Department of Hepatic Surgery II, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China.
Department of Gastroenterology Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, China.
Theranostics. 2024 Jun 1;14(9):3526-3547. doi: 10.7150/thno.95971. eCollection 2024.
Immunotherapy has demonstrated its potential to improve the prognosis of patients with hepatocellular carcinoma (HCC); however, patients' responses to immunotherapy vary a lot. A comparative analysis of the tumor microenvironment (TME) in responders and non-responders is expected to unveil the mechanisms responsible for the immunotherapy resistance and provide potential treatment targets. We performed sequencing analyses using 10x Genomics technology on six HCC patients who responded to anti-PD-1 therapy and one HCC patient who did not respond. Additionally, we obtained single cell data from untreated, responsive, and nonresponsive HCC patients from public databases, and used part of the datasets as a validation cohort. These data were integrated using algorithms such as Harmony. An independent validation cohort was established. Furthermore, we performed spatial transcriptomic sequencing on the tumor adjacent tissues of three HCC responsive patients using 10x Genomics spatial transcriptomic technology. Additionally, we analyzed data about three HCC patients obtained from public databases. Finally, we validated our conclusions using immunofluorescence, flow cytometry, and experiments. Our findings confirmed the presence of "immune barrier" partially accounting for the limited efficacy of immunotherapy. Our analysis revealed a significant increase in TREM2 Macrophages among non-responsive patients expressing multiple immunosuppressive signals. anti-Csf1r monoclonal antibodies effectively eliminated these macrophages and augmented the therapeutic effects of anti-PD-1 therapy. TCR Macrophages possessed direct tumor-killing capabilities. IL1B cDC2 was the primary functional subtype of cDC2 cells. Absence of THEMIS CD8 T subtypes might diminish immunotherapeutic effects. Furthermore, CD8 T cells entered a state of stress after anti-PD-1 treatment, which might be associated with CD8 T cell exhaustion and senescence. The profiles of immune TMEs showed differences in HCC patients responsive, non-responsive and untreated. These differences might explain the discounted efficacy of immunotherapy in some HCC patients. The cells and molecules, which we found to carry unique capabilities, may be targeted to enhance immunotherapeutic outcomes in patients with HCC.
免疫疗法已显示出改善肝细胞癌 (HCC) 患者预后的潜力;然而,患者对免疫疗法的反应差异很大。对应答者和无应答者的肿瘤微环境 (TME) 进行比较分析,有望揭示导致免疫治疗耐药的机制,并提供潜在的治疗靶点。我们使用 10x Genomics 技术对 6 名对抗 PD-1 治疗有反应的 HCC 患者和 1 名无反应的 HCC 患者进行了测序分析。此外,我们从公共数据库中获得了未经治疗、有反应和无反应的 HCC 患者的单细胞数据,并将部分数据集用作验证队列。这些数据使用 Harmony 等算法进行了整合。建立了一个独立的验证队列。此外,我们使用 10x Genomics 空间转录组学技术对 3 名 HCC 有反应患者的肿瘤邻近组织进行了空间转录组测序。此外,我们分析了从公共数据库中获得的 3 名 HCC 患者的数据。最后,我们使用免疫荧光、流式细胞术和实验验证了我们的结论。我们的研究结果证实了“免疫屏障”的存在,这在一定程度上解释了免疫疗法疗效有限的原因。我们的分析表明,在表达多种免疫抑制信号的无应答患者中,TREM2 巨噬细胞显著增加。抗 CSF1r 单克隆抗体可有效消除这些巨噬细胞,并增强抗 PD-1 治疗的疗效。TCR 巨噬细胞具有直接杀伤肿瘤的能力。IL1B cDC2 是 cDC2 细胞的主要功能亚型。THEMIS CD8 T 亚型的缺失可能会降低免疫治疗效果。此外,CD8 T 细胞在接受抗 PD-1 治疗后进入应激状态,这可能与 CD8 T 细胞耗竭和衰老有关。在 HCC 患者中,有反应者、无反应者和未治疗者的免疫 TME 特征存在差异。这些差异可能解释了为什么某些 HCC 患者的免疫疗法效果不佳。我们发现具有独特功能的细胞和分子可能成为 HCC 患者增强免疫治疗效果的靶点。