Single-Cell Transcriptomics Reveals Killing Mechanisms of Antitumor Cytotoxic CD4 TCR-T Cells.

T cell receptor-engineered T cells (TCR-Ts) have emerged as potent cancer immunotherapies. While most research focused on classical cytotoxic CD8 T cells, the application of CD4 T cells in adoptive T cell therapy has gained much interest recently. However, the cytotoxic mechanisms of CD4 TCR-Ts have not been fully revealed. In this study, we obtained an MHC class I-restricted MART-1-specific TCR sequence based on the single-cell V(D)J sequencing technology, and constructed MART-1-specific CD4 TCR-Ts and CD8 TCR-Ts. The antitumor effects of CD4 TCR-Ts were comparable to those of CD8 TCR-Ts and . To delineate the killing mechanisms of cytotoxic CD4 TCR-Ts, we performed single-cell RNA sequencing and found that classical granule-dependent and independent cytolytic pathways were commonly used in CD4 and CD8 TCR-Ts, while high expression of and various costimulatory receptors were unique features for cytotoxic CD4 TCR-Ts. Further signaling pathway analysis revealed that transcription factors Runx3 and Blimp1/Tbx21 were crucial for the development and killing function of cytotoxic CD4 T cells. Taken together, we report the antitumor effects and multifaceted killing mechanisms of CD4 TCR-Ts, and also indicate that MHC class I-restricted CD4 TCR-Ts could serve as potential adoptive T cell therapies.