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Publication : Cancer-induced nerve injury promotes resistance to anti-PD-1 therapy.

First Author  Baruch EN Year  2025
Journal  Nature Volume  646
Issue  8084 Pages  462-473
PubMed ID  40836096 Mgi Jnum  J:375308
Mgi Id  MGI:8264890 Doi  10.1038/s41586-025-09370-8
Citation  Baruch EN, et al. (2025) Cancer-induced nerve injury promotes resistance to anti-PD-1 therapy. Nature 646(8084):462-473
abstractText  Perineural invasion (PNI) is a well-established factor of poor prognosis in multiple cancer types(1), yet its mechanism remains unclear. Here we provide clinical and mechanistic insights into the role of PNI and cancer-induced nerve injury (CINI) in resistance to anti-PD-1 therapy. Our study demonstrates that PNI and CINI of tumour-associated nerves are associated with poor response to anti-PD-1 therapy among patients with cutaneous squamous cell carcinoma, melanoma and gastric cancer. Electron microscopy and electrical conduction analyses reveal that cancer cells degrade the nerve fibre myelin sheets. The injured neurons respond by autonomously initiating IL-6- and type I interferon-mediated inflammation to promote nerve healing and regeneration. As the tumour grows, the CINI burden increases, and its associated inflammation becomes chronic and skews the general immune tone within the tumour microenvironment into a suppressive and exhaustive state. The CINI-driven anti-PD-1 resistance can be reversed by targeting multiple steps in the CINI signalling process: denervating the tumour, conditional knockout of the transcription factor mediating the injury signal within neurons (Atf3), knockout of interferon-alpha receptor signalling (Ifnar1(-/-)) or by combining anti-PD-1 and anti-IL-6-receptor blockade. Our findings demonstrate the direct immunoregulatory roles of CINI and its therapeutic potential.
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