Immu-27. non-tumor cell ido1 non-enzymatically decreases rt + pd-1 mab treatment efficacy in older adults with glioblastoma

Abstract Checkmate 498 is a large, randomized, phase 3 clinical trial that demonstrated an improved hazard ratio for younger but not older adults with MGMT unmethylated GBM treated with RT + PD-1 mAb. In an effort to better understand the biological determinant, indoleamine 2,3 dioxygenase 1 (IDO1), and its relationship with reducing RT + PD-1 mAb treatment efficacy in older adults with GBM, we created and/or compared 20-26 month-old C57BL/6 background mice that were IDO1-T2A-GFP [wild-type (WT); negative control (n=16)], IDO1 enzyme null [with normal IDO1 expression potential but incapable of tryptophan metabolism (n=16)], IDO1KO (n=4), Ido1fl/fl (n=14), Lysm-Cre+→Ido1fl/fl [IDO1-deficient in monocytes, macrophages, and microglia (n=20)], CD11c-Cre+→Ido1fl/fl [IDO1-deficient in dendritic cells (n=23)], Tie2-Cre+→Ido1fl/fl [IDO1-deficient in endothelial cells (n=14)]. Mice were intracranially (ic.) engrafted with 5×103 syngeneic GL261 followed by treatment with radiation (RT) + PD-1 mAb beginning at 14-days post ic. IDO1 WT and IDO1 enzyme null mice had a survival rate of 12.5% and 18.75% at 90-day post ic., respectively, which was significantly reduced as compared to IDO1KO mice with a 75% survival rate (p< 0.05). Tie2-Cre+→Ido1fl/fl mice, CD11c-Cre+→Ido1fl/fl, and Lysm-Cre+→Ido1fl/fl mice had a 100%, 96%, and 70% survival rate at 90-day post ic., respectively, as compared to Ido1fl/fl mice with a 42% survival rate (p< 0.05). Significantly reduced kynurenine (KYN) levels were found in IDO1 enzyme null and IDO1KO mice as compared to WT mice (p< 0.001). Unexpectedly, kynurenine levels were also reduced in Tie2-Cre+→Ido1fl/fl but not in CD11c-Cre+→Ido1fl/fl, Lysm-Cre+→Ido1fl/fl or Ido1fl/fl mice (p< 0.05). Tryptophan (TRP) levels did not change between mouse groups. These data support the hypothesis that non-tumor cell IDO1 reduces immunotherapeutic efficacy in older adults with GBM through a TRP-KYN pathway-independent mechanism.