IntroductionMultiple myeloma results from the clonal outgrowth of malignant plasma cells and is primarily confined to the bone marrow (BM). In addition to the direct effect of plasma cells on normal hematopoietic function, myeloma-induced lytic bone disease affects the majority of patients and represents a major comorbidity. [1][2][3] The interaction of malignant plasma cells with the surrounding stromal microenvironment mediated by increased receptor activator of nuclear factor-kappa B ligand (RANKL) production and reduced osteoprotegrin secretion plays a critical role in accelerating osteoclast (OC)-mediated bone resorption and destruction. 4,5 However, the putative role of additional factors of the bone destructive process is currently unknown.Immunologically, the BM possesses several unique properties. It is a reservoir of memory T cells with heightened antigen specificity 6,7 and is capable of effectively priming naive T-cell responses. 8 The non-tumor-bearing marrow also serves as a reservoir of regulatory T cells (Tregs). 9 In multiple myeloma, we have previously shown that marrow infiltrating lymphocytes (MILs) are more effectively activated and expanded, possess greater antitumor activity than peripheral blood lymphocytes (PBLs) from the same patients, and thus represent more suitable T cells for adoptive immunotherapy in this disease. 10,11 Considering these unique features of MILs, we hypothesized that factors must be present within the tumor microenvironment and absent in the non-tumor-bearing host that are critical in facilitating T-cell activation.Beyond the classic Th1 and Th2 subsets of helper T cells, Th17 T cells have recently been identified as important in the response to pulmonary and colonic bacterial infections as well as key mediators of pathology in numerous autoimmune conditions, including rheumatoid arthritis, systemic lupus erythematosis, and inflammatory bowel diseases. 12 These cells represent a newly defined lineage of T lymphocytes capable of producing interleukin-17 (IL-17) but not interferon-␥ (IFN-␥) or IL-4. As such, they are distinct from the canonical Th1 or Th2 lineages. 13 Th17 differentiation is mediated by transforming growth factor- (TGF-) and IL-6. 14 In contrast, increased levels of IL-6 suppress Treg formation. 15 The critical role of IL-6 in the suppression of Treg differentiation and promotion of Th17 differentiation 15 raises the possibility that myeloma, known to produce significant amounts of IL-6, could alter the Th17/Treg balance. Considering the role of Th17 cells in autoimmune diseases and their recent implication in the bone destruction observed in rheumatoid arthritis, 16 we sought to determine whether MILs from myeloma patients produced IL-17 and whether this T-cell population contributed to the osteolytic bone disease in multiple myeloma.
Methods
SamplesBM and PBL samples were obtained from both myeloma patients (N ϭ 68) and normal donors (N ϭ 6) under informed consent in accordance with the Declaration of Helsinki with approval from the Institutional ...