Subtype-dependent PD-L1 stability and immune context shape immunotherapy response in hepatocellular carcinoma

Immune checkpoint inhibitors (ICIs) targeting the PD-1/PD-L1 axis have expanded treatment options for hepatocellular carcinoma (HCC), yet only a subset of patients achieves durable responses. Limited efficacy reflects gaps in understanding PD-L1 regulation, including its biochemical heterogeneity, subtype-specific stability, and effects on tumor-immune interactions. We aimed to dissect these mechanisms and identify integrated biomarkers predictive of immunotherapy response.

Human HCC and paired non-tumoral tissues, an HBV-driven transgenic mouse model, and five HCC cell lines representing Hoshida/Caruso subtypes were analyzed. PD-L1 expression, glycosylation, and stability were assessed by Western blot, flow cytometry, and immunohistochemistry. Functional assays included co-cultures of HCC cells with primary activated PBMCs from multiple healthy donors. Cells were treated with durvalumab or atezolizumab, in the presence or absence of IFN-γ stimulation. PD-L1 turnover was evaluated using cycloheximide and proteasome inhibition.

PD-L1 protein was increased in ~60% of tumors, particularly in virally driven HCC. Elevated PD-L1 in non-tumoral liver was associated with higher recurrence risk. Biochemical profiling revealed multiple PD-L1 species: mature N-glycosylated and intermediate forms indicative of enhanced stability were enriched in tumors. Glycosylated PD-L1 displayed prolonged half-life in S1/CL3 subtypes, whereas S2/CL1 cells exhibited rapid, proteasome-dependent turnover. PD-L1 abundance alone did not predict immune susceptibility: S1-like cells, despite higher PD-L1, were highly sensitive to CD8⁺ T-cell-mediated killing and PD-L1 blockade, whereas S2-like cells were more resistant to cytotoxicity. ICIs induced donor-dependent cytotoxicity, with variable responder profiles; durvalumab outperformed atezolizumab, consistent with reduced glycosylation dependence. IFN-γ priming enhanced PD-L1 expression and restored immune responsiveness in low-responder co-cultures. Overall, tumors with stable glycosylated PD-L1 (S1-like) rely on PD-L1-mediated immune suppression and may benefit from PD-L1-targeted therapies, whereas tumors with low or rapidly turned-over PD-L1 (S2-like) exhibit dynamic PD-L1 regulation with increased reliance on de novo synthesis, limiting responsiveness to PD-L1 blockade alone and supporting the need for combinatorial approaches.

PD-L1 regulation in HCC depends on molecular subtype, post-translational stability, and host immune competence. Integrating these factors provides a framework for guiding patient selection and optimizing immunotherapy.