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Checkpoint CD47 expression in classical Hodgkin lymphoma
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Experimental and Clinical Oncology.ORCID iD: 0000-0002-3393-1106
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Clinical and experimental pathology.ORCID iD: 0000-0002-0226-5681
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Molecular tools. Uppsala University, Science for Life Laboratory, SciLifeLab.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Experimental and Clinical Oncology.ORCID iD: 0000-0001-6158-3041
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2022 (English)In: British Journal of Haematology, ISSN 0007-1048, E-ISSN 1365-2141, Vol. 197, no 5, p. 580-589Article in journal (Refereed) Published
Abstract [en]

The glycoprotein CD47 regulates antiphagocytic activity via signal regulatory protein alpha (SIRPa). This study investigated CD47 expression on Hodgkin and Reed–Sternberg (HRS) cells in the classical Hodgkin lymphoma (cHL) tumour microenvironment and its correlation with prognosis, programmed-death (PD) immune markers, and SIRPa+ leukocytes. We conducted immunohistochemistry with CD47 and SIRPa antibodies on diagnostic biopsies (tissue microarrays) from cHL patients from two cohorts (n = 178). In cohort I (n = 136) patients with high expression of CD47 on HRS cells (n = 48) had a significantly inferior event-free survival [hazard ratio (HR) = 5.57; 95% confidence interval (CI), 2.78–11.20; p < 0.001] and overall survival (OS) (HR = 8.54; 95% CI, 3.19–22.90; p < 0.001) compared with patients with low expression (n = 88). The survival results remained statistically significant in multivariable Cox regression adjusted for known prognostic factors. In cohort II (n = 42) high HRS cell CD47 expression also carried shorter event-free survival (EFS) (HR = 5.96; 95% CI, 1.20–29.59; p = 0.029) and OS (HR = 5.61; 95% CI, 0.58–54.15; p = 0.136), although it did not retain statistical significance in the multivariable analysis. Further, high CD47 expression did not correlate with SIRPa+ leukocytes or PD-1, PD-L1 and PD-L2 expression. This study provides a deeper understanding of the role of CD47 in cHL during an era of emerging CD47 therapies.

Place, publisher, year, edition, pages
John Wiley & Sons, 2022. Vol. 197, no 5, p. 580-589
Keywords [en]
Hodgkin lymphoma, CD47, lymphoma, SIRPa, tumour markers
National Category
Cancer and Oncology Hematology
Identifiers
URN: urn:nbn:se:uu:diva-455841DOI: 10.1111/bjh.18137ISI: 000770154000001PubMedID: 35301709OAI: oai:DiVA.org:uu-455841DiVA, id: diva2:1602190
Note

Authors in thesis list of papers: Gholiha, A.R., Hollander, P., Hedstrom, G., Molin, D., Hjalgrim, H., Smedby, K.E., Glimelius, I., Hashemi, J., Amini, R-M., Enblad, G.

Title in thesis list of papers: Checkpoint CD47 Expression Predicts Inferior Survival in classical Hodgkin Lymphoma

Available from: 2021-10-11 Created: 2021-10-11 Last updated: 2022-09-14Bibliographically approved
In thesis
1. Immunologic Markers in the Tumor Microenvironment of Classical Hodgkin Lymphoma
Open this publication in new window or tab >>Immunologic Markers in the Tumor Microenvironment of Classical Hodgkin Lymphoma
2021 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

In classical Hodgkin lymphoma (cHL), cytokine regulation and cellular composition of the tumor microenvironment (TME) is crucial for tumor cell survival. In paper I, we examined the presence of CD138+ plasma cells and IgG4+ plasma cells in diagnostic cHL biopsies with immunohistochemistry (IHC). We found that increasing proportions of CD138+ plasma cells in the TME were associated with B-symptoms and inferior survival. IgG4+ plasma cells in the TME were a rare finding. In paper II, we investigated IL-6+ leukocytes and IL-6+ Hodgkin-Reed-Sternberg (HRS) cells in the TME of primary cHL. We observed that an IL-6+ leukocyte proportion of ≤ 1% in the TME was an independent adverse prognostic marker for event-free and overall survival. Further, the presence of IL-6+ leukocytes correlated with an increased proportion of CD138+ plasma cells and CD68+macrophages in the TME. IL-6+ HRS cells correlated with increased proportions of CD68+macrophages, PD-L1+ leukocytes, and PD-L1+HRS cells. In paper III, we investigated CD47 surface glycoprotein expression on HRS cells in the TME. CD47 is mainly known to promote antiphagocytic signaling via interaction with the SIRPa protein on phagocytic cells. IHC for CD47 was performed on diagnostic cHL biopsies. Cases with high CD47 expression on HRS cells had an inferior survival in univariate and multivariate analyses, adjusting for established prognostic factors compared with patients with low CD47 expression on HRS cells. In paper IV, using the Proximity Extension Assay (PEA) method, we identified 17 distinguishing immunologic proteins in cHL when comparing cHL diagnostic tissue lysates with reactive lymph node lysates from controls. In addition, 8 of these 17 proteins were elevated in cHL plasma compared with plasma from controls. Several of the identified proteins have established evidence in cHL as PD-L1, IL-6, CCL17, LAG3, and several proteins were introduced as new potential targets. In conclusion, our findings increase our knowledge regarding several immunological elements within the TME of cHL introducing clinicopathological associations of prognostic and potential therapeutic future implications. 

 

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2021. p. 64
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1776
Keywords
Tumor microenvironment, immunohistochemistry, immune checkpoints, Plasma cells, IL-6 cytokine, Proteomics, CD47. 
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-455817 (URN)978-91-513-1314-6 (ISBN)
Public defence
2021-12-03, Martin H:son Holmdahl-salen,, Akademiska Sjukhuset, ingång 100, 13:00 (English)
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Available from: 2021-11-09 Created: 2021-10-13 Last updated: 2021-12-29

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Gholiha, Alex RezaHollander, PeterLöf, LizaGlimelius, IngridHedström, GustafMolin, DanielHashemi, JamilehAmini, Rose-MarieEnblad, Gunilla

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Gholiha, Alex RezaHollander, PeterLöf, LizaGlimelius, IngridHedström, GustafMolin, DanielHashemi, JamilehAmini, Rose-MarieEnblad, Gunilla
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Experimental and Clinical OncologyClinical and experimental pathologyMolecular toolsScience for Life Laboratory, SciLifeLab
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