Immunology Program, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY.
Department of Pharmacology, Weill Cornell Medicine, New York, NY.
Blood. 2024 Jul 11;144(2):171-186. doi: 10.1182/blood.2023022293.
Multiple myeloma is a plasma cell malignancy that is currently incurable with conventional therapies. Following the success of CD19-targeted chimeric antigen receptor (CAR) T cells in leukemia and lymphoma, CAR T cells targeting B-cell maturation antigen (BCMA) more recently demonstrated impressive activity in relapsed and refractory myeloma patients. However, BCMA-directed therapy can fail due to weak expression of BCMA on myeloma cells, suggesting that novel approaches to better address this antigen-low disease may improve patient outcomes. We hypothesized that engineered secretion of the proinflammatory cytokine interleukin-18 (IL-18) and multiantigen targeting could improve CAR T-cell activity against BCMA-low myeloma. In a syngeneic murine model of myeloma, CAR T cells targeting the myeloma-associated antigens BCMA and B-cell activating factor receptor (BAFF-R) failed to eliminate myeloma when these antigens were weakly expressed, whereas IL-18-secreting CAR T cells targeting these antigens promoted myeloma clearance. IL-18-secreting CAR T cells developed an effector-like T-cell phenotype, promoted interferon-gamma production, reprogrammed the myeloma bone marrow microenvironment through type-I/II interferon signaling, and activated macrophages to mediate antimyeloma activity. Simultaneous targeting of weakly-expressed BCMA and BAFF-R with dual-CAR T cells enhanced T-cell:target-cell avidity, increased overall CAR signal strength, and stimulated antimyeloma activity. Dual-antigen targeting augmented CAR T-cell secretion of engineered IL-18 and facilitated elimination of larger myeloma burdens in vivo. Our results demonstrate that combination of engineered IL-18 secretion and multiantigen targeting can eliminate myeloma with weak antigen expression through distinct mechanisms.
多发性骨髓瘤是一种浆细胞恶性肿瘤,目前用常规疗法无法治愈。在 CD19 靶向嵌合抗原受体 (CAR) T 细胞在白血病和淋巴瘤中取得成功之后,最近针对 B 细胞成熟抗原 (BCMA) 的 CAR T 细胞在复发性和难治性骨髓瘤患者中显示出了令人瞩目的疗效。然而,BCMA 靶向治疗可能会失败,这是由于骨髓瘤细胞上 BCMA 的表达较弱,这表明采用新方法更好地解决这种抗原低表达疾病可能会改善患者的预后。我们假设,工程化分泌促炎细胞因子白细胞介素-18 (IL-18) 和多抗原靶向可以提高 CAR T 细胞针对低表达 BCMA 的骨髓瘤的活性。在骨髓瘤的同种异体小鼠模型中,当这些抗原弱表达时,针对骨髓瘤相关抗原 BCMA 和 B 细胞激活因子受体 (BAFF-R) 的 CAR T 细胞未能消除骨髓瘤,而针对这些抗原的分泌 IL-18 的 CAR T 细胞则促进了骨髓瘤的清除。分泌 IL-18 的 CAR T 细胞表现出效应 T 细胞样表型,促进干扰素-γ的产生,通过 I 型/II 型干扰素信号重塑骨髓瘤骨髓微环境,并激活巨噬细胞介导抗骨髓瘤活性。用双 CAR T 细胞同时靶向弱表达的 BCMA 和 BAFF-R 可增强 T 细胞:靶细胞亲和力,增加总体 CAR 信号强度,并刺激抗骨髓瘤活性。双抗原靶向增强了 CAR T 细胞对工程化 IL-18 的分泌,并有助于在体内消除更大的骨髓瘤负担。我们的研究结果表明,通过独特的机制,工程化 IL-18 分泌和多抗原靶向的组合可以消除弱抗原表达的骨髓瘤。
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