No-Joon Song

Given its status as the leading cause of global cancer mortality, there is a critical need to enhance immunotherapy strategies for lung cancer to overcome widespread resistance to current treatments. Immunotherapy recruits the patient’s immune system to attack and destroy cancer cells. While highly effective in a subset of patients, chronic exposure of immune cells to cancer cells leads to a progressive loss of effector T cell function and progression of T cell exhaustion; now considered two well-established hallmarks of immunotherapy resistance. The tumor-immune microenvironment (TIME)-driven differentiation into the exhausted T cell phenotype is marked by a loss of metabolic plasticity and epigenome-wide changes in distribution of repressive histone marks such as histone H3 subunit methylation at lysine 27 (H3K27me ³ ). Here, we studied how these processes are connected to metabolite availability within the TIME. In vitro , chronic antigen stimulation and hypoxia led to rapid loss of effector function, associated with a suppression of alpha-ketoglutarate (aKG) intracellular concentrations in T cells. Supplementation of cell-permeable aKG led to a rescue of effector cytokine production and to improved cytotoxic capacity despite chronic antigen stimulation and hypoxia. Increased intracellular aKG levels restored the activity of H3K27 demethylases UTX and JMJD3, consistent with epigenome-wide decreased H3K27me ³ . In vivo , dietary supplementation with commercially available calcium-aKG (Ca-aKG) supplements led to an elevation of serum and intratumoral aKG levels associated with a significant increase of immunotherapy effectiveness in mouse models of NSCLC. Clinical samples from patients with NSCLC contained significantly decreased serum aKG levels in older NSCLC patients (>65 years of age). Analysis identified a novel association between serum aKG levels and poor immunotherapy response. Thus, our work demonstrates that intratumoral metabolite “starvation” can be therapeutically exploited to improve immunotherapy outcomes in non-small cell lung cancer (NSCLC).

Supplementary Figure 2. Trispecific CAR T Cell Persistence by gag gene PCR (single dose infusion versus split dose infusion).

Supplementary Figure 4. Immunophenotypic and functional characteristics CD8+ CAR + T cells and CD4+ CAR + T cells in post-CAR T infusion PBMCs at Day 7.

Supplementary Figure 1. Trial Schema.

Supplementary Table 2. Toxicity and other clinical outcomes.

Supplementary Figure 6. Trispecific CAR + T cell Gating Strategy for spectral flow cytometry.

Supplementary Figure 3. Statistical Analysis (Area Under the Curve) Trispecific CAR T Cell Persistence by PCR Data.

Supplementary Figure 5: Immunophenotypic and functional characteristics CD8+ CAR + T cells and CD4+ CAR + T cells in Post-CAR T PBMCs at Day 14.

Supplementary Table 1. Representativeness of Study Participants.