The MLL3/TP53/PIK3CA cancer driver mutations promote HIF1α-dependent recruitment and differentiation of pro-tumor ICOShiGITRhiBlimp-1+effector regulatory T cells in breast tumors

While essential gatekeepers of immune homeostasis, Foxp3 + regulatory T (T reg ) cells infiltrating tumors acquire distinct phenotypes and become highly immunosuppressive, promoting tumor immune escape and growth. How this occurs and relates to tumor-driver mutations is largely uncharacterized. Herein, we created a mouse mammary stem cell-based tumor model using CRISPR gene editing in which we introduced known human cancer-driver mutations. These included functional loss of the MLL3 histone methyltransferase and p53, and constitutive PI3-kinase activation, recapitulating the genetic makeup of aggressive breast cancers. We show that MLL3 loss fosters tumorigenesis by promoting the rapid establishment of an immunosuppressive microenvironment through induction of HIF1α, which increases the secretion of the chemokine CCL2 by tumor cells and the recruitment of higher numbers of Foxp3 + T reg cells via CCR2. Greater infiltration of T reg cells also correlates with MLL3 downregulation and mutations in human breast cancer biopsies. Interestingly, HIF1α enforces the differentiation of tumor-infiltrating T reg cells into highly immunosuppressive ICOS hi GITR hi Blimp-1 hi effector T reg cells that enable rapid tumor escape. Monoclonal antibody targeting of ICOS or GITR inhibits tumorigenesis in most mice even two months after the cessation of treatment as well as the growth of established tumors, suggesting possible therapeutic opportunities for MLL3-mutant breast cancers.