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Blood, 1 January 2002, Vol. 99, No. 1, pp. 232-237
NEOPLASIA
Expression of the granzyme B inhibitor, protease inhibitor 9, by
tumor cells in patients with non-Hodgkin and Hodgkin lymphoma: a novel
protective mechanism for tumor cells to circumvent the immune
system?
Bellinda A. Bladergroen,
Chris J. L. M. Meijer,
Rosita
L. ten Berge,
C. Erik Hack,
Jettie J. F. Muris,
Danny F. Dukers,
Andreas Chott,
Yoshiaki Kazama,
Joost J. Oudejans,
Oskar van
Berkum, and
J. Alain Kummer
From the Department of Pathology, Free University
Medical Center, Amsterdam, The Netherlands; Department of
Pathophysiology of Plasma Proteins, CLB, Amsterdam, The Netherlands;
Department of Clinical Pathology, General Hospital Vienna, Austria; and
Department of Pathology, University of New Mexico, Albuquerque.
In tumor cells, the serine protease granzyme B is the primary
mediator of apoptosis induced by cytotoxic T lymphocytes (CTLs)/natural killer (NK) cells. The human intracellular serpin proteinase inhibitor 9 (PI9) is the only known human protein able to inhibit the proteolytic activity of granzyme B. When present in the cytoplasm of T lymphocytes, PI9 is thought to protect CTLs against apoptosis induced by their own
misdirected granzyme B. Based on the speculation that tumors may also
express PI9 to escape CTL/NK cell surveillance, immunohistochemical studies on the expression of PI9 in various lymphomas were performed. Ninety-two cases of T-cell non-Hodgkin lymphoma (NHL), 75 cases of
B-cell NHL, and 57 cases of Hodgkin lymphomas were stained with a
PI9-specific monoclonal antibody. In T-cell NHL, highest PI9 expression
was found in the extranodal T-cell NHL. In nearly 90% of
enteropathy-type T-cell NHLs and 80% of NK/T-cell, nasal-type lymphomas, the majority of the tumor cells expressed PI9. In nodal T-anaplastic large cell lymphomas and peripheral T-cell lymphomas (not
otherwise specified), PI9 expression occurred less frequently. In
B-cell NHL, PI9 expression was associated with high-grade malignancy; 43% of diffuse large B-cell lymphomas showed PI9+ tumor
cells. Finally, PI9 expression was also found in 10% of Hodgkin
lymphomas. This is the first report describing the expression of the
granzyme B inhibitor PI9 in human neoplastic cells in vivo. Expression
of this inhibitor is yet another mechanism used by tumor cells to
escape their elimination by cytotoxic lymphocytes.

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