Modulation of NK cells with checkpoint inhibitors in the context of cancer immunotherapy.

The incidence of some types of tumours has increased progressively in recent years and is expected to continue growing in the coming years due in part to the aging of the population. The design of new therapies based on natural killer (NK) cells opens new possibilities especially for the treatment of elderly patients who are particularly susceptible to the toxicity of conventional chemotherapy treatments. In recent years, the potential use of NK cells in cancer immunotherapy has been of great interest thanks to advances in the study of NK cell biology. The identification of key points (checkpoints) in the activation of NK cells that can be regulated by monoclonal antibodies has allowed the design of new therapeutic strategies based on NK cells. However, there are still limitations for its use and the first clinical trials blocking KIR inhibitory receptors have shown little efficacy by inhibiting the maturation of NK cells. Blockade of other inhibitory receptors such as TIGIT, TIM3, LAG3 and PD1 may represent novel strategies to increase NK function in cancer patients. Altogether, the identification of NK cell and tumour cell markers of resistance or susceptibility to the action of NK cells will contribute to identifying those patients that will most likely benefit from NK cell-based immunotherapy.

Immunosenescence: limitations of natural killer cell-based cancer immunotherapy.

Cancer is primarily considered a disease of old age. Immunosenescence refers to the age-associated changes in the immune system, and its contribution to the increased risk of cancer in old individuals has been discussed for many years. Natural killer (NK) cells are cytotoxic innate immune cells specialized in defence against tumour and virus-infected cells. NK cell cytotoxicity is the result of a fine balance between activating and inhibitory receptors. Several activating receptors have been identified that recognize different ligands frequently found over-expressed on tumour cells or virus-infected cells. The most important NK cell inhibitory receptors interact with major histocompatibility complex class I molecules expressed on almost all nucleated cells preventing NK cell-mediated lysis of healthy cells. NK cell immunosenescence is characterized by a redistribution of NK cell subsets, a diminished expression of several activating receptors and lower per-cell cytotoxicity. Altered expression of activating receptors has also been described in young and elderly cancer patients probably due to chronic exposure to ligands on tumour cells. Thus, the effect of both age and cancer may act synergistically to diminish NK cell-mediated tumour immunosurveillance. Different strategies harnessing the power of NK cells to target tumour cells have been designed including adoptive therapy with autologous or allogeneic expanded NK cells. In addition, checkpoint blockade of inhibitory receptors and the use of agonist antibodies to stimulate activating receptors are emerging areas of research. In this context, the effect of immunosenescence should be considered to improve the efficiency of cancer immunotherapy.

NK cell recognition and killing of melanoma cells is controlled by multiple activating receptor-ligand interactions.

The role of natural killer (NK) cells in tumor immunosurveillance has been recently underlined. A better understanding of the receptor-ligand interactions between NK cells and solid tumor cells is essential for introducing more effective NK cell-based immunotherapy protocols into clinical practice. We previously analyzed the surface expression of ligands for NK cell-activating receptors and costimulatory molecules in a large panel of melanoma cell lines. Although the expression of ligands for NK cell-activating receptors is variable, the majority of melanoma cell lines express ligands for NKG2D and for DNAX accessory molecule-1 (DNAM-1). While the NKG2D receptor has been described as the principal entity responsible for the lysis of several melanoma cell lines, the role of natural cytotoxicity receptors (NCRs) and DNAM-1 receptors in NK cell recognition and killing of melanoma cells has been recently emphasized. Antibody-mediated masking of NKG2D, NCRs, and DNAM-1 has proven that NKG2D, NCRs, and DNAM-1 frequently cooperate in the lysis of melanoma cells. In this work, we provide an overview of recent advances in the study of melanoma cells' susceptibility to NK cell-mediated lysis and how multiple receptor-ligand interactions participate in melanoma cell elimination.