Abstract. Aldehyde dehydrogenase (ALDH) 1 is expressed in various stem/progenitor cells, including cancer-initiating cells (CICs). In the present study, ALDH1 expression was immunohistochemically examined in diffuse large B-cell lymphoma (DLBCL). Unexpectedly, ALDH1 expression was occasionally detected in stromal cells, but not in lymphoma cells. Positively stained cells were CD68 + cells with voluminous cytoplasm and fascin + cells with reticular morphology, designated as macrophages and dendritic cells (DCs), respectively. The presence of ALDH1 + macrophages was not correlated with stage, response to therapies and prognosis. However, cases with ALDH1 + DCs were mostly nodal, which showed a poorer response to therapies and a worse overall survival rate than cases without ALDH1 + DCs. The presence of ALDH1 + DCs appears to be involved in the malignant potential of DLBCL in lymph node.
IntroductionAldehyde dehydrogenase (ALDH) 1 is a predominant isoform of the ALDH family in mammals, which oxidizes retinol to retinoic acid at the early stage of stem cell differentiation (1). ALDH1 is expressed in various stem/progenitor cells, such as hematopoietic and neural stem cells (1-3). In addition to normal tissues, a small population of tumor cells expresses ALDH1 at a high level. The ALDH1-high population of tumor cells is resistant to antitumor agents and exhibits a tumorigenic potential, suggesting that ALDH1 is one of the markers for cancer-initiating cells (CICs) (1). The presence of a large number of ALDH1-high cells is indicative of poor prognosis in cancers of the breast (1,4), lung (5), pancreas (6), bladder (7) and prostate (8).CICs were first identified in leukemia (9). Although lymphoma is the most common disease among hematologic malignancies, CICs have not yet been determined in lymphoma. In the present study, ALDH1 expression was examined in tissues involved by diffuse large B-cell lymphoma (DLBCL) to investigate the presence of CICs. Unexpectedly, no lymphoma cells expressed ALDH1. Instead, ALDH1 expression was detected in surrounding non-tumorigenic cells. Stromal cells consist of vasculature, fibroblasts and inflammatory cells, such as lymphocytes, macrophages and dendritic cells (DCs). It is well known that stromal cells affect the character of tumors (10). For example, the macrophage subpopulation named M1 produces interleukin (IL)-12 which promotes tumoricidal responses, whereas another subpopulation, named M2, produces IL-10 which aids in tumor progression (11). In the present study, ALDH1 expression in non-tumorigenic stromal cells of tissues involved by DLBCL was evaluated, and its clinical implications were examined.
Materials and methodsClinical samples. Forty-six patients, who were diagnosed with DLBCL at Osaka University Hospital during the period from April 2006 to December 2009 and whose follow-up data could be accessed, were examined. Clinicopathological findings in these 46 patients are summarized in Table I. There were 19 men and 27 women with ages ranging from 29 to 78 years (median age,...