Treatment of clonal hematopoiesis associated atherosclerosis via vaccine-based clearance of the mutant cells

Abstract

Introduction: Clonal hematopoiesis of indeterminate potential (CHIP), driven by somatic mutations (e.g., TET2), is an independent risk factor for atherosclerosis (AS). CHIP-mutant macrophages promote plaque inflammation, but targeted therapies are lacking. Crucially, whether these clones acquire immunogenic neoantigens—enabling immune clearance—remains unexplored. Objective: To investigate if Tet2-mutant cells in CHIP-associated AS develop immunogenic neoantigens and evaluate a neoantigen-targeting vaccine strategy. Methods: Tet2 was edited in hematopoietic cells via CRISPR/Cas9 and transplanted into Ldlr^-/- mice fed a high-fat diet to model CHIP-accelerated AS. DNA and RNA sequencing of Tet2-mutant macrophages identified nonsynonymous mutations. Neoantigen immunogenicity was predicted in NetMHCpan. A therapeutic vaccine (GelVax) encapsulating mutant cell lysates (neoantigen source), GM-CSF (DC recruitment), and R848 (TLR agonist) within a biocompatible hydrogel was developed. Efficacy was assessed in the AS model. Results: Tet2 deficiency exacerbated atherosclerosis (+72% plaque area) and systemic inflammation.  DNA and RNA sequencing results identified 2 mutations showing high MHC-I binding affinity, suggesting neoantigenicity. GelVax vaccination reduced aortic plaque burden by 45%, selectively cleared Tet2-mutant macrophages in plaques, attenuated systemic cytokines (TNF-α, IL-1β) and improved plaque stability (↓ necrotic core, ↑ collagen). The protection was primarily CD8⁺ T-cell dependent. Conclusion: Tet2-mutant cells in CHIP-associated AS acquire immunogenic neoantigens. Leveraging these antigens via a hydrogel vaccine induces clone-specific CD8⁺ T cell responses, clears pathogenic macrophages, and ameliorates atherosclerosis. This validates mutant neoantigens as actionable targets for CHIP-driven cardiovascular disease.