Hypofractionated Radiotherapy Upregulates Several Immune Checkpoint Molecules in Head and Neck Squamous Cell Carcinoma Cells Independently of the HPV Status While ICOS-L Is Upregulated Only on HPV-Positive Cells
Sebastian Wimmer, Lisa Deloch, Michael Hader, Anja Derer, Fridolin Grottker, Thomas Weissmann, Markus Hecht, Antoniu-Oreste Gostian, Rainer Fietkau, Benjamin Frey, Udo S Gaipl, Sebastian Wimmer, Lisa Deloch, Michael Hader, Anja Derer, Fridolin Grottker, Thomas Weissmann, Markus Hecht, Antoniu-Oreste Gostian, Rainer Fietkau, Benjamin Frey, Udo S Gaipl
Abstract
While the treatment of squamous cell carcinoma of the head and neck (HNSCC) with radiotherapy (RT) is complemented more and more by immunotherapy in clinical trials, little is known about the impact of the human papillomavirus (HPV) status or the applied RT scheme on the immune phenotype of the tumor cells. Therefore, we aimed to examine the impact of the HPV status of four human HNSCC cell lines on cell death and the expression of immune checkpoint molecules (ICMs) after RT with either hypofractionation irradiation (5x3.0Gy) or a high single dose (1x19.3Gy) via multicolor flow cytometry and quantitative PCR at an early time point after therapy. In our study, 5x3.0Gy RT induced high numbers of early and late apoptotic cells independent of the HPV status, but necrosis was only increased in the HPV-positive UM-Scc-47 cells. Generally, the immune stimulatory ICMs (CD70, CD137-L, ICOS-L) were less affected by RT compared to the immune suppressive ones (PD-L1, PD-L2, and the herpesvirus entry mediator (HVEM)). A significant higher surface expression of the analyzed ICMs was found after hypofractionated RT compared to a single high dose; however, regardless of the HPV status, with the exception of ICOS-L. Here, HPV-positive HNSCC tumor cells showed a stronger response to 5x3.0Gy than HPV-negative ones. On the RNA level, only minor alterations of ICMs were observed following RT, with the exception of the HPV negative cell line CAL33 treated with 5x3.0Gy, where PD-L2, HVEM and CD70 were significantly increased. We conclude that the HPV status may not distinctly predict immunological responses following RT, and thus cannot be used as a single predictive marker for therapy responses in HNSCC. In contrast, the patient-specific individual expression of ICMs following RT is preferable for the targeted patient selection for immune therapy directed against distinct ICM.
Keywords: HNSCC; HPV status; immune checkpoint molecules; immunotherapy; radiotherapy.
Conflict of interest statement
M.H. (Michael Hader), U.S.G. and R.F. received support for presentation activities from -Ing. Sennewald Medizintechnik GmbH. R.F., U.S.G. and B.F. have received support for investigator initiated clinical studies (IITs) from Merck Sharp & Dohme and AstraZeneca. R.F. and U.S.G. also contributed at Advisory Boards Meetings of AstraZeneca and Bristol-Myers Squibb. M.H. (Markus Hecht): Merck Serono (advisory role, speakers’ bureau, honoraria, travel expenses, research funding); MSD (advisory role, speakers’ bureau, honoraria, travel expenses, research funding); AstraZeneca (research funding); Novartis (research funding); BMS (advisory role, honoraria, speakers’ bureau); Teva (travel expenses). S.W., L.D., A.D., F.G., A.-O.G. and T.W. have no conflict of interest.
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