Dual CD4-based CAR T cells with distinct costimulatory domains mitigate HIV pathogenesis in vivo

CR Maldini, DT Claiborne, K Okawa, T Chen… - Nature medicine, 2020 - nature.com
CR Maldini, DT Claiborne, K Okawa, T Chen, DL Dopkin, X Shan, KA Power, RT Trifonova…
Nature medicine, 2020nature.com
An effective strategy to cure HIV will likely require a potent and sustained antiviral T cell
response. Here we explored the utility of chimeric antigen receptor (CAR) T cells, expressing
the CD4 ectodomain to confer specificity for the HIV envelope, to mitigate HIV-induced
pathogenesis in bone marrow, liver, thymus (BLT) humanized mice. CAR T cells expressing
the 4-1BB/CD3-ζ endodomain were insufficient to prevent viral rebound and CD4+ T cell
loss after the discontinuation of antiretroviral therapy. Through iterative improvements to the …
Abstract
An effective strategy to cure HIV will likely require a potent and sustained antiviral T cell response. Here we explored the utility of chimeric antigen receptor (CAR) T cells, expressing the CD4 ectodomain to confer specificity for the HIV envelope, to mitigate HIV-induced pathogenesis in bone marrow, liver, thymus (BLT) humanized mice. CAR T cells expressing the 4-1BB/CD3-ζ endodomain were insufficient to prevent viral rebound and CD4+ T cell loss after the discontinuation of antiretroviral therapy. Through iterative improvements to the CAR T cell product, we developed Dual-CAR T cells that simultaneously expressed both 4-1BB/CD3-ζ and CD28/CD3-ζ endodomains. Dual-CAR T cells exhibited expansion kinetics that exceeded 4-1BB-, CD28- and third-generation costimulated CAR T cells, elicited effector functions equivalent to CD28-costimulated CAR T cells and prevented HIV-induced CD4+ T cell loss despite persistent viremia. Moreover, when Dual-CAR T cells were protected from HIV infection through expression of the C34-CXCR4 fusion inhibitor, these cells significantly reduced acute-phase viremia, as well as accelerated HIV suppression in the presence of antiretroviral therapy and reduced tissue viral burden. Collectively, these studies demonstrate the enhanced therapeutic potency of a novel Dual-CAR T cell product with the potential to effectively treat HIV infection.
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