Certain BCG-reactive responses are associated with bladder cancer prognosis

A subset of bladder patients does not respond to BCG treatment effectively and the underlying reason behind this observation is currently unclear. CD4(+) T cells are composed of various subsets that each expresses a distinctive set of cytokines and can potently shift the immune response toward various directions. In this study, we examined the CD4(+) T-cell cytokine response in bladder cancer patients toward BCG stimulation. We found that bladder cancer patients presented a variety of responses toward BCG, with no uniform characteristics. Those patients with high IFN-gamma and IL-21 expression in CD4(+) T cells presented significantly better prognosis than patients with low cytokine secretion in CD4(+) T cells. Tumor-infiltrating CD4(+) T cells were significantly less potent in expressing IFN-gamma, IL-4, and IL-17, and more potent in expressing IL-10 than circulating CD4(+) T cells. In addition, we found no difference in CD80, CD86, or MHC II expression by macrophages from patients with different IFN-gamma and IL-21 levels. However, the secretion of IL-12, a Th1-skewing cytokine, was released at significantly higher level by macrophages from patients with high IFN-gamma or high IL-21 secretion. We also identified that modulating monocytes/macrophages by GM-CSF-mediated polarization resulted in significantly elevated expression of IFN-gamma and IL-21 from CD4(+) T cells. Overall, these results suggested that the specific types of responses mounted by CD4(+) T cells were critical to the final outcome of bladder cancer patients and can be influenced by monocyte/macrophage polarization.