Abstract
A vast body of evidence provides support to a central role of exaggerated production of interferon-γ (IFN-γ) in causing hypercytokinemia and signs and symptoms of hemophagocytic lymphohistiocytosis (HLH). In this chapter, we describe briefly the roles of IFN-γ in innate and adaptive immunity and in host defense, summarize results from animal models of primary HLH and secondary HLH with a particular emphasis on targeted therapeutic approaches, review data on biomarkers associated with activation of the IFN-γ pathway, and discuss initial efficacy and safety results of IFN-γ neutralization in humans.
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References
Ivashkiv, L. B. (2018). IFNgamma: Signalling, epigenetics and roles in immunity, metabolism, disease and cancer immunotherapy. Nature Reviews. Immunology, 18, 545–558.
Schoenborn, J. R., & Wilson, C. B. (2007). Regulation of interferon-gamma during innate and adaptive immune responses. Advances in Immunology, 96, 41–101.
Blouin, C. M., & Lamaze, C. (2013). Interferon gamma receptor: The beginning of the journey. Frontiers in Immunology, 4, 267.
de Weerd, N. A., & Nguyen, T. (2012). The interferons and their receptors—Distribution and regulation. Immunology and Cell Biology, 90, 483–491.
Suarez-Ramirez, J. E., Tarrio, M. L., Kim, K., Demers, D. A., & Biron, C. A. (2014). CD8 T cells in innate immune responses: Using STAT4-dependent but antigen-independent pathways to gamma interferon during viral infection. MBio, 5, e01978–e01914.
Kannan, Y., Yu, J., Raices, R. M., Seshadri, S., Wei, M., Caligiuri, M. A., et al. (2011). IkappaBzeta augments IL-12- and IL-18-mediated IFN-gamma production in human NK cells. Blood, 117, 2855–2863.
Majoros, A., Platanitis, E., Kernbauer-Holzl, E., Rosebrock, F., Muller, M., & Decker, T. (2017). Canonical and non-canonical aspects of JAK-STAT signaling: Lessons from interferons for cytokine responses. Frontiers in Immunology, 8, 29.
Xie, C., Liu, C., Wu, B., Lin, Y., Ma, T., Xiong, H., et al. (2016). Effects of IRF1 and IFN-beta interaction on the M1 polarization of macrophages and its antitumor function. International Journal of Molecular Medicine, 38, 148–160.
Chistiakov, D. A., Myasoedova, V. A., Revin, V. V., Orekhov, A. N., & Bobryshev, Y. V. (2018). The impact of interferon-regulatory factors to macrophage differentiation and polarization into M1 and M2. Immunobiology, 223, 101–111.
Sica, A., & Mantovani, A. (2012). Macrophage plasticity and polarization: In vivo veritas. The Journal of Clinical Investigation, 122, 787–795.
Asano, M., Nakane, A., & Minagawa, T. (1993). Endogenous gamma interferon is essential in granuloma formation induced by glycolipid-containing mycolic acid in mice. Infection and Immunity, 61, 2872–2878.
Green, D. S., Young, H. A., & Valencia, J. C. (2017). Current prospects of type II interferon gamma signaling and autoimmunity. The Journal of Biological Chemistry, 292, 13925–13933.
Pearl, J. E., Saunders, B., Ehlers, S., Orme, I. M., & Cooper, A. M. (2001). Inflammation and lymphocyte activation during mycobacterial infection in the interferon-gamma-deficient mouse. Cellular Immunology, 211, 43–50.
Swindle, E. J., Brown, J. M., Radinger, M., DeLeo, F. R., & Metcalfe, D. D. (2015). Interferon-gamma enhances both the anti-bacterial and the pro-inflammatory response of human mast cells to Staphylococcus aureus. Immunology, 146, 470–485.
Choi, J., Kim, S. T., & Craft, J. (2012). The pathogenesis of systemic lupus erythematosus-an update. Current Opinion in Immunology, 24, 651–657.
Schroder, K., Hertzog, P. J., Ravasi, T., & Hume, D. A. (2004). Interferon-gamma: An overview of signals, mechanisms and functions. Journal of Leukocyte Biology, 75, 163–189.
Fidan, I., Yesilyurt, E., Gurelik, F. C., Erdal, B., & Imir, T. (2008). Effects of recombinant interferon-gamma on cytokine secretion from monocyte-derived macrophages infected with Salmonella typhi. Comparative Immunology, Microbiology and Infectious Diseases, 31, 467–475.
Bao, S., Beagley, K. W., France, M. P., Shen, J., & Husband, A. J. (2000). Interferon-gamma plays a critical role in intestinal immunity against Salmonella typhimurium infection. Immunology, 99, 464–472.
van de Berg, P. J., Heutinck, K. M., Raabe, R., Minnee, R. C., Young, S. L., van Donselaar-van der Pant, K. A., et al. (2010). Human cytomegalovirus induces systemic immune activation characterized by a type 1 cytokine signature. The Journal of Infectious Diseases, 202, 690–699.
Sainz Jr., B., LaMarca, H. L., Garry, R. F., & Morris, C. A. (2005). Synergistic inhibition of human cytomegalovirus replication by interferon-alpha/beta and interferon-gamma. Virology Journal, 2, 14.
Brisse, E., Imbrechts, M., Put, K., Avau, A., Mitera, T., Berghmans, N., et al. (2016). Mouse cytomegalovirus infection in BALB/c mice resembles virus-associated secondary hemophagocytic lymphohistiocytosis and shows a pathogenesis distinct from primary hemophagocytic lymphohistiocytosis. Journal of Immunology, 196, 3124–3134.
Flynn, J. L., Chan, J., Triebold, K. J., Dalton, D. K., Stewart, T. A., & Bloom, B. R. (1993). An essential role for interferon gamma in resistance to Mycobacterium tuberculosis infection. The Journal of Experimental Medicine, 178, 2249–2254.
Salat, J., Sak, B., Le, T., & Kopecky, J. (2004). Susceptibility of IFN-gamma or IL-12 knock-out and SCID mice to infection with two microsporidian species, Encephalitozoon cuniculi and E. intestinalis. Folia Parasitologica, 51, 275–282.
Dorman, S. E., Uzel, G., Roesler, J., Bradley, J. S., Bastian, J., Billman, G., et al. (1999). Viral infections in interferon-gamma receptor deficiency. The Journal of Pediatrics, 135, 640–643.
Remus, N., Reichenbach, J., Picard, C., Rietschel, C., Wood, P., Lammas, D., et al. (2001). Impaired interferon gamma-mediated immunity and susceptibility to mycobacterial infection in childhood. Pediatric Research, 50, 8–13.
Tran, D. Q. (2005). Susceptibility to mycobacterial infections due to interferon-gamma and interleukin-12 pathway defects. Allergy and Asthma Proceedings, 26, 418–421.
Sologuren, I., Boisson-Dupuis, S., Pestano, J., Vincent, Q. B., Fernandez-Perez, L., Chapgier, A., et al. (2011). Partial recessive IFN-gammaR1 deficiency: Genetic, immunological and clinical features of 14 patients from 11 kindreds. Human Molecular Genetics, 20, 1509–1523.
Lammas, D. A., Casanova, J. L., & Kumararatne, D. S. (2000). Clinical consequences of defects in the IL-12-dependent interferon-gamma (IFN-gamma) pathway. Clinical and Experimental Immunology, 121, 417–425.
Kampmann, B., Hemingway, C., Stephens, A., Davidson, R., Goodsall, A., Anderson, S., et al. (2005). Acquired predisposition to mycobacterial disease due to autoantibodies to IFN-gamma. The Journal of Clinical Investigation, 115, 2480–2488.
Wongkulab, P., Wipasa, J., Chaiwarith, R., & Supparatpinyo, K. (2013). Autoantibody to interferon-gamma associated with adult-onset immunodeficiency in non-HIV individuals in Northern Thailand. PLoS One, 8, e76371.
Zoller, E. E., Lykens, J. E., Terrell, C. E., Aliberti, J., Filipovich, A. H., Henson, P. M., et al. (2011). Hemophagocytosis causes a consumptive anemia of inflammation. The Journal of Experimental Medicine, 208, 1203–1214.
Behrens, E. M., Canna, S. W., Slade, K., Rao, S., Kreiger, P. A., Paessler, M., et al. (2011). Repeated TLR9 stimulation results in macrophage activation syndrome-like disease in mice. The Journal of Clinical Investigation, 121, 2264–2277.
Crozat, K., Hoebe, K., Ugolini, S., Hong, N. A., Janssen, E., Rutschmann, S., et al. (2007). Jinx, an MCMV susceptibility phenotype caused by disruption of Unc13d: A mouse model of type 3 familial hemophagocytic lymphohistiocytosis. The Journal of Experimental Medicine, 204, 853–863.
Czar, M. J., Kersh, E. N., Mijares, L. A., Lanier, G., Lewis, J., Yap, G., et al. (2001). Altered lymphocyte responses and cytokine production in mice deficient in the X-linked lymphoproliferative disease gene SH2D1A/DSHP/SAP. Proceedings of the National Academy of Sciences of the United States of America, 98, 7449–7454.
Kogl, T., Muller, J., Jessen, B., Schmitt-Graeff, A., Janka, G., Ehl, S., et al. (2013). Hemophagocytic lymphohistiocytosis in syntaxin-11-deficient mice: T-cell exhaustion limits fatal disease. Blood, 121, 604–613.
Pachlopnik Schmid, J., Ho, C. H., Chretien, F., Lefebvre, J. M., Pivert, G., Kosco-Vilbois, M., et al. (2009). Neutralization of IFNgamma defeats haemophagocytosis in LCMV-infected perforin- and Rab27a-deficient mice. EMBO Molecular Medicine, 1, 112–124.
Prencipe, G., Caiello, I., Pascarella, A., Grom, A. A., Bracaglia, C., Chatel, L., et al. (2018). Neutralization of IFN-gamma reverts clinical and laboratory features in a mouse model of macrophage activation syndrome. The Journal of Allergy and Clinical Immunology, 141, 1439–1449.
Jordan, M. B., Hildeman, D., Kappler, J., & Marrack, P. (2004). An animal model of hemophagocytic lymphohistiocytosis (HLH): CD8+ T cells and interferon gamma are essential for the disorder. Blood, 104, 735–743.
Buatois, V., Chatel, L., Cons, L., Lory, S., Richard, F., Guilhot, F., et al. (2017). Use of a mouse model to identify a blood biomarker for IFNgamma activity in pediatric secondary hemophagocytic lymphohistiocytosis. Translational Research, 180, 37–52 e32.
de Benedetti, F., Massa, M., Robbioni, P., Ravelli, A., Burgio, G. R., & Martini, A. (1991). Correlation of serum interleukin-6 levels with joint involvement and thrombocytosis in systemic juvenile rheumatoid arthritis. Arthritis and Rheumatism, 34, 1158–1163.
Strippoli, R., Carvello, F., Scianaro, R., De Pasquale, L., Vivarelli, M., Petrini, S., et al. (2012). Amplification of the response to Toll-like receptor ligands by prolonged exposure to interleukin-6 in mice: Implication for the pathogenesis of macrophage activation syndrome. Arthritis and Rheumatism, 64, 1680–1688.
Humblet-Baron, S., Barber, J. S., Roca, C. P., Lenaerts, A., Koni, P. A., & Liston, A. (2019). Murine myeloproliferative disorder as a consequence of impaired collaboration between dendritic cells and CD4 T cells. Blood, 133, 319–330.
Weaver, L. K., Chu, N., & Behrens, E. M. (2019). Brief report: Interferon-gamma-mediated immunopathology potentiated by toll-like receptor 9 activation in a murine model of macrophage activation syndrome. Arthritis & Rhematology, 71, 161–168.
Henter, J. I., Elinder, G., Soder, O., Hansson, M., Andersson, B., & Andersson, U. (1991). Hypercytokinemia in familial hemophagocytic lymphohistiocytosis. Blood, 78, 2918–2922.
Imashuku, S., Hibi, S., Sako, M., Ishii, T., Kohdera, U., Kitazawa, K., et al. (1998). Heterogeneity of immune markers in hemophagocytic lymphohistiocytosis: Comparative study of 9 familial and 14 familial inheritance-unproved cases. Journal of Pediatric Hematology/Oncology, 20, 207–214.
Imashuku, S., Hibi, S., Tabata, Y., Sako, M., Sekine, Y., Hirayama, K., et al. (1998). Biomarker and morphological characteristics of Epstein-Barr virus-related hemophagocytic lymphohistiocytosis. Medical and Pediatric Oncology, 31, 131–137.
Put, K., Avau, A., Brisse, E., Mitera, T., Put, S., Proost, P., et al. (2015). Cytokines in systemic juvenile idiopathic arthritis and haemophagocytic lymphohistiocytosis: Tipping the balance between interleukin-18 and interferon-gamma. Rheumatology (Oxford), 54, 1507–1517.
Schneider, E. M., Lorenz, I., Muller-Rosenberger, M., Steinbach, G., Kron, M., & Janka-Schaub, G. E. (2002). Hemophagocytic lymphohistiocytosis is associated with deficiencies of cellular cytolysis but normal expression of transcripts relevant to killer-cell-induced apoptosis. Blood, 100, 2891–2898.
Xu, X. J., Tang, Y. M., Song, H., Yang, S. L., Xu, W. Q., Zhao, N., et al. (2012). Diagnostic accuracy of a specific cytokine pattern in hemophagocytic lymphohistiocytosis in children. The Journal of Pediatrics, 160, 984–990 e981.
Yang, S. L., Xu, X. J., Tang, Y. M., Song, H., Xu, W. Q., Zhao, F. Y., et al. (2016). Associations between inflammatory cytokines and organ damage in pediatric patients with hemophagocytic lymphohistiocytosis. Cytokine, 85, 14–17.
Bracaglia, C., de Graaf, K., Pires Marafon, D., Guilhot, F., Ferlin, W., Prencipe, G., et al. (2017). Elevated circulating levels of interferon-gamma and interferon-gamma-induced chemokines characterise patients with macrophage activation syndrome complicating systemic juvenile idiopathic arthritis. Annals of the Rheumatic Diseases, 76, 166–172.
De Benedetti, F., Brunner, H. I., Ruperto, N., Kenwright, A., Wright, S., Calvo, I., et al. (2012). Randomized trial of tocilizumab in systemic juvenile idiopathic arthritis. The New England Journal of Medicine, 367, 2385–2395.
Ruperto, N., Brunner, H. I., Quartier, P., Constantin, T., Wulffraat, N., Horneff, G., et al. (2012). Two randomized trials of canakinumab in systemic juvenile idiopathic arthritis. The New England Journal of Medicine, 367, 2396–2406.
Shimizu, M., Yokoyama, T., Yamada, K., Kaneda, H., Wada, H., Wada, T., et al. (2010). Distinct cytokine profiles of systemic-onset juvenile idiopathic arthritis-associated macrophage activation syndrome with particular emphasis on the role of interleukin-18 in its pathogenesis. Rheumatology (Oxford), 49, 1645–1653.
Weiss, E. S., Girard-Guyonvarc’h, C., Holzinger, D., de Jesus, A. A., Tariq, Z., Picarsic, J., et al. (2018). Interleukin-18 diagnostically distinguishes and pathogenically promotes human and murine macrophage activation syndrome. Blood, 131, 1442–1455.
Lam, M. T. C., Coppola S., Krumbach, O. H. F., Prencipe, G., Insalaco, A., Cifaldi, C., et al. (2019). A novel autoinflammatory disease characterized by neonatal-onset cytopenia with autoinflammation, rash, and hemophagocytosis (NOCARH) due to aberrant CDC42 function. Congress of the International Society of Systemic Autoinflammatory Diseases.
Girard-Guyonvarc’h, C., Palomo, J., Martin, P., Rodriguez, E., Troccaz, S., Palmer, G., et al. (2018). Unopposed IL-18 signaling leads to severe TLR9-induced macrophage activation syndrome in mice. Blood, 131, 1430–1441.
Lortat-Jacob, H., Baltzer, F., & Grimaud, J. A. (1996). Heparin decreases the blood clearance of interferon-gamma and increases its activity by limiting the processing of its carboxyl-terminal sequence. The Journal of Biological Chemistry, 271, 16139–16143.
Lortat-Jacob, H., Brisson, C., Guerret, S., & Morel, G. (1996). Non-receptor-mediated tissue localization of human interferon-gamma: Role of heparan sulfate/heparin-like molecules. Cytokine, 8, 557–566.
Takada, H., Takahata, Y., Nomura, A., Ohga, S., Mizuno, Y., & Hara, T. (2003). Increased serum levels of interferon-gamma-inducible protein 10 and monokine induced by gamma interferon in patients with haemophagocytic lymphohistiocytosis. Clinical and Experimental Immunology, 133, 448–453.
My, L. T., Lien le, B., Hsieh, W. C., Imamura, T., Anh, T. N., Anh, P. N., et al. (2010). Comprehensive analyses and characterization of haemophagocytic lymphohistiocytosis in Vietnamese children. British Journal of Haematology, 148, 301–310.
Han, J. H., Suh, C. H., Jung, J. Y., Ahn, M. H., Han, M. H., Kwon, J. E., et al. (2017). Elevated circulating levels of the interferon-gamma-induced chemokines are associated with disease activity and cutaneous manifestations in adult-onset Still’s disease. Scientific Reports, 7, 46652.
Billiau, A. D., Roskams, T., Van Damme-Lombaerts, R., Matthys, P., & Wouters, C. (2005). Macrophage activation syndrome: Characteristic findings on liver biopsy illustrating the key role of activated, IFN-gamma-producing lymphocytes and IL-6- and TNF-alpha-producing macrophages. Blood, 105, 1648–1651.
Locatelli, F., Jordan, M. B., Allen, C. E., Cesaro, S., Sevilla, J., Rao, A., et al. (2018). Safety and efficacy of emapalumab in pediatric patients with primary hemophagocytic lymphohistiocytosis. American Society of Hematology Annual Meeting.
Lounder, D. T., Bin, Q., de Min, C., & Jordan, M. B. (2019). Treatment of refractory hemophagocytic lymphohistiocytosis with emapalumab despite severe concurrent infections. Blood Advances, 3, 47–50.
Bracaglia, C. (2018). Emapalumab, an anti-interferon gamma monoclonal antibody in two patients with NLRC4-related disease and severe hemophagocytic lymphohistiocytosis (HLH). Pediatric Rheumatolology, 16, 2.
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De Benedetti, F. (2019). Anti-interferon-γ Therapy for Cytokine Storm Syndromes. In: Cron, R., Behrens, E. (eds) Cytokine Storm Syndrome. Springer, Cham. https://doi.org/10.1007/978-3-030-22094-5_33
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