Sex-based considerations in the choice for a TLR9 or TLR7/8 agonist to arm the sentinel lymph node in early-stage melanoma.
Intradermal delivery of the Toll-like receptor (TLR)-9 agonist agatolimod/CPG7909, prior to sentinel lymph node (SLN) biopsy was previously shown to induce locoregional and systemic immunity, reduce tumor-involved SLN rates, and improve recurrence-free survival in patients with early-stage melanoma. Remarkably, men exhibited superior dendritic cell (DC) maturation. Here, we report on further sex-based differences in the immune response after intradermal administration of CPG7909, which included higher CD80/CD83 expression levels in conventional (c) DC subsets in men's as compared to women's SLN, as well as higher ex-vivo release levels of IL-1β, TNF, and IL-6 (all contributors to cDC activation) and Th1/Th2 cytokines. In an effort to identify a more effective DC-activating therapy for women, we compared the in-vitro effects of CPG7909 with those of the TLR7/8 agonist resiquimod/R848 on SLN single cells from female patients. R848 induced superior cDC subset activation and TNF, IL-6, IL-10, IL-12, IFNγ, and CXCL10 release. Correlation analyses suggested that IFNα, TNF, and IL-6 were key for CPG7909-induced LNR-cDC activation, whereas R848's effect appeared more cytokine-independent. We conclude that combining locally delivered CPG7909 and R848 in early-stage melanoma will ensure full-range DC subset activation and robust pro-inflammatory T-cell responses in melanoma SLN, independent of sex.
Authors
Notohardjo Notohardjo, Toffoli Toffoli, Muijlwijk Muijlwijk, van den Hout van den Hout, Kandiah Kandiah, Labots Labots, van de Ven van de Ven, van den Eertwegh van den Eertwegh, de Gruijl de Gruijl
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