The dual role of TIGIT in regulatory and effector T cells in chronic liver disease.

BACKGROUND & AIMS: Effective control of chronic liver diseases (CLD) requires suppression of effector T cells by CD4(+)CD25(+)CD127(low) regulatory T cells (Tregs). This study investigated the role of TIGIT, a co-inhibitory receptor, in CLD by examining the phenotype, recruitment, localisation, and function of TIGIT(+)Tregs and how TIGIT augments Treg function. We also elucidated the function of TIGIT(+)effector T cells on hepatocytes. METHODS: Liver infiltrating (CLD explants n = 7, donor liver n = 4) and peripheral (CLD blood n = 22, healthy control blood n = 10) TIGIT(+)Tregs and TIGIT(+)effector T cells were phenotyped by flow cytometry, and their localisation was examined by immunohistochemistry. Phenotypic and functional changes in TIGIT(+)Tregs in response to TIGIT agonism and IL-2 supplementation were also assessed. TIGIT(+)effector T cell-induced primary hepatocyte apoptosis was investigated using co-culture experiments and blocking assays. RESULTS: TIGIT(+)Tregs were more suppressive towards CD4(+)T cells than TIGIT(-)Tregs (p = 0.04254), and their suppressive action was IL-10 dependent. TIGIT expression was highly enriched on intrahepatic Tregs compared to effector T cells (p <0.0001). TIGIT(+)Tregs and TIGIT(+)effector T cells expressed CXCR3 and VLA-4 and localised around hepatocytes which express TIGIT ligand, CD155. TIGIT(+)Tregs also exhibited significantly higher cytotoxic T lymphocyte-associated antigen-4 (CTLA-4; p = 0.0012), FoxP3 (p <0.0001), and CD39 (p <0.0001) expression than TIGIT(-)Tregs. TIGIT agonism upregulated FoxP3 and CTLA-4 on Tregs, reduced proliferation, and increased TNF-α expression. Supplementing TIGIT(+)Tregs with IL-2 further enhanced FoxP3 and CTLA-4 expression. In contrast, TIGIT(+)effector T cells displayed reduced cytotoxicity towards hepatocytes, which reversed upon TIGIT blockade. CONCLUSIONS: TIGIT(+)Tregs are highly suppressive and can be enhanced in response to TIGIT agonism and IL-2 stimulation, demonstrating their translational therapeutic potential. However, TIGIT blockade on CD8(+)T cells induces hepatitis, caution is required when using anti-TIGIT therapy. IMPACT AND IMPLICATIONS: We identified a highly suppressive subset of regulatory T cells in the liver, defined as TIGIT(+)CD39(+)CTLA-4(+)Tregs. TIGIT agonists and IL-2 enhanced the suppressive function of this cell subset. The TIGIT ligand, CD155, is expressed on inflamed hepatocytes, and TIGIT blockade in oncology could instigate checkpoint inhibitor induced liver injury (CHILI). These findings have implications for future therapy in liver disease.