1 4866 126 ORTHOGONAL CRISPR SCREENS TO IDENTIFY TRANSCRIPTIONAL AND EPIGENETIC REGULATORS OF HUMAN CD8 T CELL FUNCTION. THE CLINICAL RESPONSE TO ADOPTIVE T CELL THERAPIES IS STRONGLY ASSOCIATED WITH TRANSCRIPTIONAL AND EPIGENETIC STATE. THUS, TECHNOLOGIES TO DISCOVER REGULATORS OF T CELL GENE NETWORKS AND THEIR CORRESPONDING PHENOTYPES HAVE GREAT POTENTIAL TO IMPROVE THE EFFICACY OF T CELL THERAPIES. WE DEVELOPED POOLED CRISPR SCREENING APPROACHES WITH COMPACT EPIGENOME EDITORS TO SYSTEMATICALLY PROFILE THE EFFECTS OF ACTIVATION AND REPRESSION OF 120 TRANSCRIPTION FACTORS AND EPIGENETIC MODIFIERS ON HUMAN CD8+ T CELL STATE. THESE SCREENS NOMINATED KNOWN AND NOVEL REGULATORS OF T CELL PHENOTYPES WITH BATF3 EMERGING AS A HIGH CONFIDENCE GENE IN BOTH SCREENS. WE FOUND THAT BATF3 OVEREXPRESSION PROMOTED SPECIFIC FEATURES OF MEMORY T CELLS SUCH AS INCREASED IL7R EXPRESSION AND GLYCOLYTIC CAPACITY, WHILE ATTENUATING GENE PROGRAMS ASSOCIATED WITH CYTOTOXICITY, REGULATORY T CELL FUNCTION, AND T CELL EXHAUSTION. IN THE CONTEXT OF CHRONIC ANTIGEN STIMULATION, BATF3 OVEREXPRESSION COUNTERED PHENOTYPIC AND EPIGENETIC SIGNATURES OF T CELL EXHAUSTION. CAR T CELLS OVEREXPRESSING BATF3 SIGNIFICANTLY OUTPERFORMED CONTROL CAR T CELLS IN BOTH IN VITRO AND IN VIVO TUMOR MODELS. MOREOVER, WE FOUND THAT BATF3 PROGRAMMED A TRANSCRIPTIONAL PROFILE THAT CORRELATED WITH POSITIVE CLINICAL RESPONSE TO ADOPTIVE T CELL THERAPY. FINALLY, WE PERFORMED CRISPR KNOCKOUT SCREENS WITH AND WITHOUT BATF3 OVEREXPRESSION TO DEFINE CO-FACTORS AND DOWNSTREAM FACTORS OF BATF3, AS WELL AS OTHER THERAPEUTIC TARGETS. THESE SCREENS POINTED TO A MODEL WHERE BATF3 INTERACTS WITH JUNB AND IRF4 TO REGULATE GENE EXPRESSION AND ILLUMINATED SEVERAL OTHER NOVEL TARGETS FOR FURTHER INVESTIGATION. 2023 2 1054 36 CLINICAL IMPLICATIONS OF T CELL EXHAUSTION FOR CANCER IMMUNOTHERAPY. IMMUNOTHERAPY HAS BEEN A REMARKABLE CLINICAL ADVANCEMENT IN THE TREATMENT OF CANCER. T CELLS ARE PIVOTAL TO THE EFFICACY OF CURRENT CANCER IMMUNOTHERAPIES, INCLUDING IMMUNE-CHECKPOINT INHIBITORS AND ADOPTIVE CELL THERAPIES. HOWEVER, CANCER IS ASSOCIATED WITH T CELL EXHAUSTION, A HYPOFUNCTIONAL STATE CHARACTERIZED BY PROGRESSIVE LOSS OF T CELL EFFECTOR FUNCTIONS AND SELF-RENEWAL CAPACITY. THE 'UN-EXHAUSTING' OF T CELLS IN THE TUMOUR MICROENVIRONMENT IS COMMONLY REGARDED AS A KEY MECHANISM OF ACTION FOR IMMUNE-CHECKPOINT INHIBITORS, AND T CELL EXHAUSTION IS CONSIDERED A PATHWAY OF RESISTANCE FOR CELLULAR IMMUNOTHERAPIES. SEVERAL ELEGANT STUDIES HAVE PROVIDED IMPORTANT INSIGHTS INTO THE TRANSCRIPTIONAL AND EPIGENETIC PROGRAMMES THAT GOVERN T CELL EXHAUSTION. IN THIS REVIEW, WE HIGHLIGHT RECENT DISCOVERIES RELATED TO THE IMMUNOBIOLOGY OF T CELL EXHAUSTION THAT OFFER A MORE NUANCED PERSPECTIVE BEYOND THIS HYPOFUNCTIONAL STATE BEING ENTIRELY UNDESIRABLE. WE REVIEW EVIDENCE THAT T CELL EXHAUSTION MIGHT BE AS MUCH A REFLECTION AS IT IS THE CAUSE OF POOR TUMOUR CONTROL. FURTHERMORE, WE HYPOTHESIZE THAT, IN CERTAIN CONTEXTS OF CHRONIC ANTIGEN STIMULATION, INTERRUPTION OF THE EXHAUSTION PROGRAMME MIGHT IMPAIR T CELL PERSISTENCE. THEREFORE, THE PRIORITIZATION OF INTERVENTIONS THAT MITIGATE THE DEVELOPMENT OF T CELL EXHAUSTION, INCLUDING ORTHOGONAL CYTOREDUCTION THERAPIES AND NOVEL CELLULAR ENGINEERING STRATEGIES, MIGHT ULTIMATELY CONFER SUPERIOR CLINICAL OUTCOMES AND THE GREATEST ADVANCES IN CANCER IMMUNOTHERAPY. 2022 3 3288 28 HIERARCHICAL TRANSCRIPTIONAL NETWORK GOVERNING HETEROGENEOUS T CELL EXHAUSTION AND ITS IMPLICATIONS FOR IMMUNE CHECKPOINT BLOCKADE. THE FUNDAMENTAL PRINCIPLE OF IMMUNE CHECKPOINT BLOCKADE (ICB) IS TO PROTECT TUMOR-INFILTRATING T CELLS FROM BEING EXHAUSTED. DESPITE THE REMARKABLE SUCCESS ACHIEVED BY ICB TREATMENT, ONLY A SMALL GROUP OF PATIENTS BENEFIT FROM IT. CHARACTERIZED BY A HYPOFUNCTIONAL STATE WITH THE EXPRESSION OF MULTIPLE INHIBITORY RECEPTORS, EXHAUSTED T (TEX) CELLS ARE A MAJOR OBSTACLE IN IMPROVING ICB. T CELL EXHAUSTION IS A PROGRESSIVE PROCESS WHICH ADAPTS TO PERSISTENT ANTIGEN STIMULATION IN CHRONIC INFECTIONS AND CANCERS. IN THIS REVIEW, WE ELUCIDATE THE HETEROGENEITY OF TEX CELLS AND OFFER NEW INSIGHTS INTO THE HIERARCHICAL TRANSCRIPTIONAL REGULATION OF T CELL EXHAUSTION. FACTORS AND SIGNALING PATHWAYS THAT INDUCE AND PROMOTE EXHAUSTION ARE ALSO SUMMARIZED. MOREOVER, WE REVIEW THE EPIGENETIC AND METABOLIC ALTERATIONS OF TEX CELLS AND DISCUSS HOW PD-1 SIGNALING AFFECTS THE BALANCE BETWEEN T CELL ACTIVATION AND EXHAUSTION, AIMING TO PROVIDE MORE THERAPEUTIC TARGETS FOR APPLICATIONS OF COMBINATIONAL IMMUNOTHERAPIES. 2023 4 1278 32 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 5 771 32 CD8(+) T CELL EXHAUSTION. CD8(+) T CELLS ARE IMPORTANT FOR THE PROTECTIVE IMMUNITY AGAINST INTRACELLULAR PATHOGENS AND TUMOR. IN THE CASE OF CHRONIC INFECTION OR CANCER, CD8(+) T CELLS ARE EXPOSED TO PERSISTENT ANTIGEN AND/OR INFLAMMATORY SIGNALS. THIS EXCESSIVE AMOUNT OF SIGNALS OFTEN LEADS CD8(+) T CELLS TO GRADUAL DETERIORATION OF T CELL FUNCTION, A STATE CALLED "EXHAUSTION." EXHAUSTED T CELLS ARE CHARACTERIZED BY PROGRESSIVE LOSS OF EFFECTOR FUNCTIONS (CYTOKINE PRODUCTION AND KILLING FUNCTION), EXPRESSION OF MULTIPLE INHIBITORY RECEPTORS (SUCH AS PD-1 AND LAG3), DYSREGULATED METABOLISM, POOR MEMORY RECALL RESPONSE, AND HOMEOSTATIC PROLIFERATION. THESE ALTERED FUNCTIONS ARE CLOSELY RELATED WITH ALTERED TRANSCRIPTIONAL PROGRAM AND EPIGENETIC LANDSCAPE THAT CLEARLY DISTINGUISH EXHAUSTED T CELLS FROM NORMAL EFFECTOR AND MEMORY T CELLS. T CELL EXHAUSTION IS OFTEN ASSOCIATED WITH INEFFICIENT CONTROL OF PERSISTING INFECTIONS AND CANCERS, BUT RE-INVIGORATION OF EXHAUSTED T CELLS WITH INHIBITORY RECEPTOR BLOCKADE CAN PROMOTE IMPROVED IMMUNITY AND DISEASE OUTCOME. ACCUMULATING EVIDENCES SUPPORT THE THERAPEUTIC POTENTIAL OF TARGETING EXHAUSTED T CELLS. HOWEVER, EXHAUSTED T CELLS COMPRISE HETEROGENOUS CELL POPULATION WITH DISTINCT RESPONSIVENESS TO INTERVENTION. UNDERSTANDING MOLECULAR MECHANISM OF T CELL EXHAUSTION IS ESSENTIAL TO ESTABLISH RATIONAL IMMUNOTHERAPEUTIC INTERVENTIONS. 2019 6 3054 32 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 7 769 34 CD8 T CELL EXHAUSTION DURING CHRONIC VIRAL INFECTION AND CANCER. EXHAUSTED CD8 T (TEX) CELLS ARE A DISTINCT CELL LINEAGE THAT ARISE DURING CHRONIC INFECTIONS AND CANCERS IN ANIMAL MODELS AND HUMANS. TEX CELLS ARE CHARACTERIZED BY PROGRESSIVE LOSS OF EFFECTOR FUNCTIONS, HIGH AND SUSTAINED INHIBITORY RECEPTOR EXPRESSION, METABOLIC DYSREGULATION, POOR MEMORY RECALL AND HOMEOSTATIC SELF-RENEWAL, AND DISTINCT TRANSCRIPTIONAL AND EPIGENETIC PROGRAMS. THE ABILITY TO REINVIGORATE TEX CELLS THROUGH INHIBITORY RECEPTOR BLOCKADE, SUCH AS ALPHAPD-1, HIGHLIGHTS THE THERAPEUTIC POTENTIAL OF TARGETING THIS POPULATION. EMERGING INSIGHTS INTO THE MECHANISMS OF EXHAUSTION ARE INFORMING IMMUNOTHERAPIES FOR CANCER AND CHRONIC INFECTIONS. HOWEVER, LIKE OTHER IMMUNE CELLS, TEX CELLS ARE HETEROGENEOUS AND INCLUDE PROGENITOR AND TERMINAL SUBSETS WITH UNIQUE CHARACTERISTICS AND RESPONSES TO CHECKPOINT BLOCKADE. HERE, WE REVIEW OUR CURRENT UNDERSTANDING OF TEX CELL BIOLOGY, INCLUDING THE DEVELOPMENTAL PATHS, TRANSCRIPTIONAL AND EPIGENETIC FEATURES, AND CELL INTRINSIC AND EXTRINSIC FACTORS CONTRIBUTING TO EXHAUSTION AND HOW THIS KNOWLEDGE MAY INFORM THERAPEUTIC TARGETING OF TEX CELLS IN CHRONIC INFECTIONS, AUTOIMMUNITY, AND CANCER. 2019 8 790 24 CELLULAR AND MOLECULAR MECHANISMS OF CD8(+) T CELL DIFFERENTIATION, DYSFUNCTION AND EXHAUSTION. T CELLS FOLLOW A TRIPHASIC DISTINCT PATHWAY OF ACTIVATION, PROLIFERATION AND DIFFERENTIATION BEFORE BECOMING FUNCTIONALLY AND PHENOTYPICALLY "EXHAUSTED" IN SETTINGS OF CHRONIC INFECTION, AUTOIMMUNITY AND IN CANCER. EXHAUSTED T CELLS PROGRESSIVELY LOSE CANONICAL EFFECTOR FUNCTIONS, EXHIBIT ALTERED TRANSCRIPTIONAL NETWORKS AND EPIGENETIC SIGNATURES AND GAIN CONSTITUTIVE EXPRESSION OF A BROAD COINHIBITORY RECEPTOR SUITE. THIS REVIEW OUTLINES RECENT ADVANCES IN OUR UNDERSTANDING OF EXHAUSTED T CELL BIOLOGY AND EXAMINES CELLULAR AND MOLECULAR MECHANISMS BY WHICH A STATE OF DYSFUNCTION OR EXHAUSTION IS ESTABLISHED, AND MECHANISMS BY WHICH EXHAUSTED T CELLS MAY STILL CONTRIBUTE TO PATHOGEN OR TUMOUR CONTROL. FURTHER, THIS REVIEW DESCRIBES OUR UNDERSTANDING OF EXHAUSTED T CELL HETEROGENEITY AND OUTLINES THE MECHANISMS BY WHICH CHECKPOINT BLOCKADE DIFFERENTIALLY ENGAGES EXHAUSTED T CELL SUBSETS TO OVERCOME EXHAUSTION AND RECOVER T CELL FUNCTION. 2020 9 4177 40 MEMORY T CELL, EXHAUSTION, AND TUMOR IMMUNITY. CD8(+)T CELLS ARE IMPORTANT IN PROTECTIVE IMMUNITY AGAINST INTRACELLULAR PATHOGENS AND TUMORS. IN CHRONIC INFECTIONS OR CANCER, CD8(+)T CELLS ARE CONSTANTLY EXPOSED TO ANTIGENS AND INFLAMMATORY SIGNALS. SUCH EXCESSIVE AND CONSTITUTIVE SIGNALS LEAD TO THE DETERIORATION OF T CELL FUNCTION, CALLED 'EXHAUSTION'. EXHAUSTED T CELLS ARE CHARACTERIZED BY LOW PROLIFERATION IN RESPONSE TO ANTIGEN STIMULATION, PROGRESSIVE LOSS OF EFFECTOR FUNCTION (CYTOKINE PRODUCTION AND KILLING FUNCTION), EXPRESSION OF MULTIPLE INHIBITORY RECEPTORS SUCH AS PD-1, TIM3, AND LAG3, AND METABOLIC ALTERATIONS FROM OXIDATIVE PHOSPHORYLATION TO GLYCOLYSIS. THESE DYSFUNCTIONS ARE ASSOCIATED WITH ALTERED TRANSCRIPTIONAL PROGRAMS AND EPIGENETIC REGULATIONS AND RECENT STUDIES SUGGESTED THAT NR4A AND TOX TRANSCRIPTION FACTORS ARE DEEPLY INVOLVED IN EXHAUSTION PHENOTYPES. HOWEVER, AN INCREASE THE EARLY MEMORY T CELLS INCLUDING STEM CELL MEMORY T (T(SCM)) CELLS IS CRITICAL FOR T CELL PERSISTENCE AND EFFICIENT TUMOR KILLING ESPECIALLY FOR ADOPTIVE CANCER IMMUNOTHERAPY SUCH AS CAR-T CELL THERAPY. AN INCREASING AMOUNT OF EVIDENCE SUPPORTS THE THERAPEUTIC POTENTIAL OF TARGETING EXHAUSTED T CELLS AND T(SCM) CELLS. WE HAVE BEGUN TO UNDERSTAND THE MOLECULAR MECHANISMS OF T CELL EXHAUSTION AND EARLY MEMORY FORMATION, AND THE CLINICAL APPLICATION OF CONVERTING EXHAUSTED T CELLS TO REJUVENATED EARLY MEMORY T CELLS IS THE GOAL OF OUR STUDY. 2020 10 715 21 CAFFEINE INTAKE EXERTS DUAL GENOME-WIDE EFFECTS ON HIPPOCAMPAL METABOLISM AND LEARNING-DEPENDENT TRANSCRIPTION. CAFFEINE IS THE MOST WIDELY CONSUMED PSYCHOACTIVE SUBSTANCE IN THE WORLD. STRIKINGLY, THE MOLECULAR PATHWAYS ENGAGED BY ITS REGULAR CONSUMPTION REMAIN UNCLEAR. WE HEREIN ADDRESSED THE MECHANISMS ASSOCIATED WITH HABITUAL (CHRONIC) CAFFEINE CONSUMPTION IN THE MOUSE HIPPOCAMPUS USING UNTARGETED ORTHOGONAL OMICS TECHNIQUES. OUR RESULTS REVEALED THAT CHRONIC CAFFEINE EXERTS CONCERTED PLEIOTROPIC EFFECTS IN THE HIPPOCAMPUS AT THE EPIGENOMIC, PROTEOMIC, AND METABOLOMIC LEVELS. CAFFEINE LOWERED METABOLISM-RELATED PROCESSES (E.G., AT THE LEVEL OF METABOLOMICS AND GENE EXPRESSION) IN BULK TISSUE, WHILE IT INDUCED NEURON-SPECIFIC EPIGENETIC CHANGES AT SYNAPTIC TRANSMISSION/PLASTICITY-RELATED GENES AND INCREASED EXPERIENCE-DRIVEN TRANSCRIPTIONAL ACTIVITY. ALTOGETHER, THESE FINDINGS SUGGEST THAT REGULAR CAFFEINE INTAKE IMPROVES THE SIGNAL-TO-NOISE RATIO DURING INFORMATION ENCODING, IN PART THROUGH FINE-TUNING OF METABOLIC GENES, WHILE BOOSTING THE SALIENCE OF INFORMATION PROCESSING DURING LEARNING IN NEURONAL CIRCUITS. 2022 11 438 30 ANTIGEN-DRIVEN EGR2 EXPRESSION IS REQUIRED FOR EXHAUSTED CD8(+) T CELL STABILITY AND MAINTENANCE. CHRONIC STIMULATION OF CD8(+) T CELLS TRIGGERS EXHAUSTION, A DISTINCT DIFFERENTIATION STATE WITH DIMINISHED EFFECTOR FUNCTION. EXHAUSTED CELLS EXIST IN MULTIPLE DIFFERENTIATION STATES, FROM STEM-LIKE PROGENITORS THAT ARE THE KEY MEDIATORS OF THE RESPONSE TO CHECKPOINT BLOCKADE, THROUGH TO TERMINALLY EXHAUSTED CELLS. DUE TO ITS CLINICAL RELEVANCE, THERE IS SUBSTANTIAL INTEREST IN DEFINING THE PATHWAYS THAT CONTROL DIFFERENTIATION AND MAINTENANCE OF THESE SUBSETS. HERE, WE SHOW THAT CHRONIC ANTIGEN INDUCES THE ANERGY-ASSOCIATED TRANSCRIPTION FACTOR EGR2 SELECTIVELY WITHIN PROGENITOR EXHAUSTED CELLS IN BOTH CHRONIC LCMV AND TUMOURS. EGR2 ENABLES TERMINAL EXHAUSTION AND STABILIZES THE EXHAUSTED TRANSCRIPTIONAL STATE BY BOTH DIRECT EGR2-DEPENDENT CONTROL OF KEY EXHAUSTION-ASSOCIATED GENES, AND INDIRECT MAINTENANCE OF THE EXHAUSTED EPIGENETIC STATE. WE SHOW THAT EGR2 IS A REGULATOR OF EXHAUSTION THAT EPIGENETICALLY AND TRANSCRIPTIONALLY MAINTAINS THE DIFFERENTIATION COMPETENCY OF PROGENITOR EXHAUSTED CELLS. 2021 12 6319 40 THE ROAD LESS TAKEN: LESS APPRECIATED PATHWAYS FOR MANIPULATING CD8(+) T CELL EXHAUSTION. EXHAUSTED CD8(+) T (TEX) CELLS ARE A DISTINCT CELL POPULATION THAT ARISE DURING PERSISTENT ANTIGEN EXPOSURE IN THE CONTEXT OF CHRONIC INFECTIONS AND CANCERS. ALTHOUGH CHARACTERIZED BY PROGRESSIVE LOSS OF EFFECTOR FUNCTIONS, HIGH AND SUSTAINED INHIBITORY RECEPTOR EXPRESSION AND DISTINCT TRANSCRIPTIONAL AND EPIGENETIC PROGRAMS, TEX CELLS ARE HETEROGENEOUS. AMONG THESE, A SELF-RENEWING TCF-1(+) TEX POPULATION, HAVING UNIQUE CHARACTERISTICS AND THE ABILITY TO RESPOND TO IMMUNE-CHECKPOINT BLOCKADE, GIVES RISE TO TCF-1(-) TERMINALLY TEX CELLS. THESE TCF-1(+) CELLS HAVE STEM CELL-LIKE PROPERTIES SIMILAR TO MEMORY T CELL POPULATIONS, BUT THE SIGNALS THAT REGULATE THE DEVELOPMENTAL PATHWAYS AND RELATIONSHIPS AMONG EXHAUSTED CELL POPULATIONS ARE STILL UNCLEAR. HERE, WE REVIEW OUR CURRENT UNDERSTANDING OF TEX CELL BIOLOGY, AND DISCUSS SOME LESS APPRECIATED MOLECULES AND PATHWAYS AFFECTING T CELL EXHAUSTION. WE HIGHLIGHT TWO CO-STIMULATORY RECEPTORS, CD226 AND CD137, AND THEIR ROLE IN INDUCING OR RESTRAINING T CELL EXHAUSTION, AS WELL AS SIGNALING PATHWAYS THAT MAY BE AMENABLE TO PHARMACOLOGICAL INHIBITION WITH A FOCUS ON PHOSPHOINOSITIDE-3 KINASE AND IL-2 PARTIAL AGONISTS. FINALLY, WE DISCUSS NOVEL METHODS THAT MAY INCREASE TCF-1(+) POPULATIONS AND THEREFORE IMPROVE IMMUNOTHERAPY RESPONSIVENESS. UNDERSTANDING FEATURES OF AND PATHWAYS TO EXHAUSTION HAS IMPORTANT IMPLICATIONS FOR THE SUCCESS OF IMMUNOTHERAPY, INCLUDING CHECKPOINT BLOCKADE AND ADOPTIVE T-CELL TRANSFER THERAPIES. 2022 13 5162 30 PRECISION MEDICINE DRIVEN BY CANCER SYSTEMS BIOLOGY. MOLECULAR INSIGHTS FROM GENOME AND SYSTEMS BIOLOGY ARE INFLUENCING HOW CANCER IS DIAGNOSED AND TREATED. WE CRITICALLY EVALUATE BIG DATA CHALLENGES IN PRECISION MEDICINE. THE MELANOMA RESEARCH COMMUNITY HAS IDENTIFIED DISTINCT SUBTYPES INVOLVING CHRONIC SUN-INDUCED DAMAGE AND THE MITOGEN-ACTIVATED PROTEIN KINASE DRIVER PATHWAY. IN ADDITION, DESPITE LOW MUTATION BURDEN, NON-GENOMIC MITOGEN-ACTIVATED PROTEIN KINASE MELANOMA DRIVERS ARE FOUND IN MEMBRANE RECEPTORS, METABOLISM, OR EPIGENETIC SIGNALING WITH THE ABILITY TO BYPASS CENTRAL MITOGEN-ACTIVATED PROTEIN KINASE MOLECULES AND ACTIVATING A SIMILAR PROGRAM OF MITOGENIC EFFECTORS. MUTATION HOTSPOTS, STRUCTURAL MODELING, UV SIGNATURE, AND GENOMIC AS WELL AS NON-GENOMIC MECHANISMS OF DISEASE INITIATION AND PROGRESSION ARE TAKEN INTO CONSIDERATION TO IDENTIFY RESISTANCE MUTATIONS AND NOVEL DRUG TARGETS. A COMPREHENSIVE PRECISION MEDICINE PROFILE OF A MALIGNANT MELANOMA PATIENT ILLUSTRATES FUTURE RATIONAL DRUG TARGETING STRATEGIES. NETWORK ANALYSIS EMPHASIZES AN IMPORTANT ROLE OF EPIGENETIC AND METABOLIC MASTER REGULATORS IN ONCOGENESIS. CO-OCCURRENCE OF DRIVER MUTATIONS IN SIGNALING, METABOLIC, AND EPIGENETIC FACTORS HIGHLIGHTS HOW CUMULATIVE ALTERATIONS OF OUR GENOMES AND EPIGENOMES PROGRESSIVELY LEAD TO UNCONTROLLED CELL PROLIFERATION. PRECISION INSIGHTS HAVE THE ABILITY TO IDENTIFY INDEPENDENT MOLECULAR PATHWAYS SUITABLE FOR DRUG TARGETING. SYNERGISTIC TREATMENT COMBINATIONS OF ORTHOGONAL MODALITIES INCLUDING IMMUNOTHERAPY, MITOGEN-ACTIVATED PROTEIN KINASE INHIBITORS, EPIGENETIC INHIBITORS, AND METABOLIC INHIBITORS HAVE THE POTENTIAL TO OVERCOME IMMUNE EVASION, SIDE EFFECTS, AND DRUG RESISTANCE. 2017 14 6121 25 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 15 5358 31 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 16 5806 38 STRATEGIES TO REINVIGORATE EXHAUSTED CD8(+) T CELLS IN TUMOR MICROENVIRONMENT. CD8(+) T CELL EXHAUSTION IS A STABLE DYSFUNCTIONAL STATE DRIVEN BY CHRONIC ANTIGEN STIMULATION IN THE TUMOR MICROENVIRONMENT (TME). DIFFERENTIATION OF EXHAUSTED CD8(+) T CELLS (CD8(+) TEXS) IS ACCOMPANIED BY EXTENSIVE TRANSCRIPTIONAL, EPIGENETIC AND METABOLIC REPROGRAMMING. CD8(+) TEXS ARE MAINLY CHARACTERIZED BY IMPAIRED PROLIFERATIVE AND CYTOTOXIC CAPACITY AS WELL AS THE INCREASED EXPRESSION OF MULTIPLE CO-INHIBITORY RECEPTORS. PRECLINICAL TUMOR STUDIES AND CLINICAL COHORTS HAVE DEMONSTRATED THAT T CELL EXHAUSTION IS FIRMLY ASSOCIATED WITH POOR CLINICAL OUTCOMES IN A VARIETY OF CANCERS. MORE IMPORTANTLY, CD8(+) TEXS ARE REGARDED AS THE MAIN RESPONDER TO IMMUNE CHECKPOINT BLOCKADE (ICB). HOWEVER, TO DATE, A LARGE NUMBER OF CANCER PATIENTS HAVE FAILED TO ACHIEVE DURABLE RESPONSES AFTER ICB. THEREFORE, IMPROVING CD8(+) TEXS MAY BE A BREAKTHROUGH POINT TO REVERSE THE CURRENT DILEMMA OF CANCER IMMUNOTHERAPY AND ELIMINATE CANCERS. STRATEGIES TO REINVIGORATE CD8(+) TEXS IN TME MAINLY INCLUDE ICB, TRANSCRIPTION FACTOR-BASED THERAPY, EPIGENETIC THERAPY, METABOLISM-BASED THERAPY AND CYTOKINE THERAPY, WHICH TARGET ON DIFFERENT ASPECTS OF EXHAUSTION PROGRESSION. EACH OF THEM HAS ITS ADVANTAGES AND APPLICATION SCOPE. IN THIS REVIEW, WE MAINLY FOCUS ON THE MAJOR ADVANCES OF CURRENT STRATEGIES TO REINVIGORATE CD8(+) TEXS IN TME. WE SUMMARIZE THEIR EFFICACY AND MECHANISMS, IDENTIFY THE PROMISING MONOTHERAPY AND COMBINED THERAPY AND PROPOSE SUGGESTIONS TO ENHANCE THE TREATMENT EFFICACY TO SIGNIFICANTLY BOOST ANTI-TUMOR IMMUNITY AND ACHIEVE BETTER CLINICAL OUTCOMES. 2023 17 1379 25 DEVELOPMENTAL RELATIONSHIPS OF FOUR EXHAUSTED CD8(+) T CELL SUBSETS REVEALS UNDERLYING TRANSCRIPTIONAL AND EPIGENETIC LANDSCAPE CONTROL MECHANISMS. CD8(+) T CELL EXHAUSTION IS A MAJOR BARRIER TO CURRENT ANTI-CANCER IMMUNOTHERAPIES. DESPITE THIS, THE DEVELOPMENTAL BIOLOGY OF EXHAUSTED CD8(+) T CELLS (TEX) REMAINS POORLY DEFINED, RESTRAINING IMPROVEMENT OF STRATEGIES AIMED AT "RE-INVIGORATING" TEX CELLS. HERE, WE DEFINED A FOUR-CELL-STAGE DEVELOPMENTAL FRAMEWORK FOR TEX CELLS. TWO TCF1(+) PROGENITOR SUBSETS WERE IDENTIFIED, ONE TISSUE RESTRICTED AND QUIESCENT AND ONE MORE BLOOD ACCESSIBLE, THAT GRADUALLY LOST TCF1 AS IT DIVIDED AND CONVERTED TO A THIRD INTERMEDIATE TEX SUBSET. THIS INTERMEDIATE SUBSET RE-ENGAGED SOME EFFECTOR BIOLOGY AND INCREASED UPON PD-L1 BLOCKADE BUT ULTIMATELY CONVERTED INTO A FOURTH, TERMINALLY EXHAUSTED SUBSET. BY USING TRANSCRIPTIONAL AND EPIGENETIC ANALYSES, WE IDENTIFIED THE CONTROL MECHANISMS UNDERLYING SUBSET TRANSITIONS AND DEFINED A KEY INTERPLAY BETWEEN TCF1, T-BET, AND TOX IN THE PROCESS. THESE DATA REVEAL A FOUR-STAGE DEVELOPMENTAL HIERARCHY FOR TEX CELLS AND DEFINE THE MOLECULAR, TRANSCRIPTIONAL, AND EPIGENETIC MECHANISMS THAT COULD PROVIDE OPPORTUNITIES TO IMPROVE CANCER IMMUNOTHERAPY. 2020 18 5620 36 SCHRODINGER'S T CELLS: MOLECULAR INSIGHTS INTO STEMNESS AND EXHAUSTION. T CELL STEMNESS AND EXHAUSTION COEXIST AS TWO KEY CONTRASTING PHENOMENA DURING CHRONIC ANTIGEN STIMULATION, SUCH AS INFECTION, TRANSPLANT, CANCER, AND AUTOIMMUNITY. T CELL EXHAUSTION REFERS TO THE PROGRESSIVE LOSS OF EFFECTOR FUNCTION CAUSED BY CHRONIC ANTIGEN EXPOSURE. EXHAUSTED T (T(EX)) CELLS HIGHLY EXPRESS MULTIPLE INHIBITORY RECEPTORS AND EXHIBIT SEVERE DEFECTS IN CELL PROLIFERATION AND CYTOKINE PRODUCTION. THE TERM T CELL STEMNESS DESCRIBES THE STEM CELL-LIKE BEHAVIORS OF T CELLS, INCLUDING SELF-RENEWAL, MULTIPOTENCY, AND FUNCTIONAL PERSISTENCE. IT IS WELL ACCEPTED THAT NAIVE AND SOME MEMORY T CELL SUBSETS HAVE STEM CELL-LIKE PROPERTIES. WHEN INVESTIGATING THE EXHAUSTIVE DIFFERENTIATION OF T CELLS IN CHRONIC INFECTION AND CANCER, RECENT STUDIES HIGHLIGHTED THE STEMNESS OF "PRECURSORS OF EXHAUSTED" T (T(PEX)) CELLS PRIOR TO THEIR TERMINAL DIFFERENTIATION TO T(EX) CELLS. CLINICALLY SUCCESSFUL CHECKPOINT BLOCKADES FOR CANCER TREATMENT APPEAR TO INVIGORATE ANTITUMOR T(PEX) CELLS BUT NOT T(EX) CELLS. HERE WE DISCUSS THE TRANSCRIPTIONAL AND EPIGENETIC REGULATIONS OF T CELL STEMNESS AND EXHAUSTION, WITH A FOCUS ON HOW SYSTEMS IMMUNOLOGY WAS AND WILL BE UTILIZED TO DEFINE THE MOLECULAR BASIS UNDERLYING THE TRANSITION OF T(PEX) TO T(EX) CELLS. WE SUGGEST A "STEPWISE MODEL" OF T CELL STEMNESS AND EXHAUSTION, IN WHICH LOSS OF STEMNESS AND EXHAUSTION PROGRESSION ARE GRADUAL MULTI-STEP PROCESSES. WE PROVIDE PERSPECTIVES ON THE RESEARCH NEEDED TO DEFINE T CELL STEMNESS AND EXHAUSTION IN THE TRANSPLANTATION SETTING, IN WHICH ALLOGENIC T CELLS ARE ALSO CHRONICALLY EXPOSED TO ALLOANTIGENS. A BETTER UNDERSTANDING OF T CELL STEMNESS AND EXHAUSTION WILL SHED LIGHT ON DEVELOPING NOVEL STRATEGIES FOR IMMUNOTHERAPIES. 2021 19 6851 39 [MOLECULAR PROFILES OF EXHAUSTED T CELLS AND THEIR IMPACT ON RESPONSE TO IMMUNE CHECKPOINT BLOCKADE]. T CELL EXHAUSTION IS INDUCED IN THE CONTEXT OF CHRONIC VIRUS INFECTION AND TUMOR MICROENVIRONMENT, IN WHICH CYTOTOXIC T CELLS ARE REPEATEDLY EXPOSED TO THE TARGET ANTIGEN AND DEPRIVED OF THEIR EFFECTOR FUNCTIONS. MULTIPLE STUDIES HAVE ALREADY SHOWN THE SIGNIFICANT IMPACT OF IMMUNE CHECKPOINT MOLECULES SUCH AS PD1 ON FUNCTIONAL PROPERTIES OF EXHAUSTED T CELLS. IN ADDITION TO THESE SIGNALS, EXHAUSTED T CELLS POSSESS DISTINCT TRANSCRIPTIONAL AND EPIGENETIC PROFILES COMPARED WITH CONVENTIONAL EFFECTOR AND MEMORY T CELLS. IMPORTANTLY, MOST OF THESE FEATURES ARE NOT AFFECTED BY IMMUNE CHECKPOINT BLOCKADE, SUGGESTING THAT GENETIC AND EPIGENETIC REMODELING OF T CELLS IS AN UNDERLYING MOLECULAR MECHANISM ESSENTIAL FOR T CELL EXHAUSTION. MOREOVER, IT HAS NOW BEEN EVIDENT THAT EXHAUSTED T CELLS ARE A HETEROGENEOUS CELL POPULATION COMPOSED OF DISTINCT T CELL SUBSETS, AND THESE FUNCTIONAL DIFFERENCES PROFOUNDLY AFFECT THERAPEUTIC EFFICACY OF CANCER IMMUNOTHERAPY. IN THIS REVIEW, I WILL DISCUSS RECENT STUDIES INVESTIGATING MOLECULAR MECHANISMS OF T CELL EXHAUSTION, INCLUDING NOVEL KEY MOLECULES ESSENTIALLY ASSOCIATED WITH T CELL EXHAUSTION. THESE FINDINGS ARE POTENTIALLY APPLICABLE TO REINVIGORATE EFFECTOR FUNCTIONS OF EXHAUSTED T CELLS. 2022 20 833 13 CHARTING A SHARED EPIGENETIC PATHWAY TO CD8(+) T CELL DYSFUNCTION IN INFECTION AND CANCER. PRITYKIN ET AL. (2021) ESTABLISH A COMPREHENSIVE CHROMATIN ATLAS OF CD8(+) T CELL DYSFUNCTION IN CHRONIC VIRAL INFECTION AND CANCER VIA ANALYSIS OF BULK AND SINGLE-CELL ATAC-SEQ DATASETS ACROSS IMMUNE CHALLENGES. THESE RESULTS UNIFY THE CLASSIFICATION SCHEME AND MOLECULAR PROGRAMS DRIVING CD8(+) T CELL DYSFUNCTION ACROSS DISEASE SETTINGS AND WILL FACILITATE BASIC DISCOVERY AND TRANSLATIONAL EFFORTS IN T CELL IMMUNITY. 2021