• Thymocyte signaling via a transgenic survivin-reactive TCR induced T-ALL with 100% penetrance.• Thymic expression of signaling receptors targeting TAAs coexpressed in the thymus poses a risk for leukemogenesis.T-cell receptors (TCRs) and chimeric antigen receptors recognizing tumor-associated antigens (TAAs) can now be engineered to be expressed on a wide array of immune effectors. Engineered receptors targeting TAAs have most commonly been expressed on mature T cells, however, some have postulated that receptor expression on immune progenitors could yield T cells with enhanced potency. We generated mice (survivin-TCRtransgenic [Sur-TCR-Tg]) expressing a TCR recognizing the immunodominant epitope ) of murine survivin during early stages of thymopoiesis. Spontaneous T-cell acute lymphoblastic leukemia (T-ALL) occurred in 100% of Sur-TCR-Tg mice derived from 3 separate founders. The leukemias expressed the Sur-TCR and signaled in response to the Sur 20-28 peptide. In preleukemic mice, we observed increased cycling of doublenegative thymocytes expressing the Sur-TCR and increased nuclear translocation of nuclear factor of activated T cells, consistent with TCR signaling induced by survivin expression in the murine thymus. b2M 2/2 Sur-TCR-Tg mice, which cannot effectively present survivin peptides on class I major histocompatibility complex, had significantly diminished rates of leukemia. We conclude that TCR signaling during the early stages of thymopoiesis mediates an oncogenic signal, and therefore expression of signaling receptors on developing thymocytes with specificity for TAAs expressed in the thymus could pose a risk for neoplasia, independent of insertional mutagenesis. (Blood. 2015;125(19):2958-2967)
IntroductionAdoptive immunotherapy has shown increasing promise as a treatment of cancer, driven in part by advances in genetic engineering that permit efficient expression of receptors targeting tumor antigens on immune effectors. Several clinical trials have demonstrated antitumor efficacy following adoptive transfer of mature T cells engineered to express T-cell receptors (TCRs) targeting tumor-associated antigens (TAAs), including NY-ESO-1, 1 MART-1, 2,3 and MAGE-A3. 4 Similarly, impressive antitumor effects have recently been observed following transfer of mature T cells engineered using retroviruses to express chimeric antigen receptors targeting TAAs. [5][6][7] In these studies, toxicity has related to autoimmunity 3,[8][9][10] and cytokine release syndrome, [11][12][13] but oncogenesis as a result of retroviral-based gene transfer has not been observed. This stands in contrast to the clinical experience following gene therapy for interleukin 2 receptor gc 2/2 (IL2Rgc
2/2) congenital immunodeficiency where 5 of 20 patients developed T-cell acute lymphoblastic leukemia (T-ALL) following retroviral-mediated expression of IL2Rgc in hematopoietic stem cells.14-16 Leukemia in this setting was associated with insertional mutagenesis, with integration of the IL2Rgc transgene into regulatory regions of the ...