HLA-E and NKG2A Mediate Resistance to BCG Immunotherapy in Non-Muscle-Invasive Bladder Cancer.

TitleHLA-E and NKG2A Mediate Resistance to BCG Immunotherapy in Non-Muscle-Invasive Bladder Cancer.
Publication TypeJournal Article
Year of Publication2025
AuthorsRanti D, Yu H, Salomé B, Bang S, Duquesne I, Wang YA, Bieber C, Strandgaard T, Merritt E, Doherty G, Narasimhan A, Okulate I, Houghton S, Hug B, Kim J, Ravichandran H, Demetriou A, Li Z, Lindskrog SV, da Silva ANMRangel, Ruan DF, Daza J, J Ingles C, Rai R, Hegewisch-Solloa E, Mace EM, Fernandez-Rodriguez R, Izadmehr S, Farkas AM, Cruz-Encarnacion P, Shroff S, Patel F, Tran M, Youssef D, Ananthanarayanan A, Park J, Geanon D, Kelly G, Lee B, Nie K, Miake-Lye S, Xie H, Chen R, Bi C, Rizakos T, Villagomez B, Thin TH, Garcia-Barros M, Brown H, Martin B, Mateo A, Soto A, Sussman R, Shiwlani S, Francisco-Simon S, Beaumont KG, Wang Y-C, Wang L, Sebra RP, Smith S, Skobe M, Clancy-Thompson E, Palmer D, Hammond S, Yolmo P, Koti M, Hopkins BD, Wiklund P, Zhu J, Bravo-Cordero JJ, Brody R, Chen Z, Kim-Schulze S, Dyrskjøt L, Elemento O, Tocheva A, Song W-M, Bhardwaj N, Galsky MD, Sfakianos JP, Horowitz A
JournalbioRxiv
Date Published2025 Sep 09
ISSN2692-8205
Abstract

Bacillus Calmette-Guérin (BCG) is the first-line therapy for high-grade non-muscle-invasive bladder cancer (NMIBC), yet many patients experience recurrence due to immune evasion. We identify HLA-E and NKG2A as mediators of adaptive resistance involving chronic activation of NK and T cells in BCG-unresponsive tumors. Prolonged IFN-γ exposure enhances HLA-E and PD-L1 expression on recurrent tumors, accompanied by the accumulation of NKG2A+ NK and CD8 T cells. HLA-E tumor cells preferentially cluster near CXCL12-rich stromal regions with dense effector cell presence, underscoring a spatially segregated tumor architecture. Although cytotoxic lymphocytes retain effector potential, their activity is restrained by HLA-E/NKG2A and PD-L1/PD-1 pathways located in their immediate neighborhood within the bladder tumor microenvironment. These data reveal a spatially organized immune escape program that limits anti-tumor immunity. Our findings support dually targeting NKG2A and PD-L1 checkpoint blockade as a rational, bladder-sparing strategy for patients with BCG-unresponsive NMIBC.

DOI10.1101/2024.09.02.610816
Alternate JournalbioRxiv
PubMed ID39282294
PubMed Central IDPMC11398371
Grant ListR01 CA244780 / CA / NCI NIH HHS / United States
U19 AI168632 / AI / NIAID NIH HHS / United States
U24 CA264032 / CA / NCI NIH HHS / United States
R21 CA274148 / CA / NCI NIH HHS / United States
R01 AI187598 / AI / NIAID NIH HHS / United States
R01 CA269954 / CA / NCI NIH HHS / United States
R21 AI130760 / AI / NIAID NIH HHS / United States
R01 NS111997 / NS / NINDS NIH HHS / United States
R01 CA271619 / CA / NCI NIH HHS / United States
R01 CA301050 / CA / NCI NIH HHS / United States
R01 CA271545 / CA / NCI NIH HHS / United States
R61 CA278402 / CA / NCI NIH HHS / United States
OT2 CA297580 / CA / NCI NIH HHS / United States
OT2 OD032720 / OD / NIH HHS / United States
R01 CA271915 / CA / NCI NIH HHS / United States
R01 NS127984 / NS / NINDS NIH HHS / United States
U01 DA058527 / DA / NIDA NIH HHS / United States
R35 GM142918 / GM / NIGMS NIH HHS / United States
P30 CA196521 / CA / NCI NIH HHS / United States