Microbial-mediated immunotherapy is a promising innovation in tumor therapy with broad application prospects. Its advantage lies in the ability of microorganisms to cope with tumor diversity as well as immune evasion mechanisms, activate the immune system, and enhance the anti-tumor immune activity. N. caninum is a specialized intracellular protozoan, of which there is no evidence of the zoonotic potential [8, 24]. Currently, there are only three reports on the successful inhibition of thymoma and melanoma by N. caninum [19–21]. In this study, we found that N. caninum can inhibit the development of tumors by activating the Th1-type immune response in three different murine tumor models, including Lewis subcutaneous tumors, Lewis and B16F10 melanoma lung metastasis.
Animal models with characteristics appropriate for studying tumors are essential in tumor research. The construction of a Lewis subcutaneous tumor model was successfully achieved in this investigation, with a previously established procedure [25]. The metastatic tumor models were constructed by tail vein injection method to simulate the naturally occurring metastasis of the tumor [26, 27]. Moreover, it has been shown that metastatic tumors formed by tail vein injection in mice are similar to metastatic tumors metastasized from in situ tumors to the lungs in terms of gene expression [28, 29]. In the present study, the occurrence of metastatic foci in the lung was observed on days 7 and 12 following the administration of B16F10 and LLC cells through the tail vein, and no anomalies were observed in any other tissues. On the 21st day after tumor cells injection, it was observed that only one out of the 30 melanoma mouse models exhibited a tumor with approximately 2 mm in diameter in the peritoneal mesentery. This occurrence may be ascribed to individual variations, which aligns the previous findings reported by Stackpole et al. [30]. In which melanoma metastasized first to the lungs, then from the lungs to other organs throughout the body, including the brain, adrenal glands, kidneys, ovaries, pancreas, and mesenteries.
Previous studies indicated that the number of live N. caninum tachyzoites for the treatment of tumor is 2×106 [19]. However, it was not clear whether a low dose of N. caninum would produce a sufficient anti-tumor immune response. Then N. caninum tachyzoites with 10 times and 5 times (2×105 and 1×106) lower than the previous therapeutic doses were used to assess the anti-tumor effects, respectively. And the results showed that the tumor size decreases with the therapeutic number of N. caninum tachyzoites increases, indicating that a sufficient number of N. caninum tachyzoites can stimulate the body to produce a stronger anti-tumor immune response within a safe range.
In our work, Lewis subcutaneous tumor volume in mice treated with N. caninum by intratumoral injection increased on the first few days after treatment, and then an abrupt shrinkage. Contrary to the hard texture of the tumor in mice of the control group and subcutaneous N. caninum treatment group, the touch of the tumor in mice treated with N. caninum by intratumoral injection is between soft and hard. It is speculated that a specific structure or antigen produced by the N. caninum is accountable for the active lysis of tumor cells. In addition, HE staining revealed that there were more cell deaths in tumor of mice treated with N. caninum by intratumoral injection, compared to the mice in the subcutaneous N. caninum treatment groups, which may also corroborate this result. Similar effects were also observed on subcutaneous B16F10 melanoma inhibited by N. caninum in mice [20].
Recent research conclusively demonstrated the significance of the tumor microenvironment (TME) for anti-tumor immune response [31]. Immunotherapy has the potential to reshape the TME effectively, enhancing the recognition and elimination of cancer cells by the host immune system [32]. The results of this study showed that N. caninum treatments increased the infiltration of CD8+ T cells, macrophages and NK cells in Lewis subcutaneous tumor, as well as increased the levels of Th1-type cytokines IL-12, IFN-γ, IL-10, TNF-α, and IL-2 in tumor tissues and lungs of lung metastatic mice, which transformed "cold tumor" into "hot tumors", similar to the report by [19]. IL-2 is a strong stimulator of proliferative and cytolytic activity, and combination therapy with IL-12 has been reported to synergistically induce anti-tumor responses [33]. IL-10, this complex cytokine has been shown to inhibit the expression of pro-inflammatory cytokines such as TNF-α and IFN-γ, it has also been investigated to increase NK cytolytic activity [34–36]. Our studies supported that IL-10 has an anti-tumor effect, and therefore the function of IL-10 must be reassessed on a case-by-case basis in the context of the TME. IL-15 promotes the regression of many types of tumors mainly by promoting the proliferation and activation of CD8+ T cells and NK cells [21, 37]. The upregulation of IL-15 may be a positive trend for the treatment of tumors in our study.
Several studies have revealed that intracellular protozoa can inhibit tumor growth and metastasis by inhibiting angiogenesis [38]. The vascular endothelial growth factor VEGF plays a critical mediator in angiogenesis, which can directly target tumor cells, promote tumor growth and metastasis, promote endothelial cell proliferation, migration, and invasion [39–41]. In our study, there was no statistically significant difference in mRNA expression of VEGF in Lewis subcutaneous tumors and B16F10 melanoma lung metastasis, but a significant decrease in the mRNA expression levels of VEGF was observed in the Lewis lung metastases after N. caninum treatment. Lantier et al. found that N. caninum could decrease the mRNA expression levels of VEGF in RG7 TME in mice treated by intratumoral injection, but not by subcutaneous injection [19]. However, Li et al. reported that N. caninum could not decrease the mRNA expression levels of VEGF in B16F10 melanoma tumor microenvironment in mice treated both by intratumoral injection and subcutaneous injection [20]. T. gondii, which is morphologically and structurally very similar to N. caninum, has been reported to inhibit the growth of melanoma and Lewis lung carcinoma tumors by inhibiting angiogenesis through induction of hypoxia and ischemic necrosis [42, 43], but not decrease the mRNA expression levels of VEGF in RG7 TME. Thus, we hypothesize that N. caninum possesses antiangiogenic capacity, but the manifestation of this potential may be related to the specific tumor type or manner of colonization.
PD-L1 has been demonstrated in several tumor models as the factor associated with poor prognosis [44], PD-L1 ligand expressed on the surface of tumor cells could bind to the PD-1 receptor expressed on the surface of T cells, leading to inhibition of T cell proliferation, activation, cytokine production, and alter metabolism and cytotoxic T lymphocytes (CTLs) killer functions. Thus, the overexpression of PD-L1 inhibits T-lymphocyte activation in the TME, which leading to immune evasion [45]. However, in this study, N. caninum treatment significantly increased the PD-L1 expression in both subcutaneous and lung metastases, consistent with our previous report [20]. T. gondii could also increase the expression of PD-L1 in tumors significantly, and in combination with PD-L1 blocking therapies, T. gondii showed a synergistic effect in prolonging mouse survival and inhibiting tumor growth in several preclinical mouse models [14]. Hence, N. caninum may also increase the anti-tumor effect of PD-L1 blockers by increasing the expression of PD-L1 in tumors microenvironment.
Although the presence of N. caninum DNA was detected in the lungs and brains of mice with subcutaneous and metastatic tumors, mice did not show symptoms of neosporosis after N. caninum treatments, suggesting that N. caninum may be a safe anti-tumor agent. However, we found that the tumors may continue to grow after the N. caninum treatment was stopped for a period of 15–20 days, and. a higher dosing of N. caninum treatment may lead to neosporosis in mice. Therefore, more rational protocols are needed, including that N. caninum can be modified to reduce toxicity without compromising treatment efficacy, anti-tumor properties from N. caninum can be screened to make a tumor vaccine, and N. caninum can be combined with immune checkpoint inhibitors against cancer.
Altogether, our results indicate that N. caninum not only inhibits the growth of Lewis subcutaneous tumors, but also inhibits the development of Lewis and B16 melanomas lung metastatic in mice by stimulating the immune response and inhibiting angiogenesis. N. caninum and its anti-tumor properties may be a safe and effective anti-tumor tool.