Xiao and Zhu et al. engineered an inhalable small extracellular vesicle (sEV) loaded with mesothelin-specific CAR mRNA (CARmRNA@aCD206 sEVs) to generate CAR-Ms in situ. in a lung metastasis mouse model, inhaled CARmRNA@aCD206 sEVs accumulated in the lungs, selectively delivered CAR mRNA into macrophages via CD206 recognition, and polarized macrophages to an immunostimulatory phenotype with enhanced phagocytosis. The in situ-generated CAR-Ms showed enhanced pro-inflammatory cytokine secretion and antitumor cytotoxicity, reduced tumor burden, induced long-term immune memory, prevented recurrence, and prolonged overall survival.
Contributed by Shishir Pant
ABSTRACT: Cancer metastasis and recurrence remain the leading causes of cancer-related mortality, and lung is a major metastatic anatomical location. Chimeric antigen receptor macrophages (CAR-M) represent promising candidates for cancer therapy owing to their superior tumour-infiltrating and antigen-specific phagocytotic abilities, and to being professional antigen presenting cells. However, broader applications of CAR-Ms face challenges such as complex manufacturing processes and predominant accumulation in the liver following intravenous administration. Here we present an inhalable engineered small extracellular vesicle (sEV), which contains mesothelin-specific CAR messenger RNA (CAR(mRNA)@aCD206 sEVs) for in situ generation of CAR-Ms. The sEVs are surface-integrated with anti-CD206 single-chain variable fragments (scFv) to target CD206-expressing, immunosuppressive (M2 phenotype) macrophages. The results in mouse models suggest that inhaled CAR(mRNA)@aCD206 sEVs could accumulate in lung tissue and deliver CAR mRNA specifically to macrophages, facilitating in situ CAR-M production. In a lung metastasis model, inhaled CAR(mRNA)@aCD206 sEVs effectively inhibit tumor growth and prime long-term memory immunity to prevent tumour recurrence. Collectively, our engineered sEV delivery platform demonstrates capability to selectively deliver CAR mRNA to macrophages in lung tissue, providing a promising immunotherapy strategy to effectively combat lung metastasis and recurrence via generation of CAR-Ms in situ.