Adoptive cell therapy, especially chimeric antigen receptor (CAR) therapy, has revolutionized cancer immunotherapy, showing remarkable results in the treatment of chronic viral infections and malignancies. Currently, there are six US Food and Drug Administration (FDA) approved adoptive CAR-engineered T (CAR-T) cell products for treating B cell lymphoma (BCL) or multiple myeloma (MM) patients: Yescarta (Kite Pharma, 2017), Kymriah (Novartis, 2017), Tecartus (Kite Pharma, 2020), Breyanzi (Bristol Myers Squibb, 2021), Abecma (Bristol Myers Squibb, 2021), and Carvykti (Legend, 2022).Despite the impressive outcomes, the current FDA-approved cell therapies fall into the autologous category: T cells obtained from the patient via leukapheresis and reinjected back into the same patient. This approach is high-cost, time-consuming, and patient-selective. Some patients may not have enough time waiting for the manufacturing to be completed. Therefore, new approaches that allow rapid production of large-scale and ready-to-use therapeutic cells are in great demand. The work presented in this thesis aims to provide alternative platforms for off- the-shelf cancer immunotherapy. By differentiating genetically engineered stem cells (i.e.,
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hematopoietic stem cells and pluripotent stem cells), we developed multiple in vitro culture systems to robustly generate large-scale CAR-armed invariant nature killer T (NKT) cells suitable for allogeneic cell therapy.
Chapter 1 introduces the background of iNKT cells, the-state-of-the-arts of stem cell engineering, and the previous study of engineering stem cell into iNKT cells.
Chapter 2 reports a successful platform that utilizing artificial thymic organoid (ATO) culture methods to generate large-scale CAR-armed iNKT (CAR-iNKT) cells for cancer immunotherapy. The HSC-engineered iNKT cells closely resembled endogenous iNKT cells and exhibited potent antitumor efficacy and high safety in the xenograft multiple myeloma mouse model.
Chapter 3 reports a feeder-free in vitro culture system to differentiate engineered stem cells into CAR-eNKT cells. The novel platform is robust and compatible for delivering different CAR cargos and additional molecules. The independence of murine derived feeder cells eliminates the potential risk of cross-species contamination during manufacturing.
Chapter 4 switch the focus from previous chapters and starts to develop pluripotent stem cells (PSCs) derived CAR-iNKT cells for cancer immunotherapy. The unlimited expansion capability, capacity for clonal selection and ease of genetic engineering of PSCs allow them to be an ideal candidate providing unlimited source for off-the-shelf allogeneic cell therapies.
Chapter 5 summarizes the thesis, discusses the challenge, and provides future perspectives for developing stem cell and iNKT-based off-the-shelf cancer immunotherapy. It is believed that more fundamental studies will be critical to further develop the next generation immunotherapy.