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CO-SIGNALING MOLECULES AND ANTITUMOR IMMUNITY IN AGING
Co-signaling signals are essential for the augmentation of APC-mediated T cell responses in
antitumor immunity. For example, expression of CD80 (B7.1) and CD86 (B7.2) on APCs or
tumor cells is crucial for promoting antitumor T cell responses.82 Several studies have
demonstrated decreased expression of these co-signaling molecules on aged DCs, which
may contribute to the reduced capacity for T cell stimulation by DCs during aging.73,74
Lustgarten et al. investigated whether CD80 expression on tumor cells was important for the
enhancement of antitumor responses in aged mice. Immunization with the foreign protein
enhanced GFP (EGFP)-expressing BM-185 pre-B-cell lymphoma cells (BM-185-EGFP)
yielded an antitumor immune response in young, but not in aged, mice. However,
immunization with CD80-expressing BM-185-EGFP tumor cells (BM-185-EGFP-CD80)
yielded an antitumor immune response in both young and aged mice, although the tumor
rejection was lower in aged mice compared with young mice.83
There is increasing evidence that several other members of the TNFR family, including
OX40 (CD134), 4-1BB (CD137), CD27, and CD30, may be important as secondary costimulatory
molecules when co-signaling molecules are reduced and insufficient for T cell
stimulation during aging. In studies evaluating the effect of additional OX40 signaling in
antitumor immune responses in aged mice, immunization with BM-185-EGFP-CD80 in
combination with an anti-OX40 mAb markedly improved antitumor response in aged
mice.83 Similarly, an apoptotic tumor cell-pulsed DC vaccine in combination with an anti-
OX40 mAb significantly enhanced the antitumor immune response in aged mice.84
Interestingly, Ruby and Weinberg investigated the efficacy of an anti-OX40 mAb alone in
middle-aged and elderly sarcoma-tumor-bearing mice, and confirmed that the administration
of the mAb to these mice significantly reduced antitumor efficacy because of the decreased
number of differentiated T cells, and was not due to an alteration of the surface expression
of OX40 on T cells.85,86 Furthermore, administration of the anti-OX40 mAb in combination
with IL-12, a cytokine that is essential for T cell differentiation, partially restored the
deficiency in OX40-mediated antitumor efficacy in older mice. 4-1BB is also a member of
the TNFR family that is expressed on activated T cells and co-stimulates both CD4 and CD8
T cells. In particular, Bansal- Pakala and Croft reported that the administration of an agonist
Ab to 4-1BB rescued defective T cell priming in aged mice.87
Similarly, Sharma et al. revealed that apoptotic tumor cell-pulsed DC vaccination in
combination with an anti-4-1BB mAb significantly enhanced the antitumor immune
response in aged mice.84 These results suggest that the insufficient antitumor immune
responses in aging may be restored by the efficient expression of co-stimulatory signals.
V. TLRS AND ANTITUMOR IMMUNITY IN AGING
Recent studies have revealed that innate immune responses and adaptive immune responses
collaborate to induce a strong antitumor immune response. For example, the mediation of
innate immune responses by members of the Toll-like receptor (TLR) family results in the
subsequent induction of protective adaptive immune responses in antitumor immunity.88,89
Several studies have demonstrated that advancing age may affect the expression and
function of TLRs, and the response to TLR ligands in the innate immune system. Renshaw
et al. reported that aged splenic and peritoneal macrophages express significantly lower
levels of TLRs and secrete significantly lower levels of cytokines after stimulation with
various TLR ligands.90 Previous studies have shown that CpG-ODN stimulates
plasmacytoid DCs to produce type I interferons (IFN ¦Á and ¦Â), which inhibit the synthesis of
Th2 cytokines by CD4 T cells and induce IL-4-inhibited Th1 cells to synthesize IL-2, IL-12,
and IFN-¦Ã. In turn, these induce NK cells, NKT cells, and CTLs in the antitumor immune
responses.91 Sharma et al. reported that the intratumoral injection of CpG-ODN yielded
complete rejection of in vivo tumors in both young and old mice; however, injection of poly
I:C exhibited in vivo tumor rejection only in young mice.92 The authors also revealed that
the induction of the antitumor immune response by in vivo challenge with CpG-ODN, but
not poly I:C in old mice, was correlated with the upregulation of pro-inflammatory cytokine
secretion, significant accumulation of CD4 T cells, CD8 T cells, NK cells, and APCs within
the tumor, and reduction of the number of Tregs within the tumor. These results indicate that
the efficacy of TLR ligands in antitumor immunity may be reduced during the aging
process. Moreover, there is a difference in capacity to induce immune responses among the
various TLR ligands in the old mice.92 It appears that CpG-ODN may constitute a possible
therapeutic approach to overcome the age-associated immune defects in cancer
immunotherapy and restore the antitumor immune response in the elderly.
VI. IMMUNOSUPPRESSIVE CELLS AND ANTITUMOR IMMUNITY IN AGING
Advancing age may alter the prevalence and function of immune suppressive cells such as
CD4+ CD25+FoxP3+ regulatory T cells (Tregs) and myeloid-derived suppressor cells
(MDSCs). Tregs accumulate in tumor-bearing hosts and play fundamental roles in blocking
antitumor immune responses.93,94 MDSCs, a heterogeneous population comprised of
immature myeloid cells, accumulate within sites of cancer, inflammation, and infection,95,96
and have a strong capability to suppress both adaptive and innate immune responses.
Accumulating evidence has revealed that the elimination of either population in a tumorbearing
host may contribute to enhanced antitumor immune responses.
Whereas the age-dependent changes in the number of Tregs and their function remain
controversial, 30 several studies have suggested that Tregs accumulate with age and are
involved in the age-associated immune dysfunction. Gregg et al. reported that the number of
human peripheral blood Tregs increases with age, whereas the function of these cells is
comparable between the young and the old.97 Sharma et al. reported that the increased
frequency of Tregs in aged mice prevented the cytotoxic T cell response in aged tumorbearing
mice.98 Pan et al. also showed that the accumulation of Tregs in aged humans and
mice was closely associated with lung tumor burden.99 Further studies will be required to
test Treg frequency and functions in the periphery versus within the tumor itself, and the
impact on clinical outcome.
Similar to the Tregs, it has been demonstrated that the decline of antitumor T cell function in
aged animal is also correlated with the accumulation of MDSCs with age. Grizzle et al.
revealed that MDSCs are increased in the spleen of aged mice, and that adoptive transfer of
these aged MDSCs delayed tumor rejection significantly in young tumor-bearing mice
Similarly, Sharma et al. revealed that apoptotic tumor cell-pulsed DC vaccination in
combination with an anti-4-1BB mAb significantly enhanced the antitumor immune
response in aged mice.84 These results suggest that the insufficient antitumor immune
responses in aging may be restored by the efficient expression of co-stimulatory signals.
Tomihara et al. Page 5
Crit Rev Oncog. Author manuscript; available in PMC 2014 March 20.
NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript
V. TLRS AND ANTITUMOR IMMUNITY IN AGING
Recent studies have revealed that innate immune responses and adaptive immune responses
collaborate to induce a strong antitumor immune response. For example, the mediation of
innate immune responses by members of the Toll-like receptor (TLR) family results in the
subsequent induction of protective adaptive immune responses in antitumor immunity.88,89
Several studies have demonstrated that advancing age may affect the expression and
function of TLRs, and the response to TLR ligands in the innate immune system. Renshaw
et al. reported that aged splenic and peritoneal macrophages express significantly lower
levels of TLRs and secrete significantly lower levels of cytokines after stimulation with
various TLR ligands.90 Previous studies have shown that CpG-ODN stimulates
plasmacytoid DCs to produce type I interferons (IFN ¦Á and ¦Â), which inhibit the synthesis of
Th2 cytokines by CD4 T cells and induce IL-4-inhibited Th1 cells to synthesize IL-2, IL-12,
and IFN-¦Ã. In turn, these induce NK cells, NKT cells, and CTLs in the antitumor immune
responses.91 Sharma et al. reported that the intratumoral injection of CpG-ODN yielded
complete rejection of in vivo tumors in both young and old mice; however, injection of poly
I:C exhibited in vivo tumor rejection only in young mice.92 The authors also revealed that
the induction of the antitumor immune response by in vivo challenge with CpG-ODN, but
not poly I:C in old mice, was correlated with the upregulation of pro-inflammatory cytokine
secretion, significant accumulation of CD4 T cells, CD8 T cells, NK cells, and APCs within
the tumor, and reduction of the number of Tregs within the tumor. These results indicate that
the efficacy of TLR ligands in antitumor immunity may be reduced during the aging
process. Moreover, there is a difference in capacity to induce immune responses among the
various TLR ligands in the old mice.92 It appears that CpG-ODN may constitute a possible
therapeutic approach to overcome the age-associated immune defects in cancer
immunotherapy and restore the antitumor immune response in the elderly.
VI. IMMUNOSUPPRESSIVE CELLS AND ANTITUMOR IMMUNITY IN AGING
Advancing age may alter the prevalence and function of immune suppressive cells such as
CD4+ CD25+FoxP3+ regulatory T cells (Tregs) and myeloid-derived suppressor cells
(MDSCs). Tregs accumulate in tumor-bearing hosts and play fundamental roles in blocking
antitumor immune responses.93,94 MDSCs, a heterogeneous population comprised of
immature myeloid cells, accumulate within sites of cancer, inflammation, and infection,95,96
and have a strong capability to suppress both adaptive and innate immune responses.
Accumulating evidence has revealed that the elimination of either population in a tumorbearing
host may contribute to enhanced antitumor immune responses.
Whereas the age-dependent changes in the number of Tregs and their function remain
controversial, 30 several studies have suggested that Tregs accumulate with age and are
involved in the age-associated immune dysfunction. Gregg et al. reported that the number of
human peripheral blood Tregs increases with age, whereas the function of these cells is
comparable between the young and the old.97 Sharma et al. reported that the increased
frequency of Tregs in aged mice prevented the cytotoxic T cell response in aged tumorbearing
mice.98 Pan et al. also showed that the accumulation of Tregs in aged humans and
mice was closely associated with lung tumor burden.99 Further studies will be required to
test Treg frequency and functions in the periphery versus within the tumor itself, and the
impact on clinical outcome.
Similar to the Tregs, it has been demonstrated that the decline of antitumor T cell function in
aged animal is also correlated with the accumulation of MDSCs with age. Grizzle et al.
revealed that MDSCs are increased in the spleen of aged mice, and that adoptive transfer of
these aged MDSCs delayed tumor rejection significantly in young tumor-bearing mice.100
Tomihara et al. Page 6
Crit Rev Oncog. Author manuscript; available in PMC 2014 March 20.
NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript
More recently, the proportion of MDSCs was found to be elevated significantly in elderly
patients with a history of cancer.101
Importantly, a number of pro-inflammatory cytokines that are required for the differentiation
of MDSCs (e.g., TNF-¦Á, IL-6, and IL-1¦Â) are increased in the old,101,102 suggesting that the
age-related inflammatory milieu possibly promotes the accumulation and activation of
MDSCs that subsequently could contribute to the increased aging-associated cancer
incidence. Interestingly, it is possible to note a mutual interaction between the Treg cells and
the MDSCs. In fact, MDSC contributes to Treg induction in cancer, but, in turn, Tregs may
regulate MDSC expansion with a mechanism of positive feedback. In support, our group
reported an age-specific inverse correlation between the prevalence of Tregs and MDSCs.103
We examined the antitumor response to Treg depletion in the B16 melanoma model and
revealed that Treg depletion alone using denileukin diftitox (DT) exerted therapeutic effects
only in young mice but not aged mice. Furthermore, Treg depletion using DT in aged mice
resulted in an increased number of MDSCs. MDSC depletion in combination with Treg
depletion restored the impaired efficacy of Treg depletion in aged mice, suggesting that
Tregs control the prevalence of MDSCs in aged mice and that Treg depletion in combination
with MDSC depletion may be an effective cancer immune therapy approach for the elderly.
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