Evaluating the impact of car design on the tumor immune microenvironment and anti-tumor response in syngeneic glioma models

Abstract B7-H3 CAR T-cells have limited efficacy in immunocompetent mouse models indicating a suppressive role of the tumor immune microenvironment (TIME). In this study, we set to optimize B7-H3 CAR structure and examine the effects of CAR design on brain TIME. We generated a panel of second-generation B7-H3-specific CARs with different transmembrane (CD8, CD28), costimulatory (CD28, 4-1BB), and activation (ζ, mutζ) domains. We then compared the cytolytic activity, expansion, and anti-tumor activity of T-cells expressing these CARs. Results showed that T-cells expressing B7-H3 CARs with CD28 transmembrane/costimulatory domains have superior efficacy in vitro. Yet, providing optimized costimulation and signaling did not induce superior anti-glioma efficacy of B7-H3 CAR T-cells in vivo. Additionally, incorporating 4-1BB signaling into CD28-based CAR T-cells by expressing 4-1BBL on their cell surface enhances the therapeutic efficacy and persistence of B7-H3 CAR T-cells in vitro. However, transgenic expression of 4-1BBL in CD28-based CARs was not associated with further enhanced anti-glioma efficacy of B7-H3 CAR T-cells in vivo. Next, using high-dimensional flow cytometry and spatial transcriptomic analyses, we show that suppressive tumor-associated macrophages (TAMs) infiltrate tumors in non-responder mice and they predominantly surround the tumor edges. Additionally, minimal T-cell infiltrates were observed in these tumors with predominantly exhausted and dysfunctional phenotypes. Analysis of gene-expression signatures early after CAR T-cell treatment revealed that tumors treated with CD28-based CARs differentially upregulate genes associated with inflammatory myeloid responses. While treatment with other signaling domains’ containing CARs upregulates pathways predictive of suppressive TAM and regulatory/dysfunctional T-cell responses. We show that global depletion of brain macrophages using CSF1R inhibitor exacerbates CAR T-cell anti-tumor activity. In summary, our results show that specific CAR domains induce an early inflammatory immune hub predictive of potent anti-tumor responses. Additionally, inflammatory macrophages are needed for successful CAR T-cell activation and anti-glioma responses.