Direct and Natural Killer Cell-Mediated Anti-Tumor Effects of Low-Dose Bortezomib in Hepatocellular Carcinoma.

Background & Aims: Hepatocellular carcinoma (HCC) displays a particular resistance to conventional cytostatic agents. Therefore, alternative treatment strategies focus on novel substances exhibiting anti-neoplastic and/or immunomodulatory activity enhancing for example Natural Killer (NK) cell anti-tumor reactivity. However, the tumor-associated ligands engaging activating NK cell receptors are largely unknown. Exceptions are the NKG2D ligands (NKG2DL) of the MIC and ULBP protein families, which potently stimulate NK cell responses. We studied the consequences of proteasome inhibition with regard to direct and NK cell-mediated effects against HCC.

Methods: Primary human hepatocytes (PHH) from different donors, hepatoma cell lines and NK cells were exposed to Bortezomib. Growth and viability of hepatoma cells and PHH as well as immunomodulatory effects including alterations of NKG2DL expression on hepatoma cells, specific induction of NK cell cytotoxicity and IFN-γ production were investigated.

Results: Bortezomib treatment inhibited hepatoma cell growth with IC₅₀ values between 2.4 and 7.7 nanomol/liter. These low doses increased MICA/B mRNA levels and total and cell surface protein expression in hepatoma cells, which stimulated cytotoxicity and IFN-γ production of cocultured NK cells. Importantly, while IFN-γ production of NK cells was concentration-dependently reduced, low-dose Bortezomib neither induced NKG2DL expression or cell death in PHH nor altered NK cell cytotoxicity.

Conclusions: Low-dose Bortezomib mediates a specific dual anti-tumor effect in HCC by inhibiting tumor cell proliferation and by priming hepatoma cells for NK cell anti-tumor reactivity. Our data suggest the clinical evaluation of Bortezomib treatment in HCC, especially in combination with immunotherapeutic approaches like adoptive NK cell transfer.