1 590 132 BET BROMODOMAIN PROTEIN INHIBITION REVERSES CHIMERIC ANTIGEN RECEPTOR EXTINCTION AND REINVIGORATES EXHAUSTED T CELLS IN CHRONIC LYMPHOCYTIC LEUKEMIA. CHIMERIC ANTIGEN RECEPTOR (CAR) T CELLS HAVE INDUCED REMARKABLE ANTITUMOR RESPONSES IN B CELL MALIGNANCIES. SOME PATIENTS DO NOT RESPOND BECAUSE OF T CELL DEFICIENCIES THAT HAMPER THE EXPANSION, PERSISTENCE, AND EFFECTOR FUNCTION OF THESE CELLS. WE USED LONGITUDINAL IMMUNE PROFILING TO IDENTIFY PHENOTYPIC AND PHARMACODYNAMIC CHANGES IN CD19-DIRECTED CAR T CELLS IN PATIENTS WITH CHRONIC LYMPHOCYTIC LEUKEMIA (CLL). CAR EXPRESSION MAINTENANCE WAS ALSO INVESTIGATED BECAUSE THIS CAN AFFECT RESPONSE DURABILITY. CAR T CELL FAILURE WAS ACCOMPANIED BY PREEXISTING T CELL-INTRINSIC DEFECTS OR DYSFUNCTION ACQUIRED AFTER INFUSION. IN A SMALL SUBSET OF PATIENTS, CAR SILENCING WAS OBSERVED COINCIDENT WITH LEUKEMIA RELAPSE. USING A SMALL MOLECULE INHIBITOR, WE DEMONSTRATED THAT THE BROMODOMAIN AND EXTRA-TERMINAL (BET) FAMILY OF CHROMATIN ADAPTERS PLAYS A ROLE IN DOWNREGULATING CAR EXPRESSION. BET PROTEIN BLOCKADE ALSO AMELIORATED CAR T CELL EXHAUSTION AS MANIFESTED BY INHIBITORY RECEPTOR REDUCTION, ENHANCED METABOLIC FITNESS, INCREASED PROLIFERATIVE CAPACITY, AND ENRICHED TRANSCRIPTOMIC SIGNATURES OF T CELL REINVIGORATION. BET INHIBITION DECREASED LEVELS OF THE TET2 METHYLCYTOSINE DIOXYGENASE, AND FORCED EXPRESSION OF THE TET2 CATALYTIC DOMAIN ELIMINATED THE POTENCY-ENHANCING EFFECTS OF BET PROTEIN TARGETING IN CAR T CELLS, PROVIDING A MECHANISM LINKING BET PROTEINS AND T CELL DYSFUNCTION. THUS, MODULATING BET EPIGENETIC READERS MAY IMPROVE THE EFFICACY OF CELL-BASED IMMUNOTHERAPIES. 2021 2 1313 46 DELETING DNMT3A IN CAR T CELLS PREVENTS EXHAUSTION AND ENHANCES ANTITUMOR ACTIVITY. CHIMERIC ANTIGEN RECEPTOR (CAR) T CELL THERAPY IS REVOLUTIONIZING CANCER IMMUNOTHERAPY FOR PATIENTS WITH B CELL MALIGNANCIES AND IS NOW BEING DEVELOPED FOR SOLID TUMORS AND CHRONIC VIRAL INFECTIONS. ALTHOUGH CLINICAL TRIALS HAVE DEMONSTRATED THE CURATIVE POTENTIAL OF CAR T CELL THERAPY, A SUBSTANTIAL AND WELL-ESTABLISHED LIMITATION IS THE HEIGHTENED CONTRACTION AND TRANSIENT PERSISTENCE OF CAR T CELLS DURING PROLONGED ANTIGEN EXPOSURE. THE UNDERLYING MECHANISM(S) FOR THIS DYSFUNCTIONAL STATE, OFTEN TERMED CAR T CELL EXHAUSTION, REMAINS POORLY DEFINED. HERE, WE REPORT THAT EXHAUSTION OF HUMAN CAR T CELLS OCCURS THROUGH AN EPIGENETIC REPRESSION OF THE T CELL'S MULTIPOTENT DEVELOPMENTAL POTENTIAL. DELETION OF THE DE NOVO DNA METHYLTRANSFERASE 3 ALPHA (DNMT3A) IN T CELLS EXPRESSING FIRST- OR SECOND-GENERATION CARS UNIVERSALLY PRESERVED THE CELLS' ABILITY TO PROLIFERATE AND MOUNT AN ANTITUMOR RESPONSE DURING PROLONGED TUMOR EXPOSURE. THE INCREASED FUNCTIONALITY OF THE EXHAUSTION-RESISTANT DNMT3A KNOCKOUT CAR T CELLS WAS COUPLED TO AN UP-REGULATION OF INTERLEUKIN-10, AND GENOME-WIDE DNA METHYLATION PROFILING DEFINED AN ATLAS OF GENES TARGETED FOR EPIGENETIC SILENCING. THIS ATLAS PROVIDES A MOLECULAR DEFINITION OF CAR T CELL EXHAUSTION, WHICH INCLUDES MANY TRANSCRIPTIONAL REGULATORS THAT LIMIT THE "STEMNESS" OF IMMUNE CELLS, INCLUDING CD28, CCR7, TCF7, AND LEF1. LAST, WE DEMONSTRATE THAT THIS EPIGENETICALLY REGULATED MULTIPOTENCY PROGRAM IS FIRMLY COUPLED TO THE CLINICAL OUTCOME OF PRIOR CAR T CELL THERAPIES. THESE DATA DOCUMENT THE CRITICAL ROLE EPIGENETIC MECHANISMS PLAY IN LIMITING THE FATE POTENTIAL OF HUMAN T CELLS AND PROVIDE A ROAD MAP FOR LEVERAGING THIS INFORMATION FOR IMPROVING CAR T CELL EFFICACY. 2021 3 559 24 BACH2 ENFORCES THE TRANSCRIPTIONAL AND EPIGENETIC PROGRAMS OF STEM-LIKE CD8(+) T CELLS. DURING CHRONIC INFECTION AND CANCER, A SELF-RENEWING CD8(+) T CELL SUBSET MAINTAINS LONG-TERM IMMUNITY AND IS CRITICAL TO THE EFFECTIVENESS OF IMMUNOTHERAPY. THESE STEM-LIKE CD8(+) T CELLS DIVERGE FROM OTHER CD8(+) SUBSETS EARLY AFTER CHRONIC VIRAL INFECTION. HOWEVER, PATHWAYS GUARDING STEM-LIKE CD8(+) T CELLS AGAINST TERMINAL EXHAUSTION REMAIN UNCLEAR. HERE, WE SHOW THAT THE GENE ENCODING TRANSCRIPTIONAL REPRESSOR BACH2 IS TRANSCRIPTIONALLY AND EPIGENETICALLY ACTIVE IN STEM-LIKE CD8(+) T CELLS BUT NOT TERMINALLY EXHAUSTED CELLS EARLY AFTER INFECTION. BACH2 OVEREXPRESSION ENFORCED STEM-LIKE CELL FATE, WHEREAS BACH2 DEFICIENCY IMPAIRED STEM-LIKE CD8(+) T CELL DIFFERENTIATION. SINGLE-CELL TRANSCRIPTOMIC AND EPIGENOMIC APPROACHES REVEALED THAT BACH2 ESTABLISHED THE TRANSCRIPTIONAL AND EPIGENETIC PROGRAMS OF STEM-LIKE CD8(+) T CELLS. IN ADDITION, BACH2 SUPPRESSED THE MOLECULAR PROGRAM DRIVING TERMINAL EXHAUSTION THROUGH TRANSCRIPTIONAL REPRESSION AND EPIGENETIC SILENCING. THUS, OUR STUDY REVEALS A NEW PATHWAY THAT ENFORCES COMMITMENT TO STEM-LIKE CD8(+) LINEAGE AND PREVENTS AN ALTERNATIVE TERMINALLY EXHAUSTED CELL FATE. 2021 4 1462 45 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 5 5082 47 PI3KDELTA/GAMMA INHIBITION PROMOTES HUMAN CART CELL EPIGENETIC AND METABOLIC REPROGRAMMING TO ENHANCE ANTITUMOR CYTOTOXICITY. CURRENT LIMITATIONS IN USING CHIMERIC ANTIGEN RECEPTOR T(CART) CELLS TO TREAT PATIENTS WITH HEMATOLOGICAL CANCERS INCLUDE LIMITED EXPANSION AND PERSISTENCE IN VIVO THAT CONTRIBUTE TO CANCER RELAPSE. PATIENTS WITH CHRONIC LYMPHOCYTIC LEUKEMIA (CLL) HAVE TERMINALLY DIFFERENTIATED T CELLS WITH AN EXHAUSTED PHENOTYPE AND EXPERIENCE LOW COMPLETE RESPONSE RATES AFTER AUTOLOGOUS CART THERAPY. BECAUSE PI3K INHIBITOR THERAPY IS ASSOCIATED WITH THE DEVELOPMENT OF T-CELL-MEDIATED AUTOIMMUNITY, WE STUDIED THE EFFECTS OF INHIBITING THE PI3KDELTA AND PI3KGAMMA ISOFORMS DURING THE MANUFACTURE OF CART CELLS PREPARED FROM PATIENTS WITH CLL. DUAL PI3KDELTA/GAMMA INHIBITION NORMALIZED CD4/CD8 RATIOS AND MAXIMIZED THE NUMBER OF CD8+ T-STEM CELL MEMORY, NAIVE, AND CENTRAL MEMORY T-CELLS WITH DOSE-DEPENDENT DECREASES IN EXPRESSION OF THE TIM-3 EXHAUSTION MARKER. CART CELLS MANUFACTURED WITH DUVELISIB (DUV-CART CELLS) SHOWED SIGNIFICANTLY INCREASED IN VITRO CYTOTOXICITY AGAINST CD19+ CLL TARGETS CAUSED BY INCREASED FREQUENCIES OF CD8+ CART CELLS. DUV-CART CELLS HAD INCREASED EXPRESSION OF THE MITOCHONDRIAL FUSION PROTEIN MFN2, WITH AN ASSOCIATED INCREASE IN THE RELATIVE CONTENT OF MITOCHONDRIA. DUV-CART CELLS EXHIBITED INCREASED SIRT1 AND TCF1/7 EXPRESSION, WHICH CORRELATED WITH EPIGENETIC REPROGRAMING OF DUV-CART CELLS TOWARD STEM-LIKE PROPERTIES. AFTER TRANSFER TO NOG MICE ENGRAFTED WITH A HUMAN CLL CELL LINE, DUV-CART CELLS EXPRESSING EITHER A CD28 OR 41BB COSTIMULATORY DOMAIN DEMONSTRATED SIGNIFICANTLY INCREASED IN VIVO EXPANSION OF CD8+ CART CELLS, FASTER ELIMINATION OF CLL, AND LONGER PERSISTENCE. DUV-CART CELLS SIGNIFICANTLY ENHANCED SURVIVAL OF CLL-BEARING MICE COMPARED WITH CONVENTIONALLY MANUFACTURED CART CELLS. IN SUMMARY, EXPOSURE OF CART TO A PI3KDELTA/GAMMA INHIBITOR DURING MANUFACTURING ENRICHED THE CART PRODUCT FOR CD8+ CART CELLS WITH STEM-LIKE QUALITIES AND ENHANCED EFFICACY IN ELIMINATING CLL IN VIVO. 2022 6 2421 31 EPIGENETIC SIGNATURE OF PD-1+ TCF1+ CD8 T CELLS THAT ACT AS RESOURCE CELLS DURING CHRONIC VIRAL INFECTION AND RESPOND TO PD-1 BLOCKADE. WE HAVE RECENTLY DEFINED A NOVEL POPULATION OF PD-1 (PROGRAMMED CELL DEATH 1)+ TCF1 (T CELL FACTOR 1)+ VIRUS-SPECIFIC CD8 T CELLS THAT FUNCTION AS RESOURCE CELLS DURING CHRONIC LCMV INFECTION AND PROVIDE THE PROLIFERATIVE BURST SEEN AFTER PD-1 BLOCKADE. SUCH CD8 T CELLS HAVE BEEN FOUND IN OTHER CHRONIC INFECTIONS AND ALSO IN CANCER IN MICE AND HUMANS. THESE CD8 T CELLS EXHIBIT STEM-LIKE PROPERTIES UNDERGOING SELF-RENEWAL AND ALSO DIFFERENTIATING INTO THE TERMINALLY EXHAUSTED CD8 T CELLS. HERE WE COMPARED THE EPIGENETIC SIGNATURE OF STEM-LIKE CD8 T CELLS WITH EXHAUSTED CD8 T CELLS. ATAC-SEQ ANALYSIS SHOWED THAT STEM-LIKE CD8 T CELLS HAD A UNIQUE SIGNATURE IMPLICATING ACTIVITY OF HMG (TCF) AND RHD (NF-KAPPAB) TRANSCRIPTION FACTOR FAMILY MEMBERS IN CONTRAST TO HIGHER ACCESSIBILITY TO ETS AND RUNX MOTIFS IN EXHAUSTED CD8 T CELLS. IN ADDITION, REGULATORY REGIONS OF THE TRANSCRIPTION FACTORS TCF7 AND ID3 WERE MORE ACCESSIBLE IN STEM-LIKE CELLS WHEREAS PRDM1 AND ID2 WERE MORE ACCESSIBLE IN EXHAUSTED CD8 T CELLS. WE ALSO COMPARED THE EPIGENETIC SIGNATURES OF THE 2 CD8 T CELL SUBSETS FROM CHRONICALLY INFECTED MICE WITH EFFECTOR AND MEMORY CD8 T CELLS GENERATED AFTER AN ACUTE LCMV INFECTION. BOTH CD8 T CELL SUBSETS GENERATED DURING CHRONIC INFECTION WERE STRIKINGLY DIFFERENT FROM CD8 T CELL SUBSETS FROM ACUTE INFECTION. INTERESTINGLY, THE STEM-LIKE CD8 T CELL SUBSET FROM CHRONIC INFECTION, DESPITE SHARING KEY FUNCTIONAL PROPERTIES WITH MEMORY CD8 T CELLS, HAD A VERY DISTINCT EPIGENETIC PROGRAM. THESE RESULTS SHOW THAT THE CHRONIC STEM-LIKE CD8 T CELL PROGRAM REPRESENTS A SPECIFIC ADAPTATION OF THE T CELL RESPONSE TO PERSISTENT ANTIGENIC STIMULATION. 2019 7 730 31 CANCER CELLS RESISTANT TO IMMUNE CHECKPOINT BLOCKADE ACQUIRE INTERFERON-ASSOCIATED EPIGENETIC MEMORY TO SUSTAIN T CELL DYSFUNCTION. PROLONGED INTERFERON (IFN) SIGNALING IN CANCER CELLS CAN PROMOTE RESISTANCE TO IMMUNE CHECKPOINT BLOCKADE (ICB). HOW CANCER CELLS RETAIN EFFECTS OF PROLONGED IFN STIMULATION TO COORDINATE RESISTANCE IS UNCLEAR. WE SHOW THAT, ACROSS HUMAN AND/OR MOUSE TUMORS, IMMUNE DYSFUNCTION IS ASSOCIATED WITH CANCER CELLS ACQUIRING EPIGENETIC FEATURES OF INFLAMMATORY MEMORY. HERE, INFLAMMATORY MEMORY DOMAINS, MANY OF WHICH ARE INITIATED BY CHRONIC IFN-GAMMA, ARE MAINTAINED BY SIGNAL TRANSDUCER AND ACTIVATOR OF TRANSCRIPTION (STAT)1 AND IFN REGULATORY FACTOR (IRF)3 AND LINK HISTONE 3 LYSINE 4 MONOMETHYLATION (H3K4ME1)-MARKED CHROMATIN ACCESSIBILITY TO INCREASED EXPRESSION OF A SUBSET OF IFN-STIMULATED GENES (ISGS). THESE ISGS INCLUDE THE RNA SENSOR OAS1 THAT AMPLIFIES TYPE I IFN (IFN-I) AND IMMUNE INHIBITORY GENES. ABROGATING CANCER CELL IFN-I SIGNALING RESTORES ANTI-PROGRAMMED CELL DEATH PROTEIN 1 (PD1) RESPONSE BY INCREASING IFN-GAMMA IN IMMUNE CELLS, PROMOTING DENDRITIC CELL AND CD8(+) T CELL INTERACTIONS, AND EXPANDING T CELLS TOWARD EFFECTOR-LIKE STATES RATHER THAN EXHAUSTED STATES. THUS, CANCER CELLS ACQUIRE INFLAMMATORY MEMORY TO AUGMENT A SUBSET OF ISGS THAT PROMOTE AND PREDICT IFN-DRIVEN IMMUNE DYSFUNCTION. 2023 8 1007 29 CHRONIC VIRUS INFECTION ENFORCES DEMETHYLATION OF THE LOCUS THAT ENCODES PD-1 IN ANTIGEN-SPECIFIC CD8(+) T CELLS. FUNCTIONALLY EXHAUSTED T CELLS HAVE HIGH EXPRESSION OF THE PD-1 INHIBITORY RECEPTOR, AND THERAPIES THAT BLOCK PD-1 SIGNALING SHOW PROMISE FOR RESOLVING CHRONIC VIRAL INFECTIONS AND CANCER. BY USING HUMAN AND MURINE SYSTEMS OF ACUTE AND CHRONIC VIRAL INFECTIONS, WE ANALYZED EPIGENETIC REGULATION OF PD-1 EXPRESSION DURING CD8(+) T CELL DIFFERENTIATION. DURING ACUTE INFECTION, NAIVE TO EFFECTOR CD8(+) T CELL DIFFERENTIATION WAS ACCOMPANIED BY A TRANSIENT LOSS OF DNA METHYLATION OF THE PDCD1 LOCUS THAT WAS DIRECTLY COUPLED TO THE DURATION AND STRENGTH OF T CELL RECEPTOR SIGNALING. FURTHER DIFFERENTIATION INTO FUNCTIONAL MEMORY CELLS COINCIDED WITH PDCD1 REMETHYLATION, PROVIDING AN ADAPTED PROGRAM FOR REGULATION OF PD-1 EXPRESSION. IN CONTRAST, THE PDCD1 REGULATORY REGION WAS COMPLETELY DEMETHYLATED IN EXHAUSTED CD8(+) T CELLS AND REMAINED UNMETHYLATED EVEN WHEN VIRUS TITERS DECREASED. THIS LACK OF DNA REMETHYLATION LEAVES THE PDCD1 LOCUS POISED FOR RAPID EXPRESSION, POTENTIALLY PROVIDING A SIGNAL FOR PREMATURE TERMINATION OF ANTIVIRAL FUNCTIONS. 2011 9 6121 20 THE EPIGENETIC LANDSCAPE OF T CELL EXHAUSTION. EXHAUSTED T CELLS IN CANCER AND CHRONIC VIRAL INFECTION EXPRESS DISTINCTIVE PATTERNS OF GENES, INCLUDING SUSTAINED EXPRESSION OF PROGRAMMED CELL DEATH PROTEIN 1 (PD-1). HOWEVER, THE REGULATION OF GENE EXPRESSION IN EXHAUSTED T CELLS IS POORLY UNDERSTOOD. HERE, WE DEFINE THE ACCESSIBLE CHROMATIN LANDSCAPE IN EXHAUSTED CD8(+) T CELLS AND SHOW THAT IT IS DISTINCT FROM FUNCTIONAL MEMORY CD8(+) T CELLS. EXHAUSTED CD8(+) T CELLS IN HUMANS AND A MOUSE MODEL OF CHRONIC VIRAL INFECTION ACQUIRE A STATE-SPECIFIC EPIGENETIC LANDSCAPE ORGANIZED INTO FUNCTIONAL MODULES OF ENHANCERS. GENOME EDITING SHOWS THAT PD-1 EXPRESSION IS REGULATED IN PART BY AN EXHAUSTION-SPECIFIC ENHANCER THAT CONTAINS ESSENTIAL RAR, T-BET, AND SOX3 MOTIFS. FUNCTIONAL ENHANCER MAPS MAY OFFER TARGETS FOR GENOME EDITING THAT ALTER GENE EXPRESSION PREFERENTIALLY IN EXHAUSTED CD8(+) T CELLS. 2016 10 6448 38 THERAPEUTIC SHUTDOWN OF HBV TRANSCRIPTS PROMOTES REAPPEARANCE OF THE SMC5/6 COMPLEX AND SILENCING OF THE VIRAL GENOME IN VIVO. OBJECTIVE: THERAPEUTIC STRATEGIES SILENCING AND REDUCING THE HEPATITIS B VIRUS (HBV) RESERVOIR, THE COVALENTLY CLOSED CIRCULAR DNA (CCCDNA), HAVE THE POTENTIAL TO CURE CHRONIC HBV INFECTION. WE AIMED TO INVESTIGATE THE IMPACT OF SMALL INTERFERRING RNA (SIRNA) TARGETING ALL HBV TRANSCRIPTS OR PEGYLATED INTERFERON-ALPHA (PEG-IFNALPHA) ON THE VIRAL REGULATORY HBX PROTEIN AND THE STRUCTURAL MAINTENANCE OF CHROMOSOME 5/6 COMPLEX (SMC5/6), A HOST FACTOR SUPPRESSING CCCDNA TRANSCRIPTION. IN PARTICULAR, WE ASSESSED WHETHER INTERVENTIONS LOWERING HBV TRANSCRIPTS CAN ACHIEVE AND MAINTAIN SILENCING OF CCCDNA TRANSCRIPTION IN VIVO. DESIGN: HBV-INFECTED HUMAN LIVER CHIMERIC MICE WERE TREATED WITH SIRNA OR PEG-IFNALPHA. VIROLOGICAL AND HOST CHANGES WERE ANALYSED AT THE END OF TREATMENT AND DURING THE REBOUND PHASE BY QUALITATIVE PCR, ELISA, IMMUNOBLOTTING AND CHROMATIN IMMUNOPRECIPITATION. RNA IN SITU HYBRIDISATION WAS COMBINED WITH IMMUNOFLUORESCENCE TO DETECT SMC6 AND HBV RNAS AT SINGLE CELL LEVEL. THE ENTRY INHIBITOR MYRCLUDEX-B WAS USED DURING THE REBOUND PHASE TO AVOID NEW INFECTION EVENTS. RESULTS: BOTH SIRNA AND PEG-IFNALPHA STRONGLY REDUCED ALL HBV MARKERS, INCLUDING HBX LEVELS, THUS ENABLING THE REAPPEARANCE OF SMC5/6 IN HEPATOCYTES THAT ACHIEVED HBV-RNA NEGATIVISATION AND SMC5/6 ASSOCIATION WITH THE CCCDNA. ONLY IFN REDUCED CCCDNA LOADS AND ENHANCED IFN-STIMULATED GENES. HOWEVER, THE ANTIVIRAL EFFECTS DID NOT PERSIST OFF TREATMENT AND SMC5/6 WAS AGAIN DEGRADED. REMARKABLY, THE BLOCKADE OF VIRAL ENTRY THAT STARTED AT THE END OF TREATMENT HINDERED RENEWED DEGRADATION OF SMC5/6. CONCLUSION: THESE RESULTS REVEAL THAT THERAPEUTICS ABROGATING ALL HBV TRANSCRIPTS INCLUDING HBX PROMOTE EPIGENETIC SUPPRESSION OF THE HBV MINICHROMOSOME, WHEREAS STRATEGIES PROTECTING THE HUMAN HEPATOCYTES FROM REINFECTION ARE NEEDED TO MAINTAIN CCCDNA SILENCING. 2022 11 1278 26 DE NOVO EPIGENETIC PROGRAMS INHIBIT PD-1 BLOCKADE-MEDIATED T CELL REJUVENATION. IMMUNE-CHECKPOINT-BLOCKADE (ICB)-MEDIATED REJUVENATION OF EXHAUSTED T CELLS HAS EMERGED AS A PROMISING APPROACH FOR TREATING VARIOUS CANCERS AND CHRONIC INFECTIONS. HOWEVER, T CELLS THAT BECOME FULLY EXHAUSTED DURING PROLONGED ANTIGEN EXPOSURE REMAIN REFRACTORY TO ICB-MEDIATED REJUVENATION. WE REPORT THAT BLOCKING DE NOVO DNA METHYLATION IN ACTIVATED CD8 T CELLS ALLOWS THEM TO RETAIN THEIR EFFECTOR FUNCTIONS DESPITE CHRONIC STIMULATION DURING A PERSISTENT VIRAL INFECTION. WHOLE-GENOME BISULFITE SEQUENCING OF ANTIGEN-SPECIFIC MURINE CD8 T CELLS AT THE EFFECTOR AND EXHAUSTION STAGES OF AN IMMUNE RESPONSE IDENTIFIED PROGRESSIVELY ACQUIRED HERITABLE DE NOVO METHYLATION PROGRAMS THAT RESTRICT T CELL EXPANSION AND CLONAL DIVERSITY DURING PD-1 BLOCKADE TREATMENT. MOREOVER, THESE EXHAUSTION-ASSOCIATED DNA-METHYLATION PROGRAMS WERE ACQUIRED IN TUMOR-INFILTRATING PD-1HI CD8 T CELLS, AND APPROACHES TO REVERSE THESE PROGRAMS IMPROVED T CELL RESPONSES AND TUMOR CONTROL DURING ICB. THESE DATA ESTABLISH DE NOVO DNA-METHYLATION PROGRAMMING AS A REGULATOR OF T CELL EXHAUSTION AND BARRIER OF ICB-MEDIATED T CELL REJUVENATION. 2017 12 6899 22 [THE DEVELOPMENT HISTORY AND FUTURE PERSPECTIVE OF MOLECULARLY TARGETED THERAPY]. THE ORIGIN OF MOLECULARLY TARGETED DRUGS DATES BACK TO 'MAGIC BULLET' THEORY PROPOSED BY PAUL EHRLICH. THE SUCCESS OF ABL TYROSINE KINASE INHIBITOR, IMATINIB FOR THE TREATMENT OF CHRONIC MYELOID LEUKEMIA REALIZED THAT SMALL MOLECULES INHIBITING ATP BINDING CAN BECOME SPECIFIC INHIBITORS FOR THE RELEVANT KINASES. SUBSEQUENTLY, A NUMBER OF KINASE INHIBITORS WHICH TARGETS VARIOUS SIGNAL TRANSDUCTION MOLECULES, ARE IN THE CLINICAL FIELD OR UNDER DEVELOPMENT. THE CLINICAL SUCCESS OF ANTIBODY THERAPEUTICS HAS BEEN ACHIEVED BY THE GENETIC ENGINEERING WHICH MAKES HUMAN-MOUSE CHIMERIC, HUMANIZED OR HUMAN ANTIBODY. TO AUGMENT THE THERAPEUTIC EFFECTS OF ANTIBODY, RADIOISOTOPE-CONJUGATE ANTIBODY AND ANTIBODY-DRUG CONJUGATE HAVE COME TO THE CLINICAL FIELD. IN THE NEAR FUTURE, WE HAVE TO DEVELOP THE COMBINATION THERAPY OF MOLECULARLY TARGETED DRUGS AND ALSO INHIBITORS FOR EPIGENETIC AND TRANSCRIPTIONAL REGULATORS. 2014 13 3373 33 HISTONE MODULATION BLOCKS TREG-INDUCED FOXP3 BINDING TO THE IL-2 PROMOTER OF VIRUS-SPECIFIC CD8(+) T CELLS FROM FELINE IMMUNODEFICIENCY VIRUS-INFECTED CATS. CD8(+) T CELLS ARE CRITICAL FOR CONTROLLING HIV INFECTION. DURING THE CHRONIC PHASE OF LENTIVIRAL INFECTION, CD8(+) T CELLS LOSE THEIR PROLIFERATIVE CAPACITY AND EXHIBIT IMPAIRED ANTIVIRAL FUNCTION. THIS LOSS OF CD8(+) T CELL FUNCTION IS DUE, IN PART, TO CD4(+)CD25(+) T REGULATORY (TREG) CELL-MEDIATED SUPPRESSION. OUR RESEARCH GROUP HAS DEMONSTRATED THAT LENTIVIRUS-ACTIVATED CD4(+)CD25(+) TREG CELLS INDUCE THE REPRESSIVE TRANSCRIPTION FACTOR FORKHEAD BOX P3 (FOXP3) IN AUTOLOGOUS CD8(+) T CELLS FOLLOWING CO-CULTURE. WE HAVE RECENTLY REPORTED THAT TREG-INDUCED FOXP3 BINDS THE INTERLEUKIN-2 (IL-2), INTERFERON-GAMMA (IFN- GAMMA), AND TUMOR NECROSIS FACTOR-ALPHA (TNF-ALPHA) PROMOTERS IN VIRUS-SPECIFIC CD8(+) T CELLS. THESE DATA SUGGEST AN IMPORTANT ROLE OF FOXP3-MEDIATED CD8(+) T CELL DYSFUNCTION IN LENTIVIRAL INFECTION. TO ELUCIDATE THE MECHANISM OF THIS SUPPRESSION, WE PREVIOUSLY REPORTED THAT DECREASED METHYLATION FACILITATES FOXP3 BINDING IN MITOGEN-ACTIVATED CD8(+) T CELLS FROM FELINE IMMUNODEFICIENCY VIRUS (FIV)-INFECTED CATS. WE DEMONSTRATED THE REDUCED BINDING OF FOXP3 TO THE IL-2 PROMOTER BY INCREASING METHYLATION OF CD8(+) T CELLS. IN THE STUDIES PRESENTED HERE, WE ASK IF ANOTHER FORM OF EPIGENETIC MODULATION MIGHT ALLEVIATE FOXP3-MEDIATED SUPPRESSION IN CD8(+) T CELLS. WE HYPOTHESIZED THAT DECREASING HISTONE ACETYLATION IN VIRUS-SPECIFIC CD8(+) T CELLS WOULD DECREASE TREG-INDUCED FOXP3 BINDING TO THE IL-2 PROMOTER. INDEED, USING ANACARDIC ACID (AA), A KNOWN HISTONE ACETYL TRANSFERASE (HAT) INHIBITOR, WE DEMONSTRATE A REDUCTION IN FOXP3 BINDING TO THE IL-2 PROMOTER IN VIRUS-SPECIFIC CD8(+) T CELLS CO-CULTURED WITH AUTOLOGOUS TREG CELLS. THESE DATA IDENTIFY A NOVEL MECHANISM OF FOXP3-MEDIATED CD8(+) T CELL DYSFUNCTION DURING LENTIVIRAL INFECTION. 2018 14 5704 26 SINGLE-CELL RNA-SEQ REVEALS TOX AS A KEY REGULATOR OF CD8(+) T CELL PERSISTENCE IN CHRONIC INFECTION. PROGENITOR-LIKE CD8(+) T CELLS MEDIATE LONG-TERM IMMUNITY TO CHRONIC INFECTION AND CANCER AND RESPOND POTENTLY TO IMMUNE CHECKPOINT BLOCKADE. THESE CELLS SHARE TRANSCRIPTIONAL REGULATORS WITH MEMORY PRECURSOR CELLS, INCLUDING T CELL-SPECIFIC TRANSCRIPTION FACTOR 1 (TCF1), BUT IT IS UNCLEAR WHETHER THEY ADOPT DISTINCT PROGRAMS TO ADAPT TO THE IMMUNOSUPPRESSIVE ENVIRONMENT. BY COMPARING THE SINGLE-CELL TRANSCRIPTOMES AND EPIGENETIC PROFILES OF CD8(+) T CELLS RESPONDING TO ACUTE AND CHRONIC VIRAL INFECTIONS, WE FOUND THAT PROGENITOR-LIKE CD8(+) T CELLS BECAME DISTINCT FROM MEMORY PRECURSOR CELLS BEFORE THE PEAK OF THE T CELL RESPONSE. WE DISCOVERED A COEXPRESSION GENE MODULE CONTAINING TOX THAT EXHIBITED HIGHER TRANSCRIPTIONAL ACTIVITY ASSOCIATED WITH MORE ABUNDANT ACTIVE HISTONE MARKS IN PROGENITOR-LIKE CELLS THAN MEMORY PRECURSOR CELLS. MOREOVER, THYMOCYTE SELECTION-ASSOCIATED HIGH MOBILITY GROUP BOX PROTEIN TOX (TOX) PROMOTED THE PERSISTENCE OF ANTIVIRAL CD8(+) T CELLS AND WAS REQUIRED FOR THE PROGRAMMING OF PROGENITOR-LIKE CD8(+) T CELLS. THUS, LONG-TERM CD8(+) T CELL IMMUNITY TO CHRONIC VIRAL INFECTION REQUIRES UNIQUE TRANSCRIPTIONAL AND EPIGENETIC PROGRAMS ASSOCIATED WITH THE TRANSCRIPTION FACTOR TOX. 2019 15 1319 37 DEMETHYLATION OF THE PD-1 PROMOTER IS IMPRINTED DURING THE EFFECTOR PHASE OF CD8 T CELL EXHAUSTION. PD-1 IS AN INHIBITORY RECEPTOR THAT HAS A MAJOR ROLE IN T CELL DYSFUNCTION DURING CHRONIC INFECTIONS AND CANCER. WHILE DEMETHYLATION OF THE PD-1 PROMOTER DNA IS OBSERVED IN EXHAUSTED T CELLS ISOLATED FROM CHRONICALLY INFECTED INDIVIDUALS, LITTLE IS KNOWN ABOUT WHEN THIS STABLE DEMETHYLATION OF PD-1 PROMOTER DNA IS PROGRAMMED DURING THE COURSE OF A CHRONIC INFECTION. TO ASSESS IF PD-1 PROMOTER DNA DEMETHYLATION IS IMPACTED BY PROLONGED STIMULATION DURING EFFECTOR PHASE OF CHRONIC INFECTION, WE ADOPTIVELY TRANSFERRED VIRUS-SPECIFIC DAY 8 EFFECTOR CD8 T CELLS FROM MICE INFECTED WITH LYMPHOCYTIC CHORIOMENINGITIS VIRUS (LCMV) CLONE 13 INTO RECIPIENT MICE THAT HAD CLEARED AN ACUTE INFECTION. WE OBSERVED THAT LCMV-SPECIFIC CD8 T CELLS FROM CHRONICALLY INFECTED MICE MAINTAINED THEIR SURFACE EXPRESSION OF PD-1 EVEN AFTER TRANSFER INTO ACUTE IMMUNE MICE UNTIL DAY 45 POSTTRANSFER. INTERESTINGLY, THE PD-1 TRANSCRIPTIONAL REGULATORY REGION CONTINUED TO REMAIN UNMETHYLATED IN THESE DONOR CD8 T CELLS GENERATED FROM A CHRONIC INFECTION. THE OBSERVED MAINTENANCE OF PD-1 SURFACE EXPRESSION AND THE DEMETHYLATED PD-1 PROMOTER WERE NOT A RESULT OF RESIDUAL ANTIGEN IN THE RECIPIENT MICE, BECAUSE SIMILAR RESULTS WERE SEEN WHEN CHRONIC INFECTION-INDUCED EFFECTOR CELLS WERE TRANSFERRED INTO MICE INFECTED WITH A VARIANT STRAIN OF LCMV (LCMV V35A) BEARING A MUTATION IN THE COGNATE MAJOR HISTOCOMPATIBILITY COMPLEX CLASS I (MHC-I) EPITOPE THAT IS RECOGNIZED BY THE DONOR CD8 T CELLS. IMPORTANTLY, THE MAINTENANCE OF PD-1 PROMOTER DEMETHYLATION IN MEMORY CD8 T CELLS WAS COUPLED WITH IMPAIRED CLONAL EXPANSION AND HIGHER PD-1 RE-EXPRESSION UPON SECONDARY CHALLENGE. THESE DATA SHOW THAT THE IMPRINTING OF THE EPIGENETIC PROGRAM OF THE INHIBITORY RECEPTOR PD-1 OCCURS DURING THE EFFECTOR PHASE OF CHRONIC VIRAL INFECTION. IMPORTANCE: SINCE PD-1 IS A MAJOR INHIBITORY RECEPTOR REGULATING T CELL DYSFUNCTION DURING CHRONIC VIRAL INFECTION AND CANCERS, A BETTER UNDERSTANDING OF THE MECHANISMS THAT REGULATE PD-1 EXPRESSION IS IMPORTANT. IN THIS WORK, WE DEMONSTRATE THAT THE PD-1 EPIGENETIC PROGRAM IN ANTIGEN-SPECIFIC CD8 T CELLS IS FIXED DURING THE PRIMING PHASE OF CHRONIC INFECTION. 2016 16 3794 32 INTERLEUKIN-33 MEDIATES BOTH IMMUNE-RELATED AND NON-IMMUNE-RELATED INHIBITORY EFFECTS AGAINST HEPATITIS B VIRUS. CHRONIC INFECTION BY HEPATITIS B VIRUS (HBV) IS ASSOCIATED WITH HIGH RISKS OF LIVER FIBROSIS, CIRRHOSIS AND HEPATOCELLULAR CARCINOMA. HBV COVALENTLY CLOSED CIRCULAR DNA (CCCDNA) IN THE NUCLEUS OF INFECTED HEPATOCYTE SERVES AS TRANSCRIPTION TEMPLATE. NEITHER NATURAL RESOLUTION OF ACUTE INFECTION NOR CURRENT TREATMENT OPTIONS FOR CHRONIC INFECTION ARE BELIEVED TO CAUSE CCCDNA CLEARANCE. WE PREVIOUSLY SHOWED THAT INJECTION OF IL-33-EXPRESSING PLASMID FACILITATED CLEARANCE OF INTRAHEPATIC HBV DNA IN A MOUSE MODEL OF HBV PERSISTENCE. IN THIS WORK, HBV-TARGETING THERAPEUTIC EFFECTS OF IL-33 WERE FURTHER EXPLORED. MURINE IL-33 DELIVERED BY RECOMBINANT ADENO-ASSOCIATED VIRUS (AAV-MIL-33) INDUCED CLEARANCE OF BOTH SERUM HBV MARKERS AND INTRAHEPATIC HBV DNA IN TWO MOUSE MODELS OF HBV PERSISTENCE BASED ON REPLICON PLASMID AND RECOMBINANT CCCDNA (RCCCDNA) RESPECTIVELY. CLEARANCE WAS ASSOCIATED WITH SERUM ALT ELEVATIONS AND LIVER INFILTRATIONS BY CD4(+) AND CD8(+) T CELLS, INDICATING IL-33-INDUCED CELLULAR IMMUNE RESPONSES AGAINST HBV-HARBORING CELLS. ADOPTIVE TRANSFER OF SPLENOCYTES FROM AAV-MIL-33-CURED MICE WAS INDEED SUFFICIENT TO ENGENDER SIMILAR CLEARANCE IN RECIPIENT MICE. IN VITRO, INTRACELLULAR, INSTEAD OF EXTRACELLULAR, IL-33 WAS MAINLY RESPONSIBLE FOR REPRESSING VIRAL TRANSCRIPTION, PROTEIN PRODUCTION AND GENOME REPLICATION IN HUH7 CELLS TRANSFECTED WITH HBV REPLICON OR RCCCDNA. IL-33 WAS SHOWN TO BE RECRUITED ONTO RCCCDNA MINICHROMOSOME ACCOMPANIED BY LOSS OF TRANSCRIPTIONAL ACTIVATION EPIGENETIC MARKS. FINALLY, TRANSFECTION OF IL-33 INTO HBV-INFECTED HEPG2/NTCP CELLS RESULTED IN REDUCED TRANSCRIPTION, ANTIGEN EXPRESSION AND GENOME REPLICATION, SUGGESTING REPRESSION OF CANONICAL CCCDNA. THESE DATA DEMONSTRATED DIVERSE INHIBITORY EFFECTS ON HBV AND HBV-INFECTED CELLS MEDIATED BY IL-33, AND SUGGEST IL-33 AS AN INTERESTING THERAPEUTIC CANDIDATE. 2022 17 2242 32 EPIGENETIC MODULATION OF CD8(+) T CELL FUNCTION IN LENTIVIRUS INFECTIONS: A REVIEW. CD8(+) T CELLS ARE CRITICAL FOR CONTROLLING VIREMIA DURING HUMAN IMMUNODEFICIENCY VIRUS (HIV) INFECTION. THESE CELLS PRODUCE CYTOLYTIC FACTORS AND ANTIVIRAL CYTOKINES THAT ELIMINATE VIRALLY- INFECTED CELLS. DURING THE CHRONIC PHASE OF HIV INFECTION, CD8(+) T CELLS PROGRESSIVELY LOSE THEIR PROLIFERATIVE CAPACITY AND ANTIVIRAL FUNCTIONS. THESE DYSFUNCTIONAL CELLS ARE UNABLE TO CLEAR THE PRODUCTIVELY INFECTED AND REACTIVATED CELLS, REPRESENTING A ROADBLOCK IN HIV CURE. THEREFORE, MECHANISMS TO UNDERSTAND CD8(+) T CELL DYSFUNCTION AND STRATEGIES TO BOOST CD8(+) T CELL FUNCTION NEED TO BE INVESTIGATED. USING THE FELINE IMMUNODEFICIENCY VIRUS (FIV) MODEL FOR LENTIVIRAL PERSISTENCE, WE HAVE DEMONSTRATED THAT CD8(+) T CELLS EXHIBIT EPIGENETIC CHANGES SUCH AS DNA DEMETHYLATION DURING THE COURSE OF INFECTION AS COMPARED TO UNINFECTED CATS. WE HAVE ALSO DEMONSTRATED THAT LENTIVIRUS-ACTIVATED CD4(+)CD25(+) T REGULATORY CELLS INDUCE FORKHEAD BOX P3 (FOXP3) EXPRESSION IN VIRUS-SPECIFIC CD8(+) T CELL TARGETS, WHICH BINDS THE INTERLEUKIN (IL)-2, TUMOR NECROSIS FACTOR (TNF)-Α, AND INTERFERON (IFN)-Γ PROMOTERS IN THESE CD8(+) T CELLS. FINALLY, WE HAVE REPORTED THAT EPIGENETIC MODULATION REDUCES FOXP3 BINDING TO THESE PROMOTER REGIONS. THIS REVIEW COMPARES AND CONTRASTS OUR CURRENT UNDERSTANDING OF CD8(+) T CELL EPIGENETICS AND MECHANISMS OF LYMPHOCYTE SUPPRESSION DURING THE COURSE OF LENTIVIRAL INFECTION FOR TWO ANIMAL MODELS, FIV AND SIMIAN IMMUNODEFICIENCY VIRUS (SIV). 2018 18 5358 25 REBALANCING TGFBETA1/BMP SIGNALS IN EXHAUSTED T CELLS UNLOCKS RESPONSIVENESS TO IMMUNE CHECKPOINT BLOCKADE THERAPY. T CELL DYSFUNCTIONALITY PREVENTS THE CLEARANCE OF CHRONIC INFECTIONS AND CANCER. FURTHERMORE, EPIGENETIC PROGRAMMING IN DYSFUNCTIONAL CD8(+) T CELLS LIMITS THEIR RESPONSE TO IMMUNOTHERAPIES, INCLUDING IMMUNE CHECKPOINT BLOCKADE (ICB). HOWEVER, IT IS UNCLEAR WHICH UPSTREAM SIGNALS DRIVE ACQUISITION OF DYSFUNCTIONAL EPIGENETIC PROGRAMS, AND WHETHER THERAPEUTICALLY TARGETING THESE SIGNALS CAN REMODEL TERMINALLY DYSFUNCTIONAL T CELLS TO AN ICB-RESPONSIVE STATE. HERE WE INNOVATE AN IN VITRO MODEL SYSTEM OF STABLE HUMAN T CELL DYSFUNCTION AND SHOW THAT CHRONIC TGFBETA1 SIGNALING IN POSTEFFECTOR CD8(+) T CELLS ACCELERATES THEIR TERMINAL DYSFUNCTION THROUGH STABLE EPIGENETIC CHANGES. CONVERSELY, BOOSTING BONE MORPHOGENETIC PROTEIN (BMP) SIGNALING WHILE BLOCKING TGFBETA1 PRESERVED EFFECTOR AND MEMORY PROGRAMS IN CHRONICALLY STIMULATED HUMAN CD8(+) T CELLS, INDUCING SUPERIOR RESPONSES TO TUMORS AND SYNERGIZING THE ICB RESPONSES DURING CHRONIC VIRAL INFECTION. THUS, REBALANCING TGFBETA1/BMP SIGNALS PROVIDES AN EXCITING NEW APPROACH TO UNLEASH DYSFUNCTIONAL CD8(+) T CELLS AND ENHANCE T CELL IMMUNOTHERAPIES. 2023 19 3054 31 GENOME-WIDE CRISPR SCREENS OF T CELL EXHAUSTION IDENTIFY CHROMATIN REMODELING FACTORS THAT LIMIT T CELL PERSISTENCE. T CELL EXHAUSTION LIMITS ANTITUMOR IMMUNITY, BUT THE MOLECULAR DETERMINANTS OF THIS PROCESS REMAIN POORLY UNDERSTOOD. USING A CHRONIC STIMULATION ASSAY, WE PERFORMED GENOME-WIDE CRISPR-CAS9 SCREENS TO SYSTEMATICALLY DISCOVER REGULATORS OF T CELL EXHAUSTION, WHICH IDENTIFIED AN ENRICHMENT OF EPIGENETIC FACTORS. IN VIVO CRISPR SCREENS IN MURINE AND HUMAN TUMOR MODELS DEMONSTRATED THAT PERTURBATION OF THE INO80 AND BAF CHROMATIN REMODELING COMPLEXES IMPROVED T CELL PERSISTENCE IN TUMORS. IN VIVO PERTURB-SEQ REVEALED DISTINCT TRANSCRIPTIONAL ROLES OF EACH COMPLEX AND THAT DEPLETION OF CANONICAL BAF COMPLEX MEMBERS, INCLUDING ARID1A, RESULTED IN THE MAINTENANCE OF AN EFFECTOR PROGRAM AND DOWNREGULATION OF EXHAUSTION-RELATED GENES IN TUMOR-INFILTRATING T CELLS. FINALLY, ARID1A DEPLETION LIMITED THE ACQUISITION OF EXHAUSTION-ASSOCIATED CHROMATIN ACCESSIBILITY AND LED TO IMPROVED ANTITUMOR IMMUNITY. IN SUMMARY, WE PROVIDE AN ATLAS OF THE GENETIC REGULATORS OF T CELL EXHAUSTION AND DEMONSTRATE THAT MODULATION OF EPIGENETIC STATE CAN IMPROVE T CELL RESPONSES IN CANCER IMMUNOTHERAPY. 2022 20 6522 39 TRANSCRIPTIONAL AND EPIGENETIC REGULATION OF T CELL HYPORESPONSIVENESS. NAIVE CD8(+) T CELLS DIFFERENTIATE INTO EFFECTOR AND MEMORY CYTOLYTIC T CELLS (CTLS) DURING AN ACUTE INFECTION. IN CONTRAST, IN SCENARIOS OF PERSISTENT ANTIGEN STIMULATION, SUCH AS CHRONIC INFECTIONS AND CANCER, ANTIGEN-SPECIFIC CTLS SHOW A GRADUAL DECREASE IN EFFECTOR FUNCTION, A PHENOMENON THAT HAS BEEN TERMED CD8(+) T CELL "EXHAUSTION" OR "DYSFUNCTION." ANOTHER HYPORESPONSIVE STATE, TERMED "ANERGY", IS OBSERVED WHEN T CELLS ARE ACTIVATED IN THE ABSENCE OF POSITIVE COSTIMULATORY SIGNALS. AMONG THE MANY NEGATIVE REGULATORS INDUCED IN HYPORESPONSIVE T CELLS ARE INHIBITORY CELL-SURFACE RECEPTORS, SUCH AS PD-1, LAG-3, CTLA-4, AND TIM-3; "CHECKPOINT BLOCKADE" THERAPIES THAT INVOLVE TREATMENT OF PATIENTS WITH CANCER WITH BLOCKING ANTIBODIES TO THOSE RECEPTORS SHOW CONSIDERABLE PROMISE IN THE CLINIC BECAUSE THE BLOCKING ANTIBODIES CAN MITIGATE HYPORESPONSIVENESS AND PROMOTE TUMOR REJECTION. IN THIS REVIEW, WE DESCRIBE RECENT ADVANCES IN OUR MOLECULAR UNDERSTANDING OF THESE HYPORESPONSIVE STATES. WE REVIEW EVIDENCE FOR THE INVOLVEMENT OF DIVERSE TRANSCRIPTION FACTORS, METABOLIC PROGRAMS, AND CHROMATIN ACCESSIBILITY CHANGES IN HYPORESPONSIVE T CELLS, AND WE DISCUSS HOW CHECKPOINT BLOCKADE THERAPIES AFFECT THE MOLECULAR PROGRAM OF CD8(+) T CELL EXHAUSTION. 2017