B and T lymphocyte attenuator (BTLA) and PD-1 pathway dual blockade promotes antitumor immune responses by reversing CD8+ T-cell exhaustion in non-small cell lung cancer

BackgroundImmunotherapies targeting the programmed cell death 1 (PD-1)/programmed death ligand 1 (PD-L1) have shown great promise for a subset of patients with non-small cell lung cancer (NSCLC). However, safe and robust combination therapies are still needed to bring the benefit to broader patient...

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Main Authors: Yang Zhang, Yang Yang, Yuanyuan Zeng, Qiuxia Qu, Dan Shen, Chuanyong Mu, Wei Lei, Meiqin Su, Jingyu Mao, Lirong Gao, Zeyi Liu, Cheng Chen, Jian-an Huang
Format: Article
Language:English
Published: Frontiers Media S.A. 2025-05-01
Series:Frontiers in Immunology
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Online Access:https://www.frontiersin.org/articles/10.3389/fimmu.2025.1553042/full
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author Yang Zhang
Yang Zhang
Yang Yang
Yang Yang
Yuanyuan Zeng
Yuanyuan Zeng
Qiuxia Qu
Dan Shen
Chuanyong Mu
Wei Lei
Meiqin Su
Jingyu Mao
Lirong Gao
Zeyi Liu
Zeyi Liu
Cheng Chen
Jian-an Huang
Jian-an Huang
author_facet Yang Zhang
Yang Zhang
Yang Yang
Yang Yang
Yuanyuan Zeng
Yuanyuan Zeng
Qiuxia Qu
Dan Shen
Chuanyong Mu
Wei Lei
Meiqin Su
Jingyu Mao
Lirong Gao
Zeyi Liu
Zeyi Liu
Cheng Chen
Jian-an Huang
Jian-an Huang
author_sort Yang Zhang
collection DOAJ
description BackgroundImmunotherapies targeting the programmed cell death 1 (PD-1)/programmed death ligand 1 (PD-L1) have shown great promise for a subset of patients with non-small cell lung cancer (NSCLC). However, safe and robust combination therapies are still needed to bring the benefit to broader patient populations.Methodswe performed in vivo treatment with PD-L1 antibody in Lewis lung carcinoma (LLC)-derived murine NSCLC model. Expression of B and T lymphocyte attenuator (BTLA) was detected during treatment. We evaluated the effects of the combination of anti-BTLA and anti-PD-L1 mAbs on tumor growth and overall survival of mice. In addition, distribution and function of immune cells were analyzed by flow cytometry. The role of BTLA in human and murine CD8+ T cells and its impact on reversing exhausted phenotype of PD-1+CD8+ T cell by PD-L1 blockade were analyzed. Furthermore, we investigated expression and distribution of BTLA on lymphocytes in tumor microenvironment of different specimens from NSCLC patients.ResultsThere was no significant difference overall survival between anti-PD-L1 therapy and IgG in LLC-bearing mice, and BTLA expression was increased on CD8+ T cells after PD-L1 antibody treatment. LLC-bearing mice treated with combination of anti-BTLA and anti-PD-L1 therapy had an improved overall survival than anti-BTLA or anti-PD-L1 alone. Compared to monotherapy with anti-BTLA or anti-PD-L1, mice treated with combination therapy demonstrated increased infiltration of CD8+ and CD4+ T cells, as well as increased expression of IFN-γ, TNF-α and Ki-67 in CD8+ T cells. In addition, CD8+ T cells co-expressing BTLA and PD-1 exhibited the most exhausted phenotype to resist PD-L1 blockade therapy. Furthermore, BTLA+CD8+ T cells were abnormally increased in different specimens from NSCLC patients, and CD8+ T cells expressing BTLA in NSCLC microenvironment were correlated with clinical response to anti-PD-1 therapy in NSCLC patients.ConclusionOur results show that BTLA and PD-1 cooperatively inhibit the activity of CD8+ T cells and are associated with resistance to PD-1/PD-L1 pathway blockade in NSCLC patients. Anti-BTLA blockade enhances the antitumor efficacy of anti-PD-L1 therapy. Dual BTLA and PD-1/PD-L1 blockade should be further explored to elicit potent antitumor CD8+ T-cell responses in NSCLC patients.
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spelling doaj-art-c2d7c437cb994c27b89199160cd9e06f2025-08-20T03:07:28ZengFrontiers Media S.A.Frontiers in Immunology1664-32242025-05-011610.3389/fimmu.2025.15530421553042B and T lymphocyte attenuator (BTLA) and PD-1 pathway dual blockade promotes antitumor immune responses by reversing CD8+ T-cell exhaustion in non-small cell lung cancerYang Zhang0Yang Zhang1Yang Yang2Yang Yang3Yuanyuan Zeng4Yuanyuan Zeng5Qiuxia Qu6Dan Shen7Chuanyong Mu8Wei Lei9Meiqin Su10Jingyu Mao11Lirong Gao12Zeyi Liu13Zeyi Liu14Cheng Chen15Jian-an Huang16Jian-an Huang17Department of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Soochow University, Suzhou, ChinaInstitute of Respiratory Diseases, Soochow University, Suzhou, ChinaDepartment of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Soochow University, Suzhou, ChinaInstitute of Respiratory Diseases, Soochow University, Suzhou, ChinaDepartment of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Soochow University, Suzhou, ChinaInstitute of Respiratory Diseases, Soochow University, Suzhou, ChinaClinical Immunology Laboratory, the First Affiliated Hospital of Soochow University, Suzhou, ChinaDepartment of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Soochow University, Suzhou, ChinaDepartment of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Soochow University, Suzhou, ChinaDepartment of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Soochow University, Suzhou, ChinaDepartment of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Soochow University, Suzhou, ChinaDepartment of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Soochow University, Suzhou, ChinaDepartment of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Soochow University, Suzhou, ChinaDepartment of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Soochow University, Suzhou, ChinaInstitute of Respiratory Diseases, Soochow University, Suzhou, ChinaDepartment of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Soochow University, Suzhou, ChinaDepartment of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Soochow University, Suzhou, ChinaInstitute of Respiratory Diseases, Soochow University, Suzhou, ChinaBackgroundImmunotherapies targeting the programmed cell death 1 (PD-1)/programmed death ligand 1 (PD-L1) have shown great promise for a subset of patients with non-small cell lung cancer (NSCLC). However, safe and robust combination therapies are still needed to bring the benefit to broader patient populations.Methodswe performed in vivo treatment with PD-L1 antibody in Lewis lung carcinoma (LLC)-derived murine NSCLC model. Expression of B and T lymphocyte attenuator (BTLA) was detected during treatment. We evaluated the effects of the combination of anti-BTLA and anti-PD-L1 mAbs on tumor growth and overall survival of mice. In addition, distribution and function of immune cells were analyzed by flow cytometry. The role of BTLA in human and murine CD8+ T cells and its impact on reversing exhausted phenotype of PD-1+CD8+ T cell by PD-L1 blockade were analyzed. Furthermore, we investigated expression and distribution of BTLA on lymphocytes in tumor microenvironment of different specimens from NSCLC patients.ResultsThere was no significant difference overall survival between anti-PD-L1 therapy and IgG in LLC-bearing mice, and BTLA expression was increased on CD8+ T cells after PD-L1 antibody treatment. LLC-bearing mice treated with combination of anti-BTLA and anti-PD-L1 therapy had an improved overall survival than anti-BTLA or anti-PD-L1 alone. Compared to monotherapy with anti-BTLA or anti-PD-L1, mice treated with combination therapy demonstrated increased infiltration of CD8+ and CD4+ T cells, as well as increased expression of IFN-γ, TNF-α and Ki-67 in CD8+ T cells. In addition, CD8+ T cells co-expressing BTLA and PD-1 exhibited the most exhausted phenotype to resist PD-L1 blockade therapy. Furthermore, BTLA+CD8+ T cells were abnormally increased in different specimens from NSCLC patients, and CD8+ T cells expressing BTLA in NSCLC microenvironment were correlated with clinical response to anti-PD-1 therapy in NSCLC patients.ConclusionOur results show that BTLA and PD-1 cooperatively inhibit the activity of CD8+ T cells and are associated with resistance to PD-1/PD-L1 pathway blockade in NSCLC patients. Anti-BTLA blockade enhances the antitumor efficacy of anti-PD-L1 therapy. Dual BTLA and PD-1/PD-L1 blockade should be further explored to elicit potent antitumor CD8+ T-cell responses in NSCLC patients.https://www.frontiersin.org/articles/10.3389/fimmu.2025.1553042/fullNSCLCBTLAPD-1/PD-L1immunotherapycombination
spellingShingle Yang Zhang
Yang Zhang
Yang Yang
Yang Yang
Yuanyuan Zeng
Yuanyuan Zeng
Qiuxia Qu
Dan Shen
Chuanyong Mu
Wei Lei
Meiqin Su
Jingyu Mao
Lirong Gao
Zeyi Liu
Zeyi Liu
Cheng Chen
Jian-an Huang
Jian-an Huang
B and T lymphocyte attenuator (BTLA) and PD-1 pathway dual blockade promotes antitumor immune responses by reversing CD8+ T-cell exhaustion in non-small cell lung cancer
Frontiers in Immunology
NSCLC
BTLA
PD-1/PD-L1
immunotherapy
combination
title B and T lymphocyte attenuator (BTLA) and PD-1 pathway dual blockade promotes antitumor immune responses by reversing CD8+ T-cell exhaustion in non-small cell lung cancer
title_full B and T lymphocyte attenuator (BTLA) and PD-1 pathway dual blockade promotes antitumor immune responses by reversing CD8+ T-cell exhaustion in non-small cell lung cancer
title_fullStr B and T lymphocyte attenuator (BTLA) and PD-1 pathway dual blockade promotes antitumor immune responses by reversing CD8+ T-cell exhaustion in non-small cell lung cancer
title_full_unstemmed B and T lymphocyte attenuator (BTLA) and PD-1 pathway dual blockade promotes antitumor immune responses by reversing CD8+ T-cell exhaustion in non-small cell lung cancer
title_short B and T lymphocyte attenuator (BTLA) and PD-1 pathway dual blockade promotes antitumor immune responses by reversing CD8+ T-cell exhaustion in non-small cell lung cancer
title_sort b and t lymphocyte attenuator btla and pd 1 pathway dual blockade promotes antitumor immune responses by reversing cd8 t cell exhaustion in non small cell lung cancer
topic NSCLC
BTLA
PD-1/PD-L1
immunotherapy
combination
url https://www.frontiersin.org/articles/10.3389/fimmu.2025.1553042/full
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