Glioblastoma multiforme (GBM) is the most common malignant brain cancer that invades normal brain tissue and impedes surgical eradication, resulting in early local recurrence and high mortality. In addition, most therapeutic agents lack permeability across the blood brain barrier (BBB), further reducing the efficacy of chemotherapy. Thus, effective treatment against GBM requires tumor specific targets and efficient intracranial drug delivery. With the most recent advances in immunotherapy, genetically engineered T cells with chimeric antigen receptors (CARs) are becoming a promising approach for treating cancer. By transducing T lymphocytes with CAR constructs containing a tumor-associated antigen (TAA) recognition domain linked to the constant regions of a signaling T cell receptor, CAR T cells may recognize a predefined TAA with high specificity in a non-MHC restricted manner, and is independent of antigen processing. Active T cells can travel across the BBB, providing additional advantage for drug delivery and tumor targeting. Here we review the CAR design and technical innovations, the major targets that are in pre-clinical and clinical development with a focus on GBM, and multiple strategies developed to improve CAR T cell efficacy.

T lymphocytes engineered with chimeric antigen receptors (CARs) have shown remarkable success in the treatment of leukemias. Conventional CARs seek to recapitulate TCR and costimulatory signals through fusion of T cell signaling elements into a single receptor. The robust anti-tumor activity of CAR T cells is often accompanied by debilitating toxicities due to excessive T cell activation and cytokine production following infusion. Our lab has generated a novel chimeric receptor termed T cell antigen coupler (TAC), which is designed to engage native T cell signaling domains for cellular activation. In a murine xenograft model, we previously found that TAC T cells mediated rapid tumour regression in the absence of toxicities. Comparatively, CAR T cells elicited significant lethal toxicities to the mice due to reactivity against an unspecific antigen that resulted in excessive proliferation and cytokine production in vivo. Here, we report that TAC and CAR T cells have fundamentally different biology, both at rest, and during activation. TAC T cells were more sensitive to the context of stimulation compared to CAR T cells. Whereas TAC T cells can discriminate between antigen bound to a bead, or antigen present on a cell, CAR T cells do not make the same distinction and responds equally well to both. Compared to several different CAR constructs, TAC T cells are less prone to tonic signaling and T cell differentiation in the absence of antigen. These findings support that TAC T cells may pose a safety benefit as a cancer immunotherapy, due to its distinct biology from CAR T cells that enables them to require more stringent contexts for activation. / Thesis / Master of Science (MSc) / Cytotoxic T cells are also known as “resident killer” cells of the immune system, as they can seek and eliminate diseased or infected tissue, including cancer cells. However, cancer cells can evade elimination by T cells over time. Genetic engineering of T cells allows us to re-arm T cells against cancer cells. T cells isolated from a patient are genetically modified to recognize cancer cells specifically. So far, these modified T cells have been successful against several leukemias. However, the side effects of this treatment can be substantial and life-threatening, due to the massive reaction of the T cells against the cancer cells following infusion. We explore the biology of two different types of engineered T cells to better understand the interaction between T cell and tumour cell. Our results aim towards mitigating the side effects of T cell treatment, while investigating how we can improve its effectiveness for the future.

Immunotherapy for cancer is a young research field progressing at high speed. The first chimera of an antibody and a signaling chain was designed by Zelig Eshhar and was later further developed to enhance existing T cell therapy by combining a single-chain fragment of an antibody with the CD3 zeta chain of the TCR complex. T cells expressing these chimeric antigen receptors (CARs) could recognize and specifically kill tumor cells. However the T cells, lacked in persistence and tumor rejection did not occur. Thus, the CAR constructs have been improved by providing the T cell with costimulatory signals promoting activation. The focus of this thesis has been to evaluate second and third generation αCD19-CAR T cells for the treatment of B cell leukemia and lymphoma. B cell tumors commonly upregulate anti-apoptotic proteins such as Bcl-2, which generates therapy resistance. In the first paper a second generation (2G) αCD19-CD28-CAR T cell was combined with the Bcl-2 family inhibitor ABT-737. ABT-737 sensitized tumor cells to CAR T cell therapy and may be an interesting clinical combination treatment. In paper II, the phenotype and function of a third generation (3G) αCD19-CD28-4-1BB-CAR T cell were evaluated. B cell-stimulated CAR T cells showed increased proliferation and an antigen-driven accumulation of CAR+ T cells. 3G CAR T cells had equal cytotoxic capacity, similar lineage, memory and exhaustion profile phenotype compared to 2G CARs. However, 3G CAR T cells proliferated better and had increased activation of intracellular signaling pathways compared to 2G CAR T cells. In paper III, αCD19-CD28-4-1BB-CAR T cells were used to stimulate immature dendritic cells leading to an upregulation of maturation markers on co-cultured dendritic cells. Hence, CAR T cells may not only directly kill the tumor cells, but may induce bystander immunity that indirectly aids tumor control. This thesis also include supplementary information about the development and implementation of protocols for GMP production of CAR T cell batches for a phase I/IIa clinical trial currently ongoing for patients with refractory B cell leukemia and lymphoma. So far, two patients have safely been treated on the lowest dose.

Malgré le succès de l’utilisation des lymphocytes T modifiées par des récepteur antigéniques chimériques (CAR) contre les leucémies, celles-ci présentent des limites comme leur risque de CRS et leur inefficacité dans les tumeurs solides. Plusieurs autres immunothérapies cellulaires ont été proposées pour pallier à ces inconvénients. Les cellules natural killer (NK) ont plusieurs propriétés qui en font une alternative avantageuse aux cellules T dans les immunothérapies. Cependant, les cellules NK restent difficiles à modifier avec les outils actuels et leur efficacité reste limitée par les mécanismes immunosuppresseurs des tumeurs. Nous avons réussi à augmenter l’efficacité de transduction avec une nouvelle glycoprotéine, le BaEVRless. Nous avons aussi démontré que cette enveloppe ne provoque pas de modification du phénotype ou de l’activité intrinsèque des cellules NK. Dans un modèle de leucémie, nous avons déterminé que l’utilisation du BaEVRless permet la production de cellules CAR-NK fonctionnelles. Les cellules NK peuvent aussi être transduites efficacement par des constructions lentivirales portant les séquences codant pour deux constructions CAR simultanément. Nous avons aussi démontré que l’édition génomique des NK par la technologie Clustered Regularly Interspersed Short Palindromic Repeats (CRISPR) est possible en utilisant une livraison non-virale. Avec cette méthode, nous avons pu réduire l’expression de NKG2A. Les cellules NK avec une expresssion réduite de NKG2A étaient résistantes à l’inhibition par HLA-E, exprimé sur des lignées de cancer du sein et du colon. Cet effet a été confirmé in vivo dans un modèle préclinique xenogénique. Ces résultats montrent deux stratégies qui pourraient permettre d’améliorer les immunothérapies à base de cellules NK. / Despite the overwhelming success of chimeric antigen receptor (CAR)-modified T lymphocytes against leukemias, some limitations have been observed, such as the risk of developing CRS and the lack of efficiency in solid tumor settings. Many other cell-based immunotherapies have been explored to circumvent those caveats. Natural killer (NK) cells present many advantageous properties that could make them a very promising alternative to T cells in immunotherapies. However, NK cells have some caveats, mainly they are hard to modify using conventional tools and they are sensitive to many inhibitory signals expressed by cancer cells. We managed to greatly improve the efficiency of transduction using a novel viral glycoprotein, BaEVRless. In the process, we determined that this novel enveloppe glycoprotein did not modify the phenotype or intrinsic activity of the transduced NK cells. In a leukemia model, we also showed that the BaEVRless can be used to generate functionnal CAR-NK cells. Moreover, the NK cells can be transduced with larger lentiviral constructions bearing two simultaneous CAR-coding sequences. We also demonstrated that Clustered Regularly Interspersed Short Palindromic Repeats (CRISPR) modification of NK cells using a non-viral approach was possible. Using this approach, we generated NK cells with lower NKG2A expression, that were resistant to the inhibitory effects of HLA-E. This affect was seen in a breast cancer model and a colon cancer model. The in vitro results were confirmed in an in vivo preclinical xenogeneic model. Together, those results represent two improvements applicable to NK cell-based immunotherapies.