Genome-wide CRISPR Screening Reveals Cullin-1 as a Therapeutic Target Enhancing Efficacy of CD19-directed Immunotherapy

Two documented clinical failures match this mechanism, or a single Phase 3 failure is on record.

Abstract excerpt

Cancer immunotherapy targeting B-cell specific CD19 antigen meant a major breakthrough in the treatment of B-cell malignancies. Yet, vast proportion of treated patients experience relapse and failure of the therapy. Although multiple mechanisms of CD19-immunotherapy failure have been described, CD19-negative relapses represent the major hurdle in achieving higher and durable response rates. Our established in vitro co-culture models revealed that suboptimal CAR-T cell performance, inefficient to mediate target cell killing, results in robust downregulation of CD19 target antigen. Using genome-wide CRISPR screening, we addressed the mechanisms responsible for such CD19 downregulation and identified Cullin-1 and CD81 playing instrumental role in negative and positive regulation of CD19 expression, respectively. Inhibiting Cullin-1 activity with pevonedistat prevents the loss of CD19 under immunotherapeutic pressure, results in higher CD19 surface levels and consequently enhances the efficacy of target cell killing by CD19-CAR-T cells, CD19-CAR-NK cells and CD19-targeting antibody treatment. Mechanistically, we show that pevonedistat blocks the degradation of CD19 upon its internalization and allows its recycling back to the plasma membrane. CD81 chaperone protein is critically involved in this process as the absence of CD81 abrogates the effect of pevonedistat. In summary, we identify Cullin-1 as a novel and druggable regulator of CD19 protein stability. Cullin-1 inhibition augments CD19 surface expression, thereby improving the efficiency of CD19-targeting immunotherapies, thus arguing for potential incorporation of pevonedistat into novel combination therapies.