Comorbidity between lung cancer and COVID-19 pneumonia: role of immunoregulatory gene transcripts in high ACE2-expressing normal lung

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  • Vladimir Lazar
  • Jacques Raynaud
  • Shai Magidi
  • Catherine Bresson
  • Jean François Martini
  • Susan Galbraith
  • Fanny Wunder
  • Amir Onn
  • Gerald Batist
  • Nicolas Girard
  • C. S. Pramesh
  • Amal Al-Omari
  • Sadakatsu Ikeda
  • Guy Berchem
  • Jean Yves Blay
  • Benjamin Solomon
  • Enriqueta Felip
  • Josep Tabernero
  • Eitan Rubin
  • Thierry Philip
  • Angel Porgador
  • Ioana Berindan-Neagoe
  • Richard L. Schilsky
  • Razelle Kurzrock

Background: SARS-CoV-2 (COVID-19) elicits a T-cell antigen-mediated immune response of variable efficacy. To understand this variability, we explored transcriptomic expression of angiotensin-converting enzyme 2 (ACE2, the SARS-CoV-2 receptor) and of immunoregulatory genes in normal lung tissues from patients with non-small cell lung cancer (NSCLC). Methods: This study used the transcriptomic and the clinical data for NSCLC patients generated during the CHEMORES study [n = 123 primary resected (early-stage) NSCLC] and the WINTHER clinical trial (n = 32 metastatic NSCLC). Results: We identified patient subgroups with high and low ACE2 expression (p = 1.55 × 10−19) in normal lung tissue, presumed to be at higher and lower risk, respectively, of developing severe COVID-19 should they become infected. ACE2 transcript expression in normal lung tissues (but not in tumor tissue) of patients with NSCLC was higher in individuals with more advanced disease. High-ACE2 expressors had significantly higher levels of CD8+ cytotoxic T lymphocytes and natural killer cells but with presumably impaired function by high Thymocyte Selection-Associated High Mobility Group Box Protein TOX (TOX) expression. In addition, immune checkpoint-related molecules – PD-L1, CTLA-4, PD-1, and TIGIT – are more highly expressed in normal (but not tumor) lung tissues; these molecules might dampen immune response to either viruses or cancer. Importantly, however, high inducible T-cell co-stimulator (ICOS), which can amplify immune and cytokine reactivity, significantly correlated with high ACE2 expression in univariable analysis of normal lung (but not lung tumor tissue). Conclusions: We report a normal lung immune-tolerant state that may explain a potential comorbidity risk between two diseases – NSCLC and susceptibility to COVID-19 pneumonia. Further, a NSCLC patient subgroup has normal lung tissue expressing high ACE2 and high ICOS transcripts, the latter potentially promoting a hyperimmune response, and possibly leading to severe COVID-19 pulmonary compromise.

Original languageEnglish
JournalTherapeutic Advances in Medical Oncology
Volume14
Pages (from-to)1-15
Number of pages15
ISSN1758-8340
DOIs
Publication statusPublished - 2022

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© The Author(s), 2022.

    Research areas

  • ACE2 expression, cancer, COVID-19, normal lung, transcriptomics

ID: 341058358