Preclinical in vivo modeling of cytokine release syndrome induced by ErbB-retargeted human T cells: identifying a window of therapeutic opportunity?

SJC Van der Stegen, DM Davies, S Wilkie… - The Journal of …, 2013 - journals.aai.org
SJC Van der Stegen, DM Davies, S Wilkie, J Foster, JK Sosabowski, J Burnet, LM Whilding…
The Journal of Immunology, 2013journals.aai.org
The ErbB network is dysregulated in many solid tumors. To exploit this, we have developed
a chimeric Ag receptor (CAR) named T1E28z that targets several pathogenetically relevant
ErbB dimers. T1E28z is coexpressed with a chimeric cytokine receptor named 4αβ
(combination termed T4), enabling the selective expansion of engineered T cells using IL-4.
Human T4+ T cells exhibit antitumor activity against several ErbB+ cancer types. However,
ErbB receptors are also expressed in several healthy tissues, raising concerns about toxic …
Abstract
The ErbB network is dysregulated in many solid tumors. To exploit this, we have developed a chimeric Ag receptor (CAR) named T1E28z that targets several pathogenetically relevant ErbB dimers. T1E28z is coexpressed with a chimeric cytokine receptor named 4αβ (combination termed T4), enabling the selective expansion of engineered T cells using IL-4. Human T4+ T cells exhibit antitumor activity against several ErbB+ cancer types. However, ErbB receptors are also expressed in several healthy tissues, raising concerns about toxic potential. In this study, we have evaluated safety of T4 immunotherapy in vivo using a SCID beige mouse model. We show that the human T1E28z CAR efficiently recognizes mouse ErbB+ cells, rendering this species suitable to evaluate preclinical toxicity. Administration of T4+ T cells using the iv or intratumoral routes achieves partial tumor regression without clinical or histopathologic toxicity. In contrast, when delivered ip, tumor reduction is accompanied by dose-dependent side effects. Toxicity mediated by T4+ T cells results from target recognition in both tumor and healthy tissues, leading to release of both human (IL-2/IFN-γ) and murine (IL-6) cytokines. In extreme cases, outcome is lethal. Both toxicity and IL-6 release can be ameliorated by prior macrophage depletion, consistent with clinical data that implicate IL-6 in this pathogenic event. These data demonstrate that CAR-induced cytokine release syndrome can be modeled in mice that express target Ag in an appropriate distribution. Furthermore, our findings argue that ErbB-retargeted T cells can achieve therapeutic benefit in the absence of unacceptable toxicity, providing that route of administration and dose are carefully optimized.
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