Bhlhe40 Governs T Cell Effector Differentiation with Distinct Requirements in CD4 and CD8 T Cells for Anti-PD-1 and Anti-CTLA-4 Efficacy

Abstract

The transcriptional programs enabling T cells to mediate anti-tumor immunity remain incompletely defined. Here, we identify Bhlhe40 as a key transcriptional regulator that coordinates both CD4 and CD8 T cell effector programs, revealing divergent cell-specific requirements during anti-PD-1 versus anti-CTLA-4 immune checkpoint therapy (ICT). Using conditional knockout mice, we show that anti-PD-1 efficacy depends on CD8 T cell-intrinsic Bhlhe40, whereas anti-CTLA-4 remains effective through Bhlhe40-dependent CD4 T cell Th1 programs that buffer impaired effector function in Bhlhe40-deficient CD8 T cells. Mechanistically, loss of Bhlhe40 reduces IFN-{gamma} production and skews CD8 T cells toward TCF-1-expressing progenitor exhausted/stem-like states at the expense of effector differentiation, impairing glycolytic fitness under both therapies and mitochondrial function during anti-PD-1 treatment, thereby revealing a Bhlhe40-dependent coupling between effector differentiation, cytokine production, and metabolic fitness that is particularly critical for anti-PD-1 efficacy. CD8 T cell-intrinsic Bhlhe40 also promotes critical ICT-induced remodeling from M2-like CX3CR1 macrophages to inflammatory iNOS macrophages. Analysis of human cancer datasets supported our preclinical observations, revealing that BHLHE40 is enriched in tumor-reactive and activated/exhausted CD8 T cells, where its expression is inversely correlated with TCF7 (TCF-1) and positively associated with TOX, GZMB, and IFNG. Moreover, persistent CD8 T cell clones from basal cell carcinoma responders exhibited significantly higher BHLHE40 expression at pre-treatment than those from non-responders to PD-1 blockade. Together, these findings establish Bhlhe40 not only as a transcriptional coordinator of T cell effector programs, but also as a therapy-specific, subset-dependent determinant that differentially governs CD4 and CD8 T cell contributions to anti-PD-1 and anti-CTLA-4 efficacy.