title: Histone deacetylase inhibitors enhance expression of NKG2D ligands in Ewing sarcoma and sensitize for natural killer cell-mediated cytolysis.
abstract: BACKGROUND
  Ewing sarcoma patients have a poor prognosis despite multimodal therapy. Integration of combination immunotherapeutic strategies into first-/second-line regimens represents promising treatment options, particularly for patients with intrinsic or acquired resistance to conventional therapies. We evaluated the susceptibility of Ewing sarcoma to natural killer cell-based combination immunotherapy, by assessing the capacity of histone deacetylase inhibitors to improve immune recognition and sensitize for natural killer cell cytotoxicity.
  
  
  METHODS
  Using flow cytometry, ELISA and immunohistochemistry, expression of natural killer cell receptor ligands was assessed in chemotherapy-sensitive/-resistant Ewing sarcoma cell lines, plasma and tumours. Natural killer cell cytotoxicity was evaluated in Chromium release assays. Using ATM/ATR inhibitor caffeine, the contribution of the DNA damage response pathway to histone deacetylase inhibitor-induced ligand expression was assessed.
  
  
  RESULTS
  Despite comparable expression of natural killer cell receptor ligands, chemotherapy-resistant Ewing sarcoma exhibited reduced susceptibility to resting natural killer cells. Interleukin-15-activation of natural killer cells overcame this reduced sensitivity. Histone deacetylase inhibitor-pretreatment induced NKG2D-ligand expression in an ATM/ATR-dependent manner and sensitized for NKG2D-dependent cytotoxicity (2/4 cell lines). NKG2D-ligands were expressed in vivo, regardless of chemotherapy-response and disease stage. Soluble NKG2D-ligand plasma concentrations did not differ between patients and controls.
  
  
  CONCLUSIONS
  Our data provide a rationale for combination immunotherapy involving immune effector and target cell manipulation in first-/second-line treatment regimens for Ewing sarcoma.
authors.affiliation: Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands. a.lankester@lumc.nl.
authors.forename: Dagmar
authors.initials: D
authors.lastname: Berghuis
authors.forename: Marco W
authors.initials: MW
authors.lastname: Schilham
authors.forename: Hanneke I
authors.initials: HI
authors.lastname: Vos
authors.forename: Susy J
authors.initials: SJ
authors.lastname: Santos
authors.forename: Stephan
authors.initials: S
authors.lastname: Kloess
authors.forename: Emilie P
authors.initials: EP
authors.lastname: Buddingh'
authors.forename: R Maarten
authors.initials: RM
authors.lastname: Egeler
authors.forename: Pancras Cw
authors.initials: PC
authors.lastname: Hogendoorn
authors.forename: Arjan C
authors.initials: AC
authors.lastname: Lankester