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NR4A transcription factors limit CAR T cell function in solid tumours
Open accessAbstract
T cells expressing chimeric antigen receptors (CAR T cells) targeting human CD19 (hCD19) have shown clinical efficacy against B cell malignancies 1,2. CAR T cells have been less effective against solid tumours 3-5, in part because they enter a hyporesponsive ('exhausted' or 'dysfunctional') state 6-9 triggered by chronic antigen stimulation and characterized by upregulation of inhibitory receptors and loss of effector function. To investigate the function of CAR T cells in solid tumours, we transferred hCD19-reactive CAR T cells into hCD19+ tumour-bearing mice. CD8+CAR+ tumour-infiltrating lymphocytes and CD8+ endogenous tumour-infiltrating lymphocytes expressing the inhibitory receptors PD-1 and TIM3 exhibited similar profiles of gene expression and chromatin accessibility, associated with secondary activation of nuclear receptor transcription factors NR4A1 (also known as NUR77), NR4A2 (NURR1) and NR4A3 (NOR1) by the initiating transcription factor NFAT (nuclear factor of activated T cells)10-12. CD8+ T cells from humans with cancer or chronic viral infections 13-15 expressed high levels of NR4A transcription factors and displayed enrichment of NR4A-binding motifs in accessible chromatin regions. CAR T cells lacking all three NR4A transcription factors (Nr4a triple knockout) promoted tumour regression and prolonged the survival of tumour-bearing mice. Nr4a triple knockout CAR tumour-infiltrating lymphocytes displayed phenotypes and gene expression profiles characteristic of CD8+ effector T cells, and chromatin regions uniquely accessible in Nr4a triple knockout CAR tumour-infiltrating lymphocytes compared to wild type were enriched for binding motifs for NF-κB and AP-1, transcription factors involved in activation of T cells. We identify NR4A transcription factors as having an important role in the cell-intrinsic program of T cell hyporesponsiveness and point to NR4A inhibition as a promising strategy for cancer immunotherapy.
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“Because Nr4a2 is highly related to Nr4a1 and has been found to promote T cell exhaustion (33-35),”
From Bile acid synthesis impedes tumor-specific T cell responses during liver cancer (2025) · cites this paper as [34]
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“T cell exhaustion also limits the efficacy of chimeric antigen receptor (CAR) T cell therapy against solid tumours14–17.”
From Proteotoxic stress response drives T cell exhaustion and immune evasion (2025) · cites this paper as [15]
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“NFAT-induced transcription factors, including NR4A and TOX, drive T cell exhaustion/dysfunction44–47.”
From Tumor-specific cholinergic CD4+ T lymphocytes guide immunosurveillance of hepatocellular carcinoma (2023) · cites this paper as [44]
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Self-citationγδ T Cell Update: Adaptate Orchestrators of Immune Surveillance
Hayday, A. (2019) · The Journal of Immunology · doi:10.4049/jimmunol.1800934 · Cited by 199
“In this regard, Skint/Btnl-selected gd T cells are rich in Nr4a transcriptional regulators, which compose signatures of chronically activated CD8 TCRab tumor-infiltrating lymphocytes (82).”
BackgroundRavi, A., Hellmann, M. D., Arniella, M. B., Holton, M., Freeman, S. S., Naranbhai, V., Stewart, C., Leshchiner, I., Kim, J., Akiyama, Y., et al. (2023) · Nature Genetics · doi:10.1038/s41588-023-01355-5 · Cited by 201
Guedan, S., Madar, A., Casado‐Medrano, V., Shaw, C. E., Wing, A., Liu, F., Young, R. M., June, C. H., & Posey, A. D. (2020) · Journal of Clinical Investigation · doi:10.1172/jci133215 · Cited by 190
“Strategies to eliminate the exhaustion-related gene programs downstream of NFAT activation in CAR-T cells have demonstrated enhanced antitumor activity (64).”
BackgroundWang, D., Prager, B. C., Gimple, R. C., Aguilar, B., Alizadeh, D., Tang, H., Lv, D., Starr, R., Brito, A., Wu, Q., et al. (2020) · Cancer Discovery · doi:10.1158/2159-8290.cd-20-1243 · Cited by 185
From concept to cure: The evolution of CAR-T cell therapy
Patel, K. K., Tariveranmoshabad, M., Kadu, S., Shobaki, N., & June, C. H. (2025) · Molecular Therapy · doi:10.1016/j.ymthe.2025.03.005 · Cited by 211
CD3 bispecific antibody–induced cytokine release is dispensable for cytotoxic T cell activity
Li, J., Piskol, R., Ybarra, R., Chen, Y.-J. J., Li, J., Slaga, D., Hristopoulos, M. L., Clark, R., Modrusan, Z. D., Tótpál, K., et al. (2019) · Science Translational Medicine · doi:10.1126/scitranslmed.aax8861 · Cited by 184
“Cytokine secretion has also been proposed as a means to characterize the exhausted state of T cells (20, 21).”
BackgroundChen, Y., Zander, R., Wu, X., Schauder, D., Kasmani, M. Y., Shen, J., Zheng, S., Burns, R., Taparowsky, E. J., & Cui, W. (2021) · Nature Immunology · doi:10.1038/s41590-021-00965-7 · Cited by 183
Next-Generation CAR T-cell Therapies
Young, R. M., Engel, N. W., Uslu, U., Wellhausen, N., & June, C. H. (2022) · Cancer Discovery · doi:10.1158/2159-8290.cd-21-1683 · Cited by 191
Mechanisms of resistance to chimeric antigen receptor-T cells in haematological malignancies
Ruella, M., Korell, F., Porazzi, P., & Maus, M. V. (2023) · Nature Reviews Drug Discovery · doi:10.1038/s41573-023-00807-1 · Cited by 197
Single-cell CRISPR screens in vivo map T cell fate regulomes in cancer
Zhou, P., Shi, H., Huang, H., Sun, X., Yuan, S., Chapman, N. M., Connelly, J. P., Lim, S. A., Saravia, J., Anil, K. C., et al. (2023) · Nature · doi:10.1038/s41586-023-06733-x · Cited by 190
“The B16-hCD19 cell line was constructed by transducing B16-F10 cells with an amphotropic virus containing hCD19 and sorting cells with the top 10% of hCD19 expression 12 .”
BackgroundMethodInfluentialBile acid synthesis impedes tumor-specific T cell responses during liver cancer
Varanasi, S. K., Chen, D., Liu, Y., Johnson, M. A., Miller, C. M., Ganguly, S., Lande, K., LaPorta, M. A., Hoffmann, F. A., Mann, T. H., et al. (2025) · Science · doi:10.1126/science.adl4100 · Cited by 177
Zhang, X., Zhang, C., Qiao, M., Cheng, C., Tang, N., Lu, S., Sun, W. C., Xu, B., Cao, Y., Wei, X., et al. (2022) · Cancer Cell · doi:10.1016/j.ccell.2022.09.013 · Cited by 176
Gene modification strategies for next-generation CAR T cells against solid cancers
Tian, Y., Li, Y., Shao, Y., & Zhang, Y. (2020) · Journal of Hematology & Oncology · doi:10.1186/s13045-020-00890-6 · Cited by 179
Lu, Y.-J., Barreira‐Silva, P., Boyce, S., Powers, J., Cavallo, K., & Behar, S. M. (2021) · Cell Reports · doi:10.1016/j.celrep.2021.109696 · Cited by 176
Inosine induces stemness features in CAR-T cells and enhances potency
Klysz, D. D., Fowler, C., Malipatlolla, M. B., Stuani, L., Freitas, K. A., Chen, Y., Meier, S. L., Dániel, B., Sándor, K., Xu, P., et al. (2024) · Cancer Cell · doi:10.1016/j.ccell.2024.01.002 · Cited by 181
Counteracting CAR T cell dysfunction
Poorebrahim, M., Melief, J., de Coaña, Y. P., Wickström, S. L., Arregui, A. C., & Kiessling, R. W. (2020) · Oncogene · doi:10.1038/s41388-020-01501-x · Cited by 172
Genetic engineering of T cells for immunotherapy
Ellis, G. I., Sheppard, N. C., & Riley, J. L. (2021) · Nature Reviews Genetics · doi:10.1038/s41576-021-00329-9 · Cited by 170
CD8+ T cell exhaustion and cancer immunotherapy
Wang, Q., Qin, Y., & Li, B. (2023) · Cancer Letters · doi:10.1016/j.canlet.2022.216043 · Cited by 155
Zhang, Z., Li, F., Tian, Y., Cao, L., Gao, Q., Zhang, C., Zhang, K., Shen, C., Ping, Y., Maimela, N. R., et al. (2020) · The Journal of Immunology · doi:10.4049/jimmunol.1901213 · Cited by 162
“(encodes PD-1) expression as well as surface levels of PD-1 were significantly decreased in absence of NR4A and upregulated in NR4A-expressing cells (44).”
BackgroundKim, K.-S., Park, S., Park, S. Y., Kim, G., Park, S. M., Cho, J.-W., Kim, D., Park, Y. M., Koh, Y. W., Kim, H. R., et al. (2020) · Genome Medicine · doi:10.1186/s13073-020-00722-9 · Cited by 164
“The expression of NR4A1, a TF that induces T cell exhaustion [27, 28], was upregulated at later stages of the exhaustion state.”
BackgroundMechanisms of T-Cell Exhaustion in Pancreatic Cancer
Saka, D., Gökalp, M., Piyade, B., Çevik, N. C., Sever, E. A., Unutmaz, D., Ceyhan, G. O., Demir, İ. E., & Asimgil, H. (2020) · Cancers · doi:10.3390/cancers12082274 · Cited by 160
Enhanced T cell effector activity by targeting the Mediator kinase module
Freitas, K. A., Belk, J. A., Sotillo, E., Quinn, P. J., Ramello, M. C., Malipatlolla, M. B., Dániel, B., Sándor, K., Klysz, D. D., Bjelajac, J. R., et al. (2022) · Science · doi:10.1126/science.abn5647 · Cited by 159
“BA CCD19-28 Control sg1 CD19-28 MED12 sg49 CD45RO C C R 7 % T E M o f C D 8+ C A R + % T E M o f C D 4+ C A R + MED12 sg49 Control sg1 U M A P 1 UMAP2 2.33 1.33 18.178.2 3.00 4.44 76.915.6 0 20 40 60 80 100 0 20 40 60 80 100 E Glycolysis MTORC1 signaling NES = 1.73 FDR = 0.003 NES = 1.57 FDR = 0.0110 0.35 Control sg1…”
BackgroundInfluentialLiikanen, I., Lauhan, C. R., Quon, S., Omilusik, K. D., Phan, A. T., Bartrolí, L. B., Ferry, A., Goulding, J., Chen, J., Scott-Browne, J. P., et al. (2021) · Journal of Clinical Investigation · doi:10.1172/jci143729 · Cited by 160
“hCD19) as previously described (48) (Figure 9A and Supplemental Figure 6, A–D).”
BackgroundSelf-citationExhaustion of CAR T cells: potential causes and solutions
Kouro, T., Himuro, H., & Sasada, T. (2022) · Journal of Translational Medicine · doi:10.1186/s12967-022-03442-3 · Cited by 156
“Interestingly, in comparison to wild-type CAR T cells, the transfer of NR4A1, NR4A2, and NR4A3 triple knockout CAR T cells to tumor-bearing mice decreased the proportion of highly exhausted CAR T cells among the tumor-infiltrating lymphocytes and led to a better prognosis [57].”
BackgroundResultCheng, Y., Gunasegaran, B., Singh, H. D., Dutertre, C.-A., Loh, C. Y., Lim, J. Q., Crawford, J. C., Lee, H. K., Zhang, X., Lee, B., et al. (2021) · Immunity · doi:10.1016/j.immuni.2021.06.013 · Cited by 142
Self-citationRecent advances and applications of CRISPR-Cas9 in cancer immunotherapy
Liu, Z., Shi, M., Ren, Y., Xu, H., Weng, S., Ning, W., Ge, X., Liu, L., Guo, C., Duo, M., et al. (2023) · Molecular Cancer · doi:10.1186/s12943-023-01738-6 · Cited by 160
“The researches indicated that the deficiency of nuclear receptor 4A (NR4A) induced by Cre/LoxP, a site-specific knockout system mediated by Cre recombinases, leads to the down-regulation of PD1 and TIM-3 [79].”
BackgroundDeletion of Cbl-b inhibits CD8 + T-cell exhaustion and promotes CAR T-cell function
Kumar, J., Kumar, R., Singh, A. K., Tsakem, E. L., Kathania, M., Riese, M. J., Theiss, A. L., Davila, M. L., & Venuprasad, K. (2021) · Journal for ImmunoTherapy of Cancer · doi:10.1136/jitc-2020-001688 · Cited by 139
Lukhele, S., Abd-Rabbo, D., Guo, M., Shen, J., Elsaesser, H. J., Quevedo, R., Carew, M., Gadalla, R., Snell, L. M., Mahesh, L., et al. (2022) · Immunity · doi:10.1016/j.immuni.2022.10.020 · Cited by 136
Hossain, M. A., Liu, G., Dai, B., Si, Y., Yang, Q., Wazir, J., Birnbaumer, L., & Yang, Y. (2020) · Medicinal Research Reviews · doi:10.1002/med.21727 · Cited by 138
“NR4A deficiency in CD8+ CTLs displayed a strong en- richment in open chromatin regions with binding motifs for TFs involved in Teff functions, such as NF‐κB, basic region‐leucine zipper, T‐bet, and AP‐1.317 Interestingly, adoptive transfer of NR4A‐deficient chimeric antigen receptor T (CAR‐”
BackgroundInfluentialThe current state and future of T-cell exhaustion research
Jenkins, E. M., Whitehead, T., Fellermeyer, M., Davis, S. J., & Sharma, S. (2023) · Oxford Open Immunology · doi:10.1093/oxfimm/iqad006 · Cited by 153
“Summary of transcription factors expression associated with effector, progenitor and terminally exhausted T cells Transcription factor Effector T cell Progenitor exhausted T cell Terminally exhausted T cell References TCF-1 High High Low [8, 22] Ratio of T-bet and EOMES More T-bet More T-bet More EOMES [18, 19, 21] BA…”
BackgroundYoshikawa, T., Wu, Z., Inoue, S., Kasuya, H., Matsushita, H., Takahashi, Y., Kuroda, H., Hosoda, W., Suzuki, S., & Kagoya, Y. (2021) · Blood · doi:10.1182/blood.2021012714 · Cited by 134
Jung, I.-Y., Narayan, V., McDonald, S., Rech, A. J., Bartoszek, R. L., Hong, G., Suhoski, M. M., Xu, J., Boesteanu, A. C., Barber-Rotenberg, J. S., et al. (2022) · Science Translational Medicine · doi:10.1126/scitranslmed.abn7336 · Cited by 145
“We discovered that PRDM1 KO CAR T-cells chronically challenged with tumor targets display upregulation of a battery of exhaustion-associated transcription factors, including those belonging to the NR4A and TOX families which are reported to drive a cell-intrinsic program of T-cell hyporesponsiveness (50).”
BackgroundLecocq, Q., Keyaerts, M., Devoogdt, N., & Breckpot, K. (2020) · International Journal of Molecular Sciences · doi:10.3390/ijms22010075 · Cited by 135
Herring, J. A., Elison, W. S., & Tessem, J. S. (2019) · Cells · doi:10.3390/cells8111373 · Cited by 136
“H2O2 treatment is commonly used to measure cellular viability as ROS is sufficient to induce apoptosis [98,154,155].”
BackgroundT cell exhaustion in malignant gliomas
Watowich, M., Gilbert, M. R., & Larion, M. (2023) · Trends in cancer · doi:10.1016/j.trecan.2022.12.008 · Cited by 140
The Paradoxical Roles of Orphan Nuclear Receptor 4A (NR4A) in Cancer
Safe, S. H., & Karki, K. (2020) · Molecular Cancer Research · doi:10.1158/1541-7786.mcr-20-0707 · Cited by 130
“Analysis of tumor-infiltrating lymphocytes (TIL) shows that in exhausted T cells, NR4A is overexpressed, and this is accompanied by enhanced expression of PD-L1 and Tim3, decreased expression of cytokines, and low levels of cell killing (159).”
BackgroundPapavassiliou, A. G., & Musti, A. M. (2020) · Cells · doi:10.3390/cells9112470 · Cited by 124
“Furthermore, CAR T cells deficient in either TOX or NR4A reduced the expression of IRs and displayed greater chromatin accessibility at genomic regions enriched for motifs binding NF-κB and canonical AP-1 [29,31].”
BackgroundInfluentialAdvancing CAR T cell therapy through the use of multidimensional omics data
Yang, J., Chen, Y., Jing, Y., Green, M. R., & Han, L. (2023) · Nature Reviews Clinical Oncology · doi:10.1038/s41571-023-00729-2 · Cited by 130
Metadata
- Authors
- Chen, J., López-Moyado, I. F., Seo, H., Lio, C.-W. J., Hempleman, L. J., Sekiya, T., Yoshimura, A., Scott-Browne, J. P., & Rao, A.
- Affiliations
- La Jolla Institute for Immunology (US)
- National Center for Global Health and Medicine (JP)
- Keio University (JP)
- Corresponding author
- Chen, Joyce
- Scott-Browne, James P.
- Rao, Anjana
- ORCID
- Venue
- Nature
- Published
- 2019-02-27
- Volume
- 567
- Issue
- 7749
- Pages
- 530-534
- ISSN
- 0028-0836 (ISSN-L)
- 1476-4687
- PMC
- PMC6546093
- OpenAlex
- W2917547201
- Cited by
- 874
- References
- 47
- Citations by year
- 2026: 136 · 2025: 127 · 2024: 122 · 2023: 134 · 2022: 101 · 2021: 121 · 2020: 93 · 2019: 40
- FWCI
- 37.10
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Nature (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- Seoul National University Open Repository (Seoul National University) (submittedVersion)
- Funders
- National Institutes of Health (1s10od016262-01)
- Japan Society for the Promotion of Science (18H02673, 19H04822, 16KT0114, 17H06175, 16K15292)
- National Institute of General Medical Sciences (T32GM007752)
- National Institute of Allergy and Infectious Diseases (R01AI109842, R01AI048213, R56AI109842, R01AI040127)
- National Institute of Dental and Craniofacial Research (U01DE028227)
- National Center for Research Resources (S10RR027366)
- Topics
- Health Sciences › Medicine › Oncology › CAR-T cell therapy research
- Health Sciences › Medicine › Oncology › Cancer Immunotherapy and Biomarkers
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Nuclear Receptors and Signaling
- Keywords
- Nur77, Nurr1, NOR-1, chimeric antigen receptor T cells, CD19, T cell exhaustion, solid tumors, chromatin accessibility, NFAT, PD-1, TIM-3, tumor-infiltrating lymphocytes, effector T cells, cancer immunotherapy, transcriptional reprogramming
- MeSH terms
- Receptors, Chimeric Antigen, Animals, Chromatin, DNA-Binding Proteins, Female, Humans, Male, Melanoma, Experimental, Mice, Inbred C57BL, Neoplasms, Receptors, Steroid, Receptors, Thyroid Hormone, Transcription Factors, Survival Rate, Lymphocytes, Tumor-Infiltrating, NF-kappa B, CD8-Positive T-Lymphocytes, Transcription Factor AP-1, Antigens, CD19, Adoptive Transfer, Gene Expression Profiling, Cell Line, Tumor, Mice, Nuclear Receptor Subfamily 4, Group A, Member 1, Nuclear Receptor Subfamily 4, Group A, Member 2
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