biostudies-literatureWang YNIAID NIH HHSNCI NIH HHSNIGMS NIH HHS1025-1035https://www.ebi.ac.uk/biostudies/studies/S-EPMC12657239biostudies-literatureUnknown647(8091)Chronic infections and cancer cause T cell dysfunction known as exhaustion. This cell state is caused by persistent antigen exposure, suboptimal co-stimulation and a plethora of hostile factors that dampen protective immunity and limit the efficacy of immunotherapies^1-4. The mechanisms that underlie T cell exhaustion remain poorly understood. Here we analyse the proteome of CD8⁺ exhausted T (T_ex) cells across multiple states of exhaustion in the context of both chronic viral infections and cancer. We show that there is a non-stochastic pathway-specific discordance between mRNA and protein dynamics between T effector (T_eff) and T_ex cells. We identify a distinct proteotoxic stress response (PSR) in T_ex cells, which we term T_ex-PSR. Contrary to canonical stress responses that induce a reduction in protein synthesis^5,6, T_ex-PSR involves an increase in global translation activity and an upregulation of specialized chaperone proteins. T_ex-PSR is further characterized by the accumulation of protein aggregates and stress granules and an increase in autophagy-dominant protein catabolism. We establish that disruption of proteostasis alone can convert T_eff cells to T_ex cells, and we link T_ex-PSR mechanistically to persistent AKT signalling. Finally, disruption of T_ex-PSR-associated chaperones in CD8⁺ T cells improves cancer immunotherapy in preclinical models. Moreover, a high T_ex-PSR in T cells from patients with cancer confers poor responses to clinical immunotherapy. Collectively, our findings indicate that T_ex-PSR is a hallmark and a mechanistic driver of T cell exhaustion, which raises the possibility of targeting proteostasis pathways as an approach for cancer immunotherapy.NatureProteotoxic stress response drives T cell exhaustion and immune evasion.PMC12657239R01 CA282501R35 GM150723R01 AI170926R01 CA262069R21 CA267394Abdel-Hakeem MSSong NJWen HHuang SCWang RShannon AEMandula JKGhoneim HEChen XYousif AWang YWu WWang ZXiao TXin GGhosh GSearle BCVelegraki MBeusch CMMa ADawood ASSaadey AALi ZAmankwah YSGordon DEfalseProteotoxic stress response drives T cell exhaustion and immune evasion.Chronic infections and cancer cause T cell dysfunction known as exhaustion. This cell state is caused by persistent antigen exposure, suboptimal co-stimulation and a plethora of hostile factors that dampen protective immunity and limit the efficacy of immunotherapies^1-4. The mechanisms that underlie T cell exhaustion remain poorly understood. Here we analyse the proteome of CD8⁺ exhausted T (T_ex) cells across multiple states of exhaustion in the context of both chronic viral infections and cancer. We show that there is a non-stochastic pathway-specific discordance between mRNA and protein dynamics between T effector (T_eff) and T_ex cells. We identify a distinct proteotoxic stress response (PSR) in T_ex cells, which we term T_ex-PSR. Contrary to canonical stress responses that induce a reduction in protein synthesis^5,6, T_ex-PSR involves an increase in global translation activity and an upregulation of specialized chaperone proteins. T_ex-PSR is further characterized by the accumulation of protein aggregates and stress granules and an increase in autophagy-dominant protein catabolism. We establish that disruption of proteostasis alone can convert T_eff cells to T_ex cells, and we link T_ex-PSR mechanistically to persistent AKT signalling. Finally, disruption of T_ex-PSR-associated chaperones in CD8⁺ T cells improves cancer immunotherapy in preclinical models. Moreover, a high T_ex-PSR in T cells from patients with cancer confers poor responses to clinical immunotherapy. Collectively, our findings indicate that T_ex-PSR is a hallmark and a mechanistic driver of T cell exhaustion, which raises the possibility of targeting proteostasis pathways as an approach for cancer immunotherapy.2025-01-01T00:00:00Z2025 Nov2026-06-06T15:44:08.204Z2026-06-02T03:09:18.557ZS-EPMC126572394103458010.1038/s41586-025-09539-1