Závěrečná zpráva o řešení grantu Agentury pro zdravotnický výzkum MZ ČR
nestr.
T lymfocyty s chimerickým antigenním receptorem (CAR) představují nejmodernější technologii v cílené buněčné terapii onkologických onemocnění. Slibné klinické výsledky byly publikovány v léčbě hemato-onkologických malignit, avšak výsledky v léčbě solidních nádorů nejsou zatím tak povzbudivé. V navrhovaném projektu se budeme věnovat validaci protokolů pro výrobu CAR T-lymfocytů proti solidním nádorům v režimu správné laboratorní praxe. Zaměříme se hlavně na cílové antigeny GD2, PSMA a PSCA. Standardní operační protokoly a analytické certifikáty budou předány Státnímu ústavu pro kontrolu léčiv ke schválení. Na projektu budou spolupracovat tři špičková výzkumná pracoviště: (i) Mezinárodní centrum klinického výzkumu Fakultní nemocnice u sv. Anny v Brně, (ii) Centrum analýzy biomedicínského obrazu na Masarykově Univerzitě v Brně (MU-CBIA) a (iii) Ústav hematologie a krevní transfuze v Praze (ÚHKT). Naším hlavním cílem je zavést technologii výroby CAR T-lymfocytů pro cílenou buněčnou terapii solidních tumorů a tím umožnit přenos do klinické praxe.; Chimeric antigen receptor (CAR) T-cell is a cutting edge technology for targeted cell therapy of oncologic diseases. Promising clinical results were reported for hematological malignancies, but the results in solid tumors are not that encouranging yet. Here we propose to validate protocols for the production of CAR T-cells against solid tumor antigens under cGMP rules. We will focus mainly on target antigens GD2, PSMA, and PSCA. Standard operation protocols and analytical certificates will be presented to the State Institute for Drug Control for their approval. The consortium of three prominent research facilities will participate on this project: (i) International Clinical Research Center of St. Anne's University Hospital Brno (FNUSA-ICRC), (ii) Centre for Biomedical Image Analysis at Masaryk University Brno (MU-CBIA), and (iii) Institute of Hematology and Blood Transfusion in Prague (UHKT). Our main aim is to establish production of CAR T-cells for anti-solid tumor therapy which can be translated into clinical applications.
- Klíčová slova
- advanced therapy medicinal products, solid tumors, T-lymfocyty, T-cells, solidní tumory, Chimerický antigenní receptor, Správná laboratorní praxe, Přípravky moderní terapie, Chimeric antigen receptor, Current Good Manufacturing Practice,
- NLK Publikační typ
- závěrečné zprávy o řešení grantu AZV MZ ČR
BACKGROUND: The non-viral production of CAR-T cells through electroporation of transposon DNA plasmids is an alternative approach to lentiviral/retroviral methods. This method is particularly suitable for early-phase clinical trials involving novel types of CAR-T cells. The primary disadvantage of non-viral methods is the lower production efficiency compared to viral-based methods, which becomes a limiting factor for CAR-T production, especially in chemotherapy-pretreated lymphopenic patients. METHODS: We describe a good manufacturing practice (GMP)-compliant protocol for producing CD19 and CD123-specific CAR-T cells based on the electroporation of transposon vectors. The lymphocytes were purified from the blood of patients undergoing chemotherapy for B-NHL or AML and were electroporated with piggyBac transposon encoding CAR19 or CAR123, respectively. Electroporated cells were then polyclonally activated by anti-CD3/CD28 antibodies and a combination of cytokines (IL-4, IL-7, IL-21). The expansion was carried out in the presence of irradiated allogeneic blood-derived mononuclear cells (i.e., the feeder) for up to 21 days. RESULTS: Expansion in the presence of the feeder enhanced CAR-T production yield (4.5-fold in CAR19 and 9.3-fold in CAR123). Detailed flow-cytometric analysis revealed the persistence of early-memory CAR-T cells and a low vector-copy number after production in the presence of the feeder, with no negative impact on the cytotoxicity of feeder-produced CAR19 and CAR123 T cells. Furthermore, large-scale manufacturing of CAR19 carried out under GMP conditions using PBMCs obtained from B-NHL patients (starting number=200x10e6 cells) enabled the production of >50x10e6 CAR19 in 7 out of 8 cases in the presence of the feeder while only in 2 out of 8 cases without the feeder. CONCLUSIONS: The described approach enables GMP-compatible production of sufficient numbers of CAR19 and CAR123 T cells for clinical application and provides the basis for non-viral manufacturing of novel experimental CAR-T cells that can be tested in early-phase clinical trials. This manufacturing approach can complement and advance novel experimental immunotherapeutic strategies against human hematologic malignancies.
- MeSH
- akutní myeloidní leukemie * terapie imunologie genetika MeSH
- allogeneické buňky imunologie MeSH
- antigeny CD19 * imunologie genetika MeSH
- B-buněčný lymfom terapie imunologie genetika MeSH
- chimerické antigenní receptory * genetika imunologie MeSH
- elektroporace MeSH
- imunoterapie adoptivní * metody MeSH
- lidé MeSH
- podkladové buňky MeSH
- T-lymfocyty imunologie metabolismus MeSH
- transpozibilní elementy DNA * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
Tisagenlecleucel (tisa-cel) is a CD19-specific CAR-T cell product approved for the treatment of relapsed/refractory (r/r) DLBCL or B-ALL. We have followed a group of patients diagnosed with childhood B-ALL (n = 5), adult B-ALL (n = 2), and DLBCL (n = 25) who were treated with tisa-cel under non-clinical trial conditions. The goal was to determine how the intensive pretreatment of patients affects the produced CAR-T cells, their in vivo expansion, and the outcome of the therapy. Multiparametric flow cytometry was used to analyze the material used for manufacturing CAR-T cells (apheresis), the CAR-T cell product itself, and blood samples obtained at three timepoints after administration. We present the analysis of memory phenotype of CD4/CD8 CAR-T lymphocytes (CD45RA, CD62L, CD27, CD28) and the expression of inhibitory receptors (PD-1, TIGIT). In addition, we show its relation to the patients' clinical characteristics, such as tumor burden and sensitivity to prior therapies. Patients who responded to therapy had a higher percentage of CD8+CD45RA+CD27+ T cells in the apheresis, although not in the produced CAR-Ts. Patients with primary refractory aggressive B-cell lymphomas had the poorest outcomes which was characterized by undetectable CAR-T cell expansion in vivo. No clear correlation of the outcome with the immunophenotypes of CAR-Ts was observed. Our results suggest that an important parameter predicting therapy efficacy is CAR-Ts' level of expansion in vivo but not the immunophenotype. After CAR-T cells' administration, measurements at several timepoints accurately detect their proliferation intensity in vivo. The outcome of CAR-T cell therapy largely depends on biological characteristics of the tumors rather than on the immunophenotype of produced CAR-Ts.
T-cell malignancies can be divided into precursor (T-acute lymphoblastic leukemia/lymphoblastic lymphoma, T-ALL/LBL) and mature T-cell neoplasms, which are comprised of 28 different entities. Most of these malignancies are aggressive with rather poor prognosis. Prognosis of relapsed/refractory (R/R) disease is especially dismal, with an expected survival only several months after progression. Targeted therapies, such as antiCD30 immunotoxin brentuximab vedotin, antiCD38 antibody daratumumab, and anti-CCR4 antibody mogamulizumab are effective only in subsets of patients with T-cell neoplasms. T-cells equipped with chimeric antigen receptor (CAR-Ts) are routinely used for treatment of R/R B-cell malignancies, however, there are specific obstacles for their use in T-cell leukemias and lymphomas which are fratricide killing, risk of transfection of malignant cells, and T-cell aplasia. The solution for these problems relies on target antigen selection, CRISPR/Cas9 or TALEN gene editing, posttranslational regulation of CAR-T surface antigen expression, and safety switches. Structural chromosomal changes and global changes in gene expression were observed with gene-edited products. We identified 49 studies of CAR-based therapies registered on www.clinicaltrials.gov. Most of them target CD30 or CD7 antigen. Results are available only for a minority of these studies. In general, clinical responses are above 50% but reported follow-up is very short. Specific toxicities of CAR-based therapies, namely cytokine release syndrome (CRS), seem to be connected with the antigen of interest and source of cells for manufacturing. CRS is more frequent in antiCD7 CAR-T cells than in antiCD30 cells, but it is mild in most patients. More severe CRS was observed after gene-edited allogeneic CAR-T cells. Immune effector cell associated neurotoxicity (ICANS) was mild and infrequent. Graft-versus-host disease (GvHD) after allogeneic CAR-T cells from previous hematopoietic stem cell donor was also observed. Most frequent toxicities, similarly to antiCD19 CAR-T cells, are cytopenias. CAR-based cellular therapy seems feasible and effective for T-cell malignancies, however, the optimal design of CAR-based products is still unknown and long-term follow-up is needed for evaluation of their true potential.
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
Liečba T-bunkami s chimérickým antigénnym receptorom (CAR T) patrí medzi najnovšie terapeutické postupy v hematoonkológii. Metóda využíva geneticky modifikované autológne T-lymfocyty, ktoré v organizme pacienta dokážu identifikovať cieľové nádorové bunky a zneškodniť ich. Anti-CD19 CAR T liečba je v súčasnosti indikovaná u detských a mladých dospelých pacientov s relabovanou alebo refraktérnou (R/R) B-akútnou lymfoblastovou leukémiou (B-ALL) a dospelých pacientov s R/R agresívnymi B-bunkovými lymfómami po dvoch alebo viacerých líniách systémovej liečby. V práci prezentujeme kazuistiku pacienta s refraktérnym difúznym veľkobunkovým B-lymfómom, u ktorého bola po zlyhaní predchádzajúcich línií protinádorovej liečby úspešne využitá CAR T terapia.
CAR T therapy, based on T-cells with the chimeric antigen receptor, represents one of the latest therapeutic approaches in haematooncology. It uses genetically modificated autologous T-lymphocytes that are able to identify and destroy target tumour cells in patient ́s organism. Today anti-CD19 CAR T therapy is indicated in children and young adults with relapsed or refractory (R/R) B-acute lymphoblastic leukaemia (B-ALL) and adult patients with R/R aggressive B-cell lymphoma after at least two lineages of immunochemotherapy. Here we present a case report of the patient with refractory diffuse large B-cell lymphoma who was successfully treated with CAR T cells.
- MeSH
- chimerické antigenní receptory * terapeutické užití MeSH
- difúzní velkobuněčný B-lymfom * terapie MeSH
- imunologické faktory terapeutické užití MeSH
- imunoterapie adoptivní metody MeSH
- lidé středního věku MeSH
- lidé MeSH
- protinádorové látky terapeutické užití MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
The piggyBac transposon system provides a non-viral alternative for cost-efficient and simple chimeric antigen receptor (CAR) T cell production. The generation of clinical-grade CAR T cells requires strict adherence to current good manufacturing practice (cGMP) standards. Unfortunately, the high costs of commonly used lentiviral or retroviral vectors limit the manufacturing of clinical-grade CAR T cells in many non-commercial academic institutions. Here, we present a manufacturing platform for highly efficient generation of CD19-specific CAR T cells (CAR19 T cells) based on co-electroporation of linear DNA transposon and mRNA encoding the piggyBac transposase. The transposon is prepared enzymatically in vitro by PCR and contains the CAR transgene flanked by piggyBac 3' and 5' arms. The mRNA is similarly prepared via in vitro transcription. CAR19 T cells are expanded in the combination of cytokines interleukin (IL)-4, IL-7, and IL-21 to prevent terminal differentiation of CAR T cells. The accurate control of vector copy number (VCN) is achieved by decreasing the concentration of the transposon DNA, and the procedure yields up to 1 × 108 CAR19 T cells per one electroporation of 1 × 107 peripheral blood mononuclear cells (PBMCs) after 21 days of in vitro culture. Produced cells contain >60% CAR+ cells with VCN < 3. In summary, the described manufacturing platform enables a straightforward cGMP certification, since the transposon and transposase are produced abiotically in vitro via enzymatic synthesis. It is suitable for the cost-effective production of highly experimental, early-phase CAR T cell products.
- Publikační typ
- časopisecké články MeSH
