Epstein-Barr virus orchestrates spatial reorganization and immunomodulation in the classic Hodgkin lymphoma tumor microenvironment

Yao Yu Yeo*, Huaying Qiu*, Yunhao Bai*, Bokai Zhu*, Yuzhou Chang, Fabio Iannelli, Stephanie Pei Tung Yiu, Jason Yeung, Hendrik A Michel, Yuchen Wang, Yang Wang, Wenrui Wu, Kyle Wright, Muhammad Shaban, Sam Sadigh, Dingani Nkosi, Vignesh Shanmugam, Philip Rock, Precious Cramer, Julia Paczkowska, Pierre Stephan, Guanrui Liao, Amy Y Huang, Hongbo Wang, Han Chen, Leonie Frauenfeld, Louisa Kaufmann, Stefano Pileri, Bidisha Mitra, Benjamin E Gewurz, Bo Zhao, Garry P Nolan, Baochun Zhang, Alex K Shalek, Michael Angelo, Christian M Schürch, Faisal Mahmood, Roberto Chiarle, Qin Ma, W Richard Burack, Margaret A Shipp, Scott J Rodig^#, Sizun Jiang^#

Abstract

Classic Hodgkin lymphoma (cHL) is composed of rare malignant Hodgkin and Reed-Sternberg (HRS) cells within a T-cell-rich tumor microenvironment (TME). Epstein-Barr virus (EBV) is present in ∼25% of cases, but its contribution to pathogenesis and immunomodulation remains unclear due to technical barriers. Using complementary spatial proteomics and transcriptomics across multi-institutional cohorts, we systematically map key EBV-linked TME reorganization. EBV-positive cHL exhibits distinct immunological features, including memory CD8 T cell enrichment, heightened T cell dysfunction spatially correlated with HRS proximity, and terminally exhausted T cell signatures contrasting with progenitor-exhausted patterns in EBV-negative disease. We identify EBV-encoded LMP1 as a factor in T cell dysfunction through enhanced HRS:CD8 interactions, and its expression level correlates with T cell terminal exhaustion in a distance-dependent manner. This spatial framework dissects viral-mediated immune evasion in the cHL TME, highlighting potential therapeutic opportunities to target virus-associated T cell dysfunction for precision immunotherapy in virus-associated malignancies.