Fig. 6. Rapamycin/vitamin C cocktail rescues 4-1BB CAR-Treg function.
Eight- to 12-week-old male NSG mice were conditioned with busulfan on days −2 and −1 before IV injection of 5.106 HLA-A2+ PBMCs followed by retroorbital injection of 5 × 106 of Tregs (b–d): PBMC group (n = 16), CD28 CAR-Tregs (n = 14), 4-1BB CAR-Tregs (n = 10), 4-1BB + rapamycin/vitamin c (n = 13), and MOCK-Tregs (n = 8) from 4, 4, 1, 3, and 2 independent experiments, respectively. a Schematic design of the experiment. Mice were weighed and scored for GVHD three times a week and bled weekly for flow-cytometry analysis. b Survival curves (left panel) and GVHD scores (right panel). Log-rank Mantel-Cox tests comparing the indicated groups. Both CD28 and 4-1BB CAR-Tregs + rapamycin/vitamin c groups demonstrate a significantly better survival than the PBMC group (****p < 0.0001). c Plasma human IFN-γ levels were measured by cytometry bead array at days 10, 17, and 24. IFN-γ levels are significantly lower in CAR-Treg groups than in the PBMC group at day 17 (CD28, ***p = 0,0004; 4-1BB, *p = 0,0147, 4-1BB + rapamycin/vitamin C, *p = 0,0147) and at day 24 (CD28, ***p = 0,0002 and 4-1BB + rapamycin/vitamin C, **p = 0,0073). d Representative contour plots of circulating murine and human cells and frequencies of transferred PBMCs (lower panels). Compared to PBMC group, chimerism is statistically different at days 10 (4-1BB, ****p < 0,0001), 17 (MOCK, *p = 0,0274; CD28, **p = 0,0060; 4-1BB + rapamycin/vitamin C, ***p = 0,0005) and 24 (CD28, ****p < 0,0001; 4-1BB + rapamycin/vitamin C, **p = 0,0030). e Histologic analysis of liver and lung lesions at sacrifice from three independent experiments and three different donors, except for MOCK-Tregs (two experiments) and 4-1BB CAR-Tregs (one experiment). PBMCs only (n = 9), CD28 CAR-Tregs (n = 11), 4-1BB CAR-Tregs (n = 10), 4-1BB CAR-Tregs + rapamycin/ vitamin C (n = 10), and MOCK-Tregs (n = 4). Statistical significance is observed in the following comparisons: PBMC vs. 4-1BB + rapamycin/vitamin C, p < 0.0001 (liver) and p = 0.0346 (lung); PBMC vs. CD28, p = 0,0076 (liver) and p = 0,0043 (lung); PBMC vs. 4-1BB, p = 0,04 (liver) and p = 0.0031 (lung); and 4-1BB cultured with or without rapamycin/vitamin C p = 0,0002 (liver). Data are depicted as mean +/− SEM (panels b to e) and compared using two-tailed Mann–Whitney test (c to e) (*p < 0.05, **p < 0.01, ***p < 0.001, ****p < 0.0001). Abbreviations: B, busulfan; L, bioluminescence.