Nobles Christopher L, Sherrill-Mix Scott, Everett John K, Reddy Shantan, Fraietta Joseph A, Porter David L, Frey Noelle, Gill Saar I, Grupp Stephan A, Maude Shannon L, Siegel Donald L, Levine Bruce L, June Carl H, Lacey Simon F, Melenhorst J Joseph, Bushman Frederic D
Department of Microbiology.
Center for Cellular Immunotherapies.
J Clin Invest. 2020 Feb 3;130(2):673-685. doi: 10.1172/JCI130144.
Chimeric antigen receptor-engineered T cells targeting CD19 (CART19) provide an effective treatment for pediatric acute lymphoblastic leukemia but are less effective for chronic lymphocytic leukemia (CLL), focusing attention on improving efficacy. CART19 harbor an engineered receptor, which is delivered through lentiviral vector integration, thereby marking cell lineages and modifying the cellular genome by insertional mutagenesis. We recently reported that vector integration within the host TET2 gene was associated with CLL remission. Here, we investigated clonal population structure and therapeutic outcomes in another 39 patients by high-throughput sequencing of vector-integration sites. Genes at integration sites enriched in responders were commonly found in cell-signaling and chromatin modification pathways, suggesting that insertional mutagenesis in these genes promoted therapeutic T cell proliferation. We also developed a multivariate model based on integration-site distributions and found that data from preinfusion products forecasted response in CLL successfully in discovery and validation cohorts and, in day 28 samples, reported responders to CLL therapy with high accuracy. These data clarify how insertional mutagenesis can modulate cell proliferation in CART19 therapy and how data on integration-site distributions can be linked to treatment outcomes.
靶向CD19的嵌合抗原受体工程化T细胞(CART19)为小儿急性淋巴细胞白血病提供了一种有效的治疗方法,但对慢性淋巴细胞白血病(CLL)的疗效较差,这使得人们将注意力集中在提高疗效上。CART19含有一种通过慢病毒载体整合递送的工程化受体,从而标记细胞谱系并通过插入诱变修饰细胞基因组。我们最近报道,宿主TET2基因内的载体整合与CLL缓解有关。在这里,我们通过对载体整合位点进行高通量测序,研究了另外39例患者的克隆群体结构和治疗结果。在应答者中富集的整合位点处的基因常见于细胞信号传导和染色质修饰途径,这表明这些基因中的插入诱变促进了治疗性T细胞的增殖。我们还基于整合位点分布开发了一个多变量模型,发现来自输注前产物的数据在发现和验证队列中成功预测了CLL的反应,并且在第28天的样本中,能够高度准确地报告CLL治疗的应答者。这些数据阐明了插入诱变如何在CART19治疗中调节细胞增殖,以及整合位点分布的数据如何与治疗结果相关联。
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