Q1 · MEDICINE
Article
Author: Tran, Ben ; Harrison, Aaron ; MacDonald, Sean ; Slaney, Clare ; Wang, Minyu ; Qin, Vicky Mengfei ; Terry, Rachael L ; D'Souza, Criselle ; Darcy, Phillip K ; Neeson, Paul J ; Giuffrida, Lauren ; Thio, Niko ; Tantalo, Daniela ; Kershaw, Michael H ; Desai, Jayesh ; Solomon, Ben ; Harrison, Simon J ; Trapani, Joseph A ; Butler, Jeanne ; Prince, H Miles ; Petrone, Pasquale ; Beavis, Paul A ; Sek, Kevin ; Zhu, Joe Jiang ; Thia, Kevin ; Scott, Andrew M ; Ekert, Paul G ; Nguyen, Thu Ngoc ; Meyran, Deborah
Patients who receive chimeric antigen receptor (CAR)–T cells that are enriched in memory T cells exhibit better disease control as a result of increased expansion and persistence of the CAR-T cells. Human memory T cells include stem-like CD8
+
memory T cell progenitors that can become either functional stem-like T (T
STEM
) cells or dysfunctional T progenitor exhausted (T
PEX
) cells. To that end, we demonstrated that T
STEM
cells were less abundant in infused CAR-T cell products in a phase 1 clinical trial testing Lewis Y-CAR-T cells (NCT03851146), and the infused CAR-T cells displayed poor persistence in patients. To address this issue, we developed a production protocol to generate T
STEM
-like CAR-T cells enriched for expression of genes in cell replication pathways. Compared with conventional CAR-T cells, T
STEM
-like CAR-T cells had enhanced proliferative capacity and increased cytokine secretion after CAR stimulation, including after chronic CAR stimulation in vitro. These responses were dependent on the presence of CD4
+
T cells during T
STEM
-like CAR-T cell production. Adoptive transfer of T
STEM
-like CAR-T cells induced better control of established tumors and resistance to tumor rechallenge in preclinical models. These more favorable outcomes were associated with increased persistence of T
STEM
-like CAR-T cells and an increased memory T cell pool. Last, T
STEM
-like CAR-T cells and anti–programmed cell death protein 1 (PD-1) treatment eradicated established tumors, and this was associated with increased tumor-infiltrating CD8
+
CAR
+
T cells producing interferon-γ. In conclusion, our CAR-T cell protocol generated T
STEM
-like CAR-T cells with enhanced therapeutic efficacy, resulting in increased proliferative capacity and persistence in vivo.