What question did this study set out to answer?

The research investigates how KEAP1 loss affects immune evasion and response to PD-1 blockade in lung adenocarcinoma.

April 5, 2026

Abstract 171: KEAP1 loss-of-function suppresses immunogenic ferroptosis and limits PD-1 blockade efficacy through an NRF2-FSP1 pathway.

Key Points

The research investigates how KEAP1 loss affects immune evasion and response to PD-1 blockade in lung adenocarcinoma.
Analyzed patient data correlating KEAP1 mutations with PD-1 response
Used murine tumor models to assess anti-PD-1 therapy effectiveness
Conducted in vitro assays on dendritic cell function and ferroptosis
Measured damage-associated molecular patterns and cytokine profiles
Examined the role of the FSP1-CoQ10 axis in immune response
KEAP1 mutations were linked to poor PD-1 blockade response and lower dendritic cell infiltration
KEAP1-deficient tumors showed resistance to anti-PD-1 therapy in mouse models
Impaired dendritic cell function observed, including reduced maturation and T-cell priming
KEAP1 loss inhibited ferroptosis and led to insufficient release of immunogenic DAMPs
Targeting the FSP1-CoQ10 pathway helped restore dendritic cell function and may improve immunotherapy efficacy

Abstract

Abstract Background Loss-of-function mutations in KEAP1 frequently occur in lung adenocarcinoma and are associated with poor prognosis and limited benefit from immunotherapy. However, the mechanisms linking KEAP1 deficiency to immune evasion remain elusive. Methods We combined patient data analysis, in vivo tumor models, and in vitro co-culture systems to investigate how KEAP1 deficiency shapes dendritic cell (DC) biology and response to PD-1 blockade. Ferroptosis induction assays, damage-associated molecular patterns (DAMPs) quantification, cytokine profiling, and mechanistic interrogation of the FSP1-CoQ10 axis were performed to delineate underlying pathways. Results Clinically, KEAP1 mutations correlated with poor response to PD-1 blockade and reduced DC infiltration. In murine models, KEAP1-deficient tumors exhibited marked resistance to anti-PD-1 therapy. Mechanistically, KEAP1 loss impaired DC function in vitro, as evidenced by reduced maturation, phagocytosis, and naïve CD8+ T-cell priming capacity. This defect was linked to two complementary mechanisms. First, KEAP1-deficient tumor cells resisted ferroptosis and failed to release immunogenic DAMPs, including extracellular ATP, HMGB1, and calreticulin. Second, KEAP1 deficiency reprogrammed the cytokine secretion profile, with downregulation of CCL2, IL-6, CXCL1, and CXCL2, thereby diminishing DC recruitment and inflammatory signaling. Notably, inhibition of the FSP1-CoQ10 antioxidant axis restored ferroptosis-associated immunogenic cell death. Conclusions Our study identifies KEAP1 deficiency as a driver of immune-cold tumor microenvironments and resistance to PD-1 blockade, acting through impaired ferroptosis-induced immunogenic cell death and disrupted DC function. Targeting the FSP1-CoQ10 pathway may restore DC function and sensitize KEAP1-mutant lung cancers to immunotherapy. Citation Format: Xinfeng Wang, Yuxin Yao, Tomi Jun, Kuan-lin Huang, Nan Sun, Jie He. KEAP1 loss-of-function suppresses immunogenic ferroptosis and limits PD-1 blockade efficacy through an NRF2-FSP1 pathway abstract. In: Proceedings of the American Association for Cancer Research Annual Meeting 2026; Part 1 (Regular Abstracts); 2026 Apr 17-22; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2026;86(7 Suppl):Abstract nr 171.

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