Abstract Background: Platelet-activating factor (PAF) is one of the lipid mediators in ultraviolet-induced immunosuppression signaling. Sentinel lymph nodes (SLNs) are the first organs to receive lymphatic drainage via afferent lymphatic channels leading directly from the primary melanoma. In patients with nodal metastasis, it has been shown that the SLN has a profoundly immunotolerant microenvironment. We sought to determine whether lymphatic fluid signals, including PAF, may be involved in modulating the SLN immune microenvironment to favor melanoma metastasis. Hypothesis: Upregulation of PAF can bind to its receptor on monocytes and activate downstream immunosuppressive chemokines, resulting in an immunosuppressed environment in SLNs that permits nodal metastasis and melanoma progression. Methods: Lymphatic fluids, plasma samples, and SLN samples were collected from patients undergoing surgical excision of melanoma with SLN biopsy under an IRB-approved protocol. Metabolic analyses were performed on lymphatic fluids from high- versus low-risk patients by two-dimensional liquid chromatography system coupled with mass spectrometry (2D LC-MS). Single cell sequencing was done on single cell suspensions from SLN samples. Protein array was used to compare the cytokine and chemokine levels in plasma samples from high- versus low-risk melanoma patients. We compared two groups: low-risk (no SLN metastasis) and high-risk (with SLN metastasis). Results: Lymphatic fluid PAF levels were 3-fold greater in high-risk melanoma patients compared with low-risk patients (p=0.0039). Macrophages were identified as the cell type with greatest PTAFR (platelet-activating factor receptor) expression by single cell sequencing. CCL17 levels in plasma samples from high-risk patients were significantly lower than in low-risk patients (p<0.05). These results suggest that increased PAF in lymphatic fluid may bind to PTAFR in SLN macrophages, inhibit chemokines (such as CCL17), and result in an immunosuppressive SLN environment to favor nodal metastasis and melanoma progression. Conclusion: Lymphatic fluid PAF signaling may contribute to an immunotolerant microenvironment in the SLN that allows nodal metastasis and melanoma progression through downregulation of CCL17. Further studies will investigate whether this pathway can be exploited to therapeutic advantage. Citation Format: Austin McMasters, Julia Chariker, Jae Yeon Hwang, Xinmin Yin, Xipeng Ma, Raobo Xu, Xiang Zhang, Juw Won Park, Kelly M. McMasters, Hongying Hao. Activation of platelet-activating factor (PAF) in high-risk melanoma patients with nodal metastasis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 5526.
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