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Longitudinal PET imaging demonstrates biphasic CAR T cell responses in survivors
Yogindra Vedvyas, Enda Shevlin, Marjan Zaman, Irene M. Min, Alejandro Amor-Coarasa, Spencer Park, Susan Park, Keon-Woo Kwon, Turner Smith, Yonghua Luo, Dohyun Kim, Young Kim, Benedict Law, Richard Ting, John Babich, Moonsoo M. Jin
Yogindra Vedvyas, Enda Shevlin, Marjan Zaman, Irene M. Min, Alejandro Amor-Coarasa, Spencer Park, Susan Park, Keon-Woo Kwon, Turner Smith, Yonghua Luo, Dohyun Kim, Young Kim, Benedict Law, Richard Ting, John Babich, Moonsoo M. Jin
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Research Article Immunology Therapeutics

Longitudinal PET imaging demonstrates biphasic CAR T cell responses in survivors

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Abstract

Clinical monitoring of adoptive T cell transfer (ACT) utilizes serial blood analyses to discern T cell activity. While useful, these data are 1-dimensional and lack spatiotemporal information related to treatment efficacy or toxicity. We utilized a human genetic reporter, somatostatin receptor 2 (SSTR2), and PET, to quantitatively and longitudinally visualize whole-body T cell distribution and antitumor dynamics using a clinically approved radiotracer. Initial evaluations determined that SSTR2-expressing T cells were detectable at low densities with high sensitivity and specificity. SSTR2-based PET was applied to ACT of chimeric antigen receptor (CAR) T cells targeting intercellular adhesion molecule-1, which is overexpressed in anaplastic thyroid tumors. Timely CAR T cell infusions resulted in survival of tumor-bearing mice, while later infusions led to uniform death. Real-time PET imaging revealed biphasic T cell expansion and contraction at tumor sites among survivors, with peak tumor burden preceding peak T cell burden by several days. In contrast, nonsurvivors displayed unrelenting increases in tumor and T cell burden, indicating that tumor growth was outpacing T cell killing. Thus, longitudinal PET imaging of SSTR2-positive ACT dynamics enables prognostic, spatiotemporal monitoring with unprecedented clarity and detail to facilitate comprehensive therapy evaluation with potential for clinical translation.

Authors

Yogindra Vedvyas, Enda Shevlin, Marjan Zaman, Irene M. Min, Alejandro Amor-Coarasa, Spencer Park, Susan Park, Keon-Woo Kwon, Turner Smith, Yonghua Luo, Dohyun Kim, Young Kim, Benedict Law, Richard Ting, John Babich, Moonsoo M. Jin

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Figure 5

Quantitative PET for detection of CAR T cells and luminescence of tumor burden in survivors vs. nonsurvivors.

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Quantitative PET for detection of CAR T cells and luminescence of tumor ...
Representative longitudinal, PET/CT (coronal view of 20-mm-thick plane, maximum intensity projection [MIP]) and concurrent bioluminescence imaging of survivors (n = 4) (A) vs. nonsurvivors (n = 5) (E). Diaphragms are traced with dotted lines, drawn to visualize tumor burdens separately in lungs and liver. Trend-line graphs plot region of interest (ROI) values for DOTATOC uptake (percentage injection dose per volume [%ID/cm3]) against bioluminescence values (photons [P]/sec) in the lungs taken from the same mice on the same day. Luminescence images are drawn with the same upper bound (106 P/mm2/sec) with gradually increasing lower bounds (X16, X20 for 2.5 × 104 P/mm2/sec and X23, X27 for 5 × 104 P/mm2/sec) for clarity of delineating tumor burden. Longitudinal PET/CT images of the upper body cropped at the kidney apex are drawn with a uniform range of DOTATOC concentrations (0.5–5.0 %ID/cm3), while whole-body PET/CT images are drawn in 0.5–5.0 %ID/cm3 for (A) and 1–10 %ID/cm3 for (E). Quantification of luminescence and DOTATOC uptake by the lungs (B and F) and body weight change (C and G) is shown for survivors and nonsurvivors. Representative longitudinal, PET/CT (transverse view of 1-mm-thick plane, MIP) views of lungs are shown for survivors (D) and nonsurvivors (H). PET images are drawn in indicated ranges. X, number of days after tumor xenograft; SR, treated with SSTR2-R6.5-CAR–transduced T cells.

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