2019 July ; 571(7764): 211–218. doi:10.1038/s41586-019-1325-x | Omar Khan, Josephine R. Giles, Sierra McDonald, Sasikanth Manne, Shin Foong Ngiow, Kunal P. Patel, Michael T. Werner, Alexander C. Huang, Katherine A. Alexander, Jennifer E. Wu, John Attanasio, Patrick Yan, Sangeeth M. George, Bertram Bengsch, Ryan P. Staube, Greg Donahue, Wei Xu, Ravi K. Amaravadi, Xiaowei Xu, Giorgos C. Karakousis, Tara C. Mitchell, Lynn M. Schuchter, Jonathan Kaye, Shelley L. Berger, E. John Wherry
The study identifies the HMG-box transcription factor TOX as a central regulator of exhausted CD8+ T cells (T<sub>EX</sub>). TOX is essential for the development of T<sub>EX</sub> but dispensable for effector (T<sub>EFF</sub>) and memory (T<sub>MEM</sub>) CD8+ T cells. TOX is induced by calcineurin and NFAT2 and operates in a feed-forward loop to become calcineurin-independent and sustained in T<sub>EX</sub>. Robust TOX expression results in the commitment to T<sub>EX</sub> by translating persistent stimulation into a distinct T<sub>EX</sub> transcriptional and epigenetic developmental program. TOX represses terminal T<sub>EFF</sub>-specific epigenetic events while initiating key T<sub>EX</sub>-specific epigenetic changes, highlighting its role as a critical coordinator of T<sub>EX</sub> programming. These findings have implications for the ontogeny of T<sub>EX</sub> and therapeutic strategies targeting this cell type.The study identifies the HMG-box transcription factor TOX as a central regulator of exhausted CD8+ T cells (T<sub>EX</sub>). TOX is essential for the development of T<sub>EX</sub> but dispensable for effector (T<sub>EFF</sub>) and memory (T<sub>MEM</sub>) CD8+ T cells. TOX is induced by calcineurin and NFAT2 and operates in a feed-forward loop to become calcineurin-independent and sustained in T<sub>EX</sub>. Robust TOX expression results in the commitment to T<sub>EX</sub> by translating persistent stimulation into a distinct T<sub>EX</sub> transcriptional and epigenetic developmental program. TOX represses terminal T<sub>EFF</sub>-specific epigenetic events while initiating key T<sub>EX</sub>-specific epigenetic changes, highlighting its role as a critical coordinator of T<sub>EX</sub> programming. These findings have implications for the ontogeny of T<sub>EX</sub> and therapeutic strategies targeting this cell type.