CD4+ T cells are critical regulators of immune responses, but their functional role in human breast cancer is relatively unknown. The goal of this study was to produce an image of CD4+ T cells infiltrating breast tumors using limited ex vivo manipulation to better understand the in vivo differences associated with patient prognosis. We performed comprehensive molecular profiling of infiltrating CD4+ T cells isolated from untreated invasive primary tumors and found that the infiltrating T cell subpopulations included follicular helper T (Tfh) cells, which have not previously been found in solid tumors, as well as Th1, Th2, and Th17 effector memory cells and Tregs. T cell signaling pathway alterations included a mixture of activation and suppression characterized by restricted cytokine/chemokine production, which inversely paralleled lymphoid infiltration levels and could be reproduced in activated donor CD4+ T cells treated with primary tumor supernatant. A comparison of extensively versus minimally infiltrated tumors showed that CXCL13-producing CD4+ Tfh cells distinguish extensive immune infiltrates, principally located in tertiary lymphoid structure germinal centers. An 8-gene Tfh signature, signifying organized antitumor immunity, robustly predicted survival or preoperative response to chemotherapy. Our identification of CD4+ Tfh cells in breast cancer suggests that they are an important immune element whose presence in the tumor is a prognostic factor.
Chunyan Gu-Trantien, Sherene Loi, Soizic Garaud, Carole Equeter, Myriam Libin, Alexandre de Wind, Marie Ravoet, Hélène Le Buanec, Catherine Sibille, Germain Manfouo-Foutsop, Isabelle Veys, Benjamin Haibe-Kains, Sandeep K. Singhal, Stefan Michiels, Françoise Rothé, Roberto Salgado, Hugues Duvillier, Michail Ignatiadis, Christine Desmedt, Dominique Bron, Denis Larsimont, Martine Piccart, Christos Sotiriou, Karen Willard-Gallo