IntroductionProgrammed death-1 (PD-1), a member of the CD28 costimulatory receptor superfamily, inhibits T-cell activity by providing a second signal to T cells in conjunction with signaling through the T-cell receptor. 1 To date, B7-H1 and B7-DC have been identified as ligands for PD-1 (PD-Ls). During chronic viral infection, PD-1 is selectively up-regulated by the exhausted T cells, and blockade of this pathway restores CD8 ϩ T-cell function and reduces viral load. 2 This signaling system has been recently highlighted in the research of human immunodeficiency virus (HIV) infection. [3][4][5][6] In addition, PD-1 is indicated to be involved in the evasion of tumor immunity. [7][8][9][10] Hodgkin lymphoma (HL) is characterized by massive reactive infiltrates surrounding Hodgkin/Reed-Sternberg (H/RS) cells. HL patients are well recognized as having defective cellular immunity; they are susceptible to bacterial, fungal, and viral infections, and in vitro studies show depressed T-cell proliferation and reduced synthesis of Th1 cytokines. 11 We report here that PD-1-PD-L signaling system is operative in patients with HL, and tumor-infiltrating T cells around H/RS cells seem to be kept in balance by this inhibitory signaling. Our findings illuminate the mechanism for deficient cellular immunity observed in HL patients, and propose a potentially effective immunologic strategy for the treatment of HL. Methods Cell lines and clinical sample preparationThe following cell lines were described previously 12,13 : HL cell lines KM-H2, L428, and HDLM-2; anaplastic large cell lymphoma (ALCL) cell line DEL; follicular lymphoma cell line FL-218; diffuse large B-cell lymphoma (DLBCL) cell line KIS-1; Burkitt lymphoma cell lines Daudi, Raji, Middle 91, Tree 92, and Ramos; adult T-cell leukemia/lymphoma cell line HUT 102; and acute T-cell leukemia cell line Jurkat. LCL-OHN is an Epstein-Barr virus (EBV)-transformed lymphoblastoid B-cell line (LCL). Peripheral blood samples were collected from 19 HL patients, 12 B-NHL patients, and 11 healthy volunteers after informed consent was obtained in accordance with the Declaration of Helsinki. This study is approved by the institutional review board of Kyoto University. After removing red blood cells using ACK lysis buffer, leukocytes were subjected to flow cytometry. For immunohistochemistry, tissue specimens were snap-frozen in OCT compound (TissueTek, Tokyo, Japan) and stored at Ϫ80°C. Reverse transcription-polymerase chain reaction, flow cytometry, and immunohistochemistryTotal RNA was isolated from cells with Trizol (Invitrogen, Carlsbad, CA), and cDNA was synthesized using MultiScribe Reverse Transcriptase (Applied Biosystems, Foster City, CA). PCR assays were performed by the conventional method using Taq polymerase (TaKaRa Biotechnology, Shiga, Japan). For flow cytometry, cells were analyzed on a FACScan (Becton Dickinson, Mansfield, MS). The following antibodies were used: PEconjugated B7-H1 and B7-DC (eBioscience, San Diego, CA), FITC-PD-1 (BD Pharmingen, San Diego, CA), PC5-CD4 a...

Accumulating evidences indicate that ceramide is closely involved in apoptotic cell death in neurodegenerative disorders and aging. We examined ceramide levels in the cerebrospinal fluid (CSF) or brain tissues from patients with neurodegenerative disorders and the mechanism of how intra- and extracellular ceramide was regulated during neuronal apoptosis. We screened the ceramide levels in the CSF of patients with neurodegenerative disorders, and found that ceramide was significantly increased in patients with Alzheimer's disease (AD) than in patients with age-matched amyotrophic lateral sclerosis (ALS) and other neurological controls. With immunohistochemistry in AD brains, ceramide was aberrantly expressed in astroglia in the frontal cortices, but not detected in ALS and control brains. To explore for the regulation of ceramide in astroglia in Alzheimer's disease brains, we examined the metabolism of ceramide during neuronal apoptosis. In retinoic acid (RA)-induced neuronal apoptosis, RA slightly increased de novo synthesis of ceramide, but interestingly, RA dramatically inhibited conversion of [14C] ceramide to glucosylceramide (GlcCer), suggesting that the increase of ceramide mass is mainly due to inhibition of the ceramide-metabolizing enzyme GlcCer synthase. In addition, a significant increase of the [14C] ceramide level in the culture medium was detected by chasing and turnover experiments without alteration of extracellular [14C] sphingomyelin levels. A 2.5-fold increase of ceramide mass in the supernatant was also detected after 48 h of treatment with RA. These results suggest a regulatory mechanism of intracellular ceramide through inhibition of GlcCer synthase and a possible role of ceramide as an extracellular/intercellular mediator for neuronal apoptosis. The increased ceramide level in the CSF from AD patients, which may be derived from astroglia, raises a possibility of neuronal apoptosis by the response to intercellular ceramide in AD.

Key Points• Auto-HSCT in CR1 provides long-term remission in BPDCN patients.• RIC allo-HSCT and MAC allo-HSCT results are comparable.We sought to clarify the role of high-dose chemotherapy followed by autologous hematopoietic stem cell transplantation (auto-HSCT) and allogeneic hematopoietic stem cell transplantation (allo-HSCT) to treat blastic plasmacytoid dendritic cell neoplasm (BPDCN). We retrospectively identified 25 BPDCN patients (allo-HSCT, n 5 14; auto-HSCT, n 5 11) from registry data of the Japan Society for Hematopoietic Cell Transplantation and analyzed clinicopathologic data and clinical outcomes after transplantation. The median age at HSCT was 58 years (range, 17-67 years). All 11 patients who underwent auto-HSCT were in the first complete remission (CR1). With a median follow-up of 53.5 months, the overall survival rates at 4 years for patients who underwent auto-HSCT and allo-HSCT were 82% and 53% (P 5 .11), respectively, and progression-free survival rates were 73% and 48% (P 5 .14), respectively. Auto-HSCT for BPDCN in CR1 appears to provide promising results and deserves further evaluation in the setting of prospective trials. (Blood. 2015;125(23):3559-3562)

Transplantation-associated thrombotic microangiopathy (TA-TMA) is a devastating complication of hematopoietic stem cell transplantation. TA-TMA likely represents the final stage of vascular endothelial injury; however, its pathophysiology is largely unknown, making clinical management difficult. Recently, the association of neutrophil extracellular traps (NETs) with the development of thrombotic thrombocytopenic purpura and hemolytic uremic syndrome has been reported. Thus, we explored whether NETs are also relevant to the occurrence of TA-TMA. We retrospectively analyzed post-transplant trends of serum NET levels in 90 patients, 11 of whom developed TA-TMA. Relative to baseline (before the conditioning regimen), elevated serum NET levels either at 4 weeks after transplantation or as early as the day of transplantation were associated with significantly increased risk of TA-TMA. In contrast, thrombomodulin, a potential marker for TA-TMA, was not helpful to predict the occurrence of TA-TMA in our study. In addition, we directly detected glomerular deposition of NETs in 2 TA-TMA patients. Increased NET levels are a significant risk factor for TA-TMA, suggesting that NET level is a useful biomarker for TA-TMA.

Our data demonstrate that patients in the EBVMCU, a specific clinical subgroup of MTX-LPD, had a better clinical outcome when MTX was withdrawn than did other patients with MTX-LPD.