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Altered immune signatures in breast cancer lymph nodes with metastases revealed by spatial proteome analyses.

BACKGROUND: Metastasis to lymph nodes is strongly associated with reduced survival in breast cancer patients. To increase the understanding on how lymph node metastasis impairs the local immune response in affected lymph nodes, we here studied spatial proteomic changes of critical lymph node immune populations in uninvolved lymph nodes (UnLN) and paired lymph nodes with metastases (LNM) from five breast cancer patients. METHODS: The proteome was analyzed for cortical lymphocyte compartments, subcapsular sinus (SCS) and medullary sinus (MS) CD169+ macrophages, using the Digital Spatial Profiling (DSP) platform from NanoString. RESULTS: Our results identified a stable proteome of SCS CD169+ macrophages in LNM, with the exception for downregulation of the anti-apoptotic protein Bcl-xL and FAPα, but a clear reduction in numbers of SCS CD169+ macrophages in LNM. In contrast, the proteome of MS CD169+ macrophages, B-cell compartments and interfollicular T-cells showed altered immune signatures in LNM, indicating that the decline in SCS CD169+ macrophages coincide with a malfunction in the local, anti-tumor immune responses. CONCLUSIONS: The findings from our study support the notion that metastasis to lymph nodes in breast cancer patients modifies local immune responses. These changes may contribute to explain unsuccessful therapeutic responses, and thereby worsened prognosis, for breast cancer patients with LNM.

Breast Neoplasms

alpha-Naphthyl acetate esterase activity--a cytochemical marker for T lymphocytees. Correlation with immunologic studies of normal tissues, lymphocytic leukemias, non-Hodgkin's lymphomas, Hodgkin's disease, and other lymphoproliferative disorders.

Cytochemical identification of T lymphocytes on the basis of alpha-naphthyl acetate esterase (NAE) activity was compared with immunologic markers for cell suspensions and/or cryostat sections of 113 specimens. Nonneoplastic tissues (peripheral blood, lymph nodes, spleens, tonsils, thymus, and pleural fluid) and specimens from various lymphoproliferative disorders, including acute and chronic lymphocytic leukemia, lymphosarcoma cell leukemia, hairy cell leukemia, non-Hodgkin's lymphomas of B-and T-cell types, and Hodgkin's disease, were evaluated. T (E-rosetting) cells demonstrated several patterns of NAE reactivity: 1) a strong globular reaction product, the most specific pattern for T-cell identification, 2) granular cytoplasmic staining, or 3) no reactivity. B lymphocytes revealed a granular pattern of NAE staining, were devoid of enzyme, or, in rare instances, exhibited strong NAE activity. Percentages of lymphoid cells with strong (globular) NAE activity closely paralleled T-cell (E-rosette) values in the majority of cases, with the best correlations observed for peripheral blood studies. However, discordant results were noted for some neoplastic and nonneoplastic tissues, including cases of T-cell lymphoma or leukemia. Markedly discrepant results were noted for thymic lymphocytes, most of which revealed E-rosette formation and weak or absent NAE activity. Lymph nodes involved by Hodgkin's disease demonstrated a heterogeneous pattern of staining in E-rosetting cells and in Reed-Sternberg variants. Cryostat section studies of reactive lymph nodes and nodular lymphomas demonstrated strong NAE staining in lymphoid cells of T-cell (interfollicular, internodular) areas, with little or no positivity in follicles or nodules (B-cell areas). NAE staining patterns further suggested that T cells comprise part of the follicular cuff and possibly represent a minor population of some neoplastic nodules. Although NAE determinations do not represent a consistently reliable alternative to immunologic methods for T-cell identification, this easily applicable cytochemical marker is complementary to other techniques in assessing neoplastic or nonneoplastic tissues, particularly cryostat sections. (Am J Pathol 97:17--42, 1979).

Adult

Immunoglobulin-containing cells in human tonsils as demonstrated by immunohistochemistry.

Intracellular immunoglobulin has been demonstrated in human palatine tonsils by the unlabelled antibody peroxidase-antiperoxidase complex (PAP) method in which rabbit antiserum to a range of human immunoglobulins (Igs) was linked to the PAP complex by an intermediate stage of swine antiserum to rabbit Ig. The effects of different methods of fixation and processing have been compared, formol-saline fixation giving the best results. The PAP technique proved greatly superior to the fluorescein isothiocyanate (FITC)-based technique, not only in sensitivity but in permitting study of the finer histological and cytological features. The lymphoid follicles are shown to have three distinct zones, two forming the follicle centre (zones (a) and (b)), and the third (zone (c)) the lymphocyte cap. Ig synthesis appeared to begin in the cells in zone (b). IgG, IgA, IgM, IgE and IgD were present in all tonsils, with IgG predominating, confirming that the tonsil resembles lymph nodes more closely than it does alimentary lymphoid tissue. Some follicles contained more than one type of Ig. The tonsil appears to have a well-developed T-dependent area, the lymphoid follicles forming a B-cell area. The structure of the tonsil would seem to facilitate contact between its lymphoid tissue and antigens in the crypts, and it is postulated that some T cells within the crypt epithelium, after contact with antigen, may leave the tonsil by the efferent lymphatics and enter the peripheral circulation by the thoracic duct, whilst other primed T cells interact with B cells in the follicle centres. Some B cells may then start to synthesize immunoglobulin, whilst others become memory cells in the lymphocyte 'cap' of the follicle.

Adolescent

The organization of lymphoid tissue in relation to function.

Organized lymphoid tissue is found in the thymus, spleen, lymph nodes; lining the respiratory and alimentary tracts; and also occurring at sites of chronic inflammation. Apart from the thymus which is involved in the regulation of T-cell function, the other tissues are organized into T-cell and B-cell areas. Lymphocytes in T-cell areas respond by proliferation in cell-mediated immunity and by the production of suppressor cells and helper for antibody formation. B-cell areas are involved in the humoral antibody response. B-cells are segregated into lymph follicles where they form germinal centers and are found at the corticomedullary junction where they differentiate into plasma cells. The role of lymph follicles in becoming germinal centers is poorly understood, but these areas are known to be the site of antigen trapping in primed animals. The particular function of the spleen as a localized area of lymphoid tissue along the course of the blood vascular system is discussed, particularly with respect to its ability to respond to soluble antigen released from sites of localized antigen deposition such as tumors.

Antibody Formation

An electron microscopic and enzyme histochemical study of the boundary zone between the white and red pulp of the human spleen.

Three parts were distinguished by electron microscopy and by enzyme histochemistry at the boundary zone between the white and red pulp of the human spleen. The first was the inner layer of the perifollicular region, composed of medium-sized lymphocytes with abundant free ribosomes in their cytoplasm. A small number of reticulum cells intervened among these lymphocytes. This inner layer was considered to correspond to the "Follikelaussenzone" (Strasser). The second was the outer layer of the perifollicular region, composed of a meshwork of reticulum cells with reticular fibers, and sheathed and non-sheathed arteries. Small and medium-sized lymphocytes, granulocytes, erythrocytes, platelets, and a small number of plasma cells were observed in the mesh spaces. This outer layer was considered to correspond to the "marginal zone" (Snook). At the outermost part of this layer, the venous sinus appeared. There was no distinct border between this layer and the red pulp. The third was the neighboring region of the periarterial lymphoid sheath, showeing similar structure and cellular components to the outer layer of the perifollicular region. It was characteristic feature for the lymphocytes and some of the reticulum cells of this region to have a strong activity for alkaline phosphatase reaction, while the lymphocytes of the outer layer showed only a weak activity. Adenosine triphosphatase and 5'-nucleotidase activities were demonstrated on the lymphocytes of these three parts of the boundary zone as well as the lymph follicle. Different activities for these enzyme reactions may indicate the functional properties of the B-cell system.

Adenosine Triphosphatases

The postnatal development of the white pulp in the rat spleen and the onset of immunocompetence against a thymus-independent and a thymus-dependent antigen.

The spleen of the rat contains 5 well delineated compartments: a central and peripheral part of the periarteriolar lymphatic sheath (PALS), the marginal zone and the follicle with centre and corona. A study was made on the development of these compartments in correlation with the onset of immunocompetence of the spleen. The spleens of animals in the age range from 1-40 days were studied with the light and electron microscopes. Immunocompetence was assessed by measuring serum antibody levels 5 days after intravenous antigen administration. Comparable doses of paratyphoid vaccin (PTV) and sheep red blood cells (SRBC) were used: PTV as a thymus-independent, SRBC as a thymus-dependent antigen. At the first day of life few lymphocytes are present around small arterioles. The marginal zone is first present at 9 days of age. At 14 days of age the typical thymus-dependent area develops. Interdigitating cells, which seem to develop from monocytes, and lymphocytes are present in close apposition. Primary follicles were first seen on 20 days of age, follicle centres at 25 or 30 days of age. The appearance of "typical" dendritic cells coincided with the appearance of follicle centres. The first titre against PTV was seen after antigen administration at 9 days after birth, against SRBC after injection in 14 days old animals. As PTV is a thymus-independent antigen it needs only B-cells for a primary IgM response. The appearance of functional B-cells in sufficient numbers to give a measurable response therefore coincides with the appearance of the marginal zone. Although T-cells are present from birth, the response against SRBC is delayed until the thymus-dependent area has developed. Thus, in the first 2 weeks of life, T-cells are either immature, or they are not able to react, because their microenvironment is not yet adequate.

Animals

The generation of memory cells. I. The role of C3 in the generation of B memory cells.

Adult thymectomized, repopulated mice were chronically depleted of circulating C3 by treatment with cobra venom factor after primary immunization with dinitrophenylated haemocyanin (DNP-KLH). This treatment totally abrogated the development of B-cell memory in such mice, as assayed by a co-operative lymphocyte transfer. The failure of memory development appeared to involve impaired precursor proliferation following priming. It was further shown that the localization of DNP-KLH in splenic lymphoid follicles is both antibody and C3-dependent; thymus-deprived mice make sufficient antibody to DNP-KLH to effect follicular localization of the antigen. On the basis of these and earlier observations we suggest that the development of B-memory cells involves the formation of antigen-antibody-C3 complexes on dendritic cells in lymphoid follicles. C3 may serve to stabilize the antigen bridge between dendritic cells and virgin precursors. In complete contrast, C3 depletion had little effect on the functional expression of primed B cells, thus suggesting that only the early stages of B-cell triggering are C3 dependent.

Animals

Histological and histochemical pattern of phytohemagglutinin (PHA) skin test in patients with sarcoidosis.

Phytohemagglutinin (PHA) is a non-specific stimulant of blastogenic transformation and proliferation of T-lymphocytes in vitro. This material has been used for detection of a reduced lymphoblastic transformation in vitro and, as a skin test, for providing information in the evaluation of cellular immunodeficiency in man (BLAESE et al. 1973). As in sarcoidosis the immunological features are "depression of delayed-type hypersensitivity suggesting T-cell anergy and raised serum immunoglobulins suggesting B-cell overactivity", the authors used PHA skin test in comparison with patients with tuberculosis and M. Hodgkin. PHA positive reactions recorded at 72 hrs. were in 95% for sarcoidosis, 90% for tuberculosis and 5% for M. Hodgkin. But the histological and histochemical investigation of cutaneous biopsies demonstrated three significant differences at 72 hrs. in untreated patients with sarcoidosis compared to the material of tuberculosis patients: formation of lymphatic pseudo-follicles, an increased number of arteriovenous anastomoses and appearance of C-mucopolysaccharide (a histochemical marker of connective tissue in sarcoidosis). There were in sarcoidosis, unlike tuberculosis, blast cells, plasmocytes and a number of lymphocytes at 72 hrs. It is difficult for the authors to explain the different behaviour of the PHA skin test in sarcoidosis and tuberculosis. The appearance of the C-mucopolysaccharide might be a result of the raised serum level of IgM in patients with sarcoidosis.

Glycosaminoglycans

Study of malignant lymphomas from the aspect of immunoglobulin production.

Intracytoplasmic localization of immunoglobulins in neoplastic cells of malignant lymphomas was studied by both light and electron microscopic immunoperoxidase methods. This was demonstrated in 17 out of 71 cases submitted to light or electron microscopic immunoperoxidase methods. Out of 19 cases examined by the electron microscopic immunoperoxidase method, immunoglobulins were intracellularly identified in 10 cases; 3 out of 6 cases which were diagnosed as follicular lymphoma, 3 out of 5 cases of reticulosarcoma, 2 out of 6 cases of lymphosarcoma and 2 cases of immunoblastic sarcoma. Out of the above 10 cases, IgM was demonstrated in 9 cases except one of immunoblastic sarcoma in which IgA, IgG and IgM were identified intracellularly. In addition to these findings, our ultracytological and pathological studies have indicated that immunoglobulin-producing tumors can be classified into the following three major groups according to their cellular origin; germinal centers (group 1), primary follicles (group 2) and extrafollicular (group 3). Group 1 is comprised of follicular lymphoma and reticulosarcoma, group 2 lymphosarcoma, and group 3 immunoblastic sarcoma.

Adolescent

Alkaline phosphatase-positive malignant lymphoma. A subtype of B-cell lymphomas.

Alkaline phosphatase (ALP) activity was evaluated histochemically and cytochemically in concert with immunologic technics in 60 cases of non-Hodgkin's lymphomas and lymphocytic leukemias. Surface membranes of neoplastic cells were positive for ALP only in certain B-cell malignancies: 3 of 6 lymphocytic lymphomas of intermediate differentiation, 4 of 13 nodular lymphomas, and 1 of 7 Burkett's lymphomas. All other B-cell tumors, including chronic lymphocytic leukemia, well-differentiated lymphocytic lymphoma, and diffuse "histiocytic" lymphoma, were ALP-negative. The neoplastic cells of Sezary syndrome and lymphoblastic lymphoma were also consistently negative for ALP. In control lymph nodes ALP-positive lymphocytes were present only in primary follicles and in mantle zones of secondary follicles. ALP-positive lymphomas appear to be neoplastic counterparts of these normal lymphocytes, not only cytochemically, but also with respect to their morphologic and immunologic characteristics. Furthermore, histochemical inhibition tests suggested that the ALP activity demonstrated may reflect a newly recognized, unique isoenzyme.

Alkaline Phosphatase

Predominantly T-cell infiltrate in rheumatoid synovial membranes.

Lymphocytes infiltrating synovial membranes were characterized in eight patients with proliferative rheumatoid synovitis. Surface immunoglobulins were studied with use of immunofluorescence, and the C3 receptor was detected by adherence of red cells coated with antibody and complement - both are B-cell markers. Spontaneous rosette formation with sheep erythrocytes was used as a T-cell marker. To obtain viable lymphocytes in suspension, the villous synovium of five of these patients was digested with collagenase and deoxyribonuclease. Populations enriched in lymphocytes could be obtained by velocity sedimentation. Whereas only 9 to 35 per cent of lymphocytes bore surface immunoglobulins, the majority (70 to 85 per cent) formed sheep-erythrocyte rosettes. Cells bearing the C3 receptor constituted a distinct minority of synovial lymphocytes in frozen-tissue sections, and were found in follicle-like accumulations. These data indicate that the predominant infiltrating lymphocyte in proliferative rheumatoid synovitis is a T cell.

Adolescent

Nodular paragranuloma and progressively transformed germinal centers. Ultrastructural and immunohistologic findings.

Ultrastructural and immunohistologic findings in a nodular variant of Hodgkin's disease with lymphocytic predominance, called nodular paragranuloma, are presented and compared with those in so-called progressively transformed germinal centers. These are large follicles with numerous lymphocytes which can be found not only in nonspecific lymphadenitis, but also in lymph nodes from patients with nodular paragranuloma. The immunoperoxidase technique was applied on paraffin sections to detect intracytoplasmic immunoglobulin and lysozyme. The so-called L & H type Sternberg-Reed cells contained IgG and one type of light chain per cell, suggesting that such cells produce immunoglobulin. The ultrastructure of the L & H type Sternberg-Reed cells favored the immunoblastic nature of these cells. It is concluded that nodular paragranuloma differs from other types of Hodgkin's disease by its localization in B-cell areas and the presence of atypical B immunoblasts.

B-Lymphocytes

Persistent and fatal central-nervous-system ECHOvirus infections in patients with agammaglobulinemia.

We observed persistent ECHOvirus infection of the central nervous system, as defined by continued presence of isolatable virus in cerebrospinal fluid, in five patients with agammaglobulinemia. The immunologic deficit in each was characterized by absence of surface-immunoglobulin-bearing B lymphocytes and of lymph-node cortical follicles, but normal T-cell function. ECHOviruses 30, 19, 9 and 33 were recovered from cerebrospinal fluid for periods varying from two months to three years. The patients had few signs of acute central-nervous-system infection. Three of the five patients had a dermatomyositis-like syndrome, with peripheral lymphocytes that reacted with anti-human leukemia-specific primate and rabbit serums in a cytotoxicity assay. These data suggest that intact B-cell function is essential for eradication of ECHOvirus infection of the central nervous system.

Adult

Detection of intracellular immunoglobulin in nodular lymphomas.

In lymph node tissue sections, six of 11 human cases of nodular lymphoma showed immunoglobulin within malignant nodules, and seven of nine cases of benign follicular hyperplasia showed immunoglobulin within follicles. In addition, distributions of lymphocyte cell membrane markers for T cells and B cells were determined in ten of 11 cases of nodular lymphoma. Lymphocyte suspensions in five cases contained monoclonal immunoglobulins and in three cases neoplastic cells showed a lack of surface membrane immunoglobulins. In two cases, the distribution of lymphocyte surface markers could not be distinguished from cells of benign lymph nodes. Combined data from intracytoplasmic immunoglobulin studies and lymphocyte surface marker assays indicated that eight of ten cases are of B cell lineage. Thus, the detection of intracellular immunoglobulin is not helpful in differentiating benign follicular hyperplasia from nodular lymphoma, but is complementary to lymphocyte surface marker assays in the determination of the origin of neoplastic cells in lymphoreticular malignancies.

Antibodies

Tumor growth of the reticuloendothelial system.

From the author's hitherto studies on the reticuloendothelial system (RES) it was concluded that the RES is not a single cell system of identical origin, morphology and function but is a group of several types of cells of different origin. From this point of view the heterogeneity of tumors of the RES was studied to reveal the following results. Tumors of the "Reticuloendothel" (Aschoff) reveal pictures of endothelioma, while tumors of histiocytes in connective tissue show findings of fibrohistiocytoma. Histiocytes and reticulum cells of lymph nodes are respectively independent cells, and reticulum cells do not partake in the in the development of histiocytosis or histiocytic sarcoma. Follicular lymphoma is a neoplastic growth of reticulum cells having desmosomes in lymph follicles, and tumor cells of the majority of reticulum cell sarcoma are similar to the cells forming the lymph node anlage in the early fetal stage (lymphoreticular cell). Ewing's sarcoma is considered to be a kind of angiopericytoma.

Animals

Histochemistry of normal and diseased human lymph nodes.

Gomori's metal precipitate technique was used to demonstrate the phosphatase activity of the human cervical lymph node in health and disease, using four different phosphate esters (sodium beta-glycerophosphate and adenosine triphosphate at pH 9, riboflavin 5'-phosphate at pH 9.2 and 5'-monophosphoric acid at pH 8.3). In fetal lymph nodes, using 5'-monophosphoric acid, an outstanding positive activity was noticed in the lymphatic follicles. With the other three substrates there was either no nodular reaction or just a narrow rim of positive activity around the follicles, the internodular tissue being negative with all four substrates used. With chronic non-specific lymphadenitis the enzyme hydrolysing the three substrates (beta-glycerophosphate, riboflavin 5'-phosphate and adenosine triphosphate) began to make their appearance. It seems that with lymphadenitis, a qualitative change of the phosphatase activity takes place. A special characteristic pattern of phosphatase activity has been described in both 'early' and 'caseating' tuberculous lymphadenitis. In malignant lymphomas it was noticed that no activity was encountered with any of the four substrates in reticulum cell sarcoma. However, in lymphosarcoma a positive activity was obtained when either beta-glycerophosphate or adenosine triphosphate substrates was used, to the extent that one can depend upon this characteristic phosphatase activity in differentiating between reticulum cell sarcoma and lymphosarcoma. However, no enzymatic activity was obtained when the other two phosphate esters were used.

Adenosine Triphosphate

Mg2+-dependent adenosine triphosphatase as an enzyme histochemical marker for the lymphomas of B-cell origin.

Twenty-nine cases of malignant lymphoma were studied by the enzyme histochemical method and membrane surface markers. Strong adenosine triphosphatase (ATPase) activity was demonstrated in 15 cases of 20 B lymphomas and in one case of null-cell lymphoma (1/1) by a light- and electron-microscopic enzyme histochemical method according to Wachstein et al. Neoplastic cells in nodules of 2 nodular lymphomas (0/2) and in 8 cases of T lymphomas (0/8) did not show any ATPase activity enzyme-histochemically. The ATPase activity of B lymphomas was electron-microscopically demonstrated on the plasma membrane of lymphoma cells but not in the cytoplasmic organelles. The specificity of ATPase activity in B lymphomas was also examined enzyme-histochemically with reference to normal lymphoid tissues. Such specificity was similar to that of non-neoplastic B lymphocytes of primary follicles and the mantle zone of secondary follicles in lymphoid tissues. Therefore, ATPase is one of the useful enzyme histochemical markers in differentiating T and B subclasses of malignant lymphomas.

Adenosine Triphosphatases

Splenic modifications induced by cyclophosphamide in C3H/He, nude, and "B" mice.

The spleen cell population of adult C3H/He mice injected with a single sublethal dose of cyclophosphamide (CY) has been analyzed. An initial phase of spleen atrophy is followed by a considerable hypertrophy, and a progressive return to normal. During the phase of spleen atrophy, both B and T cell compartments are depleted, as estimated by the percentages of cells killed by anti-Thy 1-2 and anti-Ig antisera plus complement. During the stage of regeneration, the percentage of Ig + cells increases rapidly, and at the peak of splenomegaly, the percentage of Ig + cells is high whereas almost no Thy 1-2 + cells are detectable. Progresively, the spleen cell content returns to the original values. In thymo-deprived mice (nude mice and B mice) the percentage of null cells increases during the stage of regeneration, and B mice develop a large number of Ig +-bearing cells. Histologic examination shows that follicles (B-dependent areas) disappear 1 to 2 days before periarteriolar sheaths (T-dependent areas). At the peak of splenomegaly the architecture of the spleen is destroyed, and the interstitial tissue is composed of a dense and uniform layer of lymphoid cells. Progressively, the architecture returns to normal. In nude mice, the disappearance of follicles, and the appearance of a homogenous layer of lymphocytes has been observed. When analyzed for their pattern of electrophoretic mobilities (E.M.), spleen cells from untreated mice reveal two peaks of E.M. 0.80 and 1.15 micron x s-1 x V-1 x cm-1. After CY treatment, during the step of splenic hypertrophy, these two peaks disappear, and a single peak of intermediate mobility appears. In T-deprived mice, a single peak of the same mobility is detected at this stage. The nature and origin of cells which appear during the phase of regeneration are unclear, but their appearance in T-deprived mice argues against thymo dependence. These spleen cells have the ability to suppress the response of normal spleen lymphocytes to T and B cell mitogens.

Animals