Modification of cytokine-induced killer cells with folate receptor alpha (FRα)-specific chimeric antigen receptors enhances their antitumor immunity toward FRα-positive ovarian cancers

Folate receptor alpha (FRα) is aberrantly expressed in ovarian cancers but largely absent in normal tissues, and therefore represents an attractive target for immunotherapy. In recent years, modification of T cells with chimeric antigen receptor (CAR) targeting FRα has been reported to improve antitumor immunity of T cells. However, there are limited data regarding CAR-modified cytokine-induced killer (CAR-CIK) cells. In the present study, we modified CIK cells with FRα-specific CARs and investigated their antitumor immunity against ovarian cancers. We found that both non-transduced and mock CAR-transduced CIK cells showed only low antitumor activity against either FRα-positive (FRα+) or FRα-negative (FRα−) targets. However, all three generations of CAR-modified CIK cells showed enhanced antitumor activity against FRα+ targets, but not FRα− targets. First-generation ζ-CAR-CIK cells increased production of IFN-γ, enhanced short-term cytotoxicity against FRα+ ovarian cancer cells, and showed modest and short-term suppression of established tumors; while second-generation 28ζ- and third-generation 28BBζ-CAR-CIK cells showed significant proliferation, enhanced secretion of IL-2, eliminated the FRα+ ovarian cancer cells in long-term co-culture, and showed dramatic and long-term inhibition of tumor growth and prolonged survival of xenograft-bearing mice. It is noteworthy that the 28BBζ-CAR was more potent in the modification of CIK cells than 28ζ-CAR both in vitro and in vivo. Moreover, CAR-CIK cells showed more efficient anticancer activity compared with CAR-T cells in vitro, but less efficient than CAR-T cells in vivo. According to these results, we conclude that modification of CIK cells with FRα-specific CARs enhances their antitumor immunity to FRα+ ovarian cancers. The third-generation 28BB-ζ CAR containing 4-1BB co-stimulation was more efficient in modification of CIK cells than either first-generation ζ-CAR or second-generation CD28-ζ-CAR.