1 2268 132 EPIGENETIC PROGRAMMING OF T CELLS IMPACTS IMMUNE RECONSTITUTION IN HEMATOPOIETIC STEM CELL TRANSPLANT RECIPIENTS. IMMUNE RECONSTITUTION FOLLOWING HEMATOPOIETIC STEM CELL TRANSPLANTATION (HSCT) IS CRITICAL IN PREVENTING HARMFUL SEQUELAE IN RECIPIENTS WITH CYTOMEGALOVIRUS (CMV) INFECTION. TO UNDERSTAND THE MOLECULAR MECHANISMS UNDERLYING IMMUNE RECONSTITUTION KINETICS, WE PROFILED THE TRANSCRIPTOME-CHROMATIN ACCESSIBILITY LANDSCAPE OF CMV-SPECIFIC CD8(+) T CELLS FROM HCST RECIPIENTS WITH DIFFERENT IMMUNE RECONSTITUTION EFFICIENCIES. CMV-SPECIFIC T CELLS FROM HSCT RECIPIENTS WITH STABLE ANTIVIRAL IMMUNITY EXPRESSED HIGHER LEVELS OF INTERFERON/DEFENSE RESPONSE AND CELL CYCLE GENES IN AN INTERCONNECTED NETWORK INVOLVING PI3KCG, STAT5B, NFAT, RBPJ, AND LOWER HDAC6, INCREASING CHROMATIN ACCESSIBILITY AT THE ENHANCER REGIONS OF IMMUNE AND T-CELL RECEPTOR SIGNALING PATHWAY GENES. BY CONTRAST, THE TRANSCRIPTIONAL AND EPIGENOMIC SIGNATURES OF CMV-SPECIFIC T CELLS FROM HSCT RECIPIENTS WITH UNSTABLE IMMUNE RECONSTITUTION SHOWED COMMONALITIES WITH T-CELL RESPONSES IN OTHER NONRESOLVING CHRONIC INFECTIONS. THESE SIGNATURES INCLUDED HIGHER LEVELS OF EGR AND KLF FACTORS THAT, ALONG WITH LOWER JARID2 EXPRESSION, MAINTAINED HIGHER ACCESSIBILITY AT PROMOTER AND CPG-RICH REGIONS OF GENES ASSOCIATED WITH APOPTOSIS. FURTHERMORE, EPIGENETIC TARGETING VIA INHIBITION OF HDAC6 OR JARID2 ENHANCED THE TRANSCRIPTION OF GENES ASSOCIATED WITH DIFFERENTIAL RESPONSES, SUGGESTING THAT DRUGS TARGETING EPIGENOMIC MODIFIERS MAY HAVE THERAPEUTIC POTENTIAL FOR ENHANCING IMMUNE RECONSTITUTION IN HSCT RECIPIENTS. TAKEN TOGETHER, THESE ANALYSES DEMONSTRATE THAT TRANSCRIPTION FACTORS AND CHROMATIN MODULATORS CREATE DIFFERENT CHROMATIN ACCESSIBILITY LANDSCAPES IN T CELLS OF HSCT RECIPIENTS THAT NOT ONLY AFFECT IMMEDIATE GENE EXPRESSION BUT ALSO DIFFERENTIALLY PRIME CELLS FOR RESPONSES TO ADDITIONAL SIGNALS. EPIGENETIC THERAPY MAY BE A PROMISING STRATEGY TO PROMOTE IMMUNE RECONSTITUTION IN HSCT RECIPIENTS. 2018 2 1307 40 DEFINING A METHYLATION SIGNATURE ASSOCIATED WITH OPERATIONAL TOLERANCE IN KIDNEY TRANSPLANT RECIPIENTS. OPERATIONAL TOLERANCE AFTER KIDNEY TRANSPLANTATION IS DEFINED AS STABLE GRAFT ACCEPTANCE WITHOUT THE NEED FOR IMMUNOSUPPRESSION THERAPY. HOWEVER, IT IS NOT CLEAR WHICH CELLULAR AND MOLECULAR PATHWAYS ARE DRIVING TOLERANCE IN THESE PATIENTS. WE PERFORMED GENOME-WIDE ANALYSIS OF DNA METHYLATION IN PERIPHERAL BLOOD MONONUCLEAR CELLS FROM KIDNEY TRANSPLANT RECIPIENTS WITH CHRONIC REJECTION AND OPERATIONAL TOLERANCE FROM THE GENETIC ANALYSIS OF MOLECULAR BIOMARKERS OF IMMUNOLOGICAL TOLERANCE (GAMBIT) STUDY. OUR RESULTS SHOWED THAT BOTH CLINICAL STAGES DIVERGE IN 2737 GENES, INDICATING THAT EACH ONE HAS A SPECIFIC METHYLATION SIGNATURE ASSOCIATED WITH TRANSPLANT OUTCOME. WE ALSO OBSERVED THAT TOLERANCE IS ASSOCIATED WITH DEMETHYLATION IN GENES INVOLVED IN IMMUNE FUNCTION, INCLUDING B AND T CELL ACTIVATION AND TH17 DIFFERENTIATION, WHILE IN CHRONIC REJECTION IT IS ASSOCIATED WITH INTRACELLULAR SIGNALING AND UBIQUITINATION PATHWAYS. USING CO-EXPRESSION NETWORK ANALYSIS, WE SELECTED 12 GENOMIC REGIONS THAT ARE SPECIFICALLY HYPOMETHYLATED OR HYPERMETHYLATED IN TOLERANT PATIENTS. ANALYSIS OF THESE GENES IN TRANSPLANTED PATIENTS WITH LOW DOSE OF STEROIDS SHOWED THAT THESE HAVE A SIMILAR METHYLATION SIGNATURE TO THAT OF TOLERANT RECIPIENTS. OVERALL, THESE RESULTS DEMONSTRATE THAT METHYLATION ANALYSIS CAN MIRROR THE IMMUNE STATUS ASSOCIATED WITH TRANSPLANT OUTCOME AND PROVIDES A STARTING POINT FOR UNDERSTANDING THE EPIGENETIC MECHANISMS ASSOCIATED WITH TOLERANCE. 2021 3 5900 39 T-CELL EXHAUSTION IN ORGAN TRANSPLANTATION. EXHAUSTION OF T CELLS OCCURS IN RESPONSE TO LONG-TERM EXPOSURE TO SELF AND FOREIGN ANTIGENS. IT LIMITS T CELL CAPACITY TO PROLIFERATE AND PRODUCE CYTOKINES, LEADING TO AN IMPAIRED ABILITY TO CLEAR CHRONIC INFECTIONS OR ERADICATE TUMORS. T-CELL EXHAUSTION IS ASSOCIATED WITH A SPECIFIC TRANSCRIPTIONAL, EPIGENETIC, AND METABOLIC PROGRAM AND CHARACTERISTIC CELL SURFACE MARKERS' EXPRESSION. RECENT STUDIES HAVE BEGUN TO ELUCIDATE THE ROLE OF T-CELL EXHAUSTION IN TRANSPLANT. HIGHER LEVELS OF EXHAUSTED T CELLS HAVE BEEN ASSOCIATED WITH BETTER GRAFT FUNCTION IN KIDNEY TRANSPLANT RECIPIENTS. IN CONTRAST, REINVIGORATING EXHAUSTED T CELLS BY IMMUNE CHECKPOINT BLOCKADE THERAPIES, WHILE PROMOTING TUMOR CLEARANCE, INCREASES THE RISK OF ACUTE REJECTION. LYMPHOCYTE DEPLETION AND HIGH ALLOANTIGEN LOAD HAVE BEEN IDENTIFIED AS MAJOR DRIVERS OF T-CELL EXHAUSTION. THIS COULD ACCOUNT, AT LEAST IN PART, FOR THE REDUCED RATES OF ACUTE REJECTION IN ORGAN TRANSPLANT RECIPIENTS INDUCED WITH THYMOGLOBULIN AND FOR THE PRO-TOLEROGENIC EFFECTS OF A LARGE ORGAN SUCH AS THE LIVER. AMONG THE DRUGS THAT ARE WIDELY USED FOR MAINTENANCE IMMUNOSUPPRESSION, CALCINEURIN INHIBITORS HAVE A CONTRASTING INHIBITORY EFFECT ON EXHAUSTION OF T CELLS, WHILE THE INFLUENCE OF MTOR INHIBITORS IS STILL UNCLEAR. HARNESSING OR ENCOURAGING THE NATURAL PROCESSES OF EXHAUSTION MAY PROVIDE A NOVEL STRATEGY TO PROMOTE GRAFT SURVIVAL AND TRANSPLANTATION TOLERANCE. 2022 4 2056 31 EPIGENETIC CONTROL OF CD8(+) T CELL DIFFERENTIATION. UPON STIMULATION, SMALL NUMBERS OF NAIVE CD8(+) T CELLS PROLIFERATE AND DIFFERENTIATE INTO A VARIETY OF MEMORY AND EFFECTOR CELL TYPES. CD8(+) T CELLS CAN PERSIST FOR YEARS AND KILL TUMOUR CELLS AND VIRALLY INFECTED CELLS. THE FUNCTIONAL AND PHENOTYPIC CHANGES THAT OCCUR DURING CD8(+) T CELL DIFFERENTIATION ARE WELL CHARACTERIZED, BUT THE EPIGENETIC STATES THAT UNDERLIE THESE CHANGES ARE INCOMPLETELY UNDERSTOOD. HERE, WE REVIEW THE EPIGENETIC PROCESSES THAT DIRECT CD8(+) T CELL DIFFERENTIATION AND FUNCTION. WE FOCUS ON EPIGENETIC MODIFICATION OF DNA AND ASSOCIATED HISTONES AT GENES AND THEIR REGULATORY ELEMENTS. WE ALSO DESCRIBE STRUCTURAL CHANGES IN CHROMATIN ORGANIZATION THAT AFFECT GENE EXPRESSION. FINALLY, WE EXAMINE THE TRANSLATIONAL POTENTIAL OF EPIGENETIC INTERVENTIONS TO IMPROVE CD8(+) T CELL FUNCTION IN INDIVIDUALS WITH CHRONIC INFECTIONS AND CANCER. 2018 5 2389 34 EPIGENETIC REPOLARIZATION OF T LYMPHOCYTES FROM CHRONIC LYMPHOCYTIC LEUKEMIA PATIENTS USING 5-AZA-2'-DEOXYCYTIDINE. T CELL IMMUNE DYSFUNCTION HAS AN IMPORTANT ROLE IN THE PROFOUND IMMUNE SUPPRESSION THAT CHARACTERIZES CHRONIC LYMPHOCYTIC LEUKEMIA (CLL). IMPROPER POLARIZATION OF T CELLS HAS BEEN PROPOSED AS ONE OF THE MECHANISM INVOLVED. MOUNTING DATA IMPLICATES CHROMATIN REGULATION, NAMELY PROMOTER METHYLATION, IN THE PLASTICITY OF NAIVE HUMAN T CELLS. RECENT IN VITRO EVIDENCE INDICATES THAT THIS PLASTICITY MAY BE PHENOTYPICALLY ALTERED BY USING METHYLATION INHIBITORS WHICH ARE APPROVED FOR CLINICAL USE IN CERTAIN TYPES OF CANCER. THESE RESULTS BEG THE QUESTION: CAN THE INEFFECTIVE POLARIZATION OF T LYMPHOCYTES IN THE CONTEXT OF CLL BE EFFECTIVELY MODULATED USING METHYLATION INHIBITORS IN A SUSTAINABLE THERAPEUTIC FASHION? TO ANSWER THIS QUESTION OUR LABORATORY HAS STUDIED THE EFFECTS OF 5-AZA-2'-DEOXYCYTIDINE (5A2) IN HELPER AND CYTOTOXIC T LYMPHOCYTES FROM HEALTHY DONORS AND CLL PATIENTS IN WELL CHARACTERIZED MOLECULAR AND EPIGENETIC SIGNALING PATHWAYS INVOLVED IN EFFECTIVE POLARIZATION. MOREOVER, WE SOUGHT TO INVESTIGATE THE CONSEQUENCES OF METHYLATION INHIBITOR TREATMENT ON LYMPHOCYTE SURVIVAL, ACTIVATION INTENSITY, AND NAIVE CELL POLARIZATION. OUR DATA INDICATES THAT 5A2 TREATMENT CAN DEPOLARIZE TH2 CELLS TO EFFECTIVELY SECRETE INTERFERON GAMMA, SIGNAL VIA T-BET, AND ACHIEVE DEMETHYLATION OF CRITICAL TH1 SPECIFIC PROMOTERS. MOREOVER, WE DEMONSTRATE THAT 5A2 CAN FORCE TH1 POLARIZATION OF NAIVE T CELLS DESPITE A STRONG IL-4 STIMULI AND A LACK OF IL-12. IN CONCLUSION OUR DATA SEEKS TO DEFINE A MODALITY IN WHICH IMPROPER OR INEFFECTIVE T CELL POLARIZATION CAN BE ALTERED BY 5AZA AND COULD BE INCORPORATED IN FUTURE THERAPEUTIC INTERVENTIONS. 2011 6 2055 26 EPIGENETIC CONTROL DURING LYMPHOID DEVELOPMENT AND IMMUNE RESPONSES: ABERRANT REGULATION, VIRUSES, AND CANCER. METHYLATION OF CYTOSINES CONTROLS A NUMBER OF BIOLOGIC PROCESSES SUCH AS IMPRINTING AND X CHROMOSOMAL INACTIVATION. DNA HYPERMETHYLATION IS CLOSELY ASSOCIATED WITH TRANSCRIPTIONAL SILENCING, WHILE DNA HYPOMETHYLATION IS ASSOCIATED WITH TRANSCRIPTIONAL ACTIVATION. HYPOACETYLATION OF HISTONES LEADS TO COMPACT CHROMATIN WITH REDUCED ACCESSIBILITY TO THE TRANSCRIPTIONAL MACHINERY. METHYL-CPG BINDING PROTEINS CAN RECRUIT COREPRESSORS AND HISTONE DEACETYLASES; THUS, THE INTERPLAY BETWEEN THESE EPIGENETIC MECHANISMS REGULATES GENE ACTIVATION. METHYLATION HAS BEEN IMPLICATED AS AN IMPORTANT MECHANISM DURING IMMUNE DEVELOPMENT, CONTROLLING VDJ RECOMBINATION, LINEAGE-SPECIFIC EXPRESSION OF CELL SURFACE ANTIGENS, AND TRANSCRIPTIONAL REGULATION OF CYTOKINE GENES DURING IMMUNE RESPONSES. ABERRATIONS IN EPIGENETIC MACHINERY, EITHER BY GENETIC MUTATIONS OR BY SOMATIC CHANGES SUCH AS VIRAL INFECTIONS, ARE ASSOCIATED WITH EARLY ALTERATIONS IN CHRONIC DISEASES SUCH AS IMMUNODEFICIENCY AND CANCER. 2003 7 2146 36 EPIGENETIC MANIPULATION RESTORES FUNCTIONS OF DEFECTIVE CD8(+) T CELLS FROM CHRONIC VIRAL INFECTION. FUNCTIONAL EXHAUSTION OF ANTIGEN-SPECIFIC T CELLS IS A DEFINING CHARACTERISTIC OF MANY CHRONIC INFECTIONS, BUT THE UNDERLYING MECHANISMS OF T CELL DYSFUNCTION ARE NOT WELL UNDERSTOOD. EPIGENETICS PLAYS AN IMPORTANT ROLE IN THE CONTROL OF T CELL DEVELOPMENT, DIFFERENTIATION, AND FUNCTION. TO EXAMINE IF EPIGENETICS ALSO PLAYS A ROLE IN T CELL EXHAUSTION, WE ANALYZED CHROMATIN REMODELING IN CD8(+) T CELLS FROM MICE WITH CHRONIC LYMPHOCYTIC CHORIOMENINGITIS VIRUS INFECTION. WE OBSERVED DOWNREGULATION OF DIACETYLATED HISTONE H3 IN BOTH VIRUS-SPECIFIC AND TOTAL CD8(+) T CELLS, AND FUNCTIONAL DEFECTS NOT ONLY IN VIRUS-SPECIFIC CD8(+) T CELLS BUT ALSO WITHIN THE TOTAL CD8(+) T CELL POPULATION. IN VITRO TREATMENT OF THESE EXHAUSTED CD8(+) T CELLS WITH HISTONE DEACETYLASE INHIBITORS RESTORED DIACETYLATED HISTONE H3 LEVELS, AND IMPROVED THEIR IMMUNE FUNCTIONS. UPON ADOPTIVE TRANSFER, THESE TREATED CD8(+) T CELLS DEVELOPED INTO FUNCTIONAL MEMORY T CELLS IN VIVO THAT ENHANCED PROTECTIVE IMMUNITY. THESE RESULTS DEFINE A ROLE OF EPIGENETICS IN T CELL EXHAUSTION AND SUGGEST EPIGENETIC MANIPULATION AS A NOVEL MOLECULAR THERAPY TO RESTORE IMMUNE FUNCTIONS. 2014 8 1594 34 DNA METHYLATION PROFILING REVEALS DIFFERENCES IN THE 3 HUMAN MONOCYTE SUBSETS AND IDENTIFIES UREMIA TO INDUCE DNA METHYLATION CHANGES DURING DIFFERENTIATION. HUMAN MONOCYTES ARE A HETEROGENEOUS CELL POPULATION CONSISTING OF 3 SUBSETS: CLASSICAL CD14++CD16-, INTERMEDIATE CD14++CD16+ AND NONCLASSICAL CD14+CD16++ MONOCYTES. VIA POORLY CHARACTERIZED MECHANISMS, INTERMEDIATE MONOCYTE COUNTS RISE IN CHRONIC INFLAMMATORY DISEASES, AMONG WHICH CHRONIC KIDNEY DISEASE IS OF PARTICULAR EPIDEMIOLOGIC IMPORTANCE. DNA METHYLATION IS A CENTRAL EPIGENETIC FEATURE THAT CONTROLS HEMATOPOIESIS. BY APPLYING NEXT-GENERATION METHYL-SEQUENCING WE NOW TESTED HOW FAR THE 3 MONOCYTE SUBSETS DIFFER IN THEIR DNA METHYLOME AND WHETHER UREMIA INDUCES DNA METHYLATION CHANGES IN DIFFERENTIATING MONOCYTES. WE FOUND THAT EACH MONOCYTE SUBSET DISPLAYS A UNIQUE PHENOTYPE WITH REGARDS TO DNA METHYLATION. GENES WITH DIFFERENTIALLY METHYLATED PROMOTER REGIONS IN INTERMEDIATE MONOCYTES WERE LINKED TO DISTINCT IMMUNOLOGICAL PROCESSES, WHICH IS IN LINE WITH RESULTS FROM RECENT GENE EXPRESSION ANALYSES. IN VITRO, UREMIA INDUCED DYSREGULATION OF DNA METHYLATION IN DIFFERENTIATING MONOCYTES, WHICH AFFECTED SEVERAL TRANSCRIPTION REGULATORS IMPORTANT FOR MONOCYTE DIFFERENTIATION (E.G., FLT3, HDAC1, MNT) AND LED TO ENHANCED GENERATION OF INTERMEDIATE MONOCYTES. AS POTENTIAL MEDIATOR, THE UREMIC TOXIN AND METHYLATION INHIBITOR S-ADENOSYLHOMOCYSTEINE INDUCED SHIFTS IN MONOCYTE SUBSETS IN VITRO, AND ASSOCIATED WITH MONOCYTE SUBSET COUNTS IN VIVO. OUR DATA SUPPORT THE CONCEPT OF MONOCYTE TRICHOTOMY AND THE DISTINCT ROLE OF INTERMEDIATE MONOCYTES IN HUMAN IMMUNITY. THE SHIFT IN MONOCYTE SUBSETS THAT OCCURS IN CHRONIC KIDNEY DISEASE, A PROINFLAMMATORY CONDITION OF SUBSTANTIAL EPIDEMIOLOGICAL IMPACT, MAY BE INDUCED BY ACCUMULATION OF UREMIC TOXINS THAT MEDIATE EPIGENETIC DYSREGULATION. 2016 9 942 31 CHRONIC LYMPHOCYTIC LEUKEMIA PRESENCE IMPAIRS ANTIGEN-SPECIFIC CD8(+) T-CELL RESPONSES THROUGH EPIGENETIC REPROGRAMMING TOWARDS SHORT-LIVED EFFECTORS. T-CELL DYSREGULATION IN CHRONIC LYMPHOCYTIC LEUKEMIA (CLL) ASSOCIATES WITH LOW RESPONSE RATES TO AUTOLOGOUS T CELL-BASED THERAPIES. HOW CLL AFFECTS ANTIGEN-SPECIFIC T-CELL RESPONSES REMAINS LARGELY UNKNOWN. WE INVESTIGATED (EPI)GENETIC AND FUNCTIONAL CONSEQUENCES OF ANTIGEN-SPECIFIC T-CELL RESPONSES IN PRESENCE OF CLL IN VITRO AND IN AN ADOPTIVE-TRANSFER MURINE MODEL. ALREADY AT STEADY-STATE, ANTIGEN-EXPERIENCED PATIENT-DERIVED T CELLS WERE SKEWED TOWARDS SHORT-LIVED EFFECTOR CELLS (SLEC) AT THE EXPENSE OF MEMORY-PRECURSOR EFFECTOR CELLS (MPEC). STIMULATION OF THESE T CELLS IN VITRO SHOWED RAPID INDUCTION OF EFFECTOR GENES AND SUPPRESSION OF KEY MEMORY TRANSCRIPTION FACTORS ONLY IN PRESENCE OF CLL CELLS, INDICATING EPIGENETIC REGULATION. THIS WAS INVESTIGATED IN VIVO BY FOLLOWING ANTIGEN-SPECIFIC RESPONSES OF NAIVE OT-I CD8(+) CELLS TO MCMV-OVA IN PRESENCE/ABSENCE OF TCL1 B-CELL LEUKEMIA. PRESENCE OF LEUKEMIA RESULTED IN INCREASED SLEC FORMATION, WITH DISTURBED INFLAMMATORY CYTOKINE PRODUCTION. CHROMATIN AND TRANSCRIPTOME PROFILING REVEALED STRONG EPIGENETIC MODIFICATIONS, LEADING TO ACTIVATION OF AN EFFECTOR AND SILENCING OF A MEMORY PROFILE THROUGH PRESENCE OF CLL CELLS. SECONDARY CHALLENGE IN VIVO CONFIRMED DYSFUNCTIONAL MEMORY RESPONSES BY ANTIGEN-EXPERIENCED OT-I CELLS GENERATED IN PRESENCE OF CLL. ALTOGETHER, WE SHOW THAT PRESENCE OF CLL INDUCES A SHORT-LIVED EFFECTOR PHENOTYPE AND IMPAIRED MEMORY RESPONSES BY EPIGENETIC REPROGRAMMING DURING PRIMARY RESPONSES. 2023 10 5982 37 TET2 REGULATES IMMUNE TOLERANCE IN CHRONICALLY ACTIVATED MAST CELLS. MUTATION OF THE TET2 DNA-HYDROXYMETHYLASE HAS BEEN ASSOCIATED WITH A NUMBER OF IMMUNE PATHOLOGIES. THE DISPARITY IN PHENOTYPE AND CLINICAL PRESENTATION AMONG THESE PATHOLOGIES LEADS TO QUESTIONS REGARDING THE ROLE OF TET2 MUTATION IN PROMOTING DISEASE EVOLUTION IN DIFFERENT IMMUNE CELL TYPES. HERE WE SHOW THAT, IN PRIMARY MAST CELLS, TET2 EXPRESSION IS INDUCED IN RESPONSE TO CHRONIC AND ACUTE ACTIVATION SIGNALS. IN TET2-DEFICIENT MAST CELLS, CHRONIC ACTIVATION VIA THE ONCOGENIC KITD816V ALLELE ASSOCIATED WITH MASTOCYTOSIS, SELECTS FOR A SPECIFIC EPIGENETIC SIGNATURE CHARACTERIZED BY HYPERMETHYLATED DNA REGIONS (HMR) AT IMMUNE RESPONSE GENES. H3K27AC AND TRANSCRIPTION FACTOR BINDING IS CONSISTENT WITH PRIMING OR MORE OPEN CHROMATIN AT BOTH HMR AND NON-HMR IN PROXIMITY TO IMMUNE GENES IN THESE CELLS, AND THIS SIGNATURE COINCIDES WITH INCREASED PATHOLOGICAL INFLAMMATION SIGNALS. HMR ARE ALSO ASSOCIATED WITH A SUBSET OF IMMUNE GENES THAT ARE DIRECT TARGETS OF TET2 AND REPRESSED IN TET2-DEFICIENT CELLS. REPRESSION OF THESE GENES RESULTS IN IMMUNE TOLERANCE TO ACUTE STIMULATION THAT CAN BE RESCUED WITH VITAMIN C TREATMENT OR REITERATED WITH A TET INHIBITOR. OVERALL, OUR DATA SUPPORT A MODEL WHERE TET2 PLAYS A DIRECT ROLE IN PREVENTING IMMUNE TOLERANCE IN CHRONICALLY ACTIVATED MAST CELLS, SUPPORTING TET2 AS A VIABLE TARGET TO REPROGRAM THE INNATE IMMUNE RESPONSE FOR INNOVATIVE THERAPIES. 2022 11 5894 42 T CELL EPIGENETIC REMODELING AND ACCELERATED EPIGENETIC AGING ARE LINKED TO LONG-TERM IMMUNE ALTERATIONS IN CHILDHOOD CANCER SURVIVORS. BACKGROUND: CANCER TREATMENTS HAVE SUBSTANTIALLY IMPROVED CHILDHOOD CANCER SURVIVAL BUT ARE ACCOMPANIED BY LONG-TERM COMPLICATIONS, NOTABLY CHRONIC INFLAMMATORY DISEASES. WE HYPOTHESIZE THAT CANCER TREATMENTS COULD LEAD TO LONG-TERM EPIGENETIC CHANGES IN IMMUNE CELLS, RESULTING IN INCREASED PREVALENCE OF INFLAMMATORY DISEASES IN CANCER SURVIVORS. RESULTS: TO TEST THIS HYPOTHESIS, WE ESTABLISHED THE EPIGENETIC AND TRANSCRIPTOMIC PROFILES OF IMMUNE CELLS FROM 44 CHILDHOOD CANCER SURVIVORS (CCS, > 16 YEARS OLD) ON FULL REMISSION (> 5 YEARS) WHO HAD RECEIVED CHEMOTHERAPY ALONE OR IN COMBINATION WITH TOTAL BODY IRRADIATION (TBI) AND HEMATOPOIETIC STEM CELL TRANSPLANT (HSCT). WE FOUND THAT MORE THAN 10 YEARS POST-TREATMENT, CCS TREATED WITH TBI/HSCT SHOWED AN ALTERED DNA METHYLATION SIGNATURE IN T CELL, PARTICULARLY AT GENES CONTROLLING IMMUNE AND INFLAMMATORY PROCESSES AND OXIDATIVE STRESS. DNA METHYLATION REMODELING IN T CELL WAS PARTIALLY ASSOCIATED WITH CHRONIC EXPRESSION CHANGES OF NEARBY GENES, INCREASED FREQUENCY OF TYPE 1 CYTOKINE-PRODUCING T CELL, ELEVATED SYSTEMIC LEVELS OF THESE CYTOKINES, AND OVER-ACTIVATION OF RELATED SIGNALING PATHWAYS. SURVIVORS EXPOSED TO TBI/HSCT WERE FURTHER CHARACTERIZED BY AN EPIGENETIC-AGING-SIGNATURE OF T CELL CONSISTENT WITH ACCELERATED EPIGENETIC AGING. TO INVESTIGATE THE POTENTIAL CONTRIBUTION OF IRRADIATION TO THESE CHANGES, WE ESTABLISHED TWO CELL CULTURE MODELS. WE IDENTIFIED THAT RADIATION PARTIALLY RECAPITULATED THE IMMUNE CHANGES OBSERVED IN SURVIVORS THROUGH A BYSTANDER EFFECT THAT COULD BE MEDIATED BY CIRCULATING FACTORS. CONCLUSION: CANCER TREATMENTS, IN PARTICULAR TBI/HSCT, ARE ASSOCIATED WITH LONG-TERM IMMUNE DISTURBANCES. WE PROPOSE THAT EPIGENETIC REMODELING OF IMMUNE CELLS FOLLOWING CANCER THERAPY AUGMENTS INFLAMMATORY- AND AGE-RELATED DISEASES, INCLUDING METABOLIC COMPLICATIONS, IN CHILDHOOD CANCER SURVIVORS. 2018 12 851 22 CHIP-SEQ ANALYSIS OF HUMAN CHRONIC MYELOID LEUKEMIA CELLS. MANY TRANSCRIPTION FACTORS, CHROMATIN-ASSOCIATED PROTEINS AND REGULATORY DNA ELEMENTS ARE GENETICALLY AND/OR EPIGENETICALLY ALTERED IN CANCER, INCLUDING CHRONIC MYELOID LEUKEMIA (CML). THIS LEADS TO DEREGULATION OF TRANSCRIPTION THAT IS OFTEN CAUSALLY LINKED TO THE TUMORIGENIC STATE. CHROMATIN-IMMUNOPRECIPITATION COUPLED WITH MASSIVELY PARALLEL DNA SEQUENCING (CHIP-SEQ) IS THE KEY TECHNOLOGY TO STUDY TRANSCRIPTION AS IT ALLOWS IN VIVO WHOLE-GENOME MAPPING OF EPIGENETIC MODIFICATIONS AND INTERACTIONS OF PROTEINS WITH DNA OR CHROMATIN. HOWEVER, NUMEROUS DNA/CHROMATIN-BINDING PROTEINS, INCLUDING EZH2, REMAIN DIFFICULT TO "CHIP," THUS YIELDING GENOME-WIDE BINDING MAPS OF ONLY SUBOPTIMAL QUALITY. HERE, WE DESCRIBE A CHIP-SEQ PROTOCOL OPTIMIZED FOR HIGH-QUALITY PROTEIN-GENOME BINDING MAPS THAT HAVE PROVEN ESPECIALLY USEFUL FOR STUDYING DIFFICULT TO 'CHIP' TRANSCRIPTION REGULATORY FACTORS IN CHRONIC MYELOID LEUKEMIA (CML) AND RELATED MALIGNANCIES. 2016 13 6530 36 TRANSCRIPTIONAL REGULATION AND T CELL EXHAUSTION. PURPOSE OF REVIEW: THIS REVIEW HIGHLIGHTS THE CONTROL OF TRANSCRIPTIONAL NETWORKS, INCLUDING INDUCTION OF INHIBITORY RECEPTORS, BY T CELL-SPECIFIC TRANSCRIPTION FACTORS IN EXHAUSTED T CELLS THAT ACCUMULATE IN CHRONIC VIRAL INFECTIONS INCLUDING HIV. RECENT FINDINGS: TRANSCRIPTIONAL PROFILING HAS ESTABLISHED DISTINCT MOLECULAR PHENOTYPES FOR EXHAUSTED CD4 AND CD8 T CELLS IN CHRONIC VIRAL INFECTION MODELS. THERE EXISTS A SUBSET OF TRANSCRIPTION FACTORS ASSOCIATED WITH EXHAUSTION, NOTABLY BLIMP-1, BASIC LEUCINE ZIPPER TRANSCRIPTION FACTOR, ATF-LIKE AND HELIOS. EPIGENETIC PHENOMENA ARE LIKELY IMPORTANT IN REGULATING GENE EXPRESSION NETWORKS DURING EXHAUSTION AS ILLUSTRATED BY PROGRAMMED DEATH 1 PROMOTER METHYLATION PATTERNS. SUMMARY: FOLLOWING CHRONIC VIRAL INFECTIONS, CD4 AND CD8 T CELLS DEFINED FUNCTIONALLY AND PHENOTYPICALLY AS EXHAUSTED HAVE DISTINCT TRANSCRIPTIONAL PROFILES. THESE STUDIES HAVE IDENTIFIED A CORE SET OF TRANSCRIPTION FACTORS THAT HAVE BEEN IMPLICATED IN PROMOTING EXHAUSTION. HOWEVER, NO SINGLE FACTOR APPEARS TO BE AN EXHAUSTION DETERMINING FACTOR, SUGGESTING THAT T CELL EXHAUSTION REFLECTS A COMBINATORIAL MECHANISM WITH MULTIPLE TRANSCRIPTION FACTORS INTERACTING TO INFLUENCE THE DEVELOPMENT OF FUNCTIONALLY EXHAUSTED T CELLS AS WELL AS DIFFERENT T EFFECTOR POPULATIONS. 2014 14 1533 28 DNA METHYLATION DYNAMICS DURING B CELL MATURATION UNDERLIE A CONTINUUM OF DISEASE PHENOTYPES IN CHRONIC LYMPHOCYTIC LEUKEMIA. CHARTING DIFFERENCES BETWEEN TUMORS AND NORMAL TISSUE IS A MAINSTAY OF CANCER RESEARCH. HOWEVER, CLONAL TUMOR EXPANSION FROM COMPLEX NORMAL TISSUE ARCHITECTURES POTENTIALLY OBSCURES CANCER-SPECIFIC EVENTS, INCLUDING DIVERGENT EPIGENETIC PATTERNS. USING WHOLE-GENOME BISULFITE SEQUENCING OF NORMAL B CELL SUBSETS, WE OBSERVED BROAD EPIGENETIC PROGRAMMING OF SELECTIVE TRANSCRIPTION FACTOR BINDING SITES COINCIDENT WITH THE DEGREE OF B CELL MATURATION. BY COMPARING NORMAL B CELLS TO MALIGNANT B CELLS FROM 268 PATIENTS WITH CHRONIC LYMPHOCYTIC LEUKEMIA (CLL), WE SHOWED THAT TUMORS DERIVE LARGELY FROM A CONTINUUM OF MATURATION STATES REFLECTED IN NORMAL DEVELOPMENTAL STAGES. EPIGENETIC MATURATION IN CLL WAS ASSOCIATED WITH AN INDOLENT GENE EXPRESSION PATTERN AND INCREASINGLY FAVORABLE CLINICAL OUTCOMES. WE FURTHER UNCOVERED THAT MOST PREVIOUSLY REPORTED TUMOR-SPECIFIC METHYLATION EVENTS ARE NORMALLY PRESENT IN NON-MALIGNANT B CELLS. INSTEAD, WE IDENTIFIED A POTENTIAL PATHOGENIC ROLE FOR TRANSCRIPTION FACTOR DYSREGULATION IN CLL, WHERE EXCESS PROGRAMMING BY EGR AND NFAT WITH REDUCED EBF AND AP-1 PROGRAMMING IMBALANCES THE NORMAL B CELL EPIGENETIC PROGRAM. 2016 15 5223 39 PRIMARY MURINE CD4+ T CELLS FAIL TO ACQUIRE THE ABILITY TO PRODUCE EFFECTOR CYTOKINES WHEN ACTIVE RAS IS PRESENT DURING TH1/TH2 DIFFERENTIATION. CONSTITUTIVE RAS SIGNALING HAS BEEN SHOWN TO AUGMENT IL-2 PRODUCTION, REVERSE ANERGY, AND FUNCTIONALLY REPLACE MANY ASPECTS OF CD28 CO-STIMULATION IN CD4+ T CELLS. THESE DATA RAISE THE POSSIBILITY THAT INTRODUCTION OF ACTIVE RAS INTO PRIMARY T CELLS MIGHT RESULT IN IMPROVED FUNCTIONALITY IN PATHOLOGIC SITUATIONS OF T CELL DYSFUNCTION, SUCH AS CANCER OR CHRONIC VIRAL INFECTION. TO TEST THE BIOLOGIC EFFECTS OF ACTIVE RAS IN PRIMARY T CELLS, CD4+ T CELLS FROM COXSACKIE-ADENOVIRUS RECEPTOR TRANSGENIC MICE WERE TRANSDUCED WITH AN ADENOVIRUS ENCODING ACTIVE RAS. AS EXPECTED, ACTIVE RAS AUGMENTED IL-2 PRODUCTION IN NAIVE CD4+ T CELLS. HOWEVER, WHEN CELLS WERE CULTURED FOR 4 DAYS UNDER CONDITIONS TO PROMOTE EFFECTOR CELL DIFFERENTIATION, ACTIVE RAS INHIBITED THE ABILITY OF CD4+ T CELLS TO ACQUIRE A TH1 OR TH2 EFFECTOR CYTOKINE PROFILE. THIS DIFFERENTIATION DEFECT WAS NOT DUE TO DEFICIENT STAT4 OR STAT6 ACTIVATION BY IL-12 OR IL-4, RESPECTIVELY, NOR WAS IT ASSOCIATED WITH DEFICIENT INDUCTION OF T-BET AND GATA-3 EXPRESSION. IMPAIRED EFFECTOR CYTOKINE PRODUCTION IN ACTIVE RAS-TRANSDUCED CELLS WAS ASSOCIATED WITH DEFICIENT DEMETHYLATION OF THE IL-4 GENE LOCUS. OUR RESULTS INDICATE THAT, DESPITE AUGMENTING ACUTE ACTIVATION OF NAIVE T CELLS, CONSTITUTIVE RAS SIGNALING INHIBITS THE ABILITY OF CD4+ T CELLS TO PROPERLY DIFFERENTIATE INTO TH1/TH2 EFFECTOR CYTOKINE-PRODUCING CELLS, IN PART BY INTERFERING WITH EPIGENETIC MODIFICATION OF EFFECTOR GENE LOCI. ALTERNATIVE STRATEGIES TO POTENTIATE RAS PATHWAY SIGNALING IN T CELLS IN A MORE REGULATED FASHION SHOULD BE CONSIDERED AS A THERAPEUTIC APPROACH TO IMPROVE IMMUNE RESPONSES IN VIVO. 2014 16 1462 35 DISRUPTION OF TET2 PROMOTES THE THERAPEUTIC EFFICACY OF CD19-TARGETED T CELLS. CANCER IMMUNOTHERAPY BASED ON GENETICALLY REDIRECTING T CELLS HAS BEEN USED SUCCESSFULLY TO TREAT B CELL MALIGNANCIES(1-3). IN THIS STRATEGY, THE T CELL GENOME IS MODIFIED BY INTEGRATION OF VIRAL VECTORS OR TRANSPOSONS ENCODING CHIMAERIC ANTIGEN RECEPTORS (CARS) THAT DIRECT TUMOUR CELL KILLING. HOWEVER, THIS APPROACH IS OFTEN LIMITED BY THE EXTENT OF EXPANSION AND PERSISTENCE OF CAR T CELLS(4,5). HERE WE REPORT MECHANISTIC INSIGHTS FROM STUDIES OF A PATIENT WITH CHRONIC LYMPHOCYTIC LEUKAEMIA TREATED WITH CAR T CELLS TARGETING THE CD19 PROTEIN. FOLLOWING INFUSION OF CAR T CELLS, ANTI-TUMOUR ACTIVITY WAS EVIDENT IN THE PERIPHERAL BLOOD, LYMPH NODES AND BONE MARROW; THIS ACTIVITY WAS ACCOMPANIED BY COMPLETE REMISSION. UNEXPECTEDLY, AT THE PEAK OF THE RESPONSE, 94% OF CAR T CELLS ORIGINATED FROM A SINGLE CLONE IN WHICH LENTIVIRAL VECTOR-MEDIATED INSERTION OF THE CAR TRANSGENE DISRUPTED THE METHYLCYTOSINE DIOXYGENASE TET2 GENE. FURTHER ANALYSIS REVEALED A HYPOMORPHIC MUTATION IN THIS PATIENT'S SECOND TET2 ALLELE. TET2-DISRUPTED CAR T CELLS EXHIBITED AN EPIGENETIC PROFILE CONSISTENT WITH ALTERED T CELL DIFFERENTIATION AND, AT THE PEAK OF EXPANSION, DISPLAYED A CENTRAL MEMORY PHENOTYPE. EXPERIMENTAL KNOCKDOWN OF TET2 RECAPITULATED THE POTENCY-ENHANCING EFFECT OF TET2 DYSFUNCTION IN THIS PATIENT'S CAR T CELLS. THESE FINDINGS SUGGEST THAT THE PROGENY OF A SINGLE CAR T CELL INDUCED LEUKAEMIA REMISSION AND THAT TET2 MODIFICATION MAY BE USEFUL FOR IMPROVING IMMUNOTHERAPIES. 2018 17 6677 32 USING EPIGENETICS TO DEFINE VACCINE-INDUCED MEMORY T CELLS. MEMORY T CELLS GENERATED FROM ACUTE INFECTION OR VACCINATION HAVE THE POTENTIAL TO PROVIDE THE HOST WITH LIFE-LONG IMMUNITY AGAINST RE-INFECTION. PROTECTION BY MEMORY T CELLS IS ACHIEVED THROUGH THEIR ACQUIRED ABILITY TO PERSIST AT ANATOMICAL SITES OF THE PRIMARY INFECTION AS WELL AS MAINTAINING A HEIGHTENED ABILITY TO RECALL EFFECTOR FUNCTIONS. THE MAINTENANCE OF CD8 AND CD4 T CELL FUNCTION IN A STATE OF READINESS IS KEY TO LIFE-LONG IMMUNITY AND MANIFEST THROUGH CHANGES IN TRANSCRIPTIONAL REGULATION. YET, THE ABILITY TO IDENTIFY POISED TRANSCRIPTIONAL PROGRAMS AT THE MAINTENANCE STAGE OF THE RESPONSE IS LACKING FROM MOST TRANSCRIPTIONAL PROFILING STUDIES OF MEMORY T CELLS. EPIGENETIC PROFILING ALLOWS FOR THE ASSESSMENT OF TRANSCRIPTIONALLY POISED (PROMOTERS THAT ARE READILY ACCESSIBLE FOR TRANSCRIPTION) STATES OF ANTIGEN-SPECIFIC T CELLS WITHOUT MANIPULATION OF THE ACTIVATION STATE OF THE CELL. HERE WE REVIEW RECENT STUDIES THAT HAVE EXAMINED EPIGENETIC PROGRAMS OF EFFECTOR AND MEMORY T CELL SUBSETS. THESE REPORTS DEMONSTRATE THAT ACQUISITION OF EPIGENETIC PROGRAMS DURING MEMORY T CELL DIFFERENTIATION TO ACUTE AND CHRONIC INFECTIONS IS COUPLED TO, AND POTENTIALLY REGULATE, THE CELL'S RECALL RESPONSE. WE DISCUSS THE USEFULNESS OF EPIGENETIC PROFILING IN CHARACTERIZING T CELL DIFFERENTIATION STATE AND FUNCTION FOR PRECLINICAL EVALUATION OF VACCINES AND THE CURRENT METHODOLOGIES FOR SINGLE LOCUS VERSUS GENOME-WIDE EPIGENETIC PROFILING. 2013 18 5872 24 SUSTAINED TNF-ALPHA STIMULATION LEADS TO TRANSCRIPTIONAL MEMORY THAT GREATLY ENHANCES SIGNAL SENSITIVITY AND ROBUSTNESS. TRANSCRIPTIONAL MEMORY ALLOWS CERTAIN GENES TO RESPOND TO PREVIOUSLY EXPERIENCED SIGNALS MORE ROBUSTLY. HOWEVER, WHETHER AND HOW THE KEY PROINFLAMMATORY CYTOKINE TNF-ALPHA MEDIATES TRANSCRIPTIONAL MEMORY ARE POORLY UNDERSTOOD. USING HEK293F CELLS AS A MODEL SYSTEM, WE REPORT THAT SUSTAINED TNF-ALPHA STIMULATION INDUCES TRANSCRIPTIONAL MEMORY DEPENDENT ON TET ENZYMES. THE HYPOMETHYLATED STATUS OF TRANSCRIPTIONAL REGULATORY REGIONS CAN BE INHERITED, FACILITATING NF-KAPPAB BINDING AND MORE ROBUST SUBSEQUENT ACTIVATION. A HIGH INITIAL METHYLATION LEVEL AND CPG DENSITY AROUND KAPPAB SITES ARE CORRELATED WITH THE FUNCTIONAL POTENTIAL OF TRANSCRIPTIONAL MEMORY MODULES. INTERESTINGLY, THE CALCB GENE, ENCODING THE PROVEN MIGRAINE THERAPEUTIC TARGET CGRP, EXHIBITS THE BEST TRANSCRIPTIONAL MEMORY. A NEIGHBORING PRIMATE-SPECIFIC ENDOGENOUS RETROVIRUS STIMULATES MORE RAPID, MORE STRONG, AND AT LEAST 100-FOLD MORE SENSITIVE CALCB INDUCTION IN SUBSEQUENT TNF-ALPHA STIMULATION. OUR STUDY REVEALS THAT TNF-ALPHA-MEDIATED TRANSCRIPTIONAL MEMORY IS GOVERNED BY ACTIVE DNA DEMETHYLATION AND GREATLY SENSITIZES MEMORY GENES TO MUCH LOWER DOSES OF INFLAMMATORY CUES. 2020 19 655 40 BLOCKADE OF IMMUNE-CHECKPOINT B7-H4 AND LYSINE DEMETHYLASE 5B IN ESOPHAGEAL SQUAMOUS CELL CARCINOMA CONFERS PROTECTIVE IMMUNITY AGAINST P. GINGIVALIS INFECTION. PATHOGENS ARE CAPABLE OF HIJACKING IMMUNE DEFENSE MECHANISMS, THEREBY CREATING A TOLEROGENIC ENVIRONMENT FOR HYPERMUTATED MALIGNANT CELLS THAT ARISE WITHIN THE SITE OF INFECTION. IMMUNE CHECKPOINT-ORIENTED IMMUNOTHERAPIES HAVE SHOWN CONSIDERABLE PROMISE. EQUALLY IMPORTANT, THE EPIGENETIC REPROGRAMMING OF AN IMMUNE-EVASIVE PHENOTYPE THAT ACTIVATES THE IMMUNE SYSTEM IN A SYNERGISTIC MANNER CAN IMPROVE IMMUNOTHERAPY OUTCOMES. THESE ADVANCES HAVE LED TO COMBINATIONS OF EPIGENETIC- AND IMMUNE-BASED THERAPEUTICS. WE PREVIOUSLY DEMONSTRATED THAT PORPHYROMONAS GINGIVALIS ISOLATED FROM ESOPHAGEAL SQUAMOUS CELL CARCINOMA (ESCC) LESIONS REPRESENTS A MAJOR PATHOGEN ASSOCIATED WITH THIS DEADLY DISEASE. IN THIS STUDY, WE EXAMINED THE MECHANISMS ASSOCIATED WITH HOST IMMUNITY DURING P. GINGIVALIS INFECTION AND DEMONSTRATED THAT EXPERIMENTALLY INFECTED ESCC RESPONDS BY INCREASING THE EXPRESSION OF B7-H4 AND LYSINE DEMETHYLASE 5B, WHICH ALLOWED SUBSEQUENT IN VIVO ANALYSIS OF THE IMMUNOTHERAPEUTIC EFFECTS OF ANTI-B7-H4 AND HISTONE DEMETHYLASE INHIBITORS IN MODELS OF CHRONIC INFECTION AND IMMUNITY AGAINST XENOGRAFTED HUMAN TUMORS. USING THREE DIFFERENT PRECLINICAL MOUSE MODELS RECEIVING COMBINED THERAPY, WE SHOWED THAT MICE MOUNTED STRONG RESISTANCE AGAINST P. GINGIVALIS INFECTION AND TUMOR CHALLENGE. THIS MAY HAVE OCCURRED VIA GENERATION OF A T CELL-MEDIATED RESPONSE IN THE MICROENVIRONMENT AND FORMATION OF IMMUNE MEMORY. IN ESCC SUBJECTS, COEXPRESSION OF B7-H4 AND KDM5B CORRELATED MORE SIGNIFICANTLY WITH BACTERIAL LOAD THAN WITH THE EXPRESSION OF EITHER MOLECULE ALONE. THESE RESULTS HIGHLIGHT THE UNIQUE ABILITY OF P. GINGIVALIS TO EVADE IMMUNITY AND DEFINE POTENTIAL TARGETS THAT CAN BE EXPLOITED THERAPEUTICALLY TO IMPROVE THE CONTROL OF P. GINGIVALIS INFECTION AND THE DEVELOPMENT OF ASSOCIATED NEOPLASIA. 2019 20 2764 33 EXPRESSION PATTERN, REGULATION, AND CLINICAL SIGNIFICANCE OF TOX IN BREAST CANCER. THYMOCYTE SELECTION-ASSOCIATED HIGH MOBILITY GROUP BOX PROTEIN (TOX) IS A TRANSCRIPTION FACTOR IMPLICATED IN THE REGULATION OF T CELL EXHAUSTION DURING CHRONIC INFECTION AND CANCER. WHILE TOX IS BEING TARGETED FOR CANCER IMMUNOTHERAPY, LIMITED INFORMATION IS AVAILABLE ABOUT ITS SIGNIFICANCE IN BREAST CANCER AND OTHER SOLID TUMORS. WE PERFORMED A COMPREHENSIVE ANALYSIS OF TOX GENE EXPRESSION, ITS EPIGENETIC REGULATION, PROTEIN LOCALIZATION, RELATION TO TUMOR INFILTRATING IMMUNE CELL COMPOSITION, AND PROGNOSTIC SIGNIFICANCE IN BREAST CANCER USING PUBLICLY AVAILABLE DATASETS. OUR RESULTS SUGGEST AN INVERSE CORRELATION BETWEEN TOX EXPRESSION AND DNA METHYLATION IN TUMOR CELLS. HOWEVER, ITS EXPRESSION IS ELEVATED IN TUMOR INFILTRATING IMMUNE CELLS (TIICS), WHICH MAY COMPENSATES FOR THE TOTAL TOX LEVELS IN THE TUMOR AS A WHOLE. FURTHERMORE, HIGHER TOX LEVELS IN TUMORS ARE ASSOCIATED WITH T CELL EXHAUSTION SIGNATURES ALONG WITH PRESENCE OF ACTIVE INFLAMMATORY RESPONSE, INCLUDING ELEVATED LEVELS OF T CELL EFFECTOR CYTOKINES. SURVIVAL ANALYSIS ALSO CONFIRMED THAT HIGHER EXPRESSION OF TOX IS ASSOCIATED WITH BETTER PROGNOSIS IN BREAST CANCER. THEREFORE, EXPRESSION OF TOX MAY SERVE AS A NOVEL PROGNOSTIC MARKER FOR THIS MALIGNANCY. 2021