Okada et al. engineered and evaluated the efficacy of GPC2-CAR T cells with constitutive production of soluble IL-15/IL-21, membrane-tethered IL-15 and IL-21, or NFAT-inducible expression of membrane-tethered IL-15 and IL-21 in a high-tumor-burden neuroblastoma (NB) murine model. All engineered GPC2-CAR T cells showed enhanced cytotoxicity relative to control GPC2-CAR T cells. Compared to CAR T cells with constitutive cytokine expression, which maintained a pro-inflammatory signature after tumor elimination, leading to hypercytokinemia and death, NFAT-inducible tethered IL-15/IL-21 showed an immunosuppressive transcriptional profile with acceptable tolerability.

Contributed by Shishir Pant

ABSTRACT: Neuroblastoma (NB) is a highly aggressive childhood solid tumor with poor outcomes. Chimeric antigen receptor (CAR) T cells have shown limited efficacy in NB, with the best outcomes reported in patients with a low tumor burden, highlighting the need for further CAR optimization. One approach to addressing the high tumor burden involves engineering CAR T cells to release or express transgenic cytokines. However, its systemic toxicity remains an important therapeutic challenge. Here, we evaluated the efficacy of interleukin (IL)-15- and IL-21-enhanced glypican-2 (GPC2)-targeted CAR T cells (GPC2-CAR T cells) in targeting high-burden NB. Three strategies for expressing the cytokines were evaluated: constitutive secretion (GPC2-CAR+sol.IL15.IL21), constitutive membrane-tethered expression (GPC2-CAR+teth.IL15.IL21), and NFAT-inducible membrane-tethered expression (GPC2-CAR+NFAT.IL15.IL21). Engineered GPC2-CAR T cells were tested in vitro and in vivo using high NB-burden xenograft models. Additionally, single-cell RNA sequencing was used to profile the effector cells in the tumor microenvironment. All three versions of GPC2-CAR T cells significantly enhanced killing against a high NB burden, both in vitro and in vivo, relative to control GPC2-CAR T cells. Mice treated with GPC2-CAR+NFAT.IL15.IL21 exhibited significantly lower anorexia-associated morbidity/mortality. Supporting these data, tumor-infiltrating GPC2-CAR+NFAT.IL15.IL21 developed an immunosuppressive transcriptional profile upon tumor regression, leading to prolonged survival in treated mice. In contrast, GPC2-CAR+teth.IL15.IL21 maintained a pro-inflammatory transcriptional signature despite near tumor clearance, resulting in hypercytokinemia and death. NFAT-inducible co-expression of tethered IL-15/IL-21 enhanced GPC2-CAR T-cell function against a high NB burden with acceptable tolerability in mice. Further studies are required to validate these findings.

Author Info: (1) National Cancer Institute, Bethesda, United States. (2) National Cancer Institute, Bethesda, United States. (3) National Cancer Institute, Bethesda, Maryland, United States. (4

Author Info: (1) National Cancer Institute, Bethesda, United States. (2) National Cancer Institute, Bethesda, United States. (3) National Cancer Institute, Bethesda, Maryland, United States. (4) Keio University School of Medicine, Shinjuku, Tokyo, Japan. (5) National Cancer Institute, Bethesda, United States. (6) National Cancer Institute, Bethesda, MD, United States. (7) NCI-Frederick, Bethesda, MD, United States. (8) National Institutes of Health, United States. (9) National Cancer Institute, Bethesda, MD, United States. (10) National Cancer Institute, Bethesda, MD, United States. (11) National Cancer Institute, Bethesda, Maryland, United States. (12) Rutgers, The State University of New Jersey, New Brunswick, New Jersey, United States. (13) National Cancer Institute, Bethesda, MD, United States. (14) National Cancer Institute, Bethesda, MD, United States. (15) National Cancer Institute, Bethesda, United States.