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Blood, 11 June 2009, Vol. 113, No. 24, pp. 6102-6111.
Prepublished online as a Blood First Edition Paper on April 14, 2009; DOI 10.1182/blood-2008-12-195354.


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IMMUNOBIOLOGY

Indoleamine 2,3-dioxygenase controls conversion of Foxp3+ Tregs to TH17-like cells in tumor-draining lymph nodes

Madhav D. Sharma1,2, De-Yan Hou1,2, Yanjun Liu2, Pandelakis A. Koni2,3, Richard Metz4, Phillip Chandler2,3, Andrew L. Mellor2,3, Yukai He2,3, and David H. Munn1,2

1 Department of Pediatrics, 2 Cancer Immunotherapy Program, and 3 Department of Medicine, Medical College of Georgia, Augusta; and 4 Lankenau Institute for Medical Research, Wynnewood, PA

The immunoregulatory enzyme indoleamine 2,3-dioxygenase (IDO) is expressed by a subset of murine plasmacytoid DCs (pDCs) in tumor-draining lymph nodes (TDLNs), where it can potently activate Foxp3+ regulatory T cells (Tregs). We now show that IDO functions as a molecular switch in TDLNs, maintaining Tregs in their normal suppressive phenotype when IDO was active, but allowing inflammation-induced conversion of Tregs to a polyfunctional T-helper phenotype similar to proinflammatory T-helper-17 (TH17) cells when IDO was blocked. In vitro, conversion of Tregs to the TH17-like phenotype was driven by antigen-activated effector T cells and required interleukin-6 (IL-6) produced by activated pDCs. IDO regulated this conversion by dominantly suppressing production of IL-6 in pDCs, in a GCN2-kinase dependent fashion. In vivo, using a model of established B16 melanoma, the combination of an IDO-inhibitor drug plus antitumor vaccine caused up-regulation of IL-6 in pDCs and in situ conversion of a majority of Tregs to the TH17 phenotype, with marked enhancement of CD8+ T-cell activation and antitumor efficacy. Thus, Tregs in TDLNs can be actively reprogrammed in situ into T-helper cells, without the need for physical depletion, and IDO serves as a key regulator of this critical conversion.


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