Article

Inducible Apoptosis as a Safety Switch for Adoptive Cell Therapy

Antonio Di StasiCenter for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital, Houston, TX 77030, USASiok‐Keen TeyCenter for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital and Methodist Hospital, HoustonGianpietro DottiBaylor College of MedicineYuriko FujitaCenter for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital and Methodist Hospital, HoustonAlana A. Kennedy‐NasserCenter for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital and Methodist Hospital, HoustonCaridad MartinezCenter for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital and Methodist Hospital, HoustonKarin StraathofCenter for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital and Methodist Hospital, HoustonEnli LiuCenter for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital and Methodist Hospital, HoustonApril DurettCenter for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital and Methodist Hospital, HoustonBambi GrilleyCenter for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital and Methodist Hospital, HoustonHao LiuCenter for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital and Methodist Hospital, HoustonCarolina Colli CruzCenter for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital and Methodist Hospital, HoustonBarbara SavoldoCenter for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital and Methodist Hospital, HoustonAdrian P. GeeCenter for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital and Methodist Hospital, HoustonJohn SchindlerUniversity of Texas Southwestern Medical School, DallasRobert A. KranceCenter for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital and Methodist Hospital, HoustonHelen E. HeslopCenter for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital and Methodist Hospital, HoustonDavid M. SpencerCenter for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital and Methodist Hospital, HoustonCliona M. RooneyCenter for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital and Methodist Hospital, HoustonMalcolm K. BrennerCenter for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital and Methodist Hospital, Houston

2011en

ABI

Abstract

BACKGROUND: Cellular therapies could play a role in cancer treatment and regenerative medicine if it were possible to quickly eliminate the infused cells in case of adverse events. We devised an inducible T-cell safety switch that is based on the fusion of human caspase 9 to a modified human FK-binding protein, allowing conditional dimerization. When exposed to a synthetic dimerizing drug, the inducible caspase 9 (iCasp9) becomes activated and leads to the rapid death of cells expressing this construct. METHODS: We tested the activity of our safety switch by introducing the gene into donor T cells given to enhance immune reconstitution in recipients of haploidentical stem-cell transplants. Patients received AP1903, an otherwise bioinert small-molecule dimerizing drug, if graft-versus-host disease (GVHD) developed. We measured the effects of AP1903 on GVHD and on the function and persistence of the cells containing the iCasp9 safety switch. RESULTS: Five patients between the ages of 3 and 17 years who had undergone stem-cell transplantation for relapsed acute leukemia were treated with the genetically modified T cells. The cells were detected in peripheral blood from all five patients and increased in number over time, despite their constitutive transgene expression. A single dose of dimerizing drug, given to four patients in whom GVHD developed, eliminated more than 90% of the modified T cells within 30 minutes after administration and ended the GVHD without recurrence. CONCLUSIONS: The iCasp9 cell-suicide system may increase the safety of cellular therapies and expand their clinical applications. (Funded by the National Heart, Lung, and Blood Institute and the National Cancer Institute; ClinicalTrials.gov number, NCT00710892.).

Identifiers

DOI: 10.1056/nejmoa1106152

Citations and references

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