Department of Gastrointestinal Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
Central Laboratory, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Acta Biomater. 2023 Jul 1;164:538-552. doi: 10.1016/j.actbio.2023.04.001. Epub 2023 Apr 9.
Liver metastasis is the leading cause of death in colorectal cancer. Immunotherapy using immune checkpoint blockade (ICB) is ineffective due to its immunological cold tumor nature. Herein, we prepared a nanodrug (NCG) encapsulating the transforming growth factor-β receptor inhibitor galunisertib (Gal) and the sonosensitizer chlorin e6 (Ce6), which was aimed to turn this type of cold tumor into a hot one to promote the ICB-based immunotherapy against it. After delivery to the tumor, NCG under ultrasonic irradiation generated reactive oxygen species causing tumor immunogenic cell death and releasing immunostimulatory signals such as calreticulin and HMGB1, which increased tumor immunogenicity and activated the innate T lymphocyte immune response. Moreover, NCG responded to the acidic microenvironment and released Gal, inhibiting phosphorylation and inducing immunosuppressive Smad2/3 signaling. Consequently, the differentiation of MDSCs was inhibited, M1-like polarization of tumor-associated macrophages was induced, and the immunosuppressive barrier of tumor-associated fibroblasts was destroyed to increase the infiltration of effector T cells, which reversed the immunosuppression of the tumor microenvironment and improved the therapeutic efficacy of anti-PD-L1 antibodies. Notably, in the liver metastasis mouse model, combination therapy using NCG (+) and aPD-L1 inhibited the growth of colon cancer liver metastasis, manifesting potential in treating this popular yet intractable malignancy. STATEMENT OF SIGNIFICANCE: Only a limited number of patients with colorectal cancer and liver metastasis can benefit from immune checkpoint blockade therapy, as most of them are microsatellite stable, immunologically cold tumors. Interestingly, there is compelling evidence that sonodynamic therapy (SDT) can convert immunosuppressed cold tumors into hot ones, trigger tumor immunogenic cell death non-invasively, and boost cytotoxic T cells infiltration. However, its therapeutic efficacy is constrained by the abundance of transforming growth factor-β (TGF-β) cytokines in the tumor microenvironment. Here, we reported a TGF-β-targeted inhibitory nanodrug that improved SDT in colon cancer and liver metastasis, reversed the immunosuppressive tumor microenvironment and boosted the immune response to anti-PD-L1 therapy in this cancer. It demonstrated the potential to cure this prevalent but incurable malignancy.
肝转移是结直肠癌患者死亡的主要原因。由于其免疫原性冷肿瘤的性质,免疫检查点阻断(ICB)的免疫疗法效果不佳。在此,我们制备了一种纳米药物(NCG),其中包含转化生长因子-β受体抑制剂 galunisertib(Gal)和声敏剂氯乙酮(Ce6),旨在将这种冷肿瘤转变为热肿瘤,以促进基于 ICB 的免疫治疗。NCG 递送到肿瘤后,在超声照射下产生活性氧,导致肿瘤免疫原性细胞死亡,并释放免疫刺激信号,如钙网蛋白和 HMGB1,从而增加肿瘤免疫原性并激活固有 T 淋巴细胞免疫反应。此外,NCG 响应酸性微环境并释放 Gal,抑制磷酸化并诱导免疫抑制性 Smad2/3 信号。因此,抑制了 MDSCs 的分化,诱导了肿瘤相关巨噬细胞的 M1 样极化,并破坏了肿瘤相关成纤维细胞的免疫抑制屏障,增加了效应 T 细胞的浸润,从而逆转了肿瘤微环境的免疫抑制,提高了抗 PD-L1 抗体的治疗效果。值得注意的是,在结直肠癌肝转移的小鼠模型中,NCG(+)和 aPD-L1 的联合治疗抑制了结肠癌肝转移的生长,表现出治疗这种流行但难治性恶性肿瘤的潜力。
意义声明:只有少数结直肠癌和肝转移患者可以从免疫检查点阻断治疗中获益,因为他们中的大多数是微卫星稳定的、免疫原性冷肿瘤。有趣的是,有强有力的证据表明声动力学疗法(SDT)可以将免疫抑制性冷肿瘤转化为热肿瘤,非侵入性地触发肿瘤免疫原性细胞死亡,并增强细胞毒性 T 细胞浸润。然而,其治疗效果受到肿瘤微环境中转化生长因子-β(TGF-β)细胞因子丰度的限制。在这里,我们报道了一种靶向 TGF-β的抑制性纳米药物,该药物可改善结直肠癌和肝转移的 SDT,逆转免疫抑制性肿瘤微环境,并增强对这种癌症的抗 PD-L1 治疗的免疫反应。它显示了治愈这种普遍但难以治愈的恶性肿瘤的潜力。
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