The etiologic agent of adult T-cell leukemia (ATL) is human T cell lymphotropic virus type I (HTLV-I). The HTLV-I proteinTax alters gene expression, including those of cytokines and their receptors, which plays an important role in early stages of ATL. Here we demonstrate that expression of interleukin-9 (IL-9) is activated by Tax via an NF-B motif in its proximal promoter, whereas IL-9 receptor-␣ (IL-9R␣) expression is not induced by Tax. However, supporting a role for IL-9/IL-9R␣ in ATL, a neutralizing monoclonal antibody directed toward IL-9R␣ inhibited ex vivo spontaneous proliferation of primary ATL cells from several patients. Fluorescence-activated cell sorter analysis of freshly isolated peripheral blood mononuclear cells from these patients revealed high level expression of IL-9R␣ on their CD14-expressing monocytes. Furthermore, purified T cells or monocytes alone from these patients did not proliferate ex vivo, whereas mixtures of these cell types manifested significant proliferation through a contact-dependent manner. Taken together, our data suggest that primary ATL cells, via IL-9, support the action of IL-9R␣/CD14-expressing monocytes, which subsequently support the ex vivo spontaneous proliferation of malignant T cells. In summary, these data support a role for IL-9 and its receptor in ATL by a paracrine mechanism. (Blood. 2008; 111:5163-5172)
IntroductionAdult T-cell leukemia (ATL) is a highly aggressive neoplasm characterized by a clonal expansion of CD4 ϩ lymphocytes and by a monoclonal integration of human T cell lymphotropic virus type I (HTLV-I) provirus(es) in the tumor cells. 1,2 HTLV-I is a type C retrovirus endemic in southern Japan, the Caribbean basin, Central and Southern Africa, and South America. 3,4 Less than 5% of HTLV-I-infected persons develop either ATL or a chronic inflammatory disease of the central nervous system termed HTLV-Iassociated myelopathy/tropical spastic paraparesis (HAM/TSP). Although the precise mechanisms of ATL leukemogenesis remain unclear, it has been suggested that the transformation of T cells in the early stages of the disease is mediated by the HTLV-I Tax protein (p40). Tax activates long terminal repeat-directed transcription by recruiting members of the cAMP response element-binding/ and activating transcription factors family to the viral promoter. In addition, Tax activates other cellular transcription factors, such as NF-B. Tax is associated with the expression of cellular genes, 5 including the cytokine 6-10 and cytokine receptor genes. 7,[11][12][13] It has been suggested that the dysregulation of cytokines and their receptors in HTLV-I-infected persons may play an important role in the early course of disease via autocrine stimulation. 9,11 Interleukin-9 (IL-9) is a T cell-derived cytokine with pleiotropic activities on various cell types. 14-16 IL-9 is mainly expressed by activated CD4 ϩ T cells. 17 The functions of IL-9 are mediated through the IL-9 receptor (IL-9R), which is a member of the hematopoietin receptor superfamily. 18 The IL-9 recept...