Salmonella‐based therapy targeting indoleamine 2,3‐dioxygenase restructures the immune contexture to improve checkpoint blockade efficacy

Nancy D. Ebelt, Edith Zuniga, Monica Marzagalli, Vic Zamloot, Bruce R. Blazar, Ravi Salgia, Edwin R. Manuel

Research output: Contribution to journalArticlepeer-review


Therapeutic options for non‐small cell lung cancer (NSCLC) treatment have changed dramatically in recent years with the advent of novel immunotherapeutic approaches. Among these, immune checkpoint blockade (ICB) using monoclonal antibodies has shown tremendous promise in approximately 20% of patients. In order to better predict patients that will respond to ICB treatment, biomarkers such as tumor‐associated CD8+ T cell frequency, tumor checkpoint protein status and mutational burden have been utilized, however, with mixed success. In this study, we hypothesized that significantly altering the suppressive tumor immune landscape in NSCLC could potentially improve ICB efficacy. Using sub‐therapeutic doses of our Salmonella typhimurium‐based therapy targeting the suppressive molecule indoleamine 2,3‐dioxygenase (shIDO‐ST) in tumor-bearing mice, we observed dramatic changes in immune subset phenotypes that included increases in antigen presentation markers, decreased regulatory T cell frequency and overall reduced checkpoint protein expression. Combination shIDO‐ST treatment with anti‐PD‐1/CTLA‐4 antibodies enhanced tumor growth control, compared to either treatment alone, which was associated with significant intratumoral infiltration by CD8+ and CD4+ T cells. Ultimately, we show that increases in antigen presentation markers and infiltration by T cells is correlated with significantly increased survival in NSCLC patients. These results suggest that the success of ICB therapy may be more accurately predicted by taking into account multiple factors such as potential for antigen presentation and immune subset repertoire in addition to markers already being considered. Alternatively, combination treatment with agents such as shIDO‐ST could be used to create a more conducive tumor microenvironment for improving responses to ICB.

Original languageEnglish (US)
Article number617
Pages (from-to)1-20
Number of pages20
Issue number12
StatePublished - 2020

Bibliographical note

Funding Information:
Conflicts of Interest: BRB receives remuneration as an advisor to Magenta Therapeutics and BlueRock Therapeutics, research funding from BlueRock Therapeutics, Rheos Medicines, Childrens’ Cancer Research Fund, and KidsFirst Fund, and is a co‐founder of Tmunity. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results. No other authors declare competing interests.

Funding Information:
Funding: This study was funded by an NCCN Young Investigator Award and COH Shared Resources grant (both to ERM). Research reported in this publication included work performed in the Molecular Pathology, Animal Resource Center, Small Animal Imaging and Light Microscopy Digital Imaging cores supported by the National Cancer Institute of the National Institutes of Health under grant number P30CA033572. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Publisher Copyright:
© 2020 by the authors. Licensee MDPI, Basel, Switzerland.


  • Anti‐CTLA4
  • Anti‐PD‐1
  • Immune checkpoint blockade
  • Indoleamine 2,3‐dioxygenase
  • Non‐small cell lung cancer
  • Salmonella typhimurium
  • Small‐hairpin RNA

PubMed: MeSH publication types

  • Journal Article


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