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Limiting CD4+T cell responses is important to prevent solid organ transplant rejection. In a mouse model of costimulation blockade-dependent cardiac allograft tolerance, we previously reported that alloreactive CD4+conventional T cells (Tconvs) develop dysfunction, losing proliferative capacity. In parallel, induction of transplantation tolerance is dependent on the presence of regulatory T cells (Tregs). Whether susceptibility of CD4+Tconvs to Treg suppression is modulated during tolerance induction is unknown. We found that alloreactive Tconvs from transplant tolerant mice had augmented sensitivity to Treg suppression when compared with memory T cells from rejector mice and expressed a transcriptional profile distinct from these memory T cells, including down-regulated expression of the transcription factor Special AT-rich sequence-binding protein 1 (Satb1). Mechanistically, Satb1 deficiency in CD4+T cells limited their expression of CD25 and IL-2, and addition of Tregs, which express higher levels of CD25 than Satb1-deficient Tconvs and successfully competed for IL-2, resulted in greater suppression of Satb1-deficient than wild-type Tconvs in vitro. In vivo, Satb1-deficient Tconvs were more susceptible to Treg suppression, resulting in significantly prolonged skin allograft survival. Overall, our study reveals that transplantation tolerance is associated with Tconvs’ susceptibility to Treg suppression, via modulated expression of Tconv-intrinsic Satb1. Targeting Satb1 in the context of Treg-sparing immunosuppressive therapies might be exploited to improve transplant outcomes.

Introduction: A single arm trial (NCT007773097) and a double-blind, placebo controlled randomized trial (NCT02134925) were conducted in patients with newly diagnosed advanced colonic adenomas to test the safety and immunogenicity of the MUC1 antigen vaccine and its potential to prevent new adenoma formation. These are the first trials of a non-viral cancer vaccine administered in the absence of cancer. In both trials, the vaccine was safe and strongly immunogenic in 43% and 25% of participants (Responders), respectively. The lack of robust response in a significant number of participants suggested, for the first time, that even in a premalignant setting, the immune system may have already been exposed to regulatory influences that, in the case of the vaccine, determine who does and who does not respond. We hypothesized that there could be molecular and cellular differences in the immune competence between vaccine responders and non-responders, and that they could be identified by studying their pre-vaccination peripheral blood mononuclear cells (PBMCs). Methods: The two MUC1 vaccine trials are described in https://doi.org/10.1101/2022.10.05.22280474 and https://doi.org/10.1158%2F1940-6207.CAPR-12-0275. We performed single cell RNA-sequencing (scRNAseq) on banked pre-vaccination PBMCs from 16 Responders and 16 Non-Responders, determined by anti-MUC1 IgG response. Using differential gene expression (DGE), pathway enrichment, and network estimation analyses, we identified specific cell types, genes, and pathways that differ between responders and non-responders. Results: Pre-vaccination PBMCs from Responders contained a significantly higher percentage of CD4+ naive T cells, while Non-Responders showed significantly higher percentage of CD8+ T effector memory (TEM) cells and a higher percentage of CD16+ monocytes. DGE and gene interaction network analysis showed a higher level of expression of T cell activation genes, such as Fos and Jun, in the CD4+ naive T cells in Responders. Further network analysis showed that these genes were directly connected to response. We also found pre-vaccination specific gene ontology (GO) pathways for translational and transcriptional activity enriched in all cell types in Responders compared to Non-Responders. Conclusion: Our analyses identified candidate biomarkers that are predictive of a preventative cancer vaccine response. Thus, our results can be used for patient selection for vaccine administration. Furthermore, we identified cell type differences and transcriptional pathways that provide information of possible mechanisms of vaccine response. Citation Format: Daniel Y. Yuan, Michelle L. McKeague, Matthew T. Dracz, Olivera J. Finn, Panayiotis V. Benos. Single cell transcriptomics uncovers cellular and molecular differences in PBMCs of responders and non-responders to the MUC1 cancer vaccine given in the preventative setting [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 6537.

During premalignant and malignant transformation, cells undergo antigenic changes that can be recognized by the immune system, and this can be leveraged both for immune prevention and therapy. One such change occurs with MUC1, or Mucin-1, a large variable number tandem repeat (VNTR)-containing transmembrane protein that is overexpressed and hypoglycosylated on a majority of precancerous and adenocarcinoma cells, including those of the colon, lung, breast, pancreas and ovaries. This tumor form of MUC1 is recognized by both cellular and humoral immunity. Healthy individuals at high risk of developing colon cancer due to a history of colonic polyps were enrolled in a clinical trial testing the feasibility of prophylactic vaccination against the tumor form of MUC1, also expressed on polyps (Kimura et al., 2013). Half the participants generated high levels of anti-MUC1 IgG antibodies, some of which were cloned to further analyze their tumor specificity and to potentially develop them as therapeutics for patients with cancer (Lohmueller et al., 2016). As these fully human IgG1 monoclonal antibodies (mAbs) were selected and affinity matured in healthy individuals who experienced no negative side effects to the vaccine in >10 years, it increases the likelihood that as therapeutics they will be safe. To study anti-tumor efficacy and mechanism(s) of action of 12 of these mAbs, tumor cells were co-incubated with immune cells in the presence of the mAbs, and each mAb’s ability to mediate antibody-dependent cellular cytotoxicity (ADCC) by NK cells, antibody-dependent cellular phagocytosis (ADCP) by monocytes, antibody-dependent trogocytosis/trogoptosis (ADCT) by neutrophils, antibody-dependent cytokine release (ADCR) and complement dependent cytotoxicity (CDC) was assessed. Several MUC1 mAbs examined could mediate ADCC, ADCP, ADCT and ADCR, with some mechanisms being cell-line dependent. One mAb was selected for in vivo testing and found to delay breast cancer growth and prolong survival in immunocompromised mice lacking T cells, B cells and NK cells, pointing to ADCP and ADCT as important anti-tumor functions. Additionally, the relationship between epitope location and immune effector functions was explored by creating different MUC1 constructs that vary epitope distance from the cell surface, number of epitopes, etc, to test properties of the target antigen that may affect antibody efficacy. These latter experiments revealed an increased efficiency in phagocytosis and trogocytosis when the mAbs bound an epitope that was both proximal to and anchored to the membrane. Notably, unlike published studies of rituximab and alemtuzumab, the amount of MUC1 mAb binding did not always correlate with increased effector function. Our results may inform not only the development of these MUC1-based therapies but more broadly future therapeutic mAb design against a variety of targets. Citation Format: Michelle L. McKeague, Jason Lohmueller, Matthew T. Dracz, Najla Saadallah, Jia Xue, Eric D. Ricci, William Lu, Olivera J. Finn. Patient-derived, vaccine-elicited, anti-MUC1 antibodies directly target tumor cells for elimination via multiple immune mechanisms [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr LB179.