[HTML][HTML] Human CAR T cells with cell-intrinsic PD-1 checkpoint blockade resist tumor-mediated inhibition

L Cherkassky, A Morello… - The Journal of …, 2016 - Am Soc Clin Investig
L Cherkassky, A Morello, J Villena-Vargas, Y Feng, DS Dimitrov, DR Jones, M Sadelain…
The Journal of clinical investigation, 2016Am Soc Clin Investig
Following immune attack, solid tumors upregulate coinhibitory ligands that bind to inhibitory
receptors on T cells. This adaptive resistance compromises the efficacy of chimeric antigen
receptor (CAR) T cell therapies, which redirect T cells to solid tumors. Here, we investigated
whether programmed death-1–mediated (PD-1–mediated) T cell exhaustion affects
mesothelin-targeted CAR T cells and explored cell-intrinsic strategies to overcome inhibition
of CAR T cells. Using an orthotopic mouse model of pleural mesothelioma, we determined …
Following immune attack, solid tumors upregulate coinhibitory ligands that bind to inhibitory receptors on T cells. This adaptive resistance compromises the efficacy of chimeric antigen receptor (CAR) T cell therapies, which redirect T cells to solid tumors. Here, we investigated whether programmed death-1–mediated (PD-1–mediated) T cell exhaustion affects mesothelin-targeted CAR T cells and explored cell-intrinsic strategies to overcome inhibition of CAR T cells. Using an orthotopic mouse model of pleural mesothelioma, we determined that relatively high doses of both CD28- and 4-1BB–based second-generation CAR T cells achieved tumor eradication. CAR-mediated CD28 and 4-1BB costimulation resulted in similar levels of T cell persistence in animals treated with low T cell doses; however, PD-1 upregulation within the tumor microenvironment inhibited T cell function. At lower doses, 4-1BB CAR T cells retained their cytotoxic and cytokine secretion functions longer than CD28 CAR T cells. The prolonged function of 4-1BB CAR T cells correlated with improved survival. PD-1/PD-1 ligand [PD-L1] pathway interference, through PD-1 antibody checkpoint blockade, cell-intrinsic PD-1 shRNA blockade, or a PD-1 dominant negative receptor, restored the effector function of CD28 CAR T cells. These findings provide mechanistic insights into human CAR T cell exhaustion in solid tumors and suggest that PD-1/PD-L1 blockade may be an effective strategy for improving the potency of CAR T cell therapies.
The Journal of Clinical Investigation