Targeted T-cell therapy is a potentially less toxic strategy than allogeneic stem cell transplantation for providing a cytotoxic antileukemic response to eliminate leukemic stem cells (LSCs) in acute myeloid leukemia (AML). However, this strategy requires identification of leukemiaassociated antigens that are immunogenic and exhibit selective high expression in AML LSCs. Using microarray expression analysis of LSCs, hematopoietic cell subpopulations, and peripheral tissues to screen for candidate antigens, cyclin-A1 was identified as a candidate gene. Cyclin-A1 promotes cell proliferation and survival, has been shown to be leukemogenic in mice, is detected in LSCs of more than 50% of AML patients, and is minimally expressed in normal tissues with exception of testis. Using dendritic cells pulsed with a cyclin-A1 peptide library, we generated T cells against several cyclin-A1 oligopeptides. Two HLA A*0201-restricted epitopes were further characterized, and specific CD8 T-cell clones recognized both peptide-pulsed target cells and the HLA A*0201-positive AML line THP-1, which expresses cyclin-A1. Furthermore, cyclin-A1-specific CD8 T cells lysed primary AML cells. Thus, cyclin-A1 is the first prototypic leukemiatestis-antigen to be expressed in AML LSCs. The pro-oncogenic activity, high expression levels, and multitude of immunogenic epitopes make it a viable target for pursuing T cell-based therapy approaches. (Blood. 2012;119(23):5492-5501)
IntroductionIt is well established that acute myeloid leukemia (AML) is organized hierarchically, initiated and maintained by a small population of cells referred to as leukemia stem cells (LSCs) that are characterized not only by unlimited reproductive capacity but also by enhanced resistance to chemotherapy and radiation. This primitive cell population, which is usually contained within a subpopulation of leukemic cells that are CD34 ϩ but lack expression of CD38 and lineage markers, is essential and adequate for long-term engraftment of primary AML cells in NOD/SCID transplantation models. [1][2][3] The LSC model suggests that, for a therapeutic anti-AML effect to be curative in patients, it will be necessary to identify strategies that efficiently eliminate the LSC compartment, which is often resistant to conventional chemotherapy.In patients with intermediate-risk, high-risk, or relapsed AML, the allogeneic T cell-mediated graft-versus-leukemia effect after hematopoietic cell transplantation (HCT) or infusion of donorderived lymphocytes in the post-HCT period has been shown to be essential for achievement of long-term remissions. [4][5][6][7] However, allogeneic HCT and unselected donor lymphocyte infusions are associated with significant toxicity because of both the conditioning regimen and the graft-versus-host activity of donor lymphocytes. An alternative strategy to provide anti-LSCs cytotoxic T lymphocytes to treat AML patients would use more targeted T-cell therapy, consisting of either adoptive transfer of T cells specific for, or vaccination against, leukemia ass...