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ILT-2 residues Tyr38 and Tyr76 bind Phe195 in HLA-G α3 domain, ILT-4 residues Tyr36 and Arg38 bind Phe195–Tyr197 loop in HLA-G α3 domain. (A) ILT-2 binds HLA-G heavy chain associated with β2m (HLA-G1 and HLA-G5). (B) ILT-4 binds both β2m-free (HLA-G2 and HLA-G6) and β2m-associated (HLA-G1 and HLA-G5) HLA-G heavy chain. (C) A panel of novel HLA-G isoforms including isoforms without α1 domain and transmembrane region, or with an extended 5’-region generated by HLA-G mRNA alternative splicing were predicted. However, molecular structure of these novel isoforms and remain to be identified, and interaction with ILTs is unknown yet.  and  represent ILT-2 and ILT-4 binding site in HLA-G isoforms.
Review
30 June 2021

Immune checkpoint inhibitors (ICIs) have become a promising immunotherapy for cancers. Human leukocyte antigen-G (HLA-G), a neoantigen, its biological functions and clinical relevance have been extensively investigated in malignancies, and early clinical trials with “anti-HLA-G strategy” are being launched for advance solid cancer immunotherapy. The mechanism of HLA-G as a new ICI is that HLA-G can bind immune cell bearing inhibitory receptors, the immunoglobulin-like transcript (ILT)-2 and ILT-4. HLA-G/ILT-2/-4 (HLA-G/ILTs) signaling can drive comprehensive immune suppression, promote tumor growth and disease progression. Though clinical benefits could be expected with application of HLA-G antibodies to blockade the HLA-G/ILTs signaling in solid cancer immunotherapy, major challenges with the diversity of HLA-G isoforms, HLA-G/ILTs binding specificity, intra- and inter-tumor heterogeneity of HLA-G, lack of isoform-specific antibodies and validated assay protocols, which could dramatically affect the clinical efficacy. Clinical benefits of HLA-G-targeted solid cancer immunotherapy may be fluctuated or even premature unless major challenges are addressed.

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