DISRUPTION OF CTLA-4 BUT NOT PD-1 ENHANCES AND INVIGORATES CHIMERIC ANTIGEN RECEPTOR T CELLS

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Degree type
Doctor of Philosophy (PhD)
Graduate group
Cell and Molecular Biology
Discipline
Biology
Immunology and Infectious Disease
Linguistics
Subject
Acute Lymphoblastic Leukemia (ALL) and Chronic Lymphocytic Leukemia (CLL)
Cancer Immunotherapy
CART cells
CRISPR/Cas9
PD-1 and CTLA-4
T cell exhaustion or dysfunction
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2023
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Agarwal, Sangya
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Abstract

Chimeric antigen receptor (CAR) T cell therapy targeting CD19 has achieved remarkable success in treating B-cell malignancies, however, some patients fail to respond due to poor fitness of the adoptively transferred T cells. To potentially increase the number of patients that could benefit from CART19 therapy, we investigated whether CRISPR-Cas9-mediated disruption of PDCD1 and/or CTLA- 4 in patient T cells could enhance efficacy and restore CART cell function. Indeed, we demonstrate, in both an in vitro model of CART cell dysfunction and xenograft mouse models, that disruption of CTLA-4, but not PDCD1 or PDCD1 and CTLA-4 results in superior CART cell performance evidenced by increased proliferation, cytokine production, and superior anti-tumor response. Furthermore, CART19 cells manufactured from T cells lacking CTLA-4 maintain CAR expression on the T cell surface under conditions of chronic antigen exposure, which is a driver of CAR- dysfunction. To understand mechanistically how CTLA-4 disruption contributes to the increased anti-tumor efficacy of CART19 cells we perform transcriptomic analyses and identify upregulated pathways, aligning with the observed therapeutic superiority, including granzyme A and B signaling, cell cycle regulation, and cytokine signaling. Moreover, CTLA-4 disrupted CART19 cells display unopposed CD28 signaling, which is observed by pathway analyses. Importantly we confirm the clinical relevance of these results, establishing that depletion of CTLA-4 rescues the function of T cells from leukemia patients that previously failed CART cell treatment and enables the manufacture of potent CART19 products from CLL patient T cells that previously produced an ineffective product. Our findings reveal that disruption of CTLA-4 invigorates dysfunctional patient T cells, providing a strategy for increasing the number of patients that respond to CART19 therapy.

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June, Carl, H.
Date of degree
2023
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