年龄增长、免疫抑制与胶质母细胞瘤患者发病率之间的相关性。

The Coincidence Between Increasing Age, Immunosuppression, and the Incidence of Patients With Glioblastoma.

作者信息

Ladomersky Erik, Scholtens Denise M, Kocherginsky Masha, Hibler Elizabeth A, Bartom Elizabeth T, Otto-Meyer Sebastian, Zhai Lijie, Lauing Kristen L, Choi Jaehyuk, Sosman Jeffrey A, Wu Jennifer D, Zhang Bin, Lukas Rimas V, Wainwright Derek A

机构信息

Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.

Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.

出版信息

Front Pharmacol. 2019 Mar 27;10:200. doi: 10.3389/fphar.2019.00200. eCollection 2019.

Abstract

Glioblastoma (GBM) is the most aggressive primary brain tumor in adults and is associated with a median overall survival (mOS) of 16-21 months. Our previous work found a negative association between advanced aging and the survival benefit after treatment with immunotherapy in an experimental brain tumor model. Given the recent phase III clinical success of immunotherapy in patients with many types of cancer, but not for patients with GBM, we hypothesize that aging enhances immunosuppression in the brain and contributes to the lack of efficacy for immunotherapy to improve mOS in patients with malignant glioma. Herein, we compare epidemiological data for the incidence and mortality of patients with central nervous system (CNS) cancers, in addition to immune-related gene expression in the normal human brain, as well as peripheral blood immunological changes across the adult lifespan. Data were extracted from the National Cancer Institute's surveillance, epidemiology, and end results (SEER)-, the Broad Institute's Genotype Tissue Expression project (GTEx)-, and the University of California San Francisco's 10k Immunomes-databases and analyzed for associations with aging. The proportion of elderly individuals, defined as ≥65 years of age, has predominantly increased for more than 100 years in the United States. Over time, the rise in elderly United States citizens has correlated with an increased incidence and mortality rate associated with primary brain and other CNS cancer. With advanced aging, human mRNA expression for factors associated with immunoregulation including immunosuppressive indoleamine 2,3 dioxygenase 1 (IDO) and programmed death-ligand 1 (PD-L1), as well as the dendritic cell surface marker, CD11c, increase in the brain of normal human subjects, coincident with increased circulating immunosuppressive Tregs and decreased cytolytic CD8 T cells in the peripheral blood. Strikingly, these changes are maximally pronounced in the 60-69 year old group; consistent with the median age of a diagnosis for GBM. These data demonstrate a significant association between normal human aging and increased immunosuppression in the circulation and CNS; particularly late in life. Our data raise several hypotheses including that, aging: (i) progressively suppresses normal immunosurveillance and thereby contributes to GBM cell initiation and/or outgrowth; (ii) decreases immunotherapeutic efficacy against malignant glioma.

摘要

胶质母细胞瘤(GBM)是成人中最具侵袭性的原发性脑肿瘤,其总体中位生存期(mOS)为16 - 21个月。我们之前的研究发现在实验性脑肿瘤模型中,高龄与免疫治疗后的生存获益呈负相关。鉴于免疫疗法近期在多种癌症患者中取得了III期临床成功,但在GBM患者中却未取得成功,我们推测衰老会增强大脑中的免疫抑制作用,并导致免疫疗法无法有效提高恶性胶质瘤患者的mOS。在此,我们比较了中枢神经系统(CNS)癌症患者的发病率和死亡率的流行病学数据,以及正常人类大脑中与免疫相关的基因表达,还有成年期外周血免疫变化情况。数据从美国国立癌症研究所的监测、流行病学和最终结果(SEER)数据库、布罗德研究所的基因型组织表达项目(GTEx)数据库以及加利福尼亚大学旧金山分校的10k免疫组数据库中提取,并分析其与衰老的相关性。在美国,年龄≥65岁的老年人比例在100多年来主要呈上升趋势。随着时间推移,美国老年公民数量的增加与原发性脑癌和其他CNS癌症的发病率及死亡率上升相关。随着年龄增长,正常人类大脑中与免疫调节相关因子的mRNA表达增加,包括免疫抑制性吲哚胺2,3 - 双加氧酶1(IDO)和程序性死亡配体1(PD - L1),以及树突状细胞表面标志物CD11c,同时外周血中循环免疫抑制性调节性T细胞(Tregs)增加,细胞溶解性CD8 T细胞减少。引人注目的是,这些变化在60 - 69岁年龄组中最为明显,这与GBM的诊断中位年龄一致。这些数据表明正常人类衰老与循环系统和CNS中免疫抑制增加之间存在显著关联,尤其是在生命后期。我们的数据提出了几个假设,包括衰老:(i)逐渐抑制正常的免疫监视,从而促进GBM细胞的起始和/或生长;(ii)降低对恶性胶质瘤的免疫治疗效果。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8b95/6446059/fcb5c5c6b316/fphar-10-00200-g001.jpg

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