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Ubiquitin‑driven regulation of immune checkpoints in lung cancer: Mechanisms and therapeutic implications (Review)

  • Authors:
    • Lin Chai
    • Lin-Rong Pang
    • Yi-Ting Li
    • Jia-Hui Wang
    • Jun Chen
    • Zu-Guo Yuan
    • Xiao-Feng Jin
  • View Affiliations / Copyright

    Affiliations: Department of Chemoradiotherapy, The Affiliated People's Hospital of Ningbo University, Ningbo, Zhejiang 315040, P.R. China, Zhejiang Key Laboratory of Pathophysiology, Department of Biochemistry and Molecular Biology, Health Science Center, Ningbo University, Ningbo, Zhejiang 315211, P.R. China
    Copyright: © Chai et al. This is an open access article distributed under the terms of Creative Commons Attribution License [CC BY 4.0].
  • Article Number: 248
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    Published online on: July 15, 2026
       https://doi.org/10.3892/etm.2026.13243
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Abstract

The ubiquitin‑proteasome system is a master regulator of anti‑tumor immunity in lung cancer, which primarily functions through controlling the stability of immune checkpoint proteins. The present review offers a synthesis concerning how a dynamic balance between E3 ubiquitin ligases (E3s) and deubiquitinases (DUBs) dictates the fate of key checkpoint proteins, including programmed cell death protein 1/programmed death‑ligand 1, lymphocyte‑activating gene 3 and B7 homolog 4. Although specific E3s are known to promote checkpoint degradation to enhance T‑cell function in certain contexts, and DUBs frequently stabilize these proteins to foster immune evasion, these effects are context‑dependent; for example, certain E3s are paradoxically able to promote immune evasion, whereas the inhibition of select DUBs synergizes with immune checkpoint blockade. This regulatory interplay extends to core oncogenic pathways, including the phosphoinositide 3‑kinase/AKT and mitogen‑activated protein kinase signaling pathways, which indirectly modulate checkpoint expression. Therapeutically, targeting these enzymes with various agents, such as the ubiquitin‑specific peptidase 7 inhibitor P5091 or the repurposed drug canagliflozin, has the effect of synergizing with immune checkpoint blockade through reshaping the tumor microenvironment. However, clinical translation is challenged by tumor heterogeneity, pathway redundancy and the complexity of the ubiquitin network. Future progress in this area hinges on precision drug design, predictive biomarker development and rational combination therapies that are informed by a deeper mechanistic understanding of ubiquitin‑driven immune regulation. 
View Figures

Figure 1

Ubiquitination modification process,
the ubiquitin-proteasome pathway and the types of ubiquitination
modifications. (A) The ubiquitination process is depicted. First,
with ATP providing energy, the ubiquitin-activating enzyme E1
activates the ubiquitin molecule. Secondly, the
ubiquitin-activating enzyme E1 transfers the activated ubiquitin
molecule to the ubiquitin-binding enzyme E2. Finally, the ubiquitin
ligase E3 attaches the bound ubiquitin to the target protein. (B)
The ubiquitin-proteasome pathway is shown. Ubiquitinated proteins
bind to the 19S complex and are degraded at the proteolytic β
subunit. The 19S subunit binds to multiple ubiquitin chains, and
ATP unfolds the protein substrate and transfers it to the 20S core
particle. The protein is subsequently degraded into small
oligopeptides <25 amino acids in length through the 20S core.
This mediates ubiquitin-independent protein degradation. (C) The
types of ubiquitination modifications. In the ubiquitin chain, the
ubiquitin portion can bind to its lysine residues (K11, K27, K6,
K29, K33, K63 and K48) or the N-terminal methionine residue (M1).
Each chain is recognized by different ubiquitin binding domains,
thereby targeting proteins in specific signaling pathways. Ub,
ubiquitin.

Figure 2

Role of Ubiquitinating and
Deubiquitinating enzymes in PD-1/PD-L1 immune checkpoints. A
schematic diagram of the ubiquitination regulatory network of the T
cell immune checkpoint protein PD-1 and its ligand PD-L1 in the
tumor microenvironment, showing the regulatory effects of
deubiquitinating enzymes and E3 ligases on the stability and
function of PD-1, and elucidating the molecular mechanism via which
ubiquitination modification mediates T cell exhaustion and immune
escape. PD-1, programmed cell death protein 1; PD-L1, programmed
death-ligand 1; MHC, major histocompatibility complex; TCR, T-cell
receptor; SPOP, speckle-type POZ protein; FBXO22, F-box protein 22;
FBW7, F-box and WD repeat domain-containing 7; AIP4, atrophin-1
interacting protein 4; RNF182, ring finger protein 182; Cbl,
Casitas B-lineage lymphoma; USP, ubiquitin-specific peptidase;
OTUB2, OTU and ubiquitin aldehyde-binding 2; TRIM35, tripartite
motif-containing 35; TRIP12, thyroid hormone receptor interactor
12; WWP2, WW domain-containing E3 ubiquitin-protein ligase 2.

Figure 3

Therapeutic targeting of
ubiquitin-modifying enzymes to enhance immune checkpoint blockade
in lung cancer. The left panel illustrates E3 ligase activation
strategies (canagliflozin/SPOP, PIK-93/CUL4A, metformin/AXIN1,
6-OAP/β-TrCP, FBXO38, FBW7) and DUB inhibition approaches
(P5091/USP7, USP8, OTUB2, USP2, USP2a) that modulate immune
checkpoint stability and tumor microenvironment remodeling. The
right upper panel summarizes clinically established and prospective
biomarker-driven combination strategies. The lower right panel
depicts next-generation modalities, including PROTACs, molecular
glues and allosteric modulators. PD-1, programmed cell death
protein 1; PD-L1, programmed death-ligand 1; DUBs, deubiquitinating
enzymes; SPOP, speckle-type POZ protein; FBXO22, F-box protein 22;
FBW7, F-box and WD repeat domain-containing 7; RNF5, ring finger
protein 5; USP, ubiquitin-specific peptidase; OTUB2, OTU and
ubiquitin aldehyde-binding 2; ER, endoplasmic reticulum; SGLT2,
sodium-glucose cotransporter-2; CUL4A, cullin 4A; AXIN1, axis
inhibition protein 1; FGL1, fibrinogen-like protein 1; β-TrCP,
β-transducin repeat-containing protein; STING, stimulator of
interferon genes; LAG-3, lymphocyte-activating gene 3; TAMs,
tumor-associated macrophages; ICI, immune checkpoint inhibitor;
ERAD, ER-associated protein degradation; B7-H4, B7 homolog 4;
STK11, serine/threonine kinase 11; NSCLC, non-small cell lung
cancer; PROTAC, proteolysis-targeting chimera; VHL, Von
Hippel-Lindau; CRBN, cereblon; EGFR, epidermal growth factor
receptor; KRAS, Kirsten rat sarcoma viral oncogene homolog; ICB,
immune checkpoint blockade.

Figure 4

Summary of inhibitors targeting the
ubiquitinating and deubiquitinating enzymes in lung cancer.
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Copy and paste a formatted citation
Spandidos Publications style
Chai L, Pang L, Li Y, Wang J, Chen J, Yuan Z and Jin X: Ubiquitin‑driven regulation of immune checkpoints in lung cancer: Mechanisms and therapeutic implications (Review). Exp Ther Med 32: 248, 2026.
APA
Chai, L., Pang, L., Li, Y., Wang, J., Chen, J., Yuan, Z., & Jin, X. (2026). Ubiquitin‑driven regulation of immune checkpoints in lung cancer: Mechanisms and therapeutic implications (Review). Experimental and Therapeutic Medicine, 32, 248. https://doi.org/10.3892/etm.2026.13243
MLA
Chai, L., Pang, L., Li, Y., Wang, J., Chen, J., Yuan, Z., Jin, X."Ubiquitin‑driven regulation of immune checkpoints in lung cancer: Mechanisms and therapeutic implications (Review)". Experimental and Therapeutic Medicine 32.3 (2026): 248.
Chicago
Chai, L., Pang, L., Li, Y., Wang, J., Chen, J., Yuan, Z., Jin, X."Ubiquitin‑driven regulation of immune checkpoints in lung cancer: Mechanisms and therapeutic implications (Review)". Experimental and Therapeutic Medicine 32, no. 3 (2026): 248. https://doi.org/10.3892/etm.2026.13243
Copy and paste a formatted citation
x
Spandidos Publications style
Chai L, Pang L, Li Y, Wang J, Chen J, Yuan Z and Jin X: Ubiquitin‑driven regulation of immune checkpoints in lung cancer: Mechanisms and therapeutic implications (Review). Exp Ther Med 32: 248, 2026.
APA
Chai, L., Pang, L., Li, Y., Wang, J., Chen, J., Yuan, Z., & Jin, X. (2026). Ubiquitin‑driven regulation of immune checkpoints in lung cancer: Mechanisms and therapeutic implications (Review). Experimental and Therapeutic Medicine, 32, 248. https://doi.org/10.3892/etm.2026.13243
MLA
Chai, L., Pang, L., Li, Y., Wang, J., Chen, J., Yuan, Z., Jin, X."Ubiquitin‑driven regulation of immune checkpoints in lung cancer: Mechanisms and therapeutic implications (Review)". Experimental and Therapeutic Medicine 32.3 (2026): 248.
Chicago
Chai, L., Pang, L., Li, Y., Wang, J., Chen, J., Yuan, Z., Jin, X."Ubiquitin‑driven regulation of immune checkpoints in lung cancer: Mechanisms and therapeutic implications (Review)". Experimental and Therapeutic Medicine 32, no. 3 (2026): 248. https://doi.org/10.3892/etm.2026.13243
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