Chimeric Antigen Receptor Signaling Research Articles

Degron-Based bioPROTACs for Controlling Signaling in CAR T Cells.

Chimeric antigen receptor (CAR) T cells have made a tremendous impact in the clinic, but potent signaling through the CAR can be detrimental to treatment safety and efficacy. The use of protein degradation to control CAR signaling can address these issues in preclinical models. Existing strategies for regulating CAR stability rely on small molecules to induce systemic degradation. In contrast to small molecule regulation, genetic circuits offer a more precise method to control CAR signaling in an autonomous cell-by-cell fashion. Here, we describe a programmable protein degradation tool that adopts the framework of bioPROTACs, heterobifunctional proteins that are composed of a target recognition domain fused to a domain that recruits the endogenous ubiquitin proteasome system. We develop novel bioPROTACs that utilize a compact four-residue degron and demonstrate degradation of cytosolic and membrane protein targets using either a nanobody or synthetic leucine zipper as a protein binder. Our bioPROTACs exhibit potent degradation of CARs and can inhibit CAR signaling in primary human T cells. We demonstrate the utility of our bioPROTACs by constructing a genetic circuit to degrade the tyrosine kinase ZAP70 in response to recognition of a specific membrane-bound antigen. This circuit can disrupt CAR T cell signaling only in the presence of a specific cell population. These results suggest that bioPROTACs are powerful tools for expanding the CAR T cell engineering toolbox.

Artificial Intelligence-Powered Molecular Docking and Steered Molecular Dynamics for Accurate scFv Selection of Anti-CD30 Chimeric Antigen Receptors.

Chimeric antigen receptor (CAR) T cells represent a revolutionary immunotherapy that allows specific tumor recognition by a unique single-chain fragment variable (scFv) derived from monoclonal antibodies (mAbs). scFv selection is consequently a fundamental step for CAR construction, to ensure accurate and effective CAR signaling toward tumor antigen binding. However, conventional in vitro and in vivo biological approaches to compare different scFv-derived CARs are expensive and labor-intensive. With the aim to predict the finest scFv binding before CAR-T cell engineering, we performed artificial intelligence (AI)-guided molecular docking and steered molecular dynamics analysis of different anti-CD30 mAb clones. Virtual computational scFv screening showed comparable results to surface plasmon resonance (SPR) and functional CAR-T cell in vitro and in vivo assays, respectively, in terms of binding capacity and anti-tumor efficacy. The proposed fast and low-cost in silico analysis has the potential to advance the development of novel CAR constructs, with a substantial impact on reducing time, costs, and the need for laboratory animal use.

The BTLA-HVEM axis restricts CAR T cell efficacy in cancer.

The efficacy of T cell-based immunotherapies is limited by immunosuppressive pressures in the tumor microenvironment. Here we show a predominant role for the interaction between BTLA on effector T cells and HVEM (TNFRSF14) on immunosuppressive tumor microenvironment cells, namely regulatory T cells. High BTLA expression in chimeric antigen receptor (CAR) T cells correlated with poor clinical response to treatment. Therefore, we deleted BTLA in CAR T cells and show improved tumor control and persistence in models of lymphoma and solid malignancies. Mechanistically, BTLA inhibits CAR T cells via recruitment of tyrosine phosphatases SHP-1 and SHP-2, upon trans engagement with HVEM. BTLA knockout thus promotes CAR signaling and subsequently enhances effector function. Overall, these data indicate that the BTLA-HVEM axis is a crucial immune checkpoint in CAR T cell immunotherapy and warrants the use of strategies to overcome this barrier.

Phospho-mimetic CD3ε variants prevent TCR and CAR signaling.

Antigen binding to the T cell antigen receptor (TCR) leads to the phosphorylation of the immunoreceptor tyrosine-based activation motifs (ITAMs) of the CD3 complex, and thereby to T cell activation. The CD3ε subunit plays a unique role in TCR activation by recruiting the kinase LCK and the adaptor protein NCK prior to ITAM phosphorylation. Here, we aimed to investigate how phosphorylation of the individual CD3ε ITAM tyrosines impacts the CD3ε signalosome. We mimicked irreversible tyrosine phosphorylation by substituting glutamic acid for the tyrosine residues in the CD3ε ITAM. Integrating CD3ε phospho-mimetic variants into the complete TCR-CD3 complex resulted in reduced TCR signal transduction, which was partially compensated by the involvement of the other TCR-CD3 ITAMs. By using novel CD3ε phospho-mimetic Chimeric Antigen Receptor (CAR) variants, we avoided any compensatory effects of other ITAMs in the TCR-CD3 complex. We demonstrated that irreversible CD3ε phosphorylation prevented signal transduction upon CAR engagement. Mechanistically, we demonstrated that glutamic acid substitution at the N-terminal tyrosine residue of the CD3ε ITAM (Y39E) significantly reduces NCK binding to the TCR. In contrast, mutation at the C-terminal tyrosine of the CD3ε ITAM (Y50E) abolished LCK recruitment to the TCR, while increasing NCK binding. Double mutation at the C- and N-terminal tyrosines (Y39/50E) allowed ZAP70 to bind, but reduced the interaction with LCK and NCK. The data demonstrate that the dynamic phosphorylation of the CD3ε ITAM tyrosines is essential for CD3ε to orchestrate optimal TCR and CARsignaling and highlights the key role of CD3ε signalosome to tune signal transduction.

Newer generations of multi-target CAR and STAb-T immunotherapeutics: NEXT CART Consortium as a cooperative effort to overcome current limitations.

Adoptive T cellular immunotherapies have emerged as relevant approaches for treating cancer patients who have relapsed or become refractory (R/R) to traditional cancer treatments. Chimeric antigen receptor (CAR) T-cell therapy has improved survival in various hematological malignancies. However, significant limitations still impede the widespread adoption of these therapies in most cancers. To advance in this field, six research groups have created the "NEXT Generation CART MAD Consortium" (NEXT CART) in Madrid's Community, which aims to develop novel cell-based immunotherapies for R/R and poor prognosis cancers. At NEXT CART, various basic and translational research groups and hospitals in Madrid concur to share and synergize their basic expertise in immunotherapy, gene therapy, and immunological synapse, and clinical expertise in pediatric and adult oncology. NEXT CART goal is to develop new cell engineering approaches and treatments for R/R adult and pediatric neoplasms to evaluate in multicenter clinical trials. Here, we discuss the current limitations of T cell-based therapies and introduce our perspective on future developments. Advancement opportunities include developing allogeneic products, optimizing CAR signaling domains, combining cellular immunotherapies, multi-targeting strategies, and improving tumor-infiltrating lymphocytes (TILs)/T cell receptor (TCR) therapy. Furthermore, basic studies aim to identify novel tumor targets, tumor molecules in the tumor microenvironment that impact CAR efficacy, and strategies to enhance the efficiency of the immunological synapse between immune and tumor cells. Our perspective of current cellular immunotherapy underscores the potential of these treatments while acknowledging the existing hurdles that demand innovative solutions to develop their potential for cancer treatment fully.

Abstract 6330: A novel monoclonal antibody for the detection, enrichment and activation of cells expressing scFv-based chimeric antigen receptors

Abstract Introduction: Chimeric Antigen Receptor (CAR)-T cell therapy is a highly innovative form of immunotherapy that has proven to be successful in the treatment of B cell malignancies and multiple myeloma. As this treatment modality continues to evolve toward the targeting of novel tumor antigens and engineering of CAR constructs that enhance cell persistence, there is a need for reagents that can be leveraged to selectively interrogate multiple aspects of CAR-T cell biology. Here, we report on a novel and highly versatile recombinant rabbit monoclonal antibody raised against the Gly4Ser peptide linker, which is commonly integrated into single-chain variable fragment (scFv)-based CARs. This antibody can be leveraged for flow cytometry-based CAR detection, bead-based CAR-T cell enrichment, and selective activation of CAR transduced cells. Methods: The recombinant monoclonal antibody, E7O2V, was generated by immunizing rabbits with a synthetic peptide containing multiple repeats of the Gly4Ser core pentapeptide. E7O2V was directly conjugated to a panel of fluorophores and validated for specificity in a live cell flow cytometry assay using non-transduced and CAR-transduced primary human T cells. To assess its utility in cell enrichment using bead-based sorting, a biotinylated conjugate of E7O2V was used in combination with streptavidin releasable magnetic meads to immunoaffinity purify CAR transduced cells from a mixed population. Finally, a plate-bound antibody stimulation assay was leveraged to assess the ability of E7O2V to selectively activate CAR transduced cells. Results: Live cell flow cytometric analysis of CAR-transduced primary human T cells revealed that E7O2V could detect surface expressed CARs, independent of scFv specificity. No specific staining was observed on non-transduced cells. Furthermore, flow cytometric analysis of bead-free, purified cells revealed that biotinylated E7O2V could enrich CAR transduced cells to a high degree of purity and viability. E7O2V was found to selectively activate CAR transduced cells, but not non-transduced cells, as demonstrated by upregulation of cell surface activation markers, including CD69 and CD25. Conclusions: Exploiting the commonly used Gly4Ser linker of scFv-based CARs for antibody discovery, we identified a novel and highly versatile monoclonal antibody, E7O2V. This antibody binds to CARs of varying antigen specificity and can be leveraged in multiple assay formats to interrogate various attributes of CAR transduced cells, including CAR expression, CAR signaling, and transcriptome profiling enabled by bead-based enrichment. Citation Format: Amrik Singh, Sarah L'Heureux, Jeremy Fisher. A novel monoclonal antibody for the detection, enrichment and activation of cells expressing scFv-based chimeric antigen receptors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 6330.

Mechanical force determines chimeric antigen receptor microclustering and signaling

The chimeric antigen receptor (CAR)-T cells are activated to trigger the lytic machinery after antigen engagement, and this has been successfully applied clinically as therapy. The mechanism by which antigen binding leads to the initiation of CAR signaling remains poorly understood. Here, we used a set of short double-stranded (ds) DNA tethers with mechanical forces ranging from ∼12 to ∼51 piconewtons (pN) to manipulate the mechanical force of antigen tether and decouple the microclustering and signaling events. Our results revealed that antigen binding-induced CAR microclustering and signaling are mechanical force-dependent. Additionally, the mechanical force delivered to the antigen tether by the CAR for microclustering is generated by autonomous cell contractility. Mechanistically, the mechanical force-induced strong adhesion and CAR diffusion confinement led to CAR microclustering. Moreover, cytotoxicity may have a lower mechanical force threshold than cytokine generation. Collectively, these results support a model of mechanical force-induced CAR microclustering for signaling.

Abstract A042: Quantitative multiplex immunoprecipitation reveals distinct protein interaction networks responsible for discrepant in vivo activity exhibited by two second generation CD22-targeted chimeric antigen receptors

Abstract The Pediatric Leukemia Adoptive Therapy (PLAT) trials at Seattle Children’s Hospital have pioneered the use of chimeric antigen receptor (CAR) T cell (CAR-T) therapies in pediatric patients with B cell Acute Lymphoblastic Leukemia. The landmark PLAT-02 trial (n=45), utilizing a second-generation CD19-directed CAR, observed a 93% remission rate following CAR-T infusion. However, approximately half of these subjects relapsed within one year and nearly a third of those tumors no longer expressed the CD19 target. The PLAT-04 trial (n=4) was subsequently conceived with a second-generation CAR (SCRI-C22v1) engineered to target CD22, an alternative antigen expressed on the B cell surface. Despite promising preclinical data, SCRI-C22v1 failed to generate anti-leukemic activity in all four subjects and the trial was halted. In response, a different second-generation CD22-directed CAR (SCRI-C22v2) was engineered, replacing the CD28 transmembrane domain and IgG4 hinge domain in SCRI-C22v1 with a continuous CD8 hinge and transmembrane domain while retaining identical 4-1BB and CD3ζ intracellular signaling domains. The modified SCRI-C22v2 displayed improved anti-tumor activity in preclinical models and was ultimately tested in patients in the PLAT-07 trial (n=4), where it exhibited strong in vivo expansion and persistence while inducing complete remission after 1 month in all four subjects. To investigate the molecular signaling responsible for clinical differences observed between SCRI-C22v1 and SCRI-C22v2, we applied an emerging proteomic technology, Quantitative Multiplex Immunoprecipitation (QMI), that captures medium-throughput quantitative data about fold changes in protein interaction networks downstream of the CAR. CAR-T products from healthy donors expressing either SCRI-C22v1 or SCRI-C22v2 were stimulated with fixed K562 cells expressing CD22 and protein interaction networks were profiled with QMI, revealing distinct differences in signal transduction downstream of the CAR. Contrary to expectation, it was the ineffective SCRI-C22v1 that exhibited significantly enhanced signalosome formation, engaging more strongly than SCRI-C22v2 with both the classical CD3ζ-ZAP70-LAT-SLP76 pathway as well as the non-classical TRAF pathway. Interestingly, the clinically successful SCRI-C22v2 demonstrated stronger baseline engagement with inhibitory molecules that attenuate canonical TCR signaling such as SHP2 and UBASH3A, suggesting regulatory control of CAR signaling is crucial for optimal clinical responses. Since the CAR is a synthetic receptor, it should be possible to bioengineer optimized signal transduction to some extent, and our group continues to work towards identifying an optimized QMI signature that can be used as a CAR-tune network for the rational design of more effective CAR-T therapies. Citation Format: Eric Bueter, Corinne Summers, Isabella Draper, Joshua Gustafson, Stephen EP Smith, Kamila Gwiazda, Julie Park, Colleen Annesley, Rebecca Gardner, Michael Jensen. Quantitative multiplex immunoprecipitation reveals distinct protein interaction networks responsible for discrepant in vivo activity exhibited by two second generation CD22-targeted chimeric antigen receptors [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Tumor Immunology and Immunotherapy; 2023 Oct 1-4; Toronto, Ontario, Canada. Philadelphia (PA): AACR; Cancer Immunol Res 2023;11(12 Suppl):Abstract nr A042.

Naturally Occurring Mutations in Human T Cell Lymphomas Enhance Engineered T Cell Therapies

T cell therapies, including chimeric antigen receptor (CAR) T cells, have revolutionized cancer therapy. However, impressive responses are limited to a subset of patients with hematological cancers and have not been unlocked in patients with solid tumors, which represent 90% of adult cancers. Adoptive T cell therapy in both treatment-resistant hematological malignancies and solid cancers is limited by a complex combination of factors, including poor in vivo persistence, immunosuppressive environmental factors, and T cell exhaustion. New solutions to overcome these limitations are needed to address the significant unmet need for effective cell therapies. To overcome this engineering problem, we turned to spontaneously occurring T cell cancers. Over time, T cells, like other cells in the adult, acquire somatic mutations. When these mutations increase the fitness of the T cell, T cell clones emerge via positive selection. These T cell cancers develop genetic means to overcome similar cell-intrinsic and cell-extrinsic immunosuppressive factors facing anti-tumor T cells. Additionally, mutations from T cell cancers may unlock modifications not available by current screening approaches, because evolution employs any mutation available in nature. Like existing approaches, these mutations can modify gene expression by gene locus duplication or deletion. However, unlike current approaches, gain-of-function point mutations or translocations can be introduced that have unique, outsized effects unachievable by modulation of wild-type gene expression. Here, we have generated a first-of-its-kind library of 71 mutations and 45 wild-type over-expression controls. We performed in vitro and in vivo screening to identify the effects of these mutations on CAR signaling, cytokine production, and accumulation in vivo in tumors. These screens converged on a gene fusion, CARD11-PIK3R3. Mechanistically, CARD11-PIK3R3 enhances CAR-dependent CARD11-BCL10-MALT1 complex signaling including NF-κB/AP-1 transcriptional activity and MALT1 substrate cleavage, in a BCL10 dependent manner. In vivo, CARD11-PIK3R3 transduced T cells exhibit enhanced intratumoral accumulation, effector functions, and therapeutic efficacy. Importantly, CARD11-PIK3R3 expression was sufficient to reduce T cell dose requirements and protect against tumor re-challenge in an immunotherapy refractory syngeneic model in the absence of lymphodepletion. Our results indicate that exploiting naturally occurring mutations represents a promising approach to explore the extremes of T cell biology and discover how solutions derived from evolution of malignant T cells can improve a broad range of T cell therapies. Notably, the gene fusion we identified would be inaccessible through previous T cell screening efforts such as loss of function, CRISPR activation, or wild-type gene over-expression screens. Finally, our results implicate the CARD11-BCL10-MALT1 signalosome as a key regulator of therapeutic T cell function. Altogether, investigation of T cell lymphoma mutations in the context of adoptively transferred T cells has the promise to both improve cellular therapies and to elucidate new T cell biology.

Regulation of the Transcriptional Repressor BACH2 Overcomes Tonic Signaling-Driven CAR T Cell Dysfunction

Unlike endogenous T cell receptors (TCRs), chimeric antigen receptors (CARs) have an intrinsic predisposition to initiate intracellular signaling in the absence of target antigen (Long AH, Nature Medicine 2015). This phenomenon, referred to as tonic signaling, has previously been shown to be a potent driver of T cell exhaustion when CARs contain the CD28 costimulatory domain (Lynn R, Nature 2019). We previously showed that, in contrast to CD28, CARs containing the 41BB costimulatory domain acquire enhanced functionality from tonic signaling (Singh N, Nature Medicine 2021). These data indicate that the impact of tonic CAR signaling is directly dependent on the CAR costimulatory domain. To understand the molecular regulators responsible for this divergent functionality, we generated CARs targeting CD22, an established immunotherapy target for B cell malignancies, that contained either CD28 or 41BB costimulatory domains and either did or did not signal tonically (22/28+, 22/BB+, 22/28-, 22/BB-). We confirmed that tonic signaling of CD28 drove impaired cytotoxic function, T cell expansion and cytokine secretion in response to antigen, while tonic 41BB improved all parameters of T cell function. Bulk RNA sequencing of CAR T cell products at the conclusion of manufacturing, when the impact of tonic CAR signaling was predicted to be most impactful, revealed significantly more transcriptional activity in both tonic CARs. Comparison of differentially expressed genes demonstrated that 22/28+ had high expression of targets of NFAT and AP1, transcription factors that promote T cell effector function but are also drivers of T cell exhaustion when persistently active (Martinez GJ, Immunity 2015; Lynn R, Nature 2019). 22/BB+ instead demonstrated high activity of BACH2, a transcriptional repressor that has recently been shown to preserve naïve and memory cell states by antagonizing effector programs (Yao C, Nature Immunology 2021; Roychoudhuri R, Nature Immunology 2016). We generated 22/28+ cells that overexpressed BACH2 (22/28+_BACH2) and found that this intervention completely rescued acute anti-tumor function, with cytotoxic activity of these cells equivalent to 22/BB+. Mass cytometry revealed that 22/28+_BACH2 cells were phenotypically very similar to 22/BB+ cells at the conclusion of manufacturing and after stimulation with target cells, expressing high levels of granzyme B, perforin, IFNγ and markers of memory differentiation. Intriguingly, 22/28+_BACH2 cells expressed very high levels of the transcription factor TCF7, known to play a role in maintaining memory, suggesting that transgenic BACH2 expression play a broad role in lineage regulation. To interrogate how BACH2 overexpression impacted long-term T cell function, we chronically stimulated these cells using our established in vitro protocol (Selli ME, STAR Protocols 2023) in which co-cultures of CAR T cells and tumors are continually replenished with additional tumor to maintain a persistent and high antigen burden. Similar to our previous studies, early function of 22/28+_BACH2 cells was significantly improved over 22/28+ but BACH2 overexpressing cells lost the ability to proliferate and kill tumor cells much earlier than either 22/28+ or 22/BB+. Phenotypic analysis revealed at time of cell failure revealed that almost all 22/28+_BACH2 cells expressed markers of a central memory phenotype (CD62L hiCD45RO hi). Collectively, these data suggest that BACH2 overexpression can overcome tonic CAR signaling-induced dysfunction by antagonizing exhaustion programs but simultaneously “locks” these cells into a memory state with restrained effector function, thus limiting their long-term efficacy.

Mitochondrial Isocitrate Dehydrogenase Inhibition Enhances CAR T-Cell Function By Restraining Antioxidant Metabolism and Histone Acetylation

Introduction: The efficacy of chimeric antigen receptor (CAR) T-cell therapy is hampered by relapse in hematologic malignancies and by hyporesponsiveness in solid tumors. Mitochondria are vital for the regulation of memory T-cell formation or exhaustion. A mitochondria-related compound screening was performed and we found that the FDA-approved isocitrate dehydrogenase 2 (IDH2) inhibitor enasidenib enhances long-lived memory CAR T-cell formation, and improves tumor clearance in vivo. IDH2 as the key component of the tricarboxylic acid (TCA) cycle, we hypothesized that IDH2 inhibition might promote CAR T-cell persistence by reprogramming the metabolism. The study aims to systematically evaluate the role and the mechanism of IDH2 inhibition on CAR T cells, and explore the application of enasidenib in CAR T-cell therapy. Methods and Results: To identify mitochondrial components that affect the long-term efficacy of CAR T-cells, we performed an in vitro screening using a mitochondria-related compound library based on the enrichment of the CD62L + CAR T-cell subset, which mainly contains T memory stem cells (T SCM) and central memory T cells (T CM). Among several candidate compounds that promoted memory CAR T-cell formation, enasidenib (ENA), an inhibitor of both wild-type and mutant IDH2 enzymes, was the most effective one. The proportion of CD62L has increased by over 20%. To determine the effect of ENA on exhaustion induced by tonic CAR signaling and tumor antigen stimulation, we measured the expression of inhibitory receptors PD-1, TIM-3, and LAG-3 and the level of apoptosis in freshly expanded CAR T cells and B-ALL encountered CAR T cells. CAR T cells treated with ENA exhibited reduced surface levels of those inhibitory receptors. We measured the production of granzyme B and IFNγ, and tumor rechallenge assay in CAR T cells after ENA treatment to assess the effector function, ENA treated CAR T cells exerted enhanced and sustained cytotoxicity in a tumor rechallenge assay at an extreme E:T ratio of 1:10. These results were observed not only in CD19-41BBζ CAR T cells, but also in CD19-28ζ and GD2-28ζ CAR T cells. CAR T cells expanded in the presence of ENA significantly prolonged survival of recipients after Nalm-6 infusion (p < 0.0001), extended in vivo ENA treatment further enhanced CAR T-cell expansion and tumor suppression. The median survival was extended from 45 to 67.5 days. Consistent with the effect of ENA treatment, IDH2 knockdown increased the proportions of the T scm/T n and T cm subsets, and alleviated CAR T-cell exhaustion. IDH2-knockdown CAR T cells had sustained cytotoxicity and higher CD62L expression after rounds of killing B-ALL cells in vitro. To systematically explore the effects of IDH2 inhibition on the metabolism of CAR T cells, relative metabolite amounts was measured using mass spectrometry (MS). IDH2-inhibited CAR T cells exhibited a substantial reduction of metabolites in the TCA cycle, including succinate, fumarate, and malate, and in the glycolysis pathway, including lactate, phosphoenolpyruvate. Mechanistically, IDH2 inhibition reprogram central carbon metabolism of CAR T cells by redirects glucose carbon utilization from glycolysis to the pentose phosphate pathway. In addition, IDH2 limits cytosolic acetyl-CoA level to prevent histone acetylation that promotes memory cell formation. Significance: Our study indicates that metabolic intervention in CAR T cells with the FDA-approved IDH2 inhibitor enasidenib can advance current treatment, with better tumor eradication and CAR T-cell persistence.

Dual-inhibitory domain iCARs improve the efficiency of the AND-NOT gate CAR T strategy.

CAR (chimeric antigen receptor) T cell therapy has shown clinical success in treating hematological malignancies, but its treatment of solid tumors has been limited. One major challenge is on-target, off-tumor toxicity, where CAR T cells also damage normal tissues that express the targeted antigen. To reduce this detrimental side-effect, Boolean-logic gates like AND-NOT gates have utilized an inhibitory CAR (iCAR) to specifically curb CAR T cell activity at selected nonmalignant tissue sites. However, the strategy seems inefficient, requiring high levels of iCAR and its target antigen for inhibition. Using a TROP2-targeting iCAR with a single PD1 inhibitory domain to inhibit a CEACAM5-targeting CAR (CEACAR), we observed that the inefficiency was due to a kinetic delay in iCAR inhibition of cytotoxicity. To improve iCAR efficiency, we modified three features of the iCAR-the avidity, the affinity, and the intracellular signaling domains. Increasing the avidity but not the affinity of the iCAR led to significant reductions in the delay. iCARs containing twelve different inhibitory signaling domains were screened for improved inhibition, and three domains (BTLA, LAIR-1, and SIGLEC-9) each suppressed CAR T function but did not enhance inhibitory kinetics. When inhibitory domains of LAIR-1 or SIGLEC-9 were combined with PD-1 into a single dual-inhibitory domain iCAR (DiCARs) and tested with the CEACAR, inhibition efficiency improved as evidenced by a significant reduction in the inhibitory delay. These data indicate that a delicate balance between CAR and iCAR signaling strength and kinetics must be achieved to regulate AND-NOT gate CAR T cell selectivity.

CD19-CAR Cytokine Induced Killer Cells Armored with IL-18 Control Tumor Burden, Prolong Mouse Survival and Result in In Vivo Persistence of CAR-CIK Cells in a Model of B-Cell Acute Lymphoblastic Leukemia

Rationale: Cytokine induced killer cells (CIK) are a promising cancer immunotherapy. Recently CIK cells modified to express chimeric antigen receptors (CAR) target CD19 expressing hematological malignancies including B-cell acute lymphoblastic leukemia (B-ALL). Despite encouraging clinical trial results, insufficient CAR-CIK anti-tumor activity and persistence pose major obstacles towards improved efficacy in vivo. Therefore, we optimized our CAR-CIK platform by introducing two modifications to the CD19-CAR construct. The first modification “armored” CAR-CIK cells by inserting the IL-18 gene in a bicistronic DNA plasmid enabling simultaneous surface expression of the CAR protein and secretion of IL-18, which demonstrated improved CAR-T cell function. The second modification attenuated the CD28 cytoplasmic signaling domain of the CAR molecule to enhance anti-tumor activity and in vivo persistence since recent findings demonstrate that persistent or chronic CAR signaling can impair anti-tumor activity and in vivo persistence. Methods: CARCIK-1918 cells generated from donor-derived CIK cells are engineered to express CAR and IL-18 using the non-viral Sleeping Beauty (SB) transposon system. CIK cells were generated from donor PBMCs by the sequential addition of IFN-ϒ and stimulation with anti-CD3 antibody plus IL-2. After 2 days of stimulation CIK cells were co-electroporated with SB100X transposase mRNA and plasmid DNA containing a bicistronic transgene encoding both the anti-CD19 CAR and IL-18. This second-generation CAR contains a fusion of the CD28 transmembrane domain, intracellular CD28 and, TCR CD3ζ chain. In some instances, the cytoplasmic CD28 signaling domain is modified to attenuate CD28 signaling. This method of gene transfer results in stable surface expression of the CAR on CD3+ cells through a 17-day culture period. Day 17 cells are harvested, frozen and used for all subsequent studies. CARCIK-1918 cells are stimulated in vitro with CD19+ REH tumor cells and the phenotype of activated cells was characterized by multi-color flow cytometry. IL-18 secretion was determined by cytokine bead array analysis of supernatants collected post stimulation. CARCIK-1918 cells with or without the attenuated CD28 signaling domain were tested in vivo in a xenograft model of B-ALL, using NSG mice engrafted with CD19+ Raji tumor cells. Tumor burden was assessed weekly by bioluminescence imaging, the in vivo persistence of CARCIK-1918 cells was measured by flow cytometry, and survival was monitored throughout the study. Results: CARCIK-1918 cells express both IL-18 and CAR with or without attenuated CD28 signaling. Furthermore, stimulation of CARCIK-1918 cells with CD19+ REH tumor cells increases the frequency of CAR-CIK cells with a memory phenotype and concurrent upregulation of the high affinity IL-2 receptor, CD25, and the costimulatory receptor CD137. Expression of IL-18 leads to higher engraftment of CAR-CIK cells in tumor bearing NSG mice compared to unarmored controls. NSG mice engrafted with luciferase positive Raji cells demonstrated decreased bioluminescent signal following CARCIK-1918 treatment, consistent with CARCIK derived anti-leukemic activity. This anti-tumor activity corresponded to a statistically significant improvement in survival as mice treated with 2 nd generation CAR transgene CARCIK cells with or without attenuated CD28 signaling had a median survival of 37.5 (n=10; p=0.0001) and 38 (n=12; p =0.0001 days), respectively, compared to untreated mice that develop progressive highly disseminated tumor and succumb to disease by 3 weeks post tumor inoculation (n=11; median survival 18 days). Interestingly, mice treated with CARCIK-1918 cells with the CD28 attenuated signaling domain exhibited better tumor control and enhanced persistence in vivo, despite no significant improvement in survival compared to WT CD28 signaling CARCIK-1918 cells. Summary: This study demonstrates that administration of CAR-CIK cells armored with IL-18 results in a significant survival advantage for tumor challenged animals versus untreated animals. Furthermore, modifying the cytoplasmic CD28 domain to attenuate signaling, results in better control of tumor burden, and persistence of CARCIK-1918 cells in vivo. Our study is the first report of IL-18 armored CAR-CIK cells which may present a promising, novel strategy for the treatment of B-ALL.

Signaling Role of Viral Protein Motif and Its Application in CAR T Cell Therapy

Adoptive cell therapy using Chimeric Antigen Receptor (CAR) T cells, such as Tisagenlecleucel and Axicabtagene Ciloleucel, has revolutionized cancer immunotherapy and become a game-changer in cancer care. However, several challenges, including durable remission and limited expansion after infusion, persist. Recent work from the Riddell lab (PMID: 34429382) demonstrated that T Cell Receptors (TCRs) are more sensitive than CARs due to the presence of T cell signaling proteins like CD3-, CD3ε, and CD3-, which facilitate the recruitment of Lck to phosphorylate immunoreceptor tyrosine-based activation motifs (ITAMs). Although CARs were designed to mimic TCR signaling, they still lack the full sensitivity. In this study, we hypothesized that enhancing tyrosine phosphorylation of the immunoreceptor tyrosine-based activation motifs (ITAMs) presented on CD3 in CAR T cells amplifies the CAR-mediated signaling as well as improves sensitivity of CAR co-stimulatory signaling. To achieve this, we developed a novel co-stimulation system where anti-CD19 CAR T cells co-expressed Tip37, a 37-amino acid segment of the Herpesvirus saimiri (HVS) tyrosine-protein kinase-interacting protein (Tip). This specific segment interacts exclusively with the major T cell kinase, Lck, effectively regulating its kinase activation. The critical region for this interaction lies within 37 amino acids (146-182) in the central part of Tip, which contains two motifs: the SH3 binding motif (SH3B; 174-182) and the C-terminal Src-related kinase homology motif (CSKH; 146-155). The 37 amino acid peptide fragments alone form a stable complex with Lck. Lck is crucial in the initial stages of T cell activation, not only when triggered by the native TCR stimulation but also in response to CAR-antigen stimulation. Following antigen-induced T cell activation, Lck initiates the phosphorylation of tyrosines in the ITAMs present in CD3ζ domains. This leads to the recruitment of ZAP70 kinases to the ITAMs of CD3ζ, facilitating the formation of signaling protein complexes. The results of our in vitro experiments using the immortalized T cell line, Jurkat cells, demonstrate that the inclusion of the Tip37 component in the CAR leads to the formation of the Lck-CAR complex. This, in turn, significantly enhances the phosphorylation of ITAMs in CARs and triggers downstream signaling. Importantly, the CAR T cells with the Tip37 co-stimulatory domain do not secrete cytokines when in an unstimulated state. This suggests that the heightened Lck phosphorylation does not lead to the auto-activation of T cells. As a result, CAR T cells engineered with Tip37 can be considered safe and hold promise for future applications. We engineered CAR19 T cells co-expressing Tip (Tip-CART19 cells) with a co-stimulatory domain of 4-1BB and CD3 (Tip-CART19 cells). As a control, we generated CART19 cells lacking the TIP domain (WT CART19 cells). We confirmed that Tip expression induced enhanced CD3 phosphorylation in CART19 T cells. Additionally, we observed that a significantly augmented outgrowth of CD8+ cells engineered with the TIP-containing CAR compared with canonical CAR T cells. Further, TIP-CAR T cells displayed increased expression of CD38 and Ki67. Interestingly, we also noted an expansion of CCR7+CD45RA- central memory subsets in CD4+ CART19 cells and CCR7-CD45RA- effector memory subsets in CD8+ CART19 cells. Finally, as evidenced by apparent changes in phenotype, Tip-CART19 cells exhibited improved cytotoxic ability and significant outgrowth of CART19 cells with in vitro repeated CAR stimulation using CD19-expressing tumor cells, as previously described in our study (Fraietta et al., Nature 2018). This study highlights that amplification of the constitutive Lck recruitment and amplified CD3 phosphorylation in CART19 cells via the introduction of Tip37 domain results in enhanced anti-leukemia cytotoxic ability and preservation of proliferative function in CART19 cells. Our discovery introduces a novel approach for amplifying CAR signaling to improve CAR T cell therapy.

NFAT and NF-κB dynamically co-regulate TCR and CAR signaling responses in human T cells

While it has been established that the responses of Tcells to antigens are combinatorially regulated by multiple signaling pathways, it remains elusive what mechanisms cells utilize to quantitatively modulate Tcell responses during pathway integration. Here, we show that two key pathways in Tcell signaling, calcium/nuclear factor of activated Tcells (NFAT) and protein kinase C (PKC)/nuclear factor κB (NF-κB), integrate through a dynamic and combinatorial strategy to fine-tune Tcell response genes. At the cis-regulatory level, the two pathways integrate through co-binding of NFAT and NF-κB to immune response genes. Pathway integration is further regulated temporally, where Tcell receptor (TCR) and chimeric antigen receptor (CAR) activation signals modulate the temporal relationships between the nuclear localization dynamics of NFAT and NF-κB. Such physical and temporal integrations together contribute to distinct modes of expression modulation for genes. Thus, the temporal relationships between regulators can be modulated to affect their co-targets during immune responses, underscoring the importance of dynamic combinatorial regulation in cellular signaling.

Abstract 4093: Dual targeted CAR immunotherapy for neuroblastoma using γδ T cells

Abstract Cellular immunotherapy for aggressive pediatric solid tumors like neuroblastoma (NB) has focused on autologous products of αβ T cells, that so far, have been uniformly unsuccessful. γδ T cells offer a potentially superior, off-the-shelf therapy that is directly cytotoxic towards tumors without alloreactivity. Furthermore, γδ T cell infiltration of the hostile, solid tumor microenvironment is a prognostic marker of favorable disease outcome. Our team recently opened a first-in-child evaluation of unengineered allogeneic γδ T cells in combination with dinutuximab, an anti-GD2 antibody, and chemotherapy (NCT05400603). Our focus now is to optimize a second-generation γδ T-cell therapy by engineering the expression of tumor targeting chimeric antigen receptors (CAR). We hypothesize that CAR-targeting will further enhance γδ T-cell homing and antitumor potency. While anti-GD2 antibodies have been clinically successful immunotherapies for NB, GD2-targeted cell therapies need improvement. Our team recently validated a novel immunotherapy target for NB, protein tyrosine kinase 7 (PTK7), an inactive tyrosine kinase expressed highly amongst all NBs with low to no normal pediatric tissue expression. We designed a dual-targeting platform directed against both GD2 and PTK7 using γδ T cells, where CARs are separately encoded and dually expressed. Previously optimized transgenes containing GD2 or PTK7 scFv targeting domains followed by a CD8 hinge region, CD28 co-stim/trans-membrane domain, and CD3ζ signalling domain were inserted under the T7 promoter for mRNA production. Purified mRNA was electroporated into γδ T cells following their thaw from cryopreservation. Electroporation titrations were performed to optimize CAR expression to be detected up to 72 hours post-modification, which is compatible with the approximate in vivo lifespan γδ T cells in mice. Simultaneous expression of both CARs appears highest 24 h after electroporation, with ~70% of the target γδ T cell population modified. Anti-GD2/PTK7 γδ T cells are potent against the NB cell line IMR5 (GD2+PTK7+) in a 4 h cytotoxicity assay at effector:target ratios as low as 0.5:1. Importantly, specificity is also shown against NB cell lines genetically engineered to represent the clinical heterogeneity of GD2 and PTK7 expression that may be observed, where the dual CAR therapy is effective against GD2+PTK7+, GD2+PTK7−, and GD2−PTK7+, but not GD2−PTK7− NBs. In conclusion, we developed a dual CAR-based cellular therapy for NB using γδ T cells as an effector population in place of classical αβ T cells. Early studies demonstrate feasibility for innovative dual CAR expression and show promise for strong anti-NB potency. Future work will optimize CAR signaling domains for maximal efficacy in solid tumors, as well as confirm efficacy and safety in vivo with results rapidly translatable into our established γδ T cell clinical trial pipeline. Citation Format: Hunter C. Jonus, Jasmine Y. Lee, Jordan A. Silva, H. Trent Spencer, Kelly C. Goldsmith. Dual targeted CAR immunotherapy for neuroblastoma using γδ T cells. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 4093.

Design of diversified chimeric antigen receptors through rational module recombination

Chimeric antigen receptor (CAR)-T cells have shown great promise in cancer therapy. However, the anti-tumor efficiency is limited due to the CAR-induced Tcell apoptosis or exhaustion. The intracellular domain of CAR comprised of various signaling modules orchestrates CAR-T cell behaviors. The modularity of CAR signaling domain functions as the "mainboard" to assemble diversified downstream signaling components. Here, we implemented the modular recombination strategy to construct a library of CARs with synthetic co-signaling modules adopted from immunoglobin-like superfamily (IgSF) and tumor necrosis factor receptor superfamily (TNFRSF). We quantitatively characterized the signaling behaviors of these recombinants by both NFAT and NF-κB reporter, and identified a set of new CARs with diverse signaling behaviors. Specifically, the 28(NM)-BB(MC) CAR-T cells exhibited improved cytotoxicity and Tcell persistence. The synthetic approach can promote our understanding of the signaling principles of CAR molecule, and provide a powerful tool box for CAR-T cell engineering.

Strength of CAR signaling determines T cell versus ILC differentiation from pluripotent stem cells

Generation of chimeric antigen receptor (CAR) Tcells from pluripotent stem cells (PSCs) will enable advances in cancer immunotherapy. Understanding how CARs affect Tcell differentiation from PSCs is important for this effort. The recently described artificial thymic organoid (ATO) system supports invitro differentiation of PSCs to Tcells. Unexpectedly, PSCs transduced with a CD19-targeted CAR resulted in diversion of Tcell differentiation to the innate lymphoid cell 2 (ILC2) lineage in ATOs. Tcells and ILC2s are closely related lymphoid lineages with shared developmental and transcriptional programs. Mechanistically, we show that antigen-independent CAR signaling during lymphoid development enriched for ILC2-primed precursors at the expense of Tcell precursors. We applied this understanding to modulate CAR signaling strength through expression level, structure, and presentation of cognate antigen to demonstrate that the Tcell-versus-ILC lineage decision can be rationally controlled in either direction, providing a framework for achieving CAR-T cell development from PSCs.

CD28-CAR-T cell activation through FYN kinase signaling rather than LCK enhances therapeutic performance

Signal transduction induced by chimeric antigen receptors (CARs) is generally believed to rely on the activity of the SRC family kinase (SFK) LCK, as is the case with Tcell receptor (TCR) signaling. Here, we show that CAR signaling occurs in the absence of LCK. This LCK-independent signaling requires the related SFK FYN and a CD28 intracellular domain within the CAR. LCK-deficient CAR-T cells are strongly signaled through CAR and have better invivo efficacy with reduced exhaustion phenotype and enhanced induction of memory and proliferation. These distinctions can be attributed to the fact that FYN signaling tends to promote proliferation and survival, whereas LCK signaling promotes strong signaling that tends to lead to exhaustion. This non-canonical signaling of CAR-T cells provides insight into the initiation of both TCR and CAR signaling and has important clinical implications for improvement of CAR function.

Imaging CAR-T Synapse as a Quality Control for CAR Engineering.

The chimeric antigen receptor (CAR) evolves as a powerful tool to reprogram T cells for targeted killing. CAR-T therapy succeeded in treating certain types of blood cancers, and its application is now expanding towards solid tumors, autoimmune diseases, viral infection, and fibrosis. These require the design of a large number of new CARs that target a variety of antigens. Here we described two methods as a quality control for validating newly developed CARs: (1) the cell-cell conjugation assay as a reflection of efficient binding of CAR to antigen in the cellular context and (2) CD45 exclusion in the synapse as an indication of CAR signaling potential. These assays examine prerequisites for a functional CAR-T and reveal causes for ineffective CAR-T activation.