Fumarate Hydratase Enhances the Therapeutic Effect of PD-1 Antibody in Colorectal Cancer by Regulating PCSK9
by
Le Qin
1,2,†, 
Liang Shi
1,†,
Yu Wang
3,
Haixin Yu
4,
Zhouyuan Du
4,
Mian Chen
1,
Yuxuan Cai
1,
Yinghao Cao
4,
Shenghe Deng
1,
Jun Wang
1,
Denglong Cheng
1,
Yixin Heng
2,
Jiaxin Xu
2,
Kailin Cai
1,* and
Ke Wu
1,* 1
Department of Gastrointestinal Surgery, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan 430022, China
2
Department of General Surgery, The First Affiliated Hospital of Shihezi University, Shihezi 832008, China
3
Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
4
Department of Digestive Surgical Oncology, Cancer Center, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan 430022, China
*
Authors to whom correspondence should be addressed.
†
These authors contributed equally to this work.
Cancers 2024, 16(4), 713; https://doi.org/10.3390/cancers16040713
Submission received: 14 December 2023
/
Revised: 13 January 2024
/
Accepted: 22 January 2024
/
Published: 8 February 2024
(This article belongs to the Section Cancer Immunology and Immunotherapy)
Simple Summary
This research revealed that the downregulation of fumarate hydratase in patients is associated with poor prognosis. Mechanistically, FH binds to RAN, which inhibits the nuclear import of the PCSK9 transcription factor SREBF1/2, thus reducing the expression of PCSK9. This leads to increased clonal expansion of CD8+ T cells while the number of Tregs remains unchanged, and the expression of PD-L1 does not change significantly, thus enhancing the immunotherapy response. Importantly, combined therapy targeting PCSK9 and PD-1 may be beneficial for patients with CRC and low FH expression. Considering these results, our findings hold potential for future clinical applications.
Abstract
Despite the notable achievements of programmed death 1 (PD-1) antibodies in treating various cancers, the overall efficacy remains limited in the majority of colorectal cancer (CRC) cases. Metabolism reprogramming of tumors inhibits the tricarboxylic acid (TCA) cycle, leading to down-regulation of fumarate hydratase (FH), which is related to poor prognosis in CRC patients. By establishing a tumor-bearing mouse model of CRC with Fh1 expression deficiency, we confirmed that the therapeutic effect of PD-1 antibodies alone was suboptimal in mice with low Fh1 expression, which was improved by combination with a protein invertase subtilisin/kexin 9 (PCSK9) inhibitor. Mechanistically, FH binds to Ras-related nucleoprotein (RAN), which inhibits the nuclear import of the PCSK9 transcription factor SREBF1/2, thus reducing the expression of PCSK9. This leads to increased clonal expansion of CD8+ T cells while the number of Tregs remains unchanged, and the expression of PD-L1 does not change significantly, thus enhancing the immunotherapy response. On the contrary, the expression of PCSK9 increased in CRC cells with low FH expression, which antagonized the effects of immunotherapy. Overall, CRC patients with low FH expression may benefit from combinatorial therapy with PD-1 antibodies and PCSK9 inhibitors to enhance the curative effect.
