The FLRT3-UNC5B checkpoint pathway inhibits T cell-based cancer immunotherapies

Sci Adv. 2024 Mar;10(9):eadj4698. doi: 10.1126/sciadv.adj4698. Epub 2024 Mar 1.

Abstract

Cancers exploit coinhibitory receptors on T cells to escape tumor immunity, and targeting such mechanisms has shown remarkable clinical benefit, but in a limited subset of patients. We hypothesized that cancer cells mimic noncanonical mechanisms of early development such as axon guidance pathways to evade T cell immunity. Using gain-of-function genetic screens, we profiled axon guidance proteins on human T cells and their cognate ligands and identified fibronectin leucine-rich transmembrane protein 3 (FLRT3) as a ligand that inhibits T cell activity. We demonstrated that FLRT3 inhibits T cells through UNC5B, an axon guidance receptor that is up-regulated on activated human T cells. FLRT3 expressed in human cancers favored tumor growth and inhibited CAR-T and BiTE + T cell killing and infiltration in humanized cancer models. An FLRT3 monoclonal antibody that blocked FLRT3-UNC5B interactions reversed these effects in an immune-dependent manner. This study supports the concept that axon guidance proteins mimic T cell checkpoints and can be targeted for cancer immunotherapy.

MeSH terms

  • Humans
  • Immunotherapy
  • Membrane Glycoproteins
  • Neoplasms* / genetics
  • Neoplasms* / therapy
  • Netrin Receptors
  • T-Lymphocytes*

Substances

  • FLRT3 protein, human
  • Membrane Glycoproteins
  • UNC5B protein, human
  • Netrin Receptors