Cooperative CAR targeting to selectively eliminate AML and minimize escape

S Haubner, J Mansilla-Soto, S Nataraj, F Kogel… - Cancer cell, 2023 - cell.com
S Haubner, J Mansilla-Soto, S Nataraj, F Kogel, Q Chang, E de Stanchina, M Lopez, MR Ng…
Cancer cell, 2023cell.com
Acute myeloid leukemia (AML) poses a singular challenge for chimeric antigen receptor
(CAR) therapy owing to its phenotypic heterogeneity and similarity to normal hematopoietic
stem/progenitor cells (HSPCs). Here we expound a CAR strategy intended to efficiently
target AML while minimizing HSPC toxicity. Quantification of target expression in
relapsed/refractory patient samples and normal HSPCs reveals a therapeutic window for
gated co-targeting of ADGRE2 and CLEC12A: We combine an attenuated ADGRE2-CAR …
Summary
Acute myeloid leukemia (AML) poses a singular challenge for chimeric antigen receptor (CAR) therapy owing to its phenotypic heterogeneity and similarity to normal hematopoietic stem/progenitor cells (HSPCs). Here we expound a CAR strategy intended to efficiently target AML while minimizing HSPC toxicity. Quantification of target expression in relapsed/refractory patient samples and normal HSPCs reveals a therapeutic window for gated co-targeting of ADGRE2 and CLEC12A: We combine an attenuated ADGRE2-CAR with a CLEC12A-chimeric costimulatory receptor (ADCLEC.syn1) to preferentially engage ADGRE2posCLEC12Apos leukemic stem cells over ADGRE2lowCLEC12Aneg normal HSPCs. ADCLEC.syn1 prevents antigen escape in AML xenograft models, outperforms the ADGRE2-CAR alone and eradicates AML despite proximate myelopoiesis in humanized mice. Off-target HSPC toxicity is similar to that of a CD19-CAR and can be mitigated by reducing CAR T cell-derived interferon-γ. Overall, we demonstrate the ability of target density-adapted cooperative CAR targeting to selectively eliminate AML and potentially obviate the need for hematopoietic rescue.
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