Trogocytosis-mediated transfer of FOLR2 from Nurse-like cells to CLL cells is linked to their activation and proliferation

Communication with the lymphoid microenvironment is crucial for survival and proliferation of neoplastic B cells in chronic lymphocytic leukemia (CLL). In this study, we examined nurse-like cells (NLCs), CLL-specific macrophages, strongly implicated in CLL pathogenesis, and their interaction with leukemic cells. Using primary patient cells, we demonstrated that NLCs express high levels of folate receptor beta (FOLR2), which correlates with increased survival of cancer cells in vitro. Furthermore, we discovered that CLL cells acquire functional FOLR2 from NLCs via trogocytosis, enhancing their folate uptake. By mimicking the CLL microenvironment with soluble factors, CD40L and IL-15, we observed a strong NLC-dependent CLL cell activation and proliferation. Moreover, we linked this phenomenon with trogocytosis, by demonstrating that FOLR2+ CLL cells are the predominant population of actively cycling cancer cells. By multiplex immunofluorescence analysis of CLL patient lymph nodes, we confirmed the presence of FOLR2 NLCs, and observed their enrichment in more aggressive and proliferative CLL cases. Finally, we detected FOLR2 cancer cells, providing evidence of trogocytosis in situ. Taken together, we propose FOLR2 as a novel marker of protective NLCs, and highlight the importance of trogocytosis in improved CLL cell adaptation, including NLC-mediated activation and proliferation. O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=58 SRC="FIGDIR/small/630890v3_ufig1.gif" ALT="Figure 1"> View larger version (22K): org.highwire.dtl.DTLVardef@1cde6d6org.highwire.dtl.DTLVardef@ee0f67org.highwire.dtl.DTLVardef@1355cb3org.highwire.dtl.DTLVardef@590b29_HPS_FORMAT_FIGEXP M_FIG O_FLOATNOScheme 1.C_FLOATNO Schematic representation of trogocytosis-mediated acquisition of NLC-derived FOLR2 by CLL cells, and its impact on promoting cancer cell adaptability to folate deprivation. 1) CLL cells enter the lymph node (LN) and engage in contact with FOLR2+ NLCs. 2) The presence of T cell- and stromal cell-derived cytokines, CD40L and IL-15 promotes the activation and trogocytosis-mediated acquisition of FOLR2 by CLL cells. 3) FOLR2 trogocytic CLL cells have an advantage in folate acquisition and show increased proliferation compared to the remaining population of cancer cells C_FIG SUMMARYO_LICLL cells acquire functional FOLR2 from NLCs via trogocytosis, a process that is closely linked with enhanced CLL cell activation and proliferation in vitro C_LIO_LIIncreased Frequency of FOLR2 expressing macrophages in more aggressive and proliferative cases of CLL. C_LIO_LIFOLR2 is a marker of M2-like protective NLCs in vitro C_LI