PURPOSE: Upregulation of programmed death-ligand 1 (PD-L1) on circulating and tumor-infiltrating myeloid cells is a critical component of GBM-mediated immunosuppression that has been associated with diminished response to vaccine immunotherapy and poor survival. While GBM-derived soluble factors have been implicated in myeloid PD-L1 expression, the identity of such factors has remained unknown. This study aimed to identify factors responsible for myeloid PD-L1 upregulation as potential targets for immune modulation Experimental Design: Conditioned media from patient-derived GBM explant cell cultures was assessed for cytokine expression and utilized to stimulate naive myeloid cells. Myeloid PD-L1 induction was quantified by flow cytometry. Candidate cytokines correlated with PD-L1 induction were evaluated in tumor sections and plasma for relationships with survival and myeloid PD-L1 expression. The role of identified cytokines on immunosuppression and survival was investigated in vivo utilizing immune competent C57BL/6 mice bearing syngeneic GL261 and CT-2A tumors. RESULTS: GBM-derived interleukin-6 (IL-6) was identified as a cytokine that is necessary and sufficient for myeloid PD-L1 induction in GBM through a signal transducer and activator of transcription 3 (STAT3)-dependent mechanism. Inhibition of IL-6 signaling in orthotopic murine glioma models was associated with reduced myeloid PD-L1 expression, diminished tumor growth, and increased survival. The therapeutic benefit of anti-IL-6 therapy proved to be CD8+ T cell dependent, and the anti-tumor activity was additive with that provided by programmed death-1 (PD-1) targeted immunotherapy. CONCLUSIONS: Our findings suggest that disruption of IL-6 signaling in GBM reduces local and systemic myeloid-driven immunosuppression and enhances immune-mediated anti-tumor responses against GBM.

Author Info: (1) Neurological Surgery, Northwestern University, Feinberg School of Medicine. (2) Neurological Surgery, Northwestern University. (3) Neurological Surgery, Northwestern University

Author Info: (1) Neurological Surgery, Northwestern University, Feinberg School of Medicine. (2) Neurological Surgery, Northwestern University. (3) Neurological Surgery, Northwestern University. (4) Neurosurgery, Barrow Neurological Institute. (5) Neurological Surgery, University of California San Francisco Medical Center. (6) Neurological Surgery, Northwestern University. (7) Neurological Surgery, Northwestern University. (8) Otolaryngology Head and Neck Surgery, Stanford University School of Medicine. (9) Neurosurgery, University of Virginia. (10) Neurological Surgery, Northwestern University. (11) Neurological Surgery, Northwestern University. (12) Neurological Surgery, Northwestern University. (13) Neurological Surgery, Northwestern University. (14) Neurological Surgery, Northwestern University, Feinberg School of Medicine. (15) Pathology, Northwestern University, Feinberg School of Medicine. (16) Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine. (17) Neurological Surgery, Feinberg School of Medicine, Northwestern University. (18) Neurological Surgery, Northwestern University orin.bloch@northwestern.edu.