Division of Oncology, Section of Cellular Therapies, Washington University School of Medicine, St. Louis, MO.
Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO.
Blood. 2023 Jun 29;141(26):3153-3165. doi: 10.1182/blood.2023020100.
T cells engineered to express chimeric antigen receptors (CARs) targeting CD19 have demonstrated impressive activity against relapsed or refractory B-cell cancers yet fail to induce durable remissions for nearly half of all patients treated. Enhancing the efficacy of this therapy requires detailed understanding of the molecular circuitry that restrains CAR-driven antitumor T-cell function. We developed and validated an in vitro model that drives T-cell dysfunction through chronic CAR activation and interrogated how CAR costimulatory domains, central components of CAR structure and function, contribute to T-cell failure. We found that chronic activation of CD28-based CARs results in activation of classical T-cell exhaustion programs and development of dysfunctional cells that bear the hallmarks of exhaustion. In contrast, 41BB-based CARs activate a divergent molecular program and direct differentiation of T cells into a novel cell state. Interrogation using CAR T cells from a patient with progressive lymphoma confirmed the activation of this novel program in a failing clinical product. Furthermore, we demonstrate that 41BB-dependent activation of the transcription factor FOXO3 is directly responsible for impairing CAR T-cell function. These findings identify that costimulatory domains are critical regulators of CAR-driven T-cell failure and that targeted interventions are required to overcome costimulation-dependent dysfunctional programs.
经嵌合抗原受体(CAR)修饰表达靶向 CD19 的 T 细胞在治疗复发或难治性 B 细胞癌症方面表现出了令人瞩目的疗效,但仍有近一半的接受治疗的患者无法获得持久缓解。为了提高这种治疗方法的疗效,需要详细了解限制 CAR 驱动的抗肿瘤 T 细胞功能的分子机制。我们开发并验证了一种体外模型,该模型通过慢性 CAR 激活导致 T 细胞功能障碍,并研究了 CAR 共刺激结构域(CAR 结构和功能的核心组成部分)如何导致 T 细胞衰竭。我们发现,基于 CD28 的 CAR 的慢性激活导致经典 T 细胞耗竭程序的激活和功能失调细胞的发展,这些细胞具有耗竭的特征。相比之下,41BB 基于的 CAR 会激活不同的分子程序,并将 T 细胞定向分化为一种新型细胞状态。使用来自进展性淋巴瘤患者的 CAR T 细胞进行的检测证实了该新型程序在失效的临床产品中的激活。此外,我们证明 FOXO3 转录因子的 41BB 依赖性激活直接导致 CAR T 细胞功能受损。这些发现表明,共刺激结构域是 CAR 驱动的 T 细胞衰竭的关键调节因子,需要进行靶向干预以克服共刺激依赖性的功能失调程序。
Am Soc Clin Oncol Educ Book. 2019-1
Curr Treat Options Oncol. 2020-2-5
Front Immunol. 2025-8-8
Nat Rev Clin Oncol. 2025-4
Nat Rev Drug Discov. 2025-5
Front Immunol. 2025-1-16
Nat Immunol. 2022-11
Science. 2021-12-17
Cell. 2021-12-9