Role of OX40 in T Cell Biology of Cancer and Infectious Disease

In this article learn why OX40 is now a key candidate for cancer and immune disease therapy.
OX40, also known as gp34, CD134, or TNFRSF4, is a member of the TNF superfamily. It is primarily expressed on activated effector and regulatory CD4 and CD8 T cells; it can also be expressed by NKT cells, NK cells, and neutrophils in the immune system.1 It is a costimulatory molecule whose ligand, OX40L (CD252), is expressed by antigen presenting cells including dendritic cells.2 and macrophages3 Signaling via OX40 recruits TRAF2 and TRAF5 to activate the NFkB pathway, which is negatively regulated by TRAF3.4 OX40 is upregulated on newly activated T cells following engagement of the T cell receptor. Engagement of OX40 also promotes the formation of memory T cells, and reactivated T cells upregulate OX40 more quickly than do T cells activated for the first time.5 OX40 also promotes cell survival through maintenance of Bcl-xL, Bcl-2, and Akt levels, whereas lack of OX40 leads to apoptosis.1,6
Upregulation of OX40 is found in numerous inflammatory diseases. Constitutive engagement of OX40 results in autoimmune diseases including experimental autoimmune encephalomyelitis (a model of multiple sclerosis) and inflammatory bowel diseases including celiac disease, Crohn’s disease, and ulcerative colitis.7–9 Not only is expression of OX40 associated with these disease states, but blockade of OX40 in both experimental autoimmune encephalomyelitis.10 and inflammatory bowel disease11 ameliorates symptoms of the disease and lowers the levels inflammatory markers. OX40 expression is also found on alloreactive T cells in acute graft-versus-host disease, a severe side effect of bone marrow transplantation. These T cells are found throughout the body, in liver, skin, spleen, and lymph node of disease-affected hosts12 However, current therapies for these autoimmune diseases do not include OX40 blockade.
Conversely, targeting of OX40 has been tested in clinical trials for cancer. Inflammation in the cancer setting is indicative of an anti-tumor immune response, and OX40 expression on T cells in the tumor microenvironment is a marker of inflammation. OX40-expressing tumor-specific T cells have been found in the draining lymph nodes and/or tumor bed of melanoma, head and neck cancer.13, breast cancer14, and colorectal cancer15 In primary colorectal cancer patients, this pattern of OX40 expression is associated with increased survival.15 Several preclinical models have demonstrated that OX40 agonism in combination with checkpoint blockade immunotherapies including anti-4-1BB, anti-PD-L1, and anti-CTLA4, leads to increased survival.16 The first clinical trial using a OX40 agonist as a treatment for cancer began in 200617 and since then, over ten more trials using an OX40 agonist either alone or in combination have been approved. OX40 agonism has additionally been effective as in combination therapies for cancer when added to radiotherapy, chemotherapy, and immune activating therapies including IL-2 and TLR agonists.16
Detection of human OX40/CD134 by immunohistochemistry.
Detection of human OX40/CD134 by immunohistochemistry.
Detection of human OX40/CD134 (red) by immunohistochemistry.
Detection of human OX40/CD134 (red) by immunohistochemistry.
Detection of human OX40/CD134 by immunocytochemistry.
Detection of human OX40/CD134 by immunocytochemistry.

References

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