Major Histocompatibility Complex Class Research Articles

A Bimetallic Metal-Organic-Framework-Based Biomimetic Nanoplatform Enhances Anti-Leukemia Immunity via Synchronizing DNA Demethylation and RNA Hypermethylation.

Epigenetic-alterations-mediated antigenicity reducing in leukemic blasts (LBs) is one of the critical mechanisms of immune escape and resistance to T-cell-based immunotherapy. Herein, a bimetallic metal-organic framework (MOF)-based biomimetic nanoplatform (termed as AFMMB) that consists of a DNA hypomethylating agent, a leukemia stem cell (LSC) membrane, and pro-autophagic peptide is fabricated. These AFMMB particles selectively target not only LBs but also LSCs due to the homing effect and immune compatibility of the LSC membrane, and induce autophagy by binding to the Golgi-apparatus-associated protein. The autophagy-triggered dissolution of AFMMB releases active components, resulting in the restoration of the stimulator of interferon genes pathway by inhibiting DNA methylation, upregulation of major histocompatibility complex class-I molecules, and induction of RNA-methylation-mediated decay of programmed cell death protein ligand transcripts. These dual epigenetic changes eventually enhance T-cell-mediated immune response due to increased antigenicity of leukemic cells. AFMMB also can suppress growth and metastases of solid tumor, whichwassuggestive of a pan-cancer effect. These findings demonstrate that AFMMB may serve as a promising new nanoplatform for dual epigenetic therapy against cancer and warrants clinical validation.

Remodeling Tumor Immunogenicity with Dual-Activatable Binary CRISPR Nanomedicine for Cancer Immunotherapy.

The specific recognition of cancer cells by the body's immune system is an essential step in initiating antitumor immunity. However, the decreased expression of major histocompatibility complex class I (MHC-1) and overexpression of programmed death ligand 1 (PD-L1) causes insufficient tumor-associated antigens presentation and inactivation of T cells, which accounts for poor immunogenicity. To remodel tumor immunogenicity, herein, a dual-activatable binary CRISPR nanomedicine (DBCN) that can efficiently deliver a CRISPR system into tumor tissues and specifically control its activation is reported. This DBCN is made of a thioketal-cross-linked polyplex core and an acid-detachable polymer shell, which can maintain stability during blood circulation, while detaching a polymer shell to facilitate the cellular internalization of the CRISPR system after entering tumor tissues and ultimately activating gene editing under exogenous laser irradiation, thereby maximizing the therapeutic benefits and reducing potential safety concerns. With the collaborative application of multiple CRISPR systems, DBCN efficiently corrects both dysregulation of MHC-1 and PD-L1 expression in tumors, thus initiating robust T cell-dependent antitumor immune responses to inhibit malignant tumor growth, metastasis, and recurrence. Given the increasing abundance of CRISPR toolkits, this research provides an appealing therapeutic strategy and a universal delivery platform to develop more advanced CRISPR-based cancer treatments.

The pre-existing T cell landscape determines the response to bispecific T cell engagers in multiple myeloma patients

Bispecific Tcell engagers (TCEs) have shown promise in the treatment of various cancers, but the immunological mechanism and molecular determinants of primary and acquired resistance to TCEs remain poorly understood. Here, we identify conserved behaviors of bone marrow-residing Tcells in multiple myeloma patients undergoing BCMAxCD3 TCE therapy. We show that the immune repertoire reacts to TCE therapy with cell state-dependent clonal expansion and find evidence supporting the coupling of tumor recognition via major histocompatibility complex class I (MHC class I), exhaustion, and clinical response. We find the abundance of exhausted-like CD8+ Tcell clones to be associated with clinical response failure, and we describe loss of target epitope and MHC class I as tumor-intrinsic adaptations to TCEs. These findings advance ourunderstanding of the invivo mechanism of TCE treatment in humans and provide the rationale for predictive immune-monitoring and conditioning of the immune repertoire to guide future immunotherapy in hematological malignancies.

Epigenetic therapies for neuroblastoma: immunogenicity awakens.

The development of immunotherapies for neuroblastoma remains challenging owing to the low immunogenicity of neuroblastoma cells, as reflected by the low expression of one of the main triggers of immune recognition, the major histocompatibility complex class I (MHC-I). Cornel et al. showed that epigenetic modulation of neuroblastoma cells with a histone deacetylase inhibitor can boost the expression of major histocompatibility complex class I, among other immune receptors, priming their recognition by T- and natural killer cells. By leveraging the developmentally related aberrant epigenetic landscapes of neuroblastoma, these discoveries pave the way to overcome a major limitation in the field of neuroblastoma immunotherapy.

Enhancement of Immune Responses Elicited by Nanovaccines through a Cross-Presentation Pathway.

Numerous studies have aimed to develop novel advanced vaccines, in part because traditional vaccines have been unsuccessful in preventing rapidly emerging and reemerging viral and bacterial infections. There is a need for an advanced vaccine delivery system to ensure the successful induction of humoral and cellular immune responses. In particular, the ability of nanovaccines to modulate intracellular antigen delivery by inducing exogenous antigens (loaded onto major histocompatibility complex class 1 molecules) in CD8+ T cells, the so-called cross-presentation pathway, has attracted a great deal of attention. Protection against viral and intracellular bacterial infections relies on cross-presentation. This review discusses the advantages, requirements, and preparation of nanovaccines, the cross-presentation mechanism, the several parameters affecting cross-presentation by nanovaccines, and future perspectives.

Bone marrow mesenchymal stem cell-derived exosomes attenuate the maturation of dendritic cells and reduce the rejection of allogeneic transplantation

Bone mesenchymal stem cell (BMSC)-derived exosomes (B-exos) are attractive for applications in enabling alloantigen tolerance. An in-depth mechanistic understanding of the interaction between B-exos and dendritic cells (DCs) could lead to novel cell-based therapies for allogeneic transplantation. To examine whether B-exos exert immunomodulatory effects on DC function and maturation. After mixed culture of BMSCs and DCs for 48 h, DCs from the upper layer were collected to analyze the expression levels of surface markers and mRNAs of inflammation-related cytokines. Then, before being collected to detect the mRNA and protein expression levels of indoleamine 2,3-dioxygenase (IDO), the DCs were co-cultured with B-exos. Then, the treated DCs from different groups were co-cultured with naïve CD4+ T cells from the mouse spleen. The proliferation of CD4+ T cells and the proportion of CD4+CD25+Foxp3+ T cells were analyzed. Finally, the skins of BALB/c mice were transplanted to the back of C57 mice in order to establish a mouse allogeneic skin transplantation model. The co-culture of DCs with BMSCs downregulated the expression of the major histocompatibility complex class II (MHC-II) and CD80/86 costimulatory molecules on DCs. Moreover, B-exos increased the expression of IDO in DCs treated with lipopolysaccharide (LPS). The proliferation of CD4+CD25+Foxp3+ T cells increased when cultured with B-exos-exposed DCs. Finally, mice recipients injected with B-exos-treated DCs had significantly prolonged survival after receiving the skin allograft. Taken together, these data suggest that the B-exos suppress the maturation of DCs and increase the expression of IDO, which might shed light on the role of B-exos in inducing alloantigen tolerance.

Human brain organoid model of maternal immune activation identifies radial glia cells as selectively vulnerable.

Maternal immune activation (MIA) during critical windows of gestation is correlated with long-term neurodevelopmental deficits in the offspring, including increased risk for autism spectrum disorder (ASD) in humans. Interleukin 6 (IL-6) derived from the gestational parent is one of the major molecular mediators by which MIA alters the developing brain. In this study, we establish a human three-dimensional (3D) in vitro model of MIA by treating induced pluripotent stem cell-derived dorsal forebrain organoids with a constitutively active form of IL-6, Hyper-IL-6. We validate our model by showing that dorsal forebrain organoids express the molecular machinery necessary for responding to Hyper-IL-6 and activate STAT signaling upon Hyper-IL-6 treatment. RNA sequencing analysis reveals the upregulation of major histocompatibility complex class I (MHCI) genes in response to Hyper-IL-6 exposure, which have been implicated with ASD. We find a small increase in the proportion of radial glia cells after Hyper-IL-6 treatment through immunohistochemistry and single-cell RNA-sequencing. We further show that radial glia cells are the cell type with the highest number of differentially expressed genes, and Hyper-IL-6 treatment leads to the downregulation of genes related to protein translation in line with a mouse model of MIA. Additionally, we identify differentially expressed genes not found in mouse models of MIA, which might drive species-specific responses to MIA. Finally, we show abnormal cortical layering as a long-term consequence of Hyper-IL-6 treatment. In summary, we establish a human 3D model of MIA, which can be used to study the cellular and molecular mechanisms underlying the increased risk for developing disorders such as ASD.

Characterization of immunomodulatory B-cells and T-cells to generate extremely targeted immunoassays and vaccines

Introduction: The Rubella virus has worldwide occurrence and congenital Rubella syndrome are widely recognized as emerging infection in several parts of the world. Methodology: We investigated for peptide vaccine with specific T and B-cell epitopes was identified through bioinformatics-based approaches. These were identified utilizing available Rubella virus E1 glycoprotein sequence databases. The outer-membrane glycoprotein, E1 is a target protein for the prediction of best antigens. Results: The bioinformatics online software Bepipred 2 was used for prediction of potential B-cell epitope (pfcntphgqlevqvppdpgd) was identified and it has shown high conversation against E1 glycoprotein and few other bioinformatics online software NetMHCpan, IEDB and NetCTL was used to identify maximum surface-exposed residues. T-Cell epitope (rpvalpral) was identified and shown to be conserved to E1 Glycoprotein. Predicted epitopes were found to had promiscuous class-I major histocompatibility complex binding affinity to major histocompatibility complex super types, antigenicity scores and high proteasomal cleavage. The three-dimensional modelled structures was created using I-TASSER online server for highlighting the predicted T- and B- cell epitopes. Conclusion: The predicted T and B cell epitope could be used for development of immunoglobulin assay and vaccines.

Tumor microenvironment remodeling after neoadjuvant immunotherapy in non-small cell lung cancer revealed by single-cell RNA sequencing

BackgroundImmunotherapy has revolutionized cancer treatment, but most patients are refractory to immunotherapy or acquire resistance, with the underlying mechanisms remaining to be explored.MethodsWe characterized the transcriptomes of ~92,000 single cells from 3 pre-treatment and 12 post-treatment patients with non-small cell lung cancer (NSCLC) who received neoadjuvant PD-1 blockade combined with chemotherapy. The 12 post-treatment samples were categorized into two groups based on pathologic response: major pathologic response (MPR; n = 4) and non-MPR (NMPR; n = 8).ResultsDistinct therapy-induced cancer cell transcriptomes were associated with clinical response. Cancer cells from MPR patients exhibited a signature of activated antigen presentation via major histocompatibility complex class II (MHC-II). Further, the transcriptional signatures of FCRL4+FCRL5+ memory B cells and CD16+CX3CR1+ monocytes were enriched in MPR patients and are predictors of immunotherapy response. Cancer cells from NMPR patients exhibited overexpression of estrogen metabolism enzymes and elevated serum estradiol. In all patients, therapy promoted expansion and activation of cytotoxic T cells and CD16+ NK cells, reduction of immunosuppressive Tregs, and activation of memory CD8+T cells into an effector phenotype. Tissue-resident macrophages were expanded after therapy, and tumor-associated macrophages (TAMs) were remodeled into a neutral instead of an anti-tumor phenotype. We revealed the heterogeneity of neutrophils during immunotherapy and identified an aged CCL3+ neutrophil subset was decreased in MPR patients. The aged CCL3+ neutrophils were predicted to interact with SPP1+ TAMs through a positive feedback loop to contribute to a poor therapy response.ConclusionsNeoadjuvant PD-1 blockade combined with chemotherapy led to distinct NSCLC tumor microenvironment transcriptomes that correlated with therapy response. Although limited by a small patient sample size subjected to combination therapy, this study provides novel biomarkers to predict therapy response and suggests potential strategies to overcome immunotherapy resistance.

Abstract PD9-02: MHC class I and PD-L1 expression in triple-negative breast cancer subtypes: impact on T-cell infiltration and clinical outcome

Abstract Background: Triple-negative breast cancer (TNBC) is a heterogeneous group of cancer with dismal prognosis. In an effort to discover therapeutic targets, TNBC has been further stratified into molecular subtypes. Immune checkpoint inhibitors targeting programmed cell death protein 1 (PD-1) and its ligand (PD-L1) have been increasingly utilized for the treatment of TNBC. Difficulty remains, however, in appropriate patient selection for treatment, as many PD-L1-positive cancers fail to show durable responses to PD-1/PD-L1 inhibition. Major histocompatibility complex (MHC) class I molecules play a crucial role in the presentation of tumor antigenic peptides to cytotoxic T cells. Loss of MHC class I expression in tumor cells represents a possible mechanism of immunotherapeutic resistance in PD-L1-positive cancers. However, little is known about the clinical impact and value of MHC class I expression in TNBC subtypes. Thus, this study examined MHC class I expression in TNBC subtypes with attention to PD-L1 expression and T cell infiltration. Materials and methods: MHC class I and PD-L1 expression were assessed by immunohistochemistry in 256 TNBC samples using tissue microarray. Immunohistochemistry for the TNBC molecular subtype-surrogate markers [cytokeratin 5/6 (CK5/6), CK14, epidermal growth factor receptor (EGFR), and androgen receptor (AR)], CD3, and CD8 was also performed. TNBC subtypes were classified into three subtypes: basal-like (BL), luminal AR (LAR), and unclassifiable type (UN). Results: All immunohistochemical markers were interpretable in 240 cases. TNBCs were classified into BL (65.8%), LAR (11.3%), and UN (22.9%) subtypes. Loss of MHC class I expression was found in 62 of 240 (25.8%) cases and was observed in 23.4% of BL, 40.7% of LAR, and 25.9% of UN subtype. PD-L1 expression in tumor-associated immune cells (≥1%) was seen in 69.2% (166/240). Among 166 PD-L1-positive TNBC cases, loss of MHC class I expression was seen in 16.4% of BL, 31.3% of LAR, and 20.0% of UN subtype. Loss of MHC class I expression was associated with low stromal TILs density and low CD3+ and CD8+ T-cell infiltration in BL subtype. CD3+ and CD8+ T-cell infiltration in TNBC subtype had a positive correlation with PD-L1 expression. In PD-L1 positive BL subtype, MHC class I lost expression showed a lower infiltration with CD3+ and CD8+ T-cells than MHC class I intact expression. In BL subtype, PD-L1 expression was associated with better disease-free survival and loss of MHC class I expression was associated with poor overall survival. However, MHC class I and PD-L1 expressions were not independent prognostic factors for disease-free or overall survival. Conclusions: Loss of MHC class I expression was found in TNBC, including PD-L1 positive cases. In PD-L1 positive BL subtype, loss of MHC class I expression was associated with low CD3 and CD8+ T-cell infiltration. Our results suggest that the evaluation of PD-L1 and MHC class I expression together is very important for the selection of potential responders to anti-PD-1/PD-L1 therapy for the TNBCs, especially the BL subtype. Citation Format: ji shin lee, nah ihm kim, min ho park. MHC class I and PD-L1 expression in triple-negative breast cancer subtypes: impact on T-cell infiltration and clinical outcome [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr PD9-02.

β2-microglobulin functions as an endogenous NMDAR antagonist to impair synaptic function.

Down syndrome (DS) is a neurological disorder with multiple immune-related symptoms; however, crosstalk between the CNS and peripheral immune system remains unexplored. Using parabiosis and plasma infusion, we found that blood-borne factors drive synaptic deficits in DS. Proteomic analysis revealed elevation of β2-microglobulin (B2M), a major histocompatibility complex class I (MHC-I) component, in human DS plasma. Systemic administration of B2M in wild-type mice led to synaptic and memory defects similar to those observed in DS mice. Moreover, genetic ablation of B2m or systemic administration of an anti-B2M antibody counteracts synaptic impairments in DS mice. Mechanistically, we demonstrate that B2M antagonizes NMDA receptor (NMDAR) function through interactions with the GluN1-S2 loop; blocking B2M-NMDAR interactions using competitive peptides restores NMDAR-dependent synaptic function. Our findings identify B2M as an endogenous NMDAR antagonist and reveal a pathophysiological role for circulating B2M in NMDAR dysfunction in DS and related cognitive disorders.

Do female bluethroats without extra-pair offspring have more MHC-compatible social mates?

Genes of the major histocompatibility complex (MHC) are crucial for adaptive immunity in jawed vertebrates, and theory predicts that there should be mate choice for optimizing MHC constitution in the offspring. In a previous study, we demonstrated a non-random female choice of extra-pair males in the bluethroat (Luscinia svecica), yielding offspring that was closer to an intermediate MHC class II (MHCII) allele count than their within-pair halfsiblings. The present study tests whether social pairs with only within-pair young (WPY) in their brood, in the same study population, had a combined MHC-constitution closer to a presumed intermediate optimum, than social pairs with extra-pair young (EPY), with a corresponding pattern in their offspring. As expected, we found that WPY from pure WPY-broods were more MHC-optimal than WPY from mixed broods, but only in broods of young (second year) males. Correspondingly, there was a tendency for social pairs with only WPY in their brood to be more MHC-compatible than social pairs with EPY in their brood, when the male was young. Older bluethroat males have considerably larger testes than young males, and their higher sperm competitiveness could help them secure paternity in their own brood, also when they are not MHC-compatible. In other words, in the sexual conflict over paternity, females may be more likely to realise their preference for a MHC-compatible mate when paired to a young male. As a possible fitness indicator, immune responsiveness to an injected antigen (PHA) was elevated for offspring closer to “the golden mean” in MHCII allele count.Significance statementThis study contributes to our understanding of MHC-based mate choice in extra-pair mating systems, by showing that female bluethroats (Luscinia svecica) with an MHCII-compatible social mate tend to have no extra-pair young in their brood, but only when the social male is young. This elucidates a possible sexual conflict, in which older social males are able to override female preferences and prevent other males from gaining paternity in their brood through higher sperm production. Studying systems in which extra-pair paternity occurs offers an insight into the genetic benefits of mate choice, as extra-pair males, in contrast to social males, generally contribute only sperm. Further, the strict and thorough genotyping scheme applied in this study enabled us to demonstrate a preference for “the golden mean” in MHC-diversity in a species with one of the highest MHC class II-diversity known to date.

Abstract PD4-06: PD4-06 Obesity-associated changes in transcriptomic profile and immune landscape of primary breast cancer revealed by bulk and single-cell gene expression data

Abstract Background: Breast cancer (BC) is one of the cancer types recognized as an obesity-associated disease. Current understandings of molecular mechanisms underlying the BC-obesity connection however largely came from experimental models while systematic investigation of the impact of obesity on BC biology in large patient series is still lacking. The purpose of this study is to discover changes in the transcriptomic profile of primary BC according to patients’ body mass index (BMI). Data and Methods: Bulk and single-cell gene expression data from treatment-naïve primary breast tumors from non-underweight patients were retrieved from the MINDACT trial (NCT00433589; N = 1481) and the pre-treatment cohort of the BioKey trial (NCT03197389, N = 36), respectively. Three categories were considered for BMI: lean, overweight and obese. The main analyses focused on the invasive carcinoma of no special type (NST) estrogen receptor-positive/HER2-negative (ER+/HER2-, N_bulk = 735, N_single-cell(sc) = 10) and NST ER-/HER2- (N_bulk = 118, N_sc = 15) subgroups. The bulk expression data was subjected to differential gene expression analyses according to BMI which was adjusted for menopausal status and tumor grade, then followed by gene set enrichment analyses. Clustering and cluster annotation were performed on the single-cell profiling data before differentially expressed genes according to BMI were identified for each of the present cell types. Results: Obesity-associated differences in the transcriptomic profile of breast tumors, which were subtle but potentially indicative of a biological relationship, were revealed by the bulk data. In both investigated subgroups, tumors from obese patients were shown to be enriched in cell cycle hallmarks. In ER-/HER2- tumors, adiposity further increased MYC signaling. We also observed different obesity-associated changes according to the ER status. Among ER+/HER2- tumors, those from obese patients were enriched in hallmarks related to inflammatory response compared to those from lean patients. In contrast, these hallmarks appeared to be enriched in the ER-/HER2- tumors from lean patients. Our investigation of the single-cell data further revealed shifts in the cell composition of tumor tissue and cell type-specific transcriptomic differences according to BMI which were more pronounced than those detected from the bulk data. ER+/HER2- tumors from obese patients have a higher frequency of immunosuppressive and pro-tumoral cell subpopulations such as dendritic cells (DC) enriched in immunoregulatory molecules (p = .03), LYVE1+ macrophages (p = .02) and myofibroblasts (p = .03) than those from lean patients. Overexpression of Cyclin D1 and CD24 was found in cancer cells in ER+/HER2- tumors from obese patients. A reduction in anti-tumor immune responses was evident with downregulation of multiple interferons in CD8+ and CD4+ T cells as well as B cells. We observed in the ER-/HER2- subgroup increased infiltration of plasmacytoid DC (p = .01), CCL2+ macrophages (p = .01) in tumors from obese versus lean patients, while fibroblasts showed an opposite tendency. Additionally, significant obesity-associated downregulation of major histocompatibility complex (MHC) molecules class I in cancer cells and MHC class II molecules in B cells could be suggestive of deficient antigen presentation and activation of cytotoxic and helper T cells. Conclusion: We highlighted the impact of obesity on the remodeling of tumor and tumor microenvironment which might generally lead to a suppression of anti-tumor immune responses, albeit potentially via diverse axes according to the ER status. Although investigation on a larger cohort is warranted, our current results suggest that obesity-associated transcriptomic changes in BC could be highly cell type-specific, hence we recommend single-cell approaches in addition to spatial multi-omics analysis to further elucidate the interplay between obesity and BC. Citation Format: Ha-Linh Nguyen, Tatjana Geukens, Marion Maetens, Karen Van Baelen, Maxim De Schepper, Coralie Poncet, Mauro Delorenzi, Marjanka K. Schmid, Emiel Rutgers, Laura Van ’t Veer, Martine Piccart, Fatima Cardoso, Giuseppe Viale, Ayse Bassez, Hanne Vos, Patrick Neven, Ines Nevelsteen, Kevin Punie, Hans Wildiers, Giuseppe Floris, Diether Lambrechts, Ann Smeets, Elia Biganzoli, François Richard, Christine Desmedt. PD4-06 Obesity-associated changes in transcriptomic profile and immune landscape of primary breast cancer revealed by bulk and single-cell gene expression data [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr PD4-06.

Blockade of endothelin-1 receptor B regulates molecules of the major histocompatibility complex in sickle cell disease.

Major Histocompatibility Complex (MHC) molecules have been proposed to play a role in Sickle Cell Disease (SCD) pathophysiology. Endothelial cells express MHC molecules following exposure to cytokines. SCD is characterized, in part, by vascular endothelial cell activation, increased oxidative stress, sickle cell adhesion, and excess levels of endothelin-1 (ET-1) contributing to vaso-occlusive crises. ET-1 activates endothelial cells, induces oxidative stress and inflammation, and alters erythrocyte volume homeostasis. However, the role of ET-1 on MHC regulation in SCD is unclear. We first studied two sickle transgenic knockout mouse models of moderate to severe disease phenotype, βS-Antilles and Berkeley (BERK) mice. We observed significant increases in H2-Aa mRNA levels in spleens, lungs, and kidneys from transgenic sickle mice when compared to transgenic knockout mice expressing human hemoglobin A (HbA). Mice treated for 14 days with ET-1 receptor antagonists significantly reduced H2-Aa mRNA levels. We characterized the effect of ET-1 on MHC class II expression in the human endothelial cell line EA.hy926. We observed dose-dependent increases in the expression of MHC class II (HLA-DRA) and MHC transcription factor (CIITA) that were significantly blocked by treatment with BQ788, a selective blocker of ET-1 type B receptors. Chromatin immunoprecipitation studies in EA.hy926 cells showed that ET-1 increased Histone H3 acetylation of the HLA-DRA promoter, an event blocked by BQ788 treatment. These results implicate ET-1 as a novel regulator of MHC class II molecules and suggest that ET-1 receptor blockade represents a promising therapeutic approach to regulate both immune and vascular responses in SCD.

A rare case of viral-associated trichodysplasia spinulosa in a patient with chronic lymphocytic leukemia.

Dear Editors, Viral-associated trichodysplasia spinulosa (VATS) is a cutaneous eruption of folliculo-centric shiny papules and alopecia that most commonly occurs in transplant recipient patients.1 Here, we present an extremely rare case of VATS in a female patient with chronic lymphocytic leukemia (CLL). An informed consent was obtained from the patient for this report. A 63-year-old female presented with a 2-month history of multiple reddish-pinkish papules on her face in the setting of long-standing CLL. Physical examination also showed leonine facies, superciliary madarosis, and an infiltrative nose. Many spiny red papules and spicules were located on her face, neck, chest, arms, and back (Fig. 1A and B). A punch biopsy of one of the lesions on the back revealed prominent trichohyalin granules with disruption of the normal follicular maturation showing basophilic inclusions within the follicular ostia consistent with VATS (Fig. 2A and B).Fig. 1.: Clinical progression of viral-associated trichodysplasia spinulosa treated with topical cidofovir. Spiny red papules and spicules concentrated on face (A) and upper back (B) found on initial presentation. Face showing dramatically decreased spicules and papules, particularly on cheek and forehead, after 9 months of treatment with topical cidofovir (C).Fig. 2.: Pathological findings of viral-associated trichodysplasia spinulosa showing unusual prominent trichohyalin granules with disruption of the normal follicular maturation showing basophilic inclusions within the follicular ostia, shown at magnification 100× (A) and 400× (B).Importantly, the patient was not on any immunosuppressive therapy when she developed the VATS lesions. The most recent treatment for her CLL had been approximately 1 year ago, when she had finished 6 cycles of bendamustine plus rituximab. Prior to that round of treatment, her small lymphocytic lymphoma had been diagnosed over 20 years ago but had not required therapy for 10 years. A complete work up for immunosuppression including HIV testing, T-cell subsets, immunoglobulins, and re-staging of small lymphocytic lymphoma was performed. She was negative for HIV-1/2 antibody/HIV-1 antigen screening. She had evidence of hypogammaglobulinemia with an IgG of 667 mg/dL and low IgG subclasses 2, 3, and 4 (72, 16, and 1.3 mg/dL, respectively). IgG subclass 1 was normal (482 mg/dL). A peripheral blood flow cytometry showed absolute T-cell lymphopenia with low CD3+ and CD3+CD4+ absolute counts (504 and 267.2/µL, respectively), but no evidence of lymphoproliferative disease. Laboratory values showed a low absolute lymphocyte count of 0.8/µL. Prior treatment of the skin lesions by the primary care physician included topical corticosteroids, topical metronidazole, and oral cephalexin, and were not effective. After the diagnosis was established, the patient was treated with 450 mg valganciclovir twice daily to target the underlying polyomavirus, but showed no improvement over 4 months. 3% topical cidofovir twice daily was then added, and the patient showed significant improvement over the following 9 months on both 450 mg valganciclovir twice daily and 3% topical cidofovir treatment (Fig. 1C). During this period, valganciclovir was discontinued by the patient for a period of 3 months due to apparent lack of efficacy but was restarted based on dermatology recommendation. The plan of care is to continue this treatment indefinitely as maintenance therapy. Although VATS has been reported frequently in transplant recipient patients and patients with acute lymphocytic leukemia and non-Hodgkin’s lymphoma, there are only 3 previously reported account of VATS in a patient with CLL in the literature.2–4 Importantly, the previously reported patient developed VATS just 2 months after ceasing fludarabine,3 whereas our patient had been off immunosuppressive agents for nearly 1 year prior to developing VATS. Thus, our unique case highlights the dermatologically significant impact of CLL-induced immunodeficiency. The etiology of the immunodeficiency caused by CLL is multifactorial, including hypogammaglobulinemia, hypocomplementemia, and altered major histocompatibility complex class II antigens on cancer cells.5 Finally, this case emphasizes the important role that topical cidofovir may have in treating patients with treatment-resistant VATS.6 Conflicts of interest None. Funding None. Study approval N/A. Author contributions RC and SB: Writing and editing manuscript. JM and JP: Interpretation of information and editing. JL: Editing manuscript, supervision.

PD-L1 and MHC Class I Expression in High-grade Ovarian Cancers, Including Platinum-resistant Recurrences Treated With Checkpoint Inhibitor Therapy.

Immune-modulating therapies targeting the programmed cell death-1/programmed cell death ligand-1 (PD-L1) immunosuppressive system have been used successfully in many solid tumor types. There is evidence that biomarkers such as PD-L1 and major histocompatibility complex (MHC) class I help identify candidates for anti-programmed cell death-1/PD-L1 checkpoint inhibition, though the evidence is limited in ovarian malignancies. PD-L1 and MHC Class I immunostaining was performed on pretreatment whole tissue sections in 30 cases of high-grade ovarian carcinoma. The PD-L1 combined positive score was calculated (a score of ≥1 is considered positive). MHC class I status was categorized as an intact or subclonal loss. In patients who received immunotherapy, drug response was assessed using RECIST criteria. PD-L1 was positive in 26 of 30 cases (87%; combined positive score: 1 to 100). Seven of 30 patients showed subclonal loss of MHC class I (23%), and this occurred in both PD-L1 negative (3/4; 75%) and PD-L1 positive (4/26; 15%) cases. Only 1 of 17 patients who received immunotherapy in the setting of a platinum-resistant recurrence responded to the addition of immunotherapy, and all 17 died of disease. In the setting of recurrent disease, patients did not respond to immunotherapy regardless of PD-L1/MHC class I status, suggesting that these immunostains may not be effective predictive biomarkers in this setting. Subclonal loss of expression of MHC class I occurs in ovarian carcinoma, including in PD-L1 positive cases, suggesting that the 2 pathways of immune evasion may not be mutually exclusive and that it may be important to interrogate MHC class I status in PD-L1 positive tumors to identify additional immune evasion mechanisms in these tumors.

Development of antidrug antibodies against adalimumab maps to variation within the HLA-DR peptide-binding groove.

Targeted biologic therapies can elicit an undesirable host immune response characterized by the development of antidrug antibodies (ADA), an important cause of treatment failure. The most widely used biologic across immune-mediated diseases is adalimumab, a tumor necrosis factor inhibitor. This study aimed to identify genetic variants that contribute to the development of ADA against adalimumab, thereby influencing treatment failure. In patients with psoriasis on their first course of adalimumab, in whom serum ADA had been evaluated 6-36 months after starting treatment, we observed a genome-wide association with ADA against adalimumab within the major histocompatibility complex (MHC). The association signal mapped to the presence of tryptophan at position 9 and lysine at position 71 of the HLA-DR peptide-binding groove, with both residues conferring protection against ADA. Underscoring their clinical relevance, these residues were also protective against treatment failure. Our findings highlight antigenic peptide presentation via MHC class II as a critical mechanism in the development of ADA against biologic therapies and downstream treatment response.

I-Ag7 β56/57 polymorphisms regulate non-cognate negative selection to CD4+ T cell orchestrators of type 1 diabetes.

Genetic susceptibility to type 1 diabetes is associated with homozygous expression of major histocompatibility complex class II alleles that carry specific beta chain polymorphisms. Why heterozygous expression of these major histocompatibility complex class II alleles does not confer a similar predisposition is unresolved. Using a nonobese diabetic mouse model, here we show that heterozygous expression of the type 1 diabetes-protective allele I-Ag7 β56P/57D induces negative selection to the I-Ag7-restricted T cell repertoire, including beta-islet-specific CD4+ T cells. Surprisingly, negative selection occurs despite I-Ag7 β56P/57D having a reduced ability to present beta-islet antigens to CD4+ T cells. Peripheral manifestations of non-cognate negative selection include a near complete loss of beta-islet-specific CXCR6+ CD4+ T cells, an inability to cross-prime islet-specific glucose-6-phosphatase catalytic subunit-related protein and insulin-specific CD8+ T cells and disease arrest at the insulitis stage. These data reveal that negative selection on non-cognate self-antigens in the thymus can promote T cell tolerance and protection from autoimmunity.

Immune surveillance of brain metastatic cancer cells is mediated by IFITM1.

Brain metastasis, most commonly originating from lung cancer, increases cancer morbidity and mortality. Although metastatic colonization is the rate-limiting and most complex step of the metastatic cascade, the underlying mechanisms are poorly understood. Here, in vivo genome-wide CRISPR-Cas9 screening revealed that loss of interferon-induced transmembrane protein 1 (IFITM1) promotes brain colonization of human lung cancer cells. Incipient brain metastatic cancer cells with high expression of IFITM1 secrete microglia-activating complement component 3 and enhance the cytolytic activity of CD8+ T cells by increasing the expression and membrane localization of major histocompatibility complex class I. After activation, microglia (of the innate immune system) and cytotoxic CD8+ T lymphocytes (of the adaptive immune system) were found to jointly eliminate cancer cells by releasing interferon-gamma and inducing phagocytosis and T-cell-mediated killing. In human cancer clinical trials, immune checkpoint blockade therapy response was significantly correlated with IFITM1 expression, and IFITM1 enhanced the brain metastasis suppression efficacy of PD-1 blockade in mice. Our results exemplify a novel mechanism through which metastatic cancer cells overcome the innate and adaptive immune responses to colonize the brain, and suggest that a combination therapy increasing IFITM1 expression in metastatic cells with PD-1 blockade may be a promising strategy to reduce metastasis.

Thymus antibody-secreting cells possess an interferon gene signature and are preferentially expanded in young female mice

Antibody-secreting cells (ASCs) are key contributors to humoral immunity through immunoglobulin production and the potential to be long-lived. ASC persistence has been recognized in the autoimmune thymus (THY); however, only recently has this population been appreciated in healthy THY tissue. We showed that the young female THY was skewed toward higher production ofASCs relative to males. However, these differences disappeared with age.Inboth sexes, THY ASCs included Ki-67+ plasmablasts which required CD154(CD40L) signals for their propagation. Single cell RNA-sequencing revealed that THY ASCs were enriched for an interferon responsive transcriptional signature relative to those from bone marrow and spleen. Flow cytometry confirmed that THY ASCs had increased levels of Toll-like receptor 7 as well as CD69 and major histocompatibility complex class II. Overall, we identified fundamental aspects of THY ASC biology which may be leveraged for future in depth studies of this population in both health and disease.