Name: monitoring pd-1-blocking antibodies bound to t cells derived from a drop of peripheral blood
Uploaded: 2020-02-05T13:00:00
Description: Watch this Scientific Journal Video about Monitoring PD-1-Blocking Antibodies Bound to T Cells Derived from a Drop of Peripheral Blood at JoVE.com

This work was supported by grants to S.K. from the Japan Society for the Promotion of Science KAKENHI (JP17K16045) and the Japan Agency for Medical Research and Development (JP18cm0106335 and 19cm0106310).

Sampling was performed during routine clinical procedures. All human samples were obtained after informed consent was provided by the subjects, in accordance with the Declaration of Helsinki and with the approval of the ethical review board of the Graduate School of Medicine, Osaka University, Japan (15383 and 752).
1. Whole Blood Sample Preparation and Staining
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	<li>Collect whole blood samples into blood collection tubes containing ethylene diamine tetra-acetic acid (EDTA). 
	NOTE...

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	<li>Gong, J., Chehrazi-Raffle, A., Reddi, S., Salgia, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Development+of+PD-1+and+PD-L1+inhibitors+as+a+form+of+cancer+immunotherapy:+a+comprehensive+review+of+registration+trials+and+future+considerations.">Development of PD-1 and PD-L1 inhibitors as a form of cancer immunotherapy: a comprehensive review of registration trials and future considerations.</a> Journal for ImmunoTherapy of Cancer. 6 (1), 8 (2018).</li><li>Borghaei, H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Nivolumab+versus+Docetaxel+in+Advanced+Nonsquamous+Non-Small-Cell+Lung+Cancer.">Nivolumab versus Docetaxel in Advanced Nonsquamous Non-Small-Cell Lung Cancer.</a> The New England Journal of Medicine. 373 (17), 1627-1639 (2015).</li><li>Brahmer, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Nivolumab+versus+Docetaxel+in+Advanced+Squamous-Cell+Non-Small-Cell+Lung+Cancer.">Nivolumab versus Docetaxel in Advanced Squamous-Cell Non-Small-Cell Lung Cancer.</a> The New England Journal of Medicine. 373 (2), 123-135 (2015).</li><li>Herbst, R. S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Pembrolizumab+versus+docetaxel+for+previously+treated,+PD-L1-positive,+advanced+non-small-cell+lung+cancer+(KEYNOTE-010):+a+randomised+controlled+trial.">Pembrolizumab versus docetaxel for previously treated, PD-L1-positive, advanced non-small-cell lung cancer (KEYNOTE-010): a randomised controlled trial.</a> The Lancet. 387 (10027), 1540-1550 (2016).</li><li>Postow, M. A., Sidlow, R., Hellmann, M. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Immune-Related+Adverse+Events+Associated+with+Immune+Checkpoint+Blockade.">Immune-Related Adverse Events Associated with Immune Checkpoint Blockade.</a> The New England Journal of Medicine. 378 (2), 158-168 (2018).</li><li>Weber, J. S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Safety+Profile+of+Nivolumab+Monotherapy:+A+Pooled+Analysis+of+Patients+With+Advanced+Melanoma.">Safety Profile of Nivolumab Monotherapy: A Pooled Analysis of Patients With Advanced Melanoma.</a> Journal of Clinical Oncology. 35 (7), 785-792 (2017).</li><li>Champiat, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Management+of+immune+checkpoint+blockade+dysimmune+toxicities:+a+collaborative+position+paper.">Management of immune checkpoint blockade dysimmune toxicities: a collaborative position paper.</a> Annals of Oncology. 27 (4), 559-574 (2016).</li><li>Brahmer, J. R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Phase+I+study+of+single-agent+anti-programmed+death-1+(MDX-1106)+in+refractory+solid+tumors:+safety,+clinical+activity,+pharmacodynamics,+and+immunologic+correlates.">Phase I study of single-agent anti-programmed death-1 (MDX-1106) in refractory solid tumors: safety, clinical activity, pharmacodynamics, and immunologic correlates.</a> Journal of Clinical Oncology. 28 (19), 3167-3175 (2010).</li><li>Bommareddy, P. K., Lowe, D. B., Kaufman, H. L., Rabkin, S. D., Saha, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Multi-parametric+flow+cytometry+staining+procedure+for+analyzing+tumor-infiltrating+immune+cells+following+oncolytic+herpes+simplex+virus+immunotherapy+in+intracranial+glioblastoma.">Multi-parametric flow cytometry staining procedure for analyzing tumor-infiltrating immune cells following oncolytic herpes simplex virus immunotherapy in intracranial glioblastoma.</a> Journal of Biological Methods. 6 (2), 112 (2019).</li><li>Osa, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Clinical+implications+of+monitoring+nivolumab+immunokinetics+in+non-small+cell+lung+cancer+patients.">Clinical implications of monitoring nivolumab immunokinetics in non-small cell lung cancer patients.</a> JCI Insight. 3 (19), 59125 (2018).</li><li>Zelba, H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Accurate+quantification+of+T-cells+expressing+PD-1+in+patients+on+anti-PD-1+immunotherapy.">Accurate quantification of T-cells expressing PD-1 in patients on anti-PD-1 immunotherapy.</a> Cancer Immunology, Immunotherapy. 67 (12), 1845-1851 (2018).</li><li>Simoni, Y., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Bystander+CD8(+)+T+cells+are+abundant+and+phenotypically+distinct+in+human+tumour+infiltrates.">Bystander CD8(+) T cells are abundant and phenotypically distinct in human tumour infiltrates.</a> Nature. 557 (7706), 575-579 (2018).</li><li>Chiu, H. H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Development+of+a+general+method+for+quantifying+IgG-based+therapeutic+monoclonal+antibodies+in+human+plasma+using+protein+G+purification+coupled+with+a+two+internal+standard+calibration+strategy+using+LC-MS/MS.">Development of a general method for quantifying IgG-based therapeutic monoclonal antibodies in human plasma using protein G purification coupled with a two internal standard calibration strategy using LC-MS/MS.</a> Analytica Chimica Acta. 1019, 93-102 (2018).</li></ol>

In this article, we report a method using a flow cytometer to detect PD-1&#8211;blocking antibodies bound to T cells derived from a drop of peripheral blood, which we originally developed for nivolumab detection10. Although this technique is very simple and easy to perform, two important points should be noted in order to obtain accurate results. One is that to detect PD-1 molecules, an appropriate antibody that competes with nivolumab and pembrolizumab should be used. This issue was evaluated in ...

PD-1&#8211;blocking antibodies have become the standard choice for treatment of various types of cancer, including non-small cell lung cancer (NSCLC)1,2,3,4. They show a remarkable therapeutic effect in a subset of cancer patients who have not responded to conventional cytotoxic chemotherapies. However, immune checkpoint inhibitors (ICIs), which include PD-1&#8211;blocking antibodies, can cause a unique and distinct spectrum of adverse events, termed immune-related adverse events (irAEs)5. Although irAEs can affect almost all tissues, they are most commonly observed in the gastrointestinal tract, endocrine glands, skin, and liver, and they can cause pruritus, rash, nausea, diarrhea, and thyroid disorders6,7. In general, most irAEs appear within 1 to 2 months after the initiation of ICIs. However, in some cases, they can occur later than 1 year after the beginning of treatment or even after treatment cessation6,7. They also cause various symptoms that may be difficult to discriminate from other pathologies. Thus, it can be challenging to promptly diagnose irAEs and treat them appropriately. irAEs can affect all tissues, and their onset is strongly influenced by circulating immune cells, especially T cells bound to PD-1&#8211;blocking antibodies. Therefore, a straightforward and minimally invasive method to monitor antibody-targeted T cells is important in clinical settings.
Here, we developed a simple method to assess the binding of PD-1&#8211;blocking antibodies to T cells using a drop of peripheral whole blood from cancer patients who received nivolumab or pembrolizumab. Using this approach, we were able to monitor each of the following: 1) the duration of antibody binding to T cells, 2) the occupancy of T cell PD-1 molecules by therapeutic antibodies, and 3) the activation status and immunological features of T cells. This method is a modification of a previously reported technique8. The amount of blood required is almost the same as that needed for a glucose test, and the approach does not require mononuclear cell enrichment or co-culturing with PD-1&#8211;blocking antibodies. We confirmed that this method can also be performed using frozen samples, including peripheral blood mononuclear cells (PBMCs) and cells from pleural effusion, pericardial effusion, bronchoalveolar lavage fluid, and cerebrospinal fluid, suggesting that this strategy may be useful in the context of a multicenter study. This method may facilitate the early diagnosis of irAEs, and also help to determine the appropriate immunosuppressive treatments to control their symptoms and to identify the optimal times to initiate subsequent therapies after PD-1 inhibitors.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>10X RBC Lysis Buffer (Multi-species)</td>
			<td>Thermo Fisher Scientific</td>
			<td>00-4300-54</td>
			<td>50 mL</td>
		</tr>
		<tr>
			<td>APC/Cyanine7 anti-human CD4 Antibody</td>
			<td>BioLegend</td>
			<td>300518</td>
			<td>Clone RPA-T4</td>
		</tr>
		<tr>
			<td>BD FACS Canto II Flow Cytometer</td>
			<td>BD</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Brilliant Violet 510 anti-human CD8a Antibody</td>
			<td>BioLegend</td>
			<td>301048</td>
			<td>Clone RPA-T8</td>
		</tr>
		<tr>
			<td>Dulbecco&#39;s Phosphate Buffered Saline</td>
			<td>nacalai tesque</td>
			<td>14249-95</td>
			<td>500 mL</td>
		</tr>
		<tr>
			<td>Falcon Round-Bottom Polystyrene Tubes</td>
			<td>STEMCELL Technologies</td>
			<td>352058</td>
			<td>5 mL</td>
		</tr>
		<tr>
			<td>FcR Blocking Reagent, human</td>
			<td>Miltenyi Biotec</td>
			<td>130-059-901</td>
			<td>2 mL</td>
		</tr>
		<tr>
			<td>FLOWJO</td>
			<td>BD</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Gibco Fetal Bovine Serum</td>
			<td>Thermo Fisher Scientific</td>
			<td>12676029</td>
			<td>500 mL</td>
		</tr>
		<tr>
			<td>Mouse IgG1 monoclonal - Isotype control</td>
			<td>abcam</td>
			<td>ab81200</td>
			<td></td>
		</tr>
		<tr>
			<td>Mouse monoclonal Anti-Human IgG4 Fc</td>
			<td>abcam</td>
			<td>ab99825</td>
			<td>Clone HP6025</td>
		</tr>
		<tr>
			<td>Pacific Blue Mouse Anti-Human CD3</td>
			<td>BD</td>
			<td>558117</td>
			<td>Clone UCHT1</td>
		</tr>
		<tr>
			<td>PE-Cy7 Mouse anti-Human CD279 (PD-1)</td>
			<td>BD</td>
			<td>561272</td>
			<td>Clone EH12.1</td>
		</tr>
		<tr>
			<td>PE-Cy7 Mouse IgG1 &#954; Isotype Control</td>
			<td>BD</td>
			<td>557646</td>
			<td></td>
		</tr>
	</tbody>
</table>

monitoring pd-1-blocking antibodies bound to t cells derived from a drop of peripheral blood

Immune checkpoint inhibitors, including PD-1&#8211;blocking antibodies, have significantly improved treatment outcomes in various types of cancer. The pharmacological efficacy of these immunotherapies is long lasting, extending even beyond the discontinuation of their injections, due to persistent blood concentrations. Here we developed a simple flow cytometry assay to evaluate the T cell binding status of the PD-1&#8211;blocking antibodies nivolumab and pembrolizumab. Like a glucose test, this assay requires just a single drop of peripheral blood. Visualizing antibody binding on T cells is more reliable than measuring antibody blood concentrations. In addition, if necessary, we can potentially analyze many distinctive immune-related markers on T cells bound to PD-1&#8211;blocking antibodies. Thus, this is a simple and minimally invasive strategy to analyze the pharmacological effect of PD-1&#8211;blocking antibodies in cancer patients.

The gating strategy and flow cytometry analysis (Figure 1) can detect PD-1&#8211;blocking antibody binding to T cells obtained from a drop of NSCLC patient peripheral blood. Before PD-1&#8211;blocking antibody is administered, no human IgG4-positive CD8 or CD4 T cells are present, and PD-1 expression can be confirmed by a PD-1&#8211;detecting antibody (EH12.1) (Figure 2A). After nivolumab or pembrolizumab administration, IgG4 (nivolumab, pembrol...

Watch this Scientific Journal Video about Monitoring PD-1-Blocking Antibodies Bound to T Cells Derived from a Drop of Peripheral Blood at JoVE.com

Monitoring PD-1-Blocking Antibodies Bound to T Cells Derived from a Drop of Peripheral Blood

We developed a simple flow cytometry assay for evaluating the binding of PD-1&#8211;blocking antibodies to T cells, requiring only a drop of peripheral blood from cancer patients.

Immune checkpoint inhibitors, including PD-1&#8211;blocking antibodies, have significantly improved treatment outcomes in various types of cancer. The ...

Because this method determines PD-1-blocking antibody-bound cells using peripheral blood from patients, the specific subset responsible for antitumor effects and immune-related adverse events can be identified. This method needs only a tiny amount of blood sample and the analyzing process is fairly simple and quick. It just needs a flow cytometry machine.To begin, collect whole blood samples into blood collection tubes containing EDTA. Treat each five milliliter round bottom polystyrene flow cytometry tube with one milliliter of 2%fetal bovine serum in PBS. Vortex for 10 seconds.Then transfer 20 microliters of whole blood samples to the treated five milliliter round bottom tubes. Add 20 microliters of 2%FBS in PBS and 10 microliters of human-specific FC receptor blocking reagent. Mix well and incubate for 15 minutes at room temperature.Next, add 500 microliters of red blood cell lysis buffer. Mix well and incubate for 10 minutes at room temperature. Add four milliliters of 2%FBS in PBS and spin down cells at 400 times g for five minutes at four degrees Celsius.Remove the supernatant by aspiration. Repeat the wash and aspiration process. Resuspend the cells in 100 microliters of 2%FBS in PBS and divide into two tubes of 50 microliters each.Add surface marker antibodies. Mix well and incubate for 20 minutes at room temperature in the dark. Wash samples twice in 2%FBS in PBS as previously.Resuspend the cells in 200 microliters of 2%FBS in PBS. Insert the tubes into the flow cytometer and acquire cells following the recommended protocol. Record 10, 000 events as the lymphocyte gate and export flow data as FCS files for analysis.Open files in the analysis software and click on the file of isotype control to visualize the cells on a forward scatter versus side scatter plot and gate lymphocytes. Select single cells using FSCH versus FSCW and SSCH versus SSCW and display them on a CD3 versus CD8 or CD3 versus CD4 plot. Gate the CD8 T-cells and CD4 T-cells respectively.Select the gated cells and display them on a PD-1 versus human IgG4 plot. And then based on isotype control, select Q3 to identify PD-1-blocking antibody-bound CD8 and CD4 T-cells. In this study, the gating strategy and flow cytometry analysis detected PD-1-blocking antibody binding to T-cells obtained from a drop of patient peripheral blood.The PD-1 versus human IgG4 plot shows the binding status of PD-1-blocking antibodies on T-cells. Orange dots and black dots indicate anti-IgG4 antibody and isotype control staining respectively. Before PD-1-blocking antibody was administered, no human IgG4 positive CD8 or CD4 T-cells were present and PD-1 expression was confirmed by a PD-1 detecting antibody.After nivolumab or pembrolizumab administration, IgG4 can be detected on T-cells by anti-IgG4 antibody whereas the PD-1 detecting antibody EH12.1 does not recognize any PD-1 on T-cells. The red, blue, and green gates indicate complete binding, partial binding and loss of binding respectively. After patients discontinued nivolumab and pembrolizumab, the status of PD-1-blocking antibody binding to CD8 T-cells decreased.There was partial binding and finally complete loss of binding. Please make sure to mix the blood sample with RBC lysis as well. Also, mixing the RBC lysis before surface marker staining is the key step in this method.If the researcher has access to an advanced flow cytometry machine, PD-1-blocking antibody-bound T-cells can be evaluated with more and more markers related to This strategy can be applied for profiling T-cell phenotypes responsible for adverse events caused by PD-1-blocking antibodies. Sampling from patients with developed adverse events is important to evaluate the utility of this strategy.

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