IntroductionAdaptive immunity plays a crucial role in tumor immunosurveillance. [1][2][3] It has been shown that tumor-infiltrating effector T cells are associated with improved prognoses in multiple human cancers, 4-6 whereas tumor-infiltrating regulatory T (Treg) cells are negatively associated with patient outcome. 6,7 Th17 cells are newly identified effector CD4 ϩ T cells. Th17 cells and interleukin-17 (IL-17) play an active role in inflammation and autoimmune diseases. [8][9][10][11][12][13][14][15] Th17 cells are found in both mouse and human tumors. 16,17 However, the biologic role of Th17 cells is poorly understood in the tumor microenvironment. In this report, we examined the phenotype, cytokine profile, generation, functional relevance, and immunologic and clinical predictive values of Th17 cells in 201 patients with ovarian cancers. We provide novel insight into the nature of Th17 cells in the tumor microenvironment in patients with cancer. This information may be useful for designing more effective cancer immunotherapies.
Methods
Human subjectsWe studied previously untreated patients with 201 ovarian carcinomas. Survival data were available for 85 patients (supplemental Table 1, available on the Blood website; see the Supplemental Materials link at the top of the online article). Patients gave written, informed consent in accordance with the Declaration of Helsinki. The study was approved by the University of Michigan Institutional Review Board.
Cells and tissuesCells and tissues were obtained from ascites, blood, lymph nodes, and tumors as we described. 16,18,19 Immune cells, including monocytes, macrophages, myeloid dendritic cells, plasmacytoid dendritic cells, and T-cell subsets, were enriched using paramagnetic beads (StemCell Technologies) and sorted with FACSAria (Becton Dickinson) as we described. 16,18,19 Cell purity was more than 98% as confirmed by flow cytometry (LSR II; Becton Dickinson).
FACSFor cytokine detection, the cells were stimulated with phorbol myristate acetate (50 ng/mL; Sigma-Aldrich), ionomycin (1 M; Sigma-Aldrich) for 4 hours before staining. Cells were first stained extracellularly with specific antibodies against human CD3, CD4, CD8, CD11b, CD11c, CD14, CD15, CD16, CD19, CD25, CD39, CD45, CD45RO, CD49a, CD49c, CD49d, CD49e, CD56, CD123, CD161, PD-1, CCR4, CCR6, CCR7, CXCR4, HLA-DR, and annexin V (BD Biosciences), CCR2, CXCR3, and CCR5 (R&D Systems), EpCam (StemCell Technologies), then were fixed and permeabilized with Perm/Fix solution (eBioscience), and finally were stained intracellularly with anti-IL-2, anti-IL-10, anti-IL-17, anti-tumor necrosis factor-␣, anti-interferon-␥ (IFN-␥), anti-Granzyme A, anti-Ki-67, and anti-FOXP3 (all from BD Biosciences, except anti-IL-17, eBioscience). Samples were acquired on a LSR II (BD Biosciences), and data were analyzed with DIVA software (BD Biosciences).
Th17 induction and suppressionFresh peripheral blood and tumor-associated CD14 ϩ macrophages were sorted 19 and cocultured with T cells as indicated for 3 to 5 days in the An In...