Abstract Improved methods for generating human pluripotent stem cell (hPSC)-derived cells and tissues have rapidly expanded the field of regenerative medicine. Yet, in most cases, hPSC-derived cells need to be protected, ideally in a localized manner, from an antagonistic host immune response. Chimeric antigen receptor (CAR) technology can confer new antigen specificities to effector T cells and, more recently, regulatory T cells (Tregs), potent immunosuppressive cells. However, one challenge in CAR design is identifying a target molecule uniquely expressed by the cells of interest to prevent unwanted off-target effects. Here, we developed a combinatorial genetic engineering approach to confer CAR-Treg-mediated localized immune protection specifically to transplanted stem cell-derived cells using a humanized type 1 diabetes preclinical mouse model. We engineered hPSCs to express a truncated epidermal growth factor receptor (EGFRt) and differentiated functional stem cell derived beta-like cells (sBCs) from them. In parallel, we generated EGFR CAR-Tregs that were activated by EGFRt-expressing sBCs without disrupting Treg identity. Strikingly, activated CAR-Tregs suppressed innate and adaptive effector immune responses in vitro and prevented effector CAR-T-cell-mediated sBC graft destruction in vivo. These data provide evidence that combinatorial genome engineering of hPSCs and Tregs can be harnessed to protect hPSC-derived tissues from immune attack via immune tolerance induction.
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