Gastroenterology. 2020 Apr 07. pii: S0016-5085(20)30461-3. [Epub ahead of print]
David Kung-Chun Chiu,
Vincent Wai-Hin Yuen,
Jacinth Wing-Sum Cheu,
Larry Lai Wei,
Vox Ting,
Michael Fehlings,
Hermi Sumatoh,
Alessandra Nardin,
Evan W Newell,
Irene Oi-Lin Ng,
Thomas Chung-Cheung Yau,
Chun-Ming Wong,
Carmen Chak-Lui Wong.
BACKGROUND & AIMS: Immune checkpoint inhibitors are effective in treatment of some hepatocellular carcinomas (HCCs), but these tumors do not always respond to inhibitors of programmed cell death 1 (PDCD1, also called PD1). We investigated mechanisms of resistance of liver tumors in mice to infiltrating T cells.METHODS: Mice were given hydrodynamic tail vein injections of CRISPR-Cas9 and transposon vectors to disrupt Trp53 and overexpress Myc (Trp53KO/C-MycOE mice). PVRL1 and PVRL3 were knocked down in Hepa1-6 cells using short hairpin RNAs. Hepa1-6 cells were injected into livers of C57BL/6 mice; some mice were given intraperitoneal injections of antibodies against PD1, TIGIT, or CD8 before the cancer cells were injected. Liver tissues were collected from mice and analyzed by histology, immunohistochemistry, and quantitative real-time PCR; tumors were analyzed by mass cytometry using markers to detect T cells and other lymphocytes. We obtained HCC and non-tumor liver tissues and clinical data from patients who underwent surgery in Hong Kong and analyzed the tissues by immunohistochemistry.
RESULTS: Trp53KO/C-MycOE mice developed liver tumors in 3-5 weeks; injections of anti-PD1 did not slow tumor development. Tumors from mice given anti-PD1 had larger numbers of memory CD8+ T cells (CD44+CD62L-KLRGint) and T cells that expressed PD1, LAG3, and TIGIT, compared with mice not given the antibody. HCC tissues from patients had higher levels of PVRL1 mRNA and protein than non-tumor tissues. Increased PVRL1 associated with shorter times of disease-free survival. Knockdown of PVRL1 in Hepa1-6 cells caused them to form smaller tumors in mice, infiltrated by higher numbers of CD8+ T cells that expressed the inhibitory protein TIGIT; these effects were not observed in mice with depletion of CD8+ T cells. In Hepa1-6 cells, PVRL1 stabilized cell surface PVR, which interacted with TIGIT on CD8+ T cells; knockdown of PVRL1 reduced cell-surface levels of PVR but not levels of Pvr mRNA. In Trp53KO/C-MycOE mice and mice with tumors grown from Hepa1-6 cells, injection of the combination of anti-PD1 and anti-TIGIT significantly reduced tumor growth, increased the ratio of cytotoxic to regulatory T cells in tumors, and prolonged survival.
CONCLUSIONS: PVRL1, which is upregulated by HCC cells, stabilizes cell surface PVR, which interacts with TIGIT, an inhibitory molecule on CD8+ effector memory T cells. This suppresses the anti-tumor immune response. Inhibitors of PVRL1, along with anti-PD1 and anti-TIGIT, might be developed for treatment of HCC.
Keywords: immune regulation; immunotherapy; liver cancer; mouse model