1. Introduction
Epithelial ovarian cancer (EOC) is the leading cause of gynecological cancer death. High-grade serous ovarian carcinoma represents 70% of EOC and accounts for 90% of advanced-stage disease and mortality [
1,
2]. The late diagnosis is one of the main factors contributing to a low 5-year survival rate recently estimated at 50% [
3]. EOC is considered a tumor type with potential immunoreactivity due to the well-documented positive correlation between the presence of tumor-infiltrating lymphocytes and better clinical outcomes [
4,
5,
6,
7,
8]. However, immune checkpoint inhibitors have demonstrated limited efficacy in EOC [
7,
9], and the lack of well-defined actionable antigens has hampered the development of therapeutic vaccines [
7,
10].
The dominant paradigm holds that anti-tumor immune responses enhanced by immune checkpoint therapies are primarily directed toward tumor-specific antigens (TSAs) [
11,
12,
13]. There are two types of TSAs: mutated TSAs (mTSAs) and aberrantly expressed TSAs (aeTSAs). mTSAs derive from mutated DNA sequences, typically located in exons of protein-coding genes. In contrast, aeTSAs result from the translation of any open reading frames not expressed in normal adult somatic cells. Their presence in cancer cells arises from cancer-specific epigenetic changes and splicing aberrations [
13,
14,
15,
16,
17]. So far, cancer vaccine research has given considerable attention to mTSAs. However, mass spectrometry (MS) analyses failed to detect most predicted mTSAs on the surface of tumor cells [
18,
19,
20,
21]. To identify TSAs, we developed a proteogenomic approach that integrates transcriptomic and MS analyses. MS validation represents the most solid evidence that TSAs are genuinely presented by cancer cells [
19,
22,
23]. Using this method, we reported that, in EOC and other tumor types, most TSAs belong to the aeTSA category [
14,
17,
24,
25], making their evaluation of particular interest in cancer vaccine development.
Optimal targets for cancer vaccine development should possess two main features [
26,
27]. First, they should be cancer-specific. Indeed, TSAs are expected to be immunogenic because cognate T cells escape central immune tolerance. Second, optimal targets should be shared by a significant proportion of EOCs, thereby facilitating the development of off-the-shelf cancer vaccines and TCR-based biologics. Most EOC aeTSAs are shared by a substantial proportion of tumors [
24]. In the present study, we aimed to evaluate the therapeutic potential of these TSAs against EOCs by assessing their capacity to induce antigen (ag)-specific T-cell responses. To this end, we stimulated naïve CD8 T cells with dendritic cells pulsed with synthetic TSA peptides. We then assessed TSA presentation by MS analyses and estimated T cell responses using TCR Vβ CDR3 sequencing and tetramer staining.
4. Discussion
The strength of the initial T-cell response is influenced by the level and duration of presentation of the relevant peptide-HLA complexes in secondary lymphoid organs [
59,
60,
61,
62]. Thus, in the context of cancer vaccines, the capacity of TSAs to be well-presented by dendritic cells will also significantly influence the magnitude of T-cell responses that will emerge from the vaccination. We postulate that the careful quantification and optimization of TSA presentation by moDCs can improve the design of TSA vaccines. We focused on quantifying TSAs presented at the surface of moDCs using targeted MS analyses. We have shown that most of the TSAs investigated (90%) can be detected by MS after peptide pulsing on moDCs and that the abundance of peptide presentation strongly correlated with the predicted binding affinity of these peptides for their cognate HLA molecules (
Figure 2d). In this study, the TSAs were tested by modules, which could lead to a potential competition between TSAs from the same module for binding on their HLA allotypes. Although this effect was minimized by regrouping a maximum of five TSAs in each module, the presentation at the cell surface could have been decreased for some peptides due to this competition. Hence, pulsing with individual peptides might improve the presentation of those with lower MHC-binding affinity.
According to NetMHCPan4.1 binding predictions, 10/48 TSAs and the modified MelanA epitope (ELAGIGILTV) are weak binders for their respective HLA allotypes (percentile rank binding affinity above the threshold of strong binders of 0.5%,
Figure S2a and
Table S1). As we (
Figure 4e and f) and others [
48,
63,
64,
65,
66,
67,
68] have shown that ELAGIGILTV induces robust CD8 T cell responses, we conclude that predicted weak binders can be highly immunogenic. Among the 10 TSAs qualified as weak binders by NetMHCPan4.1, seven were detected by MS at t=0h after pulsing. In contrast, the three others were not detected (p4, p5, and p45), indicating that other parameters also influence the detection by MS. Interestingly, while we didn't detect p4 (HLA-A*01:01) on moDCs after peptide pulsing, it induced a significant expansion of tetramer-positive CD8 T cells in one donor (D15), which was also used for MS experiments (
Figure 2a and
Figure 4b,
Table S3). Extremely low abundances, as low as a single copy per cell, can induce a T-cell response [
69]. Thus, the amount of p4 presented by moDCs from D15 was probably below the MS detection threshold but sufficient to trigger a specific T-cell expansion.
Several parameters can influence peptide detection sensitivity by MS, including low stability of peptides in solution, hydrophobicity, ionization efficacy or losses during the immunoprecipitation process [
70,
71]. Despite their prediction as strong HLA binders, p8 and p18 were not detected by MS at t=0h. We speculate that their detection by MS was decreased because of either one or several of the parameters mentioned above. One control peptide (ctl3) was also not detected by MS after peptide pulsing. This peptide's high positive charge probably resulted in limited capacity factor (k') and irreproducible MS detection [
72]. Overall, the high detection rate of TSAs (90% at t=0h) and their abundance comparable to immunogenic viral peptides after moDCs' pulsing evocate a good immunogenic potential. Since the predicted binding affinity of peptides for their cognate HLA strongly correlated with their presentation level after pulsing, it would be a sensible parameter for the prioritization of TSAs to be included in vaccines.
We also noticed that the binding competition for HLA molecules could sometimes reduce TSA abundance at the cell surface and restrain their MS detection. Multi-peptide vaccines are more effective than single-peptide formulations as they mitigate the risk of immune escape [
73,
74]. However, if multiple tumor-specific antigens are present in a vaccine formulation, it is also essential to consider the possibility of competition for presentation on the surface of dendritic cells. Indeed, Aurisicchio and colleagues have shown that some epitopes can suffer from competition with other epitopes, both when delivered in the format of a minigene or as a peptide mixture [
75]. From a vaccine design point of view, it can be deleterious to include TSA candidates that will compete for HLA binding but won't induce a strong T-cell response. This means that optimal vaccine design should include testing of individual peptides.
TSAs tested herein were initially identified by untargeted liquid chromatography-tandem MS (LC-MS/MS) [
24]. In this article, we detected and quantified most of them by sensitive targeted LC-MS/MS after pulsing of moDCs. This method is the only one that can directly and quantitatively estimate the number of TSA peptide copies presented by moDCs. However, immunoprecipitation-based HLA peptide isolation cannot distinguish HLA-restricted peptides on the cell surface from intracellular HLA-peptide complexes, which is unsuitable for immunotherapy applications [
76,
77]. Still, we observed increased frequencies of TCR clonotypes with Vβ CDR3 sequencing after functional expansion protocol for all the TSAs tested, thus validating their surface presentation after individual pulsing on moDCs.
A key factor regulating TSA immunogenicity is the presence of TSA-specific CD8 T cells in the pre-immune repertoire. In the present study, we evaluated the immunogenicity of TSAs using two different techniques: TCR Vβ CDR3 sequencing and tetramer staining after functional expansion. TCR Vβ CDR3 sequencing showed that CD8 T cell clonotypes could expand against all the TSAs tested. Although this assay appears highly sensitive for detecting TSA-specific CD8 T cells, it gives no information about their structural and functional avidity. Moreover, tetramer staining is the gold standard tool for monitoring ag-specific T cells but has been shown to require a TCR-pMHC affinity exceeding what T-cell activation requires [
78]. This affinity threshold means tetramer staining can fail to detect functional T cells [
78,
79,
80,
81]. Accordingly, we detected tetramer-positive CD8 T cells for 33% (13/39) of the TSAs, while sensitive TCR Vβ CDR3 sequencing results revealed expanded TCR clonotypes for all of them. Tetramers are particularly useful for detecting and isolating antigen-specific T cells but are not, per se, a measure of functionality. Thus, adding functional assays, such as ELISpots and cytotoxicity assays, would undoubtedly improve the prioritization of TSA targets.
Predicted peptide-HLA (p-HLA) binding affinity and stability correlated with peptide presentation levels measured by targeted MS (
Figure 2d and h). p-HLA stability was shown to influence immunogenicity[
82], and our data reinforce the idea that p-HLA affinity and stability are essential factors to consider when prioritizing targets. However, while these parameters predict antigen presentation, they do not predict T-cell recognition. Indeed, p-HLA binding affinity and stability did not correlate with immunogenicity testing with tetramer staining or TCR Vβ CDR3-sequencing assays. Immunogenicity prediction is complex and challenging as it is governed by many factors. In addition, selecting "true" non-immunogenic peptides to train the algorithms is difficult. Indeed, a negative T cell assay result only means that a peptide failed to induce a T cell response in that particular experiment. A failed expansion could be explained by the stochasticity in any naïve CD8 T cell sampling. Ag-specific T cell frequencies in PBMCs can be as low as one tetramer-positive cell per ten million CD8 T cells [
55]. Furthermore, there are important interindividual differences in the TCR repertoire [
83]. Hence, the limited sensitivity and scalability of
in vitro immunogenicity assays commonly yield false-negative results, thereby creating noise in the datasets used to train immunogenicity prediction tools.
In this study, we used moDCs to evaluate TSA presentation and immunogenicity. In a few replicates, we tested mRNA electroporation in addition to peptide pulsing to induce endogenous processing and presentation of TSAs. Notably, electroporated and peptide-pulsed DCs led to similar expansion levels of tetramer-positive T cells (
Figure 4a–c and
Table S5). Nonetheless, the yield and quality of moDCs exhibit significant interindividual differences, and these dendritic cells are less effective at T-cell stimulation than genuine conventional DCs [
84,
85,
86]. Given the limitations of moDC vaccines, mRNA vaccines present several attractive features for clinical usage. The remarkable progress and efficacy demonstrated by mRNA-based vaccines against SARS-CoV-2 have underscored the transformative potential of this technology. Beyond their short manufacturing process and excellent safety record, mRNA vaccines present diverse design options to enhance antigen translation or interferon signaling [
87,
88,
89,
90,
91,
92,
93]. Thus, several clinical trials of mRNA-based cancer vaccines are ongoing [
94]. In this context, our study reinforces the idea that a careful evaluation of two parameters is required to optimize the design of anti-tumor vaccines: i) HLA binding competition among epitopes included in a TSA-encoding mRNA and ii) the capacity of each epitope to induce a robust immune response.