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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 6

Ex vivo analysis of CAR T cell and tumor density in lungs.

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Ex vivo analysis of CAR T cell and tumor density in lungs.
Ex vivo, GFP+...
Ex vivo, GFP+ tumor cell fluorescence of representative lungs and liver, and flow cytometry of total, live-gated lung cells from (A) survivors (n = 4) and (B) nonsurvivors (n = 5). Organs were harvested, imaged, and analyzed by flow cytometry on day 28 after xenograft (X28). (C) DOTATOC uptake (percentage injection dose per volume [%ID/cm3]) by the lungs in SR1–SR9 mice are plotted against the percentages of T cells (CD3+) determined by flow cytometry. (D) Representative histological images are shown for paraffin-embedded H&E-stained sections of 1 entire lung lobe (top), and anti–human CD3 antibody with hematoxylin counterstain (middle). High-magnification views (yellow boxed regions in middle sections) show tumor cells and CD3-stained T cells (bottom). Tumor cells are identified by dark hematoxylin-stained nuclei. Human CD3+ cells are stained brown. Scale bars: 2 mm (top and middle sections) and 200 μm (bottom sections). Lungs were harvested from healthy mice with no tumor, mice 23 days after tumor xenograft and no T cell treatment (X23/no T cell), and X28 for T cell–treated survivors and nonsurvivors.

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