CD4+Foxp3+ regulatory T cells (Tregs) are key to maintain peripheral self-tolerance and suppress immune responses to tumors. Their accumulation in the tumor microenvironment (TME) correlates with poor clinical outcome in several human cancers, including breast cancer (BC). However, the properties of intratumoral Tregs remain largely unknown. Here, we found that a functionally distinct subpopulation of tumor-infiltrating Tregs, which express the Foxp3 splicing variant retaining exon 2 (Foxp3E2), is prominent in the TME and peripheral blood of hormone receptor-positive (HR+) BC subjects with poor prognosis. Notably, a comprehensive examination of the Tumor Cell Genome Atlas (TCGA) validated Foxp3E2 as an independent prognostic marker in all other BC subtypes. We found that FOXP3E2 expression underlies BCs with highly immune suppressive landscape, defective mismatch repair and a stem-like signature thus highlighting pathways involved in tumor immune evasion. Finally, we confirmed the higher immunosuppressive capacity of BC patients-derived Foxp3E2+ Tregs by functional assays. Our study suggests Foxp3E2+ Tregs might be used as an independent biomarker to predict BC prognosis and recurrence, and to develop super-targeted depletion-based immunotherapies.
