Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, USA.
Department of Radiation Oncology, Stanford University, Stanford, CA 94305, USA.
Sci Transl Med. 2024 Sep 18;16(765):eadk0642. doi: 10.1126/scitranslmed.adk0642.
Radiation therapy (RT) activates multiple immunologic effects in the tumor microenvironment (TME), with diverse dose-response relationships observed. We hypothesized that, in contrast with homogeneous RT, a heterogeneous RT dose would simultaneously optimize activation of multiple immunogenic effects in a single TME, resulting in a more effective antitumor immune response. Using high-dose-rate brachytherapy, we treated mice bearing syngeneic tumors with a single fraction of heterogeneous RT at a dose ranging from 2 to 30 gray. When combined with dual immune checkpoint inhibition in murine models, heterogeneous RT generated more potent antitumor responses in distant, nonirradiated tumors compared with any homogeneous dose. The antitumor effect after heterogeneous RT required CD4 and CD8 T cells and low-dose RT to a portion of the tumor. At the 3-day post-RT time point, dose heterogeneity imprinted the targeted TME with spatial differences in immune-related gene expression, antigen presentation, and susceptibility of tumor cells to immune-mediated destruction. At a later 10-day post-RT time point, high-, moderate-, or low-RT-dose regions demonstrated distinct infiltrating immune cell populations. This was associated with an increase in the expression of effector-associated cytokines in circulating CD8 T cells. Consistent with enhanced adaptive immune priming, heterogeneous RT promoted clonal expansion of effector CD8 T cells. These findings illuminate the breadth of dose-dependent effects of RT on the TME and the capacity of heterogeneous RT to promote antitumor immunity when combined with immune checkpoint inhibitors.
放射治疗(RT)在肿瘤微环境(TME)中激活多种免疫效应,观察到不同的剂量反应关系。我们假设,与均匀 RT 不同,不均匀 RT 剂量会同时优化单一 TME 中多种免疫原性效应的激活,从而产生更有效的抗肿瘤免疫反应。我们使用高剂量率近距离放射治疗,用 2 至 30 格雷的不均匀 RT 单次剂量治疗携带同源肿瘤的小鼠。当与小鼠模型中的双重免疫检查点抑制联合使用时,与任何均匀剂量相比,不均匀 RT 在远处未照射的肿瘤中产生了更强的抗肿瘤反应。不均匀 RT 后的抗肿瘤作用需要 CD4 和 CD8 T 细胞以及肿瘤的一小部分接受低剂量 RT。在 RT 后 3 天的时间点,剂量不均匀性在靶向 TME 中留下了免疫相关基因表达、抗原呈递和肿瘤细胞对免疫介导破坏的易感性的空间差异。在稍后的 RT 后 10 天时间点,高、中或低 RT 剂量区域显示出不同的浸润免疫细胞群。这与循环 CD8 T 细胞中效应相关细胞因子表达的增加有关。与增强适应性免疫启动一致,不均匀 RT 促进了效应 CD8 T 细胞的克隆扩增。这些发现阐明了 RT 对 TME 的剂量依赖性影响的广度,以及当与免疫检查点抑制剂联合使用时不均匀 RT 促进抗肿瘤免疫的能力。
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