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NK-cell recognition: missing self & stress ligands

Natural killer cells patrol for cells that have lost their identity papers (MHC-I) or that display stress flags. Cancers that hide from T cells by dropping MHC-I become visible to NK cells, unless they also shed the stress flags, wrap themselves in a second inhibitory badge (HLA-E), or soak the neighbourhood in TGF-β.

NK activation integrates inhibitory signals from KIRs and NKG2A (binding classical HLA-A/B/C and HLA-E respectively; 'missing self' when MHC-I is lost) against activating signals from NKG2D (MICA/B, ULBP1-6, induced by DNA damage and oncogenes), DNAM-1 (CD155, CD112), NKp30 (B7-H6), NKp46, and CD16 (FcγRIIIa, mediating ADCC by IgG1 antibodies such as trastuzumab and cetuximab). Killing is by perforin/granzyme and death ligands; IFN-γ recruits and licenses the adaptive response. Tumour escape: proteolytic shedding of MICA/B (ADAM10/17), HLA-E upregulation engaging NKG2A (monalizumab, mixed results), TIGIT and PVRIG competing with DNAM-1 for CD155, TGF-β and adenosine downregulating NKG2D, platelet cloaking of CTCs. NK cells are central to clearing circulating tumour cells and dormant cells and to controlling MHC-I-negative escape variants after checkpoint or CAR-T therapy. Therapeutics: CAR-NK (cord blood, iPSC-derived, off the shelf, low CRS), NK engagers (CD16×target), IL-15 superagonists (nogapendekin alfa approved in NMIBC), anti-NKG2A, antibody afucosylation to boost ADCC.

In one picture

Guards who stop anyone not wearing a staff badge (MHC-I) or anyone visibly panicking (stress ligands). Cancer's trick against T cells (throwing away the badge) makes it conspicuous to these guards, so successful tumours also learn to stop panicking, borrow a visitor badge (HLA-E) and bribe the guards with TGF-β.

Diagram

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MHC-I → KIR (inhibit)HLA-E → NKG2A (inhibit)MICA/B, ULBP → NKG2DNK cell decisionCD16 ← IgG1 antibody (ADC…TIGIT vs DNAM-1 (CD155)Perforin, granzyme, IFN-γMICA shedding, TGF-βCAR-NK, IL-15, NK engagersactivatesinhibitsdruggable target (click)hit by selected productescape route

How drugs attack it

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  • IgG1 antibodies (trastuzumab, cetuximab, rituximab) recruit NK ADCC; afucosylated antibodies (obinutuzumab, margetuximab) bind CD16 harder
  • IL-15 superagonist nogapendekin alfa (BCG-unresponsive NMIBC); CAR-NK and NK engagers in trials
  • Anti-NKG2A (monalizumab) and anti-TIGIT (tiragolumab) release inhibitory checks, with mixed phase 3 results
  • NK-based therapies address MHC-I-loss escape from T-cell therapies

Connected

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