Type: Oral
Session: 703. Cellular Immunotherapies: Basic and Translational: Overcoming Challenges in CAR-T Therapies Through Biological Insights
Hematology Disease Topics & Pathways:
Research, Fundamental Science, Biological therapies, Plasma Cell Disorders, Chimeric Antigen Receptor (CAR)-T Cell Therapies, Diseases, Therapies, Lymphoid Malignancies, Adverse Events, Technology and Procedures, omics technologies
Methods and Results: We analyzed clinical samples from patients with multiple myeloma receiving BCMA-CAR-T cell therapy, and obtained a multimodal dataset pertaining to CRS severity by multiplexed cytokine and multi-omic single-cell analyses. First, we generated a multi-plex profile to comprehensively reveal the kinetics of CRS-related cytokines. Plasma samples were collected from 6 patients with severe CRS, at serial time points: before lymphodepletion, after CAR-T infusion before CRS initiation, at CRS initiation, CRS peak and CRS recovery stage. These samples were analyzed for a 45-plex cytokine profile, and we identified 3 main cytokines (IL-2, IL-4 and IL-17A) as signatures of CRS initiation and 24 cytokines at the CRS peak stage, with the latter consisting of known CRS biomarkers (IL-1, IL-6 and CRP) and new CRS-related cytokines (IL-3, CCL20 and CXCL1). Next, we conducted single-cell multi-omic analyses on the transcriptome, immunome and epigenome of CAR-T and bystander immune cells. We collected 111 samples from 16 patients (5 with severe CRS, 6 with mild CRS and 5 non-CRS) for scRNA-seq and scTCR-seq, and 28 samples from 10 patients (3 with severe CRS, 4 with mild CRS and 3 non-CRS patients) for scATAC-seq. scRNA-seq analysis demonstrated systematic and diverse changes across cellular subpopulation and their dynamic cytokine expression across the course of CRS. Moreover, integrated scRNA-seq and scTCR-seq analyses illustrated the developmental trajectory and clonal diversity of CAR-T and endogenous T cells. Specifically, we detected clonal expansion of a CD8+ effector memory T cell subsets upon CRS recovery, which was positively correlated with the persistence of CAR T cells in vivo. Meanwhile, combined analyses of scATAC-seq and scRNA-seq deciphered the chromatin accessibility and cis-regulatory network in CAR-T cells at different CRS stages. Finally, we identified a CD40LG+ CD4+ subpopulation in pre-infusion CAR-T products which was associated with CRS severity and could be used as a predictive biomarker of severe CRS. These results were further validated by sorting CD40LG+ CD4+ CAR-T cell subset from the product, and co-culture with monocytes and tumor cells. This subpopulation of CAR-T cells was shown to upregulate IL-13 production and activate monocytes, resulting in the elevation of multiple cytokines associated with CRS.
Significance: Our comprehensive multi-omics analyses provide a temporal atlas of CRS at the single-cell level, delineating the critical roles of CAR-T cells, monocytes, endogenous T cells and NKT cells across the course of CRS. Further, we identified a key subpopulation in pre-infusion CAR-T products as a biomarker of CRS severity, providing clinically-relevant insights about both prediction and intervention of CRS.
Disclosures: No relevant conflicts of interest to declare.