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Several perturbations in the number of peripheral blood leukocytes, such as neutrophilia and lymphopenia associated with Coronavirus disease 2019 (COVID-19) severity, point to systemic molecular cell cycle alterations during severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. However, the landscape of cell cycle alterations in COVID-19 remains primarily unexplored. Here, we performed an integrative systems immunology analysis of publicly available proteome and transcriptome data to characterize global changes in the cell cycle signature of COVID-19 patients. We found significantly enriched cell cycle-associated gene co-expression modules and an interconnected network of cell cycle-associated differentially expressed proteins (DEPs) and genes (DEGs) by integrating the molecular data of 1,469 individuals (981 SARS-CoV-2 infected patients and 488 controls [either healthy controls or individuals with other respiratory illnesses]). Among these DEPs and DEGs are several cyclins (CCNs), cell division cycles (CDCs), cyclin-dependent kinases (CDKs), and mini-chromosome maintenance (MCMs) proteins. COVID-19 patients partially shared the expression pattern of some cell cycle-associated genes with other respiratory illnesses but exhibited some specific differential features. Notably, the cell cycle signature predominated in the patients' blood leukocytes (B, T, and NK cells) and was associated with COVID-19 severity and disease trajectories. These results provide a unique global understanding of distinct alterations in cell cycle-associated molecules in COVID-19 patients, suggesting new putative pathways for therapeutic intervention. This article is protected by copyright. All rights reserved.

Chimeric Antigen Receptor T (CAR-T) cells are certainly an important therapy for patients with relapsed and/or refractory hematologic malignancies. Currently, there are five CAR-T cell products approved by the FDA but several research groups and/or biopharmaceutical companies are encouraged to develop new products based on CAR cells using T or other cell types. Production of CAR cells requires intensive work from the basic, pre-clinical to translational levels, aiming to overcome technical difficulties and failure in the production. At least five key common steps are needed for the manipulation of T-lymphocytes (or other cells), such as: cell type selection, activation, gene delivery, cell expansion and final product formulation. However, reproducible manufacturing of high-quality clinical-grade CAR cell products is still required to apply this technology to a greater number of patients. This chapter will discuss the present and future development of new CAR designs that are safer and more effective to improve this therapy, achieving more selective killing of malignant cells and less toxicity to be applied in the clinical setting.

Introduction Anti-CD19 CAR-T cell therapy has been associated with improved outcomes in R/r DLBCL. In Brazil, management of patients treated with this therapy can be cumbersome due to the lack of experience with this therapeutic product in most centers. Objective Describe a case of successful anti-CD19 CAR-T cell treatment as salvage therapy in a patient previously exposed to 5 therapy lines, including autologous HSCT, as well as detail the patient's follow-up post CAR-T cell infusion. Methods Case description, with patient's laboratory and imaging results during follow-up. Results A 62-year-old male patient with a 7-year history of DLBCL, previously treated with 5 lines of therapy, was referred to Cleveland (Dr Marcos de Lima) to receive anti-CD19 CAR T-cells in March 2020 following disease relapse after autologous transplant and refractoriness to later therapeutic lines. Referral was due to the lack of available therapies with curative intent in Brazil, associated to the availability to enroll in an anti-CD19 CAR-T cell therapy clinical trial (CASE 2417) at the Seidman Cancer Center in Cleveland, Ohio, USA. PET-CT results before CAR-T cell treatment are shown in Figure 1. The infused cell product was manufactured with the automated CliniMACS®Prodigy platform using a commercial lentiviral vector. As pre-infusion lymphodepletion therapy, the patient received cyclophosphamide 60 mg/kg on D-6 and fludarabine 25 mg/m2 on days D-5 to D-3. The infusion of the CAR T cells occurred on 20/02/2020 – cellular dose: 2 x 106/kg. As early complications, the patient had grade II CRS and severe neutropenia related to the use of sulfamethoxazole-trimethoprim for pneumocystis prophylaxis. There was no neurotoxicity. Patient remained hospitalized for a month, and returned to follow-up at HC/FMUSP in May 2020. During patient follow-up, regular evaluation of immune reconstitution is being performed – table 1. Analysis of immune reconstitution by flow cytometry after CAR-T cell therapy showed reconstitution of CD3+, CD8+ and NK (CD3-CD16+CD56+) lymphocytes, reduced levels of CD4+ lymphocytes and absence of CD19+ B cells (Table 1). Given the old age of the patient, exposure to multiple lines of therapy and lack of consensus in the literature, we opted for monthly immunoglobulin replacement in the first year. Patient is receiving infectious prophylaxis with acyclovir and monthly pentamidine. There have been no infectious complications so far. Disease reassessment with PET-CT 6 and 12 months after therapy demonstrated a complete response (CR) (Figure 2). Although we do not have available data regarding CAR-T cell persistence, the serial evaluation of lymphocyte subpopulations confirms persistent B cell aplasia. Conclusions Anti-CD19 CAR T-cell therapy is efficient therapy in R/r DLBCL, with manageable late toxicities. This patient's persistent B cell aplasia associated with CR from disease 16 months post-infusion suggests persistence of circulating CAR-T cells.

Antitumor viral vaccines, and more particularly poxviral vaccines, represent an active field for clinical development and translational research. To improve the efficacy and treatment outcome, new viral vectors are sought, with emphasis on their abilities to stimulate innate immunity, to display tumor antigens and to induce a specific T-cell response.We screened for a new poxviral backbone with improved innate and adaptive immune stimulation using IFN-α secretion levels in infected PBMC cultures as selection criteria. Assessment of virus effectiveness was madeThe bovine pseudocowpox virus (PCPV) stood out among several poxviruses for its ability to induce significant secretion of IFN-α. PCPV produced efficient activation of human monocytes and dendritic cells, degranulation of NK cells and reversed MDSC-induced T-cell suppression, without being offensive to activated T cells. A PCPV-based vaccine, encoding the HPV16 E7 protein (PCPV-E7), stimulated strong antigen-specific T-cell responses in TC1 tumor-bearing mice. Complete regression of tumors was obtained in a CD8We propose PCPV as a viral vector suitable for vaccination in the field of personalised cancer vaccines, in particular for heterologous prime-boost regimens.

SUMMARYMacrophage infiltration is a hallmark of solid cancers and overall macrophage infiltration is correlated with lower patient survival and resistance to therapy. However, tumor-associated macrophages are phenotypically and functionally heterogeneous. Specific tumor-associated macrophage subsets might be endowed with antagonistic role on cancer progression and on the development of anti-tumor immunity. For instance, monocyte-derived TREM2+ tumor-associated macrophages have pro-tumorigenic and immunosuppressive functions. Here, we identify a discrete population of FOLR2+ tumor-associated macrophages positively correlating with patient survival in breast cancer. FOLR2+ macrophages are evolutionarily conserved across species and populate human and murine healthy mammary gland. Moreover, FOLR2+ macrophages co-localize with lymphoid aggregates containing CD8+ T cells in breast cancer and across ten other types of cancers. This study highlights antagonistic roles for tumor-associated macrophage subsets and paves the way for subset-specific therapeutic interventions in macrophages-based cancer therapies.

Although mutations leading to a compromised nuclear envelope cause diseases such as muscular dystrophies or accelerated aging, the consequences of mechanically induced nuclear envelope ruptures are less known. Here, we show that nuclear envelope ruptures induce DNA damage that promotes senescence in non-transformed cells and induces an invasive phenotype in human breast cancer cells. We find that the endoplasmic reticulum (ER)-associated exonuclease TREX1 translocates into the nucleus after nuclear envelope rupture and is required to induce DNA damage. Inside the mammary duct, cellular crowding leads to nuclear envelope ruptures that generate TREX1-dependent DNA damage, thereby driving the progression of in situ carcinoma to the invasive stage. DNA damage and nuclear envelope rupture markers were also enriched at the invasive edge of human tumors. We propose that DNA damage in mechanically challenged nuclei could affect the pathophysiology of crowded tissues by modulating proliferation and extracellular matrix degradation of normal and transformed cells.

In this systematic review, we foresee what could be the approved scenario in the next few years for CAR-T cell therapies directed against hematological and solid tumor malignancies. China and the USA are the leading regions in numbers of clinical studies involving CAR-T. Hematological antigens CD19 and BCMA are the most targeted, followed by mesothelin, GPC3, CEA, MUC1, HER2, and EGFR for solid tumors. Most CAR constructs are second-generation, although third and fourth generations are being largely explored. Moreover, the benefit of combining CAR-T treatment with immune checkpoint inhibitors and other drugs is also being assessed. Data regarding product formulation and administration, such as cell phenotype, transfection technique, and cell dosage, are scarce and could not be retrieved. Better tracking of trials’ status and results on the ClinicalTrials.gov database should aid in a more concise and general view of the ongoing clinical trials involving CAR-T cell therapy.

Macrophage infiltration is a hallmark of solid cancers, and overall macrophage infiltration correlates with lower patient survival and resistance to therapy. Tumor-associated macrophages, however, are phenotypically and functionally heterogeneous. Specific subsets of tumor-associated macrophage might be endowed with distinct roles on cancer progression and antitumor immunity. Here, we identify a discrete population of FOLR2

Tumor-draining lymph node (TDLN) invasion by metastatic cells in breast cancer correlates with poor prognosis and is associated with local immunosuppression, which can be partly mediated by regulatory T cells (Tregs). Here, we study Tregs from matched tumor-invaded and non-invaded TDLNs, and breast tumors. We observe that Treg frequencies increase with nodal invasion, and that Tregs express higher levels of co-inhibitory/stimulatory receptors than effector cells. Also, while Tregs show conserved suppressive function in TDLN and tumor, conventional T cells (Tconvs) in TDLNs proliferate and produce Th1-inflammatory cytokines, but are dysfunctional in the tumor. We describe a common transcriptomic signature shared by Tregs from tumors and nodes, including CD80, which is significantly associated with poor patient survival. TCR RNA-sequencing analysis indicates trafficking between TDLNs and tumors and ongoing Tconv/Treg conversion. Overall, TDLN Tregs are functional and express a distinct pattern of druggable co-receptors, highlighting their potential as targets for cancer immunotherapy., Tumor-draining lymph nodes are often the first site of metastasis in breast cancer patients. Here, the authors show that metastatic lymph nodes are characterized by the accumulation of suppressive regulatory T cells with a distinct phenotype compared to matched non-invaded lymph nodes and tumors.

Objectives The accumulation of tumor‐associated macrophages (TAMs) is correlated with poor clinical outcome, but the mechanisms governing their differentiation from circulating monocytes remain unclear in humans. Methods Using multicolor flow cytometry, we evaluated TAMs phenotype in 93 breast cancer (BC) patients. Furthermore, monocytes from healthy donors were cultured in the presence of supernatants from dilacerated primary tumors to investigate their differentiation into macrophages (MΦ) in vitro. Additionally, we used transcriptomic analysis to evaluate BC patients’ blood monocytes profiles. Results We observed that high intra‐tumor CD163‐expressing TAM density is predictive of reduced survival in BC patients. In vitro, M‐CSF, TGF‐β and VEGF from primary tumor supernatants skewed the differentiation of healthy donor blood monocytes towards CD163highCD86lowIL‐10high M2‐like MΦ that strongly suppressed CD4+ T‐cell expansion via PD‐L1 and IL‐10. In addition, blood monocytes from about 40% of BC patients displayed an altered response to in vitro stimulation, being refractory to type‐1 MΦ (M1‐MΦ) differentiation and secreting higher amounts of immunosuppressive, metastatic‐related and angiogenic cytokines. Aside from showing that monocyte transcriptome is significantly altered by the presence of BC, we also demonstrated an overall metabolic de‐activation in refractory monocytes of BC patients. In contrast, monocytes from sensitive BC patients undergoing normal M1‐MΦ differentiation showed up‐regulation of IFN‐response genes and had no signs of metabolic alteration. Conclusion Altogether, our results suggest that systemic factors skew BC patient blood monocytes towards a pro‐metastatic profile, resulting in the accumulation of further polarised CD163high TAMs resembling type‐2 MΦ (M2‐MΦ) in the local BC microenvironment. These data indicate that monitoring circulating monocytes in BC patients may provide an indication of early systemic alterations induced by cancer and, thus, be instrumental in the development of improved personalised immunotherapeutic interventions., The mechanisms governing suppressive tumor‐associated macrophage (TAM) generation from circulating monocytes remain unclear in humans. In this study, we identify tumor‐derived M‐CSF, TGF‐β and VEGF as key factors skewing monocytes towards immunosuppressive CD163highCD86lowIL‐10high M2‐like macrophages (MΦ). We also describe an intrinsic metabolic de‐activation in breast cancer (BC) patient monocytes refractory to type‐1 MΦ (M1‐MΦ) differentiation that contrast with the active intrinsic IFN‐signalling pathway detected in sensitive BC patient monocytes undergoing normal M1‐MΦ differentiation. Thus, the combined local and systemic skewing of monocytes may give rise to the accumulation of suppressive M2‐like TAMs, contributing to the immune response failure and impacting on BC patient outcome.

International audience; Rhabdoid tumors (RTs) are genomically simple pediatric cancers driven by the biallelic inactivation of SMARCB1, leading to SWI/SNF chromatin remodeler complex deficiency. Comprehensive evaluation of the immune infiltrates of human and mice RTs, including immunohistochemistry, bulk RNA sequencing and DNA methylation profiling studies showed a high rate of tumors infiltrated by T and myeloid cells. Single-cell RNA (scRNA) and T cell receptor sequencing highlighted the heterogeneity of these cells and revealed therapeutically targetable exhausted effector and clonally expanded tissue resident memory CD8+ T subpopulations, likely representing tumor-specific cells. Checkpoint blockade therapy in an experimental RT model induced the regression of established tumors and durable immune responses. Finally, we show that one mechanism mediating RTs immunogenicity involves SMARCB1-dependent re-expression of endogenous retroviruses and interferon-signaling activation.

Summary Dendritic cells (DCs) are antigen-presenting cells controlling T cell activation. In humans, the diversity, ontogeny, and functional capabilities of DC subsets are not fully understood. Here, we identified circulating CD88−CD1c+CD163+ DCs (called DC3s) as immediate precursors of inflammatory CD88−CD14+CD1c+CD163+FcεRI+ DCs. DC3s develop via a specific pathway activated by GM-CSF, independent of cDC-restricted (CDP) and monocyte-restricted (cMoP) progenitors. Like classical DCs but unlike monocytes, DC3s drove activation of naive T cells. In vitro, DC3s displayed a distinctive ability to prime CD8+ T cells expressing a tissue homing signature and the epithelial homing alpha-E integrin (CD103) through transforming growth factor β (TGF-β) signaling. In vivo, DC3s infiltrated luminal breast cancer primary tumors, and DC3 infiltration correlated positively with CD8+CD103+CD69+ tissue-resident memory T cells. Together, these findings define DC3s as a lineage of inflammatory DCs endowed with a strong potential to regulate tumor immunity., Graphical Abstract, Highlights • DC3s are phenotypic and functional intermediates between cDC2s and monocytes • GM-CSF alone, but not FLT3L, supports efficient differentiation of DC3s • DC3s do not differentiate via cDC (CDP)- or monocyte-restricted (cMoP) progenitors • DC3s prime TRM cells in vitro and correlate with TRM expansion in primary breast cancer, Bourdely et al. identify human CD88−CD1c+CD163+ DC3s as a pro-inflammatory phagocyte lineage sharing features with monocytes and conventional DCs. DC3s efficiently induce differentiation of CD103+CD8+ T cells in vitro, and their infiltration correlates with CD8+CD69+CD103+ TRM accumulation in breast tumors.

Mice reconstituted with a human immune system and bearing human tumors represent a promising model for developing novel cancer immunotherapies. Here, we used mass cytometry and multi-parametric flow cytometry to characterize human leukocytes infiltrating a human breast cancer tumor model in immunocompromised NOD.SCID.γc-null mice reconstituted with a human immune system and compared it to samples of breast cancer patients. We observed highly activated human CD4+ and CD8+ T cells in the tumor, as well as minor subsets of innate immune cells in both settings. We also report that ICOS+ CD4+ regulatory T cells (Treg) were enriched in the tumor relative to the periphery in humanized mice and patients, providing a target to affect Treg and tumor growth. Indeed, administration of a neutralizing mAb to human ICOS reduced Treg proportions and numbers and improved CD4+ T cell proliferation in humanized mice. Moreover, a combination of the anti-ICOS mAb with cyclophosphamide reduced tumor growth, and that was associated with an improved CD8 to Treg ratio. However, depletion of human CD8+ T cells only marginally affected tumor control whereas depletion of murine myeloid cells abrogated the effect of the combination therapy. Altogether, our results indicate that a combination of anti-ICOS mAb and chemotherapy controls tumor growth in humanized mice and highlight the crucial implication of innate immunity in treatment efficacy, opening new perspectives for the treatment of breast cancer.One sentence summaryICOS expressed on Tregs is a promising target to improve tumor immunity in humansAbbreviationsICOSInducible CostimulatoryNSGNOD.SCID.gc-nullTregregulatory T cellsCTXcyclophosphamideHuMicehumanized miceCyTOFcytometry time-of-flighttSNEtdistributed stochastic neighbor embeddingpDCsplasmacytoid dendritic cellsDCdendritic cellsICDimmunogenic cell death

Visit the Cancer Research 75th Anniversary [timeline][1]. See related article by Lewis and Pollard, [Cancer Res 2006;66:605–12][2] . In this 75th Anniversary issue commentary, we discuss a seminal review published in 2006 by Claire E. Lewis and Jeffrey W. Pollard in Cancer Research , entitled

In order to evaluate the immune infiltrate of AT/RT, we conducted a combined immunohistochemical, multiparametric flow cytometry and transcriptomic analysis of a series of 49 human AT/RT. This revealed substantial heterogeneity, with some subgroups of AT/RT showing a prominent immune infiltrate. In details, our analyses indicated that: i) myeloid cells were the most abundant immune population, including both microglial cells and non-resident pro-tumoral M2-polarized macrophages, ii) tumor-infiltrating lymphocytes consisted in equal proportions of CD4+ and CD8+ T cells with few regulatory T cells, and iii) immune modulatory molecules PD-L1 and TIM-3 were expressed at high levels. Intratumoral cytolytic activity of CD8+ T cells highly correlated with both interferon gamma and alpha signatures, confirming the involvement of both adaptive and innate immune cells in the anti-tumor response. A genetically engineered mouse model of AT/RT recently established in our laboratory recapitulates many of these traits, including important infiltration by both lymphoid and myeloid cells sharing similar phenotypic characteristics. Using this model, we showed that blockade of the PD-1/PD-L1 pathway significantly impaired tumor growth and induced memory against a second engraftment, confirming an anti-tumoral T cell memory response. Combination with TIM-3 blockade showed synergistic effects. Additionally, targeting the myeloid infiltrate by TLR3 activation with poly(I:C) induced a potent anti-tumor effect which, combined with PD-1 blockade, led to complete tumor regression in over 85% of treated mice. In conclusion, we demonstrate that immune infiltration is a recurrent property of AT/RT and that immunotherapy, particularly combination regimens, have promising therapeutic potential.

Background: Lung cancer is the most prevalent cancer and a high fatality disease. Despite of all available therapeutic approaches, drug resistance of chemotherapy agents for patients remain as an obstacle. New drugs integrating immunotherapeutic and conventional cytotoxic effects is a powerful strategy for the treatment of cancer to overcome this limitation. Antineoplastic phospholipids combine both of these activities by affecting lipid metabolism and signaling through lipid rafts. Therefore, they emerge as interesting scaffolds for designing new drugs. Objective: We aimed to evaluate antineoplastic phospholipids as scaffolds for designing new drugs for lung cancer treatment. Methods: The initial screening in A549 cells was performed by MTT assay. Others cytotoxic effects were evaluated in A549 cells by clonogenic assay, Matrigel 3D culture and flow cytometry analyses of cell cycle, apoptosis, mitochondrial membrane electronic potential and superoxide production. Immunological effects of ED were accessed on dendritic cells (DCs) and the expression of some markers were evaluated by flow cytometry. In vivo lung colonization analysis was performed after intravenously injection of A549 cells and daily treatment with ED. Results: Herein, ED showed to be the most efficient compound concerning cytotoxic, thereby, ED was selected for following tests. ED showed a cytotoxic profile in both monolayer and 3D culture and also in vivo models using A549 cells. This profile is due to G0/G1 phase cellular arrest and apoptosis drove by mitochondrial membrane depolarization and superoxide overproduction. Moreover, ED modulated DCs toward an activated pattern by the increased expression of CD83 and a remarkable decreased expression of PD-L1/CD274 on DCs membrane. Conclusions: Thus, ED is an interesting antitumor drug prototype due to not only its direct cellular cytotoxicity but also given its immunological features.

Uric acid is a damage-associated molecular pattern (DAMP), released from ischemic tissues and dying cells which, when crystalized, is able to activate the NLRP3 inflammasome. Soluble uric acid (sUA) is found in high concentrations in the serum of great apes, and even higher in some diseases, before the appearance of crystals. In the present study, we sought to investigate whether uric acid, in the soluble form, could also activate the NLRP3 inflammasome and induce the production of IL-1β. We monitored ROS, mitochondrial area and respiratory parameters from macrophages following sUA stimulus. We observed that sUA is released in a hypoxic environment and is able to induce IL-1β release. This process is followed by production of mitochondrial ROS, ASC speck formation and caspase-1 activation. Nlrp3−/− macrophages presented a protected redox state, increased maximum and reserve oxygen consumption ratio (OCR) and higher VDAC protein levels when compared to WT and Myd88−/− cells. Using a disease model characterized by increased sUA levels, we observed a correlation between sUA, inflammasome activation and fibrosis. These findings suggest sUA activates the NLRP3 inflammasome. We propose that future therapeutic strategies for renal fibrosis should include strategies that block sUA or inhibit its recognition by phagocytes. © The Author(s) 2017. This work is licensed under a Creative Commons Attribution 4.0 International License. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in the credit line; if the material is not included under the Creative Commons license, users will need to obtain permission from the license holder to reproduce the material. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

Cervical cancer is a major public health problem and one of the leading causes of cancer deaths in women. Virtually all cases of cervical cancer, as well as a growing share of anal and head/neck tumors, are associated with human papillomavirus (HPV) infection. Despite the effectiveness, the available prophylactic vaccines do not benefit women with cervical lesions or cancer. Therefore, the search of new immunotherapeutic approaches to treat HPV-induced tumors is still a priority. The present study characterizes a therapeutic antitumor vaccine based on the genetic fusion of the Herpes simplex virus-1 (HSV-1) glycoprotein D (gD) with the E7 oncoprotein from HPV-16 (gDE7). Two subcutaneous doses of gDE7, admixed with poly (I:C), conferred complete and long-lasting therapeutic antitumor protection on mice previously challenged with tumor cells expressing the HPV-16 oncoproteins. The vaccine induced multifunctional E7-specific CD8+ T cells with cytotoxic activity and effector memory phenotype (CD44+ CD62Llow). In addition, gDE7 admixed with poly (I:C) vaccination controlled the expansion of tumor-induced regulatory T cells and myeloid-derived suppressor cells. More importantly, gDE7 activated mouse CD11c+ CD8α+ and human BDCA3+ dendritic cells (DC), specialized in antigen cross-presentation to CD8+ T cells, under in vitro conditions. These results indicated that the activation of a specific DC population, mediated by gD, improved the antigen-specific immune responses and the therapeutic performance induced by antitumor vaccines. These results open perspectives for the clinical testing of gDE7-based vaccines under the concept of active immunization as a tool for the therapeutic control of cancer. Mol Cancer Ther; 16(9); 1922–33. ©2017 AACR.

Immunotherapy using checkpoint inhibitors has changed the way we treat several aggressive cancers such as melanoma, non-small cell lung and head & neck cancers, among others, with durable responses achieved in the metastatic setting. However, unfortunately, the vast majority of patients do not respond to checkpoint inhibition therapy and a minority of patients, who do respond to treatment, develop secondary resistance and experience relapse by mechanisms still inadequately understood. Emerging evidence shows that alterations in multiple signaling pathways are involved in primary and/or secondary resistance to checkpoint inhibition. In this review we discuss how selected cancer-cell autonomous cues may influence the outcome of cancer immunotherapy, particularly immune checkpoint inhibition.

Oral squamous cell carcinoma (OSCC) is the most prevalent malignant tumor among head and neck cancers, with 300,000 new cases and 145,000 deaths around the world per year, with less than 50% survival rate of advanced cases after five years of diagnosis. The molecular mechanisms involved in immunosurveillance and oral cancer development are poorly understood and, neither molecular markers nor immunotherapy response predictors are available. However, recent findings in molecular biology and immunology of cancer cell have shown that tumor-stroma communication promotes intense suppressive signaling in the microenvironment, which may contribute to failure of therapy. Tumor-stroma communication is not an unidirectional process, driven only by cancer cells. Other resident cells, like cancer-associated fibroblasts (CAFs), immune cells as macrophages and lymphocytes, endothelial cells and tumor stem cells, which are in an intense cross-talk by cell-cell contact, secreted factors and other components of the extracellular matrix (ECM), can alter and be altered by the microenvironment. In this context, the cancer-derived extracellular vesicles (EVs) acquire a significant pathological role in cell-cell communication by changing the phenotype of the recipient cells, promoting tumor growth and metastasis. Here, we explored the role of three different source of EVs, originated from normal gingival keratinocyte (HMK) and from less (SCC9) and high (HSC3) aggressive OSCC cell lines in the modulation of monocyte-derived macrophage M1 or M2 phenotypes, and their ability to contribute to the suppressive phenotype in the tumor microenvironment. CD163 expression, a marker of M2 macrophages, was significantly increased in CD14+ monocytes stimulated by HSC3-EVs, in comparison with non-stimulated monocytes, HMK- and SCC9-EVs-stimulated cells. In addition, CD64+/CD86+/CD80+ M1 macrophage subset, differentiated by GM-CSF/IFN-gamma, showed a decreased expression of the T-cell co-stimulatory molecule, CD86 after stimulus with HSC3-EVs. Furthermore, the mass spectrometry analysis of HSC3-EV protein contents identified a set of up- and down-regulated candidate proteins that may be involved in immunoregulation and suppressive pathways. Since the M2 macrophage phenotype is associated with increased angiogenesis, immunological tolerance and development of neoplastic cells, the M1 subset, the classically activated macrophages, may recognize and eliminate cancer cells. Thus, our results indicate that EVs from aggressive cells HSC3 may contribute to immunosuppressive tumor microenvironment in oral cancer by deviating macrophages into a tumor-promoting instead of a tumor-controlling phenotype. Citation Format: Ana Karina Oliveira, Thiago Andrade Patente, Rodrigo Nalio Ramos, Ariane Busso Lopes, Romênia Ramos Domingues, Mariane Tami Amano, Eliana Blini Marengo, Jose Alexandre Barbuto, Adriana Franco Squina. Oral cancer cell-derived extracellular vesicles can modulate an immunosuppressive microenvironment through M2 phenotype polarization [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 2800.

O desenvolvimento do câncer está associado a falhas no sistema imune. Investigamos como o microambiente tumoral de mama afetaria a diferenciação de monócitos. Observamos que a alta frequência de macrófagos (MΦ) CD163+ associou-se à baixa sobrevida das pacientes e a um baixo infiltrado de células T CD3+ nos tumores. Sobrenadantes obtidos da dilaceração des tumores (SNDil) induziram a diferenciação de monócitos para MΦ CD163highIL-10high, os quais suprimiram células T CD4+. O fenótipo CD163highIL-10high associou-se a altos níveis de M-CSF, TGF-β e VEGF nos tumores. Monócitos circulantes de pacientes falharam em diferenciar-se em M1-M Φ; deram origem à DCs capazes de induzir alta frequência de células T reguladoras (Tregs) e produziram altos níveis de citocinas anti-inflamatórias sob ativação por LPS. Em conclusão, o microambiente tumoral favorece a diferenciação de MΦ CD163highIL-10high supressivos e afeta sistemicamente o potencial de diferenciação de monócitos de pacientes. Cancer development is associated with failures in the immune system. We investigated here if breast tumor microenvironment affect the differentiation of monocytes. We observed that the high frequency of macrophages (MΦ) CD163+ was associated with poor patients survival and a low infiltration of CD3+ T cells in tumors. Supernatants obtained from dilacerated tumors (SNDil) skewed the differentiation of monocytes into CD163highIL10high MΦ, which suppressed CD4+ T cells. The CD163highIL-10high phenotype was associated with high levels of M-CSF, TGF-β and VEGF in tumors. Circulating monocytes from patients failed to differentiate into M1-MΦ; gave rise to DCs able to induce high frequency of regulatory T cells (Tregs) and produced high levels of anti-inflammatory cytokines under LPS activation. In conclusion, the tumor microenvironment promotes the differentiation of suppressive CD163highIL10high MΦ and affects the potential of differentiation of patients\' monocytes systemically.

As células dendríticas (DCs) são as mais eficazes células apresentadoras de antígenos. Mesmo com a possibilidade da geração de DCs in vitro, que permitiu a criação de protocolos de vacinação antitumoral, mecanismos de tolerância periférica, mediados por células T reguladoras, impedem uma resposta imune antitumoral eficaz. O presente estudo visou avaliar, in vitro, a geração de linfócitos T reguladores por células dendríticas derivadas de pacientes portadoras de câncer de mama. Para tanto, DCs foram diferenciadas a partir de monócitos do sangue periférico de pacientes com câncer, por sete dias, na presença de GM-CSF e IL-4 (DCs imaturas - iDCs), e ativadas, por adição de TNF-a no dia cinco de cultura (DCs maduras - mDCs). As DCs foram caracterizadas, por citometria de fluxo, quanto à: expressão de CD1a, CD11c, CD14, CD80, CD86, CD83, CD123, PD-L1, HLA-ABC e HLA-DR; produção de IL-10 e TGF-beta1, por ELISA; e ainda em ensaio funcional, que se deu pela co-cultura das DCs com linfócitos T (CD3+, CD3+CD25neg ou CD4+CD25neg), isolados por microsferas imunomagnéticas. Após co-cultura, a expressão de CD25, a proliferação (diluição de CFSE), a produção de citocinas (IFN-g, IL-10, TGF-beta1) e a geração de células Tregs foram analisadas. As células foram caracterizadas como Tregs por seu fenótipo (CD4+CD25+CD127lowCTLA-4+Foxp3+) e sua capacidade supressora sobre linfócitos alogeneicos. iDCs de pacientes apresentaram aumento da expressão de CD86 (com duas subpopulações: CD86High e CD86Low) e CD123 além de produção elevada de IL-10 e TGF-beta1 bioativo. Co-culturas com DCs de pacientes apresentaram níveis altos de TGF-beta1 bioativo (298,08 pg/ml x ctrl: 57,63 pg/ml) e induziram um alta freqüência de Tregs (iDCs: 57% ± 4,1; mDCs: 48% ± 5,0 x ctrl: 2,5% ± 0,7) a partir de precursores CD25negFoxp3neg, que foram capazes de suprimir a proliferação de linfócitos alogeneicos. O bloqueio de TGF-beta nas co-culturas reduziu parcialmente a freqüência de Treg geradas por DCs de pacientes. Esses achados são condizentes com a alta freqüência de Tregs no sangue periférico dessas mesmas pacientes (19,5% ± 2,3 x 8% ± 2,3) e com a presença de células com fenótipo de DCs no sangue, apresentando marcação semelhante a iDCs geradas in vitro. Por outro lado, iDCs provenientes de doadoras saudáveis induziram estimulação linfocitária mais intensa (35,7% ± 7,9 x 11,8 ± 5,9% CD25+), intensa proliferação de linfócitos CD4+ (82,7% x 29,4%) e CD8+ (73,8% x 21%) e alta produção de IFN-g (109,85 pg/ml x 7,86 pg/ml) nas co-culturas. Estes dados indicam que DCs derivadas de monócitos de pacientes com câncer de mama apresentam um viés imunossupressor que não é estritamente dependente do seu status de maturação ou de TGF-beta. Esses achados além de contribuir para a compreensão das interações entre o sistema imune e as neoplasias, devem ser considerados no delineamento de protocolos imunoterapêuticos baseados em DCs. Dendritic cells (DCs) are the most effective professional antigen-presenting cells. Even considering the possibility of generating DCs in vitro, which allowed the design of antitumor vaccination protocols, mechanisms of peripheral tolerance mediated by regulatory T cells prevent an effective antitumor immune response. The aim of our study was evaluate, in vitro, the induction of regulatory T cells by dendritic cells derived from breast cancer patients.DCs were differentiated from breast cancer patients blood monocytes, for seven days, in the presence of GM-CSF and IL-4 (immature DCs- iDCs) and activated by TNF-a on day five of culture (mature DCs- mDCs). DCs were characterized by flow cytometry to CD1a, CD11c, CD14, CD80, CD86, CD83, CD123, PD-L1, HLA-ABC and HLA-DR expression; the cytokine secretion to IL-10 and bioactive TGF-beta1, by ELISA; and in functional assay by co-culturing DCs with T lymphocytes (CD3+, CD3+CD25neg or CD4+CD25neg) isolated by microbeads. Cell activation (CD25 expression), proliferation (CFSE dilution), cytokine production (IFN-gamma, IL-10 and TGF-beta1) and de novo regulatory T cells (Tregs) generation, were analyzed in these co-cultures after 5 or 6 days. Tregs were characterized by their phenotype (CD4+CD25+CD127LowCTLA-4+Foxp3+) and suppressive capability on allogeneic T cell proliferation. Patients iDCs showed a higher expression of CD86 (two subpopulation: CD86High and CD86Low) and CD123 beyond the elevated production of IL-10 and bioactive TGF-beta1. Co-cultures using patients DCs presented high levels of bioactive TGF-beta1 (298.08 pg/ml x ctrl: 57.63 pg/ml) and induced elevated frequency of Tregs (iDCs: 57% ± 4.1; mDCs: 48% ± 5.0 x ctrl: 2.5% ± 0.7) from CD25neg Foxp3neg precursors, which were able to suppress the allogeneic lymphocyte proliferation. The TGF-beta blocking partially reduced the frequency of induced Tregs by patients DCs. These findings are consistent with the higher frequency of Tregs on peripheral blood of those patients (19.5% ± 2.3 x ctrl 8% ± 2.3) and the presence of DCs also on the blood, showing similar markings with iDCs generated in vitro. Contrastingly, iDCs from healthy donors were better stimulator cells, leading to a higher CD25+ cell frequency (ctrl 35.7% ± 7.9 x 11.8 ± 5.9% CD25+), more intense proliferation of CD4+ (82.7% x 29.4%) and CD8+ (73.8% x 21%) cells and higher production of IFN-gamma (109.85 pg/ml x 7.86 pg/ml) on co-cultures. These data indicate that DCs derived from breast cancer patients show an immunosuppressive bias that is not strictly dependent on DCs maturation status or TGF-beta. Finally, these observations call to caution in the use of patients monocytes for the generation of DC-based vaccines and also contribute to the comprehension of the interactions between the immune system and cancer.

The chromophobe renal cell carcinoma (ChRCC), though associated with a hereditary cancer syndrome, has a good prognosis after tumor removal. The lack of recurrence could be related to the absence of immune system compromise in patients or to an effective functional recovery of immune functions after tumor removal. Thus, we evaluated monocyte-derived dendritic cells (Mo-DCs) in a 34-year-old male who had a ChRCC, before and after tumor removal.CD14(+) monocytes from the patient's peripheral blood, 1 week before and 3 months after partial nephrectomy, were differentiated in vitro into immature and mature Mo-DCs. These were harvested, analyzed by flow cytometry and used as stimulators of allogeneic T cells. Supernatants from cultures were collected for cytokine analysis.Tumor removal was associated with decreased expression of PD-L1, but also, surprisingly, of CD205, HLA-DR, CD80 and CD86 by Mo-DCs. Also, Mo-DC's ability to stimulate T cell proliferation increased, along with IL-2Rα expression and IFN-γ production. Simultaneously, the patients' Mo-DCs ability to induce Foxp3(+) T cells decreased after surgery. One-year postoperative follow-up shows no tumor recurrence.The presence of a ChRCC affected Mo-DCs generated in vitro, which recovered their function after tumor removal. This indicates that the favorable outcome observed after ChRCC resection may be due to the restoration of immunocompetence. Furthermore, since functional alterations described for DCs within tumors may be also found in Mo-DCs, their accurate functional analysis-not restricted to the determination of their surface immunophenotype-may provide an indirect "window" to the tumor microenvironment.

Background CD40 ligand (CD40L) deficiency predisposes to opportunistic infections, including those caused by fungi and intracellular bacteria. Studies of CD40L-deficient patients reveal the critical role of CD40L-CD40 interaction for the function of T, B, and dendritic cells. However, the consequences of CD40L deficiency on macrophage function remain to be investigated. Objectives We sought to determine the effect of CD40L absence on monocyte-derived macrophage responses. Methods After observing the improvement of refractory disseminated mycobacterial infection in a CD40L-deficient patient by recombinant human IFN-γ (rhIFN-γ) adjuvant therapy, we investigated macrophage functions from CD40L-deficient patients. We analyzed the killing activity, oxidative burst, cytokine production, and in vitro effects of rhIFN-γ and soluble CD40 ligand (sCD40L) treatment on macrophages. In addition, the effect of CD40L absence on the macrophage transcriptome before and after rhIFN-γ treatment was studied. Results Macrophages from CD40L-deficient patients exhibited defective fungicidal activity and reduced oxidative burst, both of which improved in the presence of rhIFN-γ but not sCD40L. In contrast, rhIFN-γ and sCD40L ameliorate impaired production of inflammatory cytokines. Furthermore, rhIFN-γ reversed defective control of Mycobacterium tuberculosis proliferation by patients' macrophages. The absence of CD40L dysregulated the macrophage transcriptome, which was improved by rhIFN-γ. Additionally, rhIFN-γ increased expression levels of pattern recognition receptors, such as Toll-like receptors 1 and 2, dectin 1, and dendritic cell–specific intercellular adhesion molecule 3–grabbing nonintegrin in macrophages from both control subjects and patients. Conclusion Absence of CD40L impairs macrophage development and function. In addition, the improvement of macrophage immune responses by IFN-γ suggests this cytokine as a potential therapeutic option for patients with CD40L deficiency.

Proteases are recognized environmental allergens, but little is known about the mechanisms responsible for sensing enzyme activity and initiating the development of allergic inflammation. Because usage of the serine protease subtilisin in the detergent industry resulted in an outbreak of occupational asthma in workers, we sought to develop an experimental model of allergic lung inflammation to subtilisin and to determine the immunological mechanisms involved in type 2 responses. By using a mouse model of allergic airway disease, we have defined in this study that s.c. or intranasal sensitization followed by airway challenge to subtilisin induces prototypic allergic lung inflammation, characterized by airway eosinophilia, type 2 cytokine release, mucus production, high levels of serum IgE, and airway reactivity. These allergic responses were dependent on subtilisin protease activity, protease-activated receptor-2, IL-33R ST2, and MyD88 signaling. Also, subtilisin stimulated the expression of the proallergic cytokines IL-1α, IL-33, thymic stromal lymphopoietin, and the growth factor amphiregulin in a human bronchial epithelial cell line. Notably, acute administration of subtilisin into the airways increased lung IL-5–producing type 2 innate lymphoid cells, which required protease-activated receptor-2 expression. Finally, subtilisin activity acted as a Th2 adjuvant to an unrelated airborne Ag-promoting allergic inflammation to inhaled OVA. Therefore, we established a murine model of occupational asthma to a serine protease and characterized the main molecular pathways involved in allergic sensitization to subtilisin that potentially contribute to initiate allergic airway disease.

BackgroundMesenchymal stem cells have prominent immune modulatory properties, which may have clinical applications; however their major source, bone marrow, is of limited availability. On the other hand, mesenchymal stem cells derived from human exfoliated deciduous teeth (SHEDs) are readily accessible, but their immune regulatory properties have not been completely investigated. This study was designed, therefore, to evaluate the SHEDs influence on DCs differentiation, maturation, ability to activate T cells and to expand CD4(+)Foxp3(+) T cells.Methodology/principal findingsThe experiments were based in cellular co-culture during differentiation and maturation of monocyte derived-DCs (moDCs), with, or not, presence of SHEDs. After co-culture with SHEDs, (moDCs) presented lower expression of BDCA-1 and CD11c, in comparison to DC cultivated without SHEDs. CD40, CD80, CD83 and CD86 levels were also decreased in mature DCs (mDCs) after co-cultivation with SHEDs. To assess the ability of SHEDs-exposed moDCs to modulate T cell responses, the former were separated from SHEDs, and co-cultured with peripheral blood lymphocytes. After 5 days, the proliferation of CD4(+) and CD8(+) T cells was evaluated and found to be lower than that induced by moDCs cultivated without SHEDs. In addition, an increase in the proportion of CD4(+)Foxp3(+)IL-10(+) T cells was observed among cells stimulated by mature moDCs that were previously cultivated with SHEDs. Soluble factors released during co-cultures also showed a reduction in the pro-inflammatory cytokines (IL-2, TNF-α and IFN-γ), and an increase in the anti-inflammatory molecule IL-10.Conclusion/significanceThis study shows that SHEDs induce an immune regulatory phenotype in moDCs cells, evidenced by changes in maturation and differentiation rates, inhibition of lymphocyte stimulation and ability to expand CD4(+)Foxp3(+) T cells. Further characterization and validation of this phenomenon could support the use of SHEDs, directly or indirectly for immune modulation in the clinical practice.

Objetivo: Analisar a literatura cientifica para a expressao de PD-L1 no infiltrado de celulas imunes de tumores do tipo CPCNP, alem de seu potencial uso como biomarcador preditivo de desfechos clinicos e de resposta a imunoterapia com drogas anti PD-1 e anti PD-L1. Metodos: 5 bases de dados foram consultadas para buscas (PubMed, Web of Science, Scopus, Lilacs e Clinical Trials.gov.). Artigos foram incluidos se pertinentes, disponiveis atraves de acesso institucional e se escritos em Portugues, Ingles ou Espanhol. Nao houve restricao na selecao quanto tipo de estudo ou ano de publicacao. Resultados: 15 artigos foram selecionados. Foi observado relacao entre o nivel de expressao de PD-L1 e a presenca de celulas dendriticas imaturas, alem de expressao constitutiva da molecula em fibroblastos de pacientes com CPCNP. A expressao de PD-L1 nas celulas imunes infiltradas correlacionou-se com sobrevida aumentada e resposta tumoral melhor apos terapia com atezolizumab, alem de beneficios clinicos na terapia anti-PD-1. Outros artigos demonstram correlacao significativa entre a expressao de PD-L1 em linfocitos T perifericos e desfechos clinicos. Discussao: Observacoes preliminares demonstraram que a expressao de PD-L1 nas celulas imunes estao relacionadas ao sucesso clinico da imunoterapia e ao microambiente imunossupressor visto no CPCNP.

Engagement of programmed death-1 (PD-1) with its two ligands [programmed death ligand-1 (PD-L1) and PD-L2] has been associated with the suppression of tumor-reactive T cells; however, the underlying mechanism for this T-cell dysfunction is not clear. We hypothesized that PD-1 and PD-L1 signals are, in part, responsible for squamous cell carcinoma (SCC) escape from immune antitumor regulation by modulation of the tumor environment. In the present study, we used a multistage model of SCC to examine the role of PD-1/PD-L1 activation during tumor development. Tumor sites presented an increased percentage of CD4(+) and CD8(+) T cells expressing PD-1 when compared with non-tumorigenic control mice, whereas the expression of PD-L1 was particularly increased in F4/80(+) macrophages in tumor sites. Further, the systemic immune neutralization of PD-1 resulted in a decreased number and delayed incidence rate of papillomas followed by a differential expression of cytokeratins, suggesting that the PD-1-PD-L1 interaction contributes to the progression of SCC by downregulation of antitumor responses. In fact, blocking PD-1 increased the percentage of CD8(+) and CD4(+) T cells, and the levels of interferon-γ in the tumor sites. Our results indicated involvement of PD-1(+) T cells in SCC development and in the modulation of the inflammatory immune response.

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) Jeffrey Modell Foundation Background: Patients with X-linked hyper-IgM syndrome (X-HIGM) due to CD40 ligand (CD40L) mutations are susceptible to fungal pathogens; however, the underlying susceptibility mechanisms remain poorly understood.Objective: To determine whether monocyte-derived dendritic cells (DCs) from patients with X-HIGM exhibit normal responses to fungal pathogens.Methods: DCs from patients and controls were evaluated for the expression of costimulatory (CD80 and CD86) and MHC class II molecules and for their ability to produce IL-12 and IL-10 in response to Candida albicans and Paracoccidioides brasiliensis. We also evaluated the ability of C albicans- and P brasiliensis-pulsed mature DCs to induce autologous T-cell proliferation, generation of T helper (T-H) 17 cells, and production of IFN-gamma, TGF-beta, IL-4, IL-5, and IL-17.Results: Immature DCs from patients with X-HIGM showed reduced expression of CD80, CD86, and HLA-DR, which could be reversed by exogenous trimeric soluble CD40L. Most important, mature DCs from patients with X-HIGM differentiated by coculturing DCs with fungi secreted minimal amounts of IL-12 but substantial amounts of IL-10 compared with mature DCs from normal individuals. Coculture of mature DCs from X-HIGM patients with autologous T cells led to low IFN-g production, whereas IL-4 and IL-5 production was increased. T-cell proliferation and IL-17 secretion were normal. Finally, in vitro incubation with soluble CD40L reversed the decreased IL-12 production and the skewed T-H(2) pattern response.Conclusion: Absence of CD40L during monocyte/DC differentiation leads to functional DC abnormalities, which may contribute to the susceptibility to fungal infections in patients with X-HIGM. (J Allergy Clin Immunol 2012; 129: 778-86.) Univ São Paulo, Dept Immunol, Inst Biomed Sci, BR-05508000 São Paulo, Brazil Pediat Allergy & Immunol Clin, Caxias Do Sul, Brazil Albert Sabin Hosp, Fortaleza, Ceara, Brazil Pequeno Principe Hosp, Curitiba, Parana, Brazil Univ Fed Parana, Dept Pediat, Sch Med, BR-80060000 Curitiba, Parana, Brazil Universidade Federal de São Paulo, Dept Pediat, Div Allergy Immunol & Rheumatol, São Paulo, Brazil Univ Washington, Sch Med, Dept Pediat, Seattle, WA 98195 USA Seattle Childrens Hosp, Seattle, WA USA Universidade Federal de São Paulo, Dept Pediat, Div Allergy Immunol & Rheumatol, São Paulo, Brazil FAPESP: 2008/06635-0 FAPESP: 2008/55700-9 FAPESP: 2009/54599-5 Web of Science

Squamous cell carcinoma (SCC) constitutes a microenvironment that could modulate the antitumor immune response. Also, tumor-infiltrating lymphocytes are believed to play complex regulatory roles in antitumor immunity against SCC. The presence of regulatory T cells (Tregs) has been associated with the suppression of tumor-reactive T cells. However, the underlying mechanism for this T cell dysfunction is not clear. We used a multistage model of SCC to examine the role of Treg cells during tumor development. 7,12-dimethylbenz[a]-anthracene/phorbol 12-myristate 13-acetate treatment and systemic depletion of Treg cells using an anti-CD25 monoclonal antibody (PC61) resulted in a decrease in the number and incidence of papilloma. Furthermore, CD25 depletion increased the proportion of CD8 + and CD4 + T cells that were isolated from tumor lesions. The levels of interleukin (IL)-1β, IL-10, IL-12, IL-13, interferon-γ, transforming growth factor-β and tumor necrosis factor-α, but not IL-17, were increased in the tumor microenvironment after Treg depletion. Therefore, our results indicated involvement of CD25 + T cells in SCC development and in the suppression of the inflammatory immune response.

Immune deviation induced by breast cancer may have a role in current failures of dendritic cell-based immunotherapy. DCs orchestrate immune responses contributing to the pattern of response developed. In cancer, DCs may play a dysfunctional role in the induction of CD4+CD25+Foxp3+ Tregs, contributing to immune evasion. We show here that Mo-DCs from breast cancer patients show an altered phenotype and induce preferentially Tregs, a phenomenon that occurred regardless of DC maturation stimulus (sCD40L, cytokine cocktail, TNF-α, and LPS). The Mo-DCs of patients induced low proliferation of allogeneic CD3+CD25negFoxp3neg cells, which after becoming CD25+, suppressed mitogen-stimulated T cells. Contrastingly, Mo-DCs from healthy donors induced a stronger proliferative response, a low frequency of CD4+CD25+Foxp3+ with no suppressive activity. Furthermore, healthy Mo-DCs induced higher levels of IFN-γ, whereas the Mo-DCs of patients induced higher levels of bioactive TGF-β1 and IL-10 in cocultures with allogeneic T cells. Interestingly, TGF-β1 blocking with mAb in cocultures was not enough to completely revert the Mo-DCs of patientsˈ bias toward Treg induction. Altogether, these findings should be considered in immunotherapeutic approaches for cancer based on Mo-DCs.