Tsukamoto et al. studied the effects of aging on immune response mechanisms associated with immune-related adverse events (irAEs) following ICB therapy. In an irAE mouse tumor model, anti-PD-1 therapy in aged, but not young mice resulted in irAE-like IgG-mediated multiorgan toxicity due to ectopic buildup of tertiary lymphoid-like structures containing CD4+ T cells and B cells. Mechanistically, CD4+ T cells stimulated IL-21 production in irAE organs, resulting in CXCL13 activation. Toxicity was reduced by B cell depletion, or by blockade of IL-21 or CXCL13. Systemic increases in CXCL13 and T cell IL-21 correlated with irAE incidence in ICB-treated patients.
Contributed by Katherine Turner
ABSTRACT: Clinical success of immune-checkpoint blockade (ICB) cancer immunotherapy is compromised by increased risk of immune-related adverse events (irAEs). However, mechanistic action(s) of immune responses underlying development of irAE remain not fully explored. Here, we found that in tumor-bearing aged, but not young, mice, antiprogrammed death receptor (PD)-1 therapy elicited irAE-like multiorgan dysfunctions with ectopic accumulation of T and B cells in damaged organs. In this preclinical model, the organ toxicities were mediated by immunoglobulin G (IgG) deposition because administration of IG from ICB-treated aged mice induced the pathogenicity specifically in nave aged hosts. Mechanistically, CD4 T-cell-derived interleukin (IL)-21 upregulated B-cell-homing chemokine, CXCL13, preferentially in irAE organs from aged mice treated with anti-PD-1 therapy. The ICB-induced pathogenicity was alleviated by B-cell depletion or by blockade of IL-21 or CXCL13 activity. These results suggest that age-associated immune regulatory milieu contributes to the formation of tertiary lymphoid structure-like lymphocytic aggregates in irAE organs and irAE-related toxicity employing IL-21-CXCL13-auto-antibody axis. Supporting this, a systemic increase in CXCL13 and Il21 expression in CD4 T cells correlated with irAE incidence in ICB-treated patients. These findings provide rationale for therapeutic usefulness of CXCL13 in irAE management.