ADAM protease inhibition overcomes resistance of breast cancer stem-like cells to γδ T cell immunotherapy

Breast cancer stem cells (BCSC) are highly resistant to current therapies, and are responsible for metastatic burden and relapse. Gamma delta T cells ({gamma}{delta}Tc) are immunosurveillance cells with tremendous anti-tumoral activity, and a growing number of clinical trials have confirmed the safety of {gamma}{delta}Tc immunotherapy for various malignancies. Herein, we demonstrate that {gamma}{delta}Tc can kill BCSC, but to a lesser extent than non-cancer stem cells (NSC). Immune evasion was orchestrated by several mechanisms. The BCSC secretome rendered {gamma}{delta}Tc hypo-responsive by reducing proliferation, cytotoxicity and IFN-{gamma} production, while increasing expression of co-inhibitory receptors on {gamma}{delta}Tc. BCSC and target cells surviving {gamma}{delta}Tc cytotoxicity had higher PD-L1 co-inhibitory ligand expression, and blocking PD-1 on {gamma}{delta}Tc significantly overcame BCSC resistance to {gamma}{delta}Tc killing. Fas/FasL signaling was dysfunctional in BCSC due to upregulation of the anti-apoptotic protein MCL-1, which could be partially overcome using dMCL1-2, an MCL-1 degrader. Moreover, the BCSC fraction shed higher levels of the NKG2D ligand MICA compared to NSC. Inhibiting MICA shedding using the ADAM inhibitor GW280264X overcame BCSC resistance to {gamma}{delta}Tc killing, rendering BCSC as sensitive to {gamma}{delta}Tc cytotoxicity as NSC. Collectively, our data unravel multiple mechanisms exploited by BCSC to evade {gamma}{delta}Tc killing, which may also come into play in BCSC resistance to other cytotoxic lymphocytes. Developing strategies to overcome this resistance will increase the efficacy of cancer immunotherapy and lead to improved outcomes for cancer patients. One Sentence SummaryBreast cancer stem-like cells are resistant to {gamma}{delta} T cell targeting, which can be overcome by inhibiting ADAM proteases that facilitate MICA/B shedding.