Merkel Cell Carcinoma (MCC) is a neuroendocrine skin cancer that is diagnosed in 1500 Americans each year and has a disease-specific mortality of 46%. Multiple lines of epidemiologic and clinical data strongly link environmental ultraviolet (UV) exposure to the development of MCC. One role of UV that may contribute to the development of MCC is its immune suppressive action in the skin. Other risk factors for MCC include immune system dysfunction (e.g. HIV, organ transplant medications, chronic lymphocytic leukemia), advanced age, and a recently discovered polyomavirus (the Merkel cell polyomavirus, MCPyV). Despite the rising number of deaths from MCC and the increasing body of evidence acknowledging the importance of the immune system in preventing and controlling this cancer, the nature of the cellular immune response to the tumor remains largely uncharacterized. We hypothesize that persistently expressed MCPyV viral proteins are immunogenic to T-cells and we will investigate how this tumor escapes immune system surveillance in an immune competent host.
In Aim 1, we will define the specificity, phenotype and effector function profile of the cellular immune response to two representative MCPyV antigens in MCC patients. These studies will contribute to an ongoing effort in our lab to target MCPyV for rational immunotherapy. Extending our preliminary data, we will characterize two immune escape mechanisms that may be important for MCC initiation and progression. Studies in Aim 2 will investigate immune tolerance by antigen specific regulatory T cells (a subset of which may be UV-induced). The mechanisms and reversibility of Major Histocompatibility Complex class I (MHC-I) down-regulation will be explored in Aim 3. The studies in this proposal will capitalize on a rich repository of clinically annotated human tumor and blood samples. We are currently following the clinical status of over 300 MCC patients and in many of these cases we have blood and/or tissue samples that are archival, frozen or fresh. In addition, multi-disciplinary collaborations (including with an immunologist focused on viral skin infections) have been established to train the applicant in the relevant disciplines of immunology, molecular and cancer biology, as well as epidemiological and clinical studies pertinent to the pathogenesis of Merkel cell carcinoma. This interdisciplinary training environment is thus ideally suited for preparing the applicant for a career as a physician-scientist. In summary, these proposed translational studies will characterize MCPyV-reactive T cells and immune evasion mechanisms employed by a UV-associated skin malignancy, which is an important step for developing promising immune-based therapy for Merkel cell cancer patients.

Public Health Relevance

Lay statement: Merkel Cell Carcinoma (MCC) is a very lethal skin cancer associated with sun exposure and a newly discovered virus. MCC kills about 500 people a year in the U.S., and there are no good treatments for advanced MCC. Learning more about how the cancer interacts with the immune system and how sun exposure causes MCC may give us insight into how to design targeted treatments for MCC patients in the future.

National Institute of Health (NIH)
Individual Predoctoral NRSA for M.D./Ph.D. Fellowships (ADAMHA) (F30)
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Special Emphasis Panel (ZRG1)
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Humble, Michael C
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University of Washington
Internal Medicine/Medicine
Schools of Medicine
United States
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Chapuis, Aude G; Afanasiev, Olga K; Iyer, Jayasri G et al. (2014) Regression of metastatic Merkel cell carcinoma following transfer of polyomavirus-specific T cells and therapies capable of re-inducing HLA class-I. Cancer Immunol Res 2:27-36
Afanasiev, Olga K; Nagase, Kotaro; Simonson, William et al. (2013) Vascular E-selectin expression correlates with CD8 lymphocyte infiltration and improved outcome in Merkel cell carcinoma. J Invest Dermatol 133:2065-73
Afanasiev, Olga K; Yelistratova, Lola; Miller, Natalie et al. (2013) Merkel polyomavirus-specific T cells fluctuate with merkel cell carcinoma burden and express therapeutically targetable PD-1 and Tim-3 exhaustion markers. Clin Cancer Res 19:5351-60
Iyer, Jayasri G; Afanasiev, Olga K; McClurkan, Christopher et al. (2011) Merkel cell polyomavirus-specific CD8? and CD4? T-cell responses identified in Merkel cell carcinomas and blood. Clin Cancer Res 17:6671-80