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NY-ESO-1 (CTAG1B) Expression in Mesenchymal Tumors

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NY-ESO-1 (CTAG1B) Expression in Mesenchymal Tumors Modern Pathology (2015) 28, 587–595 & 2015 USCAP, Inc. All rights reserved 0893-3952/15 $32.00 587 NY-ESO-1 (CTAG1B) expression in mesenchymal tumors Makoto Endo1,2,7, Marieke A de Graaff3,7, Davis R Ingram4, Simin Lim1, Dina C Lev4, Inge H Briaire-de Bruijn3, Neeta Somaiah5, Judith VMG Bove´e3, Alexander J Lazar6 and Torsten O Nielsen1 1Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada; 2Department of Orthopaedic Surgery, Kyushu University, Fukuoka, Japan; 3Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands; 4Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; 5Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA and 6Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA New York esophageal squamous cell carcinoma 1 (NY-ESO-1, CTAG1B) is a cancer-testis antigen and currently a focus of several targeted immunotherapeutic strategies. We performed a large-scale immunohistochemical expression study of NY-ESO-1 using tissue microarrays of mesenchymal tumors from three institutions in an international collaboration. A total of 1132 intermediate and malignant and 175 benign mesenchymal lesions were enrolled in this study. Immunohistochemical staining was performed on tissue microarrays using a monoclonal antibody for NY-ESO-1. Among mesenchymal tumors, myxoid liposarcomas showed the highest positivity for NY-ESO-1 (88%), followed by synovial sarcomas (49%), myxofibrosarcomas (35%), and conventional chondrosarcomas (28%). Positivity of NY-ESO-1 in the remaining mesenchymal tumors was consistently low, and no immunoreactivity was observed in benign mesenchymal lesions. On the basis of these findings, nearly 90% of myxoid liposarcomas, as well as a significant proportion of synovial sarcomas, myxofibrosarcomas, and conventional chondrosarcomas are good candidates for immunotherapy targeting NY-ESO-1. Modern Pathology (2015) 28, 587–595; doi:10.1038/modpathol.2014.155; published online 21 November 2014 New York esophageal squamous cell carcinoma 1 clinical trial of adoptive immunotherapy, using (NY-ESO-1), encoded by the CTAG1B gene, is a genetically modified T cells directed against NY- cancer-testis antigen that was identified in 1997 ESO-1, demonstrated objective clinical responses in from the serum of a patient with esophageal squa- a number of metastatic synovial sarcoma and mela- mous cell carcinoma.1 Cancer-testis antigens such as noma patients with NY-ESO-1-positive tumors.5 The NY-ESO-1 have attracted increasing attention as results of that clinical trial highlight the potential immunotherapeutic targets because, among normal effectiveness of immunotherapy against tumors tissues, they are expressed only in adult testis germ expressing NY-ESO-1, and several clinical trials cells and are atypically re-expressed in many (using antigen sensitization, adoptive T-cell transfer, malignancies.2,3 NY-ESO-1 is of particular interest and dendritic cell vaccine strategies) are currently to researchers and clinicians because it is highly underway. immunogenic and is expressed in a variety of Mesenchymal tumors arising from bone or soft carcinomas, melanomas, and sarcomas.4 A recent tissues comprise many histologic subtypes, which even when taken together occur at a much lower rate than the more common carcinomas, creating a Correspondence: Dr TO Nielsen, MD, PhD, Department of practical barrier to developing new drug therapies. Pathology and Laboratory Medicine, University of British Colum- However, the well-defined biology of many sarco- bia, Room 509–2660 Oak Street, Vancouver, British Columbia mas suggests they may be particularly susceptible to V6H 3Z6, Canada. appropriate targeted strategies. Recent studies have E-mail: [email protected] 7These authors contributed equally to this work. reported NY-ESO-1 expression in an especially large Received 13 June 2014; revised 9 October 2014; accepted 15 proportion of myxoid liposarcomas and synovial October 2014; published online 21 November 2014 sarcomas.2,6–9 These studies also revealed the www.modernpathology.org NY-ESO-1 in mesenchymal tumors 588 M Endo et al absence of NY-ESO-1 expression in their histologic using the Standard Cell Conditioning 1 (CC1) mimics such as myxoma, myxofibrosarcoma, protocol (Ventana, Tucson, AZ, USA). Sections extraskeletal myxoid chondrosarcoma, and low- were incubated with mouse anti-NY-ESO-1 mono- grade fibromyxoid sarcoma, and concluded that clonal antibody (clone E978, Invitrogen, Carlsbad, immunohistochemical staining of NY-ESO-1 is CA, USA) at 1:25 dilution for 2 h at room tem- useful not only for candidate selection in perature, and then with UltraMap HRP-conjugated immunotherapy, but also for histologic differential anti-mouse IgG secondary antibody for 16 min. diagnosis. A limitation of these previous studies is The ChromoMap DAB Kit (Ventana) provided the that the sample sizes were too small to be conclusive visualization chromogen. Slides were then counter- and lacked independent external validation. stained with hematoxylin and mounted. Immuno- The goals of this study are to validate published histochemical staining of the tissue microarrays of reports of NY-ESO-1 expression in myxoid liposar- the LUMC was performed manually; 4 mm sections coma and synovial sarcoma patients on a larger were transferred to adhesive-coated slides (Leica sample set, and to investigate NY-ESO-1 expression Biosystems, Rijswijk, The Netherlands) and dried in other mesenchymal tumors not represented in overnight at 37 1C. Next slides were deparaffinized previous studies. To do so, we undertook a multi- in xylene, rehydrated and incubated in 0.3% institutional NY-ESO-1 expression survey on tissue methanol/H2O2 at room temperature for 20 min to microarrays encompassing a wide variety of malig- block the endogenous peroxidase activity. Antigen nant, intermediate, and benign bone and soft tissue retrieval was performed by 10 min microwave tumors, seeking to determine whether NY-ESO-1 is treatment in tris/EDTA-solution (pH ¼ 9.0), followed indeed useful in the differential diagnosis among by the addition of the primary NY-ESO-1 / CTAG1B mesenchymal tumors and to identify subtypes antibody (1:100, clone E978, Invitrogen) and that are most likely to benefit from NY-ESO-1 overnight incubation in a moist chamber at room immunotherapy. temperature. Next, slides were incubated with PowerVision Poly-HRP (Leica), visualized with DAB þ Substrate Chromogen System (DAKO, Materials and methods Heverlee, Belgium) and counterstained with hemato- xylin. All wash steps were carried out in PBS. Tumor Samples and Tissue Microarrays In both protocols, the staining was preceded by a titration series on normal testis, and during the In this study, formalin-fixed paraffin-embedded actual staining, testis was included as a positive tissue microarrays from three institutions, the control, and as the tissue present in the negative University of British Columbia (UBC), the MD control reaction (without the addition of the primary Anderson Cancer Center (MDACC), and the Leiden antibody). University Medical Center (LUMC), with a diverse selection of benign, intermediate, and malignant mesenchymal tumors were used. Each tissue micro- Digital Images array contains duplicate, triplicate, or quadruplicate 0.6 mm (UBC, LUMC), 1.5 mm (LUMC), or 2.0 mm Digital images of immunostained and H&E-stained (MDACC, LUMC) cores derived from representative tissue microarrays of UBC were acquired using a viable diagnostic areas identified by a specialized BLISS imager (Bacus Laboratories, Lombard, IL, bone and soft tissue tumor pathologist (TON, AJL, USA). A relational database was constructed that JVMGB). Tissue microarrays from UBC included in correlates scoring and identification information this study are TMA 01-003,10 TMA 03-008,11 TMA with images of each core. This information is 06-007,12 TMA 06-001B,13 TMAs 08-019, 09-006, publicly accessible at http://www.gpecimage.ubc.ca 10-009,14 TMAs 12-004, 12-005, 12-006, 12-010,15 (username: nyeso1; password: nyeso1). and TMA MPNST.16 From MDACC, myxoid liposar- coma tissue microarrays contained untreated tumors and tumors pre-treated with chemotherapy, radia- Evaluation of Immunohistochemistry tion, or a combination of both.17,18 From the LUMC, The tissue microarray slides were evaluated under a tissue microarrays were selected containing chon- drosarcomas,19,20 osteosarcomas,21 myxoid liposar- light microscope or on the scanned images by two to five independent observers (ME, MAG, TON, comas, and a variety of benign and malignant soft JVMGB, AJL), including three experienced bone and tissue tumors.22,23 soft tissue tumor subspecialty pathologists (TON, JVMGB, AJL). NY-ESO-1 immunopositivity was Immunohistochemistry scored in a semiquantitative manner for the inten- sity (0 ¼ negative, 1 ¼ weak positive, 2 ¼ moderate Immunohistochemical staining was performed with positive, 3 ¼ strong positive) and the percentage of an autostainer for tissue microarrays of the UBC positive tumor cells (0 ¼ 0%, 1 ¼ 1–25%, 2 ¼ 26– and MDACC following protocols as described pre- 50%, 3 ¼ 51–75%, 4 ¼ 76–100%). Each core on the viously.24 Briefly, antigen retrieval was performed tissue microarrays was scored separately and the Modern Pathology (2015) 28, 587–595 NY-ESO-1 in mesenchymal tumors M Endo et al 589 average score from cores of the same
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