Checkpoint blockade of the Programmed cell Death-1 (PD-1)
immunoreceptor with its ligand 1 (PD-L1) by the monoclonal antibody pembrolizumab
provided compelling clinical results among various cancer types, yet the
molecular mechanism by which this drug blocks the PD-1:PD-L1 binding interface and
reactivates exhausted T cells remains unclear. To address this question, we
examined the conformational motion of PD-1 associated with the binding of
pembrolizumab. The largely overlooked innate plasticity of both PD-1 C’D and FG
loops appears crucial to closing in the receptor edges on the drug. Herein, we
describe how PD-1 bends to initiate the formation of a deep binding groove (371
Å<sup>3</sup>) across several epitopes while engaging pembrolizumab. Our analysis
ultimately provided a rational design for mimicking the pembrolizumab H3 loop [RDYRFDMGFD]
as a PD-1 inhibitor. A series of H3 loop mimics were synthesized and their
folding characterized by CD and NMR spectroscopy. As a result, a first-in-class
<i>b</i>-hairpin peptide inhibitor
of the PD-1/PD-L1 interface was identified (IC<sub>50</sub> of 0.6 ± 0.2 μM). Overall, this study
demonstrates that the dynamic groove formed between the C’D and FG loops of
PD-1 is an attractive target for the development of peptide-based PD-1
inhibitors.