491 BASECAMP-1: an observational study to identify relapsed solid tumor patients with human leukocyte antigen (HLA) loss of heterozygosity (LOH) and leukapheresis for future CAR T-cell therapy

Background

Solid tumors comprise >90% of cancers. Metastatic colorectal cancer, non-small cell lung cancer, and pancreatic cancer are among the leading causes of cancer-related mortality (5-year overall survival: 14%, 6%, and 3%, respectively).1Chimeric antigen receptor (CAR) T-cell therapy demonstrated clinical outcomes in hematologic malignancies.2 3 However, translating engineered T-cell therapies to solid tumors proves difficult due to a lack of tumor-specific targets that discriminate cancer cells from normal cells. In previous studies, the use of a carcinoembryonic antigen T-cell receptors and mesothelin CARs both resulted in dose-limiting on-target, off-tumor toxicities.4 5 TmodTM CAR T-cell therapy addresses these challenges by leveraging dual receptors to create a robust AND NOT signal integrator capable of killing tumor cells, while leaving healthy cells intact (figure 1).6 Tmod platform technology is a versatile system that may be applied to T cells and natural killer cells in autologous and allogeneic settings.HLA LOH offers a definitive tumor versus normal discriminator target for CAR T-cell therapy.6 7 The 2 receptors comprise an activator that recognizes an antigen present on the surface of normal and tumor cells and a blocker that recognizes a second surface antigen from an allele lost only in tumor cells. HLA LOH has been observed in ~13% across all solid tumors and up to 33% of pancreatic cancers.8 New technologies have shown higher HLA LOH rates; however, it is unclear whether patients with HLA LOH in their primary tumor tissues are at higher risk for recurrence. BASECAMP-1 is an observational study with key objectives: 1) To determine and identify patients with somatic HLA LOH eligible for Tmod CAR T-cell therapy, and 2) Subsequent leukapheresis and manufacturing feasibility for future Tmod CAR T-cell trials.

Methods

BASECAMP-1 (NCT04981119) patient eligibility has 2 parts (figure 2): 1) Patients will be initially screened to identify germline HLA-A*02 heterozygosity by central next-generation sequencing (NGS). If HLA-A*02 heterozygosity is confirmed, primary archival tumor tissue will be analyzed by xT-Onco NGS testing9 to determine if somatic tumor HLA-A*02 LOH is present; 2) If the tumor demonstrates HLA-A*02 LOH and the patient screens eligible, the patient will undergo leukapheresis. Patients enrolled in the study who undergo leukapheresis will be evaluated for safety 7 days post-leukapheresis and followed for relapsed status. Banked T cells will be available for subsequent autologous Tmod CAR T-cell therapy at the time of relapse.

Abstract 491 Figure 1

Illustration of the Tmod T cell engaging with tumor cells with somatic loss of HLA-A*02 and with normal cells

Abstract 491 Figure 2

Study schema. HLA, human leukocyte antigen; LOH, loss of heterozygosity; NGS, next generation sequencing

Trial Registration

NCT04981119

References

American Cancer Society. Cancer Facts & Figures 2021. Atlanta: American Cancer Society; 2021.

Neelapu S, Locke F, Bartlett N, et al. Axicabtagene ciloleucel CAR T-cell therapy in refractory large B-cell lymphoma. N Engl J Med 2017;377(26):2531–2544.

Maude S, Laetsch T, Buechner J, et al. Tisagenlecleucel in children and young adults with B-cell lymphoblastic leukemia. N Engl J Med 2018;378(5):439–448.

Parkhurst M, Yang J, Langan R, et al. T cells targeting carcinoembryonic antigen can mediate regression of metastatic colorectal cancer but induce severe transient colitis. Mol Ther 2011;19(3):620–626.

Haas AR, Tanyi JL, O’Hara MH, et al. Phase I study of lentiviral-transduced chimeric antigen receptor-modified T cells recognizing mesothelin in advanced solid cancers. Mol Ther. 2019;27(11):1919–1929.

Hamburger A, DiAndreth B, Cui J, et al. Engineered T cells directed at tumors with defined allelic loss. Mol Immunol 2020;128:298–310.

Hwang M, Mog B, Douglass J, et al. Targeting loss of heterozygosity for cancer-specific immunotherapy. Proc Natl Acad Sci U S A 2021;118(12):e2022410118.

The Cancer Genome Atlas (TCGA) Research Network. https://www.cancer.gov/tcga. Accessed June 2021.

Perera J, Mapes B, Lau D, et al. Detection of human leukocyte antigen class I loss of heterozygosity in solid tumor types by next-generation DNA sequencing. J Immunother Cancer 2019;7(suppl 1):103.

Activation of CAR and non-CAR T cells within the tumor microenvironment following CAR T cell therapy

Mechanisms of chimeric antigen receptor (CAR) T cell-mediated antitumor immunity and toxicity remain poorly characterized because few studies examine the intact tumor microenvironment (TME) following CAR T cell infusion. Axicabtagene ciloleucel is an autologous anti-CD19 CAR T cell therapy approved for patients with large B cell lymphoma. We devised multiplex immunostaining and ISH assays to interrogate CAR T cells and other immune cell infiltrates in biopsies of diffuse large B cell lymphoma following axicabtagene ciloleucel infusion. We found that a majority of intratumoral CAR T cells expressed markers of T cell activation but, unexpectedly, constituted ≤5% of all T cells within the TME 5 days or more after therapy. Large numbers of T cells without CAR were also activated within the TME after axicabtagene ciloleucel infusion; these cells were positive for Ki-67, IFN-γ, granzyme B (GzmB), and/or PD-1 and were found at the highest levels in biopsies with CAR T cells. Additionally, non-CAR immune cells were the exclusive source of IL-6, a cytokine associated with cytokine release syndrome, and were found at their highest numbers in biopsies with CAR T cells. These data suggest that intratumoral CAR T cells are associated with non-CAR immune cell activation within the TME with both beneficial and pathological effects.

Plasma membrane Ca(2+) ATPase Atp2b1a regulates bone mineralization in zebrafish

The zebrafish transgenic lines provide a possibility to observe the development of tissues and organs in real time. Using the reporter line for the zebrafish plasma membrane Ca(2+) ATPase (SqET4), we detected its expression in the epithelium of pharyngeal teeth and analyzed its role in their calcification and that of cranial bones. atp2b1a's expression in the pharyngeal epithelium is faithfully recapitulated in the SqET4 transgenics by GFP expression. We showed by morpholino knockdown of Atp2b1a translations as well as chemical inhibition of Atp2b1a pump activity using carboxyeosin, that its activity is required to facilitate calcification of the developing pharyngeal teeth by the dental epithelium. Atp2b1a could be required during calcification of endochondral bones, where it acts at two levels: 1) by exporting Ca(2+) from ameloblasts, it provides raw material for calcifying the pharyngeal teeth by adjacent odontoblasts; and 2) by regulating terminal differentiation of pharyngeal epithelial cells, including ameloblasts required for tissue hyper-mineralization. atp2b1a's expression in the pharyngeal epithelium is regulated by the homeodomain transcription factor dlx2b.

atp2b1a regulates Ca(2+) export during differentiation and regeneration of mechanosensory hair cells in zebrafish

The molecular mechanisms of development of mechanosensory hair cells have been tackled successfully due to in vivo studies in the zebrafish lateral line. The enhancer trap (ET) transgenic line, SqET4 was instrumental in these studies even despite a lack of a link of its GFP expression pattern to a particular gene(s). We mapped the Tol2 transposon insertion of the SqET4 transgenics onto Chr. 4 next to a gene encoding Atp2b1a (Pmca1) - one of the four PMCAs acting to export Ca(2+) from a cell. atp2b1a expression recapitulates that of GFP during the development of mechanoreceptors of the inner ear and lateral line. atp2b1a expression correlates with the regeneration of these cells. Thus, SqET4 represents the Tg:atp2b1a-GFP line, which links Ca(2+) metabolism and the differentiation of mechanoreceptors. The morpholino-mediated knockdown of atp2b1a blocks Ca(2+) export and affects the division of hair cell progenitors, resulting in their accumulation. Under the control of a master gene of hair cells, Atoh1a, Atp2b1a functions during progenitor cell proliferation and hair cell differentiation. Given the similarity between the phenotypes of atp2b1a morphants and embryos treated with the pan-PMCA inhibitor 5(6)-carboxyeosin, Atp2b1a emerges as member of the Atp2b family responsible for Ca(2+) export during the development of hair cells.

Zebrafish transgenic Enhancer TRAP line database (ZETRAP)

Background

The zebrafish, Danio rerio, is used as a model organism to study vertebrate genetics and development. An effective enhancer trap (ET) in zebrafish using the Tol2 transposon has been demonstrated. This approach could be used to study embryogenesis of a vertebrate species in real time and with high resolution.

Description

The information gathered during the course of systematic investigation of many ET transgenic lines have been collected and compiled in the form of an online database – the Zebrafish Enhancer TRAP lines database (ZETRAP).

Conclusion

ZETRAP is a web-based system that provides data and information to the scientific community about the developmental, genetic and genomic aspects of transgenic zebrafish lines obtained using Tol2 transposon-mediated transgenesis. The current version (version 1.0) contains description of 27 ET lines that express EGFP in various organs and tissues, for example, heart, brain, notochord, gut, etc. It also includes information on insertion sites of the Tol2 transposon in these lines.

Are temporal characteristics of fast repetitive oscillating movement invariant?

Validation of the proportional duration model was attempted using very fast single-joint repetitive horizontal abductive-adductive movements of the stretched upper extremity with minimal cognitive input. Participants drew oscillating horizontal lines during 20 sec. over relatively short distances as quickly as possible without visual feedback. Spatial, temporal, and kinetic parameters were analysed. The amplitude and the time spent accelerating, decelerating, and reversing in both directions of each experimental line were recorded and related to the centre of gravity of the upper extremity. The accelerations of the centre of mass of the upper extremity were calculated and used to calculate the forces involved. The ratios of durations were compared and intercorrelated for the two fastest, two average, and two slowest cycles from each participant. Results exhibited significant standard deviations and variability of temporal and kinetic parameters within individual trials. The number of significant coefficients of correlation within individual trials was small despite the controlling influence of the same generalised motor program. The proportional duration model did not hold for our data. Peripheral factors (probably the length-tension relationship rule for skeletal muscles and viscosity of muscle) may be important in this type of action.

[Clinical application of three-dimensional ultrasound imaging as intraoperative navigation for liver surgery]

Intraoperative hepatic ultrasonography provides a great deal of information about tumor location and vascular anatomy in the liver, and is an indispensable procedure for hepatic resection. However, an accurate three-dimensional understanding of ultrasound (US) images depends on the operator's skill and experience, as the original display is two dimensional. We developed a new three-dimensional US (3D-US) image processing method by application of the intensity projection method to US. The minimum and maximum intensity projection can display the arrangement of blood vessels (hepatic veins and portal veins) and hyperechoic regions, respectively. The intensity projection from several points of view can reconstruct 3D imaging by cine-display. Moving a probe manually, images are taken and processed on a real-time basis (in about 10 seconds). 3D-US was used in 24 patients undergoing hepatic resection, and allowed easy visualization of the tumors and vascular anatomy. It is considered to be an efficient and safe navigation system in liver surgery.

[Experiences in clinical diagnosis of paroxysmal nocturnal hemoglobinuria (PNH)]

Two hundred and three cases of PNH diagnosed (according to the National Unified Diagnosed Criteria, 1987) and treated from 1949 to 1992 in Peking Union Medical Hospital were analyzed retrospectively in an attempt to investigate the factors leading to delayed diagnosis. The presenting manifestation was anemia in 56.7% of the patients. Next was hemorrhage (24.6%). Hemoglobinuria was seen only in 12.8% of the cases at the onset. Ham test was persistently negative in 10.4% of the patients. Only one third of all the cases was correctly diagnosed as PNH within one year after onset. Aplastic anemia or anemia of unknown cause was first diagnosed in 60.1% of cases. The heterogeneity of the manifestations and the lack of sensitive and also specific laboratory tests were the factors leading to delayed diagnosis, but negligence of PNH in differential diagnosis seem to be a major the main cause. Constant awareness of the possibility and careful follow-up accompanied with repeated laboratory examinations in a suspected case are crucial for early diagnosis of PNH.

Host fidelity is an effective premating barrier between sympatric races of the apple maggot fly

Models of sympatric speciation for phytophagous insects posit a central role for host plant-associated mating as a premating isolating mechanism in lieu of geographic barriers to gene flow. Here, by means of three mark-and-recapture studies, we confirm that host fidelity (i.e., the tendency of an insect to reproduce on the same host species that it used in earlier life-history stages) restricts gene flow between sympatric apple- and hawthorn-infesting races of Rhagoletis pomonella (Diptera: Tephritidae) to approximately 6% per generation. Genetically based differences in host preference, adult eclosion under the "correct" host species, and allochronic isolation contribute to host fidelity in various degrees in the races. The results verify that host-associated adaptation can produce reproductive isolation as a correlated character (a key premise of sympatric speciation). The study also represents one of the few or perhaps only example in animals where the intra-specific isolating effects of specific phenotypes have been quantified in nature.