Wijewarnasuriya et al. show that excessive costimulation of CAR T cells through endogenous and ectopic CD28 (or 4-1BB) leads to T cell dysfunction. A first-generation CAR construct targeting CD19 and secreting IL-12 (m19ζIL12) showed increased cytotoxicity and prolonged mouse survival compared to CAR construct with additional CD28 costimulation (m1928ζIL12) in mice bearing syngeneic EL4 tumors expressing truncated mouse CD19. Endogenous B cells upregulated CD80 – the endogenous T cell CD28-stimulating ligand – which, along with ectopic CD28, led to excessive CAR T cell costimulation and upregulation of PD-1, LAG3, and TIM3.

Contributed by Shishir Pant

ABSTRACT: Although clinical responses with CD19 targeting CAR T-cell treatment have been observed in patients with certain hematological malignancies, high rates of disease relapse highlight the necessity to understand and improve mechanisms of CAR T-cell failure. Since T-cell dysfunction is thought to contribute to CAR T-cell treatment failure, understanding what mechanisms drive T cells into this dysfunctional state may aid optimal design of efficacious CAR T cells. Dysfunctional CAR T cells have been characterized as having upregulated inhibitory receptors and decreased cytolytic capabilities. Previous studies have identified a role for sustained CAR CD3zeta signaling in CAR T-cell dysfunction. Here, we demonstrate a mechanism that drives dysfunction in CAR T cells through excessive costimulation. Fully activated CD19 targeted CAR T cells were rendered dysfunctional upon stimulation with both endogenous CD28 stimulation and CAR mediated CD28 costimulation. Costimulation driven dysfunction of CAR T cells was demonstrated in a syngeneic immunocompetent mouse model, in which CAR T cells were activated with signals 1 (CD3zeta), 2 (CD28), and 3 (IL12). Thus, we show that CAR T-cell dysfunction can be driven through excessive CD28 and 4-1BB costimulation.

Author Info: (1) Medicine, Memorial Sloan Kettering Cancer Center. (2) Medicine, Memorial Sloan Kettering Cancer Center. (3) Medicine, Memorial Sloan Kettering Cancer Center. (4) Hematology and

Author Info: (1) Medicine, Memorial Sloan Kettering Cancer Center. (2) Medicine, Memorial Sloan Kettering Cancer Center. (3) Medicine, Memorial Sloan Kettering Cancer Center. (4) Hematology and Medical Oncology, Emory University School of Medicine. (5) Medicine, Memorial Sloan Kettering Cancer Center brentjer@mskcc.org.