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Background  The endoplasmic reticulum oxidoreductin-1-like ( ERO1L ) gene encodes an endoplasmic reticulum luminal localized glycoprotein known to associated with hypoxia, however, the role of  ERO1L  in shaping the tumor immune microenvironment (TIME) is yet to be elucidated in lung adenocarcinoma (LUAD).    Methods  In this study, raw datasets (including RNA-seq, methylation, sgRNA-seq, phenotype, and survival data) were obtained from public databases. This data was analyzed and used to explore the biological landscape of  ERO1L  in immune infiltration. Expression data was used to characterize samples. Using gene signatures and cell quantification, stromal and immune infiltration was determined. These findings were used to predict sensitivity to immunotherapy.    Results  This study found that  ERO1L  was significantly overexpressed in LUAD in comparison to normal tissue. This overexpression was found to be a result of hypomethylation of the  ERO1L  promoter. Overexpression of  ERO1L  resulted in an immune-suppressive TIME  via  the recruitment of immune-suppressive cells including regulatory T cells (T regs ), cancer associated fibroblasts, M2-type macrophages, and myeloid-derived suppressor cells. Using the Tumor Immune Dysfunction and Exclusion (TIDE) framework, it was identified that patients in the  ERO1L   high  group possessed a significantly lower response rate to immunotherapy in comparison to the  ERO1L   low  group. Mechanistic analysis revealed that overexpression of  ERO1L  was associated with the upregulation of JAK-STAT and NF-κB signaling pathways, thus affecting chemokine and cytokine patterns in the TIME.    Conclusions  This study found that overexpression of  ERO1L  was associated with poor prognoses in patients with LUAD. Overexpression of  ERO1L  was indicative of a hypoxia-induced immune-suppressive TIME, which was shown to confer resistance to immunotherapy in patients with LUAD. Further studies are required to assess the potential role of  ERO1L  as a biomarker for immunotherapy efficacy in LUAD.

ERO1L Is a Novel and Potential Biomarker in Lung Adenocarcinoma and Shapes the Immune-Suppressive Tumor Microenvironment