Hans Wildiers

Introduction\n\nCancer immunotherapy is designed to activate the immune system against cancer cells. This field has been revitalized with the discovery of immune checkpoints such as programmed cell death protein-1 (PD-1) and its ligand (PD-L1). PD-L1 has been exploited for immune therapy with varying success depending on the tumor type, with several studies pointing towards cancer metabolism as one of the possible causes of this variability.\n\nOne of the most common tumor associated metabolic alteration is increased expression of choline kinase-α (Chk-α), characterized by increased phosphocholine (PC) and total choline-containing compounds. Since the presence of PC on proteins has been related to escape from immune surveillance, here, we investigated the relationship between Chk-α, PC and PD-L1.\n\n \n\nMethods\n\nExperiments were performed using triple negative breast MDA-MB-231 cells transiently transfected with small interfering RNA (siRNA) against Chk-α or PD-L1 following standard protocols. Total RNA was isolated, complementary cDNA synthesised and quantitative real-time PCR performed using IQ SYBR Green supermix and gene specific primers.\n\nFor high resolution 1H Magnetic Resonance Spectroscopy (MRS), cell extracts were obtained using a dual-phase extraction method. 1H MRS was recorded on a Bruker Biospin Avance-III 750 MHz spectrometer. Integrals of the metabolites of interest were determined and normalized to the TSP reference and the number of cells. Metabolites were estimated from at least three experimental samples. Statistical significance was evaluated using the Student t-test.\n\n \n\nResults and Discussion\n\nWe observed that silencing Chk-α resulted in a significant increase of PD-L1 expression and silencing PD-L1 resulted in a significant increase of Chk-α expression. Consistent with the molecular changes, a significant increase of PC was observed in cells transfected with PD-L1 siRNA. Metabolic changes, however, extended well beyond the choline containing compounds. We identified changes in amino acids, organic acids, nucleotides and other compounds. Furthermore, we found that PD-L1 downregulation profoundly altered the lipid profile of MDA-MB-231 cells.\n\nMetabolic characterization showed that cells with downregulated Chk-α levels shifted towards a more immunosuppressive profile through metabolic reprogramming, increasing the production of metabolites that have been linked to decreased effectiveness of T-cells. Our data also suggest that low levels of PD-L1 can skew cancer cell metabolism towards a more immunosuppressive profile by a significant increase of lipid production and changes in the lipid profile. These results provide new insights in the role of PD-L1 in the cancer metabolome that may be exploited to improve the outcome of treatment with immune checkpoint inhibitors.

AIMS: To investigate the association between tumour characteristics and HER-2/neu by immunohistochemistry in primary operable breast cancer. METHODS: The association between HER-2/neu and other clinicopathological factors was evaluated in 1362 consecutive patients with primary breast cancer treated between 2000 and July 2003 in one centre. Microscopic tumour size, tumour grade, lymph node status, patient's age, oestrogen receptor (ER), progesterone receptor (PR), and joint ER/PR status were evaluated, using the chi2 test for univariate analysis and logistic regression for multivariate analysis. The hormone receptors and HER-2/neu were studied immunohistochemically. Using the HER-2/neu DAKO scoring system, scores of 0, 1+, or 2+ were defined as negative and 3+ as positive. Data for DAKO scores 2+/3+ versus 0/1+ are also presented. RESULTS: Hormone receptor negative breast cancers were more often HER-2/neu positive than hormone receptor positive cancers, both for ER (28.7% v 6.8%) and PR (19.9% v 5.9%). In multivariate analysis, both ER, PR, and tumour grade were independently associated with HER-2/neu. In ER+ tumours, HER-2/neu overexpression was significantly lower in PR+ than in PR- cases (11.5% v 5.4%). HER-2/neu overexpression (2.7%) was lowest in the large subgroup of ER+PR+ tumours with low tumour grade (grade 1-2), comprising 46.1% of all patients. CONCLUSIONS: ER, PR, and tumour grade are independent predictors for HER-2/neu overexpression in women with primary operable breast cancer. ER and PR are negatively associated with HER-2/neu, whereas tumour grade is positively associated with HER-2/neu. In women with ER+ tumours, PR status also affects the likelihood of HER-2/neu expression.