We focused on reducing drug resistance to PD-1 inhibitors due to lack of CD8+ T cells infiltration. This paper focused on the search for CD8+ T cells infiltration-related factors and explored infiltration mechanisms so as to provide new concepts for improving immunotherapy.
We selected samples from two data sets, calculated CD8+ T cell infiltration in melanoma tissue samples using the CIBERSORT package, identified co-expressed genes that promoted CD8+ T cells infiltration using the WGCNA algorithm, and performed preliminary screening based on intersection results.
We subsequently selected nine genes in the survival analysis that were most significantly associated with reduced mortality as key genes promoting CD8+ T cells infiltration. We performed functional enrichment in a biological process (BP) in which these genes were enriched in the IFN-γ mediated signaling pathway as well as in the antigen presentation and processing pathway. Through correlation analysis with angiogenic factors, angiogenic inhibitors and tumor purity, we verified that these nine genes inhibit tumor progression in the tumor microenvironment.
In GSEA analysis, the biopathways enriched in the high expression group of key genes were associated with tumor immunity. Key genes play important roles in CD8+ T cells infiltration in some cancers: CCL5, GBP5, GZMA, GZMH, IRF1, LAG3, NKG7, PRF1 and PSMB10 were identified as promoting factors for CD8+ T cell infiltration, all of which had independent prognostic effects.
CCL5 is a chemokine expressed by T lymphocytes, macrophages, platelets, synovium fibroblasts, renal tubular epithelial cells and tumor cells[26]. Harlin et al. found that CCL5 produced by melanoma cells helped chemokine recruitment of CD8+ effector T cells, and lack of key chemokines may limit CD8+ T cell migration, thereby limiting the effectiveness of anti-tumor immunity[27]. PRF1 is expressed by a protein called perforin, which is expressed by CD8+ T cells and NK cells and is essential for cell-mediated cytotoxicity and effective control of pathogens[28]. Taube et al. demonstrated that CD8A, PRF1 and CCL5 were overexpressed in PD-L1+ melanoma by QRT-PCR analysis and were involved in the activation of CD8+ T cells[29]. GZMA is the most abundant protease in cytotoxic particles of NK cells[30]. Inoue et al. examined mRNA levels of immune-related genes in melanoma patients before and after immunotherapy with nivolumab and found increased CD8 and GZMA expression levels[31]. IRF1 is an effective antiviral, antitumor and immunoregulatory protein. Many studies reported that IRF1 is closely related to tumor inhibition. CD8+ T cells in IRF1-deficient melanoma showed increased cytotoxicity, the expression of PD-L1 was up-regulated, and tumor growth was more easily restored[32]. LAG3 is the third alternative inhibitory receptor targeted in tumor microenvironment, which has attracted much attention and research in clinical trials[33]. Frohlich et al. found that LAG3 methylation in melanoma tissues was associated with CD8+ T cells infiltration and IFN-γ signaling, and they believed that LAG3 could be used as a substitute biomarker for cytotoxic anti-tumor response[34]. NKG7 is one of the most expressed genes in NK cells and is essential for cytotoxic degranulation of NK cells and CD8+ T cells as well as the activation and pro-inflammatory response of CD4+ T cells[35]. Through mapping T cell receptor cloning, Fairfax et al. found that patients who responded to immunotherapy had more CD8+ T cell-related large clones overexpressed gene NKG7 than did non-responders[36]. Although the relationship between GBP5, GZMH, PSMB10 and CD8+ T cells has not been clearly demonstrated in melanoma, some of them have been verified in other types of cancer. GBP5 and other immunomodulatory genes were significantly up-regulated in myeloid carcinoma of the colon, promoting the infiltration of CD8+ T cells in myeloid carcinoma[37].
Nine co-expressed genes promoting CD8+ T cell infiltration were significantly enriched in the IFN-γ pathway, suggesting that IFN-γ may be closely related to CD8+ T cell infiltration. Dangaj et al. found that T cell infiltration required tumor cell-derived CCL5, and CXCL9 secretion by IFN-γ differentiated myeloid cells was amplified; in immunoreactive and immunoresponsive tumors, the synergistic effect of tumor-derived CCL5 and IFN-γ-induced CXCR3 ligand secreted by bone marrow cells is the key to coordinate T cell infiltration[38]. Jia et al. analyzed the distribution of tumor infiltrating T cells and the expression of PD-L1 in the orthotopic murine glioma model; GBP5, IRF1, as IFN-γ-induced genes were positively correlated with PD-L1 scores as a measure of alternative IFN-γ levels[39]. It was proposed that tumors with high neutrophil burdens are characterized by T cell response dullness, characterized by decreased expression of cytotoxic T cell genes such as CD8A, CD8B, GZMA and GZMB. There was decreased infiltration of CD3+ T cells and CD8+ T cells, and decreased expression of IFN-γ-related genes[40]. Lichtenegger et al. found that blocking LAG-3 led to higher T cell activation and an increase in IFN-γ secretion compared with inhibition of other pathways; they concluded that the novel immune response was strongly enhanced by blocking LAG-3 or blocking both LAG 3 and PD-1[41]. The promoter region of PSMB10 gene contains two IFN stimulus response elements, interregulated by IFN; this was confirmed by in vitro mutagenesis[42].
Curtsinger et al. stimulated CD8+ T cells in mice using antigen-specific B7-1, and found that they could rapidly produce a small amount of IFN-γ, with the production peaking at about 8 hours and decreasing after 24 hours[43]. When CD8+ T cells are exposed to mild temperatures, they promoted the production of specific IFN-γ, which increased the lethality of tumor target cells[44]. Karachaliou et al. treated 21 melanoma patients with pembrolizumab and found that patients with high IFN-γ expression had significantly longer progress-free survival than those with low IFN-γ expression[45].
A limitation of this paper is that we only included a total of 800 cases in two cohorts in two databases. More samples are needed to validate the scientific accuracy of the results. Although this paper is a comprehensive data analysis, it still needs to be further verified using in vitro experiments.
In summary, CCL5, GBP5, GZMA, GZMH, IRF1, LAG3, NKG7, PRF1 and PSMB10 are co-expression promotors of CD8+ T cell infiltration. Among them, CCL5, GZMA, IRF1, LAG3, NKG7 and PRF1 are closely related to CD8+ T cell infiltration in melanoma tissues. While there is no conclusive evidence that CD8+ T cell infiltration in melanoma tissues is closely related to GBP5, GZMH, PSMB10, it is worth exploring. The lack of CD8+ T cells in central tumor areas has become a major obstacle to immunotherapy for solid tumors, especially melanoma. Therefore, novel therapeutic strategies that promote the accumulation of CD8+ T cells in central tumor regions are urgently needed. We highlighted the complexity of immune checkpoint regulation in tumor microenvironments and identified several factors that may contribute to synergistic immunosuppression. These factors may be involved in the tumor escape mechanism of anti-PD-1/PD-L1 treatment; therefore, they can be considered for co-targeting in future immunotherapy.