TNFRSF14 (HVEM) is a novel immune checkpoint for cancer immunotherapy in humanized mice

Background: TNFRSF14 (herpes virus entry mediator (HVEM) delivers a negative signal to T cells through the B and T Lymphocyte Attenuator (BTLA) molecule and has been associated with a worse prognosis in numerous malignancies. A formal demonstration that the HVEM/BTLA axis can be targeted for cancer immunotherapy is however still lacking. Methods: We used immunodeficient NOD.SCID.gc-null mice reconstituted with human PBMC and grafted with human tumor cell lines subcutaneously. Tumor growth was compared using linear and non linear regression statistical modeling. The phenotype of tumor-infiltrating leukocytes was determined by flow cytometry. Statistical testing between groups was performed by a non-parametric t test. Quantification of mRNA in the tumor was performed using NanoString pre-designed panels. Bioinformatics analyses were performed using Metascape, Gene Set Enrichment Analysis and Ingenuity Pathways Analysis with embedded statistical testing. Results: We showed that a murine monoclonal antibody to human HVEM significantly impacted the growth of various HVEM-positive cancer cell lines in humanized NSG mice. Using CRISPR/cas9 mediated deletion of HVEM, we showed that HVEM expression by the tumor was necessary and sufficient to observe the therapeutic effect. Tumor cell killing by the mAb was dependent on innate immune cells still present in NSG mice, as indicated by in vivo and in vitro assays. Mechanistically, tumor control by human T cells by the mAb was dependent on CD8 T cells and was associated with an increase in the proliferation and number of tumor-infiltrating leukocytes. Accordingly, the expression of genes belonging to T cell activation pathways, such as JAK/STAT and NFKB were enriched in anti-HVEM-treated mice, whereas genes associated with immuno-suppressive pathways were decreased. Finally, we developed a simple in vivo assay to directly demonstrate that HVEM/BTLA is an immune checkpoint for T-cell mediated tumor control. Conclusions: Our results show that targeting HVEM is a promising strategy for cancer immunotherapy.