Exposed phosphatidylserine is an inhibitory molecule in T cell exhaustion

2026-05-21 00:00:00Medina,ChristopherB.,Sobierajska,Ewelina,Gong,Minghao,McManus,DanielT.,Thapa,Maheshwor,Lee,Judong,Im,SeJin,Toombs,JasonE.,Mitchell,JoshuaM.,Wang,Yating,Carlisle,JenniferW.,Freeman,GordonJ.,Master,VirajA.,Ramalingam,Sures
Nature 2026年8115期

Abstract

In cancer and chronic infection, CD8 T cell exhaustion is hallmarked by expression of inhibitory receptors such as PD1, TIM3, LAG3 and others 1 , 2 , 3 . Thus, inhibitory molecule focus has been limited to cell-surface proteins. Here we evaluate the surface lipid metabolite phosphatidylserine (PS) as a regulator of exhaustion. PS primarily localizes to the inner plasma membrane of live cells but is well known to be externalized to the outer membrane during cell death. The role of exposed PS on live immune cells is less clear. We show that viable, antigen-specific CD8 T cells externalize PS during lymphocytic choriomeningitis virus (LCMV) infection. T cell activation induced initial PS exposure, and chronic antigen stimulation sustained externalization. Transcriptomic and lipidomic analyses also identified PS accumulation in exhausted CD8 T cells. To evaluate a role for exposed PS in exhaustion, we treated LCMV chronically infected mice with a PS-targeting antibody (mch1N11) 4 and found that it expanded LCMV-specific CD8 responses. PD1 + TCF1 + stem-like CD8 T cells downregulated quiescence-associated gene modules and increased proliferation after antibody treatment, highlighting an inhibitory role for PS. Mechanistically, exposed PS on T cells functioned extrinsically to suppress dendritic cell immunostimulatory phenotypes, in turn limiting CD8 T cell responses. PS-targeting antibody with anti-PDL1 synergized to increase CD8 responses and improve viral control. Finally, we show that PD1 + CD8 T cells from human tumours can also expose PS. In summary, we detail CD8 T cell PS biology and provide insight into a mechanism by which exposed PS functions as a ‘non-classical’ extrinsic inhibitory molecule in exhaustion.

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Fig. 1: Antigen-specific CD8 T cells expose PS.
Fig. 2: PS-targeting antibody increases virus-specific PD1 + CD8 T cell responses.
Fig. 3: PS regulates self-renewal and differentiation of PD1 + TCF1 + stem-like CD8 T cells.
Fig. 4: Targeting exposed PS stimulates the antigen-presenting capacity of CD11c + DCs.
Fig. 5: PS-targeting antibody synergizes with PD1–PDL1 blockade during chronic infection.
Fig. 6: PS exposure is conserved on PD1 + CD8 T cells in human cancer.

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