Abstract LT02: Regulation of Exhausted CD8+ T cell Differentiation by IKZF Transcription Factors
Authors: Reading Sinead M. , Munoz Isabelle , de Menezes Maria N. , Saw Nicole Y. L. , Ambani Krutika , Ahn Antonio , Nussing Simone , Roth Sara , Sampurno Shienny , Ramsbottom Kelly M. , Trapani Joseph A. , Good-Jacobson Kim L. , Johnstone Ricky W. , Goel Shom , Beavis Paul A. , Parish Ian A. 
Published: April 2024

Abstract
CD8+ T cells are indispensable for pathogen and tumour clearance, although can induce immunopathology if left unrestricted. T cell exhaustion, progressively programmed in the context of persistent antigen exposure, ensures partial control while mitigating immunopathological risk. However, exhaustion is characterised by curtailed proliferative capacity, cytokine production and cytotoxic functions, which tumours and chronic pathogens exploit to persist. As such, transiently disrupting exhaustion has emerged as a therapeutic strategy for treating cancer. Exhausted cells transition through multiple differentiation states, from stem-like progenitors that mediate response to checkpoint blockade, to terminal effector or exhausted cells. Unfortunately, only a fraction of patients respond to checkpoint blockade long-term, in part due to loss of the therapy responsive progenitor population. Therefore, understanding the molecular pathways moderating the exhausted states, hindering the effector populations, and promoting terminal exhaustion is essential for augmenting cancer immunotherapy. We identify IKZF transcription factors, Ikaros (IKZF1), Helios (IKZF2) and Aiolos (IKZF3), as key mediators of T cell exhaustion using gene knock-out mice and a CRISPR-mediated genetic knock-out system in both chronic infection and tumour models. We elucidate the molecular pathways involved in regulation of T cell exhaustion by IKZF transcription factor using an array of RNA sequencing, ATAC sequencing and flow cytometric validation technologies. IKZF1 and IKZF3 are critical regulators of exhausted subset expansion, retention, phenotype and cytokine function. Strikingly, dual IKZF1 and IKZF3 ablation boosts the response of anti-tumour and anti-viral exhausted T cells, potentially via the formation of atypical, exhausted T cell populations and the enrichment of functional exhausted subsets. Excitingly, dual ablation vastly improves survival and tumour control in a solid tumour, HER2-specific CAR T cell model. Cumulatively, our data highlight a novel role for IKZF transcription factors in biasing exhausted T cell differentiation and provides potentially important clinical implications, directing future cancer immunotherapies targeting T cell exhaustion.
Citation Format: Sinead M. Reading, Isabelle Munoz, Maria N. de Menezes, Nicole Y. L. Saw, Krutika Ambani, Antonio Ahn, Simone Nussing, Sara Roth, Shienny Sampurno, Kelly M. Ramsbottom, Joseph A. Trapani, Kim L. Good-Jacobson, Ricky W. Johnstone, Shom Goel, Paul A. Beavis, Ian A. Parish. Regulation of Exhausted CD8+ T cell Differentiation by IKZF Transcription Factors [abstract]. In: Proceedings of Frontiers in Cancer Science; 2023 Nov 6-8; Singapore. Philadelphia (PA): AACR; Cancer Res 2024;84(8_Suppl):Abstract nr LT02.