Blockade of CD7 expression in T cells for effective chimeric antigen receptor targeting of T-cell malignancies

YT Png, N Vinanica, T Kamiya, N Shimasaki… - Blood …, 2017 - ashpublications.org
YT Png, N Vinanica, T Kamiya, N Shimasaki, E Coustan-Smith, D Campana
Blood advances, 2017ashpublications.org
Effective immunotherapies for T-cell malignancies are lacking. We devised a novel
approach based on chimeric antigen receptor (CAR)–redirected T lymphocytes. We selected
CD7 as a target because of its consistent expression in T-cell acute lymphoblastic leukemia
(T-ALL), including the most aggressive subtype, early T-cell precursor (ETP)–ALL. In 49
diagnostic T-ALL samples (including 14 ETP-ALL samples), median CD7 expression was>
99%; CD7 expression remained high at relapse (n= 14), and during chemotherapy (n= 54) …
Abstract
Effective immunotherapies for T-cell malignancies are lacking. We devised a novel approach based on chimeric antigen receptor (CAR)–redirected T lymphocytes. We selected CD7 as a target because of its consistent expression in T-cell acute lymphoblastic leukemia (T-ALL), including the most aggressive subtype, early T-cell precursor (ETP)–ALL. In 49 diagnostic T-ALL samples (including 14 ETP-ALL samples), median CD7 expression was >99%; CD7 expression remained high at relapse (n = 14), and during chemotherapy (n = 54). We targeted CD7 with a second-generation CAR (anti-CD7–41BB-CD3ζ), but CAR expression in T lymphocytes caused fratricide due to the presence of CD7 in the T cells themselves. To downregulate CD7 and control fratricide, we applied a new method (protein expression blocker [PEBL]), based on an anti-CD7 single-chain variable fragment coupled with an intracellular retention domain. Transduction of anti-CD7 PEBL resulted in virtually instantaneous abrogation of surface CD7 expression in all transduced T cells; 2.0% ± 1.7% were CD7+ vs 98.1% ± 1.5% of mock-transduced T cells (n = 5; P < .0001). PEBL expression did not impair T-cell proliferation, interferon-γ and tumor necrosis factor–α secretion, or cytotoxicity, and eliminated CAR-mediated fratricide. PEBL-CAR T cells were highly cytotoxic against CD7+ leukemic cells in vitro and were consistently more potent than CD7+ T cells spared by fratricide. They also showed strong anti-leukemic activity in cell line– and patient-derived T-ALL xenografts. The strategy described in this study fits well with existing clinical-grade cell manufacturing processes and can be rapidly implemented for the treatment of patients with high-risk T-cell malignancies.
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