PDF file - 3091K, Supplemental Figure 1: Cell cycle progression occurs more rapidly in CD15+ cells than in CD15- cells.

BACKGROUNDChronic pulmonary graft-versus-host disease (cpGVHD) after hematopoietic cell transplant (HCT) manifests as progressive airway and parenchymal lung fibrosis. On the basis of our prior data, mice that undergo allogeneic HCT with Tbet-knockout donors (AlloTbet) have increased lung Th17 cells and IL-17A and develop fibrosis resembling human cpGVHD. The role of IL-17A in posttransplant pulmonary fibrosis remains incompletely understood. We hypothesized that IL-17A is necessary for development of murine cpGVHD in this model.METHODSAlloTbet mice received weekly intraperitoneal anti-IL-17A or IgG (200 μg/mouse) starting 2 weeks post-HCT and were sacrificed after week 5. Histologic airway and parenchymal fibrosis were semiquantitatively graded in a blinded fashion. Lung cells and proteins were measured by flow cytometry, ELISA, and multicytokine assays.RESULTSAnti-IL-17A modestly decreased airway and parenchymal lung fibrosis, along with a striking reduction in pulmonary neutrophilia, IL-6, MIP-1α, MIP-1β, CXCL1, and CXCL5 in AlloTbet mice. Additionally, anti-IL-17A decreased CCL2, inflammatory monocytes and macrophages, and Th17 cells.CONCLUSIONSIn the setting of murine AlloHCT with Tbet donors, IL-17A blockade decreases fibrotic features of cpGVHD. This may be mediated by the observed reduction in neutrophils or specific lung monocyte and macrophage populations or alternatively via a direct effect on fibroblasts. Collectively, our results further suggest that anti-IL-17A strategies could prove useful in preventing alloimmune-driven fibrotic lung diseases.

What are China's Protestants doing outside the walls of their homes and churches? This article is the result of collaboration between the three named authors, all of whom conducted fieldwork for it. It examines the range of community service and charity work (including poverty alleviation, disaster relief, education, nursing homes, medical care, and various forms of evangelism) that Chinese Protestants have in the past and still do undertake within the contemporary Chinese Communist Party-state (CCP). Drawing on extensive fieldwork over several years in multiple sites across the PRC, the researchers ask: (i) in what ways do CCP policies on religion help or hinder Protestant social service? and (ii) to what extent are Protestant efforts in harmony with or beyond the control of CCP religious policies?

Background Pulmonary GVHD (pGVHD) is an important complication of hematopoietic cell transplant (HCT) and is thought to be a consequence of the HCT conditioning regimen, allogeneic donor cells, and posttransplant lung exposures. We have previously demonstrated that serial inhaled lipopolysaccharide (LPS) exposures potentiate the development of pGVHD after murine allogeneic HCT. In the current study we hypothesized that allogeneic lymphocytes and environmental exposures alone, in the absence of a pre-conditioning regimen, would cause features of pGVHD and would lead to a different T cell expansion pattern compared to syngeneic cells. Methods Recipient Rag1−/− mice received a transfer of allogeneic (Allo) or syngeneic (Syn) spleen cells. After 1 week of immune reconstitution, mice received 5 daily inhaled LPS exposures and were sacrificed 72 hours after the last LPS exposure. Lung physiology, histology, and protein levels in bronchoalveolar lavage (BAL) were assessed. Lung cells were analyzed by flow cytometry. Results Both Allo and Syn mice that undergo LPS exposures (AlloLPS and SynLPS) have prominent lymphocytic inflammation in their lungs, resembling pGVHD pathology, not seen in LPS-unexposed or non-transplanted controls. Compared to SynLPS, however, AlloLPS have significantly increased levels of BAL protein and enhancement of airway hyperreactivity, consistent with more severe lung injury. This injury in AlloLPS mice is associated with an increase in CD8 T cells and effector CD4 T cells, as well as a decrease in regulatory to effector CD4 T cell ratio. Additionally, cytokine analysis is consistent with a preferential Th1 differentiation and upregulation of pulmonary CCL5 and granzyme B. Conclusions Allogeneic lymphocyte transfer into lymphocyte-deficient mice, followed by LPS exposures, causes features of pGVHD and lung injury in the absence of a pre-conditioning HCT regimen. This lung disease associated with an expansion of allogeneic effector T cells provides a novel model to dissect mechanisms of pGVHD independent of conditioning.

Environmental exposures are a potential trigger of chronic pulmonary graft-versus-host disease (pGVHD) after successful recovery from hematopoietic cell transplant (HCT). We hypothesized that inhalations of LPS, a prototypic environmental stimulus, trigger pGVHD via increased pulmonary recruitment of donor-derived antigen-presenting cells (APCs) through the C-C motif ligand 2 (CCL2)-C-C motif receptor 2 (CCR2) chemokine axis. B10.BR(H2(k)) and C57BL/6(H2(b)) mice underwent allogeneic (Allo) or syngeneic (Syn) HCT with wild-type (WT) C57BL/6, CCL2(-/-), or CCR2(-/-) donors. After 4 weeks, recipient mice received daily inhaled LPS for 5 days and were killed at multiple time points. Allo mice exposed to repeated inhaled LPS developed prominent lymphocytic bronchiolitis, similar to human pGVHD. The increase in pulmonary T cells in Allo mice after LPS exposures was accompanied by increased CCL2, CCR2, and Type-1 T-helper cytokines as well as by monocytes and monocyte-derived dendritic cells (moDCs) compared with Syn and nontransplanted controls. Using CCL2(-/-) donors leads to a significant decrease in lung DCs but to only mildly reduced CD4 T cells. Using CCR2(-/-) donors significantly reduces lung DCs and moDCs but does not change T cells. CCL2 or CCR2 deficiency does not alter pGVHD pathology but increases airway hyperreactivity and IL-5 or IL-13 cytokines. Our results show that hematopoietic donor-derived CCL2 and CCR2 regulate recruitment of APCs to the Allo lung after LPS exposure. Although they do not alter pathologic pGVHD, their absence is associated with increased airway hyperreactivity and IL-5 and IL-13 cytokines. These results suggest that the APC changes that result from CCL2-CCR2 blockade may have unexpected effects on T cell differentiation and physiologic outcomes in HCT.

Diacetyl (DA), a component of artificial butter flavoring, has been linked to the development of bronchiolitis obliterans (BO), a disease of airway epithelial injury and airway fibrosis. The epidermal growth factor receptor ligand, amphiregulin (AREG), has been implicated in other types of epithelial injury and lung fibrosis. We investigated the effects of DA directly on the pulmonary epithelium, and we hypothesized that DA exposure would result in epithelial cell shedding of AREG. Consistent with this hypothesis, we demonstrate that DA increases AREG by the pulmonary epithelial cell line NCI-H292 and by multiple independent primary human airway epithelial donors grown under physiologically relevant conditions at the air-liquid interface. Furthermore, we demonstrate that AREG shedding occurs through a TNF-α-converting enzyme (TACE)-dependent mechanism via inhibition of TACE activity in epithelial cells using the small molecule inhibitor, TNF-α protease inhibitor-1, as well as TACE-specific small inhibitor RNA. Finally, we demonstrate supportive in vivo results showing increased AREG transcript and protein levels in the lungs of rodents with DA-induced BO. In summary, our novel in vitro and in vivo observations suggest that further study of AREG is warranted in the pathogenesis of DA-induced BO.

Abstract Medulloblastoma is the most common malignant brain tumor in children. Although aggressive surgery, radiation, and chemotherapy have improved outcomes, survivors suffer severe long-term side effects, and many patients still succumb to their disease. For patients whose tumors are driven by mutations in the sonic hedgehog (SHH) pathway, SHH antagonists offer some hope. However, many SHH-associated medulloblastomas do not respond to these drugs, and those that do may develop resistance. Therefore, more effective treatment strategies are needed for both SHH and non-SHH–associated medulloblastoma. One such strategy involves targeting the cells that are critical for maintaining tumor growth, known as tumor-propagating cells (TPC). We previously identified a population of TPCs in tumors from patched mutant mice, a model for SHH-dependent medulloblastoma. These cells express the surface antigen CD15/SSEA-1 and have elevated levels of genes associated with the G2–M phases of the cell cycle. Here, we show that CD15+ cells progress more rapidly through the cell cycle than CD15− cells and contain an increased proportion of cells in G2–M, suggesting that they might be vulnerable to inhibitors of this phase. Indeed, exposure of tumor cells to inhibitors of Aurora kinase (Aurk) and Polo-like kinases (Plk), key regulators of G2–M, induces cell-cycle arrest, apoptosis, and enhanced sensitivity to conventional chemotherapy. Moreover, treatment of tumor-bearing mice with these agents significantly inhibits tumor progression. Importantly, cells from human patient-derived medulloblastoma xenografts are also sensitive to Aurk and Plk inhibitors. Our findings suggest that targeting G2–M regulators may represent a novel approach for treatment of human medulloblastoma. Cancer Res; 73(20); 6310–22. ©2013 AACR.

Abstract The growth of many tumors has been suggested to depend on a subset of tumor cells with an extensive capacity for self-renewal, termed cancer stem cells or tumor-initiating cells (TICs). These cells are not necessarily abundant or proliferative, but because they are long-lived and often resistant to conventional therapies, they are thought to contribute to tumor resistance and recurrence. Therefore, identifying these cells and finding approaches to targeting them has become an important goal in cancer research. We recently identified a population of TICs in a mouse model of medulloblastoma, the most common malignant brain tumor in children. These cells, marked by expression of the cell surface antigen CD15, are capable of propagating tumors following transplantation, whereas CD15– cells from the same donors cannot. To gain insight into the molecular mechanisms underlying the increased tumorigenic potential of CD15+ cells, we compared their gene expression profile to that of CD15– cells. Among the genes most consistently elevated in CD15+ cells were regulators of the G2/M phases of the cell cycle. This observation led us to hypothesize that CD15+ cells display altered cell cycle regulation, and that these cells might be particularly vulnerable to inhibitors of cell cycle progression. Here we show that CD15+ cells move more quickly through the G1 and S phases of the cell cycle, and as a result contain an increased proportion of cells in G2/M. Consistent with this cell cycle skewing, CD15+ cells express higher levels of the G2/M regulators Aurora Kinase (Aurk) and Polo-like Kinase (Plk). Treatment of tumor cells with small molecule antagonists of Aurk or Plk inhibits cell cycle progression, promotes apoptosis and enhances sensitivity to other modes of chemotherapy. Treatment of tumor-bearing mice with these agents also significantly inhibits tumor progression. Importantly, cells from medulloblastoma patient-derived xenografts are also sensitive to Aurk and Plk inhibitors. These findings suggest that inhibitors of Aurk and Plk may be useful for targeting TICs and may represent a novel avenue for therapy of human medulloblastoma. Citation Format: Shirley Markant, Lourdes Adriana Esparza, Kelly Barton, Jesse Sun, Robert Wechsler-Reya,. Targeting tumor-initiating cells in medulloblastoma. [abstract]. In: Proceedings of the Eleventh Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2012 Oct 16-19; Anaheim, CA. Philadelphia (PA): AACR; Cancer Prev Res 2012;5(11 Suppl):Abstract nr CN07-02.

Medulloblastoma is the most common malignant brain tumor in children. While the current treatment strategy of surgery plus radiation has a 60–80% cure rate, the survivors suffer severe side effects, including growth delays and cognitive deficits. Therefore, more effective, less toxic treatments are needed. One approach to achieving this is targeting the cells within a tumor that are capable of re-populating the tumor, known as tumor-propagating cells (TPCs). These cells are thought to be responsible for tumor resistance to conventional therapies. In the patched mutant mouse model of medulloblastoma, TPCs are marked by expression of the cell surface carbohydrate antigen CD15. Our previous studies have suggested that CD15+ cells display increased expression of genes associated with the G2/M phases of the cell cycle. Cell cycle analysis suggests that CD15+ cells move quickly through the G1 and S phases of the cell cycle, but accumulate in the G2/M phases. This accumulation in G2/M may represent a vulnerability of CD15+ TPCs, and inhibition of G2/M regulators, such as Aurora kinases, may represent one approach for targeting TPCs and overcoming therapeutic resistance. Treatment of tumor cells from patched mutant mice or human Hedgehog-associated medulloblastoma with Aurora kinase inhibitors in vitro leads to inhibition of proliferation, arrest in G2/M and apoptosis. Furthermore, in vivo treatment of tumor-bearing mice with Aurora kinase inhibitors significantly delays tumor progression and prolongs survival. Our findings suggest that targeting Aurora kinases in TPCs may represent a new approach for the treatment of human medulloblastoma.

Abstract Medulloblastoma is the most common malignant brain tumor in children. While the current treatment strategy of surgery, radiation and chemotherapy has a 60-80% cure rate, the survivors suffer severe side effects, including growth delays and cognitive deficits. Therefore, more effective, less toxic treatments are needed. One approach to achieving this is targeting the cells within a tumor that are capable of re-populating the tumor, known as tumor-propagating cells (TPCs). In the patched mutant mouse model of medulloblastoma, TPCs are marked by expression of the cell surface carbohydrate antigen CD15. Our previous studies suggest that CD15+ cells display increased expression of genes associated with G2/M phase of the cell cycle. Cell cycle analysis suggests that these CD15+ cells move quickly through the G1 and S phases of the cell cycle, but accumulate in G2/M phase. Therefore, inhibition of G2/M regulators, such as Aurora kinases, may represent one approach to targeting TPCs in these tumors. Treatment of tumor cells with the Aurora kinase inhibitor VX-680 (tozasertib) leads to inhibition of proliferation in vitro, with arrest in G2/M and apoptosis. Preliminary studies suggest that patched mutant tumors are also sensitive to Aurora kinase inhibition in vivo. Our findings suggest that targeting Aurora kinases may represent a novel approach for the treatment of hedgehog-associated human medulloblastoma. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 3443. doi:10.1158/1538-7445.AM2011-3443