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  • A61K39/00—Medicinal preparations containing antigens or antibodies
  • A61K39/395—Antibodies; Immunoglobulins; Immune serum, e.g. antilymphocytic serum
  • A61K39/39533—Antibodies; Immunoglobulins; Immune serum, e.g. antilymphocytic serum against materials from animals
  • A61K39/39558—Antibodies; Immunoglobulins; Immune serum, e.g. antilymphocytic serum against materials from animals against tumor tissues, cells, antigens
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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  • A61K39/395—Antibodies; Immunoglobulins; Immune serum, e.g. antilymphocytic serum
• • A—HUMAN NECESSITIES
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  • A61K40/00—Cellular immunotherapy
  • A61K40/10—Cellular immunotherapy characterised by the cell type used
  • A61K40/15—Natural-killer [NK] cells; Natural-killer T [NKT] cells
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  • A61K40/40—Cellular immunotherapy characterised by antigens that are targeted or presented by cells of the immune system
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  • A61K40/42—Cancer antigens
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  • C07K14/705—Receptors; Cell surface antigens; Cell surface determinants
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  • C07K16/28—Immunoglobulins [IG], e.g. monoclonal or polyclonal antibodies against material from animals or humans against receptors, cell surface antigens or cell surface determinants
  • C07K16/2803—Immunoglobulins [IG], e.g. monoclonal or polyclonal antibodies against material from animals or humans against receptors, cell surface antigens or cell surface determinants against the immunoglobulin superfamily
  • C07K16/2833—Immunoglobulins [IG], e.g. monoclonal or polyclonal antibodies against material from animals or humans against receptors, cell surface antigens or cell surface determinants against the immunoglobulin superfamily against MHC-molecules, e.g. HLA-molecules
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  • C07K16/28—Immunoglobulins [IG], e.g. monoclonal or polyclonal antibodies against material from animals or humans against receptors, cell surface antigens or cell surface determinants
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  • C12N5/00—Undifferentiated human, animal or plant cells, e.g. cell lines; Tissues; Cultivation or maintenance thereof; Culture media therefor
  • C12N5/06—Animal cells or tissues; Human cells or tissues
  • C12N5/0602—Vertebrate cells
  • C12N5/0634—Cells from the blood or the immune system
  • C12N5/0646—Natural killers cells [NK], NKT cells
• • A—HUMAN NECESSITIES
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• • A—HUMAN NECESSITIES
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  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K2300/00—Mixtures or combinations of active ingredients, wherein at least one active ingredient is fully defined in groups A61K31/00 - A61K41/00
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  • C07K2317/00—Immunoglobulins specific features
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  • C07K2317/32—Immunoglobulins specific features characterized by aspects of specificity or valency specific for a neo-epitope on a complex, e.g. antibody-antigen or ligand-receptor
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  • C07K2317/33—Crossreactivity, e.g. for species or epitope, or lack of said crossreactivity
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  • C07K2317/00—Immunoglobulins specific features
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  • C07K2317/34—Identification of a linear epitope shorter than 20 amino acid residues or of a conformational epitope defined by amino acid residues
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  • C07K2317/00—Immunoglobulins specific features
  • C07K2317/40—Immunoglobulins specific features characterized by post-translational modification
  • C07K2317/41—Glycosylation, sialylation, or fucosylation
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  • C07—ORGANIC CHEMISTRY
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  • C07K2317/00—Immunoglobulins specific features
  • C07K2317/70—Immunoglobulins specific features characterized by effect upon binding to a cell or to an antigen
  • C07K2317/73—Inducing cell death, e.g. apoptosis, necrosis or inhibition of cell proliferation
  • C07K2317/732—Antibody-dependent cellular cytotoxicity [ADCC]
• • C—CHEMISTRY; METALLURGY
  • C07—ORGANIC CHEMISTRY
  • C07K—PEPTIDES
  • C07K2319/00—Fusion polypeptide
  • C07K2319/01—Fusion polypeptide containing a localisation/targetting motif
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  • C12N2502/00—Coculture with; Conditioned medium produced by
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  • C12N2510/00—Genetically modified cells

Definitions

• the invention relates generally to a process for producing personalized cancer immunotherapies which may be customized on a patient-by-patient basis. More specifically, it relates to antibodies targeting neoepitopes on the surface of diseased cells , with the antibodies acting in concert with immune cells.
• Cancer immunotherapy is the use of immune cells, immune system-related molecules, or immunization methods to treat cancer.
• immunotherapy approaches include checkpoint blockade, targeted therapy with monoclonal antibodies, adoptive cellular therapies, and therapeutic immunization with cancer antigens.
• Checkpoint blockade antibodies e.g. ipilimumab, pembrolizumab
• targeted antibody therapies are intended to direct cytotoxic responses toward cancer cells overexpressing certain surface molecules (e.g. cetuximab specific for Epidermal Growth Factor Receptor, EGFR).
• Cellular therapies include ex vivo expansion and administration of autologous or allogeneic immune cells (e.g.
• T cells T cells, natural killer (NK) cells), as well as engineering cells to express chimeric antigen receptors (CARs) specific for cell surface molecules such as CD 19.
• CARs chimeric antigen receptors
• SUBSTITUTE SHEET (RULE 26) cells often results in adverse events.
• Most CAR-T cell therapies target both cancerous cells and normal cells, based on the most commonly chosen target antigens, and therefore lack true cancer specificity. While the theoretical benefit of neoepitope immunization is its true cancer specificity, significant clinical success has yet to be achieved with this approach. Broadly speaking, immunotherapy approaches thus far have suffered either from lack of specificity, high toxicity, lack of efficacy, challenges in generation, or a combination of the above.
• a composition for treating cancer comprising one or more antibodies (or antigen-binding fragments thereof) that specifically bind a tumor-specific epitope-HLA complex, and an effective amount of a cytotoxic immune effector cell, wherein the composition is personalized given that [a] the tumor-specific epitope is a patient-specific neoepitope displayed on the HLA (Human Leukocyte Antigen) system, and [b] the cytotoxic immune effector cells are capable of engaging the antibody (or antibodies, or antibody fragments) through their Fc-gamma (Fey) receptors on the cell surface, and subsequently inducing ADCC (Antibody Dependent Cell-mediated Cytotoxicity) or ADCP (Antibody Dependent Cell-mediated Phagocytosis), being a cell type selected from the group consisting of NK cells, macrophages, monocytes, neutrophils, dendritic cells, or any combination thereof.
• ADCC Antibody Dependent Cell-mediated Cytotoxicity
• ADCP Antibody Dependent Cell-mediated Ph
• a method of producing a composition for treating cancer comprising the following steps: obtaining a tumor specimen from a subject and identifying tumor-specific genetic mutations expressed by the tumor through sequencing, generating HLA/neoepitope complexes based on the identified tumor-specific genetic mutations,
• SUBSTITUTE SHEET (RULE 26) immunizing a non-human animal with the HLA/neoepitope complexes, isolating B cells that produce neoepitope-specific antibodies or antigen-binding fragments thereof from the immunized non-human animal, verifying that the neoepitope-specific antibodies bind to the tumor, producing an effective amount of the neoepitope-specific antibodies or antibody fragments, and combining [a] an effective amount of the antibody (or antibodies or antibody fragments) that specifically bind the tumor-specific epitope-HLA complex, along with [b] an effective amount of a cytotoxic immune effector cell capable of engaging the antibody (or antibodies, or antibody fragments) through the Fc-gamma (Fey) receptors on the cell surface, and subsequently inducing ADCC (Antibody Dependent Cell-mediated Cytotoxicity) or ADCP (Antibody Dependent Cell-mediated Phagocytosis), being selected from the group consisting of
• the invention includes a composition for treating cancer, said composition comprising: a. one or more antibodies, or antigen-binding fragments thereof that specifically bind one or more tumor-specific epitopes, and b. an effective amount of a cytotoxic immune effector cell.
• the composition is personalized.
• the tumor-specific epitope is a neoepitope.
• the antibodies or antigen-binding fragments thereof are humanized.
• the antibodies or antigen-binding fragments thereof are fully human.
• the antibodies or antigen-binding fragments thereof are afucosylated.
• the antibody or antigen-binding fragment thereof is bispecific.
• the tumor-specific epitope is a neoepitope/HLA complex.
• the cytotoxic immune effector cells are a cell type selected from the group consisting of NK cells, macrophages, monocytes, neutrophils, dendritic cells, and any combination thereof.
• the cytotoxic immune effector cells are irradiated.
• the invention includes a method of producing a composition for treating cancer, said method comprising: a. obtaining a tumor specimen from a subject and identifying tumor-specific genetic mutations expressed by the tumor through sequencing, b. generating HLA/neoepitope complexes based on the identified tumor-specific genetic mutations, c. immunizing a non-human animal with the HLA/neoepitope complexes, d. isolating B cells from the immunized non-human animal that produce HLA/neoepitope- specific antibodies or facilitate the generation of antigen-binding fragments thereof, e.
• the sequencing is next-generation sequencing.
• the non-human animal is humanized.
• the non-human animal produces fully-human antibodies.
• the non-human humanized animal is selected from the group consisting of a rat, a mouse, a rabbit, a donkey, a goat, a camel, a llama, an alpaca, and a shark.
• the HLA/neoepitope-specific antibodies are generated through a non-animal method.
• the non-animal method is phage display.
• the antibodies or antigen-binding fragments thereof are afucosylated.
• the isotype of the antibodies supports ADCC or ADCP.
• the isotype of the antibodies are further modified from an isotype that does not support ADCC or ADCP to an isotype that supports ADCC or ADCP.
• HLA/neoepitope complexes are selected from the group consisting of monomeric complexes, pentameric complexes, tetrameric complexes, dextran- linked complexes, and any combination thereof.
• the cytotoxic immune effector cells are a cell type selected from the group consisting of NK cells, macrophages, monocytes, neutrophils, dendritic cells, and any combination thereof.
• the invention includes a method of producing a composition for treating cancer, said method comprising: a. obtaining a tumor specimen from a subject and identifying tumor-specific genetic mutations expressed by the tumor through sequencing, b. generating HLA/neoepitope complexes based on the identified tumor-specific genetic mutations, c. immunizing a non-human animal with the HLA/neoepitope complexes, d. isolating B cells from the immunized non-human animal that produce HLA/neoepitope- specific antibodies or facilitate the generation of antigen-binding fragments thereof, e. verifying that the HLA/neoepitope-specific antibodies bind to the tumor, f.
• CARs chimeric antigen receptors
• the sequencing is next-generation sequencing.
• the non-human animal is humanized.
• the non-human animal produces fully-human antibodies.
• the non-human humanized animal is selected from the group consisting of a rat, a mouse, a rabbit, a donkey, a goat, a camel, a llama, an alpaca, and a shark.
• the HLA/neoepitope-specific antibodies are generated through a non-animal method.
• the non-animal method is phage display.
• generating the CAR further comprises the step of generating an scFv based on the antigen-binding domains of the antibodies.
• the CAR further comprises a transmembrane domain, a signaling domain, and a costimulatory domain.
• the HLA/neoepitope complexes are selected from the group consisting of monomeric complexes, pentameric complexes, tetrameric complexes, dextran- linked complexes, and any combination thereof.
• the cytotoxic immune effector cells are a cell type selected from the group consisting of NK cells, T cells, NK T cells, or any combination thereof.
• the cytotoxic immune effector cell is an NK cell.
• the cytotoxic immune effector cell is a CD8+ T cell.
• the invention includes a method of treating cancer in a subject in need thereof, said method comprising: a. obtaining a tumor specimen from the subject and identifying tumor-specific neoepitopes expressed by the tumor through sequencing, b. generating HLA/neoepitope complexes from the identified tumor-specific neoepitopes, c. immunizing a non-human mammal with the HLA/neoepitope complexes, d. isolating B cells that produce HLA/neoepitope-specific antibodies or antigen-binding fragments thereof from the immunized non-human mammal, e.
• the sequencing is next-generation sequencing.
• the non-human animal is humanized.
• the non-human animal produces fully-human antibodies.
• the non-human humanized animal is selected from the group consisting of a rat, a mouse, a rabbit, a donkey, a goat, a camel, a llama, an alpaca, and a shark.
• the HLA/neoepitope-specific antibodies are generated through a non-animal method.
• the non-animal method is phage display.
• the HLA/neoepitope-specific antibodies are afucosylated.
• the isotype of the antibodies supports ADCC or ADCP.
• the isotype of the antibodies are further modified from an isotype that does not support ADCC or ADCP to an isotype that supports ADCC or ADCP.
• the HLA/neoepitope complexes are selected from the group consisting of monomeric complexes, pentameric complexes, tetrameric complexes, dextran- linked complexes, and any combination thereof.
• the cytotoxic immune effector cells are a cell type selected from the group consisting of NK cells, macrophages, monocytes, neutrophils, dendritic cells, or any combination thereof.
• the invention includes a method of treating cancer in a subject in need thereof, said method comprising: a. obtaining a tumor specimen from the subject and identifying tumor-specific neoepitopes expressed by the tumor through sequencing, b. generating HLA/neoepitope complexes from the identified tumor-specific neoepitopes, c. immunizing a non-human mammal with the HLA/neoepitope complexes, d. isolating B cells that produce HLA/neoepitope-specific antibodies or antigen-binding fragments thereof from the immunized non-human mammal, e.
• CAR chimeric antigen receptor
• the sequencing is next-generation sequencing.
• the non-human animal is humanized.
• the non-human humanized animal is selected from the group consisting of a rat, a mouse, a rabbit, a donkey, a goat, a camel, a llama, an alpaca, and a shark.
• the HLA/neoepitope-specific antibodies are generated through a non-animal method.
• the non-animal method is phage display.
• the HLA/neoepitope complexes are selected from the group consisting of monomeric complexes, pentameric complexes, tetrameric complexes, dextran- linked complexes, and any combination thereof.
• generating the CAR further comprises the step of generating an scFv based on the antigen-binding domains of the antibodies.
• the CAR further comprises a transmembrane domain, a signaling domain, and a costimulatory domain.
• the HLA/neoepitope complexes are selected from the group consisting of monomeric complexes, pentameric complexes, tetrameric complexes, dextran- linked complexes, and any combination thereof.
• the cytotoxic immune effector cells are a cell type selected from the group consisting of NK cells, T cells, NK T cells, or any combination thereof.
• the cytotoxic immune effector cell is an NK cell.
• the cytotoxic immune effector cell is a CD8+ T cell.
• Figure 1 is a simplified flow chart of the process by which the proposed personalized cancer immunotherapy is manufactured.
• Figure 2 is a mechanism of action of the present invention. Implicit in Figure 2 are scenarios where the CD16 on the surface of the effector immune cells is instead any Fc-gamma receptor, including but not limited to CD 16, or CD32, or CD64.
• Figure 2 legends correspond as follows: 201 Mutations result in translation of non-self amino acid sequences, 202 The antigen processing pathway leads to the presentation of neoepitopes on HLA molecules, 203 Personalized TCR-like antibodies against the neoepitope-HLA complex bind to cancer cells with high specificity, 204 CD16 FcyRIII) on effector cells binds with high affinity to the Fc region, activating the cytotoxic effector function, 205 cytotoxic activity leads to specific killing of cancer cells.
• Figure 3 is a simplified flow chart of the process by which the proposed personalized cancer immunotherapy is manufactured, in the preferred embodiment.
• Figure 4 is a mechanism of action of the proposed immunotherapy, in the preferred embodiment.
• Figure 4 legends correspond as follows: 401 Frameshift mutations result in translation of non-self amino acid sequences, 402 The antigen processing pathway leads to the presentation of neoepitopes on HLA molecules, 403 Personalized TCR-like antibodies against the neoepitope-HLA complex bind to cancer cells with high specificity, 404 CD 16 (FcyRIII) on NK cells binds with high affinity to the afucosylated Fc region, activating the cytotoxic effector function, 405 Degranulation of cytotoxic granules, and/or secretion of cytokines, leads to specific killing of cancer cells.
• Figure 5 is a detailed flow chart of the process by which the proposed personalized cancer immunotherapy is manufactured and administered, in the preferred embodiment.
• Figure 5 legends correspond as follows: 502 Blood Sample, 504 Tumor sample, 506 Next-generation DNA sequencing, 508 RNA sequencing, 510 Identify expressed frameshift mutations in tumor, 512 Predict frameshift-derived high-affinity neoepitopes based on HLA haplotype, 514 Produce HLA neoepitope tetramers, 516 Immunize OmniRats with HLA-neoepitope tetramers, 518 Immunize OmniRats with HLA-neoepitope tetramers a second time, 520 Enrich B cells from spleen and lymph nodes, 522 Stain B cells with HLA-neoepitope tetramers, 524 Single cell sorting of neoepitope-specific B cells, 526 Test Ab:Ag by ELISA524, 5
• Figure 6 is a detailed flowchart of an embodiment where SNV-derived neoepitopes are targeted.
• Figure 6 legends correspond as follows: 601 Identify expressed frameshift mutations in tumor, 602 predict frameshift-derived high-affinity neoepitopes based on HLA haplotype, 603 test Ab:Ag binding by ELISA, 604 stain tumor cells with candidate anti-neoepitope antibodies, 605 successful tumor-binding HLA-neoepitope-specific antibodies are selected.
• Figure 7 is a mechanism of action of an embodiment where SNV-derived neoepitopes are targeted.
• Figure 7 legends correspond as follows: 701 SNV mutations result in translation of amino acid sequences containing a single amino acid change, 702 the antigen processing pathway leads to the presentation of neoepitopes on HLA molecules, 703 personalized TCR-like antibodies against the neoepitope-HLA complex bind to cancer cells with high specificity, 704 CD 16 (FcyRIII) on NK cells binds with high affinity to the afucosylated Fc region activating the cytotoxic effector function, 705 degranulation of cytotoxic granules, an/or secretion of cytokines leads to specific killing of cancer cells.
• 701 SNV mutations result in translation of amino acid sequences containing a single amino acid change
• 702 the antigen processing pathway leads to the presentation of neoepitopes on HLA molecules
• Figure 8 is a detailed flowchart of an embodiment where monomers, or other multimers besides tetramers, of HLA-neoepitope complexes are used for immunization and/or testing.
• Figure 8 legends correspond as follows: 801 Produce HLA-neoepitope monomers or multimers, 802 immunize OmniRats with HLA-neoepitope monomers or multimers, 803 immunize OmniRats with HLA-neoepitope monomers or multimers a second time, 804 stain B cells with HLA-neoepitope monomers or multimers.
• FIG 9 is a detailed flowchart of an embodiment where the TCR-like antibodies are engineered in some way, e g. bispecificity, or a modified Fc region to optimize effector function.
• Figure 9 legends correspond as follows: 901 engineering antibodies to be bi-specific and/or to have modified Fc region.
• Figure 10 is a mechanism of action of an embodiment where the TCR-like antibodies are engineered in some way, e g. bispecificity, or a modified Fc region to optimize effector function.
• Figure 9 legends correspond as follows: 1001 Frameshift mutations result in translation of nonself amino acid sequences, 1002 The antigen processing pathway leads to the presentation of neoepitopes on HLA molecules, 1003 Personalized TCR-like and/or bispecific antibodies against the neoepitope-HLA complex bind to cancer cells with high specificity, 1004 CD 16 (FcyRIII) on NK cells binds with high affinity to the engineered Fc region, activating the cytotoxic effector function, 1005 Degranulation of cytotoxic granules, and/or secretion of cytokines, leads to specific killing of cancer cells.
• FcyRIII CD 16
• Figure 11 is a detailed flowchart of an embodiment where different cell types are administered to the patient, such as macrophages, neutrophils, monocytes, or dendritic cells.
• Figure 11 legends correspond as follows: 1101 culture macrophages, neutrophils, monocytes, or io
• SUBSTITUTE SHEET (RULE 26) dendritic cells in cytotoxicity -enhancing media, 1102 irradiate cells (only necessary if an immortalized cell line).
• Figure 12 is a mechanism of action of an embodiment where different cell types are administered to the patient, such as macrophages, neutrophils, monocytes, or dendritic cells.
• Figure 12 legends correspond as follows: 1201 Frameshift mutations result in translation of nonself amino acid sequences, 1202
• the antigen processing pathway leads to the presentation of neoepitopes on HLA molecules, 1203 Personalized TCR-like antibodies against the neoepitope- HLA complex bind to cancer cells with high specificity, 1204 CD16 (FcyRIII) or CD32 (FcyRII) on effector cells binds with high affinity to the afucosylated Fc region, activating the cytotoxic effector function (ADCC or ADCP), 1205 Antibody-dependent cellular phagocytosis (ADCP) or other cytotoxic mechanism.
• ADCC cytotoxic effector function
• ADCP Antibody-dependent cellular phagocytosis
• Figure 13 is a detailed flowchart of an embodiment where the cells administered to the patient are genetically engineered.
• Figure 13 legends correspond as follows: 1301 genetically engineer cytotoxic effector cells (e.g. knock-out certain genes), 1302 irradiate engineered cells.
• Figure 14 is a mechanism of action of an embodiment where the cells administered to the patient are genetically engineered.
• Figure 14 legends correspond as follows: 1401 Frameshift mutations result in translation of non-self amino acid sequences, 1402 The antigen processing pathway leads to the presentation of neoepitopes on HLA molecules, 1403 Personalized TCR- like antibodies against the neoepitope-HLA complex bind to cancer cells with high specificity, 1404 Fey receptor on engineered effector cells binds with high affinity to the afucosylated Fc region, activating the cytotoxic effector function, 1405 Degranulation of cytotoxic granules, and/or secretion of cytokines, leads to specific killing of cancer cells.
• Figure 15 is a detailed flowchart of an embodiment where the NK cells administered to the patient are autologous or, alternatively, allogeneic cells either from blood donors or cord blood.
• Figure 15 legends correspond as follows: 1501 culture autologous NK cells, or allogeneic NK cells sourced from cord blood or donor blood, in cytotoxicity-enhancing media.
• Figure 16 is a detailed flowchart of an embodiment where the administered cytotoxic effector cells express a CAR construct, and the neoepitope specificity is conferred not by an antibody but by the scFv portion of the CAR. Implicit in Figure 16 is the option of including the administration of TCR-like antibodies generated against the neoepitope-HLA complexes.
• Figure 16 legends correspond as follows: 1601 successful tumor-binding HLA-neoepitope-specific
• SUBSTITUTE SHEET (RULE 26) antibodies are converted into scFv sequences and cloned into a CAR construct, 1602 cytotoxic effector cells are transduced with the CAR construct, 1603 infusion of CAR-expressing effector cells.
• Figure 17 is a mechanism of action of an embodiment where the administered cytotoxic effector cells express a CAR construct, and the neoepitope specificity is conferred not by an antibody but by the scFv portion of the CAR. Implicit in Figure 17 is the option of including the administration of TCR-like antibodies generated against the neoepitope-HLA complexes.
• Figure 17 legends correspond as follows: 1701 frameshift mutations result in translation of non-self amino acid sequences, 1702 The antigen processing pathway leads to the presentation of neoepitopes on HLA molecules., 1703 personalized TCR-like single-chain variable fragment (scFv) incorporated into a chimeric antigen receptor (CAR) against the neoepitope-HLA complex bind to cancer cells with high specificity, 1704 cytotoxic effector cells are engineered to express the neoepitope-specific CAR, degranulation of cytotoxic granules, and/or secretion of cytokines, leads to specific killing of cancer cells.
• scFv TCR-like single-chain variable fragment
• CAR chimeric antigen receptor
• Figure 18 illustrates the gating strategy for flow cytometry analysis.
• a large forward scatter / side scatter gate capturing both effector cells and target cells was used to exclude debris.
• Target (EL4) cells were distinguished from effector (NK) cells based on CFSE staining. Apoptosis and death of target cells were quantified using Annexin V staining of phosphatidyl- serine and SYTOX blue staining of DNA, respectively. Degranulation, i.e. cytotoxic activity, of NK cells was quantified using an antibody against CD 107a. Representative dot plots from several different cocultures are shown for demonstration.
• Figures 19A-19B depicts an ADCC-mediated boost in NK cell killing of target cells via a TCR-like antibody directed against the neoepitope displayed by target cells.
• EL4 cells were incubated with SIINFEKL peptide to load cell-surface MHC molecules (H2K b ) with this specific peptide.
• Figure 19A After 4 hours in monoculture with or without anti-SIINFEKL-H2K b IgG2a antibody, the EL4 cells were stained with SYTOX blue to quantify dead cells.
• Figure 19B represents the same experimental endpoint as in A, but for the co-culture experimental groups. Freshly isolated primary mouse NK cells were added at 3 different Effector: Target ratios, and cocultured with or without antibody for 4 hours. Since the EL4 monocultures demonstrated a statistically significant direct cytotoxic effect of the antibody (without any NK cells), this
• Figures 21A-21B depict ADCC via the TCR-like antibody occurring by apoptosis more than by necrosis, and both ADCC-apoptosis and ADCC-necrosis are boosted by increasing E:T ratios.
• the data represented in Figure 19 was further analyzed on the basis of Annexin-V staining to quantify: [Figure 21A] target cell death through Apoptosis (Annexin-V positive staining) and [Figure 2 IB] target-cell death through non-apoptotic Necrosis (Annexin-V negative staining).
• SIINFEKL peptide-loaded EL4 cells were cultured with or without anti-SIINFEKL-H2K b IgG2a antibody as in the previous figures.
• Figure 22 illustrates that Degranulation of NK cells increases in the presence of the antibody as measured by CD 107a staining.
• SIINFEKL peptide-loaded EL4 cells were cultured with or without anti-SIINFEKL-H2K b IgG2a antibody as in the previous figures.
• cells were also stained throughout the 4-hour incubation with an antibody against CD 107a.
• CD 107a is a marker of degranulation by NK cells, a mechanism used by NK cells to
• FIGS 23A-23B depict the anti-SIINFEKL-H2K b antibody binding specifically to SIINFEKL-pulsed EL4 cells.
• EL4 cells were incubated with SIINFEKL peptide to load cell-surface MHC molecules, or incubated in similar conditions without any peptide. Both peptide-pulsed and unpulsed cells were then incubated with or without the anti-SIINFEKL-H2K b antibody. All four of these experimental groups were subsequently stained with a PE-conjugated secondary antibody specific for mouse IgG - for analysis through flow cytometry. Four replicates were used for each of the four conditions.
• Figure 24 is a diagram illustrating the workflow to generate several novel TCR-like antibodies against a “public” frameshift-derived neoantigen commonly found in AML. Legends correspond as follows: 2401 produce HLA-neoepitope complexes, 2402 immunize OmniRats with HLA-neoepitope complexes, 2403 immunize OmniRats with HLA-neoepitope complexes a second time, 2404 enrich B cells from spleen and lymph nodes, 2405 stain B cells with HLA- neoepitope complexes, 2406 single-cell sorting of neoepitope specific B cells, 2407 RT-PCR and sequencing, 2408 clone (human) variable region sequences into human antibody vectors, 2409 transfect CHO cells and produce test batches of candidate antibodies, 2410 test Ab:Ag binding by ELISA, 2411 autologous NK cells, 2412 allogeneic NK cells (e g. donor-
• an element means one element or more than one element.
• “About” as used herein when referring to a measurable value such as an amount, a temporal duration, and the like, is meant to encompass variations of ⁇ 20% or ⁇ 10%, more preferably ⁇ 5%, even more preferably ⁇ 1%, and still more preferably ⁇ 0.1% from the specified value, as such variations are appropriate to perform the disclosed methods.
• Antigen-binding fragment as used herein shall mean the part of an antibody that facilitates binding to its cognate antigen, including but not limited to the F(ab’)2 fragment, Fab fragment, single-chain variable fragment (scFv), and single-domain antibody.
• Immunoglobulin-humanized as used herein shall mean an animal that has undergone genetic modification such that its endogenous immunoglobulin genes are no longer expressed, and human immunoglobulin genes are expressed instead. These animals produce “fully human” antibodies, rather than “humanized” antibodies.
• Neoantigen as used herein shall mean a protein which, as a result of somatic mutation, contains one or more changes in its amino acid sequence compared to the normal protein produced by cells lacking the mutation.
• Neoepitope as used herein shall mean a peptide presented on cell-surface MHC molecules, derived from a neoantigen, and containing one or more of its changed amino acid residues.
• Personalized as used herein shall mean developed individually for each patient.
• neoantigen-HLA Human Leukocyte Antigen
• MHC Major Histocompatibility Complex
• SUBSTITUTE SHEET (RULE 26) example, description of a range such as from 1 to 6 should be considered to have specifically disclosed subranges such as from 1 to 3, from 1 to 4, from 1 to 5, from 2 to 4, from 2 to 6, from 3 to 6 etc., as well as individual numbers within that range, for example, 1, 2, 2.7, 3, 4, 5, 5.3, and 6. This applies regardless of the breadth of the range.
• the invention described herein is a novel approach to personalized cancer immunotherapy that uses monoclonal antibodies against tumor-specific neoepitope-HLA complexes (specific to each patient’s cancer) to induce Fc gamma (Fey) receptor-expressing cytotoxic effector cells (endogenous and/or exogenously introduced by cell infusion) to kill cancerous cells in a highly specific manner.
• the invention includes the targeting of patients’ tumor-specific neoantigens by leveraging antibody-dependent cellular cytotoxicity (ADCC), or antibody-dependent cellular phagocytosis (ADCP) by Fey receptor-expressing cytotoxic effector cells, rather than the more conventional dependence on the natural anti-neoantigen T cell response from the patients’ own immune systems.
• ADCC antibody-dependent cellular cytotoxicity
• ADCP antibody-dependent cellular phagocytosis
• the present invention overcomes the limitations and challenges of existing immunotherapy approaches by uniquely combining and leveraging several distinct concepts, including but not limited to: (1) targeting neoepitope-HLA complexes, (2) monoclonal antibodies against specific antigens combined with cytotoxic effector immune cells, and (3) the specific mechanisms of ADCC (or ADCP, or a combination of ADCC and ADCP) offered by endogenous immune cells or adoptive cellular therapy.
• Antibodies may be developed on a patient-by-patient basis, or on the basis of neoepitopes shared amongst a group of patients, against the mutated peptides that are presented by HLA molecules on cancer cells (these HLA-peptide complexes are normally targeted by the T cell receptor (TCR); therefore, the antibodies are “TCR-like”) (Dahan, R. & Reiter, Y. (2012) Expert Rev. Mol. Med. 14, e6).
• Infused Fey receptor-expressing cytotoxic effector cells e.g.
• NK cells expressing CD16, macrophages expressing CD32 are directed by these TCR-like antibodies to specifically attack each particular patient’s cancer cells, primarily leveraging the mechanisms of ADCC, or ADCP (or both ADCC and ADCP).
• ADCC or ADCP
• Figure l is a pictorial representation of an embodiment of the invention. Beginning with freshly isolated tumor tissue following surgery or biopsy, mutations may be identified by
• SUBSTITUTE SHEET (RULE 26) comparing the DNA sequences of tumor tissue and normal tissue (blood).
• Next-generation sequencing platforms such as Illumina and/or Ion Torrent may be used individually or combined - by sequencing with two different platforms and only using mutations detected by both, confidence in the identified mutations is high (Sherafat, et al. (2020) BMC Bioinformatics 21 : 498).
• Mutated peptides, complexed with HLA molecules may be used to immunize rats.
• Rat B cells producing TCR-like antibodies specific for the neoepitope-HLA complexes may be isolated, and the antibodies may be tested for binding to the tumor cells (Ouisse, (2017) BMC Biotechnol. 17, 3).
• Those antibodies which test positive for tumor-specific binding may be produced in larger quantities by producer cells (e.g. CHO, HEK-293).
• producer cells e.g. CHO, HEK-293.
• the resulting monoclonal antibodies targeting tumor-specific mutations may be administered to the patient, either alone or along with an infusion of Fey receptor-expressing cytotoxic effector cells.
• TCR-like antibodies targeting tumor-specific neoepitopes may be administered along with Fc-gamma receptor-expressing cytotoxic effector cells, the cytotoxic action of the infused cells is directed specifically against tumor cells.
• the mechanism of this embodiment of the invention is depicted in Figure 2.
• the particular category of neoepitope targeted by the TCR-like antibodies is that derived from insertion/deletion (InDei) mutations resulting in frameshifts.
• the neoepitopes that arise from frameshift mutations are entirely foreign; unlike neoepitopes arising from single nucleotide variant (SNV) mutations, there is no associated “self’ counterpart epitope.
• SNV single nucleotide variant
• immunoglobulin-humanized rats (“OmniRats”) are used for immunizations to generate neoepitope-specific B cells. This leads to the production of “fully human” antibodies, minimizing the risk of adverse events in patients.
• the final antibodies to be delivered to the patient are produced by producer cells engineered to generate afucosylated antibodies, which lead to enhanced cytotoxic activity by effector cells.
• the effector cells are natural killer (NK) cells, cultured in media to enhance their cytotoxic activity, and irradiated prior to administration to the patient.
• NK natural killer
• SUBSTITUTE SHEET (RULE 26) This preferred embodiment of the invention is intended to combine the most promising aspects of disparate research avenues and therapeutic approaches uniquely and optimally - mutated peptide neoepitopes, targeted therapy using monoclonal antibodies, and adoptive NK cell therapy - into a novel approach with personalized antibody therapy that acts in concert with cellular therapy, and is more effective and less toxic overall.
• FIG. 4 The mechanism of action of one embodiment, which is the preferred embodiment depicted in Figure 3, is depicted in Figure 4.
• Certain cancer types e.g. renal cell carcinoma
• these high-InDel cancers therefore have the highest likelihood of having frameshifts in protein-coding genes (Bailey, et al. (2016) Cell 173: 371-385. el8)(Turajlic, et al. (2017) Zance/ Oncol. 18: 1009-1021).
• Frameshifts often result in extended sequences of amino acids that are completely novel - that is, they are unlike any amino acid sequence seen in normal human cells. When these novel sequences undergo antigen processing (e.g.
• neoepitopes truly cancer-specific epitopes that are completely unlike any HLA- presented “self’ epitope, and therefore represent a unique target for personalization of therapy (Linnebacher, et al. (2001) Int. J. Cancer. 93: 6—11.)
• high-InDel cancer types are the main candidates for the immunotherapy
• frameshift-derived neoepitopes are the preferred targets for the monoclonal TCR-like antibody development.
• frameshift-derived neoepitopes unlike SNV-derived neoepitopes, lack a similar “self’ peptide counterpart sequence that may be presented by normal cells; frameshift-derived neoepitopes therefore offer the prospect of higher specificity of directed therapy against cancer cells while leaving normal cells unaffected.
• the variable region of the antibody binds the neoepitope-HLA complex, and the constant region (i.e. the Fc region) is available to be bound by Fc receptors such as CD16, or CD32, or CD64.
• the Fc region is afucosylated, having been produced by producer cells engineered to generate afucosylated antibodies.
• the CD16 molecule on the surface of the infused NK cells triggers the cytotoxic activity, consisting of cytokine secretion and/or the release of cytotoxic granules, killing the tumor cell.
• the cytotoxic activity in the preferred embodiment, is antibody-dependent cellular cytotoxicity (ADCC).
• SUBSTITUTE SHEET (RULE 26) follows: 502 Blood Sample, 504 Tumor sample, 506 Next-generation DNA sequencing, 508 RNA sequencing, 510 Identify expressed frameshift mutations in tumor, 512 Predict frameshift- derived high-affinity neoepitopes based on HLA haplotype, 514 Produce HLA neoepitope tetramers, 516 Immunize OmniRats with HLA-neoepitope tetramers, 518 Immunize OmniRats with HLA-neoepitope tetramers a second time, 520 Enrich B cells from spleen and lymph nodes, 522 Stain B cells with HLA-neoepitope tetramers, 524 Single cell sorting of neoepitope-specific B cells, 526 Test Ab:Ag by ELISA524, 528 RT-PCR and sequencing of positives, 530 Clone (human) variable region sequences into human
• GenScript, JPT synthesize custom peptides.
• Several companies e.g. MBL International, Prolmmune
• custom HLA-peptide tetramers and/or provide kits.
• SUBSTITUTE SHEET 100 pg HLA-peptide complex in PBS 16 days later, has been shown to generate high- affinity anti-HLA-peptide antibodies in rats, 5 days after the second immunization?.
• GMP Larger-scale production of tumor cell-binding antibodies, using producer cells engineered to produce afucosylated (ADCC-optimized) antibodies.
• SNV-derived neoepitopes are identified in the tumor. While these neoepitopes have “self” counterpart epitopes that differ by only one amino acid residue, and therefore raise the possibility of crossreactivity of the TCR-like antibodies against normal tissue, this challenge is overcome by adding further rounds of specificity testing to the process (see Figures 6 and 7). Additionally, neoepitopes arising from any other type of mutation (e.g. translocations), or from dysfunctional RNA splicing, or from any other mechanism that is tumor-specific, constitute candidate targets for this therapy.
• any other type of mutation e.g. translocations
• dysfunctional RNA splicing or from any other mechanism that is tumor-specific
• neoepitopes presented by HLA classes other than class I constitute the targets for the therapy.
• the tumorspecific molecules targeted by the therapy are mutated cell surface molecules (e.g. receptors, adhesion molecules), where the mutations have created substantive tumor-specific changes in the structure of the extracellular portions of the molecules, to an extent that they can be distinguished from their unmutated counterparts by antibodies.
• mutated cell surface molecules e.g. receptors, adhesion molecules
• Embodiments of this invention include mutations of any kind / source, for example somatic mutations, passenger mutations and others.
• the tumor-specific molecular targets of the therapy are not changes in amino acid sequences per se, but instead are changes in post-translational modifications, including but not limited to glycosylation patterns and acetylation. Included are neoantigens that arise due to a combination of amino acid sequence changes along with post- translational modifications.
• the HLA-epitope complexes used to immunize the rats, and/or those used to isolate specific rat B cells, and/or those used to test antibody binding are either monomeric, pentameric, or dextran-linked, instead of tetrameric (see Figure 8).
• the immunized rats are a strain of rat other than OmniRats.
• the immunized animal is an animal other than a rat, including but not limited to a mouse, a rabbit, a donkey, a goat, a camel, a llama, an alpaca, and a shark.
• the tumor-specific antibodies are generated by a means other than immunizing animals and sorting their antigen-specific B cells, including but not limited to the use of phage display libraries, and antibody gene transfer by injection of antibody-encoding nucleic acid (e.g. DNA) into the patients.
• a means other than immunizing animals and sorting their antigen-specific B cells including but not limited to the use of phage display libraries, and antibody gene transfer by injection of antibody-encoding nucleic acid (e.g. DNA) into the patients.
• the TCR-like antibodies are engineered or produced differently than in the preferred embodiment.
• the Fc region of the antibodies could be altered in other ways (e.g. the engineering of disulfide bonds within the antibody structure; Hagihara, Y. and Saerens, D., (2014). Biochimica et Biophysica Acta (BBA)-Proteins and Proteomics, 1844(11), pp.2016- 2023.).
• variable region may also be engineered in various ways, for example, the antibody may be bispecific (see Figures 9 and 10), where the bispecific antibody may be directed against two distinct neoepitopes, or the combination of a neoepitope and a regular epitope (i.e. an epitope that is not a neoepitope).
• the antibody could be conjugated to a drug, such as an anti-cancer drug, i.e. antibody-drug conjugates.
• Other embodiments include methods (e.g. molecular methods) to modify / engineer antibodies.
• the neoepitope-specific antibodies used in the therapy are polyclonal instead of monoclonal.
• the neoepitope-specific antibodies are not full antibodies, but instead are antigen-binding fragments, including but not limited to the F(ab’)2 fragment, Fab fragment, single-chain variable fragment (scFv), and single-domain antibody.
• cell types other than NK cells may be leveraged (endogenous or exogenously administered) in concert with the neoepitope targeting antibody.
• the therapy depends on the interaction between the Fc region of the TCR-like antibody and the Fey receptor on the surface of the effector cells.
• Certain cell types including but not limited to cells of the innate immune system such as macrophages, monocytes, neutrophils, and dendritic cells which express one of, or a combination of, the Fey receptors CD 16, CD32, and CD64; these cell types could alternatively serve as the effector cells in the therapy (see Figures 11 and 12). Implicit in these alternative embodiments is the option of using subsets or subpopulations of these cell types, for example memory NK cells.
• cell types other than cells of the innate immune system may be used (in concert with the neoepitope targeting antibody), for example the following cell types which are also known to express Fey receptors: activated T cells, endothelial cells, microglial cells, osteoclasts, and mesangial cells .
• the target disease cell may manifest a neoepitope in the context of disease(s) other than cancer, including but not limited to autoimmune diseases.
• the neoepitope-specific antibodies used in the therapy will be of isotype IgG, because Fey receptors bind to the constant region of IgG antibodies.
• the specific subclass of IgG e.g. IgGl, IgG3, etc.
• ADCC mechanism of action intended
• ADCP cell types being employed in the therapy.
• Several different isotypes or isotype subclasses may be used individually or combined in a particular therapy.
• the isotype (or subclass) of the antibody is switched from an inactive or undesired isotype (or subclass) to one with the desired properties.
• the same antibody and even the same effector cell can induce both ADCC and ADCP (Strohl, W. and Strohl, L., 2012. 8-Monoclonal antibody targets and mechanisms of action. Thera Antibody Eng, 9, pp.163-196.). Also, different antibodies against the same target can be used.
• SUBSTITUTE SHEET induce various mechanisms, including ADCC and ADCP (Cleary, K.L., Chan, H.C., James, S., Glennie, M.J. and Cragg, M.S., 2017. Antibody distance from the cell membrane regulates antibody effector mechanisms. The Journal of Immunology, 198(10), pp.3999-4011).
• a set of antibodies may be generated against a given neoepitope.
• the infused effector cells are genetically engineered. These manipulations may include, but are not limited to, knocking out or knocking down certain genes, overexpression of certain genes, or expression of exogenous genes (see Figures 13 and 14).
• the infused effector cells are obtained from one of several potential sources.
• NK cells could be sourced from allogeneic donors, cord blood, or the patient’s own blood; alternatively, several NK cell lines could potentially be used, provided that they express CD 16, and are irradiated prior to administration to the patient (see Figure 15).
• the production of whole antibodies is replaced with the production of a corresponding scFv sequence, followed by cloning into a chimeric antigen receptor (CAR) construct. Effector cells are then engineered to express the CAR construct prior to infusion.
• CAR chimeric antigen receptor
• administration of TCR-like antibodies against neoepitopes may be used in combination with CAR effector cells, or the TCR-like antibodies may not be part of the therapy protocol, with the antigen specificity provided by the membrane-bound CAR (see Figures 16 and 17). Implicit in Figures 16 and 17 is the option of including the administration of TCR-like antibodies generated against the neoepitope-HLA complexes.
• Certain embodiments of the invention may leverage therapeutic mechanisms of antibodies which are independent of ADCC or ADCP, for example CDC (Complement Dependent Cytotoxicity).
• Certain embodiments of the invention include treating the same patient with more than one antibody generated against newer neoepitopes being manifested in the patient’s body over
• SUBSTITUTE SHEET (RULE 26) time, for example different neoepitopes appearing in different tumors during the process of cancer metastasis.
• the invention can potentially be used for treatment of any cancer for which a biopsy or surgical sample can be obtained.
• the most promising treatment candidates are those cancers which contain, on average, a high number of InDei mutations.
• the frameshift- derived neoepitopes that result from InDei mutations are most likely to enable the production of successful tumor-specific antibodies that lack cross reactivity with “self’ epitopes.
• one series of embodiments focuses on high-InDel cancers and their associated frameshift-derived neoepitopes.
• certain embodiments target other types of mutations, e.g. single nucleotide variants (SNVs), as well.
• SNVs single nucleotide variants
• One series of embodiments focuses upon cancers which tend to contain high numbers of InDeis, including but not limited to kidney cancers, melanoma, bladder urothelial carcinoma, lung adenocarcinoma, uterine carcinosarcoma, uterine corpus endometrial carcinoma, breast cancer, head and neck cancers, and stomach adenocarcinoma.
• any cancer with expressed SNV mutations in the exome would be a candidate for this immunotherapy. This would include the vast majority of cancers.
• the invention includes the targeting of patients’ tumor-specific neoantigens by leveraging antibody-dependent cellular cytotoxicity (ADCC), or antibody-dependent cellular phagocytosis (ADCP) by Fey receptor-expressing cytotoxic effector cells, rather than the more conventional dependence on the natural anti-neoantigen T cell response from the patients’ own immune systems.
• ADCC antibody-dependent cellular cytotoxicity
• ADCP antibody-dependent cellular phagocytosis
• the present invention produces antibodies that bind only to tumor cells:
• Existing targeted monoclonal antibody treatments target cell-surface molecules such as CD20 (e.g. rituximab), EGFR (e.g.
• SUBSTITUTE SHEET (RULE 26) cetuximab), HER2 (e.g. trastuzumab), and several others.
• HER2 e.g. trastuzumab
• SUBSTITUTE SHEET (RULE 26) cetuximab
• HER2 e.g. trastuzumab
• TCR-like antibodies specific for those neoepitopes would only bind with high affinity to cancer cells.
• the present invention targets the infused cells to the cancer cells in a highly tumor-specific manner: Numerous cell-based therapies are undergoing clinical trials, but none of these approaches are based on targeting the effector cells to cancer cells in a highly specific manner. Since the present invention targets effector cells to cancer cells using antibodies as bridges that only bind to cancer cells, a much higher level of effector specificity is achieved.
• the present invention does not rely on the patient’s natural T-cell immune response:
• Research efforts by other groups have aimed at developing therapeutic immunizations, on a patient-by- patient basis, intended to initiate (or “reinvigorate”) a T cell response against neoepitopes presented by cancerous cells. These efforts have run into several challenges, and significant clinical success has not been achieved.
• the present invention eschews these challenges by targeting cancer cells in a way that does not rely on the patient’s T cell response. Instead, it uses externally-generated antibodies to target the neoepitopes, combined with externally -generated (i.e.
• the current invention therefore makes the outcome of therapy more predictable and targeted, given its reliance on both antibody recognition of neoepitopes, as well as innate immune effector cell functions of ADCC or ADCP (or combination of ADCC and ADCP).
• our invention is not centered on any specific neoepitope, and can therefore be applied (e.g. in a personalized manner) to any neoepitope either already known, or to neoepitopes which will be discovered in the future.
• SUBSTITUTE SHEET • Unlike work by some groups generating transgenic TCRs or CARs that target neoepitopes, the present invention can be more easily developed on a patient-by-patient basis to produce truly personalized therapies: Other research and development groups, also looking to harness the extraordinarily specificity of neoepitopes, have developed transgenic neoepitope-specific TCRs, and/or neoepitope-specific CARs. In each of these cases, the cytotoxic effector cells (whether NK cells or otherwise) would need to be transduced with the neoepitope-specific construct when there is no dependence on antibody-based recognition of the neoepitope.
• the present invention relies on antibody-based recognition of the neoepitopes, while also specifically leveraging the ADCC or ADCP mechanisms of those immune effector cells, which can support ADCC or ADCP through Fc-gamma receptors (e.g. CD 16 and CD32 receptors respectively for ADCC and ADCP). Because the personalization relies on the generation of personalized antibodies rather than personalized genetically modified immune effector cells, the present invention also offers better efficiency in the generation of personalized therapy.
• Fc-gamma receptors e.g. CD 16 and CD32 receptors respectively for ADCC and ADCP.
• the current invention offers the unique combination of [a] more time-efficient and resource-efficient antibody based personalization of therapy, along with [b] the effectiveness of immune effector cells working in concert with antibodies to more selectively target cancer cells over normal cells - by virtue of the targeting of neoepitope- HLA complexes by antibodies which bridge adoptively transferred immune effector cells to target cancerous cells.
• Example 1 Antibody against Neoepitope Induces Natural Killer (NK) Cell Mechanism of ADCC [Antibody Dependent Cell-mediated Cytotoxicity] to Kill Target Cells presenting the Neoepitope.
• NK Natural Killer
• neoepitopes constitute attractive targets for cancer immunotherapy (Brennick et al. (2017) Immunotherapy, 9(4), pp.361-371)
• the novel methodology disclosed herein to generate antibody therapeutics directed against neoepitopes is centered on two specific cellular mechanisms manifested primarily by cells of the innate immune system which leverage antibodies as a bridge to neoepitopes on the surface of cancer calls, namely the mechanisms of ADCC and ADCP [Antibody Dependent Cell-mediated Cytotoxicity and Antibody Dependent Cell -mediated Phagocytosis] (Gogesch et al. (2021) International Journal of Molecular Sciences, 22(16), p.8947).
• TCR-like antibodies generated against neoepitopes can induce ADCC cytotoxic activity of Natural Killer (NK) effector cells towards target cells presenting those specific neoepitopes.
• NK Natural Killer
• model peptide epitope SIINFEKL served as a “model neoepitope” or “surrogate neoepitope.” That is, for the purpose of proof-of-concept experiments, antibody -mediated NK cell responses against the surrogate neoepitope SIINFEKL are considered mechanistically equivalent to the envisioned antibody-mediated NK cell responses against neoepitopes in diseased cells (such as cancer cells), especially those neoepitopes which are derived from frameshift mutations and result in completely novel or foreign peptide sequences.
• the anti-SIINFEKL-H2K b antibody (clone 25.D1-16) is a commercially available “TCR-like antibody” (that is, it binds to a peptide-MHC complex much like a TCR does).
• This antibody was chosen for preliminary proof of concept experiments due to its well-established use in detecting the SIINFEKL-H2K b complex (with SIINFEKL representing a model neoantigen or neoepitope).
• this mouse antibody’s isotype is IgGl (which does not induce ADCC activity)
• the switch to IgG2a was performed by cloning the variable region sequences of both the heavy chain and light chain of the original
• SUBSTITUTE SHEET (RULE 26) 25.D1-16 antibody into a mouse IgG2a plasmid (pTRIOZ-m!gG2a) commercially available from Invivogen (San Diego, CA). Production of the plasmid, and subsequent recombinant expression of the antibody protein in the Chinese Hamster Ovary (CHO) cells, were performed by Azenta (Chelmsford, MA). Protein purification was performed using Protein A agarose.
• NK cells were enriched from 5 mouse spleens using an immunomagnetic negative selection kit from StemCell Technologies (Vancouver, Canada).
• the primary NK cells were added to the wells to achieve E:T ratios of 0.5: 1, 1.5: 1, and 5:1.
• monoculture wells were set up for both the targets (EL4 cells) and the effectors (NK cells).
• PE phycoerythrin
• APC Allophycocyanin
• Annexin V Allophycocyanin
• APC/FireTM750-conjugated anti- NKp46 antibody Data was acquired on a Bio-Rad ZE5 flow cytometer (Univ of CT). The gating strategy used for analysis is depicted in Figure 18.
• SUBSTITUTE SHEET (RULE 26) target cells, which becomes increasingly significant with increasing E:T ratio, represents ADCC activity mediated by the added TCR-like antibody.
• E:T ratio 0.5: 1
• ADCC contributed a 10.4% increase in target cell killing over the background “natural” cytotoxic activity of the NK cells when the antibody was absent.
• ratios of 1.5 : 1 and 5 : 1 the ADCC contribution was higher at 17.7% and 38.1%, respectively, and was statistically significant in both cases.
• these coculture ADCC values were calculated after subtracting the direct cytotoxic effect of the antibody on the peptide-pulsed EL4 cells, illustrated in Figure 19A.
• LDH Lactate dehydrogenase
• a cytosolic enzyme that is only released into the culture medium when cells die, was quantified in supernatant samples from all monocultures and co-cultures at the end of the 4-hour incubation.
• addition of the TCR-like antibody caused an increase in the cytotoxic activity of NK cells in a E:T ratio-dependent manner ( Figure 20). At the lowest ratio, LDH release trended upward without reaching significance.
• Figure 20 provides further corroboration (through LDH quantification) of the target cell death quantification observed through flow cytometry ( Figure 2). Additionally, the boost in antibody-induced ADCC cytotoxicity as a function of increasing E:T ratios observed through flow cytometry ( Figure 2) was re-confirmed by the LDH quantification ( Figure 20), which again confirmed the boost in antibody -induced ADCC cytotoxicity as a function of increasing E:T ratios.
• Figure 21 establishes that the ADCC quantification observed in Figure 2 is a cumulative outcome of both apoptosis-based ADCC cytotoxicity (Figure 21A) and necrosis-based ADCC cytotoxicity which is non-apoptotic ( Figure 2 IB). Additionally, the boost in antibody-induced ADCC cytotoxicity as a function of increasing E:T ratios, as observed in Figure 19B, also holds true for both ADCC-apoptosis and ADCC-necrosis, where antibody-induced ADCC-apoptosis is boosted with increasing E:T ratios ( Figure 21A, boosted by 18.8%, 26.0%, and 49.8%,
• Figure 22 clearly establishes that the degranulation process of NK cells, which is central to their innate immune function of targeting diseased cells, is enhanced during the antibodybased induction of the ADCC mechanism of NK cells (by a TCR-like antibody against a peptide- MHC complex), directed against target cells displaying the SIINFEKL-H2K b complex.
• the experimental result represented by Figure 23 establishes that the result obtained in the complementary experiment (represented by Figures 18-22) of ADCC induction is based on the specific binding of the SIINFEKL-H2K b complex on the surface of the target EL4 cells by the anti-SIINFEKL-H2K b antibody, and that this antibody binding is the basis of the ADCC quantification represented by Figures 19-21.
• SUBSTITUTE SHEET (RULE 26) illustrates that antibodies can be generated against neoepitopes to induce the ADCC mechanism on NK cells for the purpose of NK cell killing of diseased cells displaying the neoepitope.
• o Antibodies are the basis of the personalization in several embodiments of the current invention, rather than cellular therapy being the basis of personalization. Antibodies offer greater efficiencies in their generation and use compared to cellular therapy, for example they are faster and cheaper to produce. o Antibodies may be administered to the patient as a single antibody (against a single neoepitope), or a combination of two or more antibodies (against two or more distinct epitopes), thus offering treatment efficiency. o Exogenously added cellular therapy i.e. adoptive cellular therapy is optional and not a requirement, given that some embodiments of the current invention only
• SUBSTITUTE SHEET (RULE 26) require antibody administration to the patient, with a reliance on endogenous immune cells in the patient’s body, and without any exogenous cellular therapy.
• Embodiments of the current invention offer efficiency in treatment.
• exogenous cellular therapy is being administered in concert with the neoepitope targeting Antibody therapy, there is a range of cells to choose from (e.g. NK cells, macrophages, neutrophils etc.).
• one or more types of cellular therapy may be administered for the purpose of synergy of biological effects, for example the administration of exogenous NK cells combined with exogenous macrophages for the induction of both the ADCC mechanism (through CD16 on NK cells) and the ADCP mechanism (through CD32 on macrophages) to fight the disease.
• exogenous NK cells combined with exogenous macrophages for the induction of both the ADCC mechanism (through CD16 on NK cells) and the ADCP mechanism (through CD32 on macrophages) to fight the disease.
• Newer antibodies can continue to be generated in response to further mutations in the disease manifestation during the course of treatment (for example, in a scenario where different neoepitopes appear as the cancer metastasizes).
• This opportunity for treatment flexibility is offered by virtue of the resource-efficiency inherent to antibody generation versus cellular therapy generation. In other words, the therapy is adaptable to the disease.
• the experimental results summarized in this section provide evidence that the current invention creates novel processes to generate personalized therapy by virtue of generating antibodies that selectively target neoepitopes on diseased cells, and the leveraging of the cellular mechanisms of ADCC, ADCP, or a combination of ADCC and ADCP.
• TCR-like antibody specific for a particular peptide-MHC complex in this case, a model antigen serving as a “surrogate neoepitope”
• a model antigen serving as a “surrogate neoepitope” is capable of inducing ADCC activity by NK cells. Further experimentation is planned to [a] demonstrate that this ADCC activity leads to antitumor activity in vivo, [b] demonstrate that new TCR-like antibodies can be generated against known neoepitopes in humans using the methods described in the detailed description, and [c] demonstrate that the new anti-neoepitope TCR-like antibodies induce ADCC activity.
• E.G7 Another cell line, E.G7, is derived from EL4 but unlike EL4 cells, E.G7 is stably transfected with chicken egg ovalbumin (OVA), and given that OVA has the amino acid sequence SIINFEKL, E.G7 cells therefore present the “surrogate” neoepitope SIINFEKL on cell-surface H2K b molecules even without separate exposure to the SIINFEKL peptide. Both of these tumor cell lines are tumorigenic in C57BL/6 mice, i.e. intradermal implantation leads to progressive tumor growth which can be monitored over time.
• OVA chicken egg ovalbumin
• mice will be implanted with either [a] EL4 tumors, where EL4 cells have not been exposed to the SIINFEKL peptide (negative control), or [b] E.G7 tumors (which have the antibody’s target on their surface), and treat the mice with various doses of the antibody.
• adoptive transfers of primary NK cells freshly isolated from other C57BL/6 mice
• Endpoints will include the change in tumor size over time, and mouse survival.
• HLA-A*02:01 binding neoepitope (amino acid sequence CLAVEEVSL) arising from a four-base-pair insertion in NPM1 that results in a brief alternative reading frame translation (Van der Lee, et al. (2019) J. Clin. Invest. 129(2):774-85).
• This frameshift mutation is found in 30% of AML patients, making it a “public” neoantigen.
• HLA-A*02:01 is a highly prevalent HLA allele.
• the first phase of the project will have the following objectives: (1) Generate several novel TCR-like antibodies against this “public” frameshift-derived neoantigen commonly found in AML, and (2) test the candidate antibodies in vitro to evaluate their ability to induce ADCC activity by human NK cells against AML cells.
• the top performing candidate antibodies (about 3 - 5 different antibodies) will constitute a shortlist to be tested preclinically in the second phase of the project.
• Monomeric complexes without biotinylation or fluorophore conjugation, will be produced for the purpose of immunizing animals and performing ELISAs (discussed below); in addition, fluorophore-conjugated HLA-peptide tetramers will be produced for the purpose of fluorescence-activated cell sorting.
• Immunomagnetic negative selection kits will be used to enrich the B cells by removing most T cells and other cells present in the dissociated lymphoid tissues.
• the resulting cell suspensions consisting of greater than 90% B cells, will be prepared for the next step, fluorescence-activated cell sorting.
• the purpose of this step will be to isolate individual B cells whose B cell receptors specifically bind the HLA-A*02: 01 -CLAVEEVSL complex. Cells will be stained with antibodies against rat IgG (to select B cells) and the T cell receptor (to exclude T cells), and several fluorescently labeled HLA-peptide tetramer complexes.
• B cells with specificity for a particular HLA-peptide complex are successfully isolated using the following staining and gating strategy: (1) Cells are stained with tetramers of the HLA-peptide of interest, but two different fluorophores are used. For example, cells are stained with tetramer conjugated to Fluorescein isothiocyanate (FITC) and simultaneously stained with the same tetramer conjugated to Phycoerythrin (PE). Meanwhile, the cells are also stained with another tetramer of an irrelevant HLA-peptide complex conjugated to a different fluorophore (e.g. APC).
• FITC Fluorescein isothiocyanate
• PE Phycoerythrin
• SUBSTITUTE SHEET (RULE 26) (2) During cell sorting, a gate is set to select those B cells positive for both of the fluorophores associated with the tetramer of interest (in this case FITC and PE), i.e. double-positive cells. For those double-positive cells, an additional gate is set to select those cells negative for the fluorophore associated with the irrelevant tetramer (in this case APC).
• Using two different fluorophores for positive selection of the tetramer of interest excludes B cells specific for the fluorophores; meanwhile, the negative gate on the irrelevant tetramer excludes B cells specific for the HLA molecule itself (rather than the antigen peptide in association with the HLA molecule) and also excludes B cells specific for
• the resulting number of individual B cells collected is small (less than 100), but some of them show high specificity and high affinity for the HLA-peptide complex used for immunization (-12%).
• variable region sequences will be cloned into a eukaryotic expression vector encoding a human antibody of the IgGl isotype.
• CHO cells will be transiently transfected to produce the anti-HLA- neoepitope antibodies.
• Supernatants will be collected from transfected CHO cell cultures, and antibody purification will be performed using human IgG isolation kits. It is expected that 20-80 B cell clones will be isolated from a single immunized OmniRat; therefore, it is expected that 2
• HLA-A*02:01- CLAVEEVSL complexes (monomers) will be used that were used to immunize the animals.
• wells will be coated with these HLA-peptide complexes or irrelevant HLA-peptide complexes.
• Each antibody will be individually tested for binding to these HLA-peptide complexes. Those which show only weak binding to HLA-A*02:01- CLAVEEVSL, or show binding significantly greater than background to the irrelevant complex, will be discarded. Those which bind strongly to HLA-A*02:01-CLAVEEVSL, but not to the irrelevant HLA-peptide complex, will be kept as candidate antibodies to be tested further in ADCC assays (the second objective).
• TCR-like antibody specific for the SIINFEKL-H2K b complex (a model antigen serving as a “surrogate neoepitope”) is capable of inducing ADCC activity by NK cells.
• cancer cells sourced from AML patients will be used. These cancer cells will be procured from a university teaching hospital, e.g. UConn Health or University of Minnesota. Since candidate antibodies will be specific for a neoepitope presented by HLA-A*02:01, most of the AML samples will be obtained from patients possessing that HLA allele. However, a small number of AML samples lacking that allele will also be obtained to serve as negative controls.
• AML samples will undergo Sanger sequencing to test for the presence of the particular four-base-pair insertion in NPM1, which ought to be present in 30% of the samples, that leads to the presentation of the “public” neoepitope CLAVEEVSL on HLA- A*02:01. All samples positive for HLA-A*02:01, and also possessing the correct mutation, will be selected for use in ADCC experiments. However, some HLA-A*02: 01 -positive samples lacking the correct mutation to serve as negative controls will also be selected.
• NK cells For effector cells in the ADCC assays, primary human NK cells from healthy donors will be used. Fresh buffy coats will be procured from Research Blood Components (Watertown, MA), and the PBMCs will be obtained using density gradient centrifugation. NK cells will be enriched using immunomagnetic negative selection.
• each of the candidate antibodies will be tested for their ability to induce ADCC by NK cells against AML cells with or without the HLA-A*02:01 allele, and with or without the frameshift mutation that results in presentation of CLAVEEVSL.
• each experiment will include at least four AML samples possessing the correct allele and correct mutation, at least one AML sample lacking the correct allele, and at least one AML sample lacking the correct mutation.
• cocultures will be set up at multiple effector Target ratios (e.g. 1 : 1, 4: 1, and 10: 1) and at multiple antibody concentrations (e.g. 0 pg/mL, 0.02 pg/mL, 0.2 pg/mL, 2
• SUBSTITUTE SHEET (RULE 26) pg/mL). Isotype control antibodies will also be included as a negative control. Cocultures will proceed for 4 - 6 hours. Cultures of AML cells in the absence of effector (NK) cells will be treated similarly, to establish the baseline death of these AML cells under these conditions. Death of AML cells will be quantified using flow cytometry, following staining with a membrane impermeable nuclear stain (e.g. propidium iodide) as well as an apoptosis marker (e.g. Annexin V). There will be four technical replicates for each group.
• a membrane impermeable nuclear stain e.g. propidium iodide
• an apoptosis marker e.g. Annexin V
• ADCC activity is expected in the presence of antibody only when (1) the AML sample contains the NPM1 frameshift mutation leading to presentation of the “public” neoepitope CLAVEEVSL, and (2) the AML sample expresses HLA-A*02:01. The 3 - 5 antibodies inducing the greatest ADCC activity will be chosen for future animal experimentation.
• Embodiment 1 provides a composition for treating cancer, said composition comprising: a. one or more antibodies, or antigen-binding fragments thereof that specifically bind one or more tumor-specific epitopes, and b. an effective amount of a cytotoxic immune effector cell.
• Embodiment 2 provides the composition of embodiment 1, wherein the composition is personalized.
• Embodiment 3 provides the composition of embodiment 1, wherein the tumor-specific epitope is a neoepitope.
• Embodiment 4 provides the composition of embodiment 1, wherein the antibodies or antigen-binding fragments thereof are humanized.
• Embodiment 5 provides the composition of embodiment 1, wherein the antibodies or antigen-binding fragments thereof are fully human.
• Embodiment 6 provides the composition of embodiment 1, wherein the antibodies or antigen-binding fragments thereof are afucosylated.
• Embodiment 7 provides the composition of embodiment 1, wherein the antibody or antigen-binding fragment thereof is bispecific.
• Embodiment 8 provides the composition of embodiment 1, wherein the tumor-specific epitope is a neoepitope/HLA complex.
• Embodiment 9 provides the composition of embodiment 1, wherein the cytotoxic immune effector cells are a cell type selected from the group consisting of NK cells, macrophages, monocytes, neutrophils, dendritic cells, or any combination thereof.
• the cytotoxic immune effector cells are a cell type selected from the group consisting of NK cells, macrophages, monocytes, neutrophils, dendritic cells, or any combination thereof.
• Embodiment 10 provides the composition of embodiment 1, wherein the cytotoxic immune effector cells are irradiated.
• Embodiment 11 provides a method of producing a composition for treating cancer, said method comprising: a. obtaining a tumor specimen from a subject and identifying tumor-specific genetic mutations expressed by the tumor through sequencing, b. generating HLA/neoepitope complexes based on the identified tumorspecific genetic mutations, c. immunizing a non-human animal with the HLA/neoepitope complexes, d. isolating B cells from the immunized non-human animal that produce HLA/neoepitope-specific antibodies or facilitate the generation of antigenbinding fragments thereof, e. verifying that the HLA/neoepitope-specific antibodies bind to the tumor, f. producing an effective amount of the HL A/neoepitope-specific antibodies, and g. combining the effective amount of the HLA/neoepitope-specific antibodies with an effective amount of a cytotoxic immune effector cell.
• Embodiment 12 provides the method of embodiment 11, wherein the sequencing is nextgeneration sequencing.
• Embodiment 13 provides the method of embodiment 11, wherein the non-human animal is humanized.
• Embodiment 14 provides the method of embodiment 11, wherein the non-human animal produces fully-human antibodies.
• Embodiment 15 provides the method of embodiment 13, wherein the non-human humanized animal is selected from the group consisting of a rat, a mouse, a rabbit, a donkey, a goat, a camel, a llama, an alpaca, and a shark.
• Embodiment 16 provides the composition of embodiment 11, wherein the HLA/neoepitope-specific antibodies are generated through a non-animal method.
• Embodiment 17 provides the composition of embodiment 16, wherein the non-animal method of phage display.
• Embodiment 18 provides the composition of embodiment 11, wherein the antibodies or antigen-binding fragments thereof are afucosylated.
• Embodiment 19 provides the composition of embodiment 11, wherein the isotype of the antibodies supports ADCC or ADCP.
• Embodiment 20 provides the composition of embodiment 11, wherein the isotype of the antibodies are further modified from an isotype that does not support ADCC or ADCP to an isotype that supports ADCC or ADCP.
• Embodiment 21 provides the method of embodiment 11, wherein the HLA/neoepitope complexes are selected from the group consisting of monomeric complexes, pentameric complexes, tetrameric complexes, dextran-linked complexes, and any combination thereof.
• Embodiment 22 provides the method of embodiment 11, wherein the cytotoxic immune effector cells are a cell type selected from the group consisting of NK cells, macrophages, monocytes, neutrophils, dendritic cells, or any combination thereof.
• the cytotoxic immune effector cells are a cell type selected from the group consisting of NK cells, macrophages, monocytes, neutrophils, dendritic cells, or any combination thereof.
• Embodiment 23 provides a method of producing a composition for treating cancer, said method comprising: a. obtaining a tumor specimen from a subject and identifying tumor-specific genetic mutations expressed by the tumor through sequencing, b. generating HLA/neoepitope complexes based on the identified tumorspecific genetic mutations, c. immunizing a non-human animal with the HLA/neoepitope complexes,
• SUBSTITUTE SHEET (RULE 26) d. isolating B cells from the immunized non-human animal that produce HLA/neoepitope-specific antibodies or facilitate the generation of antigenbinding fragments thereof, e. verifying that the HLA/neoepitope-specific antibodies bind to the tumor, f. generating one or more a chimeric antigen receptors (CARs) comprising the antigen binding domains from the HLA/neoepitope-specific antibodies, and g. expressing the CARs in a cytotoxic immune effector cell.
• CARs chimeric antigen receptors
• Embodiment 24 provides the method of embodiment 23, wherein the sequencing is nextgeneration sequencing.
• Embodiment 25 provides the method of embodiment 23, wherein the non-human animal is humanized.
• Embodiment 26 provides the method of embodiment 23, wherein the non-human animal produces fully-human antibodies.
• Embodiment 27 provides the method of embodiment 23, wherein the non-human humanized animal is selected from the group consisting of a rat, a mouse, a rabbit, a donkey, a goat, a camel, a llama, an alpaca, and a shark.
• Embodiment 28 provides the method of embodiment 23, wherein the HLA/neoepitope- specific antibodies are generated through a non-animal method.
• Embodiment 29 provides the method of embodiment 23, wherein the non-animal method is phage display.
• Embodiment 30 provides the composition of embodiment 23, wherein generating the CAR further comprises the step of generating an scFv based on the antigen-binding domains of the antibodies.
• Embodiment 31 provides the composition of embodiment 23, wherein the CAR further comprises a transmembrane domain, a signaling domain, and a costimulatory domain.
• Embodiment 32 provides the method of embodiment 23, wherein the HLA/neoepitope complexes are selected from the group consisting of monomeric complexes, pentameric complexes, tetrameric complexes, dextran-linked complexes, and any combination thereof.
• Embodiment 33 provides the method of embodiment 23, wherein the cytotoxic immune effector cells are a cell type selected from the group consisting of NK cells, T cells, NK T cells, or any combination thereof.
• Embodiment 34 provides the method of embodiment 23, wherein the cytotoxic immune effector cell is an NK cell.
• Embodiment 35 provides the method of embodiment 23, wherein the cytotoxic immune effector cell is a CD8+ T cell.
• Embodiment 36 provides a method of treating cancer in a subject in need thereof, said method comprising: a. obtaining a tumor specimen from the subject and identifying tumorspecific neoepitopes expressed by the tumor through sequencing, b. generating HLA/neoepitope complexes from the identified tumor-specific neoepitopes, c. immunizing a non-human mammal with the HLA/neoepitope complexes, d. isolating B cells that produce HLA/neoepitope-specific antibodies or antigen-binding fragments thereof from the immunized non-human mammal, e.
• Embodiment 37 provides the method of embodiment 36, wherein the sequencing is nextgeneration sequencing.
• Embodiment 38 provides the method of embodiment 36, wherein the non-human animal is humanized.
• Embodiment 39 provides the method of embodiment 36, wherein the non-human animal produces fully-human antibodies.
• Embodiment 40 provides the method of embodiment 36, wherein the non-human humanized animal is selected the group consisting of a rat, a mouse, a rabbit, a donkey, a goat, a camel, a llama, an alpaca, and a shark.
• Embodiment 41 provides the method of embodiment 36, wherein the HLA/neoepitope- specific antibodies are generated through a non-animal method.
• Embodiment 42 provides the method of embodiment 36, wherein the non-animal method is phage display.
• Embodiment 43 provides the method of embodiment 36, wherein the HLA/neoepitope- specific antibodies are afucosylated.
• Embodiment 44 provides the method of embodiment 36, wherein the isotype of the antibodies supports ADCC or ADCP.
• Embodiment 45 provides the method of embodiment 36, wherein the isotype of the antibodies are further modified from an isotype that does not support ADCC or ADCP to an isotype that supports ADCC or ADCP.
• Embodiment 46 provides the method of embodiment 36, wherein the HLA/neoepitope complexes are selected from the group consisting of monomeric complexes, pentameric complexes, tetrameric complexes, dextran-linked complexes, and any combination thereof.
• Embodiment 47 provides the method of embodiment 36, wherein the cytotoxic immune effector cells are a cell type selected from the group consisting of NK cells, macrophages, monocytes, neutrophils, dendritic cells, or any combination thereof.
• Embodiment 48 provides a method of treating cancer in a subject in need thereof, said method comprising: a. obtaining a tumor specimen from the subject and identifying tumorspecific neoepitopes expressed by the tumor through sequencing, b. generating HLA/neoepitope complexes from the identified tumor-specific neoepitopes, c. immunizing a non-human mammal with the HLA/neoepitope complexes, d. isolating B cells that produce HLA/neoepitope-specific antibodies or antigen-binding fragments thereof from the immunized non-human mammal, e. verifying that the HLA/neoepitope-specific antibodies bind to the tumor,
• SUBSTITUTE SHEET (RULE 26) f. generating a chimeric antigen receptor (CAR) comprising the antigenbinding domains from the HLA/neoepitope-specific antibodies, g. expressing the CAR in a cytotoxic immune effector cell, and h. administering to the subject an effective amount of the cytotoxic immune effector cell, thereby treating the cancer.
• CAR chimeric antigen receptor
• Embodiment 49 provides the method of embodiment 48, wherein the sequencing is nextgeneration sequencing.
• Embodiment 50 provides the method of embodiment 48, wherein the non-human animal is humanized.
• Embodiment 51 provides the method of embodiment 48, wherein the non-human animal produces fully-human antibodies.
• Embodiment 52 provides the method of embodiment 48, wherein the non-human humanized animal is selected from the group consisting of a rat, a mouse, a rabbit, a donkey, a goat, a camel, a llama, an alpaca, and a shark.
• Embodiment 53 provides the method of embodiment 48, wherein the HLA/neoepitope- specific antibodies are generated through a non-animal method.
• Embodiment 54 provides the method of embodiment 48, wherein the non-animal method is phage display.
• Embodiment 55 provides the method of embodiment 48, wherein the HLA/neoepitope complexes are selected from the group consisting of monomeric complexes, pentameric complexes, tetrameric complexes, dextran-linked complexes, and any combination thereof.
• Embodiment 56 provides the composition of embodiment 48, wherein generating the CAR further comprises the step of generating an scFv based on the antigen-binding domains of the antibodies.
• Embodiment 57 provides the composition of embodiment 48, wherein the CAR further comprises a transmembrane domain, a signaling domain, and a costimulatory domain.
• Embodiment 58 provides the method of embodiment 48, wherein the cytotoxic immune effector cells are a cell type selected from the group consisting of NK cells, T cells, NK T cells, or any combination thereof.
• Embodiment 59 provides the method of embodiment 48, wherein the cytotoxic immune effector cell is an NK cell.
• Embodiment 60 provides the method of embodiment 48, wherein the cytotoxic immune effector cell is a CD8+ T cell.

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