Generation Chimeric Antigen Receptor Research Articles

Abstract 5326: Comparison of CAR-T cell-mediated cytotoxicity assays with suspension tumor cells using high-throughput plate-based image cytometry method

Abstract In the recent decade, chimeric antigen receptor (CAR)-T cell therapy has revolutionized strategies for cancer treatments due to its highly effective clinical efficacy and response for B cell malignancies. Currently, there are six CAR-T cell products available in the market including Kymriah, Yescarta, Tecartus, Breyanzi, Abecma, and Carvykt. The success of CAR-T cell therapy has stimulated the increase in the research and development of various CAR constructs to target different tumor types. Therefore, a robust and efficient in vitro potency assay is needed to quickly identify potential CAR gene design from a library of construct candidates. Traditionally, in vitro CAR-T cell-mediated cytotoxicity is assessed using release assays such as 51Cr (radioactivity), calcein (fluorescence), and LDH (enzymatic). However, release assays indirectly measure cell death via molecules released in supernatant and typically limited to only endpoint assays. In addition, handling and disposing of 51Cr hazardous materials is less preferred. Luciferase reporter assay, although highly sensitive, has similar drawbacks as the release assays. Finally, flow cytometry method can directly measure cell death and viability, but can be time-consuming and requires a large number of CAR-T cells when the effector-to-target (E:T) ratio is high. Furthermore, additional steps are required for adherent cells that require trypsinization. Image cytometry methodologies have been utilized for various CAR-T cell-mediated cytotoxicity assay using different fluorescent labeling methods, mainly due to their ease-of-use, ability to capture cell images for verification, and higher throughput performance. In this work, we employed the Celigo high-throughput plate-based Image Cytometer to evaluate and compare two CAR-T cell-mediated cytotoxicity assays using GFP-expressing or fluorescent dye-labeled myeloma and plasmacytoma cells. Performing time- and E:T ratio-dependent CAR-T cell-mediated cytotoxicity assays, the GFP-based method demonstrated higher sensitivity in detecting the level of cytotoxicity when compared to the CMFDA/DAPI viability method. We have established the criteria and considerations for the selection of cytotoxicity assays that are fit-for-purpose to ensure the results produced are meaningful for the specific testing conditions. Citation Format: Leo Li-Ying Chan, Yu-Jun Sun, Yi-Chun Chen, Wei-Kai Hua, Sariena Chiung-Yuan Wu. Comparison of CAR-T cell-mediated cytotoxicity assays with suspension tumor cells using high-throughput plate-based image cytometry method. [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 5326.

Study of the suppression of a tumor growth expressing a carcinoembryonic antigen with a new high-tech drug carplasmin (CAR-T therapy) in Balb/c nude mice

Introduction. Adoptive immunotherapy based on chimeric antigen receptors (CAR) is considered as a promising direction in the treatment of solid malignant tumors. To produce genetically modified human T-lymphocytes, lenti/retroviral transduction is currently most often used. However, safety concerns associated with the viral vector production and possible unwanted genome modification limit the clinical utility of CAR-T cells. Therefore, non-viral transfection methods, in particular electroporation, using of DNA or RNA vectors, are being actively studied as a method for producing CAR-T lymphocytes.Aim. To evaluate in vivo antitumor activity of the new high-tech drug carplasmin, intended for CAR-T therapy of tumors expressing carcinoembryonic antigen (CEA). Materials and methods. Carplasmin was obtained by electroporation of activated human lymphocytes with plasmid DNA carrying the third generation CAR gene specific to CEA. The study was performed on a human colorectal cancer xenograft model obtained by intraperitoneal injection of CEA-positive HCT116 cell line to athymic Balb/c nude mice. Carplasmin treatment was carried out once a week, starting from the third day after HCT116 cell inoculation. Mice in the two control groups were treated with either electroporated lymphocytes without plasmid addition (pulse-lymphocytes) or RPMI-1640 culture medium (group without treatment).Results. In vivo, carplasmin demonstrated a pronounced antitumor effect. Seven weekly injections of the drug to inoculated mice led to a prominent effect of antitumor therapy: 80 % of the animals in the experimental group survived (with 40 % of the mice had a complete remission without signs of a detectable tumor), compared to 100 % death in the control group (without treatment).Conclusion. The results of preclinical efficacy studies demonstrate that carplasmin is a promising drug for the treatment of CEA-positive intraperitoneal tumors.

In situ MUC1-specific CAR engineering of tumor-supportive macrophages stimulates tumoricidal immunity against pancreatic adenocarcinoma

Chimeric antigen receptor (CAR) T-cell therapy has revolutionized intervention strategies for various primary malignancies. However, the implementation of this approach in solid tumors, including fatal gastrointestinal cancer pancreatic adenocarcinoma (PAAD), is limited. Given the endogenous functions of macrophages and their extensive infiltration in the solid tumor microenvironment (TME), liposomalized nanoporters (LNPs) are constructed for in situ genetic engineering of intratumoral macrophages with a mucin 1-specific CAR, which redirect the phagocytic activity of these cells to target cancerous PAAD cells and subsequently prime locoregional anti-PAAD immunity. When systemically administered, any LNPs that escape clearance by the reticuloendothelial system become passively enriched in tumor tissues and unshell upon triggering with legumain intratumorally. The liberated nanoporters in turn introduce the CAR gene into the nucleus of macrophages, thereby locoregionally yielding PAAD-targeted CAR macrophages, which significantly enhances the antigen-specific phagocytosis by macrophages, elevates the antigen presentation specificity, and serially boosts the population of cytotoxic T lymphocytes, thus reducing the tumor burden and prolonging survival in PAAD mouse models. Our technology provides a practical antitumor immunotherapy for PAAD patients and may be broadly applicable for patients suffering from other solid malignancies that dually overexpress mucin 1 and legumain.

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.

CAR T cell therapy becomes CHIC: "cytokine help intensified CAR" T cells.

Chimeric antigen receptors (CARs) in the canonical "second generation" format provide two signals for inducing T cell effector functions; the primary "signal-1" is provided through the TCR CD3ζ chain and the "signal-2" through a linked costimulatory domain to augment activation. While therapy with second generation CAR T cells can induce remissions of leukemia/lymphoma in a spectacular fashion, CAR T cell persistence is frequently limited which is thought to be due to timely limited activation. Following the "three-signal" dogma for inducing a sustained T cell response, cytokines were supplemented to provide "signal-3" to CAR T cells. Recent progress in the understanding of structural biology and receptor signaling has allowed to engineer cytokines for more selective, fine-tuned stimulation of CAR T cells including an artificial autocrine loop of a transgenic cytokine, a cytokine anchored to the CAR T cell membrane or inserted into the extracellular CAR domain, and a cytokine receptor signaling moiety co-expressed with the CAR or inserted into the CAR endodomain. Here we discuss the recent strategies and options for engineering such "cytokine help intensified CAR" (CHIC) T cells for use in adoptive cell therapy.

Exploration of Tumor Biopsy Gene Signatures to Understand the Role of the Tumor Microenvironment in Outcomes to Lisocabtagene Maraleucel.

In the TRANSCEND NHL 001 study, 53% of patients with relapsed/refractory large B-cell lymphoma (LBCL) treated with lisocabtagene maraleucel (liso-cel) achieved a complete response (CR). To determine characteristics of patients who did and did not achieve a CR, we examined the tumor biology and microenvironment from lymph node tumor biopsies. LBCL biopsies from liso-cel-treated patients were taken pretreatment and ∼11 days posttreatment for RNA sequencing (RNA-seq) and multiplex immunofluorescence (mIF). We analyzed gene expression data from pretreatment biopsies (N = 78) to identify gene sets enriched in patients who achieved a CR to those with progressive disease. Pretreatment biopsies from month-3 CR patients displayed higher expression levels of T-cell and stroma-associated genes, and lower expression of cell-cycle genes. To interpret whether LBCL samples were "follicular lymphoma (FL)-like," we constructed an independent gene expression signature and found that patients with a higher "FL-like" gene expression score had longer progression-free survival (PFS). Cell of origin was not associated with response or PFS, but double-hit gene expression was associated with shorter PFS. The day 11 posttreatment samples (RNA-seq, N = 73; mIF, N = 53) had higher levels of chimeric antigen receptor (CAR) T-cell densities and CAR gene expression, general immune infiltration, and immune activation in patients with CR. Further, the majority of T cells in the day 11 samples were endogenous. Gene expression signatures in liso-cel-treated patients with LBCL can inform the development of combination therapies and next-generation CAR T-cell therapies.

The signaling and the metabolic differences of various CAR T cell designs

Chimeric antigen receptor (CAR) T cell therapy is introduced as an effective, rapidly evolving therapeutic to treat cancer, especially cancers derived from hematological cells, such as B cells. CAR T cell gene constructs combine a tumor-targeting device coupled to the T cell receptor (TCR) zeta chain domain with different signaling domains such as domains derived from CD28 or 4-1BB (CD137). The incorporation of each specific co-stimulatory domain targets the immunometabolic pathways of CAR T cells as well as other signaling pathways. Defining the immunometabolic and signaling pathways by which CAR T cells become and remain active, survive, and eliminate their targets may represent a huge step forward in this relatively young research field as the CAR gene can be tailored to gain optimal function also for solid tumors with elaborate immunosuppression and protective stroma. There is a close relationship between different signaling domains applied in CAR T cells, and difficult to evaluate the benefit from different tested CAR gene constructs. In this review, we attempt to collect the latest findings regarding the CAR T cell signaling pathways that affect immunometabolic pathways.

Bispecific PSMA antibodies and CAR-T in metastatic castration-resistant prostate cancer.

Prostate cancer is the most common cancer among men and the second leading cause of cancer-related deaths in men in the United States. The treatment paradigm for prostate cancer has evolved with the emergence of a variety of novel therapies which have improved survival; however, treatment-related toxicities are abundant and durable responses remain rare. Immune checkpoint inhibitors have shown modest activity in a small subset of patients with prostate cancer and have not had an impact on most men with advanced disease. The discovery of prostate-specific membrane antigen (PSMA) and the understanding of its specificity to prostate cancer has identified it as an ideal tumor-associated antigen and has revived the enthusiasm for immunotherapeutics in prostate cancer. T-cell immunotherapy in the form of bispecific T-cell engagers (BiTEs) and chimeric antigen receptor (CAR) T-cell therapy have shown exceptional success in treating various hematologic malignancies, and are now being tested in patients with prostate cancer with drug design centered on various target ligands including not just PSMA, but others as well including six-transmembrane epithelial antigen of the prostate 1 (STEAP1) and prostate stem cell antigen (PSCA). This summative review will focus on the data surrounding PSMA-targeting T-cell therapies. Early clinical studies with both classes of T-cell redirecting therapies have demonstrated antitumor activity; however, there are multiple challenges with this class of agents, including dose-limiting toxicity, 'on-target, off-tumor' immune-related toxicity, and difficulty in maintaining sustained immune responses within a complex and overtly immunosuppressive tumor microenvironment. Reflecting on experiences from recent trials has been key toward understanding mechanisms of immune escape and limitations in developing these drugs in prostate cancer. Newer generation BiTE and CAR T-cell constructs, either alone or as part of combination therapy, are currently under investigation with modifications in drug design to overcome these barriers. Ongoing innovation in drug development will likely foster successful implementation of T-cell immunotherapy bringing transformational change to the treatment of prostate cancer.

A simple and effective method to purify and activate T cells for successful generation of chimeric antigen receptor T (CAR-T) cells from patients with high monocyte count

BackgroundChimeric antigen receptor T (CAR-T) cells are genetically modified T cells with redirected specificity and potent T-cell-mediated cytotoxicity toward malignant cells. Despite several CAR-T products being approved and commercialized in the USA, Europe, and China, CAR-T products still require additional optimization to ensure reproducible and cost-effective manufacture. Here, we investigated the critical parameters in the CD3+ T-cell isolation process that significantly impacted CAR-T manufacturing's success.MethodsCAR-T cells were prepared from cryopreserved peripheral blood mononuclear cells (PBMC). The thawed PBMC was rested overnight before the CD3+ T cell isolation process using CTS™ Dynabeads™ CD3/CD28. Different isolation media, cell-bead co-incubation time, and cell density were examined in this study. Activated CD3+ T cells were transduced with a gamma retroviral vector carrying the CD19 or BCMA CAR sequence. The CAR-T cells proliferated in a culture medium supplemented with interleukin 2 (IL-2).ResultsCD14+ monocytes hindered T-cell isolation when X-VIVO 15 basic medium was used as the selection buffer. The activation of T cells was blocked because monocytes actively engulfed CD3/28 beads. In contrast, when DPBS was the selection medium, the T-cell isolation and activation were no longer blocked, even in patients whose PBMC contained abnormally high CD14+ monocytes and a low level of CD3+ T cells.ConclusionsIn this study, we discovered that selecting CD3+ T-cell isolation media is critical for improving T-cell activation, transduction, and CAR-T proliferation. Using DPBS as a CD3+ T cell isolation buffer significantly improved the success rate and shortened the duration of CAR-T production. The optimized process has been successfully applied in our ongoing clinical trials.Trial registration NCT03798509: Human CD19 Targeted T Cells Injection Therapy for Relapsed and Refractory CD19-positive Leukemia. Date of registration: January 10, 2019. NCT03720457: Human CD19 Targeted T Cells Injection (CD19 CAR-T) Therapy for Relapsed and Refractory CD19-positive Lymphoma. Date of registration: October 25, 2018. NCT04003168: Human BCMA Targeted T Cells Injection Therapy for BCMA-positive Relapsed/Refractory Multiple Myeloma. Date of registration: July 1, 2019

Long-term Follow-up of CD20-directed Chimeric Antigen Receptor Adoptive T-cell Therapy

Chimeric antigen receptor (CAR) T cell therapy targeting B-cell antigens has led to unprecedented success in inducing complete response (CR) rates in refractory B-cell non-Hodgkin lymphomas (NHLs). We previously reported the results of a pilot trial testing a 3rd generation CAR with 4-1BB and CD28 costimulatory domains targeting CD20 in patients (pts) with relapsed B-cell lymphomas (NCT00621452). 3 pts received cyclophosphamide (CY) 1 g/m2 IV for lymphodepletion 2 days prior to a series of 3 CAR T cell infusions 2 to 5 days apart in escalating doses followed by 2 weeks of low-dose IL-2. Here, we report the long term follow up of 2 of these pts. The third pt, UPN-02, died of progressive mantle cell lymphoma (MCL) and myelodysplastic syndrome at ~26 months (mos) post-treatment. Pt UPN-03, with relapsed MCL, had no evaluable disease after an excisional biopsy following protocol therapy. He relapsed after 2 years with a left flank mass, which was then radiated. He was re-treated with CY lymphodepletion, a dose of 1.8 x 109 CAR T cells/m2, and low-dose IL-2. At 6 weeks post infusion, he developed a small mass at the margin of his previous radiation field suspected to be recurrent MCL. This mass spontaneously regressed 1 mo later. Subsequent CT scans showed a residual soft tissue mass that gradually decreased over time and met criteria for CR by CT criteria. He remained in remission, albeit with detectable minimal residual disease (MRD) by ClonoSEQ assay, for the next 8.4 years until developing a subcutaneous chest mass and axillary adenopathy with biopsy showing recurrent MCL. Pt UPN-04, with relapsed follicular lymphoma (FL), had stable disease by CT at 1 mo but went on to have a partial response at ~3 mos. By 12 mos post-CAR T treatment there was evidence of progressive disease. However, between 2.5 and 3 years post-treatment he experienced resolution of all palpable nodes, and a near-CR was confirmed by CT at 35 mos after treatment. He remained without any clinical signs of progression with low level MRD by ClonoSEQ for the next 4 years. At 7.2 years post-CAR T cell treatment, he was found to have recurrent FL. CAR T cells were detectable for up to 12 mos in UPN-03 and 9 mos in UPN-04 by qPCR assay. B-cell recovery over time in both pts confirmed a lack of functional CAR T cell persistence. Given these findings, along with the durable responses observed in both pts, we hypothesized that these late remissions were caused by endogenous immune responses triggered by CAR T cell therapy. To evaluate this, we performed western blot assays incubating post-infusion serum with autologous tumor cell lysates followed by incubation with an anti-human IgG antibody, which showed new bands at post clinical response timepoints in both pts. ELISPOT assays with PBMCs co-incubated with autologous tumor cells exhibited spikes in IFN-γ secreting cells compared with control cells at timepoints proximal to their clinical responses. These findings suggested the occurrence of both humoral and cellular anti-tumor responses. To better characterize the T-cell response, we performed high-throughput TCR-β sequencing (Adaptive ImmunoSEQ) for UPN-04. We conducted a differential abundance analysis to identify possible tumor-reactive T cells, with the hypothesis that tumor-reactive T cell clones would be increased near the timepoints with clinical responses at ~3 and 35 mos. We identified 12 and 7 sequences, respectively, at these timepoints that were significantly increased compared to baseline (FDR < 0.05) and not present in the CAR-T product; 3 sequences were present at both 3 and 35 mos, and 1 of these was also significantly enriched in a post-infusion tumor biopsy, suggesting possible tumor-specificity. These results support the hypothesis that the late responses were mediated by endogenous T cells rather than CAR T cells. In summary, we report long-term remissions in 2 of 3 pts treated with CD20-targeted CAR T cell therapy, with evidence of endogenous anti-tumor immune responses. Together with previously published reports of epitope spreading after CAR-T for solid tumors, and in mouse models of lymphoma, these results suggest that CAR T cells have the capacity to elicit endogenous anti-tumor immune responses in lymphoma. Our use of CY without fludarabine as lymphodepletion may have facilitated such responses. Future research is warranted to enhance epitope spreading after CAR-T therapy as a bulwark against escape by antigen loss or loss of CAR-T persistence.

Modeling Patient-Specific CAR-T Cell Dynamics: Multiphasic Kinetics via Phenotypic Differentiation.

Chimeric Antigen Receptor (CAR)-T cell immunotherapy revolutionized cancer treatment and consists of the genetic modification of T lymphocytes with a CAR gene, aiming to increase their ability to recognize and kill antigen-specific tumor cells. The dynamics of CAR-T cell responses in patients present multiphasic kinetics with distribution, expansion, contraction, and persistence phases. The characteristics and duration of each phase depend on the tumor type, the infused product, and patient-specific characteristics. We present a mathematical model that describes the multiphasic CAR-T cell dynamics resulting from the interplay between CAR-T and tumor cells, considering patient and product heterogeneities. The CAR-T cell population is divided into functional (distributed and effector), memory, and exhausted CAR-T cell phenotypes. The model is able to describe the diversity of CAR-T cell dynamical behaviors in different patients and hematological cancers as well as their therapy outcomes. Our results indicate that the joint assessment of the area under the concentration-time curve in the first 28 days and the corresponding fraction of non-exhausted CAR-T cells may be considered a potential marker to classify therapy responses. Overall, the analysis of different CAR-T cell phenotypes can be a key aspect for a better understanding of the whole CAR-T cell dynamics.

Next generations of CAR-T cells - new therapeutic opportunities in hematology?

In recent years, the introduction of chimeric antigen receptor (CAR) T-cell therapies into clinics has been a breakthrough in treating relapsed or refractory malignancies in hematology and oncology. To date, Food and Drug Administration (FDA) has approved six CAR-T therapies for specific non-Hodgkin lymphomas, B-cell acute lymphoblastic leukemia, and multiple myeloma. All registered treatments and most clinical trials are based on so-called 2nd generation CARs, which consist of an extracellular antigen-binding region, one costimulatory domain, and a CD3z signaling domain. Unfortunately, despite remarkable overall treatment outcomes, a relatively high percentage of patients do not benefit from CAR-T therapy (overall response rate varies between 50 and 100%, with following relapse rates as high as 66% due to limited durability of the response). Moreover, it is associated with adverse effects such as cytokine release syndrome and neurotoxicity. Advances in immunology and molecular engineering have facilitated the construction of the next generation of CAR-T cells equipped with various molecular mechanisms. These include additional costimulatory domains (3rd generation), safety switches, immune-checkpoint modulation, cytokine expression, or knockout of therapy-interfering molecules, to name just a few. Implementation of next-generation CAR T-cells may allow overcoming current limitations of CAR-T therapies, decreasing unwanted side effects, and targeting other hematological malignancies. Accordingly, some clinical trials are currently evaluating the safety and efficacy of novel CAR-T therapies. This review describes the CAR-T cell constructs concerning the clinical application, summarizes completed and ongoing clinical trials of next-generation CAR-T therapies, and presents future perspectives.

Role of antibody engineering in generation of derivatives starting from MOv19 MAb: 40years of biological/therapeutic tools against folate receptor alfa.

In the 1980s, we developed and characterized numerous murine monoclonal antibodies (MAbs) directed against human tumor-associated antigens. This mini review is focused on the generation of derivatives of an anti-folate receptor α (FRα) MAbs, named MOv19, exploiting the antibody-engineering progresses in the last 40 years. The FRα location on the luminal surface of proliferating epithelial cells, inaccessible to circulation, versus its over-expression in the entire surface of numerous carcinomas suggested a role for anti-FRα MAbs in the diagnosis and/or treatment of solid tumors. Presently, two MOv19 derivatives are in clinical trials: a chimeric resurfaced version in an antibody-drug conjugate format (SORAYA trial, 2022) and the murine scFv in a second generation chimeric antigen receptor, CAR-T (Phase Ia, 2021). MOv19 and its derivatives could be considered a relevant example that well-characterized anti-tumor murine Mabs and antibody engineering could be combined to generate useful therapeutic tools.

ALL-IN-ONE VIRUS-FREE MANUFACTURING PROCESS OF ALLOGENEIC CHIMERIC ANTIGEN RECEPTOR (CAR) T CELLS USING CRISPR/CAS9

Chimeric antigen receptor (CAR) T cell therapy has emerged as a promising therapeutic opportunity against blood cancers, leading to the six FDA-approved CAR T cell products. All commercially available products are produced following an autologous strategy, which represents a bottleneck for the widespread adoption of this technology due to the poor quality and quantity of patients’ T cells. Allogeneic T cells from healthy donors are an excellent alternative over the autologous ones, allowing the production of a ready-to-use therapy besides additional benefits, such as standardization of the final product, cost reduction through manufacturing scale-up, and the possibility of multiple genetic modifications. Safety concerns related to the use of cells from third-party donors can be easily eliminated through T cell receptor (TCR) knock-out with the demonstrated prevention of graft-versus-host disease development. Here we describe CRISPR/Cas9 editing for TRAC ( T Cell Receptor Alpha Constant )-targeted genomic integration of the CAR transgene and the consequent TCR knock-out in a fast and efficient virus-free manufacturing process. For the CRISPR/Cas9-mediated knock-in, we designed a plasmid containing the second-generation anti-CD19 CAR flanked by arms homologous to the desired cut site. This sequence was PCR amplified and purified, resulting in a highly concentrated double-stranded DNA (dsDNA) template for the homology-directed repair (HDR). Human T cells isolated from healthy donors were electroporated with the dsDNA-HDR templates (dsDNA-HDRT) and Cas9 ribonucleoproteins (RNPs) targeting the human TRAC locus. Cells were assayed on days 5 and 11 post-electroporation for CAR expression and killing efficiency, respectively. A mCherry transgene flanked by the same homology arms was also included as a control. Preliminary studies using the mCherry dsDNA-HDRT indicated a 1.2-fold improvement in the editing efficiency by adding the positively charged polymer poly-L-glutamic acid (40 μg) that binds to RNPs and reduces aggregates. Additionally, by culturing the electroporated cells with varying concentrations of an NHEJ inhibitor, we observed a 1.4 to 2-fold increase in mCherry knock-in, suggesting a favorable condition for the HDR. Based on the established optimized conditions, we electroporated T cells with the CAR dsDNA-HDRT (3.1 kb length, 6 μg) and got 88% of CAR+ cells five days after electroporation. The viability was 27% on day 3 and reached about 60% on day 7. On-target CAR gene integration was confirmed through an “in-out” PCR assay on the genomic DNA using primers specific to the TRAC locus and CAR transmembrane domain. We then analyzed the in vitro cytotoxicity of CAR T cells by coculturing them with GFP-expressing tumor cell lines. Complete growth inhibition of the RS4-11 cells (CD19 + ) was achieved at the 5:1, 10:1, and 50:1 effector-to-target ratios. For the K562 cells (CD19-), conversely, the killing activity was related to the T cells themselves since CAR expression did not further decrease the tumor cell number. These results demonstrate robust cytotoxic function and target specificity of the CAR T cell products. Combined, the data provide a proof-of-concept for the virus-free manufacturing process of allogeneic anti-CD19 CAR T cells, enabling CAR knock-in and TCR knock-out in an all-in-one strategy.

P06.02.B Advanced CAR-T cell against orthotopic glioblastoma mouse model

Abstract Background The adoptive and engineered chimeric antigen receptor (CAR) T cells have demonstrated remarkable success in treating hematologic cancers; however, this success has yet to be extrapolated to solid tumors such as glioblastoma multiforme (GBM). The purpose of this study was to evaluate the survival efficacy using advanced CAR-T cells in orthotopic GBM mouse model. Material and Methods Advanced CAR-T cell, which reprograms the patient’s T-cells with a transgene encoding part of interleukin-7 receptor-α (ΔIL7Rα) domain in addition to the CD3ζ signaling domain and 4-1BB costimulatory domain in the advanced CAR gene to exhibit excellent in vivo persistence and anti-tumor effect of advanced CAR-T cells. In addition to the advanced CAR gene, TGF-beta converter is introduced, which converts the inhibitory signal of TGF-beta, an immunosuppressive cytokine overexpressed in the hostile tumor microenvironment, into the activation signal of the cytokine IL-18 in advanced CAR-T cells.DAY9 NSG mice bearing orthotopically xenografted GBM cell lines (1 × 105 U251MG expressing IL13Rα2) were randomized to 8 experimental groups. Each experimental group was intravenously injected with only once with different subtype advanced CAR-T cells (Td ~ 47.3% of 5 × 106) and monitored for survival. Results Among treatment groups, mice treated with advanced CAR-T cells of TGF-β converter subtype demonstrated a statistically significant increase in survival (p=0.042, 95%CI, 0.375-0.981) compared with other subtypes. In DAY9 orthotopic GBM mouse model, we showed that a single I.V. injection of advanced CAR-T cells targeting IL13Rα2-specific tumor achieved survival benefit. Conclusion This study is the first report to show statistically significant survival benefit in DAY9 orthotopic GBM mouse model using a single I.V. injection of advanced CAR-T cells, yet merits further clinical trials in real world of clinical setting.

CAR-T therapy as a consolidation in remission B-ALL patients with poor prognosis.

BackgroundTo date, almost all studies regarding chimeric antigen receptor (CAR)‐T cell therapy for B‐cell acute lymphoblastic leukemia (B‐ALL) were performed in refractory/relapsed (r/r) or minimal residual disease‐positive patients. CAR‐T therapy in remission patients has not been reported.AimTo observe the treatment outcome of CAR‐T cells for remission B‐ALL patients with poor prognosis.Methods and ResultsCAR‐T treatment was applied to two B‐ALL patients in remission status who had poor prognostic factors and refused transplantation, and one case was unable to accept standard chemotherapy owing to multiple complications. The procedure of CAR‐T therapy in these two remission patients was the same as that in r/r B‐ALL patients. Lentiviral vectors encoding second generation CARs composed of CD3ζ and 4‐1BB were used to produce CAR‐T cells. Lymphodepleting agents fludarabine and cyclophosphamide were administered prior to cell infusion. Grade I cytokine release syndrome occurred after each T‐cell infusion and there was no neurotoxicity. CAR‐T treatment followed by non‐intensive maintenance chemotherapy and targeted drugs allowed both patients to obtain a long‐term event‐free survival of more than three and a half years without transplantation.ConclusionsCAR‐T therapy could be used in high‐risk B‐ALL patients as a consolidation to avoid transplantation, the combination of CAR‐T and following maintenance therapy may be better than CAR‐T alone for durable remission.

Secretory co-factors in next-generation cellular therapies for cancer.

Since chimeric antigen receptor (CAR) T-cell therapies for hematologic malignancies were approved by the U.S. Food and Drug Administration, numerous “next-generation” CAR T cells have been developed to improve their safety, efficacy, and applicability. Although some of these novel therapeutic strategies are promising, it remains difficult to apply these therapies to solid tumors and to control adverse effects, such as cytokine release syndrome and neurotoxicity. CAR T cells are generated using highly scalable genetic engineering techniques. One of the major strategies for producing next-generation CAR T cells involves the integration of useful co-factor(s) into the artificial genetic design of the CAR gene, resulting in next-generation CAR T cells that express both CAR and the co-factor(s). Many soluble co-factors have been reported for CAR T cells and their therapeutic effects and toxicity have been tested by systemic injection; therefore, CAR T cells harnessing secretory co-factors could be close to clinical application. Here, we review the various secretory co-factors that have been reported to improve the therapeutic efficacy of CAR T cells and ameliorate adverse events. In addition, we discuss the different co-factor expression systems that have been used to optimize their beneficial effects. Altogether, we demonstrate that combining CAR T cells with secretory co-factors will lead to next-generation CAR T-cell therapies that can be used against broader types of cancers and might provide advanced tools for more complicated synthetic immunotherapies.

Intracavity generation of glioma stem cell-specific CAR macrophages primes locoregional immunity for postoperative glioblastoma therapy.

Glioblastoma multiforme (GBM) remains incurable despite aggressive implementation of multimodal treatments after surgical debulking. Almost all patients with GBM relapse within a narrow margin around the initial resected lesion due to postsurgery residual glioma stem cells (GSCs). Tracking and eradicating postsurgery residual GSCs is critical for preventing postoperative relapse of this devastating disease, yet effective strategies remain elusive. Here, we report a cavity-injectable nanoporter-hydrogel superstructure that creates GSC-specific chimeric antigen receptor (CAR) macrophages/microglia (MΦs) surrounding the cavity to prevent GBM relapse. Specifically, we demonstrate that the CAR gene-laden nanoporter in the hydrogel can introduce GSC-targeted CAR genes into MΦ nuclei after intracavity delivery to generate CAR-MΦs in mouse models of GBM. These CAR-MΦs were able to seek and engulf GSCs and clear residual GSCs by stimulating an adaptive antitumor immune response in the tumor microenvironment and prevented postoperative glioma relapse by inducing long-term antitumor immunity in mice. In an orthotopic patient-derived glioblastoma humanized mouse model, the combined treatment with nanoporter-hydrogel superstructure and CD47 antibody increased the frequency of positive immune responding cells and suppressed the negative immune regulating cells, conferring a robust tumoricidal immunity surrounding the postsurgical cavity and inhibiting postoperative glioblastoma relapse. Therefore, our work establishes a locoregional treatment strategy for priming cancer stem cell-specific tumoricidal immunity with broad application in patients suffering from recurrent malignancies.

Comparison of chimeric antigen receptor-T cell-mediated cytotoxicity assays with suspension tumor cells using plate-based image cytometry method.

In the recent decade, chimeric antigen receptor (CAR)-T cell therapy has revolutionized strategies for cancer treatments due to its highly effective clinical efficacy and response for B cell malignancies. The success of CAR-T cell therapy has stimulated the increase in the research and development of various CAR constructs to target different tumor types. Therefore, a robust and efficient in vitro potency assay is needed to quickly identify potential CAR gene design from a library of construct candidates. Image cytometry methodologies have been utilized for various CAR-T cell-mediated cytotoxicity assay using different fluorescent labeling methods, mainly due to their ease-of-use, ability to capture cell images for verification, and higher throughput performance. In this work, we employed the Celigo Image Cytometer to evaluate and compare two CAR-T cell-mediated cytotoxicity assays using GFP-expressing or fluorescent dye-labeled myeloma and plasmacytoma cells. The GFP-based method demonstrated higher sensitivity in detecting CAR-T cell-mediated cytotoxicity when compared to the CMFDA/DAPI viability method. We have established the criteria and considerations for the selection of cytotoxicity assays that are fit-for-purpose to ensure the results produced are meaningful for the specific testing conditions.

Discovery of a Transferrin Receptor 1-Binding Aptamer and Its Application in Cancer Cell Depletion for Adoptive T-Cell Therapy Manufacturing.

The clinical manufacturing of chimeric antigen receptor (CAR) T cells includes cell selection, activation, gene transduction, and expansion. While the method of T-cell selection varies across companies, current methods do not actively eliminate the cancer cells in the patient's apheresis product from the healthy immune cells. Alarmingly, it has been found that transduction of a single leukemic B cell with the CAR gene can confer resistance to CAR T-cell therapy and lead to treatment failure. In this study, we report the identification of a novel high-affinity DNA aptamer, termed tJBA8.1, that binds transferrin receptor 1 (TfR1), a receptor broadly upregulated by cancer cells. Using competition assays, high resolution cryo-EM, and de novo model building of the aptamer into the resulting electron density, we reveal that tJBA8.1 shares a binding site on TfR1 with holo-transferrin, the natural ligand of TfR1. We use tJBA8.1 to effectively deplete B lymphoma cells spiked into peripheral blood mononuclear cells with minimal impact on the healthy immune cell composition. Lastly, we present opportunities for affinity improvement of tJBA8.1. As TfR1 expression is broadly upregulated in many cancers, including difficult-to-treat T-cell leukemias and lymphomas, our work provides a facile, universal, and inexpensive approach for comprehensively removing cancerous cells from patient apheresis products for safe manufacturing of adoptive T-cell therapies.