Hypomethylation and up-regulation of PD-1 in T cells by azacytidine in MDS/AML patients: A rationale for combined targeting of PD-1 and DNA methylation
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Hypomethylation and up-regulation of PD-1 in T cells by azacytidine in MDS/AML patients : A rationale for combined targeting of PD-1 and DNA methylation. / Ørskov, Andreas D; Treppendahl, Marianne B; Skovbo, Anni; Holm, Mette S; Friis, Lone Smidstrup; Hokland, Marianne; Grønbæk, Kirsten.
I: OncoTarget, Bind 6, Nr. 11, 2015, s. 9612-26.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Hypomethylation and up-regulation of PD-1 in T cells by azacytidine in MDS/AML patients
T2 - A rationale for combined targeting of PD-1 and DNA methylation
AU - Ørskov, Andreas D
AU - Treppendahl, Marianne B
AU - Skovbo, Anni
AU - Holm, Mette S
AU - Friis, Lone Smidstrup
AU - Hokland, Marianne
AU - Grønbæk, Kirsten
PY - 2015
Y1 - 2015
N2 - The hypomethylating agents (HMAs) are standard therapy for patients with higher-risk myelodysplastic syndrome (MDS); however, the majority of the patients will lose their response to HMAs over time due to unknown mechanisms. It has recently been shown that T cell expression of the immunoinhibitory receptor PD-1 is regulated by DNA methylation. In 12 of 27 patients (44%) PD-1 promoter demethylation was observed in sorted peripheral blood T cells isolated over consecutive cycles of treatment with 5-azacytidine (5-aza). The PD-1 promoter demethylation correlated with an increase in PD-1 expression. Moreover, demethylation of the PD-1 promoter correlated with a significantly worse overall response rate (8% vs. 60%, p = 0.014), and a trend towards a shorter overall survival (p = 0.11) was observed. A significantly higher baseline methylation level of the PD-1 promoter was observed in T cells of non-responding patients compared to healthy controls (p = 0.023). Accordingly, in addition to their beneficial function, HMAs induce PD-1 expression on T cells in the MDS microenvironment, thereby likely hampering the immune response against the MDS blasts. Thus, we suggest that activation of the PD-1 checkpoint during HMA treatment can be a possible resistance mechanism, which may be overcome by combination therapy with a PD-1 pathway inhibitor.
AB - The hypomethylating agents (HMAs) are standard therapy for patients with higher-risk myelodysplastic syndrome (MDS); however, the majority of the patients will lose their response to HMAs over time due to unknown mechanisms. It has recently been shown that T cell expression of the immunoinhibitory receptor PD-1 is regulated by DNA methylation. In 12 of 27 patients (44%) PD-1 promoter demethylation was observed in sorted peripheral blood T cells isolated over consecutive cycles of treatment with 5-azacytidine (5-aza). The PD-1 promoter demethylation correlated with an increase in PD-1 expression. Moreover, demethylation of the PD-1 promoter correlated with a significantly worse overall response rate (8% vs. 60%, p = 0.014), and a trend towards a shorter overall survival (p = 0.11) was observed. A significantly higher baseline methylation level of the PD-1 promoter was observed in T cells of non-responding patients compared to healthy controls (p = 0.023). Accordingly, in addition to their beneficial function, HMAs induce PD-1 expression on T cells in the MDS microenvironment, thereby likely hampering the immune response against the MDS blasts. Thus, we suggest that activation of the PD-1 checkpoint during HMA treatment can be a possible resistance mechanism, which may be overcome by combination therapy with a PD-1 pathway inhibitor.
KW - Aged
KW - Aged, 80 and over
KW - Antimetabolites
KW - Azacitidine
KW - Blood Cells
KW - DNA Methylation
KW - Drug Resistance
KW - Female
KW - Gene Expression Regulation
KW - Humans
KW - Leukemia, Myeloid, Acute
KW - Leukemia, Myelomonocytic, Chronic
KW - Lymphocyte Activation
KW - Male
KW - Middle Aged
KW - Myelodysplastic Syndromes
KW - Neoplasm Proteins
KW - Programmed Cell Death 1 Receptor
KW - Promoter Regions, Genetic
KW - RNA, Messenger
KW - RNA, Neoplasm
KW - T-Lymphocyte Subsets
U2 - 10.18632/oncotarget.3324
DO - 10.18632/oncotarget.3324
M3 - Journal article
C2 - 25823822
VL - 6
SP - 9612
EP - 9626
JO - Oncotarget
JF - Oncotarget
SN - 1949-2553
IS - 11
ER -
ID: 162677510