Department of Medical Oncology, Candiolo Cancer Institute, Fondazione del Piemonte per l'Oncologia-IRCCS, Candiolo, Italy.
Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA.
Blood. 2024 Jun 20;143(25):2612-2626. doi: 10.1182/blood.2023022777.
Immunogenic cell death (ICD) is a form of cell death by which cancer treatments can induce a clinically relevant antitumor immune response in a broad range of cancers. In multiple myeloma (MM), the proteasome inhibitor bortezomib is an ICD inducer and creates durable therapeutic responses in patients. However, eventual relapse and resistance to bortezomib appear inevitable. Here, by integrating patient transcriptomic data with an analysis of calreticulin (CRT) protein interactors, we found that GABA type A receptor-associated protein (GABARAP) is a key player whose loss prevented tumor cell death from being perceived as immunogenic after bortezomib treatment. GABARAP is located on chromosome 17p, which is commonly deleted in patients with high risk MM. GABARAP deletion impaired the exposure of the eat-me signal CRT on the surface of dying MM cells in vitro and in vivo, thus reducing tumor cell phagocytosis by dendritic cells and the subsequent antitumor T-cell response. Low GABARAP was independently associated with shorter survival in patients with MM and reduced tumor immune infiltration. Mechanistically, we found that GABARAP deletion blocked ICD signaling by decreasing autophagy and altering Golgi apparatus morphology, with consequent defects in the downstream vesicular transport of CRT. Conversely, upregulating autophagy using rapamycin restored Golgi morphology, CRT exposure, and ICD signaling in GABARAPKO cells undergoing bortezomib treatment. Therefore, coupling an ICD inducer, such as bortezomib, with an autophagy inducer, such as rapamycin, may improve patient outcomes in MM, in which low GABARAP in the form of del(17p) is common and leads to worse outcomes.
免疫原性细胞死亡(ICD)是一种细胞死亡形式,通过这种形式,癌症治疗可以在广泛的癌症中诱导临床相关的抗肿瘤免疫反应。在多发性骨髓瘤(MM)中,蛋白酶体抑制剂硼替佐米是一种 ICD 诱导剂,可在患者中产生持久的治疗反应。然而,最终的复发和对硼替佐米的耐药性似乎不可避免。在这里,我们通过整合患者转录组数据和钙网蛋白(CRT)蛋白相互作用体的分析,发现 GABA 型 A 受体相关蛋白(GABARAP)是一个关键的参与者,其缺失阻止了硼替佐米治疗后肿瘤细胞死亡被视为免疫原性。GABARAP 位于染色体 17p 上,在高危 MM 患者中经常缺失。GABARAP 缺失损害了体外和体内死亡 MM 细胞表面 CRT 吞噬信号的暴露,从而减少了树突状细胞对肿瘤细胞的吞噬作用和随后的抗肿瘤 T 细胞反应。低 GABARAP 与 MM 患者的生存时间缩短和肿瘤免疫浸润减少独立相关。在机制上,我们发现 GABARAP 缺失通过减少自噬和改变高尔基器形态来阻断 ICD 信号,从而导致 CRT 的下游囊泡运输缺陷。相反,使用雷帕霉素上调自噬可恢复 GABARAPKO 细胞在硼替佐米治疗过程中的高尔基形态、CRT 暴露和 ICD 信号。因此,将 ICD 诱导剂(如硼替佐米)与自噬诱导剂(如雷帕霉素)结合使用,可能会改善 MM 患者的预后,因为形式为 del(17p)的低 GABARAP 很常见,并且会导致更差的结局。
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