ALBERT

Description: Chimeric Antigen Receptors (CARs) are engineered transmembrane proteins consisting of an antibody-derived antigen recognition domain linked to intracellular cell signaling domains. CAR engineered autologous T cells have been successful in the treatment of a variety of hematologic malignancies. However, several major caveats, including lack of universal donors, long manufacturing times, and absence of a donor in immunologically frail patients, have limited the successful translation of CAR-T cell based therapy to a larger pool of patients. A universal, easy to manufacture, "off the shelf" CAR-based product could potentially address these limitations and result in a lower cost of goods. Towards developing an "off the shelf" CAR-based therapy for Multiple Myeloma (MM), we explored the feasibility and preclinical efficacy of expressing CD38 CARs in KHYG-1 cells, a natural killer (NK) cell line, first established by Yagita et al from a patient with aggressive NK leukemia (Leukemia, 2000). To this end, we effectively transduced KHYG-1 cells with high-affinity CD38 CARs as well as our recently reported affinity-optimized CD38 CARs, which can readily target MM cells with high CD38 expression, while ignoring non-malignant cells with intermediate, low or no CD38 expression when brought to expression on T cells (Drent et al, Molecular Therapy 2017). Moreover, we assessed performance of first and second generation CARs, with co-stimulatory domains CD28 and 4-1BB, and found the combination of CD28/CD3ζ to lead to the best results. After expanding the CAR transduced KHYG-1 cells, we analyzed their phenotype and efficacy in MM by analyzing their cytotoxic activity against CD38+ and CD38- MM and AML cell lines (UM9/THP-1 and U266/HL60, respectively), and against primary MM cells. The CD38-CAR transduced KHYG-1 cells showed no phenotypic alterations, and at effector to target ratios as low as 1:1, induced a high cytotoxicity towards CD38+ cell lines as compared to mock or non-transduced KHYG-1, demonstrating the important contribution of the CD38 CAR on the KHYG-1 NK cell surface. CD38- cell lines were unaffected by both CD38-CAR transduced KHYG-1 cells and mock or non-transduced KHYG-1 cells, indicating the specificity towards CD38 of the CAR and thus the potential safety of the CD38-CAR KHYG-1 cell. Similarly, ex vivo assays using primary MM cells revealed superior cytotoxic activity of CD38-CAR KHYG-1 cells as compared to mock or non-transduced KHYG-1 cells (median 86,5% vs 14% at 1:1 E:T ratio, n=2, Figure 1A). Confirming our previous results we identified an affinity-optimized CD38-CAR which mediated strong primary MM cell cytotoxicity with little or no "off tumor" effect. Normal immune cells (B, T, monocytes), which were either CD38 negative or only intermediate positive, were unaffected (Figure 1B-D), suggesting the potential safety of the CAR-NK cell therapy for clinical applications. As clinical administration would require irradiation of CD38-CAR KHYG-1 cells, we tested the effect of irradiation on their proliferative and cytotoxicity potential. Irradiation with 10Gy, while drastically inhibiting proliferative activity and viability (50% survival after 3 days), did not affect cytotoxicity, suggesting that repeated administrations of irradiated, CD38-CAR transduced KYHG-1 cells may exert effective in vivo anti-tumor activity, which is currently being evaluated in appropriate in vivo models, specifically the humanized bone scaffold in vivo model published by Groen et al (Blood, 2012). In conclusion, we demonstrate that the incorporation of CAR technology into the immortal NK cell line KHYG-1 has enormous potential to become a safe and effective "off the shelf" therapy for MM. Disclosures Stikvoort: Onkimmune: Research Funding. Sarkar:Onkimmune: Research Funding. van de Donk:Amgen: Research Funding; Janssen Pharmceuticals: Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Novartis: Research Funding; Bristol-Myers Squibb: Research Funding; Celgene: Research Funding. Zweegman:Takeda: Membership on an entity's Board of Directors or advisory committees, Research Funding; Takeda: Membership on an entity's Board of Directors or advisory committees, Research Funding; Celgene Corp.: Membership on an entity's Board of Directors or advisory committees, Research Funding; Janssen: Membership on an entity's Board of Directors or advisory committees, Research Funding. O'Dwyer:Janssen: Membership on an entity's Board of Directors or advisory committees, Research Funding; Onkimmune: Equity Ownership, Membership on an entity's Board of Directors or advisory committees, Research Funding; BMS: Research Funding; Celgene: Research Funding; Glycomimetics: Research Funding; Abbvie: Membership on an entity's Board of Directors or advisory committees. Mutis:Gilead: Research Funding; Celgene: Research Funding; Novartis: Research Funding; OnkImmune: Research Funding; Genmab: Research Funding; Janssen: Membership on an entity's Board of Directors or advisory committees, Research Funding.

Description: Chimeric Antigen Receptors (CARs) are engineered transmembrane proteins consisting of an antibody (ab)-derived antigen recognition domain linked to intracellular T cell signaling domains. Cytotoxic T cells endowed with tumor-reactive CARs are highly promising tools for immunotherapy of cancer. There are however only a few truly tumor specific molecules that can be targeted by CARs, a drawback for the broad application of CAR T cell therapy. Indeed, when we recently aimed at targeting CD38high multiple myeloma (MM) with T cells transduced with high affinity CD38CARs, we observed that they not only lysed the CD38high MM cells but also CD38+ normal hematopoietic cells, pointing towards potential safety issues of such tumor-associated, but not entirely tumor-specific CARs. Therefore, using CD38 as a model for antigen we now tested whether it would be possible to reduce the on target, off-tumor effects of such CARs by optimizing their target cell affinity. To this end, we generated a new panel of CD38 abs through the "light chain exchange" method, in which heavy chains of two high affinity CD38 abs were combined with 176 different germ line light chains. This approach revealed around 100 new abs, which displayed 10- 〉1000 fold lower affinity to CD38 as compared to the parental abs. After categorizing them in three classes based on CD38 binding affinity, we used 8 abs from each class to generate 24 different CD38-CAR constructs. Testing the cytotoxic activity of T cells transduced with these CD38-CARs against CD38++ MM cell lines, primary MM cells and CD38+ normal hematopoietic cells in vitro and in vivo demonstrated that CD38-CAR T cells with ca. 1000 fold lower affinity to CD38 could still effectively lyse CD38++ MM cells while there was little or no cytotoxicity against CD38+ healthy hematopoietic cells. The results of this study reveal that it is possible to reduce the on-target off-tumor effects of CARs by optimizing their affinity. Thus, tailored affinity of the ab binding domain may open up new roads for CAR therapy. Disclosures van de Donk: Janssen: Research Funding; Celgene: Research Funding; BMS: Research Funding; Amgen: Research Funding. Lokhorst:Janssen: Membership on an entity's Board of Directors or advisory committees, Research Funding; Genmab: Research Funding. Mutis:Celgene: Research Funding; Genmab: Research Funding; Janssen: Membership on an entity's Board of Directors or advisory committees, Research Funding.

Description: The tumor microenvironment of multiple myeloma (MM) is known to play a critical role in disease pathogenesis, MM cell survival, and drug resistance. In addition, we have previously demonstrated the impact of the microenvironment also on immunotherapies. We discovered that bone marrow mesenchymal stromal cells (BMMSCs) protected MM cells from HLA restricted CD4 and CD8 cytotoxic T cells and NK cell-mediated daratumumab dependent cytotoxicity through a cell-adhesion mediated immune resistance (CAM-IR). This CAM-IR corresponded with the upregulation of anti-apoptotic proteins Survivin and Mcl-1 in MM cells and could be modulated by small inhibitors of these molecules. We now extended our studies to investigate the impact of the microenvironment on novel immunotherapeutic approaches such as chimeric antigen receptor-transduced T cells (CAR T cells) and death receptor mediated antibody treatments, which can induce direct apoptosis in MM cells. We also investigated the possibility to modulate CAM-IR with small molecule inhibitors of Survivin, XIAP, and Mcl-1. To this end, we tested a panel of MM reactive CAR T cells directed against CD38, BCMA, and CD138, with different target affinities, for their potential to kill MM cells in the absence or presence of BMMSCs. We observed no effect of BMMSCs on the cytotoxic capacity of BCMA- and CD38-targeting CAR T cells with high affinity for the target and that were capable of inducing high levels of MM cell lysis at very low effector to target ratios. In contrast, BMMSCs effectively protected MM cells against killing by BCMA- and CD38-targeting CAR T cells with relative low affinity, or CD138-targeting CAR T cells that were less powerful in their lytic activity. Taken together, we discovered a significant inverse correlation between the lytic capacity of the CAR T cells and the extent of BMMSC-mediated protection. Additionally, we found that BMMSCs protected MM cells from apoptosis induction by death receptor 5 (DR5; or TRAIL receptor 2) antibodies. In all cases of BMMSC-mediated protection against CAR T cells as well as DR5 antibodies or daratumumab, the protection could be abrogated by an inhibitor of Survivin, XIAP, and Mcl-1. This indicates that BMMSC-mediated protection against CAR T cell or antibody-mediated lysis is indeed associated with an upregulation of anti-apoptotic proteins, similarly to the well-described cell adhesion mediated drug resistance. In conclusion, our results confirm the potential negative impact of the tumor microenvironment in the development of an adaptive resistance of MM cells against immunotherapies. Our data further suggest that this microenvironmental shielding of MM cells can be overcome either by increasing the avidity of immune killer cells or through combination of immunotherapy with inhibitors of anti-apoptotic mediators. Figure 1 Disclosures Li: Canget Bio Tekpharma LLC: Membership on an entity's Board of Directors or advisory committees. Zweegman:Celgene: Membership on an entity's Board of Directors or advisory committees, Research Funding; Takeda: Membership on an entity's Board of Directors or advisory committees, Research Funding; Janssen Pharmaceuticals: Membership on an entity's Board of Directors or advisory committees, Research Funding. Themeli:Covagen: Consultancy. Van De Donk:Janssen Pharmaceuticals: Membership on an entity's Board of Directors or advisory committees, Research Funding; Bristol-Myers Squibb: Membership on an entity's Board of Directors or advisory committees, Research Funding; AMGEN: Membership on an entity's Board of Directors or advisory committees, Research Funding; Takeda: Membership on an entity's Board of Directors or advisory committees; Servier: Membership on an entity's Board of Directors or advisory committees; Celgene Corporation: Membership on an entity's Board of Directors or advisory committees, Research Funding; Bayer: Membership on an entity's Board of Directors or advisory committees; Roche: Membership on an entity's Board of Directors or advisory committees. Mutis:Aduro: Research Funding; Celgene: Research Funding; BMS: Research Funding; Amgen: Research Funding; Onkimmune: Research Funding; Janssen Pharmaceuticals: Research Funding; Novartis: Research Funding.