Constitutively active MyD88/CD40 costimulation enhances expansion and efficacy of chimeric antigen receptor T cells targeting hematological malignancies

Leukemia. 2019 Sep;33(9):2195-2207. doi: 10.1038/s41375-019-0417-9. Epub 2019 Feb 28.

Abstract

Successful adoptive chimeric antigen receptor (CAR) T-cell therapies against hematological malignancies require CAR-T expansion and durable persistence following infusion. Balancing increased CAR-T potency with safety, including severe cytokine-release syndrome (sCRS) and neurotoxicity, warrants inclusion of safety mechanisms to control in vivo CAR-T activity. Here, we describe a novel CAR-T cell platform that utilizes expression of the toll-like receptor (TLR) adaptor molecule, MyD88, and tumor-necrosis factor family member, CD40 (MC), tethered to the CAR molecule through an intentionally inefficient 2A linker system, providing a constitutive signal that drives CAR-T survival, proliferation, and antitumor activity against CD19+ and CD123+ hematological cancers. Robust activity of MC-enhanced CAR-T cells was associated with cachexia in animal models that corresponded with high levels of human cytokine production. However, toxicity could be successfully resolved by using the inducible caspase-9 (iC9) safety switch to reduce serum cytokines, by administration of a neutralizing antibody against TNF-α, or by selecting "low" cytokine-producing CD8+ T cells, without loss of antitumor activity. Interestingly, high basal activity was essential for in vivo CAR-T expansion. This study shows that co-opting novel signaling elements (i.e., MyD88 and CD40) and development of a unique CAR-T architecture can drive T-cell proliferation in vivo to enhance CAR-T therapies.

MeSH terms

  • Animals
  • Antigens, CD19 / immunology
  • CD40 Antigens / immunology*
  • CD8-Positive T-Lymphocytes / immunology*
  • Cell Proliferation / drug effects
  • HEK293 Cells
  • Hematologic Neoplasms / immunology*
  • Hematologic Neoplasms / therapy*
  • Humans
  • Immunotherapy, Adoptive / methods
  • Lymphocyte Activation / immunology
  • Mice
  • Mice, Inbred NOD
  • Myeloid Differentiation Factor 88 / immunology*
  • Receptors, Antigen, T-Cell / immunology*
  • Receptors, Chimeric Antigen / immunology*
  • Signal Transduction / immunology
  • THP-1 Cells

Substances

  • Antigens, CD19
  • CD40 Antigens
  • Myd88 protein, mouse
  • Myeloid Differentiation Factor 88
  • Receptors, Antigen, T-Cell
  • Receptors, Chimeric Antigen