Department of Biological Sciences, Korea Advanced Institute of Science and Technology, Daejeon 34141, Republic of Korea; Curocell Inc., Daejeon 34109, Republic of Korea.
Department of Biological Sciences, Korea Advanced Institute of Science and Technology, Daejeon 34141, Republic of Korea; Curocell Inc., Daejeon 34109, Republic of Korea.
Mol Ther. 2022 Feb 2;30(2):579-592. doi: 10.1016/j.ymthe.2021.10.004. Epub 2021 Oct 8.
CD19-targeting chimeric antigen receptor (CAR) T cells have become an important therapeutic option for patients with relapsed and refractory B cell malignancies. However, a significant portion of patients still do not benefit from the therapy owing to various resistance mechanisms, including high expression of multiple inhibitory immune checkpoint receptors. Here, we report a lentiviral two-in-one CAR T approach in which two checkpoint receptors are downregulated simultaneously by a dual short hairpin RNA cassette integrated into a CAR vector. Using this system, we evaluated CD19-targeting CAR T cells in the context of four different checkpoint combinations-PD-1/TIM-3, PD-1/LAG-3, PD-1/CTLA-4, and PD-1/TIGIT-and found that CAR T cells with PD-1/TIGIT downregulation uniquely exerted synergistic antitumor effects. Importantly, functional and phenotypic analyses suggested that downregulation of PD-1 enhances short-term effector function, whereas downregulation of TIGIT is primarily responsible for maintaining a less differentiated/exhausted state, providing a potential mechanism for the observed synergy. The PD-1/TIGIT-downregulated CAR T cells generated from diffuse large B cell lymphoma patient-derived T cells also showed robust antitumor activity and significantly improved persistence in vivo. The efficacy and safety of PD-1/TIGIT-downregulated CD19-targeting CAR T cells are currently being evaluated in adult patients with relapsed or refractory large B cell lymphoma (ClinicalTrials.gov: NCT04836507).
嵌合抗原受体 (CAR) T 细胞靶向 CD19 已成为复发和难治性 B 细胞恶性肿瘤患者的重要治疗选择。然而,由于多种耐药机制,包括多种抑制性免疫检查点受体的高表达,仍有相当一部分患者无法从该治疗中获益。在这里,我们报告了一种基于慢病毒的双靶 CAR T 方法,其中两个检查点受体通过整合到 CAR 载体中的双短发夹 RNA 盒同时下调。使用该系统,我们在四种不同的检查点组合(PD-1/TIM-3、PD-1/LAG-3、PD-1/CTLA-4 和 PD-1/TIGIT)的背景下评估了 CD19 靶向 CAR T 细胞,发现 PD-1/TIGIT 下调的 CAR T 细胞具有独特的协同抗肿瘤作用。重要的是,功能和表型分析表明,PD-1 的下调增强了短期效应功能,而 TIGIT 的下调主要负责维持较少分化/耗竭状态,为观察到的协同作用提供了潜在机制。还从弥漫性大 B 细胞淋巴瘤患者来源的 T 细胞中生成的具有 PD-1/TIGIT 下调的 CAR T 细胞也显示出强大的抗肿瘤活性,并显著提高了体内持久性。目前正在对复发或难治性大 B 细胞淋巴瘤的成年患者进行 PD-1/TIGIT 下调的 CD19 靶向 CAR T 细胞的疗效和安全性评估(ClinicalTrials.gov:NCT04836507)。
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