High-intensity focused ultrasound (hIFU) triggers immune sensitization of refractory murine neuroblastoma to checkpoint inhibitor therapy

Document Type

Journal Article

Publication Date



Clinical Cancer Research








© 2020 American Association for Cancer Research Inc.. All rights reserved. Purpose: Immunotherapy promises unprecedented benefits to patients with cancer. However, the majority of cancer types, including high-risk neuroblastoma, remain immunologically unresponsive. High-intensity focused ultrasound (HIFU) is a noninvasive technique that can mechanically fractionate tumors, transforming immunologically ''cold'' tumors into responsive ''hot'' tumors. Experimental Design: We treated <2% of tumor volume in previously unresponsive, large, refractory murine neuroblastoma tumors with mechanical HIFU and assessed systemic immune response using flow cytometry, ELISA, and gene sequencing. In addition, we combined this treatment with aCTLA-4 and aPD-L1 to study its effect on the immune response and long-term survival. Results: Combining HIFU with aCTLA-4 and aPD-L1 significantly enhances antitumor response, improving survival from 0% to 62.5%. HIFU alone causes upregulation of splenic and lymph node NK cells and circulating IL2, IFNg, and DAMPs, whereas immune regulators like CD4þFoxp3þ, IL10, and VEGF-A are significantly reduced. HIFU combined with checkpoint inhibitors induced significant increases in intratumoral CD4þ, CD8aþ, and CD8aþCD11cþ cells, CD11cþ in regional lymph nodes, and decrease in circulating IL10 compared with untreated group. We also report significant abscopal effect following unilateral treatment of mice with large, established bilateral tumors using HIFU and checkpoint inhibitors compared with tumors treated with HIFU or checkpoint inhibitors alone (61.1% survival, P < 0.0001). This combination treatment significantly also induces CD4þCD44þhiCD62Lþlow and CD8aþCD44þhiCD62Lþlow population and is adoptively transferable, imparting immunity, slowing subsequent de novo tumor engraftment. Conclusions: Mechanical fractionation of tumors using HIFU can effectively induce immune sensitization in a previously unresponsive murine neuroblastoma model and promises a novel yet efficacious immunoadjuvant modality to overcome therapeutic resistance.

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