# Combining lenalidomide with IL-2 family of cytokines enhances activating receptor and perforin/granzyme expression in NK cells

## TL;DR

Combining lenalidomide with IL-2 family cytokines boosts NK cell function by increasing cytotoxic molecules and overcoming lenalidomide's negative effects.

## Contribution

The study reveals a novel strategy to enhance NK cell activity by combining lenalidomide with IL-2 family cytokines.

## Key findings

- Lenalidomide reduces NK cell proliferation but this is overcome by IL-2 family cytokines.
- Combining lenalidomide with IL-2 family cytokines increases perforin and granzyme expression in NK cells.
- The effect is mediated through STAT5 activation and modulation of the PI3K/AKT pathway.

## Abstract

Lenalidomide is an immunomodulatory drug approved in the treatment of autoimmune disease, inflammation, and cancer. Its impact continues to grow due to its diverse spectrum of effects hampered only by toxicities and reduced efficacy. Therefore, development of strategies that enhance function while reducing drawbacks remains a prime goal.

The mechanisms of action of lenalidomide on the activity of natural killer cells (NK cells) remains understudied yet could be critical for the development of strategies to enhance its efficacy. These cells are critical drivers of anti-tumor immune responses which are often functionally suppressed in malignancies. NK cell and T cell survival and function is driven by the IL-2 family of cytokines (IL-2 or IL-15) and work has shown that lenalidomide potentially works by increasing the secretion of IL-2 by other lymphocytes, such as CD4+ T helper cells. Thus, we hypothesized that improving NK activity with IL-2 family of cytokines could lead to enhanced lenalidomide-induced responses of these cells.

We show that lenalidomide does not affect NK cell viability but reduces their proliferation through cell cycle arrest which could be overcome by exogenous addition of IL-2 family of cytokines. Moreover, lenalidomide induced the secretion of IL-2 on isolated NK cells although it also modulated NK receptor expression, such as NKp46, trough downregulation of PI3K/AKT pathway reduction. This was overcome by exogeneous addition of IL-2 family of cytokines increasing natural cytotoxicity, through higher perforin and granzyme expression. Mechanistically, this increased gene and protein expression occurred through the activation of STAT5 by lenalidomide which was also enhanced through the exogenous addition of IL-2 family of cytokines and modulation of IL-2R subunit changes.

These data provide a rationale for the combination of lenalidomide with IL-2 family of cytokines to enhance the effectiveness of NK cells.