Liliana Rodrigues Loureiro

The Prostate Stem Cell Antigen (PSCA) is not only overexpressed in prostate cancer (PC) but also in many other tumors, including cervical cancer (CC). The adaptor chimeric antigen receptor (CAR) platform RevCAR can be used for immunotargeting of PSCA-expressing tumor cells. We found that the CC cell line SiHa natively expresses PSCA. The expression was sufficient for redirection of RevCAR T-cells using recently described RevCAR target modules (RevTMs) directed against PSCA. Like almost all PC cell lines, however, SiHa cells also downregulate their PSCA expression in cell culture. To overcome this limitation, we established artificially PSCA-overexpressing SiHa cells. Retargeting of RevCAR T-cells strictly depends on PSCA-directed RevTMs and PSCA-expressing target cells. It leads to (i) upregulation of CD69, Perforin and Granzyme B, (ii) lysis of target cells with EC₅₀ values in the picomolar range, and (iii) cytokine secretion of IFN-γ, TNF-α, GM-CSF and IL-2. Phenotypic analysis shows a prominent increase in memory RevCAR T-cells but only a slight increase in exhausted cells, indicating a low level of tonic signaling of RevCAR T-cells. Together, our data supports an efficient and safe immunotargeting of PSCA-expressing CC cells with the RevCAR technology.

The fibroblast activation protein alpha (FAPα) is overexpressed in the tumor microenvironment of most solid cancers and, in some cases, in cancer cells, making it an interesting target for theranostic applications. T-cells modified to express a chimeric antigen receptor (CAR) against FAP have recently been described. We previously established the UniCAR system, in which UniCAR T-cells can be repeatedly switched on and off via dosing with a bifunctional adaptor molecule, known as target module (TM). Here, we describe the first FAPI-based immunotheranostic UniCAR TMs (FAPI TMs), enabling both non-invasive molecular imaging and UniCAR T-cell immunotherapy. The FAPI TMs consist of the UAMC-1110 FAPI moiety, the NODA-GA chelator for copper-64 labeling, and the UniCAR epitope (E5B9). Following computational analyses, three FAPI TMs with polyethylene glycol (PEG) spacers of either four, twelve, or 24 units were synthesized. Although the three novel TMs specifically accumulate in FAP-positive tumors in xenograft mice, only the FAPI TMs with an extended spacer (PEG₁₂ and PEG₂₄) redirect UniCAR T-cells to FAP-positive target cells both in vitro and in an immunodeficient mouse model. In line with the computational studies, the E5B9 epitope is not accessible for binding when the PEG₄-based FAPI TM is bound to FAP. Our work demonstrates that the length of the spacer in FAPI TMs is critical for the effective redirection of UniCAR T-cells to FAP-positive cells. Overall, our novel FAPI TMs may represent highly promising immunotheranostic tools for personalized non-invasive diagnostic imaging and immunotherapy of cancer patients.

Target modules (TMs), intermediate molecules required for UniCAR T-cell therapy, are promising molecules for immunotheranostic approaches. In the current work, we developed TMs containing a monomeric or dimeric form of the antagonist bombesin peptide (BBN2) and assessed their potential for diagnostic imaging using positron emission tomography (PET) as well as immunotherapy in combination with UniCAR T-cells to target and image GRPR expression in prostate cancer. Synthesized monomeric and dimeric BBN2 TMs retained binding to GRPR in vitro. Both BBN2 TMs specifically activated and redirected UniCAR T-cells to eradicate PC3 and LNCaP cancer cells with high efficiency and in a comparable manner. UniCAR T-cells retained a non-exhausted memory phenotype favorable to their persistence and fitness. The ⁶⁸Ga-labeled BBN2 TMs showed proof-of-target towards GRPR in PC3 and LNCaP xenografts with similar uptake profiles for both BBN2 TMs in dynamic PET experiments. Clearance occurred exclusively through renal elimination. A tremendously increased in vivo metabolic stability of the BBN2 TMs was observed compared to their counterparts without E5B9. Both monomeric and dimeric BBN2 TMs represent novel and promising immunotheranostic tools for application in prostate cancer with exceptionally high in vivo metabolic stability.

Selection and optimization of therapies for cancer patients urgently needs personalization. Portable point-of-care electronic biosensors emerge as a groundbreaking solution to contribute to better decision-making in precision oncology. This study showcases the innovative use of extended gate field-effect transistor (EG-FET) biosensors to monitor the concentration and pharmacokinetics of immunotherapeutic drugs in vivo. Complementary positron emission tomography (PET) and radioactivity biodistribution studies in mice validate the EG-FET measurements. We introduce a novel indirect assay format for detecting target modules in an adapter CAR T-cell therapy model, effectively addressing the limitations of traditional potentiometric measurements. The EG-FET sensors exhibit exceptional sensitivity, and fulfill the requirements for immunotherapeutic drug monitoring without the need for complex radioactive labeling. In pharmacokinetic evaluations, the FET-based biosensor's performance aligns with standard radioactive measurements, revealing the distinct lifespans of small-sized TMs (15 minutes for scFv type) and larger TMs (14 hours for IgG4 type). These promising findings advocate for further exploration of next-generation biosensors in therapeutic monitoring roles. With their cost, size, and response time advantages, these biosensors hold immense potential for advancing personalized oncology, transcending the conventional diagnostic roles typically highlighted in the literature.

Although Chimeric Antigen Receptor (CAR) T-cells have shown high efficacy in hematologic malignancies, they can cause severe to life-threatening side effects. To address these safety concerns, we have developed adaptor CAR platforms, like the UniCAR system. The redirection of UniCAR T-cells to target cells relies on a Target Module (TM), containing the E5B9 epitope and a tumor-specific binding moiety. Appropriate UniCAR-T activation thus involves two interactions: between the TM and the CAR T-cell, and the TM and the target cell. Here, we investigate if and how alterations of the amino acid sequence of the E5B9 UniCAR epitope impact the interaction between TMs and the UniCAR. We identify the new epitope E5B9L, for which the monoclonal antibody 5B9 has the greatest affinity. We then integrate the E5B9L peptide in previously established TMs directed to Fibroblast Activation Protein (FAP) and assess if such changes in the UniCAR epitope of the TMs affect UniCAR T-cell potency. Binding properties of the newly generated anti-FAP-E5B9L TMs to UniCAR and their ability to redirect UniCAR T-cells were compared side-by-side with the ones of anti-FAP-E5B9 TMs. Despite a substantial variation in the affinity of the different TMs to the UniCAR, no significant differences were observed in the cytotoxic and cytokine-release profiles of the redirected T-cells. Overall, our work indicates that increasing affinity of the UniCAR to the TM does not play a crucial role in such adaptor CAR system, as it does not significantly impact the potency of the UniCAR T-cells.

Background: Chimeric antigen receptor (CAR) T-cells are a promising approach in cancer immunotherapy, particularly for treating hematologic malignancies. Yet, their effectiveness is limited when tackling solid tumors, where immune cell infiltration and immunosuppressive tumor microenvironments (TME) are major hurdles. Fibroblast activation protein (FAP) is highly expressed on cancer-associated fibroblasts (CAFs) and various tumor cells, playing an important role in tumor growth and immunosuppression. Aiming to modulate the TME with increased clinical safety and effectiveness, we developed novel small and size-extended immunotheranostic UniCAR target modules (TMs) targeting FAP. Methods: The specific binding and functionality of the αFAP-scFv TM and the size-extended αFAP-IgG4 TM were assessed using 2D and 3D in vitro models as well as in vivo. Their specific tumor accumulation and diagnostic potential were evaluated using PET studies after functionalization with a chelator and suitable radionuclide. Results: The αFAP-scFv and -IgG4 TMs effectively and specifically redirected UniCAR T-cells using 2D, 3D, and in vivo models. Moreover, a remarkably high and specific accumulation of radiolabeled FAP-targeting TMs at the tumor site of xenograft mouse models was observed. Conclusions: These findings demonstrate that the novel αFAP TMs are promising immunotheranostic tools to foster cancer imaging and treatment, paving the way for a more convenient, individualized, and safer treatment of cancer patients. Graphical

Background Chimeric antigen receptor (CAR) T-cells are a promising approach in cancer immunotherapy, particularly for treating hematologic malignancies. Yet, their effectiveness is limited when tackling solid tumors, where immune cell infiltration and immunosuppressive tumor microenvironments (TME) are major hurdles. Fibroblast activation protein (FAP) is highly expressed on cancer-associated fibroblasts (CAFs) and various tumor cells, playing an important role in tumor growth and immunosuppression. Aiming to modulate the TME with increased clinical safety and effectiveness, we developed novel small and size-extended immunotheranostic UniCAR target modules (TMs) targeting FAP. Methods The specific binding and functionality of the αFAP-scFv TM and the size extended αFAP-IgG4 TM were assessed using 2D and 3D in vitro models as well as in vivo. Their specific tumor accumulation and diagnostic potential was evaluated using PET studies after functionalization with a chelator and suitable radionuclide. Results The αFAP-scFv and -IgG4 TMs effectively and specifically redirected UniCAR T-cells using 2D, 3D, and in vivo models. Moreover, a remarkably high and specific accumulation of radiolabeled FAP-targeting TMs at the tumor site of xenograft mouse models was observed. Conclusions These findings demonstrate that the novel αFAP TMs are promising immunotheranostic tools to foster cancer imaging and treatment, paving the way for a more convenient, individualized, and safer treatment of cancer patients.

Noninvasive molecular imaging of the PD-1/PD-L1 immune checkpoint is of high clinical relevance for patient stratification and therapy monitoring in cancer patients. Here we report nine small-molecule PD-L1 radiotracers with solubilizing sulfonic acids and a linker–chelator system, designed by molecular docking experiments and synthesized according to a new, convergent synthetic strategy. Binding affinities were determined both in cellular saturation and real-time binding assay (LigandTracer), revealing dissociation constants in the single digit nanomolar range. Incubation in human serum and liver microsomes proved in vitro stability of these compounds. Small animal PET/CT imaging, in mice bearing PD-L1 overexpressing and PD-L1 negative tumors, showed moderate to low uptake. All compounds were cleared primarily through the hepatobiliary excretion route and showed a long circulation time. The latter was attributed to strong blood albumin binding effects, discovered during our binding experiments. Taken together, these compounds are a promising starting point for further development of a new class of PD-L1 targeting radiotracers.

Radiation of tumor cells can lead to the selection and outgrowth of tumor escape variants. As radioresistant tumor cells are still sensitive to retargeting of T cells, it appears promising to combine radio- with immunotherapy keeping in mind that the radiation of tumors favors the local conditions for immunotherapy. However, radiation of solid tumors will not only hit the tumor cells but also the infiltrated immune cells. Therefore, we wanted to learn how radiation influences the functionality of T cells with respect to retargeting to tumor cells via a conventional bispecific T cell engager (BiTE) and our previously described modular BiTE format UNImAb. T cells were irradiated between 2 and 50 Gy. Low dose radiation of T cells up to about 20 Gy caused an increased release of the cytokines IL-2, TNF and interferon-γ and an improved capability to kill target cells. Although radiation with 50 Gy strongly reduced the function of the T cells, it did not completely abrogate the functionality of the T cells.

Chimeric antigen receptor (CAR)-expressing T-cells are without a doubt a breakthrough therapy for hematological malignancies. Despite their success, clinical experience has revealed several challenges, which include relapse after targeting single antigens such as CD19 in the case of B-cell acute lymphoblastic leukemia (B-ALL), and the occurrence of side effects that could be severe in some cases. Therefore, it became clear that improved safety approaches, and targeting multiple antigens, should be considered to further improve CAR T-cell therapy for B-ALL. In this paper, we address both issues by investigating the use of CD10 as a therapeutic target for B-ALL with our switchable UniCAR system. The UniCAR platform is a modular platform that depends on the presence of two elements to function. These include UniCAR T-cells and the target modules (TMs), which cross-link the T-cells to their respective targets on tumor cells. The TMs function as keys that control the switchability of UniCAR T-cells. Here, we demonstrate that UniCAR T-cells, armed with anti-CD10 TM, can efficiently kill B-ALL cell lines, as well as patient-derived B-ALL blasts, thereby highlighting the exciting possibility for using CD10 as an emerging therapeutic target for B-cell malignancies.