Cytotoxic T lymphocyte responses against melanocytes and melanoma
© Chang et al; licensee BioMed Central Ltd. 2011
Received: 29 April 2011
Accepted: 27 July 2011
Published: 27 July 2011
Vitiligo is a common toxicity associated with immunotherapy for melanoma. Cytotoxic T lymphocytes (CTLs) against melanoma commonly target melanoma-associated antigens (MAAs) which are also expressed by melanocytes. To uncouple vitiligo from melanoma destruction, it is important to understand if CTLs can respond against melanoma and melanocytes at different levels.
To understand the dichotomous role of MAA-specific CTL, we characterized the functional reactivities of established CTL clones directed to MAAs against melanoma and melanocyte cell lines.
CTL clones generated from melanoma patients were capable of eliciting MHC-restricted, MAA-specific lysis against melanocyte cell lines as well as melanoma cells. Among the tested HLA-A*0201-restricted CTL clones, melanocytes evoked equal to slightly higher degranulation and cytolytic responses as compared to melanoma cells. Moreover, MAA-specific T cells from vaccinated patients responded directly ex vivo to melanoma and melanocytes. Melanoma cells express slightly higher levels of MART-1 and gp100 than melanocytes as measured by quantitative reverse-transcriptase polymerase chain reaction (qRT-PCR) and immunohistochemistry.
Our data suggest that CTLs respond to melanoma and melanocytes equally in vitro and directly ex vivo.
Recent FDA approval of ipilimumab for metastatic melanoma provides strong support for the ability of the immune system to mediate a beneficial effect against this disease. However, immunotherapies for melanoma, including ipilimumab  and adoptive cellular therapies , come with substantial toxicities, including vitiligo [3–5], ocular  and systemic autoimmunity . As such, a major need in next-generation melanoma immunotherapy is to uncouple tumor immunity from autoimmunity . To improve the functional effectiveness of melanoma-reactive CTLs, understanding the factors leading to recognition of self and the barriers to breaking immune tolerance is crucial.
Two decades ago, pioneering work from the Rosenberg  and Boon  groups first demonstrated that T cells infiltrating human melanoma often target self, non-mutated proteins that are also expressed by normal melanocytes. These include enzymes in the biosynthesis of melanin, such as MART-1, gp100, and tyrosinase . How these self tumor-associated antigens (TAAs) elicit T cell responses in the context of melanoma remains unclear. It is suggested that TAAs are overexpressed in melanoma cells, thus eliciting responses by low avidity TAA-specific T cells that escape central deletion [11, 12]. If true, this offers an opportunity to target melanoma without harming normal melanocytes by specifically eliciting low avidity TAA-specific T cells .
In this study, we address whether CTLs respond to and target melanoma cells and normal melanocytes differently. We utilized a set of MART- or gp100-specific CTL clones that were determined to be high, intermediate, or low avidity (recognition efficiency, RE) based on peptide titrations. We assessed both CTL degranulation via mobilization of CD107, an integral membrane protein within cytolytic granules [14–16], and target cell killing via chromium release assays. We also determined if target cells express the cognate TAAs at similar levels, and relate these to cytotoxicity.
Materials and methods
CTL clones were generated using protocols as previously described . Briefly, samples were obtained from four different patients (the patients were anonymously identified by numbers as "476", "422", "462", "520") with resected stage III or IV melanoma patients under informed consent approved by the institutional review boards of the National Cancer Institute (NCI; Bethesda, Maryland) and the Los Angeles County/University of Southern California; sample analysis was performed under protocols approved by the institutional review board of Stanford University. Peripheral blood mononuclear cell (PBMC) samples were obtained from patients after vaccination with melanoma-associated antigens (MAA) peptides MART 26-35 (27L) (ELAGIGILTV) and gp100 209-217 (210M) (IMDQVPSFV) at the University of Southern California Norris Cancer Center (Los Angeles, California). The samples were analyzed by FACS for MAA-specific T cells using HLA-A*0201/peptide tetramer-phycoerythrin (PE) made with MART A26 or gp100 209-217 (Beckman Coulter). Recognition efficiency and cytolytic capability of each CTL clone was determined as previously described [15, 17].
Melanoma cell lines Malme-3M, MeWo, A375 and the T2 cell line were purchased from American Type Culture Collection (ATCC, Manassas, Virginia), and mel526 was obtained from the Surgery Branch of NCI. Melanocyte line HeMn-MP 4C0197 was purchased from Cascade Biologics (Portland, Oregon), and lines HeMn-LP and HeMn-MP with lot numbers 3C0523, 3C0527, 3C0651, 3C0659, 3C0764, and 3C0661 were kindly provided by Dr. Gary Shipley (Cascade Biologics). HLA-A*0201 status was tested in each melanocyte lot using direct PCR by the Stanford Histocompatibility Laboratory (Stanford, CA). T2 cells were pulsed and washed with either one of the MAA peptides, MART 26-35 or gp100 209-217, at a concentration of 10 μg/mL for 1 hour in 7% CO2 prior to each assay.
CD107 Mobilization Assay
All assays were done in duplicates with an effector to target (E:T) ratio of 1:1, 2 × 105 of CTLs and 2 × 105 target cells in each well of 96-well plates. T2 cells were prepared as described above. The following was added each well in order: 1 μl of 2 mM monensin (Sigma, St. Louis, Missouri) in 100% EtOH, 100 μl of target cells, 100 μl of effector cells and 1 μl each of CD107a-allophycocyanin (APC) and CD107b-APC antibodies (Abs). The cells are mixed well using a multichannel pipettor and brought into contact by centrifugation at 1000 rpm for 1 min. Effectors and targets were incubated at 37°C in 7% CO2 for 4 hours. After the incubation, the plates were centrifuged at 1100 rpm for 1 min to pellet cells, and the supernatant was removed. Cell-cell conjugates were disrupted by washing the cells using 1 x PBS with 0.02% sodium azide and 0.5 mM EDTA.
Flow Cytometric Analysis
After incubation with CD107 Abs, cells were washed and further stained with anti-human CD8-FITC (Caltag Laboratories, Burlingame, California; dilution of 1:200) and CD19-CyChrome (Becton Dickinson, San Jose, CA; dilution of 1:80). Cells were incubated for 1 hour at 4°C and were washed twice before analysis. Cells were analyzed using a two-laser, four-color FACSCalibur (Becton Dickinson). A minimum of 30,000 events were acquired and analyzed using Flowjo (TreeStar, San Carlos, California). Lymphocytes were identified by forward and side scatter signals, then selected for CD8 positivity and CD19 negativity. Gated cells were plotted for CD107 verses CD8 to determine level of T cell degranulation. Gates were analyzed for number and percentage of cells.
Chromium Release Cytotoxicity Assay and Determination of Recognition Efficiency
Cytotoxicity was measured in a standard 51Cr release assay and all experiments were done in triplicates for each condition. Briefly, target cells were labeled with 51Cr for overnight at 37°C in 7% CO2. T2 cells were pulsed with peptides in conditions described above. Effectors were incubated with targets at a ratio of 10:1 (E:T) for 4 hours, and chromium release was measured. Percent cytotoxicity was calculated using the mean of the triplicates. Cytotoxicity of each CTL clone is expressed by % specific lysis ± % std dev. To determine the recognition efficiency (RE), chromium-labeled T2 targets were pulsed with a range of native peptide concentrations, generally starting at 10-6 M and decreasing by log steps to 10-14 M. For each CTL clone, percent cytotoxicity was plotted against peptide concentration and the negative log of the concentration. The peptide concentration at which the curve crossed 40% cytotoxicity was recorded as the RE of that clone. All assays were done twice.
Quantitative Reverse-transcriptase Polymerase Chain Reaction (qRT-PCR)
RNA from melanocytes, melanoma cells and unpulsed T2 were extracted as previously described . cDNA synthesis was performed according to the manufacturer's protocol using Superscipt II reverse transcriptase (Invitrogen, Carlsbad, California) primed with oligo-dT. Oligonucleotide primers used in qRT-PCR were synthesized based on published MART-1 and gp100 primer sequences . Both primers were synthesized commercially by Elim Biopharmaceuticals (Hayward, California); the primer sequences are as follows: gp100(S): 5'-AGTTCTAGGGGGCCCAGTGTCT-3', (AS): 5'-GGGCCAGGCTCCAGGTAAGTAT-3'; MART-1 (Melan-A)(S):5'-TGACCCTACAAGATGCCAAGAG-3', (AS): 5'-ATCATGCATTGCAACATTTATTGATGGAG-3'. The real-time qRT-PCR was performed in single wells of a 96-well plate (BioRad, Hercules, California) in a 25 μl reaction mixture using components of the Sybr Green qPCR system according to manufacturer's protocol (Invitrogen). Cycling of cDNA involved denaturation at 95°C for 30s, annealing at 50°C for 1 min and extension at 70°C for 1 min for 40 cycles using the iCycler iQ™ (BioRad). Fluorescence was measured following each cycle and displayed graphically (iCycler iQ Real-time Detection System Software, version 2.3, BioRad). The software determined a cycle threshold (Ct) value, which identified the first cycle at which the fluorescence was detected above the baseline for that sample or standard. The Ct value of MAA divided by Ct value of glyceraldehyde-3-phosphate dehydrogenase, an internal control, to express the relative ratio of mRNA expression in each cell line. Each qRT-PCR was performed in duplicate and data represents the mean of the duplicate of relative ratio in each condition.
Formalin-fixed paraffin-embedded sections were obtained from primary or metastatic tumors and surrounding skin biopsies of patients with malignant melanoma in accordance with protocols approved by Stanford University. Monoclonal antibodies to Melan-A and gp100 (HMB45) were purchased from DAKO (Carpinteria, CA) and immunohistochemistry was carried out following the manufacturer's recommended conditions. Samples were analyzed in the Department of Pathology by a single pathologist (EJS). The extent of staining was scored as percentage of melanocytes or malignant cells testing positive for the presence of either Melan-A or gp100. Each patient sample was then assigned to one of three groups: <5%, 5-20%, >20%.
Data are presented as mean ± standard error of mean. Two-tailed Student's T-test was used where appropriate with significance defined at p < 0.05. Standard linear regression analysis was used to determine correlation between degranulation and cytotoxicity assays.
HLA-A2 Characterization of Target Cells and Recognition Efficiencies of Effector Cells
Summary of HLA-A2 status in neonatal melanocyte lines
Characterization of MART-1 and gp100 - specific CTL clones by recognition efficiency.
RE for native peptide (-log of peptide concentration, M)
CTL Degranulation Upon Contact with Melanocytes Compared to Melanoma Cells
Lymphocytes From Vaccinated Patients Are Reactive Against Melanocytes Ex Vivo
Melanocytes are Equally Prone To CTL-Mediated Lysis as Melanoma Cells
Quantification and Comparison of Melanoma-Associated Antigen Expression In Melanocytes Versus Melanoma Cells
Relative ratio of TAA mRNA expression in each target cell compared to glyceraldehye-3-phosphate dehydrogenase.
Target Cell Antigen
Immunohistochemistry staining for MART and gp100 in melanoma and melanocyte clusters in 5 melanoma patient cases.#
Autoimmunity against melanocytes has been observed to correlate with better clinical outcomes in malignant melanoma patients both anecdotally and in clinical trials of immunotherapies [8, 11, 22–25]. Can this treatment-related toxicity be uncoupled from anti-tumor activity? In this study, to examine the association between tumor killing and autoimmunity, MAA-specific CTLs were tested for degranulation and cytolysis against melanocyte and melanoma targets. MART-1 and gp100-specific CTL clones of high RE responded against melanocytes and melanoma targets, with a trend toward higher reactivity against melanocytes than melanoma. High avidity HLA-A*0201-specific clones non-specifically degranulate against A*0201-negative melanocyte lines at low levels insufficient for killing.
To address the notion that melanoma cells overexpress MAAs and may be preferentially targeted by lower RE CTLs that escape thymic deletion, we also analyzed reactivity patterns of intermediate and low RE CTL clones. Intermediate RE, MAA-specific CTLs responded comparably or slightly higher against melanocytes than melanoma cells. Low RE, MAA-specific CTLs showed little to no response against melanocytes and melanoma cells, even though they robustly lysed T2 cells pulsed with relevant peptide. Thus, these data argue against a previously held notion that low RE, MAA-specific CTLs can preferentially target melanoma cells and not normal melanocytes. Rather, these data suggest that MAA-specific CTLs respond against melanoma and melanocytes equally in vitro. This is consistent with a study showing melanoma lysis by vitiligo lesion-infiltrating CTLs . This is not limited to in vitro expanded CTL clones, but also in directly ex vivo CTLs from patients post-vaccination. Technical challenges imposed by limited patient samples and low proportions of tumor-specific CTLs in the PBMC do not allow for a more detailed analysis or direct comparison to our in vitro observations. However, by selecting pMHC tetramer+, CD8+ T cells which represent MART-1 or gp100-specific CTLs, we observed similar levels of degranulation from these ex vivo CTLs upon contact with HLA-A2 melanocytes as compared to HLA-A2 melanoma cells.
In this study, there is a trend towards a lower degranulation efficiency of MART-1 specific clones against T2 target cells pulsed with MART peptides, when compared to gp100-specific clones against T2 pulsed gp100 peptides. In our previous studies, the RE scores observed for MART-1 specific clones presented with MART peptides were at a relatively lower range compared to clones presented with other peptides [15–17]. We hypothesize that this is likely due to the short predicted half-life of MART peptides (native and heteroclitic) in complex with the HLA-A*0201 molecule. Moreover, Rubio-Godoy et al.  found discrepancy between CTL effector functions measured by cytokine secretion and target cell lytic activities in their tyrosinase-specific clones. In their study, T cell clones detected by IFN-γ ELISPOT but not detectable by pMHC multimer staining were able to lyse tyrosinase peptide-pulsed target cells as efficiently as those stained by pMHC multimers. The authors attributed such differences to the kinetics of pMHC-multimer interaction with TCR among the clones studied. We speculate that while the lower degranulation efficiency correlates to the low RE observed for our MART-1 specific clone as expected, the high cytotoxicity observed may be a reflection of co-stimulation of other cytokine production such as IFN-γ following CD107 degranulation.
Vaccine immunotherapy for melanoma can be associated with autoimmune effects of vitiligo. The incidence of vitiligo in patients with melanoma, although rare, is estimated to be seven to ten-fold higher than the general population . The occurrence of vitiligo in melanoma patients undergoing immunotherapy may be due to both qualitative and quantitative differences between the CD8+ T cells in the two diseases. In a murine model by Steitz et al. , there appeared to be a two-step requirement for MAA-specific CD8+ T cells to break tolerance in the development of vitiligo. First, the stimulation and expansion of MAA-specific CD8+ T cells requires CD4+ T cell help in vivo during the "induction phase". Then, in the "effector phase", the CD8+ T cells require a strong local inflammatory stimulus for autoimmune destruction of melanocytes within the skin. Garbelli et al.  also reviewed data supportive of a qualitative difference between MAA-specific T cell responses in vitiligo and melanoma. In the several studies reviewed, CD8+ T cells isolated from vitiligo lesions or patients were found to have augmented functional avidity than those from their melanoma counterparts.
From a quantitative standpoint, incidence of vitiligo may be rare due to the low percentages of functional CTLs against melanoma antigens in the peripheral blood after vaccination. Our data is largely similar to what had been observed in other published studies. In study by Jacobs et al. , the authors found that when vitiligo occurs, MAA-specific CD8+ T cells were observed in high percentages in both tumor and vitiligo lesions, supportive of the hypothesis that vitiligo may not be uncoupled from anti-tumor effect, and even indicative of the success of immunotherapy. However, only <0.2% of the peripheral lymphocyte isolated from the studied patient demonstrated MAA-specific tetramer staining. In this study, <0.6% of peripheral blood lymphocytes from our post-vaccinated patient samples demonstrated MAA-specific activity.
It is suggested that target recognition by CD8 T cells is dependent upon a critical threshold amount of MHC/MAA peptide expression on the cell surface [31–33]. Studies have shown that MAA expression may be highly variable across various clinical stages and different melanoma samples [34–36], with tumor escape from immune recognition achieved by loss of MAA or MHC expression [36–40]. Our data suggest that melanocytes and melanoma cells express MAAs at or above the recognition thresholds of high RE CTLs, as these effectors lysed both targets equally even though melanoma cells express the relevant MAAs at slightly higher levels. In contrast, for intermediate and low RE CTLs, lysis of melanoma and melanocytes was substantially below lysis of T2 pulsed with excess peptide. As such, increasing MAA expression levels specifically in melanoma cells, in context of immunotherapy with intermediate and low RE CTLs may be a possible avenue to uncouple tumor immunity from autoimmunity.
Among the tested HLA-A*0201-restricted CTL clones in this study, melanocytes evoked equal to slightly higher degranulation and cytolytic responses as compared to melanoma cells. Furthermore, MAA-specific T cells from vaccinated patients responded directly ex vivo to melanoma and melanocytes equally. These results suggest that CTL recognition and killing of melanoma may not be differentiated from autoimmune cytotoxicity of normal melanocytes.
We are grateful to Dr. Gary Shipley of Cascade Biologics for providing the melanocyte lines HeMn-LP and HeMn-MP used in this study.
- Hodi FS, O'Day SJ, McDermott DF, Weber RW, Sosman JA, Haanen JB, Gonzalez R, Robert C, Schadendorf D, Hassel JC, Akerley W, van den Eertwegh AJ, Lutzky J, Lorigan P, Vaubel JM, Linette GP, Hogg D, Ottensmeier CH, Lebbé C, Peschel C, Quirt I, Clark JI, Wolchok JD, Weber JS, Tian J, Yellin MJ, Nichol GM, Hoos A, Urba WJ: Improved survival with ipilimumab in patients with metastatic melanoma. N Engl J Med. 2010, 363: 711-723. 10.1056/NEJMoa1003466.PubMed CentralView ArticlePubMedGoogle Scholar
- Dudley ME, Yang JC, Sherry R, Hughes MS, Royal R, Kammula U, Robbins PF, Huang J, Citrin DE, Leitman SF, Wunderlich J, Restifo NP, Thomasian A, Downey SG, Smith FO, Klapper J, Morton K, Laurencot C, White DE, Rosenberg SA: Adoptive cell therapy for patients with metastatic melanoma: evaluation of intensive myeloablative chemoradiation preparative regimens. J Clin Oncol. 2008, 26: 5233-5239. 10.1200/JCO.2008.16.5449.PubMed CentralView ArticlePubMedGoogle Scholar
- Yee C, Thompson JA, Roche P, Byrd DR, Lee PP, Piepkorn M, Kenyon K, Davis MM, Riddell SR, Greenberg PD: Melanocyte destruction after antigen-specific immunotherapy of melanoma: direct evidence of t cell-mediated vitiligo. J Exp Med. 2000, 192: 1637-1644. 10.1084/jem.192.11.1637.PubMed CentralView ArticlePubMedGoogle Scholar
- Garbelli S, Mantovani S, Palermo B, Giachino C: Melanocyte-specific, cytotoxic T cell responses in vitiligo: the effective variant of melanoma immunity?. Pigment Cell Res. 2005, 18: 234-242. 10.1111/j.1600-0749.2005.00244.x.View ArticlePubMedGoogle Scholar
- Wankowicz-Kalinska A, Le Poole C, van den Wijngaard R, Storkus WJ, Das PK: Melanocyte-specific immune response in melanoma and vitiligo: two faces of the same coin?. Pigment Cell Res. 2003, 16: 254-260. 10.1034/j.1600-0749.2003.00038.x.View ArticlePubMedGoogle Scholar
- Palmer DC, Chan CC, Gattinoni L, Wrzesinski C, Paulos CM, Hinrichs CS, Powell DJ, Klebanoff CA, Finkelstein SE, Fariss RN, Yu Z, Nussenblatt RB, Rosenberg SA, Restifo NP: Effective tumor treatment targeting a melanoma/melanocyte-associated antigen triggers severe ocular autoimmunity. Proc Natl Acad Sci USA. 2008, 105: 8061-8066. 10.1073/pnas.0710929105.PubMed CentralView ArticlePubMedGoogle Scholar
- Bouwhuis MG, Ten Hagen TL, Suciu S, Eggermont AM: Autoimmunity and treatment outcome in melanoma. Curr Opin Oncol. 2011, 23: 170-176. 10.1097/CCO.0b013e328341edff.View ArticlePubMedGoogle Scholar
- Rosenberg SA, Kawakami Y, Robbins PF, Wang R: Identification of the genes encoding cancer antigens: implications for cancer immunotherapy. Adv Cancer Res. 1996, 70: 145-177.View ArticlePubMedGoogle Scholar
- Boon T: Tumor antigens recognized by cytolytic T lymphocytes: present perspectives for specific immunotherapy. Int J Cancer. 1993, 54: 177-180. 10.1002/ijc.2910540202.View ArticlePubMedGoogle Scholar
- Kawakami Y, Robbins PF, Wang RF, Parkhurst M, Kang X, Rosenberg SA: The use of melanosomal proteins in the immunotherapy of melanoma. J Immunother. 1998, 21: 237-246. 10.1097/00002371-199807000-00001.View ArticlePubMedGoogle Scholar
- Okamoto T, Irie RF, Fujii S, Huang SK, Nizze AJ, Morton DL, Hoon DS: Anti-tyrosinase-related protein-2 immune response in vitiligo patients and melanoma patients receiving active-specific immunotherapy. J Invest Dermatol. 1998, 111: 1034-1039. 10.1046/j.1523-1747.1998.00411.x.View ArticlePubMedGoogle Scholar
- Guevara-Patino JA, Turk MJ, Wolchok JD, Houghton AN: Immunity to cancer through immune recognition of altered self: studies with melanoma. Adv Cancer Res. 2003, 90: 157-177.View ArticlePubMedGoogle Scholar
- Morgan DJ, Kreuwel HT, Fleck S, Levitsky HI, Pardoll DM, Sherman LA: Activation of low avidity CTL specific for a self epitope results in tumor rejection but not autoimmunity. J Immunol. 1998, 160: 643-651.PubMedGoogle Scholar
- Betts MR, Brenchley JM, Price DA, De Rosa SC, Douek DC, Roederer M, Koup RA: Sensitive and viable identification of antigen-specific CD8+ T cells by a flow cytometric assay for degranulation. J Immunol Methods. 2003, 281: 65-78. 10.1016/S0022-1759(03)00265-5.View ArticlePubMedGoogle Scholar
- Kohrt HE, Shu CT, Stuge TB, Holmes SP, Weber J, Lee PP: Rapid assessment of recognition efficiency and functional capacity of antigen-specific T-cell responses. J Immunother. 2005, 28: 297-305. 10.1097/01.cji.0000162780.96310.e4.View ArticlePubMedGoogle Scholar
- Rubio V, Stuge TB, Singh N, Betts MR, Weber JS, Roederer M, Lee PP: Ex vivo identification, isolation and analysis of tumor-cytolytic T cells. Nat Med. 2003, 9: 1377-1382. 10.1038/nm942.View ArticlePubMedGoogle Scholar
- Stuge TB, Holmes SP, Saharan S, Tuettenberg A, Roederer M, Weber JS, Lee PP: Diversity and recognition efficiency of T cell responses to cancer. PLoS Med. 2004, 1: e28-10.1371/journal.pmed.0010028.PubMed CentralView ArticlePubMedGoogle Scholar
- Chomczynski P, Sacchi N: Single-step method of RNA isolation by acid guanidinium thiocyanate-phenol-chloroform extraction. Anal Biochem. 1987, 162: 156-159.View ArticlePubMedGoogle Scholar
- Jungbluth AA, Iversen K, Coplan K, Williamson B, Chen YT, Stockert E, Old LJ, Busam KJ: Expression of melanocyte-associated markers gp-100 and Melan-A/MART-1 in angiomyolipomas. An immunohistochemical and rt-PCR analysis. Virchows Arch. 1999, 434: 429-435. 10.1007/s004280050362.View ArticlePubMedGoogle Scholar
- Carrabba MG, Castelli C, Maeurer MJ, Squarcina P, Cova A, Pilla L, Renkvist N, Parmiani G, Rivoltini L: Suboptimal activation of CD8(+) T cells by melanoma-derived altered peptide ligands: role of Melan-A/MART-1 optimized analogues. Cancer Res. 2003, 63: 1560-1567.PubMedGoogle Scholar
- Yee C, Savage PA, Lee PP, Davis MM, Greenberg PD: Isolation of high avidity melanoma-reactive CTL from heterogeneous populations using peptide-MHC tetramers. J Immunol. 1999, 162: 2227-2234.PubMedGoogle Scholar
- Gogas H, Ioannovich J, Dafni U, Stavropoulou-Giokas C, Frangia K, Tsoutsos D, Panagiotou P, Polyzos A, Papadopoulos O, Stratigos A: Prognostic significance of autoimmunity during treatment of melanoma with interferon. N Engl J Med. 2006, 354: 709-718. 10.1056/NEJMoa053007.View ArticlePubMedGoogle Scholar
- Nordlund JJ, Kirkwood JM, Forget BM, Milton G, Albert DM, Lerner AB: Vitiligo in patients with metastatic melanoma: a good prognostic sign. J Am Acad Dermatol. 1983, 9: 689-696. 10.1016/S0190-9622(83)70182-9.View ArticlePubMedGoogle Scholar
- Bystryn JC, Rigel D, Friedman RJ, Kopf A: Prognostic significance of hypopigmentation in malignant melanoma. Arch Dermatol. 1987, 123: 1053-1055. 10.1001/archderm.123.8.1053.View ArticlePubMedGoogle Scholar
- Boasberg PD, Hoon DS, Piro LD, Martin MA, Fujimoto A, Kristedja TS, Bhachu S, Ye X, Deck RR, O'Day SJ: Enhanced survival associated with vitiligo expression during maintenance biotherapy for metastatic melanoma. J Invest Dermatol. 2006, 126: 2658-2663. 10.1038/sj.jid.5700545.View ArticlePubMedGoogle Scholar
- Le Gal FA, Avril MF, Bosq J, Lefebvre P, Deschemin JC, Andrieu M, Dore MX, Guillet JG: Direct evidence to support the role of antigen-specific CD8(+) T cells in melanoma-associated vitiligo. J Invest Dermatol. 2001, 117: 1464-1470. 10.1046/j.0022-202x.2001.01605.x.View ArticlePubMedGoogle Scholar
- Rubio-Godoy V, Dutoit V, Rimoldi D, Lienard D, Lejeune F, Speiser D, Guillaume P, Cerottini JC, Romero P, Valmori D: Discrepancy between ELISPOT IFN-gamma secretion and binding of A2/peptide multimers to TCR reveals interclonal dissociation of CTL effector function from TCR-peptide/MHC complexes half-life. Proc Natl Acad Sci USA. 2001, 98: 10302-10307. 10.1073/pnas.181348898.PubMed CentralView ArticlePubMedGoogle Scholar
- Schallreuter KU, Levenig C, Berger J: Vitiligo and cutaneous melanoma. A case study. Dermatologica. 1991, 183: 239-245. 10.1159/000247693.View ArticlePubMedGoogle Scholar
- Steitz J, Bruck J, Lenz J, Buchs S, Tuting T: Peripheral CD8+ T cell tolerance against melanocytic self-antigens in the skin is regulated in two steps by CD4+ T cells and local inflammation: implications for the pathophysiology of vitiligo. J Invest Dermatol. 2005, 124: 144-150. 10.1111/j.0022-202X.2004.23538.x.View ArticlePubMedGoogle Scholar
- Jacobs JF, Aarntzen EH, Sibelt LA, Blokx WA, Boullart AC, Gerritsen MJ, Hoogerbrugge PM, Figdor CG, Adema GJ, Punt CJ, de Vries IJ: Vaccine-specific local T cell reactivity in immunotherapy-associated vitiligo in melanoma patients. Cancer Immunol Immunother. 2009, 58: 145-151. 10.1007/s00262-008-0506-5.View ArticlePubMedGoogle Scholar
- Rivoltini L, Barracchini KC, Viggiano V, Kawakami Y, Smith A, Mixon A, Restifo NP, Topalian SL, Simonis TB, Rosenberg SA, Marincola FM: Quantitative correlation between HLA class I allele expression and recognition of melanoma cells by antigen-specific cytotoxic T lymphocytes. Cancer Res. 1995, 55: 3149-3157.PubMed CentralPubMedGoogle Scholar
- Lethe B, van der Bruggen P, Brasseur F, Boon T: MAGE-1 expression threshold for the lysis of melanoma cell lines by a specific cytotoxic T lymphocyte. Melanoma Res. 1997, 7 (Suppl 2): S83-88.PubMedGoogle Scholar
- Riker AI, Kammula US, Panelli MC, Wang E, Ohnmacht GA, Steinberg SM, Rosenberg SA, Marincola FM: Threshold levels of gene expression of the melanoma antigen gp100 correlate with tumor cell recognition by cytotoxic T lymphocytes. Int J Cancer. 2000, 86: 818-826. 10.1002/(SICI)1097-0215(20000615)86:6<818::AID-IJC10>3.0.CO;2-W.View ArticlePubMedGoogle Scholar
- Barrow C, Browning J, MacGregor D, Davis ID, Sturrock S, Jungbluth AA, Cebon J: Tumor antigen expression in melanoma varies according to antigen and stage. Clin Cancer Res. 2006, 12: 764-771. 10.1158/1078-0432.CCR-05-1544.View ArticlePubMedGoogle Scholar
- Murer K, Urosevic M, Willers J, Selvam P, Laine E, Burg G, Dummer R: Expression of Melan-A/MART-1 in primary melanoma cell cultures has prognostic implication in metastatic melanoma patients. Melanoma Res. 2004, 14: 257-262. 10.1097/01.cmr.0000136713.21029.56.View ArticlePubMedGoogle Scholar
- Urosevic M, Braun B, Willers J, Burg G, Dummer R: Expression of melanoma-associated antigens in melanoma cell cultures. Exp Dermatol. 2005, 14: 491-497. 10.1111/j.0906-6705.2005.00305.x.View ArticlePubMedGoogle Scholar
- Khong HT, Wang QJ, Rosenberg SA: Identification of multiple antigens recognized by tumor-infiltrating lymphocytes from a single patient: tumor escape by antigen loss and loss of MHC expression. J Immunother. 2004, 27: 184-190. 10.1097/00002371-200405000-00002.PubMed CentralView ArticlePubMedGoogle Scholar
- Durda PJ, Dunn IS, Rose LB, Butera D, Benson EM, Pandolfi F, Kurnick JT: Induction of "antigen silencing" in melanomas by oncostatin M: down-modulation of melanocyte antigen expression. Mol Cancer Res. 2003, 1: 411-419.PubMedGoogle Scholar
- Kurnick JT, Ramirez-Montagut T, Boyle LA, Andrews DM, Pandolfi F, Durda PJ, Butera D, Dunn IS, Benson EM, Gobin SJ, van den Elsen PJ: A novel autocrine pathway of tumor escape from immune recognition: melanoma cell lines produce a soluble protein that diminishes expression of the gene encoding the melanocyte lineage melan-A/MART-1 antigen through down-modulation of its promoter. J Immunol. 2001, 167: 1204-1211.View ArticlePubMedGoogle Scholar
- Maeurer MJ, Gollin SM, Storkus WJ, Swaney W, Karbach J, Martin D, Castelli C, Salter R, Knuth A, Lotze MT: Tumor escape from immune recognition: loss of HLA-A2 melanoma cell surface expression is associated with a complex rearrangement of the short arm of chromosome 6. Clin Cancer Res. 1996, 2: 641-652.PubMedGoogle Scholar
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