Translational opportunities for targeting the Th17 axis in acute graft-vs.-host disease

International audienceAllogeneic stem cell transplantation (allo-SCT) is a curative therapy for different life-threatening malignant and non-malignant hematologic disorders. Acute graft-vs.-host disease (aGVHD) and particularly gastrointestinal aGVHD remains a major source of morbidity and mortality following allo-SCT, which limits the use of this treatment in a broader spectrum of patients. Better understanding of aGVHD pathophysiology is indispensable to identify new therapeutic targets for aGVHD prevention and therapy. Growing amount of data suggest a role for T helper (Th)17 cells in aGVHD pathophysiology. In this review, we will discuss the current knowledge in this area in animal models and in humans. We will then describe new potential treatments for aGVHD along the Th17 axis

L'interleukine-22 dans la maladie du greffon contre l'hôte après allogreffe de cellules souches hématopoïétiques

Graft-versus-host disease (GVHD) is still the major complication after allogeneic stem cell transplantation. GVHDresults from the activation of the immune response and the recognition by donor T cells of alloantigens leading totissue injury, especially in skin, gut and liver. Interleukin-22 (IL-22) is a cytokine secreted by CD4+ T cells Th1 andTh17 but also by innate lymphoid cells (ILC). Given that IL-22 functions in the GVHD target tissues, weinvestigated its contribution in GVHD physiopathology using mouse experimental models. We showed that IL-22deficiency in donor cells reduced the severity of GVHD by limiting systemic and local inflammation. Moreover, inthe large intestine, IL-22 acts in synergy with type I interferon to increase Th1-like inflammation. In humans,GVHD severity is associated with microbiotal modification in the intestine. We demonstrated that IL-22 deficiencyin donor cells seems to favor lactobacillus colonization instead of clostridium. These changes of microbiotacomposition may reduce the severity of intestinal GVHD. Finally, we showed that the antitumor effect is preservedeven in absence of IL-22 donor cells. Overall, our data support the design of new clinical approaches aiming totarget IL-22 pathways in GVHD patients.La maladie du greffon contre l’hôte (GVHD) reste la complication majeure de l’allogreffe de cellules soucheshématopoïétiques (allo-CSH). La GVHD résulte de l’activation de la réponse immunitaire et de la reconnaissanced’alloantigènes par les lymphocytes T (LT) du donneur, entrainant ainsi des lésions tissulaires principalement auniveau de la peau, des intestins et du foie. L’interleukine-22 (IL-22) est une cytokine sécrétée par les LT Th1,Th17 et les cellules de l’immunité innée (ILC). Compte tenu des propriétés de l’IL-22 dans les tissus cibles de laGVHD, nous avons évalué sa contribution dans la physiopathologie de la maladie à l’aide de modèlesexpérimentaux murins. Il apparaît que les souris qui reçoivent des lymphocytes T invalidés pour l’IL-22développent une maladie moins sévère, et leur mortalité est diminuée. L’IL-22 issue du greffon participe donc à lasévérité de la GVHD en favorisant l’inflammation systémique, mais aussi locale au niveau des organes cibles. Deplus, dans les intestins, l’IL-22 agit en synergie avec les interférons de type I pour amplifier l’inflammation de typeTh1 au cours de la GVHD. Chez l’homme, la GVHD est associée à une modification du microbiote intestinal.Nous avons montré que l’absence d’IL-22 semble favoriser la colonisation de lactobacilles au détriment declostridiums, ce qui pourrait également participer à la diminution de la GVHD intestinale. Enfin, nous avonsmontré que l’effet anti-tumoral est préservé malgré l’absence d’IL-22. Ces résultats permettent donc d’envisagerde nouvelles perspectives thérapeutiques dans le traitement de la GVHD

Interleukine-22 in graft-versus-host disease after allogeneic stem cell transplantation

La maladie du greffon contre l’hôte (GVHD) reste la complication majeure de l’allogreffe de cellules soucheshématopoïétiques (allo-CSH). La GVHD résulte de l’activation de la réponse immunitaire et de la reconnaissanced’alloantigènes par les lymphocytes T (LT) du donneur, entrainant ainsi des lésions tissulaires principalement auniveau de la peau, des intestins et du foie. L’interleukine-22 (IL-22) est une cytokine sécrétée par les LT Th1,Th17 et les cellules de l’immunité innée (ILC). Compte tenu des propriétés de l’IL-22 dans les tissus cibles de laGVHD, nous avons évalué sa contribution dans la physiopathologie de la maladie à l’aide de modèlesexpérimentaux murins. Il apparaît que les souris qui reçoivent des lymphocytes T invalidés pour l’IL-22développent une maladie moins sévère, et leur mortalité est diminuée. L’IL-22 issue du greffon participe donc à lasévérité de la GVHD en favorisant l’inflammation systémique, mais aussi locale au niveau des organes cibles. Deplus, dans les intestins, l’IL-22 agit en synergie avec les interférons de type I pour amplifier l’inflammation de typeTh1 au cours de la GVHD. Chez l’homme, la GVHD est associée à une modification du microbiote intestinal.Nous avons montré que l’absence d’IL-22 semble favoriser la colonisation de lactobacilles au détriment declostridiums, ce qui pourrait également participer à la diminution de la GVHD intestinale. Enfin, nous avonsmontré que l’effet anti-tumoral est préservé malgré l’absence d’IL-22. Ces résultats permettent donc d’envisagerde nouvelles perspectives thérapeutiques dans le traitement de la GVHD.Graft-versus-host disease (GVHD) is still the major complication after allogeneic stem cell transplantation. GVHDresults from the activation of the immune response and the recognition by donor T cells of alloantigens leading totissue injury, especially in skin, gut and liver. Interleukin-22 (IL-22) is a cytokine secreted by CD4+ T cells Th1 andTh17 but also by innate lymphoid cells (ILC). Given that IL-22 functions in the GVHD target tissues, weinvestigated its contribution in GVHD physiopathology using mouse experimental models. We showed that IL-22deficiency in donor cells reduced the severity of GVHD by limiting systemic and local inflammation. Moreover, inthe large intestine, IL-22 acts in synergy with type I interferon to increase Th1-like inflammation. In humans,GVHD severity is associated with microbiotal modification in the intestine. We demonstrated that IL-22 deficiencyin donor cells seems to favor lactobacillus colonization instead of clostridium. These changes of microbiotacomposition may reduce the severity of intestinal GVHD. Finally, we showed that the antitumor effect is preservedeven in absence of IL-22 donor cells. Overall, our data support the design of new clinical approaches aiming totarget IL-22 pathways in GVHD patients

Arsenic trioxide induces regulatory functions of plasmacytoid dendritic cells through interferon-α inhibition

International audienceArsenic trioxide (As 2 O 3) is recently found to have therapeutic potential in systemic sclerosis (SSc), a life-threatening multi-system fibrosing autoimmune disease with type I inter-feron (IFN-I) signature. Chronically activated plasmacytoid dendritic cells (pDCs) are responsible for IFN-I secretion and are closely related with fibrosis establishment in SSc. In this study, we showed that high concentrations of As 2 O 3 induced apoptosis of pDCs via mitochondrial pathway with increased BAX/BCL-2 ratio, while independent of reactive oxygen species generation. Notably, at clinical relevant concentrations, As 2 O 3 preferentially inhibited IFN-a secretion as compared to other cytokines such as TNF-a, probably due to potent down-regulation of the total protein and mRNA expression, as well as phosphorylation of the interferon regulatory factor 7 (IRF7). In addition, As 2 O 3 induced a suppressive phenotype, and in combination with cytokine inhibition, it down-regulated pDCs' capacity to induce CD4 þ T cell proliferation, Th1/Th22 polarization, and B cell differentiation towards plasmablasts. Moreover, chronically activated pDCs from SSc patients were not resistant to the selective IFN-a inhibition, and regulatory phenotype induced by As 2 O 3. Collectively, our data suggest that As 2 O 3 could target pDCs and exert its treatment efficacy in SSc, and more autoimmune disorders with IFN-I signature

LXR agonist treatment of blastic plasmacytoid dendritic cell neoplasm restores cholesterol efflux and triggers apoptosis

International audienceBlastic plasmacytoid dendritic cell (PDC) neoplasm (BPDCN) is an aggressive hematological malignancy with a poor prognosis that derives from PDCs. No consensus for optimal treatment modalities is available today and the full characterization of this leukemia is still emerging. We identified here a BPDCN-specific transcriptomic profile when compared with those of acute myeloid leukemia and T-acute lymphoblastic leukemia, as well as the transcriptomic signature of primary PDCs. This BPDCN gene signature identified a dysregulation of genes involved in cholesterol homeostasis, some of them being liver X receptor (LXR) target genes. LXR agonist treatment of primary BPDCN cells and BPDCN cell lines restored LXR target gene expression and increased cholesterol efflux via the upregulation of adenosine triphosphate-binding cassette (ABC) transporters, ABCA1 and ABCG1. LXR agonist treatment was responsible for limiting BPDCN cell proliferation and inducing intrinsic apoptotic cell death. LXR activation in BPDCN cells was shown to interfere with 3 signaling pathways associated with leukemic cell survival, namely: NF-kB activation, as well as Akt and STAT5 phosphorylation in response to the BPDCN growth/survival factor interleukin-3. These effects were increased by the stimulation of cholesterol efflux through a lipid acceptor, the apolipoprotein A1. In vivo experiments using a mouse model of BPDCN cell xenograft revealed a decrease of leukemic cell infiltration and BPDCN-induced cytopenia associated with increased survival after LXR agonist treatment. This demonstrates that cholesterol homeostasis is modified in BPDCN and can be normalized by treatment with LXR agonists which can be proposed as a new therapeutic approach

In vivo and in vitro sensitivity of blastic plasmacytoid dendritic cell neoplasm to SL-401, an interleukin-3 receptor targeted biologic agent.

International audienceBlastic plasmacytoid dendritic cell neoplasm is an aggressive malignancy derived from plasmacytoid dendritic cells. There is currently no accepted standard of care for treating this neoplasm, and therapeutic strategies have never been prospectively evaluated. Since blastic plasmacytoid dendritic cell neoplasm cells express high levels of interleukin-3 receptor α chain (IL3-Rα or CD123), antitumor effects of the interleukin-3 receptor-targeted drug SL-401 against blastic plasmacytoid dendritic cell neoplasm were evaluated in vitro and in vivo. The cytotoxicity of SL-401 was assessed in patient-derived blastic plasmacytoid dendritic cell neoplasm cell lines (CAL-1 and GEN2.2) and in primary blastic plasmacytoid dendritic cell neoplasm cells isolated from 12 patients using flow cytometry and an in vitro cytotoxicity assay. The cytotoxic effects of SL-401 were compared to those of several relevant cytotoxic agents. SL-401 exhibited a robust cytotoxicity against blastic plasmacytoid dendritic cell neoplasm cells in a dose-dependent manner. Additionally, the cytotoxic effects of SL-401 were observed at substantially lower concentrations than those achieved in clinical trials to date. Survival of mice inoculated with a blastic plasmacytoid dendritic cell neoplasm cell line and treated with a single cycle of SL-401 was significantly longer than that of untreated controls (median survival, 58 versus 17 days, P<0.001). These findings indicate that blastic plasmacytoid dendritic cell neoplasm cells are highly sensitive to SL-401, and support further evaluation of SL-401 in patients suffering from blastic plasmacytoid dendritic cell neoplasm