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Beyond CD30 Targeting: Brentuximab Vedotin Triggers Immunogenic Cell Death and Antitumor Immunity in Mycosis Fungoides, Overcoming Resistance via BCL2 Inhibition

ABSTRACT: Background: Mycosis fungoides (MF), the most common subtype of cutaneous T cell lymphoma (CTCL), has poor prognosis in advanced stages due to lack of effective therapies. Brentuximab vedotin (BV), an antigen-drug conjugate targeting CD30, is approved for CD30+ MF after prior systemic treatment. However, many patients develop resistance with unclarified mechanisms. Method: We conducted single-cell RNA sequencing on 13 paired tumor samples from 6 CD30+ MF patients treated with BV. Eight post-treatment samples were grouped into responsive (n = 5) and non-responsive (n = 3) lesions based on pathologic response. Combination effects of BV and BCL2 inhibitors were assessed in CD30+ CTCL cell lines. Result: BV induced immunogenic cell death (ICD) in both CD30+ and CD30- malignant T cells, enhancing their MHC-II-mediated antigen presentation in responsive lesions. Besides, BV specifically enhanced the IFNα/γ responses in CD30- malignant T cells. These coincided with TME reprogramming: diminished immunosuppressive function of Tregs and activated antitumor immunity mediated by dendritic cells, CD8+ T and NK cells. In non-responsive lesions, resistance was driven by distinct mechanisms: CD30+ malignant T cells upregulated the drug efflux transporter ABCB1 and exhibited impaired endosomal processing, while CD30- tumor cells overexpressed the anti-apoptotic protein BCL2 and displayed blunted IFN response. We confirmed potent synergy between BV and BCL2 inhibitors in CTCL cell lines, overcoming resistance. Conclusion: Beyond direct CD30+ targeting, BV transforms the immunosuppressive milieu by inducing ICD in tumor cells and suppressing Tregs. Resistance involves ABCB1 upregulation in CD30+ cells and BCL2-mediated survival in CD30- cells. Combining BV with BCL2 inhibitors represents a promising strategy to overcome resistance in CD30+ CTCL.

ORGANISM(S): Homo sapiens

PROVIDER: GSE303446 | GEO | 2026/05/20

REPOSITORIES: GEO

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Project description:Increasing evidences support a potential role for the Signal Transducer and Activator of Transcription-3 (STAT3) as a tumor driver in cutaneous T-cell lymphoma (CTCL). However, the mechanisms leading to STAT3 pathway activation in CTCL and how STAT3 activation contributes to lymphomagenesis remains primarily not enough explored. Recently, we found that miR-124, a known STAT3 regulator in cancer, is robustly silenced in Mycosis Fungoides (MF) tumor-stage and CTCL cell lines and we have herein studied whether deregulation of miR-124 contributes to activate STAT3 pathway in CTCL. Material and Methods: DNA methylation status of miR-124 and its expression levels in response to the DNA-demethylating agent azacitidine were evaluated in CTCL cell lines by pyrosequencing analysis. CTCL cell lines were transient transfected with a lentiviral vector encoding miR-124 and transfected cells were analyzed for phosphorylated STAT3 (P-STAT3) levels. The impact on STAT3 signaling was evaluated using expression microarray on CTCL cell lines in both conditions, miR-124 absent (malignant condition) versus miR-124 expressed (lentiviral transduction). Results: A significant promoter methylation and silencing of miR-124 in MF tumor samples and CTCL cell lines was detected. DNA methylation levels of miR-124 in CTCL cell lines were restored (and subsequently miR-124 were overexpressed) after DNA demethylation. Ectopic lentiviral expression of miR-124 downregulated STAT3 in the different CTCL cell lines. Genes differentially expressed regarding miR-124 regulation in CTCL cell lines indicated impact on known cell survival and function pathways and, particularly, intervention on miR-124 expression modulated different STAT3 pathway components. Conclusions: Our study deciphers a novel epigenetic mechanisms regulating STAT3 pathway in CTCL. This might contribute to a better understanding the molecular basis in CTCL development. Deregulation of STAT3 seems to have a major impact on cell survival in CTCL cell lines indicating the potential interest of targeting STAT3 with specific therapies.

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Beyond CD30 Targeting: Brentuximab Vedotin Triggers Immunogenic Cell Death and Antitumor Immunity in Mycosis Fungoides, Overcoming Resistance via BCL2 Inhibition

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