Inducible T cell co-stimulator (ICOS, CD278) is an activating costimulatory immune checkpoint expressed on activated T cells. It is a type I transmembrane glycoprotein which belongs to the CD28 family of co-stimulatory immunoreceptors. It is present on the T cell surface as a disulfide bond-linked homo-dimer and is rapidly upregulated upon TCR cross-linking and/or CD28 co-stimulation. Its ligand, ICOSL (also known as CD275, B7RP-1, B7-H2), is mainly expressed by antigen-presenting cells (APCs), dendritic cells (DCs), macrophages, and somatic cells, including tumor cells in the tumor microenvironment. ICOS plays a non-overlapping role in the functional differentiation of T follicular helper cells (Tfh), Th2, and Th17 lymphocytes.
Fig.1. ICOS signal transduction.1,2
ICOS/ICOSL binding generates various activities among the diversity of T cell subpopulations, including T cell activation and effector functions and the sustained suppressive activities mediated by regulatory T cells. This dual role in both antitumor and protumor activities makes targeting the ICOS/ICOSL pathway attractive to enhance anti-tumor immune responses.
The expression of ICOS-positive lymphocytes and ICOSL has been reported in various tumor settings and considered with alternate prognostic valence. The activity of ICOS appears to be linked to T cell activation following CTLA-4 blockage. ICOS stimulation may significantly enhance the immune-stimulatory effect of CTLA-4 blocking antibodies that, conversely, are impaired in ICOS knock-out models.
Current studies support ICOS as a relevant and potentially exploitable marker of T cell activation. Its expression by CD4 and CD8 T lymphocytes after treatments with checkpoint inhibitors may indicate the intended re-activation of the anticancer immune response. It seems to be associated with clinical responses and correlates with prognosis. Currently, the available evidence supports a foreseeable therapeutic scenario wherein ICOS stimulation may be explored more in association with anti-CTLA4 or anti-PD-1 than a single treatment.
The ICOS/ICOSL axis has been proved to promote either antitumor T cell responses or protumor responses when triggered in Tregs. Thus, both agonistic and antagonistic monoclonal antibodies (mAbs) targeting this pathway are being investigated for cancer immunotherapy.
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