Cytokine-induced Memory-like Natural Killer Cells Research Articles

CAR memory-like NK cells targeting the membrane proximal domain of mesothelin demonstrate promising activity in ovarian cancer.

Epithelial ovarian cancer (EOC) remains one of the most lethal gynecological cancers. Cytokine-induced memory-like (CIML) natural killer (NK) cells have shown promising results in preclinical and early-phase clinical trials. In the current study, CIML NK cells demonstrated superior antitumor responses against a panel of EOC cell lines, increased expression of activation receptors, and up-regulation of genes involved in cell cycle/proliferation and down-regulation of inhibitory/suppressive genes. CIML NK cells transduced with a chimeric antigen receptor (CAR) targeting the membrane-proximal domain of mesothelin (MSLN) further improved the antitumor responses against MSLN-expressing EOC cells and patient-derived xenograft tumor cells. CAR arming of the CIML NK cells subtanstially reduced their dysfunction in patient-derived ascites fluid with transcriptomic changes related to altered metabolism and tonic signaling as potential mechanisms. Lastly, the adoptive transfer of MSLN-CAR CIML NK cells demonstrated remarkable inhibition of tumor growth and prevented metastatic spread in xenograft mice, supporting their potential as an effective therapeutic strategy in EOC.

Synergizing CAR with memory-like NK cells

Natural killer (NK) cells are crucial for combating the tumor growth and spread of cancer. The receptors which inhibit and activate NK cells coordinate to recognize "self" or "missing-self" to determine whether NK cells should be activated to destroy the targets. NK cells exhibit intrinsic memory to haptens and viral infections despite lacking antigen-specific receptors. A combination of Interleukins may create cytokine-induced memory-like (ML) NK cells that respond more vigorously to tumors and lessen symptoms in cancer patients. Meanwhile, chimeric antigen receptors (CAR) have been utilized to modify NK cells. CAR-NK cells have been tested to be more powerful in treating solid tumors and hematological cancers in both pre-clinical and clinical trials. A few recent studies showed that when ML NK cells are armed with CAR, the resulting CAR-ML-NK cells demonstrated better survival in human xenograft models as well as enhanced responses against cancer cells in vitro and in vivo.

CTLA-4 Blockade Results in the Enrichment of Proliferative CD56 dimCD16 + NK Cells Following Infusion of Haploidentical Donor Memory-like Natural Killer Cells Plus IL-15 Superagonist in a Phase 1 Trial

Introduction Regulatory T cells (Tregs) blunt anti-tumor responses of major immune effector cells including CD8 T cells and natural killer (NK) cells. Tregs constitutively express CTLA-4 and thus the use of ipilimumab, a CTLA-4 blocker can potentially overcome the Treg-mediated immune suppression. We (and others) have shown that a brief activation of conventional NK cells with the cytokine combination IL-12, IL-15, and IL-18 generates cytokine-induced memory-like (CIML) NK cells which exhibit enhanced anti-tumor responses, have a longer half-life (up to 90 vs ~12 days of conventional NK cells), and show promising activity in several early phase clinical trials. N-803 is an IL-15 super-agonist with a long half-life that preferentially activates and expands NK and CD8+ T cells without affecting Tregs, making it an ideal cytokine for combining with adoptive immunotherapy. In the current study, we hypothesized the use of ipilimumab (IPI) will abrogate Treg-mediated inhibition and thus allow enhanced proliferation, activation, and anti-tumor responses of the adoptively transferred CIML NK cells.To address this, we conducted a phase 1 trial of HLA-haploidentical CIML NK cells in combination with IPI and N-803 in patients with advanced head and neck cancer (HNC). Using flow cytometry and CITE-Seq on the banked peripheral blood samples, we performed an in-depth characterization of NK cells expanded following IPI pre-exposure and compared it to those who did not receive IPI. Methods We enrolled 10 patients with refractory HNC regardless of human papillomavirus (HPV) status who had prior platinum and immunotherapy (NCT04290546). All patients received lymphodepletion with fludarabine (25 mg/m 2 x 5 days) and cyclophosphamide (60 mg/kg x 2 days) during days -6 to -2 prior to haploidentical CIML NK cell infusion on day 0 (5-10 x 10 6 cells/kg=dose level 0) followed by N-803 (15 mcg/kg subcutaneously) starting on day +1 every 21-days for 4-doses. In cohort 2, patients received IPI (3 mg/kg) on day -7, no ipilimumab was given to the first 6 patients treated on the lead-in safety cohort 1. Flow cytometry using a custom NK cell panel was performed on samples collected on days +7, +14, +21, +28, +42, and +60 after CIML NK cell infusion. FlowSOM clustering was performed on NK cell markers. UMAP clustering was applied to CITE sequencing data acquired from samples collected on day +7 and day +28, and well-defined markers genes for each cluster were used to identify cell populations. NK cell function (cytotoxicity, IFNg, and CD107a) was assessed using flow-cytometry based assays. Results The median age of the patients was 58, 90% were men and 80% had oropharyngeal primaries. Mild CRS (grade 2 or lower) was observed in 60% of patients. No neurotoxicity or graft-versus-host disease was observed. Maximal expansion of NK cells occurred on day +7 following CIML NK cell infusion in 9/10 of patients. The single patient without NK cell expansion was found to have a donor-specific anti-HLA antibody. Day +7 NK cells exhibited upregulation of IFNg expression following cytokine restimulation as compared to resting NK cells. Tumor regression was observed in 50% of treated patients at day +30 based on RECIST v1.1 criteria. Patients who had tumor regression had an expansion of CD56 dimCD16 + NK cell clusters by day +14. IPI treated patients were noted to have a relative enrichment of CD16 + NK cell metaclusters at day +14 compared to no IPI patients (Figure 1A). At the time of maximal NK cell expansion, CITEseq defined NK cell clusters were dominant in both IPI and no IPI patients, but the proliferative gene sets were enriched in the IPI treated patient (Figure 1B). IPI exposure had no effect on the distribution of regulatory T cells or CD8 + T cell populations at day +28 compared to the no IPI patients. Conclusions The use of donor-derived CIML NK cells is safe and associated with tumor regression in patients with advanced HNC. The use of IPI was associated with the preferential expansion of CD16 + NK cell clusters that had enrichment of proliferative gene sets. Tumor regression was associated with CD56 dimCD16 + NK cell expansion. Further work is required to elucidate the mechanism by which IPI exposure is associated with the expansion of specific subsets of CIML NK cells.

Innate Cell Engager (ICE®) AFM13 Combined with Preactivated and Expanded (P+E) Cord Blood (CB)-Derived Natural Killer (NK) Cells for Patients with Refractory CD30-Positive Lymphomas: Final Results

CONCLUSIONS Pts with refractory Hodgkin (HL) and other CD30+ lymphomas have few effective therapies available and targeted NK cell immunotherapy is an active area of research. Transfer of non-targeted NK cells has shown limited clinical benefit as target recognition of cancer cells by NK cells constitutes a barrier. The innate cell engager AFM13 is a first-in-class CD30/CD16A bispecific antibody construct that induces selective killing of CD30+ tumor cells by engaging and activating NK cells. As a single agent, AFM13 has limited clinical activity against HL, likely due to the reduced effector function of autologous NK cells in these pts, which provides the rationale for combining AFM13 with allogeneic NK cells. Our prior preclinical work identified a promising combination of CB-derived NK cells that were first IL-12/IL-15/IL-18-preactivated followed by ex vivo expansion (P+E) with engineered K562 feeder cells expressing membrane-bound IL-21, 4-1BBL and CD48 and exogenous IL-2, and subsequently complexed with AFM13 just before infusion; these cytokine-induced memory-like NK cells presented chimeric antigen receptor (CAR)-NK-like features and increased in vitro and in vivo antitumor activity compared to either non-AFM13-precomplexed P+E NK cells or to AFM13 alone (Kerbauy et al, Clin Cancer Res 2021). Building on this work we wished to study this CB NK-cell therapy in pts with refractory CD30+ lymphomas. This investigator-initiated single-center phase I-II trial (NCT04074746) evaluated the safety and activity of P+E AFM13-precomplexed CB NK cells followed by systemic AFM13. Pts ages 15-75 with CD30+ lymphomas refractory to brentuximab vedotin were enrolled. The goals were to identify the recommended phase 2 dose (RP2D) of NK cells, estimate the overall (ORR) and complete response (CR), event-free (EFS) and overall survival (OS) rates, and study NK cell activation and persistence. Each treatment cycle consisted of fludarabine/cyclophosphamide (days −5 to −3) followed by infusion (day 0) of the AFM13-precomplexed CB NK cells, cultured for 14 days as described above, and three weekly IV infusions of AFM13 (200 mg, days 7, 14 and 21). Two cycles were planned for pts 1-19 and up to 4 cycles from patient 20 on. Response was evaluated on day 28 of each cycle. Enrollment proceeded at 3 dose levels (DL) of 10 6, 10 7 and 10 8 NK/Kg, respectively. Each patient received the same NK dose in all cycles. Between 09/20-12/22 we enrolled 42 pts (37 HL, 5 NHL), pretreated with a median 7 lines, at DL1 (N=3), DL2 (N=3) and DL3 (N=36), with 1 (N=2), 2 (N=21), 3 (N=3) or 4 cycles (N=16). All had active progressive disease at enrollment and no bridging therapy was given. The cords used for each of the 117 cycles were selected without consideration for HLA match, which was 0/6 (N=53), 1/6 (N=46), 2/6 (N=14), 3/6 (N=3) and 4/6 (N=1). The product infused consisted of >94% NK cells (expanded >2,700 fold), with only 0.02% T cells. The NK cells were 96% viable, 91% bound to AFM13, and 97.6% CD16+. The products were infused fresh. There was 1 grade 2 infusion-related reaction (IRR) in 115 infusions of AFM13-NK (0.8%) and 27 IRR infusion related reactions in 350 infusions of AFM13 (7.7%) (1 G3, 26 G2). We saw no cases of CRS, ICANS or GVHD of any grade. DL3 (10 8 NK/Kg) was established as the RP2D. The ORR and CR were 92.8% and 66.7%, respectively (94.4% and 72.2%, respectively, in 36 pts treated at the RP2D). Nine pts had a response consolidated with SCT (5 allo, 4 auto). At median follow-up of 14 (6-34) months, the EFS/OS rates are 31%/76%; median EFS/OS are 8 months/not reached. No relapses were associated with antigen loss. In the subset of pts planned for 4 cycles at RP2D, 15 of 23 pts remained event free at 6 mo (4 pts with and 11 without SCT consolidation), for 6-month EFS/OS rates of 65%/83%. Overall, 8 of the 9 pts (89%) receiving a consolidation SCT are event free at 10 to 34 months. AFM-bound CB NK cells were detected in blood from day 1 post infusion for up to 3 weeks. Donor NK levels followed similar patterns after each cycle, which argues against a sensitization after the first NK infusion. CyTOF studies showed increased expression of AFM13 and activation markers in donor NK cells. We confirmed trafficking of AFM13-bound donor NK cells to tumor sites shortly after infusion. CB-derived cytokine-induced memory-like NK cells precomplexed with AFM13 have excellent tolerability and activity for pts with heavily pretreated and refractory CD30+ lymphoma.

Enhanced expression of natural cytotoxicity receptors on cytokine-induced memory-like natural killer cells correlates with effector function.

Natural killer (NK) cells are a key component of the innate immune system, involved in defending the host against virus-infected cells and tumor immunosurveillance. Under in vitro culture conditions, IL-12/15/18 can induce a memory-like phenotype in NK cells. These cytokine-induced memory-like (CIML) NK cells possess desirable characteristics for immunotherapies, including a longer lifespan and increased cytotoxicity. In this study, NK cells were isolated from peripheral blood of healthy donors and stimulated with IL-12/15/18 to induce a memory-like phenotype or with IL-15 alone as a control. After seven days of culture, multiparametric flow cytometry analysis was performed to evaluate the phenotypic and functional profiles of CIML and control NK cells. Our results showed a significantly higher expression of CD25, CD69, NKG2D, NKp30, NKp44, NKp46, TACTILE, and Granzyme B in CIML NK cells compared to control NK cells. In contrast, KIR2D expression was significantly lower in CIML NK cells than in control NK cells. Moreover, functional experiments demonstrated that CIML NK cells displayed enhanced degranulation capacity and increased intracellular IFN-γ production against the target cell line K562. Interestingly, the degranulation capacity of CIML NK cells was positively correlated with the expression of the activating receptors NKp46 and NKp30, as well as with the inhibitory receptor TACTILE. In conclusion, this study provides a deep phenotypic characterization of in vitro-expanded CIML NK cells. Moreover, the correlations found between NK cell receptors and degranulation capacity of CIML NK cells allowed the identification of several biomarkers that could be useful in clinical settings.

Cytokines impact natural killer cell phenotype and functionality against glioblastoma in vitro.

Natural killer (NK) cells are a part of the innate immune system and first-line defense against cancer. Since they possess natural mechanisms to recognize and kill tumor cells, NK cells are considered as a potential option for an off-the-shelf allogeneic cell-based immunotherapy. Here, our objective was to identify the optimal cytokine-based, feeder-free, activation and expansion protocol for cytotoxic NK cells against glioblastoma in vitro. NK cells were enriched from human peripheral blood and expanded for 16 days with different activation and cytokine combinations. The expansion conditions were evaluated based on NK cell viability, functionality, expansion rate and purity. The cytotoxicity and degranulation of the expanded NK cells were measured in vitro from co‑cultures with the glioma cell lines U‑87 MG, U‑87 MG EGFR vIII, LN-229, U-118 and DK-MG. The best expansion protocols were selected from ultimately 39 different conditions: three magnetic cell‑selection steps (Depletion of CD3+ cells, enrichment of CD56+ cells, and depletion of CD3+ cells followed by enrichment of CD56+ cells); four activation protocols (continuous, pre-activation, re-activation, and boost); and four cytokine combinations (IL-2/15, IL‑21/15, IL‑27/18/15 and IL-12/18/15). The expansion rates varied between 2-50-fold, depending on the donor and the expansion conditions. The best expansion rate and purity were gained with sequential selection (Depletion of CD3+ cells and enrichment of CD56+ cells) from the starting material and pre-activation with IL‑12/18/15 cytokines, which are known to produce cytokine-induced memory-like NK cells. The cytotoxicity of these memory-like NK cells was enhanced with re-activation, diminishing the donor variation. The most cytotoxic NK cells were produced when cells were boosted at the end of the expansion with IL-12/18/15 or IL-21/15. According to our findings the ex vivo proliferation capacity and functionality of NK cells is affected by multiple factors, such as the donor, composition of starting material, cytokine combination and the activation protocol. The cytokines modified the NK cells' phenotype and functionality, which was evident in their reactivity against the glioma cell lines. To our knowledge, this is the first comprehensive comparative study performed to thisextent, and these findings could be used for upscaling clinical NK cellmanufacturing.

IL-12/15/18-induced cell death and mitochondrial dynamics of human NK cells.

Natural killer (NK) cells are lymphocytes with potent antitumor functions and, consequently, several NK cell-based strategies have been developed for cancer immunotherapy. A remarkable therapeutic approach is the adoptive transfer of NK cells stimulated with IL-12, IL-15 and IL-18. This cytokine stimulation endows NK cells with properties that resemble immunological memory and, for this reason, they are known as cytokine-induced memory-like (CIML) NK cells. Very promising results have been reported in clinical trials and yet, there are still unknown aspects of CIML NK cells. Here, we have conducted a preliminary study of their mitochondrial dynamics. Our results show that upon IL-12/15/18 stimulation the viability of NK cells decreased and an increment in mitochondrial superoxide levels was observed. In addition, we found that mitochondria appeared slightly elongated and their cristae density decreased following IL-12/15/18 stimulation, possibly in a process mediated by the low levels of optic atrophy type 1 (OPA1) protein. Interestingly, although mitophagy was slightly impaired, an increase in autophagic flux was observed, which might explain the reduced viability and the accumulation of unfit mitochondria. Our findings could be of relevance in order to design new strategies intended to improve the mitochondrial fitness of IL-12/15/18-stimulated NK cells with the aim of improving their therapeutic efficacy.

Brief IL-12, IL-15, IL-18 activation drives the acquisition of two distinct memory-like NK cell states

Abstract IL-12/15/18 activation induces natural killer (NK) cell differentiation into cytokine-induced memory-like (ML) NK cells with enhanced IFNγ and killing of tumor targets that is antigen independent, rendering them distinct from conventional (cNK) and CMV-induced adaptive NK cells. In leukemia patients, ML NK cells have an excellent safety profile and 47% CR rate (PMID: 32826231). Despite their clinical promise, little is known about the biology underlying ML NK cells. Based on individual variability of human ML NK cell function, we hypothesized that ML NK cells manifest molecular heterogeneity. To this end, we applied Cellular Indexing of Transcriptomes and Epitopes by Sequencing (CITE-seq) to profile RNA and protein expression on the single-cell level, and evaluated NK cell function. Overnight IL-12/15/18 stimulation induced broad activation with distinct transcriptional programs evident in CD56 brightcompared to CD56 dimNK cells. In contrast, following in vitrodifferentiation for 7 days, IL-12/15/18 activated NK cells acquired a unique transcriptional and protein signature, and manifest one of two ML NK cell states (ML-1, ML-2), or remained similar to cNK cells. ML-1 was marked by increased activating receptor expression (NKp46, NKp30, NKp44) while ML-2 had increased expression of inhibitory receptors, CD25, HLA-DR, MKI67, and IFNG. In functional assays, ML-2 cells produced more IFNγ following cytokine stimulation than ML-1 cells. Further, ML-1 and ML-2 had divergent transcription factor profiles suggesting distinct mechanisms of regulation. Collectively, our findings reveal molecular and functional heterogeneity of ML NK cells, and investigations into ML subsets in patients receiving ML NK cell therapy are ongoing. AAI Intersect Fellowship for Computational Scientists & Immunologists (JAF, TAF, AAP), T32GM139799 (JAF), P50CA171963 (TAF, MMB-E), R01CA205239 (TAF), P30CA91842 (TAF)

Abstract 3181: A novel memory-like NK cell CAR targeting the proximal mesothelin domain shows promising pre-clinical activity in ovarian cancer using cell lines, patient-derived organoid tumors, and xenograft mice

Abstract Epithelial ovarian cancer (OVC) is the leading cause of death among gynecological malignancies. Natural killer (NK) cells are an attractive platform for immunotherapy owing to their superior safety, multiple mechanisms of cytotoxicity, and reduced risk of alloreactivity. Recently, paradigm-shifting studies have shown that brief activation of NK cells with inflammatory cytokines induces differentiation into cytokine induced memory-like (CIML) feature. CIML NK cells have demonstrated potent activity in preclinical and in recent clinical trial settings, suggesting CIML NK cells as a novel platform for genetically modified chimeric antigen receptor (CAR) cells for OVC therapy. Based on patient samples and patient-derived organoids (PDOs), we confirmed mesothelin (MSLN) as an attractive candidate for NK cells. Here, we designed and tested aMSLN CAR CIML NK cells for their functionality against OVC cell lines, PDOs, and xenograft mice. We designed the aMSLN CAR using the ScFv sequence against the proximal domain of MSLN with 4-1BB and CD3z as co-stimulatory domains. Primary NK cells were purified from peripheral blood, activated using IL-12, IL-18, and IL-15 resulting in CIML NK cells. The CAR gene was transduced into CIML NK cells via our optimized BaEV lentiviral system to achieve high transduction efficiency of 40-60%. The direct cytotoxic effect of NK cells was tested against OVC cell lines where the cells were co-cultured with NK cells for 6 hours and analyzed using apoptotic markers. Compared to CIML NK cells, aMSLN CAR CIML NK cells showed enhanced cytotoxicity against OVCAR3 (47.9% vs 14.8%), SKOV3 (29.3% vs 8.0%) and OVCAR8 (60.7% vs 39.8%) cells at a 10:1 ratio. In addition, the aMSLN CAR CIML NK cells exhibit long-term cytotoxicity when evaluated over a period of 3 days; killing efficiency of 71.7% vs 37.6% and 54.6% vs 32.8% for aMSLN CAR CIML NK cells compared to CIML NK cells in OVCAR8 cells and SKOV3 cells, respectively. To test the therapeutic potential of NK cells in a relevant in vitro model, we used PDOs. After 18-hour co-culture, the cytotoxicity was determined by evaluating apoptotic EpCAM+ cancer cells amongst the organoid cell population. Results showed that aMSLN CAR CIML NK cells caused increased apoptotic cells compared to CIML NK cells; 58.2% vs 11.0%, 4.5% vs 61.0%, and 10.5% vs 32.0% in three different PDOs. Finally, we tested the in vivo therapeutic efficacy of aMSLN CAR CIML NK cells against intraperitoneal OVCAR8-mcLuc model wherein we observed significant tumor control, with 80.86% tumor growth inhibition as measured by BLI after 2 doses of 5 million/animal NK cells. We are currently evaluating the functionality of aMSLN CAR CIML NK cells after their exposure to ascites from OVC patients as well as developing methods to enhance their function in highly immunosuppressive tumor microenvironment. Citation Format: Mubin Tarannum, Khanhlinh Dinh, Juliana Vergara, Oyku Ay, Sarah Hill, Rizwan Romee. A novel memory-like NK cell CAR targeting the proximal mesothelin domain shows promising pre-clinical activity in ovarian cancer using cell lines, patient-derived organoid tumors, and xenograft mice [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 3181.

Attenuated Cytokine-Induced Memory-Like Natural Killer Cell Responses to Mycobacterium tuberculosis in Tuberculosis Patients.

This study aimed to investigate the phenotype, proliferation and functional alterations of cytokine-induced memory-like natural killer (CIML NK) cells from healthy subjects and TB patients, and assessed the efficacy of CIML NK cells in response to H37Rv-infected U937 cells in vitro. Fresh peripheral blood mononuclear cells (PBMCs) were isolated from healthy people and tuberculosis patients and activated for 16h using low-dose IL-15, or IL-12, IL-15, IL-18 combination or IL-12, IL-15, IL-18 and MTB H37Rv lysates, respectively, followed by low-dose IL-15 maintenance for another 7 days. Then, the PBMCs were co-cultured with K562 and H37Rv-infected U937, and the purified NK cells were co-cultured with H37Rv infected U937. The phenotype, proliferation and response function of CIML NK cells were assessed using flow cytometry. Finally, colony forming units were enumerated to confirm the survival of intracellular MTB. CIML NK phenotypes from TB patients were similar to healthy controls. CIML NK cells undergo higher rates of proliferation after IL-12/15/18 pre-activation. Moreover, the poor expansion potential of CIML NK cells co-stimulated with MTB lysates. CIML NK cells from healthy individuals showed enhanced IFN-γ functional to H37Rv infected U937 cells, along with significantly enhanced killing of H37Rv. However, the CIML NK cells from TB patients show attenuated IFN-γ production and now enhanced the ability of killing intracellular MTB compared to those from healthy donors after co-cultured with H37Rv infected U937. CIML NK cells from healthy individuals exist the increased ability of IFN-γ secretion and boosted anti-MTB activity in vitro, which from TB patients show impaired IFN-γ production and no enhanced anti-MTB activity compared to those from healthy donors. Additionally, we observe the poor expansion potential of CIML NK cells co-stimulated with antigens from MTB. These results open up new possibilities for NK cell-based anti-tuberculosis immunotherapeutic strategies.

Inhibition of MICA and MICB Shedding Enhances Cytokine-Induced Memory-like NK Cell-Mediated Activity Against Multiple Myeloma

Introduction Natural Killer (NK) cells are important mediators of cytotoxic immune responses against MM, and the efficacy of existing MM therapies relies substantially on NK cell function. However, MM cells develop mechanisms to escape NK cell recognition by loss of ligands for activating receptors and by inducing functional defects. To overcome reduced NK cell functionality, adoptive transfer of cytokine-induced memory-like (CIML) NK cells are of particular interest, as these cells acquire memory-like features resulting in enhanced activity upon restimulation, greater IFN-γ response, and greater anti-tumor cytotoxicity. The success of adoptive transfer of CIML NK cells in MM is dependent on the ability of NK cells to recognize malignant plasma cells (PCs). NKG2D, one of the major activating receptors on NK cells, is upregulated on CIML NK cells. NKG2D plays an important role in the immune recognition of malignant PCs through interaction with its ligands MICA and MICB. However, MM cells evade this recognition by proteolytic shedding of MICA/B from the cell surface, leading to NKG2D internalization. Rationally designed antibodies like the 7C6 monoclonal antibody (mAb) targeting the proteolytic MICA α3 domain stabilize cell surface MICA/B expression and can enhance NK cell recognition and susceptibility to NK cell-mediated cytotoxicity. Furthermore, it has been shown that Bortezomib, an FDA-approved proteasome inhibitor with potent anti-MM activity, augments MICA expression in MM. We hypothesized that use of the 7C6 mAb would allow simultaneous blockade of MICA/B shedding and ADCC by CIML NK cells resulting in enhanced targeting of MM cells, which would further synergize with Bortezomib treatment. Results Flowcytometric analysis of surface MICA/B levels on 10 human myeloma cell lines (HMCLs) demonstrated heterogeneous protein expression. MICA/B transcript levels for corresponding HMCLs were queried from the CCLE database. There was no correlation between transcript and protein expression, suggesting substantial post-translational modifications, such as proteolytic cleavage, determining surface expression levels of MICA/B in MM. To determine if proteolytic cleavage occurs in MM, we treated HMCL with the 7C6 mAb, targeting the proteolytic cleavage site. Flowcytometric analysis of MM.1S revealed that 7C6 was able to upregulate basal expression of MICA/B in a dose-dependent manner as well as inhibit MICA/B shedding. These results suggest proteolytic cleavage of MICA/B occurs in MM and that this process can be inhibited by a MICA/B stabilizing antibody. Previously, it has been shown that MICA/B levels can be upregulated in MM by Bortezomib. As heterogeneity in MICA/B expression levels was seen among HMCLs, we hypothesized that the use of 7C6 would synergize with Bortezomib. Indeed, the addition of Bortezomib to 7C6 substantially increased MICA/B surface expression. To assess the functional consequences of MICA/B stabilization, we examined the effects on NK cell activation in co-culture assays of NK cells with MM.1S pretreated with 7C6 or IC mAb. We observed enhanced NK cell function as assessed by increased CD107a degranulation, IFN-γ and TNF-α production in co-culture assays of conventional NK cells with MM.1S pre-treated with 7C6 vs IC. Next, we measured the activity of CIML NK cells to myeloma targets. CIML NK cells exhibited enhanced CD107a in response to MM targets when compared to control NK cells from the same donors (Figure 1A). Furthermore, CIML NK cells demonstrated significantly higher cytotoxicity against 7C6 pretreated MM.1S, which was dependent on increased MICA/B and NKG2D levels. CIML NK cells in NSG mice treated with 7C6-hIgG1 mAb were significantly more effective in controlling early MM tumor cell outgrowth compared to CIML NK cells in mice treated with isotype control antibodies (Figure 1B). Conclusion Here we demonstrate that inhibition of MICA/B shedding with a novel antibody 7C6 enhances CIML NK cell-mediated function against MM in vitro and in a xenograft mouse model. Preliminary data demonstrate that this treatment strategy could synergize with current treatment regimens including Bortezomib. Our data support the hypothesis that combination strategies to enhance NK cell activation can be effective to enhance NK cell-mediated immune surveillance in MM. This combined approach highlights their potential use as novel immunotherapy in MM. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Putative Predictors of Response to WU-NK-101, an Allogeneic, Enhanced Memory (ML) Natural Killer (NK) Cell Therapy Product, for Relapsed/Refractory (R/R) Acute Myeloid Leukemia (AML)

Strategies to enhance NK-cell activity prior to adoptive transfer into patients with AML have yielded inconsistent clinical benefit. Immune cells in the AML tumor microenvironment (TME) are dysfunctional, in part due to enhanced interferon-γ signaling and acquisition of a senescent-like T/NK phenotype (Vadakekolathu, et al. Sci. Transl. Med. 2020). Cytokine-induced memory-like (CIML) NK cells are more potent for anti-tumor responses than conventional NK (cNK) cells, are well tolerated, and active in patients with R/R AML (NCT#01898793) with complete response (CR)/CR with partial/incomplete hematologic recovery rate of 47% and a median DOR of 9.4 months after a single infusion (Berrien-Elliott, et al. Cancer Discov. 2020). WU-NK-101 is a cell therapy derived from healthy donor NK cells, which are activated to induce a ML-NK cell program, expanded, and frozen to create an off-the-shelf cell therapy. This abstract 1) describes the approach for treatment of R/R AML with WU-NK-101, built upon prior clinical experience with CIML-NKs; 2) characterizes TME gene expression (GE) signatures associated with outcome after the infusion of CIML-NK in R/R AML and 3) functionally characterizes WU-NK-101. Bone marrow (BM) aspirates and trephine biopsies for immune GE profiling and spatially resolved proteomics (IO360® panel, n = 740 genes, and GeoMx® DSP; NanoString Technologies) were collected at baseline (BL) and on treatment (OT) from 15 patients receiving CIML-NK cells on study NCT #01898793. ssGSEA-based scores were computed using the IOBR package in R. Machine learning was used to select features that correlated with response. Cell phenotypes were evaluated by mass cytometry. NK cell function was assayed in either conventional (N-; 20% IMDM) or TME-aligned media. Multi-omics studies were performed by mass spectrometry. Cell trafficking to TME was measured in NSG mouse tumors by tracking fluorescent-labeled WU-NK-101. Correlative studies showed that BL GE signatures reflecting heightened neutrophil infiltration, chemokine receptor expression, and cancer antigen presentation predicted response to CIML-NKs (AUROC = 0.875, 0.875 and 0.850, respectively). We computed an 8-gene signature score (RPTOR, IRF9, TLR1, NLRP3, CD7, IL6R, FUT4, IL1RN) that was significantly higher at BL in responders and that correlated with response duration (Fig. 1A). Immune deconvolution of GE data with CIBERSORT highlighted critical differences in TME cellular composition at BL in responders to CIML-NKs, including a higher inferred abundance of macrophages, gamma/delta T cells and activated dendritic cells (Fig. 1B). In OT samples from responders, glycolytic GE programs as well as purine/pyrimidine and amino acid (AA) metabolism were upregulated compared with BL; no TME modulation was observed in non-responders (Fig. 1C). Analysis of WU-NK-101 cells revealed a unique phenotype compared with cNK cells, including higher expression of activating receptors, CD25, CD69, and GZMB, which positions WU-NK-101 for rapid activation and improved cytotoxicity. The latter hypothesis was confirmed by in vitro assays, with higher half maximal effective concentration (mEC50) for cNK vs WU-NK-101 (mEC50 = 5.2 vs 1.7; P = 0.032; Fig. 1D). The adverse impact of immunosuppressive TME-aligned media on cytotoxicity was evident on cNK but negligible to WU-NK-101 (mEC50 = 16.3 vs 2.0; P = 0.018; Fig. 1D). In N-media, WU-NK-101 used glucose as its main nutritional source; in hypoglycemic TME-aligned media, AA metabolic pathways were upregulated, indicating metabolic adaptability. This was supported by increased cell surface expression of AA transporters. WU-NK-101's homing to the BM averaged 16.5 ± 2.4%, which is 5.5-fold higher than previously reported for feeder-cell+IL-2-expanded NK cells (~3%; Sato et al. Clin. Cancer Res. 2020). In summary, an 8-gene TME signature showed excellent predictive ability for response to ML-NKs. In responders, ML-NK infusion was associated with TME modulation and with metabolic re-programming. Compared to cNK cells, WU-NK-101 had enhanced trafficking to the BM, anti-tumor activity, and a metabolic profile consistent with aerobic glycolysis, potentially contributing to mitigating TME adversity. Due to their resilience to an immunosuppressive TME, WU-NK-101 cells may represent an effective treatment modality for R/R AML; a phase 1 study of WU-NK-101 in R/R AML is in development (NCT #05470140). Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Innate Cell Engager AFM13 Combined with Preactivated and Expanded Cord Blood-Derived NK Cells for Patients with Double Refractory CD30+ Lymphoma

Patients with multiple relapsed or refractory (R/R) Hodgkin lymphoma (HL) and other CD30+ lymphoma have few effective therapies available and targeted adoptive natural killer (NK) cell immunotherapy is an active area of investigation. Transfer of non-targeted NK cells has shown limited clinical benefit as target recognition of cancers by NK cells remains a substantial barrier. The innate cell engager (ICE®) construct, AFM13, is a first-in-class CD30/CD16A bispecific antibody construct that induces specific and selective killing of CD30+ tumor cells by engaging and activating NK cells. As a single agent, AFM13 has limited clinical activity against HL, likely due to the reduced effector function of autologous NK cells in these patients, which provides the rationale for the combination of AFM13 with allogeneic NK cells. Our prior preclinical work identified a promising combination of cord blood (CB)-derived NK cells that were first IL-12/IL-15/IL-18-preactivated followed by expansion (P+E) with engineered K562 feeder cells expressing membrane-bound IL-21, 4-1BB ligand and CD48 ex vivo, and subsequently complexed with AFM13 just prior to infusion (Kerbauy et al, Clin Cancer Res 2021; 27:3744-56). These cytokine-induced memory-like CB-derived NK cells precomplexed with AFM13 (AFM13-NK) presented chimeric antigen receptor (CAR)-NK cell-like features and showed an increased in vitro and in vivo antitumor activity compared to either P+E NK or AFM13 alone. Building on this work we wished to clinically study adoptive AFM13-NK cell therapy in pts with R/R CD30+ lymphomas. METHODS: This single-center phase I-II trial (NCT04074746) evaluates the safety and activity of AFM13-NK, followed by AFM13 monotherapy. Patients aged 15-75 years with R/R CD30+ lymphomas refractory to brentuximab vedotin are enrolled. The trial goals are to identify the recommended phase 2 dose (RP2D) of AFM13-NK cells, estimate the overall (ORR) and complete response (CR) rates, event-free (EFS) and overall survival (OS) rates, and studies of NK cell activation and persistence. Each treatment cycle consisted of fludarabine/cyclophosphamide (days −5 to −3), followed by infusion of the AFM13-NK cells, cultured for 14 days as described above (day 0), and three weekly IV infusions of AFM13 (200 mg, days 7, 14 and 21). Two cycles were administered to patients 1-19 and 4 cycles were given starting with patient 20. Response was evaluated on day 28 of each cycle. Patients were enrolled at 3 dose levels: DL1 (106 NK/Kg), DL2 (107NK/Kg) and DL3 (108 NK/Kg). Each patient received the same NK dose in all cycles. RESULTS: As of 7/31/22, 30 pts have been enrolled and treated (Table) at DL1 (N=3), DL2 (N=3) and DL3 (N=24), with 1 (N=1), 2 (N=24), 3 (N=3) or 4 cycles (N=3). All patients had active progressive disease at enrollment and no bridging therapy was given. The cords used for each of the 69 cycles were selected with no consideration for HLA match, which was 0/6 (N=31), 1/6 (N=31), 2/6 (N=5), 3/6 (N=1) and 4/6 (N=1). The product infused consisted of >99% NK cells (expanded >2,700 fold), with only 0.02% T cells. The NK cells were >98% viable and 92% of them were bound to AFM13. The products were infused fresh. There were no infusion-related reactions (IRR) after infusing AFM13-NK and 11 IRR in 182 infusions of AFM13 alone (6%) (1 grade 3, 10 grade 2). We saw no cases of CRS, ICANS or GVHD of any grade. DL3 (108 NK/Kg) was established as the RP2D. The ORR in the entire study is 97% with 63% CRs. All 24 patients treated at the RP2D responded (100% ORR) with 70.8% (17/24) CRs. Five patients had a response consolidated with a SCT. At median follow-up of 8 (range 1-23) months, the EFS and OS rates of all 30 patients are 57% and 83%, respectively. AFM-NK cells were detected in serum from day 1 post infusion and persisted for 3-4 weeks. Donor NK levels followed similar patterns after each cycle, which argues against a sensitization effect in the patient after the first NK infusion. Donor NK cells showed by CyTOF increased binding to AFM13 and expression of activation markers. CONCLUSIONS: This is the first clinical trial to date using an ICE® construct precomplexed with cytokine-induced memory-like CB-NK cells to treat patients with CD30+ R/R HL and NHL. Our preliminary results indicate that this ICE® precomplexed CB-NK cell therapy has an excellent tolerability profile and is highly active in patients with heavily pretreated R/R CD30+ lymphomas and warrants further investigation. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

The HIV Latency Reversal Agent HODHBt Enhances NK Cell Effector and Memory-Like Functions by Increasing Interleukin-15-Mediated STAT Activation.

ABSTRACTElimination of human immunodeficiency virus (HIV) reservoirs is a critical endpoint to eradicate HIV. One therapeutic intervention against latent HIV is “shock and kill.” This strategy is based on the transcriptional activation of latent HIV with a latency-reversing agent (LRA) with the consequent killing of the reactivated cell by either the cytopathic effect of HIV or the immune system. We have previously found that the small molecule 3-hydroxy-1,2,3-benzotriazin-4(3H)-one (HODHBt) acts as an LRA by increasing signal transducer and activator of transcription (STAT) factor activation mediated by interleukin-15 (IL-15) in cells isolated from aviremic participants. The IL-15 superagonist N-803 is currently under clinical investigation to eliminate latent reservoirs. IL-15 and N-803 share similar mechanisms of action by promoting the activation of STATs and have shown some promise in preclinical models directed toward HIV eradication. In this work, we evaluated the ability of HODHBt to enhance IL-15 signaling in natural killer (NK) cells and the biological consequences associated with increased STAT activation in NK cell effector and memory-like functions. We showed that HODHBt increased IL-15-mediated STAT phosphorylation in NK cells, resulting in increases in the secretion of CXCL-10 and interferon gamma (IFN-γ) and the expression of cytotoxic proteins, including granzyme B, granzyme A, perforin, granulysin, FASL, and TRAIL. This increased cytotoxic profile results in increased cytotoxicity against HIV-infected cells and different tumor cell lines. HODHBt also improved the generation of cytokine-induced memory-like NK cells. Overall, our data demonstrate that enhancing the magnitude of IL-15 signaling with HODHBt favors NK cell cytotoxicity and memory-like generation, and thus, targeting this pathway could be further explored for HIV cure interventions.IMPORTANCE Several clinical trials targeting the HIV latent reservoir with LRAs have been completed. In spite of a lack of clinical benefit, they have been crucial to elucidate hurdles that “shock and kill” strategies have to overcome to promote an effective reduction of the latent reservoir to lead to a cure. These hurdles include low reactivation potential mediated by LRAs, the negative influence of some LRAs on the activity of natural killer and effector CD8 T cells, an increased resistance to apoptosis of latently infected cells, and an exhausted immune system due to chronic inflammation. To that end, finding therapeutic strategies that can overcome some of these challenges could improve the outcome of shock and kill strategies aimed at HIV eradication. Here, we show that the LRA HODHBt also improves IL-15-mediated NK cell effector and memory-like functions. As such, pharmacological enhancement of IL-15-mediated STAT activation can open new therapeutic avenues toward an HIV cure.

Abstract 568: A novel memory-like NK cell CAR targeting proximal mesothelin domain shows promising preclinical activity in ovarian cancer using cell lines and patient derived organoids

Abstract Epithelial ovarian cancer (OVC) is the leading cause of death among gynecological malignancies. Natural killer (NK) cells are an attractive platform for immunotherapy owing to their superior safety, multiple mechanisms of target killing, and reduced risk of alloreactivity. Recently, paradigm-shifting studies have shown that brief activation of NK cells with inflammatory cytokines induces differentiation into cytokine induced memory-like (CIML) NK cells. CIML NK cells have demonstrated potent anti-leukemia activity in preclinical settings and in recent clinical trials and therefore represent a novel platform for genetically modified chimeric antigen receptor (CAR) cells for OVC therapy. Mesothelin (MSLN) is expressed in around 82% of OVCs and its expression is corelated with chemoresistance, increased metastasis, and poor overall survival in patients. We hypothesize arming CIML NK cells with a CAR targeting the proximal mesothelin domain will enhance their antitumor responses. We designed and tested anti-MSLN CAR CIML NK cells for their anti-cancer functionality against OVC cell lines and patient-derived organoids (PDOs). We first validated the mesothelin expression in 13 OVC patient samples which, based on pathological scoring showed high mesothelin in 8, moderate in 3, and low in 2 patient samples. PDOs also showed high expression of mesothelin, confirming it as an attractive candidate for CAR cells. We designed the aMSLN-CAR using an ScFv sequence against the proximal domain of the protein with 4-1BB and CD3ζ as co-stimulatory domains. Primary NK cells were purified from peripheral blood, activated using IL-12, IL-18, and IL-15 to afford CIML NK cells. The CAR gene was transduced into CIML NK cells via our optimized baboon lentiviral system to achieve a high transduction efficiency of 40-60%. The direct cytotoxic effect of these NK cells was tested against OVC cell lines. OVC cell lines were co-cultured with NK cells at various effector:target (E:T) ratios for 6 hours and analyzed using apoptotic markers. Compared to CIML NK cells, aMSLN-CAR CIML NK cells showed enhanced cytotoxicity against OVCAR3 (47.9% vs 14.8%), SKOV3 (29.3% vs 8.0%) and OVCAR8 (60.7% vs 39.8%) at 10:1 ratio. To test the therapeutic potential of CAR CIML NK cells in vitro, three different PDOs were used. Cytotoxicity was determined by evaluating apoptotic EpCAM+ cancer cells amongst the organoid cell population after 18-hour co-culture with NK cells. The aMSLN-CAR CIML NK cells were shown to cause increased apoptosis in cells from PDOs compared to CIML NK cells; 58.2% vs 11.0%, 4.5% vs 61.0%, and 10.5% vs 32.0%. We are currently evaluating the in vivo functionality of aMSLN-CAR CIML NK cells in a xenograft mouse model using OVC cell lines and PDOs. The successful application of CAR CIML-NK cells will pave way for the use of NK cell platforms for other solid tumors. Citation Format: Mubin Tarannum, Juliana A. Vergara, Yasmin Abdulhamid, Khanhlinh Dinh, Katherine N. Lynch, Sarah Hill, Rizwan Romee. A novel memory-like NK cell CAR targeting proximal mesothelin domain shows promising preclinical activity in ovarian cancer using cell lines and patient derived organoids [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 568.

Abstract CT540: A phase 1 trial of cytokine-induced memory-like (CIML) natural killer (NK) cell therapy with IL-15 superagonist in advanced head and neck cancer: Part 1 results

Abstract Purpose: Outcomes for patients with recurrent, incurable or metastatic (R/M) squamous cell carcinoma of the head and neck (SCCHN) refractory to platinum and immunotherapy are poor. Cellular therapies are emerging treatments with potential utility in epithelial cancers. This proof-of-concept trial investigates an allogeneic cytokine-induced, memory-like (CIML) NK cell infusion with IL-15 superagonist (sa) after lymphodepleting (LD) chemotherapy in advanced SCCHN. Patients and methods: This phase 1 single-center trial enrolled patients (pts) with R/M SCCHN regardless of human papillomavirus (HPV) status who had prior platinum and immunotherapy. Pts received LD fludarabine (25 mg/m2) and cyclophosphamide (60 mg/m2/kg) on days -6 to -2 prior to haploidentical CIML NK cell infusion on day 0 (5-10 x 106 viable cells/kg=dose level 0) followed by N-803 (IL-15sa, 15 mcg/kg subcutaneously) starting on day +1 every 21-days for 4-doses. Part 1 treated 3 pts at dose level 0; <2 DLTs triggered an additional 3 pts. Part 2 will treat an additional 6 pts with lead-in ipilimumab (day -7). Primary objective: safety, maximum tolerated dose of CIML NK cells. Secondary objectives: objective response rate, progression-free survival (PFS), overall survival (OS), and phenotypic expansion and function of adoptively transferred NK cells. Results: From 9/8/20 to 9/7/21, 6 pts enrolled to Part 1. One DLT was observed at dose level 0. Among 6 pts, median age: 59; 5/6 (83%) were men; 5/6 (83%) had oropharyngeal primaries (4 HPV+) with a median 6 prior lines of therapy for R/M disease (range: 4-8). R/M disease sites: lung, bone, skin, liver. 5/6 (83%) had offspring donors. Grade (G) 3-4 hematologic adverse events were common (6/6, 100%). One patient died of G5 febrile neutropenia and infection. Median days hospitalized: 14 (range: 9-37). Mild cytokine release syndrome was observed in 5/6 (83%) (median peak ferritin: 2248, CRP: 168); 3/5 required anti-IL6 therapy; no neurotoxicity was noted. There were no dose adjustments or discontinuation of therapy. One (17%) partial response (PR) was observed lasting 6.5 months; 4 (67%) pts had stable disease (SD), and 1 (17%) had progression. Tumor regression was observed in 3/6 (50%) pts at day +30. At a median follow-up of 9.5 months, median PFS: 3.4 months (95%CI 2.6-6.5); median OS: 4.7 months (95%CI 3.4-11.8). CIML NK cells showed large expansion in the peripheral blood (PB) at day +7 in all pts; mean increase: 66% (6-fold; standard deviation [SD] 10.5), to constitute 80% (SD 12.1) of PB lymphocytes. In pts with tumor regression at day +30 compared to those without, the % of PB NK cells remained high at day +28 (mean: 78 vs. 11%). PB NK cells remained >50% at day +42 in the pt with a PR. Conclusion: Allogeneic CIML NK cells can induce tumor regression associated with persistent CIML NK cell expansion among advanced SCCHN pts. In Part 1 we demonstrate safety and feasibility with the expected risks of LD conditioning. These findings have important implications for the development of cellular therapies in solid tumors. Citation Format: Glenn J. Hanna, Kimberly Coleman, Grace Birch, Robert A. Redd, Alejandro Alonso, Samantha Bednarz, Heather Daley, Diego E. Hernandez Rodriguez, Kit L. Shaw, Robert I. Haddad, Ravindra Uppaluri, Jerome Ritz, Sarah Nikiforow, Robert J. Soiffer, Rizwan Romee. A phase 1 trial of cytokine-induced memory-like (CIML) natural killer (NK) cell therapy with IL-15 superagonist in advanced head and neck cancer: Part 1 results [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr CT540.

Memory-like NK cells armed with a neoepitope-specific CAR exhibit potent activity against NPM1 mutated acute myeloid leukemia

Acute myeloid leukemia (AML) remains a therapeutic challenge, and a paucity of tumor-specific targets has significantly hampered the development of effective immune-based therapies. Recent paradigm-changing studies have shown that natural killer (NK) cells exhibit innate memory upon brief activation with IL-12 and IL-18, leading to cytokine-induced memory-like (CIML) NK cell differentiation. CIML NK cells have enhanced antitumor activity and have shown promising results in early phase clinical trials in patients with relapsed/refractory AML. Here, we show that arming CIML NK cells with a neoepitope-specific chimeric antigen receptor (CAR) significantly enhances their antitumor responses to nucleophosphmin-1 (NPM1)-mutated AML while avoiding off-target toxicity. CIML NK cells differentiated from peripheral blood NK cells were efficiently transduced to express a TCR-like CAR that specifically recognizes a neoepitope derived from the cytosolic oncogenic NPM1-mutated protein presented by HLA-A2. These CAR CIML NK cells displayed enhanced activity against NPM1-mutated AML cell lines and patient-derived leukemic blast cells. CAR CIML NK cells persisted invivo and significantly improved AML outcomes in xenograft models. Single-cell RNA sequencing and mass cytometry analyses identified up-regulation of cell proliferation, protein folding, immune responses, and major metabolic pathways in CAR-transduced CIML NK cells, resulting in tumor-specific, CAR-dependent activation and function in response to AML target cells. Thus, efficient arming of CIML NK cells with an NPM1-mutation-specific TCR-like CAR substantially improves their innate antitumor responses against an otherwise intracellular mutant protein. These preclinical findings justify evaluating this approach in clinical trials in HLA-A2+ AML patients with NPM1c mutations.

Expansion, persistence, and efficacy of donor memory-like NK cells infused for posttransplant relapse.

BackgroundResponses to conventional donor lymphocyte infusion for postallogeneic hematopoietic cell transplantation (HCT) relapse are typically poor. Natural killer (NK) cell–based therapy is a promising modality to treat post-HCT relapse.MethodsWe initiated this ongoing phase I trial of adoptively transferred cytokine-induced memory-like (CIML) NK cells in patients with myeloid malignancies who relapsed after haploidentical HCT. All patients received a donor-derived NK cell dose of 5 to 10 million cells/kg after lymphodepleting chemotherapy, followed by systemic IL-2 for 7 doses. High-resolution profiling with mass cytometry and single-cell RNA sequencing characterized the expanding and persistent NK cell subpopulations in a longitudinal manner after infusion.ResultsIn the first 6 enrolled patients on the trial, infusion of CIML NK cells led to a rapid 10- to 50-fold in vivo expansion that was sustained over months. The infusion was well tolerated, with fever and pancytopenia as the most common adverse events. Expansion of NK cells was distinct from IL-2 effects on endogenous post-HCT NK cells, and not dependent on CMV viremia. Immunophenotypic and transcriptional profiling revealed a dynamic evolution of the activated CIML NK cell phenotype, superimposed on the natural variation in donor NK cell repertoires.ConclusionGiven their rapid expansion and long-term persistence in an immune-compatible environment, CIML NK cells serve as a promising platform for the treatment of posttransplant relapse of myeloid disease. Further characterization of their unique in vivo biology and interaction with both T cells and tumor targets will lead to improvements in cell-based immunotherapies.Trial RegistrationClinicalTrials.gov NCT04024761.FundingDunkin’ Donuts, NIH/National Cancer Institute, and the Leukemia and Lymphoma Society.

Cytokine-Induced Memory-Like NK Cells: From the Basics to Clinical Applications.

Natural killer (NK) cells are lymphocytes with a key role in the defense against viral infections and tumor cells. Although NK cells are classified as innate lymphoid cells (ILCs), under certain circumstances they exhibit adaptive and memory-like features. The latter may be achieved, among others, by a brief stimulation with interleukin (IL)-12, IL-15 and IL-18. These cytokine-induced memory-like (CIML) NK cells resemble the trained immunity observed in myeloid cells. CIML NK cells undergo transcriptional, epigenetic and metabolic reprogramming that, along with changes in the expression of cell surface receptors and components of cytotoxic granules, are responsible for their enhanced effector functions after a resting period. In addition, these memory-like NK cells persist for a long time, which make them a good candidate for cancer immunotherapy. Currently, several clinical trials are testing CIML NK cells infusions to treat tumors, mostly hematological malignancies. In relapse/refractory acute myeloid leukemia (AML), the adoptive transfer of CIML NK cells is safe and complete clinical remissions have been observed. In our review, we sought to summarize the current knowledge about the generation and molecular basis of NK cell memory-like responses and the up-to-date results from clinical trials with CIML NK cells.

Cytokine-Induced Memory-like NK Cells Have a Distinct Single Cell Transcriptional Profile and Persist for Months in Adult and Pediatric Leukemia Patients after Adoptive Transfer

Natural killer (NK) cells are innate lymphoid cells that mediate anti-tumor responses and exhibit innate memory following stimulation with IL-12, IL-15, and IL-18, thereby differentiating into cytokine-induced memory-like (ML) NK cells. ML NK cells have well-described enhanced anti-tumor properties; however, the molecular mechanisms underlying their enhanced functionality are not well-understood. Initial reports of allogeneic donor ML NK cellular therapy for relapsed/refractory (rel/ref) acute myeloid leukemia (AML) demonstrated safety and a 47% CR/CRi rate (PMID32826231). In this setting, allogeneic ML NK cells are rejected after 3 weeks by recipient T cells, which precludes long-term evaluation of their biology. To address this limitation, we conducted a clinical trial for rel/ref AML patients that added adoptive transfer of same-donor ML NK cells on day +7 of a reduced-intensity conditioning (RIC) MHC-haploidentical HCT, followed by 4 doses of IL-15 (N-803) over 2 weeks (NCT02782546). Since the ML NK cells are from the HCT donor, they are not rejected, but remain MHC-haploidentical to the patient leukemia. Using samples from these patients, we profiled the single cell transcriptomes of NK cells using multidimensional CITE-seq, combining scRNAseq with a custom NK panel of antibodies.To identify donor ML NK cells in an unbiased fashion, we developed a CITE-seq ML NK classifier from in vitro differentiated paired conventional NK (cNK) and ML NK cells. This classifier was applied via transfer learning to CITE-seq analyzed samples from the donor (cNK cells) and patients at days +28 and +60. This approach identified 28-40% of NK cells as ML at Day +28 post-HCT. Only 1-6% of donor peripheral blood NK cells and 4-7% of NK cells in comparator leukemia patients at day +28 after conventional haplo-HCT alone were identified as ML NK cells (Fig 1A). These ML NK cells had a cell surface receptor profile analogous to a previously reported mass cytometry phenotype. Within the CITE-seq data, ML NK cells expressed a transcriptional profile consistent with enhanced functionality (GZMK, GZMA, GNLY), secreted proteins (LTB, CKLF), a distinct adhesome, and evidence of prior activation (MHC Class II and interferon-inducible genes). ML NK cells had a unique NK receptor repertoire including increased KIR2DL4, KLRC1(NKG2A), CD300A, NCAM1(CD56) , and CD2 with decreased expression of the inhibitory receptor KLRB1(CD161). Furthermore, ML NK cells upregulated HOPX, a transcription factor implicated in memory T cells and murine CMV adaptive NK cells. Additionally, ML NK cells downregulated transcription factors related to terminal maturation (ZEB2) and exhaustion (NR4A2).We next sought to identify changes during ML differentiation in patients post-HCT from day +28 to +60 post-HCT. Trajectory analysis identified a ML NK cell state distinct from cNK cells that was present at least 60 days post-HCT (Fig 1B). The ML transcriptional phenotype continued to modulate during late differentiation, including downregulation of GZMK and NCAM1, and upregulation of maturation related transcription factors, while maintaining high expression of HOPX. ML NK cells retained their enhanced functionality during in vivo differentiation, as patient ML NK cells had significantly increased IFNγ production compared to cNK cells after restimulation with leukemia targets or cytokines using mass cytometry (Fig. 2). Subsequently, we confirmed the ML CITE-seq profile in an independent clinical trial treating pediatric AML relapsed after allogenic HCT with same-donor ML NK cells (NCT03068819). In this setting, ML NK cells expressed a similar transcriptional signature and persisted for at least 2 months in the absence of exogenous cytokine support. Thus, ML NK cells possess a distinct transcriptional and surface proteomic profile and undergo in vivo differentiation while persisting within patients for at least 2 months. These findings reveal novel and unique aspects of the ML NK cell molecular program, as well as their prolonged functional persistence in vivo in patients, assisting in future clinical trial design. [Display omitted] DisclosuresFoltz: Kiadis: Patents & Royalties: TGFbeta expanded NK cells; EMD Millipore: Other: canine antibody licensing fees. Berrien-Elliott: Wugen: Consultancy, Patents & Royalties: 017001-PRO1, Research Funding. Bednarski: Horizon Pharmaceuticals: Membership on an entity's Board of Directors or advisory committees. Fehniger: Wugen: Consultancy, Current equity holder in publicly-traded company, Patents & Royalties: related to memory like NK cells, Research Funding; ImmunityBio: Research Funding; Kiadis: Other; Affimed: Research Funding; Compass Therapeutics: Research Funding; HCW Biologics: Research Funding; OrcaBio: Other; Indapta: Other.