In this comprehensive review, Pauken et al. provided emerging evidence on the role of the PD-1 pathway in T cell exhaustion and differentiation, the complexity of PD-1 ligands (B7-1/PD-L1 and PD-L2-RGMb-neogenin) and binding patterns (cis and trans), and current developments in PD-1 checkpoint blockade in cancer. The review highlights the regulatory roles of the PD-1 pathway in diverse differentiation stages of αβ T cells, Tregs, NK, and lymphoid cells, and in tumor cells. The promising results from neoadjuvant anti-PD-1/PD-L1 therapy in several cancers were emphasized, and questions about the optimal timing and alternative methods for PD-1 pathway intervention were raised.
Contributed by Shishir Pant
ABSTRACT: The PD-1 pathway is a cornerstone in immune regulation. While the PD-1 pathway has received considerable attention for its role in contributing to the maintenance of T cell exhaustion in chronic infection and cancer, the PD-1 pathway plays diverse roles in regulating host immunity beyond T cell exhaustion. Here, we discuss emerging concepts in the PD-1 pathway, including (1) the impact of PD-1 inhibitors on diverse T cell differentiation states including effector and memory T cell development during acute infection, as well as T cell exhaustion during chronic infection and cancer, (2) the role of PD-1 in regulating Treg cells, NK cells, and ILCs, and (3) the functions of PD-L1/B7-1 and PD-L2/RGMb/neogenin interactions. We then discuss the emerging use of neoadjuvant PD-1 blockade in the treatment of early-stage cancers and how the timing of PD-1 blockade may improve clinical outcomes. The diverse binding partners of PD-1 and its associated ligands, broad expression patterns of the receptors and ligands, differential impact of PD-1 modulation on cells depending on location and state of differentiation, and timing of PD-1 blockade add additional layers of complexity to the PD-1 pathway, and are important considerations for improving the efficacy and safety of PD-1 pathway therapeutics.