Purpose: Immunogenic cell death (ICD) is a cell death modality that plays a vital role in anticancer therapy. In this study, we investigated whether lenvatinib induces ICD in hepatocellular carcinoma and how it affects cancer cell behavior. Patients and Methods: Hepatoma cells were treated with 0.5 μM lenvatinib for two weeks, and damage-associated molecular patterns were assessed using the expression of calreticulin, high mobility group box 1, and ATP secretion. Transcriptome sequencing was performed to investigate the effects of lenvatinib on hepatocellular carcinoma. Additionally, CU CPT 4A and TAK-242 were used to inhibit TLR3 and TLR4 expressions, respectively. Flow cytometry was used to assess PD-L1 expression. Kaplan–Meier and Cox regression models were applied for prognosis assessment. Results: After treatment with lenvatinib, there was a significant increase in ICD-associated damage-associated molecular patterns, such as calreticulin on the cell membrane, extracellular ATP, and high mobility group box 1, in hepatoma cells. Following treatment with lenvatinib, there was a significant increase in the downstream immunogenic cell death receptors, including TLR3 and TLR4. Furthermore, lenvatinib increased the expression of PD-L1, which was later inhibited by TLR4. Interestingly, inhibiting TLR3 in MHCC-97H and Huh7 cells strengthened their proliferative capacity. Moreover, TLR3 inhibition was identified as an independent risk factor for overall survival and recurrence-free survival in patients with hepatocellular carcinoma. Conclusion: Our study revealed that lenvatinib induced ICD in hepatocellular carcinoma and upregulated PD-L1 expression through TLR4 while promoting cell apoptosis through TLR3. Antibodies against PD-1/PD-L1 can enhance the efficacy of lenvatinib in the management of hepatocellular carcinoma. Graphical Abstract:

Peripheral blood lymphocytes (PBLs), which play a pivotal role in orchestrating the immune system, garner minimal attention in hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC). The impact of primary liver cancers on PBLs remains unexplored. In this study, flow cytometry facilitated the quantification of cell populations, while transcriptome of PBLs was executed utilizing 10× single-cell sequencing technology. Additionally, pertinent cases were curated from the GEO database. Subsequent bioinformatics and statistical analyses were conducted utilizing R (4.2.1) software. Elevated counts of NK cells and CD8+ T cells were observed in both ICC and HCC when compared to benign liver disease (BLD). In the multivariate Cox model, NK cells and CD8+ T cells emerged as independent risk factors for recurrence-free survival. Single-cell sequencing of PBLs uncovered the downregulation of TGFβ signaling in tumor-derived CD8+ T cells. Pathway enrichment analysis, based on differential expression profiling, highlighted aberrations in selenium metabolism. Proteomic analysis of preoperative and postoperative peripheral blood samples from patients undergoing tumor resection revealed a significant upregulation of SELENBP1 and a significant downregulation of SEPP1. Primary liver cancer has a definite impact on PBLs, manifested by alterations in cellular quantities and selenoprotein metabolism.

Background Hepatocellular carcinoma (HCC) is a major cause of cancer-related deaths worldwide, often diagnosed at advanced stages with limited treatment options. Despite advancements in systemic therapies, including the use of lenvatinib, the survival rate for advanced HCC remains low due to drug resistance and tumor heterogeneity. Method This study employed single-cell sequencing and spatial transcriptomics to investigate intra-tumor heterogeneity and identify subpopulations of malignant cells with inherent drug resistance. Tumor samples were obtained from patients undergoing lenvatinib, and differential analysis was performed to identify biomarkers associated with drug resistance. Results Analysis revealed significant differences in treatment response between different HCC nodules within the same patient, indicating intra-tumor heterogeneity. Single-cell sequencing and spatial transcriptomics identified distinct cell clusters within tumors, with specific subpopulations showing inherent resistance to lenvatinib. Differential analysis identified 17 common upregulated genes, including PCK1 and ALDH1A1, which were significantly associated with drug resistance. Pseudotime analysis further supported the role of PCK1 and ALDH1A1 as potential biomarkers of inherent drug resistance in HCC. This study highlights the importance of tumor heterogeneity and identifying biomarkers associated with drug resistance in HCC. Conclusions The findings suggest that PCK1 and ALDH1A1 may serve as potential biomarkers for predicting treatment response and guiding therapeutic strategies in HCC patients.