Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA, USA.
Nat Med. 2018 May;24(5):563-571. doi: 10.1038/s41591-018-0010-1. Epub 2018 Apr 30.
Tolerance to self-antigens prevents the elimination of cancer by the immune system. We used synthetic chimeric antigen receptors (CARs) to overcome immunological tolerance and mediate tumor rejection in patients with chronic lymphocytic leukemia (CLL). Remission was induced in a subset of subjects, but most did not respond. Comprehensive assessment of patient-derived CAR T cells to identify mechanisms of therapeutic success and failure has not been explored. We performed genomic, phenotypic and functional evaluations to identify determinants of response. Transcriptomic profiling revealed that CAR T cells from complete-responding patients with CLL were enriched in memory-related genes, including IL-6/STAT3 signatures, whereas T cells from nonresponders upregulated programs involved in effector differentiation, glycolysis, exhaustion and apoptosis. Sustained remission was associated with an elevated frequency of CD27CD45ROCD8 T cells before CAR T cell generation, and these lymphocytes possessed memory-like characteristics. Highly functional CAR T cells from patients produced STAT3-related cytokines, and serum IL-6 correlated with CAR T cell expansion. IL-6/STAT3 blockade diminished CAR T cell proliferation. Furthermore, a mechanistically relevant population of CD27PD-1CD8 CAR T cells expressing high levels of the IL-6 receptor predicts therapeutic response and is responsible for tumor control. These findings uncover new features of CAR T cell biology and underscore the potential of using pretreatment biomarkers of response to advance immunotherapies.
自身抗原的耐受性阻止了免疫系统对癌症的消除。我们使用合成嵌合抗原受体(CAR)来克服免疫耐受,介导慢性淋巴细胞白血病(CLL)患者的肿瘤排斥。在一部分患者中诱导了缓解,但大多数患者没有反应。综合评估患者来源的 CAR T 细胞以确定治疗成功和失败的机制尚未得到探索。我们进行了基因组、表型和功能评估,以确定反应的决定因素。转录组谱分析显示,来自完全缓解的 CLL 患者的 CAR T 细胞富含与记忆相关的基因,包括 IL-6/STAT3 特征,而无反应者的 T 细胞上调了涉及效应细胞分化、糖酵解、衰竭和凋亡的程序。在 CAR T 细胞生成之前,持续性缓解与 CD27CD45ROCD8 T 细胞的频率升高有关,这些淋巴细胞具有记忆样特征。来自患者的功能强大的 CAR T 细胞产生与 STAT3 相关的细胞因子,血清 IL-6 与 CAR T 细胞扩增相关。IL-6/STAT3 阻断减少了 CAR T 细胞的增殖。此外,高表达 IL-6 受体的 CD27PD-1CD8 CAR T 细胞的一个具有机制相关性的群体可预测治疗反应,并负责肿瘤控制。这些发现揭示了 CAR T 细胞生物学的新特征,并强调了使用治疗反应的预处理生物标志物来推进免疫疗法的潜力。
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