将 CAR 与嵌合共刺激受体结合可增强 T 细胞对低抗原密度的敏感性,并促进其持久性。

Combining a CAR and a chimeric costimulatory receptor enhances T cell sensitivity to low antigen density and promotes persistence.

机构信息

Department of Hematology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, 1081 HV Amsterdam, Netherlands.

Center for Cell Engineering, Immunology Program, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.

出版信息

Sci Transl Med. 2021 Dec 8;13(623):eabh1962. doi: 10.1126/scitranslmed.abh1962.

Abstract

Despite the high remission rates achieved using T cells bearing a chimeric antigen receptor (CAR) against hematogical malignancies, there is still a considerable proportion of patients who eventually experience tumor relapse. Clinical studies have established that mechanisms of treatment failure include the down-regulation of target antigen expression and the limited persistence of effective CAR T cells. We hypothesized that dual targeting mediated by a CAR and a chimeric costimulatory receptor (CCR) could simultaneously enhance T cell cytotoxicity and improve durability. Concomitant high-affinity engagement of a CD38-binding CCR enhanced the cytotoxicity of BCMA-CAR and CD19-CAR T cells by increasing their functional binding avidity. In comparison to second-generation BCMA-CAR or CD19-CAR T cells, double-targeted CAR + CD38-CCR T cells exhibited increased sensitivity to recognize and lyse tumor variants of multiple myeloma and acute lymphoblastic leukemia with low antigen density in vitro. In addition, complimentary costimulation by 4-1BB and CD28 endodomains provided by the CAR and CCR combination conferred increased cytokine secretion and expansion and improved persistence in vivo. The cumulatively improved properties of CAR + CCR T cells enabled the in vivo eradication of antigen-low tumor clones, which were otherwise resistant to treatment with conventional CAR T cells. Therefore, multiplexing targeting and costimulation through the combination of a CAR and a CCR is a powerful strategy to improve the clinical outcomes of CAR T cells by enhancing cytotoxic efficacy and persistence, thus preventing relapses of tumor clones with low target antigen density.

摘要

尽管针对血液恶性肿瘤的嵌合抗原受体 (CAR) 修饰 T 细胞能够实现高缓解率,但仍有相当一部分患者最终会出现肿瘤复发。临床研究已经证实,治疗失败的机制包括靶抗原表达下调和有效的 CAR T 细胞持续存在有限。我们假设通过 CAR 和嵌合共刺激受体 (CCR) 的双重靶向可以同时增强 T 细胞的细胞毒性并提高持久性。同时,通过高亲和力结合 CD38 的 CCR 的共结合增强了 BCMA-CAR 和 CD19-CAR T 细胞的细胞毒性,提高了它们的功能结合亲和力。与第二代 BCMA-CAR 或 CD19-CAR T 细胞相比,双靶向 CAR + CD38-CCR T 细胞对体外具有低抗原密度的多发性骨髓瘤和急性淋巴细胞白血病的肿瘤变异体的识别和裂解的敏感性增加。此外,CAR 和 CCR 组合提供的 4-1BB 和 CD28 内源性共刺激提供了增加的细胞因子分泌和扩增,并改善了体内的持久性。CAR + CCR T 细胞累积改善的特性使体内清除抗原低肿瘤克隆成为可能,否则这些克隆对常规 CAR T 细胞治疗具有抗性。因此,通过 CAR 和 CCR 的组合进行多重靶向和共刺激是一种通过增强细胞毒性效力和持久性来改善 CAR T 细胞临床结果的强大策略,从而防止具有低靶抗原密度的肿瘤克隆复发。

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