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Definitions

• Tumor-specific T cell based immunotherapies including therapies employing engineered T cells, have been investigated for anti-tumor treatment.
• the T cells used in such therapies do not remain active in vivo for long enough periods.
• the tumor-specificity of the T cells is relatively low, in part because of the heterogeneous nature of solid tumors and the potential for off-target effects on noncancerous cells when targeting self antigens. Therefore, there is a need in the art for tumor-specific cancer therapies with improved anti-tumor specificity and function.
• Chimeric antigen receptors are composed of an extracellular tumor recognition/targeting domain, an extracellular linker/spacer, a transmembrane domain, and intracellular T cell-activating and co-stimulatory signaling domains.
• the design of the recognition/targeting domain is critical to avoiding deleterious off-target effects.
• the majority of CAR tumor targeting domains are single chain variable fragments (scFvs) derived from antibody sequences that exploit the specificity of antibody binding to particular antigens.
• scFvs single chain variable fragments
• CAR tumor targeting domains derived from normal receptor ligands such as the IL-13 cytokine CAR that targets cells expressing the IL-13 receptor, IL13Ra2.
• Adoptive T cell therapy utilizing engineered T cells expressing a CAR has demonstrated robust and durable clinical efficacy in patients with CD 19+ B-cell malignancies (Priceman et al. 2015 Curr Opin Oncol; Maus et al. 2014 Blood 123: 2625- 2635. With early successes in hematologic diseases, broader application of this approach to solid tumors is now under intense investigation.
• trastuzumab and pertuzumab the most promising treatment combination of two HER2 -targeted antibodies, trastuzumab and pertuzumab, plus docetaxel yields a median overall survival of 56.5 months and an extension of progression-free survival of only 6.3 months over trastuzumab and docetaxel alone.
• chimeric transmembrane immunoreceptors (chimeric antigen receptors or "CARs") which comprise an extracellular domain, a transmembrane region and an intracellular signaling domain.
• the extracellular domain includes a scFv targeted to HER2 and, optionally, a spacer, comprising, for example, a portion of human Fe domain.
• the transmembrane portion includes, for example, a CD4 transmembrane domain, a CD8 transmembrane domain, a CD28 transmembrane domain, or a CD3 transmembrane domain.
• the intracellular signaling domain includes the signaling domain from the zeta chain of the human CD3 complex ( ⁇ 3 ⁇ ) and one or more costimulatory domains, for example, a 4-IBB or a CD28 costimulatory domain.
• the extracellular domain enables the CAR, when expressed on the surface of a T cell, to direct T cell activity to those cells expressing HER2.
• Such cells include certain breast cancer cells and certain brain cancer cells.
• the inclusion of a costimulatory domain, such as the 4- IBB (CD 137) costimulatory domain in series with CD3 ⁇ in the intracellular region enables the T cell to receive co- stimulatory signals.
• T cells for example, patient-specific, autologous T cells can be engineered to express the CARs described herein, and the engineered cells can be expanded and used in ACT.
• Various T cell subsets including both alpha beta T cells and gamma delta T cells, can be used.
• the CAR can be expressed in other immune cells such as NK cells.
• a patient is treated with an immune cell expressing a CAR described herein the cell can be an autologous T cell or an allogenic T cell.
• the cells used are a cell population that includes both CD4+ and CD8+ central memory T cells (TCM), which are CD62L+, CCR7+, CD45RO+, and CD45RA-, or the cells used are a cell population that includes CD4+ and CD8+ TCM cells, stem central memory T cells and naive T cells (i.e., apopulation of TCM/SCM/N cells).
• TCM central memory T cells
• stem central memory T cells i.e., apopulation of TCM/SCM/N cells.
• TCM/SCM/N cells are CD62L+, CCR7+ and include both CD45RA+ and CD45RO+ cells as well as both CD4+ cells and CD8+ cells.
• the use of such cells can improve long-term persistence of the cells after adoptive transfer compared to the use of other types of patient-specific T cells.
• a nucleic acid molecule encoding a CAR comprising: an scFv targeted to HER2 (e.g.,
• the costimulatory domain is selected from the group consisting of: a CD28 costimulatory domain or a variant thereof having 1-5 (e.g., 1 or 2) amino acid modifications, a 4-lBB costimulatory domain or a variant thereof having 1-5 (e.g., 1 or 2) amino acid modifications and an OX40 costimulatory domain or a variant thereof having 1-5 (e.g., 1 or 2) amino acid modifications.
• a 4- 1BB costimulatory domain or a variant thereof having 1-5 (e.g., 1 or 2) amino acid modifications in present.
• costimulatory domains for example a CD28 co-stimulatory domain or a variant thereof having 1-5 (e.g., 1 or 2) amino acid modifications (e.g., substitutions) and a 4-l BB co-stimulatory domain or a variant thereof having 1-5 (e.g., 1 or 2) amino acid modifications (e.g., substitutions).
• 1-5 e.g., 1 or 2 amino acid modification
• 4-l BB co-stimulatory domain or a variant thereof having 1-5 (e.g., 1 or 2) amino acid modifications e.g., substitutions
• the 1-5 (e.g., 1 or 2) amino acid modification are substitutions.
• the CAR comprises: an scFv targeted to HER2; two different costimulatory domains selected from the group consisting of: a CD28 costimulatory domain or a variant thereof having 1-5 (e.g., 1 or 2) amino acid
• transmembrane domain or a variant thereof having 1-2 amino acid modifications a costimulatory domain (e.g., a CD28 co-stimulatory domain or a variant thereof having 1- 5 (e.g., 1 or 2) amino acid modifications (e.g., substitutions); or a 4-l BB co-stimulatory domain or a variant thereof having 1-5 (e.g., 1 or 2) amino acid modifications (e.g., substitutions); or both a CD28 co-stimulatory domain or a variant thereof having 1-5 (e.g., 1 or 2) amino acid modifications (e.g., substitutions) and a 4-1 BB co-stimulatory domain or a variant thereof having 1-5 (e.g., 1 or 2) amino acid modifications (e.g., substitutions); and ⁇ 3 ⁇ signaling domain of a variant thereof having 1-2 amino acid modifications; a spacer region located between the HER2 scFv or variant thereof and the transmembrane domain (e.g., the spacer region comprises an amino
• costimulatory domain selected from: CD28 and CD28gg.
• 1-5 (e.g., 1 or 2) amino acid modification are substitutions, e.g., conservative substitutions.
• nucleic acid molecule expresses a polypeptide comprising an amino acid sequence selected from SEQ ID NOs: 26-41; the chimeric antigen receptor comprises an amino acid sequence selected from SEQ ID NOs: 26-41.
• the population of human T cells comprise a vector expressing a chimeric antigen receptor comprising an amino acid sequence selected from any of SEQ ID NOs: 26-41 or a variant thereof having 1-5 amino acid modifications (e.g., l or 2) amino acid modifications (e.g., substitutions);
• the population of human T cells comprises central memory T cells (TCM cells) e.g., at least 20%, 30%, 40%, 50% 60%, 70%, 80% of the cells are TCM cells, or the population of T cells comprises a combination of central memory T cells, naive T cells and stem central memory cells (TCM/SCM/N cells) e.g., at least 20%, 30%, 40%, 50% 60%, 70%, 80% of the cells are TCM/SCM/N cells.
• the population of T cells includes both CD4+ cells and CD8+ cells (e.g., at least 20% of the CD3+ T cells are CD4+ and at least 3% of the CD3+ T cells are CD8+ and at least 70, 80 or 90% are either CD4+ or CD8+; at least 15%, 20%, 25%, 30%, 35%, 40%, 50%, 60% of the cells CD3+ cells are CD4+ and at
• CD3+ cells are CD8+ cells.
• a method of treating cancer in a patient comprising administering a population of autologous or allogeneic human T cells (e.g., autologous or allogenic T cells comprising central memory T cells (TCM cells) or a combination of central memory
• a population of autologous or allogeneic human T cells e.g., autologous or allogenic T cells comprising central memory T cells (TCM cells) or a combination of central memory
• T cells naive T cells and stem central memory cells
• the T cells are TCM/SCM/N cells
• the population of T cells includes both CD4+ cells and CD8+ cells (e.g., at least 20% of the CD3+ T cells are CD4+ and at least 3% of the CD3+ T cells are CD8+ and at least 70, 80 or 90% are either CD4+ or CD8+; at least 15%, 20%, 25%, 30%, 35%,
• CD3+ cells 40%, 50%, 60% of the cells CD3+ cells are CD4+ and at least 4%, 5%, 8%, 10%, 20 of the CD3+ cells are CD8+ cells) transduced by a vector comprising an expression cassette encoding a chimeric antigen receptor, wherein chimeric antigen receptor comprises an amino acid sequence selected from SEQ ID NOs: 26-41 or a variant thereof having 1-5
• the cancer is brain cancer, e.g., an HER2-expressing brain cancer that is a metastasis from breast cancer; and the transduced human T cells where prepared by a method comprising obtaining T cells from the patient, treating the T cells to isolate central memory T cells, and transducing at least a portion of the central memory cells to with a viral vector comprising an expression cassette encoding a chimeric antigen receptor, wherein chimeric antigen receptor comprises an amino acid sequence selected from SEQ ID NOs: 26 or 27 or a variant thereof having 1-5 (e.g., 1 or 2) amino acid modifications (e.g., substitutions).
• the CAR T cells are administered not directly the brain tumor, but are instead administered to the intraventricular space within the brain of the patient.
• nucleic acid molecule encoding a polypeptide comprising an amino acid sequence that is at least 95% identical to an amino acid sequence selected from SEQ ID NOs 26-41 ; a nucleic acid molecule encoding an polypeptide comprising an amino acid sequence that is identical to an amino acid sequence selected from SEQ ID NOs: 26-41 except for the presence of no more than 5 amino acid substitutions, deletions or insertions; a nucleic acid molecule encoding an polypeptide comprising an amino acid sequence that is identical to an amino acid sequence selected from SEQ ID NOs:26- 4 1 except for the presence of no more than 5 amino acid substitutions; and a nucleic acid molecule encoding an polypeptide comprising an amino acid sequence that is identical to an amino acid sequence selected from SEQ ID NOs:26-41 except for the presence of no more than 2 amino acid substitutions.
• This disclosure also includes nucleic acid molecules that encode any of the CARs described herein (e.g., vectors that include a nucleic acid sequence encoding one of the CARs) and isolated T lymphocytes that express any of the CARs described herein.
• the CAR described herein can include a spacer region located between the HER2 binding domain (e.g., a HER2 scFv) and the transmembrane domain.
• a spacer region located between the HER2 binding domain (e.g., a HER2 scFv) and the transmembrane domain.
• spacers can be used. Some of them include at least portion of a human Fc region, for example a hinge portion of a human Fc region or a CH3 domain or variants thereof.
• Table 1 below provides various spacers that can be used in the CARs described herein. Table 1: Examples of Spacers
• Some spacer regions include all or part of an immunoglobulin (e.g., IgG l, IgG2, IgG3, IgG4) hinge region, i.e., the sequence that falls between the CHI and CH2 domains of an immunoglobulin, e.g., an IgG4 Fe hinge or a CD8 hinge.
• Some spacer regions include an immunoglobulin CH3 domain or both a CH3 domain and a CH2 domain.
• the immunoglobulin derived sequences can include one or more amino acid modifications, for example, 1, 2, 3, 4 or 5 substitutions, e.g., substitutions that reduce off- target binding.
• amino acid modification refers to an amino acid substitution, insertion, and/or deletion in a protein or peptide sequence.
• An “amino acid substitution” or “substitution” refers to replacement of an amino acid at a particular position in a parent peptide or protein sequence with another amino acid.
• a substitution can be made to change an amino acid in the resulting protein in a non-conservative manner (i.e., by changing the codon from an amino acid belonging to a grouping of amino acids having a particular size or characteristic to an amino acid belonging to another grouping) or in a conservative manner (i.e., by changing the codon from an amino acid belonging to a grouping of amino acids having a particular size or characteristic to an amino acid belonging to the same grouping).
• Amino acids with nonpolar R groups Alanine, Valine, Leucine, Isoleucine, Proline, Phenylalanine, Tryptophan, Methionine
• Amino acids with uncharged polar R groups Glycine, Serine, Threonine, Cysteine, Tyrosine, Asparagine, Glutamine
• Amino acids with charged polar R groups negatively charged at pH 6.0: Aspartic acid, Glutamic acid
• Basic amino acids positively charged at pH 6.0
• Lysine, Arginine, Histidine at pH 6.0
• Another grouping may be those amino acids with phenyl groups: Phenylalanine, Tryptophan, and Tyrosine.
• the spacer is derived from an IgG l, IgG2, IgG3, or IgG4 that includes one or more amino acid residues substituted with an amino acid residue different from that present in an unmodified spacer.
• the one or more substituted amino acid residues are selected from, but not limited to one or more amino acid residues at positions 220, 226, 228, 229, 230, 233, 234, 235, 234, 237, 238, 239, 243, 247, 267, 268, 280, 290, 292, 297, 298, 299, 300, 305, 309, 218, 326, 330, 331, 332, 333, 334, 336, 339, or a combination thereof.
• the first amino acid in the IgG4(L235E,N297Q) spacer in Table 1 is 219 and the first amino acid in the IgG4(HL-CH3) spacer in Table 1 is 219 as is the first amino acid in the IgG hinge sequence and the IgG4 hinge linker (HL) sequence in Table 1
• the modified spacer is derived from an IgGl , IgG2, IgG3, or IgG4 that includes, but is not limited to, one or more of the following amino acid residue substitutions: C220S, C226S, S228P, C229S, P230S, E233P, V234A, L234V, L234F, L234A, L235A, L235E, G236A, G237A, P238S, S239D, F243L, P247I, S267E, H268Q, S280H, K290S, K290E, K290N, R292P, N297A, N297Q, S298A, S298G, S298D, S298V, T299A, Y300L, V305I, V309L, E318A, K326A, K326W, K326E, L328F, A330L, A330S,
• the modified spacer is derived from IgG4 region that includes one or more amino acid residues substituted with an amino acid residue different from that present in an unmodified region.
• the one or more substituted amino acid residues are selected from, but not limited to, one or more amino acid residues at positions 220, 226, 228, 229, 230, 233, 234, 235, 234, 237, 238, 239, 243, 247, 267, 268, 280, 290, 292, 297, 298, 299, 300, 305, 309, 218, 326, 330, 331, 332, 333, 334, 336, 339, or a combination thereof.
• the modified spacer is derived from an IgG4 region that includes, but is not limited to, one or more of the following amino acid residue substitutions: 220S, 226S, 228P, 229S, 230S, 233P, 234A, 234V, 234F, 234A, 235A, 235E, 236A, 237A, 238S, 239D, 243L, 2471, 267E, 268Q, 280H, 290S, 290E, 290N, 292P, 297A, 297Q, 298A, 298G, 298D, 298V, 299A, 300L, 3051, 309L, 318A, 326A, 326W, 326E, 328F, 330L, 330S, 331S, 331S, 332E, 333A, 333S, 333S, 334A, 339D, 339Q, 396L, or a combination thereof,
• EU index or EU numbering scheme For amino acid positions in immunoglobulin discussed herein, numbering is according to the EU index or EU numbering scheme (Kabat et al. 1991 Sequences of Proteins of Immunological Interest, 5th Ed., United States Public Health Service, National Institutes of Health, Bethesda, hereby entirely incorporated by reference).
• the EU index or EU index as in Kabat or EU numbering scheme refers to the numbering of the EU antibody (Edelman et al. 1969 Proc Natl Acad Sci USA 63:78-85).
• transmembrane domains can be used in the.
• Table 2 includes examples of suitable transmembrane domains. Where a spacer domain is present, the transmembrane domain is located carboxy terminal to the spacer domain.
• CARs include one or more (e.g., two) costimulatory domains.
• the costimulatory domain(s) are located between the transmembrane domain and the CD3 ⁇ signaling domain.
• Table 3 includes examples of suitable costimulatory domains together with the sequence of the CD3 ⁇ signaling domain.
• Figure 1 depicts the amino acid sequence of Her2scFv-IgG4(L235E,N297Q)- CD28tm-CD28gg-Zeta-T2A-CD 19t.
• the various domains are listed in order below the sequence and are indicated by alternating underlining and non-underlining.
• the mature CAR sequence (SEQ ID N0:26) does not include the GMCSFRa signal peptide, theT2A skip sequence or truncated CD 19.
• Figure 2 depicts the amino acid sequence of Her2scFv-IgG4(L235E,N297Q)- CD8tm-41BB-Zeta-T2A-CD 19t.
• the various domains are listed in order below the sequence and are indicated by alternating underlining and non-underlining.
• the mature CAR sequence (SEQ ID N0:27) does not include the GMCSFRa signal peptide, theT2A skip sequence or truncated CD 19.
• Figures 3A-D depict HER2-specific CAR constructs and CAR T cell expansion data.
• Figures 4A-D depict in vitro characterization of HER2-CAR T cells against breast cancer cell lines.
• Figures 5A-5F depict the result of studies on the in vitro tumor activity of HER2- CAR T cells.
• Figures 6A-6I depict the result of studies on the in vivo anti-tumor efficacy of local intratumorally-delivered HER2-CAR T cells.
• Figures 7A-7D depict the results of studies on local delivery of HER2-CAR T cells in human orthotopic BBM xenograft models.
• Figures 8A-8D depict the results of studies on intraventrical delivery of HER2- CAR T cells.
• Figures 9-14 Depict additional CAR targeted to HER2.
• FIGS 15A-15C depict the results of studies characterizing certain additional CAR with various spacers.
• the IgG3(EQ) is in Figure 2; DeltaCh2 is in Figure 11 ; CD8h is in Figure 9; HL is in Figure 10; and L is in Figure 14.
• Figures 16A-16C show the results of studies examining CD 107a and INF gamma produced when TCM expressing the varios CAAR are exposed to cells not expressing HER2 (MDA- MB-468), low HER2 (231BR), low HER2 (231BRHER2LO) or high HER2
• Figures 17A-17D show the results of studies examining PD-1 production and tumor cell killing ins various cell lines with the CAR of Figure 2 ( ⁇ 2( ⁇ (3 ⁇ 4 ⁇ or Figure 14
• FIGS. 18A-18B show the results of studies examining CD 107a and INF gamma produced when TCM expressing the varios CAAR are exposed to cells not expressing HER2 (MDA- MB-468), low HER2 (231BR), low HER2 (231BRHER2LO) or high HER2
• HER2 chimeric antigen receptors targeting HER2 and useful in treating HER2-expressing breast cancer as well as breast to brain metastasis.
• the CAR described herein can be used in ACT to treat HER2 expressing tumors in the brain by intraventricular or intratumoral delivery.
• a chimeric antigen is a recombinant biomolecule that contains, at a minimum, an extracellular recognition domain, a transmembrane region, and an intracellular signaling domain.
• a CAR can include a ligand that specifically binds a cell surface receptor.
• the extracellular recognition domain (also referred to as the extracellular domain or simply by the recognition element which it contains) comprises a recognition element that specifically binds to a molecule present on the cell surface of a target cell.
• the transmembrane region anchors the CAR in the membrane.
• the intracellular signaling domain comprises the signaling domain from the zeta chain of the human CD3 complex and optionally comprises one or more costimulatory signaling domains.
• CARs can both to bind antigen and transduce T cell activation, independent of MHC restriction.
• CARs are "universal" immunoreceptors which can treat a population of patients with antigen-positive tumors irrespective of their HLA genotype.
• Adoptive immunotherapy using T lymphocytes that express a tumor-specific CAR can be a powerful therapeutic strategy for the treatment of cancer.
• the CAR described herein can be produced using a vector in which the CAR open reading frame is followed by a T2A ribosome skip sequence and a truncated CD 19 (CD19t), which lacks the cytoplasmic signaling tail (truncated at amino acid 323).
• CD19t provides an inert, non- immunogenic surface marker that allows for accurate measurement of gene modified cells, and enables positive selection of gene-modified cells, as well as efficient cell tracking and/or imaging of the therapeutic T cells in vivo following adoptive transfer.
• Co-expression of CD 19t provides a marker for immunological targeting of the transduced cells in vivo using clinically available antibodies and/or immunotoxin reagents to selectively delete the therapeutic cells, and thereby functioning as a suicide switch.
• the CAR described herein can be produced by any means known in the art, though preferably it is produced using recombinant DNA techniques.
• Nucleic acids encoding the several regions of the chimeric receptor can be prepared and assembled into a complete coding sequence by standard techniques of molecular cloning known in the art (genomic library screening, PCR, primer-assisted ligation, site-directed mutagenesis, etc.) as is convenient.
• the resulting coding region is preferably inserted into an expression vector and used to transform a suitable expression host cell line, preferably a T lymphocyte cell line, and most preferably an autologous T lymphocyte cell line.
• Various T cell subsets isolated from the patient including unselected PBMC or enriched CD3 T cells or enriched CD3 or memory T cell subsets or TCM or TCM/SCM/N can be transduced with a vector for CAR expression.
• Central memory T cells are one useful T cell subset.
• Central memory T cell can be isolated from peripheral blood mononuclear cells (PBMC) by enriching for CD45RO+/CD62L+ cells, using, for example, the
• CliniMACS® device to immunomagnetically select cells expressing the desired receptors.
• the cells enriched for central memory T cells can be activated with anti- CD3/CD28, transduced with, for example, a SIN lentiviral vector that directs the expression of the CAR as well as a truncated human CD 19 (CD19t), a non-immunogenic surface marker for both in vivo detection and potential ex vivo selection.
• the activated/genetically modified central memory T cells can be expanded in vitro with IL- 2/IL-15 and then cryopreserved.
• One CAR comprising a HER2 scFv described herein is referred to as Her2scFv- IgG4(L235E, N297Q)-CD28tm-CD28gg-Zeta-T2A-CD19t.
• This CAR includes a variety of important features including: a scFv targeted to HER2; an IgG4 Fe region that is mutated at two sites within the CH2 region (L235E; N297Q) in a manner that reduces binding by Fe receptors (FcRs); a CD28 transmembrane domain, a CD28 co-stimulatory domain, and CD3 ⁇ activation domain.
• Figure 1 presents the amino acid sequence of this CAR, including the sequence of the truncated CD 19 sequence used for monitoring CAR expression and the T2A ribosomal skip sequence that allows the CAR to be produced without fusion of the truncated CD 19 sequence.
• the immature CAR includes: GMCSFR signal peptide, HER2 scFv, IgG4 that acts as a spacer, a CD8 transmembrane domain, a 4-IBB co-stimulatory domain that includes a LL to GG sequence alteration, a three Gly sequence, CD3 Zeta stimulatory domain.
• the transcript also encodes a T2A ribosomal sequence and a truncated CD 19 sequence that are not part of the CAR protein sequence.
• the mature CAR is identical to the immature CAR, but lacks the GMCSF signal peptide.
• the epFflV7 vector is a vector that can used for expression of the HER2-specific CAR. Is was produced from pFflV7 vector. Importantly, this vector uses the human EFI promoter to drive expression of the CAR. Both the 5' and 3' sequences of the vector were derived from pv653RSN as previously derived from the FIXBc2 provirus.
• the polypurine tract DNA flap sequences (cPPT) were derived from FflV-I strain pNL4-3 from the NTH AIDS Reagent Repository.
• the woodchuck post-transcriptional regulatory element (WPRE) sequence was previously described.
• pv653RSN containing 653 bp from gag-pol plus 5' and 3' long-terminal repeats (LTRs) with an intervening SL3 -neomycin phosphotransferase gene (Neo), was subcloned into pBluescript, as follows: In Step I , the sequences from 5' LTR to rev-responsive element (RRE) made p5 'FflV-I 51 , and then the 5' LTR was modified by removing sequences upstream of the TATA box, and ligated first to a CMV enhancer and then to the SV40 origin of replication (p5'FflV-2).
• RRE rev-responsive element
• Step 2 after cloning the 3' LTR into pBluescript to make p3THV-l, a 400-bp deletion in the 3' LTR enhancer/promoter was made to remove cis- regulatory elements in HIV U3 and form p3'FflV-2.
• Step 3 fragments isolated from the p5'fflV-3 and p3'HIV-2 were ligated to make pfflV-3.
• Step 4 the p3'HIV-2 was further modified by removing extra upstream HIV sequences to generate p3 HIV-3 and a 600-bp BamHI-Sall fragment containing WPRE was added to p3 'HIV-3 to make the p3'HIV-4.
• Step 5 the pfflV-3 RRE was reduced in size by PCR and ligated to a 5' fragment from pHTV-3 (not shown) and to the p3 'HIV-4, to make pHIV-6.
• Step 6 a 190-bp Bglll-BamHI fragment containing the cPPT DNA flap sequence from HIV- 1 pNL4-3 (55) was amplified from pNL4-3 and placed between the RRE and the WPRE sequences in pHTV6 to make pHIV- 7.
• This parent plasmid pHTV7-GFP (GFP, green fluorescent protein) was used to package the parent vector using a four-plasmid system.
• a packaging signal, psi ( ⁇ ), is required for efficient packaging of viral genome into the vector.
• the RRE and WPRE enhance the RNA transcript transport and expression of the transgene.
• the flap sequence, in combination with WPRE, has been demonstrated to enhance the transduction efficiency of lentiviral vector in mammalian cells.
• helper functions required for production of the viral vector
• l) pCgp encodes the gag/pol protein required for viral vector assembly
• pCMV-Rev2 encodes the Rev protein, which acts on the RRE sequence to assist in the transportation of the viral genome for efficient packaging
• pCMV-G encodes the glycoprotein of the vesiculo-stomatitis virus (VSV), which is required for infectivity of the viral vector.
• VSV vesiculo-stomatitis virus
• the regions of homology include a packaging signal region of approximately 600 nucleotides, located in the gag/pol sequence of the pCgp helper plasmid; a CMV promoter sequence in all three helper plasmids; and a RRE sequence in the helper plasmid pCgp. It is highly improbable that replication competent recombinant virus could be generated due to the homology in these regions, as it would require multiple recombination events. Additionally, any resulting recombinants would be missing the functional LTR and tat sequences required for lentiviral replication.
• the CMV promoter was replaced by the EFla-HTLV promoter (EFlp), and the new plasmid was named epHTV7.
• the EFlp has 563 bp and was introduced into epHTV7 using Nrul and Nhel, after the CMV promoter was excised.
• the lentiviral genome excluding gag/pol and rev that are necessary for the pathogenicity of the wild-type virus and are required for productive infection of target cells, has been removed from this system.
• the vector construct does not contain an intact 3'LTR promoter, so the resulting expressed and reverse transcribed DNA proviral genome in targeted cells will have inactive LTRs.
• no FflV-I derived sequences will be transcribed from the provirus and only the therapeutic sequences will be expressed from their respective promoters.
• the removal of the LTR promoter activity in the SIN vector is expected to significantly reduce the possibility of unintentional activation of host genes.
• Vectors for transduction of patient T cells can be prepared as follows. For each plasmid the plasmid expressing the CAR and, optionally, a marker such as truncated CD19; 2) pCgp; 3) pCMV-G; and 4) pCMV-Rev2), a seed bank is generated, which is used to inoculate the fermenter to produce sufficient quantities of plasmid DNA. The plasmid DNA is tested for identity, sterility and endotoxin prior to its use in producing lentiviral vector.
• a marker such as truncated CD19; 2) pCgp; 3) pCMV-G; and 4) pCMV-Rev2
• cells are expanded from the 293T working cell (WCB), which has been tested to confirm sterility and the absence of viral contamination.
• a vial of 293T cells from the 293T WCB is thawed.
• Cells are grown and expanded until sufficient numbers of cells exists to plate an appropriate number of 10 layer cell factories (CFs) for vector production and cell train maintenance.
• CFs layer cell factories
• the lentiviral vector is produced in sub-batches of up to 10 CFs. Two sub-batches can be produced in the same week leading to the production of approximately 20 L of lentiviral supernatant/week. The material produced from all sub-batches is pooled during the downstream processing phase, in order to produce one lot of product.
• 293 T cells are plated in CFs in 293T medium (DMEM with 10% FBS). Factories are placed in a 37°C incubator and horizontally leveled in order to get an even distribution of the cells on all the layers of the CF.
• the initial tangential flow ultrafiltration (TFF) concentration of the endonuclease-treated supernatant is used to remove residual low molecular weight components from the crude supernatant, while concentrating the virus ⁇ 20 fold.
• the clarified endonuclease-treated viral supernatant is circulated through a hollow fiber cartridge with a NMWCO of 500 kD at a flow rate designed to maintain the shear rate at -4,000 sec "1 or less, while maximizing the flux rate.
• Diafiltration of the nuclease-treated supernatant is initiated during the concentration process to sustain the cartridge performance.
• An 80% permeate replacement rate is established, using 4% lactose in PBS as the diafiltration buffer.
• the viral supernatant is brought to the target volume, representing a 20-fold concentration of the crude supernatant, and the diafiltration is continued for 4 additional exchange volumes, with the permeate replacement rate at 100%.
• Further concentration of the viral product is accomplished by using a high speed centrifugation technique.
• Each sub-batch of the lentivirus is pelleted using a Sorvall RC- 26 plus centrifuge at 6000 RPM (6,088 RCF) at 6°C for 16-20 h.
• the viral pellet from each sub-batch is then reconstituted in a 50 ml_ volume with 4% lactose in PBS.
• the reconstituted pellet in this buffer represents the final formulation for the virus preparation.
• the entire vector concentration process results in a 200-fold volume reduction, approximately. Following the completion of all of the sub-batches, the material is then placed at -80°C, while samples from each sub-batch are tested for sterility.
• the sub-batches are rapidly thawed at 37°C with frequent agitation.
• the material is then pooled and manually aliquoted in the Class II Type A/B3 biosafety cabinet.
• a fill configuration of 1 rriL of the concentrated lentivirus in sterile USP class 6, externally threaded 0-ring cryovials is used.
• TCM are to be used to express the CAR
• suitable patient cells can be prepared as follows. First, T lymphocytes are obtained from a patient by leukopheresis, and the appropriate allogenic or autologous T cell subset, for example, Central Memory T cells (TCM), are genetically altered to express the CAR, then administered back to the patient by any clinically acceptable means, to achieve anti-cancer therapy.
• TCM Central Memory T cells
• Suitable TcM can be generated as follow. Apheresis products obtained from consented research participants are ficolled, washed and incubated overnight. Cells are then depleted of monocyte, regulatory T cell and naive T cell populations using GMP grade anti-CD 14, anti-CD25 and anti-CD45RA reagents (Miltenyi Biotec) and the CliniMACSTM separation device. Following depletion, negative fraction cells are enriched for CD62L+ TCM cells using DREG56-biotin (COH clinical grade) and anti- biotin microbeads (Miltenyi Biotec) on the CliniMACSTM separation device.
• TCM cells are formulated in complete X-Vivol 5 plus 50
• IU/mL IL-2 and 0.5 ng/mL IL-15 are transferred to a Teflon cell culture bag, where they are stimulated with Dynal ClinExTM Vivo CD3/CD28 beads.
• MOI multiplicity of infection
• Cultures are maintained for up to 42 days with addition of complete X-Vivol 5 and IL-2 and IL-15 cytokine as required for cell expansion (keeping cell density between 3x10 5 and 2x10 6 viable cells/mL, and cytokine supplementation every Monday, Wednesday and Friday of culture). Cells typically expand to approximately 10 9 cells under these conditions within 21 days.
• cells are harvested, washed twice and formulated in clinical grade cryopreservation medium (Cryostore CS5, BioLife Solutions).
• cryopreserved and released product On the day(s) of T cell infusion, the cryopreserved and released product is thawed, washed and formulated for re-infusion.
• the cryopreserved vials containing the released cell product are removed from liquid nitrogen storage, thawed, cooled and washed with a PBS/2% human serum albumin (HSA) Wash Buffer. After centrifugation, the supernatant is removed and the cells resuspended in a Preservative-Free Normal Saline (PFNS)/2% HSA infusion diluent. Samples are removed for quality control testing.
• PFNS Preservative-Free Normal Saline
• HSA Preservative-Free Normal Saline
• Figure 3A is a schematic diagram of two the HER2-specifc CAR constructs depicted in Figure 1 and Figure 2.
• ⁇ 2( ⁇ (3 ⁇ 428 ⁇ the scFv is tethered to the membrane by a modified IgG4 Fc linker (double mutant, L235E; N297Q), containing a CD28 transmembrane domain, an intracellular CD28 co-stimulatory domain and a cytolytic CD3 ⁇ domain.
• the T2A skip sequence separates the CAR from a truncated CD 19 (CD19t) protein employed for cell tracking.
• HER2(EQ)BB ⁇ is similar except that the costimulatory domain is 4-1 BB rather than CD28 and the transmembrane domain is a CD8 transmembrane domain rather than a CD28 transmembrane domain.
• Human central memory (TCM) cells were transfected with a lentiviral vector expressing either
• Figure 3B depicts representative FACS data of human TCM surface phenotype.
• Figure 3C depicts the results of assays for CD 19 and Protein L expression in TCM transfected with a lentiviral vector expressing either
• HER2-negative lines LCL lymphoma, MDA-MB-468, U87 glioma
• low-HER2 expressing lines MDA-MB-361, 231BR
• high-HER2 expressing lines SKBR3, BT474, BBM l
• Flow cytometry gated on CAR+ T cells was used to characterize CD 107a degranulation and IFNy production in Mock
• PD-1 induction in CD8+ CAR T cells following a 72h co- culture with tumor targets that are HER2 -negative (LCL lymphoma, MDA-MB-468, U87 glioma), low-HER2 expressing (MDA-MB-361, 231BR) or high-HER2 expressing (SKBR3, BT474, BBM 1) was measured, and the results of this analysis are presented in Figure 5C.
• Tumor cell killing with Effector Tumor (E:T) ratio ranging from 0.25: 1 to 2: 1 was measured for both ⁇ 3 ⁇ 42( ⁇ (3 ⁇ 428 ⁇ or ⁇ 3 ⁇ 42( ⁇ (3 ⁇ 4 ⁇ CAR T cells.
• the results of this analysis are presented in Figure 5D, which shows that both ⁇ 3 ⁇ 42( ⁇ (3 ⁇ 428 ⁇ and HER2(EQ)BB ⁇ are effective in tumor cell killing in vitro.
• CFSE proliferation of HER2-CAR T cells following a 72h co-culture with MDA-MB-468 or BBMl cells was measured by flow cytometry.
• the results of this analysis are presented in Figure 5E, which shows that ⁇ 3 ⁇ 42( ⁇ (3 ⁇ 4 ⁇ CAR T cells proliferate more than ⁇ 3 ⁇ 42( ⁇ (3 ⁇ 428 ⁇ CAR T cells.
• FIGS. 6A-6C are H&E staining of tumors. Mice were treating by injection directly into the tumor with Mock (untransduced) or ⁇ 3 ⁇ 42( ⁇ (3 ⁇ 4 ⁇ CAR T cells.
• Figures 6D-6F depict the results of optical imaging of the tumors and Figures 6G-61are Kaplan-Meier survival curves for mice treated locally with either at day 3, 8 or 14 post tumor injection. These studies show that ⁇ 3 ⁇ 42( ⁇ (3 ⁇ 4 ⁇ CAR T cells have potent anti -tumor efficacy in vivo when injected directly into the tumor.
• BBM1 cells 0.2M
• BT474 0.15M
• BT474 (Figure 7B) tumors were monitored by luciferase-based optical imaging. Kaplan Meier curves are presented in Figure 7C and Figure 7D.
• FIG. 8A illustrates the region of tumor implantation by stereotactic injection of BBM I cells (0.2M), and intraventricular T cell delivery. Staining of tumors is depicted in Figure 8B. At day 14 post tumor injection, HER2(EQ)28 ⁇ HER2(EQ)BB ⁇ or Mock (untransduced) T cells (0.5M) were injected intratumorally. Tumor growth was monitored by luciferase- based optical imaging.
• Figures 8C presents the flux averages for each treatment group, and Figure 8D presents the Kaplan Meier survival curve for each treatment group.
• FIGS 9-14 depict the amino acid sequences of a various CAR having different linkers. Specifically, the CAR differ in the sequence and length of the portion between the HER2 targeted scFv and the transmembrane domain.
• the transmembrane domain is CD8, CD28 or CD28gg.
• the co- stimulatory domain is 4-1BB or CD28. All have a CD3 ⁇ stimulatory domain.
• a T2A skip sequence separates the CAR from a truncated CD 19 (CD19t) protein employed for cell tracking.
• Figure 15A schematically depicts various HER2 CAR that are identical except for the sequence and length of the portion between the HER2 scFv and the CD8
• FIG. 15B depicts the results of assays for CD 19 and Protein L expression in TCM transfected with a lentiviral vector expressing the indicated CAR. As can be seen from these results, transfection efficiency as assessed by CD 19 expression was similar for both CAR. However, Protein L expression was lower for ⁇ 2( ⁇ (3) ⁇ than for HER2(EQ)28C suggesting that the HER2(EQ)BBC CAR is less stable that the
• FIG. 15C shows that none of the CAR interfere with T cell expansion.
• Figures 16-18 show the results of additional studies showing that a CAR with a very short spacer (Figure 14) is relatively selective for CAR expressing high levels of HER2. Such CAR may be useful in treating HER2 expressing cancers where it is desirable to spare cells expressing a lower level of HER2 than the cancerous cells.

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