Loss of fas expression and function is coupled with colon cancer resistance to immune checkpoint inhibitor immunotherapy

Despite the remarkable efficacy of immune checkpoint inhibitor (ICI) immunotherapy in various types of human cancers, colon cancer, except for the approximately 4% microsatellite- instable (MSI) colon cancer, does not respond to ICI immunotherapy. ICI acts through activating CTLs that use the Fas-FasL pathway as one of the two effector mechanisms to suppress tumor. Cancer stem cells are often associated with resistance to therapy including immunotherapy, but the functions of Fas in colon cancer apoptosis and colon cancer stem cells are currently conflicting and highly debated. We report here that decreased Fas expression is coupled with a subset of CD133 ⁺ CD24 ^lo colon cancer cells in vitro and in vivo. Consistent of the lower Fas expression level, this subset of CD133 ⁺ CD24 ^lo Fas ^lo colon cancer cells exhibits decreased sensitivity to FasL-induced apoptosis. Furthermore, FasL selectively enriches CD133 ⁺ CD24 ^lo Fas ^lo colon cancer cells. CD133 ⁺ CD24 ^lo Fas ^lo colon cancer cells exhibit increased lung colonization potential in experimental metastatic mouse models and decreased sensitivity to tumor-specific CTL adoptive transfer and ICI immunotherapies. Interestingly, FasL challenge selectively enriched this subset of colon cancer cells in microsatellite-stable (MSS) but not in the MSI human colon cancer cell lines. Consistent with the downregulation of Fas expression in CD133 ⁺ CD24 ^lo cells, lower Fas expression level is significantly correlated with decreased survival in patients with human colon cancer. Implications: Our data determine that CD133 ⁺ CD24 ^lo Fas ^lo colon cancer cells are capable to evade Fas-FasL cytotoxicity of tumor-reactive CTLs and targeting this subset of colon cancer cells is potentially an effective approach to suppress colon cancer immune evasion.