Establishing mouse models of NSCLC with known driver mutations and varying TMB
Given the low mutational burden in Kras-mutant GEMMs of NSCLC, we reasoned these tumors would be resistant to anti-PD-1 therapy. We screened cell lines established from Kras-mutant GEMMs of NSCLC with common co-occurring genomic alterations, namely K, KP, and KPL, with anti-PD-1 antibody in immunocompetent mice. Primary resistance to anti-PD-1 immunotherapy was observed across all cell lines, except for K, which showed a statistically significant but modest response to PD-1 blockade (Fig. 1a, and Supplemental Figures S2A, S2B and S2C). Because loss of a functional PD-L1 axis has been implicated in primary resistance to ICIs, we assessed the capacity of IFN-γ to upregulate PD-L1 in K, KP, and KPL cells in vitro [15]. IFN-γ stimulation resulted in the upregulation of PD-L1 in all cell lines examined, confirming an intact PD-L1 axis (Supplemental Figure S2D).
To establish Kras-mutant NSCLC cell lines that harbor the essential genomic drivers of the disease and increased TMB, we subjected one cell line from each genomic background, namely K, KP and KPL, to the carcinogen MNU for various durations (3, 5, and 7 exposures to MNU for 45 min each time, designated as 3M, 5M, and 7M, respectively) (Fig. 1b). Although we evaluated other tobacco related carcinogens for this purpose, namely benzyo[a]pyrene and nicotine-derived nitrosamine ketone (NNK), we found MNU to have the highest in vitro efficacy to increase the mutational load of cell lines as determined by WES. MNU is a widely utilized in vivo carcinogen to generate murine models of NSCLCs [9]. Although the mechanism of MNU-mediated DNA damage is distinct from tobacco smoking, its potency and wide utility, documented in the literature, suggests MNU as an effective agent for generating passenger mutations in NSCLC cell lines that already possess the critical driver mutations of the Kras-mutant NSCLC. WES revealed a dose-dependent increase in the number of non-synonymous mutations across all genomic backgrounds, resulting in higher TMBs (Fig. 1b). In parallel to increased TMB within each family of isogeneic cell lines, we observed an increased proportion of mutations with low VAF, indicating increased tumor heterogeneity (Fig. 1c). MNU did not result in changes in the genomic copy number of parental cell lines which were diploid. Evaluation of the copy number and mutations of the driver genes confirmed the deletion of Tp53 in KP cell lines and Tp53 and Lkb1 in KPL cell lines. Wild-type Tp53 was preserved in K cell lines. No additional Kras mutated alleles were detected in MNU-treated K, KP and KPL cell lines. The VAFs of the Kras mutation were around 0.4–0.6 in all cell lines, indicating that each cell line maintained the heterozygous Kras mutation. We then assessed the evolution of mutations within each family of cell lines with increased exposure to MNU, and detected mutations that were shared among parental, 3M, 5M and 7M cells within each genetic background, as well as private mutations which were specific to each cell line (Fig. 1d). The presence of both private and shared mutations in each family of cell lines provides a unique opportunity to evaluate the immune editing of these mutations in response to therapy in syngeneic studies.
Higher TMB results in decreased tumor growth
To determine the effect of increased TMB on in vivo tumor growth, we screened each family of cell lines with varying TMB in syngeneic models. Across all genomic backgrounds, we observed diminished in vivo tumor growth with incremental increases in TMB (Fig. 2a). Increasing the number of injected cells led to robust tumor growth of K-3M, KP-3M, KPL-3M and KPL-5M cells, while other lines, namely K-5M, K-7M, KP-5M, KP-7M, KPL-7M, were rejected or displayed diminished growth rates (data not shown). Evaluation of in vitro growth rates of cell lines with varying TMB within each family revealed minimal differences (Supplemental Figure S3). These results indicate that diminished in vivo growth associated with increased TMB is likely immune-mediated. To further confirm this finding, we evaluated the in vivo growth of the K, KP and KPL parental cells, and their associated 7M counterparts in immunocompromised SCID mice which lack T and B cells (Fig. 2b). We observed similar tumor growth rates of K-7M and KP-7M compared to their parental counterparts, while KPL-7M showed minor but statistically significant reduction in tumor growth compared to parental KPL cells. Given that there was no difference in growth rates of KPL-P and KPL-7M in vitro (Supplemental Figure S3), the slightly reduced growth rate of KPL-7M in vivo could possibly be related to other immune-mediated pathways such as natural killer cells. These results suggest that the decreased tumor growth rates associated with high TMB in immunocompetent mice are predominantly due to host adaptive immune responses.
Next, we assessed the stability of the TMB in our syngeneic model system to ensure that in vivo host immune editing does not result in outgrowth of tumors with low TMB. We utilized KPL-3M as a representative model and performed WES of KPL-3M subcutaneous tumors in immunocompetent mice at day 25. We observed that subcutaneous KPL-3M tumors maintained 30% of the mutations present in KPL-3M cells prior to in vivo mouse inoculation (Fig. 2c). These represent stable mutations that are not edited by host immune cells. We also observed emergence of new mutations which likely result from the expansion of minor subclones that are below the detection threshold in KPL-3M cells (Fig. 2c). Overall, approximately 30% of total mutations were shared between two independent tumors (Fig. 2c). Taken together, these data suggest that the KPL-3M tumors maintain high TMB in vivo with a considerable overlap in their mutational profiles.
High TMB is associated with increased local and systemic tumor-specific T cells
To define the immune responses induced by high TMB in each genetic background, we utilized cells with robust in vivo growth and moderate mutation burden, namely K-Parent, K-3M, KP-Parent, KP-3M, KPL-Parent, KPL-3M, and KPL-5M. We first evaluated the lymphoid compartment of the TME. We observed a significant increase in the number of tumor-infiltrating lymphocytes (TILs) and an increase in CD8+ to regulatory T (Treg) cell ratio in the TME with increased TMB in each genetic background (Fig. 3a). In addition, a higher percentage of infiltrating CD8+ T cells in the tumors with high TMB expressed the proliferation marker Ki-67 compared to their respective parental tumors.
Next, we evaluated the expression of the early activation/exhaustion marker PD-1 on TILs and observed higher expression of PD-1 on CD8+ T cells in KP and KPL tumors with high TMB compared to their parental counterparts (Fig. 3a). Studies reveal that tumor-specific CD8+ TILs in human cancers express high levels of PD-1 and that this phenotype can identify the diverse repertoire of clonally expanded tumor-reactive T cells. Thus, our results suggest that increased TMB in the KP and KPL models results in increased tumor-specific CD8+ T cell responses [16, 17]. In parallel, we detected increased co-expression of the checkpoint TIM-3, a marker of increased T cell exhaustion with prolonged antigen exposure, on PD-1+CD8+ T cells in KP and KPL tumors with high TMB compared to their parental counterparts. However, we observed no difference in tumor CD8+ T cell exhaustion between K-parent and K-3M tumors. This observation is likely due to increased immunogenicity of the K-parent tumors, which contain high TILs and increased CD8+ T cell exhaustion at baseline and exhibit slow in vivo growth with modest sensitivity to anti-PD-1 therapy. These results support the hypothesis that a higher TMB results in increased tumor-reactive PD-1+ T cells within the TME, which become exhausted with persistent antigen stimulation.
Peripheral tumor neoantigen-specific T cells which overlap with clonal tumor-specific TILs have also been identified in circulating PD-1+CD8+ T cells in melanoma patients [18]. Therefore, we evaluated the lymphoid compartment within the spleen of tumor-bearing mice, including expression of PD-1 on CD8+ T cells (Fig. 3a). We observed an increase in splenic PD-1+CD8+ T cells in mice bearing K, KP, and KPL tumors with high TMB compared to the parental counterparts, including a statistically significant increase in mice bearing KPL-5M tumors compared to those bearing KPL-3M tumors (Fig. 3a). These data suggest that increased TMB results in increased systemic tumor-specific T cells in our murine models.
Next, we evaluated the myeloid compartment of the TME and observed TMB-mediated changes in the immune phenotypes shared across all genetic backgrounds, as well as marked differences specific to KPL cells (Fig. 3b and Supplemental Figure S4A). High TMB was associated with a significant increase in the professional antigen-presenting dendritic cells (DCs) in the KP and KPL tumors, with no differences observed in K tumors. We observed no differences in the number of tumor-associated macrophages (TAMs) in K-3M and KP-3M compared to the respective parental tumors, but we observed an increase in TAMs in KPL-3M and KPL-5M tumors compared to KPL-Parent. We evaluated changes in the MDSCs and found that high TMB was associated with decreased MDSCs across all genetic backgrounds. KPL tumors contained a significantly higher percentage of MDSCs (over 80% of CD45+ cells), which were predominantly G-MDSCs expressing the neutrophil marker Ly6G (Fig. 3b and Supplemental Figure S4B). We observed a similar phenotype in the spleen where KPL tumor-bearing mice had a significantly higher percentage of G-MDSCs compared to mice bearing K and KP tumors (Supplemental Figure S4C). This immune phenotype in KPL models is consistent with studies in Kras-mutant murine and KRAS-mutant human NSCLC where LKB1 loss is associated with a T cell-suppressed and neutrophil-enriched TME [19,20,21].
We further evaluated the expression of PD-L1 by tumors and the myeloid cells in the TME (Fig. 3c). We observed an increase in PD-L1 expression on TAMs in K and KPL tumors with increased TMB compared to their parental counterparts but no difference between KP-3M and KP-Parent. We observed increased PD-L1 expression on MDSCs in the KPL tumors with higher TMB, with the greatest expression observed in KPL-5M, but no difference was detected within the K and KP genetic background. Increased PD-L1 expression was also observed on tumors with an increased TMB in each genetic background. Taken together, the observed overall trend of increased PD-L1 expression associated with increasing TMB implies amplified adaptive immune resistance within the TME.
Anti-PD-1 responses in cell lines with high TMB recapitulate the therapeutic vulnerabilities of KRAS-mutant human NSCLC
We evaluated the efficacy of PD-1 blockade in K-3M, KP-3M and KPL-3M tumors with increased TMB (Fig. 4a and Supplemental Figure S5A). Anti-PD-1 therapy resulted in robust anti-tumor responses with an eradication of 33% of K-3M tumors. Similarly, 44% of KP-3M tumors were rejected and others stabilized in response to anti-PD-1. In contrast, anti-PD-1 efficacy was limited in KPL-3M tumors where PD-1 blockade resulted in reduced tumor growth without a complete rejection. This result is in agreement with the recent findings in human KRAS-mutant lung adenocarcinoma in which LKB1 loss was shown to be a major driver of primary resistance to PD-1 blockade [20]. We next assessed the efficacy of PD-1 blockade in mice bearing KPL-5M tumors and observed significant anti-tumor responses with the rejection of approximately 50% of tumors (Fig. 4b). These data suggest that the increased TMB of KPL-5M tumors could overcome the immunosuppressed TME and enhance responses to PD-1 blockade. This is in agreement with our immunophenotyping results of the KPL family of tumors in which mice bearing KPL-5M tumors possessed the highest number of local and systemic activated PD1+ CD8+ T cells (Fig. 3a). PD1+ CD8+ T cells have been shown to contain pools of tumor neoantigen-specific T cells that can be reinvigorated following PD-1 blockade [22, 23]. The mice bearing KPL-5M tumors, that had a complete anti-tumor response to anti-PD1, were subsequently rechallenged with KPL-5M cells. In response to the rechallenge, we observed an initial tumor growth followed by spontaneous rejection of all tumors (Fig. 4c), indicating the establishment of systemic anti-tumor immunity in response to PD-1 blockade in mice bearing KPL-5M tumors.
Given that KPL-5M shares 47 truncal and branch mutations with the KPL-Parent (Fig. 1d), we assessed whether the mice that had eradicated the KPL-5M tumors following anti-PD-1 treatment could reject the parental tumors by inoculating the mice with KPL-Parent cells 3 months after the initial rejection (Fig. 4d). All of the mice eliminated the KPL-Parent tumors after an initial growth, while the naïve control mice succumbed to implantation of KPL-Parent tumors in less than 30 days. Computational analysis of putative neoantigens in the KPL-Parent revealed 11 truncal and 17 branch neoantigens which were shared with KPL-3M, KPL-5M or KPL-7M (Fig. 4e and Supplemental Figure S5B). These results indicate the presence of tumor-specific memory T cells against shared neoantigen(s) between KPL-5M and KPL-Parent tumors in anti-PD-1 treated mice that had eradicated KPL-5M tumors. Despite this finding, T cell responses against these shared neoantigen(s) are not sufficient to eradicate KPL-Parent tumors in naïve mice treated with PD-1 blockade (Fig. 1a). This may be due to profound immunosuppression in the TME of KPL-Parent tumors that represses the initial host anti-tumor T cell responses (Fig. 3). In contrast, eradication of KPL-P tumors in the rechallenge experiments may be predominantly mediated by memory T cells, which can generate a rapid recall response to secondary challenge that overcomes the immunosuppressive TME. The presence of shared neoantigen(s) in these isogenic cell lines with varying TMB provides a unique opportunity to investigate immune responses against truncal and branch mutations in the context of TMB-associated changes in the TME.
In summary, we report novel Kras-mutant murine models of NSCLC bearing common driver gene alterations and increased TMB (Supplemental Table S2). Although the nature of the additional somatic mutations induced by MNU may not fully recapitulate the spectrum of tobacco-related mutations observed in human KRAS-mutant NSCLC, these murine models are clinically relevant because they possess the dominant driver mutations of KRAS-mutant NSCLC that determine distinct TMEs and clinical phenotypes as well as passenger mutations that can elicit adaptive immune responses. In contrast to existing Kras-mutant GEMMs of NSCLC that possess few mutations and have limited utility in immunotherapy studies, our models with increased TMB recapitulate the therapeutic vulnerabilities to anti-PD-1 which mirrors that of human KRAS-mutant NSCLC. The KPL-3M model with co-occurring Kras and Lkb1 mutations, neutrophil-enriched TME, physiologically relevant TMB, and limited efficacy to anti-PD-1 serves as a clinically relevant model for preclinical immunotherapy studies, given loss of LKB1 is a dominant driver of resistance in human NSCLC. We anticipate that these novel immunogenic murine models will facilitate the development of future immunotherapies for NSCLC.