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bioRxiv · 10.1101/2025.03.07.642090

PRAME Epitopes are T-Cell Immunovulnerabilities in BRD4::NUTM1 Initiated NUT Carcinoma

Jensen, J. L.·Peterson, S. K.·Yu, S.·Kinjo, T.·Price, B. A.·Sambade, M.·Vesko, S.·DeBetta, J. D.·Geyer, J. K.·Nickel, K. P.·Kimple, R. J.·Kotecha, R. S.·Davis, I. J.·Wang, J. R.·French, C. A.·Kuhlman, B.·Rubinsteyn, A.·Weiss, J.·Vincent, B. G.
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Abstract

BackgroundNUT carcinoma is a rare but highly lethal solid tumor without an effective standard of care. NUT carcinoma is caused by bromodomain-containing NUTM1 fusion oncogenes, most commonly BRD4::NUTM1. BRD4::NUTM1 recruits p300 to acetylate H3K27 forming expansive stretches of hyperacetylated chromatin called "megadomains" with the overexpression of corresponding oncogenes, including MYC. We hypothesized that transcriptional dysregulation caused by BRD4::NUTM1 would lead to the generation of cancer-specific antigens that could be therapeutically actionable. MethodsWe integrated genomics, computational antigen prediction software, targeted immunopeptidomics using single- and double-labeled peptide standards, and gain/loss-of-function genetic experiments on a panel of cell lines (N=5), a patient derived xenograft, a tissue microarray (N=77), and patient samples from the Tempus AI Sequencing Database harboring evidence of NUTM1 fusions (N=165). We created an PRAME425 T-cell receptor x SP34 CD3 bispecific molecule modeled after brenetafusp, an PRAME425 T-cell receptor bispecific T-cell engager, as well as PRAME425 TCR T-cells based on anzutresgene autoleucel and we applied these products to NUT carcinoma cells in vitro. ResultsWe identified PRAME as the most commonly expressed cancer/testis antigen in patient samples harboring the three canonical NUT carcinoma fusions (BRD4::NUTM1, BRD3::NUTM1, and NSD3::NUTM1). Additionally, 56% (43/77) of NUT carcinoma tissue microarray samples stained positive for PRAME. BRD4::NUTM1 expression in HEK 293T cells enhanced PRAME levels and BRD4::NUTM1 knockout in NUT carcinoma cells reduced PRAME levels. Immunopeptidomics detected more PRAME-derived HLA ligands (N=9) than all other cancer/testis antigens combined (N=5). Targeted mass spectrometry detected the HLA-A*02:01/SLLQHLIGL (PRAME425) epitope in 100% (4/4) of HLA-A*02+, PRAME+ NUT carcinoma samples at higher levels (>0.01 fM) than HLA-A*02:01/RLDQLLRHV (PRAME312) or HLA-A*02:01/YLHARLREL (PRAME462). The PRAME425 T-cell receptor x SP34 CD3 bispecific molecule and PRAME425 TCR T-cells each exhibited potent, T-cell mediated cytotoxicity against PRAME+ NUT carcinoma cells. ConclusionsPRAME is highly and frequently expressed in NUT carcinoma and the most common oncoprotein causing NUT carcinoma, BRD4::NUTM1, contributes to these high PRAME levels. PRAME epitopes presented by HLA Class I are a previously unrecognized therapeutic vulnerability for NUT carcinoma that warrant clinical trials testing PRAME targeted immunotherapies in this neglected patient population. What is already known on this topicNUT carcinoma is a devastating malignancy that is recalcitrant to cytotoxic chemotherapy, T-cell checkpoint blockade, and targeted therapies in the form of bromodomain inhibitors. What this study addsNUT carcinoma tumors are high in the cancer/testis gene PRAME. The oncogene most commonly causing NUT carcinoma, BRD4::NUTM1, contributes to these high levels. NUT carcinoma cells present PRAME epitopes on HLA Class I molecules and are susceptible to PRAME-directed, T-cell mediated cytotoxicity. How this study might affect research, practice or policyOur results argue for phase I/II clinical trials testing PRAME immunotherapies like brenetafusp or anzutresgene autoleucel in PRAME+ NUT carcinoma patients. Graphical Abstract O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=149 SRC="FIGDIR/small/642090v3_ufig1.gif" ALT="Figure 1"> View larger version (38K): org.highwire.dtl.DTLVardef@495654org.highwire.dtl.DTLVardef@c2b975org.highwire.dtl.DTLVardef@1de507org.highwire.dtl.DTLVardef@a76d33_HPS_FORMAT_FIGEXP M_FIG C_FIG

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Jensen, J. L., Peterson, S. K., Yu, S., Kinjo, T., Price, B. A., Sambade, M., Vesko, S., DeBetta, J. D., Geyer, J. K., Nickel, K. P., Kimple, R. J., Kotecha, R. S., Davis, I. J., Wang, J. R., French, C. A., Kuhlman, B., Rubinsteyn, A., Weiss, J., Vincent, B. G.. 2025-03-12. PRAME Epitopes are T-Cell Immunovulnerabilities in BRD4::NUTM1 Initiated NUT Carcinoma. https://doi.org/10.1101/2025.03.07.642090

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