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501 Dual-Vector-Transduction with Single-Step Magnetic Selection (Zip-sort) Increases Transgenic Payloads to Enhance CAR T Cell Activity

Program: Oral and Poster Abstracts
Type: Oral
Session: 702. CAR-T Cell Therapies: Basic and Translational: Enhancements in CAR-T Cell Signaling, Delivery & Manufacturing
Hematology Disease Topics & Pathways:
Research, Translational Research, Chimeric Antigen Receptor (CAR)-T Cell Therapies, Diseases, Treatment Considerations, Biological therapies, Lymphoid Malignancies, Myeloid Malignancies, Technology and Procedures
Sunday, December 8, 2024: 10:00 AM

Scott E. James, MD, PhD1, Sophia Chen, MD1*, Brandon Ng, PhD2*, Jacob Fischman2*, Lorenz Jahn, PhD2*, Alexander P. Boardman, MD3*, Adhithi Rajagopalan, PhD1*, Harold K Elias, MD2, Alyssa R Massa1*, Dylan Manuele2*, Katherine Nichols2*, Amina Lazrak2*, Nicole Lee2*, Aoife Doto, PhD4*, Alexander McMarland, PhD4*, Angelina Petrichenko4*, John Everett, PhD4*, Frederic Bushman, PhD4*, Teng Fei, PhD5*, Anastasia Kousa, PhD1*, Andri Leo L Lemarquis, MD, PhD1*, Susan DeWolf, MD6*, Jonathan U. Peled, MD, PhD7, Santosha A. Vardhana, MD, PhD3, Christopher A. Klebanoff, MD8* and Marcel R.M. van den Brink, MD, PhD9

1City of Hope National Medical Center, Duarte, CA
2Memorial Sloan Kettering Cancer Center, New York, NY
3Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
4Department of Microbiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
5Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
6Department of Medicine, Leukemia Service, Memorial Sloan Kettering Cancer Center, New York, NY
7Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY
8Memorial Sloan Kettering Cancer Center, New York
9Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA

Introduction: Chimeric antigen receptor (CAR) T cells have demonstrated potent activity in hematologic malignancies and are showing promise in treating solid tumors. However, tumor cells can escape from CAR T cells through multiple mechanisms including (1) insufficient or heterogeneous target antigen expression which promotes antigen low or antigen-negative escape, and (2) upregulation of inhibitory ligands or receptors on tumor cells and T cells, which impairs T cell persistence and function. CAR T cells can also (3) become exhausted in response to repetitive antigen challenges in the tumor microenvironment. While many innovations in CAR design and manufacturing have been developed to overcome individual tumor escape mechanisms, addressing multiple immune evasion strategies simultaneously will likely require engineering T cells with multiple countermeasures. However, engineering T cells with multiple transgenes is limited by packaging constraints and efficiencies of current vector systems. To overcome these challenges, we engineered a leucine zipper-based cell purification method, called Zip-sort, that enables selective single-step magnetic purification of T cells transduced with two vectors to increase transgene payload.

Methods: We constructed a system whereby each of two vectors co-expresses a heterodimerizing leucine zipper pair, resulting in affinity-tag expression only on the surface of dual-transduced cells, and enabling selective immunomagnetic purification. Leveraging the increased packaging capacity afforded by the Zip-sort methodology, we co-expressed multiple CARs and switch receptors to enable T cells to overcome antigenic heterogeneity, resist exhaustion, and persist and proliferate in response to inhibitory ligand expression. We also included dual safety switches to enable CAR T cell elimination in case of toxicity. We dual-transduced T cells to express up to four CARs targeting CD19, CD20, CD79b, and BAFF-R and up to three switch receptors including Fas-4-1BB, CD200R-CD27, and PD-1-OX40. We characterized these multi-CAR multi-Switch receptor T cells in vitro with live cell imaging evaluating NFkB signaling, T cell proliferation, and target cell elimination, with single-cell RNA sequencing, and with multiparameter flow cytometry. We also established and tested syngeneic mouse models of pre-B-cell and acute myeloid leukemia with antigen heterogeneity and inhibitory ligand overexpression.

Results: Zip-sort methodology enabled production of highly purified dual-transduced T cells over a range of initial transduction efficiencies without significantly affecting patterns of genomic vector integration compared with single-transduced T cells. Integrated vector copy number was on average two-fold higher in dual-transduced vs. single-transduced T cells. By engineering Zip-sorting technology into safety switches and switch receptors, we further extended the functions of this system while limiting vector insert size. Following single-step Zip-sort purification, dual-transduced T cells expressed multiple CARs and switch receptors with uniformly high purity and receptor expression. These modifications enabled T cells to eliminate heterogeneous leukemia populations expressing up to four target antigens and up to three inhibitory ligands. Dual-CAR T cells targeting CD19 and CD20 and co-expressing Fas-4-1BB, CD200R-CD27, and PD-1-OX40 switch receptors survived and eliminated targets with high FasL expression and proliferated in response to CD200 and PD-L1 expression on leukemia cells. Co-expression of multiple switch receptors reduced transcriptomic signatures of exhaustion in dual-CAR T cells, upregulated gene pathways related to proliferation and metabolic activity, enhanced the capacity of T cells to lyse target cells and release cytokines following repeated antigen challenges, and promoted leukemia clearance in vivo.

Conclusion: Zip-sort purification of dual-transduced T cells facilitates production of complex cell products incorporating multiple transgenic payloads. Our proof of principle experiments demonstrate that T cells can be engineered to overcome multiple tumor resistance mechanisms simultaneously. The Zip-sort system provides a powerful methodology to construct and compare novel cellular therapies and is compatible with clinical translation based on immunomagnetic selection principles.

Disclosures: Boardman: Bristol Myers Squibb: Consultancy; OncLive: Honoraria; Cancer Study Group, LLC: Consultancy. Peled: Crestone Inc: Consultancy; Seres Therapeutics: Patents & Royalties, Research Funding; Prodigy Biosciences: Current equity holder in publicly-traded company, Membership on an entity's Board of Directors or advisory committees; DaVolterra: Consultancy; Canaccord Genuity, Inc: Consultancy; CSL Behring: Consultancy; MaaT Pharma: Consultancy; Postbiotics Plus Research: Current equity holder in publicly-traded company, Membership on an entity's Board of Directors or advisory committees. Klebanoff: Achilles Therapeutics: Consultancy; Affini-T: Consultancy; Aleta BioTherapeutics: Consultancy; Bellicum Pharmaceuticals: Consultancy; Bristol Myers Squibb: Consultancy; Catamaran Bio: Consultancy; Cell Design Labs: Consultancy; Decheng Capital: Consultancy; G1 Therapeutics: Consultancy; Klus Pharma: Consultancy; Obsidian Therapeutics: Consultancy; PACT Pharma: Consultancy; Roche/Genentech: Consultancy; Royalty Pharma: Consultancy; Affini-T Therapeutics: Current equity holder in private company.

*signifies non-member of ASH