra cellula di Reed Sternberg e microambiente: c èc. un vallo immunologico a difesa della cellule di Reed Sternberg?

Transcription

1 Firenze, March 29th 2012 Colloquio tra cellula di Reed Sternberg e microambiente: c èc un vallo immunologico a difesa della cellule di Reed Sternberg? 2 parte: Ruolo di EBV e del background genetico S.Hohaus Istituto di Ematologia, Università Cattolica S. Cuore

2 Schematic of the crosstalk between malignant Hodgkin Reed-Sternberg (HRS) cells and the tumor microenvironment in classical Hodgkin's lymphoma. Steidl C et al. JCO 2011;29:

3 T cell subsets HRS cell PDL1 GAL1 PD-1 CD7 FasL TH1 Inhibition TGFβ IL-7 TARC MDC CCL20 IL-10 (T-bet) CD95 CCR4 IL-10 CTL (GrB; TIA) TH2 / Treg Inhibition (FoxP3) Expansion

4 T cell subsets: Impact of EBV HRS cell GAL1 CTL EBV IL-12 CCL20 IP10 (CXCL10) Mig (CXCL9) CXCR3 IL-10 CCR4 IL-10 TH2 / Treg TH1

5 Immune Escape: Role of Gal-1

6 Immune Escape: Role of HLA NK HRS cell HLA-G HLA class II EBV-negative Loss of HLA worse prognosis HLA class I Th EBV-negative CTL EBV+: increased CTL HLA-A: presentation of EBV-derived peptides

7 Immune Escape: Role of HLA

8 Immune Escape: Role of HLA HLA-A*01: increased risk of EBV+ HL (no efficient CTL response) HLA-A*02: protective against EBV+HL (HLA-A*02 presents EBV-derived peptides of EBV-latency type II genes)

9 Immune Escape: Role of HLA Hjalgrim et al., PNAS 2010 Hjalgrim et al. New England J Med 2003

10 Immune Escape: Role of the Genetic Background Genome-wide association study on 589 chl cases / 5199 controls and validation on 2057 chl cases and 3416 controls Enciso Mora et al., Nature Gen 2010

11 Immune Escape: Role of the Genetic Background Genome-wide association study on 393 chl cases / 3315 controls Cozen et al., Blood 2012

12 Immune Escape: Role of the Genetic Background Cozen et al., Blood 2012

13 Immune Escape: Role of the Genetic Background Genome-wide association study on 1200 chl cases / 6417 controls defined for EBV SNP Gene OR 95% C.I. P All EBVpos EBVneg rs MICB x rs HLA DRA x rs HLA A x rs HCG x rs HLA DRA x rs q31: IL x 10 9 Urayama et al., J Natl Cancer Inst 2012

14 IL10 plasma levels and Prognosis Probability of EFS < 65 pg/ml > 65 pg/ml (N=89) Time (Years) p=0.02 Hohaus et al, Leuk Res 2009; 33:1352

15 MulRvariate Analysis of Risk Factors for Outcome in PaRents with Hodgkin s Lymphoma Hohaus et al, Ann Oncol 2007; 18:1376

16 IL 10 levels and Polymorphisms Tumor Stage: IV Gender: Male Host Genetic Background: HR 95% C.I. p IL AA IL GG High IL-10 plasma levels Hohaus et al, Leuk Res 2009; 33:1352

17 TARC Plasma Levels As Early Response Marker Pla[el et al, Haematologica 2012; 97, 410

18 Macrophages and EBV Progression-free survival CD68+ cells <5% CD68+ cells >5% p= Time (Months) EBER CD68 Neg. Pos. Total < 5% > 5% Total p=0.03 Hohaus et al, Clin Cancer Res, 2011; 17:2885

19 Viral Load of EBV DNA in Plasma According to EBV in HRS cells p< EBV copy numbers/ ml plasma (log) neg Negative N=39 Positive N=18 EBER Hohaus et al, Clin Cancer Res, 2011; 17:2885

20 Circulating cell-free DNA Probability of FFTF normal elevated p= Time (months) Hohaus et al, Ann Oncol, 2009; 20:1408

21 CorrelaRons between EBV DNA Load and Biological Parameters Variable Correlation coefficient P* Cell-free DNA IL-6 concentration Lymphocyte count Neutrophil count EBNA-1 titers VCA titers *p values are calculated by Spearman rank Hohaus et al, Clin Cancer Res, 2011; 17:2885

22 Macrophages Circulating viral and cellular DNA Tumor tissue Peripheral Blood EBV EBV-DNA Cellular DNA CD68+ Tumor-associated Macrophage

23 Macrophages Variable CD68 >5% p* WBC count (n=55) lower 0.03 Hb (n=55) lower 0.06 Albumin (n=49) lower EBV DNA (n=49) higher IL 6 concentraron (n=55) higher 0.04 Cell free DNA (n=55) higher 0.01 No differences for TARC, IL 10, VES, fibrinogen

24 Anemia in HL: The Role of IL-6 and Hepcidin LIVER Hepcidin Hepcidin Fpn Fpn MACROPHAGE IL-6 Hepcidin Fpn IRON RESTRICTION DUODENUM IL-6 RBC BONE MARROW REED STERNBERG CELL and surrounding MICROENVIRONMENT Hohaus et al, J Clin Onc, 2010; 28:2538

25 Conclusions EBV impacts on the composition of the microenvironment favoring CTL and Th1 reaction and macrophage infiltration. Association of EBV+ HL with HLA-A*01 indicates a reduced CTL response against EBV-derived peptides. We observed an inverse correlation of EBV-DNA load to EBNA1 antibody titers and lymphocyte counts that may indicate a reduction in immune surveillance, favoring the expansion of EBV+ HRS cells in HL. Associations of EBV- HL with polymorphisms in the HLA-DRA suggest alteration in immune response as contributing factor also in EBV-neg HL. The genetic backgound may modulate the microenvironment. Early changes in the microenvironment may signal response (TARC levels).

26 Acknowledgments Universita Cattolica S. Cuore, Roma Ematologia Manuela Giachelia Giuseppina Massini Barbara Vannata Annarosa Cuccaro Elisa Cupelli Francesco D Alò Maria Teresa Voso Giuseppe Leone Radioterapia Mario Balducci Anatomia Patologica Maurizio Martini Valeriana Cesarini Luigi M. Larocca Microbiologia Rosaria Santangelo Medicina Nucleare Maria Lucia Calcagni Vittoria Rufini