Low molecular weight heparin synergistically enhances the efficacy of adoptive and anti-PD-1-based immunotherapy by increasing lymphocyte infiltration in colorectal cancer

Yibo Quan; Jie He; Qi Zou; Liuxi Zhang; Qihui Sun; Hongli Huang; Wanglin Li; Keping Xie; Fang Wei

doi:10.1136/jitc-2023-007080

Low molecular weight heparin synergistically enhances the efficacy of adoptive and anti-PD-1-based immunotherapy by increasing lymphocyte infiltration in colorectal cancer

J Immunother Cancer. 2023 Aug;11(8):e007080. doi: 10.1136/jitc-2023-007080.

Authors

Yibo Quan^#¹, Jie He^#^{1

2}, Qi Zou^#^{1

2}, Liuxi Zhang^#^{1

2}, Qihui Sun², Hongli Huang¹, Wanglin Li³, Keping Xie⁴, Fang Wei^{3

2}

Affiliations

¹ Guangzhou Digestive Disease Center, Guangzhou First People's Hospital and The Second Affiliated Hospital, South China University of Technology School of Medicine, South China University of Technology, Guangzhou, China.
² Center for Pancreatic Cancer Research and Department of Immunology, The South China University of Technology School of Medicine, South China University of Technology, Guangzhou, China.
³ Guangzhou Digestive Disease Center, Guangzhou First People's Hospital and The Second Affiliated Hospital, South China University of Technology School of Medicine, South China University of Technology, Guangzhou, China eyfangwei@scut.edu.cn scutmedicine@scut.edu.cn eylwl@scut.edu.cn.
⁴ Center for Pancreatic Cancer Research and Department of Immunology, The South China University of Technology School of Medicine, South China University of Technology, Guangzhou, China eyfangwei@scut.edu.cn scutmedicine@scut.edu.cn eylwl@scut.edu.cn.

^# Contributed equally.

Abstract

Background: Immunotherapy, including adoptive cell therapy (ACT) and immune checkpoint inhibitors (ICIs), has a limited effect in most patients with colorectal cancer (CRC), and the efficacy is further limited in patients with liver metastasis. Lack of antitumor lymphocyte infiltration could be a major cause, and there remains an urgent need for more potent and safer therapies for CRC.

Methods: In this study, the antitumoral synergism of low molecular weight heparin (LMWH) combined with immunotherapy in the microsatellite stable (MSS) highly aggressive murine model of CRC was fully evaluated.

Results: Dual LMWH and ACT objectively mediated the stagnation of tumor growth and inhibition of liver metastasis, neither LMWH nor ACT alone had any antitumoral activity on them. The combination of LMWH and ACT obviously increased the infiltration of intratumor CD8⁺ T cells, as revealed by multiplex immunohistochemistry, purified CD8⁺ T-cell transfer assay, and IVIM in vivo imaging. Mechanistically, evaluation of changes in the tumor microenvironment revealed that LMWH improved tumor vascular normalization and facilitated the trafficking of activated CD8⁺ T cells into tumors. Similarly, LMWH combined with anti-programmed cell death protein 1 (PD-1) therapy provided superior antitumor activity as compared with the single PD-1 blockade in murine CT26 tumor models.

Conclusions: LMWH could enhance ACT and ICIs-based immunotherapy by increasing lymphocyte infiltration into tumors, especially cytotoxic CD8⁺ T cells. These results indicate that combining LMWH with an immunotherapy strategy presents a promising and safe approach for CRC treatment, especially in MSS tumors.

Keywords: gastrointestinal neoplasms; immune checkpoint inhibitors; immunotherapy, adoptive; lymphocytes, tumor-infiltrating; tumor microenvironment.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Animals
CD8-Positive T-Lymphocytes
Colorectal Neoplasms* / drug therapy
Heparin, Low-Molecular-Weight / pharmacology
Heparin, Low-Molecular-Weight / therapeutic use
Humans
Immunotherapy
Liver Neoplasms*
Mice
Tumor Microenvironment

Substances

Heparin, Low-Molecular-Weight