HESI/FDA workshop on immunomodulators and cancer risk assessment: Building blocks for a weight-of-evidence approach.

Profound immunosuppression (e.g., AIDS, transplant therapy) is epidemiologically associated with an increased cancer risk, and often with oncogenic viruses. It is currently unclear how broadly this association translates to therapeutics that modulate immunity. A workshop co-sponsored by the FDA and HESI examined how perturbing the immune system may contribute to carcinogenesis, and highlighted priorities for improving non-clinical risk assessment of targeted immunomodulatory therapies. Conclusions from the workshop were as follows. 1) While profound altered immunity can promote tumorigenesis, not all components of the immune system are equally important in defense against or promotion of cancer and a similar cancer risk for all immunomodulatory molecules should not be assumed. 2) Rodent carcinogenicity studies have limitations and are generally not reliable predictors of cancer risk associated with immunosuppression. 3) Cancer risk needs to be evaluated based on mechanism-based weight-of-evidence, including data from immune function tests most relevant to tumor immunosurveillance or promotion. 4) Information from nonclinical experiments, clinical epidemiology and immunomodulatory therapeutics show that immunosurveillance involves a complex network of cells and mediators. To support a weight-of-evidence approach, an increased focus on understanding the quantitative relationship between changes in relevant immune function tests and cancer risk is needed.

Quantification of epitope-specific MHC class-II-restricted T cells following lymphocytic choriomeningitis virus infection.

CD4(+) T cells are critical for the control of many viruses; however, the numbers of virus-specific CD4(+) cells that are expanded following infection are unknown. We have addressed this issue by enumerating virus-specific, MHC class-II-restricted T cells following infection of mice with lymphocytic choriomeningitis virus (LCMV). We have found that the numbers of T cells that produce interferon-gamma in response to stimulation with three different class-II-restricted LCMV epitopes increase from undetectable numbers in noninfected animals to between 4 x 10(5) and 2 x 10(6) cells per spleen at the peak of the T cell response. This contrasts with the numbers of virus-specific class-I-restricted T cells which expand to 1 x 10(7) to 2 x 10(7) cells per spleen during the same time period. We could not reproducibly detect virus-specific class-I-restricted or class-II-restricted T cells that produced interleukin-4 at any time following LCMV infection, indicating that infection with this virus induces a predominantly type 1 cytokine response. In contrast to the rapid decrease in the numbers of class-I-restricted T cells, the numbers of LCMV-specific class-II-restricted T cells declined gradually following the peak of the T cell response. We demonstrate, therefore, that following infection with LCMV there is expansion of both class-I-restricted and class-II-restricted virus-specific T cells; however, the degree of expansion of class-II-restricted T cells is substantially less than that observed for class-I-restricted cells. Furthermore, the downregulation phase of the class-II-restricted response is protracted compared with the precipitous contraction of the antiviral CD8(+) T cell response.