Anti-ovarian carcinoma anti-T3 heteroconjugates or hybrid antibodies induce tumor cell lysis by cytotoxic T-cells

In vivo persistence, tumor localization, and antitumor activity of CAR-engineered T cells is enhanced by costimulatory signaling through CD137 (4-1BB)

Human T cells engineered to express a chimeric antigen receptor (CAR) specific for folate receptor-α (FRα) have shown robust antitumor activity against epithelial cancers in vitro but not in the clinic because of their inability to persist and home to tumor in vivo. In this study, CARs were constructed containing a FRα-specific scFv (MOv19) coupled to the T-cell receptor CD3ζ chain signaling module alone (MOv19-ζ) or in combination with the CD137 (4-1BB) costimulatory motif in tandem (MOv19-BBζ). Primary human T cells transduced to express conventional MOv19-ζ or costimulated MOv19-BBζ CARs secreted various proinflammatory cytokines, and exerted cytotoxic function when cocultured with FRα(+) tumor cells in vitro. However, only transfer of human T cells expressing the costimulated MOv19-BBζ CAR mediated tumor regression in immunodeficient mice bearing large, established FRα(+) human cancer. MOv19-BBζ CAR T-cell infusion mediated tumor regression in models of metastatic intraperitoneal, subcutaneous, and lung-involved human ovarian cancer. Importantly, tumor response was associated with the selective survival and tumor localization of human T cells in vivo and was only observed in mice receiving costimulated MOv19-BBζ CAR T cells. T-cell persistence and antitumor activity were primarily antigen-driven; however, antigen-independent CD137 signaling by CAR improved T-cell persistence but not antitumor activity in vivo. Our results show that anti-FRα CAR outfitted with CD137 costimulatory signaling in tandem overcome issues of T-cell persistence and tumor localization that limit the conventional FRα T-cell targeting strategy to provide potent antitumor activity in vivo.

T-cell based cancer immunotherapy: direct or redirected tumor-cell recognition?

In development of strategies for immunotherapy of cancer a new emphasis is emerging, termed T-cell retargeting, which involves artificial redirection of cytotoxic T lymphocytes (CTL) against cancer cells, using bispecific reagents. In this article, Gideon Beun, Cornelis van de Velde and Gert Jan Fleuren evaluate this potential strategy for cellular immunotherapy, and propose how the gap between in vitro results and clinical application might be bridged.

Bispecific anti-human red blood Rhesus-D antigen x anti Fc gamma RI targeted antibody-dependent cell-mediated cytotoxicity and phagocytosis by mononuclear leucocytes

The Fc receptor mediated antibody-dependent cell-mediated cytotoxicity (ADCC) and phagocytosis induced by bispecific antibody (BsAb) to the high-affinity Fc receptor for IgG (Fc gamma RI) and to human red blood group antigen RhD were studied in vitro, using human mononuclear leucocytes as effector cells. The results were compared with those obtained by using a human monoclonal IgG1 anti-RhD used alone and a reference human polyclonal anti-RhD antibody. The effect of non-specific human IgG on FcR-mediated functions by mononuclear leucocytes was checked. The results demonstrate that BsAb presents a high resistance of Fc-mediated function to blockade by non-specific human IgG compared with that of both polyclonal and monoclonal anti-RhD antibodies. These results further encourage possible clinical application of bispecific antibody in passive immunotherapy.

Heteroconjugated antibodies enhance lymphocyte-mediated tumour cell lysis in vitro and in vivo

Covalent linkage of an antitumour antibody specific for a tumour cell surface antigen to an antilymphocyte antibody specific for the T lymphocyte receptor complex produces a heteroconjugated antibody that can activate and redirect cytotoxic T lymphocytes to lyse tumour cells. The ability of an antilymphocyte-antitumour heteroconjugate (500A2 x 96.5) to direct the lysis of murine melanoma cells by cultured murine lymphocytes was tested in vitro using a 4-h chromium release assay and in vivo with a tumour neutralization assay. In vitro, the addition of heteroconjugated antibody significantly increased tumour lysis by murine C3H/HeN lymphocytes (median specific lysis 82.7 per cent with lymphocytes plus heteroconjugate versus 9.5 per cent for lymphocytes alone, P less than 0.001). In vivo, treatment with heteroconjugated antibody plus lymphocytes significantly reduced the development of pulmonary metastases after intravenous tumour administration (median number of pulmonary metastases 28.5 for combined treatment versus 250 for heteroconjugate or lymphocytes alone, P less than 0.001).

Retargeting of human lymphocytes against human ovarian carcinoma cells by bispecific antibodies: from laboratory to clinic

We have selected a monoclonal antibody (MOv18) reactive with ovarian carcinoma, which exhibits a restricted tumor specificity, a high affinity constant and which recognizes a 38-kDa glycoprotein homogeneously expressed on the cell surface of 90% of human ovarian carcinomas. Localization studies with radiolabelled MOv18 showed that MOv18 could specifically reach ovarian carcinoma cells growing in the peritoneal cavity of nu/nu mice. MOv18 did not mediate antibody-dependent cellular cytotoxicity via Fc and could not be used as a carrier for toxins due to poor internalization of the antigen-antibody complex. Bispecific F(ab')2 antibodies made with MOv18 and an antibody reactive with CD3 were able to redirect the cytotoxicity of peripheral blood lymphocytes (PBL) against ovarian carcinoma cells both in vitro and in vivo in an animal model. The treatment of athymic mice bearing a human ovarian carcinoma intraperitoneally, with human PBL coated with the bispecific F(ab')2, significantly prolonged survival of the animals compared with tumour-bearing untreated and control mice treated with PBL alone. Four ovarian cancer patients have been treated with autologous lymphocytes coated with this bispecific F(ab')2 in a phase I clinical trial. No serious side-effects were observed but patients developed human anti-murine antibodies mainly directed against the idiotype of MOv18. We have now begun phase II clinical trials in ovarian cancer patients.

Bifunctional antibodies and their potential clinical applications

Bifunctional antibodies are monovalent, bispecific, antibody-derived molecules. They have been produced by both chemical and biological means. They are thought to have several advantages over monoclonal antibodies in both immunotherapy and immunodiagnosis. Bifunctional antibodies have been shown to be efficient in the targeting of drugs, toxins, radiolabelled haptens and effector cells on to diseased tissues, primarily cancer cells. In addition, bifunctional antibodies have been used to develop novel immunoassays. The full potential of bifunctional antibodies has yet to be realised.

Bispecific antibodies and retargeted cellular cytotoxicity: novel approaches to cancer therapy

We have used a relatively new technology to increase the number of human lymphocytes that will react with human ovarian carcinoma cells. This technology, often called "retargeting of the immune system," can temporarily redirect the activity of immune cells that were originally committed to react with foreign substances other than cancer cells. In the example presented here, the antitumor effects of retargeted human T lymphocytes, collected from normal donors, were tested in immunodeficient mice with a human ovarian carcinoma line growing intraperitoneally. We retargeted T cells in vitro with a bispecific antibody that reacted with the T cell receptor complex and with a cell-surface antigen expressed by the ovarian carcinoma cells. Retargeted lymphocytes, injected intraperitoneally into mice 4 days after intraperitoneal injection of the tumor cells, impeded tumor growth and doubled the host survival time. These findings provide support for the concept that treatment of ovarian cancer patients with retargeted T cells could prove beneficial.

Engineering T lymphocyte antigen specificity

Targeting of immune cells by bispecific antibodies has proven to be a powerful tool for the investigation of cellular cytotoxicity, lymphocyte activation and induction of cytokine production, as well as to represent an innovative form of immunotherapy for the treatment of cancer. The hallmark of this approach is the use of the specificity of monoclonal antibodies to join target and immune cells by virtue of the dual specificity of bispecific antibodies for the two entities. More precisely, the bispecific antibody has two different binding sites, which are capable of recognizing tumor associated antigens on the one hand and lymphocyte activation sites on the other. This process of crosslinking results in the activation of the lymphocyte and triggering of its lytic machinery, as well as lymphokine production. A major advantage of this therapeutic modality is, that use is made of the normal cellular immune defence system and therefore is only associated with minor toxicity. The distinct lymphocyte populations, which can be used for adoptive immunotherapy and the various bispecific antibody preparations, as well as the chimeric immunoglobulin/T cell receptor construction, are the major topics of this review.

T cell targeting in cancer therapy

Targeting of immune cells by bispecific antibodies has proven a powerful tool for the investigation of cellular cytotoxicity, lymphocyte activation and induction of cytokine production, as well as to represent an innovative form of immunotherapy for the treatment of cancer. The hallmark of this approach is the use of the specificity of monoclonal antibodies to join target and immune cells by virtue of the dual specificity of bispecific antibodies for the two entities. More precisely the bispecific antibody has two different binding sites, which are capable of recognizing tumor associated antigens on the one hand and lymphocyte activation sites on the other. This process of crosslinking results in the activation of the lymphocyte and triggering of its lytic machinery, as well as lymphokine production. A major advantage of this therapeutic modality is, that use is made of the normal cellular immune defence system and therefore is only associated with minor toxicity. The distinct lymphocyte populations, which can be used for adoptive immunotherapy and the various bispecific antibody preparations, as well as the chimeric immunoglobulin/T cell receptor construction are the major topics of this review.

Bifunctional antibodies: concept, production and applications

Immunoglobulins, or antibodies, are monospecific, bivalent antigen-binding molecules. Bifunctional antibodies are bispecific, with each arm binding to a different antigen, and may be produced by biological or chemical methods. Biological production involves the fusion of two monoclonal antibody-producing hybridomas or of an immunised spleen cell and a hybridoma. The resulting hybrid hybridomas (quadromas or triomas) secrete a mixture of parenteral monoclonal antibodies and bifunctional antibody. In chemical production, the parental monoclonal antibodies can be 'chopped up and reconstituted' to produce the bifunctional antibody only. Bifunctional antibodies have a variety of potential uses. They were originally proposed as an aid to cancer chemotherapy where one of the arms of the antibody would bind to a tumour marker and the other to a drug, toxin, or cytotoxic cell. Functional agents can thus be target directly onto tumour cells, accumulating with higher density, yet with reduced side effects for the patient. Further applications have been proposed involving enzyme immobilization and novel immunoassay techniques. This review describes developments that have taken place in bifunctional antibody technology to date.

A novel technique for the production of hybrid antibodies

Chemically linked bifunctional antibodies (heteroconjugates) composed of one antibody specific for the TcR/CD3 complex on cytotoxic T cells and another specific for viral antigens expressed on the surface of infected cells have been shown to redirect CTL to lyse virus-infected cells. Hybrid antibodies are bifunctional antibodies produced by the fusion of two hybridomas. As a result of their native dimeric immunoglobulin structure, hybrid antibodies may be more effective than heteroconjugates in vivo. We have developed a unique method for production of hybrid antibodies by infecting each hybridoma with a different retrovirus vector which confers resistance to either G418 or methotrexate. The hybridomas are fused and selected in medium containing both inhibitors. Using this technique, we have produced hybrid antibodies made up of one antibody combining site which binds to the TcR and a second specific for the hemagglutinin of X-31 influenza virus. We show that this hybrid antibody effectively mediates the lysis of virus-infected cells in the presence of appropriate CTL. Thus hybrid antibodies as well as heteroconjugates can redirect CTL to lyse virus-infected targets.

Activation of mononuclear cells to be used for hybrid monoclonal antibody-induced lysis of human ovarian carcinoma cells

Recently we reported that cytotoxic T-cell clones can be retargeted to unrelated tumor cells by bispecific monoclonal antibodies (MAbs), anti-CD3 and anti-ovarian carcinoma (alpha OC/TR) (Mezzanzanica et al., 1988). In the perspective of in vivo tumor immunotherapy, as an alternative to cytotoxic T lymphocytes (CTL) from T-cell clones, since human peripheral blood mononuclear cells (PBMCs) without stimulation were quite ineffective, a suitable in vitro activation method was developed to render PBMCs lytic for relevant targets in the presence of the bispecific hybrid MAb alpha OC/TR. This activation protocol was applied to PBMCs from 9 healthy donors (HD) and 6 ovarian carcinoma patients (P) and to tumor-associated lymphocytes (TAL) from 4 ovarian carcinoma P. The method consisted of in vitro stimulation with phytohemagglutinin (PHA) for 2 days, followed by culture with a low dose of recombinant human interleukin-2 (rIL-2) for 6 to 10 days. The antibody-mediated lysis of CTL from HD PBMCs was found to be specifically directed against cells expressing the relevant ovarian tumor antigen when different tumor cell lines and short-term cultures of tumor and normal cells were tested. The antibody-mediated lysis of CTL from P PBMCs or TAL was efficient both on autologous and allogeneic ovarian tumor cells, whereas no reactivity with autologous normal cells was observed and LAK activity was only evident in 1 out of 4 cases. The hybrid antibody induced cytotoxic activity of CTL from P was, however, lower than that of CTL from HD.