Selective IL13Rα2-Targeted Functionality of IL13-Ligand CARs is Enhanced by Inclusion of 4-1BB Co-Stimulation

ABSTRACTChimeric antigen receptor (CAR) T cell immunotherapy is emerging as a powerful strategy for cancer therapy; however, an important safety consideration is the potential for off-tumor recognition of normal tissue. This is particularly important as ligand-based CARs are optimized for clinical translation. Our group has developed and clinically translated an IL13(E12Y) ligand- based CAR targeting the cancer antigen IL13R2 for treatment of glioblastoma (GBM). There remains limited understanding of how IL13-ligand CAR design impacts the activity and selectivity for the intended tumor-associated target IL13R2 versus the more ubiquitous unintended target IL13R1. In this study, we functionally compared IL13(E12Y)-CARs incorporating different intracellular signaling domains, including first-generation CD3{zeta}- containing CARs (IL13{zeta}), second-generation 4-1BB- (CD137) or CD28-containing CARs (IL13- BB{zeta} or IL13-28{zeta}), and third-generation CARs containing both 4-1BB and CD28 (IL13-28BB{zeta}). In vitro co-culture assays at high tumor burden establish that 2nd generation IL13-BB{zeta} or IL13- 28{zeta} outperform first-generation IL13{zeta} and 3rd generation IL13-28BB{zeta} CAR designs, with IL13- BB{zeta} providing superior CAR proliferation and in vivo anti-tumor potency in human xenograft mouse models. IL13-28{zeta} displayed a lower threshold for antigen recognition, resulting in higher off-target IL13R1 reactivity both in vitro and in vivo. Syngeneic mouse models of GBM also demonstrate safety and anti-tumor potency of murine IL13-BB{zeta} CAR T cells delivered systemically after lymphodepletion. These findings support the use of IL13-BB{zeta} CARs for greater selective recognition of IL13R2 over IL13R1, higher proliferative potential, and superior anti-tumor responsiveness. This study exemplifies the potential of modulating factors outside the antigen targeting domain of a CAR to improve selective tumor recognition..