Greisen SR, Bendix M, Nielsen MA, Pedersen K, Jensen NH, Hvid M, Mikkelsen JH, Drace T, Boesen T, Steiniche T, Schmidt H, and Deleuran B
Introduction: Immune checkpoint inhibitors (ICI) have revolutionized the treatment of metastatic malignant melanoma (MM) and improved long-term survival. Despite the impressive results, some patients still have progressive disease, and the search for biomarkers predicting response to ICI treatment is ongoing. In this search, galectin-3 (Gal-3) has been suggested as a molecule of interest, both as a marker of treatment response and as a treatment target to potentiate ICI therapy. We have previously demonstrated the binding between programmed cell death 1 (PD-1) and Gal-3, and here, we investigated the interaction between PD-1, pembrolizumab, and Gal-3 in metastatic MM patients., Methods: The binding between PD-1, pembrolizumab and Gal-3 was investigated by surface plasmon resonance (SPR) and cryogenic electron microscopy (cryo-EM). The function was studied in in vitro cultures and soluble levels of both PD-1 and Gal-3 were measured in metastatic MM patients, treated with pembrolizumab., Results: By SPR, we demonstrated that Gal-3 can block the binding between PD-1 and pembrolizumab, and further visualized a steric inhibition using cryo-EM. T cells cultured with Gal-3 had reduced pro-inflammatory cytokine production, which could not be rescued by pembrolizumab. In patients with metastatic MM, high levels of Gal-3 in plasma were found in patients with a longer progression-free survival in the study period, whereas high Gal-3 expression in the tumor was seen in patients with disease progression. Soluble PD-1 levels in plasma increased after treatment with pembrolizumab and correlated with disease progression., Conclusion: We demonstrate that the interaction between PD-1 and Gal-3 interferes with the binding of pembrolizumab, supporting that an immune suppression induced by Gal-3 in the tumor microenvironment cannot be rescued by pembrolizumab., Competing Interests: Competing interests: SRG, MB, HS: supported in part by a research grant from Investigator-Initiated Studies Program of Merck Sharp & Dohme. The opinions expressed in this paper are those of the authors and do not necessarily represent those of MSD. The grant was Institutional and awarded to SRG, MB and HS. Grant number N/A. BD: no competing interest for the current manuscript. Funding from Danish Rheumatoid Association, Aarhus University Research Foundation and Gilead Nordic Fellowship Grants. Honoraria from Astra Zeneca and advisory board member in: Boehringer Ingelheim, Eli Lilly. Other authors declare no competing interests., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)