Patients with malignancy are nearly ten times more likely to develop sepsis than the general population, and cancer represents the most common co-morbidity in septic patients. Moreover, cancer is also the co-morbidity associated with the highest risk of death in sepsis, and hospital mortality can exceed 50% in patients with cancer and either sepsis or septic shock. However, the etiology behind the increased mortality seen in cancer patients who develop sepsis compared to healthy patients who develop sepsis is not well understood. This proposal aims to understand the cellular and molecular mechanisms by which the presence of cancer increases mortality during sepsis. We have identified and characterized distinct coinhibitory receptor profiles on CD4+ T cell populations in the setting of cancer and sepsis. Importantly, these differences are functionally relevant because some coinhibitory receptor blockade strategies have fundamentally different efficacy in the setting of cancer and sepsis compared to sepsis alone. First, we found that PD-1 blockade fails to improve survival during sepsis in animals with pre-existing malignancy even though this strategy is effective in sepsis alone. The mechanisms underlying this will be investigated in this proposal. Next, we found that TIGIT blockade is effective in preventing mortality from sepsis in animals with pre-existing malignancy, but interestingly is ineffective in sepsis in previously healthy animals. These results illuminate the fact that immunologic changes occurring as a result of pre-existing malignancy can impact the responsiveness to immunotherapy for sepsis, and highlight the need to design specific immunomodulatory therapies to reverse immune dysregulation in patients with cancer and sepsis. Finally, we have identified a pathway that may be responsible for the global changes in coinhibitory receptor expression and responsiveness in cancer septic hosts. IL-27 has been shown to potently regulate the expression of multiple coinhibitory receptors on the surface of T cells in models of both cancer and autoimmunity. Our preliminary data demonstrate a profound synergistic increase in serum concentrations of IL-27 in cancer septic hosts as compared to either sepsis alone or cancer alone, demonstrating that high serum IL-27 is associated with increased coinhibitory signaling in the setting of cancer and sepsis. Thus, the overarching hypothesis of this proposal is that increased levels of IL-27 present in cancer septic hosts results in the increased expression of T cell coinhibitory molecules on distinct subsets of CD4+ T cells, both regulatory and effector, that results in functional dysregulation of immune responses and increased mortality in cancer septic hosts. Interrogation of this hypothesis will elucidate novel immunotherapeutic pathways to control T cell coinhibitory receptor expression and improve mortality and immune dysregulation in cancer septic hosts.

Public Health Relevance

Cancer is the most common comorbidity in septic patients with nearly 93,000 cases annually, and cancer is also the comorbidity associated with the highest risk of death in patients with sepsis. Our studies suggest that the presence of pre-existing malignancy results in specific immunologic alterations that may increase immune suppression following sepsis. This application is aimed at identifying which cancer-induced derangements are critical for the observed increased mortality in the setting of cancer and sepsis, in order to uncover new potential therapeutic targets to improve outcomes in a disease that is both very common and highly lethal.

Agency
National Institute of Health (NIH)
Institute
National Institute of General Medical Sciences (NIGMS)
Type
Research Project (R01)
Project #
5R01GM104323-07
Application #
9933929
Study Section
Surgery, Anesthesiology and Trauma Study Section (SAT)
Program Officer
Dunsmore, Sarah
Project Start
2013-06-01
Project End
2022-06-30
Budget Start
2020-07-01
Budget End
2021-06-30
Support Year
7
Fiscal Year
2020
Total Cost
Indirect Cost
Name
Emory University
Department
Surgery
Type
Schools of Medicine
DUNS #
066469933
City
Atlanta
State
GA
Country
United States
Zip Code
30322
Zhang, Wenxiao; Coopersmith, Craig M (2018) Dying as a Pathway to Death in Sepsis. Anesthesiology 129:238-240
Klingensmith, Nathan J; Chen, Ching-Wen; Liang, Zhe et al. (2018) Honokiol Increases CD4+ T Cell Activation and Decreases TNF but Fails to Improve Survival Following Sepsis. Shock 50:178-186
Zingarelli, Basilia; Coopersmith, Craig M; Drechsler, Susanne et al. (2018) Part I: Minimum Quality Threshold in Pre-Clinical Sepsis Studies (MQTiPSS) for Study Design And Humane Modeling Endpoints. Shock :
Fay, Katherine T; Chihade, Deena B; Chen, Ching-Wen et al. (2018) Increased mortality in CD43-deficient mice during sepsis. PLoS One 13:e0202656
Xie, Jianfeng; Robertson, Jennifer M; Chen, Ching-Wen et al. (2018) Pre-existing malignancy results in increased prevalence of distinct populations of CD4+ T cells during sepsis. PLoS One 13:e0191065
Breed, Elise R; Hilliard, Carolyn A; Yoseph, Benyam et al. (2018) The small heat shock protein HSPB1 protects mice from sepsis. Sci Rep 8:12493
Lyons, John D; Chen, Ching-Wen; Liang, Zhe et al. (2018) Murine Pancreatic Cancer Alters T Cell Activation and Apoptosis and Worsens Survival After Cecal Ligation and Puncture. Shock :
Klingensmith, Nathan J; Fay, Katherine T; Lyons, John D et al. (2018) Chronic Alcohol Ingestion Worsens Survival and Alters Gut Epithelial Apoptosis and Cd8+ T Cell Function after Pseudomonas Aeruginosa Pneumonia-Induced Sepsis. Shock :
Lorentz, C Adam; Liang, Zhe; Meng, Mei et al. (2017) Myosin light chain kinase knockout improves gut barrier function and confers a survival advantage in polymicrobial sepsis. Mol Med 23:155-165
Meng, Mei; Klingensmith, Nathan J; Coopersmith, Craig M (2017) New insights into the gut as the driver of critical illness and organ failure. Curr Opin Crit Care 23:143-148

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