Regulatory T Cells in Ovarian Cancer Are Characterized by a Highly Activated Phenotype Distinct from That in Melanoma Aras Toker1, Linh T
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Published OnlineFirst July 31, 2018; DOI: 10.1158/1078-0432.CCR-18-0554 Biology of Human Tumors Clinical Cancer Research Regulatory T Cells in Ovarian Cancer Are Characterized by a Highly Activated Phenotype Distinct from that in Melanoma Aras Toker1, Linh T. Nguyen1, Simone C. Stone1, S.Y. Cindy Yang2, Sarah Rachel Katz3, Patricia A. Shaw4, Blaise A. Clarke4, Danny Ghazarian4, Ayman Al-Habeeb4, Alexandra Easson5, Wey L. Leong5, David R. McCready5, Michael Reedijk1,2,5, Cynthia J. Guidos6,7, Trevor J. Pugh2,8, Marcus Q. Bernardini3, and Pamela S. Ohashi1,2,6 Abstract Purpose: Regulatory T (Treg) cells expressing the transcrip- number of receptors associated with TCR engagement, includ- tion factor FOXP3 are essential for the maintenance of immu- ing PD-1, 4-1BB, and ICOS. Higher PD-1 and 4-1BB expression nologic self-tolerance but play a detrimental role in most was associated with increased responsiveness to further TCR cancers due to their ability to suppress antitumor immunity. stimulation and increased suppressive capacity, respectively. The phenotype of human circulating Treg cells has been Transcriptomic and mass cytometry analyses revealed the extensively studied, but less is known about tumor-infiltrating presence of Treg cell subpopulations and further supported Treg cells. We studied the phenotype and function of tumor- a highly activated state specifically in ovarian tumors. In infiltrating Treg cells in ovarian cancer and melanoma to comparison, Treg cells infiltrating melanomas displayed identify potential Treg cell–associated molecules that can be lower FOXP3, PD-1, 4-1BB, and ICOS expression and were targeted by tumor immunotherapies. less potent suppressors of CD8 T-cell proliferation. Experimental Design: The phenotype of intratumoral Conclusions: The highly activated phenotype of ovarian and circulating Treg cells was analyzed by multicolor tumor-infiltrating Treg cells may be a key component of an flow cytometry, mass cytometry, RNA-seq, and functional immunosuppressive tumor microenvironment. Receptors assays. that are expressed by tumor-infiltrating Treg cells could be Results: Treg cells isolated from ovarian tumors displayed exploited for the design of novel combination tumor immu- a distinct cell surface phenotype with increased expression of a notherapies. Clin Cancer Res; 1–12. Ó2018 AACR. Introduction to uncover the mechanism of action and to identify biomarkers associated with response or resistance in order to establish The unprecedented success of immune checkpoint inhibitors guidelines for patient selection and provide a rationale for the has fueled efforts to further explore, expand, and develop novel development of combination immunotherapies (3, 4). cancer immunotherapy approaches. However, the mechanism Mechanisms of immune suppression within the tumor micro- of action of checkpoint inhibitors is not clear and response environment have been of particular focus, including the upre- rates are highly variable, and typically lower than 50%, across gulation of inhibitory molecules and the recruitment of sup- different cancers (1, 2). Therefore, research has been intensified pressive cell populations such as myeloid-derived suppressor cells (MDSC), tumor-associated macrophages (TAM), and reg- ulatory T (Treg) cells (5–7). 1The Campbell Family Institute for Breast Cancer Research, Princess Margaret Treg cells are essential for the maintenance of immunologic Cancer Centre, University Health Network, Toronto, Ontario, Canada. self-tolerance and the prevention of autoimmunity (8). The 2Department of Medical Biophysics, University of Toronto, Toronto, Ontario, 3 transcription factor FoxP3 is a master regulator of Treg cell Canada. Division of Gynecologic Oncology, University Health Network, fi Toronto, Ontario, Canada. 4Department of Laboratory Medicine and Pathobi- function, and its de ciency leads to devastating autoimmune ology, University Health Network, University of Toronto, Toronto, Ontario, pathology in mice (8) and humans (9). In mice expression of Canada. 5Department of Surgical Oncology, University Health Network, Toronto, FoxP3 protein is strictly restricted to bona fide suppressive Treg Ontario, Canada. 6Department of Immunology, University of Toronto, Toronto, cells, whereas in humans, effector T cells without suppressive Ontario, Canada. 7Program in Developmental and Stem Cell Biology, Hospital for 8 function can also transiently express low levels of FoxP3 upon Sick Children Research Institute, Toronto, Ontario, Canada. Princess Margaret activation (10). Among many mechanisms Treg cells deploy to Genomics Centre, University Health Network, Toronto, Ontario, Canada. exhibit their immunosuppressive function are direct lysis of Note: Supplementary data for this article are available at Clinical Cancer immune effector cells, depletion of growth factors and metabo- Research Online (http://clincancerres.aacrjournals.org/). lites, inhibition of antigen-presenting cell function, and secretion Corresponding Author: Pamela S. Ohashi, Princess Margaret Cancer Centre, 610 of regulatory cytokines (9). University Avenue, Suite 8-407, Toronto, Ontario, Canada M5G 2C9. Phone: 416- The majority of circulating Treg cells belong to a distinct 946-4501, ext. 3689; Fax: 416-204-2276; E-mail: [email protected] þ and phenotypically stable lineage of CD4 T cells in mice and doi: 10.1158/1078-0432.CCR-18-0554 humans, as the expression of the master transcription factor Ó2018 American Association for Cancer Research. FoxP3 is initiated and epigenetically imprinted during thymic www.aacrjournals.org OF1 Downloaded from clincancerres.aacrjournals.org on September 24, 2021. © 2018 American Association for Cancer Research. Published OnlineFirst July 31, 2018; DOI: 10.1158/1078-0432.CCR-18-0554 Toker et al. Translational Relevance Materials and Methods Study participants Rates of response to immunotherapy in ovarian cancer are All human tissue and blood were obtained through protocols low despite pronounced immune infiltration. Regulatory approved by the Institutional Review Board in concordance with T (Treg) cells infiltrate many human tumors and are in most the Declaration of Helsinki. Written informed consent was cases associated with poor prognosis. In this study, we obtained from all donors who provided the samples. found that tumor-infiltrating Treg cells express a distinct array of targetable immunoreceptors, and are highly acti- Tumor specimens vated and potently suppressive. Melanoma-infiltrating Treg Tumor specimens were obtained from the UHN Biospecimen cells share many features of this Treg cell phenotype, but Program, through surgical resection from patients diagnosed possess distinct differences that could require reconsidera- with epithelial ovarian cancer (mostly high-grade serous) or tion and adjustment of immunotherapeutic approaches melanoma. Patient characteristics are summarized in Supplemen- according to cancer type. A highly suppressive tumor micro- tary Table S1. Fresh tumor specimens were enzymatically digested environment could also explain the low response rate in (RPMI1640 containing 2 mmol/L L-glutamine, 1 mg/mL colla- ovarian cancer and suggests that combination therapies that genase, 10 mg/mL Pulmozyme, 100 U/mL penicillin, 100 mg/mL boost antitumor immunity and diminish immunosuppres- streptomycin, 10 mg/mL gentamicin sulfate, and 1.25 mg/mL sion could be more promising. The Treg cell expression Amphotericin B) using the GentleMACS system (Miltenyi Biotec). pattern of inhibitory receptors could become an important Tumor digests were cryopreserved in human serum containing factor to consider in treatment decisions to avoid unwanted 10% DMSO prior to analysis. A total of 2.2 Â 107 (Æ1.7 Â 107) increases in Treg cell–mediated immunosuppression by and 1.1 Â 107 (Æ1.3 Â 107) cells were processed and analyzed per cytotoxic T-cell–targeted immunotherapy regimens. ovarian tumor and melanoma specimen, respectively. Cell via- bility for the ovarian and melanoma specimens was 61.7% (Æ22.4%) and 43.0% (Æ29.1%), respectively (Supplementary Table S1). development (11, 12). However, a subset of Treg cells also retains plasticity and can revert to a phenotype with diminished Flow cytometry and cell sorting suppressive function and produce IFNg or IL17 under inflam- Cells were stained with anti-CD3 (clone OKT3), anti-CD4 þ matory conditions (13, 14). FOXP3 -suppressive Treg cells can (RPA-T4), anti-CD8 (RPA-T8), anti–PD-1 (eBioJ105), anti–4-1BB À also be induced in vivo from FOXP3 conventional T cells by (4B4-1), anti–TIM-3 (344823), anti-OX40 (Ber-ACT35), anti- stimulation in the presence of TGFb (15). Hence, the pool of TIGIT (MBSA43), anti–DNAM-1 (DX11), anti-CD27 (O323), circulating Treg cells consists of thymus-derived and peripherally anti-CD28 (CD28.2), anti-CD25 (M-A251), anti-ICOS (C398.4A), induced subsets, and the relative contribution of each subset to anti-CD45RA (HI100), and anti-CD127 (A019D5). Cells were stable and plastic Treg cell subpopulations has not been exten- fixed and permeabilized with the Foxp3 transcription factor sively studied. staining buffer set followed by intracellular staining with anti- Treg cells accumulate at the tumor site in many cancers FOXP3 (236A/E7) and anti–CTLA-4 (BNI3). Samples were including head and neck, colorectal, liver, lung, breast, ovarian, acquired on a BD LSR Fortessa SORP flow cytometer and data skin, and pancreas (5). A high prevalence of Treg cells within were analyzed using the FlowJo software. tumor-infiltrating lymphocytes (TIL) is associated