Rational design of PD-1-CD28 immunostimulatory fusion proteins for CAR T cell therapy

BackgroundIn many situations, the therapeutic efficacy of CAR T cells is limited due to immune suppression and poor persistence. Immunostimulatory fusion protein (IFP) constructs have been advanced as a tool to convert suppressive signals into stimulation and thus promote the persistence of T cells, but no universal IFP design has been established so far. We now took advantage of a PD-1-CD28 IFP as a clinically relevant structure to define key determinants of IFP activity.MethodsWe compared different PD-1-CD28 IFP variants in a human leukemia model to assess the impact of distinctive design choices on CAR T cell performance in vitro and a xenograft mouse model.ResultsWe observed that IFP constructs that putatively exceed the extracellular length of PD-1 induce T-cell response without CAR target recognition, rendering them unsuitable for tumour-specific therapy. IFP variants with physiological PD-1 length ameliorated CAR T cell effector function and proliferation in response to PD-L1(+) tumour cells in vitro and prolonged survival in vivo. Transmembrane or extracellular CD28 domains were found to be replaceable by corresponding PD-1 domains for in vivo efficacy.ConclusionPD-1-CD28 IFP constructs must mimic the physiological interaction of PD-1 with PD-L1 to retain selectivity and mediate CAR-conditional therapeutic activity.

Automated summary

This study investigates the design choices of immunostimulatory fusion protein (IFP) constructs for enhancing the therapeutic efficacy of CAR T cells. It finds that IFP variants with similar extracellular lengths to PD-1 show improved CAR T cell function and proliferation, leading to prolonged survival in a leukemia mouse model. These findings highlight the importance of mimicking the physiological interaction of PD-1 with PD-L1 in IFP design.