Cited by 113Cancer, Hypoxia, and MetabolismCancer Immunotherapy and BiomarkersFerroptosis and cancer prognosis

The DOI matches its Crossref record; 25 of the 26 references it cites were found in a registry or an index; none of the 29 sources its claims cite is checked for support yet.

Cross-talk between HIF and PD-1/PD-L1 pathways in carcinogenesis and therapy

Open access
Shurin, Michael R., Umansky, Viktor·2022·Journal of Clinical Investigation

Abstract

Tumor-associated hypoxia plays an important role in carcinogenesis and metastasis. The expression, activation, and stabilization of hypoxia-inducible transcription factors (HIFs) support malignant cell survival, proliferation, plasticity, and motility. Hypoxia also upregulates the expression of programmed cell death ligand 1 (PD-L1) in malignant and immune regulatory cells. Therefore, the combination of HIF inhibitors and checkpoint inhibitors (CPIs) is promising for boosting antitumor immunity and diminishing malignant cell plasticity and therapy resistance. In this issue of the JCI, Salman et al. report the development of a specific agent that inhibited HIF-1/2-mediated gene expression in tumor cells and suppressed tumor growth. Bailey, Liu, et al. in this issue demonstrate that targeting HIF-1α abrogated PD-L1-mediated immune evasion by suppressing PD-L1 expression on malignant and myeloid regulatory cells, causing tumor rejection. These findings suggest that targeting the HIF/PD-L1 axis with specific HIF inhibitors should improve the safety and efficacy of CPIs for cancer therapy.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

This JCI commentary reviews the cross-talk between hypoxia-inducible factors (HIFs) and the PD-1/PD-L1 axis in cancer, arguing that combining HIF inhibitors with checkpoint inhibitors (CPIs) could improve antitumor immunity and reduce therapy resistance. It highlights two companion JCI studies showing that HIF inhibition suppresses tumor growth and PD-L1–mediated immune evasion.

Key findings

  • Hypoxia stabilizes HIF-1/HIF-2, which promote angiogenesis, immunosuppression, EMT, and metabolic reprogramming, and upregulate PD-L1 on malignant and myeloid regulatory cells; hypoxia correlates with worse prognosis and resistance to therapy.
  • Salman et al. developed a low-molecular-weight agent inhibiting HIF-1/2–mediated gene expression that suppressed tumor growth in mice, reduced vascularization and immunosuppression (fewer TAMs and MDSCs via suppressed IL-4, IL-13, CXCL1), increased CTL/NK infiltration (via CXCL9/CXCL10), and raised the complete response rate to anti–PD-1 from 25% to 67%.
  • Bailey, Liu, et al. showed that pharmaceutical or genetic HIF-1α targeting suppressed PD-L1 on malignant cells and myeloid regulatory cells, reactivated TILs, caused tumor rejection, downregulated PD-1, upregulated granzyme B and perforin, and potentiated anti–CTLA-4 therapy.
  • Bailey, Liu, et al. also found that HIF-1α inhibition blocked PD-L1 at the tumor site but induced PD-L1 in normal tissues, suggesting a route to safer immunotherapy by differential PD-L1 regulation.

Methods

  • Design: a commentary/review article in the Journal of Clinical Investigation discussing the HIF/PD-L1 axis and two companion studies published in the same issue.
  • Data: no primary data; the article synthesizes published experimental and clinical literature (including refs. 1–25) and describes the findings of Salman et al. (ref. 23) and Bailey, Liu, et al. (ref. 24).
  • Analysis: narrative synthesis of mechanisms and therapeutic implications, with a proposed framework for combining HIF inhibitors with CPIs.

Limitations

  • Not stated in the paper (the commentary does not include a limitations section).
  • Evident from the text: this is a commentary without original data, so its conclusions rest on the two cited companion studies and prior literature; the highlighted findings derive largely from murine tumor models, and the authors note that testing in different tumor models and understanding interactions with TGF-β, IL-1, hormones, and growth factors remain necessary.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1172/jci159473

Cites

25 of 25 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

0 of 29 cited sources checked · 0 supported · 0 flagged

Show all 15 claims

  • It may state two separate claims as one. 15
  • Probably not a substantial claim. 3
18 of 18
  • The paper relies on this without support.

    The murine tumor model results for HIF inhibitors and CPI combinations are predictive of human cancer therapy.

    “These findings suggest that targeting the HIF/PD-L1 axis with specific HIF inhibitors should improve the safety and efficacy of CPIs for cancer therapy.”
  • The paper relies on this without support.

    HIF inhibitors can be developed that are highly specific and nontoxic in humans.

    “Salman et al. also support the notion that highly specific and nontoxic HIF inhibitors deserve further investigation when applied alone or in combination with CPIs and other targeted therapy (23).”
  • The paper relies on this without support.

    HIF-1α inhibition-induced PD-L1 expression in normal tissues leads to immune tolerance in humans.

    “Promotion of immune tolerance by differential regulation of PD-L1 in normal and cancer tissues is an important approach for safer and more successful immunotherapy (24).”
3 of 3

Claims other papers make about this one

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Citations

Cites

1 retracted

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1 of the 26 references couldn’t be matched to a known paper.

Cited by

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Items 101–113 of 113

Metadata

Authors
Shurin, M. R., & Umansky, V.
Affiliations
  • University of Pittsburgh Medical Center (US)
  • German Cancer Research Center (DE)
Corresponding author
Shurin, Michael R.
Venue
Journal of Clinical Investigation
Published
2022-05-02
Volume
132
Issue
9
ISSN
  • 0021-9738 (ISSN-L)
  • 1558-8238
OpenAlex
W4225246674
Cited by
113
References
26
Citations by year
2026: 26 · 2025: 27 · 2024: 31 · 2023: 24 · 2022: 5
FWCI
9.15
Type
journal article
Language
en
Open access
Locations
  • Journal of Clinical Investigation (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
  • University of Pittsburgh
  • Deutsches Krebsforschungszentrum
  • Universität Heidelberg
  • National Cancer Institute (P30CA047904)
Topics
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Cancer Research › Cancer, Hypoxia, and Metabolism
  • Health Sciences › Medicine › Oncology › Cancer Immunotherapy and Biomarkers
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Cancer Research › Ferroptosis and cancer prognosis
Keywords
hypoxia-inducible factor, HIF-1α, PD-L1, PD-1/PD-L1 axis, tumor hypoxia, HIF inhibitors, immune checkpoint inhibitors, cancer immunotherapy, tumor immune evasion, treatment resistance, carcinogenesis, metastasis
MeSH terms
Hypoxia, Humans, Ligands, Neoplasms, Apoptosis, B7-H1 Antigen, Programmed Cell Death 1 Receptor, Carcinogenesis

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