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Immune regeneration: implications for cancer immunotherapy and beyond
Steven L. Reiner
Steven L. Reiner
Published July 1, 2025
Citation Information: J Clin Invest. 2025;135(13):e192731. https://doi.org/10.1172/JCI192731.
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Review

Immune regeneration: implications for cancer immunotherapy and beyond

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Abstract

Cancer care is being transformed by therapies leveraging T lymphocytes to attack tumor cells. In parallel, recent basic discoveries have converged into a framework of lymphocyte-dependent immunity as a regenerative process that is sometimes outstripped by high-level engagement. In a stem cell–like fashion, selected T cells must balance mutually opposing demands of differentiation and self-renewal. Activating versus inhibitory signals to T cells instruct opposing cell metabolism, linked to alternative cell fates that arise in sibling cells through lopsided information transfer. Emerging studies indicate that durable immunotherapy response may be limited by the abundance of self-renewing T cells. Leveraging of basic discoveries of regenerative signaling to bolster sustained, stem-like output of freshly differentiated T cells is offering new strategies to overcome cancer immunotherapy resistance. Lymphocyte regeneration may also sustain harmful autoimmune attack. Undercutting the self-renewal of pathogenic clones may thus emerge as a therapeutic strategy for autoimmune diseases.

Authors

Steven L. Reiner

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Figure 2

Lymphocytes engaged in immunity must regenerate, which has limits.

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Lymphocytes engaged in immunity must regenerate, which has limits.
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Most hematopoiesis involves continuous production of differentiated lineages to offset continuous loss. Some capacity for facultative “tuning” of output can occur in emergencies, such as severe blood loss or infection. By contrast, lymphopoiesis generates a diverse repertoire of unique antigen receptors on individual clones (gray-outlined circles), followed by elimination of strongly autoreactive clones, and export to periphery in anticipation of immune response. In an acute or low-level persistent immune response, a sole T cell clone with correct receptor (red outline) is activated by antigenic plus costimulatory signals (collectively represented by lightning bolts), causing cell division, which is accompanied by differentiation and self-renewal by clonally related descendants of the selected cell. When the threat entails high-level, repetitive activation, at least two separable problems of failing immunity can ensue: (i) acquired dysfunction of differentiated cells, often referred to as “exhaustion,” and (ii) eroding abundance of self-renewing cells, which can result in diminished output of fresh, differentiated cells or complete loss of the clone and its descendants. It is speculated that prevention of erosion of self-renewal may be more actionable than reversal of differentiated cell dysfunction.

Copyright © 2025 American Society for Clinical Investigation
ISSN: 0021-9738 (print), 1558-8238 (online)

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