Abstract 3255: Targeting CD4+FOXP3+ Tregs to enhance anti-tumor immunity
Authors: Akimova Tatiana , Wang Liqing , Bartosh Zhanna , Eruslanov Evgeniy , Albelda Steven , Singhal Sunil , Aishwarya Veenu , Hancock Wayne W. 
Published: March 2024

Abstract
We strive to improve the outcomes of cancer immunotherapy by using a new generation of chemically modified self-delivering antisense oligonucleotides (ASO), termed FANA ASO, to target the key T-regulatory (Treg) cell transcription factor, FOXP3. We tested five murine FANA in 2 murine tumor models (TC1, MC38) and studied 19 human FANA FOXP3 in vitro with human healthy donor PBMC, followed by use of clinical samples from lung cancer patients and patients with mesothelioma, as well as testing in humanized mice (hu-PBMC-NSG). In murine studies, we treated mice on day 7 after tumor inoculation with Scramble control or murine FANA FOXP3, 50 mg/kg for 14 days, i.p. In the TC1 lung tumor model, we found an average 38% decrease of tumor volumes, p = 0.0007, and 22% of tumors were completely resorbed. In the MC38 colon carcinoma model, we found a 49% decrease of tumor volumes, p = 0.0182, and 13.6% of tumors were completely resorbed. In both tumor models, we observed an ~50% decrease of Foxp3 mRNA by qPCR, and decreased numbers of intratumoral Tregs by flow cytometry. This was accompanied by significant decreases (p&lt;0.05) of the mRNA and protein intratumoral levels of multiple exhaustion markers: LAG-3, CTLA-4, PD-1, Tim-3, Tigit, CD244, CD160 and VISTA, and increased expression of perforin and granzyme-b by intratumoral T cells. In addition, there were no changes in FOXP3 mRNA expression or in the numbers of Tregs in draining lymph nodes and in spleens of tumor bearing mice, suggesting that intratumoral Treg have enhanced sensitivity to FANA FOXP3 in vivo. We identified the best 5 of 19 human FANA FOXP3 and showed these had no toxic effects on cell viability or division, and downregulated FOXP3 expression over 50% in PBMC from healthy donors (p&lt;0.05). Human Treg, pre-incubated with FANA FOXP3 for 3 hours, retained only 60.3% of their suppressive function in vitro. FANA FOXP3 treatment of lung cancer tumor samples and mesothelioma pleural effusion samples resulted in a 56.4% decrease in FOXP3 mRNA expression and a 61.5% decrease in Treg numbers (all p&lt;0.05). Moreover, tumor FOXP3+ Treg had 36.7% less FOXP3 protein per cell, and downregulated CD39 expression compared to Scramble control. Targeting of cancer samples with human FANA FOXP3 in vitro was associated with increased division of CD4+ and CD8+ cells, and with downregulation of multiple exhaustion molecules, including CTLA-4, Tim-3, PD-1, LAG-3 and TIGIT. Humanized mice, treated with two human FANA FOXP3 compounds (50 mg/kg, 7days), demonstrated an absence of apparent toxic effects and human FOXP3 mRNA was downregulated by 47.4% in the blood, by 74.2% in lymph nodes and by 51.8% in the spleens (all p&lt;0.05). Hence, targeting of intratumoral Tregs using FANA FOXP3 results in enhanced immune responses to solid tumors without inducing autoimmunity, and studies are underway in combination with checkpoint inhibitors and/or CAR-T cell therapy.
Citation Format: Tatiana Akimova, Liqing Wang, Zhanna Bartosh, Evgeniy Eruslanov, Steven Albelda, Sunil Singhal, Veenu Aishwarya, Wayne W. Hancock. Targeting CD4+FOXP3+ Tregs to enhance anti-tumor immunity [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 3255.