Accurate control of dual-receptor-engineered T cell activity through a bifunctional anti-angiogenic peptide
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Chimeric antigen receptors (CARs) presented on T cell surfaces enable redirection of T cell specificity, which has enormous promise in antitumor therapy. However, excessive activity and poor control over such engineered T cells cause significant safety challenges, such as cytokine release syndrome and organ toxicities. To enhance the specificity and controllable activity of CAR-T cells, we report a novel switchable dual-receptor CAR-engineered T (sdCAR-T) cell and a new switch molecule of FITC-HM-3 bifunctional molecule (FHBM) in this study.
We designed a fusion molecule comprising FITC and HM-3. HM-3, an antitumor peptide including an Arg-Gly-Asp sequence, can specifically target integrin αvβ3 that is presented on some tumor cells. Moreover, to improve the specificity of CAR-T cells, we also generated the sdCAR-T cell line against cognate tumor cells expressing human mesothelin (MSLN) and integrin αvβ3. Finally, the activity of sdCAR-T cell and FHBM is verified via in vitro and in vivo experiments.
In the presence of FHBM, the designed sdCAR-T cells exerted high activity including activation and proliferation and had specific cytotoxicity in a time- and dose-dependent manner in vitro. Furthermore, using a combination of FHBM in nude mice, sdCAR-T cells significantly inhibited the growth of MSLN+ K562 cells and released lower levels of the cytokines (e.g., interleukin-2, interferon γ, interleukin-6, and tumor necrosis factor α) relative to conventional CAR-T cells, obtaining specific, controllable, and enhanced cytotoxicity.
Our data indicate that FHBM can accurately control timing and dose of injected CAR-T cells, and sdCAR-T cells exert significant antitumor activity while releasing lower levels of cytokines for the cognate tumor cells expressing both MSLN and integrin αvβ3. Therefore, combination therapies using sdCAR-T cells and the switch molecule FHBM have significant potential to treat malignancies.
KeywordsCancer immunotherapy Switchable dual-receptor CAR K562 cell HM-3 Bifunctional molecule
Blue fluorescent protein
Chimeric antigen receptor
Cytokine release syndrome
Fetal bovine serum
FITC-HM-3 bifunctional molecule
Green fluorescent protein
Internal ribosome entry site
Peripheral blood mononuclear cells
Phosphate buffer saline
Red fluorescent protein
Single-chain variable fragment
Switchable dual-receptor CAR-T
T cell receptor
Tumor necrosis factor α
The adoptive transfer of genetically engineered T cells expressing a chimeric antigen receptor (CAR) specific for the tumor antigen CD19 has been highly successful in the treatment of some human malignancies, including leukemia, lymphoma, and other hematological cancers [1, 2, 3, 4, 5, 6]. CAR-engineered T cells, a novel form of cancer immunotherapy, marked the beginning of a new era in the war between the immune system and the tumor and have provided an effective platform to combat cancers [7, 8, 9, 10]. However, the application of current CAR-T cell therapy is associated with some serious side toxicities, such as cytokine release syndrome (CRS) and organ toxicities, resulting from excessive activity and poor control [11, 12, 13]. To address these safety concerns while retaining potent cytotoxicity against cognate tumor cells, several innovative strategies recently have been described that regulate the selectivity and activity of CAR-T cells, including the suicide gene [14, 15], inhibitory CAR , dual-antigen receptor , and an exogenous molecule used as a switch to control CAR-T cell activity [18, 19, 20, 21].
To improve the controllable activity of injected CAR-T cells, one approach is to generate a dual-receptor mode for engineered T cells that exerts cytotoxicity against tumor cells that simultaneously express two distinct antigens. Kloss et al. created dual-receptor-engineered T cells that have specific activity against the prostate tumors expressing both prostate stem cell antigen and prostate-specific membrane antigen . Another approach is to engineer a switch molecule to control the activity of CAR-T cells. For instance, Wu et al. recently proposed a novel design, termed an ON-switch CAR, that can eliminate cognate target cells in the presence of an exogenous molecule, AP21967 . Kim et al. provided another switch molecule consisting of folate and fluorescein isothiocyanate (folate-FITC) that can regulate the cytotoxicity of FITC-specific CAR-T cells toward tumor cells expressing folate receptors . Although the ability of CAR-T cells to recognize tumor cells and normal cells has improved based on dual-receptor CARs, their excessive activity is not effectively controlled. In contrast, switch molecules can effectively control the dose of activated CAR-T cells. To date, there is no treatment paradigm of dual-receptor-modified T cells in combination with switch molecules in the field of cancer immunotherapy. Therefore, we propose a new CAR method using a dual-receptor model to enhance the efficacy and safety of T cells by introducing a novel bifunctional molecule. Compared with using a single molecule as a switch, a bifunctional molecule significantly improves the therapeutic effects of CAR-T cells by constitutive antitumor activity.
To generate engineered T cells with specific cytotoxicity for tumor cells, a wide variety of potential tumor targets are under consideration, such as mesothelin (MSLN), carcinoembryonic antigen (CEA), epidermal growth factor receptor, human epidermal growth factor receptor 2, and so on . In particular, the tumor antigen MSLN is emerging as an attractive target for cancer immunotherapy, considering its high expression on various tumors, including mesothelioma, ovarian, lung, esophageal, pancreatic, gastric, and breast cancers, which facilitates MSLN-specific CAR-T cells to eliminate these cancers [23, 24]. In addition, our previous studies have shown that the HM-3 molecule is a novel antitumor peptide composed of 18 amino acids, including an Arg-Gly-Asp sequence, which specifically targets integrin αvβ3-expressing tumor cells . In vivo and in vitro studies have shown that HM-3 suppresses tumor growth by anti-angiogenesis . Therefore, a bifunctional molecule consisting of FITC coupled with HM-3 can serve as a novel switch to precisely regulate the specificity and controllable cytotoxicity of CAR-T cells.
Here, we designed a fusion molecule of HM-3 and FITC, termed FITC-HM-3 bifunctional molecule (FHBM), as a switch to accurately control timing and dose of injected CAR-T cells. Moreover, to improve the specificity of CAR-T cells, we also generated a switchable dual-receptor CAR-T (sdCAR-T) cell line that targets both the antigen MSLN and integrin αvβ3 via the switch molecule FHBM, which we described in our previously published review . Our results demonstrated that sdCAR-T cells exert significant antitumor activity while releasing lower levels of cytokines in the presence of both cognate tumor cells and FHBM that by itself has an inhibitory effect on tumor angiogenesis, thereby improving the application of CAR-T cell therapy. Therefore, the combination therapy using sdCAR-T cells and bifunctional molecules is becoming increasingly prospective in cell-based therapies for malignancies and other diseases.
Isolation, identification, and culturing conditions of human T cells
All samples were collected under a protocol approved by the Ethics Committee of China Pharmaceutical University, following written informed consent. Peripheral blood mononuclear cells (PBMCs) were isolated from an anonymous healthy donor’s blood by Lymphoprep™ reagent (Axis-Shield). Isolated CD4+ T or CD8+ T cells were immediately enriched by positive selection with magnetic microbeads (Miltenyi Biotec). The two isolated T cell subtypes were cultured in human T cell complete medium, consisting of X-VIVO15 (Lonza), 10% (v/v) fetal bovine serum (FBS, Biological Industries), and 10 mM N-acetyl L-Cysteine (Sigma-Aldrich), supplemented with 40 and 80 IU/mL of recombinant human IL-2 (PeproTech) for CD4+ T and CD8+ T cells, respectively. The sorted T cells were resuspended in phosphate buffer saline (PBS) and stained with an anti-CD4-PE (phycoerythrin) antibody (BD Pharmingen) or an anti-CD8-APC (allophycocyanin) antibody (BD Pharmingen). The control groups were designed and stained with an isotype antibody IgG1κ-PE (BD Pharmingen) or IgG1κ-APC (BD Pharmingen), respectively. All stained cells were washed three times in PBS and processed with a flow cytometer.
Engineering of T cells by electroporation and verification of sdCAR expression
The φC31 integrase, a member of the serine integrase system, is a sequence-specific recombinase that mediates recombination between an attB site containing a donor plasmid and a pseudo-attP site within the target genome. In this research, sdCAR gene with an attB site was unidirectionally integrated into a T cell genome by a φC31 integrase at sites with a pseudo-attP sequence. The isolated CD8+ T cells or CD4+ T cells were mixed with some plasmids including sdCAR vectors and φC31 integrase vectors at a 1:50 ratio (m/m). Finally, T cells were electroporated under the electroporation condition of F1-115 program according to the manufacturer’s instructions. Then, the engineered CAR-T cells had been tested by sequencing for correctness (GenScript (Nanjing) Co., Ltd.). Expression of sdCAR structure on the surface of effector cells was verified by detection of BFP expression with a flow cytometer. In addition, BFP expression was also detected by western blot with the use of an anti-BFP antibody (BioVision).
Lentiviral engineering of target cells and detection with flow cytometry
A gene sequence containing the human MSLN (accession number NM_006665) and GFP (accession number GU452685) was synthesized by GENEWIZ® company and cloned into the pLV-vector (Hanbio Biotechnology Co., Ltd.). At the same time, a non-cognate tumor antigen gene, containing the sequence for CEA (accession number M29540), and another fluorescent protein gene mCherry (accession number KT894026) was also constructed. The engineered K562 cells after lentiviral transduction were cultured in RPMI-1640 medium supplemented with 10% FBS, 100 U/mL penicillin, and 100 μg/mL streptomycin (Sangong Biotech). In order to maintain the expression of the tumor antigen, engineered-K562 cells were cultured in medium containing 0.25 μg/mL puromycin (Sangong Biotech) or 50 μg/mL hygromycin B (Sangong Biotech) for selection of MSLN- or CEA-expressing K562 cells, respectively. In addition, the engineered HT29 cells expressed the cognate tumor antigen (MSLN) by lentiviral transduction and then selectively cultured in complete medium supplemented with 0.5 μg/mL puromycin. AsPC-1 cells were genetically engineered to express the red fluorescent protein (RFP) by lentiviral transduction. Expression of tumor antigens was detected with Western blot in which target proteins were probed with an anti-MSLN antibody (R&D Systems) or an anti-CEA antibody (R&D Systems).
Generation of the novel switch molecule FHBM
The switch molecule FHBM was generated using FluoroTag™ FITC Conjugation Kit (Sigma, #FITC1). Briefly, solute FITC and HM-3 peptide were mixed at the molar ratio of 5:1 and incubated for 2 h at room temperature in a reaction vial with gentle stirring and covering with aluminum foil to protect from light. Then, the conjugated product was purified from the unconjugated FITC molecule by size filtration with a separation column prepacked with Sephadex G-25M (Sephadex G-25M column) in order to obtain a higher purity of FHBM. Finally, FHBM was analyzed by HPLC with an isocratic mobile phase consisting of 50% acetonitrile and 50% water containing 0.1% trifluoroacetic acid. The injection volume was 10 μL, the flow rate at the mobile phase was 1.0 mL/min, and chromatography was performed at 25 °C. The molecular weight of FHBM was confirmed by mass spectrometry. In addition, the FITC/HM-3 molar ratio and the concentration of the final conjugate were determined using a spectrophotometer, calculating with some formulas involved in the manufacturer’s instruction.
sdCAR-T cell activation assays in vitro
In a U-bottom 96-well plate, the CD4+ T cells expressing the sdCAR were incubated with cognate or non-cognate antigen-expressing target cells at an effector:target cell ratio of 1:2 in varying types of switch molecules including PBS, HM-3, and FHBM, respectively. Simultaneously, a positive control was designed, including a second generation of CAR specific for MSLN (MζBB CAR), to assess the sdCAR-T cell cytotoxicity. After incubation for 24 h, the supernatant was harvested, and the levels of interleukin-2 (IL-2) or interferon γ (IFNγ) were measured using the human IL-2 or IFNγ ELISA kit (MultiSciences), respectively. At the same time, the cells were resuspended in PBS and stained with an APC-conjugated anti-human CD69 antibody (BioLegend). Stained cells were washed three times with PBS and finally resuspended in 200 μL PBS. CD69 expression was detected with a flow cytometry.
sdCAR-T cell proliferation assay in vitro
Proliferation activity of sdCAR-engineered CD4+ T cells was assessed by counting of total number of cells and the percentage of sdCAR-engineered T cells using a cell counter and flow cytometry, respectively. K562 target cells expressing the cognate antigen (MSLN) did not proliferate under the treatment with 25 μg/mL mitomycin C (MedChem Express) for 30 min at 37 °C. In a U-bottom 96-well plate, sdCAR-T cells (or MζBB CAR-T cells) and target cells were mixed at 1:2 ratio in the presence of 100 pM exogenous molecules. At the same time, the cells in the vehicle group were incubated in PBS without exogenous molecules. For blue fluorescent protein (BFP) detection, the total cells were collected for flow cytometry and cell counter analysis after incubation for 3, 4, and 5 days.
sdCAR-T cell cytotoxicity assay in vitro
For the specific cytotoxicity in vitro, the cytolytic activity was measured by the amount of LDH (lactate dehydrogenase) released into cultured media using LDH Cytotoxicity Assay Kit (Cayman chemical). For other experiments, unless otherwise stated, the cytolytic activity of sdCAR-engineered CD8+ T cells was assessed using a flow cytometry-based cytotoxicity assay . Attributed to the differential expression of green fluorescent protein (GFP) and mCherry on cognate and non-cognate K562 cells, the two types of cells could be simultaneously detected by flow cytometry in samples of each treatment condition. In this experiment, the growth state of CEA+ K562 cells is similar to MSLN+ K562 cells without the sdCAR-T cell cytotoxicity. In the in vitro assays, a cell mixture containing two tumor cell lines at a 1:1 ratio were co-incubated with sdCAR-CD8+ T cells at a T cell:target cell ratio of 5:1 in a U-bottom 96-well plate. The exogenous molecules, HM-3 or FHBM, were added at a final concentration of 100 pM in each reaction well. After a 22-h incubation and centrifugation at 800×g for 5 min, the pelleted cells were washed three times with PBS and finally resuspended in 200 μL PBS for flow cytometry analysis. For each reaction sample, the survival rate of cognate target cell was represented as a ratio of the surviving MSLN+ K562 cells to CEA+ K562 cells. The cytotoxic activity of sdCAR-T cells was enumerated based on the cognate target cell survival.
In vivo cytotoxic effect of sdCAR-T cells
Female NOD.CB17-Prkdcscid/NcrCrl (NOD SCID) mice, 6–8 weeks of age, were purchased from Charles River Laboratories (Beijing Vital River Laboratory Animal Technology Co., Ltd.) and cared by the veterinary staff. All procedures were performed as approved by the Institutional Animal Care and Use Committee of China Pharmaceutical University. A target cell mixture of MSLN+ K562 cells and CEA+ K562 cells (1 × 107 cells per cell type) was resuspended in 2 mL PBS and then injected into the intraperitoneal (i.p.) space of each nude mouse. All mice were randomly divided into six groups (five mice per group): untransduced T cell (No CAR), MζBB CAR-T cell, and sdCAR-T cells with three kinds of molecule switches (vehicle/PBS, HM-3, or FHBM). Twelve hours later, the effector cells (~ 1 × 107 cells) including T cells, conventional CAR-T cells, and sdCAR-T cells were injected i.p., followed by injection of FHBM (at 0.5 mg/kg dosage), HM-3 (at 0.5 mg/kg dosage), or PBS (vehicle group, ~ 110 μL). Thirty-six hours after the exogenous molecule or PBS injection, the mice were euthanized using a two-step euthanasia method including carbon dioxide asphyxiation followed by cervical dislocation. The tumor cells were re-suspended in 5 mL cold PBS (with 3% FBS, v/v) in the peritoneal cavity of mice. The peritoneal lavage fluid was collected as much as possible and kept on ice. Briefly, the obtained peritoneal lavage was centrifuged at 800×g for 8 min, and the collected cells were re-suspended in 1 mL red blood cell lysis solution for 30 min at room temperature to avoid the blood pollution. The supernatant derived from the peritoneal fluid was analyzed for cytokine release, such as IL-2, IFNγ, interleukin-6 (IL-6), and tumor necrosis factor α (TNFα). After centrifugation again at 800×g for 8 min, the collected cells were resuspended in 200 μL PBS for flow cytometry analysis according to the methods described in cytotoxicity assays in vitro.
For the solid tumor models, the nude mice were injected with engineered AsPC-1 cells (5 × 106 cells) intravenously. On day 7, 1 × 107 sdCAR-T cells (or MζBB CAR-T cells) were infused and switches were dosed 6 h later intravenously. On day 10 and day 20 after engineered T cell injection, the tumor burden was measured by IVIS.
For single comparisons, a two-tailed Student’s t test was used. The n values used to calculate statistics are indicated in figure legends. All experiments were replicated at least three times. The symbol n.s. indicates not significant and the symbols *, **, and *** indicate P values less than 0.05, 0.01, and 0.001, respectively.
Design features of the sdCAR structure
sdCAR expression on primary human T cells
Design of target cells and the bifunctional molecule FHBM
To investigate the specificity and cytotoxicity of sdCAR-T cells, we subcloned the cognate target antigen (MSLN) gene into a lentiviral vector containing green fluorescent protein (GFP). First, we confirmed that there was no expression of MSLN or CEA antigen on wild-type K562 cells (Fig. 2c, Additional file 1: Figure S2a). We used lentiviral particles derived from HEK293T cells to infect K562 cells and eventually obtained cognate target cells (MSLN+ K562) by puromycin selection. In our experiments, we also generated non-cognate target cells, CEA-positive K562 cells, to assess cognate target cell killing in vitro and in vivo (Additional file 1: Figure S2b). Additionally, K562 cells highly express integrin αvβ3, which can be targeted specifically by the antitumor peptide HM-3 part of FHBM (Fig. 2d). In our study, we also selected another tumor cell line, HT29, which lacks integrin αvβ3 expression, as a negative control to verify the specificity of the novel switch molecule. After lentivirus transfection, HT29 cells overexpressed the cognate tumor antigen MSLN (Fig. 2c, Additional file 1: Figure S2c).
Following the manufacturer’s instructions, we used FITC coupled with HM-3 peptide (FHBM) as a safe switch to control the activity of FITC-specific CAR-T cells. The FITC/HM-3 molar ratio was defined as the ratio of FITC to HM-3 peptide in the conjugate. We performed purity and structure analyses of isolated FHBM with chromatography and mass spectrometry, respectively (Fig. 2e). After purification, the obtained product was more than 98.83% pure (Rt = 12.08 min), which can be used as an efficacious switch to regulate sdCAR-T cell activity in the follow-up experiment. From the mass spectrometry data, the molecular weight of FHBM was 2565. Based on the molecular weights of FITC (389) and HM-3 (1797), we can infer that the ratio of FITC to HM-3 in the final conjugate was 1.97. Finally, the obtained compound had a concentration of 5.42 μM and an FITC/HM-3 molar ratio of 1.98 by spectrophotometry, which are in line with the mass spectrometry data.
Activation of human CD4+ T cells engineered with sdCAR requires the switch molecule and the cognate tumor cells
As shown in Fig. 3b, c, when co-cultured with K562 cells or CEA+ K562 cells, sdCAR-T cells secreted base levels of IL-2 or IFNγ whether treated with PBS, HM-3, or FHBM, which was similar to MζBB CAR-T cells. sdCAR-T cells co-cultured with MSLN+ K562 cells also secreted base levels of IL-2 or IFNγ in the presence of PBS or HM-3. The levels of these cytokines released from sdCAR-T cells substantially increased, however, when co-cultured with MSLN+ K562 cells in the presence of FHBM at a final concentration of 100 pM, which was significantly higher than MζBB CAR-T cell activity. For MSLN+ HT29 cells without integrin αvβ3 expression, only MζBB CAR-T cells secreted significant levels of cytokines. These results demonstrated that FHBM specifically targeted the FITC receptor expressed on sdCAR-T cells and effectively activated them in the presence of MSLN+ K562 cells. Therefore, FHBM can be developed as an efficacious switch to control the activity of sdCAR-T cells, resulting in the controllable activation of T cells and then the destruction of target cells. In addition, there was no T cell activation for the non-cognate tumor cell line (K562 cell or CEA+ K562 cell) in contrast to the significant activation for cognate tumor cells (MSLN+ K562), thereby showing specific targeting activity of sdCAR-T cells.
Similarly, for sdCAR-T cells, a remarkable upregulation of CD69, an activation marker presented on T cell surfaces, was observed only in the presence of cognate tumor cells (MSLN+ K562) and the switch molecule FHBM. T lymphocytes expressing MζBB CARs displayed a high level of CD69 expression while in contact with cognate tumor cells, whereas sdCAR described here required an additional switch molecule for high expression of CD69, allowing for control of T cell activity (Fig. 3d, Additional file 1: Figure S3).
Proliferation of sdCAR-engineered human CD4+ T cells requires the switch molecule and cognate tumor cells
We next evaluated whether the proliferation of CD4+ T cells engineered with sdCAR could be controlled by the switch molecule and MSLN+ K562 cells. Using flow cytometry assays, the percentage of sdCAR-modified CD4+ T cells can be determined by measuring the constitutive expression of BFP inserted downstream of sdCAR. For the non-cognate target cells (K562 cells or CEA+ K562 cells), sdCAR-T cell had no significant proliferation (Fig. 3e, f). In the presence of MSLN+ K562 cells, sdCAR-T cell proliferation was regulated by the switch molecule FHBM. A similar degree of T cell proliferation was characterized in MζBB CAR-T cells only in the presence of MSLN+ K562 cells (Fig. 3g). For HT29 cells expressing MSLNs, no sdCAR-T cells showed proliferation whether treated with PBS, HM-3, or FHBM; however, MSLN-specific CAR-T cells had strong proliferation (Fig. 3h). Proliferation allowed for amplification of T cell function, but excessive proliferation can initiate some systemic and severe toxicities, such as CRS and “on-target, off-tumor” toxicity. Therefore, the new molecule FHBM acts as a switch to effectively regulate sdCAR-T cell proliferation, avoiding some of the side effects derived from the overactivation of sdCAR-T cells.
Dual-gated antitumor cytotoxicity of sdCAR-engineered CD8+ T cells
We next investigated whether the sdCAR framework provided temporal control of T cell cytotoxicity. During a 14-h experiment, CD8+ T cells expressing the sdCAR structure did not have specific cytotoxicity for cognate target cells until the exogenous addition of FHBM (Fig. 4f). In vitro cytotoxicity experiments showed that MSLN+ K562 cells were killed by sdCAR-expressing CD8+ T cells in an FHBM-dependent manner. We next determined whether the sdCAR-T cell cytotoxicity could be immediately terminated by FHBM removal and then resumed after the re-addition of FHBM. Our proof-of-principle experiment consisted of three stages to implement the presence-absence-presence of FHBM in co-cultures of sdCAR-T and MSLN+ K562 cells (Additional file 1: Figure S5a). The data showed that sdCAR-T cell cytotoxicity was detected only in the first and third stages of the experiment; therefore, FHBM provided a flexible platform for temporal control over CAR-T cell action (Additional file 1: Figure S5b). The cytotoxicity of T cells expressing this dual-receptor CAR was strictly dependent on the exogenous molecule FHBM in addition to cognate tumor cells expressing MSLN and integrin αvβ3.
Next, we measured whether the cytolytic capacities of the engineered CD8+ T cells depended on the dose of FHBM. The results revealed that the percentage of surviving cognate target cells decreased with an increase of FHBM concentration (Fig. 4g). The killing of cognate target cells with lower concentrations of FHBM (≤ 0.5 pM) was similar to the killing levels of wild-type T cells without CAR engineering. In contrast, at higher concentrations (≥ 100 pM), sdCAR-modified CD8+ T cells yielded a similar antitumor response with a less than 20% survival rate of target cells because the FITC receptor of sdCAR has been saturated. In addition, sdCAR-T cells in the presence of 100 pM FHBM had a similar cytotoxicity compared with that of conventional CAR-T cells (MζBB CAR-T cells). Therefore, the new CAR structure with a switchable receptor functions as a dial for titratable control over the magnitude of apoptosis in the target cell population.
In vivo cognate tumor cell killing in the presence of a switch molecule
Next, we verified whether sdCAR-engineered T cells combined with a bifunctional molecule can achieve positive responses against solid tumor expressing integrin αvβ3 and MSLN in xenograft. First, we demonstrated that the pancreatic cancer cell line AsPC-1 highly expressed the integrin αvβ3 and MSLN, and the target cells were genetically engineered to express the red fluorescent protein (RFP) (Additional file 1: Figure S9a-S9c). Consistent with the previous study, mice treated with sdCAR-T cells and FHBM (0.5 mg/kg) achieved rapid tumor clearance at day 20 (after sdCAR-T cell infusion), which was similar to that of mice treated with MζBB CAR-T cells (Additional file 1: Figure S9d).
In agreement with our in vitro results, the combination of FHBM and sdCAR-T cells resulted in high killing efficiency of cognate target cells expressing integrin αvβ3 and MSLN in vivo. These results demonstrated that the activity of CAR-T cells was significantly enhanced through both the dual-receptor CAR and a bifunctional molecule. Finally, we confirmed that the sdCAR-T cell cytotoxicity was effectively controlled with two combined inputs in vivo, a cognate tumor cell and a switch molecule, thereby mitigating CRS and “on-target, off-tumor” toxicity.
With advances in tumor biology and immunology, the adoptive transfer of T cells expressing CARs has become a new approach for cancer treatment in recent years . To achieve specificity and controllable cytotoxicity of CAR-T cells, several strategies have been described that use either negative regulation or positive regulation of the T cell signaling pathway. In the present study, the activity of engineered T cells endowed with CARs was significantly improved through the simultaneous actions of a dual-receptor CAR and a bifunctional molecule. For the first time, we proposed a dual-receptor CAR specific for FITC and MSLN, and its cytotoxicity was effectively controlled with the use of two combined inputs, a switch molecule and cognate tumor cells expressing integrin αvβ3 and MSLN, thereby enhancing the safety of CAR-T cell therapy. In addition, sdCAR-T cells with FHBM cleared MSLN+ K562 cells with lower levels of cytokine release relative to MζBB CAR-T cells in an in vivo experiment, thereby mitigating CRS toxicity.
In our results, FHBM as a switch molecule is required for sdCAR-T cell activity including activation, proliferation, and cytotoxicity. In addition, cognate tumor cells expressing MSLN and integrin αvβ3 are required for sdCAR-T cell function. Compared with the first generation of CAR-T cells, sdCAR-T cells designed here are not activated in the presence of FHBM and tumor cells that express integrin αvβ3 and do not express MSLN (such as CEA+ K562 cells). Theoretically, the FITC receptor expressed on T cell surfaces has a weak affinity for FHBM, which triggers the phosphorylation of the intracellular CD3ζ signal domain yet is not sufficient to initiate T cell activation [17, 28, 29, 30]. Therefore, sdCAR-T cells were inactivated with only the use of FHBM, potentially avoiding the anaphylaxis observed in the FITC-folate clinical trial described previously . Interestingly, in the presence of cognate tumor cells and FHBM, sdCAR-T cells were synergistically activated because of the phosphorylation of both the CD3ζ and 4-1BB signal domains. Thus, the sdCAR-T cell activity was strictly dependent on the switch molecule and cognate tumor cells.
We envision that our sdCAR structure combined with a bifunctional molecule can achieve positive responses against solid tumors in spite of the blunt immune-surveillance, including some immune suppressor cells, cytokines, and physical barriers around tumor tissues [32, 33, 34]. In our opinion, the bifunctional molecule containing both a targeted part specific for sdCAR-T cells and an active part with the ability to improve the tumor microenvironment serves as a “switch” to control the state of sdCAR-T cells and a “scavenger” that clears immunosuppressive factors or physical barriers around tumor tissues (Fig. 6b). Adoptive cell therapies involving sdCAR-T cells and a bifunctional molecule are thought to have a major effect upon at least one of these factors described above, thereby producing potential benefits in patients with refractory and relapsed malignancies. In conclusion, our sdCAR-T cell strategy making use of a bifunctional switch-molecule program T cells with a significant specificity and controllable cytotoxicity. The time- and dose-dependent regulation of sdCAR-T cell activity advances adoptive cell therapy using genetically modified T cells one step further toward precision medicine.
Results from this observational study indicate that a new switch molecule FHBM can accurately regulate the switchable dual-receptor CAR-T (sdCAR-T) cell activity in a time- and dose-dependent manner and sdCAR-T cells exert significant antitumor activity while releasing lower levels of cytokines for the cognate tumor cells expressing both MSLN and integrin αvβ3. Therefore, the combination therapy using sdCAR-T cells and FHBM is becoming increasingly prospective in cancer immunotherapy.
This work was supported by the Project Program of State Key Laboratory of Natural Medicines (No. SKLNMBZ201403) and the National Science and Technology Major Projects of New Drugs (No. 2014ZX09508007) in China. This project was also funded by the Priority Academic Program Development of Jiangsu Higher Education Institutions (PAPD).
Availability of data and materials
All data generated or analyzed during this study are included in this published article (and its supplementary information files).
EH designed the experiment and contributed to the writing of the manuscript. JG, JX, CLin, CLiu, ML, JHao, and SS performed the experiments. XC, WQ, and JHu analyzed data. HX contributed to the writing of the manuscript and revised the manuscript. All authors read and approved the final manuscript.
Ethics approval and consent to participate
All healthy peripheral blood was collected under a protocol approved by the Ethics Committee of China Pharmaceutical University, following written informed consent. All animal studies were approved by the Institutional Animal Care and Use Committee of China Pharmaceutical University (approval no. SYXK2012-0035).
Consent for publication
The authors declare that they have no competing interests.
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