Immune cells and their inflammatory mediators modify β cells and cause checkpoint inhibitor–induced diabetes
Ana Luisa Perdigoto, Songyan Deng, Katherine C. Du, Manik Kuchroo, Daniel B. Burkhardt, Alexander Tong, Gary Israel, Marie E. Robert, Stuart P. Weisberg, Nancy Kirkiles-Smith, Angeliki M. Stamatouli, Harriet M. Kluger, Zoe Quandt, Arabella Young, Mei-Ling Yang, Mark J. Mamula, Jordan S. Pober, Mark S. Anderson, Smita Krishnaswamy, Kevan C. Herold
Ana Luisa Perdigoto, Songyan Deng, Katherine C. Du, Manik Kuchroo, Daniel B. Burkhardt, Alexander Tong, Gary Israel, Marie E. Robert, Stuart P. Weisberg, Nancy Kirkiles-Smith, Angeliki M. Stamatouli, Harriet M. Kluger, Zoe Quandt, Arabella Young, Mei-Ling Yang, Mark J. Mamula, Jordan S. Pober, Mark S. Anderson, Smita Krishnaswamy, Kevan C. Herold
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Research Article

Immune cells and their inflammatory mediators modify β cells and cause checkpoint inhibitor–induced diabetes

Abstract

Checkpoint inhibitors (CPIs) targeting programmed death 1 (PD-1)/programmed death ligand 1 (PD-L1) and cytotoxic T lymphocyte antigen 4 (CTLA-4) have revolutionized cancer treatment but can trigger autoimmune complications, including CPI-induced diabetes mellitus (CPI-DM), which occurs preferentially with PD-1 blockade. We found evidence of pancreatic inflammation in patients with CPI-DM with shrinkage of pancreases, increased pancreatic enzymes, and in a case from a patient who died with CPI-DM, peri-islet lymphocytic infiltration. In the NOD mouse model, anti–PD-L1 but not anti–CTLA-4 induced diabetes rapidly. RNA sequencing revealed that cytolytic IFN-γ+CD8+ T cells infiltrated islets with anti–PD-L1. Changes in β cells were predominantly driven by IFN-γ and TNF-α and included induction of a potentially novel β cell population with transcriptional changes suggesting dedifferentiation. IFN-γ increased checkpoint ligand expression and activated apoptosis pathways in human β cells in vitro. Treatment with anti–IFN-γ and anti–TNF-α prevented CPI-DM in anti–PD-L1–treated NOD mice. CPIs targeting the PD-1/PD-L1 pathway resulted in transcriptional changes in β cells and immune infiltrates that may lead to the development of diabetes. Inhibition of inflammatory cytokines can prevent CPI-DM, suggesting a strategy for clinical application to prevent this complication.

Authors

Ana Luisa Perdigoto, Songyan Deng, Katherine C. Du, Manik Kuchroo, Daniel B. Burkhardt, Alexander Tong, Gary Israel, Marie E. Robert, Stuart P. Weisberg, Nancy Kirkiles-Smith, Angeliki M. Stamatouli, Harriet M. Kluger, Zoe Quandt, Arabella Young, Mei-Ling Yang, Mark J. Mamula, Jordan S. Pober, Mark S. Anderson, Smita Krishnaswamy, Kevan C. Herold

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Figure 8

Blocking IFN-γ and TNF-α significantly delays the development of diabetes.

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Blocking IFN-γ and TNF-α significantly delays the development of diabete...
(A) IFN-γ and TNF-α were neutralized in NOD mice concurrently treated with anti–PD-L1 to assess the effect on diabetes induction. Anti–TNF-α alone did not delay the induction of anti–PD-L1–induced diabetes (median time = 18.5 versus 14 days, P = 0.97), but neutralization of anti–IFN-γ alone did delay the time to diabetes (median time = 35.5 days, P = 0.18). Blocking both IFN-γ and TNF-α significantly delayed the development of diabetes (median time = undef, P = 0.006). n = 16 for anti–PD-L1 only, n = 10 for anti–PD-L1 + anti–IFN-γ, n = 4 for anti–PD-L1 + anti–TNF-α, n = 13 for anti–PD-L1 + anti–IFN-γ + anti–TNF-α. χ2, log-rank (Mantel-Cox) test. (B) Grades of insulitis observed in age-matched control NOD (n = 3 mice), anti–PD-L1 only (n = 3 mice), and anti–PD-L1 + anti–IFN-γ + anti–TNF-α–treated NOD mice (n = 4 mice). n = 10–20 islets per condition. A greater degree of insulitis was observed with anti–PD-L1 only (χ2 P < 0.0001). Representative H&E images are shown for anti–PD-L1 only and anti–PD-L1 + anti–IFN-γ + anti–TNF-α islets. Scale bar: 25 μm.