Abstract Redirecting patient’s endogenous T cells to safely and effectively eradicate tumors continues to offer compelling therapeutic opportunities. We found that EVOLVE, a trispecific antibody targeting a tumor-specific antigen together with integrated CD3 activation and CD2 costimulation, led to unique T cell activation profiles. Like the events observed with intact or artificial antigen presenting cells, these trispecific antibodies were sufficient to trigger the formation of a CD2 corolla surrounding the immunological synapse, independent of membrane CD58, on 95% primary human T cells, in a tumor-antigen dependent manner, compared to 20% observed with CD3-matched bispecifics. Trispecific antibodies demonstrated significant functional advantages over conventional bispecific antibodies, with corolla-associated signaling leading to a 1.6-fold amplification of T cell activation events. This resulted in an over 10-fold increase in killing potency against high-antigen-expressing tumor cells and a 20-fold enhancement of killing potency against low-antigen-expressing tumor cells. These findings provide fundamental insights into the CD2 tropism for corolla localization, even when the CD2 and CD3 ligands are covalently linked to each other, confirming the potential for EVOLVE to initiate CD2-costimulatory signaling at the T cell synapse, thereby enhancing the therapeutic efficacy of T cell engagers. Citation Format: Sergio Trombetta, Shengpan Zhang, Tanmay Mitra, Salvatore Valvo, Colleen Brown, Oksana Segreeva, Stella Martomo, Martin Preyer, Jay Fine, Jeremy Myers, Michael Dustin. Pharmacological integration of CD3 and CD2 signaling triggers formation of a CD2 corolla that boosts T cell activation [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2026; Part 1 (Regular Abstracts); 2026 Apr 17-22; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2026;86(7 Suppl):Abstract nr 5594.

Abstract The inhibitory receptor programmed cell death protein 1 (PD-1) suppresses T cell activation primarily by recruiting the src homology 2 domain-containing phosphatase 2 (SHP2), thereby unleashing its phosphatase activity. However, a purely enzymatic model struggles to fully explain the rapid and robust disruption of proximal T cell receptor (TCR) and CD28 signaling. Here, by integrating X-ray crystallography, single-molecule magnetic tweezers, supported lipid bilayers, TIRF imaging, liquid–liquid phase separation, and cellular assays, we uncover a dual-layered inhibitory mechanism of the PD-1/SHP2 axis. Mechanistically, we determine the crystal structure of SHP2 in complex with dually phosphorylated PD-1 cytoplasmic motifs (pPD-1), revealing a ligand-induced open conformation, which is distinct from the oncogenic E76K-associated state. We further directly resolve the closed-to-open conformational dynamics of individual SHP2 molecules, characterized by an 8-nm transition amplitude, and demonstrate that pPD-1 accelerates the transition by at least 94-fold. Crucially, the pPD-1-mediated highly open conformation exposes the tandem SH2 (t-SH2) domains to function as a biophysical barrier. Independent of phosphatase activity, these domains directly dismantle pTCR and pCD28 signaling condensates to suppress T cell activation. Together, our findings establish a model in which pPD-1 remodels SHP2 structural dynamics and drives a non-catalytic inhibitory mechanism of TCR and CD28 signaling, suggesting next-generation immunotherapy design to reverse T cell suppression.

During direct communication between two cells, the plasma membranes of each cell serve as a platform for ligand-receptor interaction initiating downstream signaling cascades. In immune cell signaling, this cell-cell interface - the immune synapse - is highly spatiotemporally organized. Multiple stimulatory and co-stimulatory signals need to be integrated over time to ensure proper immune cell function. This process is still not fully understood given the vast complexity of interactions between proteins, lipids, glycocalyx and associated cortical actin cytoskeleton. Here, we presented a fully artificial model system to study the interface between two vesicles and a semi-artificial one between a live cell and a vesicle to reconstitute 3D contacts. We investigated the distribution and reorganization of immune cell proteins at artificial and semi-artificial contacts. We show the enrichment and depletion of different proteins in the synapse and how different peptides with varying affinity presented by the same MHC class I affect T cell activation. We further explored the distribution of glycocalyx elements and showed differential partitioning of different sugar moieties in the interface. While we focused on the T cell interface here, our model systems are powerful tools to study the distribution and reorganization of lipids, proteins and glycocalyx components at any cell-cell contact.

Introduction Regulatory T-cells (Treg) are critical for immune homeostasis. Treg adoptive transfer can treat inflammatory disorders in mice and patients but have been variably efficacious. Strategies to enhance Treg therapeutic efficacy are needed.Treg predominantly depend upon oxidative phosphorylation (OXPHOS) for energy and suppressive function. Fatty acid oxidation (FAO) contributes to Treg OXPHOS and effector differentiation. FAO is opposed by acetyl-CoA carboxylase-1 (ACC1), an enzyme critical for fatty acid (FA) synthesis and de novo lipogenesis. Objective Given the importance of FAO and OXPHOS in Treg function we evaluated the effect of ACC1 small molecule inhibition or knockout on mouse and human Treg functional potency in vitro and in vivo. Results ACC1 Treg-specific knockout (KO) and small molecule inhibition with ND630 (a small molecule already being testing for cancer treatment) each increased mouse Treg in vitro suppressive function. Flow cytometry and RNA-sequencing identified an effector Treg phenotype after ACC1 inhibition, with increased LAG3, TIGIT, Tbet, CD25, IL-10 and BATF (FigA). In a fully-MHC mismatched acute GVHD mouse model, ACC1KO Treg infused on day 0 were superior in preventing acute GVHD compared to wild-type (WT) Treg. In mice with established chronic GVHD (cGVHD) and bronchiolitis obliterans (BOS), ACC1KO Treg given on d28 post-transplant were more potent than WT Treg in reversing pathologic lung function changes and fibrosis (FigB). ACC1KO and ND630, each augmented Treg FAO, OXPHOS and mitochondrial fusion. Impairing FAO, OXPHOS or mitochondrial fusion with small molecules or siRNA abrogated the beneficial metabolic and functional effects of ACC1 inhibition. Reciprocally, directly augmenting mitochondrial fusion with M1 (fusion promoter) and mDIVI1 (fission inhibitor), even in the absence of ACC1 inhibition, significantly enhanced Treg suppressive and metabolic function in vitro, and capacity to treat established cGVHD.Finally, we performed RNA-sequencing of Treg from patients with chronic GVHD, and identified that Treg from patients responding to low dose IL-2 therapy had a similar transcriptional profile to ACC1 inhibited mouse Treg, including reduced ACC1 expression. Furthermore, ex vivo expanded human Treg treated with ND630 demonstrated augmented suppressor function in vitro and in preventing xenogeneic GVHD (FigC). Conclusion Inhibiting ACC1 function in murine or human Treg amplified their metabolic and suppressive potency, driven by increased FAO, OXPHOS and mitochondrial fusion. Murine ACC1KO Treg demonstrated greater efficacy in preventing aGVHD and treating cGVHD mice with established cGVHD. The adoptive transfer of human Treg pretreated with ND630 increased their potency in a xenogenic GVHD model. Treg ACC1 inhibition with ND630 warrants consideration as an adjuvant to Treg in GVHD clinical trials.

Protein tyrosine phosphatase nonreceptor type 22 (PTPN22) is a key negative regulator of T cell activation, acting with C-terminal Src kinase (Csk) to suppress early T cell receptor (TCR) signaling and maintain immune tolerance. Given that the autoimmune disease-associated R620W variant alters T cell responses, we investigated the effects of PTPN22 on T cell activation. We identified a role for PTPN22 in modulating cytoskeletal dynamics at the immunological synapse in Jurkat cells through its interaction with proline-serine-threonine phosphatase-interacting protein 1 (PSTPIP1), a cytoskeletal adaptor protein that recruits actin nucleation-promoting factors, including WASp, to the TCR. PTPN22 deficiency or inhibition disrupted Arp2/3-dependent actin remodeling, leading to excessive central F-actin foci, PSTPIP1 mislocalization, and enhanced Ca2+ signaling, especially under low-affinity stimulation of the TCR. Super-resolution DNA-PAINT analysis revealed that loss of PTPN22 promoted aberrant PSTPIP1-TCR nanoscale colocalization and increased TCR clustering. These findings uncover a PTPN22-PSTPIP1 signaling axis that is critical for regulating cytoskeletal remodeling and receptor organization, providing insights into T cell hyperactivation that may be relevant to autoimmune disease.

Cytotoxic attack particles released by CTLs and NK cells include diverse phospholipid membrane and glycoprotein encapsulated entities that contribute to target cell killing. Supramolecular attack particles (SMAPs) are one type of particle characterized by a cytotoxic core enriched in granzymes and perforin surrounded by a proteinaceous shell including thrombospondin (TSP)-1. TSP-4 was also detected in bulk analysis of SMAPs released by CTLs; however, it has not been investigated whether TSP-4 contributes to distinct SMAP types or the same SMAP type as TSP-1 and, if in the same type of SMAP, whether TSP-4 and TSP-1 cooperate or compete. Here, we observed that TSP-4 expression increased upon CD8+ T cell activation while, surprisingly, TSP-1 was down-regulated. Correlative Light and Electron Microscopy and Stimulated Emission Depletion microscopy localized TSP-4 and TSP-1 in SMAP-containing multicore granules. Superresolution dSTORM revealed that TSP-4 and TSP-1 are usually enriched in the same SMAPs while particles with single-positive shells are rare. Retention Using Selective Hooks assays showed that TSP-4 localizes to the lytic granules faster than TSP-1 and promotes its accumulation therein. TSP-4 contributed to direct CTL-mediated killing, as previously shown for TSP-1. TSP-4 and TSP-1 were both required for latent SMAP-mediated cell killing, in which released SMAPs kill targets after removal of the CTLs. Of note, we found that chronic lymphocytic leukemia (CLL) cell culture supernatants suppressed expression of TSP-4 in CTL and latent SMAP-mediated killing. These results identify TSP-4 as a functionally important component of SMAPs and suggest that SMAPs may be targeted for immune suppression by CLL.

T cell therapies show little success in treating ovarian cancer; therefore, it is crucial to understand the barriers they confront. Most late-stage patients form ascites, which act as a liquid tumor environment. Using patient acelluar ovarian cancer ascites fluid (aOCA) as an ex vivo model of ovarian cancer, we show that aOCA impair T cell activation at early TCR signaling events. Removing lipids from aOCA partially rescues this activation deficit. Informed by these data, we hypothesized that lipids in aOCA disrupt TCR dynamics by altering the overall lipid composition and membrane features. Using untargeted lipidomics, we determine that T cells activated in aOCA are enriched in phosphatidylcholine species. Imaging using the membrane dye C-Laurdan showed that T cell membrane order is increased in aOCA but not delipidated (DL) aOCA. High resolution imaging revealed that immune synapse formation is similar in aOCA and DL aOCA; however, TCR clusters are smaller and less frequent in aOCA. TCR clustering is impacted by internalization and recycling. Accordingly, we find that TCR internalization is intact, but recycling is impaired in aOCA. Together, our data demonstrate that lipids in aOCA reduce TCR recycling and cluster size at the immune synapse, resulting in severe activation defects. These data showcase a previously uninvestigated mechanism of T cell dysfunction in aOCA and suggest the use of pre-activated T cell therapies to improve therapeutic efficacy in ovarian cancer. Tumor Immunology: Cellular Responses and Tumor Microevironment (TIME)

Bispecific T cell engagers (TcEs) link T cell receptors to tumor-associated antigens on cancer cells, forming cytotoxic immunological synapses (IS). Close membrane-to-membrane contact (≤13 nm) has been proposed as a key mechanism of TcE function. To investigate this and identify potential additional mechanisms, we compared four immunoglobulin G1-based (IgG1) TcE Formats (A–D) targeting CD3ε and Her2, designed to create varying intermembrane distances (A < B < C < D). Small-angle X-ray scattering (SAXS) and modeling of the conformational states of isolated TcEs and TcE–antigen complexes predicted close contacts (≤13 nm) for Formats A and B and far contacts (≥18 nm) for Formats C and D. In supported lipid bilayer (SLB) model interfaces, Formats A and B recruited, whereas Formats C and D repelled, CD2–CD58 interactions. Formats A and B also excluded bulky Quantum dots more effectively. SAXS also revealed that TcE–antigen complexes formed by Formats A and C were less flexible than complexes formed by Formats B and D. Functional data with Her2-expressing tumor cells showed cytotoxicity, surface marker expression, and cytokine release following the order A > B = C > D. In a minimal system for IS formation on SLBs, TcE performance followed the trend A = B = C > D. Addition of close contact requiring CD58 costimulation revealed phospholipase C-γ activation matching cytotoxicity with A > B = C > D. Our findings suggest that when adhesion is equivalent, TcE potency is determined by two parameters: contact distance and flexibility. Both the close/far-contact formation axis and the low/high flexibility axis significantly impact TcE potency, explaining the similar potency of Format B (close contact/high flexibility) and C (far contact/low flexibility).

Targeting the JAK/STAT pathway has emerged as a key therapeutic strategy for managing Rheumatoid Arthritis (RA). JAK inhibitors suppress cytokine-mediated signaling, including the critical IL-6/STAT3 axis, thereby effectively targeting different aspects of the pathological process. However, despite their clinical efficacy, a subset of RA patients remains refractory to JAK inhibition, underscoring the need for alternative approaches. Here, we identify a novel JAK-independent mechanism of STAT3 activation, which is triggered by the formation of the immunological synapse (IS) in naive CD4+ T cells. Our data demonstrates that LCK mediates the TCR-dependent phosphorylation of STAT3 at the IS, highlighting this pathway as a previously unrecognized hallmark of early T cell activation. Furthermore, we show that the synaptic LCK/TCR-STAT3 pathway is compromised in RA. This discovery highlights a new therapeutic target for RA beyond JAK inhibitors, offering potential avenues for treating patients resistant to current therapies.

The voltage-gated potassium channel Kv1.3 contributes to action potential conduction in sensory neurons and to sustained increases in cytoplasmic Ca2+ that activate immune cells. Here, we found that two distinct endocytosis-inducing stimuli acted through the same residues in Kv1.3 to control surface abundance and activity of the channel. Upon stimulation of the growth factor receptor EGFR, which stimulates Tyr-directed kinases and is important in neuronal differentiation, or of the Ser/Thr kinase PKC, which participates in the down-regulation of inflammatory responses, Kv1.3 underwent ubiquitination-dependent endocytosis that routed channel proteins to lysosomes for degradation. We mapped two lysine clusters in the N and C termini of Kv1.3, both of which became ubiquitinated upon activation of either Tyr or Ser/Thr kinases and whose combined mutation had an additive effect in reducing ubiquitination and endocytosis. Manipulations that prevented the ubiquitination or decreased the endocytosis of Kv1.3 resulted in increased Kv1.3 abundance at the immunological synapse and activity in primary human T cells. Prolonged channel accumulation at this location would be expected to increase Kv1.3-dependent leukocyte activation and lead to chronic inflammatory pathologies. Thus, ubiquitination fine-tunes cell biology by inducing the endocytosis and turnover of Kv1.3 in response to biological stimuli and insults.

Background There are very scarce data regarding the outcome of elderly patients with acute lymphoblastic leukemia (ALL) who received allogeneic hematopoietic stem cell transplantation (alloHSCT) as consolidation therapy in 1rst or higher complete remission (CR). Most studies evaluating the benefit of alloHSCT in ALL include both young and elderly populations. Thus, the optimal conditioning regimen still need to be determined in a frail population represented by patients over 60 years old. In addition, total body irradiation (TBI) dose is of first importance, as prior reports demonstrated its potential higher anti-leukemic effect. We here present the outcome of ALL patients older than 59 years from the Société Francophone de Greffe de Moelle et Thérapie Cellulaire (SFGM-TC) registry. Method This is a retrospective study. The primary outcome was overall survival (OS). Secondary outcomes were progression free survival (PFS), non-relapse mortality (NRM), relapse incidence (RI), acute Graft-versus-host disease (aGvHD) grade II-IV, chronic GvHD, neutrophil engraftment and GvHD-free relapse-free survival (GRFS). Competing risks analyses were performed to analyze NRM with competing event relapse, and aGvHD grade II-IV, chronic GvHD and neutrophil engraftment with competing events relapse and death. Univariable analyses were performed using the log-rang test for OS and PFS, while Gray's test was used for cumulative incidence (CI). Multivariable analyses were performed using the Cox proportional hazards regression model including age, ALL subtype, time from diagnosis to alloHSCT, disease status at alloHSCT, donor to patient CMV status, donor to patient sex, ATG use, myeloablative conditioning (MAC), TBI use. Results A total of 316 patients ≥ 60 years old transplanted for ALL from 2012 to 2022 in 36 participating centers were included in this study. Patient's characteristics are described in Table 1. With a median follow up of 34.5 months (IQR 29.5-38.8), 3-year OS was 46% (95% CI 40-53%) (Figure 1A) with only the disease status at transplant impacting negatively OS, 53% (95% CI 46-60%) in CR1, 32% (95% CI 21-49%) in CR2, 29% (95% CI 13-63%) in advanced disease, p=0.002 and the ALL subtype, 59% (95% CI 51-68%) in Ph+ ALL, 40% (95% CI 29-54%) in Ph- ALL, 34% (95% CI 20-55%) in T-ALL, 20% (95% CI 9-42%) in other/NA, p<0.001. 3-year PFS was 41% (95% CI 35-48%) (Figure 1B) with the disease status at transplant impacting negatively, 49% (95% CI 42-57%) in CR1, 26% (95% CI 16-42%) in CR2, 22% (95% CI 9-58%) in advanced disease, p<0.001, the ALL subtype, 51% (95% CI 42-61%) in Ph+ ALL, 41% (95% CI 31-54%) in Ph- ALL, 21% (95% CI 10-41%) in T-ALL, 21% (95% CI11-43%) in other/NA, p<0.001, year of HSCT worse < 2018, p=0.007, CMV -/- worse, p=0.033, absence of TBI worse, p=0.018. 3-year NRM was 23% (95% CI 18-28%) (Figure 1C) and none of the factors impacted it. 3-year RI was 36% (95% CI 31-42%) (Figure 1D) with the disease status at transplant impacting negatively, 29% (95% CI 23-36%) in CR1, 50% (95% CI 35-63%) in CR2, 56% (95% CI 26-77%) in advanced disease, p=0.0042, the ALL subtype, 26% (95% CI 19-34%) in Ph+ ALL, 43% (95% CI 31-54%) in Ph- ALL, 57% (95% CI 38-73%) in T-ALL, 42% (95% CI 25-59%) in other/NA, p=0.0064, year of HSCT worse < 2018, p=0.0216, CMV -/- worse, p<0.001, absence of TBI worse, p=0.0069, MRD worse, p=0.0111. 3-year GRFS was 30% (95% CI 25-37%) with the disease status at transplant impacting negatively, 35% (95% CI 28-43%) in CR1, 22% (95% CI 13-37%) in CR2, 23% (95% CI 9-59%) in advanced disease, p=0.029, the ALL subtype, 37% (95% CI 30-47%) in Ph+ ALL, 33% (95% CI 23-46%) in Ph- ALL, 15% (95% CI 7-32%) in T-ALL, 17% (95% CI 8-38%) in other/NA, p=0.0029, year of HSCT worse < 2018, p<0.001. CI of aGVHD grade II-IV was 33% (95% CI 28-38%), grade III-IV 11% (95% CI 8-15%), cGVHD 35% (95% CI30-41%), extensive cGVHD 21% (95% CI 16-26%).Multivariable analyses confirmed a worse OS and PFS for advanced disease, with a HR of 1.79 (95% CI 1.22-2.64), p=0.00322 and ALL subtype with a HR for other than Ph+ ALL of 1.99 (95%CI 1.42-2.79). Conclusion: This study suggests that alloHSCT is a reasonable option for elderly ALL patients without any impact of age but advanced disease and ALL subtype other than Ph+ ALL negatively influenced the outcome.

Chimeric antigen receptor (CAR) T cell immunotherapy represents a breakthrough in the treatment of hematological malignancies, but poor specificity has limited its applicability to solid tumors. By contrast, natural T cells harboring T cell receptors (TCRs) can discriminate between neoantigen-expressing cancer cells and self-antigen-expressing healthy tissues but have limited potency against tumors. We used a high-throughput platform to systematically evaluate the impact of co-expressing a TCR and CAR on the same CAR T cell. While strong TCR-antigen interactions enhanced CAR activation, weak TCR-antigen interactions actively antagonized their activation. Mathematical modeling captured this TCR-CAR crosstalk in CAR T cells, allowing us to engineer dual TCR/CAR T cells targeting neoantigens (HHATL8F/p53R175H) and human epithelial growth factor receptor 2 (HER2) ligands, respectively. These T cells exhibited superior anti-cancer activity and minimal toxicity against healthy tissue compared with conventional CAR T cells in a humanized solid tumor mouse model. Harnessing pre-existing inhibitory crosstalk between receptors, therefore, paves the way for the design of more precise cancer immunotherapies.

Tregs are critical for maintaining immune homeostasis, and their adoptive transfer can treat murine inflammatory disorders. In patients, Treg therapies have been variably efficacious. Therefore, new strategies to enhance Treg therapeutic efficacy are needed. Tregs predominantly depend on oxidative phosphorylation (OXPHOS) for energy and suppressive function. Fatty acid oxidation (FAO) contributes to Treg OXPHOS and can be important for Treg "effector" differentiation, but FAO activity is inhibited by coordinated activity of the isoenzymes acetyl-CoA carboxylase-1 and -2 (ACC1 and ACC2). Here, we show that small-molecule inhibition or Treg-specific genetic deletion of ACC1 significantly increases Treg suppressive function in vitro and in mice with established chronic graft-versus-host disease. ACC1 inhibition skewed Tregs toward an "effector" phenotype and enhanced FAO-mediated OXPHOS, mitochondrial function, and mitochondrial fusion. Inhibiting mitochondrial fusion diminished the effect of ACC1 inhibition. Reciprocally, promoting mitochondrial fusion, even in the absence of ACC1 modulation, resulted in a Treg functional and metabolic phenotype similar to that seen with ACC1 inhibition, indicating a key role for mitochondrial fusion in Treg-suppressive potency. Ex vivo-expanded, ACC1 inhibitor-treated human Tregs similarly augmented suppressor function, as observed with murine Tregs. Together, these data suggest that ACC1 manipulation may be exploited to modulate Treg function in patients.

Immunological processes that underpin human immune responses to therapeutics and vaccine components, such as vaccine adjuvants, remain poorly defined due to a paucity of models that faithfully recapitulate immune activation in lymphoid tissues. We describe precision-cut human lymph node (LN) slices as a functioning, architecturally preserved, full-organ cross-sectional model system. Using single-cell transcriptomics and multiplexed imaging, we explore early inflammatory response to a potent, clinically relevant liposomal vaccine adjuvant containing a TLR4-agonist and QS-21 saponin. Both TLR4 and NLRP3 inflammasome activation are involved in the direct initiation of the inflammatory response to adjuvant by monocytes and macrophages (Mon./Mac.) with secretion of interleukin (IL)-1β, but not IL-18, dependent on TLR4 signaling. Innate lymphoid cells, including natural killer cells, are indirectly activated by Mon./Mac.-produced cytokines, signaling downstream to B cells via interferon-γ secretion. Resident LN stromal populations, primed both directly and indirectly by vaccine adjuvant, are instrumental in mediating inflammatory cell recruitment, particularly neutrophils.

Self-assembly is a fundamental property of living matter that drives the three-dimensional organization of cell collectives such as tissues and organs. Here, the co-assembly of synthetic and natural cells is leveraged to create hybrid living 3D cancer cultures. We screen a range of synthetic cell models for their ability to form augmented tumoroids with artificial but controllable micro-environments, and show that the balance of inter- and extracellular adhesion and synthetic cell surface tension are key material properties driving integrated co-assembly. We demonstrate that synthetic cells based on droplet-supported lipid bilayers can establish artificial tumor immune microenvironments (ART-TIMEs), mimicking immunogenic signals within tumoroids and eliminating the need to integrate complex living immune cells. Using the ART-TIME approach, we identify a AhR-ARNT-mediated co-signaling mechanism between PD-1 and CD2 as a driver in immune evasion of pancreatic ductal adenocarcinoma. Our study advances the field of hybrid organoid engineering, offers opportunities for the construction and modelling of artificial tumour environments, and marks a step towards the design of functional living/non-living cytomimetic materials.

Chronic eosinophilic leukemia (CEL) is a rare myeloproliferative neoplasm. Diagnosis of CEL is often challenging, notably because of the lack of recurrent and specific molecular event. We report here a case of CEL occurring in a 49-year-old man who presented a persistent hypereosinophilia (HE) associated with anemia and thrombopenia. Karyotyping showed a translocation t(5;12)(q31;p13). Targeted RNA Sequencing identified a novel ETV6::RAPGEF6 fusion gene, confirmed by RT-PCR. Despite several lines of treatment, the patient died after 16 months of duration with transformation to acute myeloid leukemia (AML).Contrary to myeloid/lymphoid neoplasms with eosinophilia and tyrosine kinase gene fusions (MLN-TK), where fusion genes are both class defining and involve tyrosine kinase genes as the 3' partner, fusion genes are exceedingly rare in non-MLN-TK myeloid malignancies with HE. The most reported fusion gene is ETV6::ACSL6, in rare cases. Previously, overexpression of IL3 (interleukin 3) has been described in myeloid neoplasms with ETV6::ACSL6 (previously named ACS2). In our case of CEL with the ETV6::RAPGEF6 fusion, we also demonstrated overexpression of IL3, which could potentially result from the proximity of the IL3 gene to RAPGEF6, similar to what is observed with ACSL6 and IL3. The use of RNA sequencing in routine diagnosis of CEL could provide evidence for clonal event such as gene fusion, improving diagnosis as well as prognosis and therapeutic approaches.

Cell identity genes that exhibit complex regulation are marked by super-enhancer (SE) architecture. Assessment of SEs in natural killer (NK) cells identified Ugcg, encoding the enzyme responsible for glycosphingolipid (GSL) synthesis. Conditional deletion of Ugcg in early hematopoiesis abrogated NK cell generation while sparing other lineages. Pharmacological inhibition of UGCG disrupted cytotoxic granules and cytotoxicity, reduced expansion after viral infection, and promoted apoptosis. B4galt5 transcribes an enzyme downstream of UGCG and possesses SE structure. Addition of its product, lactosylceramide (LacCer), reversed apoptosis due to UGCG inhibition. By contrast, complex GSLs, such as asialo-GM1, were not required for NK cell viability and granule integrity. Ugcg and B4galt5 were upregulated in CD8+ T cells during viral infection, correlating with the acquisition of cytotoxic machinery. Antigen-specific CD8+ T cells lacking Ugcg failed to expand during infection. Our study reveals a selective and essential role of GSL metabolism in NK and CD8+ T cell biology.

Pancreatic ductal adenocarcinoma has a dismal prognosis. A comprehensive analysis of single-cell multi-omic data from matched tumour-infiltrated CD45+ cells and peripheral blood in 12 patients, and two published datasets, reveals a complex immune infiltrate. Patients have either a myeloid-enriched or adaptive-enriched tumour microenvironment. Adaptive immune cell-enriched is intrinsically linked with highly distinct B and T cell clonal selection, diversification, and differentiation. Using TCR data, we see the largest clonal expansions in CD8 effector memory, senescent cells, and highly activated regulatory T cells which are induced within the tumour from naïve cells. We identify pathways that potentially lead to a suppressive microenvironment, including investigational targets TIGIT/PVR and SIRPA/CD47. Analysis of patients from the APACT clinical trial shows that myeloid enrichment had a shorter overall survival compared to those with adaptive cell enrichment. Strategies for rationale therapeutic development in this disease include boosting of B cell responses, targeting immunosuppressive macrophages, and specific Treg cell depletion approaches. Pancreatic ductal adenocarcinoma (PDAC) has a poor prognosis involving evasion of immune control. Here, the authors perform a comprehensive analysis of single-cell multi-omic data revealing either a myeloid-enriched or adaptive-enriched tumour microenvironment, linked to distinct B and T cell clonal selection and differentiation, distinct overall survival, and potential therapeutic approaches.