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  • 1
    In: Journal for ImmunoTherapy of Cancer, BMJ, Vol. 9, No. 8 ( 2021-08), p. e002352-
    Abstract: Anti-CD19 chimeric antigen receptor T cells (CART-19) frequently induce remissions in hemato-oncological patients with recurred and/or refractory B-cell tumors. However, malignant cells sometimes escape the immunotherapeutic targeting by CD19 gene mutations, alternative splicing or lineage switch, commonly causing lack of CD19 expression on the surface of neoplastic cells. We assumed that, in addition to the known mechanisms, other means could act on CD19 to drive antigen-negative relapse. Methods Herein, we studied the mechanism of antigen loss in an in vivo CD19-negative recurrence model of chronic lymphocytic leukemia (CLL) to CART-19, established using NOD- scid IL2Rg null mice and HG3 cell line. We validated our findings in vitro in immortalized B-cell lines and primary CLL cells. Results In our in vivo CLL recurrence model, up to 70% of CART-19-treated mice eventually recurred with CD19-negative disease weeks after initial positive response. We found that the lack of CD19 expression was caused by promoter DNA hypermethylation. Importantly, the expression loss was partially reversible by treatment with a demethylating agent. Moreover, this escape mechanism was common for 3 B-cell immortalized lines as well as primary CLL cells, as assessed by in vitro coculture experiments. Conclusions Epigenetically driven antigen escape could represent a novel, yet at least partially reversible, means of CD19 loss to CART-19 in B-cell tumors.
    Type of Medium: Online Resource
    ISSN: 2051-1426
    Language: English
    Publisher: BMJ
    Publication Date: 2021
    detail.hit.zdb_id: 2719863-7
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  • 2
    In: Journal for ImmunoTherapy of Cancer, BMJ, Vol. 8, No. 1 ( 2020-03), p. e000471-
    Abstract: While achieving prolonged remissions in other B cell-derived malignancies, chimeric antigen receptor (CAR) T cells still underperform when injected into patients with chronic lymphocytic leukemia (CLL). We studied the influence of genetics on CLL response to anti-CD19 CAR T-cell therapy. Methods First, we studied 32 primary CLL samples composed of 26 immunoglobulin heavy-chain gene variable ( IGHV )-unmutated (9 ATM -mutated, 8 TP53 -mutated, and 9 without mutations in ATM , TP53 , NOTCH1 or SF3B1 ) and 6 IGHV -mutated samples without mutations in the above-mentioned genes. Then, we mimicked the leukemic microenvironment in the primary cells by ‘2S stimulation’ through interleukin-2 and nuclear factor kappa B. Finally, CRISPR/Cas9-generated ATM - knockout and TP53- knockout clones (four and seven, respectively) from CLL-derived cell lines MEC1 and HG3 were used. All these samples were exposed to CAR T cells. In vivo survival study in NSG mice using HG3 wild-type (WT), ATM - knockout or TP53- knockout cells was also performed. Results Primary unstimulated CLL cells were specifically eliminated after 〉 24 hours of coculture with CAR T cells. ‘2S’ stimulated cells showed increased survival when exposed to CAR T cells compared with unstimulated ones, confirming the positive effect of this stimulation on CLL cells’ in vitro fitness. After 96 hours of coculture, there was no difference in survival among the genetic classes. Finally, CAR T cells were specifically activated in vitro in the presence of target knockout cell lines as shown by the production of interferon-γ when compared with control (CTRL) T cells (p=0.0020), but there was no difference in knockout cells’ survival. In vivo, CAR T cells prolonged the survival of mice injected with WT, TP53 -knockout and ATM -knockout HG3 tumor cells as compared with CTRL T cells (p=0.0485, 0.0204 and 〈 0.0001, respectively). When compared with ATM -knockout, TP53 -knockout disease was associated with an earlier time of onset (p 〈 0.0001), higher tumor burden (p=0.0002) and inefficient T-cell engraftment (p=0.0012). Conclusions While in vitro no differences in survival of CLL cells of various genetic backgrounds were observed, CAR T cells showed a different effectiveness at eradicating tumor cells in vivo depending on the driver mutation. Early disease onset, high-tumor burden and inefficient T-cell engraftment, associated with TP53 -knockout tumors in our experimental setting, ultimately led to inferior performance of CAR T cells.
    Type of Medium: Online Resource
    ISSN: 2051-1426
    Language: English
    Publisher: BMJ
    Publication Date: 2020
    detail.hit.zdb_id: 2719863-7
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  • 3
    In: Blood, American Society of Hematology, Vol. 132, No. Supplement 1 ( 2018-11-29), p. 4407-4407
    Abstract: Background: Chronic lymphocytic leukemia (CLL) still remains an incurable disease. In spite of tremendous success of some targeted agents, the main mode of therapy in routine practice relies on the application of CD20 monoclonal antibodies (mAbs). Yet, majority of patients relapses and fails the immunotherapy, the major reason presumably being low expression of CD20 target protein on the surface of malignant cells. Whereas the molecular mechanisms regulating CD20 are largely unknown, the possibility to modulate CD20 levels seems an appealing strategy to enhance the success rate of CD20 immunotherapy. Aim: We aimed to screen epigenetic drug library on our generated immunotherapy-resistant CLL cell lines in order to reveal drugs able to upregulate CD20 expression and thereby sensitize cells to further CD20-mAb treatment. Methods: Through chronic cell exposure to gradually increasing doses of CD20 mAbs we have generated cells permanently resistant to anti-CD20 immunotherapy. These cells have strongly reduced CD20 expression. Epigenetic drug library (182 drugs) was applied on such cells in triplicates at 10uM concentration for 72 hours and changes in CD20 expression were determined by flow cytometry. Viability of the cells treated with epigenetic drugs in combination with CD20 mAb was measured by a CellTiter-Glo assay. Results: Screening the library of 182 epigenetic drugs on immunotherapy-resistant CD20-low cells revealed multiple drugs that were able to upregulate CD20 expression more than 2-fold. Among these were significantly enriched multiple inhibitors of Aurora kinases (AURK). In fact, there were 12 diverse Aurora kinase inhibitors among the top 16 hits. In parallel, we performed another epigenetic screen on our resistant cells, combining the epigenetic drugs with the addition of CD20-mAb Rituximab (RTX) to search for drugs able to sensitize cells to RTX treatment. Aurora kinase inhibitors were again found among the top three groups of strongest immunotherapy sensitizers. We could then validate several selected AURK inhibitors in individual experiments and showed that the upregulation of CD20 was concentration dependent. Importantly, we did not observe any induction of CD20 in non-B cell lines upon AURK inhibitor treatment. On contrary, we found that AURK inhibitors triggered marked increase in CD20 in cell lines resistant to both RTX and also to another CD20 mAb Ofatumumab, whereas they had only minor effect upon wildtype cells. The increase in CD20 was sustained for extended time periods. Pretreating resistant cells with AURK inhibitors followed by RTX treatment induced a profound shift in the viability curve, leading to a 50-fold improvement in EC50 for RTX as compared to cells without pretreatment. Conclusion: Aurora kinase inhibitors are able to specifically and strongly enhance expression of CD20 antigen on the surface of immunotherapy-resistant cells and thereby they strongly sensitize cells to further treatment with CD20 mAbs. These inhibitors thus seem as suitable candidates for combination therapy together with CD20 antibodies. This research has been financially supported by the Ministry of Education, Youth and Sports of the Czech Republic under the project CEITEC 2020 (LQ1601) and by the research grant AZV-MZ-CR 15-33561AA-4/2015 and grant MUNI/A/0968/2017. Disclosures Doubek: Janssen: Consultancy, Honoraria; Roche: Consultancy, Honoraria; Affimed: Research Funding; AbbVie: Consultancy, Research Funding; Gilead: Consultancy, Honoraria, Research Funding; Novartis: Consultancy. Mayer:Eisai: Research Funding; Novartis: Research Funding; Johnson & Johnson: Research Funding; Roche: Research Funding; Affimed: Research Funding.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
    RVK:
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2018
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
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  • 4
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  • 5
    In: Blood, American Society of Hematology, Vol. 128, No. 22 ( 2016-12-02), p. 3968-3968
    Abstract: Standard treatment of B-lymphoid malignancies nowadays still relies on the administration of monoclonal antibodies (mAbs), with CD20 antigen being the prime target. Although initially effective, repeated cycles of anti-CD20 monoclonal antibody therapy often result in the loss of CD20 on the surface of malignant B cells and consequently in therapy resistance. In spite of the widespread use of CD20 monoclonal antibodies, the exact mechanisms regulating CD20 expression stay largely unrevealed and it mainly remains unclear whether they can be exploited pharmacologically to modulate expression of CD20 in the clinic. Interestingly, application of CD20 mAbs on various B-cell lines in vitro triggers active CD20 signaling within the cells. This signal transmission results in rapid CD20 downregulation at the surface accompanied by dramatically reduced CD20 transcription. Contrary to the prompt initial downmodulation of CD20 transcription, it takes several days upon mAb removal until CD20 transcriptional gene activity and thereafter CD20 surface levels are restored back to normal. To further study cellular mechanisms responsible for regulating CD20 expression, we have mimicked the situation in patients in an in vitro setting by repeated chronic treatments of diverse B-cell lines with gradually increasing doses of clinically used anti-CD20 monoclonal antibodies Rituximab, Ofatumumab and Obinutuzumab. Thereby, we managed to generate permanently resistant lines that no more respond to additional administration of any of the anti-CD20 mAbs. Notably, these cells have permanently strongly downregulated CD20 expression, both on the cell surface as well as already on the level of mRNA gene transcription. In addition, we have utilized the state-of-the-art CRISPR/Cas9 system to fully knock out CD20 gene in B-cell lymphoma (Ramos) and CLL (MEC1) cell lines. As expected, these cells are totally resistant to CD20 monoclonal antibodies. CD20 was originally proposed to function as a calcium channel and to contribute to B-cell receptor signaling, however the exact function of CD20 remains largely elusive yet. Using both experimental systems, we demonstrate that B cells with the loss of CD20 have fairly normal B-cell receptor signaling with no signs of any large defect. Specifically, activation of major signaling proteins like SYK, AKT, ERK, PLCgamma or p38 upon BCR stimulation was equal in CD20 depleted cells when compared to normal cells. Also calcium flux in response to BCR triggering seems to be normal in CD20-deficient cells, thus suggesting that CD20 is dispensable for proper B-cell receptor signaling. Next, we have performed RNA sequencing on these cells in order to better understand intracellular changes on a more global level that are imposed by the deletion or chronic downmodulation of CD20. We have compared the expression of individual genes and gene sets in cells upon CD20 removal and have performed the differential gene set enrichment analysis that will be presented. In summary, analysis of mechanisms regulating CD20 expression and/or function is critically needed for identification of potential novel drug targets that might be applied in the clinic to control CD20 persistence and thereby improve the outcome of anti-CD20 monoclonal antibody therapy. This research has been financially supported by the Ministry of Education, Youth and Sports of the Czech Republic under the project CEITEC 2020 (LQ1601) and by the research grant AZV-MZ-CR 15-33561AA-4/2015 and grant MUNI/A/1028/2015. Disclosures No relevant conflicts of interest to declare.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
    RVK:
    RVK:
    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2016
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
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