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4ß7 Integrin Expression Predicts Digestive Tract Involvement in Mantle Cell Lymphoma
From the Departments of Pathology*
(FG, NB) and
Hematology,
Hôpital Necker-Enfants
Malades, Université René Descartes-Paris EA 219, and the
Departments of Internal Medecine,
Hematology,§
and
Pathology,¶
Hôtel-Dieu, Paris, France
| Abstract |
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4ß7 on tumoral cells from
peripheral lymph node in patients with newly diagnosed mantle cell
lymphoma (MCL) to check whether it is associated with gastrointestinal
involvement. Expression of the
4ß1 integrin and the peripheral
lymph node addressin CD62L were also examined. Thirteen MCL patients
presenting with peripheral lymphadenopathy were studied. Expression of
the mucosal homing receptor integrin
4ß7 by peripheral lymph node
lymphoma cells was found to be frequent (5/13) and associated with
gastrointestinal involvement (5/7). In contrast, lymphoma cells
from patients without gastrointestinal involvement did not express
4ß7 (6/6) (P = 0.03). These data suggest that
4ß7 integrin is expressed by a subset of MCLs and that its
expression may predict digestive tract involvement in MCL,
furnishing a basis for recognizing two distinct clinical and phenotypic
forms, ie, "digestive homing (or digestive
primitive)" versus "peripheral" MCL. Further
studies on more patients will be needed to understand the impact of
biological differences on the prognosis of these two clinical
forms.
| Introduction |
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The
4ß7/MAdCAM-1 pair is one of the best characterized
receptor-ligand pairs shown to play a role in the control of
leukocyte circulation. Integrin
4ß7 (LPAM-1) mediates murine and
human B and T memory lymphocyte migration into the intestinal mucosa by
binding to MAdCAM-1, a vascular recognition molecule selectively
expressed on digestive tract lamina propria, Peyer's patch
endothelium, and the spleen. 5-9
Indeed,
in mice with targeted disruption of the ß7 (ß7-/-) or the
4
integrin, the formation of the gut-associated lymphoid tissue (GALT) is
severely impaired, whereas ß7-/- mice exhibit otherwise normal
immune system development and function.10,11
Human MAdCAM-1 was recently cloned and MAdCAM-1 mRNA and protein were
found to be expressed mainly in the small bowel and to a lesser extent
in the colon and spleen.8,9
4 integrin may
also be expressed on leukocytes as a heterodimeric integrin with the
ß1 integrin chain (CD18).
4ß1 is a ligand for VCAM-1 (CD106) and
is involved in adhesion to cytokine-activated endothelial cells,
germinal centers within lymph nodes,12,13
and
bone marrow stromal cells.14
We previously proposed that expression of
4ß7 on peripheral
tumoral cells was associated with digestive tract involvement in
Langerhans cell histiocytosis, a clonal proliferative disease of
dendritic cell origin.15
Mantle-cell lymphoma
(MCL) is a recently reappraised entity among B-cell non-Hodgkin's
lymphoma, on the basis of its clinical course and morphological,
immunophenotypic, cytogenetic, and molecular
features.16
Although no prospective study is
available, digestive tract involvement appears to be more frequent in
MCL at diagnosis compared to other peripheral lymphomas; it was
diagnosed at presentation in 11.5% to 15% of MCL
patients.17
In the present study, we investigated
whether the "homing model" may be of clinical relevance in MCL
digestive tract involvement and whether the
4ß7 adhesion molecule
may, if it is expressed on peripheral tumoral cells, help to predict
the existence of gastrointestinal (GI) tract involvement.
| Materials and Methods |
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Thirteen consecutive patients with nodal peripheral MCL for whom material from frozen lymph node biopsy was available and who underwent digestive tract endoscopic examination and biopsies were studied.
Histology and Immunohistochemistry
Deparaffinized lymph node sections were stained with
hematoxylin-eosin-safran, Giemsa stain, and silver stain.
Immunohistochemistry was performed on deparaffinized formalin-fixed
sections with an avidin-biotin-peroxidase
protocol18
revealed by 33' diaminobenzidine as
chromogen (Vectasin ABC Kit, Vector, CA), using antibodies against CD20
(clone L26, IgG2a, Dako, Glostrup, Denmark), and CD3 (clone PS1, IgG2a,
Immunotech, Marseille, France). Immunohistochemistry was then performed
on frozen lymph node biopsies using 5-micrometer-thick cryostat
sections with the same avidin-biotin-peroxidase protocol revealed by
33' diaminobenzidine as chromogen. Antibodies used on frozen sections
were CD22 (clone To15, IgG2b, Dako), CD3 (clone PSI, IgG2a,
Immunotech), CD5 (clone L17F12, IgG2a, Becton Dickinson,
Mountain View, CA), CD10 (clone ALB1, IgG1, Immunotech), CD23 (clone
MHM6, IgG1, Dako), CD62L (L-selectin, clone DREG-56, IgG1, R&D Systems,
Minneapolis, MN), anti-
4ß7 (clone Act-1, IgG1, kindly provided by
Dr. A.I. Lazarovits, Robarts Research Institute, University of Western
Ontario, London, Ontario, Canada), CD49d (VLA4,
4 integrin chain,
clone 44H6, IgG1, T-Cell Diagnostics, Woburn, MA), and CD29 (ß1
integrin chain, clone K20, IgG2a, Immunotech). Cases were considered
positive for
4ß7 staining when most tumoral cells stained positive
(>70%). The topography of
4ß7 positivity was compared to B-cell
antigen staining to distinguish between T cells and tumoral B-cell
nodules. When only minor populations showed positive
4ß7 staining,
this positivity was shown to correspond to T cells' areas.
Molecular Analysis
Cytogenetic and molecular studies of the t (11;14) translocation and of the cyclin D1 mRNA could be performed as previously described19,20 in 11 of 13 cases.
Statistical Analysis
Fisher's exact test, two-tailed, for small samples was used.21
| Results |
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MCL was diagnosed on lymph node biopsies according to histological
and immunophenotypical criteria16,19
(Table 1)
. To further confirm the diagnosis,
cytogenetic and molecular studies were informative in 10 of 13 cases
(Table 1)
. Patients were staged according to the Ann Arbor
classification on the basis of physical examination, routine laboratory
tests, chest X-ray and/or CT scan, abdominal ultrasound and/or CT scan,
and bone marrow trephine biopsy.
|
Characteristics of Digestive Tract Involvement
Digestive tract involvement was not associated with specific
digestive clinical symptoms. In the seven patients with histologically
proven digestive tract involvement, one patient had diarrhea (patient
2), three had a history of abdominal pain (patients 1, 4, and 5), and
three patients had no symptoms. Endoscopy revealed features of
lymphomatous polyposis consisting of abnormal thick folds in the
stomach and/or polyps in the small bowel in four cases (patients 2, 4,
5, and 6), and either a normal aspect or nonspecific lesions (ie,
gastritis) in three cases (patients 1, 3, and 7). Histological
examination revealed multifocal involvement in six out of the seven
positive cases (Table 1)
.
4ß7 Expression on Peripheral Lymph Node Lymphoma Cells Is
Associated with GI Tract Involvement in Patients with Mantle Cell
Lymphoma
4ß7 heterodimeric integrin expression on peripheral lymph
node lymphoma cells at diagnosis was absent in all patients (6/6)
without GI tract involvement. In contrast, expression of
4ß7 on
peripheral lymphoma cells was detected in five of the seven patients
with histologically proven digestive involvement
(P = 0.03) (Figure 1
, Tables 1 and 2
). Patients 3 and 7, who displayed
microscopic digestive tract involvement without
4ß7 positivity of
tumoral cells from peripheral lymph node, did not present macroscopic
GI involvement at endoscopy. Lymphoma cells infiltrating the GI tract
expressed
4ß7 in 3/3 tested patients with
4ß7 positivity of
tumoral cells from peripheral lymph node, whereas in patient 7, tumoral
cells from the GI tract were not recognized by the anti-
4ß7
antibody. Thus, in this patient tumoral cells from both the GI tract
and the peripheral lymph node did not express
4ß7.
|
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4 and ß1 integrin chains. Lymphoma cells in almost
all MCL patients (11/12) did not express the lymph node homing receptor
CD62L.
Interestingly, splenomegaly was present in all cases with digestive
involvement, but in only two of six cases without digestive involvement
(P = 0.04) (Table 2)
. However, when comparing
4ß7-positive patients to
4ß7-negative patients, the
correlation with splenomegaly was not statistically significant (5/5
vs. 4/8).
| Discussion |
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4ß7 and are associated with multifocal lymphomatous involvement of
the GI tract. In contrast, MCL without digestive tract involvement did
not express
4ß7.
4ß7 integrin expression may thus represent a
specific marker of GI tract involvement in MCL. Moreover, splenomegaly
appears to be more frequent in
4ß7-positive MCL. These data on
lymphoma cells are consistent with the physiological pattern of
expression of
4ß7 ligand MAdCAM-1 at the mRNA and protein
levels in the human bowel and spleen.8,9
However, not all patients with digestive tract involvement were found
to express
4ß7 in our study. Two patients displayed microscopic
digestive tract involvement without
4ß7 positivity of tumoral
cells in the peripheral lymph node. Both patients had circulating
lymphoma cells, as did three of the five patients with
4ß7-positive lymph node. Both patients also displayed unremarkable
macroscopic features at endoscopy, in contrast to four of the five
4ß7-positive patients. Interestingly, in one of these two patients
(patient 7)
4ß7 immunostaining could be performed on digestive
tract tumoral cells and was negative. Thus, in these two cases
digestive tract involvement may be due to a nonspecific leukemic
spreading, as suggested by the lack of macroscopic lesions and the
negativity of the
4ß7 staining of digestive tract tumoral cells,
or to an unknown adhesion molecule. Alternatively, we cannot exclude
the possibility that the
4ß7 antigen might be present but not
recognized by the ACT-1 antibody in these two patients.
While the present study was in progress, others reported that T-cell
leukemia/lymphoma dissemination to the digestive tract may also be
related to
4ß7 expression detected at the peripheral
level.22
Together with our previous work on
Langerhans cell histiocytosis,15
these data
strongly suggest that GI tract involvement is associated with
4ß7
expression in T-cell, B-cell, and dendritic cell neoplasms.
Although data on the molecular basis of normal B-cell homing are
scarce, we may hypothesize that expression of the mucosal receptor
4ß7 on a subset of MCL might be instrumental in their
dissemination to the digestive tract. MCL cells have been proposed to
originate from follicle mantle cells,16
which
represent naive B cells. Human naive T and B cells are usually
4ß7-negative.23
4ß7-positive MCL may
thus represent the neoplastic counterpart of follicle mantle cells
originating from digestive tract-associated lymphoid tissue, having
thus acquired
4ß7,24
whereas
4ß7-negative MCL may originate from the peripheral lymph node's
follicle mantle cells.
In agreement with this hypothesis, a primary GI lymphoma known as
multiple lymphomatous polyposis (MLP), which represents about 8% of
the primary GI lymphomas,25
was recently shown to
share morphological, immunophenotypic, cytogenetic, and molecular
characteristics with MCL.26,27
GI tumoral cells
from MLP were shown to express
4ß7.28,29
However, these studies did not investigate the correlation between
4ß7 expression by peripheral tumoral cells and digestive tract
involvement in presenting peripheral MCL. The two clinical entities,
MLP and MCL, clearly overlap. Recent studies showed that 29% to 42%
of lymphomas diagnosed as MLP are associated at diagnosis with enlarged
peripheral lymph nodes.27,30
Therefore, MCL
appears to be a heterogeneous disease with two distinct clinical and
phenotypic forms, ie,
4ß7-positive "digestive homing," which
may originate from the mucosal associated lymphoid tissue and be
identical to MLP, and
4ß7-negative peripheral MCL, usually without
preferential tropism for the digestive tract.
The homing of lymphocytes to peripheral lymph nodes is thought to
depend on L-selectin (CD62L, peripheral lymph node homing
receptor)31
which binds to peripheral vascular
addressin consisting of sialylated
glycoproteins.32
Surprisingly, although lymph
nodes were involved, CD62L was not expressed by either
4ß7-positive or
4ß7-negative MCL nodal tumoral cells in this
study, in contrast to small lymphocytic lymphoma (unpublished
data), suggesting that L-selectin is not responsible for lymph
node involvement in MCL. However, all tested MCL expressed both
4
and ß1 integrins. The
4ß1 integrin is involved in adhesion to
cytokine-activated endothelial cells, to germinal centers within lymph
nodes,12,13
and marrow stromal
cells14
and may play a role in lymph node and
bone marrow involvement in MCL.
GI tract involvement has not been identified so far as an adverse
prognostic factor in MCL.33
However, GI tract
involvement was not systematically explored in patients with MCL until
the present work, so a definitive conclusion cannot be drawn, and no
prospective study is available. More advanced disease in MCL patients
with digestive tract involvement might reflect the late discovery (ie,
when peripheral lymph nodes are involved) of the primary intestinal
disease known as MLP. Alternatively, it might result from more
aggressive behavior of
4ß7-positive lymphoma cells, because it was
recently suggested that
4ß7-positive lymphoblastic lymphomas share
an aggressive clinical course.34
The present study shows that
4ß7 expression is strongly associated
with and may predict GI tract involvement in MCL. This finding may
support the recognition of two distinct clinical and phenotypic forms
of MCL, ie, "digestive homing" vs. "peripheral," and
help to identify patients for whom GI tract endoscopic examination is
suitable. Further studies addressing the prognostic significance of
4ß7 expression should be considered. Moreover, therapeutic
strategies currently under development should include exploration of
the digestive tract to ensure the quality of response to therapy.
| Acknowledgements |
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| Footnotes |
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Supported by grants from the Association pour la Recherche sur le Cancer (no. 4023) and the Comité de Paris/Ligue Nationale contre le Cancer no. (97/RS-RC/52). FG is a recipient of a Prix de l'Internat fellowship from the Assistance Publique-Hôpitaux de Paris.
Accepted for publication August 31, 1998.
| References |
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4ß7 and LFA-1 in lymphocyte homing to Peyer's patch-HEV in situ: the multistep model confirmed and refined. Immunity 1995, 3:99-108[Medline]
4 ß 7 on a subset of human CD4+ memory T cells with hallmarks of gut-tropism. J Immunol 1993, 151:717-29[Abstract]
4ß7-integrin binding domain of murine MAdCAM-1, but extreme divergence of mucin-like sequences. J Immunol 1996, 156:2851-2857[Abstract]
4 integrins during fetal and adult hematopoiesis. Cell 1996, 85:997-1008[Medline]
4ß7. Scand J Immunol 1995, 42:662-672[Medline]
4ß7 in malignant lymphomatous polyposis of the intestine. Gastroenterology 1994, 107:1519-1523[Medline]
4ß7 in gastrointestinal non-Hodgkin's lymphomas. Am J Pathol 1997, 150:919-927[Abstract]
4ß7 integrin expression is associated with the leukemic evolution of human and murine T-cell lymphoblastic lymphomas: Am J Pathol 1997, 150:15951605
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