Aberrant tryptophan metabolism leads to unfavorable outcomes in lenalidomide‐treated myeloma patients

Indoleamine 2,3‐dioxygenase 1 (IDO), an enzyme that metabolizes tryptophan (Trp) to kynurenine (Kyn), is an important microenvironmental factor suppressing antitumor immunity. Here, we investigated the clinical impact of aberrant Trp metabolism in patients with multiple myeloma (MM) treated with len...

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Published in:Hematological oncology 2023-08, Vol.41 (3), p.424-433
Main Authors: Asano, Arisa, Ri, Masaki, Masaki, Ayako, Maeda, Yasuhiro, Tachita, Takuto, Hirade, Kentaro, Marumo, Yoshiaki, Nakashima, Takahiro, Hagiwara, Shinya, Kinoshita, Shiori, Suzuki, Tomotaka, Narita, Tomoko, Kusumoto, Shigeru, Komatsu, Hirokazu, Inagaki, Hiroshi, Iida, Shinsuke
Format: Article
Language:English
Subjects:
Cell culture
Dexamethasone
Dioxygenase
IDO
Immunity
Immunotherapy
Kyn/Trp
lenalidomide
Lymphocytes
Lymphocytes T
Medical prognosis
Metabolism
Multiple myeloma
stromal cell
Stromal cells
Survival
Targeted cancer therapy
Tryptophan
Tumors
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Summary:Indoleamine 2,3‐dioxygenase 1 (IDO), an enzyme that metabolizes tryptophan (Trp) to kynurenine (Kyn), is an important microenvironmental factor suppressing antitumor immunity. Here, we investigated the clinical impact of aberrant Trp metabolism in patients with multiple myeloma (MM) treated with lenalidomide (Len) and evaluated its effects on T cell immunity ex vivo. Kyn and Trp concentrations were quantified in sera from 72 patients with relapsed or refractory MM prior to the initiation of therapy with Len plus dexamethasone (Ld). Associations of the Kyn/Trp ratio with progression‐free survival (PFS) and overall survival (OS) were analyzed. The expressions of IDO in tumor and stromal cells were evaluated during co‐culture, and the effects of culture medium containing low Trp and high Kyn concentrations on T cells in the presence of Len were investigated. Patients with high serum Kyn/Trp ratios (≥46.0, n = 22) had significantly shorter PFS and OS than those with low ratios (4.9 vs. 12.6 months, and 15.5 vs. 45.7 months, respectively). MM cells promoted IDO expression in stromal cells during co‐culture in both a direct contact and an indirect manner. Incubation in medium with a high Kyn/Trp ratio significantly inhibited T cell cytokine production and upregulated the expression of inhibitory immune receptors. These effects were sustained even in the presence of Len. In conclusion, a high serum Kyn/Trp ratio is associated with poor prognosis in patients with MM. We propose that aberrant Trp metabolism reduces anti‐tumor immunity and the efficacy of Len therapy.
ISSN:0278-0232
1099-1069
DOI:10.1002/hon.3108