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Characterizing escape pathways associated with HIV-specific CAR T cell therapies
Thesis   Open access

Characterizing escape pathways associated with HIV-specific CAR T cell therapies

Alexandria Brooke Criswell
Master of Science (M.S.), Drexel University
Aug 2024
DOI:
https://doi.org/10.17918/00010498
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Abstract

Broadly neutralizing antibodies (bNAbs) CAR T cell Escape pathways HIV-Specific CAR T cell Next generation sequencing Cytology Virology
Chimeric antigen receptor (CAR) T cells have been used as an effective therapy for treatment-refractory cancers but may be a useful intervention for other chronic diseases such as Human Immunodeficiency Virus (HIV) infection. A diverse range of broadly-neutralizing antibodies (bNAbs) exhibiting potent affinity for conserved epitopes on the HIV envelope glycoprotein are available for CAR T cell targeting. This offers the opportunity to engineer an array of HIV-specific CAR T cell products to elucidate bNAb specificities associated with enhanced potency. However, there are challenges when using bNAb-based CAR T cells as a treatment for HIV in vivo, particularly the high mutation rate of HIV reverse transcription during replication. This can lead to the rapid emergence and selection of escape mutations that prevent bNAb CAR recognition of HIV envelope on infected cells, leading to poor clearance and treatment failure. Using humanized mice, we were able to map HIV evolution through amplification and deep sequencing of the HIV env gene at longitudinal timepoints. Moreover, we identified putative escape mutations associated with CAR T cell therapy at all 6 canonical bNAb epitopes, providing a comprehensive picture of HIV evolution in response to Env-targeting CAR T cells. Importantly, characterization of the escape pathways arising in response to each bNAb CAR provides the opportunity to design combination bNAb CAR T cell therapies to target multiple HIV Env epitopes simultaneously to restrict HIV escape and control plasma viremia.

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