Metabolic adaptation of ovarian tumors in patients treated with an IDO1 inhibitor constrains antitumor immune responses

Kunle Odunsi, Feng Qian, Amit A. Lugade, Han Yu, Melissa A. Geller, Steven P. Fling, Judith C. Kaiser, Andreanne M. Lacroix, Leonard D'Amico, Nirasha Ramchurren, Chihiro Morishima, Mary L. Disis, Lucas Dennis, Patrick Danaher, Sarah Warren, Van Anh Nguyen, Sudharshan Ravi, Takemasa Tsuji, Spencer Rosario, Wenjuan ZhaAlan Hutson, Song Liu, Shashikant Lele, Emese Zsiros, A. J.Robert McGray, Jessie Chiello, Richard Koya, Thinle Chodon, Carl D. Morrison, Vasanta Putluri, Nagireddy Putluri, Donald E. Mager, Rudiyanto Gunawan, Martin A. Cheever, Sebastiano Battaglia, Junko Matsuzaki

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


To uncover underlying mechanisms associated with failure of indoleamine 2,3-dioxygenase 1 (IDO1) blockade in clinical trials, we conducted a pilot, window-of-opportunity clinical study in 17 patients with newly diagnosed advanced high-grade serous ovarian cancer before their standard tumor debulking surgery. Patients were treated with the IDO1 inhibitor epacadostat, and immunologic, transcriptomic, and metabolomic characterization of the tumor microenvironment was undertaken in baseline and posttreatment tumor biopsies. IDO1 inhibition resulted in efficient blockade of the kynurenine pathway of tryptophan degradation and was accompanied by a metabolic adaptation that shunted tryptophan catabolism toward the serotonin pathway. This resulted in elevated nicotinamide adenine dinucleotide (NAD+), which reduced T cell proliferation and function. Because NAD+ metabolites could be ligands for purinergic receptors, we investigated the impact of blocking purinergic receptors in the presence or absence of NAD+ on T cell proliferation and function in our mouse model. We demonstrated that A2a and A2b purinergic receptor antagonists, SCH58261 or PSB1115, respectively, rescued NAD+-mediated suppression of T cell proliferation and function. Combining IDO1 inhibition and A2a/A2b receptor blockade improved survival and boosted the antitumor immune signature in mice with IDO1 overexpressing ovarian cancer. These findings elucidate the downstream adaptive metabolic consequences of IDO1 blockade in ovarian cancers that may undermine antitumor T cell responses in the tumor microenvironment.

Original languageEnglish (US)
Article numberabg8402
JournalScience Translational Medicine
Issue number636
StatePublished - Mar 16 2022

Bibliographical note

Publisher Copyright:
© 2022 The Authors.

PubMed: MeSH publication types

  • Journal Article
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't


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