14 Natural killer cells have impaired cytotoxicity in advanced renal cell carcinoma

Abstract Background Natural killer (NK) cells are key mediators of anti-tumor activity in multiple cancers, including clear cell renal cell carcinoma (ccRCC). However, the phenotype and function of NK cells across different disease stages of ccRCC is incompletely characterized. Methods Single-cell RNA (scRNA)-sequencing (10x Genomics) data from tumor and adjacent normal kidney from ccRCC was analyzed at multiple clinical stages (localized – stage I/II/III; and advanced – stage IV). Graph-based clustering and lineage markers were used to identify distinct NK cell populations. Differential gene expression analysis was performed to further investigate NK cell phenotype and to derive a gene expression signature (GES). Gene signatures from NK cell subclusters of interest were used to interrogate bulk transcriptomic datasets and expression with clinical outcomes. Tumor-infiltrating NK cell function (cytokine production and cytotoxicity) was assessed by isolation of live NK cells from ccRCC tissue, co-culture with K562 target cells, and measurement of cytokine (IFNgamma) and cytotoxicity (CD107a) markers by flow cytometry. Results Single-cell transcriptomic data were analyzed from 13 patients with ccRCC (tumor and normal kidney), resulting in 21,139 high-quality NK cells. Patients with advanced/metastatic RCC had a lower proportion of NK cells versus total immune cells in the tumor microenvironment compared to normal kidney (p=0.036) and localized ccRCC (p=0.088). Clustering analysis revealed 6 distinct NK cell subsets. The C0.Bright-like NK cell cluster was significantly enriched in advanced ccRCC compared to localized ccRCC (p=0.048) and normal kidney (p=0.0059), expressed markers of tissue residency (ZNF683, ITGA1, CD9, ITGAE), and had decreased expression of cytotoxicity genes (GZMB, PRF1). A GES signature composed of genes upregulated in the dysfunctional C0.Bright-like NK cell cluster was used to interrogate bulk RNA-sequencing data from The Cancer Genome Atlas clear cell cohort, providing validation in a large, independent cohort, of an increase in this dysfunctional NK subset in advanced ccRCC compared to localized ccRCC (p=0.00039) and normal tissue (p=5.3e-05). To functionally confirm the decreased cytotoxicity of this dysfunctional NK population, CD45+CD56+CD3- NK cells were isolated from advanced ccRCC, and co-cultured with K562 target cells. Consistent with the transcriptomic phenotype, tumor-resident CD49a+CD9+ NK cells had cytokine production (IFNgamma) but decreased markers of cytotoxicity (CD107a) compared to CD49a-CD9- NK cells. By contrast, CD49a+CD9+ NK cells isolated from peripheral blood or normal kidney tissue maintained cytotoxic activity. Conclusions Among patients with ccRCC, a single-cell transcriptomic analysis revealed heterogeneous NK cell populations. A dysfunctional tumor resident NK cell phenotype was enriched among patients with advanced disease in ccRCC, and functionally confirmed to have diminished cytotoxicity. This study therefore provides insight into a new axis of immune dysfunction – decreased NK-mediated cytotoxicity – in advanced ccRCC. An improved understanding of NK cell dysfunction within ccRCC may provide a foundation for therapeutic restoration of NK-mediated anti-tumor activity in ccRCC. DOD CDMRP Funding: yes