Circulating Th17 T Cells at Treatment Onset Predict Autoimmune Toxicity of PI3Kδ Inhibitors

Author:

Gadi Deepti1,Martindale Stephen1,Chiu Pui2,Khalsa Jasneet1,Chen Pei-Hsuan1,Fernandes Stacey1,Wang Zixu1,Tyekucheva Svitlana1,Machado John-Hanson1,Fisher David1,Armand Philippe1ORCID,Davids Matthew1ORCID,Rodig Scott1,Sherry Barbara2,Brown Jennifer1ORCID

Affiliation:

1. Dana-Farber Cancer Institute

2. The Feinstein Institutes for Medical Research

Abstract

Abstract PI3Kδ inhibitors are approved for the therapy of B cell malignancies, but their clinical use has been limited by unpredictable autoimmune toxicity, despite promising efficacy and evidence that toxicity is associated with improved clinical outcomes. Prior phenotypic evaluation by CyTOF has identified increases in activated CD8 T cells with activation of Th17 T cells, as well as decreases in Tregs, particularly in patients with toxicity. Here we sought to further understand the effects of idelalisib and duvelisib in vitro, and demonstrate that both idelalisib and duvelisib can inhibit T cell proliferation as well as Th1 and Treg differentiation in vitro, while promoting Th2 and Th17 differentiation. We further demonstrate directly using intracellular flow cytometry that autoimmune toxicity in patients is associated with higher absolute numbers of CD4 and CD8 T cells with Th17 differentiation in peripheral blood prior to therapy, and that gastrointestinal tissues from patients with active autoimmune complications of PI3Kδ inhibitors show infiltration with Th17 + T cells. These same tissues show depletion of Tregs as compared to CLL patients without toxicity, suggesting that loss of Tregs may be permissive for Th17 activation to lead to autoimmune toxicity. Clinical trials to restore this balance are warranted.

Publisher

Research Square Platform LLC

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