International Journal of Celiac Disease
ISSN (Print): 2334-3427 ISSN (Online): 2334-3486 Website: https://www.sciepub.com/journal/ijcd Editor-in-chief: Samasca Gabriel
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International Journal of Celiac Disease. 2022, 10(1), 11-16
DOI: 10.12691/ijcd-10-1-7
Open AccessArticle

When Genetic Polymorphism Meets an Immune Checkpoint Inhibitor in Celiac Disease

Aaron Lerner1, 2, and Carina Benzvi1

1Chaim Sheba Medical Center, The Zabludowicz Research Center for Autoimmune Diseases, Israel

2Ariel University, Ariel, Israel

Pub. Date: September 05, 2022

Cite this paper:
Aaron Lerner and Carina Benzvi. When Genetic Polymorphism Meets an Immune Checkpoint Inhibitor in Celiac Disease. International Journal of Celiac Disease. 2022; 10(1):11-16. doi: 10.12691/ijcd-10-1-7

Abstract

Immune checkpoint inhibitors are increasingly used as adjuvant therapy in oncology; however, they have short and long-term side effects. A major one is the surge in autoimmune diseases. The number of those conditions is continuously increasing, and recently, celiac disease was added to the list. Since celiac disease is associated with CTLA-4 polymorphism and since the disease is underdiagnosed and since the patient is at risk for various cancers, upon anti-CTRA-4 immune therapy, the loss of function of the CTLA-4 protein can predispose them to overt celiac disease. The present review highlights some potential mechanisms for CTLA-4 dysfunction, putting the patients at risk of celiac disease induction.

Keywords:
checkpoint inhibitor immunotherapy cancer CTLA-4 polymorphism celiac disease pathophysiology

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References:

[1]  Nurieva, R.I., Liu, X. and Dong, C., “Yin-Yang of costimulation: crucial controls of immune tolerance and function”, Immunological reviews, 229 (1). 88-100. May 2009.
 
[2]  Chen, L. and Flies, D.B., “Molecular mechanisms of T cell co-stimulation and co-inhibition”, Nature reviews. Immunology, 13 (4).227. April 2013.
 
[3]  Dotan, A., Muller, S., Kanduc, D., David, P., Halpert, G. and Shoenfeld, Y., “The SARS-CoV-2 as an instrumental trigger of autoimmunity”, Autoimmunity reviews, 20 (4). April 2021.
 
[4]  Balomenos, D. and Martínez-A, C., “Cell-cycle regulation in immunity, tolerance and autoimmunity”, Immunology today, 21 (11). 551-555. 2000.
 
[5]  Poto, R., Troiani, T., Criscuolo, G., Marone, G., Ciardiello, F., Tocchetti, C.G. and Varricchi, G., “Holistic Approach to Immune Checkpoint Inhibitor-Related Adverse Events”, Frontiers in immunology, 13 March 2022.
 
[6]  Kumar, P., Bhattacharya, P. and Prabhakar, B.S., “A comprehensive review on the role of co-signaling receptors and Treg homeostasis in autoimmunity and tumor immunity”, Journal of Autoimmunity, 95 77-99. December 2018.
 
[7]  Kumar, P., Saini, S. and Prabhakar, B.S., “Cancer immunotherapy with check point inhibitor can cause autoimmune adverse events due to loss of Treg homeostasis”, Seminars in Cancer Biology, 64 (December 2018). 29-35. 2020.
 
[8]  Robert, C.,”A decade of immune-checkpoint inhibitors in cancer therapy”, Nature communications, 11 (1). December 2020.
 
[9]  Wang, D.Y., Salem, J.E., Cohen, J. V., Chandra, S., Menzer, C., Ye, F., Zhao, S., Das, S., Beckermann, K.E., Ha, L., et al.,”Fatal Toxic Effects Associated With Immune Checkpoint Inhibitors: A Systematic Review and Meta-analysis”, JAMA oncology, 4 (12). 1721-1728. December 2018.
 
[10]  Khan, S. and Gerber, D.E., “Autoimmunity, checkpoint inhibitor therapy and immune-related adverse events: A review”, Seminars in Cancer Biology, 64 (January). 93-101. 2020.
 
[11]  Ben Zvi, C., Ehrenfeld, M. and Shoenfeld, Y., “[IMMUNOTHERAPY WITH CHECKPOINT INHIBITORS (ICPI) AND IMMUNE RELATED ADVERSE EVENTS (IRAE’S)].”, Harefuah, 159 (7). 508-515. July 2020 Available: http://www.ncbi.nlm.nih.gov/pubmed/32720769.
 
[12]  Orlova, R., Zhukova, N., Malkova, A. and Shoenfeld, Y., “Hypothesis for the development of immune-related adverse events in immune checkpoint inhibitors therapy”, Cancer treatment and research communications, 31 January 2022.
 
[13]  Lerner, A. and Benzvi, C.,”Checkpoint Inhibitors and Induction of Celiac Disease-like Condition”, Biomedicines, 10 (3). March 2022.
 
[14]  Fernández-Mestre, M., Sánchez, K., Balbás, O., Gendzekhzadze, K., Ogando, V., Cabrera, M. and Layrisse, Z., “Influence of CTLA-4 gene polymorphism in autoimmune and infectious diseases”, Human immunology, 70 (7). 532-535. July 2009.
 
[15]  Ulker, M., Yazisiz, V., Sallakci, N., Avci, A.B., Sanlioglu, S., Yegin, O. and Terzioglu, E., “CTLA-4 gene polymorphism of exon 1(+49 A/G) in Turkish systemic lupus erythematosus patients”, International journal of immunogenetics, 36 (4). 245-250. August 2009.
 
[16]  Du, L., Yang, P., Hou, S., Zhou, H. and Kijlstra, A., “No association of CTLA-4 polymorphisms with susceptibility to Behçet disease”, British Journal of Ophthalmology, 93 (10). 1378-1381. October 2009.
 
[17]  Gouda, N.S., Fawzy, M.S. and Toraih, E.A., “Impact of cytotoxic T-lymphocyte-associated protein 4 codon 17 variant and expression on vitiligo risk”, Journal of clinical laboratory analysis, 35 (6). June 2021.
 
[18]  Abida, O., Bahloul, E., Ben Jmaa, M., Sellami, K., Zouidi, F., Fakhfakh, R., Mahfoudh, N., Turki, H. and Masmoudi, H., “Chromosome 2q33genetic polymorphisms in Tunisian endemic pemphigus foliaceus”, Molecular genetics & genomic medicine, 8 (11). November 2020.
 
[19]  Xu, W., Ren, M., Ghosh, S., Qian, K., Luo, Z., Zhang, A., Zhang, C. and Cui, J., “Defects of CTLA-4 Are Associated with Regulatory T Cells in Myasthenia Gravis Implicated by Intravenous Immunoglobulin Therapy”, Mediators of inflammation, 2020.
 
[20]  Khalid Kheiralla, K.E.,”CTLA-4 (+49A/G) Polymorphism in Type 1 Diabetes Children of Sudanese Population”, Global medical genetics, 8 (1). 011-018. March 2021.
 
[21]  Borysewicz-Sańczyk, H., Sawicka, B., Wawrusiewicz-Kurylonek, N., Głowińska-Olszewska, B., Kadłubiska, A., Gościk, J., Szadkowska, A., Łosiewicz, A., Młynarski, W., Kretowski, A., et al., “Genetic Association Study of IL2RA, IFIH1, and CTLA-4 Polymorphisms With Autoimmune Thyroid Diseases and Type 1 Diabetes”, Frontiers in pediatrics, 8 August 2020.
 
[22]  Du, P., Ma, X. and Wang, C., “Associations of CTLA4 Gene Polymorphisms with Graves’ Ophthalmopathy: A Meta-Analysis”, International journal of genomics, 2014.
 
[23]  Louthrenoo, W., Kasitanon, N., Wongthanee, A., Kuwata, S. and Takeuchi, F., “CTLA-4 polymorphisms in Thai patients with rheumatoid arthritis, systemic lupus erythematosus, and systemic sclerosis”, International journal of rheumatic diseases, 24 (11). 1378-1385. November 20219.
 
[24]  Agarwal, K., Czaja, A.J., Jones, D.E.J. and Donaldson, P.T., “Cytotoxic T lymphocyte antigen-4 (CTLA-4) gene polymorphisms and susceptibility to type 1 autoimmune hepatitis”, Hepatology (Baltimore, Md.), 31 (1). 49-53. 2000.
 
[25]  Favorova, O.O., Favorov, A. V., Boiko, A.N., Andreewski, T. V., Sudomoina, M.A., Alekseenkov, A.D., Kulakova, O.G., Gusev, E.I., Parmigiani, G. and Ochs, M.F., “Three allele combinations associated with multiple sclerosis”, BMC medical genetics, 7 July 2006.
 
[26]  Yu, L., Shao, M., Zhou, T., Xie, H., Wang, F., Kong, J., Xu, S., Shuai, Z. and Pan, F., “Association of CTLA-4 (+49 A/G) polymorphism with susceptibility to autoimmune diseases: A meta-analysis with trial sequential analysis”, International immunopharmacology, 96 July 2021.
 
[27]  Eskandari-Nasab, E., Tahmasebi, A. and Hashemi, M., “Meta-analysis: the relationship between CTLA-4 +49 A/G polymorphism and primary biliary cirrhosis and type I autoimmune hepatitis”, Immunological investigations, 44 (4). 331-348. May 2015.
 
[28]  Ismail, N.A., Toraih, E.A., Ameen, H.M., Gomaa, A.H.A. and Marie, R.E.S.M., “Association of Rs231775 Genetic Variant of Cytotoxic T-lymphocyte Associated Protein 4 with Alopecia Areata Disease in Males: A Case-Control Study”, Immunological investigations, 50 (8). 977-986. 2021.
 
[29]  Zhang, M., Ni, J., Xu, W.D., Wen, P.F., Qiu, L.J., Wang, X.S., Pan, H.F. and Ye, D.Q., “Association of CTLA-4 variants with susceptibility to inflammatory bowel disease: a meta-analysis”, Human immunology, 75 (3). 227-233. March 2014.
 
[30]  Pastuszak-Lewandoska, D., Sewerynek, E., Domańska, D., Gładyś, A., Skrzypczak, R. and Brzeziańska, E., “CTLA-4 gene polymorphisms and their influence on predisposition to autoimmune thyroid diseases (Graves’ disease and Hashimoto’s thyroiditis)”, Archives of medical science: AMS, 8 (3). 415-421. June 2012.
 
[31]  Carr, E.J., Niederer, H.A., Williams, J., Harper, L., Watts, R.A., Lyons, P.A. and Smith, K.G.C., “Confirmation of the genetic association of CTLA4 and PTPN22 with ANCA-associated vasculitis”, BMC Medical Genetics, 10 December 2009.
 
[32]  Holopainen, P., Arvas, M., Sistonen, P., Mustalahti, K., Collin, P., Mäki, M. and Partanen, J., “CD28/CTLA4 gene region on chromosome 2q33 confers genetic susceptibility to celiac disease. A linkage and family-based association study”, Tissue antigens, 53 (5). 470-475. 1999.
 
[33]  Naluai, Å.T., Nilsson, S., Samuelsson, L., Gudjónsdóttir, A.H., Ascher, H., Ek, J., Hallberg, B., Kristiansson, B., Martinsson, T., Nerman, O., et al., “The CTLA4/CD28 gene region on chromosome 2q33 confers susceptibility to celiac disease in a way possibly distinct from that of type 1 diabetes and other chronic inflammatory disorders”, Tissue antigens, 56 (4). 350-355. 2000.
 
[34]  Popat, S., Hearle, N., Hogberg, L., Braegger, C.P., O’Donoghue, D., Falth-Magnusson, K., Holmes, G.K.T., Howdle, P.D., Jenkins, H., Johnston, S., et al., “Variation in the CTLA4/CD28 gene region confers an increased risk of coeliac disease”, Annals of human genetics, 66 (Pt 2). 125-137. March 2002.
 
[35]  Song, G.G., Kim, J.H., Kim, Y.H. and Lee, Y.H., “Association between CTLA-4 polymorphisms and susceptibility to Celiac disease: a meta-analysis”, Human immunology, 74 (9).1214-1218. September 2013.
 
[36]  Pesce, G., Auricchio, R., Bagnasco, M. and Saverino, D., “Oversecretion of soluble CTLA-4 in various autoimmune diseases overlapping celiac disease”, Genetic testing and molecular biomarkers, 18 (1). 8-11. January 2014.
 
[37]  King, A.L., Moodie, S.J., Fraser, J.S., Curtis, D., Reid, E., Dearlove, A.M., Ellis, H.J. and Ciclitira, P.J., “CTLA-4/CD28 gene region is associated with genetic susceptibility to coeliac disease in UK families”, Journal of medical genetics, 39 (1). 51-54. 2002.
 
[38]  van Belzen, M.J., Mulder, C.J.J., Zhernakova, A., Pearson, P.L., Houwen, R.H.J. and Wijmenga, C., “CTLA4 +49 A/G and CT60 polymorphisms in Dutch coeliac disease patients”, European journal of human genetics: EJHG, 12 (9). 782-785. September 2004.
 
[39]  Hunt, K.A., McGovern, D.P.B., Kumar, P.J., Ghosh, S., Travis, S.P.L., Walters, J.R.F., Jewell, D.P., Playford, R.J. and van Heel, D.A.,”A common CTLA4 haplotype associated with coeliac disease”, European journal of human genetics: EJHG, 13 (4). 440-444. April 2005.
 
[40]  Brophy, K., Ryan, A.W., Thornton, J.M., Abuzakouk, M., Fitzgerald, A.P., McLoughlin, R.M., O’Morain, C., Kennedy, N.P., Stevens, F.M., Feighery, C., et al., “Haplotypes in the CTLA4 region are associated with coeliac disease in the Irish population”, Genes and immunity, 7 (1). 19-26. January 2006.
 
[41]  King, A.L., Moodie, S.J., Fraser, J.S., Curtis, D., Reid, E., Dearlove, A.M. and Ciclitira, P.J., “Coeliac disease: investigation of proposed causal variants in the CTLA4 gene region”, European journal of immunogenetics: official journal of the British Society for Histocompatibility and Immunogenetics, 30 (6). 427-432. December 2003.
 
[42]  Simone, R., Brizzolara, R., Chiappori, A., Milintenda-Floriani, F., Natale, C., Greco, L., Schiavo, M., Bagnasco, M., Pesce, G. and Saverino, D.,”A functional soluble form of CTLA-4 is present in the serum of celiac patients and correlates with mucosal injury”, International immunology, 21 (9). 1037-1045. 2009.
 
[43]  Alfadhli, S., “Overexpression and secretion of the soluble CTLA-4 splice variant in various autoimmune diseases and in cases with overlapping autoimmunity”, Genetic testing and molecular biomarkers, 17 (4). 336-341. April 2013.
 
[44]  Saverino, D., Simone, R., Bagnasco, M. and Pesce, G., “The soluble CTLA-4 receptor and its role in autoimmune diseases: An update”, Autoimmunity Highlights, 1 (2). 73-81. November 2010.
 
[45]  Schneider, H. and Rudd, C.E., “Diverse mechanisms regulate the surface expression of immunotherapeutic target ctla-4”, Frontiers in immunology, 5 (DEC). 2014.
 
[46]  Falade, A.S., Reynolds, K.L., Zubiri, L., Deshpande, V., Fintelmann, F.J., Dougan, M. and Mooradian, M.J., “Case Report: Fulminant Celiac Disease With Combination Immune Checkpoint Therapy”, Frontiers in immunology, 13 April 2022.
 
[47]  Watari, K., Konnai, S., Maekawa, N., Okagawa, T., Suzuki, Y., Murata, S. and Ohashi, K., “Immune inhibitory function of bovine CTLA-4 and the effects of its blockade in IFN-γ production”, BMC veterinary research, 15 (1). October 2019.
 
[48]  Leblanc, J., Hoibian, S., Boucraut, A., Ratone, J.P., Stoffaes, L., Dano, D., Louvel-Perrot, D., Chanez, B., Chretien, A.S., Madroszyk, A., et al., “Celiac Disease After Administration of Immune Checkpoint Inhibitors: A Case Report”, Frontiers in immunology, 12 December 2021.
 
[49]  Badran, Y.R., Shih, A., Leet, D., Mooradian, M.J., Coromilas, A., Chen, J., Kem, M., Zheng, H., Borowsky, J., Misdraji, J., et al., “Immune checkpoint inhibitor-associated celiac disease”, Journal for immunotherapy of cancer, 8 (1). June 2020.
 
[50]  Liu, X., Shi, Y., Zhang, D., Zhou, Q., Liu, J., Chen, M., Xu, Y., Zhao, J., Zhong, W. and Wang, M., “Risk factors for immune-related adverse events: what have we learned and what lies ahead?”, Biomarker research, 9 (1). December 2021.
 
[51]  De Moel, E.C., Rozeman, E.A., Kapiteijn, E.H., Verdegaal, E.M.E., Grummels, A., Bakker, J.A., Huizinga, T.W.J., Haanen, J.B., Toes, R.E.M. and Van Der Woude, D., “Autoantibody Development under Treatment with Immune-Checkpoint Inhibitors”, Cancer immunology research, 7 (1). 6-11. January 2019.
 
[52]  Kristiansen, O.P., Larsen, Z.M. and Pociot, F., “CTLA-4 in autoimmune diseases--a general susceptibility gene to autoimmunity?”, Genes and immunity, 1 (3). 170-184. 2000.
 
[53]  Tison, A., Quéré, G., Misery, L., Funck-Brentano, E., Danlos, F.X., Routier, E., Robert, C., Loriot, Y., Lambotte, O., Bonniaud, B., et al., “Safety and Efficacy of Immune Checkpoint Inhibitors in Patients With Cancer and Preexisting Autoimmune Disease: A Nationwide, Multicenter Cohort Study”, Arthritis & rheumatology (Hoboken, N.J.), 71 (12). 2100-2111. December 2019.
 
[54]  Vanderlugt, C.L. and Miller, S.D., “Epitope spreading in immune-mediated diseases: implications for immunotherapy”, Nature reviews. Immunology, 2 (2). 85-95. 2002.
 
[55]  Kwek, S.S., Dao, V., Roy, R., Hou, Y., Alajajian, D., Simko, J.P., Small, E.J. and Fong, L., “Diversity of antigen-specific responses induced in vivo with CTLA-4 blockade in prostate cancer patients”, Journal of immunology (Baltimore, Md. 1950), 189 (7). 3759-3766. October 2012.
 
[56]  Vojdani, A., Lerner, A. and Vojdani, E., “Cross-Reactivity and Sequence Homology between Al-Pha-Synuclein and Food Products: A Step Further for Parkinson’s Disease Synucleinopathy”, Cells, 10 (5).1111. May 2021.
 
[57]  Vojdani, A., Monro, J., Lanzisera, F. and Sadeghi, H., “Serological cross-reactivity between viruses and their contribution to autoimmunity”, Autoimmunity reviews, 20 (7). July 2021.
 
[58]  Lerner, A. and Benzvi, C., “Let Food Be Thy Medicine’: Gluten and Potential Role in Neurodegeneration”, Cells, 10 (4). 2021.
 
[59]  Lerner, A., Aminov, R. and Matthias, T., “Transglutaminases in Dysbiosis As Potential Environmental Drivers of Autoimmunity”, Frontiers in microbiology, 8 (JAN). January 2017.
 
[60]  Bascuñán, K.A., Araya, M., Roncoroni, L., Doneda, L. and Elli, L., “Dietary Gluten as a Conditioning Factor of the Gut Microbiota in Celiac Disease”, Advances in nutrition (Bethesda, Md.), 11 (1). 160-174. January 2020.
 
[61]  VIVARELLI, S., FALZONE, L., LEONARDI, G.C., SALMERI, M. and LIBRA, M., “Novel insights on gut microbiota manipulation and immune checkpoint inhibition in cancer (Review)”, International journal of oncology, 59 (3). September 2021.
 
[62]  Zhang, M.L. and Deshpande, V., “Histopathology of Gastrointestinal Immune-related Adverse Events: A Practical Review for the Practicing Pathologist”, The American journal of surgical pathology, 46 (1). E15-E26. January 2022.
 
[63]  Zhang, M.L., Neyaz, A., Patil, D., Chen, J., Dougan, M. and Deshpande, V., “Immune-related adverse events in the gastrointestinal tract: diagnostic utility of upper gastrointestinal biopsies”, Histopathology, 76 (2). 233-243. January 2020.
 
[64]  Mendo, R., Figueiredo, P. and Mascarenhas, L., “Checkpoint Inhibitor-Induced Gastroduodenitis: An Unusual Manifestation”, GE Portuguese journal of gastroenterology, 28 (2). 150-152. February 2021.
 
[65]  Gadhok, R., Paulon, E., Tai, C., Olushola, T., Barragry, J., Rahman, F., Di Caro, S. and Mehta, S., “Gastrointestinal consequences of cancer treatment: evaluation of 10 years’ experience at a tertiary UK centre”, Frontline gastroenterology, 12 (6). 2020.
 
[66]  Chatzileontiadou, D.S.M., Sloane, H., Nguyen, A.T., Gras, S. and Grant, E.J., “The Many Faces of CD4 + T Cells: Immunological and Structural Characteristics”, International journal of molecular sciences, 22 (1).1-27. January 2020.
 
[67]  Cook, L., Munier, C.M.L., Seddiki, N., van Bockel, D., Ontiveros, N., Hardy, M.Y., Gillies, J.K., Levings, M.K., Reid, H.H., Petersen, J., et al., “Circulating gluten-specific FOXP3 + CD39 + regulatory T cells have impaired suppressive function in patients with celiac disease”, The Journal of allergy and clinical immunology, 140 (6). 1592-1603. e8. December 2017.
 
[68]  Valk, E., Rudd, C.E. and Schneider, H., “CTLA-4 trafficking and surface expression”, Trends in immunology, 29 (6). 272-279. June 2008.