Center for Cellular Immunotherapies, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
Vaccine and Immunotherapy Center, Wistar Institute, Philadelphia, PA 19104, USA.
Sci Transl Med. 2023 Sep 20;15(714):eadi1145. doi: 10.1126/scitranslmed.adi1145.
In the absence of cell surface cancer-specific antigens, immunotherapies such as chimeric antigen receptor (CAR) T cells, monoclonal antibodies, or bispecific T cell engagers typically target lineage antigens. Currently, such immunotherapies are individually designed and tested for each disease. This approach is inefficient and limited to a few lineage antigens for which the on-target/off-tumor toxicities are clinically tolerated. Here, we sought to develop a universal CAR T cell therapy for blood cancers directed against the pan-leukocyte marker CD45. To protect healthy hematopoietic cells, including CAR T cells, from CD45-directed on-target/off-tumor toxicity while preserving the essential functions of CD45, we mapped the epitope on CD45 that is targeted by the CAR and used CRISPR adenine base editing to install a function-preserving mutation sufficient to evade CAR T cell recognition. Epitope-edited CD45 CAR T cells were fratricide resistant and effective against patient-derived acute myeloid leukemia, B cell lymphoma, and acute T cell leukemia. Epitope-edited hematopoietic stem cells (HSCs) were protected from CAR T cells and, unlike CD45 knockout cells, could engraft, persist, and differentiate in vivo. Ex vivo epitope editing in HSCs and T cells enables the safe and effective use of CD45-directed CAR T cells and bispecific T cell engagers for the universal treatment of hematologic malignancies and might be exploited for other diseases requiring intensive hematopoietic ablation.
在缺乏细胞表面癌症特异性抗原的情况下,免疫疗法(如嵌合抗原受体 (CAR) T 细胞、单克隆抗体或双特异性 T 细胞衔接器)通常针对谱系抗原。目前,这些免疫疗法是针对每种疾病单独设计和测试的。这种方法效率低下,并且仅限于少数几种谱系抗原,这些抗原的靶标/肿瘤毒性在临床上是可以耐受的。在这里,我们试图开发一种针对血液癌症的通用 CAR T 细胞疗法,该疗法针对泛白细胞标志物 CD45。为了保护包括 CAR T 细胞在内的健康造血细胞免受 CD45 靶向的靶标/肿瘤毒性,同时保留 CD45 的基本功能,我们绘制了被 CAR 靶向的 CD45 表位图谱,并使用 CRISPR 腺嘌呤碱基编辑来安装一个功能保留的突变,足以逃避 CAR T 细胞的识别。表位编辑的 CD45 CAR T 细胞具有抗自杀作用,并且对患者来源的急性髓细胞白血病、B 细胞淋巴瘤和急性 T 细胞白血病有效。表位编辑的造血干细胞 (HSC) 免受 CAR T 细胞的影响,并且与 CD45 敲除细胞不同,它们可以在体内植入、持续存在和分化。HSC 和 T 细胞的体外表位编辑可安全有效地使用 CD45 定向 CAR T 细胞和双特异性 T 细胞衔接器,用于血液恶性肿瘤的通用治疗,并且可能被用于其他需要密集造血消融的疾病。