Abstract 5574: In vivo characterization of a novel CAR-T cell therapy directed towards LGR5 for the treatment of colorectal cancer
Authors: McPeake Dylan J. , Tyllis Timona S. , Foeng Jade , Bandara Veronika , Abbott Caitlin A. , Gundsambuu Batjargal , Rohani-Rad Elaheh , Napoli Silvana , Sadlon Timothy , Barry Simon C. , McColl Shaun R. 
Published: June 2022

Abstract
Colorectal cancer (CRC) is the third most diagnosed cancer and incidence rates are rapidly increasing among young adults. Despite current treatments, the 5-year survival rate is approximately 65%, highlighting an urgent need for new therapies. Leucine-rich repeat-containing G-protein coupled receptor (LGR5) is a promising antigen target for chimeric antigen receptor (CAR)-T cell therapy, which may represent a novel effective treatment for CRC. LGR5 binds R-spondins and functions to enhance Wnt and β-catenin signalling involved in maintenance and proliferation of adult stem cells. Expression of LGR5 has been previously reported on cancer stem cells in CRC, and has been demonstrated to play a crucial role in CRC tumor initiation and metastasis. Flow cytometric analysis of LGR5 cell surface expression on in vitro and ex vivo human CRC tumour cells revealed a subpopulation of LGR5+ cells. Six LGR5-targetting CD3+ CAR-T cell variants were developed, which differed in CAR variable heavy (VH) and variable light (VL) chain orientation and hinge length. As preliminary experimentation identified that four of the six CAR-T cell variants displayed robust anti-tumour cytotoxicity in vitro, these CAR-T cell variants were tested for in vivo anti-tumour efficacy using a subcutaneous human colorectal tumor xenograft mouse model. Pre-injection phenotyping after freeze-thawing of the CAR-T cells revealed greater than 94% transduction efficiency, low expression of co-inhibitory receptors CTLA-4 and PD-1 and a high frequency of central memory T cells (CD62L+ CD45RO+). Additionally, a high frequency of the CD8+ compartment of these CAR-T cells expressed perforin, CD107a, Granzyme B and TNFα. For each variant, intravenous injection of 20x106 LGR5-targeting CAR-T cells induced significant tumor regression and gave 100-day survival post-tumor injection. Ex vivo analyses of tumors and spleens via flow cytometry at endpoint indicated CAR-T cell persistence to 100-days post-tumor injection. Of the CAR-T cells isolated from tumours ex vivo, high level expression of co-inhibitory receptors PD-1, CTLA-4, and TIM-3 was observed. The splenic T cell population was enriched for central memory T cells and expressed high levels of PD-1. Complete tumor remission was achieved in 100% of mice receiving the VH-VL orientation, medium hinge CAR construct (designated CNA3103), prompting further investigation of this variant. Intravenous injection of 5x106 CNA3103 CAR-T cells was sufficient to induce tumour remission and 100-day survival. Similarly, complete tumour rejection was achieved with a dose of 2.5x106 CNA3103 CAR-T cells in a 30-day in vivo experiment. These results demonstrate that LGR5-targeting CAR-T cells exhibit potent in vivo anti-tumor efficacy and position LGR5 as a promising CAR target antigen, prompting investigation of LGR5-targeting CAR-T cells as a therapeutic for CRC in future clinical trials.
Citation Format: Dylan J. McPeake, Timona S. Tyllis, Jade Foeng, Veronika Bandara, Caitlin A. Abbott, Batjargal Gundsambuu, Elaheh Rohani-Rad, Silvana Napoli, Timothy Sadlon, Simon C. Barry, Shaun R. McColl. In vivo characterization of a novel CAR-T cell therapy directed towards LGR5 for the treatment of colorectal cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 5574.