-Author name in bold denotes the presenting author
-Asterisk * with author name denotes a Non-ASH member
Clinically Relevant Abstract denotes an abstract that is clinically relevant.

PhD Trainee denotes that this is a recommended PHD Trainee Session.

Ticketed Session denotes that this is a ticketed session.

2039 Reprogramming T Cell EZH2 to Counteract CAR T Cell Dysfunction during Tumor Control

Program: Oral and Poster Abstracts
Session: 702. CAR-T Cell Therapies: Basic and Translational: Poster I
Hematology Disease Topics & Pathways:
Research, Fundamental Science
Saturday, December 7, 2024, 5:30 PM-7:30 PM

Mimi Chen, PhD1*, Wenbin Mo, MMSc1*, Gennaro Clando2*, Yuanyuan Tian, PhD1*, Ciril Abraham, BS1,3*, Qingrong Huang1,4*, Ying WANG1*, Morgan Chaunzwa1*, Yan Zhou, MS5*, Andrew Ip, MD, MSc6, Andre Goy, MD, MS6, Jaroslav Jelinek2*, Jozef Madzo2*, Jean-Pierre Issa2* and Yi Zhang, MD, PhD1

1Center for Discovery and Innovation, Hackensack University Medical Center, Nutley, NJ
2Coriell Institute for Medical Research, Camden, NJ
3Fels Institute and Department of Cancer Cellular Biology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA
4Clinical Immunology Core, Center for Discovery and Innovation, Hackensack University Medical Center, Nutley, NJ
5Fox Chase Cancer Center, Temple University, Philadelphia
6Lymphoma Division, John Theurer Cancer Center, Hackensack Meridian Health, Hackensack, NJ

T cell dysfunction, including memory loss and exhaustion, is a major limitation of CAR T cell therapy efficacy. Manipulating transcription factor (TF) activity ameliorates their exhaustion and memory loss during tumor control suggests tumor exposure may cause dysregulation of transcriptional programs in CAR T cells. EZH2, which catalyzes trimethylation of H3 at lysine 27 (H3K27me3) to orchestrate expression of multiple gene programs, plays a central role in the regulation of T cell immune response in mice, such as the reaction to tumor, infection and alloantigens. However, whether EZH2 is required for human CAR T cells to destroy tumor and whether tumor targets T cell EZH2 to induce CAR T cell dysfunction have never been previously defined. Here we demonstrate that EZH2 is a master regulator of CAR T cell responses critical for tumor control. Prolonged tumor exposure disrupts EZH2 function and reprogramming EZH2 in CAR T cells renders them enhanced capacity to resist tumor-induced dysfunction and memory loss. We observed that CRIPSR-Cas9 mediated EZH2 ablation in CD19-directed human CAR T cells resulted in significantly impaired expansion of CAR T cells in human xenograft Raji leukemia-bearing NSG mice, decreased CD45RA-CD62L+ central memory (TCM) phenotype cells, and increased short-lived CD45RA+CD62L- TEMRA cells and PD-1+TIM3+ terminal exhausted (TEX) cells, and ultimately the failure to eliminate leukemia. EZH2 regulated genes that are critical for sustaining cell proliferation (CDK1, CCNB1, CCNB2, TOP2A) but limiting effector T cell differentiation (PRDM1, T-BET), T cell interactions with extracellular matrix (ITGA3, ITGB3, ITGA5) and T cell expression of genes encoding protein kinases (SRC and FAK). Furthermore, EZH2 inhibited constitutive activation of AKT in CAR T cells under either homeostatic or antigen-activation conditions, which drives T cell exhaustion and memory loss. Pharmacological inhibition of PI3K, SRC and FAK resulted in significant reduction of AKT activity in EZH2-sufficient CAR T cells, but to a much less extent in EZH2-ablated CAR T cells. Thus, EZH2 is important for repressing activation of gene programs that drive effector differentiation, exhaustion and memory loss, acting as a master regulator for CAR T cells to eliminate tumor. To further address whether T cell EZH2 is a central target for tumor to induce CAR T cell dysfunction, we used a ‘stress test’ model in which infusion of low doses of CAR T cells was insufficient to eliminate leukemia, thereby creating leukemia persistence in NSG mice. We found that persistent leukemia caused significantly decreased cellular levels of EZH2 protein and H3K27me3 in CAR T cells, which was associated with reduction of TCM phenotype cells and increases of PD-1+TIM3+ TEX-like T cells. Leukemia persistence triggered EZH2 protein degradation in CAR T cells via an antigen activation-dependent mechanism. We finally examined whether ectopic expression of which form of EZH2 in CAR T cells may enable them resistance to leukemia-induced exhaustion and memory loss. Adoptive transfer experiments showed that all NSG mice receiving CAR T cells with enforced expression of wild-type EZH2 (EZH2WT), AKT phosphorylation-resistant EZH2 (EZH2S21A) or naturally occurring gain-of-function EZH2 mutant (EZH2Y646N) died from leukemia. In contrast, CD19-CAR T cells transduced with EZH2S21A/Y646N dual mutant acquired greater capacity than vector control, EZH2WT, EZH2S21A or EZH2Y646N to eliminate leukemia in NSG mice, with 42.9% (6/14) of them surviving over 70 days after transfer. Reprogramming CD19-CAR T cells with EZH2S21A/Y646N skewed them differentiation away from terminal TEX cells towards TCM-phenotype cells, inhibited expression of gene programs that regulate cytokine production, cytokine receptor signaling and cell-cell adhesion, and decreased AKT activity. Collectively, our findings provide novel epigenetic insights into the pathophysiology of T cell tumor immunity and form the conceptual basis to enhance CAR T cell therapy efficacy, thereby addressing a major barrier to the progression of CAR T cell therapy.

Disclosures: No relevant conflicts of interest to declare.

*signifies non-member of ASH