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. 2015 Oct 12;28(4):415-428.
doi: 10.1016/j.ccell.2015.09.004.

Structural Design of Engineered Costimulation Determines Tumor Rejection Kinetics and Persistence of CAR T Cells

Zeguo Zhao  1 , Maud Condomines  1 , Sjoukje J C van der Stegen  1 , Fabiana Perna  1 , Christopher C Kloss  1 , Gertrude Gunset  1 , Jason Plotkin  1 , Michel Sadelain  2
Affiliations

Structural Design of Engineered Costimulation Determines Tumor Rejection Kinetics and Persistence of CAR T Cells

Zeguo Zhao et al. Cancer Cell. .

Abstract

T cell engineering is a powerful means to rapidly generate anti-tumor T cells. The costimulatory properties of second-generation chimeric antigen receptors (CARs) determine the overall potency of adoptively transferred T cells. Using an in vivo "stress test" to challenge CD19-targeted T cells, we studied the functionality and persistence imparted by seven different CAR structures providing CD28 and/or 4-1BB costimulation. One configuration, which uses two signaling domains (CD28 and CD3ζ) and the 4-1BB ligand, provided the highest therapeutic efficacy, showing balanced tumoricidal function and increased T cell persistence accompanied by an elevated CD8/CD4 ratio and decreased exhaustion. Remarkably, induction of the IRF7/IFNβ pathway was required for optimal anti-tumor activity. Thus, 1928z-41BBL T cells possess strikingly potent intrinsic and immunomodulatory qualities.

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Figures

Figure 1
Figure 1. Therapeutic potency of first and second-generation CAR designs
One first generation, 19z1, and two second-generation CD19-specific CARs, 1928z and 19BBz, were compared for their anti-tumor effect in a systemic NALM/6 model. (A) Flow cytometric analysis showing CAR and LNGFR expression. (B) Cytotoxic activity using a 4 hr 51Cr release assay (left) and an 18 hr bioluminescence assay (right), utilizing NALM6 as targets cells. Data are means ± SD. (C) Cumulative cell counts of indicated CAR T cells upon weekly CD19 stimulation, without exogenous cytokines. Arrows indicate stimulation time points. Data are means ± SD. (D) NALM6 bearing mice were treated with 4×105 (top), 2×105 (middle) or 1×105 (bottom) indicated CAR T cells. Tumor burden shown as bioluminescent signal quantified per animal every week over a 120-day period. Quantification is the average photon count of ventral and dorsal acquisitions per animal at all given time points. Each line represents one mouse. Some groups are pooled from at least two experiments, representing n=5–14 mice per group. (E) Kaplan-Meier analysis of survival of mice in (D). *p<0.05; **p<0.01; ***p<0.001. See also Figure S1.
Figure 2
Figure 2. In vivo T cell accumulation and tumor burden kinetics of first and second generation CAR designs
NALM6 bearing mice were treated with 2×105 indicated CAR T cells. One, two and three weeks after CAR T cell infusion, mice were sacrificed and bone marrow cells were harvested. CAR T cells and NALM6 cells were analyzed and counted by flow cytometry. (A) Each dot represents one mouse, *p<0.05; **p<0.01. (B) Each line represents n=6 mice per group per timepoint. Red and green broken line respectively indicate NALM6 cell number at the time of T cell infusion and 1928z T cell accumulation at day 7. (C) Effector/Tumor (CAR T/NALM6) ratios were shown at different time points. All data are means ± SD. See also Figure S2.
Figure 3
Figure 3. Therapeutic potency of a third generation CAR and three alternative combinations of costimulatory CAR designs
(A) Flow cytometric analysis showing expression levels of the indicated CARs. (B) Cytotoxic activity using a 4 hr 51Cr release assay (left) and 18 hr bioluminescence assay (right), utilizing NALM6 cell line as targets cells. Data are means ± SD. (C) Cumulative CAR T cell counts of indicated CAR T cells upon weekly CD19 stimulation, without exogenous cytokines. Arrows indicate stimulation time points. Data are means ± SD. (D) NALM6 bearing mice were treated with 2×105 (top), or 1×105 (bottom) indicated CAR T cells. Tumor burden showed as the bioluminescent signal quantified per animal every week over a 120-day period. Quantification is the average photon count of ventral and dorsal acquisitions per animal at all given time points. Each line represents one mouse. Some groups are pooled from at least two experiments, representing n=7–14 mice per group. (E) Kaplan-Meier analysis of survival of mice in (D). *p<0.05; **p<0.01; ***p<0.001. See also Figure S3.
Figure 4
Figure 4. In vivo T cell accumulation and tumor burden kinetics of a third generation and different combinations of costimulatory CAR designs
NALM6 bearing mice were treated with 2×105 indicated CAR T cells. One, two and three weeks after CAR T cell infusion, mice were sacrificed and bone marrow cells were harvested from two femurs. CAR T cells and NALM6 cells were analyzed and counted by flow cytometry. (A) Each dot represents one mouse, *p<0.05; **p<0.01. (B) Each line represents n=6 mice per group per timepoint. Red and green broken line respectively indicate NALM6 cell number at the time of T cell infusion and 1928z-41BBL T cell accumulation at day 7 and 21. (C) Effector/Tumor (CAR T/NALM6) ratios were shown at different time points. (D) Cytotoxic activity of indicated ex vivo CAR T cells as shown using an 18 hr bioluminescence assay, utilizing NALM6 cell line as targets cells. CAR T cells were isolated from mouse spleens 3 weeks after treatment and pooled from 5–6 mice. All data are means ± SD. See also Figure S4.
Figure 5
Figure 5. Optimally combined 4-1BB and CD28 costimulation promotes higher CD8/CD4 ratios and reduces T cell exhaustion
NALM6 bearing mice were treated with 2×105 of indicated CAR T cells. Three weeks after CAR T cell infusion, mice were sacrificed and bone marrow cells were harvested from two femurs. CD4 and CD8 CAR T cells were analyzed and counted by flow cytometry. (A) CD4 and CD8 CAR T cell percentage in each mouse of indicated CAR design. Each black line represents one mouse. The green line represents the initial ratio at the time of infusion. (B) FACS plots showing PD-1, LAG-3, TIM-3 expression. (C) Exhaustion marker analysis of B. See also Figure S5.
Figure 6
Figure 6. Antigen activation combined with CD28 and 4-1BB costimulation induces strong intrinsic activation of the type I IFN pathway in human T cells
Gene expression profiles were analyzed in stimulated CD4 or CD8 CAR T cells at day 15 in culture. (A) GSEA analysis showing the enrichment of type I IFN signaling, in 1928z-41BBL versus 19z1 CD4 CAR cells. (B) Same GSEA analysis in CD8 CAR T cells. (C) Expression levels of type I IFN genes in indicated CD4 CAR T cells. (D) Expression levels of type I IFN genes in indicated CD8 CAR T cells. (E) Relative expression of IRF7 and two ISGs (OAS1 and IFI6), using qPCR for indicated CAR T cells. Data are means ± SD. (F) Relative expression of IFNB1, IRF7 and IRF3 at indicated time points after stimulation, measured by qPCR in indicated CAR T cells generated from unselected lymphocytes (PBLs), highly purified CD4 or CD8 T cells. Data are means ± SD. (G) Relative expression of IRF7 and IFNB1 at indicated time points measured by qPCR in purified ex vivo CAR T cell as described in Figures 2A and 4A. Each group was normalized to its first detectable expression level. See also Figure S6.
Figure 7
Figure 7. IRF7 is required for optimal anti-tumor efficacy of human targeted T cells
(A) Graphs indicating expression of IRF7, ISG15 and IFNB1 before (unstimulated) and after antigen activation (stimulated) detected by qPCR in sorted human T cells cotransduced with the 1928z CAR, 4-1BBL, a control shRNA (1928z+41BBL+shK+) or an anti-IRF7 shRNA (1928z+ 41BBL+ IRF7sh1+ and 1928z+ 41BBL+ IRF7sh2+). Human T cells expressing 1928z+LNGFR+shK+ were included for comparison. Data are means ± SD. (B) Histograms showing IFNβ protein levels, measured by ELISA in cell lysates of indicated T cell groups expanded in vitro for 7 days and restimulated or not with irradiated NALM6 cells for 20 hr. Data shown are representative of 5 independent experiments. Data are means ± SD. (C) IFNγ and granzyme B (GRZB) were detected by intracellular FACS staining 18 hr after antigen stimulation in indicated T cell groups from six different donors. Histograms show the average ± SEM of percentages of cells secreting the indicated molecules in CD4 or CD8 T cells. Values were normalized to that of 1928z+41-BBL+shK+ T cells in each donor to minimize inter-individual variability. (D) Impaired function induced by IRF7 knockdown is rescued by addition of IFNβ. Intracellular cytokines were measured in the indicated T cell groups from four different donors, stimulated as in (C) in the absence or presence of IFNβ. Values were normalized to that of 1928z+41BBL+shK+ T cells in each donor to minimize inter-individual variability. Data are means ± SEM. (E) Plots representing the tumor burden weekly quantified by bioluminescence imaging per animal over a 50-day period. One line represents one mouse. n=4–6 mice per group. (F) Survival is illustrated in the Kaplan-Meier analysis. *p<0.05; **p<0.01; ***p<0.001. See also Figure S7.
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