Abstract
T cells are main actors of the immune system with an essential role in protection against pathogens and cancer. The molecular key event involved in this absolutely central task is the interaction of membrane-bound specific T cell receptors with peptide-MHC complexes which initiates T cell priming, activation and recall, and thus controls a range of downstream functions. While textbooks teach us that the repertoire of mature T cells is highly diverse, it is clear that this diversity cannot possibly cover all potential foreign peptides that might be encountered during life. TCR cross-reactivity, i.e. the ability of a single TCR to recognise different peptides, offers the best solution to this biological challenge. Reports have shown that indeed, TCR cross-reactivity is surprisingly high. Hence, the T cell dilemma is the following: be as specific as possible to target foreign danger and spare self, while being able to react to a large spectrum of body-threatening situations. This has major consequences for both autoimmune diseases and cancer, and significant implications for the development of T cell-based therapies. In this review, we will present essential experimental evidence of T cell cross-reactivity, implications for two opposite immune conditions, i.e. autoimmunity vs cancer, and how this can be differently exploited for immunotherapy approaches. Finally, we will discuss the tools available for predicting cross-reactivity and how improvements in this field might boost translational approaches.
1 Introduction: basics on TCR cross-reactivity
T cells are essential players of the adaptive immunity that are not only responsible for long-term immune memory, but also orchestrate innate and adaptive immune responses. Immature T cells undergo a strict selection in the thymus which leads to the release of mature, largely self-tolerant, T cells. Each of these cells bears several 10.000 copies of a unique kind of T cell receptor (TCR) that results from the assembly of two recombined TCR chains (in most cases α and β) (, ). The TCRαβ interacts with antigens presented as peptides by cell membrane-bound molecules of the major histocompatibility complex (pMHC) on the antigen presenting cell (APC) or on the target cell, for example, after pathogen infection (Figure 1A). Importantly, the binding of peptides to the various MHC allelic products is subject to specific rules (anchor or preferred residues) (, ). The diversity of the TCRαβ T cell repertoire is high, but not unlimited. Based on the V, D and J fragments´ recombination at the two chain loci, the theoretical number of single TCRs is estimated to reach at least 1015. In fact, the sum of all different TCRs present in the human blood has been estimated to be much less, in the range of 2.5 x 107 for naïve T cells and approximately 100-fold lower for memory T cells (–). The number of potential pathogen- (and tumour-) derived epitopes presented as pMHC throughout life might well exceed this number of T cell clones. It became therefore progressively clear that the clonal selection theory, which proposed that one lymphocyte/receptor is available for each single antigen, needed to be revised, and that cross-reactivity, i.e. the ability of single TCRs to recognise multiple peptide sequences, is a frequent event (–).
Figure 1
Cross-reactivity is commonly observed when testing nearly identical peptides which differ only in 1 or 2 amino acids (aa) (for a total length of 8-10 aa for a CD8+ T cell epitope presented by MHC-class I). This is physiologically highly relevant for fighting rapidly mutating viruses like HIV, SARS-Cov-2 or dengue viruses (
A very convincing hint that our T cell immunity is shaped by cross-reactivity was provided in the elegant study of Su et al. (
Despite clear evidences about the cross-reactive nature of the TCR, it remains unclear how many single peptides can a unique TCR recognise in “real life”. According to early estimates, it should be approx. 106 (
2 T cell cross-reactivity and autoimmunity
The most obvious and detrimental consequence of T cell cross-reactivity to vast numbers of individual peptides is the risk of developing autoimmunity (Figure 1C, left panel). Although self-reactive T cells are deleted in the thymus, weakly cross-reactive T cells may survive and become activated in the periphery through the recognition of epitopes from infectious agents (microorganism antigens, MoAs), a phenomenon known as “molecular mimicry”. Memory T cells can be stimulated by peptide concentrations more than 50-fold lower than those required to stimulate naïve T cells (
Here, we mainly present three examples for the involvement of TCR cross-reactivity in the induction of autoimmune diseases: one resulting from a bacterial infection, i.e. rheumatic fever; another induced by a food component, i.e. celiac disease; and a third example representative for the many autoimmune disorders for which no clear connection to an environmental agent has been found, as for instance multiple sclerosis.
2.1 Rheumatic fever (RF)
Acute rheumatic fever is a typical example of systemic autoimmunity which occurs subsequently to an infection, namely with group A β-haemolytic streptococci (
Another crucial streptococcal antigen is N-acetyl ß D-glucosamine (GlcNac), a carbohydrate moiety of the bacteria cell wall (
2.2 Celiac disease (CeD)
Celiac disease is highly interesting in view of the fact that autoimmune reactions are induced by a food component, i.e. dietary gluten (gliadin in wheat, hordein in barley, and secalin in rye are the most prominent examples). Antibodies against gliadin-peptides and the enzyme transglutaminase-2 (TG2) are highly-specific diagnostic markers of CeD, and a CD4+ T cell response towards post-translationally modified gluten peptides has been described. The disease shows a clear genetic association to the MHC-class II allelic products HLA-DQ2 (DQ2.5: DQA1*05:01-DQB1*02:01 or DQ2.2: DQA1*02:01-DQB1*02:02, approx. 95% of the patients) and HLA-DQ8 (DQA1*03:01-DQB1*03:02, approx. 5% of the patients) (
Interestingly, gliadin is a substrate for the TG2 enzyme which catalyses deamination at glutamine residues. The conversion of Q to E aa leads to increased binding affinity of peptides to the HLA-DQ2.5/2.2/8 molecules and enhanced recognition by gluten-specific CD4+ T cells (
Even if there is ample evidence that HLA-DQ2.5, HLA-DQ2.2, or HLA-DQ8 molecules present gluten-derived peptides, expression of these allelic products alone is insufficient to cause disease. Other risk factors which may induce increased expression and activity of TG2 may also be involved. For instance, in vivo and in vitro studies support an association between gut microbiota alterations and celiac disease (
2.3 Multiple sclerosis (MS)
Multiple sclerosis is one of the most prevalent autoimmune disorders of the central nervous system (CNS), and is characterised by the loss of the protective myelin sheath that surrounds the axons of neurons (
Autoantibodies specific for a variety of CNS proteins, as for instance myelin basic protein (MBP) or myelin oligodendrocyte glycoprotein (MOG), are present in the serum, cerebrospinal fluid (CSF), and brain of MS patients (
These findings led to the concept that an immune response initially activated and expanded by an infectious agent may, in general, cross-react with autoantigens mediating CNS inflammation and induce destruction of the brain. To date, numerous infectious agents have been described to induce cross-reactive T cells against brain-specific epitopes. As an example, peptides from HSV and Pseudomonas aeruginosa bound to MHC molecules are recognised by cross reactive myelin-specific T cells (
T cell clones isolated from the blood of patients with MS show high specificity for the immunodominant MBP epitope MBP85–99 (
2.4 Evidence for TCR cross-reactivity in other autoimmune diseases
The link between infection and autoimmunity via molecular mimicry has also been investigated in other inflammatory CNS diseases, particularly in chronic Lyme disease. Following acute infection with Borrelia burgdorferi (Bb), a chronic inflammatory disease can emerge which targets joints or the CNS in the absence of residual bacterial infection. In this condition, an autoimmune response to self-antigens (similarly as described above for RF) may arise from bacterial-specific T cells (
In uveitis, it has also been shown that peptides with similar structure rather than similar aa sequences can induce cross-reactive T cell responses. For instance, similarities of 6 to 7 aa with the 14mer autoantigen peptide from retinal S-antigen (PDSAg) with peptides of 11 or 12 aa in length from different environmental proteins is sufficient to induce autoreactive CD4+ T cell recognition and experimental anterior uveitis in rats (
In type I diabetes, a T cell-mediated, HLA-DQ2 (DQA1*05:01-DQB1*02:01) and -DQ8 (DQA1*03:01-DQB1*03:02)-associated autoimmune disease directed at pancreatic β cells, insulin B-chain9-23 (B:9-23) is a key epitope presented by MHC-class II to CD4+ T cells targeting pancreatic β-cells. Lack of an acidic aa residue (i.e. aspartic acid and glutamic acid) at position 57 of the DQ8 β chain of the MHC molecule favours binding of the insulin-B peptide and is associated with increased risk of developing the disease (
2.5 Therapeutic implications in autoimmune diseases
Distinct cytokine patterns of T cell subsets make them unique and define their role in host defence or their contribution in disease pathogenesis. In autoimmune diseases, the role of Th1 and Th2 cells along with their cytokine profiles is well documented. In particular, the priming signal (specificity, affinity and avidity of the pMHC/TCR, APC/T cell interaction) controls the maturation, differentiation and function (i.e. cytokine profile) of the T cell (
The ability of altered peptide ligands (modified peptide sequences derived from an original antigenic peptide, i.e APLs) to shift an unfavourable Th1- in a more favourable Th2-response in the murine EAE model of MS has first been shown by Nicholson and colleagues (
A mimotope was also developed for patients with diabetes mellitus type 1 in order to preserve pancreatic β cell function. It was modified from the human insulin peptide B:9-23 which binds to HLA-DQ8 and is recognised by CD4+ T cells present in the islets of organ donors with type 1 diabetes ((
For celiac disease, and as mentioned in section 2.2, disease-associated T cells preferably react with “naturally produced mimotopes” that result from deamidation of gliadin-derived peptides. Epitope-specific immunotherapies are, therefore, a logical translational step. In HLA-DQ2.5-positive celiac disease patients, clinical trials using a combination of three gluten-derived peptides, which contain at least five gliadin-specific T cell epitopes presented by HLA-DQ2.5 (Nexvax2) were conducted. While the phase I studies showed preferable outcomes in terms of safety and tolerability, the recent Nexvax2 phase II trial had to be discontinued due to lack of protection to gluten challenge.
An alternative approach to the use of a single APL is the administration of peptide mixtures that contain many different antigen specificities. Random copolymers that contain aa commonly used as MHC anchors and TCR contact residues have been proposed as possible “universal APLs.” The synthetic immuno-active copolymer glatiramer acetate (GA) is comprised of four aa in random order with an average length of 40-100 residues which resemble MBP (
3 TCR cross-reactivity in the context of cancer
With the notable exception of rare antigenic aberrant sequences, e.g. mutated antigens, tumours generally present self-antigens on their MHC molecules and are poorly immunogenic (112). This can be globally seen as the result of the thymic negative selection where highly self-reactive T cells are eliminated to prevent the development of autoimmune diseases, leaving us with a TCR repertoire with only low to moderate affinity to self-antigens (113). Although this is beneficial in a healthy state, it makes tumour targeting by T cells a hard task, as it impairs the mounting of an effective and strong immune response. Hence, in contrast to the situation in autoimmune diseases, cross-reactivity of potential pathogen-specific T cells against self-antigens specifically presented by tumour cells is not only desirable, but would likely result in favourable anti-tumour immunity (114).
An early and staggering example of TCR cross-reactivity was described by the group of P. Romero for the tumour-associated antigen (TAA) Melan-A. While the frequency of any antigen-reactive T cell in the peripheral immune naïve repertoire is generally extremely low (< 1 in 100.000 T cells), up to 1 out of 1000 CD8+ T cells bind the immunodominant peptide from Melan-A26-35 (the modified A27L ligand), when presented by HLA-A*0201, both in healthy donors as in melanoma patients (115). Although numerous T cells were able to bind the pMHC, as assessed by MHC-tetramer staining, a subgroup failed to be significantly activated by the Melan-A peptide in a cytotoxicity assay. In contrast, several other tested peptides, which included proteins of self- or pathogen- origin, generated a strong response in the same assay, hinting at the highly cross-reactive nature of this repertoire of T cells (116). Further supporting this, a following study of the same group showed that a tumour-reactive CD8+ T cell clone, also specific to the same immunodominant peptide mentioned above, was able to cross-recognise numerous peptides and that stimulation of this clone with these peptides drove the expansion of a heterogeneous CD8+ T cell population, with only a fraction actually reacting to the Melan-A peptide (117). Importantly, immunisation with Melan-A peptide through vaccination leads to a reduction on the population of cross-reactive T cells and an enrichment of antigen-restricted T cells that can react with the tumour (118). These early works on TCR cross-reactivity demonstrated its relevance not only in tumour biology but also in the design of effective anti-cancer immunotherapies.
3.1 Evidence for tumour antigen recognition by pathogen-specific T cells
3.1.1 T cell cross-reactivity between virus-derived sequences and tumour antigens
Studies have described viral-specific T cells within the microenvironment of several tumour entities with no prior known viral aetiology (119). Although there is experimental evidence for the presence of intracellular bacteria or viruses in tumour cells (120–122), this local pathogen load might not be the only reason for the presence of pathogen-specific T cells within tumours. After sequencing the TCRs of tumour-infiltrating lymphocytes (TILs) in non-small cell lung carcinoma (NSCLC), Chiou et al. identified a novel TAA derived from the epithelial protein TMEM161A. A TCR recognising this peptide was shown to readily cross-react with epitopes from EBV (and E. coli). Specific T cells were not only found in NSCLC patients, but also in healthy donors, an observation which the authors offer as an explanation to the presence of virus-specific T cells within NSCLCs, but possibly also in other tumours (123). In another in silico-based approach, Ragone et al. examined the cancer peptide database and identified numerous TAAs with shared homology with viral sequences. The viruses whose sequences were most commonly shared with the tumour antigens were HIV type 1 (HIV-1), HSV, and human papillomaviruses (HPV). In addition to sequence homology, the authors also report that these peptides share structural similarities with comparable patterns of contact between the HLA molecule and the TCR (114). A recent case report has also described tumour reduction in three metastatic colorectal cancer patients upon SARS-CoV-2 infection (124). Altogether, these studies point out to the fact that pathogen- and tumour antigen- cross-reactive T cell responses might play an important role in anti-cancer immunity, and that the immune repertoire of each patient, shaped by previous infections, might be a crucial factor in disease control.
In murine melanoma models, Chiaro et al. showed that similarities between tumour- and viral- derived antigens can influence the clearance of tumours upon peptide cancer vaccination as a consequence of cross-reactive T cell activity. Upon immunisation with viral peptide pools previously selected based on their homology to tyrosinase related protein (TRP2180–188) or glycoprotein 100 (gp10025–33), a strong reduction in tumour growth was seen. Interestingly, the authors further argue that viral molecular mimicry is an important factor that dictates immune response also in metastatic human melanoma by showing a direct correlation between pre-existing Abs against CMV, and response to the immune checkpoint inhibitor (ICI) anti-PD-1 (125). TCRβ sequencing experiments further suggested that the same T cell clone recognised similar peptide sequences of MAGE-A10 and CMV. Further studies using pre-clinical murine models suggest the relevance of activating virus-specific T cells for tumour growth control (119, 126). The authors describe the formation of an immune-permissive microenvironment upon in vivo virus-peptide vaccination, whereby cross-reactivity of these viral-specific T cells with tumour antigens, although not tested, could be responsible for the effect observed. Interestingly, another study simulating immunisation of mice with the TAA and homologous viral peptides predicted a similar clearance of tumour cells in both scenarios, suggesting equivalent anti-tumour efficacy of the effector T cell response (114).
3.1.2 T cell cross-reactivity between bacterial-derived sequences and tumour antigens
Cross-reactivity of tumour-specific T cells with bacterial epitopes has also been described. In melanoma, a MAGE-A6-derived peptide (MAGE-A6172-187) was shown to be cross-reactive with its highly immunogenic homolog HF-2216-229. This mycoplasma-derived peptide and MAGE-A6 can drive the formation of memory CD8+ T cells. Interestingly, in vitro priming with dendritic cells loaded with the bacterial-derived peptide resulted in CD8+ T cells with 100-fold higher avidity to the MAGE-A6 peptide compared to that of cells primed with the MAGE-A6 peptide itself (127).
The main in vivo source of bacteria-derived antigens is the microbiota. The human gut is colonised by approximately 1014 microbes (128). The sheer number of colonising microorganisms means that exposure of immune cells to these bacteria throughout life is unavoidable, which results in the generation of an immune response against commensal-derived peptides. In a similar analysis to the one performed earlier, Ragone et al. compared all TAAs from the cancer peptide database against the microbiota species Firmicutes (taxid:1239) and Bacteroidetes (taxid:976) sequences. The authors demonstrated a high level of homology of tumour antigens and peptides derived from these species, which account for 90% of all gut microbiota (129). Flückiger et al. showed that T cell clones that recognise the cancer antigen protein glycerol-3-phosphate dehydrogenase 1-like (GPD1-L) and cross-react with epitopes derived from the tail tape measure protein (TMP) of an Enterococcus hirae (E. hirae) bacteriophage, could be detected in melanoma patients. Importantly, the authors further observed an association between the presence of this prophage in the stools of patients with renal and lung cancer, expression of GPD1-L by tumour cells, and a long-term benefit to PD-1 checkpoint blockade (130). Interestingly, in the same study, cyclophosphamide treatment of tumour-bearing mice, which induces the translocation of E. hirae from the gut lumen to the mesenteric and splenic immune tissues, resulted in improved anti-cancer CD8+ T cell responses. This anti-tumour effect was abrogated once the mice were given antibiotics and rescued by administration of E. hirae isolates. Moreover, lack of expression of the TAA by the tumour cells also abolished any anti-tumour immunity previously observed.
Other studies have also shown a favourable clinical outcome in cancer patients presenting CD4+ and CD8+ T cells specific for E. hirae, Bacteroides fragilis, Ruminococcaceae (131), and Akkermansia muciniphila (131–134). The immune repertoire, namely the frequency of precursor T cells prior to antigen exposure, is a critical factor in determining the magnitude of an immune response. Based on the aforementioned observations of cross-reactivity between numerous pathogen-derived epitopes and tumour antigens, it is plausible that the gut microbiome is an important modulator and dictator of how individuals will mount an immune response to tumours but also how they will respond to immunotherapies.
3.2 Neoantigens and T cell cross-reactivity
In contrast to the demonstrated potential of T cells to be cross-reactive (
Importantly, cross-reactive neoantigens seem to be a critical predictive factor for checkpoint inhibitor therapy efficacy. In the seminal study by Snyder et al. which first identified mutated antigens as T cell targets during checkpoint blockade, the authors observed that patients with long-term benefit to anti-CTLA-4 therapy share neoepitopes homologous to more viral and bacterial antigens, in contrast to patients with minimal or no benefit (142). These intriguing findings strongly suggest that cross-reactive T cells specific for pathogens can get activated upon checkpoint inhibition and participate in a clinically significant anti-tumour response. This is in line with the different studies presented above where the importance of the gut microbiome in checkpoint therapy responsiveness has been highlighted (143).
3.3 The two faces of TCR cross-reactivity in tumour immunotherapy
In addition to being able to dictate the outcome of immunotherapies such as checkpoint inhibition and therapeutic cancer vaccination with tumour-derived antigens, TCR cross-reactivity is currently being exploited for the development of novel and more potent cancer therapies, which we will discuss in more detail below.
3.3.1 Overcoming self-tolerance
3.3.1.1 Improving affinity
If numerous T cell clones recognise the same epitope, affinity and avidity for this epitope will be inevitable highly variable. Using checkpoint inhibitors will unleash the inhibition in all lymphocytes present in the tumour microenvironment (TME), high or low functional ones. Differently, the goal of therapeutic vaccination is to selectively drive the recruitment of high-avidity T cells and promote strong and long-lasting anti-tumour responses. As mentioned above, high-affinity T cells against TAAs are usually lacking as a consequence of negative selection in the thymus, which leaves us only with a low-affinity repertoire. This tolerance is observed when A2xneu mice (Her2/neu mice crossed with A2.1/Kb mice) are injected with the immunodominant Her2773-782 peptide, which results in little to no tumour control (144). A similar tolerance was observed when mice were injected with p53-derived peptides. In this case, the authors demonstrated that using the p53261-269 self-epitope led to the expansion of cytotoxic T lymphocytes (CTLs) in p53 wt mice with an avidity more than 10-fold lower than the ones obtained from p53 null mice (145). This nicely shows the importance of circumventing tolerance to achieve an effective cancer vaccination.
One way to improve the immunogenicity of TAAs would be to exploit the cross-reactive nature of TCRs. Identification of peptides that are not naturally processed and presented but that can be used to elicit strong cross-reactive T cell responses against the original TAAs is already an old idea. The design of such heteroclitic peptides, where the stability of interaction between the peptide and MHC molecule is improved by replacement of certain aa was shown to be a powerful strategy for both improving CTL reactivity in vitro and controlling tumor growth in mice (144, 146–150). Importantly, these heteroclitic peptides need to be recognised by T cells that cross-react with the native sequence and can, therefore, drive the killing of tumour cells naturally presenting the original peptide. Despite the encouraging results seen in pre-clinical models, this concept has failed yet to lead to the development of an effective cancer therapeutic vaccine (151, 152). A famous example was the observation by Speiser et al. that immunisation of melanoma patients with the wt Melan-A26-35 (together with CpG as adjuvant) was superior in generating high avidity, tumour-reactive T cells, compared to the Melan-A26-35 modified peptide (152). Since the only difference between the two peptides is one aa substitution at an anchoring position (A27L), it suggests that increasing pMHC binding properties is not the ultimate key for improving T cell reactivity to TAAs.
3.3.1.2 Microorganism antigens (MoAs) molecular mimicry
Recently, a novel concept exploiting TCR cross-reactivity for therapeutic purposes has emerged. It is based on the identification of natural analogue peptides capable of inducing strong T cell responses against the tumour antigen. The shared homology between pathogen-derived peptides and tumour antigens and the aforementioned correlations between cross-reactive T cells and clinical outcome makes this an attractive and promising strategy that is currently being further investigated.
We have introduced in sections 3.1 and 3.2 that tumour antigens share homology with numerous pathogen-derived epitopes which, as a consequence, can drive the activation of T cells that share the same TCR. In other words, T cells that have been activated upon exposure to a certain pathogen can cross-react with tumour antigens (Figures 1A–C). The reasons for exploiting this cross-reactivity in the context of therapeutic cancer vaccination are manifold: first, it allows to overcome the low immunogenicity and affinity of natural TAAs, since TCRs that recognise MoAs have not been depleted from the T cell repertoire. Second, memory T cells can be activated by much lower peptide concentrations as compared to their naïve counterparts (see section 2). Third, recalling T cell responses upon immunisation is obviously easier to achieve than priming new effectors, especially when considering the current lack of gold-standard strong adjuvants. Fourth, exploiting “natural” T cells that were already expanded in the body after infection should present less risk of autoimmunity, although, as exemplified in section 2, autoimmunity cannot be fully excluded.
In summary, activation of viral- or commensal- specific T cells that cross-react to the tumour cells have shown promising results in a couple of pre-clinical models. Furthermore, correlations between the presence of these T cells and clinical outcome in patients have also been drawn. All this is opening a new field of research, to identify tumour antigens and MoAs that share high homology for the developing of novel T cell-based immunotherapies for cancer (Figure 1D). Since the presence of MoAs-specific memory T cells depends on prior infections, the composition of the microbiota, and the MHC-allotype, one could speculate that the development of such strategies should be done in an individualised manner to guarantee a high success rate and decrease the risk of side effects. Combination of such therapeutic vaccinations with ICIs could unleash the expansion of potent effector memory cells that readily target the tumour antigen and are able to control tumour growth.
3.3.2 The dark side of TCR cross-reactivity
TCR cross-reactivity undoubtedly opens large avenues for developing more potent cancer therapies. However, there are important bottlenecks to consider. The possible side effects in immunotherapy, especially in adoptive T cell therapies, where optimised TCRs with high affinity against a certain peptide are administered to patients is a serious issue. Side effects with these engineered TCRs are not rare, due to the strong interaction between the TCR and its target. Very low expression levels of the antigen in healthy tissue, which was initially dismissed as potentially dangerous led to severe consequences (153, 154). This on-target toxicity is not that unexpected (Figure 1D). However, overlooking off-target effects due to TCR cross-reactivity can have similarly severe and fatal adverse effects as it was observed in the case of anti-MAGE-A3 TCR engineered T cells. Due to its restrictive expression to immune privileged sites such as placenta and testis which lack the expression of HLA molecules, MAGE-A3 was considered a genuinely tumour-specific target, since it is found to be overexpressed in multiple tumours. This bona fide target attracted the attention and promptly immunotherapies that target this molecule were developed. Contrary to the expectations, severe cases of toxicity were observed, despite the lack of antigen expression in any of the tissues affected. In the first of two well-known incidents, engineered anti-MAGE-A3112–120 (KVAELVHFL) T cells were adoptively transferred to cancer patients after nonmyeloablative lymphodepletion, who then received high doses of IL-2. This led to severe neurological damages, and even to a patient death. This fatal toxicity was attributed to a cross-reactivity of the effector TCRs with a MAGE-A12 sequence (KMAELVHFL) which has a superior binding affinity for HLA-A*0201 than MAGE-A3112–120. MAGE-A12 was found a posteriori to be expressed in the brain (153). In the second, even less predictable case, engineered lymphocytes with affinity-enhanced TCRs against the HLA-A*01-restricted MAGE-A3168-176 peptide (EVDPIGHLY) drove cardiotoxicity and patient death due to recognition of an unrelated peptide derived from the muscle protein titin (ESDPIVAQY) which is presented by cardiomyocytes (155, 156) (Figure 1D). Experimental and computational tools for prediction of potential toxicities have been improved since then and will be presented in section 4.
In general, therapeutic cancer vaccines are safe and no severe side effects have been observed to date. This may arise from the relatively low affinity of the induced T cells. The potential of MoAs to be used in immunisation approaches against tumour antigens, renders caution to what kind of side effects can arise. In a recent study, Gil-Cruz et al. showed that microbiota-derived peptide mimicry can induce lethal cardiomyopathy through the activation of heart-specific (MYH6-specific TCR) Th17 CD4+ T cells (157). In their mouse model, cross-reactive CD4+ T cells are primed in the intestine and later circulate and infiltrate the myocardium where they can damage myosin-expressing cells. In the context of checkpoint inhibition, it is tempting to speculate that not only self-, but also cross-reactive pathogen-specific T cells could be responsible for driving lethal cases of myocarditis that were observed in some patients (158, 159). The large number of auto-immune diseases that are associated with pathogen infection itself (section 2) demonstrate the delicate balance in the selection of these MoAs for therapeutic intervention.
4 Assessing TCR cross-reactivity: experimental evidence, in silico predictions and the need for high through-put testing platforms
A number of the examples of TCR cross-reactivity discussed so far have been brought to light using in vitro systems based on the testing of T cell activity against synthetic peptides. In early works, epitopic peptides of interest were modified by introducing aa substitutions at various positions. Later advances, supported by increased automatization of peptide synthesis, led to the development of synthetic peptide libraries. One common approach is to generate combinatorial (sub)libraries of peptides with each of the 20 aa fixed at one position while all other positions can be occupied by all other aa (160). Such approach can theoretically generate all possible aa sequences for a given peptide length and allows screening of up to 1012 peptides. In vitro testing of agonists or antagonists´ effects on T cell activity can be performed either by measuring cytokine secretion, killing of loaded target cells (for CD8+ T cells), or proliferation (for CD4+ and CD8+ T cells) (
Together with the development of TCR engineering and adoptive transfer therapies, currently most advanced in the oncology clinical setting, high through-put and comprehensive approaches for testing TCR cross-reactivity have become mandatory for pre-clinical development. The main interest here is to assess TCR-mediated toxicity, i.e. the potential of transferred T cells to exert deleterious effects in vivo via recognition of non-related pMHC expressed on healthy tissues (Figure 1D). This is particularly relevant when the TCR has been manipulated for increasing its affinity to the cognate pMHC or has been obtained from HLA-unmatched donors (allorestricted). Challenges for the safe use of engineered TCRs in solid tumours have been very recently reviewed (162), and we have presented examples of fatal toxicities in section 3.3. In the context of clinical development, in vitro testing of T cell reactivity against random peptide sequences, as mentioned above, is the most straight-forward approach to assess cross-reactivity. DNA-tagged pMHC multimers, which allow to address TCR-pMHC affinity more easily is an elegant alternative method (163, 164). From the point of view of experimental feasibility, all these assays require high amount of material (e.g. T cell clones), which might be circumvented by modern methods. TCR cloning and subsequent transfer in reporter cells or MHC-matched PBMCs, and possibly the use of soluble TCRs and yeast pMHC libraries can overcome the aforementioned limitations (
Which threshold of reactivity will lead to in vivo toxicity is likely impossible to predict with high accuracy and might even vary between individuals. One weakness of synthetic peptide testing is that recognition of a particular sequence by a certain TCR as measured in vitro cannot ultimately predict in vivo reactivity, since it is unknown whether this aa sequence is indeed processed and to which extent it is presented on body tissues. More sophisticated platforms try to overcome these limitations. First, testing primary normal cells from a range of organs representing essential human tissues (e.g. cardiovascular, gastrointestinal, brain, liver, among other systems) and/or a panel of tumour cell lines will assess potential off-target recognition (
Lastly, a comprehensive view of all peptides presented by MHC molecules in normal cells is needed and of utmost importance. The typical experimental setting for assessing the MHC ligand “landscape”, is to perform peptide immunoprecipitation followed by mass spectrometry analysis. First milestones steps have been engaged, with the Human Immunopeptidome Project (HIPP) and the HLA ligand atlas which both aim at deciphering the entire MHC-ligandome landscape of human healthy tissues (168, 169). In addition, quantitative analysis of peptide presentation by mass spectrometry has become possible. Using this method, it was recently shown that a peptide derived from collagen type VI A3 is present in 41% of the tumour samples analysed at an average of 228 (max 1928) copies per cell, but only in 6% of the normal tissues with an average of 28 copies (max of 49) per cell (165).
All these approaches are so far imperfect, since it cannot be excluded that an organ subpart, or specialised cells at a certain stage of differentiation or activation, may be targeted by cross-reactive T cells. As discussed earlier, the recognition by MAGE-A3 specific T cells of a titin-derived peptide expressed only in beating cardiomyocytes showed to be fatal for treated patients (155, 156). However, combining and refining them will decrease the chance of unexpected in vivo TCR cross-reactivity and toxicity. Possibly, tissue engineering and the development of 3D in vitro culture systems which better recapitulate the complexity of human organs and can be used in T cell assays might become a relevant addition to the testing pipelines.
In complement to experimental approaches, many efforts are ongoing for developing reliable in silico pipelines for predicting T cell cross-reactivity. It should be noted that many of such tools are not developed specifically for addressing cross-reactivity, but more generally to predict peptide immunogenicity (170). In principle, two aspects can be investigated: on the one hand, the probability for a peptidic sequence to be presented by various MHC allelic products, and on the other hand, the interaction of a specific TCR with a pMHC complex.
Regarding peptide MHC binding, the simplest strategy would be to start from the original peptide and deduce which altered sequence could or not bind to the presenting MHC allelic product. NetMHC and syfpeithi, which are essential publicly available tools, can deliver robust MHC-binding predictions, but they cannot directly interrogate TCR cross-reactivity. In addition, immunogenicity prediction tools based on aa properties (size, charge, aromaticity, gravy score) are also being developed (171, 172). In the tool available at the Immune Epitope Database (IEDB) (173), TCR preferences were deduced from the study of 600 immunogenic and 181 non-immunogenic 9mer peptides: the authors found out that peptides containing aromatic and large side chains aa (in particular phenylalanine) were preferentially recognised by T cells, and that positions 4-6 were the most critical, confirming previous findings. The task is much more complex when addressing the direct binding of a specific TCR to pMHC (see also section 1). Current approaches aiming at modelling such interactions in 3D are based on x-ray crystallography data (174–176). In addition, pMTnet, NetTCR and ERGO are neural networks that predict pMHC-TCR (CDR3 regions of the TCR β, and more recently, α chains) and are in continuous refinement (177–179).
In silico tools rely on the exploitation of experimental data. Hence, in vitro testing of e.g. peptide library scanning is not only useful for current assessment of T cell cross-reactivity, it is also needed for training and improving prediction tools. In this respect, repository of TCR-pMHC interactions and affinities, as well as 3D information, such as those available at the IEDB, Altered TCR Ligand Affinities and Structures (Atlas) (180), Structural T-cell Receptor Database (STCRDab) (181) or TCR associated with pathology conditions (McPAS-TCR) (182) and PMID databases are essential. Implementation of more information, in particular for rare MHC allelic products, is still necessary and will help improving the robustness of these approaches in the next years.
5 Concluding remarks
Cross-reactivity is a very smart property of our adaptive immune system to cope with the large pathogen universe. It also plays a significant role in pathological conditions as different as autoimmunity and cancer. While it has been longer discussed that virus- or bacteria-specific T cells are associated with some autoimmune diseases, more recent research is uncovering their role in cancer. This knowledge can be exploited for therapy in both diseases. Application of mimotopes in the treatment of autoimmune diseases will depend to a large extent upon their ability to suppress immunoreactivity, for instance by stimulating regulatory anti-inflammatory CD4+ T cells, or by directly inhibiting pathogenic cytotoxic CD8+ T cells. This is obviously a complex task, and identification and prediction of self-epitopes and mimotopes recognised by particular TCRs is, therefore, important to make such antigen-specific approaches successful in autoimmune diseases. In cancer immunotherapy, TCR cross-reactivity is becoming an essential consideration, not only for designing more efficient T cell-based treatments, but also for preventing severe side effects. Considering the ongoing personalisation of therapeutic approaches, the upstream TCR selection process needs to be speed up. The development of novel and refined prediction methods is of utmost importance, but is a challenging process due to the numerous aspects that can impact cross-reactivity.
Statements
Author contributions
CG, AM, and RK conceived the review and jointly wrote the manuscript. AM prepared the figure which was reviewed by all authors. All authors contributed to the article and approved the submitted version.
Funding
CG and AM are supported by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) under Germany’s Excellence Strategy EXC 2180, 390900677.
Acknowledgments
We acknowledge support from the Open Access Publishing Fund of the University of Tübingen.
Conflict of interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Publisher’s note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
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Summary
Keywords
T cell receptor, cross-reactivity, autoimmunity, cancer, immunotherapy
Citation
Gouttefangeas C, Klein R and Maia A (2023) The good and the bad of T cell cross-reactivity: challenges and opportunities for novel therapeutics in autoimmunity and cancer. Front. Immunol. 14:1212546. doi: 10.3389/fimmu.2023.1212546
Received
26 April 2023
Accepted
24 May 2023
Published
19 June 2023
Volume
14 - 2023
Edited by
Tomasz Piotr Wypych, Polish Academy of Sciences, Poland
Reviewed by
Kenichi Hanada, National Institutes of Health (NIH), United States; Olivier Gasser, Malaghan Institute or Medical Research, New Zealand
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Copyright
© 2023 Gouttefangeas, Klein and Maia.
This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Cécile Gouttefangeas, cecile.gouttefangeas@uni-tuebingen.de
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