Introduction
Pancreatic cancer is the most lethal malignancy with less than 10% of patients surviving five years after diagnosis [
1]. In terms of new treatments, chimeric antigen receptor T (CAR-T) cell therapies have recently been shown to be highly successful for hematological malignancies, and this approach also shows promising results against solid tumors, including pancreatic cancers. However, current CAR-T cells targeting a range of different proteins have not shown remarkable efficacy against pancreatic cancer in clinical trials [
2], indicating the need to explore more effective CAR-T strategies.
Receptor tyrosine kinase TAM (TYRO3, AXL, MERTK) family members are overexpressed in several hematological malignancies, including acute myeloid leukemia, chronic myeloid leukemia, and acute lymphoid leukemia [
3,
4], and in different types of solid tumors, such as pancreatic, lung, gastric, and breast cancers [
5]. TAM family promotes tumor cell proliferation, invasion, metastasis, drug resistance, and immune escape, and their expression is negatively correlated with prognosis in cancer patients [
3].
TAM receptors have emerged as promising therapeutic targets. For example, BGB324, a small molecule inhibitor of AXL, has entered phase I/II clinical trials for acute myeloid leukemia and pancreatic cancer [
6]. Monoclonal anti-AXL antibodies could suppress the growth and metastasis of variety of cancers [
6‐
8]. AVB-500, a high-affinity AXL fusion protein, effectively increasing the chemosensitivity of ovarian cancer and endometrial cancer [
9,
10], is currently being tested in a Phase Ib clinical trial against platinum-resistant ovarian cancer [
11]. Anti-TYRO3 antibodies inhibited the cancer progression or metastasis of colon cancer and melanoma cells [
12,
13]. MERTK monoclonal antibodies promoted the apoptosis of triple-negative breast cancer and non-small cell lung cancer [
14,
15]. Targeting TAM receptors has also been an effective method to re-sensitize resistant cells [
16]. However, AXL inhibition may lead to up-regulation of other TAM members such as MERTK, which is linked to acquired drug resistance in preclinical models of head and neck squamous cell carcinoma, triple-negative breast cancer, and non-small cell lung cancer, and combination therapy targeting both AXL and MERTK could eliminate the acquired resistance and inhibit tumor growth [
17]. Therefore, targeting multiple TAM members may provide an effective means of preventing cancer drug resistance.
CAR-T is an emerging therapy targeting membrane proteins, and this approach has seen success in hematological malignancy. AXL-directed CAR-T cells have proven to be effective at inhibiting the growth of triple-negative breast cancer and chronic myelogenous leukemia [
18,
19]. The growth arrest-specific protein 6 (GAS6) is a natural ligand for all TAM family members with the highest affinity for AXL [
3]. In this study, we generate CAR-T cells based on GAS6 and demonstrate that these GAS6-CAR-T cells can recognize all the TAM members, efficiently kill pancreatic cancer cells, and inhibit the growth of tumor xenografts without causing any overt side effects in mice even when the CAR-T is demonstrated to recognize mouse TAM and efficiently lyse mouse tumor cells.
Materials and methods
Cell lines
The human pancreatic cancer cell lines ASPC1, BxPC3 and PANC1, human embryonic kidney 293 T cells (HEK-293 T), mouse embryonic fibroblast cell line NIH 3T3, and mouse breast cancer cell line 4 T-1 used in this study were maintained in our laboratory. We obtained the human pancreatic cancer cell line MIA PaCa2 and mouse hepatoma carcinoma cell line Hepa1-6 from the cell bank of the Chinese Academy of Sciences (Shanghai, China). The ASPC1-gemcitabine-resistant cell line was purchased from FENGHUISHENGWU Co. Ltd. (Hunan, China). All cell lines were authenticated by STR, and mycoplasma contamination was routinely tested by qPCR.
Luciferase-labeled cells were established by infection with pTomo-CMV-luciferase-IRES-Puro lentivirus followed by selection with puromycin (1.0 mg/mL, Gibco, USA) for 2 weeks. All cells were cultured in DMEM containing 10% fetal bovine serum (Gibco, USA), 100U/mL penicillin, and 100 mg/mL streptomycin (Gibco, USA). The culture medium of Hepa1-6 cells also contained 1.0 mM sodium pyruvate (Gibco, USA) and Gluta-MAX™ (100× , Gibco, USA), and gemcitabine-resistant ASPC1 cells were cultured with 1.0 ug/mL gemcitabine. Suspended cell spheres derived from PANC1 and MIA PaCa2, named PANC1-CSC and MIA PaCa2-CSC, respectively, were established by culturing in serum-free stem cell medium composed of DMEM/F12 (Gibco, USA), EGF (20 ng/mL, PeproTech., USA), bFGF (20 ng/mL, PeproTech., USA), and B27 (1× , Gibco, USA).
Plasmid construction and lentiviral production
CAR comprising the CD8 signal peptide, extracellular domain (amino acids 261–678) of human GAS6, the CD8 hinge spacer and transmembrane domain, CD137 (4-1BB), and the CD3ζ endo domains was cloned into the pTomo-Puro plasmid (Addgene, USA) between the AgeI and NheI restriction sites. An mKATE2 sequence was fused to the CAR via a T2A peptide to monitor the transduction efficiency. The same vector sequence without extracellular domain of GAS6 was used as a control (Mock).
To construct TAM-shRNA plasmids, the target sequences were cloned into a pLKO.1-Puro vector obtained from Addgene between the AgeI and EcoRI restriction sites. The target sequences were as follows: shAXL #1, CGAAATCCTCTATGTCAACAT, #2, CGAAAGAAGGAGACCCGTTAT; shTYRO3 #1, GGAGAGGAACTACGAAGAT CG, #2, GCATCAGCGATGAACTAAAGG; shMERTK #1, GCTCAATCAGTGTAC CTAATA, #2, GCATTGGTGTTTCCTGCATGA. Expression plasmids containing AXL (EX-Z7835-Lv105), TYRO3 (EX-A0969-Lv105), and MERTK (EX-Z8208-Lv105) were purchased from iGene Biotechnology Co., Ltd. (Guangzhou, China).
For lentiviral packaging, plasmids were transfected into HEK-293 T cells with the packaging plasmids pCMV-dR8.91 and pMD 2.G (Addgene) at a ratio of 5:2.5:1. The supernatants were collected and filtered through a 0.45-μm filter (Millipore, Bedford, MA) to remove cellular debris and centrifuged at 25,000 rpm for 2.5 h to obtain the virus precipitation.
Production of CAR-T cells
Human T cells were isolated from healthy donor blood using the RosetteSep™ Human T-Cell Enrichment Cocktail (STEMCELL, Canada) and cultured in advanced 1640 medium (Gibco, USA) containing 10% FBS (Gibco, USA) with 200 U/mL IL-2 (Invitrogen, USA) and Gluta-MAX™ (100× , Gibco, USA). To generate CAR-T cells, T cells were activated by CD3/CD28 dynabeads (Life Technologies, USA) for 72 h followed by incubation with lentiviral particles at an approximate MOI of 100 with lentiBoost (1.0 μg/mL, Sirion Biotech, Germany) for 24 h. The CAR-T cells were applied for experiments on day 3 after transduction.
Monkey T cells isolated from rhesus monkeys by density gradient centrifugation (Ficoll-Paque) were activated by nonhuman primate T-cell activation/expansion kit (Miltenyi Biotec) and cultured in RPMI-1640 medium containing 10% FBS with 200 U/mL IL-2 and Gluta-MAX™. The activated T cells were transduced with lentiviral particles of GAS6-CAR to prepare CAR-T cells.
In vitro cytotoxicity assays
The cytotoxicity of CAR-T cells was tested using a Luciferase Assay System (Promega, E1501) at variable effector-to-target (E/T) ratios of 0.5:1, 1:1, 2:1, and 4:1. Briefly, 2 × 103 target cells per well were seeded in 96-well plates with 100 μL medium, and an equal volume of effector cells was added. After 24 h of coculture, the supernatant was collected and used to determine the concentrations of IFN-γ (Invitrogen, KHC4021) and TNF-α (Proteintech, KE00154). The cells were then lysed for luciferase assay according to the instructions of the manufacturer, and the cytotoxicity of CAR-T cells was calculated as ratio to tumor cells incubated with non-transduced T (NT) cells. The results were expressed as means and standard deviations for triplicate assays.
Western blot assays
Western blotting was performed as described previously [
20]. Harvested cells were lysed in RIPA buffer, and protein concentrations were quantified using BCA protein assay kits (Beyotime, Shanghai, China). The total protein lysates were separated by 10% sodium dodecyl sulfate polyacrylamide gel electrophoresis and transferred to PVDF membranes (Millipore, Billerica, MA, USA). The membranes were blocked in Tris-buffered saline with 5% non-fat milk and 0.5% BSA for 1 h, prior to incubation with primary antibodies overnight at 4 °C and incubation with horseradish peroxidase (HRP)-conjugated secondary antibodies for 1.5 h at room temperature. Blots were visualized with chemiluminescent HRP substrate (Millipore). Detailed information of antibodies used in this experiment is listed in Additional file
1: Table S1.
Flow cytometry
The cells (1 × 10
6) were fixed in 4% formaldehyde for 15 min at room temperature. After washing, the cells were incubated with primary antibodies for 1 h and then the fluorescent secondary antibodies for 30 min at room temperature (Additional file
1: Table S1). Finally, the cells were analyzed by BD LSRFortessa Flow cytometry (BD Biosciences), and data were analyzed using FlowJo software version 10 (TreeStar, Inc.).
Quantitative real-time PCR
Total RNA and genomic DNA were extracted as described previously [
20,
21]. qPCR assays were performed with SYBR Selected Master Mix (Thermo Fisher, USA). The comparative cycle time (Ct) method was used to determine differences between samples, and the expression of target genes was normalized to 18S rRNA or GAPDH (2
−△△Ct). The primer sequences are listed in Additional file
1: Table S2.
Mouse models of cell-derived xenografts (CDX)
5 × 105 PANC1-luciferase cells were suspended in PBS containing 20% Matrigel (BD Bioscience) and subcutaneously injected into the right flank of six-week-old female NOD/ShiLtJGpt-Prkdcem26Cd52Il2rgem26Cd22 /Gpt (NCG) mice (GemPharmatech Co. Ltd., China). Mice were intraperitoneally injected with 150 mg/kg D-luciferin (BioVison, 7903-1G) after anesthesia with 1.5% isoflurane, and tumor progression was determined using an in vivo imaging software (IVIS) system (Guangzhou Biolight Biotechnology Co., Ltd., aniview100). The mice were randomly divided into two groups according to bioluminescent signals at 3rd day and treated with 1 × 107 Mock T cells or GAS6-CAR-T cells by tail vein injection. Bioluminescent signals were subsequently measured every 7 days.
Patient-derived xenograft (PDX) model of pancreatic cancer
To establish the PDX model of pancreatic cancer, 3 × 3 mm blocks of patient-derived pancreatic tumor tissues were implanted in the right flank of six-week-old female NCG mice. After 14 days, the mice were randomly divided into two groups and treated with an injection of 1 × 107 Mock T cells or GAS6-CAR-T cells. Tumor size was measured twice a week using a digital caliper, and tumor volume was calculated using the following formula: (major axis of tumor) × (minor axis of tumor)2/2. The mice were euthanized when the tumor volume reached 1000 mm3. This experiment was completed with the assistance of Sichuan Kang Cheng Biotechnology Co. (Chengdu, China).
Immunohistochemistry
To detect multicolor immunofluorescence, we performed this experiment using Opal™ Multiplex IHC Assay (Akoya Biosciences, USA) that allowed to use any standard unlabeled primary antibody, including multiple antibodies raised in the same species.
Tissues were fixed with 4% paraformaldehyde, dehydrated with gradient ethanol, and embedded in paraffin. Tissues slides were dewaxed and dehydrated, boiled in citrate buffer (pH 6.0) for antigen retrieval, and blocked using 5% normal goat serum at room temperature for 1 h. Then, the slides were incubated at 4 °C overnight with the following primary antibodies and incubated for 1 h with the corresponding HRP-conjugated secondary antibodies (Additional file
1: Table S1) and TSA Plus Fluorescein Reagent (1:50) for 10 min. Finally, nuclei were stained with DAPI. Fluorescent images were taken using a confocal microscope (Nikon, Japan), and representative microscopy images were shown.
Statistical analysis
Statistical analyses were performed using GraphPad Prism version 8.0 (GraphPad Software Inc.). All data are presented as mean ± SD. Statistical differences between two groups were analyzed using Student’s t tests with Welch correction. Statistical differences among three or more groups were analyzed by one-way or two-way ANOVA with Sidak correction. In all statistical analyses, the P values (*P < 0.05, **P < 0.01) were considered significant, ns = not significant.
Discussion
A limitation for the development of CAR-T therapies has been in the identification of ‘gold-standard’ tumor antigens, as it has been assumed that such antigens should be specifically expressed on tumors, but not on normal cells. Studies have reported that TAM proteins broadly express in not only numerous tumors, but also normal tissues or cells with basal level [
5,
22,
33,
34]. While these findings may invoke safety concern on the use of GAS6-CAR-T cells, the affinity between natural ligands and receptors is usually lower than that between antigens and antibodies, and natural ligands-based CAR will probably efficiently attack tumor cells with higher target expression, but spare normal cells with lower target expression [
35]. And we found no overt side effects and pathological changes to the major organs in mice. Furthermore, GAS6-CAR-T did not result in any obvious side effects on the physiological and biochemical indexes and blood routines of rhesus macaques. Thus, we believe that our results provide potent supports for the safety of GAS6-CAR-T cells.
CAR-T immunotherapy has achieved great success in treating hematological tumors. However, some patients experience relapse largely due to a loss of CAR-specific antigens on tumor cells or an exhaustion of CAR-T cells [
36]. Resistance to CAR-T therapy due to antigen escape can be prevented by targeting multiple tumor markers using bi- or tri-specific CARs comprising two or three single-chain variable fragments. Bi-specific CARs that have shown to be effective anti-cancer agents include those targeting CD70-B7-H3 for several solid tumors [
37], those targeting CD5–CD7 for leukemia [
38], CD19–CD20 or CD19–CD22 for B-cell malignancies [
39,
40]. Tri-specific CAR targeting CD19–CD20–CD22 has been shown to effectively inhibit the progression of B-cell tumors by reducing antigen escape [
41]. Due to the ability of some natural ligands to bind multiple receptors, some natural ligand-based CAR-T cells can avoid tumor escape by targeting multiple targets [
42]. A proliferation-inducing ligand (APRIL)-based CAR against BCMA and TACI inhibits the development of multiple myeloma [
43], and B-cell-activating factor (BAFF) ligand-based CAR against BAFF-R, BCMA, and TACI inhibits the progression of B-cell tumors [
36] by reducing antigen escape. As GAS6 is a key tumor cell survival factor and a common ligand for AXL, MERTK, and TYRO3 [
3], our data imply that GAS6-CAR-T cells can recognize and kill cells overexpressing any of the TAM proteins, and ability to kill CSCs is more dependent on the higher expression of TYRO3 and MERTK than AXL in contrast to parental cell lines. Thus, GAS6-CAR-T cells may provide enhanced antitumor effects by limiting antigen escape.
Resistance to cancer drug treatment represents the most common cause of cancer deaths [
44]. It is acquired through multiple avenues, such as acquired resistance to chemotherapies and CSCs [
24,
44]. TAM proteins are also known to promote acquired resistance to chemotherapies and CSCs [
16,
45]. We demonstrate CSCs express a higher level of TYPO3 and MERTK compared to parental cell lines and the TAM expression pattern can also be effectively targeted by GAS6-CAR-T cells. Upregulated AXL expression in gemcitabine-resistant ASPC1 cells results in lysis by GAS6-CAR-T cells in comparison with little effects on AXL-low ASPC1 cells. These suggest GAS6-CAR-T cells are ideal to be combined with conventional chemotherapies and may therefore overcome the drug resistance.
The pancreatic cancer microenvironment is characterized by extremely dense connective tissue and highly immunosuppressed cells, with non-tumor cell components comprising up to 90% of the total tumor mass [
46]. Tumor-associated macrophages as the main immunosuppressive cells in the microenvironment enhance immune suppression and angiogenesis, secrete inhibitory cytokines, and increase the carcinogenic ability of CSCs and their resistance to chemotherapy [
47]. The immunosuppression caused by tumor-associated macrophages is a significant barrier for effective pancreatic cancer therapy [
28]. Recently, CAR-T cells targeting tumor-associated macrophages were shown to be an effective strategy for slowing tumor progression [
48]. Moreover, CAR-T cells targeting F4/80 [
49] or CD123 [
50] can kill M2-type macrophages in the microenvironment and delay tumor growth. In addition to the roles in tumor cell, TAM proteins also participate in the polarization of M1 macrophages to M2 macrophages and overexpress in tumor-associated macrophages, and targeting TAM receptors can also effectively inhibit the function of macrophages and eliminate tumor cells [
29]. We demonstrated that GAS6-CAR-T cells can inhibit the growth of pancreatic cancer PDX models by elimination of both AXL-positive tumor cells and tumor-associated macrophages. Therefore, it is expected that GAS6-CAR-T cells probably offer better clinical outcomes by targeting both tumor cells and tumor-associated macrophages.
Acknowledgements
We gratefully acknowledge for the technical assistance of Core Facility of West China Hospital (Li Chai, Yi Li and Xing Xu), Histology and Imaging Platform, Core Facility of West China Hospital (Yaping Wu, Lei Wu), and Animal Experimental Center of West China Hospital (Xiaoting Chen). Manuscript editors Brent Neumann and Julian Heng (Remotely Consulting, Australia) provided professional English language editing of this article (Manuscript Certificate No. 2Vo0Jt6M).
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