T cells engineered with chimeric antigen receptors (CAR-T) have had breakthrough successes in cancer immunotherapy with FDA approvals. Still, the high cost of personalized CAR-T cell therapy hinders the accessibility from the public as a therapeutic option, and the lack of uniquely defined cancer-specific antigens brings the risk of life-threatening on-target, off-tumor toxicity. Changing the immune cell therapy platform to Natural Killer cells (NK cells) can be an option to develop allogenic off-the-shelf cell therapy. To reduce the on-target, off-tumor toxicity, developing an inhibitory CAR (iCAR) for cell therapy is necessary for precise logic computation and implementation of iCAR can broaden the spectrum of treatable cancers. This dissertation optimized the primary NK cell expansion platform with autologous PBMC and set robust virus transduction using pseudotyped retrovirus on the primary NK cells to use the NK cells as the cell therapy platform. I engineered iCAR candidates to suppress in response to a “safety antigen” on healthy cells, first in T cells and validated in NK cells, showing its efficacy against various versions of activating CAR (aCAR) drove killing of targets expressing activating antigen, while an inhibitory CAR (iCAR) suppressed cytotoxicity against targets expressing a safety antigen. Therapeutic immune cells equipped with the right pair of aCAR and iCAR platform will improve safety for currently validated cancer antigens and enable new therapies for previously unaddressed indications. / 2024-05-23T00:00:00Z

Le glioblastome (GBM) représente environ 50 % des gliomes, le type de tumeur cérébrale le plus répandu. Sa forte agressivité se traduit par un faible et inquiétant taux de survie médian de 8 mois. La résistance intensive aux traitements actuels du GBM souligne la nécessité d'approches innovantes. Malgré l'essor récent d’immunothérapies ces dernières années, le GBM présente plusieurs attributs qui entravent l’efficacité de ces thérapies. Les cellules Natural Killer (NK) possèdent d’intéressantes propriétés anti-tumorales qui encouragent leur utilisation en tant que source prometteuse de thérapie cellulaire adoptive pour relever les défis posés par le GBM. Ce projet est une collaboration avec Scott McComb (National Research Center, Ottawa), dont l'équipe a développé des vecteurs lentiviraux de récepteurs antigéniques chimériques (CARs) ciblant EGFRvIII et HER2, respectivement exprimés dans 30 % et surexprimés dans 80 % des cas de GBM. Nous proposons d’adapter ces constructions aux domaines activateurs transmembranaires et intracellulaires optimisés pour la signalisation des cellules NK. L’objectif est d'optimiser la stabilité de l'expression CAR dans les cellules NK. Cela permettra d'augmenter durablement l'efficacité et la spécificité de la cytotoxicité cellulaire de cellules cancéreuses EGFRvIII+ et HER2+. Des vecteurs lentiviraux codant pour le rapporteur eGFP sous 5 promoteurs différents ont été produits. Des cellules NK primaires activées ont été modifiées par transduction lentivirale et triées en fonction de l'expression du transgène afin d'enrichir la population de cellules modifiées. Nos données suggèrent que la séquence régulatrice minimale UCOE pourrait conférer à elle seule une expression stable et robuste du transgène dans les cellules NK pendant 12 semaines. Ce promoteur a ensuite été incorporé dans les constructions CAR-NK pour optimiser la stabilité d’expression du CAR. L’efficience des CAR anti-EGFRvIII et des CAR anti-HER2 ont été évaluées in vitro en utilisant la lignée cellulaire U87 dérivée du GBM dans des tests de cytotoxicité. Parmi les constructions sélectionnées, CAR-F269 et sdCAR-HER2-6 ont montré une cytotoxicité significativement améliorée par rapport aux cellules NK non modifiées contre des cibles spécifiques de l'antigène. L'amélioration de la cytotoxicité observée avec sdCAR-HER2-6 était positivement corrélée à l'intensité de l'expression de HER2 dans les cellules cibles. Ce projet représente une preuve de principe qui suggère le potentiel de la thérapie CAR-NK comme une voie prometteuse dans la lutte contre le GBM et d'autres tumeurs solides. / Glioblastoma (GBM) accounts for approximately 50% of gliomas, the most prevalent type of brain tumor. Its high aggressiveness results in a worrying poor median survival rate of 8 months. Intensive resistance to current treatments for GBM highlights the need for innovative approaches. Despite recent growth in immunotherapies, GBM exhibits several hallmarks that hinder effectiveness of such therapies. Natural killer (NK) cells display interesting anti-tumoral properties that encourage their use as a promising adoptive cell therapy source to address the GBM challenges. This project is a collaboration with Scott McComb (National Research Center, Ottawa), whose team developed lentiviral vectors coding for chimeric antigen receptors (CARs) targeting EGFRvIII and HER2, which are respectively expressed in 30% and overexpressed in 80% of GBM cases. We propose to adapt these constructs to transmembrane and intracellular activator domains which are optimized for NK cell signaling. The objective is to optimize the stability of CAR expression in NK cells. This will allow for a sustained increase in killing efficacy and specificity of EGFRvIII+ and HER2+ cells. First, lentiviral vectors encoding the eGFP reporter under 5 different promoters were produced. Activated primary NK cells were modified by lentiviral transduction and sorted for transgene expression to enrich the population of modified cells. Our data suggest that the minimal regulatory sequence UCOE may confer alone a stable and robust transgene expression in NK cells for 12 weeks. The UCOE promoter was then incorporated into CAR-NK constructs to optimize the stability of CAR expression. The efficiency of anti-EGFRvIII CARs and anti-HER2 CARs were evaluated in vitro using the GBM-derived U87 cell line in cytotoxicity assays. Among the screened constructs, CAR-F269 and sdCAR-HER2-6 exhibited significantly enhanced cytotoxicity against antigen-specific targets, in comparison to unmodified NK cells. The enhancement of cytotoxicity observed with sdCAR-HER2-6 was found to positively correlate with the intensity of HER2 expression in the target cells. This project represents a proof of principle that suggests the potential of CAR-NK therapy as a promising avenue of in the fight against GBM.

Cancer immunotherapies utilize the capabilities of the immune system to efficiently target malignant cells. In recent years, chimeric antigen receptor (CAR) equipped T cells showed promising results against B cell lymphomas. Autologous CAR-T cells require patientspecific manufacturing and thus extensive production facilities, resulting in high priced therapies. Along with potentially severe side effects, these are the major drawbacks of CAR-T cells therapies. Natural Killer (NK) cells pose an alternative for CAR equipped immune cells. Since NK cells can be safely transferred from healthy donors to cancer patients, they present a suitable platform for an allogeneic “off-the-shelf” immunotherapy. However, administration of activated NK cells in cancer therapy has until now shown poor anti-cancer responses, especially in solid tumors. Genetic modifications such as CARs promise to enhance recognition of tumor cells, thereby increasing anti-tumor effects and improving clinical efficacy. Although the cell biology of T and NK cells deviates in many aspects, the development of CAR-NK cells frequently follows within the footsteps of CART cells, meaning that T cell technologies are simply adopted to NK cells. In this review, we underline the unique properties of NK cells and their potential in CAR therapies. First, we summarize the characteristics of NK cell biology with a focus on signaling, a fine-tuned interaction of activating and inhibitory receptors. We then discuss why tailored NK cellspecific CAR designs promise superior efficacy compared to designs developed for T cells. We summarize current findings and developments in the CAR-NK landscape: different CAR formats and modifications to optimize signaling, to target a broader pool of antigens or to increase in vivo persistence. Finally, we address challenges beyond NK cell engineering, including expansion and manufacturing, that need to be addressed to pave the way for CAR-NK therapies from the bench to the clinics.

Background: With increasing clinical use of NK-92 cells and their CAR-modified derivatives in cancer immunotherapy, there is a growing demand for efficient production processes of these “off-the-shelf” therapeutics. In order to ensure safety and prevent the occurrence of secondary tumors, (CAR-)NK-92 cell proliferation has to be inactivated before transfusion. This is commonly achieved by gamma irradiation. Recently, we showed proof of concept that low energy electron irradiation (LEEI) is a new method for NK-92 inactivation. LEEI has several advantages over gamma irradiation, including a faster reaction time, a more reproducible dose rate and much less requirements on radiation shielding. Here, LEEI was further evaluated as a promising alternative to gamma irradiation yielding cells with highly maintained cytotoxic effector function. Methods: Effectiveness and efficiency of LEEI and gamma irradiation were analyzed using NK-92 and CD123-directed CAR-NK-92 cells. LEE-irradiated cells were extensively characterized and compared to gamma-irradiated cells via flow cytometry, cytotoxicity assays, and comet assays, amongst others. Results: Our results show that both irradiation methods caused a progressive decrease in cell viability and are, therefore, suitable for inhibition of cell proliferation. Notably, the NKmediated specific lysis of tumor cells was maintained at stable levels for three days postirradiation, with a trend towards higher activities after LEEI treatment as compared to gamma irradiation. Both gamma irradiation as well as LEEI led to substantial DNA damage and an accumulation of irradiated cells in the G2/M cell cycle phases. In addition, transcriptomic analysis of irradiated cells revealed approximately 12-fold more differentially expressed genes two hours after gamma irradiation, compared to LEEI. Analysis of surface molecules revealed an irradiation-induced decrease in surface expression of CD56, but no changes in the levels of the activating receptors NKp46, NKG2D, or NKp30. Conclusions: The presented data show that LEEI inactivates (CAR-)NK-92 cells as efficiently as gamma irradiation, but with less impact on the overall gene expression. Due to logistic advantages, LEEI might provide a superior alternative for the manufacture of (CAR-)NK-92 cells for clinical application.

<div>Cancer is responsible for the second highest cause of death in the United States, and lung cancer accounts for 13% of new cancer diagnoses, with the highest rate of cancer death at 24%. Almost 85% of these cases represent non-small cell lung cancer (NSCLC), which includes lung adenocarcinoma, the most common NSCLC subtype. Traditional cancer treatments often only temporarily stop the spread of the disease, but immunotherapies, which are becoming a standard of care, are much more promising. Natural killer (NK) cells are powerful effectors of innate immunity, and genetically engineered NK cells as immunotherapies have had encouraging clinical responses in the treatment of various cancers. However, more progress is needed for solid tumor treatment, especially for lung adenocarcinoma. The activation of cancer-associated ectoenzymes, CD39 and CD73 catalyze the phosphorylation of ATP to AMP to produce extracellular adenosine (ADO), which is a highly immunosuppressive mechanism contributing to the pathogenesis of solid tumors. Understanding adenosine effects on NK cells will help develop more robust immunotherapeutic treatments to improve cytotoxicity against solid tumors. Here, we established that tumor microenvironment ADO results in impaired metabolic and anti-tumor functions of cytokine-primed NK cells. Specifically, peripheral blood-derived NK cells stimulated with IL-2, IL-15, or a combination of IL-12 and IL-15 showed suppressed anti-tumor immunity due to ADO. This was observed by the downregulation of activation receptor expression, cytotoxicity inhibition, impairment of metabolic activity, and alterations in gene expression. To target ADO-producing CD73 on cancer cells, we redirected NK cells by fusing CD73 ScFv with intracellular and transmembrane regions of NK cell specific signaling components derived from FCyRIIIa (CD16). Engineered NK cells were shown to be cytotoxic against lung adenocarcinoma <i>in vitro</i> and impede tumor growth in a lung adenocarcinoma mouse model <i>in vivo</i>. Engineered cells also had higher levels of degranulation and cytokine release, as well as more infiltration into tumors and longer survival time in mice. In summary, the microenvironment of solid tumors is highly immunosupressive, and redirecting NK cell function using a NK-specific anti-CD73 targeting construct will help to promote anti-tumor immunity and</div><div>inhibit cancer growth for a potentially powerful new immunotherapy against solid tumors.</div>