Research ArticleCancer

Trispecific CD19-CD20-CD22–targeting duoCAR-T cells eliminate antigen-heterogeneous B cell tumors in preclinical models

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Science Translational Medicine  24 Mar 2021:
Vol. 13, Issue 586, eabc6401
DOI: 10.1126/scitranslmed.abc6401

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“Tri”-ing out CAR-T cells

Chimeric antigen receptor (CAR)–T cells have revolutionized treatment for hematological cancers. However, a remaining challenge is developing CAR-T cells that are capable of treating cancers with heterogeneous expression of CAR-T cell antigens. To address this, Schneider et al. designed trispecific duoCAR-T cells that targeted CD19, CD20, and CD22 simultaneously. The authors showed that trispecific duoCAR-T cells effectively killed antigen-heterogeneous mixtures of tumor cells in vitro. Further, they showed that trispecific duoCAR-T cells controlled burden of antigen-heterogeneous tumors in mouse models vivo. These findings suggest that a trispecific targeting strategy may address the challenge of treating antigen-heterogeneous cancers.


A substantial number of patients with leukemia and lymphoma treated with anti-CD19 or anti-CD22 monoCAR-T cell therapy relapse because of antigen loss or down-regulation. We hypothesized that B cell tumor antigen escape may be overcome by a chimeric antigen receptor (CAR) design that simultaneously targets three B cell leukemia antigens. We engineered trispecific duoCAR-T cells with lentiviral vectors encoding two CAR open reading frames that target CD19, CD20, and CD22. The duoCARs were composed of a CAR with a tandem CD19- and CD20-targeting binder, linked by the P2A self-cleaving peptide to a second CAR targeting CD22. Multiple combinations of intracellular T cell signaling motifs were evaluated. The most potent duoCAR architectures included those with ICOS, OX40, or CD27 signaling domains rather than those from CD28 or 4-1BB. We identified four optimal binder and signaling combinations that potently rejected xenografted leukemia and lymphoma tumors in vivo. Moreover, in mice bearing a mixture of B cell lymphoma lines composed of parental triple-positive cells, CD19-negative, CD20-negative, and CD22-negative variants, only the trispecific duoCAR-T cells rapidly and efficiently rejected the tumors. Each of the monoCAR-T cells failed to prevent tumor progression. Analysis of intracellular signaling profiles demonstrates that the distinct signaling of the intracellular domains used may contribute to these differential effects. Multispecific duoCAR-T cells are a promising strategy to prevent antigen loss–mediated relapse or the down-regulation of target antigen in patients with B cell malignancies.

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