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Immunotherapies are already successfully used for cancer treatment. In our lab two modular platform technologies were developed which demonstrated high success against various types of malignant cells: the universal chimeric antigen receptor (UniCAR) system, and the bispecific antibody (bsAb) based UniMAB system. Both approaches have the aim to recruit T cells to kill the malignant cells carrying a tumor associated antigen (TAA) on their surface. In the first case, UniCAR modified T cells are linked via a TAA specific target module (TM) to cancer cells. In the case of the UniMAB system, natural T cells are recruited to cancer cells via a TAA specific TM and a bsAb based effector module (EM) which binds to CD3 of T cells and to an epitope tag of the TM. In both cases, an immune complex is formed leading to T cell activation and tumor cell elimination. Most importantly, the T cell activation is dependent on the cross-linkage of T cells and tumor cells via the TM or TM/EM complex. Thus, T cell activation is steerable which increases the safety of these approaches. With the emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) leading to millions of deaths worldwide, we aimed to apply the UniCAR and UniMAB technology against SARS-CoV-2 and virus infected cells as novel immunotherapeutic treatment approach. For this purpose, we designed two TMs binding to the receptor binding domain (RBD) of SARS-CoV-2. The first TM is based on a single chain fragment variable (scFv) with specificity for RBD, whereas the second one contains the extracellular domain of the human ACE2 receptor which is the entry receptor of SARS-CoV-2. Both TMs were able to efficiently recruit either UniCAR T cells or, in combination with the EM of the UniMAB system, natural T cells to efficiently kill human cells having the RBD of SARS-CoV-2 on their surface. Remarkably, the ACE2-Mb-TM is additionally able to block RBD/ACE2 interaction and potently neutralizes pseudo- as well as live S

The COVID-19 pandemic caused by SARS-CoV-2 led to millions of infections and deaths worldwide. As this virus evolves rapidly, there is a high need for treatment options, which can win the race against new emerging variants of concern. Here, we describe a novel immunotherapeutic drug based on the SARS-CoV-2 entry receptor ACE2 and provide experimental evidence that it cannot only be used for (i) neutralization of SARS-CoV-2 in vitro and in SARS-CoV-2 infected animal models, but also for (ii) clearance of virus infected cells. For the latter purpose, we equipped the ACE2 decoy with an epitope tag. Thereby, we converted it to an adapter molecule which we successfully applied in the modular platforms UniMAB and UniCAR for retargeting of either unmodified or universal chimeric antigen receptor modified immune effector cells. Our results pave the way for a clinical application of this novel ACE2 decoy, which will clearly improve COVID-19 treatment.

Adaptor chimeric antigen receptor (CAR) T-cell therapy offers solutions for improved safety and antigen escape which represent main obstacles for the clinical translation of CAR T-cell therapy in myeloid malignancies. The adaptor CAR T-cell platform “UniCAR” is currently under early clinical investigation. Recently, first proof-of-concept of a well-tolerated, rapidly switchable, CD123-directed UniCAR T-cell product treating patients with acute myeloid leukaemia (AML) was reported. Relapsed and refractory AML is prone to a high plasticity under therapy pressure targeting one single tumour antigen. Thus, targeting of multiple tumour antigens seems to be required to achieve durable anti-tumour responses, underlining the need to further design alternative AML-specific target modules (TM) for the UniCAR platform. We here present the preclinical development of a novel FMS-like tyrosine kinase 3 (FLT3)-directed UniCAR T-cell therapy, which is highly effective for in vitro killing of both AML cell lines and primary AML samples. Furthermore, we show in vivo functionality in a murine xenograft model. PET analyses further demonstrate a short serum half-life of FLT3 TMs, which will enable a rapid on/off-switch of UniCAR T-cells. Overall, the presented preclinical data encourage the further development and clinical translation of FLT3-specific UniCAR T-cells for the therapy of AML.

Prostate specific membrane antigen (PSMA) is an excellent target for imaging and treatment of prostate carcinoma (PCa). Unfortunately, not all PCa cells express PSMA. Therefore, alternative theranostic targets are required. The membrane protein prostate stem cell antigen (PSCA) is highly overexpressed in most primary prostate carcinoma (PCa) cells and in metastatic and hor-mone refractory tumor cells. Moreover, PSCA expression positively correlates with tumor pro-gression. Therefore, it represents a potential alternative theranostic target suitable for imaging and/or radioimmunotherapy. In order to support this working hypothesis, we conjugated our previously described anti-PSCA monoclonal antibody (mAb) 7F5 with the bifunctional chelator CHX-A″-DTPA and subsequently radiolabeled it with the theranostic radionuclide 177Lu. The re-sulting radiolabeled mAb ([177Lu]Lu-CHX-A″-DTPA-7F5) was characterized both in vitro and in vivo. It showed a high radiochemical purity (>95%) and stability. The labelling did not affect its binding capability. Biodistribution studies showed a high specific tumor uptake compared to most non-targeted tissues in mice bearing PSCA-positive tumors. Accordingly, SPECT/CT images re-vealed a high tumor-to-background ratios from 16 h to 7 days after administration of [177Lu]Lu-CHX-A″-DTPA-7F5. Consequently, [177Lu]Lu-CHX-A″-DTPA-7F5 represents a promising candidate for imaging and in the future also for radioimmunotherapy.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused a pandemic with millions of infections and deaths worldwide and devastating impact on global economy. Up to now, vaccines and monoclonal antibody (mAb) therapies lack to provide a long-lasting protection against rapidly evolving new emerging SARS-CoV-2 variants. Thus, novel therapeutic options are pressingly needed especially for immunocompromised patients and/or patients with high risk for developing a severe coronavirus disease 2019 (COVID-19). In that regard, we developed a novel immunotherapeutic drug based on the SARS-CoV-2 entry receptor angiotensin-converting enzyme 2 (ACE2). This ACE2 decoy potently binds to the SARS-CoV-2 receptor binding domain (RBD), neutralizes SARS-CoV-2 as well as the Delta and Omicron variant and protects hamsters from a SARS-CoV-2 infection. To additionally use this ACE2 decoy for elimination of virus infected cells, we equipped it with an epitope tag. Thus, it can be applied as adapter molecule in the modular platform technologies UniMAB and UniCAR, which already demonstrated great success in the setting of malignant diseases. As adapter molecule the ACE2 decoy is able to efficiently recruit either universal chimeric antigen receptor (UniCAR) modified T cells or, in combination with an anti-peptide epitope-anti-CD3 bispecific Ab of the UniMAB system, unmodified T cells to efficiently kill SARS-CoV-2 RBD expressing human cells. Taken together, the ACE2 decoy represents a very promising immunotherapeutic drug for both SARS-CoV-2 variant neutralization and infected cell killing via the UniMAB and UniCAR system and might, therefore, clearly improve the treatment of COVID-19 patients.

Despite the fact that chimeric antigen receptor (CAR) engineered T cells have shown encouraging therapeutic effects in hematological setups, the targeting of solid tumor-related antigens still represents a challenge. One main issue is that the expression of this type of antigens is not restricted to cancer cells, but normal tissues express them as well to some degree. In order to avoid strong side-effects caused by on-target/off-tumor effects, more controllable and specific CAR T cell-derived technologies need to be developed. In this line of thought, we developed the switchable, flexible and programmable Reverse (Rev) CAR platform. This system is based on engineered T cells expressing RevCAR molecules, which have extracellular short peptide epitopes incapable of recognizing surface antigens. Thus, the RevCAR T cells are per se inert and will only recognize the target cell through the interaction with an antigen-specific target module, named RevTM. RevTMs are bispecific antibodies designed to bind simultaneously to the target antigen and the short epitopes on the RevCAR engineered T cells. This interaction triggers a specific activation and cytotoxic activity of the RevCAR T cells redirecting them to eradicate the cancer cells. Here, we adapted our RevCAR technology to target the carcinoembryonic antigen (CEA), which is a significant tumor marker for colorectal cancers and other carcinomas. Moreover, we developed two RevTMs with different structures: scFv- and IgG4-based. The first one is built by linking a scFv against CEA to a scFv that recognizes the RevCAR epitope through glycine and serine residues, resulting in a small sized molecule (<60 kDa) with two binding sites. The IgG4-based RevTM connects the same scFv-structures but in this case through the hinge and constant Fc regions (CH2 and CH3) of an IgG4 antibody. The formation of disulfide bridges on the hinge portion causes the formation of homodimers, resulting in a molecule with increased molecular weight (

Chimeric antigen receptor (CAR) T-cells are unquestionably considered one of the most promising approaches in cancer immunotherapy. Nonetheless, mild to severe toxicities are associated with this approach which include e.g. on-target/off-tumour toxicities and cytokine release syndrome. Aiming for increased clinical safety, a modular universal CAR (UniCAR) platform was developed by our group in which UniCAR T-cells are exclusively activated in the presence of a target module (TM) that specifically establishes the cross-link between target cells and UniCAR T-cells. Fibroblast activation protein (FAP) is highly expressed on cancer-associated fibroblasts (CAFs) present in the tumour stroma and also found to be overexpressed in tumour cells. This protein plays an important role in promoting tumour growth, metastasis, and immunosuppression and has therefore been studied as a target for cancer diagnosis and treatment. Given this and the demonstrated efficacy, flexibility and switchability of the UniCAR system, currently demonstrated in phase I clinical trials, we hereby aimed to develop TMs targeting FAP that can be used for both immunotherapeutic and theranostic approaches. For that, the single-chain variable fragment (scFv) of an anti-human FAP mAb was fused to the peptide epitope E5B9 that is recognized by the UniCAR T-cells, creating low molecular weight TMs that are rapidly eliminated allowing a specific and recurrent on/off switch of UniCAR T-cell activity via TM dosing. Additionally, extended half-life anti-FAP TMs based on the human IgG4 Fc-domain, including a mutated version, were created intending to strengthen anti-tumour responses and to ease the clinical TM administration at later stages of tumour therapy. All TMs were tested in vitro based on naturally and artificially overexpressing 2D and 3D models, and proven to specifically redirect UniCAR T-cells to FAP-expressing target cells. Positron emission tomography (PET) using 64Cu radiolabelled anti-FAP IgG4 TMs

Chimeric antigen receptor (CAR) T-cells are undoubtedly a promising approach in cancer immunotherapy. Nevertheless, mild to severe toxicities are associated with this approach including on-target/off-tumor effects and cytokine release syndrome. Aiming for increased clinical safety, adaptor CAR technologies were developed which include the modular universal CAR (UniCAR) platform developed by our group. UniCAR T-cells are exclusively activated in the presence of a target module (TM), which establishes the cross-link between cancer cells and UniCAR T-cells. These TMs are highly versatile molecules that can be constructed not only by using antibody fragments but also e.g. peptides specifically targeting a receptor or molecule on the cell´s surface. Somatostatin receptor (SSTR) subtype 2 is highly expressed in a variety of malignancies and has therefore been studied as a marker and target for cancer diagnosis and treatment. Currently, SSTR2 agonists and antagonists, such as Tyr3-octreotate (TATE) and BASS or JR11, respectively, are particularly well established and clinically implemented mostly used for diagnostic nuclear medicine. Given this and the proven flexibility and efficacy of the UniCAR system, we hereby aimed to develop small peptide-derived TMs targeting SSTR2 that can be used for both immunotherapeutic and diagnostic approaches. For that, the abovementioned SSTR2 agonist and antagonists were chemically linked to the E5B9 peptide and equipped with the radiometal chelator NODAGA. These TMs were tested in vitro and in vivo, in which they have proven to specifically redirect UniCAR T-cells to human neuroendocrine and breast SSTR2-expressing cancer cells. Furthermore, the enrichment of these anti-SSTR2 peptide TMs at the tumor site was confirmed by positron emission tomography (PET) studies. We hereby designed novel small peptide-derived TMs that can be used for redirection of UniCAR T-cells to SSTR2-expressing cancer cells as well as for PET imaging, proving to b

CAR T-cell therapy achieved unparalleled clinical success rates for treatment of patients with hematological malignancies. However, progress and clinical translation towards solid tumors is slow and hampered by many factors e.g. increased complexity, high heterogeneity and an immunosuppressive tumor microenvironment. Thus, CAR T-cell therapy alone might not result in durable antitumor responses. Combinatorial approaches are promising strategies to improve CAR T-cell efficacy in solid tumor treatment. In this regard, we here aim to combine conventional cancer theranostics with CAR T-cell immunotherapy in one single approach. By using the well-established UniCAR system, a novel, multifunctional tool termed PSCA-IgG4 target module (TM) was developed for dual prostate cancer theranostics. It comprises a human PSCA-specific binding domain, the hinge and Fc-domain of human IgG4 molecules as well as the UniCAR epitope E5B9. As shown by in vitro assays with PSCA-positive and PSCA-negative prostate cancer cells, the novel TM redirected UniCAR T cells for efficient tumor cell lysis in a strictly antigen- and TM-dependent manner. After radiolabeling with copper-64 or actinium-225, the novel PSCA-IgG4 TM was successfully applied for diagnostic imaging and targeted radioimmunotherapy. The 64Cu-labeled PSCA-IgG4 TM showed maximal tumor accumulation with optimal tumor-to-background ratios after 1.5 days. Furthermore, targeted alpha-therapy with the 225Aclabeled TM significantly delayed the outgrowth of established tumors in mice. In summary, the here presented, novel PSCA-IgG4 TM is a promising candidate for dual theranostics of prostate cancer that may help to overcome present hurdles in solid tumor therapy. After radiolabeling it facilitates not only targeted alpha-therapy and diagnostic imaging of PSCA, but can be also repurposed as a TM for UniCAR T-cell immunotherapy.

Modifying of immune effector cells with chimeric antigen receptors (CARs) has revealed a promising therapeutic potential for targeting cancer, especially with CAR-modified T cells. However, the use of other immune cells like primary NK cells or NK cell lines appeared as another advantageous approach that can be combined with CAR technology. Unlike T cells, established NK cell lines can be used allogenically as an off-the-shelf product with reduced risk of toxicities. We have established previously a modular Universal CAR platform (UniCAR) which can be switched on/off and allows the flexible targeting of various tumor antigens. This system consists of two parts, the UniCAR-expressing immune effector cells and a target module (TM). The UniCAR-immune cells cannot recognize surface antigens but are only redirected with the TM which contains an antigen-binding moiety on one hand and an epitope recognized by the UniCAR molecules on the other hand. Here, we provide a proof of concept for using the UniCAR system in combination with the NK-92 cell line to target disialoganglioside GD2-expressing tumors. The UniCAR NK-92 cells induced increase in lysis of neuroblastoma and melanoma cell lines in the presence of scFv- or human IgG4-based TMs, associated with specific release of pro-inflammatory cytokines. Moreover, UniCAR NK-92 cells were shown to be functional in eradicating GD2-expressing tumors in experimental mice. In order to investigate the in vivo half-life of the scFv- and IgG4-based TMs, they were radiolabeled with 64Cu and detected using PET imaging. Dynamic PET scanning has shown that the IgG4 format increased the half-life of the TM to around 24 folds in comparison to the scFv-based TMs. In summary, UniCAR NK-92 provides an off-the-shelf universal platform that can be combined with various antibody formats, and can be easily expanded for therapeutic use.

Due to its overexpression on the surface of prostate cancer (PCa) cells, the prostate stem cell antigen (PSCA) is a potential target for PCa diagnosis and therapy. Here we describe the development and functional characterization of a novel IgG4-based anti-PSCA antibody (Ab) derivative (anti-PSCA IgG4-TM) that is conjugated with the chelator DOTAGA. The anti-PSCA IgG4-TM represents a multimodal immunotheranostic compound that can be used (i) as target module (TM) for UniCAR T cell-based immunotherapy, (ii) for diagnostic PET imaging, and (iii) targeted alpha therapy. Cross-linkage of UniCAR T cells and PSCA-positive tumor cells via the anti-PSCA IgG4-TM results in efficient tumor cell lysis both in vitro and in vivo. After radiolabeling with 64Cu2+ the anti-PSCA IgG4-TM was successfully applied for high contrast PET imaging. In a PCa mouse model, it showed specific accumulation in PSCA-expressing tumors, while no uptake in other organs was observed. Additionally, the DOTAGA-conjugated anti-PSCA IgG4-TM was radiolabeled with 225Ac3+ and applied for targeted alpha therapy. A single injection of the 225Ac-labeled anti-PSCA IgG4-TM was able to significantly control tumor growth in experimental mice. Overall, the novel anti-PSCA IgG4-TM represents an attractive first member of a novel group of radio-/immunotheranostics that allows diagnostic imaging, endoradiotherapy, and CAR T cell immunotherapy.

Radiation of tumor cells can lead to the selection and outgrowth of tumor escape variants. As radioresistant tumor cells are still sensitive to retargeting of T cells, it appears promising to combine radio- with immunotherapy keeping in mind that the radiation of tumors favors the local conditions for immunotherapy. However, radiation of solid tumors will not only hit the tumor cells but also the infiltrated immune cells. Therefore, we wanted to learn how radiation influences the functionality of T cells with respect to retargeting to tumor cells via a conventional bispecific T cell engager (BiTE) and our previously described modular BiTE format UNImAb. T cells were irradiated between 2 and 50 Gy. Low dose radiation of T cells up to about 20 Gy caused an increased release of the cytokines IL2, TNF and interferon-g and an improved capability to kill target cells. Although radiation with 50 Gy strongly reduced the function of the T cells, it did not completely abrogate the functionality of the T cells.

Immunotherapy using CAR-T cells is a new paradigm technology for cancer treatment. To avoid severe side effects and tumor escape variants observed for conventional CAR-T cells approach, adaptor CAR technologies are under development, where intermediate target modules redirect immune cells against cancer cells. In this work, silicon nanowire field effect transistors are used to assist in the development of target modules for an optimized CAR-T cell operation. Focusing on a library of seven variants of E5B9 peptide that is used as CAR peptide epitope, we performed multiplexed binding tests in serum using nanosensor chips. Peptides have been immobilized onto the sensor to compare the signals of transistor upon titration with anti-E5B9 antibodies. Correlation analysis of binding affinities and sensitivities enabled a selection of best candidates for the interaction between CAR and target modules. Finally, cytotoxic functionality of CAR-T cells in combination with the selected target modules were successfully proven. Our results open the perspective for the nanobiosensorics to go beyond the early diagnostics in the field of clinical cancer research, and paves the way towards personalization and efficient monitoring of the immunotherapeutic treatment, where the quantitative analysis with the standard techniques is not an option.

Chimeric antigen receptor (CAR)-expressing T-cells are without a doubt a breakthrough therapy for hematological malignancies. Despite their success, clinical experience has revealed several challenges, which include relapse after targeting single antigens such as CD19 in the case of B-cell acute lymphoblastic leukemia (B-ALL), and the occurrence of side effects that could be severe in some cases. Therefore, it became clear that improved safety approaches, and targeting multiple antigens, should be considered to further improve CAR T-cell therapy for B-ALL. In this paper, we address both issues by investigating the use of CD10 as a therapeutic target for B-ALL with our switchable UniCAR system. The UniCAR platform is a modular platform that depends on the presence of two elements to function. These include UniCAR T-cells and the target modules (TMs), which cross-link the T-cells to their respective targets on tumor cells. The TMs function as keys that control the switchability of UniCAR T-cells. Here, we demonstrate that UniCAR T-cells, armed with anti-CD10 TM, can efficiently kill B-ALL cell lines, as well as patient-derived B-ALL blasts, thereby highlighting the exciting possibility for using CD10 as an emerging therapeutic target for B-cell malignancies.

Modification of autologous T cells with tumor-specific chimeric antigen receptors (CARs) has been shown to be an effective tool for treatment of hematologic malignancies. However, clinical translation towards solid tumors is still limited as demonstrated by the suboptimal performance of CAR T cells in first in-human studies. Combining advances in CAR-T cell therapy and cancer theranostics may provide a promising multimodal approach to increase therapeutic efficacy and achieve durable responses in cancer patients. Here we present the development and functional characterization of different peptide- or antibody constructs targeting tumor-associated antigens or different structures of the tumor microenvironment. Equipment of these molecules with the E5B9 peptide epitope, enabled their use in the well-established UniCAR system. Accordingly, the constructs were able to specifically activate UniCAR T cells for efficient killing of both hematological and solid tumors in vitro and in vivo. Upon conjugation of chelators like DOTAGA and NODAGA, the peptide- or antibody derivates were further successfully applied for cancer theranostics, using e.g. 68Ga, 64Cu as diagnostic radionuclides and e.g. 67Cu, 225Ac as therapeutic radionuclides. PET imaging in xenotransplanted mice has demonstrated high contrast tumor accumulation. Consistent with the stable tumor accumulation, 225Ac-labeled molecules demonstrated therapeutic efficacy in a xenograft mouse model. In summary, E5B9-tagged peptide- or antibody constructs open a new era of cancer immunotheranostics as they can be used multimodally for (i) UniCAR-T cell therapy, (ii) non-invasive diagnostic imaging and (iii) targeted radioimmunotherapy. Prospectively, they could thus bridge the gap between the fields of CAR-T cells and cancer theranostics.

Chimeric antigen receptor (CAR) T-cells show remarkable therapeutic effects especially in B-cell derived leukemias and lymphomas. However, clinical translation of such an innovative immunotherapeutic approach in highly heterogeneous hematological malignancies like acute myeloid leukemia (AML) or solid tumors is still challenging due to life-threatening side effects, immune escape and disease relapse. To overcome such major hurdles and to address the unmet need for further improvements in CAR therapy, we have established flexible, switchable and programmable adaptor CAR platform technologies named UniCAR and RevCAR. These modular strategies consist of T-cells engineered with adaptor CARs which are primarily inactive as they are incapable to recognize surface antigens. Universal adaptor CAR T-cells can be flexibly redirected to any tumor antigen and controlled by targeting modules (TMs) cross-linking adaptor CAR T- and tumor cells resulting in tumor cell lysis. As an advancement of UniCARs, RevCARs lack the extracellular antigen-binding moiety reducing the receptor size and facilitating the genetical modification of T-cells with several RevCARs possessing different specificity and functionality. Thus, the RevCAR platform enables combinatorial tumor targeting following Boolean logic gates. So far, we have successfully shown preclinical applicability of the UniCAR and RevCAR approaches to target hematological malignancies as well as solid tumors in a flexible and specific manner using tumor cell lines and patient-derived materials. Remarkably, efficiency and switchability of UniCAR T-cells were even proven for the first time in patients in a clinical phase I study. Furthermore, by targeting of two different tumor antigens, combinatorial OR and AND gate logic targeting according to the rules of Boolean algebra was accomplished using the RevCAR platform. These achievements have a high potential for an improved and personalized tumor immunotherapy.

Fibroblast activation protein (FAP), mainly expressed by cancer-associated fibroblasts (CAFs) in the tumour stroma, promotes tumour growth, metastasis, and immunosuppression and, therefore, has been studied as a target for cancer diagnosis and treatment. With regard to immunotherapy, the innovative modular universal CAR (UniCAR) platform developed by our group is one of the most promising approach due to the reduced risk for e.g. on-target/off-tumour toxicities and cytokine release syndrome. Thereby, chimeric antigen receptor (CAR) T-cells (UniCAR T cells) are exclusively activated in the presence of a target module (TM) that specifically establishes the crosslinking between target cells and UniCAR T-cells. FAP specific TMs are hypothesized to be not only immunotherapeutics with increased safety but in addition to be suitable as radionuclide-based theranostic agents. For that, low molecular weight TMs that are rapidly eliminated allowing a specific and recurrent on/off switch of UniCAR T-cell activity via TM dosing were developed by fusion of the single-chain variable fragment (scFv) of an anti-human FAP mAb to the peptide epitope E5B9 that is recognized by the UniCAR T-cells. To ease the clinical TM administration at later stages of tumour therapy and for targeted radionuclide therapy, however, TMs with extended half-life may be advantageous. Therefore, anti-FAP TMs based on the human IgG4 Fc-domain, including a mutated version, were created. All TMs were tested (i) in vitro based on naturally and artificially overexpressing 2D and 3D models and (ii) in vivo by positron emission tomography (PET) and single-photon emission tomography (SPECT) in NMRI nude mice bearing both mock transfected and FAP overexpressing HT1080 tumor xenografts. In vitro, all TMs were proven to specifically redirect UniCAR T-cells to FAP-expressing target cells. Moreover, FAP specific TMs could be conjugated to different chelators, e.g. Bispidines, NODAGA, and CHX-A-DTPA and, afterwards, radi