High-avidity TCR signaling drives an NKG2A-positive CD8 T cell exhaustion state in human tumors

T cells adopt diverse states in human disease, with tumor-specific CD8 T cells serving as the quintessential example. These cells are critical for immunotherapy response, yet acquire hypofunctional states of exhaustion that impair treatment efficacy. While significant heterogeneity is observed among exhausted CD8 T cells (TEX), the mechanisms directing their unique phenotypes remain unresolved, limiting our efforts to augment TEX cell function. Here, we profile TEX cells in human head and neck squamous cell carcinoma (HNSCC) tumors and define a major mechanism regulating their cell state. With single-cell RNA and T cell receptor (TCR) sequencing of 106,667 tumor-infiltrating CD8 T cells, we define and validate three fundamental TEX subsets, each harboring dominant clonotypes: a progenitor subset (TPEX) and two intra-tumoral populations marked by intermediate (TEX-int) or high expression of inhibitory receptors, including killer cell lectin-like receptors, such as KLRC1/NKG2A (TEX-KLR). Using an in vitro model, we show that TCR avidity-dependent NFAT signaling governs an axis between the TEX-int and TEX-KLR states across human cancers, with high-avidity signaling driving the TEX-KLR state. Additionally, we uncover that interleukin-12 signaling selectively antagonizes high-avidity TEX-KLR-specific genes, despite broadly potentiating activation and cytotoxicity. Finally, we find that TEX-int and TEX-KLR cells are associated with anti-PD-1 response in HNSCC, with both of these cell types enriched near viable cancer cells following treatment. Together, these findings reveal that TCR avidity orchestrates tumor-infiltrating TEX cell states through NFAT signaling, a tunable axis that may be targeted to improve TEX cell function.