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Bromodomain and extraterminal (BET) proteins regulate key pathways contributing to CLL pathogenesis and TME interactions, including T cell function and differentiation. Herein, we report that blocking BET protein function alleviates immunosuppressive networks in the CLL TME and repairs inherent CLL T cell defects. The pan-BET inhibitor OPN-51107 reduced exhaustion-associated cell signatures resulting in improved T cell proliferation and effector function in the E\u03bc-TCL1 splenic TME. Following BET inhibition (BET-i), TME T cells coexpressed significantly fewer inhibitory receptors (IRs) (e.g., PD-1, CD160, CD244, LAG3, VISTA). Complementary results were witnessed in primary CLL cultures, wherein OPN-51107 exerted proinflammatory effects on T cells, regardless of leukemic cell burden. BET-i additionally promotes a progenitor T cell phenotype through reduced expression of transcription factors that maintain terminal differentiation and increased expression of TCF-1, at least in part through altered chromatin accessibility. Moreover, direct T cell effects of BET-i were unmatched by common targeted therapies in CLL. This study demonstrates the immunomodulatory action of BET-i on CLL T cells and supports the inclusion of BET inhibitors in the management of CLL to alleviate terminal T cell dysfunction and potentially enhance tumoricidal T cell activity.<\/jats:p>","DOI":"10.1172\/jci.insight.177054","type":"journal-article","created":{"date-parts":[[2024,5,21]],"date-time":"2024-05-21T14:00:31Z","timestamp":1716300031000},"source":"Crossref","is-referenced-by-count":14,"title":["BET inhibition reforms the immune microenvironment and alleviates T cell dysfunction in chronic lymphocytic leukemia"],"prefix":"10.1172","volume":"9","author":[{"given":"Audrey L.","family":"Smith","sequence":"first","affiliation":[{"name":"Eppley Institute for Research in Cancer and Allied Diseases,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sydney A.","family":"Skupa","sequence":"additional","affiliation":[{"name":"Eppley Institute for Research in Cancer and Allied Diseases,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandria P.","family":"Eiken","sequence":"additional","affiliation":[{"name":"Eppley Institute for Research in Cancer and Allied Diseases,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy E.","family":"Reznicek","sequence":"additional","affiliation":[{"name":"Department of Genetics, Cell Biology and Anatomy,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Schmitz","sequence":"additional","affiliation":[{"name":"Eppley Institute for Research in Cancer and Allied Diseases,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nolan","family":"Williams","sequence":"additional","affiliation":[{"name":"Eppley Institute for Research in Cancer and Allied Diseases,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dalia Y.","family":"Moore","sequence":"additional","affiliation":[{"name":"Eppley Institute for Research in Cancer and Allied Diseases,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher R.","family":"D\u2019Angelo","sequence":"additional","affiliation":[{"name":"Division of Hematology and Oncology, Department of Internal Medicine, and"},{"name":"Fred & Pamela Buffett Cancer Center (FPBCC), University of Nebraska Medical Center (UNMC), Omaha, Nebraska, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Avyakta","family":"Kallam","sequence":"additional","affiliation":[{"name":"Division of Hematology and Oncology, Department of Internal Medicine, and"},{"name":"Fred & Pamela Buffett Cancer Center (FPBCC), University of Nebraska Medical Center (UNMC), Omaha, Nebraska, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew A.","family":"Lunning","sequence":"additional","affiliation":[{"name":"Division of Hematology and Oncology, Department of Internal Medicine, and"},{"name":"Fred & Pamela Buffett Cancer Center (FPBCC), University of Nebraska Medical Center (UNMC), Omaha, Nebraska, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R. 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