Abstract 2799: Intestinal Akkermansia muciniphila complements the therapeutic efficacy of PD1 therapy by reshaping the immunosuppressive microenvironment in nonalcoholic fatty liver disease (NAFLD)-induced hepatocellular carcinoma
Authors: Wu Xueqian , Ying Fan , Chung Katherine Po Sin , Leung Carmen Oi Ning , Lee Terence Kin Wah 
Published: March 2024

Abstract
Objectives: Nonalcoholic fatty liver disease (NAFLD)-induced hepatocellular carcinoma (HCC) is an emerging malignancy in the developed world. However, immune checkpoint inhibitors (ICIs) are ineffective for patients with this disease. Advances in research have shown that gut-liver communication contributes to NAFLD progression. Therefore, identifying a key gut microbiota for predicting ICIs response and an effective combinatorial strategy is urgently needed.
Design: 16S rRNA sequencing was employed to identify key gut microbiota crucial in developing the mouse NAFLD-induced HCC model. The in vivo roles of Akkermansia muciniphila (Akk) were evaluated by immunofluorescence staining, qPCR, mass spectrometry analysis, ELISA assay, and single-cell RNA sequencing (scRNA-seq) coupled with immune profiling analysis. The clinical and therapeutic value of Akk alone in combination with PD1 treatment was investigated.
Results: Akk was decreased from healthy to HCC tissues during HCC tumor development, and daily administration of Akk not only ameliorates liver steatosis and cholesterol biosynthesis but could effectively attenuate the development of NAFLD-induced HCC. Akk repairs the intestinal lining, with a concurrent decrease in the serum concentration of lipopolysaccharide (LPS) and bile acid metabolites. Using scRNA-seq coupled with immune profiling analyses, we found that Akk suppressed the populations of immunosuppressive cells, including monocytic myeloid-derived suppressor cells (m-MDSCs) and M2 macrophages, by suppressing the differentiation of these cells from monocytes, which leads to T cell proliferation and activation. Consistent with this finding, Akk administration, combined with PD1 treatment, exerted a maximal growth-suppressive effect, accompanied by increased infiltration and activation of T cells. Clinically, the fecal level of Akk in HCC patients was decreased in NAFLD-induced HCC patients and serves as a potential biomarker for predicting PD1 response in HCC patients.
Conclusions: Akk regulates the immune tumor environment by regulating two key immune suppressive cells via regulation of the LPS flux to develop NALFD-induced HCC. This finding provides a solid therapeutic basis for a rational combination with PD1 for the treatment of this deadly disease. Interestingly, Akk may serve as a predictive biomarker for PD1 response in HCC patients.
Citation Format: Xueqian Wu, Fan Ying, Katherine Po Sin Chung, Carmen Oi Ning Leung, Terence Kin Wah Lee. Intestinal Akkermansia muciniphila complements the therapeutic efficacy of PD1 therapy by reshaping the immunosuppressive microenvironment in nonalcoholic fatty liver disease (NAFLD)-induced hepatocellular carcinoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2799.