PROJECT SUMMARY
Solid cancers are a leading cause of cancer related death in children and there is great interest in harnessing
recent progress in immunotherapy for the treatment of pediatric solid tumors. Immune checkpoint inhibition (ICI)
is the most active form of immunotherapy for adult solid cancers, but ICI is not effective in pediatric solid tumors.
This discrepancy is explained by the low mutational burden of pediatric solid tumors, since neoantigens arising
from tumor specific mutations are the target of the most potent ICI induced immune responses. Overexpressed
non-mutated self-antigens, that are not expressed on normal vital tissues, can serve as the basis for effective
immune therapies, but immune tolerance must be overcome to induce potent immune responses to this class of
molecules. This project focuses on Ewing Sarcoma (EWS) a prototype low mutation burden solid tumor, for
which progress has stalled. Standard therapies for EWS rely on dose intensive regimens largely developed in
the 1970s and 80s which leave survivors with severe, lifelong late effects. No targeted therapeutics have been
demonstrated to be effective. Few patients with metastatic or recurrent EWS survive. Using immunopeptidome
profiling, we discovered novel peptides from lipase-1 (LIPI) and IGF2 binding protein 1 (IGF2BP1) that are
presented by HLA-A2+ on EWS. These non-mutant proteins are overexpressed at high levels in the vast majority
of EWS and are essentially absent from vital normal tissues, thereby demonstrating a very favorable profile for
immune targeting. To translate this discovery into a therapeutic application for EWS, this project applies a
workflow we developed to discover, characterize, and engineer T cells receptors (TCRs) targeting these
peptides. The major overarching challenge that the project addresses is determining the optimal approach to
identify and/or engineer high potency TCRs capable of targeting self-antigens without incurring cross-reactivity
that would result in unacceptable toxicity. In Aim 1, we test the hypothesis that TCRs targeting LIPI- and
IGF2BP1-derived peptides will be identified in HLA-A2+ hosts but will manifest low potency due to immune
tolerance. We will simultaneously discover and compare antigen reactive TCRs present in HLA-A2– hosts, which
we predict will be more potent, but may be unsafe due to cross-reactivity. In Aim 2, we use next generation
approaches to engineer natural TCRs, identified in HLA-A2+ hosts, into more potent, but safe antigen-specific
TCRs, through affinity maturation or catch bond engineering. Given the known risks for cross reactivity of high
potency TCRs, next generation engineered TCRs developed here will be closely vetted across several platforms
for cross-reactivity. In Aim 3, we use fitness enhancements developed in the Mackall lab to enhance the potency
of CAR T cells to enhance the potency of T cells expressing our lead candidate LIPI- and IGF2BP1-reactive
TCRs. The work conducted in this project will deliver state-of-the-art therapeutics ready for clinical testing in
EWS and provide general understanding regarding the optimal approach to engineer TCRs targeting self-
antigens, which will provide value in pediatric oncology and low mutation burden cancers beyond EWS.