Role of CD 20(+) T cells and related cytokines in mediating retinal microvascular changes and ocular complications in chronic-plaque type psoriasis
CYTOKINE
Authors: Fragiotta, Serena; Mangino, Giorgio; Iuliano, Marco; Potenza, Concetta; Bernardini, Nicoletta; Skroza, Nevena; Vingolo, Enzo Maria; Romeo, Giovanna
Abstract
Objective: To assess the role of CD3(+) CD20(+) CD4(-) CD8(-) double-negative (DN) or CD3(+)CD20(+) CD4/CD8(+) T cells and the related pro-inflammatory cytokines in the humor aqueous, in mediating retinal microvascular changes in patients with chronic plaque-type moderate to severe psoriasis. Design. A total of 76 patients (57.6 +/- 11.7 years) with chronic plaque-type psoriasis were initially evaluated. Nineteen patients (19 eyes) and 19 healthy volunteers (19 eyes) were subjected to dermatological evaluation with Psoriasis Area Severity Index (PASI) and the Dermatology life quality index (DLQI). Retinal images were processed using an automatized software. On the same day, a venous sample was collected and analyzed using multiparametric flow cytometry. Three out of 6 patients who presented cataract, consented to perform surgery with humor aqueous collection. The samples were analyzed using a Multi-Analyte ELISA kit for the simultaneous quantification of IL1 alpha, IL1 beta, IL2, IL4, IL6, IL8, IL10, IL12, IL17A, IFN gamma, TNF-alpha, GMCSF. Results: The CD3(+)CD4(+)/CD8(+)CD20(+)CD56(-) T cells expression was greater in the psoriatic patients (+73.9%, P < 0.001) compared to controls, but not the DN T cells (-8.2%, P = 0.30). Ocular complications were diagnosed in 61.1% of patients, microvascular parameters including artero-venous ratio (P = 0.04), subfoveal choriocapillaris/Sattler's layer, and choroidal thickness (CT, both P < 0.001) were significantly altered in psoriasis subgroup. The increased circulating levels of the CD3(+)CD4(+)/CD8(+)CD20(+)CD56(-) T cells were associated with thinning of subfoveal CT (P = 0.03) and Haller's layer (P = 0.01). Instead, the DN T cells presented an inverse relationship with disease duration (P = 0.02), DLQI score (P = 0.02), and the use of biological therapy (P = 0.05). The related cytokine patterns possibly modified in this cellular context have been investigated. No significant differences were observed in cytokines levels between psoriasis and controls, the most significant difference was detected on IL-6, without reaching statistical significance (fold change of 1.4, P = 0.13). Conclusion: Our findings demonstrated that CD20(+) T cell subpopulation is highly represented in psoriasis regardless of the use of immunomodulatory therapies, and the diffuse microvascular alterations suggested possible endothelial damage as mainstream for the genesis of psoriatic-mediated complications as further supported by the comparable concentrations of cytokines, at least as humor aqueous content, with respect to healthy eyes.
Tumor Microenvironment Composition and Severe Cytokine Release Syndrome (CRS) Influence Toxicity in Patients with Large B-Cell Lymphoma Treated with Axicabtagene Ciloleucel
CLINICAL CANCER RESEARCH
Authors: Faramand, Rawan; Jain, Michael; Staedtke, Verena; Kotani, Hiroshi; Bai, Renyuan; Reid, Kayla; Lee, Sae Bom; Spitler, Kristen; Wang, Xuefeng; Cao, Biwei; Pinilla, Javier; Lazaryan, Aleksander; Khimani, Farhad; Shah, Bijal; Chavez, Julio C.; Nishihori, Taiga; Mishra, Asmita; Mullinax, John; Gonzalez, Ricardo; Hussaini, Mohammad; Dam, Marian; Brandjes, Brigett D.; Bachmeier, Christina A.; Anasetti, Claudio; Locke, Frederick L.; Davila, Marco L.
Abstract
Purpose: One of the challenges of adoptive T-cell therapy is the development of immune-mediated toxicities including cytokine release syndrome (CRS) and neurotoxicity (NT). We aimed to identify factors that place patients at high risk of severe toxicity or treatment-related death in a cohort of 75 patients with large B-cell lymphoma treated with a standard of care CD19 targeted CAR T-cell product (axicabtagene ciloleucel). Experimental Design: Serum cytokine and catecholamine levels were measured prior to lymphodepleting chemotherapy, on the day of CAR T infusion and daily thereafter while patients remained hospitalized. Tumor biopsies were taken within 1 month prior to CAR T infusion for evaluation of gene expression. Results: We identified an association between pretreatment levels of IL6 and life-threatening CRS and NT. Because the risk of toxicity was related to pretreatment factors, we hypothesized that the tumor microenvironment (TME) may influence CAR T-cell toxicity. In pretreatment patient tumor biopsies, gene expression of myeloid markers was associated with higher toxicity. Conclusions: These results suggest that a proinflammatory state and an unfavorable TME preemptively put patients at risk for toxicity after CAR T-cell therapy. Tailoring toxicity management strategies to patient risk may reduce morbidity and mortality.