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Third Generation CD28/4-1BB CAR T Cells for Refractory CD19+ B Cell Malignancy: Generation of a GMP Protocol an Evaluation of Clinical Grade Batches
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Clinical Immunology.
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(English)Manuscript (preprint) (Other academic)
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URN: urn:nbn:se:uu:diva-232646OAI: oai:DiVA.org:uu-232646DiVA: diva2:748974
Available from: 2014-09-22 Created: 2014-09-22 Last updated: 2015-01-23
In thesis
1. CD19-targeting CAR T Cells for Treatment of B Cell Malignancies: From Bench to Bedside
Open this publication in new window or tab >>CD19-targeting CAR T Cells for Treatment of B Cell Malignancies: From Bench to Bedside
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Immunotherapy for cancer is a young research field progressing at high speed. The first chimera of an antibody and a signaling chain was designed by Zelig Eshhar and was later further developed to enhance existing T cell therapy by combining a single-chain fragment of an antibody with the CD3 zeta chain of the TCR complex. T cells expressing these chimeric antigen receptors (CARs) could recognize and specifically kill tumor cells. However the T cells, lacked in persistence and tumor rejection did not occur. Thus, the CAR constructs have been improved by providing the T cell with costimulatory signals promoting activation. The focus of this thesis has been to evaluate second and third generation αCD19-CAR T cells for the treatment of B cell leukemia and lymphoma.

B cell tumors commonly upregulate anti-apoptotic proteins such as Bcl-2, which generates therapy resistance. In the first paper a second generation (2G) αCD19-CD28-CAR T cell was combined with the Bcl-2 family inhibitor ABT-737. ABT-737 sensitized tumor cells to CAR T cell therapy and may be an interesting clinical combination treatment. In paper II, the phenotype and function of a third generation (3G) αCD19-CD28-4-1BB-CAR T cell were evaluated. B cell-stimulated CAR T cells showed increased proliferation and an antigen-driven accumulation of CAR+ T cells. 3G CAR T cells had equal cytotoxic capacity, similar lineage, memory and exhaustion profile phenotype compared to 2G CARs. However, 3G CAR T cells proliferated better and had increased activation of intracellular signaling pathways compared to 2G CAR T cells. In paper III, αCD19-CD28-4-1BB-CAR T cells were used to stimulate immature dendritic cells leading to an upregulation of maturation markers on co-cultured dendritic cells. Hence, CAR T cells may not only directly kill the tumor cells, but may induce bystander immunity that indirectly aids tumor control. This thesis also include supplementary information about the development and implementation of protocols for GMP production of CAR T cell batches for a phase I/IIa clinical trial currently ongoing for patients with refractory B cell leukemia and lymphoma. So far, two patients have safely been treated on the lowest dose.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2014. 72 p.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1031
chimeric antigen receptors, CAR T cells, T cell therapy, immunotherapy, CD19, Bcl-2 family inhibitors, B cell malignancies
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Research subject
Clinical Immunology
urn:nbn:se:uu:diva-232638 (URN)978-91-554-9047-8 (ISBN)
Public defence
2014-11-21, Rudbecksalen, Rudbecklaboratoriet, Dag Hammarskjölds väg 20, Uppsala, 09:15 (English)
Available from: 2014-10-27 Created: 2014-09-22 Last updated: 2015-01-23

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