Overexpression of PD‐L1 (CD274) on tumor cells may represent a hallmark of immune evasion, and overexpression has been documented in several tumors including cutaneous squamous cell carcinoma (cSCC). While PD‐L1/PD‐1 activity in the skin has been primarily described in inflammatory models, our goal was to examine PD‐L1 expression in human keratinocytes exposed to UV irradiation. We assessed PD‐L1 expression in human sun‐protected (SP) and sun‐damaged (SD) skin, actinic keratosis (AK), and cSCC using IHC and protein microarray. Both methods found low baseline levels of PD‐L1 in SP and SD skin and significantly increased expression in cSCC. Next, we examined PD‐L1 expression in acute models of UV exposure. In human SP skin exposed to 2‐3 MED of UV (n = 20), epidermal PD‐L1 was induced in 70% of subjects after 24 h (P = 0.0001). SKH‐1 mice exposed to acute UV also showed significant epidermal PD‐L1 induction at 16, 24 and 48 h. A time‐ and dose‐dependent induction of PD‐L1 was confirmed in cultured human keratinocytes after UV, which was markedly reduced in the presence of MEK/ERK, JNK or STAT3 inhibitors. These findings suggest that UV induces upregulation of PD‐L1 through established, pharmacologically targetable stress‐signaling pathways in keratinocytes.

Immune evasion is a molecular hallmark of cancer, and overexpression of the immune checkpoint protein PD-L1 (CD274) has been documented in several tumors including cutaneous squamous cell carcinoma (cSCC). Notably, while baseline levels of PD-L1 in normal human epidermis are low, acute solar-simulated light (SSL) exposure increases the expression of this protein in epidermal keratinocytes, an effect which can be replicated in cultured keratinocytes and in mouse models. While current immunotherapies targeting the PD-1/PD-L1 axis using monoclonal antibodies are providing therapeutic benefits in many cancers including cSCC, small molecule inhibitors are also being developed to target PD-L1 which may be amenable for topical formulation and therefore early intervention with reduced systemic exposure. We have recently tested one such molecule, BMS-202, in vitro and in vivo. BMS-202 application to keratinocytes in culture inhibits UV-induced PD-L1 RNA and protein expression. Notably, exposure to this inhibitor also reduced UV-induced stress signaling as measured by AP-1 luciferase assay in cultured keratinocytes. Topical application of BMS-202 to immunocompetent SKH-1 mouse skin resulted in significant inhibition of SSL-induced epidermal PD-L1 as determined by immunoblot analysis. NanoString nCounter Pathway™ transcriptomic analysis of full-thickness SKH-1 mouse skin shows strong inhibition of SSL-induced inflammatory responses, chemokine activity, innate immune response and NF-κB activation in BMS-202 treated samples compared to SSL-only controls. Our results indicate that early intervention against PD-L1 expression/activity could be a viable target for skin cancer photochemoprevention. Topical application of small molecule PD-L1 inhibitors such as BMS-202 may provide novel treatment options for populations at high risk for cSCC. Citation Format: Prajakta Vaishampayan, Jana Jandova, Yuchen (Ella) Ai, Viktoria Kirschnerova, Clara Curiel-Lewandrowski, Georg T. Wondrak, Sally E. Dickinson. Topical inhibition of UV-induced PD-L1 expression and inflammatory signaling by the small molecule inhibitor BMS-202. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 5254.

Toll-like receptor 4 (TLR4) is gaining attention for its role in several cancer-associated signaling pathways, including the regulation of inflammation, DNA repair and epithelial-mesenchymal transition (EMT). There is evidence that TLR4 contributes to ultraviolet (UV) radiation-induced stress signaling in skin cells, including keratinocytes. Blockade of TLR4 activity using the pharmacological antagonist resatorvid (TAK-242) inhibits not only acute UV-induced signaling in vitro and in vivo, but blocks UV-induced skin carcinogenesis in mouse models. In order to genetically explore the role of TLR4 in keratinocyte responses to UV-induced stress, we recently utilized CRISPR/Cas9 techniques to delete TLR4 from the genome of human HaCaT keratinocyte cells in culture. First, using differential gene expression analysis (employing the EMTRT2 Profiler PCR array technology) it was observed that TLR4 KO status is associated with pronounced downregulation of EMT-related gene expression (MMP9, VIM, FN1, SNAI1, TWIST1) confirmed by independent RT-qPCR analysis. TLR4 was also a determinant of UV-induced inflammatory enzyme expression including PTGS2. Phenotypically, TLR4 KO cells displayed an attenuation of Matrigel transwell migration. TLR4 KO cells demonstrated increased sensitivity to UV-induced apoptosis as detected by flow cytometry of annexin V/propidium iodide stained cells, and by immunodetection of increased PARP cleavage. Moreover, NanoString nCounter expression analysis of murine skin chronically exposed to tumorigenic UV indicated that topical resatorvid treatment was associated with MMP9 downregulation. Future studies will employ this novel TLR4 KO keratinocyte cell line as a mechanistic tool to dissect the role of TLR4 in inflammatory signaling and EMT response in the context of skin photodamage and carcinogenesis. Supported by NIH grants ES029579, R03CA230830, P01CA229112. Citation Format: Viktoria Kirschnerova, Prajakta Vaishampayan, Maria Khawam, Clara Curiel-Lewandrowski, Georg T. Wondrak, Sally E. Dickinson. TLR4 expression as a determinant of EMT and stress response gene expression in UV exposed human keratinocytes [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 2447.

Several studies have shown that the ultraviolet (UVB/A) from terrestrial solar radiation are strongly implicated in the etiology of most skin cancers via the generation of DNA lesions and reactive oxygen species (ROS). Moreover, skin is also exposed to solar near infra-red (NIR) radiation which are responsible of oxidative stress generation. Therefore, it is important to protect the most sensitized skins (actinic keratosis or atopic dermatitis) in all circumstances/all day long. Thus, the aim of this project was to develop a SPF50+ sunfilter product in stick form to provide a nomad protection for sensitized skins. We demonstrated a very good genoprotection after an acute solar simulated irradiation in an in vitro reconstructed human epidermal (RHE) model with a very high protection of UV-induced cyclobutane pyrimidine dimers formation. Moreover, the quantification of ROS revealed that the topical application of sunscreen decreased significantly the free radical production in an ex vivo human skin model after acute UVA irradiation. In addition, the stick SPF50+ protection was evaluated on healthy subjects by the quantification of NIR-generated malondialdehyde (MDA), marker of lipid peroxidation. The topical application of the product decreased significantly the MDA production after NIR irradiation. Thus, the nomad sunfilter product provides an efficient protection against IR-generated oxidative stress. Finally, we showed that topical application of the sunscreen induced a physical barrier reinforcement on the RHE model by transepithelial electric resistance. Altogether, we demonstrated that the SPF50+ sunfilter stick shows a broad spectrum photoprotection not only UVB+A but also NIR, associated to a physical barrier reinforcement, providing a complete protection of the most sensitized skins.