T regulatory cells (Treg) avert autoimmunity, but their increased levels in melanoma confer a poor prognosis. To explore the basis for Treg accumulation in melanoma, we evaluated chemokine expression in patients. A 5-fold increase was documented in the Treg chemoattractants CCL22 and CCL1 in melanoma-affected skin versus unaffected skin, as accompanied by infiltrating FoxP3+ T cells. In parallel, there was an approximately two-fold enhancement in expression of CCR4 in circulating Treg but not T effector cells. We hypothesized that redirecting Treg away from tumors might suppress autoimmune side effects caused by immune checkpoint therapeutics now used widely in the clinic. In assessing this hypothesis, we observed a marked increase in skin Treg in mice vaccinated with Ccl22, with repetitive vaccination sufficient to limit Treg accumulation and melanoma growth in the lungs of animals challenged by tumor cell injection, whether using a prevention or treatment protocol design. The observed change in Treg accumulation in this setting could not be explained by Treg conversion. Overall, our findings offered a preclinical proof of concept for the potential use of CCL22 delivered by local injection as a strategy to enhance the efficacious response to immune checkpoint therapy while suppressing its autoimmune side effects. Cancer Res; 76(21); 6230–40. ©2016 AACR.
T regulatory cells (Treg) suppress the function of dendritic cells (DC), B cells, and T cells in a contact-mediated fashion (1). When tumors develop, the expansion of Treg interfering with successful immune surveillance is a natural extension of this process (2). The abundance of peripherally induced Treg correlates with enhanced tumor growth (3). New tumor types where progression is correlated with Treg infiltration continue to be identified (4), and an even greater cohort of patients will face Treg-mediated immunosuppression in the future. Thus, a solid understanding of intratumoral Treg accumulation is important.
An increased abundance of Treg within tumors can result from enhanced proliferation, for example, when Tregs recognize antigen (3). Also, the tumor can instruct infiltrating T cells to convert into Treg, for example, through thioredoxin expression (2). The plasticity of Th17 may play a role, giving rise to Treg by conversion in the presence of intratumoral IL10 (5). Another mechanism supporting Treg abundance is chemoattraction (6). Among chemokines that can attract Treg, CCL22 may be particularly important (7). Elevated expression of CCL22 is observed in diverse tumor types (8, 9). Simultaneously elevated expression of receptors for CCL22 and other chemokines helps to explain an overabundance of Treg (10). The intratumoral vasculature will likewise affect Treg extravasation and tumor infiltration (11).
To reduce Treg abundance and support antitumor immunotherapy, patients can be pretreated with antibodies. In practice, this challenge has primarily been met by antibodies to the IL2 receptor CD25, yet such treatment also depletes activated effector T cells. Limiting Treg activation through an immune checkpoint blockade can also be of help (12). Finally, depletion using antibodies to CCR4 may be useful. This concept is being explored using mogamulizumab infusion in a clinical trial (13).
Systemic depletion of Treg can be associated with autoimmunity (14). In fact, underrepresentation of Treg is common in autoimmune conditions (15). A direct link between local underrepresentation of Treg and autoimmunity can be made in tissue-specific conditions, such as vitiligo (16). The abundance of Treg is reduced, apparently in response to limited numbers of CCL22-producing cells, including macrophages (17). In models of vitiligo, Treg depletion can induce depigmentation even in the absence of IFNγ, highlighting their relative importance (18).
As tumor immunotherapeutic approaches meet with increased success, the development of autoimmunity takes center stage. This highlights the need for the development of precise Treg depletion strategies. We recently demonstrated that Treg can be drawn to the skin by local Ccl22 overexpression (19). To simultaneously address the accumulation of Treg in melanoma and their shortfall in autoimmunity, we postulate that cutaneous overexpression of CCL22 can divert Treg away from tumors and into the skin, as highlighted in Fig. 1.
Here, we describe the abundance of relevant chemokines in human melanoma by immunostaining. We also evaluated chemokine receptor expression levels in Treg from patients and controls, and compared this with expression by CTL. Looking to Ccl22-mediated chemoattraction of Treg to the skin and its success toward mitigating autoimmune depigmentation, we applied our strategy in a mouse model of metastatic melanoma using B16 tumor cells. We measured the consequences of cutaneous Ccl22 overexpression for tumor growth and intratumoral Treg abundance, and addressed the possibility that cells may be converted to Treg on site or preferentially migrate toward Ccl22. We propose that cutaneous Ccl22 overexpression can support antitumor responses while suppressing autoimmune side effects of immunotherapy.
Materials and Methods
Human and mouse subjects
Melanoma in situ and metastatic melanoma surgical samples not required for pathologic examination and 30-mL blood samples from metastatic melanoma patients were obtained after informed consent under Institutional Review Board (IRB)–approved protocols according to the declaration of Helsinki. Metastatic tissue samples were obtained from spine, lung, lymph node, or brain, whereas melanoma in situ samples were skin-derived. In concordance with the approved protocols, no further patient information was shared with investigators. Normal human skin was obtained as otherwise discarded fresh surgical tissue, and normal human buffy coats were from LifeSource. No personal identifiers were provided to investigators, and studies were approved by the IRB. Incoming blood samples were given a tissue sample number before subjecting the samples to Ficol density gradient centrifugation to enrich the lymphocytes. Resulting peripheral blood mononuclear cells (PBMC) were stored in our liquid nitrogen inventory by tissue number until use. Tissue samples were embedded in optimal cutting temperature (OCT) compound (Sakura Finetek), snap frozen in liquid nitrogen, and stored at −80°C. Eight micrometer frozen sections were cut, fixed in acetone at 4°C, and stored at −20°C until use. For mouse experiments approved by the Loyola Institutional Animal Care and Use Committee (IACUC), 6-week-old C57BL/6, Pmel-1 (gp100 reactive, TCR transgenic mice), and Foxp3-eGFP (Treg reporter) mice were purchased from The Jackson Laboratories under IACUC approval at Loyola University Chicago and bred in house. Skin and pulmonary tissues were harvested at euthanasia and stored at −80°C.
Immunostaining of human and mouse tissues
Eight μm human tissue cryosections were preincubated with 10% normal human AB serum (Gemini Bio-Products). When staining mouse tissues, sections were fixed in 10% neutral buffered formalin. Sections were subsequently treated with SuperBlock (ScyTek Laboratories) and with 0.3% H2O2 to inactivate endogenous peroxidase. When detecting nuclear FoxP3 in mouse tissues, antigen retrieval was pursued after incubation with the primary antibody by using a sequence of 0.05% Tween (Sigma Life Sciences), 1% Triton-X100 (Fischer Scientific), and 0.05% Tween, each in TBS. Primary antibodies include clones Ta99 to TRP-1 (Covance), polyclonal rabbit antiserum to mouse and human FoxP3 (ThermoFisher) or MF-14PE rat monoclonal to mouse FoxP3 (Biolegend), 145-2C11bio, FITC or PE to mouse CD3ε (BD Biosciences) or HIT3AFITC to human CD3 (BD Biosciences), PK138Alexa Fluor 488 to mouse NK1.1 (BioLegend), 8P16-N4-L21 to human CCL1 (Enzo Life Sciences), 57203 to human CCL22 (R&D Systems), and MAB4391 to mouse Ccl22 (R&D Systems), TG6/CCR4 to human CCR4 (BioLegend), and 191704 to human CCR8 (R&D Systems). For immunofluorescent stainings, slides were coverslipped with anti-fade reagent with DAPI (Life Technologies, Fischer Scientific). For immunoenzymatic stains, primary antibodies were detected using biotinylated rabbit anti-mouse Ig (Dakopatts) combined with horseradish peroxidase–labeled streptavidin (Dakopatts) or goat anti-rabbit Ig (Dakopatts). For TUNEL stainings, an Apoptag kit (Millipore) was used. Unfixed tissues were incubated with Ta99 Ab to TRP-1 prior to formalin fixation and incubation with terminal deoxynucleotidyl transferase enzyme. Alkaline phosphatase–labeled polyclonal goat anti-mouse IgG (Dakopatts) was combined with peroxidase-labeled antidioxigenin. Alkaline phosphatase was detected using FAST Blue BB substrate (Sigma-Aldrich). Aminoethylcarbazole (AEC) was used as a peroxidase substrate (Sigma-Aldrich). Some slides were counterstained in Harris hematoxylin (Sigma Aldrich) before coverslipping in glycergel (Dakopatts). Stainings were imaged using an Olympus Scope BX53 with a Retiga 4000R 4.2 Mpixel monochrome camera (QImaging), followed by Adobe Photoshop–supported (Adobe Systems Incorporated) quantification of stained cells. In skin tissues, stained cells were analyzed within a dermal area to a depth of 3x epidermal height without reference to tumor location.
Treg conversion and migration analysis
To measure conversion of T cells into Treg in vitro, we exposed mouse splenocytes from a FoxP3-eGFP reporter mouse to cytokines. Briefly, 106 splenocytes were incubated in 24-well plates (Corning Inc. Life Sciences), in X-VIVO 20 media (Cambrex) in the presence of mouse Ccl22 (5, 50, or 500 ng/mL), human TGFβ (0.2, 2, or 20 ng/mL), or media alone in triplicate wells. After 18 hours, samples were individually analyzed for expression of CD3, CD25, and FoxP3 expression by FACS to identify Treg. The percentage of CD25+, FoxP3+ Treg among CD3+ T cells was graphed. For Transwell migration assays, 106 splenocytes from FoxP3-eGFP mice were added in triplicate to a 5-μm pore size Transwell insert (Costar) with the outer well containing chemokines Ccl1 or Ccl22 (R&D Systems) at the indicated concentrations. The Treg fraction was measured as reporter gene expressing cells among total cells by FACS analysis of the top and bottom wells after 2 hours.
Fluorocytometry of human PBMC
Approximately 3 million PBMCs were thawed for negative magnetic T-cell sorting using a labeled CD3+ enrichment antibody cocktail (StemCell Technologies). Monoclonal antibodies used for FACS analysis and sorting of peripheral blood samples include antibodies to human CD3 (clone F7.2.38; BD Biosciences); CD4FITC (clone RPA-T4; BD Biosciences); FoxP3PE (clone 206D; Biolegend); CD25PE-Cy7 (clone M-A251; BD Biosciences) or CD25PE (clone 4E3; MACS Miltenyi Biotech); CD127APC-eFlour780 (clone eBioRDR5; eBioscience); CCR4PerCP-Cy5.5 (clone TG6/CCR4; Biolegend); CCR8APC (clone FAB1429A; R&D Systems); CLAbio (HECA452bio) with streptavidinPacific Orange (Invitrogen). T lymphocytes were then first incubated in the presence of antibodies CLAbio, CCR4PerCP-Cy5.5, and CCR8APC, subsequently adding CD4FITC, CD25PE-Cy7, and CD127APC-eFlour780 to distinguish Tregs. Washed cells were incubated with streptavidinPacific Orange, followed by permeabilization and intracellular staining with anti-FoxP3PE according to the manufacturer's protocol (BioLegend). For gating purposes, an FMO (FoxP3 excluded) and a fluorescence minus three controls (CCR4, CCR8, and CLA excluded) were used. Multicolor analysis of >200,000 acquired events was performed using the FACSCanto II (BD Biosciences) and Flowjo analysis software (TreeStar). A population enriched for CD8+ effector T cells was selected as CD4− T cells among presorted T cells.
Gene gun vaccination
Ccl22 DNA or empty vector–coated microparticles were introduced into mouse skin using a Helios Gene gun (Bio-Rad). One micrometer gold microparticles (Alfa Aesar) were coated with mouse Ccl22-encoding cDNA expressed under a CMV promoter in pcDNA3.1 (19). DNA was precipitated onto gold particles in the presence of spermidine (Sigma-Aldrich) and used to coat Tefzel tubing (Bio-Rad). Mice were Naired (Church & Dwight) prior to vaccination under isoflurane anesthesia (E-Z Systems) with 4.8 μg DNA. Mice were vaccinated before tumor challenge every 6 days, or after tumor challenge every 5 days. Prior findings indicated that continued treatment was necessary to maintain elevated levels of cutaneous Treg (19).
Measuring tumor growth
In prophylactic experiments, mice were challenged with 105 B16F10 mouse melanoma cells by retro-orbital injection after 6 vaccinations at 6-day intervals. In therapeutic experiments, vaccinations were performed at 5-day intervals starting 3 days after tumor challenge. CRL-6475 mouse melanoma cells were obtained from the ATCC providing standardized authentication and quality testing, expanded in DMEM with 10% FBS and antibiotic/antimycotic (all from Thermo Fisher Scientific) and passaged twice before storing stock vials in LN2 upon confluence within 3 weeks of purchase. A stock vial was thawed and plated 16 months later and passaged once before being harvested for tumor injections. Another aliquot plated 2 weeks later tested pathogen-free by Charles River Laboratories using a rodent agent 360° PCR panel. B16 cells consistently showed >95% viability upon thaw. Tumor-challenged mice received continued vaccinations with Ccl22 or empty vector DNA for 9 days (prophylactic experiments) or 18 days (therapeutic experiments) before euthanasia. Lungs were imaged and surface pulmonary metastases were enumerated as melanized growths per pulmonary surface area prior to snap freezing the OCT-embedded tissues (Tissue Tek). In therapeutic experiments, the percent area occupied by tumor calculated in ImageJ (20) was used as the more accurate estimate of tumor burden. Tissues were immunostained to confirm metastatic invasion and to detect infiltrating Treg.
When two groups were compared as in melanoma and control lymphocytes or Ccl22-treated and empty vector–treated mice, a t test for groups of unequal variance was applied. In therapeutic experiments where tumors were followed for 18 days and larger group sizes were included, trimmed means were used. For comparisons among multiple groups, an ANOVA was used followed by the Dunnett multiple comparison test to compare treatment samples with an untreated control group.
Treg chemokines are expressed within human melanoma tumors
Immunohistology provided a first impression of Treg homing in melanoma. Representative serial sections are shown in Fig. 2. Immunostaining of a metastatic tumor in Fig. 2A illustrates tumor cells tightly packed in a central tumor area. Just outside, sparsely differentiated tumor tissue displays irregular TRP-1 staining, where Tregs are abundant as the same area is comprised primarily of FoxP3+ cells (Fig. 2B). Tregs express CCR4 (Fig. 2C), whereas CCL22 expression is at times punctate (Fig. 2D). Expression of CCR8 (Fig. 2E) and its ligand CCL1 (Fig. 2F) is found outside the central tumor area (Fig. 2D). In metastatic tumors of the lung (Fig. 2G), lymph node (Fig. 2H), or brain (Fig. 2I), a similar distribution of CCL22 expressing cells is found (arrows). Thus, chemoattractant cytokines may support Treg homing to the tumor. We quantified CCL22- and CCL1-expressing cells in four samples of melanoma in situ and superficial spreading melanoma, compared with four samples of control skin; the majority of unaffected tissues (3/4) originated from metastatic melanoma patients. An impressive 5-fold increase in the expression of CCL22 (Fig. 2J) and an average 45-fold increase in the number of CCL1-expressing cells (P < 0.05; Fig. 2K) were observed in melanoma-affected skin, suggesting that Tregs are preferentially attracted toward tumors.
Enhanced expression of homing markers by Treg from melanoma patients
Besides enhanced expression of chemokines, accumulation of Treg in tumors can be driven by homing marker expression on the surface of circulating Treg. We stained lymphocytes from blood samples of 5 melanoma patients and 5 healthy controls, selecting Treg based on expression of CD4+, CD25+, CD127low, and FoxP3+ among singlets as shown in Fig. 3A. The resulting percentages of Treg among lymphocytes were not significantly different at 2.3 ± 0.5% among healthy controls and 3.0 ± 1% among patient samples. Expression of CCR4, CCR8, and CLA (cutaneous lymphocyte antigen) was evaluated. Both the percent stained Treg (Fig. 3B) and the mean fluorescence intensity (Fig. 3C) among CCR4-expressing cells were increased among melanoma patients (P < 0.05), with 16% more Tregs staining at a 1.9-fold increased intensity. Similarly, 1.5% more melanoma Tregs expressed CCR8 at a 1.6-fold increased intensity overall. By comparison, the expression of CLA did not vary among patient and control Treg. These findings suggested that antitumor responses can be manipulated by interfering with Treg homing if chemokine receptor expression does not likewise increase on effector lymphocytes. We thus evaluated expression of chemokine receptors on non-CD4 T cells (primarily CTL) in Fig. 4. Interestingly, these T cells display no differences in CCR4 or in CLA expression, whereas a trend toward increased CCR8 expression was observed among CTL. When comparing CCR8+ lymphocytes among melanoma patients and controls, CCR8 was expressed not only by a 2-fold greater percentage of patient Treg (P < 0.05), but also among a 2.5-fold greater percentage of patient CTL (P < 0.05), thus targeting CCR8 and its interaction with CCL1 would not be fortuitous (not shown). However, expression of CCR4 is much greater among Treg compared with CTL, rendering the CCR4–CCL22 axis a valuable interaction to interfere with in melanoma. Enhanced expression of CLA on Treg compared with CD8+ T cells suggests that blocking this receptor would also relatively favor CTL infiltration; however, targeting the chemokine receptor CCR4 may be a better choice based on the 3.1-fold greater % expressing melanoma Tregs in Fig. 3 (P < 0.001). Thus, targeting the CCR4/CCL22 axis would be preferable for therapeutic applications.
Cutaneous overexpression of Ccl22 diverts Treg
Gene gun vaccination provides a mode of mechanical transfection of cutaneous cells. Marked overexpression of Ccl22 in vaccinated skin was previously demonstrated, and the same protocol was used here (19). At euthanasia, we found a trend toward a 2-fold increase in Ccl22-expressing cells in the spleen (n = 6, P = 0.07), yet the main site of overexpression was the skin, where the gold beads concentrated at the vaccination site. Ccl22 vaccination dramatically reduced vitiligo development in T-cell receptor transgenic Pmel-1 mice, where T cells respond to gp100 (19). Here, we tested whether Ccl22 may convert skin and tumor-infiltrating T cells into Treg, as reported for TGFβ. Splenocytes from FoxP3-eGFP reported mice were exposed to Ccl22, TGFβ, or medium for 18 hours before quantifying Tregs by FACS analysis. As shown in Fig. 5A–C, in example, FACS plots generated under each culture condition, and in Fig. 5D, where Tregs are quantified, exposure to Ccl22 did not induce a greater Treg compartment among splenocytes at any tested concentration, even at higher than physiologic (serum) concentrations (21). However, comparing TGFβ treatment with untreated cells indicates a significant treatment effect by ANOVA (P = 0.0002), and the % of Treg is significantly different from untreated samples (P < 0.05) at both 2 and 20 ng/mL using the Dunnett multiple comparison post-test. In Transwell migration assays (22), Tregs were significantly enriched among total splenocytes migrating toward Ccl22 (Fig. 5E) but not toward Ccl1 (Fig. 5F). Taken together, these data sparked the concept that Treg can be diverted to the skin, providing a tumor microenvironment more conducive to tumor immune surveillance.
A strategy to contain tumor growth
An important advantage of redirecting Treg over simply blocking Treg tumor homing by antibodies to deplete Treg is that skin-migrating Treg can suppress autoimmunity. We tumor-challenged Ccl22-vaccinated mice and continued to treat the animals by gene gun vaccination until dissection (Fig. 6A). Examples of pulmonary tumor growth imaged for an empty vector–vaccinated mouse compared with the Ccl22-vaccinated mouse are shown in Fig. 6B, revealing marked differences in number and size of the tumors. Quantifying pulmonary tumors, an advantage to cutaneous Ccl22 treatment is evident (Fig. 6C). We next performed therapeutic experiments where gene gun vaccination was initiated 3 days after tumor challenge and repeated only twice before euthanasia (Fig. 6D). A remarkable reduction in tumor burden is illustrated in Fig. 6E and quantified as 39% reduction in area occupied by tumor (Fig. 6F), representing a significant therapeutic effect. We demonstrated that cutaneous Ccl22 vaccination will suppress ongoing autoimmunity accompanied by greater Treg accumulation in the skin of TCR transgenic vitiligo mouse models (19). Here, we evaluated pulmonary Treg numbers in tissues from tumor-challenged mice to determine whether the same process results in reduced pulmonary immunosuppression by limiting Treg availability. In Fig. 7A–C, images of immunostained pulmonary tissue are shown to represent FoxP3+, CD3+ Treg detection. A 33% greater pulmonary Treg to total T-cell ratio was observed in untreated mice (Fig. 7D), with the majority of T cells expressing FoxP3 in untreated mice, whereas Tregs were in the minority in pulmonary tissue from Ccl22-vaccinated mice (n = 3, P < 0.05). In separate efforts to quantify FoxP3+ cells immunoenzymatically, we found a 2.8-fold greater pulmonary Treg density in untreated mice (n = 5, P < 0.01, not shown). Conversely, in the skin where Treg densities are generally markedly lower than in pulmonary tissues, a 45% increase in the ratio of Treg among T cells was found among tumor-bearing Ccl22-vaccinated over tumor-bearing control mice (Fig. 7E–G; n = 3, P < 0.05), indicating that Tregs were redirected to the skin. A 13.9-fold increase in absolute Treg densities following Ccl22 vaccination was reported in the absence of tumor (19), yet here we calculated Treg density as a fraction of total infiltrating T cells as the more important parameter to reflect Treg function. The reduced proportion of Treg apparently resulted in reduced suppression and a 57% expansion of T cells overall as evaluated in 3 tumors/group (P < 0.01; Fig. 7H), whereas natural killer (NK)–cell abundance was not significantly affected (Fig. 7I). Treatment similarly revealed a trend toward 38% increased apoptosis among tumor cells at 3 tissues/group (Fig. 7J), suggesting that reduced tumor growth partially results from impaired proliferation instead. Thus, cutaneous overexpression of Ccl22 can divert Treg away from tumor metastases, suggesting that equivalent treatment of human skin can be of immediate benefit to patients with melanoma metastases.
We observed overexpression of Treg chemoattractant cytokines in melanoma in situ tumors compared with unaffected human skin. Overexpression of CCL22 in melanoma has been associated with an accumulation of plasmacytoid DCs (23). These studies also accentuate the contribution of the tumor microenvironment to immunosuppression in melanoma. Thus, another strategy to circumvent tumor immunosuppression could be to convert immunosuppressive pDCs into a phenotype more supportive of antitumor immunity. Oversecretion of CCL1, meanwhile, can possibly be ascribed to infiltrating γδ-T cells and NK cells (24), which are more likely to support immune reactivity to tumors. Our studies suggest that the contribution of CCL1 to chemoattraction of Treg is not very selective. Yet the contribution of the CLA–P-selectin axis in attracting Treg may be a positive one; CLA is overexpressed by skin-infiltrating T cells and favors skin over tumor homing (25).
Overexpression of chemokine receptors including CXCR3 on T cells in tumor patients and intratumoral overexpression of the associated chemokines is beneficial in the case of tumor-reactive effector cells (26, 27). Interestingly, much importance has been assigned to tumor overexpression of Ccl2, an additional ligand for CCR4 (28). Perhaps the ambivalent outcomes when promoting such interaction are due to an overarching support for Treg infiltration. We initially reported that Tregs in blood from melanoma patients overexpress CCR4 (and CCR8) and may thus be preferentially en route to the tumor (29). It was later shown that blocking CCR4 can prevent the immunosuppressive consequences of Treg infiltration to tumors (30). Meanwhile, we developed an interest in rerouting Tregs that were sparse in vitiligo and decided to address both deficiencies at once by overexpressing CCL22. This concept is supported by cutaneous Ccl22 overexpression suppressing vitiligo, accompanied by preferential cutaneous Treg infiltration (19). Furthermore, that outcome is supported by overexpression of CCR4 among melanoma patient Treg.
Gene gun vaccination has been applied to human subjects vaccinated against HPV (31). One advantage of DNA vaccination is that it allows for longer lasting expression of the gene product. However, other methods of introducing CCL22 DNA may be more suitable, such as a microneedle, tattooing, or electroporation (32–33). The most effective means of vaccination likely depend on the encoded gene product.
Remarkably, cutaneous overexpression of CCL22 may supersede the effects of CCL22 naturally overexpressed in the tumor. This leads us to believe that redirecting Treg may be of particular importance to the treatment of micrometastases, whereas larger tumors with greater CCL22 expression may require more drastic treatment. Redirecting Treg might also be useful in other cancers where CCR4+ Tregs reportedly interfere with antitumor responses, including colon carcinoma, lymphoma, and glioblastoma (34–36). Support for our strategy is most convincing when investigating larger sample numbers, yet our materials were limited.
The proposed cutaneous overexpression of CCL22 may have consequences that can negatively affect its application in patients. We specifically investigated the possibility that exposure to CCL22 may convert T cells into Tregs, as reported for TGFβ (37), because we have proposed cutaneous overexpression as a treatment modality for vitiligo (19). The CCL22-mediated enhancement of antitumor responses is however not due to conversion, but rather to redirection of existing regulatory T cells to the site of cutaneous overexpression. The added benefit of suppressing autoimmunity commonly associated with antimelanoma responses can be significant (38). Few mechanisms of supporting antitumor responses will simultaneously allow for reducing autoimmune side effects of therapy. Cutaneous overexpression of CCL22 may truly separate autoimmunity from antitumor immunity (39).
Disclosure of Potential Conflicts of Interest
No potential conflicts of interest were disclosed.
Conception and design: S.W. Henning, F.C. Navarro, I.C. Le Poole
Development of methodology: F.C. Navarro, S. Chatterjee
Acquisition of data (provided animals, acquired and managed patients, provided facilities, etc.): K. Tobin, P. Farhangi Oskuei, S.W. Henning, M.F. Fernandez, E.R. Dellacecca, J.M. Eby, J.I. Clark
Analysis and interpretation of data (e.g., statistical analysis, biostatistics, computational analysis): K. Tobin, P. Farhangi Oskuei, S.W. Henning, M.F. Fernandez, E.R. Dellacecca, F.C. Navarro, J.M. Eby, S. Chatterjee, I.C. Le Poole
Writing, review, and/or revision of the manuscript: K. Tobin, P. Farhangi Oskuei, S.W. Henning, M.F. Fernandez, E.R. Dellacecca, F.C. Navarro, J.M. Eby, S. Mehrotra, J.I. Clark, I.C. Le Poole
Administrative, technical, or material support (i.e., reporting or organizing data, constructing databases): S.W. Henning, J.M. Eby
Study supervision: I.C. Le Poole
This study was supported by NIH/NCI RO1CA191317 and NIH/NIAMSRO1AR057643 (I.C. Le Poole, Principal Investigator) and NIH/NHLBIT35HL120835 (P. Farhangi Oskuei; N.J. Zeleznik-Le Ph.D., Principal Investigator).
The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked advertisement in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.