Activated ATF6α is a hepatic tumour driver restricting immunosurveillance.
Hepatocellular carcinoma (HCC) is the fastest growing cause of cancer-related mortality and there are limited therapies1. Although endoplasmic reticulum (ER) stress and the unfolded protein response (UPR) are implicated in HCC, the involvement of the UPR transducer ATF6α remains unclear2. Here we demonstrate the function of ATF6α as an ER-stress-inducing tumour driver and metabolic master regulator restricting cancer immunosurveillance for HCC, in contrast to its well-characterized role as an adaptive response to ER stress3. ATF6α activation in human HCC is significantly correlated with an aggressive tumour phenotype, characterized by reduced patient survival, enhanced tumour progression and local immunosuppression. Hepatocyte-specific ATF6α activation in mice induced progressive hepatitis with ER stress, immunosuppression and hepatocyte proliferation. Concomitantly, activated ATF6α increased glycolysis and directly repressed the gluconeogenic enzyme FBP1 by binding to gene regulatory elements. Restoring FBP1 expression limited ATF6α-activation-related pathologies. Prolonged ATF6α activation in hepatocytes triggered hepatocarcinogenesis, intratumoural T cell infiltration and nutrient-deprived immune exhaustion. Immune checkpoint blockade (ICB)4 restored immunosurveillance and reduced HCC. Consistently, patients with HCC who achieved a complete response to immunotherapy displayed significantly increased ATF6α activation compared with those with a weaker response. Targeting Atf6 through germline ablation, hepatocyte-specific ablation or therapeutic hepatocyte delivery of antisense oligonucleotides dampened HCC in preclinical liver cancer models. Thus, prolonged ATF6α activation drives ER stress, leading to glycolysis-dependent immunosuppression in liver cancer and sensitizing to ICB. Our findings suggest that persistently activated ATF6α is a tumour driver, a potential stratification marker for ICB response and a therapeutic target for HCC.
Authors
Li Li, Lebeaupin Lebeaupin, Kadianaki Kadianaki, Druelle-Cedano Druelle-Cedano, Vesper Vesper, Rennert Rennert, Huguet-Pradell Huguet-Pradell, Gomez Ramos Gomez Ramos, Fan Fan, Piecyk Piecyk, Zizmare Zizmare, Ramadori Ramadori, Li Li, Frick Frick, Qiu Qiu, Zhang Zhang, Martins Nascentes Melo Martins Nascentes Melo, Ranvir Ranvir, Shen Shen, Hanselmann Hanselmann, Kosla Kosla, Fernández-Vaquero Fernández-Vaquero, Vucur Vucur, Baskaran Baskaran, Bao Bao, Coleman Coleman, Tang Tang, Cetin Cetin, Chen Chen, Jang Jang, Del Prete Del Prete, Rahbari Rahbari, Zhang Zhang, Pham Pham, Hou Hou, Sun Sun, Gu Gu, Kim Kim, Rothermel Rothermel, Heide Heide, Ali Ali, Gallage Gallage, Talvard-Balland Talvard-Balland, Piqué-Gili Piqué-Gili, Gris-Oliver Gris-Oliver, Bevilacqua Bevilacqua, Schlicker Schlicker, Duffey Duffey, Unger Unger, Szydlowska Szydlowska, Hetzer Hetzer, Odom Odom, Machauer Machauer, Bucci Bucci, Sant Sant, Lee Lee, Rösler Rösler, Meckelmann Meckelmann, Schreck Schreck, Murray Murray, Simon Simon, Nahnsen Nahnsen, Schulze Schulze, Ho Ho, Jugold Jugold, Breuhahn Breuhahn, Mallm Mallm, Schirmacher Schirmacher, Roth Roth, Rahbari Rahbari, Tschaharganeh Tschaharganeh, Roessler Roessler, Goeppert Goeppert, Bengsch Bengsch, Andrieux Andrieux, Boerries Boerries, Malek Malek, Prinz Prinz, Weber Weber, Zeiser Zeiser, Tamayo Tamayo, Bronsert Bronsert, Kurowski Kurowski, Thimme Thimme, Yuan Yuan, Carretero Carretero, Luedde Luedde, Pinyol Pinyol, Hartmann Hartmann, Karin Karin, Tasdogan Tasdogan, Trautwein Trautwein, Mall Mall, Hofmann Hofmann, Llovet Llovet, Haller Haller, Kaufman Kaufman, Heikenwälder Heikenwälder
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