Key Points• We have created a new highly active chimeric antigen receptor (CAR) specific for CD22.• The design of new CARs may benefit more from target antigen epitope selection than from optimizing affinity.Immune targeting of B-cell malignancies using chimeric antigen receptors (CARs) is a promising new approach, but critical factors impacting CAR efficacy remain unclear. To test the suitability of targeting CD22 on precursor B-cell acute lymphoblastic leukemia (BCP-ALL), lymphoblasts from 111 patients with BCP-ALL were assayed for CD22 expression and all were found to be CD22-positive, with median CD22 expression levels of 3500 sites/cell. Three distinct binding domains targeting CD22 were fused to various TCR signaling domains ؎ an IgG heavy chain constant domain (CH2CH3) to create a series of vector constructs suitable to delineate optimal CAR configuration. CARs derived from the m971 anti-CD22 mAb, which targets a proximal CD22 epitope demonstrated superior antileukemic activity compared with those incorporating other binding domains, and addition of a 4-1BB signaling domain to CD28.CD3 constructs diminished potency, whereas increasing affinity of the anti-CD22 binding motif, and extending the CD22 binding domain away from the membrane via CH2CH3 had no effect. We conclude that second-generation m971 mAb-derived anti-CD22 CARs are promising novel therapeutics that should be tested in BCP-ALL. (Blood. 2013;121(7):1165-1174)
IntroductionDespite great progress in the treatment of children and adults with acute lymphoblastic leukemia (ALL), substantial numbers of patients continue to die of this disease and the short and long-term toxicities of standard therapy are substantial. 1-3 Monoclonal antibody-based therapies offer promise for overcoming chemoresistance and potentially diminishing the toxicities associated with therapy. 4 Among the most promising of these therapies involve the engineering of mature T lymphocytes to recognize MHC nonrestricted tumor antigens by transducing chimeric antigen receptors (CARs), reviewed by Lee at al. 5 CARs incorporate an extracellular binding domain (often derived from the antigen binding region of an antibody) with transmembrane and signaling motifs to render T cells capable of targeting any surface antigen that is amenable to antibody-like recognition. Early clinical results have demonstrated impressive antitumor effects in patients with leukemia, 6-10 although the ideal CAR design with respect to structural and signaling features remains unclear and has been the topic of intense inquiry.B-cell antigens are compelling targets for CAR-based therapies because normal tissue expression of these antigens is restricted to the B-cell lineage and clinical tolerance for B-cell ablation is high using modern supportive care. Indeed, CARs targeting CD19 have demonstrated activity against B-cell malignancies with acceptable toxicity 6-8 as have anti-CD20 antibodies in CD20 ϩ malignancies, including CD20-expressing ALL. 11 CD22 is another member of the B-cell antigen family with a tis...