The quest for spatio-temporal control of CAR T cells

Chimeric antigen receptors (CARs) are synthetic receptors capable of directing potent antigen-specific anti-tumor T cell responses. A recent report by Wu et al. extends a series of strategies aiming to curb excessive T cell activity, utilizing in this instance a chemical dimerizer to aggregate antigen-binding, T cell-activating and costimulatory domains.Chimeric antigen receptor (CAR) therapy relies on T cell engineering to generate tumor-targeted T cells with enhanced anti-tumor functions¹. CAR therapy has so far achieved its most remarkable clinical successes against CD19-positive hematological malignancies and is now on the verge of being developed for solid tumors². Two safety concerns have, however, emerged from the CD19 experience, which should be addressed for CAR therapy to be broadly applicable. One is the eventual on-target/off-tumor effect of CAR T cells on normal tissues. Even though this concern may be mitigated in the case of CD19 CAR T cell-induced B cell aplasia, strategies designed to reduce or prevent its potential occurrence with other targets are needed². The other concern is a severe cytokine release syndrome (CRS), arising from large-scale synchronized T cell activation upon engaging the target antigen in some CAR T cell recipients².Several innovative strategies have been recently proposed to address these safety concerns. These strategies make use of remote or cell autonomous controls (Figure 1), utilizing small molecules, antibodies or synthetic receptors to regulate T cell activity. One approach is to activate a latent suicide switch, such as the inducible caspase-9 (iCasp9) enzyme, through the administration of a small molecule to induce T cell apoptosis³ (Figure 1a). Bifunctional small molecules that mediate the binding between antigen and CAR have also been developed to regulate target engagement⁴ (Figure 1b). A variation on this approach uses antibodies to mediate antigen recognition on target cells and binding of T cells expressing a synthetic Fc receptor⁵ (Figure 1b). These designs enable remote temporal control of T cell activity but do not provide a means to enhance tumor selectivity of the CAR T cells. To this end, combinatorial approaches integrating two autonomous antigen inputs to control CAR T cell functions have been developed to spatially discriminate between normal and tumor cells expressing a common target. One such approach utilizes synthetic inhibitory receptors, termed iCARs, which are derived from the PD-1 or CTLA-4 receptors, to protect normal cells based on the iCAR''s recognition of an antigen present on the normal cells but not the tumor cells⁶ (Figure 1c). Another approach utilizes complementary signals split between two receptors — a CAR for T cell activation and a chimeric costimulatory receptor (CCR) providing costimulation — such that they are both expressed by the tumor cells but found alone on normal cells⁷ (Figure 1d). Acting in cell autonomous fashion, the required co-engagement of the CCR and the CAR upon recognition of two independent antigens reinforces tumor selectivity in vivo⁷.Open in a separate windowFigure 1Building controls into engineered T cells. (a) The small molecule AP1903 can dimerize the suicide switch iCasp9 to induce T cell apoptosis. (b) Bifunctional small molecule bridging the binding between antigen and CAR or antibody mediating the interaction between antigen and synthetic Fc receptor can be remote controls of CAR T cells. (c) iCAR can inhibit CAR function in the presence of an antigen present in normal cells but not tumor cells. (d) CCR binding to a second antigen in tumor cells is required for full T cell activation. (e) The small molecule AP21976 can dimerize two independent signaling entities through an FKBP-FRB module to control T cell activation. (a, b, e) Strategies employing one remote control (antibody or small molecule) in addition to one autonomous control (antigen A). (c, d) Strategies with two autonomous controls (antigen A and antigen B). Negative regulation involves inducing apoptosis (a) or turning off T cell activation (c) by input 2 while positive regulation (b, d, e) results in T cell activation by input 2.In a recent paper published in Science, Wu et al.⁸ showed a novel design incorporating a remote control of CAR T cells, whereby a small molecule is used to dimerize antigen-binding and signaling domains (Figure 1e). At variance with the small molecule-controlled suicide switch, this ON-switch design represents a positive reversible regulation, as it does not eliminate T cells but rather restricts their activities. The remote control takes advantage of well-established chemically induced dimerization (CID) modules developed in the 1990s, where two proteins bind only in the presence of a third chemical, such as a small molecule⁹. One such widely used CID module is the FKBP and FRB_T2098L that heterodimerize in the presence of rapamycin or its less immunosuppressive analog AP21976. The receptor for antigen and a dual-signaling, costimulatory and activating domain analogous to that of a second generation CAR, were independently fused to FKBP and FRB_T2098L so that AP21976-induced FKBP and FRB_T2098L dimerization could aggregate these entities (Figure 1e). This design controls intracellular assembly of a signaling complex without affecting the antigen binding properties as afforded by the bifunctional small molecules or antibodies at the interface of T cells and target cells (Figure 1b). After screening various domain configurations in leukemic Jurkat cells with AP21976-dependent NFAT activation and IL-2 production assays, a design that worked with both the FKBP-FRB_T2098L and the gibberellin-induced GID1-GAI heterodimerization modules was identified. Single molecule imaging of ON-switch CAR assembly in Jurkat cells showed that two molecular parts are equally constrained to immobilized antigens only in the presence of AP21976. Subsequent characterization of the ON-switch CAR in primary human CD4⁺ T cells showed that both AP21976 and antigen are required for the induction of CD69 expression, a biomarker of T cell activation, the secretion of both IL-2 and IFNγ, and the proliferation of CD4⁺ cells. Most gratifyingly, there was a positive correlation between these responses and the AP21976 dosage, suggesting the possibility of achieving titratable control of T cells. Human primary CD8⁺ T cells with ON-switch CAR in three different cytotoxicity assays also demonstrated antigen- and AP21976-dependent killing of tumor cells, which was also titratable by AP21976. The killing ability of ON-switch CAR CD8⁺ T cells was reversible, as removal of AP21976 abrogated tumor cell lysis.Wu et al. proceeded to explore in vivo activity in a mouse xenograft model. Due to the short plasma half-life and the high cost of AP21976, the study is limited to a very short-term protocol of 39 h. Tumor cells were injected into the peritoneal cavity 14 h prior to the injection of the engineered T cells. Four injections of AP21976 in the subsequent 25 h were required to induce anti-tumor activity in this intraperitoneal cytotoxicity assay. Further investigations with a more relevant protocol allowing for tumor engraftment and longer term follow-up of T cell effectiveness will be needed to establish whether AP21976 can remotely control ON-switch CAR T cells to reject a tumor.Wu and coauthors have thus engineered a novel ON-switch CAR design and demonstrated titratable, reversible and antigen-dependent T cell functions controlled by a dimerizing small molecule. Another group is also conducting preclinical studies exploring a variant small molecule-controlled CAR design for solid tumor rejection¹⁰. However, there are still challenges to address before future clinical applications. The authors pointed out the need to develop controller chemicals that have clinically optimized pharmacokinetic properties, as the half-life of AP21976 is short and impractical for clinical application. Thus, how many injections per day, for how many weeks or months, would be required to achieve tumor rejection? Another unresolved question is whether a small molecule with optimal pharmacokinetic properties could effectively curb CRS and off-tumor reactivity. Overall, this elegant study provides valuable insights for further refining spatio-temporal control of cell therapy and applying it to CAR T cell technology.     

Flap Endonuclease 1 Limits Telomere Fragility on the Leading Strand

The existence of redundant replication and repair systems that ensure genome stability underscores the importance of faithful DNA replication. Nowhere is this complexity more evident than in challenging DNA templates, including highly repetitive or transcribed sequences. Here, we demonstrate that flap endonuclease 1 (FEN1), a canonical lagging strand DNA replication protein, is required for normal, complete leading strand replication at telomeres. We find that the loss of FEN1 nuclease activity, but not DNA repair activities, results in leading strand-specific telomere fragility. Furthermore, we show that FEN1 depletion-induced telomere fragility is increased by RNA polymerase II inhibition and is rescued by ectopic RNase H1 expression. These data suggest that FEN1 limits leading strand-specific telomere fragility by processing RNA:DNA hybrid/flap intermediates that arise from co-directional collisions occurring between the replisome and RNA polymerase. Our data reveal the first molecular mechanism for leading strand-specific telomere fragility and the first known role for FEN1 in leading strand DNA replication. Because FEN1 mutations have been identified in human cancers, our findings raise the possibility that unresolved RNA:DNA hybrid structures contribute to the genomic instability associated with cancer.     

Protrusive waves guide 3D cell migration along nanofibers

In vivo, cells migrate on complex three-dimensional (3D) fibrous matrices, which has made investigation of the key molecular and physical mechanisms that drive cell migration difficult. Using reductionist approaches based on 3D electrospun fibers, we report for various cell types that single-cell migration along fibronectin-coated nanofibers is associated with lateral actin-based waves. These cyclical waves have a fin-like shape and propagate up to several hundred micrometers from the cell body, extending the leading edge and promoting highly persistent directional movement. Cells generate these waves through balanced activation of the Rac1/N-WASP/Arp2/3 and Rho/formins pathways. The waves originate from one major adhesion site at leading end of the cell body, which is linked through actomyosin contractility to another site at the back of the cell, allowing force generation, matrix deformation and cell translocation. By combining experimental and modeling data, we demonstrate that cell migration in a fibrous environment requires the formation and propagation of dynamic, actin based fin-like protrusions.     

Impaired Bone Homeostasis in Amyotrophic Lateral Sclerosis Mice with Muscle Atrophy

There is an intimate relationship between muscle and bone throughout life. However, how alterations in muscle functions in disease impact bone homeostasis is poorly understood. Amyotrophic lateral sclerosis (ALS) is a neuromuscular disease characterized by progressive muscle atrophy. In this study we analyzed the effects of ALS on bone using the well established G93A transgenic mouse model, which harbors an ALS-causing mutation in the gene encoding superoxide dismutase 1. We found that 4-month-old G93A mice with severe muscle atrophy had dramatically reduced trabecular and cortical bone mass compared with their sex-matched wild type (WT) control littermates. Mechanically, we found that multiple osteoblast properties, such as the formation of osteoprogenitors, activation of Akt and Erk1/2 pathways, and osteoblast differentiation capacity, were severely impaired in primary cultures and bones from G93A relative to WT mice; this could contribute to reduced bone formation in the mutant mice. Conversely, osteoclast formation and bone resorption were strikingly enhanced in primary bone marrow cultures and bones of G93A mice compared with WT mice. Furthermore, sclerostin and RANKL expression in osteocytes embedded in the bone matrix were greatly up-regulated, and β-catenin was down-regulated in osteoblasts from G93A mice when compared with those of WT mice. Interestingly, calvarial bone that does not load and long bones from 2-month-old G93A mice without muscle atrophy displayed no detectable changes in parameters for osteoblast and osteoclast functions. Thus, for the first time to our knowledge, we have demonstrated that ALS causes abnormal bone remodeling and defined the underlying molecular and cellular mechanisms.     

NEDD8 Ultimate Buster 1 Long (NUB1L) Protein Suppresses Atypical Neddylation and Promotes the Proteasomal Degradation of Misfolded Proteins

Neddylation is a posttranslational modification that controls diverse biological processes by covalently conjugating the ubiquitin-like protein NEDD8 to specific targets. Neddylation is commonly mediated by NEDD8-specific enzymes (typical neddylation) and, sometimes, by ubiquitin enzymes (atypical neddylation). Although typical neddylation is known to regulate protein function in many ways, the regulatory mechanisms and biological consequence of atypical neddylation remain largely unexplored. Here we report that NEDD8 conjugates were accumulated in the diseased hearts from mouse models and human patients. Proteotoxic stresses induced typical and atypical neddylation in cardiomyocytes. Loss of NUB1L exaggerated atypical neddylation, whereas NUB1L overexpression repressed atypical neddylation through promoting the degradation of NEDD8. Activation of atypical neddylation accumulated a surrogate misfolded protein, GFPu. In contrast, suppression of atypical neddylation by NUB1L overexpression enhanced GFPu degradation. Moreover, NUB1L depletion accumulated a cardiomyopathy-linked misfolded protein, CryAB^R120G, whereas NUB1L overexpression promoted its degradation through suppressing neddylation of ubiquitinated proteins in cardiomyocytes. Consequently, NUB1L protected cells from proteotoxic stress-induced cell injury. In summary, these data indicate that NUB1L suppresses atypical neddylation and promotes the degradation of misfolded proteins by the proteasome. Our findings also suggest that induction of NUB1L could potentially become a novel therapeutic strategy for diseases with increased proteotoxic stress.     

Strategies for Correcting Very Long Chain Acyl-CoA Dehydrogenase Deficiency

Very long acyl-CoA dehydrogenase (VLCAD) deficiency is a genetic pediatric disorder presenting with a spectrum of phenotypes that remains for the most part untreatable. Here, we present a novel strategy for the correction of VLCAD deficiency by increasing mutant VLCAD enzymatic activity. Treatment of VLCAD-deficient fibroblasts, which express distinct mutant VLCAD protein and exhibit deficient fatty acid β-oxidation, with S-nitroso-N-acetylcysteine induced site-specific S-nitrosylation of VLCAD mutants at cysteine residue 237. Cysteine 237 S-nitrosylation was associated with an 8–17-fold increase in VLCAD-specific activity and concomitant correction of acylcarnitine profile and β-oxidation capacity, two hallmarks of the disorder. Overall, this study provides biochemical evidence for a potential therapeutic modality to correct β-oxidation deficiencies.