Introduction
Natural killer cells (NK), the major innate effector cells, with their broad cytotoxicity against tumors are ideal candidates for immunotherapy [
1,
2]. NK cells are highly efficient in killing tumor cells since they do not require any priming or prior activation, unlike cytotoxic T cells, which rely on priming by antigen presenting cells. On encountering a tumor cell, the NK cell’s ability to kill is determined by the integration of signals from activating and inhibitory receptors expressed on their surface [
1]. In addition to expression of ligands to these receptors on tumor cells, oxygen deprivation or hypoxia, universally associated with the tumor microenvironment (TME), is also a key determinant of the NK cell cytotoxic response. Hypoxia is considered an adverse prognostic factor for solid tumor regression and can be detrimental to antitumor effector immune cell function [
3,
4]. NK cells have been previously shown to exhibit impaired cytolytic functions under hypoxic conditions [
2]. Given this, NK cells must initiate dynamic mechanisms to adapt to changes in oxygen tension to execute their functions. Adaptations to hypoxia are facilitated by increased expression and stabilization of transcription factor hypoxia-inducible factor-1 (HIF-1), which mediates increased transcriptional activation, glycolysis, proliferation, and angiogenesis [
9]. The underlying factors in the TME that leads to HIF upregulation in NK cells and the consequence of this upregulation to NK cell responses during hypoxia have not been thoroughly investigated.
HIF-1 is a basic heterodimeric helix–loop–helix PAS (PER/ARNT/SIM), consisting of a HIF-1α subunit complexed to the HIF-1β subunit. HIF-1α is transcribed and synthesized in response to signals from growth factors and ligands [
3]. Importantly, HIF-1α is sensitive to changes in cellular oxygen levels and is therefore regarded as a central player in the hypoxic response of the cell. Under normal oxygen tension (normoxia), the critical proline residues on HIF-1α subunits are hydroxylated (P402 and P564), recognized by pVHL, poly-ubiquitinated, and subsequently degraded via the ubiquitin–proteasome pathway [
4]. However, in hypoxic conditions, HIF-1α subunits are expressed but cannot be prolyl hydroxylated and they escape VHL recognition and subsequent degradation. The HIF-1α subunits that accumulate heterodimerize with HIF-1β to activate target gene transcription. In immune cells such as T cells and macrophages, HIF-1α is induced both by hypoxic and non-hypoxic stimuli such as T cell receptor signaling and PI3Kinase (PI3K)-mediated pathways [
5‐
8].
The common cytokine-receptor gamma-chain cytokine IL-2 is a prevalent cytokine in the TME and activates NK cells through the PI3K pathway. IL-2 modulates the immune landscape of tumors and is essential for NK cell activation and function [
9‐
12]. Importantly, soluble IL-2 secreted by activated T helper cells in response to antigen presentation in the TME can activate NK cells expressing high and intermediate affinity receptors [
13]. Addressing the response of NK cells to hypoxia in the context of IL-2 stimulation is imperative to the development of NK cells as better candidates for immunotherapy.
Here, we explored the role of IL-2 in HIF-1α expression in hypoxic NK cells. Using the NK cell line, NKL, we established that IL-2 initiates HIF-1α protein synthesis through the PI3K/mTOR pathway, while hypoxia stabilizes the HIF-1α protein. We then sought to extend our findings to human peripheral blood mononuclear cell (PBMC)-derived NK cells. We observed that freshly isolated NK cells do not stabilize HIF-1α in response to hypoxia, whereas ex vivo expansion of these cells demonstrated detectable levels of HIF-1α in response to hypoxia. In addition, we report here that HIF-1α expression in IL-2 stimulated hypoxic NK cells correlated with enhanced cytotoxic and cytokine-secreting functions.
Materials and methods
Cell lines and culture
The NK cell line, NKL, was a kind gift from Prof. Lewis Lanier, UCSF. NKL cells were cultured in RPMI 1640 medium from Corning supplemented with 10% heat-inactivated FBS, 5% non-essential amino acids, 5% sodium pyruvate, 5% penicillin streptomycin, and 100 U/mL IL-2. The colorectal cancer cell line, DLD-1, was purchased from ATCC (#CCL-221) and was cultured in RPMI 1640 medium from Corning supplemented with 10% heat-inactivated FBS and 5% penicillin streptomycin. Cell lines were maintained in normoxic conditions at 21% O2 in a 37 °C humidified incubator buffered with 5% CO2. For hypoxic conditions, NK cells were incubated in a hypoxic chamber (Biospherix, C-Chamber Incubator Subchamber) with a mixture of 1% O2, 5% CO2, and 94% N2 placed in a 37 °C humidified incubator for 24 h (NKL cells) or 72 h (PBMC NK cells). After incubation, NK cells were immediately transferred to conical tubes pre-cooled on ice and spun down at 4 °C for further processing.
Peripheral blood NK cell isolation and expansion
Peripheral blood was purchased as leukoreduction system chamber buffy coats from healthy donors at the Stanford Blood Center, Stanford. PBMCs were isolated by Ficoll-Paque PLUS (GE Healthcare) density gradient centrifugation in RPMI 1640 medium from Corning. NK cells were enriched from the PBMCs by negative selection using the NK cell isolation kit, human (Miltenyi Biotec GmbH, Bergisch Gladbach, Germany, catalog #130-092-657), according to the manufacturer's instructions by using a LS column (Miltenyi Biotec GmbH, #130-042-401) on the Midi MACS separator (Miltenyi Biotec GmbH, #130-042302).
NK cell expansion was achieved by using the “NK cell activation/expansion kit” (Miltenyi Biotec GmbH, catalog #130-094-483) according to the manufacturer's instructions. Briefly, NKp46 and CD2 biotinylated antibodies were loaded on anti-biotin-MACSiBead™ particles. MACSiBead™ particles loaded with the biotinylated antibodies were added to NK cells and cultured for 2 weeks, in NK MACS medium (Miltenyi Biotec GmbH, #130-114-429), with 5% human AB serum (Sigma–Aldrich), 1% supplement (Miltenyi Biotec GmbH, #130-114-429), 1% penicillin–streptomycin, and 400 U/mL IL-2 in 24-well plates. NK cells were passaged every 3 days at a cell density of 1–1.5 × 106 NK cells per mL of media. NK cells were maintained in a 37 °C humidified incubator buffered with 5% CO2. Purity of isolated NK cells was determined by flow cytometry and preparations stained ≥ 97% CD56+CD3− with ≤ 1% of CD3+, CD14+, and CD20+ cells.
Flow cytometry
Expression of activation and inhibitory receptors on NK cells was determined by flow cytometry. Before cell surface staining, Fc receptors on NK cells were blocked with human TruStain FcX from BioLegend (#422301). Cells (∼0.5 × 106) were then stained with viability dye (LIVE/DEAD Fixable Dead Cell Stain, ThermoFisher, #L34955), followed by staining with cell surface antibodies (listed in Antibodies and Reagents) or the corresponding isotype in 100 µl volume for 30 min on ice, followed by washes in FACS buffer (PBS with 0.25% BSA and 1 mM EDTA). A fluorescence-minus-one (FMO) control was used in all experiments to determine negative staining. Cells were subsequently fixed in BD Cytofix Fixation Buffer (BD Biosciences, #BDB554655) according to instructions. All samples were run on a CytoFlex flow cytometer (Beckman coulter) and analyzed using FlowJo v10.6.0 software.
NK cell cytotoxicity assay
NK cell cytotoxicity against target tumor cells was determined by the xCELLigence RTCA (Real-Time Cell Analyzer) SP (single-plate) Instrument (Agilent, San Diego, CA, USA) according to manufacturer’s recommendations. Fifty microliters of complete medium was added to each well of the E-plate 96, and background impedance on the plates was measured on the xCELLigence RTCA SP instrument at 37° and 5% CO2. DLD-1 cells (1 × 104/well) were seeded in the plate and used as target cells. DLD-1 cells are derived from human colorectal adenocarcinoma and exhibit mutations in their KRAS gene. They lack the surface expression of MHC class I and are thus highly susceptible to NK cell-mediated cytotoxicity. The E-plate was then placed in the xCELLigence RTCA SP cradle, and impedance measurements were recorded every 15 min. After 24 h, NK cells at various effector-to-target ratios were added in plates as effector cells. For hypoxia experiments, NKL cells were incubated in 1% O2 for 24 h and PBMC NK cells for 72 h prior to being added to the target cells. Impedance measurements were recorded every 15 min, and death of tumor cells was indicated by a decrease in cell index. Data were acquired with RTCA Software 1.2 (Agilent, Biosciences). Samples were internally normalized for the cell index value measured before NK cell addition (normalized cell index). The normalized cell index is converted to a % cytolysis plot by the xCELLigence Immunotherapy Software (xIMT).
Western blotting
Immunodetection of proteins was performed as described previously [
14]. For preparation of whole-cell lysates, NK cells were lysed in ice-cold SDS lysis buffer containing protease and phosphatase inhibitors (1 mM EDTA, 1 mM PMSF, 1 mM DTT, 1 µg/mL leupeptin, 1 mM sodium orthovanadate), followed by sonication and centrifugation at 300 g for 10 min. Lysates were separated by SDS–PAGE and immunoblotted for specific proteins as indicated. β-Actin or tubulin was used as loading control. Blots were imaged using the Odyssey Imaging System (LI-COR Biosciences). Quantification of immunoblots was performed using the Li-Cor Image Studio Software, version 5.2. Pixel intensities for each protein were measured and normalized to the loading control. Average normalized pixel intensities from multiple independent experiments were determined, and fold differences between untreated and treated samples were plotted.
P-values were calculated using the unpaired Student’s t-test.
RNA extraction and qPCR analysis
Total RNA was extracted from NKL cells using the Qiagen RNeasy kit (#74104) according to manufacturer’s protocol. RNA quality was assessed using the Nanodrop, and 550 ng RNA was used to create cDNA using the TaqMan Reverse Transcription kit (N808-0234). Ten nanograms of cDNA was used in duplicate qPCRs using master mix from TaqMan Universal PCR Master Mix (#4324018) and TaqMan primer probes. The HIF-1α, #HS00153153_M1 primer probes that span exons were used to quantify mRNA levels. qPCR was performed on an Applied Biosystems 7500 SDS real-time PCR system. β-Actin primer probes were used for normalization. Relative expression was calculated using the delta Ct method.
ELISA
NK cells were plated 80,000 cells per 200 µL in a 96-well plate with 200 U/mL IL-2 and pre-incubated in 21% or 1% O2 for 24 h. Corning 96-Well TC-Treated Microplates were coated with 10 µg/mL of each antibody/ligand (Recombinant Human ULBP-1, R &D Systems #1380-UL-050; UltraLeaf anti-CD16 ab (3G8), Biolegend #302057; UltraLeaf anti-NKp46 ab (9E2), Biolegend #331947) for 3 h and then washed three times with 1 × PBS. After antibody/ligand coating of the plates, the NK cells were then transferred to the coated plate and incubated for 18 h in 21% or 1% O2. After incubation, cells were spun down at 300 × g for 5 min. Supernatant was removed and stored at -20 °C until ELISA was performed. Human IFN-γ was assayed with the human IFN-gamma DuoSet ELISA kit (R&D DY285B) and granzyme B was assayed with human granzyme B DuoSet ELISA kit (R&D DY2906-05) according to manufacturer’s instructions. Concentrations were drawn from a standard curve performed on each plate.
Antibodies and reagents
The mAb against HIF-1α (#14179), p70 S6 kinase (#9202), and phosphorylated p70 S6 kinase at Thr389 (#9205) was purchased from Cell Signaling Technology. β-Actin (#MA1-140) was purchased from Invitrogen. Abs against ERK1–ERK2 (#ab17942) and phosphorylated ERK1–ERK2 at T202 and Y204 (#ab214362) were purchased from Abcam. Recombinant human IL-2 (#200-02) was obtained from PeproTech. The details of antibodies used in this study are listed in supplementary table 1. Inhibitors of PI3K (LY294002, #S1105), MEK (PD98059, #S1177), and the mammalian target of rapamycin (rapamycin, #AY-22989) were purchased from Selleck Chemicals. DMOG (#ab141586) was purchased from Abcam. Antibodies used for flow cytometry were purchased from BioLegend: PE-conjugated anti-NKp46 (#137603), Percp.cy5.5-conjugated anti-NKG2D (#320818), FITC-conjugated anti-CD69 (#310903), APC-conjugated anti-CD56 (#318310), and Alexa Fluor 700-conjugated anti-CD16 (#302026).
Statistical analyses and quantification
The Prism 9 (GraphPad) software was used for all statistical analyses. Comparisons between hypoxia-treated and normoxia-treated samples were made using Student’s t-test. Statistical test for each figure is described in the figure legend. qPCR assays were run in technical and biological replicates. All other assays were performed as multiple independent trials and represented as mean ± SEM. Numbers of independent experiments (n) are given in the figure legends. For western blots, one out of three independent experiments is shown. A p ≤ 0.05 was considered significant.
Discussion
NK cells are innate immune cells that are capable of invading solid tumors, and a higher number of tumor-infiltrating NK cells are associated with better survival [
19,
20]. However, NK cells that infiltrate the tumor bed are attenuated by factors within the TME. Hypoxia is one such factor in the TME that has been shown to modulate the functions of immune cells through expression of HIF-1α [
21‐
23]. In this study, we investigated the mechanisms that regulate HIF-1α expression in NK cells and correlated HIF-1α expression with NK cell functions. Using the NK cell line, NKL, and ex vivo expanded NK cells, we demonstrate that HIF-1α expression requires both hypoxia and IL-2 stimulation. IL-2-mediated PI3K/mTOR signaling initiates HIF-1α protein synthesis, while hypoxia maintained its stabilization. Critically, we show that NKL cells expressing HIF-1α in hypoxia had a better ability to kill tumor cells after hypoxia exposure. In contrast, freshly isolated NK cells that could not stabilize HIF-1α showed an impaired cytotoxicity that was overcome upon their ex vivo expansion and HIF-1α stabilization.
IL-2 on engaging its receptor CD25 on NK cells stimulates PI3K and the downstream activation of mTOR [
24,
25]. In our study, treatment with either the PI3K inhibitor LY294002 or mTOR inhibitor rapamycin resulted in inhibition of IL-2-mediated HIF-1α expression in NK cells, indicating that the activation of the PI3K/mTOR pathway is necessary for HIF-1α expression. The absence of an increase in HIF-1α transcript levels in NKL cells treated with IL-2 (irrespective of oxygen tension) and the complete absence of HIF-1α protein upon translational inhibition using cycloheximide suggests that IL-2 functions to regulate protein translation of HIF-1α to enable HIF-1α protein expression. Nevertheless, HIF-1α protein was degraded in IL-2-stimulated NKL cells in normoxia, in accordance with previously published findings by others demonstrating the role of hypoxia in HIF-1α stabilization [
26]. Under normoxic conditions, HIF-1α is rendered unstable due to its hydroxylation and subsequent degradation by the proteasome, while in hypoxia, degradation is inhibited due to limited HIF-1α hydroxylation. In our experiments, IL-2-stimulated NKL cells treated with the proteasomal inhibitor MG132 showed a clear accumulation of HIF-1α under normoxic conditions, confirming the proteasome-dependent HIF-1α degradation during normoxia and the stabilizing role of hypoxia in maintaining HIF-1α expression levels in NKL cells.
On extending our observations from the NKL cell line to human PBMC-derived NK cells, we were surprised that NK cells freshly isolated from PBMCs of healthy human donors when cultured in hypoxia in the presence of IL-2 failed to show detectable HIF-1α protein. Interestingly, treating these cells with PHD inhibitor, DMOG, resulted in significant accumulation of HIF-1α protein in NK cells in both hypoxic and normoxic conditions. Thus, freshly isolated NK cells were capable of HIF-1α protein synthesis upon IL-2 stimulation but hypoxia failed to stabilize the protein against degradation. The ability of DMOG to prevent HIF-1α degradation and demonstrate detectable HIF-1α protein levels would indicate the continued activity of PHDs in freshly isolated NK cells even during hypoxia. One possibility for continued PHD activity could be explained by redistribution of cellular oxygen in the cytoplasm due to reduced mitochondrial respiration [
27]. Assessing the metabolic status of freshly isolated NK cell could shed light on the lack of HIF-1α expression in these cells.
Ex vivo expansion of NK cells is an important source of NK cells for clinical application since it enables the efficient generation of large numbers of NK cells for repeated therapeutic use in cancer. Ex vivo expanded human NK cells are more cytotoxic and activated compared to freshly isolated NK cells [
28]. Here, we demonstrate, for the first time, that ex vivo expanded NK cells, unlike freshly isolated NK cells, are capable of expressing HIF-1α under hypoxia upon IL-2 stimulation via the PI3K/mTOR pathway. The requirement of IL-2 signaling for HIF-1α protein synthesis in human NK cells that we have shown in this study is similar to signaling requirements for HIF-1α protein synthesis in T cells. Studies in CD4 + T cells have demonstrated that hypoxia alone was insufficient to induce HIF-1α protein, and a combination of TCR-mediated signal and hypoxia was required to induce HIF-1α accumulation [
5,
29]. However, considering the pro-inflammatory environment in tumors, it is essential to thoroughly examine HIF-1α expression in NK cells, in the presence of other pro-inflammatory cytokines including IL-12, IL-18 and IL-21 that are known to play important roles in activating NK cells in the tumor microenvironment.
NK cells are early responders against tumors, a function mediated by two effector mechanisms—cytotoxicity and cytokine-secreting function. We specifically investigated whether expression of HIF-1α in the NKL cell line or the ex vivo expanded NK cells had any correlation with their anti-tumor cytotoxicity and cytokine-secreting functions. In hypoxia, NKL cells showed an increase in anti-tumor cytotoxicity as measured by the real-time cytotoxicity assay. Interestingly, they also secreted more IFN-γ when stimulated with ULBP-1 or anti-NKp46 or anti-CD16 antibodies. However, the enhanced cytotoxic response that we observed in hypoxic NKL cells could not be explained by the release of granzyme B or the expression of activating and inhibiting receptors which looked similar in both hypoxic and normoxic NKL cells. Examining the expression of a wider range of receptors including 2B4, CD94-NKG2C, NKp30, and NKp44 could shed light on the role of the receptors in NKL responses to hypoxia. Interestingly, we did not observe significant changes in secretion of granzyme B by hypoxic NK cells upon ligand stimulation. Though NK cells can kill target tumor cells by exocytosis of granzyme B, they also kill target cells by engaging death receptors such as FASL and TRAIL. The contribution of these receptors to cytotoxicity under hypoxia needs to be studied. Since HIF-1α mediates adaption to hypoxia by regulating cellular metabolism, it is probable that HIF-1α upregulation in hypoxic NKL cells may modulate its metabolism to alter effector functions.
Freshly isolated NK cells from human peripheral blood when pre-exposed to hypoxia showed a reduced ability to kill target tumor cells but no significant changes in secretion of IFN-γ, indicating that hypoxia dampened only the cytotoxicity functions. The impaired cytotoxicity by these cells could be explained by the reduction in expression of activation marker NKp46 which is a cytotoxicity triggering receptor demonstrated to be essential for cytotoxicity of freshly isolated NK cells [
30]. It is of interest to note here that these effects are independent of HIF-1α since freshly isolated NK cells are unable to stabilize HIF-1α. Our observations here are different from the results reported in the study by Velasquez et al., where IL-15 stimulation of hypoxic NK cells did not significantly alter viability of target tumor cells any differently compared to IL-15-stimulated normoxic NK cells [
31]. Though their method of hypoxic pre-culture of NK cells is comparable to ours, their conclusions were drawn from an end point cytotoxicity assay unlike the real-time quantification of cytolysis that we used in our study that provides significant and quantifiable cytotoxicity measurements at early time points.
In contrast to freshly isolated NK cells, hypoxia-treated ex vivo expanded NK cells, irrespective of the method of expansion, showed no impairment in cytotoxicity, despite the reduction in expression of activation markers NKG2D and NKp46. Interestingly, ex vivo expanded NK cells had a higher expression of CD69 in hypoxia, a stimulatory receptor for NK cell cytotoxicity, which could be responsible for overcoming any impairment of cytotoxicity during hypoxia [
32].
An area of interest arising from our findings thus far is in identifying HIF-1α-mediated metabolic changes in NK cells. NK cells have uniquely different metabolic needs to execute their cytolytic and IFN-γ-secreting functions. Activation of NK cells with cytokines increases the rate of glucose-driven glycolysis and Oxphos that in turn drives cytotoxic functions, while they are capable of IFN-γ secretion in the absence of Oxphos [
33‐
35]. The differential expression of HIF-1α in hypoxia could lead to distinct metabolic profiles of NKL, freshly isolated NK cells, and ex vivo expanded NK cells that could determine their functional differences in hypoxia, an area that remains to be investigated [
36‐
38].
Adding credence to our observation that HIF-1α promotes cytotoxicity in hypoxic NK cells is a study in a mouse tumor model with a targeted deletion of HIF-1α in NK cells, showing an increase in tumor metastasis due to reduced cytotoxicity of NK cells lacking HIF-1α [
39]. The lack of specific chemical inhibitors against HIF-1α expression has limited our ability to directly link the expression of HIF-1α to the enhanced cytotoxic effects we observed in the human NK cells in our experiments. However, genetic manipulation of HIF-1α in the NKL cell line in future experiments could provide direct evidence of effects of HIF-1α on human NK cell functions. Though in this study we have used the MHC-I-deficient colorectal tumor cell line DLD-1 to evaluate the effect of hypoxia on NK cell cytotoxicity, we have observed a similar increase in cytotoxicity of hypoxia-exposed NKL cells against an MHC-I-positive renal cell carcinoma cell line 786-O (data not shown), indicating that this effect is not restricted to MHC-I-deficient tumors. In addition, a relevant study by Sarkar et al. [
40] has demonstrated that the expression of receptors for the human MHC-I antigens HLA-ABC, the killer immunoglobulin-like receptors (KIR), was not altered on NK cells upon exposure to hypoxia. Furthermore, we acknowledge that in this study we did not investigate the expression of HIF-2α in NK cells. HIF-2α is another important hypoxia-inducible factor expressed in T cell and macrophages that plays a prominent role in their function. Studying the expression of HIF-2α in NK cells and its effect on their function and investigating whether there is any crosstalk between HIF-1α and HIF-2α expression would elucidate cooperative and synergistic interactions between these transcription factors in modulating NK cell responses to hypoxia.
To our knowledge, this is for the first time that expression of HIF-1α in hypoxic human NK cells has been correlated with their function. Based on our study, it is likely that tumor-infiltrating NK cells that reach hypoxic tumor sites in the presence of IL-2 upregulate HIF to enhance NK cell function. Our discovery demonstrating enhanced effector functions in hypoxia pretreated NKL cells and ex vivo expanded NK cells strengthens their potential use as effective candidates for adoptive immunotherapy.
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