Mechanism of CTLA-4-induced immunosuppression.

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Mechanism of CTLA-4-induced immunosuppression. Mechanism of CTLA-4-induced immunosuppression. (A) Cancer cells synthesise and release neoantigens (dots of different colours) that are captured by APCs. These cells present peptides in the context of MHC I molecules/TCRs on the surface of CD8+ cytotoxic T cells within lymph nodes. APCs can also present peptides bound to MHC II molecules to CD4+ T helper cells. T cell activation on TCR signalling requires costimulatory signals transmitted via CD28, which is activated by binding to CD80, and/or CD86, on the surface of APCs. Activated T cells upregulate CTLA-4, which competes with CD28 for binding to CD80 and/or CD86. The interaction of CTLA-4 with CD80 or CD86 results in inhibitory signalling promoting tumour growth. The immunosuppressive activity of CTLA-4 is mediated by downregulation of Th cells and enhancement of Treg cells. (B) CTLA-4 blockade by ipilimumab results in a broad enhancement of immune responses against neoantigen expressing tumour cells, which results in killing of tumour cells. APC, antigen presenting cell; CTLA-4, cytotoxic T lymphocyte-associated antigen 4; TCR, T cell receptor; Th cells, helper CD4+ T cells; Treg, regulatory T cell. Gilda Varricchi et al. ESMO Open 2017;2:e000247 Copyright © European Society for Medical Oncology. All rights reserved.